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Scholz A, Gehres V, Schrimpf A, Bleckwenn M, Deutsch T, Geier AK. Long-term mentoring relationships in undergraduate longitudinal general practice tracks - a qualitative study on the perspective of students and general practitioners. MEDICAL EDUCATION ONLINE 2023; 28:2149252. [PMID: 36463500 PMCID: PMC9728122 DOI: 10.1080/10872981.2022.2149252] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 11/15/2022] [Accepted: 11/16/2022] [Indexed: 06/01/2023]
Abstract
BACKGROUND Longitudinal general practice tracks have been established in medical faculties in Europe and worldwide to attract more graduates to general practice careers. In many programs, long-term mentoring relationships play an important role in providing students with positive role models, regular practical experiences, and acquisition of clinical skills in a community context. However, little is known about students' and general practitioner mentors' expectations, experiences, challenges, and ideas for improvement within these long-term mentoring relationships in general practice in our medical education system. METHODS Qualitative study based on semi-structured interviews with 15 students and 13 mentors. Interviews were audio-recorded and transcribed verbatim. MAXQDA was used for data analysis, following a mixed deductive/inductive approach. RESULTS Both groups had few and rather unstated expectations, particularly regarding their relationships. Consequently, expectations were often not clearly communicated. Nevertheless, a high level of satisfaction and good opportunities for teaching were achieved for both sides. The evolving familiarity facilitated a positive learning environment. Students valued independent medical tasks continuously adjusted to their current abilities. However, some felt a reluctance to demand their mentor's time and consideration. Conversely, the mentors criticized a lack of initiative from some of the students and wished that they would get more actively involved. Students, in contrast, wished for more guidance at the start of the project and joint events to deepen the relationship. CONCLUSIONS With this study, we gained detailed insights into and understanding of the nature of long-term relationships between students and mentors. Points for improvement revealed included: 1) education of both participating groups on the goals and benefits of mentoring, including binding expectations for the participants; 2) intensified support and training of teaching physicians; 3) structured and accompanied establishment of initial contact between mentor and mentee; and 4) encouraged additional shared (teaching) time, individualized timing, and intensification, if desired.
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Affiliation(s)
- Anna Scholz
- Department of General Practice, Faculty of Medicine, Leipzig University, Leipzig, Germany
| | - Vera Gehres
- Department of General Practice, Faculty of Medicine, Leipzig University, Leipzig, Germany
| | - Anne Schrimpf
- Department of General Practice, Faculty of Medicine, Leipzig University, Leipzig, Germany
| | - Markus Bleckwenn
- Department of General Practice, Faculty of Medicine, Leipzig University, Leipzig, Germany
| | - Tobias Deutsch
- Department of General Practice, Faculty of Medicine, Leipzig University, Leipzig, Germany
| | - Anne-Kathrin Geier
- Department of General Practice, Faculty of Medicine, Leipzig University, Leipzig, Germany
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Nafziger M, Geier AK, Bauch FJ, Deutsch T, Frese T. When and why do medical students drop out of extracurricular longitudinal general practice tracks? A cross-sectional study from two German medical faculties. BMJ Open 2022; 12:e064481. [PMID: 36521907 PMCID: PMC9756222 DOI: 10.1136/bmjopen-2022-064481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES To explore when and why undergraduate medical students drop out of longitudinal extracurricular general practice (GP) tracks and to describe their future career plans. DESIGN Cross-sectional online survey and descriptive analysis of routine data. SETTING GP tracks at two German medical faculties, data collection took place between September 2020 and April 2021. PARTICIPANTS Of 111 students who had taken part in one of the two GP tracks and dropped out prematurely, 101 were contactable via email. Overall, the response rate was 72.3% with 73 completed questionnaires and 75.3% of the participants were female. PRIMARY AND SECONDARY OUTCOME MEASURES Reasons for leaving the GP track (closed and free-text answers), attitudes towards a career in GP and future career plans. RESULTS Students left the tracks predominantly during the first 2 years of study. Students most frequently stated that structural reasons such as the distance to the GP teaching practice (74.2%), interest in another medical discipline (66.1%), private reasons (58.1%) and the GP mentor (53.1%) influenced their decision to drop out. However, 87.1% of the students indicated that their exit could not have been prevented by the project administration. CONCLUSIONS Reasons for dropping out differ between GP tracks and not all reasons are within reach of programme design and staff. Addressable issues include student selection with regard to career plans, support and strengthening of student-mentor relationships, the location of GP practices, and/or travel and accommodation support.
