Career In General Practice Research Articles

Effect of an intercalated research degree on general practice careers: a matched cohort study.

INTRODUCTION Intercalated degrees are one of the most focused undergraduate research training activities offered to medical students worldwide. The effect of intercalating on actual career choices has not been previously investigated. AIM To examine the effect of obtaining an intercalated research degree on choosing general practice as a career. METHODS This was a retrospective, matched cohort study of intercalating students at the University of Otago, New Zealand (1995-2008). Medical students who completed the intercalated Bachelor of Medical Sciences with Honours, BMedSc(Hons), degree were retrospectively identified. Gender- and graduation year-matched controls were identified from a publicly available graduate database in a 1:1 ratio. MEDLINE® and Google Scholar-indexed publications resulting from BMedSc(Hons) projects were determined using standardised search criteria. Speciality choice was obtained from online lists of registered doctors. RESULTS Over the 14-year period, 99 (3.9%) students completed an intercalated degree with a publication rate of 36.4%. Of these, 42 (42.4%) were female and over two-thirds (68.7%) of projects were laboratory-based. The median follow-up period after graduation was 14 years (range 7.7-21.7 years). The congruence between students' BMedSc(Hons) research subject area and clinical speciality was 9.1%. Sixteen (16.2%) intercalating students chose general practice as a career, whereas 83 (83.8%) chose 19 different hospital-based specialties. Compared to controls, students who completed an intercalated degree were significantly less likely to pursue a career in general practice (odds ratio 0.37; 95% confidence interval=0.18 - 0.77; P=0.007). DISCUSSION The present study findings suggest that completing an intercalated degree is associated with lower odds of pursuing a career in general practice. Future research should explore reasons for this observation to help develop strategies to promote primary care and general practice careers among medical graduates, including those interested in research careers.

Simon John Connell

Brought up in Lytham St Annes, Simon John Connell was certain of his chosen career in general practice from his early student days at Manchester. After house officer jobs in...

The journey to becoming a newly qualified nurse in general practice

Practice Nursing is keen to encourage more students to get excited about a career in general practice. Victoria Bell kindly shares her experience of placements and job hunting in the hope that more students will see that working in general practice is an option them

LeiKA: an optional German general practice teaching project for first-semester medical students: who is taking part and why? A cross-sectional study

ObjectivesThis study investigates students’ adoption of LeiKA, a new extracurricular longitudinal general practice (GP) teaching project. LeiKA aims to attract a broad range of students, not only those who are...

Medical students’ perceptions of a career in general practice

BackgroundRecruitment into general practice is falling and many training programmes in the UK have unfilled training posts. In 2016 NHS England pledged to increase the number of graduates entering GP training to 50%. However in 2017 only 15.3% of foundation year 2 doctors commenced general practice.AimThis work aims to understand medical students’ perceptions of a career in general practice, and how this may affect their career intentions.MethodAs part of a larger, longitudinal study at four UK universities. First and fourth year students were invited to a focus group to discuss their perceptions of a career in general practice. The recordings were transcribed and content analysis was performed.ResultsThe perceptions discussed could be broadly grouped into three categories. ‘The GP’ highlighted students’ ideas of the GP as someone who was dedicated, could create rapport, and wanted a family life. The ‘Job of the GP’ indicated students were positive about the continuity of care the job offered, but felt the work was isolating and paperwork heavy. Finally, external factors such as denigration and the ‘GP land’ concept also had an impact on students’ perceptions.ConclusionFurther work is needed to understand how these perceptions develop, how this may impact students career intentions, and how this research could be used to improve GP recruitment. This data will form part of a wider longitudinal study, the results of which will be analysed for themes and personal narratives of the students.

