General Practice Education Research Articles

A qualitative evaluation of trainee and educator experiences of Integrated Training Posts in one Vocational Training Scheme

ABSTRACT Integrated Training Posts (ITPs) were conceived in the 1990s and have recently increased in the Southwest of England. Most ITP evaluations have been small and undertaken over 13 years ago, so do not reflect the current training landscape. This qualitative study aimed to explore the views and experiences of ITPs amongst general practice trainees and educators. The location has increasing numbers of general practice trainees, International Medical Graduates (IMGs) and less-than-full-time trainees. Semi-structured interviews were undertaken with six trainees and two educators; all had experienced at least one ITP. Recordings were transcribed verbatim and coded. Thematic analysis was undertaken. Three themes were identified: ‘The role: expectations versus reality’, ‘Relevance of ITPs to future GP role’ and ‘Educational Challenges’. Most trainees valued the additional clinical experiences ITPs offered, as well as being able to trial ‘portfolio’ working. Trainee and educator expectations varied considerably, particularly whether the role was primarily service or observational. Working across multiple settings could limit contact between educator and trainee and make it difficult to identify a struggling trainee. There is a need to clarify the roles of trainees and educators involved in ITPs and whether and how this might vary between posts. Further studies could explore whether choice of ITP influences retention of general practitioners, and whether all trainees including those working less-than-full-time or IMGs benefit from ITPs.

Insights from end-of-career general practitioners on changing working conditions and generational differences: considerations for future strategies.

The landscape of general practice has experienced notable transformations in recent decades, profoundly influencing the working conditions of general practitioners (GPs). This study aimed to examine the most salient changes affecting GPs' daily practices. Through semi-structured qualitative interviews with 15 end-of-career GPs, the study explored how these changes affected work organization, equipment, working hours, work-life balance, job satisfaction, training, patient relationships, and reputation. The interviews revealed that these changes were perceived as barriers, opportunities, or a complex interplay of both for general practice. While the interviewed GPs valued technological advancements and reported positive developments in working conditions, challenges included a gradual reduction in the range of tasks, growing administrative burdens, and less practical training for young physicians. Other changes, such as new doctor-patient dynamics, the transition from single to group practice, and differing professional expectations of the younger generation, were seen as both challenging and strengthening for general practice. By combining these factors and trade-offs observed by end-of-career GPs in our study over the past few decades with general societal changes, we provide ideas for the design of future framework conditions in general practice that might enhance the attractiveness of the profession. These insights offer key considerations that can guide future strategies for general practice and medical education.

Management in education: Effective management methods and economic aspects

Relevance. The research relevance is determined by the need for effective adaptation of educational systems to modern challenges and requirements to create a stimulating educational environment for gifted children. Purpose. In this regard, the study aims to develop recommendations for effective management in educational institutions, considering individual characteristics of students and economic aspects. Methodology. Such methods as system approach, analysis, comparison, synthesis, deduction, and classification were used. Results. As a result of the study, the fundamental aspects of education management for gifted children were identified, among which the most significant are economic aspects, individualised educational programmes, leadership, and interaction. Economic factors like financial provision and stakeholder participation are essential for a sustainable education system. Personalised education brings economic and reputational benefits. The study highlights the role of leaders in a school's success and adaptability to modern challenges. Effective communication and partnership between educational institutions and parents of students are significant factors in ensuring the success of the learning and development of gifted children. Conclusions. The comparison of management in education for gifted children and students of general educational practice allowed us to reveal the challenges and perspectives in this area, as well as to confirm the need to implement individualised educational programmes for gifted children. The materials of the study can be used to improve approaches to individualised educational programmes, as well as serve as a basis for optimising financial resources in the education system. Keywords: individualised programmes; gifted children; professional competencies of teachers; role of stakeholders; leadership; financial support

Social aspects of training organization for people with limited health capacities, special educational needs and disabilities in Russia

The article reveals the social aspects of organizing the educational process for students with limited health capacities, special educational needs, and disabilities, characteristic of Russian general educational practice. The author presents a review of pedagogical, methodological, technological, special developmental, and other approaches to providing conditions for the socialization and social integration of such students in general education organizations and inclusive schools, where variability in the choice of forms of special developmental, psychological, pedagogical, and tutoring support is provided for both students and their families.