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Affiliation(s)
- Melanie Nafziger
- Institute of General Practice and Family Medicine, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Anne-Kathrin Geier
- Department of General Practice, Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Felix Johannes Bauch
- Institute of General Practice and Family Medicine, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Tobias Deutsch
- Department of General Practice, Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Thomas Frese
- Institute of General Practice and Family Medicine, Martin-Luther-University Halle-Wittenberg, Halle, Germany
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Stigler FL, Zipp CR, Jeitler K, Semlitsch T, Siebenhofer A. Comprehensive catalogue of international measures aimed at preventing general practitioner shortages. Fam Pract 2021; 38:793-801. [PMID: 34160614 DOI: 10.1093/fampra/cmab045] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Many countries are facing a shortage and misallocation of general practitioners (GPs). The development of a policy response may benefit from the knowledge of worldwide policies that have been adopted and recommended to counteract such a development. AIM To identify measures proposed or taken internationally to prevent GP shortages. DESIGN AND SETTING A literature review followed by an expert assessment focussed on sources from OECD countries. METHOD The literature search identified international policy documents and literature reviews in bibliographical databases, and examined institutional websites and references of included publications. The internet search engine Google was also used. The resulting measures were then assessed for completeness by three experts. RESULTS Ten policy documents and 32 literature reviews provided information on 102 distinct measures aimed at preventing GP shortages. The measures attempt to influence GPs at all stages of their careers. CONCLUSIONS This catalogue of measures to prevent GP shortages is significantly more comprehensive than any of the policy documents it is based on. It may serve as a blueprint for effective reforms aimed at preventing GP shortages internationally.
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Affiliation(s)
- Florian L Stigler
- Austrian health insurance fund, Health Center (ÖGK) - Styria, Graz, Austria
| | - Carolin R Zipp
- Medical University of Graz, Institute of General Practice and Evidence-Based Health Services Research, Graz, Austria
| | - Klaus Jeitler
- Medical University of Graz, Institute of General Practice and Evidence-Based Health Services Research, Graz, Austria.,Medical University of Graz, Institute for Medical Informatics, Statistics and Documentation, Graz, Austria
| | - Thomas Semlitsch
- Medical University of Graz, Institute of General Practice and Evidence-Based Health Services Research, Graz, Austria
| | - Andrea Siebenhofer
- Medical University of Graz, Institute of General Practice and Evidence-Based Health Services Research, Graz, Austria.,Goethe University Frankfurt, Institute of General Practice, Frankfurt am Main, Hessen, Germany
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Selch S, Pfisterer-Heise S, Hampe W, van den Bussche H. On the attractiveness of working as a GP and rural doctor including admission pathways to medical school - results of a German nationwide online survey among medical students in their "Practical Year". GMS JOURNAL FOR MEDICAL EDUCATION 2021; 38:Doc102. [PMID: 34651060 PMCID: PMC8493838 DOI: 10.3205/zma001498] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 03/22/2021] [Accepted: 04/26/2021] [Indexed: 06/13/2023]
Abstract
Background: One of the aims of the German student selection network (Studierendenauswahl-Verbund, stav) is to review existing procedures for selecting medical students and to relate their effectiveness to students' career aspirations as well as to their further careers. Against the background of changes in the selection procedures and the introduction of the rural doctor quota (Landarztquote), the study conducted here aims at contributing to the current discussion on the future of GP (general practitioners) care, especially in rural areas. Methods: In 2019 and 2020, the stav conducted a German nationwide online survey among medical students towards the end of their "Practical Year" (Praktisches Jahr, final-year medical students in practical training). The associations between selection parameters and students' interest in later working as a GP as well as students' preference to later work in a place with a low population density were investigated. Furthermore, socio-demographic variables and variables related to medical studies were taken into account. Statistical comparisons were carried out using Chi2- and Mann-Whitney U tests. Results: A total of 1,055 students in their Practical Year (65.4% female, 27 years) completed the survey. As their final professional position, 12.1% aspired to own a GP practice or work as employed GP after completing medical specialist training in general medicine (interested students: 9.9%) or general internal medicine (interested students: 9.5%). Compared to their fellow students, those interested in working as a GP had been more often admitted to medical school via the waiting time quota and had more often already completed vocational training in a medical-related field. 39.1% of those interested in working as a GP wanted to work in a place with a low population density. Coming from a place with a low population density as well as completing the medical internship (Famulatur) for GP care in such a place turned out to be positive influencing factors. Discussion: The observed associations between waiting time quota and interest in working as a GP as well as between origin from a place with a low population density and preferring to later work in such a place go hand in hand with changes in the access regulations for medical studies, which concern both the waiting time quota (abolition of the latter) and a regulation of the number of rural doctors (rural doctor quota). In order to evaluate the current changes in the access regulations for medical studies, longitudinal studies are desirable that cover the time from the application to study up to the medical specialist examination and further career.
