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Crombie A, Lingam S, Pascoe A, Disler P, Asaid A, Disler R. Rural general practitioner confidence in diagnosing and managing dementia: A two-stage, mixed methods study of dementia-specific training. Aust J Rural Health 2024; 32:263-274. [PMID: 38268187 DOI: 10.1111/ajr.13082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 10/16/2023] [Accepted: 01/07/2024] [Indexed: 01/26/2024] Open
Abstract
INTRODUCTION Dementias a prevalent chronic healthcare condition affecting 46 million people worldwide and projected to grow in the coming years. Australians living in rural and regional areas often lack access to specialist dementia care, despite greater prevalence relative to metropolitan areas. OBJECTIVE This study aimed to explore general practitioners (GP) understanding, confidence and attitudes towards dementia management in the rural context, and design and pilot a dementia-specific training program. DESIGN A two-stage, mixed methods design, using qualitative and quantitative methods. Sixteen regional GPs from across Victoria participated in scoping semi-structured interviews. Fourteen separate GPs in the St Anthony Family Medical Practice group in the regional Loddon-Mallee area of Victoria completed the pilot training intervention. Pre- and post-training surveys (n = 10), as well as post-training interviews (n = 10), assessed attitude and knowledge changes. FINDINGS Analysis of semi-structured scoping interviews indicated three themes regarding experience of dementia management, including: (1) attitudes to and experiences of dementia; (2) supporting people living with dementia; and (3) knowledge, education and training of dementia. The pilot dementia-specific training was found to improve attitudes (agreement across 24 best-practice indicators improved from 30% to 79%), knowledge (median increase of 2.5/10) and confidence in managing dementia and disclosing dementia diagnoses (median increase 3/10 and 2.75/10, respectively). DISCUSSION General practitioners in this study lacked initial confidence in detecting and managing dementia in a rural primary care setting. A targeted training program showed improvements in these areas. CONCLUSION Accessible, locally delivered, dementia education has the potential to improve confidence in early detection and management of people with dementia and thereby may address gaps in access to care for people living with dementia in rural settings.
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Affiliation(s)
- Angela Crombie
- School of Rural Health, Monash University, Clayton, Victoria, Australia
- Research and Innovation, Bendigo Health, Bendigo, Victoria, Australia
| | - Shivanjali Lingam
- Department of Rural Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Shepparton, Victoria, Australia
| | - Amy Pascoe
- Department of Rural Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Shepparton, Victoria, Australia
| | - Peter Disler
- School of Rural Health, Monash University, Clayton, Victoria, Australia
- Department of Rural Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Shepparton, Victoria, Australia
- St Anthony Memory Service (SAMS), Strathfieldsaye, Bendigo, Victoria, Australia
| | - Adel Asaid
- St Anthony Memory Service (SAMS), Strathfieldsaye, Bendigo, Victoria, Australia
| | - Rebecca Disler
- Department of Rural Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Shepparton, Victoria, Australia
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Yang S, Zhao H, Zhang H, Wang J, Jin H, Stirling K, Ge X, Ma L, Pu Z, Niu X, Yu D. Current status and continuing medical education need for general practitioners in Tibet, China: a cross-sectional study. BMC Med Educ 2024; 24:265. [PMID: 38459539 PMCID: PMC10924353 DOI: 10.1186/s12909-024-05143-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 02/07/2024] [Indexed: 03/10/2024]
Abstract
BACKGROUND The Tibetan area is one of China's minority regions with a shortage of general practice personnel, which requires further training and staffing. This research helps to understand the current condition and demand for general practitioner (GP) training in Tibetan areas and to provide a reference for promoting GP education and training. METHODS We conducted a cross-sectional survey using stratified sampling targeting 854 GPs in seven cities within the Tibetan Autonomous Region, utilizing an online questionnaire. Achieving a high response rate of 95.1%, 812 GPs provided invaluable insights. Our meticulously developed self-designed questionnaire, available in both Chinese and Tibetan versions, aimed to capture a wide array of data encompassing basic demographics, clinical skills, and specific training needs of GPs in the Tibetan areas. Prior to deployment, the questionnaire underwent rigorous development and refinement processes, including expert consultation and pilot testing, to ensure its content validity and reliability. In our analysis, we employed descriptive statistics to present the characteristics and current training needs of GPs in the Tibetan areas. Additionally, chi-square tests were utilized to examine discrepancies in training needs across various demographic groups, such as age, job positions, and educational backgrounds of the participating GPs. RESULTS The study was completed by 812 (812/854, 95.1%) GPs, of whom 62.4% (507/812) were female. The top three training needs were hypertension (81.4%, 661/812), pregnancy management (80.7%, 655/812), and treatment of related patient conditions and events (80.5%, 654/812). Further research shows that the training required by GPs of different ages in "puncturing, catheterization, and indwelling gastric tube use" (64.6% vs. 54.8%, p = 9.5 × 10- 6) varies statistically. GPs in various positions have different training needs in "community-based chronic disease prevention and management" (76.6% vs. 63.9%, p = 0.009). The training needs of GPs with different educational backgrounds in "debridement, suturing, and fracture fixation" (65.6% vs. 73.2%, p = 0.027) were also statistically significant. CONCLUSIONS This study suggests the need for targeted continuing medical education activities and for updating training topics and content. Course developers must consider the needs of GPs, as well as the age, job positions, and educational backgrounds of GPs practicing in the Tibetan Plateau region. TRIAL REGISTRATION Not applicable.
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Affiliation(s)
- Sen Yang
- Department of General Practice, Research Center for General Practice, Yangpu Hospital, School of Medicine, Tongji University, 450 Tengyue Road, Yangpu District, Shanghai, 200090, PR China
- Department of General Practice, Lazi County Health Service Center, Xigatse, Tibet, 858100, PR China
| | - Huaxin Zhao
- Department of Oncology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, PR China
| | - Hanzhi Zhang
- Department of General Practice, Research Center for General Practice, Yangpu Hospital, School of Medicine, Tongji University, 450 Tengyue Road, Yangpu District, Shanghai, 200090, PR China
| | - Junpeng Wang
- Medical Administration Affiliationision, Yangpu Hospital, Tongji University School of Medicine, Shanghai, 200090, PR China
| | - Hua Jin
- Department of General Practice, Research Center for General Practice, Yangpu Hospital, School of Medicine, Tongji University, 450 Tengyue Road, Yangpu District, Shanghai, 200090, PR China
- Shanghai General Practice and Community Health Development Research Center, Shanghai, 200090, PR China
| | - Kyle Stirling
- Crisis Technologies Innovation Lab, Luddy School of Informatics, Computing and Engineering, Indiana University, Bloomington, IN, 47408, USA
| | - Xuhua Ge
- Department of General Practice, Research Center for General Practice, Yangpu Hospital, School of Medicine, Tongji University, 450 Tengyue Road, Yangpu District, Shanghai, 200090, PR China
| | - Le Ma
- Department of General Practice, Research Center for General Practice, Yangpu Hospital, School of Medicine, Tongji University, 450 Tengyue Road, Yangpu District, Shanghai, 200090, PR China
| | - Zhen Pu
- Department of General Practice, Lazi County Health Service Center, Xigatse, Tibet, 858100, PR China
| | - Xiaomin Niu
- Department of Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, 241 Huaihai West Road, Shanghai, 200030, PR China.
| | - Dehua Yu
- Department of General Practice, Research Center for General Practice, Yangpu Hospital, School of Medicine, Tongji University, 450 Tengyue Road, Yangpu District, Shanghai, 200090, PR China.
- Shanghai General Practice and Community Health Development Research Center, Shanghai, 200090, PR China.
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Khan UI, Farazdaq H, Naseem A, Suleman W, Saleem S, Qadir MA, Fatima K. Evaluation of FamMed essentials: a blended-learning program for capacity building of general practitioners in Pakistan. BMC Med Educ 2024; 24:218. [PMID: 38429735 PMCID: PMC10908083 DOI: 10.1186/s12909-024-05069-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 01/18/2024] [Indexed: 03/03/2024]
Abstract
BACKGROUND To provide access to primary care and universal health coverage, Pakistan requires 60,000 trained family physicians by 2030. At present, most primary care is provided by general practitioners (GPs) who do not have any post-graduate training. Empowering GPs through competency-based programs, that strengthen their knowledge and skills, may be a cost-effective strategy for improving healthcare quality. We describe the development and evaluation of FamMed Essentials, a modular, blended-learning program to improve clinical knowledge and skills of GPs. METHODS This is a mixed method study. We used the CIPP (content, input, process and product) framework for course development and evaluation. We describe the steps used in content development, strategies for teaching and assessments, and evaluation of strengths and weaknesses of the program. In depth focus group discussions were conducted to gather insight on participants' and faculty's perceptions regarding the program's effectiveness. RESULTS Of the 137 participants who have completed the program, 72% were women and 49% had been practicing for more than five years. We saw a significant improvement in knowledge across all modules (p = < 0.001) and perceived confidence in clinical skills (p = < 0.001). An objective assessment showed participants' competence in patient management. Participants reported a high level of satisfaction (4.4 ± 0.83 on a 5-point Likert Scale). Focus group discussions revealed a positive impact on clinical practice. Flexibility and use of different teaching and learning strategies were additional strengths. In addition, participants reported an interest in further training. Power outages were highlighted as a major challenge. CONCLUSION In resource-constrained health systems, a modular, blended-learning, competency-based program is helpful to upgrade GPs knowledge without impacting their busy schedules. Accreditation of such programs and provision of a career trajectory for the trained GPs are pivotal to expansion of such initiatives.
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Affiliation(s)
- Unab I Khan
- Department of Family Medicine, Aga Khan University, Karachi, Pakistan.
| | - Hamida Farazdaq
- Department of Family Medicine, Aga Khan University, Karachi, Pakistan
| | - Azra Naseem
- Blended & Digital Learning Network, Aga Khan University, Karachi, Pakistan
| | - Waseem Suleman
- Department of Family Medicine, Aga Khan University, Karachi, Pakistan
| | - Sania Saleem
- Department of Family Medicine, Aga Khan University, Karachi, Pakistan
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Klein L, Bentley M, Moad D, Fielding A, Tapley A, van Driel M, Davey A, Mundy B, FitzGerald K, Taylor J, Norris R, Holliday E, Magin P. Perceptions of the effectiveness of using patient encounter data as an education and reflection tool in general practice training. J Prim Health Care 2024; 16:12-20. [PMID: 38546767 DOI: 10.1071/hc22158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 05/18/2023] [Indexed: 04/02/2024] Open
Abstract
Introduction Patient encounter tools provide feedback and potentially reflection on general practitioner (GP) registrars' in-practice learning and may contribute to the formative assessment of clinical competencies. However, little is known about the perceived utility of such tools. Aim To investigate the perceived utility of a patient encounter tool by GP registrars, their supervisors, and medical educators (MEs). Methods General practice registrars, supervisors and MEs from two Australian regional training organisations completed a cross-sectional questionnaire. Registrars rated how Registrar Clinical Encounters in Training (ReCEnT), a patient encounter tool, influenced their reflection on, and change in, clinical practice, learning and training. Supervisors' and MEs' perceptions provided contextual information about understanding their registrars' clinical practice, learning and training needs. Results Questionnaires were completed by 48% of registrars (n = 90), 22% of supervisors (n = 182), and 61% of MEs (n = 62). Most registrars agreed that ReCEnT helped them reflect on their clinical practice (79%), learning needs (69%) and training needs (72%). Many registrars reported changing their clinical practice (54%) and learning approaches (51%). Fewer (37%) agreed that ReCEnT influenced them to change their training plans. Most supervisors (68%) and MEs (82%) agreed ReCEnT reports helped them better understand their registrars' clinical practice. Similarly, most supervisors (63%) and MEs (68%) agreed ReCEnT reports helped them better understand their registrars' learning and training needs. Discussion ReCEnT can prompt self-reflection among registrars, leading to changes in clinical practice, learning approaches and training plans. Reaching its potential as an assessment for learning (as opposed to an assessment of learning) requires effective engagement between registrars, their supervisors and MEs.
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Affiliation(s)
- Linda Klein
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia; and GP Synergy, NSW and ACT Research and Evaluation Unit, Level 1, 20 McIntosh Drive, Mayfield West, NSW 2304, Australia
| | - Michael Bentley
- General Practice Training Tasmania, Level 3, RACT House, 179 Murray Street, Hobart, Tas. 7000, Australia
| | - Dominica Moad
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia; and GP Synergy, NSW and ACT Research and Evaluation Unit, Level 1, 20 McIntosh Drive, Mayfield West, NSW 2304, Australia
| | - Alison Fielding
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia; and GP Synergy, NSW and ACT Research and Evaluation Unit, Level 1, 20 McIntosh Drive, Mayfield West, NSW 2304, Australia
| | - Amanda Tapley
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia; and GP Synergy, NSW and ACT Research and Evaluation Unit, Level 1, 20 McIntosh Drive, Mayfield West, NSW 2304, Australia
| | - Mieke van Driel
- General Practice Clinical Unit, Faculty of Medicine, The University of Queensland, 288 Herston Road, Brisbane, Qld 4006, Australia
| | - Andrew Davey
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia; and GP Synergy, NSW and ACT Research and Evaluation Unit, Level 1, 20 McIntosh Drive, Mayfield West, NSW 2304, Australia
| | - Ben Mundy
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia; and GP Synergy, NSW and ACT Research and Evaluation Unit, Level 1, 20 McIntosh Drive, Mayfield West, NSW 2304, Australia
| | - Kristen FitzGerald
- General Practice Training Tasmania, Level 3, RACT House, 179 Murray Street, Hobart, Tas. 7000, Australia
| | - Jennifer Taylor
- GP Synergy, NSW and ACT Research and Evaluation Unit, Level 1, 20 McIntosh Drive, Mayfield West, NSW 2304, Australia
| | - Racheal Norris
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia; and GP Synergy, NSW and ACT Research and Evaluation Unit, Level 1, 20 McIntosh Drive, Mayfield West, NSW 2304, Australia
| | - Elizabeth Holliday
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia
| | - Parker Magin
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia; and GP Synergy, NSW and ACT Research and Evaluation Unit, Level 1, 20 McIntosh Drive, Mayfield West, NSW 2304, Australia
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Gjessing S, Guldberg TL, Risør T, Skals RG, Kristensen JK. Would you like to be a general practitioner? Baseline findings of a longitudinal survey among Danish medical trainees. BMC Med Educ 2024; 24:111. [PMID: 38317110 PMCID: PMC10845756 DOI: 10.1186/s12909-024-05074-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 01/19/2024] [Indexed: 02/07/2024]
Abstract
BACKGROUND Recruiting and securing primary care physician workforce has been the center of international attention for decades. In Denmark, the number of general practitioners has decreased by 8.5% since 2013. However, a rising population age and increasing prevalence of chronic diseases and multimorbidity place an even greater future need for general practitioners in Denmark. The choice of general practice as specialty has been associated with a range of both intrinsic and extrinsic factors, however, few studies have examined the recruitment potential that lies within medical trainees' who are undecided about general practice specialization. The aim of this study was, therefore, to explore how medical trainees who are undecided about general practice specialization (GP-positive/undecided) differ from medical trainees who are either committed (GP-committed) or not committed to a general practice career (GP-non-committed) regarding factors related to future work life. METHODS The present study concerns baseline findings from a longitudinal survey study. An online questionnaire was e-mailed to a national cohort of medical trainees during their transition from under- to postgraduate education. The associations between orientations towards general practice specialization and work-related factors and potential influencing factors, respectively, were analyzed using uni- and multivariable modified Poisson regression models. RESULTS Of 1,188 invited participants, 461 filled out key study variables concerning specialty preferences and rejections, corresponding to a response rate of 38.8%. We found significant positive associations between GP-positive/undecided orientation and valuing a good work/life balance and the opportunity to organize own working hours when compared to GP-non-committed respondents. Compared to the GP-committed orientations, the GP-positive/undecided orientation was associated with a positive attitude towards technology, working shift hours, and an openness towards several career paths. Across all orientations, undergraduate exposure to the specialties was found to be highly influential on the specialty preferences. CONCLUSION GP-positive/undecided medical trainees value autonomy over their working hours more than the GP-non-committed, but less than the GP-committed. However, the GP-positive/undecided respondents present more openness to different career opportunities and the use of technology in daily work. We suggest using this knowledge in the planning of recruitment strategies aiming to increase interest in general practice specialization.
