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Gottlob K, Joos S, Haumann H. The teaching and learning environment of a primary care medical student clinical attachment ("Famulatur") - a qualitative study on experiences of students and primary care physicians in Germany. GMS JOURNAL FOR MEDICAL EDUCATION 2019; 36:Doc28. [PMID: 31211223 PMCID: PMC6545615 DOI: 10.3205/zma001236] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 01/10/2019] [Accepted: 02/01/2019] [Indexed: 05/23/2023]
Abstract
Aim: Following changes in licensing regulations for doctors ("Approbationsordnung") in 2012, a 4-week clinical attachment ("Famulatur") in primary care is now mandatory for all medical students in Germany. To date, it has not been studied how the Famulatur in primary care is perceived by the learner or the teacher. The aim of this study was to explore the experiences of both medical students and primary care physicians (PCPs) with regard to the teaching and learning situation in the Famulatur in primary care. Methods: A qualitative analysis of semi-structured interviews with 12 students from the medical faculty in Tübingen, Germany, and 17 PCPs from this region, was performed. Interview material was analyzed following content analysis according to Mayring. Results: In addition to considering the variety of tasks expected of the students and the optimal time for the Famulatur during the medical curriculum, the main themes of the interviews were the strengths, weaknesses and suggestions for improvement of the Famulatur. The Famulatur was predominantly perceived positively, although it being obligatory was criticized. In particular, the 1:1 supervision and the extended duration (compared to the first curricular primary care placement ("Blockpraktikum")) were positively evaluated. PCPs and students were critical of the lack of a learning and educational Famulatur framework, which would have enabled earlier orientation and alignment of each party. Conclusion: The Famulatur offers good learning opportunities for medical students and provides an insight into primary care, which is typically seen positively; it appears to heighten enthusiasm for primary care within budding doctors. Even if the obligation should cease in "The Master Plan for Medical Studies 2020" (Masterplan Medizinstudium 2020), it would be beneficial to optimize the primary care Famulatur; the development of a student logbook and learning objectives could be helpful, for example in the form of portfolios.
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Affiliation(s)
- Kirsten Gottlob
- University Hospital Tübingen, Institute for General Practice and Interprofessional Care, Tübingen, Germany
| | - Stefanie Joos
- University Hospital Tübingen, Institute for General Practice and Interprofessional Care, Tübingen, Germany
| | - Hannah Haumann
- University Hospital Tübingen, Institute for General Practice and Interprofessional Care, Tübingen, Germany
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Herwig A, Viehmann A, Thielmann A, Gesenhues S, Weltermann B. Relevance of clerkship characteristics in changing students' interest in family medicine: a questionnaire survey. BMJ Open 2017; 7:e012794. [PMID: 28298364 PMCID: PMC5353345 DOI: 10.1136/bmjopen-2016-012794] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES Exposure to family medicine (FM) can serve to promote students' interest in this field. This study aimed at identifying clerkship characteristics which decrease or increase students' interest in FM. DESIGN This cross-sectional questionnaire study analysed students' clerkship evaluations between the years 2004 and 2014. Descriptive statistics were used to compare four predefined groups: (1) high interest in FM before and after the clerkship (Remained high), (2) poor interest before and after the clerkship (Remained low), (3) poor interest before the clerkship which improved (Increased) and (4) high interest before the clerkship which decreased (Decreased). SETTING Students' evaluations of FM clerkships in the fourth of 6 years of medical school. PARTICIPANTS All questionnaires with complete answers on students' interest in FM and its change as a result of the clerkship (2382 of 3963; 60.1%). The students' mean age was 26 years (± 3.9), 62.7% (n=1505) were female. OUTCOME MEASURE The outcome was a change in students' interest in FM after completing the clerkship. RESULTS Interest in FM after the clerkship was as follows: 40.1% (n=954) Remained high, 5.5% (n=134) Remained low, 42.1% (n=1002) Increased and 12.3% (n=292) Decreased. Students with decreased interest had performed a below-average number of learning activities (4 vs 6 activities). A total of 45.9% (n=134 of 292) of the students with decreased interest reported that the difficulty of the challenge was inadequate for their educational level: 81.3% (n=109) felt underchallenged and 18.7% (n=25) overchallenged. CONCLUSIONS In more than 50% of cases, the clerkship changed the students' interest in FM. Those with decreased interest were more frequently underchallenged. We observed an increase in FM if at least six learning activities were trained. Our findings stress the importance of well-designed FM clerkships. There is a need for standardised educational strategies which enable teaching physicians to operationalise educational requirements.