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Affiliation(s)
- Susan Selch
- University Medical Centre Hamburg-Eppendorf, Institute of Biochemistry and Molecular Cell Biology, Hamburg, Germany
- University Medical Centre Hamburg-Eppendorf, Institute and Polyclinic of General Medicine, Hamburg, Germany
| | - Stefanie Pfisterer-Heise
- University Medical Centre Hamburg-Eppendorf, Institute of Biochemistry and Molecular Cell Biology, Hamburg, Germany
| | - Wolfgang Hampe
- University Medical Centre Hamburg-Eppendorf, Institute of Biochemistry and Molecular Cell Biology, Hamburg, Germany
| | - Hendrik van den Bussche
- University Medical Centre Hamburg-Eppendorf, Institute and Polyclinic of General Medicine, Hamburg, Germany
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Becker N, Barthen L, Pauscher L, Gerlach FM, Sader R, Ravens-Taeuber G. The "practice track" - How can teaching content related to outpatient healthcare be integrated into medical studies? Learning objectives, conception and implementation of a specialized voluntary program. GMS JOURNAL FOR MEDICAL EDUCATION 2020; 37:Doc30. [PMID: 32566732 PMCID: PMC7291382 DOI: 10.3205/zma001323] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 01/09/2020] [Accepted: 02/11/2020] [Indexed: 05/28/2023]
Abstract
The "practice track" (PAT) at Goethe University Frankfurt provides students with the opportunity to focus on outpatient care during their medical studies. The aim of this article is to describe the objectives, conception and implementation of the program. At the Institute of General Practice, a new teaching concept has been developed in cooperation with the Dean's Office of the Faculty of Medicine at Goethe University and further partners. Medical students generally receive their training in highly specialized hospitals. However, the new concept will allow them to gain a practical insight into the outpatient care provided by physicians in private practice during their medical studies. Every year, 15 interested students will be able to participate in the longitudinal program, which includes internships, seminars and mentoring sessions. In the three current PAT cohorts, all 45 places have been taken up, and the first cohort has now completed the program. In addition to practical skills in the disciplines of family medicine, internal medicine, surgery, gynecology and pediatrics, it has been possible to show students the full scope of ambulatory health care. However, legal limitations to the implementation of the program in registered medical practices have meant that some parts of it could only be carried out voluntarily. Against the background of the current and future situation in health care, it makes sense that registered physicians in private practice should teach medical students about outpatient care during their medical studies. In order to establish such programs and permit their complete integration into the medical curriculum, it is essential that the necessary changes are made to medical licensing regulations.
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Affiliation(s)
- Nadja Becker
- Goethe University Frankfurt am Main, Institute of General Practice, Frankfurt/Main, Germany
| | - Linda Barthen
- Goethe University Frankfurt am Main, Institute of General Practice, Frankfurt/Main, Germany
| | - Lia Pauscher
- Goethe University Frankfurt am Main, Institute of General Practice, Frankfurt/Main, Germany
| | - Ferdinand M. Gerlach
- Goethe University Frankfurt am Main, Institute of General Practice, Frankfurt/Main, Germany
| | - Robert Sader
- Goethe University Frankfurt am Main, Dean's Office of the Faculty of Medicine, Frankfurt/Main, Germany
| | - Gisela Ravens-Taeuber
- Goethe University Frankfurt am Main, Institute of General Practice, Frankfurt/Main, Germany
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Seeger L, Becker N, Ravens-Taeuber G, Sennekamp M, Gerlach FM. "Landpartie 2.0" - Conceptual development and implementation of a longitudinal priority program to promote family medicine in rural areas. GMS JOURNAL FOR MEDICAL EDUCATION 2020; 37:Doc29. [PMID: 32566731 PMCID: PMC7291387 DOI: 10.3205/zma001322] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 01/15/2020] [Accepted: 02/11/2020] [Indexed: 05/15/2023]
Abstract
Objective: This article reports on the conceptual development and subsequent implementation of a targeted and attractive general practice teaching program in a rural area for students of human medicine at the medical faculty of Goethe University, Frankfurt am Main. Project description: Since the 2016/2017 winter semester, usually up to 15 interested students a year have had the opportunity to participate in the longitudinal priority program "Landpartie 2.0". The program runs for six semesters during the clinical stage of medical studies and consists of regular internships during which the students receive one-to-one support in a family practice, and participate in a series of seminars and an annual one-day excursion. The aim is to enable students, early on in their studies and without any obligations, to gain uninterrupted experience of providing patient care, and to find out what it means to pursue a career in family medicine. Results: Since the beginning of the annual program, 62 students have been included in it. The initial results show that the different elements of the program fulfil the expectations and requirements of participants and that their overall level of satisfaction is high. Almost 95% of students reported that they felt their knowledge had increased as a result of the internships, and they rated them as a useful part of their medical education. Despite the rural focus of the program, around half of the participants were of urban origin. Conclusion: The "Landpartie 2.0" provides students with the opportunity to familiarize themselves with family health care in a rural area. Further studies should investigate to what extent the program encourages students to continue their training with a view to pursuing a career in family medicine.