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Affiliation(s)
- Sofie Gjessing
- Center for General Practice, Aalborg University, Aalborg, Denmark.
| | - Trine Lignell Guldberg
- Department of Postgraduate Medical Education, Aalborg University Hospital, Aalborg, Denmark
| | - Torsten Risør
- Section for General Practice & Research Unit for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Section for General Practice, Department of Community Medicine, UiT, The Arctic University of Norway, Tromsø, Norway
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Fisher K, Tapley A, Ralston A, Davey A, Fielding A, van Driel M, Holliday E, Ball J, Dizon J, Spike N, Clarke L, Magin P. General practice trainees' telehealth use during the COVID-19 pandemic: a cross-sectional study. Fam Pract 2023; 40:638-647. [PMID: 36882013 PMCID: PMC10745257 DOI: 10.1093/fampra/cmad022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2023] Open
Abstract
BACKGROUND Prompted by the COVID-19 pandemic, remuneration was introduced for Australian general practice telehealth consultations. General practitioner (GP) trainees' telehealth use is of clinical, educational, and policy importance. The aim of this study was to assess the prevalence and associations of telehealth versus face-to-face consultations amongst Australian GP registrars (vocational GP trainees). METHODS Cross-sectional analysis of data from the Registrar Clinical Encounters in Training (ReCEnT) study, from 2020 to 2021 (three 6-month terms), including registrars in 3 of Australia's 9 Regional Training Organisations. In ReCEnT, GP registrars record details of 60 consecutive consultations, 6 monthly. The primary analysis used univariate and multivariable logistic regression, with outcome of whether the consultation was conducted via telehealth (phone and videoconference) or face-to-face. RESULTS 1,168 registrars recorded details of 102,286 consultations, of which 21.4% (95% confidence interval [CI]: 21.1%-21.6%) were conducted via telehealth. Statistically significant associations of a telehealth consultation included shorter consultation duration (odds ratio [OR] 0.93, 95% CI: 0.93-0.94; and mean 12.9 versus 18.7 min); fewer problems addressed per consultation (OR 0.92, 95% CI: 0.87-0.97); being less likely to seek assistance from a supervisor (OR 0.86, 95% CI: 0.76-0.96) while being more likely to generate learning goals (OR 1.18, 95% CI: 1.02-1.37); and being more likely to arrange a follow-up consultation (OR 1.18, 95% CI: 1.02-1.35). CONCLUSIONS That telehealth consultations were shorter, with higher rates of follow-up, has GP workforce/workload implications. That telehealth consultations were less likely to involve in-consultation supervisor support, but more likely to generate learning goals, has educational implications.
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Affiliation(s)
- Katie Fisher
- University of Newcastle, School of Medicine and Public Health, University Drive, Callaghan, NSW, Australia
- GP Synergy, Regional Training Organisation, NSW & ACT Research and Evaluation Unit, 20 McIntosh Drive, Mayfield West, NSW, Australia
| | - Amanda Tapley
- University of Newcastle, School of Medicine and Public Health, University Drive, Callaghan, NSW, Australia
- GP Synergy, Regional Training Organisation, NSW & ACT Research and Evaluation Unit, 20 McIntosh Drive, Mayfield West, NSW, Australia
| | - Anna Ralston
- University of Newcastle, School of Medicine and Public Health, University Drive, Callaghan, NSW, Australia
- GP Synergy, Regional Training Organisation, NSW & ACT Research and Evaluation Unit, 20 McIntosh Drive, Mayfield West, NSW, Australia
| | - Andrew Davey
- University of Newcastle, School of Medicine and Public Health, University Drive, Callaghan, NSW, Australia
- GP Synergy, Regional Training Organisation, NSW & ACT Research and Evaluation Unit, 20 McIntosh Drive, Mayfield West, NSW, Australia
| | - Alison Fielding
- University of Newcastle, School of Medicine and Public Health, University Drive, Callaghan, NSW, Australia
- GP Synergy, Regional Training Organisation, NSW & ACT Research and Evaluation Unit, 20 McIntosh Drive, Mayfield West, NSW, Australia
| | - Mieke van Driel
- University of Queensland, Faculty of Medicine, General Practice Clinical Unit, Level 8 Health Sciences Building, Royal Brisbane & Women’s Hospital, Brisbane, QLD, Australia
| | - Elizabeth Holliday
- University of Newcastle, School of Medicine and Public Health, University Drive, Callaghan, NSW, Australia
| | - Jean Ball
- Hunter Medical Research Institute, Clinical Research Design, IT and Statistical Support Unit (CReDITSS), New Lambton Heights, NSW, Australia
| | - Jason Dizon
- Hunter Medical Research Institute, Clinical Research Design, IT and Statistical Support Unit (CReDITSS), New Lambton Heights, NSW, Australia
| | - Neil Spike
- Eastern Victoria General Practice Training, Regional Training Organisation, Hawthorn, VIC, Australia
- University of Melbourne, Department of General Practice and Primary Health Care, Berkeley Street, Carlton, VIC, Australia
- Monash University, School of Rural Health, Faculty of Medicine, Nursing and Health Sciences, Clayton, VIC, Australia
| | - Lisa Clarke
- General Practice Training Tasmania, Regional Training Organisation, Hobart, TAS, Australia
| | - Parker Magin
- University of Newcastle, School of Medicine and Public Health, University Drive, Callaghan, NSW, Australia
- GP Synergy, Regional Training Organisation, NSW & ACT Research and Evaluation Unit, 20 McIntosh Drive, Mayfield West, NSW, Australia
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Metusela C, Mullan J, Kobel C, Rhee J, Batterham M, Barnett S, Bonney A. CHIME-GP trial of online education for prescribing, pathology and imaging ordering in general practice - how did it bring about behaviour change? BMC Health Serv Res 2023; 23:1346. [PMID: 38042789 PMCID: PMC10693689 DOI: 10.1186/s12913-023-10374-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 11/23/2023] [Indexed: 12/04/2023] Open
Abstract
BACKGROUND There is a need for scalable clinician education in rational medication prescribing and rational ordering of pathology and imaging to help improve patient safety and enable more efficient utilisation of healthcare resources. Our wider study evaluated the effectiveness of a multifaceted education intervention for general practitioners (GPs) in rational prescribing and ordering of pathology and imaging tests, in the context of Australia's online patient-controlled health record system, My Health Record (MHR), and found evidence for measurable behaviour change in pathology ordering among participants who completed the educational activities. This current study explored the mechanisms of behaviour change brought about by the intervention, with a view to informing the development of similar interventions in the future. METHODS This mixed methods investigation used self-reported questionnaires at baseline and post-education on MHR use and rational prescribing and test ordering. These were analysed using multi-level ordinal logistic regression models. Semi-structured interviews pre- and post-intervention were also conducted and were analysed thematically using the COM-B framework. RESULTS Of the 106 GPs recruited into the study, 60 completed baseline and 37 completed post-education questionnaires. Nineteen participants were interviewed at baseline and completion. Analysis of questionnaires demonstrated a significant increase in confidence using MHR and in self-reported frequency of MHR use, post-education compared with baseline. There were also similar improvements in confidence across the cohort pre-post education in deprescribing, frequency of review of pathology ordering regimens and evidence-based imaging. The qualitative findings showed an increase in GPs' perceived capability with, and the use of MHR, at post-education compared with baseline. Participants saw the education as an opportunity for learning, for reinforcing what they already knew, and for motivating change of behaviour in increasing their utilisation of MHR, and ordering fewer unnecessary tests and prescriptions. CONCLUSIONS Our education intervention appeared to provide its effects through providing opportunity, increasing capability and enhancing motivation to increase MHR knowledge and usage, as well as rational prescribing and test ordering behaviour. There were overlapping effects of skills acquisition and confidence across intervention arms, which may have contributed to wider changes in behaviour than the specific topic area addressed in the education. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry (ACTRN12620000010998) (09/01/2020).
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Affiliation(s)
- Christine Metusela
- Graduate School of Medicine, University of Wollongong, Wollongong, Australia.
| | - Judy Mullan
- Graduate School of Medicine, University of Wollongong, Wollongong, Australia
| | - Conrad Kobel
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, Australia
| | - Joel Rhee
- School of Population Health, University of New South Wales, Sydney, Australia
| | - Marijka Batterham
- School of Mathematics and Applied Statistics, University of Wollongong, Wollongong, Australia
| | - Stephen Barnett
- Graduate School of Medicine, University of Wollongong, Wollongong, Australia
| | - Andrew Bonney
- Graduate School of Medicine, University of Wollongong, Wollongong, Australia
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Willems J, Baker M, Samargis S, O'Shea C, Johnson C, Spike N. Pivoting in the pandemic: A regional tale of the rapid pivot to virtual continuing professional development for general practitioner supervisors during COVID-19. Aust J Gen Pract 2023; 52:809-814. [PMID: 37935155 DOI: 10.31128/ajgp-01-23-6694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2023]
Abstract
BACKGROUND The COVID-19 pandemic disrupted face-to-face delivery of general practitioner supervisor training in an unprecedented way. Simultaneously, the need for continuing professional development (CPD) amplified. The rapid pivot to virtual and blended learning solutions required great organisational agility, and a toolbox of solutions. OBJECTIVE Against the backdrop of the COVID-19 restrictions on face-to-face learning, this article shares the strategies employed to achieve the pivot to virtual CPD. DISCUSSION There was much trial and error, as well as successes and learning opportunities, as training organisations grappled with how to deliver virtual CPD during lockdowns.
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Affiliation(s)
- Julie Willems
- PhD, Senior Lecturer, Teaching Associate, Monash Rural Health @ Churchill, Churchill, Vic
| | - Michael Baker
- MBBS, FRACGP, DRANZCOG Adv, GradCertClinEd, GP Obstetrician, Bairnsdale, Vic; formerly Senior Medical Educator, Eastern Victoria General Practice Training, Churchill, Vic
| | - Stephanie Samargis
- BITS, Cert IV TAE, Freelance eLearning Specialist (Instructional Design and eLearning Development) at Curated ID, Melbourne, Vic
| | - Carolyn O'Shea
- MBBS, MMed, GradCertHlthProfEd, GradCertHealthEcon, FRACGP, General Practitioner, Greensborough, Vic; formerly Deputy Director of Medical Education and Training - General Pathway, Eastern Victoria General Practice Training, Melbourne, Vic
| | - Caroline Johnson
- MBBS, FRACGP, PhD, Senior Lecturer, Department of General Practice, The University of Melbourne, Melbourne, Vic; General Practitioner, Melbourne, Vic
| | - Neil Spike
- MBBS, FRACGP, General Practitioner, Nightcliff, Darwin, NT; Professorial Fellow, Department of General Practice and Primary Health Care, The University of Melbourne, Melbourne, Vic; Adjunct Professor, School of Rural Health, Monash University, Churchill, Vic; formerly Director of Medical Education and Training, Eastern Victoria General Practice Training, Regional Training Organisation, Melbourne, Vic
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Bonney A, Kobel C, Mullan J, Metusela C, Rhee JJ, Barnett S, Batterham M. Randomised trial of general practitioner online education for prescribing and test ordering. BMJ Open Qual 2023; 12:e002351. [PMID: 37857521 PMCID: PMC10603404 DOI: 10.1136/bmjoq-2023-002351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 09/21/2023] [Indexed: 10/21/2023] Open
Abstract
INTRODUCTION Potentially inappropriate medicine prescriptions and low-value diagnostic testing pose risks to patient safety and increases in health system costs. The aim of the Clinical and Healthcare Improvement through My Health Record usage and Education in General Practice study was to evaluate a scalable online quality improvement intervention, integrating online education regarding a national shared electronic health record and rational prescribing, pathology and imaging ordering by Australian general practitioners (GPs). METHODS The study was a parallel three-arm randomised trial comprising a prescribing education arm, a pathology education arm and an imaging education arm. Currently practising GPs in Australia were eligible to participate and randomised on a 1:1:1 basis to the study arms after consenting. The response to the intervention in reducing potentially unnecessary medicine prescriptions and tests in each arm was assessed using the other two arms as controls. The primary outcome was the cost per 100 consultations of predefined medication prescriptions, pathology and radiology test ordering 6 months following the intervention, compared with 6 months prior. Outcomes were assessed on intention-to-treat and post hoc per-protocol bases using multilevel regression models, with the analysts blinded to allocation. RESULTS In total, 106 GPs were enrolled and randomised (prescribing n=35, pathology n=36, imaging n=35). Data were available for 97 GPs at the end of trial (prescribing n=33, pathology n=32, imaging n=32) with 44 fully completing the intervention. In intention-to-treat analysis, there were no significant differences in the rates of change in costs across the three arms. Per protocol, there was a statistically significant difference in the rate of change in pathology costs (p=0.03). In the pathology arm, the rate of increase in pathology costs was significantly lower by $A187 (95% CI -$A340, -$A33) than the prescribing arm, and non-significantly $A9 (95% CI -$A128, $A110) lower than the imaging arm. DISCUSSION This study provides some evidence for reductions in costs for low-value pathology test ordering in those that completed the relevant online education. The study experienced slow uptake and low completion of the education intervention during the COVID-19 pandemic. Changes were not significant for the primary endpoint, which included all participants. Improving completion rates and combining real-time feedback on prescribing or test ordering may increase the overall effectiveness of the intervention. Given the purely online delivery of the education, there is scope for upscaling the intervention, which may provide cost-effectiveness benefits. TRIAL REGISTRATION NUMBER ACTRN12620000010998.
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Affiliation(s)
- Andrew Bonney
- Graduate School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia
| | - Conrad Kobel
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - Judy Mullan
- Graduate School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia
| | - Christine Metusela
- Graduate School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia
| | - Joel J Rhee
- School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Stephen Barnett
- Graduate School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia
| | - Marijka Batterham
- School of Mathematics and Applied Statistics, University of Wollongong, Wollongong, New South Wales, Australia
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Clifford M, McEllistrem B, Jones D. Exploring the preparedness of newly qualified general practitioners for independent practice in Ireland. Educ Prim Care 2023; 34:254-267. [PMID: 37940127 DOI: 10.1080/14739879.2023.2249429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 08/14/2023] [Indexed: 11/10/2023]
Abstract
BACKGROUND Newly qualified general practitioners' (NQGPs) experiences of transition to independent practice are varied. Most Irish GP graduates see themselves as either assistant GPs, salaried GPs or locum GPs one year post-qualification, yet anticipate partnership ten years post-qualification. Research into GP trainees' transition to independent practice is scarce, yet perceived lack of preparedness can be associated with emotional exhaustion and burnout. AIMS To explore NQGPs experience of their transition to independent practice in Ireland. METHODS A qualitative approach was taken, using virtual, semi-structured, one-to-one interviews with NQGPs within five years of graduation, practising in Ireland. Descriptive demographics of participants were obtained. Audio recordings of interviews were analysed using thematic analysis. RESULTS NQGPs reported preparedness for their clinical role, but most did not feel prepared for their non-clinical role. While NQGPs regarded independent practice as an intensive step-up from GP training, they drew on the support of GP colleagues during this transition. The decision on job selection centred largely on practice factors including location, ethos, support, and career prospects. Participants continued to develop in their identity as a GP within this transitionary period. CONCLUSION This research provides a unique insight into the experiences of NQGPs in Ireland. Specialist GP training schemes are influential in how NQGPs perceive their preparedness for independent practice; however, external factors including their place of work and alignment of professional goals play a part in this stage of NQGPs career.
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Affiliation(s)
- Muireann Clifford
- Edinburgh Medical School - Medical Education, University of Edinburgh, Edinburgh, Scotland
| | - Brian McEllistrem
- GP Training Unit, Irish College of General Practitioners, Dublin 2, Ireland
| | - Derek Jones
- Edinburgh Medical School - Medical Education, University of Edinburgh, Edinburgh, Scotland
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Bentley M, Ralston A, Clarke L, Davey A, Holliday E, Fielding A, van Driel M, Tapley A, Ball J, Fisher K, Spike N, Magin P. General practice registrars training part-time: a cross-sectional analysis of prevalence and associations. Educ Prim Care 2023; 34:244-253. [PMID: 37671661 DOI: 10.1080/14739879.2023.2248943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 07/23/2023] [Indexed: 09/07/2023]
Abstract
While GPs are working fewer clinical hours and many GP trainees (registrars) do not foresee themselves working full-time in clinical practice, little is known of the epidemiology of registrars training part-time. We aimed to establish the prevalence of general practice part-time training (PTT), and part-time registrars' characteristics and practice patterns. A cross-sectional analysis was conducted of data from the Registrar Clinical Encounters in Training project, an ongoing cohort study of Australian GP registrars' clinical experiences over 60 consecutive consultations in each of three training terms. Univariable and multivariable logistic regression analyses were conducted with the outcome 'training part-time'. 1790 registrars contributed data for 4,135 registrar-terms and 241,945 clinical encounters. Nine hundred and twenty-two registrar-terms (22%, 95%CI:21%-24%) and 52,339 clinical encounters (22%, 95%CI:21%-22%) involved PTT. Factors associated with PTT were registrar characteristics - female gender, older age, in a later training stage, performing other regular medical work; practice characteristics - working in a higher socioeconomic status area; and patient characteristics - seeing more patients new to the registrar and seeing more patients from a non-English-speaking background. No consultation or consultation action factors were significantly associated with PTT. Registrars, practices, and patient associations have GP training implications. The lack of registrar consultation or consultation action associations suggests there may be limited impact of PTT on patient care.