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Affiliation(s)
- Anna Herwig
- Institute for General Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Anja Viehmann
- Institute for General Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Anika Thielmann
- Institute for General Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Stefan Gesenhues
- Institute for General Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Birgitta Weltermann
- Institute for General Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
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Letrilliart L, Rigault-Fossier P, Fossier B, Kellou N, Paumier F, Bois C, Polazzi S, Schott AM, Zerbib Y. Comparison of French training and non-training general practices: a cross-sectional study. BMC MEDICAL EDUCATION 2016; 16:126. [PMID: 27117188 PMCID: PMC4847255 DOI: 10.1186/s12909-016-0649-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Accepted: 04/21/2016] [Indexed: 05/09/2023]
Abstract
BACKGROUND As the medicine practiced in hospital settings has become more specialized, training in primary care is becoming increasingly essential for medical students, especially for future general practitioners (GPs). Only a few limited studies have investigated the representativeness of medical practices delivering this training. The aim of this study was to assess the representativeness of French GP trainers in terms of socio-demographics, patients and activities. METHODS We conducted a cross-sectional study covering all private GPs practicing in the Rhône-Alpes region of France in 2011. This population consisted of 4992 GPs, including 623 trainers and 4369 non-trainers, managing 8,198,684 individual patients. Data from 2011 to 2012 were provided by the Regional Health Care Insurance (RHCI). We compared GP trainers with non-trainers using the Pearson chi-square test for qualitative variables and the Student t-test for quantitative variables RESULTS GP trainers do not differ from non-trainers for gender, but they tend to be younger, more frequently in mid-career, and more likely to practice in a rural area. Their patients are broadly representative of patients attending general practice for age (with the exception of a higher consultation rate for infants), but patients with medical fee exemption status relating to low income are underrepresented. GP trainers have a heavier workload in terms of office visits and on-call duties. They prescribe a higher proportion of generic drugs, perform more electrocardiograms and cervical smears, and fewer plaster casts. GP trainers show better performance in diabetes follow-up, and to a lesser extent for seasonal flu vaccination and mammograms. CONCLUSIONS GPs and patients of training practices are globally representative, which is particularly critical in countries such as France, where the length of specialty training in a general practice setting is still limited to a few months. In addition, GP trainers tend to have better clinical performance, which conforms to their teaching modelling role and may encourage other GPs to become trainers.
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Affiliation(s)
- Laurent Letrilliart
- Universite de Lyon 1, Collège universitaire de médecine générale, Lyon, France.
- Universite de Lyon, Equipe d'Accueil HESPER 7425, Lyon, France.
| | | | - Benoit Fossier
- Universite de Lyon 1, Collège universitaire de médecine générale, Lyon, France
| | - Nadir Kellou
- Universite de Lyon 1, Collège universitaire de médecine générale, Lyon, France
| | - Françoise Paumier
- Département de médicine générale, Universite de Grenoble, Grenoble, France
| | - Christophe Bois
- Département de médicine générale, Universite de Saint-Etienne, Saint-Etienne, France
| | | | - Anne-Marie Schott
- Universite de Lyon, Equipe d'Accueil HESPER 7425, Lyon, France
- Hospices Civils de Lyon, Pôle IMER, Lyon, France
| | - Yves Zerbib
- Universite de Lyon 1, Collège universitaire de médecine générale, Lyon, France
- Universite de Lyon 1, Equipe d'Accueil Sciences et Société, Historicité, Education et Pratique (S2HEP) 4148, Lyon, France
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Turkeshi E, Michels NR, Hendrickx K, Remmen R. Impact of family medicine clerkships in undergraduate medical education: a systematic review. BMJ Open 2015; 5:e008265. [PMID: 26243553 PMCID: PMC4538263 DOI: 10.1136/bmjopen-2015-008265] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVE Synthesise evidence about the impact of family medicine/general practice (FM) clerkships on undergraduate medical students, teaching general/family practitioners (FPs) and/or their patients. DATA SOURCES Medline, ERIC, PsycINFO, EMBASE and Web of Knowledge searched from 21 November to 17 December 2013. Primary, empirical, quantitative or qualitative studies, since 1990, with abstracts included. No country restrictions. Full text languages: English, French, Spanish, German, Dutch or Italian. REVIEW METHODS Independent selection and data extraction by two authors using predefined data extraction fields, including Kirkpatrick's levels for educational intervention outcomes, study quality indicators and Best Evidence Medical Education (BEME) strength of findings' grades. Descriptive narrative synthesis applied. RESULTS Sixty-four included articles: impact on students (48), teaching FPs (12) and patients (8). Sample sizes: 16-1095 students, 3-146 FPs and 94-2550 patients. Twenty-six studies evaluated at Kirkpatrick level 1, 26 at level 2 and 6 at level 3. Only one study achieved BEME's grade 5. The majority was assessed as grade 4 (27) and 3 (33). Students reported satisfaction with content and process of teaching as well as learning in FM clerkships. They enhanced previous learning, and provided unique learning on dealing with common acute and chronic conditions, health maintenance, disease prevention, communication and problem-solving skills. Students' attitudes towards FM were improved, but new or enhanced interest in FM careers did not persist without change after graduation. Teaching FPs reported increased job satisfaction and stimulation for professional development, but also increased workload and less productivity, depending on the setting. Overall, student's presence and participation did not have a negative impact on patients. CONCLUSIONS Research quality on the impact of FM clerkships is still limited, yet across different settings and countries, positive impact is reported on students, FPs and patients. Future studies should involve different stakeholders, medical schools and countries, and use standardised and validated evaluation tools.