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Affiliation(s)
- Linda Seeger
- Goethe University Frankfurt am Main, Institute of General Practice, Frankfurt/Main, Germany
- *To whom correspondence should be addressed: Linda Seeger, Goethe University Frankfurt am Main, Institute of General Practice, Theodor-Stern-Kai 7, D-60590 Frankfurt/Main, Germany, E-mail:
| | - Nadja Becker
- Goethe University Frankfurt am Main, Institute of General Practice, Frankfurt/Main, Germany
| | - Gisela Ravens-Taeuber
- Goethe University Frankfurt am Main, Institute of General Practice, Frankfurt/Main, Germany
| | - Monika Sennekamp
- Goethe University Frankfurt am Main, Institute of General Practice, Frankfurt/Main, Germany
| | - Ferdinand M. Gerlach
- Goethe University Frankfurt am Main, Institute of General Practice, Frankfurt/Main, Germany
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Longitudinal Continuity. J Gen Intern Med 2019; 34:2302. [PMID: 31420822 PMCID: PMC6848444 DOI: 10.1007/s11606-019-05272-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Geier AK, Saur C, Lippmann S, Nafziger M, Frese T, Deutsch T. LeiKA: an optional German general practice teaching project for first-semester medical students: who is taking part and why? A cross-sectional study. BMJ Open 2019; 9:e032136. [PMID: 31676656 PMCID: PMC6830716 DOI: 10.1136/bmjopen-2019-032136] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVES This study investigates students' adoption of LeiKA, a new extracurricular longitudinal general practice (GP) teaching project. LeiKA aims to attract a broad range of students, not only those who are already planning to become GPs. This study compares participants' and non-participants' characteristics, career preferences and job-related value orientations to assess the programme's initial potential to increase the number of students subsequently entering GP careers. Additionally, students' motives for taking part in the programme were explored. DESIGN We analysed administrative data and data from a cross-sectional questionnaire survey for the first three cohorts. LeiKA participants were compared with non-participants regarding baseline characteristics, career intentions and attitudes associated with GP careers. There was also a qualitative analysis of the reasons for taking part. SETTING Faculty of Medicine, University of Leipzig, Germany. PARTICIPANTS First-semester medical students in the years 2016-2018. RESULTS In the first 3 years, 86 of 90 LeiKA slots were taken, 9.0% (n=86/960) of those eligible to apply. LeiKA participants were a mean of 0.6 years older (LeiKA: 21.5 vs whole cohort: 20.9 years, p<0.001) and slightly more interested in long-term doctor-patient relationships (3.6 vs 3.3, scale from 1 'unimportant' to 5 'very important', p=0.018), but did not differ regarding other characteristics and attitudes. Although more participants definitely favoured a GP career (13.1% vs 4.9%, p=0.001), it was a possible option for most students in both groups (78.6% vs 74.0%). Early acquisition of skills and patient contact were the main motives for taking part, stated by 60.7% and 41.7% of the participants, respectively. CONCLUSIONS The extracurricular programme was taken up by a broad range of students, indicating its potential to attract more students to become GPs. The reasons for taking part that we identified may guide the planning of other similar projects.
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Affiliation(s)
- Anne-Kathrin Geier
- Department of General Practice, University of Leipzig, Faculty of Medicine, Leipzig, Germany
| | - Christiane Saur
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital Leipzig, Leipzig, Germany
| | - Stefan Lippmann
- Department of General Practice, University of Leipzig, Faculty of Medicine, Leipzig, Germany
| | - Melanie Nafziger
- Institute of General Practice and Family Medicine, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - T Frese
- Institute of General Practice and Family Medicine, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Tobias Deutsch
- Department of General Practice, University of Leipzig, Faculty of Medicine, Leipzig, Germany
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[Shortage of physicians in rural areas and in the public health service : A critical analysis of the evidence on the role of medical education and training]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2019; 61:187-194. [PMID: 29209761 DOI: 10.1007/s00103-017-2671-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND A shortage of medical personnel has been seen for several decades in at least two sectors of the healthcare system: primary care in remote areas as well as medical care in the state public health departments (Öffentliches Gesundheitswesen). Strategies to reduce these problems are being sought. OBJECTIVE This review examines the proposals, practical initiatives and empirical studies in under- and postgraduate medical education in order to estimate their potential impact on the solution of these problems. The analysis covers both Germany and Anglo-Saxon countries. MATERIALS AND METHODS The study is based on a literature search in PubMed and Medline covering the last 20 years. With regard to Germany, programmatic documents and studies published in the German Journal of General Practice (Zeitschrift für Allgemeinmedizin) were also included. RESULTS AND DISCUSSION Foreign empirical studies identify almost equal two factors with regard to primary care in remote areas: the recruitment of students from rural areas combined with special educational programs with a rural primary care orientation both in under- and postgraduate medical education. These programs should include several and longer practical working periods in primary care units and be well coordinated between the medical school and the local teaching physicians. As for the state public health sector, comparable initiatives are still lacking.
