What impact will an increased number of teaching general practices have on patients, doctors and medical students?

General Practitioner Educators on Clinical Debrief: A Qualitative Investigation into the Experience of Teaching Third-Year Medical Students to Care

Phenomenon: There is a paucity of research reporting the experiences of general practitioner clinical educators. Providing education for students could lead to better clinical skills and greater job satisfaction for the educator. However, it could also result in increased stress and mental fatigue, adding to what is an already pressured situation in the current primary care climate. Clinical Debrief is a model of case-based learning with integrated supervision developed to prepare medical students for clinical practice. This study aimed to explore the experiences of general practitioners who facilitate Clinical Debrief. Approach: Eight general practitioner educators with experience of facilitating Clinical Debrief participated in semi-structured qualitative interviews. Results were analyzed using Reflexive Thematic Analysis, and four main themes were developed. Findings: Themes included: Personal enrichment: psychological "respite" and wellbeing; Professional enrichment: Clinical Debrief as a "two-way" door; Becoming a facilitator: a journey; and, Relationships in teaching: blurred boundaries and multiple roles. Insights: Being a Clinical Debrief facilitator had a transformative impact on the personal and professional lives of the GPs who participated in this study. The implications of these findings for individual GPs, their patients, and the wider healthcare system, are discussed.

How does the introduction of a new year three GP curriculum affect future commitment to teach? An evaluation using a realist approach

In western countries, there is a trend towards increasing amounts of undergraduate medical education being delivered in General Practice (GP). However, many medical schools report difficulties with the recruitment and retainment of GP clinical teachers. Newcastle University recently introduced a new year three GP curriculum, involving an increased quantity of community-based teaching and changes to the responsibilities of GP clinical teachers. We sought to explore and explain how this curricular change affects the future teaching commitment of year three GP clinical teachers. We adopted a realist approach. We firstly developed a candidate theory of how the new curriculum may affect future teaching commitment. Data collection and analysis then involved interviews of 10 GP teachers to refine this theory and produce a final Programme Theory. The results suggest that different teachers are affected in different ways, influenced by practice and individual contexts. Some parts of the new curriculum tend to reduce future teaching commitment, whereas other aspects tend to increase commitment. Mechanisms include changes to autonomy and sense of value. The results allow medical schools to better understand how GP teacher retention can be facilitated during curricular change. We make numerous recommendations, including advocating a team-based approach to teaching, paying attention to teacher autonomy, and considering patient contact in relation to generalist, primary care-orientated medicine as a core component of GP teaching.

Symbiotic relationships through longitudinal integrated clerkships in general practice

BACKGROUND

Longitudinal integrated clerkships (LICs) are an innovation in medical education that are often successfully implemented in general practice contexts. The aim of this study was to explore the experiences and perspectives of general practitioner (GP)-tutors on the impact of LICs on their practices, patients and the wider community.

METHODS

GPs affiliated with the University of Limerick School of Medicine- LIC were invited to participate in in-depth interviews. Semi-structured interviews were conducted in person and over the phone and were based on a topic guide. The guide and approach to analysis were informed by symbiosis in medical education as a conceptual lens. Data were recorded, transcribed and analysed using an inductive thematic approach.

RESULTS

Twenty-two GPs participated. Two main themes were identified from interviews: 'roles and relationships' and 'patient-centred physicians'. Five subthemes were identified which were: 'GP-role model', 'community of learning', and 'mentorship', 'student doctors' and 'serving the community'.

CONCLUSION

LICs have the potential to develop more patient-centred future doctors, who have a greater understanding of how medicine is practised in the community. The LIC model appears to have a positive impact on all stakeholders but their success hinges on having adequate support for GPs and resourcing for the practices.

Challenges, success factors and pitfalls: implementation of distributed medical education

OBJECTIVES

There are only a few descriptive reports on the implementation of distributed medical education (DME) and these provide accounts of successful implementation from the senior leadership perspective. In Saskatchewan, over a period of 4 years (2010-2014), four family medicine residency sites were established and two additional sites could not be developed. The aim of this study was to identify challenges, success factors and pitfalls in DME implementation based upon experiences of multiple stakeholders with both successful and unsuccessful outcomes.

