Education for Primary Care最新文献

{"title":"Attitudes and experiences of GP registrars towards undergraduate teaching: has anything changed?","authors":"Joanna Leader, Hugh Alberti, Lizzie Dowling","doi":"10.1080/14739879.2023.2179427","DOIUrl":"https://doi.org/10.1080/14739879.2023.2179427","url":null,"abstract":"Developing teaching skills is part of the RCGP curriculum for GP trainees [1], and it is thought that exposing medical students to GP role models can positively affect their career choices [2]. In 2015 Marshall and Alberti conducted a study looking into GP registrars’ experiences of teaching medical students [3]. They found overwhelmingly that trainees were keen to teach medical students but had minimal opportunities available [3]. They also found that more teaching opportunities were available in hospital posts than GP posts [3]. We conducted research to look into whether these disparities still exist. The aims of this project were to determine the current level of involvement in undergraduate medical education of GP registrars in the Northern Deanery and to establish if there has been any change or improvement compared to 2015. Ethics approval was granted from Newcastle University. We initially collected data by sending the same six-question survey that was used in 2015 to ST2 and ST3 GP registrars in the region, as well as GPs who were within 5 years of CCT. Overall, 104 GPs completed the survey; their responses were collated and analysed and compared to the results from 2015. There was a large disparity between the GP registrars’ desire to get involved with teaching, and the reality. Overall, 53% said they expected to have regular involvement with teaching medical students in their future career, but 85% reported having little or no involvement with teaching in their GP posts. Overall, 76% said they would like to have done more teaching. There continues to be a disparity in teaching opportunities between hospital and GP posts. Only 13.6% of trainees reported teaching at least monthly in GP posts, whereas in hospital posts 39% of trainees taught at least monthly. There has been little change since 2015. In GP posts 85% of trainees reported having little or no involvement in teaching (down from 91% in 2015). In hospital posts 62% reported having little or no involvement in teaching (down from 73% in 2015). These results show that in fact the most improvement in teaching opportunities has occurred in hospital posts, although the improvement is still minimal. Overall, there has been little improvement in GP registrars’ involvement in teaching of medical students since 2015, yet there is still a strong desire from them to have more opportunity to do so. Teaching opportunities continue to be significantly more limited in GP posts compared to hospital posts and so this is where any future work on improvements should be focussed. More work to understand why opportunities in GP posts are so limited should also be prioritised. GP practices continue to be stretched, both financially and timewise, so GP registrars could provide a cost-effective solution to delivering undergraduate medical education. Given the benefits to both practices and registrars, we strongly recommend that this area needs to be highlighted as a matter of great importance in future.","PeriodicalId":46436,"journal":{"name":"Education for Primary Care","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9859551","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring the Irish general practice training community's perceptions on how an entrustable professional activities dashboard implementation could facilitate general practice training in Ireland.","authors":"Brian McEllistrem,&nbsp;Marije P Hennus,&nbsp;Tim Fawns,&nbsp;Karena Hanley","doi":"10.1080/14739879.2023.2191340","DOIUrl":"https://doi.org/10.1080/14739879.2023.2191340","url":null,"abstract":"<p><strong>Background: </strong>The Irish General Practitioner Training (GP) Programme is currently moving to Competency-Based Medical Education (CBME), facilitated by Programmatic Assessment (PA) and Entrustable Professional Activities (EPAs). These new assessment and feedback mechanisms may provide a rich and much sought-after dataset. However, given the possible number of feedback and assessment events, and the variety of modalities used, aggregating and interpreting these can be costly and difficult. Dashboard implementations (DI) have been purposed as a solution to bridge the gap between the large datasets and the training community at all levels.</p><p><strong>Aims: </strong>To explore the Irish GP training community's perceptions on how an EPAs DI could facilitate the delivery of GP training in Ireland.</p><p><strong>Methods: </strong>A qualitative approach was taken, using a focus group representative of different groups in the training community. Concurrently, an EPAs DI was developed. Focus group transcripts were analysed in an iterative fashion using Template Analysis to generate themes and subthemes.</p><p><strong>Results: </strong>Numerous advantages were seen in relation to the implementation of an EPAs DI around entrustment decisions, constructive alignment and summative decision-making. These advantages, however, need to be tempered with the realisation that the EPAs DI is not and should not be misinterpreted as being the learning analytic panacea for GP training.</p><p><strong>Conclusion: </strong>This paper outlines the perceptions from a postgraduate medical education training community on an EPAs DI, which would be applicable to other training communities considering introducing similar mechanisms.