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Affiliation(s)
- Michael Bentley
- General Practice Training Tasmania (GPTT), Hobart, Australia
| | - Anna Ralston
- School of Medicine and Public Health, The University of Newcastle, Callaghan, Australia
- GP Synergy, Regional Training Organisation, NSW & ACT Research and Evaluation Unit, Mayfield West, Australia
| | - Lisa Clarke
- General Practice Training Tasmania (GPTT), Hobart, Australia
| | - Andrew Davey
- School of Medicine and Public Health, The University of Newcastle, Callaghan, Australia
- GP Synergy, Regional Training Organisation, NSW & ACT Research and Evaluation Unit, Mayfield West, Australia
| | - Elizabeth Holliday
- School of Medicine and Public Health, The University of Newcastle, Callaghan, Australia
| | - Alison Fielding
- School of Medicine and Public Health, The University of Newcastle, Callaghan, Australia
- GP Synergy, Regional Training Organisation, NSW & ACT Research and Evaluation Unit, Mayfield West, Australia
| | - Mieke van Driel
- Faculty of Medicine, General Practice Clinical Unit, The University of Queensland, Brisbane, Australia
| | - Amanda Tapley
- School of Medicine and Public Health, The University of Newcastle, Callaghan, Australia
- GP Synergy, Regional Training Organisation, NSW & ACT Research and Evaluation Unit, Mayfield West, Australia
| | - Jean Ball
- Hunter Medical Research Institute (HMRI), Clinical Research Design and Statistical Support Unit (CReDITSS), New Lambton Heights, Australia
| | - Katie Fisher
- School of Medicine and Public Health, The University of Newcastle, Callaghan, Australia
- GP Synergy, Regional Training Organisation, NSW & ACT Research and Evaluation Unit, Mayfield West, Australia
| | - Neil Spike
- Eastern Victoria General Practice Training (EVGPT), Hawthorn, Australia
- School of Rural Health, Monash University, Churchill, Australia
- Department of General Practice and Primary Health Care, University of Melbourne, Carlton, Australia
| | - Parker Magin
- School of Medicine and Public Health, The University of Newcastle, Callaghan, Australia
- GP Synergy, Regional Training Organisation, NSW & ACT Research and Evaluation Unit, Mayfield West, Australia
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Goldfeld S, Tapley A, O'Connor E, Spike N, Morgan S, Freed GL, Davey A, Holliday E, Ball J, Magin P. Prevalence and associated skills of Australian general practice registrars seeing children with functional bowel and bladder problems. J Paediatr Child Health 2023; 59:979-986. [PMID: 37231975 PMCID: PMC10946612 DOI: 10.1111/jpc.16444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 05/03/2023] [Accepted: 05/15/2023] [Indexed: 05/27/2023]
Abstract
AIM Functional bowel (constipation and faecal incontinence) and bladder (urinary incontinence and enuresis) problems in children are often treated by paediatricians yet should mostly be managed by general practitioners (GPs). To understand whether the necessary skills and knowledge are being built in general practice, this study aimed to establish the prevalence and associated skills of Australian general practice registrars managing children with functional bowel and bladder problems. Together as paediatricians and GPs, we use these data to determine how best to ensure high quality, equitable care for children. METHODS We drew on 16 rounds of data collection from the Registrar Clinical Encounters in Training (ReCEnT) multi-site cohort study (2010-2017) of general practice registrars' in-consultation experience. It included a measure of paediatric consultations in which a functional bowel or bladder problem was managed, as well as demographic information. RESULTS Out of 62 721 problems/diagnoses for paediatric patients (0-17 years), 844 (1.4%) were coded as functional bowel (n = 709; 1.13% (95% confidence interval, CI: 1.05-1.22)) and/or bladder (n = 135; 0.22% (95% CI: 0.18-0.25)) presentations. Registrars were more likely to prescribe medication for bowel problems (odds ratio (OR) = 2.22 (95% CI: 1.86-2.64)) than for all other problems, but less likely to prescribe medication (OR = 0.31 (95% CI: 0.18-0.52)) for night-time wetting and more likely to make a specialist referral (OR = 1.99 (95% CI: 1.22-3.25)) compared to all other problems. CONCLUSIONS Only a small proportion of children with functional bowel and bladder problems were seen by registrars despite high prevalence in the community and amenability to management in the general practice setting (i.e. generally low morbidity and low complexity) versus need for specialists. Registrars appeared to be managing functional bowel and bladder problems according to evidence-based guidelines, but with relatively high levels of referral. Given the inequitable access to specialist care, paediatricians should support local general practice management of these problems. This might include (i) engaging with training programs to ensure appropriate education and (ii) liaising with individual registrars/practices to provide management advice for individual or example cases.
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Affiliation(s)
- Sharon Goldfeld
- Centre for Community Child Health, Murdoch Children's Research InstituteRoyal Children's HospitalMelbourneVictoriaAustralia
- Department of PaediatricsUniversity of MelbourneMelbourneVictoriaAustralia
| | - Amanda Tapley
- NSW and ACT Research and Evaluation UnitGP SynergyNewcastleNew South WalesAustralia
- School of Medicine and Public HealthUniversity of NewcastleNewcastleNew South WalesAustralia
| | - Elodie O'Connor
- Centre for Community Child Health, Murdoch Children's Research InstituteRoyal Children's HospitalMelbourneVictoriaAustralia
| | - Neil Spike
- Eastern Victoria General Practice TrainingMelbourneVictoriaAustralia
- Department of General PracticeUniversity of MelbourneMelbourneVictoriaAustralia
| | - Simon Morgan
- NSW and ACT Research and Evaluation UnitGP SynergyNewcastleNew South WalesAustralia
| | - Gary L Freed
- Child Health Evaluation and Research CenterUniversity of MichiganAnn ArborMichiganUSA
- Centre for Health Policy, Melbourne School of Population and Global HealthUniversity of MelbourneMelbourneVictoriaAustralia
| | - Andrew Davey
- NSW and ACT Research and Evaluation UnitGP SynergyNewcastleNew South WalesAustralia
- School of Medicine and Public HealthUniversity of NewcastleNewcastleNew South WalesAustralia
| | - Elizabeth Holliday
- School of Medicine and Public HealthUniversity of NewcastleNewcastleNew South WalesAustralia
| | - Jean Ball
- Clinical Research Design and Statistical Support Unit (CReDITSS)Hunter Medical Research InstituteNewcastleNew South WalesAustralia
| | - Parker Magin
- NSW and ACT Research and Evaluation UnitGP SynergyNewcastleNew South WalesAustralia
- School of Medicine and Public HealthUniversity of NewcastleNewcastleNew South WalesAustralia
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de Silva D, Roberts R, Nayar V, Rutt G, Gregory S, Khan A. Tackling differential attainment in specialist GP training in England and Scotland. Educ Prim Care 2023; 34:199-203. [PMID: 37643423 DOI: 10.1080/14739879.2023.2243453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 07/29/2023] [Indexed: 08/31/2023]
Abstract
In this article NHS England and NHS Education for Scotland describe practical ways we are tackling differences in the attainment of people training as general practitioners (GPs).Trainees from minority ethnic groups and international medical graduates are less likely than others to qualify as GPs. It is difficult to change systemic inequalities, but over the past five years we have made practical changes to GP speciality training. Educators recognise there is an issue and are trying to tackle it.For example, people who had not successfully qualified had an opportunity to return to GP training. When we provided individualised targeted support, the proportion who completed training significantly increased (76%).This was a catalyst for reviewing unconscious bias in GP training. We implemented a national programme to tackle differential attainment and system-level bias. Educators now work with all GP trainees to identify their individual needs. Supervisors are trained to recognise bias and provide targeted support. There is mental health support and regular reviews to see whether trainees are ready to sit exams. Trainee representatives are championing the learner voice in national committees. Exams are being altered to reduce unconscious bias. We are monitoring attainment over time.The key message is that differential attainment should not be in the 'too hard basket'. The narrative is changing from 'can't do' to 'must do', supported by appropriate leadership, promotion and resourcing. There is much more to do, but we are making changes, evaluating and applying our learning. We have moved from talking to taking action.
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Affiliation(s)
- Debra de Silva
- Department of primary care, The Evidence Centre, London, UK
| | | | - Vijay Nayar
- Department of primary care, NHS England, London, UK
| | - Graham Rutt
- Department of primary care, NHS England, London, UK
| | | | - Amjad Khan
- Department of primary care, NHS Education for Scotland, Edinburgh, UK
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Knight L, Page M, Crampton P, Viney R, Rich A, Griffin A. A realist evaluation of a London general practitioner trainer course. Educ Prim Care 2023; 34:220-227. [PMID: 37551013 DOI: 10.1080/14739879.2023.2241025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 07/22/2023] [Indexed: 08/09/2023]
Abstract
Clinicians with teaching and training roles should be adequately trained and assessed. However, some debate exists as to what the nature of this training should be. Historically, a postgraduate certificate in education was a pre-requisite to becoming a GP trainer but this is changing with growing concern that such a pre-requisite might act as a deterrent to potential GP trainers. This research examines the impact of a scheme designed to provide an alternative, more practical and focused, pathway to becoming a GP trainer. We interviewed 26 course participants and stakeholders of the London GP Training Course (LGPTC), observed teaching sessions, and analysed course materials. We asked what elements of the course were and weren't effective, for whom, and under what circumstances. Here, we present a summary of our main findings - that GP trainers want to know practically, not theoretically, how to be a trainer; formative assessment boosts trainees' confidence in their own skills and abilities; short, practical GP training courses can help enhance the numbers of GP trainers; important questions remain about the role and value of educational theory in education faculty development.
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Affiliation(s)
- Laura Knight
- Research Department of Medical Education, UCL Medical School, UCL, London, UK
| | - Michael Page
- Institute for Health Sciences Education, Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Paul Crampton
- Health Professions Education Unit, Hull York Medical School, University of York, York, UK
| | - Rowena Viney
- Research Department of Medical Education, UCL Medical School, UCL, London, UK
| | - Antonia Rich
- Research Department of Medical Education, UCL Medical School, UCL, London, UK
| | - Ann Griffin
- Research Department of Medical Education, UCL Medical School, UCL, London, UK
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Liang LB, Li X, Liu XP, Li CZ, Luo D, Liu F, Mao TR, Su QL. Evaluation of the star family doctors training program: an observational cohort study of a novel continuing medical education program for general practitioners within a compact medical consortium: a quantitative analysis. BMC Med Educ 2023; 23:250. [PMID: 37069532 PMCID: PMC10108467 DOI: 10.1186/s12909-023-04210-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 03/29/2023] [Indexed: 06/19/2023]
Abstract
INTRODUCTION To determine the effectiveness of the Star Family Doctors Training Program, a comprehensive Continuing professional development (CPD) program for general practitioners (GPs) in a compact medical consortium. PATIENTS AND METHODS Observational cohort study with a quantitative analyses in primary health care institutions in Sichuan Province. The interventions were as following: (1) The Star Family Doctors Training Program is a full-time, local government allocation program certified by the Health Department of Sichuan Province, emphasizing small group learning and practice, and using standard patients and medical patient simulators; 30 participants were selected by their institutions. (2) The control group underwent a self-financed after-work CPD program using conventional lectures; 50 participants were self-selected. Short-term effectiveness assessed using immediate post-training tests and self-evaluations; long-term (1 year) effectiveness evaluated using self-reported surveys. RESULTS The study involved 80 GPs (28.75% men; mean age: 38.2 ± 9.2 years). The average post-training total score was higher in the STAR group than in the control group (72.83 ± 5.73 vs. 68.18 ± 7.64; p = 0.005). Compared to the controls, STAR participants reported seeing more patients (all p < 0.05), and had more patients who signed family-doctor contracts (p = 0.001) as well as increased patient satisfaction (p = 0.03), respectively. STAR-group trainees appraised the program higher and were more willing to recommend it to colleagues (90% vs. 64%, p = 0.011). CONCLUSION The Star Family Doctors Training Program achieved good responses and provides a reference for future CPD programs.
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Affiliation(s)
- Ling-Bo Liang
- General Practice Ward/International Medical Center Ward, General Practice Medical Center, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Xu Li
- Department of Primary Health Care, Health Commission of Sichuan Province, Chengdu, 610041, China
| | - Xiang-Ping Liu
- General Practice Ward/International Medical Center Ward, General Practice Medical Center, West China Hospital, Sichuan University, Chengdu, 610041, China
- Department of Primary Health Care, The fourth People's hospital of Dazhu County, Dazhou, 635100, China
| | - Cai-Zheng Li
- General Practice Ward/International Medical Center Ward, General Practice Medical Center, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Dan Luo
- General Practice Ward/International Medical Center Ward, General Practice Medical Center, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Feng Liu
- General Practice Ward/International Medical Center Ward, General Practice Medical Center, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Ting-Rui Mao
- General Practice Ward/International Medical Center Ward, General Practice Medical Center, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Qiao-Li Su
- General Practice Ward/International Medical Center Ward, General Practice Medical Center, West China Hospital, Sichuan University, Chengdu, 610041, China.
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Young L, Anderson E, Gurney T, McArthur L, McGrail M, O'Sullivan B, Hollins A. A comparative evaluation of quality and depth of learning by trainee doctors in regional, rural, and remote locations. BMC Med Educ 2023; 23:215. [PMID: 37020284 PMCID: PMC10077336 DOI: 10.1186/s12909-023-04175-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 03/20/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND An equitable supply and distribution of medical practitioners for all the population is an important issue, especially in Australia where 28% of the population live in rural and remote areas. Research identified that training in rural/remote locations is a predictor for the uptake of rural practice, but training must provide comparable learning and clinical experiences, irrespective of location. Evidence shows GPs in rural and remote areas are more likely to be engaged in complex care. However, the quality of GP registrar education has not been systematically evaluated. This timely study evaluates GP registrar learning and clinical training experiences in regional, rural, and remote locations in Australia using assessment items and independent evaluation. METHODS The research team retrospectively analysed GP trainee formative clinical assessment reports compiled by experienced medical educators during real-time patient consultations. Written reports were assessed using Bloom's taxonomy classified into low and high cognitive level thinking. Regional, rural, and remotely located trainees were compared using Pearson chi-squared test and Fisher's exact test (for 2 × 2 comparisons) to calculate associations between categorical proportions of learning setting and 'complexity'. RESULTS 1650 reports (57% regional, 15% rural and 29% remote) were analysed, revealing a statistically significant association between learner setting and complexity of clinical reasoning. Remote trainees were required to use a high level of clinical reasoning in managing a higher proportion of their patient visits. Remotely trained GPs managed significantly more cases with high clinical complexity and saw a higher proportion of chronic and complex cases and fewer simple cases. CONCLUSIONS This retrospective study showed GP trainees in all locations experienced comparable learning experiences and depth of training. However, learning in rural and remote locations had equal or more opportunities for seeing higher complexity patients and the necessity to apply greater levels of clinical reasoning to manage each case. This evidence supports learning in rural and remote locations is of a similar standard of learning as for regional trainees and in several areas required a superior level of thinking. Training needs to seriously consider utilising rural and remote clinical placements as exceptional locations for developing and honing medical expertise.
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Affiliation(s)
- Louise Young
- College of Medicine and Dentistry, James Cook University, Queensland, Australia
| | - Emily Anderson
- College of Medicine and Dentistry, James Cook University, Queensland, Australia.
| | - Tiana Gurney
- Rural Clinical School, The University of Queensland, Queensland, Australia
| | - Lawrie McArthur
- General Practice Training, James Cook University, Queensland, Australia
| | - Matthew McGrail
- Rural Clinical School, The University of Queensland, Queensland, Australia
| | - Belinda O'Sullivan
- Rural Clinical School, The University of Queensland, Queensland, Australia
| | - Aaron Hollins
- General Practice Training, James Cook University, Queensland, Australia
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Qin H, Li S, Liu J, Ren J, Yu M. Follow-up survey of general practitioners in Zhejiang Province post-completion of position transition training in 2017-2020. BMC Med Educ 2023; 23:182. [PMID: 36964607 PMCID: PMC10038699 DOI: 10.1186/s12909-023-04151-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 03/11/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Position transition training for general practitioners in Zhejiang Province started in 2017 and has since been held once a year. By the beginning of 2022, four training sessions were completed. The purpose of this survey was to establish the current situation of trainees after their graduation and provide reference for the evaluation of the training effect. METHODS Of the 738 trainees who completed the training, 253 were contacted and followed up. A self-designed questionnaire was used to conduct the survey through online filling in. The content included questions to elucidate the following information: whereabouts after the training, registration as a general practitioner, undertaken general practice teaching and scientific research work, current occupational environment, improvement of post competence after receiving position transition training, willingness to complete survey, willingness to participate in future training programs, etc. RESULTS: A number of 253 valid questionnaires were collected with a recovery rate of 100%. Notably, 93.68% of the participants successfully completed their training and obtained the Training Certificate of General Practitioners. Further, 83.4% were registered as general practitioners, 82.94% of which added on the basis of the original registered scope of practice. Currently, most of them work in primary health care institutions, primarily occupied with medical treatment, chronic disease management, COVID-19 prevention and control, health education, and prevention and health care. Of them, 27.01% were currently undertaking teaching work, and only 3.32% of them were conducting scientific research work related to general practice. The overall satisfaction of the trainees in the three theoretical training bases was above 90%, with no statistically significant difference among them (P > 0.05). Importantly, 84.11% of the followed-up personnel hoped to continue to participate in similar training in the future to improve their general practitioner core competences. CONCLUSION The position transition training in Zhejiang Province has achieved good results, but the details of training and the implementation of policies in individual regions need to be improved. Most of the graduates were willing to continue their education, especially in general practitioners with special interests.