METHODS

Data were obtained through document analysis (n = 64, spanning 2009-2016; perspectives of government, senior leadership, management and learners), focus groups of management and operations personnel (n = 10) and interviews of senior leaders (n = 4). Challenges and success factors were ascertained through categorisation. Iterative coding guided by three sensitising frameworks was used to determine themes in organisational dynamics.

RESULTS

Both challenges and success factors included contextual variables, governance, inter- and intra-organisational relationships (most common success factor), resources (most common challenge), the learning environment and pedagogy. Management and operations were only a challenge. Organisational themes affecting the outcome and the pitfalls included the pace of development across multiple sites, collaborative governance, continuity in senior leadership, operations alignment and reconciliation of competing goals.

CONCLUSIONS

Emerging opportunities for DME can be leveraged through collaborative governance, aligned operations and resolution of competing goals, even in constrained contexts, to translate political will into success; however, there are pitfalls that need to be avoided. Our findings based upon multi-stakeholder perspectives add to the body of knowledge on deployment, carefully considering the conditions for success and associated pitfalls.

Political Economy of Infant Mortality Rate: Role of Democracy Versus Good Governance

Despite numerous studies on whether democracy reduces the infant mortality rate (IMR), the empirical results remain mixed at best. In this article, I perform several theoretical and empirical exercises that help explain why and under what conditions we should expect politics to matter most for a decrease in IMR. First, I capitalize on the epidemiological view that IMR – the most commonly used indicator of health in social sciences – is better suited to reflect public health micromanagement than overall social development. Second, I theorize that autocrats have incentives to invest in health up to a certain point, which could lead to a reduction in IMR. Third, I introduce an omitted variable – good governance – that trumps the importance of a political regime for IMR: (1) it directly affects public health micromanagement, and (2) many autocrats made inroads in achieving good governance. Finally, for the first time in such research, I use a disaggregated IMR approach to corroborate my hypotheses.

Understanding the primary care paradigm: an experiential learning focus of the early veterinary graduate

At a time where high levels of stress are reported in the veterinary profession, this study explores the challenges that veterinary graduates encounter when they enter general (first opinion) practice. Participants had written reflective accounts of their 'Most Puzzling Cases' for the postgraduate Professional Key Skills module of the Certificate in Advanced Veterinary Practice, offered by the Royal Veterinary College. Reasons that a case was puzzling, or became challenging, were thematically analysed. Fifteen summaries were analysed. Three core themes were identified: 'clinical reasoning', centred on the limitations of pattern recognition and the methods used to overcome this; the 'veterinary healthcare system', focusing on the need for continuity of care, time pressure and support in the transition to practice; and the 'owner', looking at the broader clinical skills needed to succeed in general practice. Clinical reasoning was raised as an issue; discussion of when pattern recognition is not appropriate and what to do in these cases was common. A lack of experience in general practice case types, and how to best operate in the resource-constrained environment in which they present, is the likely cause of this, suggesting that a greater focus on the primary care paradigm is needed within veterinary education.

Is three a crowd? Impact of the presence of a medical student in the general practice consultation

OBJECTIVES

To determine the impact of the presence of a medical student on the satisfaction and process of the general practice consultation from the perspective of the general practitioner (GP), patient and student.

METHODS

An observational study was conducted in regional general practices accepting third-year medical students. General practitioners, patients and medical students were asked to complete a questionnaire after each consultation. The main outcome measures were: patient satisfaction; GPs' perceived ability to deliver care; medical students' satisfaction with their learning experience; length of consultation; and patient waiting times.

RESULTS

Of the 26 GP practices approached, 11 participated in the study (42.3%). Patients returned 477 questionnaires: 252 consultations with and 225 without a student present. Thirteen GPs completed 473 questionnaires: 248 consultations with and 225 without a student. Twelve students attended 255 consultations. Most patients (83.5%) were comfortable with the presence of a student. There were no significant differences between consultations with and without a student regarding the time the patients spent in the waiting room (p = 0.6), the patients' perspectives of how the GPs dealt with their presenting problems (100% versus 99.2%; p = 0.6) and overall satisfaction with the consultation (99.2% versus 99.1%; p = 0.5). Despite these reassuring findings, a significantly higher proportion of patients in consultations without students raised sensitive or personal issues (26.3% versus 12.6%; p < 0.001). There were no statistically significant differences in the lengths of consultations with and without students (81% versus 77% for 6-20 minutes consultation; p = 0.1) or in the GPs' perceptions of how they effectively managed the presenting problem (95.1% versus 96.0%; p = 0.4). Students found that the majority (83.9%) of the 255 consultations were satisfactory for learning.