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10
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Deutsch T, Winter M, Lippmann S, Geier AK, Braun K, Frese T. Willingness, concerns, incentives and acceptable remuneration regarding an involvement in teaching undergraduates - a cross-sectional questionnaire survey among German GPs. BMC MEDICAL EDUCATION 2019; 19:33. [PMID: 30683085 PMCID: PMC6347773 DOI: 10.1186/s12909-018-1445-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 12/28/2018] [Indexed: 05/15/2023]
Abstract
BACKGROUND Worldwide, many undergraduate general practice curricula include community-based courses at general practitioners' (GPs') offices. Usually the academic general practice departments collaborate with networks of affiliated teaching practices. To successfully master the challenge of network development and extension, more information is needed about GPs' willingness to be involved in different teaching formats, important influencing factors, incentives, barriers, and the need for financial compensation. METHODS In this cross-sectional study a questionnaire survey was conducted among all GPs working in Leipzig and environs (German postal code area 04). In addition to descriptive statistics, group comparisons and logistic regression were performed to reveal differences between GPs with and without an interest in teaching. RESULTS Response rate was 45.3% with 339 analyzable questionnaires. The average age was 52.0 years and 58.4% were women. Sixty-two participants stated that they were already involved in teaching undergraduates. Altogether 60.1% of all GPs and 53.5% among those who didn't teach yet were basically interested in being involved in undergraduate education. The interested GPs could imagine devoting on average 6.9 h per month to teaching activities. GPs interested in teaching were on average younger, were more actively involved in continuing education and professional associations, and more frequently had pre-existing teaching experiences. The willingness to teach differed substantially among teaching formats. GPs were more willing to teach at their own practices rather than at university venues and they preferred skills-oriented content. Comprehensive organization on the part of the university including long-term scheduling and available teaching materials was rated as most important to increase the attractiveness of teaching. Time restraints and decreased productivity were rated as the most important barriers. Interested GPs appreciated financial compensation, particularly for teaching at university venues, and demanded amounts of money corresponding to German GPs' hourly income. CONCLUSIONS The GPs' interest in undergraduate teaching is generally high indicating a substantial pool of potential preceptors. Recruitment strategies should consider the collaboration with institutions involved in residency and continuing education as well as with professional associations. Comprehensive organization by the responsible department should be promoted and time restraints and decreased productivity should be overtly addressed and financially compensated.
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Affiliation(s)
- Tobias Deutsch
- Department of General Practice, Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Marcus Winter
- Department of General Practice, Medical Faculty, University of Leipzig, Leipzig, Germany
- Institute of General Practice and Family Medicine, Martin-Luther-University Halle-Wittenberg, Halle/Saale, Germany
| | - Stefan Lippmann
- Department of General Practice, Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Anne-Kathrin Geier
- Department of General Practice, Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Kristin Braun
- Institute of General Practice and Family Medicine, Martin-Luther-University Halle-Wittenberg, Halle/Saale, Germany
| | - Thomas Frese
- Institute of General Practice and Family Medicine, Martin-Luther-University Halle-Wittenberg, Halle/Saale, Germany
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Pohontsch NJ, Stark A, Ehrhardt M, Kötter T, Scherer M. Influences on students' empathy in medical education: an exploratory interview study with medical students in their third and last year. BMC MEDICAL EDUCATION 2018; 18:231. [PMID: 30290824 PMCID: PMC6173872 DOI: 10.1186/s12909-018-1335-7] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 09/26/2018] [Indexed: 05/04/2023]
Abstract
BACKGROUND Empathy is beneficial for patients and physicians. It facilitates treatment and improves physical and psychosocial outcomes. The therapeutic relevance of empathy emphasizes the need to help medical students develop their empathic abilities. Our study aimed to identify factors which promote or hinder the development and expression of empathy in medical students during the course of their studies. METHODS We interviewed 24 medical students (six male and six female students in their 6th semester as well as six male and six female students in their final clinical year) using semi-structured interviews. The interviews were recorded, transcribed verbatim and analyzed using Braun & Clarke's thematic analysis. RESULTS We identified four main themes influencing the development and expression of empathy. 1) Course of studies: hands-on-experience, role models, science and theory, and emphasis on the importance of empathy; 2) students: insecurities and lack of routine, increasing professionalism, previous work experiences, professional distance, mood, maturity, and personal level of empathy; 3) patients: "easy" and "difficult" patients including their state of health; and 4) surrounding conditions: time pressure/stress, work environment, and job dissatisfaction. CONCLUSIONS The development and use of empathy could be promoted by increasing: hands-on-experiences, possibilities to experience the patient's point of view and offering patient contact early in the curriculum. Students need support in reflecting on their actions, behavior and experiences with patients. Instructors need time and opportunities to reflect on their own communication with and treatment of patients, on their teaching behavior, and on their function as role models for treating patients empathically and preventing stress. Practical experiences should be made less stressful for students. The current changes implemented in some medical school curriculums (e.g., in Germany) seem to go in the right direction by integrating patient contact early on in the curriculum and focusing more on teaching adequate communication and interaction behaviors.