</p>","PeriodicalId":46436,"journal":{"name":"Education for Primary Care","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9860015","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pinch points in the consultation - and how to avoid them.","authors":"Martin Brunet","doi":"10.1080/14739879.2023.2169641","DOIUrl":"https://doi.org/10.1080/14739879.2023.2169641","url":null,"abstract":"<p><p>The GP consultation is a fluid, complex interaction that is difficult to define, but points can be identified where the consultation can run smoothly, or rapidly derail and become dysfunctional. In teaching communication skills we can help trainees to recognise these 'pinch points' and to equip them with the tools to successfully navigate the challenges they present. This paper uses the concept of the Two Houses model for the consultation to explore three such pinch points: Keeping the consultation dance going; how 'need' is a power word and should be used with caution; and the value of considering whether the patient is looking for a better understanding of their problem, or a solution, or both. Seeing the consultation as like a dance between doctor and patient can help illustrate the importance of the doctor and patient working together, and for the doctor to be alert to cues that the 'dancers' are drifting apart. The skills needed to keep the dance going throughout the consultation are considered. The perils of telling the patient that they 'don't need' something they believe they do need are explored within the concept of encountering an 'empty room' in the Two Houses model, while the distinction between gaining understanding and seeking a solution is illustrated by considering the Two Wings of the House of Decision within the model.</p>","PeriodicalId":46436,"journal":{"name":"Education for Primary Care","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9860315","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Virtual peer appraisal : talk the talk and walk the walk.","authors":"Richard Albardiaz","doi":"10.1080/14739879.2023.2182718","DOIUrl":"https://doi.org/10.1080/14739879.2023.2182718","url":null,"abstract":"<p><p>The article considers the impact of a virtual walk on the peer appraisal process and highlights the potential focus on professional well being and organisational connectedness.</p>","PeriodicalId":46436,"journal":{"name":"Education for Primary Care","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9850969","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Crisis, change and the future for teaching and learning in general practice.","authors":"Karen Kyne,&nbsp;Aileen Barrett","doi":"10.1080/14739879.2023.2181709","DOIUrl":"https://doi.org/10.1080/14739879.2023.2181709","url":null,"abstract":"<p><strong>Objectives: </strong>The aim of this study was to explore the decisions and decision-making strategies employed by academic GPs tasked with adapting the delivery of undergraduate general practice education curricula to virtual platforms during the Covid-19 pandemic. We sought to investigate how their experiences of this adaptation might influence the development of future curricula.</p><p><strong>Methods: </strong>Recognising our 'insider' positions and constructivist paradigm preferences, we approached the study from a constructivist grounded theory (CGT) perspective and participants participated in semi-structured interviews.</p><p><strong>Results: </strong>Nine participants from three university GP departments in Ireland described the transition to online delivery of the curriculum as a 'response approach'. Participants described seeking collaboration both within and between institutions. The value and limitations of student feedback as a driver for change differed between participants and recognised the impact of limited social engagement between peers on social determinants of learning. Participants with prior experience in e-learning were inclined to recommend some level of continuation. Two institutions plan to continue to incorporate aspects of blended learning.</p><p><strong>Conclusion and implications: </strong>All participants recognised a level of value (efficiency, social engagement and continuity) in online learning, they were less clear on the specific educational value and impact of this (e.g. on knowledge, skills and attributes). We need to consider which elements of undergraduate education can be delivered effectively online. Maintaining the socio-cultural learning environment is of critical importance but must be balanced by efficient, informed and strategic educational design.</p>","PeriodicalId":46436,"journal":{"name":"Education for Primary Care","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9860336","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving medical students' understanding of dementia using a movie (<i>The Father</i>).","authors":"Anuradha Baminiwatta,&nbsp;Roshan Fernando,&nbsp;Shehan Williams","doi":"10.1080/14739879.2023.2178333","DOIUrl":"https://doi.org/10.1080/14739879.2023.2178333","url":null,"abstract":"Since the late 1970s, there has been an enduring interest in the use of movies within medical education [1]. Movies provide an opportunity for students to gain a more nuanced appreciation of a person’s experience of illness. Although various educational innovations have been proposed to improve knowledge, skills and attitudes among healthcare students regarding dementia [2], it appears that the utility of movies for this purpose is underexplored. The Father is a psychological drama film released in 2020, centred on the life of an ageing individual with dementia. Reviewing the movie for The Guardian, Bradshaw writes, ‘What is deeply scary about The Father is that, without obvious first-person camera tricks, it puts us inside Anthony’s head’ [3]. Rai and Banerjee (2022) expressed a similar sentiment, ‘Maybe, for the first time in cinematic history, the viewer gets a first-person experience of the sense of bleak obscurity dementia entails’ [4]. Thus, we proposed that watching The Father could enhance students’ understanding of dementia. Students undergoing their final-year psychiatry training at the University of Kelaniya were invited to watch the movie and provide their feedback. In terms of the students’ responses (n = 108), 90.6% reported that they got ‘really involved with the feelings of the characters’ and 88.8% of students agreed they could see things from the main character’s point of view. Further, 56.5% agreed that they felt as if the