Strengthening general practice by extending specialty training?

General practice undergraduate and vocational training: ambulatory teaching and trainers' curriculum and remuneration - a cross-sectional study among 30 member countries of WONCA Europe

BACKGROUND

After a long phase without any propositions for real ambulatory training inside general practitioners' offices, general practice (GP) vocational training has begun to appear progressively and has been integrated into undergraduate medical programmes. The aim of this study was to provide an overview of GP vocational training and GP trainers in member countries of the World Organization of National Colleges, Academies and Academic Associations of General Practitioners/Family Physicians (WONCA) Europe.

METHOD

We carried out this cross-sectional study between September 2018 and March 2020. The participants responded to a questionnaire in real-life conversations, video conferences or e-mail exchanges. The respondents included GP trainers, teachers and general practitioners involved in the GP curriculum recruited during European GP congresses.

RESULTS

Representatives from 30 out of 45 WONCA Europe member countries responded to the questionnaire. Based on their responses, there is a well-established period for GP internships in undergraduate medical programmes, but with varying lengths. The programmes for some countries offer an internship after students graduate from medical school but before GP specialisation to ensure the career choice of the trainees. After specialisation, private practice GP internships are offered; however, in-hospital GP internships are more common. GP trainees no longer have a passive role during their internships. GP trainers are selected based on specific criteria and in countries, they have to follow some teacher training programmes. In addition to income from medical appointments carried out by GP trainees, GP trainers from some countries receive additional remuneration from various organisations.

CONCLUSION

This study collected information on how undergraduate and postgraduate medical students are exposed to GP, how GP training is organised and the actual status of GP trainers among WONCA Europe member countries. Our exploration of GP training provides an update of the data collected by Isabel Santos and Vitor Ramos in the 1990s and describes some specificities that can inspire other organisations to prepare young, highly qualified general practitioners.

Learning objectives of Belgian general practitioner trainees regarding their hospital training: A qualitative study

Background

In Europe, hospital training is integrated in the postgraduate curriculum of General Practitioners (GPs) according to the European Directives. However, little is known about the specific learning objectives of GP trainees during this training.

Objectives

This exploratory study investigated GP trainees’ expected learning objectives for their hospital training and the factors influencing the learning process.

Methods

Semi-structured interviews were conducted in three focus groups consisting of first-year GP trainees before their hospital training. Data were coded thematically and analysed in NVivo.

Results

A total of 22 Belgian GP trainees (55% females, average age of 26.2 years) were interviewed. Three major themes emerged: learning objectives, factors influencing learning and organisational aspects. GP trainees mainly wanted to improve their knowledge of common conditions by conducting consultations and follow certain patients’ hospitalisation trajectory. Emergency medicine or internal medicine was the preferred specialty. Other GP trainees wanted to learn more about some specific conditions. Conversely, an overloaded work schedule was dreaded to hinder effective learning. Regular meetings and supervision from their hospital trainer were deemed crucial to strengthen GP trainees’ learning trajectory.

Conclusion

GP trainees wanted to learn more about both common conditions and some specific conditions. Their previous year in a GP setting strengthened their confidence and facilitated purposeful learning. Relieving GP trainees from administrative tasks when working as supplementary doctors could strike a better balance between the continuity of the clinical department and their personal learning objectives.

An exploratory study on the mode and method of general education and training for general practice undergraduates: a narrative review

Objective

To learn from the experience of foreign general practice education mode, and to exploratory study on the mode and method of general education and training for general practice undergraduates in China.

Background

The rise of general practice medicine addresses the lack of holistic attention to patients in specialist medicine. General practice education is an important means of training general practice skills, but the development of general practice education in China is not yet matured.

Methods

By using the method of comparative education, taking the United States, Australia, France and Britain as examples. This article makes a comparative analyzes the status of general practice education in foreign countries and discusses the development of undergraduate general practice education in China from four perspectives: national policy, teacher resources, curriculum system, and education training modes.

Conclusions

The four countries attach great importance to general practice education, with mature training methods, registered practice and continuing education. It is hoped that this article can establish and improve the policy system for the development of general subject teachers and optimize the inclusive, assessment and evaluation system of general practice teachers. In addition, more attention should be paid to general practice scientific research to create a teaching team with high standards, high quality, and high scientific research literacy and to form standardized scientific teaching methods that promote the development of general medicine education and training through high-quality teaching experiences. In addition, more attention should be paid to general practice scientific research to create a teaching team with high standards, high quality, and high scientific research literacy and to form standardized scientific teaching methods that promote the development of general medicine education and training through high-quality teaching experiences.