Exploring the educational value of an ITP in integrated community care

BackgroundITPs (Integrated or Innovative Training Programmes) have been recognised as a distinct type of training post for general practice. Previous research has found them to provide an enhanced training experience. This work describes and evaluates a ‘new generation’ ITP post which piloted in the New Forest.AimThe evaluation aimed to determine if the integrated structure provided a positive educational experience and if it prepared trainees for a career in general practice. It was designed and conducted by GPST3 trainees.MethodThe post comprised a mix of 2 days a week in GP and 3 days in community healthcare posts. The posts were evaluated using a focus group of trainees and trainers, and a survey.ResultsParticipating trainees and trainers reported that the post was helpful in developing skills and competencies related to community care, but identified some challenges. Three key themes were identified: perceptions of improved quality of training; feeling better prepared for a career in GP; and better awareness of primary–secondary care system and interface.ConclusionICCs mark a welcome return of ITPs to GP training and can offer a positive experience to trainees in developing their care knowledge and skills. The trainees undertaking this evaluation gained insight into evaluation research. There continues to be a role for integrated training posts in training, especially with the increasing care complexity. ITPs can add a different dimension to experience in training.

Raising the profile of academic general practice to our medical students.

General practice is struggling to recruit and retain high-quality trainees. There is a national target to increase recruitment to general practice in order to create 5000 extra GPs by 2020.1 However, the attractiveness of the specialty has fallen relative to hospital practice.2 Currently only 15.3% of doctors completing foundation training are appointed to GP training programmes.3 Reasons for this are multifactorial but one postulated influence is students’ misperception that general practice is not a prestigious or academically challenging career choice.4 National studies support this concept: the recent ‘Destination GP’ survey jointly led by the Royal College of General Practitioners (RCGP) and the Medical Schools Council (MSC) found that only 3% of medical students associated general practice with being intellectually challenging.5 It has been acknowledged that correcting this misperception and raising the profile of academic general practice among medical students is vital in order to attract high-quality doctors and potential future educationalists and researchers into general practice, and we offer some consensus-based and evidence-based suggestions. The Wass report By Choice — Not by Chance was commissioned by Health Education England to support medical students towards careers in general practice.6 The report found that students perceive that the specialty fails to offer the variety of academic challenge that …

The influence of training experiences on career intentions of the future GP workforce: a qualitative study of new GPs in England.

BackgroundThe capacity of the UK GP workforce has not kept pace with increasing primary care workloads. Although many doctors successfully complete GP specialty training programmes, some do not progress to work in NHS general practice.AimThis article explores the training experiences and perceptions of newly qualified GPs to understand how their education, training, and early experiences of work influence their career plans.Design and settingA qualitative study of doctors in their final year of GP training (ST3) and within 5 years of completion of GP training (F5).MethodParticipants across England were recruited through training programmes, First5 groups, and publicity using social media and networks. Open narrative interviews were conducted with individuals and focus groups. Audiorecorded interviews were transcribed, and a thematic analysis was supported by NVivo and situational analysis mapping techniques.ResultsFifteen participants engaged in individual interviews and 10 focus groups were carried out with a total of 63 participants. Most doctors reported that training programmes had prepared them to deal confidently with most aspects of routine clinical GP work. However, they felt underprepared for the additional roles of running a practice and in their understanding of wider NHS organisational structures. Doctors wished to avoid unacceptably heavy workloads and voiced concerns about the longer-term sustainability of general practice.ConclusionStrategies to attract and retain enough GPs to support delivery of comprehensive primary care should consider how doctors’ early career experiences influence their career intentions. A coherent plan is needed to improve their preparation and increase confidence that they can achieve a professionally satisfying, effective, and sustainable career in NHS general practice.

Manubhai Dahyabhai Tailor

Manubhai Dahyabhai Tailor, popularly known as “Manu,” moved to UK from Eldoret, Kenya, in 1955 and from 1957 to 1962 he read medicine at the University of Birmingham Medical School....