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Affiliation(s)
- Hongli Qin
- Department of General Practice, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China
| | - Shuai Li
- Department of General Practice, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China
| | - Juanjuan Liu
- Department of General Practice, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China
| | - Jingjing Ren
- Department of General Practice, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China.
| | - Meiyue Yu
- Zhejiang University, Hangzhou, 310003, China
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Wilson R, Pryymachenko Y, Abbott JH, Dean S, Stanley J, Garrett S, Mathieson F, Dowell A, Darlow B. A Guideline-Implementation Intervention to Improve the Management of Low Back Pain in Primary Care: A Difference-in-Difference-in-Differences Analysis. Appl Health Econ Health Policy 2023; 21:253-262. [PMID: 36471226 PMCID: PMC9734860 DOI: 10.1007/s40258-022-00776-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 11/21/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Real-world adherence to clinical practice guidelines is often poor, resulting in sub-standard patient care and unnecessary healthcare costs. This study evaluates the effect of a guideline-implementation intervention for the management of low back pain (LBP) in general practice-the Fear Reduction Exercised Early (FREE) approach-on LBP-related injury insurance claims, healthcare utilisation, and costs of treatment. DESIGN Data were extracted from comprehensive nationwide New Zealand injury insurance claims records. Data were analysed using a 'triple-difference' (difference-in-difference-in-differences) method to isolate the causal effect of FREE training on LBP claims activity, comparing the difference in general practitioner (GP) LBP claims and associated activity before and after training with their non-musculoskeletal injury claims for the same periods (assumed to be unaffected by training), relative to the same comparisons for GPs not trained in the FREE approach. RESULTS Training GPs in the FREE approach resulted in significant reductions in the number of LBP injury claims lodged (- 19%, 95% CI -34 to -5), the use of physiotherapy (-30%, 95% CI - 42 to - 18) and imaging (- 27%, 95% CI - 46 to - 8%), and the healthcare costs (- 21%, 95% CI - 41 to - 1) of LBP injury. Changes in claims for earnings' compensation (- 10%, 95% CI - 34 to 13) were not significant. CONCLUSIONS A brief guideline-implementation intervention following best-practice LBP management and guideline-implementation strategies achieved significant reductions, persisting over at least 6 to18 months, in healthcare utilisation consistent with improved delivery of guideline-concordant care.
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Affiliation(s)
- Ross Wilson
- Department of Surgical Sciences, Centre for Musculoskeletal Outcomes Research, University of Otago, Dunedin, New Zealand.
| | - Yana Pryymachenko
- Department of Surgical Sciences, Centre for Musculoskeletal Outcomes Research, University of Otago, Dunedin, New Zealand
| | - J Haxby Abbott
- Department of Surgical Sciences, Centre for Musculoskeletal Outcomes Research, University of Otago, Dunedin, New Zealand
| | - Sarah Dean
- College of Medicine and Health, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - James Stanley
- Biostatistical Group, University of Otago, Wellington, New Zealand
| | - Sue Garrett
- Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand
| | - Fiona Mathieson
- Department of Psychological Medicine, University of Otago, Wellington, New Zealand
| | - Anthony Dowell
- Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand
| | - Ben Darlow
- Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand
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Grut M, de Wildt G, Clarke J, Greenfield S, Russell A. Primary health care during the COVID-19 pandemic: A qualitative exploration of the challenges and changes in practice experienced by GPs and GP trainees. PLoS One 2023; 18:e0280733. [PMID: 36758002 PMCID: PMC9910752 DOI: 10.1371/journal.pone.0280733] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 01/08/2023] [Indexed: 02/10/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has rapidly changed general practice in the UK. Research is required to understand how General Practitioners (GPs) and GP trainees adjusted to these changes, so that beneficial changes might be sustained, and Primary Health Care (PHC) can be prepared for future challenges. This study explored the experiences and perspectives of GP and GP trainees during the pandemic. METHODS Remote, semi-structured interviews (n = 21) were conducted with GPs (n = 11) and GP trainees (n = 10), recruited from across the UK using convenience and purposive sampling. Interviews were audio-recorded and transcribed verbatim. Interview data were analysed with an inductive thematic approach. RESULTS Five overarching themes were identified: (1) 'Thrown in at the deep end'; (2) Telemedicine: 'it needs to be a happy balance'; (3) Delayed referrals and 'holding' patients; (4) The Covid Cohort-training in Covid; (5) Suggestions and lessons for the future of general practice'. GPs reported a turbulent and uncertain time of major changes to PHC. They described the benefits of technology in general medicine, particularly telemedicine, when used in a balanced manner, highlighting the need for accompanying teaching and guidelines, and the importance of patient preferences. Key tools to help GPs manage patients with delayed referrals to Secondary Care were also identified. CONCLUSION Several key changes to general practice occurred as a result of the COVID-19 pandemic, including a rapid uptake of telemedicine. The pandemic exposed the strengths and limitations of normal general practice and highlighted the importance of workplace camaraderie. These findings contribute to the evidence base used to adapt PHC infrastructures as we emerge from the pandemic.
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Affiliation(s)
- Minka Grut
- Birmingham Medical School, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom
- * E-mail:
| | - Gilles de Wildt
- Birmingham Medical School, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom
| | - Joanne Clarke
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom
| | - Sheila Greenfield
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom
| | - Alice Russell
- Birmingham Medical School, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom
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Kononov OY, Matviyets LG, Trishchynska MA. ANALYSIS OF THE RESULTS OF GP-FM QUESTIONNAIRE REGARDING TRAINING IN THE SPECIALIZATION «OTOLARYNGOLOGY» BOTH AT THE UNDERGRADUATE AND POSTGRADUATE LEVELS. Wiad Lek 2023; 76:2169-2175. [PMID: 37948710 DOI: 10.36740/wlek202310106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
OBJECTIVE The aim: To research the degree of satisfaction with the training of general practitioners-family medicine (GP-FM) in the specialization "Otorhinolaryngology" in the leading higher educational institutions (HEIs) of Ukraine at undergraduate and postgraduate levels. PATIENTS AND METHODS Materials and methods: A questionnaire was conducted of 51 GP-FM doctors. RESULTS Results: The duration of otorhinolaryngology training at a medical HEI was indicated by: 49% of respondents about weeks of training, 19.6% - about months. 31.37% received separate training on ENT examination. 56.9% of people were trained in ENT departments. 76.5% of people were not satisfied with the quality of theoretical knowledge, 52.9% of respondents of practical skills at the undergraduate level. 72.6% of doctors not satisfied with the quality of theoretical knowledge, 56.8% of respondents of practical skills at the post-graduate level. 41.2% of respondents received post-graduate training in otorhinolaryngology at the GP-FM specialization cycle, 72.55% of them in a lecture format. 86.3% of people want to deepen their knowledge of otolaryngology and need to understand the etiopathogenetic mechanisms of ENT pathology. CONCLUSION Conclusions. The dissonance with the dissatisfaction of the doctors of the GPFM with the quality of the received theoretical knowledge in ENT pathology and the availability of their practical skills was revealed. It is important for GPFM doctors to undergo separate training in ENT examination and pathology with mandatory study and conscious use of etiopathogenetic mechanisms of ENT pathology, especially in inflammatory diseases.
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21
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Osborne D, De Boer K, Meyer D, Nedeljkovic M. Raising Suicide in Medical Appointments-Barriers and Facilitators Experienced by Young Adults and GPs: A Mixed-Methods Systematic Review. Int J Environ Res Public Health 2023; 20:822. [PMID: 36613144 PMCID: PMC9820164 DOI: 10.3390/ijerph20010822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 12/16/2022] [Accepted: 12/20/2022] [Indexed: 06/17/2023]
Abstract
The aim of this review was to understand the barriers and facilitators facing GPs and young adults in raising and addressing suicide in medical appointments. A mixed-methods systematic review was conducted of qualitative and quantitative studies. The focus was papers that explored barriers and facilitators experienced by young adults aged 18 to 26, and GPs working in primary care environments. Nine studies met the inclusion criteria. Four studies provided information on young adults' views, four on GPs, and one considered both GP and young adults' viewpoints. Nine barrier and seven facilitator themes were identified. Unique to this review was the recognition that young adults want GPs to initiate the conversation about suicide. They see this as a GP's responsibility. This review further confirmed that GPs lack the confidence and skills to assess suicide risk in young adults. Both findings combined could explain previous results for reduced identification of suicide risk in this cohort. GP training needs considerable focus on addressing skill deficiencies and improving GP confidence to assess suicide risk. However, introducing suicide risk screening in primary care for young adults should be a priority as this will overcome the need for young adults to voluntarily disclose thoughts of suicide.
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22
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Harkemanne E, Duyver C, Leconte S, Sawadogo K, Baeck M, Tromme I. Short- and Long-Term Evaluation of General Practitioners' Competences After a Training in Melanoma Diagnosis: Refresher Training Sessions May Be Needed. J Cancer Educ 2022; 37:1928-1941. [PMID: 34704171 PMCID: PMC8547729 DOI: 10.1007/s13187-021-02063-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 06/27/2021] [Indexed: 06/13/2023]
Abstract
General practitioners (GPs) are first-line clinicians in melanoma diagnosis. It is, therefore, important to ensure that they maintain their melanoma diagnostic accuracy over time. The objective of this study was to assess the short- and long-term competences of GPs after a training session in naked-eye melanoma diagnosis. An interventional prospective study was conducted whereby, over a 6-month period, GPs attended a 1-h melanoma diagnostic training session. To assess their acquired competences, GPs were asked to fill in a questionnaire on basic melanoma knowledge and to evaluate 10 clinical images of pigmented skin lesions prior to training, immediately after and 1 year later. In total, 89 GPs completed the questionnaire prior and immediately after training. As expected, the number of GPs who appropriately managed [Formula: see text] 50% of the melanoma cases increased after training (P < 0.001). One year after training, only 27 (30%) of the 89 GPs completed the questionnaire. This number of participants was too low to obtain significant figures but the GPs' mean overall score of appropriately managed clinical cases was much lower than in the immediate post-test. In conclusion, although this short training improved the GPs' diagnostic accuracy and management of melanoma in the short-term, participating GPs do not seem to have maintained these competences in the long-term. Further studies are needed to assess whether refresher training sessions are able to sustain acquired diagnostic and management skills.
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Affiliation(s)
- Evelyne Harkemanne
- Dermatology Department, Cliniques Universitaires Saint-Luc, Avenue Hippocrate, 10, B-1200, Brussels, Belgium.
- Institute of Experimental and Clinical Research (IREC), UCLouvain, Brussels, Belgium.
| | - Corentin Duyver
- Centre Académique de Médecine Générale (CAMG), UCLouvain, Brussels, Belgium
| | - Sophie Leconte
- Centre Académique de Médecine Générale (CAMG), UCLouvain, Brussels, Belgium
| | - Kiswendsida Sawadogo
- Statistical Support Unit, King Albert II Cancer and Hematology Institute, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Marie Baeck
- Dermatology Department, Cliniques Universitaires Saint-Luc, Avenue Hippocrate, 10, B-1200, Brussels, Belgium
- Institute of Experimental and Clinical Research (IREC), UCLouvain, Brussels, Belgium
| | - Isabelle Tromme
- Dermatology Department, Cliniques Universitaires Saint-Luc, Avenue Hippocrate, 10, B-1200, Brussels, Belgium
- King Albert II Cancer and Hematology Institute, Cliniques Universitaires Saint-Luc, Brussels, Belgium
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23
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Lindemann RF, Robson G, Cunningham DE. Commercial business and partnership aspects of general practice: the learning needs of First5 general practitioners in NHS Scotland-a qualitative study. BMJ Open 2022; 12:e056188. [PMID: 36581958 PMCID: PMC9438089 DOI: 10.1136/bmjopen-2021-056188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVES To identify the learning needs of recently qualified general practitioners (GPs) (First5) in National Health Service (NHS) Scotland concerning GP partnership and the commercial business aspects of general practice. It aimed to identify learning opportunities during General Practice Specialty Training and the first 5 years of work, and to explore their suggestions of additional resources that would improve their sense of preparedness for partnership. A secondary aim was to explore what influenced their current choice of employment model and place of work. DESIGN Qualitative research study using grounded theory methods. Recruitment was stratified to include First5 GPs from a range of NHS boards in Scotland including remote and rural areas. Participants were interviewed in small focus groups or individual interviews in person, or over the telephone depending on their preference. Interviews were audio-recorded and transcribed. Transcriptions were coded and codes developed into themes using Charmazian grounded theory methods. Data saturation was achieved and verified by the researchers. SETTING General practice in NHS Scotland. Participant GPs, within the first 5 years of completion of General Practice Specialty Training, who were working in NHS Scotland. RESULTS Twenty-seven recently qualified GPs participated in the study. Three main themes were constructed: preparedness for partnership from experiential learning in General Practice Specialty Training; perceived commercial business learning needs and preferred learning styles (with learning needs arranged into five topic areas); considerations that inform decision-making about choice of employment model and of practice. Factors that influenced the decision to enter into specific employment models were identified. CONCLUSION Lengthening the time spent in specialty training may help GP trainees gain more knowledge, skills and confidence about the commercial business aspects of general practice and of GP partnership.
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Affiliation(s)
| | - Gordon Robson
- Medicine Directorate, NHS Education for Scotland, Glasgow, UK
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24
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Halder J, Zirngibl I, Joos S, Förster C. [Point-of-care information in GP practices: Results of a survey among German GP specialists and GP trainees]. Z Evid Fortbild Qual Gesundhwes 2022; 172:92-99. [PMID: 35773084 DOI: 10.1016/j.zefq.2022.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 04/08/2022] [Accepted: 04/12/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Specific questions often arise in the context of consultations regarding, for example, diagnostics and therapeutic management. This case-specific search for information is referred to as point-of-care information. In recent years, it has been influenced by an increase in digitalization and by the development of medical expert systems providing information for medical professionals. Data on the search behavior of German general practitioners (GPs) using digital media for obtaining point-of-care information have so far not been available. The aims of this study were to describe occasion-related point-of-care information as a function of the continuing education status and to identify requirements for online research platforms. METHODS In a cross-sectional survey, 829 GP specialists (FÄ) and 475 physicians in training (ÄiW) were invited to answer a self-developed, partially standardized questionnaire. RESULTS In total, 356 questionnaires were returned (response rate: 27%). Of these, 241 (68%) were answered by FÄ and 110 (31%) by ÄiW; five participants did not provide information on their specialist status. 66% of the FÄ and 89% of the ÄiW look up information every day. 46% of the FÄ and 73% of the ÄiW use their smartphone for this purpose. Both groups most often search for medical content (94%) and for information on medications (84%). Medical expert systems are more often used by ÄiW than by FÄ; 59% of the FÄ and 82% of the ÄiW are willing to pay a fee for these services. A quick overview and relevance of information were perceived as important criteria for good information sources. DISCUSSION German GPs frequently search for occasion-related information. There are generation-related differences regarding, among other things, the use of and the receptiveness to fee-based expert systems. The clarity of presentation and the relevance of the information provided are important requirements of effective information platforms. CONCLUSION The quick search for evidence-based information relevant to clinical practice presents a challenge, particularly in broad-range specialties such as general medicine. Web-based sources are becoming increasingly popular in this regard - a trend likely to intensify in future generations of physicians. This offers great potential for medical expert systems and app-based access to best-practice guidelines. These formats should be further developed in collaboration with scientific professional societies.
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Affiliation(s)
- Julian Halder
- Universitätsklinikum Tübingen, Institut für Allgemeinmedizin und Interprofessionelle Versorgung, Tübingen, Deutschland
| | - Isabella Zirngibl
- Universitätsklinikum Tübingen, Institut für Allgemeinmedizin und Interprofessionelle Versorgung, Tübingen, Deutschland
| | - Stefanie Joos
- Universitätsklinikum Tübingen, Institut für Allgemeinmedizin und Interprofessionelle Versorgung, Tübingen, Deutschland
| | - Christian Förster
- Universitätsklinikum Tübingen, Institut für Allgemeinmedizin und Interprofessionelle Versorgung, Tübingen, Deutschland.
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White I, Benson J, Elliott T, Walters L. Australian general practice registrars' experiences of training, well-being and support during the COVID-19 pandemic: a qualitative study. BMJ Open 2022; 12:e060307. [PMID: 35725266 PMCID: PMC9213776 DOI: 10.1136/bmjopen-2021-060307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES Providing well-supported general practice (GP) training is fundamental to strengthen the primary health workforce. Research into the unique needs of GP registrars during disasters is limited. Registrar burnout and insufficient support have been associated with personal and professional detrimental effects. This study aims to explore the experiences of Australian GP registrars with learning, well-being and support from their training organisation during the COVID-19 pandemic, and to guide training organisation efforts to support registrars through future disasters. SETTING Interviews were conducted via Zoom. PARTICIPANTS Fifteen GP registrars from South Australia, Victoria and New South Wales who had experienced community-based GP training in both 2019 (prepandemic) and 2020 (early pandemic). OUTCOME MEASURES Training, well-being and support experiences were explored. Interviews were recorded and transcribed and themes analysed. RESULTS Diverse experiences were reported: changes included telehealth, online tutorials, delayed examinations and social restrictions. Social and professional connections strongly influenced experiences. Personal and training factors were also important. Additional GP training organisation support was minimally needed when strong connections were in place. CONCLUSIONS This study identifies aspects of support which shaped registrars' diverse experiences of COVID-19, particularly regarding professional and social connections. Findings illustrate the importance of broad principles around supporting registrar well-being. Particularly significant aspects of support include connection to educational mentors such as supervisors and medical educators; connection and culture within practices; opportunities to share clinical experiences; and connection to personal social supports. Participation in this global disaster contributed to registrars' developing professionalism. GP training organisations are positioned to implement monitoring and supports for registrars through disasters. Although registrars may not require significant GP training organisation intervention where powerful professional and personal connections exist, strong foundational GP training organisation supports can be established and augmented to support registrars in need before and during future disasters. These findings contribute to the global developing field of knowledge of registrar training and well-being needs during crises.
