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Gomez K, Edwards HL, Kirby J. "Who's watching?": Exploring patients' acceptance of having their consultations livestreamed for educational purposes. MEDICAL TEACHER 2024:1-5. [PMID: 39023068 DOI: 10.1080/0142159x.2024.2377813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Accepted: 07/04/2024] [Indexed: 07/20/2024]
Abstract
Shortages of clinical placements are an ever-increasing global challenge. Livestreaming clinical experiences to remotely-located learners shows promise in addressing this challenge. However, little is known about the acceptability of livestreamed clinical experiences for patients. Understanding patient views is critical to determine feasibility of this method of delivering clinical experience. This study reports on the experiences of 11 patients who participated in a livestreamed clinical experience in general practices in Yorkshire, United Kingdom. Up to five remotely-located medical students participated in each consultation. Semi-structured interviews were conducted and analysed using thematic analysis. Findings suggest that a livestreamed clinical experience did not impact patients' experience of their consultation, including willingness to withdraw from the consultation. Smartglasses worn by clinicians did not impede patient-clinician interaction, likely because they did not obstruct eye contact. Patient views varied as to whether or not they preferred to see students on the computer screen during the consultation, raising potential tensions between student learning needs and patient preference. Most patients had no preference as to whether students participated remotely or in person. These findings show promise in terms of patient acceptability but further research evaluating patient perspectives in greater numbers and in other clinical contexts is important.
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Affiliation(s)
- Kelvin Gomez
- Leeds Institute of Medical Education, Leeds School of Medicine, University of Leeds, Leeds, United Kingdom
| | - Helen L Edwards
- Leeds Institute of Health Sciences, Leeds School of Medicine, University of Leeds, Leeds, United Kingdom
| | - Jane Kirby
- Leeds Institute of Health Sciences, Leeds School of Medicine, University of Leeds, Leeds, United Kingdom
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Scholz A, Gehres V, Schrimpf A, Bleckwenn M, Deutsch T, Geier AK. Long-term mentoring relationships in undergraduate longitudinal general practice tracks - a qualitative study on the perspective of students and general practitioners. MEDICAL EDUCATION ONLINE 2023; 28:2149252. [PMID: 36463500 PMCID: PMC9728122 DOI: 10.1080/10872981.2022.2149252] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 11/15/2022] [Accepted: 11/16/2022] [Indexed: 06/01/2023]
Abstract
BACKGROUND Longitudinal general practice tracks have been established in medical faculties in Europe and worldwide to attract more graduates to general practice careers. In many programs, long-term mentoring relationships play an important role in providing students with positive role models, regular practical experiences, and acquisition of clinical skills in a community context. However, little is known about students' and general practitioner mentors' expectations, experiences, challenges, and ideas for improvement within these long-term mentoring relationships in general practice in our medical education system. METHODS Qualitative study based on semi-structured interviews with 15 students and 13 mentors. Interviews were audio-recorded and transcribed verbatim. MAXQDA was used for data analysis, following a mixed deductive/inductive approach. RESULTS Both groups had few and rather unstated expectations, particularly regarding their relationships. Consequently, expectations were often not clearly communicated. Nevertheless, a high level of satisfaction and good opportunities for teaching were achieved for both sides. The evolving familiarity facilitated a positive learning environment. Students valued independent medical tasks continuously adjusted to their current abilities. However, some felt a reluctance to demand their mentor's time and consideration. Conversely, the mentors criticized a lack of initiative from some of the students and wished that they would get more actively involved. Students, in contrast, wished for more guidance at the start of the project and joint events to deepen the relationship. CONCLUSIONS With this study, we gained detailed insights into and understanding of the nature of long-term relationships between students and mentors. Points for improvement revealed included: 1) education of both participating groups on the goals and benefits of mentoring, including binding expectations for the participants; 2) intensified support and training of teaching physicians; 3) structured and accompanied establishment of initial contact between mentor and mentee; and 4) encouraged additional shared (teaching) time, individualized timing, and intensification, if desired.
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Affiliation(s)
- Anna Scholz
- Department of General Practice, Faculty of Medicine, Leipzig University, Leipzig, Germany
| | - Vera Gehres
- Department of General Practice, Faculty of Medicine, Leipzig University, Leipzig, Germany
| | - Anne Schrimpf
- Department of General Practice, Faculty of Medicine, Leipzig University, Leipzig, Germany
| | - Markus Bleckwenn
- Department of General Practice, Faculty of Medicine, Leipzig University, Leipzig, Germany
| | - Tobias Deutsch
- Department of General Practice, Faculty of Medicine, Leipzig University, Leipzig, Germany
| | - Anne-Kathrin Geier
- Department of General Practice, Faculty of Medicine, Leipzig University, Leipzig, Germany
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Affiliation(s)
- Nada Khan
- Nada is an Exeter-based National Institute for Health and Care Research Academic Clinical Fellow in general practice, GPST4/Registrar, and an Associate Editor at the BJGP.
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Li J, Kabouji J, Bouhadoun S, Tanveer S, Filion KB, Gore G, Josephson CB, Kwon CS, Jette N, Bauer PR, Day GS, Subota A, Roberts JI, Lukmanji S, Sauro K, Ismaili AA, Rahmani F, Chelabi K, Kerdougli Y, Seulami NM, Soumana A, Khalil S, Maynard N, Keezer MR. Sensitivity and specificity of alternative screening methods for systematic reviews using text mining tools. J Clin Epidemiol 2023; 162:72-80. [PMID: 37506951 DOI: 10.1016/j.jclinepi.2023.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 07/03/2023] [Accepted: 07/19/2023] [Indexed: 07/30/2023]
Abstract
OBJECTIVES To evaluate the impact of text mining (TM) on the sensitivity and specificity of title and abstract screening strategies for systematic reviews (SRs). STUDY DESIGN AND SETTING Twenty reviewers each evaluated a 500-citation set. We compared five screening methods: conventional double screen (CDS), single screen, double screen with TM, combined double screen and single screen with TM, and single screen with TM. Rayyan, Abstrackr, and SWIFT-Review were used for each TM method. The results of a published SR were used as the reference standard. RESULTS The mean sensitivity and specificity achieved by CDS were 97.0% (95% confidence interval [CI]: 94.7, 99.3) and 95.0% (95% CI: 93.0, 97.1). When compared with single screen, CDS provided a greater sensitivity without a decrease in specificity. Rayyan, Abstrackr, and SWIFT-Review identified all relevant studies. Specificity was often higher for TM-assisted methods than that for CDS, although with mean differences of only one-to-two percentage points. For every 500 citations not requiring manual screening, 216 minutes (95% CI: 169, 264) could be saved. CONCLUSION TM-assisted screening methods resulted in similar sensitivity and modestly improved specificity as compared to CDS. The time saved with TM makes this a promising new tool for SR.
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Affiliation(s)
- Jimmy Li
- Neurology Division, Centre Hospitalier de l'Université de Sherbrooke (CHUS), Sherbrooke, Canada; Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Canada
| | - Joudy Kabouji
- Department of Pharmacy, University of Laval, Quebec City, Canada
| | - Sarah Bouhadoun
- Department of Neurology, McGill University, Montreal, Canada
| | - Sarah Tanveer
- Department of Pharmaceutical Health Services Research, University of Maryland, Baltimore, MD, USA
| | - Kristian B Filion
- Departments of Medicine and of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada; Centre for Clinical Epidemiology, Jewish General Hospital - Lady Davis Institute, Montreal, Canada
| | - Genevieve Gore
- Schulich Library of Physical Sciences, Life Sciences, and Engineering, McGill University, Montreal, Canada
| | - Colin Bruce Josephson
- Department of Clinical Neurosciences, University of Calgary, Calgary, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Canada; O'Brien Institute for Public Health, University of Calgary, Calgary, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, Canada; Center for Health Informatics, University of Calgary, Calgary, Canada
| | - Churl-Su Kwon
- Department of Neurology, Epidemiology, Neurosurgery and the Gertrude H. Sergievsky Center, Columbia University, New York, NY, USA
| | - Nathalie Jette
- Department of Clinical Neurosciences, University of Calgary, Calgary, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Canada
| | - Prisca Rachel Bauer
- Department of Psychosomatic Medicine and Psychotherapy, Faculty of Medicine, Medical Center - University of Freiburg, Freiburg, Germany
| | - Gregory S Day
- Department of Neurology, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Ann Subota
- Department of Community Health Sciences, University of Calgary, Calgary, Canada; Department of Medicine, University of Calgary, Calgary, Canada
| | - Jodie I Roberts
- Department of Community Health Sciences, University of Calgary, Calgary, Canada
| | - Sara Lukmanji
- Department of Community Health Sciences, University of Calgary, Calgary, Canada
| | - Khara Sauro
- Department of Community Health Sciences, University of Calgary, Calgary, Canada; Department of Surgery, University of Calgary, Calgary, Canada; Department of Oncology & Arnie Charbonneau Cancer Institute, University of Calgary, Calgary, Canada
| | | | - Feriel Rahmani
- Faculty of Medicine, McGill University, Montreal, Canada
| | | | | | | | - Aminata Soumana
- Department of Family Medicine, McGill University, Montreal, Canada
| | - Sarah Khalil
- Department of Family Medicine, McGill University, Montreal, Canada
| | - Noémie Maynard
- Department of Internal Medicine, McGill University, Montreal, Canada
| | - Mark Robert Keezer
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Canada; Departments of Medicine and of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada; Department of Neurosciences, Université de Montréal, Montreal, Canada; School of Public Health, Université de Montréal, Montreal, Canada.