CONCLUSIONS

The presence of a medical student during the GP consultation was satisfactory for all participant groups. These findings support the ongoing and increased placement of medical students in regional general practice. Medical educators and GPs must recognise that patients may not raise personal issues with a student present.

A BEME systematic review of UK undergraduate medical education in the general practice setting: BEME Guide No. 32

BACKGROUND

General practice is increasingly used as a learning environment in undergraduate medical education in the UK.

AIM

The aim of this project was to identify, summarise and synthesise research about undergraduate medical education in general practice in the UK.

METHODS

We systematically identified studies of undergraduate medical education within a general practice setting in the UK from 1990 onwards. All papers were summarised in a descriptive report and categorised into two in-depth syntheses: a quantitative and a qualitative in-depth review.

RESULTS

169 papers were identified, representing research from 26 UK medical schools. The in-depth review of quantitative papers (n = 7) showed that medical students learned clinical skills as well or better in general practice settings. Students receive more teaching, and clerk and examine more patients in the general practice setting than in hospital. Patient satisfaction and enablement are similar whether a student is present or not in a consultation, however, patients experience lower relational empathy. Two main thematic groups emerged from the qualitative in-depth review (n = 10): the interpersonal interactions within the teaching consultation and the socio-cultural spaces of learning which shape these interactions. The GP has a role as a broker of the interactions between patients and students. General practice is a socio-cultural and developmental learning space for students, who need to negotiate the competing cultures between hospital and general practice. Lastly, patients are transient members of the learning community, and their role requires careful facilitation.

CONCLUSIONS

General practice is as good, if not better, than hospital delivery of teaching of clinical skills. Our meta-ethnography has produced rich understandings of the complex relationships shaping possibilities for student and patient active participation in learning.

Benefits and challenges of multi-level learner rural general practices--an interview study with learners, staff and patients

BACKGROUND

General practices vary in the provision of training and education. Some practices have training as a major focus with the presence of multi-level learners and others host single learner groups or none at all. This study investigates the educational benefits and challenges associated with 'multi-level learner' practices.

METHODS

This paper comprised three case studies of rural general practices with multiple levels of learners. Qualitative data were collected from 29 interviews with learners (n = 12), staff (n = 12) and patients (n = 5). Interviews were initially analyzed using open and axial coding and thematic analysis.

RESULTS

Thematic analysis showed 'multi-level learning' in general practices has benefits and challenges to learners and the practice. Learner benefits included knowledge exchange, the opportunity for vertical peer learning, a positive learning environment and the development of a supportive network. The presence of multi-level learners promoted sharing of knowledge with all staff, a sense of community, an increase in patient services and enthused supervisors. Challenges for learners included perception of decreased access to supervisors, anxiety with peer observation, reduced access to patient presentations and patient reluctance to be seen by a learner. Practice challenges were administration requirements, high learner turnover, infrastructure requirements and the requirement for supervisors to cater to a range of learner level needs.

CONCLUSIONS

The presence of medical students, interns and registrars in general practice has educational benefits to the learners extending to the other stakeholders (staff and patients). Multi-level learners present challenges to the learners and the practice by increasing pressures on resources, staff (administrative and supervisors) and infrastructure.

Patient and preceptor attitudes towards teaching medical students in General Practice

BACKGROUND

Curricula in most western medical universities include teaching in the primary care setting as core elements. This affects GP-teachers, their patients and their interaction. Therefore, it was the aim of this study to assess the influence of the presence of medical students in the teaching practice on the attitudes of both GPs and patients.

METHODS

Seventy-four GP-preceptors were invited to answer an online survey. Patients attending consultations with a medical student present completed questionnaires either before the consultation (WR group) or immediately after consultation (AC group).

