Early generalist placements are associated with family medicine career choice: A systematic review and meta-analysis

[Ensuring primary care in Germany-findings from a quantitative survey of general practitioners]

BACKGROUND

Given the risk of a shortage of general practitioners in private practice, the question arises as to which concepts can make an effective contribution. To date, there is a lack of studies that comprehensively shed light on how general practitioners, based on their professional experience, view different approaches to ensuring primary care in the long term.

OBJECTIVES

The aim of the study was to determine the positions, attitudes, and experiences of general practitioners with regard to ensuring primary care.

METHODS

Using an online survey, a total of 4176 general practitioners were surveyed between February and June 2023. In addition to the descriptive analysis, a t-test on independent samples was used to determine significant differences between two groups.

RESULTS

Of those surveyed, 42% reported a noticeable decline of general medical practices in their area. In addition, 53% saw a declining attractiveness of primary care for young doctors, which is attributed to three problem areas: 1) the position of primary care in the healthcare system, 2) requirements for training and further education, and 3) working conditions. In order to secure primary care, those surveyed were primarily in favor of the following approaches: establishing a primary care physician system (85%), increasing the promotion of interest and points of contact in training and further education (80%), strengthening multi-professional outpatient care centers (64%), restructuring curricula (56%) and admission criteria for medical studies (50%), and reforming general medical training (53%).

CONCLUSIONS

As the results show, general practitioners have their own suggestions and preferences that complement existing expert assessments. General practitioners should be more consistently involved in the planning, implementation, and evaluation of measures to stabilize primary care.

Attitudes towards career choice and general practice: a cross-sectional survey of medical students and residents in Tyrol, Austria

BACKGROUND

The global primary healthcare workforce is declining, leading to a shortage of general practitioners. Although various educational models aim to increase interest in general practice, effective interventions are limited. The reasons for this low appeal among medical graduates remain unclear.

METHODS

This cross-sectional study surveyed medical students' and residents' attitudes towards general practice in Tyrol, Austria. The online questionnaire addressed professional values, general practice-related issues, personal professional intentions, and demographics. Data analysis employed chi-square tests and multivariate logistic regression to explore predictors of interest in general practice.

RESULTS

The study included 528 students and 103 residents. Key values identified were stable positions, assured income, and work-family reconciliation. General practice was recognised for long-term patient relationships and patient contact, with students attributing more positive work-environmental characteristics and higher reputation to it than residents. Few participants (students: 3.2%, residents: 11.7%) had opted for general practice; about half were considering it as career option. Reasons not to choose general practice were preferences for other specialties, intrinsic characteristics of general practice, workload, insufficient time for the patients, financial pressures, low reputation, and perceived mediocre training quality. Predictors of interest in general practice included perception of independent decision-making, importance of work-family balance (students), better practical experiences in general practice during medical school (students and residents), younger age, and perceiving general practice as offering a promising future (residents). Both groups felt underprepared by medical school and/or general practice training for general practice roles. The attractiveness of specialist medicine over general practice was related to clearer content boundaries, better career opportunities, and higher incomes.

CONCLUSIONS

According to these results, measures to improve attractiveness of general practice should focus on (i) high-quality undergraduate education including practical experiences, and (ii) on ensuring professional autonomy, work-family reconciliation, and job stability. Efforts to encourage more graduates to pursue this essential healthcare sector are crucial for strengthening primary healthcare and public health services.

TRIAL REGISTRATION

The study has not been registered as it did not include a direct medical intervention on human participants.

Can a Family Medicine Curriculum Increase the Attraction of Family Medicine as a Career Choice?

Hintergrund

An der Universität des Saarlandes wurde ein neu strukturierter, kompetenzbasierter Blended-learning-Pflichtkurs Allgemeinmedizin im 5. Studienjahr implementiert. In Anbetracht des drohenden Hausarztmangels untersucht diese Studie, ob ein universitärer Kurs die Studierenden in dem Wunsch, eine Weiterbildung im Fach Allgemeinmedizin zu wählen, beeinflussen kann. Es wird untersucht, welche Aspekte des Allgemeinmedizinkurses besonders motivierend sind.

Methoden

Zwei Online-Fragebögen wurden verwendet, um die Motivation für eine Weiterbildung im Fach Allgemeinmedizin vor und nach Belegen des Kurses im Sommersemester 2021 zu vergleichen. Basierend auf den Ergebnissen der Academic Motivation Scale wurde mittels Clusteranalyse das Motivationslernverhalten von Studierenden im Kurs analysiert. Motivierende Aspekte des Kurses wurden deskriptiv anhand quantitativer Daten identifiziert. Für die Datenanalyse wurden die Statistikprogramme JASP (Version 0.14.1) und Jamovi (Version 1.6) benutzt.

Ergebnisse

109 von 111 im Kurs eingeschriebenen Studierenden nahmen am ersten Fragebogen, 103 am zweiten Fragebogen teil. Studierende konnten sich nach Belegen des Kurses signifikant besser vorstellen, eine Weiterbildung im Fach Allgemeinmedizin zu wählen (p = 0,016). Vier sich in ihrer Motivation unterscheidende Cluster an Studierenden konnten identifiziert werden. Studierende empfanden die Eingrenzung auf relevante Themen, das Alignment zwischen Kurs- und Klausurinhalten, die Abstimmung der Inhalte mit mit staatsexamensrelevanten Inhalten, die symptomorientierte Lehre, die Kommunikation auf Augenhöhe und das Gefühl, mit alltäglichen Krankheiten souveräner umgehen zu können, als besonders motivierend.