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Armstrong S, Alberti H, Bhattacharya A, Dhokia B, Hall L, Lawes-Wickwar S, Lovat E, Pandya S, Park S, Pope L, Sajid M, Wilson P, Younie L. Students' and tutors' experiences of remote 'student-patient' consultations. MEDICAL TEACHER 2023; 45:1038-1046. [PMID: 36745733 DOI: 10.1080/0142159x.2023.2170777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
BACKGROUND Remote consulting has become part of the medical student clinical experience in primary care, but little research exists regarding the impact on learning. AIM To describe the experiences of General Practitioner (GP) educators and medical students in using student-led remote consultations as an educational tool. METHOD A qualitative, explorative study conducted at four UK medical schools. GP educators and medical students were purposively sampled and interviewed. RESULTS Nine themes arose: practical application, autonomy, heuristics, safety, triage of undifferentiated patients, clinical reasoning, patient inclusion in student education, student-patient interaction, and student-doctor interaction. DISCUSSION Remote consulting has become part of the clinical placement experience. This has been found to expose students to a wider variety of clinical presentations. Verbal communication, history-taking, triage, and clinical reasoning skills were practised through remote consulting, but examination skills development was lacking. Students found building rapport more challenging, although this was mitigated by having more time with patients. Greater clinical risk was perceived in remote consulting, which had potential to negatively impact students' psychological safety. Frequent debriefs could ameliorate this risk and positively impact student-doctor relationships. Student autonomy and independence increased due to greater participation and responsibility. Pre-selection of patients could be helpful but had potential to expose students to lower complexity patients.[Box: see text].
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Affiliation(s)
- Sarah Armstrong
- Primary Care Population Health Department, University College London, London, UK
| | - Hugh Alberti
- School of Medical Education, Newcastle University, Newcastle upon Tyne, UK
| | | | | | - Lauren Hall
- School of Medical Education, Newcastle University, Newcastle upon Tyne, UK
| | - Sadie Lawes-Wickwar
- Primary Care Population Health Department, University College London, London, UK
| | - Eitan Lovat
- Primary Care Population Health Department, University College London, London, UK
| | | | - Sophie Park
- Primary Care Population Health Department, University College London, London, UK
| | - Lindsey Pope
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | | | - Penny Wilson
- School of Medical Education, Newcastle University, Newcastle upon Tyne, UK
| | - Louise Younie
- Institute of Health Sciences Education, Queen Mary University of London (QMUL), London, UK
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Darnton R, Amey S, Brimicombe J. Medical students remote consulting from home and from the health centre: A survey of prevalence and supervisor perspectives. MEDICAL TEACHER 2023; 45:752-759. [PMID: 36708702 DOI: 10.1080/0142159x.2022.2158068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
PURPOSE A shift to remote consulting characterised the early stages of the COVID-19 pandemic in general practice which resulted in significant changes in the delivery of medical education. It is unclear whether these changes have been sustained and how they are perceived by faculty. METHODS We surveyed a defined population of GP practices during April 2022 with questions to elicit estimates of medical student involvement in different types of remote consultation and supervisor ratings of their confidence in supervising different modalities of remote consultation. We performed thematic analysis on free text responses from a 'resistance to change' perspective. RESULTS A response rate of 96% (n = 115) was achieved. Analysis of quantitative data identified that a significant proportion of student consultations were remote, however there was a large variation between practices. Supervisor confidence was lowest for students consulting from home. Thematic analysis identified ways in which clinical supervisors may perceive the innovation to be at odds with their overriding commitments to safety, simplicity and quality. CONCLUSIONS Remote consultations form a significant proportion of medical student activity in many practices. Some supervisors are reluctant to supervise medical students consulting from home and our findings suggest ways of addressing this so that the benefits of the innovation can be harnessed.
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Affiliation(s)
- Richard Darnton
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Sam Amey
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - James Brimicombe
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
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Harding A, Vallersnes OM, Carelli F, Kiknadze N, Karppinen H, Simmenroth A. European standards for undergraduate medical education in general practice; a blueprint - for action. EDUCATION FOR PRIMARY CARE 2023; 34:2-6. [PMID: 36730558 DOI: 10.1080/14739879.2022.2155997] [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: 02/04/2023]
Abstract
There is compelling evidence that general practice (GP) is the most effective form of healthcare. However, healthcare policy appears independent of evidence and GP is woefully under-resourced in all countries, and this affects recruitment. Recruitment to GP is proportional to the quantity and quality of undergraduate experience and national and transnational guidelines can improve undergraduate experiences by defining both the desired quantity and quality. There is good evidence that these professionally developed guidelines can be effective in changing Government policy if they are used as a touchstone to collaborate with policymakers.EURACT (European Academy of Teachers in General Practice / Family Medicine) have therefore developed transnational guidelines covering the European region. The guidelines cover the desired quantity, quality and support for undergraduate experience. Three main design principles have been used. Firstly, it is democratic. Secondly it is evidence-based, using extensive literature searching, situational analysis and surveys. Finally, it adopts a 'principles-based approach'. Generalist medicine is articulated as a series of interconnected principles that integrate and then re-focus specialist medicine to achieve the enhanced patient-orientated outcomes of primary-care. This way of articulating generalist practice delivers general principles, which can be used as learning outcomes, that are adaptable to a wide range of learning environments. Most clinical learning documents are irrelevant and are destined for dusty drawers or forgotten digital files. We therefore encourage primary care educators to use these guidelines to work with policy-makers at all levels to advocate for change, strengthening primary care education at local, national and international levels.
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General practice and the Medical Licensing Assessment. Br J Gen Pract 2022. [PMCID: PMC9512426 DOI: 10.3399/bjgp22x720905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Alberti H. Undergraduate GP educational research: So what? CLINICAL TEACHER 2022. [DOI: 10.1111/tct.13535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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10
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Shrewsbury D, Rosenthal J. Scholarship in medical education and primary care: A match made in … Aberdeen! CLINICAL TEACHER 2022. [DOI: 10.1111/tct.13540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Lamb E, Burford B, Alberti H. The impact of role modelling on the future general practitioner workforce: a systematic review. EDUCATION FOR PRIMARY CARE 2022; 33:265-279. [PMID: 35904161 PMCID: PMC9519122 DOI: 10.1080/14739879.2022.2079097] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Role modelling has been identified as an important phenomenon in medical education. Key reports have highlighted the ability of role modelling to support medical students towards careers in family medicine although the literature of specific relevance to role modelling in speciality has not been systematically explored. This systematic review aimed to fill this evidence gap by assimilating the worldwide literature on the impact of role modelling on the future general practitioner (GP) workforce. A systematic search was conducted in Medline, Embase, Scopus, Web of Science, Cochrane, ERIC and CINAHL, and all authors were involved in the article screening process. A review protocol determined those articles selected for inclusion, which were then quality assessed, coded and thematically analysed. Forty-six articles were included which generated four broad themes: the identity of role models in general practice, role modelling and becoming a doctor, the impact of role modelling on attitudes towards the speciality, and the subsequent influence on behaviours/career choice. Our systematic review confirmed that role modelling in both primary and secondary care has a crucial impact on the future GP workforce, with the potential to shape perceptions, to attract and deter individuals from the career, and to support their development as professionals. Role modelling must be consciously employed and supported as an educational strategy to facilitate the training of future GPs.
