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Greenhalgh T, Payne R, Hemmings N, Leach H, Hanson I, Khan A, Miller L, Ladds E, Clarke A, Shaw SE, Dakin F, Wieringa S, Rybczynska-Bunt S, Faulkner SD, Byng R, Kalin A, Moore L, Wherton J, Husain L, Rosen R. Training needs for staff providing remote services in general practice: a mixed-methods study. Br J Gen Pract 2024; 74:e17-e26. [PMID: 38154935 PMCID: PMC10756003 DOI: 10.3399/bjgp.2023.0251] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 08/30/2023] [Indexed: 12/30/2023] Open
Abstract
BACKGROUND Contemporary general practice includes many kinds of remote encounter. The rise in telephone, video and online modalities for triage and clinical care requires clinicians and support staff to be trained, both individually and as teams, but evidence-based competencies have not previously been produced for general practice. AIM To identify training needs, core competencies, and learning methods for staff providing remote encounters. DESIGN AND SETTING Mixed-methods study in UK general practice. METHOD Data were collated from longitudinal ethnographic case studies of 12 general practices; a multi-stakeholder workshop; interviews with policymakers, training providers, and trainees; published research; and grey literature (such as training materials and surveys). Data were coded thematically and analysed using theories of individual and team learning. RESULTS Learning to provide remote services occurred in the context of high workload, understaffing, and complex workflows. Low confidence and perceived unmet training needs were common. Training priorities for novice clinicians included basic technological skills, triage, ethics (for privacy and consent), and communication and clinical skills. Established clinicians' training priorities include advanced communication skills (for example, maintaining rapport and attentiveness), working within the limits of technologies, making complex judgements, coordinating multi-professional care in a distributed environment, and training others. Much existing training is didactic and technology focused. While basic knowledge was often gained using such methods, the ability and confidence to make complex judgements were usually acquired through experience, informal discussions, and on-the-job methods such as shadowing. Whole-team training was valued but rarely available. A draft set of competencies is offered based on the findings. CONCLUSION The knowledge needed to deliver high-quality remote encounters to diverse patient groups is complex, collective, and organisationally embedded. The vital role of non-didactic training, for example, joint clinical sessions, case-based discussions, and in-person, whole-team, on-the-job training, needs to be recognised.
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Affiliation(s)
- Trisha Greenhalgh
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Rebecca Payne
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Nina Hemmings
- Nuffield Trust, London; Health Education England, London, UK
| | - Helen Leach
- Unit of Academic Primary Care, University of Warwick, Coventry, UK
| | - Isabel Hanson
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Anwar Khan
- GP trainer, and MRCGP examiner, Ching Way Medical Centre, London, UK
| | | | - Emma Ladds
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Aileen Clarke
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Sara E Shaw
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Francesca Dakin
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Sietse Wieringa
- Centre for Sustainable Health Education, University of Oslo, Oslo, Norway
| | | | - Stuart D Faulkner
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Richard Byng
- Peninsula Schools of Medicine and Dentistry, University of Plymouth, Plymouth, UK
| | - Asli Kalin
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Lucy Moore
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Joseph Wherton
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Laiba Husain
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Jain V, Oweis E, Woods CJ. Mapping the Distance: From Competence to Capability. ATS Sch 2023; 4:400-404. [PMID: 38196680 PMCID: PMC10773267 DOI: 10.34197/ats-scholar.2023-0027vl] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 06/05/2023] [Indexed: 01/11/2024] Open
Affiliation(s)
| | - Emil Oweis
- Department of Pulmonary and Critical Care, MedStar Washington Hospital Center/Georgetown University, Washington, DC
| | - Christian J. Woods
- Department of Pulmonary and Critical Care, MedStar Washington Hospital Center/Georgetown University, Washington, DC
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Klasen JM, Schoenbaechler Z, Bogie BJM, Meienberg A, Nickel C, Bingisser R, LaDonna K. Medical students' perceptions of learning and working on the COVID-19 frontlines: '… a confirmation that I am in the right place professionally'. MEDICAL EDUCATION ONLINE 2022; 27:2082265. [PMID: 35638171 PMCID: PMC9176629 DOI: 10.1080/10872981.2022.2082265] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 05/19/2022] [Accepted: 05/23/2022] [Indexed: 06/15/2023]
Abstract
The COVID-19 pandemic caused complex and enduring challenges for healthcare providers and medical educators. The rapid changes to the medical education landscape forced universities across the world to pause traditional medical training. In Basel, Switzerland, however, medical students had the opportunity to work on the COVID-19 frontlines. Our purpose was to understand how they perceived both learning and professional identity development in this novel context. We conducted semi-structured interviews with 21 medical students who worked in a COVID-19 testing facility at the University Hospital of Basel. Using constructivist grounded theory methodology, we collected and analyzed data iteratively using the constant comparative approach to develop codes and theoretical themes. Most participants perceived working on the pandemic frontlines as a positive learning experience, that was useful for improving their technical and communication skills. Participants particularly valued the comradery amongst all team members, perceiving that the hierarchy between faculty and students was less evident in comparison to their usual learning environments. Since medical students reported that their work on the pandemic frontlines positively affected their learning, the need to create more hands-on learning opportunities for medical students challenges curriculum developers. Medical students wish to feel like full-fledged care team members rather than observing sideliners. Performing simple clinical tasks and collaborative moments in a supportive learning environment may promote learning and professional development and should be encouraged in the post-pandemic era.