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Affiliation(s)
- Isabella White
- Department of General Practice/Adelaide Rural Clinical School, The University of Adelaide Rural Clinical School, Nairne, South Australia, Australia
| | | | | | - Lucie Walters
- The University of Adelaide Rural Clinical School, Mount Gambier, South Australia, Australia
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26
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O'Sullivan B, Kippen R, Wearne E, Wallace G, Taylor C, Toukhsati SR. Enabling uptake and sustainability of supervision roles by women GPs in Australia: a narrative analysis of interviews. BMC Med Educ 2022; 22:398. [PMID: 35606778 PMCID: PMC9128131 DOI: 10.1186/s12909-022-03459-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 05/13/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Worldwide, the proportion of women entering careers in medicine is increasing. To ensure diversity and capacity in the general practice ("GP") supervision workforce, a greater understanding from the perspective of women GPs engaged in or considering the clinical supervision of trainee doctors is important. This narrative inquiry aims to explore the uptake and sustainability of supervision roles for women GPs in the Australian context. METHODS Qualitative interviews with Australian women GPs were conducted between July and September 2021. Women GPs were selected to represent a range of demographics, practice contexts, and supervision experience to promote broad perspectives. Narrative analysis drew on participant perspectives, allowing emergent stories to be explored using story arcs based on the characters, settings, problems, actions, and resolutions. These stories were evaluated by a broad research team and a high level of agreement of the final narratives and counter-narratives was achieved. RESULTS Of the 25 women who enrolled, 17 completed interviews. Six narratives emerged, including: power and control, pay, time, other life commitments, quality of supervision, and supervisor identity. These represented significant intersecting issues with the potential to impact the uptake and sustainability of supervision by women GPs. Some women GPs reported a lack of agency to make decisions about their role in supervision and were not remunerated for teaching. Uptake and sustainability of supervision was constrained by other life commitments, which could be buffered by team-sharing arrangements and a supportive practice. Although adding a burden of time atop their complex and sensitive consultations, women GPs were committed to being available to registrars and supervising at a high standard. To foster high quality supervision, women GPs were interested in up-skilling resources, building experience and harnessing support networks. Women sensed imposter syndrome when negotiating a supervisor identity, which could be managed by explicitly valuing their contribution. CONCLUSION The findings can inform the development of more specific resources, supports and structures to enable women GPs in Australia to uptake and sustain the supervision of trainee doctors at a level they find both acceptable and rewarding.
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Affiliation(s)
- B O'Sullivan
- General Practice Supervisors Australia, Bendigo, Victoria, 3550, Australia
- Monash University, Bendigo, Victoria, 3550, Australia
| | - R Kippen
- Monash University, Bendigo, Victoria, 3550, Australia
| | - E Wearne
- Eastern Victoria GP Training, Hawthorn, Victoria, 3122, Australia
| | - G Wallace
- General Practice Supervisors Australia, Bendigo, Victoria, 3550, Australia
| | - C Taylor
- General Practice Supervisors Australia, Bendigo, Victoria, 3550, Australia
| | - S R Toukhsati
- General Practice Supervisors Australia, Bendigo, Victoria, 3550, Australia.
- Monash University, Bendigo, Victoria, 3550, Australia.
- Melbourne University, Parkville, Victoria, 3052, Australia.
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27
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Tang L, Yang H, Mao Z, Li Q, Li S. The negative factors influencing the career intention of general practice trainees in eastern China: a qualitative study. BMC Med Educ 2022; 22:393. [PMID: 35597977 PMCID: PMC9124415 DOI: 10.1186/s12909-022-03456-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 05/11/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND There is an acute shortage of general practitioners (GPs) in China, and GP trainees seem to be less willing to develop their career as a GP. This study aimed to investigate negative factors influencing the career intention of GPs in eastern China from the perspective of trainees taking standardized residency training, as to identify the barriers of GP trainees becoming registered GPs, and to provide a policy-making basis for GP recruitment and retention. METHODS A qualitative description design by the purposive sample was carried out in two training bases of Jinan and Qingdao in eastern China. Face-to-face, in-depth, semi-structured interviews were conducted, audiotaped, and transcribed using thematic analysis. RESULTS Twenty-one trainees participated in this study. Thematic analysis generated five major themes: (1) low social recognition, (2) low professional identity, (3) low remuneration level, (4) imperfect training system, and (5) influence of policy factors. CONCLUSIONS Our results identified various negative factors influencing the career intentions of trainees. In order to overcome the hurdles and increase the attractiveness of GP, it is recommended that the government and the public should create a supportive environment, which can be beneficial to the construction and development of GP.
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Affiliation(s)
- Lei Tang
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, 250012 Jinan, China
- NHC Key Lab of Health Economics and Policy Research, Shandong University, 250012 Jinan, China
- Center for Health Preference Research, Shandong University, 250012 Jinan, China
| | - Huan Yang
- Department of Human Resources, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, 322000 Yiwu, China
| | - Zhuxin Mao
- School of Public Administration, Southwestern University of Finance and Economics, 611130 Chengdu, China
| | - Quan Li
- Cheeloo College of Medicine, Shandong University, 250012 Jinan, China
| | - Shunping Li
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, 250012 Jinan, China
- NHC Key Lab of Health Economics and Policy Research, Shandong University, 250012 Jinan, China
- Center for Health Preference Research, Shandong University, 250012 Jinan, China
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Magin P, Ralston A, Tapley A, Holliday E, Ball J, van Driel ML, Davey A, Klein L, FitzGerald K, Spike N, Fielding A. 'Low-value' clinical care in general practice: associations of low value care in GP trainees' practice, including formative and summative examination performance - protocol for cross-sectional and retrospective cohort study analyses using the QUestionable In Training Clinical Activities (QUIT-CA) index. BMJ Open 2022; 12:e058989. [PMID: 35545391 PMCID: PMC9096564 DOI: 10.1136/bmjopen-2021-058989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION 'Low value' clinical care and overuse of medical services are 'questionable' clinical activities that entail provision of medical services that are more likely to cause harm than good or whose benefit is disproportionately low compared with its cost. This study will seek to establish clinical practice associations of a non-observed work-based assessment of general practitioner (GP) trainees' (registrars') questionable practice (the QUestionable In Training Clinical Activities (QUIT-CA) index). We will also explore association of the QUIT-CA index with a formative observed work-based assessment, and will establish if registrars' QUIT-CA indexes are associated with summative examination performance. METHODS AND ANALYSIS We will conduct three analyses, all using data from the Registrar Clinical Encounters in Training (ReCEnT) study. ReCEnT is an ongoing (from 2010) cohort study in which Australian GP registrars record details of their in-consultation clinical and educational practice. The QUIT-CA index is compiled from ReCEnT consultation data. A cross-sectional analysis, using negative binomial regression, will establish clinical practice associations of the QUIT-CA index. A cross-sectional analysis using linear regression will be used to establish associations of QUIT-CA index with formative observed in-practice assessment (the General Practice Registrar-Competency Assessment Grid). A retrospective cohort study analysis using linear regression will be used to establish associations of the QUIT-CA index with summative examination performance (Royal Australian College of General Practice fellowship examinations results). ETHICS AND DISSEMINATION The study has ethical approval from the University of Newcastle HREC(H-2009-0323). Findings will be disseminated in peer-reviewed journal articles and conference presentations.
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Affiliation(s)
- Parker Magin
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
- NSW & ACT Research and Evaluation Unit, GP Synergy Regional Training Organisation, Mayfield West, New South Wales, Australia
| | - Anna Ralston
- NSW & ACT Research and Evaluation Unit, GP Synergy Regional Training Organisation, Mayfield West, New South Wales, Australia
| | - Amanda Tapley
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
- NSW & ACT Research and Evaluation Unit, GP Synergy Regional Training Organisation, Mayfield West, New South Wales, Australia
| | - Elizabeth Holliday
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Jean Ball
- Clinical Research Design and Statistical Support Unit (CReDITSS), Hunter Medical Research Institute (HMRI), New Lambton, New South Wales, Australia
| | - Mieke L van Driel
- Primary Care Clinical Unit, Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Andrew Davey
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
- NSW & ACT Research and Evaluation Unit, GP Synergy Regional Training Organisation, Mayfield West, New South Wales, Australia
| | - Linda Klein
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
- NSW & ACT Research and Evaluation Unit, GP Synergy Regional Training Organisation, Mayfield West, New South Wales, Australia
| | - Kristen FitzGerald
- Australian General Practice Training, General Practice Training Tasmania (GPPT), Regional Training Organisation, Hobart, Tasmania, Australia
- Tasmanian School of Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Neil Spike
- Eastern Victoria General Practice Training (EVGPT) Regional Training Organisation, Hawthorn, Victoria, Australia
- Department of General Practice and Primary Health Care, University of Melbourne, Carlton, Victoria, Australia
| | - Alison Fielding
- NSW & ACT Research and Evaluation Unit, GP Synergy Regional Training Organisation, Mayfield West, New South Wales, Australia
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Vicens C, Leiva A, Bejarano F, Sempere-Verdú E, Rodríguez-Rincón RM, Fiol F, Mengual M, Ajenjo-Navarro A, Do Pazo F, Mateu C, Folch S, Alegret S, Coll JM, Martín-Rabadán M, Socias I. Evaluation of a multicomponent intervention consisting of education and feedback to reduce benzodiazepine prescriptions by general practitioners: The BENZORED hybrid type 1 cluster randomized controlled trial. PLoS Med 2022; 19:e1003983. [PMID: 35522626 PMCID: PMC9075619 DOI: 10.1371/journal.pmed.1003983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 04/07/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Current benzodiazepine (BZD) prescription guidelines recommend short-term use to minimize the risk of dependence, cognitive impairment, and falls and fractures. However, many clinicians overprescribe BZDs and chronic use by patients is common. There is limited evidence on the effectiveness of interventions delivered by general practitioners (GPs) on reducing prescriptions and long-term use of BZDs. We aimed to evaluate the effectiveness of a multicomponent intervention for GPs that seeks to reduce BZD prescriptions and the prevalence of long-term users. METHODS AND FINDINGS We conducted a multicenter two-arm, cluster randomized controlled trial in 3 health districts in Spain (primary health centers [PHCs] in Balearic Islands, Catalonia, and Valencian Community) from September 2016 to May 2018. The 81 PHCs were randomly allocated to the intervention group (n = 41; 372 GPs) or the control group (n = 40; 377 GPs). GPs were not blinded to the allocation; however, pharmacists, researchers, and trial statisticians were blinded to the allocation arm. The intervention consisted of a workshop about the appropriate prescribing of BZDs and tapering-off long-term BZD use using a tailored stepped dose reduction with monthly BZD prescription feedback and access to a support web page. The primary outcome, based on 700 GPs (351 in the control group and 349 in the intervention group), compared changes in BZD prescriptions in defined daily doses (DDDs) per 1,000 inhabitants per day after 12 months. The 2 secondary outcomes were the proportion of long-term users (≥6 months) and the proportion of long-term users over age 65 years. Intention-to-treat (ITT) analysis was used to assess all clinical outcomes. Forty-nine GPs (21 intervention group and 28 control group) were lost to follow-up. However, all GPs were included in the ITT analysis. After 12 months, there were a statistically significant decline in total BZD prescription in the intervention group compared to the control group (mean difference: -3.24 DDDs per 1,000 inhabitants per day, 95% confidence interval (CI): -4.96, -1.53, p < 0.001). The intervention group also had a smaller number of long-term users. The adjusted absolute difference overall was -0.36 (95% CI: -0.55, -0.16, p > 0.001), and the adjusted absolute difference in long-term users over age 65 years was -0.87 (95% CI: -1.44, -0.30, p = 0.003). A key limitation of this clustered design clinical trial is the imbalance of some baseline characteristics. The control groups have a higher rate of baseline BZD prescription, and more GPs in the intervention group were women, GPs with a doctorate degree, and trainers of GP residents. CONCLUSIONS A multicomponent intervention that targeted GPs and included educational meeting, feedback about BZD prescriptions, and a support web page led to a statistically significant reduction of BZD prescriptions and fewer long-term users. Although the effect size was small, the high prevalence of BZD use in the general population suggests that large-scale implementation of this intervention could have positive effects on the health of many patients. TRIAL REGISTRATION ISRCTN ISRCTN28272199.
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Affiliation(s)
- Caterina Vicens
- Balearic Health Service IbSalut Son Serra-La Vileta Healthcare Centre, Palma, Illes Balears, Spain
- Research Network on Chronicity, Primary Care, and Health Promotion (RICAPPS)-Balearic Islands Health Research Institute (IdISBa), Mallorca, Spain
| | - Alfonso Leiva
- Research Network on Chronicity, Primary Care, and Health Promotion (RICAPPS)-Balearic Islands Health Research Institute (IdISBa), Mallorca, Spain
- Balearic Health Service IbSalut, Reseach Unit Primary care Mallorca, Palma, Illes Balears, Spain
- * E-mail:
| | - Ferran Bejarano
- Catalan Institute of Health Cat-salut, DAP Camp de Tarragona, Tarragona, Catalunya, Spain
| | - Ermengol Sempere-Verdú
- Conselleria de Sanitat Universal i Salut Pública, Paterna Healthcare Centre, Valencia, Comunitat Valenciana, Spain
| | - Raquel María Rodríguez-Rincón
- Balearic Health Service IbSalut Hospital Universitari Son Espases, Pharmacy Department,Palma de Mallorca, Illes Balears, Spain
| | - Francisca Fiol
- Balearic Health Service IbSalut Son Serra-La Vileta Healthcare Centre, Palma, Illes Balears, Spain
| | - Marta Mengual
- Catalan Institute of Health Cat-salut, DAP Camp de Tarragona, Tarragona, Catalunya, Spain
| | - Asunción Ajenjo-Navarro
- Conselleria de Sanitat Universal i Salut Pública, Paterna Healthcare Centre, Valencia, Comunitat Valenciana, Spain
| | - Fernando Do Pazo
- Balearic Health Service IbSalut Hospital Universitari Son Espases, Pharmacy Department,Palma de Mallorca, Illes Balears, Spain
| | - Catalina Mateu
- Balearic Health Service IbSalut Son Serra-La Vileta Healthcare Centre, Palma, Illes Balears, Spain
| | - Silvia Folch
- Catalan Institute of Health Cat-salut, DAP Camp de Tarragona, Tarragona, Catalunya, Spain
| | - Santiago Alegret
- Balearic Health Service IbSalut Son Serra-La Vileta Healthcare Centre, Palma, Illes Balears, Spain
| | - Jose Maria Coll
- Balearic Health Service IbSalut, Menorca Primary Care Management, Maó, Illes Baleares, Spain
| | - María Martín-Rabadán
- Balearic Health Service IbSalut, Can Misses Healthcare Centre Ibiza, Illes Baleares, Spain
| | - Isabel Socias
- Research Network on Chronicity, Primary Care, and Health Promotion (RICAPPS)-Balearic Islands Health Research Institute (IdISBa), Mallorca, Spain
- Balearic Health Service IbSalut, Manacor Healthcare Centre, Manacor, Illes Baleares, Spain
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Fielding A, Moad D, Tapley A, Davey A, Holliday E, Ball J, Bentley M, FitzGerald K, Kirby C, Turnock A, Spike N, van Driel ML, Magin P. Prevalence and associations of rural practice location in early-career general practitioners in Australia: a cross-sectional analysis. BMJ Open 2022; 12:e058892. [PMID: 35473723 PMCID: PMC9045092 DOI: 10.1136/bmjopen-2021-058892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To: (1) establish the prevalence of urban, regional, rural and remote practice location of early-career general practitioners (GPs); and (2) examine demographic and training-related characteristics associated with working in regional, rural or remote areas post attainment of vocational general practice qualifications. DESIGN Cross-sectional, questionnaire-based study, combined with contemporaneously collected data from participants' prior vocational training. SETTING Australian general practice. PARTICIPANTS Newly vocationally qualified GPs (ie, within 6 months-2 years post fellowship) who had completed vocational training with regional training organisations in New South Wales, Australian Capital Territory, eastern Victoria, and Tasmania between January 2016 and July 2018. PRIMARY OUTCOME MEASURE Rurality of post-fellowship practice location, as defined by Modified Monash Model (MMM) geographical classifications, based on current practice postcode. Prevalence of regional/rural/remote ('rural') practice was described using frequencies, and associations of rural practice were established using multivariable logistic regression, considering a range of demographic factors and training characteristics as independent variables. RESULTS A total of 354 participants completed the questionnaire (response rate 28%) with 319 providing information for their current practice location. Of these, 100 (31.4%) reported currently practising in a rural area (MMM2-7). Factors most strongly associated with practising in a rural area included having undertaken vocational GP training in a rural location OR 16.0 (95% CI 6.79 to 37.9); p<0.001; and undertaking schooling in rural area prior to university OR 4.21 (1.98, 8.94); p<0.001. CONCLUSIONS The findings suggest that vocational training experience may have a role in rural general practice location post fellowship, attenuating the previously demonstrated 'leakage' from the rural practice pipeline.