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Affiliation(s)
- Elizabeth Lamb
- School of Medical Education, The Medical School, Newcastle University, Newcastle upon Tyne, UK
| | - Bryan Burford
- School of Medical Education, The Medical School, Newcastle University, Newcastle upon Tyne, UK
| | - Hugh Alberti
- School of Medical Education, The Medical School, Newcastle University, Newcastle upon Tyne, UK
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Ross J, Holder A. Dental undergraduate students' perceptions about placements in primary dental care during the undergraduate dental curriculum: a qualitative evidence synthesis. Br Dent J 2022; 233:141-147. [DOI: 10.1038/s41415-022-4457-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 03/06/2022] [Indexed: 11/09/2022]
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Giske S, Kvangarsnes M, Landstad BJ, Hole T, Dahl BM. Medical students' learning experience and participation in communities of practice at municipal emergency care units in the primary health care system: a qualitative study. BMC MEDICAL EDUCATION 2022; 22:427. [PMID: 35655298 PMCID: PMC9164765 DOI: 10.1186/s12909-022-03492-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 05/24/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Medical education has been criticised for not adapting to changes in society, health care and technology. Internationally, it is necessary to strengthen primary health care services to accommodate the growing number of patients. In Norway, emergency care patients are increasingly treated in municipal emergency care units in the primary health care system. This study explores medical students' learning experience and how they participated in communities of practice at two municipal emergency care units in the primary health care system. METHODS In this qualitative study, we collected data from March to May 2019 using semi-structured individual interviews and systematic observations of six ninth-semester medical students undergoing two-week clerkships at municipal emergency care units. The interview transcripts were thematically analysed with a social constructivist approach. A total of 102 systematic observations were used to triangulate the findings from the thematic analysis. RESULTS Three themes illuminated what the medical students learned and how they participated in communities of practice: (i) They took responsibility for emergency care patients while participating in the physicians' community of practice and thus received intensive training in the role of a physician. (ii) They learned the physician's role in interprofessional collaboration. Collaborating with nursing students and nurses led to training in clinical procedures and insight into the nurses' role, work tasks, and community of practice. (iii) They gained in-depth knowledge through shared reflections when time was allocated for that purpose. Ethical and medical topics were elucidated from an interprofessional perspective when nursing students, nurses, and physicians participated. CONCLUSIONS Our findings suggest that this was a form of clerkship in which medical students learned the physician's role by taking responsibility for emergency care patients and participating in multiple work tasks and clinical procedures associated with physicians' and nurses' communities of practice. Participating in an interprofessional community of practice for professional reflections contributed to in-depth knowledge of ethical and medical topics from the medical and nursing perspectives.
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Affiliation(s)
- Solveig Giske
- Department of Health Sciences in Ålesund, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Ålesund, Norway.
| | - Marit Kvangarsnes
- Department of Health Sciences in Ålesund, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Ålesund, Norway
| | - Bodil J Landstad
- Department of Health Sciences, Mid Sweden University, Östersund, Sweden
| | - Torstein Hole
- Medical Department, Ålesund Hospital, Møre and Romsdal Hospital Trust, Ålesund, Norway
| | - Berit Misund Dahl
- Department of Health Sciences in Ålesund, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Ålesund, Norway
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Harrison M, Alberti H. How does the introduction of a new year three GP curriculum affect future commitment to teach? An evaluation using a realist approach. EDUCATION FOR PRIMARY CARE 2022; 33:92-101. [PMID: 35343398 DOI: 10.1080/14739879.2021.1974952] [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: 10/18/2022]
Abstract
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.
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Affiliation(s)
- Michael Harrison
- School of Medical Education, Faculty of Medical Sciences, Newcastle University Newcastle upon Tyne UK
| | - Hugh Alberti
- School of Medical Education, Faculty of Medical Sciences, Newcastle University Newcastle upon Tyne UK
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Darnton R, Khan M, Tan XS, Jenkins M. Primary care placements in the post-COVID era: A qualitative evaluation of a final year undergraduate clerkship. MEDICAL TEACHER 2022; 44:319-327. [PMID: 34860625 DOI: 10.1080/0142159x.2021.1990239] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
INTRODUCTION In March 2020, UK primary care changed dramatically due to the COVID-19 pandemic. It now has a much greater reliance on triaging, e-consultations, remote consultations, online meetings and less home visits. Re-evaluating the nature and value of learning medicine in primary care has therefore become a priority. METHOD 70 final-year medical students placed in 38 GP practices (primary care centres) across the East of England undertook a 5-week clerkship during November 2020. A sample of 10 students and 11 supervising general practitioners from 16 different GP practices were interviewed following the placement. Qualitative analysis was conducted to determine their perceptions regarding the nature and value of learning medicine in primary care now compared with prior to the pandemic. RESULTS A variety of models of implementing supervised student consultations were identified. Although contact with patients was felt to be less than pre-pandemic placements, triaging systems appeared to have increased the educational value of each individual student-patient contact. Remote consultations were essential to achieving adequate case-mix and they conferred specific educational benefits. However, depending on how they were supervised, they could have the potential to decrease students' level of responsibility for patient care. CONCLUSIONS Undergraduate primary care placements in the post-COVID era can still possess the educationally valuable attributes documented in the pre-pandemic literature. However, this is dependent on specific factors regarding their delivery.
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Affiliation(s)
- Richard Darnton
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Maaz Khan
- School of Medicine, University of Cambridge, Cambridge, UK
| | - Xiu Sheng Tan
- School of Medicine, University of Cambridge, Cambridge, UK
| | - Mark Jenkins
- Primary Care Unit, University of Cambridge, Cambridge, UK
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Noonan Z, Pope L, Traynor J. Reflections on the integration of virtual GP tutorials to the medical undergraduate curriculum at Glasgow. EDUCATION FOR PRIMARY CARE 2022; 33:180-184. [PMID: 35067218 DOI: 10.1080/14739879.2021.2021810] [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
Virtual tutorials were introduced into the Year 3 medical undergraduate curriculum at Glasgow in 2020/21. This model of teaching proved highly successful from tutor and student perspective. A hybrid teaching model, comprising virtual tutorial teaching alongside placement time will be implemented this year. Virtual (videoed) GP patient cases are selected for tutorials each week, linked to other curriculum content in Year 3. Pedagogically, this aligns pathological and clinical learning for our students and enables some consistency of taught GP content. Concomitant clinical placement time complements this learning with actual patient cases. Communication and consultation techniques considered in the virtual tutorials with facilitated tutor discussion are practised on GP placement days, encapsulating the essence of experiential learning. Challenging or unusual patient cases can be selected for teaching from the virtual case repertoire. This provides uniform exposure to clinically important aspects of general practice, and simultaneously enables an increased diversity of patient cases for our students. Logistical advantages of virtual tutorial delivery include its appeal to a different demographic of GP tutor, enabling us to diversify and expand our teaching team. Remote tutorial delivery offers a futureproof adjunct to the traditional practice-based GP teaching models.
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Affiliation(s)
- Zoe Noonan
- School of Medicine, Glasgow University, Glasgow, UK
| | - Lindsey Pope
- School of Medicine, Glasgow University, Glasgow, UK
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Nakamura K, Kanke S, Hoshi G, Toyoda Y, Yoshida K, Kassai R. Impact of general practice / family medicine clerkships on Japanese medical students: Using text mining to analyze reflective writing. Fukushima J Med Sci 2022; 68:19-24. [PMID: 35135909 PMCID: PMC9071354 DOI: 10.5387/fms.2021-24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background: In order for general practice / family medicine clerkships to be improved in undergraduate medical education, it is necessary to clarify the impacts of general practice / family medicine clerkships. Using text mining to analyze the reflective writing of medical students may be useful for further understanding the impacts of clinical clerkships on medical students. Methods: The study involved 125 fifth-year Fukushima Medical University School of Medicine students in the academic year 2018-2019. The settings were three clinics and the study period was 5 days. The clerkships included outpatient and home visits. Students’ reflective writing on their clerkship experience was collected on the final day. Text mining was used to extract the most frequent words (nouns) from the reflective writing. A co-occurrence network map was created to illustrate the relationships between the most frequent words. Results: 124 students participated in the study. The total number of sentences extracted was 321 and the total number of words was 10,627. The top five frequently-occurring words were patient, home-visit, medical practice, medical care, and family. From the co-occurrence network map, a co-occurrence relationship was recognized between home-visit and family. Conclusion: Data suggest that medical students may learn the necessity of care for the family as well as the patient in a home-care setting.