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Affiliation(s)
- N J Pohontsch
- Department of General Practice / Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - A Stark
- Department of General Practice / Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - M Ehrhardt
- Department of General Practice / Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - T Kötter
- Institute for Social Medicine and Epidemiology, University of Lübeck, Lübeck, Germany
| | - M Scherer
- Department of General Practice / Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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12
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Barthen L, Ravens-Taeuber G, Paulitsch MA, Gerlach FM, Sennekamp M. How can General Practice be incorporated longitudinally in medical studies? Students' views on the development of a new rural health program. GMS JOURNAL FOR MEDICAL EDUCATION 2018; 35:Doc42. [PMID: 30186952 PMCID: PMC6120159 DOI: 10.3205/zma001188] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 05/17/2018] [Accepted: 06/06/2018] [Indexed: 05/28/2023]
Abstract
Aim: Participation of medical students in the conceptual development of targeted and attractive teaching content for rural areas. Method: A questionnaire was developed to gather information on students' views of their current medical studies, career interests, and what requirements should be met by an optional rural health program in general practice. By means of an online survey in summer 2015, all medical students from the fourth preclinical semester onwards (n=2,150) at Goethe University Frankfurt were surveyed on one occasion. Statistical analysis was mainly descriptive. Personal attitudes towards a career as a family practitioner were examined for statistical significance. Further information was gathered on whether a measurable correlation exists between personal background and desired work location. Results: Of the 2,150 students that were contacted, 617 participated in the survey (response rate=28.7%). The results covered a wide range of ideas and recommendations and were representative both of medical students with a positive attitude toward general practice, as well as those that were rather critical of teaching in general practice. The students expected the planned health program to be of strong practical relevance and to acquaint them with the administrative and economic aspects of running a practice. Conclusions: By including the target group in the development process, it was possible to tailor the health program to meet the needs of future participants more precisely. Student participation can also be expected to result in greater acceptance of the program. The results on teaching content may also provide other medical faculties with orientation when developing comparable programs.
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Affiliation(s)
- Linda Barthen
- Goethe University Frankfurt, Institute of General Practice, Frankfurt/Main, Germany
| | | | - Michael A. Paulitsch
- Goethe University Frankfurt, Institute of General Practice, Frankfurt/Main, Germany
| | - Ferdinand M. Gerlach
- Goethe University Frankfurt, Institute of General Practice, Frankfurt/Main, Germany
| | - Monika Sennekamp
- Goethe University Frankfurt, Institute of General Practice, Frankfurt/Main, Germany
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Hansen H, Pohontsch NJ, Bole L, Schäfer I, Scherer M. Regional variations of perceived problems in ambulatory care from the perspective of general practitioners and their patients - an exploratory focus group study in urban and rural regions of northern Germany. BMC FAMILY PRACTICE 2017; 18:68. [PMID: 28545402 PMCID: PMC5445300 DOI: 10.1186/s12875-017-0637-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 05/11/2017] [Indexed: 08/26/2023]
Abstract
BACKGROUND Patients from rural and urban regions should have equitable access to health care. In Germany, the physician-patient-ratio and the supply of medical services vary greatly between urban and rural areas. The aim of our study was to explore the regional variations of the perceived health care problems in ambulatory care from the perspective of affected professionals and laypersons i.e. general practitioners and their patients. METHODS We conducted 27 focus groups with general practitioners (n = 65) and patients (n = 145) from urban areas, environs and rural areas in northern Germany. Discussions were facilitated by two researchers using a semi-structured guideline. The transcripts were content analyzed using deductive and inductive categories. RESULTS General practitioners and patients reported problems due to demographic change and patient behaviour, through structural inequalities and the ambulatory reimbursement system as well as with specialist care and inpatient care. A high physician density, associated with high competition between general practitioners, a high fluctuation of patients and a low status of general practitioners were the main problems reported in urban areas. In contrast, participants from rural areas reported an insufficient physician density, a lack of young recruits in primary care and a resulting increased workload as problematic. All regions are concerned with subjectively inadequate general practitioners' budgets, insufficiently compensated consultations and problems in the cooperation with specialists and inpatient care institutions. Most problems were mentioned by GPs and patients alike, but some (e.g. high competition rates in urban regions and problems with inpatient care) were only mentioned by GPs. CONCLUSIONS While many problems arise in urban regions as well as in rural regions, our results support the notion that there is an urgent need for action in rural areas. Possible measures include the support of telemedicine, delegation of medical services and reoccupation of vacant practices. The attractiveness of working in rural areas for general practitioners, specialists and clinicians must be increased by consolidating and expanding rural infrastructure (e.g. child care and cultural life). The above mentioned results also indicate that the ambulatory reimbursement system should be examined regarding the reported inequalities. Measures to further enhance the cooperation between general practitioners, specialists and inpatient care should be taken to solve supra-regionally reported problems. Problems showing regional variations indicate the need for measures to balance these variations between the regions. This is the first German study to analyze subjective views of the stakeholders concerned on regionally variating problems in ambulatory care. Further studies are needed to quantify the extent of the identified problems and differences. A corresponding survey is currently under way.