RESULTS

Fifty- nine preceptors completed the online survey. Physicians showed positive attitudes towards their activities as preceptors: 95% expressed a positive attitude predominantly towards being a role model and to represent the discipline and for 64% remuneration was not important. In 28 practices 508 questionnaires were completed by patients in the WR-group and 346 by the AC-group. Only 12% (WR) and 7.2% (AC) of patients expressed a preference for being seen by the doctor alone. While 16% of doctors rated that confidentiality of the doctor-patient relationship is compromised, only 4.1% (WR) and 1.7% (AC) of patients felt so.

CONCLUSION

The motivation to be a preceptor is primarily driven by personal and professional values and not by economic incentives. Further, patients have even more positive attitudes than the preceptors towards the presence of students during their consultation. Reservations to teaching students in GP-practices are, therefore, unwarranted.

Towards vertical integration in general practice education: literature review and discussion paper

BACKGROUND

Medical education policy in Ireland has enabled an increase in undergraduate and postgraduate education activity in general practice. Internationally, 'vertical integration in general practice education' is suggested as a key strategy to support the implementation of this policy development.

AIMS

To review the emerging literature on vertical integration in GP education, specifically to define the concept of 'vertical integration' with regard to education in general practice and to describe its benefits and challenges.

METHODS

We searched 'Pubmed', 'Academic Search Complete', 'Google', and 'MEDLINE' databases using multiple terms related to 'vertical integration' and 'general practice education' for relevant articles published since 2001. Discussion papers, reports, policy documents and position statements were identified from reference lists and retrieved through internet searches.

RESULTS

The key components of 'vertical integration' in GP education include continuous educational pathway, all stages in GP education, supporting the continuing educational/professional development needs of learners at each stage and effective curriculum planning and delivery. Many benefits (for GPs, learners and the community) and many challenges (for GPs/practices, learners and GPs in training) have been described. Characteristics of successful implementation include role sharing and collaborative organisational structures.

CONCLUSIONS

Recent developments in medical education in Ireland, such as the increase in medical school clinical placements in general practice and postgraduate GP training and the introduction of new competence assurance requirements offer an important opportunity to further inform how vertical integration can support increased educational activity in general practice. Describing this model, recognising its benefits and challenges and supporting its implementation in practice are priorities for medical education in Ireland.

Rewards, costs and challenges: the general practitioner's experience of teaching medical students

CONTEXT

Medical student attachments in general practices play an important role in undergraduate medical education internationally. The recruitment by universities of new teaching practices or an increase in the teaching commitment of existing practices will be necessary to address rising medical student numbers. General practitioners (GPs) are likely to weigh the perceived rewards of practice-based teaching against the perceived costs and challenges in deciding whether to accept a student placement and how to teach. These aspects of the 'lived experience' of the GP-teacher have not been adequately investigated.

OBJECTIVES

This study aims to enhance understanding of the GP clinical teacher experience in order to inform strategies for the recruitment, retention, training and support of teaching general practices.

METHODS

Sixty GP clinical teachers in Brisbane-based urban teaching general practices were interviewed individually face-to-face by the principal investigator, using a semi-structured interview plan. Representativeness was ensured through quota sampling. The interview data were analysed thematically by two of the investigators independently, following member checking of interview transcripts.

RESULTS

The results demonstrate a number of key inter-related perceived rewards, costs and challenges of teaching, including intellectual stimulation, cognitive fatigue and student characteristics.

CONCLUSIONS

The findings extend reports in the previous literature by offering a richer description of current GP-teacher experience. Participants identified teaching rewards in a manner largely consistent with previous research, with the exception of enhanced practice morale and teamwork. Findings confirm that reduced productivity and increased time pressures remain key perceived negative impacts of teaching, but also reveal a number of other important costs and challenges. They emphasise the diversity of GP experience and practice cultures, and the need for teaching to enhance both GP and patient perceptions of consultation quality without increasing the load on the GP-teacher. Recruitment and retention strategies should promote the rewards of teaching, and teacher training should respond to the costs and challenges of practice-based teaching, and facilitate the growth of GPs in their role as clinical educators.