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Affiliation(s)
- Koki Nakamura
- Department of Community and Family Medicine, Fukushima Medical University
| | - Satoshi Kanke
- Fukushima Centre for General Physicians, Fukushima Medical University
| | | | | | | | - Ryuki Kassai
- Department of Community and Family Medicine, Fukushima Medical University
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Shah A, Gasner A, Bracken K, Scott I, Kelly MA, Palombo A. Early generalist placements are associated with family medicine career choice: A systematic review and meta-analysis. MEDICAL EDUCATION 2021; 55:1242-1252. [PMID: 34075608 DOI: 10.1111/medu.14578] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 05/14/2021] [Accepted: 05/27/2021] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Many developed countries have reported shortages of Primary Care (PC) physicians. The lack of a regular primary physician is associated with inferior health outcomes. One strategy to address this shortage is to increase the proportion of medical students selecting a Family Medicine (FM) or PC career. The purpose of this systematic review is to identify whether pre-clerkship general practice placements increase students' interest in, and selection of FM or PC residencies. METHODS Three databases (PubMed, Embase, Web of Science) searched for interventional studies of pre-clerkship generalist placements in medical school. Pooled statistical analysis and meta-analysis were performed, along with narrative summaries when possible. Intervention participants (IP) were compared to controls matched (MC) for baseline interest in FM and an unmatched sample (UC) of contemporary students. FINDINGS A 11 studies were identified including a total of 5430 students (2428 intervention participants and 3002 controls). IPs were more likely to match to FM than both MC (Risk Ratio: 1.62 [95% CI: 1.03-2.55]) and UC (RR: 2.04 [1.46-2.86]). Participation in long interventions (4-11 weeks) matched to FM at higher rates than short (25-40 hours) interventions (RR: 3.15 [2.28-4.35]). The percentage of students with FM/PC as their top specialty of interest increased after the placements (mean difference: +12.8%, n = 586). CONCLUSIONS Medical students who participated in pre-clerkship general practice placements were more likely to match to a FM residency. Longer pre-clerkship placements had a stronger association with FM specialty choice. The implementation of longitudinal block generalist placements in the pre-clerkship years is one strategy for increasing interest in generalist careers. LEVEL OF EVIDENCE IV, systematic review of level III and IV studies.
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Affiliation(s)
- Ajay Shah
- Faculty of Health Sciences, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Adi Gasner
- Faculty of Health Sciences, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Keyna Bracken
- Division of Family Medicine, Department of Family Medicine, McMaster University, Hamilton, ON, Canada
| | - Ian Scott
- Department of Family Practice, University of British Columbia, Vancouver, BC, Canada
| | - Martina A Kelly
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Alessandra Palombo
- Division of Family Medicine, Department of Family Medicine, McMaster University, Hamilton, ON, Canada
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Sripa P, Thepwongsa I, Muthukumar R. Factors associated with the entry to general practice training: A multicentre study. MEDICAL TEACHER 2020; 42:1394-1400. [PMID: 32878524 DOI: 10.1080/0142159x.2020.1811846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND Despite recent studies regarding general practice (GP) career decision-making, the impact of primary care exposure during undergraduate study on career-decision-making remain unclear. PURPOSE To examine the association between primary care exposure with the entry to GP training. METHODS An unmatched case-control study design was employed. A total of 130 trainees in GP training and 260 trainees in other speciality training were randomly selected from speciality training registration. Questionnaires were used to identify primary care exposure and factors associated with career-decision making. Odds ratios (OR) and logistic regression were used to examine the association between the entry to GP training and those factors. RESULTS The response rate was 66.4%. Three variables were found associated with entering GP training, including timetabled primary care sessions in all three clinical years (adjusted OR = 2.91; 95% CI = 1.23 - 6.88), enrolling in rural medical student recruitment schemes (adjusted OR = 3.07; 95% CI = 1.05 - 8.99) and valuing core values of GP (adjusted OR = 8.46; 95% CI = 3.27 - 21.88). CONCLUSION Our findings suggest that timetabled primary care sessions in all three clinical years has a positive influence on entering GP training. This research extends our knowledge of primary care exposure regarding continuity of the exposure.
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Affiliation(s)
- Poompong Sripa
- Family Medicine Unit, Department of Community Medicine, Faculty of Medicine, Khon Kaen University, Thailand
| | - Isaraporn Thepwongsa
- Family Medicine Unit, Department of Community Medicine, Faculty of Medicine, Khon Kaen University, Thailand
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Fung CY, Tan ZM, Savage A, Rahim M, Osman F, Adnan M, Peleva E, Sam AH. Undergraduate exposure to patient presentations on the acute medical placement: a prospective study in a London teaching hospital. BMJ Open 2020; 10:e040575. [PMID: 33243804 PMCID: PMC7692979 DOI: 10.1136/bmjopen-2020-040575] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES To identify the availability and variability of learning opportunities through patient presentations on an acute medical placement at a teaching hospital. DESIGN A prospective study evaluating all acute admissions to the Acute Medical Unit over 14 days (336 hours). Clinical presentations and the day and time of admission were recorded and compared with the learning outcomes specified in the medical school curriculum. SETTING An Acute Medical Unit at a London teaching hospital. OUTCOMES (1) Number of clinical presentations to the Acute Medical Unit over 14 days and (2) differences between the availability and variation of admissions and presentations between in-hours and out-of-hours. RESULTS There were 359 admissions, representing 1318 presentations. Of those presentations, 76.6% were admitted out-of-hours and 23.4% in-hours. Gastrointestinal bleeding, tachycardia, oedema and raised inflammatory markers were over three times more common per hour out-of-hours than in-hours. Hypoxia was only seen out-of-hours. Important clinical presentations in the curriculum such as chest pain and hemiparesis were not commonly seen. CONCLUSIONS There is greater availability of presentations seen out-of-hours and a changing landscape of presentations seen in-hours. The out-of-hours presentation profile may be due to expanded community and specialist services. Medical schools need to carefully consider the timing and location of their clinical placements to maximise undergraduate learning opportunities.
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Affiliation(s)
- Chee Yeen Fung
- Imperial College School of Medicine, Imperial College London, London, UK
| | - Zhin Ming Tan
- Imperial College School of Medicine, Imperial College London, London, UK
| | - Adam Savage
- Imperial College School of Medicine, Imperial College London, London, UK
| | - Mahdi Rahim
- Imperial College School of Medicine, Imperial College London, London, UK
| | - Fatima Osman
- Imperial College School of Medicine, Imperial College London, London, UK
| | - Mohammed Adnan
- Imperial College School of Medicine, Imperial College London, London, UK
| | - Emilia Peleva
- Imperial College School of Medicine, Imperial College London, London, UK
| | - Amir H Sam
- Imperial College School of Medicine, Imperial College London, London, UK
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Lamb EI, Alberti H. Focus on medical education research in primary care: an undergraduate medical education faculty's journey. EDUCATION FOR PRIMARY CARE 2020; 32:70-72. [PMID: 33103629 DOI: 10.1080/14739879.2020.1837019] [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: 10/23/2022]
Abstract
This paper provides a viewpoint on medical education research in primary care from undergraduate medical educators, discussing the issues and questions shared with other institutions, the role of medical education research in raising the profile of academic general practice, the challenges and opportunities faced and how education-based research can form an evidence-based approach to teaching.