Constructing moments of insight: accounting for learning in classroom discussions on narrative fiction reading

ABSTRACT This article explores booktalk situations in which student teachers discuss a narrative text and construct in situ accounts of learning when recalling their reading. This study contributes to knowledge about the role of narrative fiction in general educational practice, as well as to the understanding of situated constructions of learning. Video and audio recordings were made in a seminar involving two groups of five master’s students, and the situated interaction was analysed using discursive reception theory. The results show that students construct what are here called moments of insight: a social action constructing a significant shift in participants’ self-described cognitive or emotional development, related to the reading. Students construct themselves as having been changed as both teachers and learners, either through the reading experience or when reflecting upon that experience. This demonstrates both how booktalk enables students to reflect upon their reading and their own cognitive development, and how situated classroom interaction studies enable us to engage with student learning in a naturalistic setting. This has an impact on our view of narrative fiction in educational practice, as well as educational research methods and practices.

Knowledge, Attitude, and Practice (KAP) Status toward Clinical Reasoning and Evidence-Based Medicine among the Medical Interns and Gynecology Residents of Iran University of Medical Sciences.

Clinical reasoning and evidence-based medicine (EBM) are important concepts in modern medicine. We performed this study to investigate the knowledge, attitude, and practice (KAP) status toward clinical reasoning and EBM among the medical interns and gynecology resident physicians of Iran University of Medical Sciences and related factors. A cross-sectional study (Tehran, Iran, first half of 2022) was conducted based on two researcher-made questionnaires consisting of three components for each including clinical reasoning attitude (CR-A), clinical reasoning knowledge (CR-K), clinical reasoning practice (CR-P), EBM attitude (EBM-A), EBM knowledge (EBM-K), and EBM practice (EBM-P). The related factors were age, gender, educational level, score of general practice education, having research experience, and general practice experience. A total of 60 individuals participated. The mean score was good for CR-A, moderate for CR-K, moderate for CR-P, good for EBM-A, moderate for EBM-K, and moderate for EBM-P. The total score was moderate in both clinical reasoning and EBM. Among the related factors, CR-P was associated with higher educational levels and having experience in general practice (P < 0.05). Research experience was associated with better CR-K and all KAP components for EBM (P < 0.05). The total score and many of the KAP components had moderate status for clinical reasoning and EBM. Planning on the associated factors should be regarded in the future. Such questionnaires are suggested to be validated for use in quasi-experimental studies.

Demand analysis of general practice patients for teaching clinic based on Kano model.

General practice teaching clinics play a crucial role in the training of general practitioners, as they are more likely to enhance reception skills compared to traditional training methods. The quality of teaching clinics is largely determined by the level of patient acceptance. In recent years, the Kano model has become increasingly popular in the healthcare industry and has been used to enhance patient satisfaction. The objective of this study is to apply the Kano model to investigate the needs of patients in general practice teaching clinics and to rank the significance of each demand. This study will serve as a reference for enhancing the service quality of teaching clinics and advancing the field of general practice. A total of 101 patients of general practice at the Affiliated Hospital of Yangzhou University in Jiangsu province were selected using a random convenience sampling method to participate in a questionnaire survey. The questionnaire was designed by members of our team and was based on the Kano model. The study defined the service demand, assessed the impact of both satisfaction and dissatisfaction and created a matrix bubble diagram. The study findings revealed that out of the 14 items of the general practice teaching clinic service demands, 1 item was categorized as a must-be requirement, 4 items were categorized as one-dimensional requirements, 2 items were categorized as an attractive requirement, 2 items were categorized as an indifferent requirement, and 5 items were categorized as mixed attributes. The findings of the matrix analysis showed that 4 items were situated in the area of one-dimensional attributes quadrant, 3 items were situated in the area of attractive attributes quadrant, 5 items were situated in the area of indifferent attributes quadrant, and 2 items were situated in the area of must-be attributes quadrant. The patients of general practice have positive attitudes toward teaching clinics. The findings can offer valuable insights for enhancing the quality of service and patient experience in general practice teaching clinics as well as for advancing the field of general practice.