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Affiliation(s)
- Alison Fielding
- NSW & ACT Research and Evaluation Unit, GP Synergy, Regional Training Organisation (RTO), Mayfield West, New South Wales, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
| | - Dominica Moad
- NSW & ACT Research and Evaluation Unit, GP Synergy, Regional Training Organisation (RTO), Mayfield West, New South Wales, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
| | - Amanda Tapley
- NSW & ACT Research and Evaluation Unit, GP Synergy, Regional Training Organisation (RTO), Mayfield West, New South Wales, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
| | - Andrew Davey
- NSW & ACT Research and Evaluation Unit, GP Synergy, Regional Training Organisation (RTO), Mayfield West, New South Wales, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
| | - Elizabeth Holliday
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
| | - Jean Ball
- Clinical Research Design and Statistical Support Unit (CReDITSS), University of Newcastle Hunter Medical Research Institute, New Lambton, New South Wales, Australia
| | - Michael Bentley
- Australian General Practice Training, General Practice Training Tasmania (GPPT), Regional Training Organisation, Hobart, Tasmania, Australia
| | - Kristen FitzGerald
- Australian General Practice Training, General Practice Training Tasmania (GPPT), Regional Training Organisation, Hobart, Tasmania, Australia
- Tasmanian School of Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Catherine Kirby
- Australian General Practice Training, Eastern Victoria General Practice Training (EVGPT), Regional Training Organisation, Hawthorn, Victoria, Australia
| | - Allison Turnock
- Tasmanian School of Medicine, University of Tasmania, Hobart, Tasmania, Australia
- Department of Health, Australian Government, Hobart, Tasmania, Australia
| | - Neil Spike
- Australian General Practice Training, Eastern Victoria General Practice Training (EVGPT), Regional Training Organisation, Hawthorn, Victoria, Australia
- Department of General Practice and Primary Health Care, University of Melbourne, Carlton, Victoria, Australia
| | - Mieke L van Driel
- Primary Care Clinical Unit, Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Parker Magin
- NSW & ACT Research and Evaluation Unit, GP Synergy, Regional Training Organisation (RTO), Mayfield West, New South Wales, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
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Wang T, Ru X, Zhang Y, Zhang X, Gong J, Lao L, Gao J, Pan Z. Work competence of general practitioners working in the community health services of Shanghai: a cross-sectional study based on self-assessment. BMC Med Educ 2022; 22:201. [PMID: 35321704 PMCID: PMC8944096 DOI: 10.1186/s12909-022-03227-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 02/28/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVES The aim of the study was to investigate the work competence of general practitioners (GPs) in the community health services (CHSs) of Shanghai, China. METHODS A questionnaire was designed based on a previous capacity evaluation indicator system. We used a stratified and proportional cluster sampling method in this self-assessment and cross-sectional study. We collected data with the questionnaire on GPs' demographic variables and work competence including patient care ability, teaching ability, communication skill and coordination ability. Univariate analyses were performed by Mann-Whitney U test and Kolmogorov-Smirnov test. Multivariate analyses were done with generalized liner model with significant univariate factors. RESULTS A total of 2954 GPs were sampled from 116 CHSs in Shanghai. The response rate was 99.9%. The median scores of patient care ability, teaching ability, communication skill and coordination ability were 80[70-88.75], 76[60-80] and 80[70-85] on a scale of 100, respectively. GPs who were 30-39 years old, or worked in urban CHSs, or took GP trainer's training or had teaching experience got higher scores in patient care ability. GPs who worked for 5-19 years in CHSs, or worked in CHSs with GP training program or took GP trainer's training had higher scores in teaching ability. For communication skill and coordination ability, GPs who worked in CHSs with GP standardized training program, or took GP trainer's training or had teaching experience in CHSs got higher scores. CONCLUSIONS The work competence of GPs in CHSs of Shanghai could mainly cover daily work, but still needed more improvement in teaching ability.
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Affiliation(s)
- Tianhao Wang
- Department of General Practice , Zhongshan Hospital of Fudan University, Shanghai, China
| | - Xueying Ru
- Department of General Practice , Zhongshan Hospital of Fudan University, Shanghai, China
| | - Yuan Zhang
- Department of General Practice , Zhongshan Hospital of Fudan University, Shanghai, China
| | - Xiangjie Zhang
- Department of General Practice , Zhongshan Hospital of Fudan University, Shanghai, China
| | - Jian Gong
- Department of General Practice , Zhongshan Hospital of Fudan University, Shanghai, China
| | - Limin Lao
- Department of General Practice , Zhongshan Hospital of Fudan University, Shanghai, China
| | - Junling Gao
- Public Health school, Fudan University, Shanghai, China
| | - Zhigang Pan
- Department of General Practice , Zhongshan Hospital of Fudan University, Shanghai, China.
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Tran M, Wearne S, Tapley A, Fielding A, Davey A, van Driel M, Holliday E, Ball J, FitzGerald K, Spike N, Magin P. Transitions in general practice training: quantifying epidemiological variation in trainees' experiences and clinical behaviours. BMC Med Educ 2022; 22:124. [PMID: 35197039 PMCID: PMC8867826 DOI: 10.1186/s12909-022-03178-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 02/10/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND General Practice training in Australia is delivered through the apprenticeship model. General Practice supervisors support trainees transitioning from hospital-based work towards competent independent community-based practice. The timing and manner in which support should be provided is still not well understood. This study aimed to establish the variation in clinical and educational experiences and behaviours, and location, of general practice trainees' consultations by stage of their vocational training. It was hypothesised that change is greater in earlier stages of training. METHODS A cross-sectional analysis of data (2010-2018) from the Registrar Clinical Encounters in Training (ReCEnT) study, an ongoing cohort study of Australian GP registrars' in-consultation clinical and educational experience and behaviours. Multinomial logistic regression assessed the association of demographic, educational, and clinical factors in different stages of training. The outcome factor was the training term. RESULTS Two thousand four hundred sixteen registrars contributed data for 321,414 patient consultations. For several important variables (seeing patients with chronic disease; new patients; seeking in-consultation information or assistance; ordering pathology and imaging; and working in a small or regional practice), odds ratios were considerably greater for comparisons of Term 1 and 3, relative to comparisons of Term 2 and 3. CONCLUSION Differences experienced in demographic, clinical and educational factors are significantly more pronounced earlier in registrars' training. This finding has educational and training implications with respect to resource allocation, trainee supervision and curriculum design. Sociocultural learning theory enables an understanding of the impact of transitions on, and how to support, general practice trainees and supervisors.
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Affiliation(s)
- Michael Tran
- School of Medicine, Western Sydney University, Narellan Road & Gilchrist Drive, Campbelltown, NSW 2560 Australia
| | - Susan Wearne
- Academic Unit of General Practice, Australian National University, The Canberra Hospital, Yamba Drive Garran, Canberra, ACT 2605 Australia
| | - Amanda Tapley
- School of Medicine and Public Health, University of Newcastle, University Drive, NSW 2308 Callaghan, Newcastle, Australia
- GP Synergy, Regional Training Organisation (RTO), NSW & ACT Research and Evaluation Unit, 20 McIntosh Drive, Mayfield West, NSW 2304 Australia
| | - Alison Fielding
- School of Medicine and Public Health, University of Newcastle, University Drive, NSW 2308 Callaghan, Newcastle, Australia
- GP Synergy, Regional Training Organisation (RTO), NSW & ACT Research and Evaluation Unit, 20 McIntosh Drive, Mayfield West, NSW 2304 Australia
| | - Andrew Davey
- School of Medicine and Public Health, University of Newcastle, University Drive, NSW 2308 Callaghan, Newcastle, Australia
- GP Synergy, Regional Training Organisation (RTO), NSW & ACT Research and Evaluation Unit, 20 McIntosh Drive, Mayfield West, NSW 2304 Australia
| | - Mieke van Driel
- Primary Care Clinical Unit, Faculty of Medicine, University of Queensland, Level 8, Health Sciences Building, Royal Brisbane & Women’s Hospital, Brisbane, QLD 4029 Australia
| | - Elizabeth Holliday
- School of Medicine and Public Health, University of Newcastle, University Drive, NSW 2308 Callaghan, Newcastle, Australia
| | - Jean Ball
- Clinical Research Design and Statistical Support Unit (CReDITSS), Hunter Medical Research Institute (HMRI), Lot 1, Kookaburra Cct, New Lambton Heights, NSW 2305 Australia
| | - Kristen FitzGerald
- School of Medicine, University of Tasmania, 17 Liverpool Street, TAS 7000 Hobart, Australia
- General Practice Training Tasmania (GPPT), Regional Training Organisation (RTO), Level 3, RACT House, 179 Murray Street, Hobart, TAS 7000 Australia
| | - Neil Spike
- Department of General Practice and Primary Health Care, University of Melbourne, 200 Berkeley Street Carlton, Victoria, 3053 Australia
- Eastern Victoria General Practice Training (EVGPT), Regional Training Organisation (RTO), 15 Cato Street, Hawthorn, VIC 3122 Australia
- Faculty of Medicine, Nursing and Health Sciences, School of Rural Health, Monash University, Northways Road, Churchill, VIC 3842 Australia
| | - Parker Magin
- School of Medicine and Public Health, University of Newcastle, University Drive, NSW 2308 Callaghan, Newcastle, Australia
- GP Synergy, Regional Training Organisation (RTO), NSW & ACT Research and Evaluation Unit, 20 McIntosh Drive, Mayfield West, NSW 2304 Australia
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Le Floc'h B, Bastiaens H, Le Reste JY, Nabbe P, Montier T, Peremans L. Examining positive views from students, trainees and GPs about general practice: a generational problem? A set of qualitative studies in France. BMJ Open 2022; 12:e048857. [PMID: 35105565 PMCID: PMC8808418 DOI: 10.1136/bmjopen-2021-048857] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE This study aimed to explore the positive factors related to working in general practice in France, from a student studying medicine, trainee general practitioner (GP) and GP point of view. SETTING Primary care, France. DESIGN Nine different qualitative studies involving medical students, trainees and GPs. PARTICIPANTS Sixty-seven medical students, 22 trainees in general practice and 71 GPs. RESULTS The final codebook contained 66 interpretative codes and 8 positive themes. The themes were general practice as a commitment, doctor-patient care and relationships, skills and competencies in general practice, practice organisation and work-life balance, relationship with the professional community, GPs and university, GPs in the social community and private life, relatives and family. Positive feelings about being a GP are similar throughout the different age groups, from young students to older professionals. DISCUSSION AND CONCLUSION This study provided a comprehensive picture of the satisfied GP across different ages. This picture describes GPs as patient-centred professionals who need to have the freedom to choose an efficient working environment, organise their practice, have opportunities for professional development and acquire specific competencies. Both younger and older GPs believe in the future of general practice.
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Affiliation(s)
- Bernard Le Floc'h
- Department of General Practice, Université de Bretagne Occidentale, Brest, France
- EA 7479 SPURBO, Université de Bretagne Occidentale, Brest, France
| | - Hilde Bastiaens
- Department of Primary and Interdisciplinary Care, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
| | | | - Patrice Nabbe
- Médecine Générale EA Spurbo, Université de Bretagne Occidentale, Brest, France
| | - Tristan Montier
- Unité INSERM 1078, SFR 148 ScInBioS, Université Européenne de Bretagne, Faculté de Médecine et des Sciences de la Santé, Université de Bretagne Occidentale, Brest, France
| | - Lieve Peremans
- Primary Care, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
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Chappell N, Gerard C, Gyani A, Hamblin R, Jansen RM, Lawrence A, Mackay J, Minko N, Roberts S, Shuker C, Te Karu L, White J. Using a randomised controlled trial to test the effectiveness of social norms feedback to reduce antibiotic prescribing without increasing inequities. N Z Med J 2021; 134:13-34. [PMID: 34695090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
AIMS Antibiotic overprescription is a key driver of antimicrobial resistance, and rates of community dispensing of antibiotics in New Zealand are high compared to other developed countries. We aimed to test whether a social-norm-based intervention successful elsewhere would have an effect on GPs with high prescribing rates of antibiotics. We also aimed to assess the effects on prescribing for Māori and Pacific patients. METHODS A randomised controlled trial (n=1,214) tested the effects of a letter mailed to high-prescribing GPs that presented their prescribing data in comparison to their peers. RESULTS In September-December 2019, after the letters were mailed, the antibiotic prescribing rate in the control arm was 178.8 patients prescribed antibiotics per 1,000 patients prescribed any medicine, and in the intervention arm it was 162.3, a relative difference of 9.2% (p<0.001). GPs in the intervention arm were responsible for an average of 173.5 prescriptions, versus an average of 186.8 prescriptions for GPs in the control arm, a relative difference of 13.3 or 7.1% (p<0.01). Exploratory analyses showed the intervention reduced prescribing to Māori and Pacific patients among historically high prescribing GPs but had no statistically significant impact on low prescribers. CONCLUSIONS A targeted intervention using social norms reduced prescribing of antibiotics by high-prescribing GPs. Such an approach may be promising to address inequities in access to and use of antibiotics by Māori and Pacific peoples, historically underserved by prescribers, but further investigation is needed.
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Affiliation(s)
| | - Catherine Gerard
- Evaluation Manager, Health Quality Intelligence, Health Quality & Safety Commission
| | - Alex Gyani
- Director of Research and Methodology, Behavioural Insights Team & Honorary Fellow, University of Melbourne
| | - Richard Hamblin
- Director, Health Quality Intelligence, Health Quality & Safety Commission
| | | | | | | | - Nikolai Minko
- Principal Data Scientist, Health Quality Intelligence, Health Quality & Safety Commission
| | - Sally Roberts
- Clinical Lead, Infection Prevention and Control programme, Health Quality & Safety Commission
| | - Carl Shuker
- Principal Adviser, Publications, Health Quality Intelligence, Health Quality & Safety Commission
| | - Leanne Te Karu
- Pharmacist Prescriber, Department of General Practice and Primary Health Care, University of Auckland
| | - Jan White
- General Practitioner, New Zealand Medical Association
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Sotomayor-Castillo C, Nahidi S, Li C, Hespe C, Burns PL, Shaban RZ. General practitioners' knowledge, preparedness, and experiences of managing COVID-19 in Australia. Infect Dis Health 2021; 26:166-172. [PMID: 33676878 PMCID: PMC7891055 DOI: 10.1016/j.idh.2021.01.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 01/25/2021] [Accepted: 01/26/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND COVID-19 has brought unprecedented demands to general practitioners (GPs) worldwide. We examined their knowledge, preparedness, and experiences managing COVID-19 in Australia. METHODS A cross-sectional online survey of GPs members of the Royal Australian College of General Practitioners (RACGP) was conducted between June and September 2020. RESULTS Out of 244 survey responses, a majority of GPs (76.6%) indicated having good knowledge of COVID-19, relying mostly on state/territory department of health (84.4%) and the RACGP (76.2%) websites to source up-to-date information. Most felt prepared to manage patients with COVID-19 (75.7%), yet over half reported not receiving training in the use of PPE. The majority were concerned about contracting SARS-CoV-2, more stressed than usual, and have heavier workloads. Their greatest challenges included scarcity of PPE, personal distress, and information overload. CONCLUSION Access to PPE, training, accurate information, and preparedness are fundamental for the successful role of general practices during outbreaks.
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Affiliation(s)
- Cristina Sotomayor-Castillo
- Faculty of Medicine and Health, Susan Wakil School of Nursing and Midwifery, University of Sydney, Camperdown, NSW, Australia; Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Camperdown, NSW, Australia.
| | - Shizar Nahidi
- Faculty of Medicine and Health, Susan Wakil School of Nursing and Midwifery, University of Sydney, Camperdown, NSW, Australia; Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Camperdown, NSW, Australia.
| | - Cecilia Li
- Faculty of Medicine and Health, Susan Wakil School of Nursing and Midwifery, University of Sydney, Camperdown, NSW, Australia; Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Camperdown, NSW, Australia.
| | - Charlotte Hespe
- General Practice and Primary Care Research, School of Medicine, The University of Notre Dame Australia, Sydney, NSW, Australia
| | - Penelope L Burns
- Academic Unit of General Practice, Australian National University Medical School, The Australian National University, Canberra, ACT, Australia; Department of General Practice, School of Medicine, Western Sydney University, Campbelltown, NSW, Australia
| | - Ramon Z Shaban
- Faculty of Medicine and Health, Susan Wakil School of Nursing and Midwifery, University of Sydney, Camperdown, NSW, Australia; Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Camperdown, NSW, Australia; Department of Infection Prevention and Control, Division of Infectious Diseases and Sexual Health, Westmead Hospital and Western Sydney Local Health District, Westmead, NSW, Australia; New South Wales Biocontainment Centre, Western Sydney Local Health District and New South Wales Health, NSW, Australia.