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Affiliation(s)
- Elizabeth I Lamb
- School of Medical Education, Newcastle University, The Medical School, Newcastle upon Tyne, UK.,Northumbria Primary Care, Ponteland Medical Group, Newcastle upon Tyne, UK
| | - Hugh Alberti
- School of Medical Education, Newcastle University, The Medical School, Newcastle upon Tyne, UK
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Revealing the reality of undergraduate GP teaching in UK medical curricula: a cross-sectional questionnaire study. Br J Gen Pract 2020; 70:e644-e650. [PMID: 32784219 DOI: 10.3399/bjgp20x712325] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 02/16/2020] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Time in general practice offers medical students opportunities to learn a breadth of clinical knowledge and skills relevant to their future clinical practice. Undergraduate experiences shape career decisions and current recommendations are that 25% of undergraduate curriculum time should be focused on general practice. However, previous work demonstrated that GP teaching had plateaued or reduced in UK medical schools. Therefore, an up-to-date description of undergraduate GP teaching is timely. AIM To describe the current picture of UK undergraduate GP teaching, including the amount of time and resources allocated to GP teaching. DESIGN AND SETTING A cross-sectional questionnaire study across 36 UK medical schools. METHOD The questionnaire was designed based on a previous survey performed in 2011-2013, with additional questions on human and financial support allocated to GP teaching. The questionnaire was piloted and revised prior to distribution to leads of undergraduate GP teaching in UK medical schools. RESULTS The questionnaire response rate was 100%. GP teaching constituted an average of 9.2% of medical curricula; this was lower than previous figures, though the actual number of GP sessions has remained static. The majority (n = 23) describe plans to increase GP teaching in their local curricula over the next 5 years. UK-wide average payment was 55.60 GBP/student/session of in-practice teaching, falling well below estimated costs to practices. Allocation of human resources was varied. CONCLUSION Undergraduate GP teaching provision has plateaued since 2000 and falls short of national recommendations. Chronic underinvestment in GP teaching persists at a time when teaching is expected to increase. Both aspects need to be addressed to facilitate high-quality undergraduate GP teaching and promotion of the expert medical generalist role.
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Pope L, Dubras L. Delivering medical education for future healthcare needs: a community-focused challenge. EDUCATION FOR PRIMARY CARE 2020; 31:266-269. [PMID: 32713265 DOI: 10.1080/14739879.2020.1767513] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Medical schools are required to train the workforce needed to care for the population they serve. In the UK, we are expected to produce more graduates choosing to be general practitioners and to equip all graduates with the ability to care for an ageing population with increasingly complex care needs. These doctors need to be effective members of multi-professional teams, possessing generalist skills including an understanding of uncertainty and risk. Curricula where a significant proportion of clinical learning is based in general practice are best placed to address this pedagogic need. The authors evaluate the sociocultural factors which impede the expansion of undergraduate medical education in general practice. These include historic cultural divides between secondary and primary care, medical school leadership, funding, contractual arrangements and capacity in general practice to deliver increasing education of medical students alongside other established and emerging health professions. The piece concludes with two recommendations: undergraduate student teaching should be incorporated into contract negotiations and there must be urgent UK-wide investment in appropriate placement tariff for students. Furthemore, there is an imperative to pilot and evaluate novel collaborative approaches to the education of undergraduate medical and other health professions students.
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Affiliation(s)
- Lindsey Pope
- GP Education, University of Glasgow , Glasgow, Scotland
| | - Louise Dubras
- GP Education, University of Ulster , Londonderry, Northern Ireland
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Kelly M, Sturman N, Pakchung D. Teaching and learning in general practice: ethical and legal considerations for GP teachers and medical students. Med J Aust 2020; 212:403-405.e1. [PMID: 32304235 DOI: 10.5694/mja2.50593] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Grove L, Boon V, Thompson T, Blythe A. Out of hours, out of sight? Uncovering the education potential of general practice urgent care for UK undergraduates. EDUCATION FOR PRIMARY CARE 2020; 31:218-223. [PMID: 32293983 DOI: 10.1080/14739879.2020.1747364] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
There is a need to increase undergraduate primary care exposure and subsequently enhance primary care recruitment. This study aimed to establish the current use and education potential of the primary care out of hours (OOH) learning environment. This was a mix methods study. A questionnaire was sent to UK primary care heads of teaching nationally to explore the current use of GP OOHs in the undergraduate curriculum and focus groups evaluated final year medical students' experience of an OOH placement. There was a 100% response rate from primary care heads of teaching. Despite 86% being in favour of integrating OOH placements within the undergraduate curriculum, only 28% of medical schools currently offer primary care OOH placements. 36 out of 240 students volunteered for a clinical OOH session. Focus group data from 6 of these students revealed that the placements provided unique learning opportunities and allowed students to appreciate the organisational structure of the National Health Service (NHS). However, barriers included logistical difficulties with the OOH providers and inadequate supervision. It appears that we are overlooking a unique educational opportunity for medical undergraduates. With increasing demands for GP exposure within the undergraduate curriculum, GP OOH is a useful resource for UK medical schools.
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Affiliation(s)
- Lizzie Grove
- Centre for Academic Primary Care, Bristol Medical School, University of Bristol , Bristol, UK
| | - Veronica Boon
- Centre for Academic Primary Care, Bristol Medical School, University of Bristol , Bristol, UK
| | - Trevor Thompson
- Centre for Academic Primary Care, Bristol Medical School, University of Bristol , Bristol, UK
| | - Andrew Blythe
- Centre for Academic Primary Care, Bristol Medical School, University of Bristol , Bristol, UK
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Park S, Khan N, Stevenson F, Malpass A. Patient and Public Involvement (PPI) in evidence synthesis: how the PatMed study approached embedding audience responses into the expression of a meta-ethnography. BMC Med Res Methodol 2020; 20:29. [PMID: 32041523 PMCID: PMC7011428 DOI: 10.1186/s12874-020-0918-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Accepted: 01/31/2020] [Indexed: 11/17/2022] Open
Abstract
Background Patient and public involvement (PPI) has become enshrined as an important pillar of health services empirical research, including PPI roles during stages of research development and analysis and co-design approaches. Whilst user participation has been central to qualitative evidence synthesis (QES) for decades, as seen in the Cochrane consumer network and guidelines, meta-ethnography has been slow to incorporate user participation and published examples of this occurring within meta-ethnography are sparse. In this paper, drawing upon our own experience of conducting a meta-ethnography, we focus on what it means in practice to ‘express a synthesis’ (stage 7). We suggest the methodological importance of ‘expression’ in Noblit and Hare’s seven stage process (Noblit, GW and Hare, RD. Meta-ethnography: synthesizing qualitative studies, 1988) has been overlooked, and in particular, opportunities for PPI user participation within it. Methods Meta-ethnography comprises a seven-stage process of evidence synthesis. Noblit and Hare describe the final 7th stage of the meta-ethnography process as ‘expression of synthesis’, emphasizing co-construction of findings with the audience. In a previous study we conducted a meta-ethnography exploring patient and student experience of medical education within primary care contexts. We subsequently presented and discussed initial meta-ethnography findings with PPI (students and patients) in focus groups and interviews. We transcribed patient and student PPI interpretations of synthesis findings. As a research team, we then translated these into our existing meta-ethnography findings. Results We describe, with examples, the process of involving PPI in stage 7 of meta-ethnography and discuss three methodological implications of incorporating PPI within an interpretative approach to QES: (1) we reflect on the construct hierarchy of user participants’ interpretations and consider whether incorporating these additional 1st order, 2nd level constructs implies an additional logic of 3rd order 2nd level constructs of the QES team; (2) we discuss the link between PPI user participation and what Noblit and Hare may have meant by ideas of ‘expression’ and ‘audience’ as integral to stage 7; and (3) we link PPI user participation to Noblit and Hare’s underlying theory of social explanation, i.e. how expression of the synthesis is underpinned by ideas of translation and that the synthesis must be ‘translated in the audience’s (user participants) particular language’. Conclusions The paper aims to complement recent attempts in the literature to refine and improve guidance on conducting a meta-ethnography, highlighting opportunities for PPI user participation in the processes of interpretation, translation and expression. We discuss the implications of user participation in meta-ethnography on ideas of ‘generalisability’.
