Benefits and challenges of multi-level learner rural general practices--an interview study with learners, staff and patients.

Tracy Morrison,Melanie Bryant,Debra Nestel,James Brown

doi:10.1186/1472-6920-14-234

Abstract

BackgroundGeneral practices vary in the provision of training and education. Some practices have training as a major focus with the presence of multi-level learners and others host single learner groups or none at all. This study investigates the educational benefits and challenges associated with ‘multi-level learner’ practices.MethodsThis paper comprised three case studies of rural general practices with multiple levels of learners. Qualitative data were collected from 29 interviews with learners (n = 12), staff (n = 12) and patients (n = 5). Interviews were initially analyzed using open and axial coding and thematic analysis.ResultsThematic analysis showed ‘multi-level learning’ in general practices has benefits and challenges to learners and the practice. Learner benefits included knowledge exchange, the opportunity for vertical peer learning, a positive learning environment and the development of a supportive network. The presence of multi-level learners promoted sharing of knowledge with all staff, a sense of community, an increase in patient services and enthused supervisors. Challenges for learners included perception of decreased access to supervisors, anxiety with peer observation, reduced access to patient presentations and patient reluctance to be seen by a learner. Practice challenges were administration requirements, high learner turnover, infrastructure requirements and the requirement for supervisors to cater to a range of learner level needs.ConclusionsThe presence of medical students, interns and registrars in general practice has educational benefits to the learners extending to the other stakeholders (staff and patients). Multi-level learners present challenges to the learners and the practice by increasing pressures on resources, staff (administrative and supervisors) and infrastructure.

Highlights

General practices vary in the provision of training and education
This study explores the educational benefits and challenges of multi-level learner general practices in a rural setting
Our study explored educational benefits and challenges of multi-level learners in general practices as well as benefits and challenges to the practice as a medical service organization

Summary

Introduction

Some practices have training as a major focus with the presence of multi-level learners and others host single learner groups or none at all. While some have training as a major focus with multiple levels of learners (medical students, interns and registrars), others host single-level learner groups or none at all. This study explores the educational benefits and challenges of multi-level learner general practices in a rural setting. Much literature is available exploring education in general practice settings including papers investigating various aspects of having a single learner group in the practice e.g. medical students [1,2,3,4,5,6,7] or registrars [8,9,10,11]. Specific studies conducted in the general practice setting with multi-level learner presence include an exploration of; challenges of teaching in general practice [12], the capacity with which practices may increase teaching load [13], financial considerations of learners in the practice [14,15], key elements of a primary care teaching practice [16], benefits and risks of shared learning models [17], facilitating factors and barriers to shared learning [18] and, how clinical learning occurs [19]

Methods

Results

Conclusion