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Roura M, LeMaster JW, Hannigan A, Papyan A, McCarthy S, Nurse D, Villarroel N, MacFarlane A. 'If relevant, yes; if not, no': General practitioner (GP) users and GP perceptions about asking ethnicity questions in Irish general practice: A qualitative analysis using Normalization Process Theory. PLoS One 2021; 16:e0251192. [PMID: 33979383 PMCID: PMC8115799 DOI: 10.1371/journal.pone.0251192] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 04/21/2021] [Indexed: 11/18/2022] Open
Abstract
Context The use of ethnic identifiers in health systems is recommended in several European countries as a means to identify and address heath inequities. There are barriers to implementation that have not been researched. Objective This study examines whether and how ethnicity data can be collected in Irish general practices in a meaningful and acceptable way. Methods Qualitative case study data generation was informed by Normalization Process Theory (NPT) constructs about ‘sense’ making and ‘engagement’. It consisted of individual interviews and focus group discussions based on visual participatory techniques. There were 70 informants, including 62 general practitioner (GP) users of diverse ethnic backgrounds recruited through community organisations and eight GPs identified through an inter-agency steering group. Data were analysed according to principles of thematic analysis using NPT. Results The link between ethnicity and health was often considered relevant because GP users grasped connections with genetic (skin colour, lactose intolerance), geographic (prevalence of disease, early years exposure), behavioural (culture/food) and social determinant (housing) factors. The link was less clear with religion. There was some scepticism and questions about how the collection of data would benefit GP consultations and concerns regarding confidentiality and the actual uses of these data (e.g. risk of discrimination, social control). For GPs, the main theme discussed was relevance: what added value would it bring to their consultations and was it was their role to collect these data? Their biggest concern was about data protection issues in light of the European Union (EU) General Data Protection Regulation (GDPR). The difficulty in explaining a complex concept such as ‘ethnicity’ in the limited time available in consultations was also worrying. Conclusions Implementation of an ethnicity identifier in Irish general practices will require a strong rationale that makes sense to GP users, and specific measures to ensure that its benefits outweigh any potential harm. This is in line with both our participants’ views and the EU GDPR.
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Affiliation(s)
- Maria Roura
- School of Public Health, University College Cork, Cork, Ireland
| | - Joseph W. LeMaster
- Kansas University Family Medicine Research, University of Kansas Medical Centre, The University of Kansas, Kansas City, Kansas, United States of America
| | - Ailish Hannigan
- School of Medicine & Health Research Institute, University of Limerick, Limerick, Ireland
| | - Anna Papyan
- Shannon Family Resource Centre, Shannon, Ireland
| | | | - Diane Nurse
- National Office for Social Inclusion, Health Service Executive, Dublin, Ireland
| | - Nazmy Villarroel
- Department of Sociological Studies, University of Sheffield, Sheffield, England
| | - Anne MacFarlane
- School of Medicine & Health Research Institute, University of Limerick, Limerick, Ireland
- * E-mail:
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Stengel S, Förster C, Fuchs M, Bischoff M, Ledig T, Streitlein-Böhme I, Gulich M, Haumann H, Valentini J, Kohlhaas A, Graf von Luckner A, Reith D, Fehr F, Magez J, Eismann-Schweimler J, Szecsenyi J, Joos S, Schwill S. Developing a seminar curriculum for the Competence Center for General Practice in Baden-Wuerttemberg - a progress report. GMS J Med Educ 2021; 38:Doc36. [PMID: 33763521 PMCID: PMC7958914 DOI: 10.3205/zma001432] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 11/04/2020] [Accepted: 11/20/2020] [Indexed: 05/31/2023]
Abstract
Aim: The seminar program of the KWBW Verbundweiterbildungplus® is offered by the Competence Center for Postgraduate Medical Education in Baden-Württemberg (KWBW) for physicians specializing in general practice (GP trainees). Attendance is a voluntary one comprised of 48 curricular units of 45 minutes each per GP trainee. This seminar program is meant to be attended in parallel to the postgraduate medical education in clinic or practice. The intention behind this project was to develop objectives, topics and a feasible structure for a seminar curriculum while taking time and financial constraints into account. Method: The Kern cycle was applied in an open, modified nominal group consensus technique in the form of an iterative process. Participating were 17 experts from the departments of general practice at the universities in Freiburg, Heidelberg, Tuebingen and Ulm, plus a pediatrician. Results: The main objective was defined as empowering GP trainees to independently provide high-quality primary care, including in rural areas. A basic curriculum was defined based on relevant frameworks, such as the 2018 Model Regulation for Postgraduate Medical Training (Musterweiterbildungsordnung/MWBO) and the Competency-based Curriculum General Practice (KCA). Overall, the seminar curriculum has 62 basic modules with 2 curricular units each (e.g. Basic Principles of General Practice, Chest Pain, Billing) and another 58 two-unit modules on variable topics (e.g. digitalization, travel medicine) adding up to 240 (124+116) curricular units. A blueprint with a rotation schedule for all of the teaching sites in Baden-Württemberg allows regular attendance by n=400 GP trainees over a period of five years, with individual variability in terms of program length. Conclusion: The model entails a five-year, flexible program to accompany the postgraduate medical education in general practice which can also be implemented in multicenter programs and those with high enrollments. The model's focus is on acquisition of core competencies for general practice. Despite the current shift to eLearning seminars due to SARS-CoV, the program's implementation is being continued, constantly evaluated, and used to further develop the KWBW Verbundweiterbildungplus® program.
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Affiliation(s)
- Sandra Stengel
- University Hospital Heidelberg, Department of General Practice and Health Services Research, Heidelberg, Germany
| | - Christian Förster
- University Hospital Tübingen, Institute of General Practice and Interprofessional Care, Tübingen, Germany
| | - Monika Fuchs
- University Hospital Ulm, Institute of General Practice, Ulm, Germany
| | - Martina Bischoff
- University of Freiburg, Division of General Practice, Medical Center, University Freiburg, Germany
| | - Thomas Ledig
- University Hospital Heidelberg, Department of General Practice and Health Services Research, Heidelberg, Germany
| | - Irmgard Streitlein-Böhme
- University of Freiburg, Division of General Practice, Medical Center, University Freiburg, Germany
- Ruhr-University Bochum, Medical Faculty, Department of General Practice, Bochum, Germany
| | - Markus Gulich
- University Hospital Ulm, Institute of General Practice, Ulm, Germany
| | - Hannah Haumann
- University Hospital Tübingen, Institute of General Practice and Interprofessional Care, Tübingen, Germany
| | - Jan Valentini
- University Hospital Tübingen, Institute of General Practice and Interprofessional Care, Tübingen, Germany
| | - Anja Kohlhaas
- University Hospital Heidelberg, Department of General Practice and Health Services Research, Heidelberg, Germany
| | - Andreas Graf von Luckner
- University of Freiburg, Division of General Practice, Medical Center, University Freiburg, Germany
| | - Dorothee Reith
- University Hospital Heidelberg, Department of General Practice and Health Services Research, Heidelberg, Germany
| | - Folkert Fehr
- Group Practice Dr. Folkert Fehr & Dr. Jan Buschmann, Sinsheim, Germany
| | - Julia Magez
- University Hospital Heidelberg, Department of General Practice and Health Services Research, Heidelberg, Germany
| | | | - Joachim Szecsenyi
- University Hospital Heidelberg, Department of General Practice and Health Services Research, Heidelberg, Germany
| | - Stefanie Joos
- University Hospital Tübingen, Institute of General Practice and Interprofessional Care, Tübingen, Germany
| | - Simon Schwill
- University Hospital Heidelberg, Department of General Practice and Health Services Research, Heidelberg, Germany
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Affiliation(s)
- Alex Sohal
- Chrisp Street Health Centre, London E14 6PG, UK
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39
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Muscariello R, Rendina D, Giannettino R, Ippolito S, Romano O, Coretti F, De Vita S, Martino M, Sepe C, Nuzzo V. Calcium daily intake and the efficacy of a training intervention on optimizing calcium supplementation therapy: A clinical audit. Nutr Metab Cardiovasc Dis 2021; 31:354-360. [PMID: 33092978 DOI: 10.1016/j.numecd.2020.08.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 07/22/2020] [Accepted: 08/03/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND AND AIMS Calcium is an essential element for human health, with key roles in the prevention and therapy of multifactorial conditions. Calcium dietary intake is often insufficient in the general population. The aim of this study was to perform a clinical audit for general practitioners (GPs) to understand the efficacy of training intervention on doctors' awareness about dietary calcium and supplements. METHODS AND RESULTS General practice outpatients were enrolled (Before Clinical Audit, BCA) from the same sanitary district, and calcium dietary intake was evaluated with a validated questionnaire, also collecting information about the consumption of calcium and vitamin D supplements. Then, a training intervention with a frontal lesson and discussion with GPs involved was performed. After one month of this intervention, a second outpatient enrolment was performed (Post Clinical Audit, PCA) in the same general practices to evaluate differences in nutritional suggestions and supplement prescription by GPs. In BCA, the calcium dietary intake was low, with nobody reaching 1000 mg as suggested by the guidelines. Only 6.6% and 24.5% took calcium and vitamin D supplements, respectively; in the PCA, these percentages increased to 28% and 78% for calcium and vitamin D supplements, respectively (p < 0.01 PCA vs BCA). There were no differences in calcium dietary intake between BCA and PCA. CONCLUSION Training intervention on GPs was successful to sensitize them regarding calcium intake problems; GPs tended to increase the prescription of supplements but not to suggest changes in dietary habits.
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Affiliation(s)
| | - Domenico Rendina
- Department of Clinical Medicine and Surgery, "Federico II" University, Naples, Italy
| | | | - Serena Ippolito
- Endocrinology and Nutrition Department, Ospedale del Mare, Naples, Italy
| | - Ornella Romano
- Endocrinology and Nutrition Department, Ospedale del Mare, Naples, Italy
| | - Federica Coretti
- Endocrinology and Nutrition Department, Ospedale del Mare, Naples, Italy
| | - Simone De Vita
- Endocrinology and Nutrition Department, Ospedale del Mare, Naples, Italy
| | | | - Carolina Sepe
- Endocrinology and Nutrition Department, Ospedale del Mare, Naples, Italy
| | - Vincenzo Nuzzo
- Endocrinology and Nutrition Department, Ospedale del Mare, Naples, Italy
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40
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Rochat M, De Vallière S, Favrat B. [What does a general practitioner need to know about whooping cough?]. Rev Med Suisse 2020; 16:2398-2402. [PMID: 33300701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Pertussis (whooping cough) is a vaccine-preventable bacterial infectious disease. Nevertheless, serious cases continue to be reported every year in the paediatric population. Pertussis poses a danger mainly to unimmunized or partially immunized infants under six months of age. It is still considered as a diagnostic challenge. The aim of this article is to present, through a clinical situation, the strategies for the prevention of pertussis and the correct management in case of suspicion of this disease. Through answers to questions we review the basics which every general practitioner should know.
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Affiliation(s)
- Martina Rochat
- Cabinet médical du groupe du Pays d'Enhaut, Route de l'Hôpital 17, 1660 Château d'Oex
| | - Serge De Vallière
- Centre universitaire de médecine générale et santé publique, Unisanté Lausanne, et Service de maladies infectieuses, CHUV, 1011 Lausanne
| | - Bernard Favrat
- Centre universitaire de médecine générale et santé publique, Unisanté Lausanne, et Service de maladies infectieuses, CHUV, 1011 Lausanne
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41
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Lim SC, Mustapha FI, Aagaard-Hansen J, Calopietro M, Aris T, Bjerre-Christensen U. Impact of continuing medical education for primary healthcare providers in Malaysia on diabetes knowledge, attitudes, skills and clinical practices. Med Educ Online 2020; 25:1710330. [PMID: 31891330 PMCID: PMC6968562 DOI: 10.1080/10872981.2019.1710330] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Background: Continuing Medical Education (CME) is a cornerstone of improving competencies and ensuring high-quality patient care by nurses and physicians. The Ministry of Health (MOH) Malaysia collaborated with Steno Diabetes Centre to improve diabetes-related competencies of general physicians and nurses working in primary care through a six-month training programme called the Steno REACH Certificate Course in Clinical Diabetes Care (SRCC).Objective: This impact evaluation aimed to assess the effect of participation of general physicians and nurses in the SRCC in selected public primary healthcare clinics in Kuala Lumpur and Selangor, Malaysia.Design: The quasi-experimental, embedded, mixed-methods study used concurrent data collection and the Solomon four-group design. Participants in an intervention group (Arm 1) and control group (Arm 3) were assessed by pre-and post-test, and participants in separate intervention (Arm 2) and control (Arm 4) groups were assessed by post-test only. Quantitative and qualitative methods were used to assess the effect of the programme.Results: Thirty-four of the 39 participants in the intervention groups (Arms 1 and 2) completed the SRCC and were included in the analysis. All 35 participants in the control groups (Arms 3 and 4) remained at the end of the study period. Significant improvements in diabetes-related knowledge, skills and clinical practise were found among general physicians and nurses in the intervention group after the six-month SRCC, after controlling the pretest effects. No clear changes could be traced regarding attitudes.Conclusion: SRCC participants had significant improvements in knowledge, skills and clinical practice that meet the current needs of general physicians and nurses working in primary care in Malaysia. Thus, SRCC is an effective CME approach to improving clinical diabetes care that can be scaled up to the rest of the country and, with some modification, beyond Malaysia.
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MESH Headings
- Adult
- Clinical Competence/standards
- Diabetes Mellitus/epidemiology
- Diabetes Mellitus/physiopathology
- Education, Medical, Continuing/organization & administration
- Education, Medical, Continuing/standards
- Education, Nursing, Continuing/organization & administration
- Education, Nursing, Continuing/standards
- Female
- General Practitioners/education
- Health Knowledge, Attitudes, Practice
- Humans
- Malaysia
- Male
- Middle Aged
- Primary Health Care/organization & administration
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Affiliation(s)
- Shiang Cheng Lim
- Steno Diabetes Center Copenhagen, Gentofte, Denmark
- United Nations University – International Institute for Global Health, Kuala Lumpur, Malaysia
- CONTACT Shiang Cheng Lim United Nations University – International Institute for Global Health (UNU-IIGH) Building, UKM Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, Cheras, Kuala Lumpur56000, Malaysia
| | - Feisul Idzwan Mustapha
- Steno Diabetes Center Copenhagen, Gentofte, Denmark
- Department of Public Health, Ministry of Health Malaysia, Putrajaya, Malaysia
| | - Jens Aagaard-Hansen
- Steno Diabetes Center Copenhagen, Gentofte, Denmark
- MRC Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Tahir Aris
- Institute for Public Health, Ministry of Health Malaysia, Putrajaya, Malaysia
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42
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Sandelowsky H, Krakau I, Modin S, Ställberg B, Johansson SE, Nager A. Patient outcomes following GPs' educations about COPD: a cluster randomized controlled trial. NPJ Prim Care Respir Med 2020; 30:44. [PMID: 33060615 PMCID: PMC7566632 DOI: 10.1038/s41533-020-00204-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 09/23/2020] [Indexed: 11/24/2022] Open
Abstract
This study aimed to compare patient outcomes following case method learning and traditional lectures as methods for continuing medical education (CME) about chronic obstructive pulmonary disease (COPD) for general practitioners (GPs) in Sweden. In a pragmatic cluster randomized controlled trial, COPD patients (n = 425; case method group n = 209, traditional lectures group n = 216) from 24 primary health care centers replied to questionnaires prior to and 18 months after a 2 × 2-h CME was given to GPs (n = 255). We measured changes in the scores of the Clinical COPD Questionnaire (CCQ), symptoms, needs for disease information, exacerbations, smoking, and use of pulmonary rehabilitation. The changes over time were similar for both CME methods. Patients who had used pulmonary rehabilitation increased from 13.2 to 17.8% (P = 0.04), and prevalence of smoking decreased from 28.9 to 25.1% (P = 0.003). In conclusion, neither of the used CME methods was superior than the other regarding patient outcomes. CME's primary value may lay in improving GPs' adherence to guidelines, which should lead to long-term positive changes in patient health.
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Affiliation(s)
- Hanna Sandelowsky
- Karolinska Institutet, Department of Medicine, Division of Clinical Epidemiology, SE-171 76, Stockholm, Sweden.
- Academic Primary Health Care Centre, Stockholm County Council, Box 45436, SE-104 31, Stockholm, Sweden.