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Affiliation(s)
- S Park
- Research Department of Primary Care and Population Health (PCPH), UCL Medical School, Royal Free Campus, Rowland Hill St., London, NW3 2PY, UK.
| | - N Khan
- Faculty of Medicine and Health, University of Leeds, Leeds, LS2 9JT, UK
| | - F Stevenson
- Research Department of Primary Care and Population Health (PCPH), UCL Medical School, Royal Free Campus, Rowland Hill St., London, NW3 2PY, UK
| | - A Malpass
- Centre for Academic Primary Care, Population Health Sciences, School of Social and Community Medicine, University of Bristol, Office 1.03b, Canynge Hall, 39, Whatley Rd, Bristol, BS8 2PS, UK
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Miller D, Loftus AM, O'Boyle PJ, McCloskey M, O'Kelly J, Mace D, McKeon N, Ewan SL, Moore L, Abbott A, Cunning S, McCarron MO, Paget AM. Impact of a telephone-first consultation system in general practice. Postgrad Med J 2019; 95:590-595. [PMID: 31326942 DOI: 10.1136/postgradmedj-2019-136557] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 06/08/2019] [Accepted: 06/28/2019] [Indexed: 01/08/2023]
Abstract
PURPOSE OF THE STUDY Increasing pressure on general practice prompts innovative change in service organisation. This study sought to evaluate the impact of introducing a telephone-first consultation system in a socioeconomically deprived population. STUDY DESIGN An interrupted time series of preplanned outcomes for 2 years before and 1 year postintroduction of a telephone-first system was used to measure the volume and type of general practitioner (GP) consultations and the number of patients consulted per year. Emergency department (ED) and GP out-of-hours attendances, the number of outpatient referrals, and the number of requests for laboratory tests were measured as secondary outcomes. RESULTS The telephone-first system was associated with a 20% increase in total GP consultations (telephone and face-to-face, effect estimate at 12 months, p=0.001). Face-to-face consultations decreased by 39% (p<0.001), while telephone consultations increased by 131% (p<0.001). The volume of individual patient requests for a GP consultation and the number of treatment room nurse consultations did not change. Secondary outcome measures showed no change in hospital outpatient referrals, number of requests for laboratory tests, and ED or GP out-of-hours attendances. CONCLUSIONS A telephone-first system in a deprived urban general practice can decrease delays to GP-patient contacts. The number of patients seeking a medical intervention did not differ irrespective of the consultation system used. The telephone-first system did not affect GP out-of-hours, laboratory investigations or secondary care contacts.
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Affiliation(s)
- Diane Miller
- Pharmacy and Medicines Management Centre, Antrim Hospital, Antrim, UK
| | | | | | | | - John O'Kelly
- General Practice, Aberfoyle Medical Practice, Derry, UK
| | - Donna Mace
- General Practice, Aberfoyle Medical Practice, Derry, UK
| | - Neil McKeon
- General Practice, Aberfoyle Medical Practice, Derry, UK
| | - Sian-Lee Ewan
- General Practice, Aberfoyle Medical Practice, Derry, UK
| | - Laura Moore
- General Practice, Aberfoyle Medical Practice, Derry, UK
| | - Aine Abbott
- General Practice, Aberfoyle Medical Practice, Derry, UK
| | - Shane Cunning
- General Practice, Aberfoyle Medical Practice, Derry, UK
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Rodríguez C, Bélanger E, Nugus P, Boillat M, Dove M, Steinert Y, Lalla L. Community Preceptors' Motivations and Views about Their Relationships with Medical Students During a Longitudinal Family Medicine Experience: A Qualitative Case Study. TEACHING AND LEARNING IN MEDICINE 2019; 31:119-128. [PMID: 30417708 DOI: 10.1080/10401334.2018.1489817] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Phenomenon: Although current evidence emphasizes various benefits of community-oriented programs, little is still known about the nature of the relationships that students and family physicians develop in this educational setting. Our aim in this study was twofold: to identify family physicians' motivations to enroll as preceptors in a longitudinal undergraduate family medicine program and to explore the nature of the student-preceptor relationships built during the course. Approach: This was a qualitative exploratory case study. The case was the first edition of a longitudinal family medicine experience (LFME), a course that makes up part of the novel Medicinae Doctor et Chirurgiae Magister curriculum in place in a Canadian medical school since August 2013. All 173 family physician community preceptors of the academic year 2013-2014 were considered key informants in the investigation. Forty-three preceptors finally participated in one of six focus groups conducted in the spring of 2014. Several organizational documents relative to the LFME course were also gathered. Inductive semantic thematic analysis was performed on verbatim interview transcripts. Documents helped contextualize the major themes emerging from the focus groups discussions. Findings: Enjoying teaching, promoting family medicine, and improving medical education where salient motivations for family physicians to become LFME preceptors. The findings also pointed out the complexity of the student-preceptor exchanges that unfolded over the academic year, and the ambiguous and changing nature of the role that LFME preceptors adopted in their relationships with students: from simply being facilitators of students' clinical observership to behaving as their mentors. Insights: Family physicians were highly motivated to become LFME preceptors of 1st-year medical students. Whereas they consistently valued the relationships built during the academic year with the students assigned to them, they also considered that exchanges did not always happen without difficulties, and gauged the roles they played as complex, ambiguous, and necessarily evolving over time.
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Affiliation(s)
- Charo Rodríguez
- a Department of Family Medicine , Faculty of Medicine, McGill University , Montreal , Quebec , Canada
| | - Emmanuelle Bélanger
- b Centre for Gerontology and Healthcare Research , School of Public Health, Brown University , Providence , Rhode Island , USA
| | - Peter Nugus
- c Centre for Medical Education & Department of Family Medicine , Faculty of Medicine, McGill University , Montreal , Quebec , Canada
| | - Miriam Boillat
- c Centre for Medical Education & Department of Family Medicine , Faculty of Medicine, McGill University , Montreal , Quebec , Canada
| | - Marion Dove
- a Department of Family Medicine , Faculty of Medicine, McGill University , Montreal , Quebec , Canada
| | - Yvonne Steinert
- c Centre for Medical Education & Department of Family Medicine , Faculty of Medicine, McGill University , Montreal , Quebec , Canada
| | - Leonora Lalla
- a Department of Family Medicine , Faculty of Medicine, McGill University , Montreal , Quebec , Canada
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McKinley RK, Alberti H. Distracted by the past. MEDICAL EDUCATION 2019; 53:417. [PMID: 30536418 DOI: 10.1111/medu.13771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
| | - Hugh Alberti
- School of Medical Education, Newcastle University, Newcastle, UK
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Fragkos KC, Sotiropoulos I, Frangos CC. Empathy assessment in healthcare students is highly heterogeneous: A systematic review and meta-analysis (2012-2016). World J Meta-Anal 2019; 7:1-30. [DOI: 10.13105/wjma.v7.i1.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 12/16/2018] [Accepted: 12/30/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Clinical empathy leads to improved patient satisfaction and better clinical outcomes. Currently, there are multiple empathy scales with minimal or no efforts to produce an integrated definition of clinical empathy which can be assessed sufficiently by only a few scales. Moreover, there is an unclear overall reliability of these empathy scales, hence limiting comparative evaluation.
AIM To examine which empathy scales have been used in healthcare students and to estimate their overall internal consistency.
METHODS A systematic review was performed with inclusion criteria any empirical study with quantitative data examining empathy of healthcare students toward patients between 2012 and 2016. A random effects model was used to produce a pooled estimate of the Cronbach’s alphas. The Hakstian-Whalen transformation was used for analyses based on the Rodriguez-Maeda method. Heterogeneity was quantified using the I2 statistic and further investigated with subgroup analysis and meta-regression. Publication bias was assessed using funnel plots, Egger’s test, Begg’s test, and the trim and fill analysis.
RESULTS Thirteen scales have been used to assess clinical empathy in healthcare students from forty nine studies with total sample size 49384 students. The most frequently used scale is the Jefferson Scale of Physician Empathy followed by Davis’ Interpersonal Reactivity Index. The overall reliability was 0.805 (95%CI 0.786-0.823), which is acceptable, but there was heterogeneity and publication bias. Some heterogeneity was explained by the different countries of the studies under investigation and student types but most heterogeneity remained unexplained.
CONCLUSION The results indicate that scales have satisfactory internal consistency but there are a multitude of scales, definitions and empathy components. Future research should focus on standardizing scales and creating consensus statements regarding the definition of empathy and use of appropriate scales.