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Affiliation(s)
- Eralda Turkeshi
- Faculty of Medicine, Department of Family Medicine,University of Medicine in Tirana, Tirana, Albania
| | - Nele R Michels
- Faculty of Medicine and Health Sciences, Department of General Practice, University of Antwerp, Antwerp, Belgium
| | - Kristin Hendrickx
- Faculty of Medicine and Health Sciences, Department of General Practice, University of Antwerp, Antwerp, Belgium
| | - Roy Remmen
- Faculty of Medicine and Health Sciences, Department of General Practice, University of Antwerp, Antwerp, Belgium
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Al-Rubaish AM, Abdel Rahim SI, Hassan A, Ali AA, Mokabel F, Hegazy M, Wosornu L. Developing questionnaires for students' evaluation of individual faculty's teaching skills: A Saudi Arabian pilot study. J Family Community Med 2011; 17:91-5. [PMID: 21359032 PMCID: PMC3045097 DOI: 10.4103/1319-1683.71991] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background: The National Commission for Academic Accreditation and Assessment is responsible for the academic accreditation of universities in the Kingdom of Saudi Arabia (KSA). Requirements for this include evaluation of teaching effectiveness, evidence-based conclusions, and external benchmarks. Aims: To develop a questionnaire for students’ evaluation of the teaching skills of individual instructors and provide a tool for benchmarking. Setting: College of Nursing, University of Dammam [UoD], May-June 2009. Materials and Methods: The original questionnaire was “Monash Questionnaire Series on Teaching (MonQueST) - Clinical Nursing. The UoD modification retained four areas and seven responses, but reduced items from 26 to 20. Outcome measures were factor analysis and Cronbach’s alpha coefficient. Results: Seven Nursing courses were studied, viz.: Fundamentals, Medical, Surgical, Psychiatric and Mental Health, Obstetrics and Gynecology, Pediatrics, and Family and Community Health. Total number of students was 74; missing data ranged from 5 to 27%. The explained variance ranged from 66.9% to 78.7%. The observed Cornbach’s α coefficients ranged from 0.78 to 0.93, indicating an exceptionally high reliability. The students in the study were found to be fair and frank in their evaluation.
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Okayama M, Kajii E. Does community-based education increase students' motivation to practice community health care?--a cross sectional study. BMC MEDICAL EDUCATION 2011; 11:19. [PMID: 21569332 PMCID: PMC3114788 DOI: 10.1186/1472-6920-11-19] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2011] [Accepted: 05/11/2011] [Indexed: 05/17/2023]
Abstract
BACKGROUND Community-based education has been introduced in many medical schools around the globe, but evaluation of instructional quality has remained a critical issue. Community-based education is an approach that aims to prepare students for future professional work at the community level. Instructional quality should be measured based on a program's outcomes. However, the association between learning activities and students' attitudes is unknown. The purpose of this study was to clarify what learning activities affect students' attitudes toward community health care. METHODS From 2003 to 2009, self-administered pre- and post-questionnaire surveys were given to 693 fifth-year medical students taking a 2-week clinical clerkship. Main items measured were student attitudes, which were: "I think practicing community health care is worthwhile" ("worthwhile") and "I am confident about practicing community health care" ("confidence") using a visual analogue scale (0-100). Other items were gender, training setting, and learning activities. We analyzed the difference in attitudes before and after the clerkships by paired t test and the factors associated with a positive change in attitude by logistic regression analysis. RESULTS Six hundred forty-five students (93.1%), 494 (76.6%) male and 151(23.4%) female, completed the pre- and post-questionnaires. The VAS scores of the students' attitudes for "worthwhile" and "confidence" after the clerkship were 80.2 ± 17.4 and 57.3 ± 20.1, respectively. Both of the scores increased after the clerkship. Using multivariate logistic regression analysis, "health education" was associated with a positive change for both attitudes of "worthwhile" (adjusted RR: 1.71, 95% CI: 1.10-2.66) and "confidence" (1.56, 1.08-2.25). CONCLUSIONS Community-based education motivates students to practice community health care. In addition, their motivation is increased by the health education activity. Participating in this activity probably produces a positive effect and improves the instructional quality of the program based on its outcomes.
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Affiliation(s)
- Masanobu Okayama
- Division of Community and Family Medicine, Center for Community Medicine, Jichi Medical University, 3311-1 Shimotsuke-city Tochigi, 329-0498 Japan
| | - Eiji Kajii
- Division of Community and Family Medicine, Center for Community Medicine, Jichi Medical University, 3311-1 Shimotsuke-city Tochigi, 329-0498 Japan
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Sprenger M, Baumgartner J, Moser A, Salzer HJF, Stigler FL, Wendler M. Students' and general practitioners' perceptions of a recently introduced clerkship in general practice. A survey from Austria. Eur J Gen Pract 2011; 16:148-50. [PMID: 20557273 DOI: 10.3109/13814788.2010.495404] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
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.
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