A career in academic general practice

As a GP, you will make a difference to the lives of many thousands of patients over the course of your career, but as an academic GP you could make a difference to hundreds of thousands, even millions of lives. GPs can have an impact, not just in the consulting room or in patients’ homes. Differences can be made to the lives of many through the education and training of doctors, the work of commissioning boards seeking the best services for a community, or through research and development of the latest treatments. Primary care is a highly cost-effective part of NHS healthcare, and has a key role in promoting health and wellbeing. However, these roles would not be possible without contributions from academic general practice; the continuing success of primary care depends on the academic community that supports, researches, and develops best practice.

William Dewi Rees

After national service, William Dewi Rees (who was always known as “Dewi”), met his future wife, Valerie, while a medical student in London. She was a biochemist at the Hammersmith...

Factors Determining Pakistani Medical Students' Career Preference for General Practice Residency Training.

BackgroundFew studies have explored factors affecting preference of medical students towards general practice as a career choice. We conducted a survey in Karachi across various public and private sector medical colleges to examine factors associated with students’ general practice career aspirations in Karachi, Pakistan.MethodsFrom January to March 2018, we distributed a 21-item questionnaire to final year medical students in eight medical schools. The survey asked students about their top three career preferences from 19 specialty fields, their demographics and their career priorities. Multivariable logistic regression was used to determine the effect of each item.ResultsA total of 1400 responses were obtained. The top five specialty fields chosen by students with their numbers were: internal medicine, 898 (64.2%); general practice, 337 (24.1%); pediatrics, 449 (32.1%); surgery, 380 (27.2%); and emergency medicine, 243 (17.4%). The “intent to inherit existing practice” and “other academic or professional experiences prior to medical school” had a positive association with choosing general practice while “having a physician parent’’ had a negative association among the medical students demographics after adjusting for other covariates in the multivariable logistic regression. Medical students who ranked “clinical diagnostic reasoning”, “community-oriented practice”, “involvement in preventive medicine”, and “frequent patient communication” as highly important were more likely to choose general practice, whereas, “access to advanced medical fields”, “mastering advanced procedures”, and “depth rather than breadth of practice” were less likely to be associated with general practice aspiration.ConclusionThe study’s results depicted limited interest of family medicine as a career option in graduating students, and pointed out the factors that likely influence the choice of general practice as a career are clinical diagnostic reasoning, community-oriented practice and preventive medicine.

UK medical students\u2019 attitudes towards their future careers and general practice: a cross-sectional survey and qualitative analysis of an Oxford cohort

BackgroundAgainst the background of the recruitment crisis in general practice, we aimed to determine what United Kingdom (UK) medical students value in their future careers, how they perceive careers in general practice (GP) and what influences them.MethodsCross-sectional survey of 280 final and penultimate year medical students at the University of Oxford, with questions relating to career choices, factors of importance when choosing a career and attitudes towards general practice as a career. Quantitative methods included cluster analysis, chi squared tests of independence and logistic regression analysis. Qualitative data were analysed thematically using the Framework method.ResultsResponse rate was 89% (280/315). 40% of participants said that general practice was an attractive or very attractive career option. Respondents valued job satisfaction, work-life balance and close relationships with patients. However, fewer than 20% of respondents agreed that community-based working was important to them and many (often citing particular GPs they had observed) felt that general practice as currently structured may not be satisfying or fulfilling because of high workload, financial pressures and externally imposed directives. 63% perceived GPs to have lower status than hospital specialties and 49% thought the overall culture of their medical school had negatively influenced their views towards general practice. Some respondents considered that general practice would not be intellectually challenging or compatible with a research career; some appeared to have had limited exposure to academic primary care.ConclusionsWith the caveat that this was a sample from a single medical school, medical students may be put off careers in general practice by three main things: low perceived value of community-based working and low status of general practice (linked to a prevailing medical school culture); observing the pressures under which GPs currently work; and lack of exposure to academic role models and primary care-based research opportunities. To improve recruitment of the next generation of GPs, medical schools must provide high quality placements in general practice, expose students to academic role models and highlight to policymakers the links between the current pressures in UK general practice and the recruitment crisis.