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Affiliation(s)
- Jennifer M. Klasen
- Clarunis, Department of Visceral Surgery, University Centre for Gastrointestinal and Liver Diseases, University Hospital Basel, Basel, Switzerland
| | | | - Bryce J. M. Bogie
- MD/PhD Program, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | | | - Christian Nickel
- Emergency Department, University Hospital, University of Basel, Basel, Switzerland
| | - Roland Bingisser
- Emergency Department, University Hospital, University of Basel, Basel, Switzerland
| | - Kori LaDonna
- Department of Innovation in Medical Education and Department of Medicine, University of Ottawa, Ottawa, ON, Canada
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Shah R, Tate A. Appreciative assessment. EDUCATION FOR PRIMARY CARE 2022; 33:66-68. [PMID: 35068355 DOI: 10.1080/14739879.2021.2021556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
In this article, we propose a new 'appreciative' attitude towards assessment, on two grounds. Firstly, in order to accommodate and benefit from diversity, in both medical practice and medical education; and secondly in order to promote critical thinking, self awareness and capability in trainees more generally. Appreciative assessment requires a dialogic approach - an approach which is already well established in the context of educational supervision, but which we argue is just as applicable to assessment.
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Affiliation(s)
- Rupal Shah
- GP and Trainer in Battersea, Associate Dean in the Professional Development Team in HEE, London
| | - Andy Tate
- GP in London and Regional Head of School of GP, London
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Teunissen PW, Watling CJ, Schrewe B, Asgarova S, Ellaway R, Myers K, Topps M, Bates J. Contextual Competence: How residents develop competent performance in new settings. MEDICAL EDUCATION 2021; 55:1100-1109. [PMID: 33630305 PMCID: PMC8451833 DOI: 10.1111/medu.14517] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 02/18/2021] [Accepted: 02/22/2021] [Indexed: 05/03/2023]
Abstract
INTRODUCTION Medical education continues to diversify its settings. For postgraduate trainees, moving across diverse settings, especially community-based rotations, can be challenging personally and professionally. Competent performance is embedded in context; as a result, trainees who move to new contexts are challenged to use their knowledge, skills and experience to adjust. What trainees need to adapt to and what that requires of them are poorly understood. This research takes a capability approach to understand how trainees entering a new setting develop awareness of specific contextual changes that they need to navigate and learn from. METHODS We used constructivist grounded theory with in-depth interviews. A total of 29 trainees and recent graduates from three internal medicine training programmes in Canada participated. All participants had completed at least one community-based rotation geographically far from their home training site. Interviews were recorded, transcribed and anonymised. The interview framework was adjusted several times following initial data analysis. RESULTS Contextual competence results from trainees' ability to attend to five key stages. Participants had first to meet their physiological and practical needs, followed by developing a sense of belonging and legitimacy, which paved the way for a re-constitution of competence and appropriate autonomy. Trainee's attention to these stages of adaptation was facilitated by a process of continuously moving between using their knowledge and skill foundation and recognising where and when contextual differences required new learning and adaptations. DISCUSSION An ability to recognise contextual change and adapt accordingly is part of Nussbaum and Sen's concept of capability development. We argue this key skill has not received the attention it deserves in current training models and in the support postgraduate trainees receive in practice. Recommendations include supporting residents in their capability development by debriefing their experiences of moving between settings and supporting clinical teachers as they actively coach residents through this process.
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Affiliation(s)
- Pim W. Teunissen
- School of Health Professions Education (SHE)Maastricht UniversityMaastrichtThe Netherlands
| | - Christopher J. Watling
- Department of Oncology & Centre for Education Research and InnovationUniversity of Western OntarioLondonONCanada
| | - Brett Schrewe
- Department of PediatricsUniversity of British ColumbiaVancouverBCCanada
| | - Sevinj Asgarova
- Centre for Health Education Scholarship (CHES)University of British ColumbiaVancouverBCCanada
| | - Rachel Ellaway
- Department of Community Health SciencesUniversity of CalgaryCalgaryABCanada
| | - Kathryn Myers
- Department of MedicineUniversity of Western OntarioLondonONCanada
| | - Maureen Topps
- Department of Family MedicineUniversity of CalgaryCalgaryABCanada
| | - Joanna Bates
- Department of Family Practice & Centre for Health Education Scholarship (CHES)University of British ColumbiaVancouverBCCanada
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Shah R, Ahluwalia S, Spicer J. A crisis of identity: what is the essence of general practice? Br J Gen Pract 2021; 71:246-247. [PMID: 34045243 PMCID: PMC8163474 DOI: 10.3399/bjgp21x715745] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Affiliation(s)
- Rupal Shah
- Bridge Lane Group Practice; Associate Dean, Professional Development Team, Health Education England (HEE), London
| | - Sanjiv Ahluwalia
- Wentworth Group Practice, Regional Postgraduate Dean, HEE, London
| | - John Spicer
- Country Park Practice; Senior Lecturer in Medical Law and Ethics, St George's, University of London; Provost, Royal College of General Practitioners South London Faculty, London
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