events were happening to them while watching the movie. The students also responded extremely positively on the impact of the movie on their understanding of dementia, with 96.3% reporting that the movie helped them understand the difficulties experienced by a patient with dementia; 98.1% agreeing that the movie helped them to understand the difficulties experienced by dementia caregivers; 92.5% agreeing that it improved their overall understanding of dementia. The overall quality of the movie experience was rated, on a scale of 1 to 10, at an average of 8.1 (SD = 1.1). Students correctly identified many clinical features of dementia portrayed in the movie including short-term memory loss (92.6%), progressive cognitive decline (89.8%) and sudden mood changes (85.2%). This educational innovation and its evaluation provide evidence that the movie, The Father, can be a useful educational tool to be added to the undergraduate training programme to improve students’ understanding of the lived experience of dementia. Considering the impact of dementia and its burden, all primary care doctors need to empathise with and support individuals and families experiencing the reality of living with dementia. Future studies will have to explore whether exposure to such films really brings behavioural change, by assessing attitudinal change in practice settings in the real world after the students enter qualified practice.","PeriodicalId":46436,"journal":{"name":"Education for Primary Care","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9862621","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Strike? - and what about clinical education?","authors":"Simon Gay","doi":"10.1080/14739879.2023.2194266","DOIUrl":"https://doi.org/10.1080/14739879.2023.2194266","url":null,"abstract":"As I write this editorial, at this precise moment in time in the UK junior doctors are on strike. This comes shortly after the multiple strike actions of other healthcare professionals within the British National Health System. Strikes were not simply invented for a rainy day sometime in the future. They were born out of a desperate need for change in the face of overwhelming power which sought to maintain the status quo. History is littered with numerous examples in many countries where that power was challenged in such a way, and we need to remind ourselves just how few options to effect change people have in modern societies. There are certainly not many, but strikes are definitely one of them. So where does that leave the education of healthcare professionals? Well, in the case of the current doctors’ strike, the British Medical Association guidance has included advice for students to still attend placement as directed by their medical school [1], whilst reminding those same students how important it is that they don’t work beyond their competence. One would hope that the ultimate goal of such action is to make the world a better place. Most health professionals would certainly want that for the care they provide, and see such strikes as putting patients first. The decision to strike in the face of a caring approach to your work is therefore not a small one and should not be thought of as having been taken lightly by the many thousands of healthcare professionals who have chosen to strike recently. Taking such difficult decisions inevitably causes individuals to question their own personal constructs of professionalism. After all, most of us combine our personal identity with our professional identity to the point where it is difficult sometimes to distinguish between them. I grew up personally and professionally in an era when striking was unconscionable for a doctor. However, that was the same era when it was not uncommon for doctors to work up to 80 hours consecutively without a proper rest, and when non-core hours (over time hours) were paid at a much lower rate of remuneration than core hours. Such things at least have been confined to the history books and the memories of older healthcare professionals such as myself, and that has to be good. And where is education and training in all of this unrest? Following the COVID-19 pandemic, it certainly does feel as if it is one assault after another on healthcare professionals’ education. It appears that education providers are currently maintaining clinical placements for undergraduate learners wherever they can, and whilst educational provision may be in need of modification in the face of the present industrial action it is still taking place, and in some circumstances is actually enriched by the tuition of more senior people temporarily filling the roles vacated by junior colleagues in order to maintain essential services. Education, by its very nature, is resilient and capable of generati","PeriodicalId":46436,"journal":{"name":"Education for Primary Care","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9863110","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Simulation-based training for continuing professional development within a primary care context: a systematic review.","authors":"Lucy Bray,&nbsp;Tobias Browall Krogh,&nbsp;Doris Østergaard","doi":"10.1080/14739879.2022.2161424","DOIUrl":"https://doi.org/10.1080/14739879.2022.2161424","url":null,"abstract":"<p><strong>Background: </strong>Given the increasing complexity of tasks transferred to primary care, discipline-specific educational opportunities are required for those working within this context. Simulation-based training (SBT) is widely applied within a hospital setting, underpinned by extensive research. However, little is known about the transfer of simulations' utility to primary care. This systematic review sought to determine which SBT approaches are adopted for continuing professional development within primary care and appraise their impact.</p><p><strong>Methods: </strong>Medline, Embase, CINAHL and Web of Science databases were searched, with additional articles obtained through secondary searching. Eligible studies employed and evaluated a simulation-based educational intervention for fully qualified healthcare professionals, working within primary care. Included studies were quality assessed using the Mixed Methods Appraisal Tool (v18) and their findings narratively synthesised.