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Affiliation(s)
- H Hansen
- Department of General Practice/Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - N J Pohontsch
- Department of General Practice/Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - L Bole
- Department of General Practice/Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - I Schäfer
- Department of General Practice/Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - M Scherer
- Department of General Practice/Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Samos FA, Heise M, Fuchs S, Mittmann S, Bauer A, Klement A. Pilot phase evaluation of the elective general practice class: results of student surveys of the first two years. GMS JOURNAL FOR MEDICAL EDUCATION 2017; 34:Doc4. [PMID: 28293671 PMCID: PMC5327659 DOI: 10.3205/zma001081] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 10/05/2016] [Accepted: 11/09/2016] [Indexed: 05/28/2023]
Abstract
Background: Primary health care in rural regions is currently undergoing a global crisis in respect of the next generation of practitioners. National and international recommendations advise placing greater emphasis upon practical skills and competences in medical studies. It is also in the interest of training the next generation to include mentoring and longitudinal integration of contact to teaching practices for general medicine in an early stage. Consequently, the General Practice Class (KAM) was introduced in Halle in 2011 as an elective with 20 individually mentored students per year, beginning with the first subject-related semester. We are now reporting on the results of the evaluation for the first two years. Method: A standardised online survey was carried out with all students who took part in the KAM in the two years 2011 and 2012 (N=38). For both years the survey was made at the end of the first summer semester on the basis of an adapted version of the Heidelberger Inventar zur Lehrevaluation (Heidelberg Inventory for the Evaluation of Teaching, HILVE-II) and the Berliner Evaluationsinstrument für selbsteingeschätzte, studentische Kompetenzen (Berlin Evaluation Instrument for the self-assessment of student competences, BEvaKomp). Furthermore, each year the preference for the choice of specialty and location of a medical practice was queried. Predictors for the preference of the chosen specialty and the location of a medical practice were estimated by binary logistic regression analysis. Via univariate evaluations the number of students who reported an increase in knowledge in different areas of competence as a result of the KAM was counted. Correlations between the intention to remain in the KAM and the quality of teaching were evaluated on the basis of bivariate correlations. Results: 48% of the students agreed partly or fully that the KAM seminars enhanced their specialist competence. This individual acquiring of competence in the model project represented a significant predictor for the preferred choice of the area (OR 7.98; 95% CI [1.27-50.27], p=0.027). Students who assessed the commitment (r=0.504), support (r=0.526) and interaction management (r=0.529) of the mentors positively were more likely inclined to continue their participation in the KAM. Conclusion: The successful conveyance of care-relevant competences to students proved to be an important predictor in our project for the preference of the specialty general practice. This requires that the medical mentors are suitably trained and that the students are specifically prepared for practical experience.