Students' and general practitioners' perceptions of a recently introduced clerkship in general practice. A survey from Austria

BACKGROUND

In autumn 2007, the Medical University of Graz (MUG) upgraded the status of general practice in medical training by integrating a compulsory five-week clerkship in general practice surgeries in the sixth and last year of the curriculum. In cooperation with the Styrian Academy of General Practice (STAFAM), more than 200 general practitioners (GPs) had been accredited to introduce medical students to the specific tasks, problems and decision-making process in general practice. Between October 2007 and June 2009, more than 300 students completed the clerkship.

OBJECTIVE

To explore the perceptions of students and GPs towards this new approach to undergraduate teaching in Austrian general practice.

METHODS

Between March and June 2009, we conducted a cross-sectional survey by using a self-administered questionnaire with 14 items for students as well as GPs. To limit recall bias, we gave the questionnaire to all students (n = 146) and GPs (n = 146) immediately after the clerkship. The response rates were 146/146 (100%) and 114/146 (78%) for students and GPs, respectively.

RESULTS

The study results show high satisfaction rates among students as well as GPs. Most of the students and GPs perceive the compulsory clerkship in general practice as an essential part of medical education. The organization of the clerkship had the least positive outcome.

CONCLUSION

Our survey shows that the clerkship is well accepted among Austrian medical students and GPs.

Aligning clinical resources to curriculum needs: the utility of a group of teaching hospitals

This article describes a study in two acute NHS Trusts of the availability and curriculum relevance of inpatients for undergraduate medical student learning. The study was conducted to assist a new medical school plan on how best to utilise the clinical learning resources of adjacent hospitals, at a time when basic medical education is expanding, large academic hospitals are becoming more specialised and medical care provision is shifting to smaller hospital and ambulatory settings. We found that all three hospitals showed similar proportions, mean ages and gender ratios of available patients, and provided a wide range of clinical learning opportunities. The larger academic hospital appeared to offer a narrower, more specialised, range of patient problems that were necessary to meet curriculum objectives, while the smaller hospitals provided a broader range of common problems. Opportunities to participate in clinical skills were limited in all three hospitals. None of the hospitals appeared to provide sufficient clinical material to meet all curriculum learning objectives. As acute health care delivery models change, medical schools may have to be quite deliberate in their utilisation of academic hospitals, community hospitals and primary care, matching student allocations carefully to sources of relevant learning opportunities.

Perceptions towards private medical practitioners' attachments for undergraduate medical students in Malawi

OBJECTIVE

To describe perceptions of medical students, recent medical graduates, faculty of the College of Medicine, University of Malawi and private medical practitioners (PMPs) towards an attachment of undergraduate medical students in private medical doctors' offices.

METHOD

Qualitative cross sectional study conducted in Blantyre, Malawi in 2004 using in-depth key informant interviews and content analysis.

RESULTS

In general, private medical practitioners were favourable to the idea of having medical students within their consulting offices while the majority of students, recent graduates and faculty opposed, fearing compromising teaching standards. The lack of formal post-graduate qualifications by most private medical practitioners, and nationally-approved continued medical education programs were mentioned as reasons to suspect that private medical practitioners (PMPs) could be outdated in skills and knowledge. Private medical practitioners however reported participation in credible continued professional development (CPD) programs although these were not necessary for re-registration. Students and faculty suggested that the need for privacy in private institutions unlike in the public teaching hospitals as one reason why patients may not be willing to participate in the teaching in PMPs facilities. The fact that the patients profiles with regard to disease presentation (mostly ambulatory) and higher socio-economic status may be different from patients attending the public, free for service teaching hospital was not seen as a desirable attribute to allocate students to PMPs clinics.

CONCLUSION

Faculty, medical students and recent graduates of the Malawi College of Medicine do not perceive PMPs as a resource to be tapped for the training of medical students.

'Can you take a student this morning?' Maximising effective teaching by practice nurses

OBJECTIVES

Little is known about the contribution nurses make to medical student learning. This study set out to explore the nature of practice nurse teaching during the general practice clerkship and to investigate ways in which the teacher and learner (the practice nurse and the medical student) can be best supported to maximise learning.

METHODS

Mixed focus groups were conducted with general practitioner educational supervisors and practice nurses. Further focus groups were conducted with students on completion of clerkships.

RESULTS

There is wide variation in the delivery, organisation and expectations of practice nurse teaching. Although there is some evidence of a passive learning experience, the learning dynamic and the student-nurse relationship are regarded highly.