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Affiliation(s)
- Konstantinos C Fragkos
- GI Services, University College London Hospitals NHS Foundation Trust, London NW1 2PG, United Kingdom
- Medical School, University College London, London WC1E 6BT, United Kingdom
| | - Ioannis Sotiropoulos
- Department of Accounting and Finance, University of Ioannina, Psathaki 481 00 Preveza, Greece
| | - Christos C Frangos
- Greek Research Institute for the Study of Quantitative, Social and Biomedical Problems, Athens 141 21, Greece
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Maggio LA, Thomas A, Chen HC, Ioannidis JPA, Kanter SL, Norton C, Tannery NH, Artino AR. Examining the readiness of best evidence in medical education guides for integration into educational practice: A meta-synthesis. PERSPECTIVES ON MEDICAL EDUCATION 2018; 7:292-301. [PMID: 30229529 PMCID: PMC6191397 DOI: 10.1007/s40037-018-0450-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
BACKGROUND To support evidence-informed education, health professions education (HPE) stakeholders encourage the creation and use of knowledge syntheses or reviews. However, it is unclear if these knowledge syntheses are ready for translation into educational practice. Without understanding the readiness, defined by three criteria-quality, accessibility and relevance-we risk translating weak evidence into practice and/or providing information that is not useful to educators. METHODS A librarian searched Web of Science for knowledge syntheses, specifically Best Evidence in Medical Education (BEME) Guides. This meta-synthesis focuses on BEME Guides because of their explicit goal to inform educational practice and policy. Two authors extracted data from all Guides, guided by the 25-item STructured apprOach to the Reporting In healthcare education of Evidence Synthesis (STORIES). RESULTS Forty-two Guides published in Medical Teacher between 1999 and 2017 were analyzed. No Guide met all STORIES criteria, but all included structured summaries and most described their literature search (n = 39) and study inclusion/exclusion (n = 40) procedures. Eleven Guides reported the presence of theory and/or educational principles, and eight consulted with external subject matter experts. Accessibility to each Guide's full-text and supplemental materials was variable. DISCUSSION For a subset of HPE knowledge syntheses, BEME Guides, this meta-synthesis identifies factors that support readiness and indicates potential areas of improvement, such as consistent access to Guides and inclusion of external subject matter experts on the review team. This analysis is useful for understanding the current readiness of HPE knowledge syntheses and informing future reviews to evolve so they can catalyze translation of evidence into educational practice.
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Affiliation(s)
- Lauren A Maggio
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
| | | | - H Carrie Chen
- Georgetown University School of Medicine, Washington, DC, USA
| | - John P A Ioannidis
- School of Medicine and Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, CA, USA
| | - Steven L Kanter
- School of Medicine, University of Missouri-Kansas City, Kansas City, MO, USA
| | | | | | - Anthony R Artino
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA
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Alberti H, Atkinson J. Twelve tips for the recruitment and retention of general practitioners as teachers of medical students. MEDICAL TEACHER 2018; 40:227-230. [PMID: 28845726 DOI: 10.1080/0142159x.2017.1370082] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
BACKGROUND Primary care physicians have become a fundamental aspect of teaching in modern medical school curricula worldwide with a significant proportion of undergraduate teaching taking place in primary care. There are calls for this to increase with more patient care occurring in the community but teaching capacity in primary care is a potential challenge. Medical schools, therefore, need strategies to be able to increase their primary care physician teaching workforce. METHODOLOGY We asked all Heads of General Practice Teaching in UK medical schools to share their three top tips for recruiting and retaining GPs to teach undergraduate students. The majority (two-thirds) of medical schools responded and we have summarized the answers into the following twelve tips. RESULTS Although the twelve tips are varied and comprehensive, including broad topics such as finances and training, one clear theme running through the majority of tips is good communication and relationships between education teams and GPs. CONCLUSIONS The solutions to recruiting and retaining GPs to teach undergraduate medical students are clearly multifactorial and complex. We hope that by presenting suggestions from UK GP heads of teaching as these twelve tips provides some helpful, thought-provoking ideas and inspiration for both the UK and internationally.
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Affiliation(s)
- Hugh Alberti
- a School of Medical Education , Newcastle University , Newcastle upon Tyne , UK
| | - Jane Atkinson
- a School of Medical Education , Newcastle University , Newcastle upon Tyne , UK
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Foreback J, Kusz H, Lepisto BL, Pawlaczyk B. Empathy in Internal Medicine Residents at Community-based Hospitals: A Cross-sectional Study. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2018; 5:2382120518771352. [PMID: 29780888 PMCID: PMC5954310 DOI: 10.1177/2382120518771352] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Accepted: 03/21/2018] [Indexed: 06/08/2023]
Abstract
INTRODUCTION Many research reports revealed declining empathy in medical schools that continues in postgraduate years of training. OBJECTIVE The aim of this study is to examine the self-reported empathy levels of internal medicine (IM) residents in 3 community-based teaching hospitals. METHODS The Jefferson Scale of Physician Empathy, Health Professionals version, is an online, self-administered, questionnaire that was offered to 129 current and incoming residents at 1 osteopathic and 2 allopathic, IM training programs in Flint, Michigan. RESULTS Forty-five residents responded (35% response rate). Our residents' cumulative mean empathy score was 112.5 with a SD of 12.72, which is comparable with the cumulative empathy scores for IM residents at university hospitals. There was an increase in empathy score from the beginning level of training, postgraduate year 0 (PGY0), to the PGY1 level, and a noticeable, although statistically non-significant, decrease in empathy score for both PGY2 and PGY3 residents. The graduating residents' scores were higher compared with incoming residents. CONCLUSIONS The cumulative mean empathy score in community-based IM residents showed an increase in the beginning of residents' training and decrease in empathy score by the end of training. There were significant differences in empathy scores by level of training at individual hospitals. This might be related to different targeted curricula.
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Affiliation(s)
- Jami Foreback
- McLaren-Flint Graduate Medical Education, College of Human Medicine, Michigan State University, Flint, MI, USA
| | - Halina Kusz
- McLaren-Flint Graduate Medical Education, College of Human Medicine, Michigan State University, Flint, MI, USA
| | - Brenda Lovegrove Lepisto
- Hurley Medical Center Internal Medicine Residency Program, College of Human Medicine, Michigan State University, Flint, MI, USA
| | - Barbara Pawlaczyk
- Genesys Medical Center Internal Medicine Residency Program, Colleges of Human Medicine and Osteopathic Medicine, Michigan State University, Grand Blanc, MI, USA
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Patient participation in general practice based undergraduate teaching: a focus group study of patient perspectives. Br J Gen Pract 2017; 67:e260-e266. [PMID: 28360073 DOI: 10.3399/bjgp17x690233] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 11/14/2016] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Patients make a crucial contribution to undergraduate medical education. Although a national resource is available for patients participating in research, none is as yet available for education. AIM This study aimed to explore what information patients would like about participation in general practice based undergraduate medical education, and how they would like to obtain this information. DESIGN AND SETTING Two focus groups were conducted in London-based practices involved in both undergraduate and postgraduate teaching. METHOD Patients both with and without teaching experience were recruited using leaflets, posters, and patient participation groups. An open-ended topic guide explored three areas: perceived barriers that participants anticipated or had experienced; patient roles in medical education; and what help would support participation. Focus groups were audiorecorded, transcribed, and analysed thematically. RESULTS Patients suggested ways of professionalising the teaching process. These were: making information available to patients about confidentiality, iterative consent, and normalising teaching in the practice. Patients highlighted the importance of relationships, making information available about their GPs' involvement in teaching, and initiating student-patient interactions. Participants emphasised educational principles to maximise exchange of information, including active participation of students, patient identification of student learner needs, and exchange of feedback. CONCLUSION This study will inform development of patient information resources to support their participation in teaching and access to information both before and during general practice based teaching encounters.