The discipline of general practice: recognition and teaching

The core function of medical schools is to produce the doctors the nation needs1 and the NHS is clear that it now needs 50% of medical students to choose training for general practice. However, only 16.4% of newly qualified British-trained doctors seek postgraduate GP training.2 Moreover, one-third of British-trained doctors thought that their medical schools had not put them in a position to assess a career in general practice.3 I have met several junior doctors who have not heard of, let alone read, the writings of Professors McWhinney4 and Starfield,5 two world-class thinkers about general practice. GPs without understanding of the principles of their role have a shallower vision and often lower job satisfaction. How has this happened? When the NHS was established in 1948 many arrangements were made with the medical schools at a time when general practice was not a discipline and there was no professor of general practice in the world. The medical schools were initially entirely specialist led, linked to tertiary specialist hospitals with many special privileges. Training specialists was the priority and leading specialists, like Lord Moran, a Dean of St Mary’s Medical School, saw GPs as: ‘… having fallen off the ladder’.6 Professors of general practice came late to the party, first in Scotland in 1963, and in England in 1972. They were vigorously resisted by the Bristol, Cambridge, and Oxford medical schools, which appointed late in the 1990s. General practice/primary care struggled to gain entry to medical schools and even in 2017 …

Medical students’ perceptions of general practice as a career; a phenomenological study using socialisation theory

ABSTRACTThe ageing population and push to community care has significantly increased the workload of General Practitioners (GPs) in the UK and internationally. In an attempt to tackle this, NHS England has promised 5000 more GPs by 2020/21; however, recruitment is in crisis with GP training posts remaining unfilled. Little research has been carried out to assess the fundamental questions of what medical students’ perceptions of General Practice are and what shapes their perceptions at medical school. We aimed to explore medical students’ conceptualisations of being a GP and specifically the role of the medical school in shaping their perceptions. Two focus groups of year one and year four medical students were undertaken using an interpretive phenomenological approach. Our study has revealed that medical students perceive General Practice to lack prestige and challenge. These perceptions come, at least in part, from a process of socialisation within medical school, whereby medical students internalise and adopt their role models’ perceptions and values, and the values portrayed by the hidden curriculum in their medical school culture. Perceived external pressures to pursue a career in General Practice can have a negative influence and medical schools should be made aware of this.

John Weston Smith

John Weston Smith decided on a career in medicine despite coming from a family with no medical background or experience of higher education. His father was a wages clerk for...

Changing hearts and minds: examining student nurses\u2019 experiences and perceptions of a general practice placement through a \u2018community of practice\u2019 lens

BackgroundThe recent UK Government paper ‘Five year forward view’ describes the need to move much patient management from secondary to primary care, and this will require a significant increase in the numbers of General Practice Nurses (GPNs). Until recently, there has been no clear recruitment strategy to address this. There have however been a number of proposed solutions to address the impending GPN recruitment crisis and to increase the numbers of new GPNs in post. General Practitioners (GPs) working in the Advanced Training Practice Scheme (ATPS) have been commissioned by Health Education England to provide placements for student nurses. This paper reports upon the findings of a study evaluating the South Yorkshire ATPS network in relation to nursing students’ perceptions of general practice as a placement and a potential career option post-graduation.MethodsData were collected using semi-structured interviews with 18 nursing students. Qualitative data analysis used a framework approach and themes were cross-checked within the team. The research had ethical approval and anonymity and confidentiality were maintained throughout.ResultsUsing the Communities of Practice (CoP) framework as a theoretical lens, two main themes emerged from the data: ‘Myths and misunderstandings’ outlined some of the misconceptions that abounded in the absence of an established CoP in general practice. These included perceptions of what constitutes a ‘good’ placement, an apparent lack of relevant content in the curriculum, and the widespread use of social media by students as a means of information gathering. ‘Changing hearts and minds’ referred to the need to positively influence the culture within general practice by addressing some of the longstanding myths. Through the fledgling CoP, the students’ perceptions of the GPN role in particular were positively revised, as was the prospect of a career in general practice upon graduation.ConclusionsThe CoP that is emerging through the ATPS placements appear to be gradually changing the socio-cultural landscape within general practice by enabling student nurses to experience the reality of life in general practice nursing, and to view the GPN role as a viable career option upon graduation.