CONCLUSIONS

Time spent with practice nurses is an important part of the clerkship in general practice. The nature of the practice nurse-medical student relationship differs from that of the educational supervisor-medical student relationship and can be built upon to maximise learning during the clerkship. The experience for the practice nurse, medical student and supervisor can be enhanced through formal preparation for delivering teaching.

More students, less capacity? An assessment of the competing demands on academic medical staff

CONTEXT

Medical student numbers in England have increased by more than 60% over the last decade. The capacity of universities and the National Health Service (NHS) to deliver education and training to these expanded cohorts is not clear.

METHODS

We carried out an interview study in three English medical schools, involving 60 academic, administrative, clinical and managerial staff, sampled across disciplines.

RESULTS

Given the expansion in medical student numbers, capacity in medical schools must increase. This requirement has become even more immediate in light of the shift towards more resource-intensive curricula. However, the aims of the Research Assessment Exercise and NHS policies are at odds with attempts to build teaching capacity. Although monies have been made available to recruit new staff and to backfill clinical time spent teaching, the success of these strategies is questioned by interviewees. Other initiatives, such as the new consultant contract and educational quality assurance processes, have the potential to promote the importance of teaching but are presently perceived as being inadequate so to do. As was consistently expressed by interviewees, within the competing triad of research, service delivery and teaching, the latter is perceived as taking a poor third place.

CONCLUSIONS

That research, service delivery and education are in competition will come as no surprise to UK academic staff. However, our results show a striking uniformity of opinion. We would question whether existing NHS and higher education policies enable medical schools and health care organisations to deliver education of the highest quality to the enlarged student population.

The wind of change: after the European definition--orienting undergraduate medical education towards general practice/family medicine

Traditionally, medical students are trained in an algorithmic manner, to focus on excluding serious but rare diseases by conceptualizing diagnoses through a process of exclusion based on systematic and technological investigation of an extensive list of potential diagnoses applicable to the patient's presenting symptoms and signs. Students are not often exposed to common diseases, and trivialize all that which cannot be addressed within a strictly medical model. This paper reflects on the recommendations of the EURACT Educational Agenda document, and proposes a return to empiricism in basic medical training by introducing students to primary healthcare, disease, and decision-making processes early in their training. The authors recommend the teaching of communication skills within primary care doctor-patient encounters, the exploration of new ways of teaching the doctor-patient relationship, and that students and young doctors be encouraged to prioritize quality over quantity. Will this stem the current trends towards increasing workload and burnout?

The challenges of teaching in a general practice setting

An attractive strategy to meet the increasing need for medical education is teaching in community general practice. General practice will be in a position to meet and sustain this need only if various conditions are met, including: Teaching is undertaken in general practice at all levels of medical education (medical student, postgraduate years 1-3 and GP vocational training); Standards and quality of teaching are maintained while the number of sites involved increases; Further Australian research is conducted into innovative models of general practice teaching and their cost-effectiveness; and Appropriate remuneration and infrastructure is available to support practices and general practitioners involved in teaching.

Introducing undergraduate medical teaching into general practice: an action research study

Following the publication of Tomorrow's Doctors and as a result of increasing numbers of students recruited to medical school it is necessary to involve more general practitioners (family physicians) in undergraduate medical education. Students have responded positively regarding experiences in general practices with a broad spectrum of clinical conditions to be seen and greater involvement in clinical decision-making. This action research study followed a small group general practice in South Wales through the required preparation for undergraduate medical education and its first year of teaching. Preparatory work for the practice focused mainly on summarizing patient notes, setting up a practice library and arranging accommodation for the students. Members of the Primary Health Care Team (PHCT) found that having students in the practice gave them a sense of achievement and enhanced self-worth. Individuals within the practice felt more confident in their professional role and the team ethic within the practice was strengthened. Doctors' anxieties regarding the adequacy of their clinical skills proved unfounded. Patients were reported to feel more included in their care and to have enjoyed hearing their condition being discussed with the students. Students valued the one-to-one teaching, seeing common illnesses and a variety of consulting styles. It is hoped that this paper will be of value to those responsible for recruiting GP practices into undergraduate teaching. It demonstrates benefits for the primary health care team in terms of improved morale and sense of professional self-worth. Patients felt more involved in their care. Generalization from these findings is limited by only one practice having been involved. Undergraduate teaching offers advantages, particularly in terms of professional self-esteem and team morale.