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Exposure of undergraduates to authentic GP teaching and subsequent entry to GP training: a quantitative study of UK medical schools. Br J Gen Pract 2017; 67:e248-e252. [PMID: 28246097 DOI: 10.3399/bjgp17x689881] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 11/17/2016] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND It has been suggested that the quantity of exposure to general practice teaching at medical school is associated with future choice of a career as a GP. AIM To examine the relationship between general practice exposure at medical school and the percentage of each school's graduates appointed to a general practice training programme after foundation training (postgraduate years 1 and 2). DESIGN AND SETTING A quantitative study of 29 UK medical schools. METHOD The UK Foundation Programme Office (UKFPO) destination surveys of 2014 and 2015 were used to determine the percentage of graduates of each UK medical school who were appointed to a GP training programme after foundation year 2. The Spearman rank correlation was used to examine the correlation between these data and the number of sessions spent in placements in general practice at each medical school. RESULTS A statistically significant association was demonstrated between the quantity of authentic general practice teaching at each medical school and the percentage of its graduates who entered GP training after foundation programme year 2 in both 2014 (correlation coefficient [r] 0.41, P = 0.027) and 2015 (r 0.3, P = 0.044). Authentic general practice teaching here is described as teaching in a practice with patient contact, in contrast to non-clinical sessions such as group tutorials in the medical school. DISCUSSION The authors have demonstrated, for the first time in the UK, an association between the quantity of clinical GP teaching at medical school and entry to general practice training. This study suggests that an increased use of, and investment in, undergraduate general practice placements would help to ensure that the UK meets its target of 50% of medical graduates entering general practice.
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Ryan PSJ, Gormley GJ, Hart ND. Preparation for practice: a novel role for general practice in pre-foundation assistantships. EDUCATION FOR PRIMARY CARE 2017; 28:210-215. [PMID: 28193125 DOI: 10.1080/14739879.2017.1289824] [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: 10/20/2022]
Abstract
BACKGROUND Hospital-based undergraduate assistantships are now widely established in medical school curricula. They are considered to improve graduates' preparedness for practice in their role as a foundation doctor. Foundation doctors play a key team role in ensuring patient safety during complex transitions across the hospital/primary care interface, and their self-reported preparedness for practice still varies considerably. AIMS We sought to explore what spending one week of the pre-foundation assistantship in General Practice might add. METHODS We solicited reflective audio diaries from final year students during a one-week pilot attachment delivered during the post-finals, pre-foundation assistantship period, and performed an iterative thematic analysis on the acquired data. RESULTS From this attachment in General Practice, students described diverse learning, resulting in improved preparedness for (hospital) foundation practice across several domains, impacting positively on how they might approach patients in the future. Self-confidence improved due to affirming outcomes and tutor mentorship. Students deepened their understanding of community healthcare and General Practice; and seeing the 'Patient Journey' across the interface from the patient's perspective helped them contextualise their forthcoming role as foundation doctors in managing it. DISCUSSION We believe that this novel intervention distinctively contributed to preparedness for practice. It aligns with published recommendations about extending the current assistantship model. We suggest it should be incorporated more widely into pre-foundation assistantship curricula.
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Affiliation(s)
- Peter S J Ryan
- a Centre for Medical Education , Queen's University Belfast , Belfast , UK
| | - Gerard J Gormley
- a Centre for Medical Education , Queen's University Belfast , Belfast , UK
| | - Nigel D Hart
- a Centre for Medical Education , Queen's University Belfast , Belfast , UK
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Prediger S, Harendza S. Analysis of educational research at a medical faculty in Germany and suggestions for strategic development - a case study. GMS JOURNAL FOR MEDICAL EDUCATION 2016; 33:Doc71. [PMID: 27990467 PMCID: PMC5135420 DOI: 10.3205/zma001070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 07/07/2016] [Accepted: 07/29/2016] [Indexed: 06/06/2023]
Abstract
Background: Evidence-based medical education is playing an increasingly important role in the choice of didactic methods and the development of medical curricula and assessments. In Germany, a growing number of educational research projects has accompanied an ongoing change in the medical education process. The aim of this project was to assess medical education research activities at one medical faculty to develop procedural recommendations for the support and development of best evidence medical education. Methods: Using a newly developed online questionnaire, the 65 institutes and departments of the medical faculty of Hamburg University at Hamburg University Medical-Center (UKE) were asked to report their medical education research and service projects, medical education publications, medical education theses, financial support for educational projects, and supportive structures that they would consider helpful in the future. The data were grouped, and a SWOT analysis was performed. Results: In total, 60 scientists who were involved in 112 medical education research publications between 1998 and 2014 were identified at the UKE. Twenty-five of them had published at least one manuscript as first or last author. Thirty-three UKE institutions were involved in educational service or research projects at the time of the study, and 75.8% of them received internal or external funding. Regular educational research meetings and the acquisition of co-operation partners were mentioned most frequently as beneficial supportive structures for the future. Conclusion: An analysis to define the status quo of medical education research at a medical faculty seems to be a helpful first step for the development of a strategy and structure to further support researchers in medical education.
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Affiliation(s)
- Sarah Prediger
- University Hospital Hamburg-Eppendorf, III. Medical Clinic, Hamburg, Germany
| | - Sigrid Harendza
- University Hospital Hamburg-Eppendorf, III. Medical Clinic, Hamburg, Germany
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Shemilt I, Khan N, Park S, Thomas J. Use of cost-effectiveness analysis to compare the efficiency of study identification methods in systematic reviews. Syst Rev 2016; 5:140. [PMID: 27535658 PMCID: PMC4989498 DOI: 10.1186/s13643-016-0315-4] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Accepted: 08/04/2016] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Meta-research studies investigating methods, systems, and processes designed to improve the efficiency of systematic review workflows can contribute to building an evidence base that can help to increase value and reduce waste in research. This study demonstrates the use of an economic evaluation framework to compare the costs and effects of four variant approaches to identifying eligible studies for consideration in systematic reviews. METHODS A cost-effectiveness analysis was conducted using a basic decision-analytic model, to compare the relative efficiency of 'safety first', 'double screening', 'single screening' and 'single screening with text mining' approaches in the title-abstract screening stage of a 'case study' systematic review about undergraduate medical education in UK general practice settings. Incremental cost-effectiveness ratios (ICERs) were calculated as the 'incremental cost per citation 'saved' from inappropriate exclusion' from the review. Resource use and effect parameters were estimated based on retrospective analysis of 'review process' meta-data curated alongside the 'case study' review, in conjunction with retrospective simulation studies to model the integrated use of text mining. Unit cost parameters were estimated based on the 'case study' review's project budget. A base case analysis was conducted, with deterministic sensitivity analyses to investigate the impact of variations in values of key parameters. RESULTS Use of 'single screening with text mining' would have resulted in title-abstract screening workload reductions (base case analysis) of >60 % compared with other approaches. Across modelled scenarios, the 'safety first' approach was, consistently, equally effective and less costly than conventional 'double screening'. Compared with 'single screening with text mining', estimated ICERs for the two non-dominated approaches (base case analyses) ranged from £1975 ('single screening' without a 'provisionally included' code) to £4427 ('safety first' with a 'provisionally included' code) per citation 'saved'. Patterns of results were consistent between base case and sensitivity analyses. CONCLUSIONS Alternatives to the conventional 'double screening' approach, integrating text mining, warrant further consideration as potentially more efficient approaches to identifying eligible studies for systematic reviews. Comparable economic evaluations conducted using other systematic review datasets are needed to determine the generalisability of these findings and to build an evidence base to inform guidance for review authors.
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Affiliation(s)
- Ian Shemilt
- Social Sciences Research Unit, UCL Institute of Education, London, UK.
| | - Nada Khan
- Department of Primary Care and Population Health, University College London, London, UK
| | - Sophie Park
- Department of Primary Care and Population Health, University College London, London, UK
| | - James Thomas
- Social Sciences Research Unit, UCL Institute of Education, London, UK
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Jesani H, Jesani L. Is three a crowd in a general practice setting? A medical student's view. MEDICAL EDUCATION 2016; 50:880. [PMID: 27402047 DOI: 10.1111/medu.13090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
| | - Lara Jesani
- Cardiff University, School of Medicine, Cardiff, UK
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How can medical schools encourage students to choose general practice as a career? Br J Gen Pract 2016; 66:292-3. [PMID: 27162207 DOI: 10.3399/bjgp16x685297] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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Partanen R, Ranmuthugala G, Kondalsamy-Chennakesavan S, van Driel M. Is three a crowd? Impact of the presence of a medical student in the general practice consultation. MEDICAL EDUCATION 2016; 50:225-235. [PMID: 26813001 DOI: 10.1111/medu.12935] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Revised: 07/30/2015] [Accepted: 09/21/2015] [Indexed: 06/05/2023]
Abstract
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.
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Affiliation(s)
- Riitta Partanen
- The University of Queensland, Hervey Bay, Queensland, Australia
| | | | | | - Mieke van Driel
- The University of Queensland, Hervey Bay, Queensland, Australia
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