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Affiliation(s)
- Franziska-Antonia Samos
- Martin-Luther-University Halle-Wittenberg, Medical Faculty, Institute of General Practice and Family Medicine, Halle (Saale), Germany
| | - Marcus Heise
- Martin-Luther-University Halle-Wittenberg, Medical Faculty, Institute of General Practice and Family Medicine, Halle (Saale), Germany
| | - Stephan Fuchs
- Martin-Luther-University Halle-Wittenberg, Medical Faculty, Institute of General Practice and Family Medicine, Halle (Saale), Germany
| | - Susanne Mittmann
- Martin-Luther-University Halle-Wittenberg, Medical Faculty, Institute of General Practice and Family Medicine, Halle (Saale), Germany
| | - Alexander Bauer
- Martin-Luther-University Halle-Wittenberg, Medical Faculty, Institute of General Practice and Family Medicine, Halle (Saale), Germany
| | - Andreas Klement
- Martin-Luther-University Halle-Wittenberg, Medical Faculty, Institute of General Practice and Family Medicine, Halle (Saale), Germany
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Deutsch T, Lippmann S, Heitzer M, Frese T, Sandholzer H. Choosing to become a general practitioner - What attracts and what deters? An analysis of German medical graduates' motives. J Family Med Prim Care 2016; 5:34-41. [PMID: 27453840 PMCID: PMC4943146 DOI: 10.4103/2249-4863.184620] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND To be able to counter the increasing shortage of general practitioners (GPs) in many countries, it is crucial to remain up-to-date with the decisive reasons why young physicians choose or reject a career in this field. MATERIALS AND METHODS Qualitative content analysis was performed using data from a cross-sectional survey among German medical graduates (n = 659, response rate = 64.2%). Subsequently, descriptive statistics was calculated. RESULTS The most frequent motives to have opted for a GP career were (n = 74/81): Desire for variety and change (62.2%), interest in a long-term bio-psycho-social treatment of patients (52.7%), desire for independence and self-determination (44.6%), positively perceived work-life balance (27.0%), interest in contents of the field (12.2%), and reluctance to work in a hospital (12.2%). The most frequent motives to have dismissed the seriously considered idea of becoming a GP were (n = 207/578): Reluctance to establish a practice or perceived associated risks and impairments (33.8%), stronger preference for another field (19.3%), perception of workload being too heavy or an unfavorable work-life balance (15.0%), perception of too low or inadequate earning opportunities (14.0%), perception of the GP as a distributor station with limited diagnostic and therapeutic facilities (11.6%), perception of too limited specialization or limited options for further sub-specialization (10.6%), rejection of (psycho-) social aspects and demands in general practice (9.7%), and perceived monotony (9.7%). CONCLUSION While some motives appear to be hard to influence, others reveal starting points to counter the GP shortage, in particular, with regard to working conditions, the further academic establishment, and the external presentation of the specialty.
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Affiliation(s)
- Tobias Deutsch
- Department of Primary Care, Leipzig Medical School, University of Leipzig, Leipzig, Germany
| | - Stefan Lippmann
- Department of Primary Care, Leipzig Medical School, University of Leipzig, Leipzig, Germany
| | - Maximilian Heitzer
- Department of Primary Care, Leipzig Medical School, University of Leipzig, Leipzig, Germany
| | - Thomas Frese
- Department of Primary Care, Leipzig Medical School, University of Leipzig, Leipzig, Germany
| | - Hagen Sandholzer
- Department of Primary Care, Leipzig Medical School, University of Leipzig, Leipzig, Germany
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Schäfer I, Hansen H, Pohontsch N, Bole L, Wagner HO, Führ M, Lühmann D, Scherer M. Regional variation of patient behaviour and reasons for consultation in the general practice of Northern Germany: protocol for an observational study. BMJ Open 2016; 6:e010738. [PMID: 27357194 PMCID: PMC4932249 DOI: 10.1136/bmjopen-2015-010738] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Inappropriate supply and an increasing demand on the healthcare system have been of concern for health policy in Germany for at least 15 years. In the primary care setting, this especially relates to an undersupply of general practitioners (GPs) in the countryside. In addition, there seem to be other regional differences, for example, a difference in accessing primary and secondary care between rural and urban areas. Despite these findings, regional differences in health services have not been studied extensively in Germany. Therefore, this study aims to explore regional variations of patient populations and reasons for accessing primary medical care. METHODS AND ANALYSIS We will conduct a cross-sectional observational study based on standardised interviews with 240 GPs and ∼1200 patients. Data collection started on 10 June 2015 and will probably be completed by 31 October 2016. We will include all districts and cities within 100 km from Hamburg and assign them according to the type of regions: rural, urban and environs. All eligible GPs will be invited to participate. Each practice will recruit up to 15 patients, aged 18 years or older. Questionnaires are based on a preliminary qualitative study and were pretested. Data will be analysed with descriptive statistics and regression modelling strategies adjusted for confounders and the GP-induced cluster structure. ETHICS AND DISSEMINATION Our study was approved by the Ethics Committee of the Medical Association of Hamburg and is conducted in accordance with the Declaration of Helsinki. Study participants give written informed consent before data collection and data is pseudonymised. Survey data and person identifiers are stored separately in locked cabinets and have restricted availability. The results of our study will be presented at conferences and published in peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT02558322; Pre-results.
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Affiliation(s)
- Ingmar Schäfer
- Department of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Heike Hansen
- Department of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Nadine Pohontsch
- Department of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Laura Bole
- Department of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hans-Otto Wagner
- Department of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Miriam Führ
- Department of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Dagmar Lühmann
- Department of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Scherer
- Department of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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