Training doctors in general practices: A review of the literature

OBJECTIVE

This study was undertaken to assess the evidence of whether new forms of medical training, where substantial training takes place in general practice, will be acceptable to GPs. In particular, we asked the questions: Are GPs willing to act as trainers and supervisors in their practices? Do GPs have the appropriate skills to be trainers? Do practices have the infrastructure and resources to support placements? And, are patients happy to be seen by medical students and General Practice Registrars?

DESIGN

Key Australian and international databases, key Australian journals and key Australian websites were searched for literature on general practice-based training of medical students and General Practice Registrars.

RESULTS

In the international and Australian literature, we found that many GPs consider training medical students and General Practice Registrars to be intrinsically satisfying. They vary in their skills, and most medical schools have made significant investments in training and support activities. Many practices do not have the necessary infrastructure, and investments need to be made if extended placements are to be successful. Many patients are happy to be seen by students and Registrars, but careful thought needs to be given to implementing appropriate models so that students have good learning opportunities, patients are not disadvantaged and general practices can operate efficiently.

CONCLUSION

The success of this new model of clinical placements is dependent on medical schools having a detailed understanding of the needs and expectations of GPs.

A comparison of medical students' perceptions of their initial basic clinical training placements in 'new' and established teaching hospitals

This study has examined students' perceptions of the factors influencing learning during initial hospital placements and whether differences in perceived experiences were evident between students attending new and established teaching hospitals. Five focus groups were conducted with Year III students at the University of Birmingham Medical School (UBMS): three with students attending three established teaching hospitals and two with students attached to a new teaching hospital (designated as part of the UBMS expansion programme). Extensive variation in student perception of hospital experiences was evident at the level of teaching hospital, teaching firm and individual teacher. Emergent themes were split into two main categories: 'students' perceptions of teaching and the teaching environment' and 'the new hospital learner'. Themes emerging that related to variation in student experience included the amount of structured teaching, enthusiasm of teachers, grade of teachers, specialty of designated firms and the number of students. The new teaching hospital was generally looked upon favourably by students in comparison to established teaching hospitals. Many of the factors influencing student experience relate to themes grouped under the 'new hospital learner', describing the period of adjustment experienced by students during their first encounter with this new learning environment. Interventions to improve student experience might be aimed at organisations and individuals delivering teaching. However, factors contributing to the student experience, such as the competing demand to teaching of heavy clinical workloads, are outside the scope of medical school intervention. In the absence of fundamental change, mechanisms to equip students with 'survival skills' as self-directed hospital learners should also be considered.

Evaluation of a task-based community oriented teaching model in family medicine for undergraduate medical students in Iraq

BACKGROUND

The inclusion of family medicine in medical school curricula is essential for producing competent general practitioners. The aim of this study is to evaluate a task-based, community oriented teaching model of family medicine for undergraduate students in Iraqi medical schools.

METHODS

An innovative training model in family medicine was developed based upon tasks regularly performed by family physicians providing health care services at the Primary Health Care Centre (PHCC) in Mosul, Iraq. Participants were medical students enrolled in their final clinical year. Students were assigned to one of two groups. The implementation group (28 students) was exposed to the experimental model and the control group (56 students) received the standard teaching curriculum. The study took place at the Mosul College of Medicine and at the Al-Hadba PHCC in Mosul, Iraq, during the academic year 1999-2000. Pre- and post-exposure evaluations comparing the intervention group with the control group were conducted using a variety of assessment tools.

RESULTS

The primary endpoints were improvement in knowledge of family medicine and development of essential performance skills. Results showed that the implementation group experienced a significant increase in knowledge and performance skills after exposure to the model and in comparison with the control group. Assessment of the model by participating students revealed a high degree of satisfaction with the planning, organization, and implementation of the intervention activities. Students also highly rated the relevancy of the intervention for future work.

CONCLUSION

A model on PHCC training in family medicine is essential for all Iraqi medical schools. The model is to be implemented by various relevant departments until Departments of Family medicine are established.