Are vocationally trained general practitioners better GPs? A review of research designs and outcomes

Knowledge, awareness and practice regarding familial hypercholesterolaemia among primary care physicians in Malaysia: The importance of professional training

BACKGROUND AND AIMS

This study aimed to determine knowledge, awareness and practice (KAP) regarding familial hypercholesterolaemia (FH) among Malaysian primary care physicians (PCP), and to compare KAP between PCP with postgraduate qualification (PCP-PG-Qual) and PCP without PG qualification (PCP-noPG-Qual).

METHODS

This was a cross-sectional study involving PCP with ≥1-year working experience in Malaysian primary care settings. An adapted and validated 25-item FH-KAP questionnaire was disseminated during primary care courses. Total score for each domain was calculated by summing-up the correct responses, converted into percentage scores. Normality distribution was examined and comparisons of mean/median percentage scores were made between the two groups of PCP.

RESULTS

A total of 372 PCP completed the questionnaire. Regarding knowledge, 77.7% correctly defined FH. However, only 8.3% correctly identified coronary artery disease risk in untreated FH. The mean percentage knowledge score was significantly higher in PCP-PG-Qual compared to PCP-noPG-Qual (48.9, SD ± 13.92 vs. 35.2, SD ± 14.13), t(370) = 8.66, p < 0.001. Regarding awareness, 39% were aware of the NICE FH guideline and only 27.2% were aware of FH diagnostic criteria. The median percentage awareness score was significantly higher in PCP-PG-Qual compared to PCP-noPG-Qual (15.4, IqR ± 23.08 vs. 7.7, IqR ± 11.54), p = 0.013. Regarding practice, only 19.1% stratified FH patients as high risk irrespective of other risk factors. The mean percentage practice score was significantly higher in PCP-PG-Qual compared to PCP-noPG-Qual (52.4, SD ± 12.92 vs. 42.7, SD ± 16.63), t(370) = 9.65, p < 0.001.

CONCLUSIONS

Substantial gaps in FH-KAP among Malaysian PCP were identified, with PCP-PG-Qual having better knowledge, awareness and practice than PCP-noPG-Qual, emphasising the importance of professional training and certification.

General practitioners as supervisors in postgraduate clinical education: an integrative review

CONTEXT

General practice supervisors are said to serve as the cornerstones of general practice postgraduate education and therefore it is important to clearly define their roles and what makes them effective. The commonly used definition of a supervisor is not primarily based on general practice and does not cover aspects predicted to be important according to work-based learning theory.

METHODS

We searched for papers published between 1991 and 2011 inclusive, categorised them according to whether they provided empirical evidence, descriptions or recommendations, open-coded the empirical evidence, and used the resulting coding scheme as an analytic framework within which to present a narrative summary of findings.

RESULTS

Recommendations and descriptions far outweighed empirical evidence, which showed how supervisors intertwined clinical and educational activities and formed educational alliances with resident doctors that provided a foundation for learning. Residents needed a balance of challenge, usually provided by patients, and support, provided by supervisors. Supervisors established learning environments, assessed residents' learning needs, facilitated learning, monitored the content and process of learning and the well-being of residents, and summarised learning in ways that turned 'know that' into 'know how'.

CONCLUSIONS

General practice must be expert in ensuring patients are well cared for 'by proxy' and in giving residents just the right amount of support they need to face the challenges posed by those patients. As general practice responds to contemporary clinical demands and rising numbers of undergraduate medical students, it is essential that the ability of general practice supervisors to develop and sustain supportive supervisory relationships with residents is preserved.

Feedback for general practice trainers: developing and testing a standardised instrument using the importance-quality-score method

INTRODUCTION

Although general practice vocational training has been mandatory in Germany since 1993, a service philosophy still prevails. To help general practice trainers develop their identity and skills as trainers we developed and tested a standardised instrument. The questionnaire is to be filled in by registrars after their attachment to a given practice and handed to the trainer as personal feedback on the training provided.

METHODS

Items were collected by asking experts in the field to name content that should be covered. The resulting items were reduced using the importance-quality method derived from health-related quality of life research. Reliability was tested by registrars rating their training twice 3 weeks apart. They also provided free text comments that were coded and analysed to establish criterion validity.

RESULTS

A total of 121 items were collected. Eighty registrars provided importance and quality ratings to reduce these to 43 items. Test-re-test reliability and criterion validity were also established.

CONCLUSION

The importance-quality method proved to be useful for item reduction according to the objective of the questionnaire. Instruments evaluating the quality of vocational training must be context-sensitive.

Evaluation of the PAHO/WHO training program on the detection and treatment of depression for primary care nurses in Panama

OBJECTIVE

This study evaluated the efficacy of a training program developed by Pan American Health Organization/World Health Organization (PAHO/WHO) for primary care nurses aimed at improving their capacity to detect and manage depression.

METHOD

Changes in knowledge and clinical practice were assessed in a group of primary care nurses in Panama who underwent the program. They were compared with a group of controls.

RESULTS

Nurses who underwent the training program showed a statistically significant improvement in knowledge and detection of depressive disorders. In addition, they increased their notification of patients with depression to the primary care physician. No change was noted in the control group.

CONCLUSION

The results point to the benefit of the PAHO/WHO training program for primary care nurses in the care of major depression. Further studies are required to confirm these results.

The current status and future needs of education and training in family medicine and primary care in South Africa

South Africa is undergoing tremendous political and social change affecting every sphere of society, including medical education and the delivery of health services. The legacy of its history created a health system that in some respects can be compared to the best in the world, but one also characterized by inequity, discrimination and lack of access to even basic services for the rural and the poor. Its medical education system trails behind modern trends such as problem-based learning, community-based education and the utilizing of general/family practitioners as trainers. Vocational training in family practice is not compulsory for independent practice. The discipline of family practice has nevertheless developed the programmes and core infrastructure for such a future undertaking in the form of masters programmes in family medicine at all medical schools. The recently introduced system of compulsory recertification through continuous professional development provides a window of opportunity to develop locally relevant curricula and appropriate education and training methods for family practitioners. Challenges for family practice include the establishment of the role and value of the discipline in a developing country with a health system based on a nurse-driven primary care service and the re-orientation of family medicine teachers, trained in a biomedical paradigm, to the patient-centred approach. The aspirations of family practice are to define the core content of the discipline, establish and nurture a culture of research in primary care, and to develop and introduce appropriate under and postgraduate training programmes for the new generation of family doctors.