</p><p><strong>Results: </strong>Forty-nine studies were included, sampling 4,601 primary care health professionals. Studies primarily adopted a quantitative design and demonstrated variable quality. Simulation approaches comprised standardised patients (n = 21), role-play (n = 14), virtual (n = 6), manikin (n = 5) and mixed manikin/standardised patients (n = 3). Efficacy was evaluated across Kirkpatrick levels and demonstrated a positive impact for knowledge-, skills- and attitude-based outcomes, though this was limited in select studies.</p><p><strong>Discussion: </strong>SBT has been adopted in the education of the spectrum of health professionals working within primary care, with the most common approach being standardised patients. Simulation delivers an acceptable and effective educational method, demonstrating a positive impact across various learning objectives. Further research assessing the impact at an organisational- and patient-level is required.</p>","PeriodicalId":46436,"journal":{"name":"Education for Primary Care","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10217902","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early-career general practitioners' perceptions of the utility of vocational training for subsequent independent practice.","authors":"Michael Tran,&nbsp;Susan Wearne,&nbsp;Alison Fielding,&nbsp;Dominica Moad,&nbsp;Amanda Tapley,&nbsp;Elizabeth Holliday,&nbsp;Jean Ball,&nbsp;Andrew Davey,&nbsp;Mieke van Driel,&nbsp;Kristen FitzGerald,&nbsp;Neil Spike,&nbsp;Michael Bentley,&nbsp;Catherine Kirby,&nbsp;Parker Magin","doi":"10.1080/14739879.2023.2176264","DOIUrl":"https://doi.org/10.1080/14739879.2023.2176264","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate Australian early-career general practitioners' perceptions of the utility of their prior vocational training in preparing them for independent specialist practice. We hypothesised that in-practice teaching would be perceived as more useful than formal education delivered by Regional Training Organisations (RTOs).</p><p><strong>Methods and materials: </strong>A cross-sectional questionnaire-based study of early-career general practitioners (RTO 'alumni'). The outcomes were Likert scale ratings of alumni's perceived impact of RTO education versus in-practice training on their preparedness for independent practice. Ratings were compared using Wilcoxon signed-rank tests. Multivariable linear regression was used to establish alumni characteristics associated with perceptions of utility of in-practice versus RTO-delivered education.</p><p><strong>Results: </strong>Three hundred and fifty-four alumni responded (response rate 28%). In-practice training was rated statistically significantly higher than RTO education for minor procedural skills, teaching skills, professional responsibilities, tolerating clinical uncertainty, and preparing for managing child and adolescent health, aged care, chronic disease, multi-morbidity and mental health. RTO education rated higher than in-practice training for practising evidence-based medicine and Aboriginal and Torres Strait Islander health. For a number of further areas, there was no statistically significant difference in alumni ratings of utility.</p><p><strong>Conclusions: </strong>In-practice or RTO-led teaching was perceived as more useful for some components of independent practice, whilst for others there was no significant difference. The findings support recognition of the individual educational components of a blended education/training structure.</p>","PeriodicalId":46436,"journal":{"name":"Education for Primary Care","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10217916","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"LIC in the time of COVID: experiences of LIC tutors during the COVID-19 pandemic in Scotland.","authors":"Zoë McElhinney,&nbsp;Genevieve Hoskison,&nbsp;Maggie Bartlett","doi":"10.1080/14739879.2022.2161423","DOIUrl":"https://doi.org/10.1080/14739879.2022.2161423","url":null,"abstract":"<p><p>In March 2020, due to the escalating global coronavirus (COVID-19) pandemic, clinical placements for most medical students in the UK were suspended. A phased resumption of clinical placements started at the beginning of academic year 2020/2021. For the Scottish Graduate Entry Medicine programme (ScotGEM), 2020/21 was the first year that Dundee School of Medicine's comprehensive LIC was extended to all 54 students in the penultimate year of the ScotGEM programme. This cross-sectional qualitative study explored aspects of tutors' experiences of supporting LIC students in their practices. Thematic analysis of the data identified significant themes relating to the effects of the coronavirus pandemic on the organisation of the LIC placements and the experiences of the tutors, and the ways in which they adapted placements to the rapidly changing clinical and social landscapes. The changes necessitated by the pandemic posed significant challenges for practice-based tutors in ensuring that students had valuable educational experiences despite the constraints of social distancing requirements and the reduction in face-to-face consultations. However, tutors also identified several positive aspects of the changes which will be of interest to those involved in the organisation and delivery of both LIC and shorter General Practice based clinical attachments. Positive relationships between LIC students and practices enhanced the success of LIC placements. We will discuss how lessons learned from the experience of tutors in the pandemic could be used in the longer term to enrich the LIC experience and General Practice placements more generally.</p>","PeriodicalId":46436,"journal":{"name":"Education for Primary Care","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9860312","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}