Analysis of the History and Current Situation of the Development of General Practice Teaching Clinics in China

Analysis of the History and Current Situation of the Development of General Practice Teaching Clinics in China

Primary care in the world of integrated care systems: education and training for general practice

Here, we discuss the required education and training for the emergent and evolving roles of GPs and other healthcare professionals within Integrated Care Systems (ICSs). We underscore the importance of collaborative skills for all medical specialties, and the need for interprofessional education and leadership development in undergraduate and postgraduate medical training. We also argue for a paradigm shift in medical education, away from traditional siloed approaches and toward comprehensive training that prepares practitioners to excel in integrated and multidisciplinary healthcare environments, within which expert generalists (GPs) and specialists collaborate in individual patient care and concurrently co-develop innovative system pathways for chronic medical conditions, including complexity and frailty. We highlight the need to align workforce development with evolving healthcare systems and the existing obstacles hindering this alignment.

Exploring English Teachers’ Pedagogical Wellbeing and Classroom Issues: A Narrative Inquiry

This paper deals with the classroom issues of English as a Foreign Language (EFL) teaching in the context of Nepal and the EFL teachers' ways of addressing them. More specifically, it connects how pedagogical strengths help teachers address the issues that appear in language classrooms. The research has been carried out outlining the qualitative approach grounded in an interpretive research paradigm. The data were collected from three university teachers. Methodologically, the study adopts the three-dimensional narrative spaces as the prior procedures of research methods for theoretical insight. It concludes that teachers' profound knowledge and skills about their well-being are useful to integrate various cultures and content in the classrooms. Pedagogically inbuilt potentials of teachers maximally enhance learners' learning opportunities. Thus, the conclusion obtained in this study is assessed considering teachers' understanding, of classroom issues and their ways of addressing those problems but they may not be generalizable. However, it contributes to teachers' education in general and ELT practice in Nepal in particular.

Current Insights in The Barrier of Continuing Education for General Practitioners in China and Construction of A Novel Raining Model

Since 1997, China has been carrying out general practice education and has promulgated and implemented the “General Practitioner System”, conducting general practice job transfer training and “5+3” standardized training. However, the continuing education of general practitioners in China was the weakest. This study looked insights in the barrier of continuing education for General Practitioners in China: There was no unified mode and standard for continuing education for general practitioners, lacked of management system covering the entire practice cycle of general practitioners, the focus of post graduation training was unclear, the overall level of the teaching staff was not high, and the enthusiasm of general practitioners to participate in continuing education was poor. In response to these issues, the authors constructed and implemented a full cycle general practitioner continuing education model guided by job competence. Based on summarizing the 10 core job competencies of general practitioners, they constructed a general practitioner training faculty, established general practitioner related systems (continuing education system, practice management system, and professional title promotion system), designed training courses, and conducted hierarchical training, We organized multi-path scientific research training and conducted comprehensive quality management for the continuing education of general practitioners, achieving satisfactory results. Our raining model provided a useful reference for the current continuing education of general practitioners in China and is worth promoting and applying.

Teaching – educate, educating – teach: theory and practice of general education of persons sentenced to imprisonment

Teaching – educate, educating – teach: theory and practice of general education of persons sentenced to imprisonment

Where Merleau-Ponty Meets Dewey: Habit, Embodiment, and Education

This paper utilises selective writings by John Dewey and Maurice Merleau-Ponty as the conceptual basis for considering how an enhanced synergistic focus on habit and embodiment could support practice gains in schools. The paper focuses on Dewey’s belief that established habits can help students to incorporate experiences into evaluations of educational progress and Merleau-Ponty’s spotlight on the body-subject, and how it provides a holistic way of conceiving relations that avoid over privileging abstraction and cognition and under-representing the centrality of the body in human experience. We then evaluate the role of language and reflection in relation to habit, embodiment, and education before discussing some of the general educational practice considerations which might improve the quality of students learning experiences. In conclusion, we consider the possibilities for Dewey’s pragmatism to function as a theoretical bridge to Merleau-Ponty’s phenomenology of perception and the nature of experience. We argue that while it is important to recognise points of difference, in relation to philosophical treatments of habit and embodiment, it is also important to consider the overlap and new connections between Merleau-Ponty and Dewey which are valuable to take forward in contemporary education.

