Teaching in practice: a qualitative factor analysis of community-based teaching.

Abstract

In response to Tomorrow's Doctors, the use of primary care as a teaching base has been extended in many medical curricula. Previous reports have largely been speculative, looking at the theoretical possibilities and concerns of general practitioner teachers; in order to validate such studies, it is now important to evaluate the experience of those actually engaged in new teaching opportunities. In addition, curriculum developers need to go beyond descriptive studies to weight the factors which may help or hinder new teaching. The aim of this qualitative study was to use the context of a substantive increase in community-based teaching to evaluate the perspective of key general practice tutors on factors related to recruitment and retention, impact and outcomes, curriculum delivery, training and support, and quality assurance of the course. Data were collected by written questionnaires to a sample of 45 general practitioners, plus semi-structured interviews with 15 general practitioners (33% of total sample). The data were purposively analysed to seek key factors, which were weighted by 'force field' analysis to show the balance of positive and negative factors. The data demonstrate important factors which may facilitate or impair community-based teaching at the levels of tutor, student, practice, and academic context. A 'cycle of satisfaction' is described, where personal motivation, shared team responsibility for teaching, and an enhanced professional self-image may all be crucial interdependent contributors. Suggestions are drawn from the data on key elements of effective academic support and possible practical quality indicators.