‘Evaluation of the First Year(s) of Physicians’ Collaboration on an Interdisciplinary Electronic Consultation Platform in the Netherlands: a mixed-methods observational study. (Preprint)

Background

Complexity of health problems and aging of the population create an ongoing burden on the health care system with the general practitioner (GP) being the gatekeeper in primary care. In GPs daily practice, collaboration with specialists and exchange of knowledge from the secondary care play a crucial role in this system. Communication between primary and secondary care has shortcomings for health care workers that want to practice sustainable patient-centered health care. Therefore, a new digital interactive platform was developed: Prisma.

Objective

This study aims to describe the development of a digital consultation platform (Prisma) to connect GPs with hospital specialists via the Siilo application and to evaluate the first year of use, including consultations, topic diversity, and number of participating physicians.

Methods

We conducted a mixed methods observational study, analyzing qualitative and quantitative data for cases posted on the platform between June 2018 and May 2020. Any GP can post questions to an interdisciplinary group of secondary care specialists, with the platform designed to facilitate discussion and knowledge exchange for all users.

Results

In total, 3674 cases were posted by 424 GPs across 16 specialisms. Most questions and answers concerned diagnosis, nonmedical treatment, and medication. Mean response time was 76 minutes (range 44-252). An average of 3 users engaged with each case (up to 7 specialists). Almost half of the internal medicine cases received responses from at least two specialisms in secondary care, contrasting with about one-fifth for dermatology. Of note, the growth in consultations was steepest for dermatology.

Conclusions

Digital consultations offer the possibility for GPs to receive quick responses when seeking advice. The interdisciplinary approach of Prisma creates opportunities for digital patient-centered networking.

Exploring educational integrated training posts in general practice: a phenomenological study of trainees' perspectives

This study explores the experience of undertaking an educational integrated training post (ITP) in general practice. There are problems with General Practice (GP) recruitment and retention in the UK and worldwide. It is thought that integrated training programmes (ITPs) within GP training may offer a new and appealing way of training, which may address this problem. Health Education England North East (HEENE) has been running educational integrated training posts for over 5 years. Integrated training schemes such as this have been rarely studied and in particular the trainees' perspectives. In order to improve understanding of these posts and their potential for aiding GP recruitment, we undertook a qualitative study to explore trainees' perceptions of the experience of undertaking an educational ITP. The study takes an interpretive phenomenological approach using focus groups and one-to-one interviews which were audio-recorded, transcribed and thematically analysed. Emerging themes from the data captured participants' views of their experience of undertaking the posts, as well as the factors influencing their decisions to undertake the posts. The overarching theme found centred on identity formation. The study draws upon social learning theories to help understand and explain the themes identified and the influence on the individuals. For the interested stakeholder, this provides an insight into the individuals' experience and highlights important areas that could be targeted and utilised in the development of future general practice training models.

Investigation and analysis of standardized training for residents of general practitioners of Gansu Province in China

BACKGROUND

China's standardized training for residents of General Practitioners (GPs) is aimed at providing the postgraduate training for family doctors who will serve the primary health care institutions. The aim of this paper is to investigate the standardized training situation, satisfaction with standardized training, work situation, intention, satisfaction and attitude of GPs who have finished standardized training.

METHODS

This study was undertaken in 6 training hospitals in Gansu province using a questionnaire with 45 questions.

RESULTS

Approximately 275 residents of GPs were enrolled. Finally, 263 residents completed the questionnaire (95.64% response rate), including 133 females (50.57%) and 130 males (49.43%) with an average age of 28 years (standard deviation, 1.93 years; range, 25-36 years). Additionally, 56.65% were single and 43.35% were married. Of all subjects, 92.40% residents had obtained certification of standardized training for residents of GPs and only 39.54% residents were satisfied with monthly income during training. There were 171 oriented rural medical graduates, of whom, only 42.69% expressed the willing to continue working in the primary health care institutions after the serve time (6 years) expired. Around 86.31% of residents of GPs who had finished standardized training got jobs with more than half serving in the primary health care institutions. For medical institutions and sanitary bureau were clear about general medicine policies, only 29.96% subjects registered as GPs. Among the residents in general practice department, 68.42% were engaged in the diagnosis and treatment of common disease and frequently-occurring diseases as well as referral of patients. The percentage of residents who were satisfied with the job and income were 30.40 and 14.98%, respectively.

CONCLUSION

Standardized training for residents of GPs in China is gradually improving. In order to cultivate more GPs and increase their willing to serve in the primary health care institutions, it is necessary to formulate and execute better policy of GPs, publize general medicine and improve the training quality.