Academic outreach: Fostering learning and research in general practice

Abstract

UK general practitioners (GPs) are invited todescribe their involvement in research in their annualappraisal. As far as we are aware, this is the first timethat GPs’ research activities will be ‘‘officially’’audited in this country, and yet researchers reportincreasing difficulty recruiting practitioners as parti-cipants in primary care research. For many practi-tioners, the reasons for not engaging in researchremain the same as those reported by Olsen almost adecade ago, namely low morale, increasing workloadand bureaucracy, problems with recruitment, andretention of general practitioners (1). Today generalpractices may be involved in research either on aspecific project or as part of a research network.However, most GPs, even in ‘‘research-active’’practices do not design the project, much lessanalyse or interpret the data. Their involvement isoften limited to the decision to allow their practice tohost a project, with practice staff facilitating access todata and occasionally helping to recruit patients.One stimulus to developing a greater involvement inthe research process may be the habit of reading andevaluating published work. A prerequisite is compe-tence in critical reading. An effective strategy forintroducing critical appraisal skills or establishing‘‘journal clubs’’ in primary care clinical settings hasnot been established (2). The challenges of establish-ing ‘‘journal clubs’’ in primary care include thosethat limit the involvement of practitioners in higherprofessional education courses, namely the need toinvest time and the availability of local or accessiblecourses (3).Research in primary care appears to be dichot-omized into research ‘‘on’’ general practice andresearch ‘‘in’’ general practice. The former consistslargely of projects in which clinicians recruit patientsto pharmaceutical trials. The latter addresses ques-tions posed by that discipline cognisant of theconstraints imposed by complex but concise con-sultations. The prized outputs of such projects mayinclude innovations or insights informed by therealities of serving patients with co-morbidities,exercising autonomy and presenting undifferentiatedillness. We report one way to engage the primarycare clinical community in research.The scheme consists of short clinical and aca-demic outreach visits by a university clinical lecturerin general practice aimed at establishing journalclubs and stimulating interest in research. Outreachvisits are variously called university-based educa-tional detailing, public interest detailing and aca-demic detailing. Such visits, particularly whencombined with social marketing, appear to modifyhealth professionals’ behaviour (4). The use of localopinion leaders to influence professional practice ispromising but inadequately researched, as is the useof interactive workshops, including journal clubs(5,6). General practitioners are ambivalent aboutparticipating in research or engaging formally incritical reading. Academic outreach, when allied tothe offer of clinical support, may nurture an interestin research in general practice and primary care. Itmay result in an interest in critical reading as well asstimulate correspondence in academic journals.