What determines medical students\u2019 career preference for general practice residency training?: a multicenter survey in Japan

BackgroundFew studies have systematically explored factors affecting medical students’ general practice career choice. We conducted a nationwide multicenter survey (Japan MEdical Career of Students: JMECS) to examine factors associated with students’ general practice career aspirations in Japan, where it has been decided that general practice will be officially acknowledged as a new discipline.MethodsFrom April to December 2015, we distributed a 21-item questionnaire to final year medical students in 17 medical schools. The survey asked students about their top three career preferences from 19 specialty fields, their demographics and their career priorities. Multivariable logistic regression was used to determine the effect of each item.ResultsA total of 1264 responses were included in the analyses. The top three specialty choice were internal medicine: 833 (65.9%), general practice: 408 (32.3%), and pediatrics: 372 (29.4%). Among demographic factors, “plan to inherit other’s practice” positively associated with choosing general practice, whereas “having physician parent” had negative correlation. After controlling for potential confounders, students who ranked the following items as highly important were more likely to choose general practice: “clinical diagnostic reasoning (adjusted odds ratio (aOR): 1.65, 95% CI 1.40–1.94)”, “community-oriented practice (aOR: 1.33, 95% CI 1.13–1.57)”, and” involvement in preventive medicine (aOR: 1.18, 95% CI 1.01–1.38)”. On the contrary, “acute care rather than chronic care”, “mastering advanced procedures”, and “depth rather than breadth of practice” were less likely to be associated with general practice aspiration.ConclusionsOur nationwide multicenter survey found several features associated with general practice career aspirations: clinical diagnostic reasoning; community-oriented practice; and preventive medicine. These results can be fundamental to future research and the development of recruitment strategies.

Pre-registration house officer training in psychiatry: the London experience

AIMS AND METHOD To evaluate whether new pre-registration house officer posts in psychiatry deliver training leading to increased confidence in target skills, based on General Medical Council requirements, and to evaluate trainees9 satisfaction with these posts. A structured questionnaire was filled out by the first nine incumbents of the PRHO posts before and after the placements. RESULTS Trainees9 confidence improved in all the target skills and the posts were all rated as good or excellent. The posts attracted trainees who were potentially interested in a career in psychiatry or general practice. CLINICAL IMPLICATIONS PRHO posts in psychiatry deliver training that meets General Medical Council objectives, and trainees9 confidence with core psychiatric skills improves after undertaking the placements.

Supporting primary care nurses to work at an advanced level through changing practices' organisational governance.

General practice nurses wishing to develop their careers in general practice are often unsupported, relying on the culture of individual practices. Given the structural diversity of Australian general practice, we qualitatively explored staff experiences of organisational governance, what supports are in place and can be used to assist nurses to advance. Semi-structured interviews with 28 staff (including nurses, GPs, receptions and practice managers) were undertaken across three practices, as part of a case-study approach. It was found that general practice staff know little of organisational governance and how it may be harnessed. Practical and flexible organisational governance were the most important factors in supporting general practice nurses to develop and utilise nursing skills, but advocacy from medical colleagues was necessary to support advancement. Barriers include funding structures, non-supportive cultures and inflexible organisational governance structures. Organisation governance has the potential to assist nurses to work at an advanced level, but significant financial, structural and cultural barriers may be too difficult for organisational governance resources alone to overcome. In addition to utilising resources, it may be useful for general practices to undertake a review of how they function as a team and reflect upon their practice culture.