- Karolinska Institutet, NVS, Section for Family Medicine and Primary Care, Alfred Nobels Allé 23, Huddinge, SE-141 83, Stockholm, Sweden.
| | - Ingvar Krakau
- Karolinska Institutet, Department of Medicine, Division of Clinical Epidemiology, SE-171 76, Stockholm, Sweden
| | - Sonja Modin
- Karolinska Institutet, NVS, Section for Family Medicine and Primary Care, Alfred Nobels Allé 23, Huddinge, SE-141 83, Stockholm, Sweden
| | - Björn Ställberg
- Uppsala University, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Box 564, SE-751 22, Uppsala, Sweden
| | - Sven-Erik Johansson
- Lund University, Center for Primary Health Care Research, Department of Clinical Sciences, SE-205 02, Malmö, Sweden
| | - Anna Nager
- Karolinska Institutet, NVS, Section for Family Medicine and Primary Care, Alfred Nobels Allé 23, Huddinge, SE-141 83, Stockholm, Sweden
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43
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van Beek C, Mulleners WM, Poelen J. [Headache in adults; article for education and training purposes]. Ned Tijdschr Geneeskd 2020; 164:D4146. [PMID: 32757508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Headache is one of the most common complaints for which patients request help from the general practitioner (GP). Anxiety and fear of serious illness are the most common reasons for consulting the GP, but a request for medication and worries about daily functioning can also prompt the consultation. In this educational article we describe a practical approach to the symptom 'headache' in adults on the basis of a number of questions. Our aim is to enable the general practitioner to: recognise alarm signals; identify the type of primary headache correctly; discuss, implement and evaluate the appropriate treatment; and reassure the patient.
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Affiliation(s)
| | - W M Mulleners
- Canisius Wilhelmina Ziekenhuis, afd. Neurologie, Nijmegen
- Contact: W.M. Mulleners
| | - J Poelen
- Canisius Wilhelmina Ziekenhuis, afd. Neurologie, Nijmegen
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Wang H, He J, Zhang D, Wu Y, Wang P, Cai H. Investigation and analysis of standardized training for residents of general practitioners of Gansu Province in China. BMC Fam Pract 2020; 21:112. [PMID: 32560693 PMCID: PMC7304171 DOI: 10.1186/s12875-020-01185-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 06/09/2020] [Indexed: 11/10/2022]
Abstract
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.
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Affiliation(s)
- Hongjing Wang
- Department of Medical Affairs, Gansu Provincial Hospital, Lanzhou, Gansu, China
| | - Jin He
- Department of Medical Affairs, Gansu Provincial Hospital, Lanzhou, Gansu, China
| | - Dongzhi Zhang
- Department of Discipline Construction Management, Gansu Provincial Hospital, Lanzhou, Gansu, China
| | - Yue Wu
- Department of Burn, Gansu Provincial Hospital, Lanzhou, Gansu, China
| | - Peidong Wang
- Department of Residents Training Management, Gansu Provincial Hospital, Lanzhou, Gansu, China
| | - Hui Cai
- Gansu Provincial Hospital, Lanzhou, Gansu, China.
- Hospital Management Research Center, Lanzhou University, Lanzhou, Gansu, China.
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45
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Harapan H, Setiawan AM, Yufika A, Anwar S, Wahyuni S, Asrizal FW, Sufri MR, Putra RP, Wijayanti NP, Salwiyadi S, Maulana R, Khusna A, Nusrina I, Shidiq M, Fitriani D, Muharrir M, Husna CA, Yusri F, Maulana R, Utomo PS, Andalas M, Wagner AL, Mudatsir M. Confidence in managing human monkeypox cases in Asia: A cross-sectional survey among general practitioners in Indonesia. Acta Trop 2020; 206:105450. [PMID: 32194068 PMCID: PMC7111046 DOI: 10.1016/j.actatropica.2020.105450] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Revised: 03/14/2020] [Accepted: 03/14/2020] [Indexed: 01/22/2023]
Abstract
The current re-emergence of human monkeypox (HMPX) is a global concern for endemic and non-endemic countries, but healthcare workers in some regions, like Asia, have less experience with identifying and treating HMPX cases. This study aimed to assess the confidence and its predictors in HMPX case management among general practitioners (GPs), the frontline doctors in Indonesia, and to explore their perspectives on HMPX. Between May and July 2019, GPs in Indonesia completed an online-based survey. The questionnaire collected information on GPs' confidence, perspective, sociodemographic, workplace and professional characteristics, exposure to HMPX information and knowledge on HMPX. A logistic regression analysis was employed to explore the explanatory variables influencing the confidence and the perspective. We included 395 GPs in our analysis (77.4% out of 510 responses received) of which 10.1% and 34.9% were classified having good confidence using an 80% and 70% cut-off for confidence score, respectively. In the adjusted analysis, receiving information about HMPX during medical training was the only variable significantly associated with good confidence (adjusted odds ratio 2.74, 95% confidence interval 1.57 to 4.78 and p < 0.001). Approximately 73.6% and 77.9% of GPs agreed that HMPX is an important infectious disease and it has potential to detrimentally impact the Indonesian economy, respectively. In addition, 88.8% of GPs suggested that the disease should be incorporated into the National Medical Curriculum of Indonesia. In conclusion, in case of HMPX outbreak, majority of the GPs in Indonesia seem to be less confident in diagnosing and treating cases, using their current knowledge, skills and their workplace facilities. Therefore, a systematic strategy to improve their confidence in managing HMPX is required.
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Affiliation(s)
- Harapan Harapan
- Medical Research Unit, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Aceh 23111, Indonesia; Tropical Disease Centre, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Aceh 23111, Indonesia; Department of Microbiology, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Aceh 23111, Indonesia.
| | - Abdul M Setiawan
- Department of Microbiology, Faculty of Medicine and Health Sciences, Maulana Malik Ibrahim State Islamic University of Malang, Malang, East Java 65144, Indonesia
| | - Amanda Yufika
- Department of Family Medicine, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Aceh 23111, Indonesia
| | - Samsul Anwar
- Department of Statistics, Faculty of Mathematics and Natural Sciences, Universitas Syiah Kuala, Banda Aceh, Aceh 23111, Indonesia
| | - Sri Wahyuni
- Faculty of Medicine, Universitas Malikussaleh, Lhokseumawe, Aceh 24531, Indonesia
| | | | - Muhammad R Sufri
- Banda Aceh Port Health Office, Ministry of Health, Aceh Besar, Aceh 23352, Indonesia
| | - Reza P Putra
- Medical Research Unit, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Aceh 23111, Indonesia
| | | | - Salwiyadi Salwiyadi
- Department of Internal Medicine, School of Medicine, Universitas Syiah Kuala Banda Aceh, Aceh 23111, Indonesia
| | - Razi Maulana
- Department of Obstetrics and Gynecology, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Aceh 23111, Indonesia; Department of Obstetrics and Gynecology, Zainoel Abidin Hospital, Banda Aceh, Aceh 24415, Indonesia
| | | | - Ina Nusrina
- Department of Health Service, District Health Office, Aceh Besar, Aceh 23912, Indonesia
| | - Muhammad Shidiq
- Nusa Jaya Public Health Center, Halmahera Timur, North Maluku 97863, Indonesia
| | - Devi Fitriani
- Teunom Public Health Center, Aceh Jaya, Aceh 23653, Indonesia
| | - Muharrir Muharrir
- Medical Research Unit, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Aceh 23111, Indonesia
| | - Cut A Husna
- Department of Microbiology, Universitas Malikussaleh, Lhokseumawe, Aceh 24531, Indonesia
| | - Fitria Yusri
- Faculty of Medicine, Universitas Malikussaleh, Lhokseumawe, Aceh 24531, Indonesia
| | - Reza Maulana
- Medical Research Unit, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Aceh 23111, Indonesia
| | - Prattama S Utomo
- Department of Medical Education and Bioethics, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogjakarta, 55281, Indonesia
| | - Mohd Andalas
- Medical Research Unit, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Aceh 23111, Indonesia; Department of Obstetrics and Gynecology, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Aceh 23111, Indonesia; Department of Obstetrics and Gynecology, Zainoel Abidin Hospital, Banda Aceh, Aceh 24415, Indonesia
| | - Abram L Wagner
- Department of Epidemiology, University of Michigan, Ann Arbor, Michigan, MI 48109, USA
| | - Mudatsir Mudatsir
- Medical Research Unit, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Aceh 23111, Indonesia; Tropical Disease Centre, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Aceh 23111, Indonesia; Department of Microbiology, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Aceh 23111, Indonesia
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Chang T, Ibrahim S, Ranasinghe HM, Mihirini AHTM, Weerasinghe D, Vithanage TDP, Banagala C, Arambepola C. Knowledge of Stroke, Its Warning Symptoms, Risk Factors and Treatment among the General Public and General Practitioners in a South Asian Population. J Stroke Cerebrovasc Dis 2020; 29:104760. [PMID: 32173224 DOI: 10.1016/j.jstrokecerebrovasdis.2020.104760] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2019] [Accepted: 02/13/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND An adequate stroke literacy among the general public and first-contact physicians is an essential prerequisite to ensure timely treatment and prevention of stroke. Knowledge on stroke pathophysiology, warning symptoms, risk factors and treatment, and its determinants was assessed among general public and general practitioners (GPs) in a South Asian population. METHODS A cross-sectional study was conducted among relatives of nonstroke patients admitted to the apex tertiary-care hospital in Sri Lanka. Trained doctors administered pretested, structured, open- and close-ended questionnaires. A postal survey using self-administered questionnaires was conducted among all registered GPs in Sri Lanka. RESULTS The sample of general public (51.7% males; mean age = 40.7 years) from 21 of 25 districts of Sri Lanka was 840 (response-rate = 97.4%) while the sample of GPs (77.6% males; mean age = 59.63 years) was 98 (response-rate = 30%). Of the general public, 83.2% were aware of a vascular aetiology of stroke, but only 46.8% were aware that the affected organ was the brain while 67.5% believed that either the heart or limb muscles die as sequalae of stroke. Over 50% correctly identified stroke warning symptoms while 84.7% would seek immediate Western medical treatment. Approximately, 32%-46% were not aware of the major stroke risk factors. Lower education (adj. OR = 1.7; 95% CI = 1.3-2.3), absence of stroke risk factors (2.6; 1.9-3.7) and nonutility of information sources (1.5; 1.0-2.0) determined poor knowledge on risk factors. Only about 1 in 8 GPs accurately defined stroke and TIA while only 43.9% correctly classified stroke subtypes. Only 1 in 10 GPs were aware of the recommended therapeutic window for thrombolysis. Older age (P = 0.01) and longer service (P = 0.04) of GPs were associated with not requesting brain imaging in stroke. CONCLUSIONS Strategies to educate both the public and first-contact physicians to improve stroke literacy need to be an integral part of programmes that aim to reduce the burden of stroke in any population.
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Affiliation(s)
- Thashi Chang
- Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka.
| | - Shiyana Ibrahim
- Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Hasanthika M Ranasinghe
- Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - A H T M Mihirini
- Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Dinushi Weerasinghe
- Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - T D P Vithanage
- Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Chinthaka Banagala
- Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Carukshi Arambepola
- Department of Community Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
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Couch D, O'Sullivan B, Russell D, McGrail M. 'It's so rich, you know, what they could be experiencing': rural places for general practitioner learning. Health Sociol Rev 2020; 29:76-91. [PMID: 33411661 DOI: 10.1080/14461242.2019.1695137] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 11/15/2019] [Indexed: 05/25/2023]
Abstract
Globally there is an urban/rural divide in relation to health and healthcare access. A key strategy for addressing general practitioner shortages in rural areas is GP vocational training in rural places, as this may aid in developing practitioners' scope, values and community orientation, and increase propensity for rural practice. This creates a need for deeper understanding of the nature and quality of this training. Rural GPs are well-positioned to reflect on vocational learning in 'place'. We aimed to explore rural GPs' perceptions and experiences of GP vocational learning in relation to rural places. Semi-structured interviews were conducted with 25 GPs based in smaller rural communities in Tasmania. Inductive and theoretical thematic analysis was undertaken. Rural places provide learning opportunities for GP registrars, which shape the relationships between GPs and registrars and their communities. Rural GPs are committed to developing the next generation and improving access to primary care for their communities. Rural places provide unique learning environments for general practice, including rich learning, relationships and community commitment.
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Affiliation(s)
- Danielle Couch
- La Trobe Rural Health School, La Trobe University, Bendigo, Australia
- School of Rural Health, Monash University, Bendigo, Australia
| | - Belinda O'Sullivan
- School of Rural Health, Monash University, Bendigo, Australia
- Rural Clinical School, University of Queensland, Toowoomba and Rockhampton, Australia
| | - Deborah Russell
- School of Rural Health, Monash University, Bendigo, Australia
- Flinders Northern Territory, Alice Springs, Australia
| | - Matthew McGrail
- School of Rural Health, Monash University, Bendigo, Australia
- Rural Clinical School, University of Queensland, Toowoomba and Rockhampton, Australia
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48
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Grant R, Nash M, Hansen E. What does inclusive sexual and reproductive healthcare look like for bisexual, pansexual and queer women? Findings from an exploratory study from Tasmania, Australia. Cult Health Sex 2020; 22:247-260. [PMID: 30958103 DOI: 10.1080/13691058.2019.1584334] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 02/13/2019] [Indexed: 06/09/2023]
Abstract
Increased awareness of the health disparities faced by lesbian, gay, bisexual, transgender, intersex and queer (LGBTIQ) people has driven the need for LGBTIQ-inclusive medical practices internationally. However, despite bisexual, pansexual and queer women's increased sexual health risks and reduced engagement with health services, there is little qualitative research examining their healthcare experiences. In addition, healthcare practitioners continue to report lack of awareness and competence in inclusive practice, particularly regarding these groups. To address these gaps in the literature and practice, this study draws on 21 qualitative interviews with women and general practitioners, comparing and contrasting their understandings and experiences of inclusive sexual and reproductive healthcare. Findings reveal that women value practitioners who take a non-judgemental approach, use inclusive language and are knowledgeable or willing to self-educate about LGBTIQ issues. Practitioners describe prioritising visual indicators of inclusivity, using inclusive language and embracing professional development. However, women and doctors both identify knowledge gaps among healthcare providers and the need for additional training opportunities to support effective inclusive practice.
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Affiliation(s)
- Ruby Grant
- School of Social Sciences, University of Tasmania, Hobart, Tasmania, Australia
| | - Meredith Nash
- School of Social Sciences, University of Tasmania, Hobart, Tasmania, Australia
| | - Emily Hansen
- School of Social Sciences, University of Tasmania, Hobart, Tasmania, Australia
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Abstract
BACKGROUND Attention Deficit Hyperactivity Disorder (ADHD) is underdiagnosed in many European countries and the process of accessing care and diagnosis is complex and variable. In many countries, general practitioners (GPs) refer on to secondary care where individuals receive an assessment and, if appropriate, a diagnosis and access to care. It is therefore essential that GPs have a clear understanding of the disorder and its care pathways. While previous studies have highlighted potential barriers in GPs' ADHD awareness, this qualitative study aims to further explore individual stakeholders' experiences. METHODS Semi-structured interviews explored the views of multiple stakeholders- GPs (n = 5), healthcare specialists (n = 5), patients (adults with ADHD n = 5) and parents (n = 5) with experience of the presentation and management of ADHD in primary care. These interviews were analysed using thematic analyses and following principles of grounded theory. RESULTS Stakeholders described ADHD assessment, diagnosis and treatment as an intricate process. Many factors affected this process such as complex pathways, lack of services, limited GP recognition and knowledge, and communicative difficulties between and within multiple stakeholders. CONCLUSION This analysis underlines the significant impact that receiving (or not) a diagnosis can have, and further explores muddled ADHD care pathways, highlighting key issues around GP identification and the shortage of adult services. Implications for practice and future research are discussed, suggesting a strong need for more commissioned pathways and GP specific educational programs.
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Affiliation(s)
- B French
- Division of Psychiatry & Applied Psychology, University of Nottingham, Nottingham, England.
- UK & Centre for ADHD and Neurodevelopmental Disorders Across the Lifespan (CANDAL), Institute of Mental Health, University of Nottingham, Nottingham, England.
| | - E Perez Vallejos
- Division of Psychiatry & Applied Psychology, University of Nottingham, Nottingham, England
- UK & Centre for ADHD and Neurodevelopmental Disorders Across the Lifespan (CANDAL), Institute of Mental Health, University of Nottingham, Nottingham, England
| | - K Sayal
- Division of Psychiatry & Applied Psychology, University of Nottingham, Nottingham, England
- UK & Centre for ADHD and Neurodevelopmental Disorders Across the Lifespan (CANDAL), Institute of Mental Health, University of Nottingham, Nottingham, England
| | - D Daley
- Division of Psychiatry & Applied Psychology, University of Nottingham, Nottingham, England
- UK & Centre for ADHD and Neurodevelopmental Disorders Across the Lifespan (CANDAL), Institute of Mental Health, University of Nottingham, Nottingham, England
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50
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Schneider M, Pruijm M, Halabi G. [Peritoneal dialysis : what the general practitioner should know about peritoneal dialysis]. Rev Med Suisse 2020; 16:390-394. [PMID: 32129014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Peritoneal dialysis (PD) has often been considered as a renal replacement method that is not feasible for the elderly population. Numerous recent studies have shown that this method is in fact very well, if not better tolerated by elderly patients. In Switzerland and abroad, its economic advantages have also been underlined during the past ten years. As a consequence, the use of PD is increasing, and primary care physicians are more often confronted to PD patients. Therefore, they have to be aware of some basic treatment principles, which are reviewed in this article.
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Affiliation(s)
| | - Menno Pruijm
- Service de néphrologie et hypertension, CHUV, 1011 Lausanne
| | - Georges Halabi
- Service de néphrologie et hypertension, CHUV, 1011 Lausanne
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