Schlussfolgerungen

Ein Pflichtkurs Allgemeinmedizin kann die Wahl einer späteren Spezialisierung in der Allgemeinmedizin möglicherweise beeinflussen. Die identifizierten motivierenden Aspekte können für zukünftige Kursentwicklungen in der Allgemeinmedizin hilfreich sein.

Understanding concepts of generalism and specialism amongst medical students at a research-intensive London medical school

BACKGROUND

Many prominent UK medical organisations have identified a need for more generalist clinicians to address the complex requirements of an aging society. We sought to clarify attitudes towards "Specialists" and "Generalists" amongst medical students and junior doctors at Imperial College School of Medicine.

METHODS

A survey exploring medical students' beliefs was followed up by qualitative analysis of focus groups of medical students and Imperial-graduate foundation year doctors.

RESULTS

First year medical students associated specialists with academia and higher income, and generalists with ease of training and job availability. Senior (Years 5/6) medical students associated specialists even more firmly with broader influence and academic work, whilst generalists were assigned lower prestige but the same workload as specialists. The medical student focus group discussed concepts of Generalism pertaining only to Primary Care. In contrast, the foundation year doctor focus group revealed that Generalism was now seen to include some hospital care, and the perception that generalists sat lower in a knowledge hierarchy had been challenged.

CONCLUSION

Perceptions that Generalism is associated with lower prestige in the medical profession are already present at the very start of medical school and seem to be reinforced during undergraduate training. In early postgraduate clinical practice, the perceived knowledge and prestige hierarchy lessens. These findings can help inform curriculum redesign and the promotion of Generalism as a rewarding career aspiration.

Evidence-oriented teaching of geriatric psychiatry: a narrative literature synthesis and pilot evaluation of a clerkship seminar

INTRODUCTION

The field of geriatric psychiatry has in recent decades developed into an independent discipline, incorporating elements of psychiatry, neurology and internal medicine. In view of demographic changes, this field is becoming increasingly relevant for primary care and undergraduate medical training. So far, however, there is little educational guidance for instructional design of geriatric psychiatry in undergraduate medical education.

PROJECT DESCRIPTION

A narrative literature review of medical education studies in the field of geriatric psychiatry was conducted. Student evaluations of a geriatric psychiatry clerkship seminar were analyzed, followed by a target group analysis. Results informed the iterative development of new clerkship seminar content and structure. This was implemented and evaluated over several academic cycles. Learning material was made available via the open-source learning management system "ILIAS".

RESULTS

A total of 29 medical education articles were identified and evaluated. The previous seminar in geriatric psychiatry at our university hospital was rated below average (Likert item overall rating of 4.3/6 compared to other seminars with an average overall rating of 5.2, p<0.001). An evidence-oriented revision of the content and instructional design was implemented. Activation of learners, self-reference effect, and audience questioning were used during the lecture. Additionally, two geriatric psychiatry case scenarios were adapted for discussion. We saw continuous improvement of student evaluations of the revised course, reaching a rating improvement of 5.3 out of 6 (p<0.01, U=135.5 Cohen's d=1.28).

CONCLUSION

A systematic approach was used to develop a geriatric psychiatry clerkship seminar, based on medical education evidence, for undergraduate medical students, resulting in better student evaluations. The teaching materials can be adapted for local implementation at other teaching hospitals. Future studies should also explore effects regarding higher learning outcomes.

Medical education interventions influencing physician distribution into underserved communities: a scoping review

BACKGROUND AND OBJECTIVE

Physician maldistribution is a global problem that hinders patients' abilities to access healthcare services. Medical education presents an opportunity to influence physicians towards meeting the healthcare needs of underserved communities when establishing their practice. Understanding the impact of educational interventions designed to offset physician maldistribution is crucial to informing health human resource strategies aimed at ensuring that the disposition of the physician workforce best serves the diverse needs of all patients and communities.

METHODS

A scoping review was conducted using a six-stage framework to help map current evidence on educational interventions designed to influence physicians' decisions or intention to establish practice in underserved areas. A search strategy was developed and used to conduct database searches. Data were synthesized according to the types of interventions and the location in the medical education professional development trajectory, that influence physician intention or decision for rural and underserved practice locations.

RESULTS

There were 130 articles included in the review, categorized according to four categories: preferential admissions criteria, undergraduate training in underserved areas, postgraduate training in underserved areas, and financial incentives. A fifth category was constructed to reflect initiatives comprised of various combinations of these four interventions. Most studies demonstrated a positive impact on practice location, suggesting that selecting students from underserved or rural areas, requiring them to attend rural campuses, and/or participate in rural clerkships or rotations are influential in distributing physicians in underserved or rural locations. However, these studies may be confounded by various factors including rural origin, pre-existing interest in rural practice, and lifestyle. Articles also had various limitations including self-selection bias, and a lack of standard definition for underservedness.

CONCLUSIONS

Various educational interventions can influence physician practice location: preferential admissions criteria, rural experiences during undergraduate and postgraduate medical training, and financial incentives. Educators and policymakers should consider the social identity, preferences, and motivations of aspiring physicians as they have considerable impact on the effectiveness of education initiatives designed to influence physician distribution in underserved locations.