Individualized and Innovation-Centered General Education in a Chinese STEM University

The concept and practice of general education have been widely discussed and debated in the Euro-American world, but its adaptation in China needs further discussion and understanding. Over the past decade, its impact on Chinese higher education is increasingly salient, with a large number of Chinese first-tier universities claiming to initiate general education reforms to their previously narrowly focused undergraduate programs. This paper explores the development, implementation, and support of general education in a new type of research university in China from an organizational perspective. Through a case study of the Southern University of Science and Technology (SUSTech) prior to the COVID-19 pandemic, this paper examines SUSTech’s individualized and innovation-based general education system, highlighting its institution-wide approach and innovation-centered perspective. The findings underscore the importance of integrating general education principles throughout the university to foster self-directed thinkers and cultivate students’ self-awareness, interests, and passions. This study also reveals how general education is used as an organizational solution to address a variety of historical and complicated issues that challenge Chinese universities. This research serves as a catalyst for reform and innovation in Chinese higher education, inspiring transformative practices that meet the evolving needs of students and society.

Cultural Attitudes towards General Practice within Medical Schools: Experiences of GP Curriculum Leaders

ABSTRACT Introduction UK undergraduate medical curricula are under pressure to become more community-focused and generalist in approach to equip all future doctors with generalist skills and increase recruitment to generalist specialities like general practice. However, the amount of general practice teaching in UK undergraduate curricula is static or falling. Undervaluing, in the form of general practice denigration and undermining, is increasingly recognised from a student perspective. However, little is known about the perspectives of academics working within medical schools. Aim To explore the cultural attitudes towards general practice within medical schools as experienced by general practice curriculum leaders. Methods A qualitative study using semi-structured interviews of eight general practice curriculum leaders in UK medical schools. Purposive sampling for diversity was used. Interviews were analysed using reflexive thematic analysis. Findings Seven themes were identified covering ‘a kaleidoscope of attitudes towards general practice’, ‘overt everyday denigration of general practice’, ‘a hidden curriculum of undervaluing general practice’, ‘valuing general practice: representation, recognition and respect’, ‘relating to others, relating to oneself’, ‘power, empowerment and vulnerability’, and ‘the pandemic as an opportunity’. Conclusions Cultural attitudes towards general practice were diverse: a spectrum varying from valuing general practice to overt denigration, with a ‘hidden curriculum’ of subtle undervaluing of general practice. Hierarchical, tense relationships between general practice and hospital were a recurring theme. Leadership was identified as important in setting the tone for cultural attitudes, as well as indicating general practice is valued when general practitioners are included within leadership. Recommendations include a shift in narrative from denigration to mutual speciality respect between all doctors.

Supervisor conversations: Influencing attitudes through decolonisation in general practice education.

Embedded attitudes within the medical workforce mean supervisors have a key role in the practice and promotion of decolonised and antiracist approaches totheir engagement with Aboriginal andTorres Strait Islander health medicaleducation. The aim of this paper is to provide an understanding of the practical application of decolonised and antiracist approaches for the general practitioner (GP) supervisor. Decolonised and antiracist approaches can elevate supervisor engagement withtheir GP trainees and assist understanding of the health of Aboriginal and Torres Strait Islander peoples.

Association between Undergraduate Education for Community-Based Medicine and General Practice Majors: A Longitudinal Study in Japan.

There is a shortage of general practitioners in Japan. With the revision of educational guidelines, general practice (GP) education has improved. However, the amount of education on GP in medical schools remains inconsistent. This study examined the relationship between medical students' amount of GP-related education and their subsequent choice of GP majors. A retrospective cohort study was conducted in a teaching hospital in Japan. Participants were residents in the hospital. The exposure comprised compulsory lectures and training time for community-based medicine in medical schools. The outcome included participants choosing GP majors after their initial 2-year junior residency. Fifty-one participants were included in the final analysis. Of these, 14 majored in GP and 37 in non-GP after their initial 2-year junior residency. Of the participants who took GP lectures for 18 hours or more, 11 chose GP majors, and 18 chose non-GP majors (risk ratio, 2.78; 95% confidence interval [CI], 0.88-8.79). Of the participants who underwent training for 12 days or more, 10 chose GP majors, and 16 chose non-GP majors (risk ratio, 2.40; 95% CI, 0.87-6.68). The results do not support the association between the amount of compulsory undergraduate education for community-based medicine and the subsequent increase in the number of residents choosing GP majors in Japan. Educators would do well to explore different approaches, such as improving the quality of education to increase the number of GP residents. Further research is needed to reach more definitive conclusions.

General practice undergraduate and vocational training: ambulatory teaching and trainers’ curriculum and remuneration – a cross-sectional study among 30 member countries of WONCA Europe

BackgroundAfter a long phase without any propositions for real ambulatory training inside general practitioners’ offices, general practice (GP) vocational training has begun to appear progressively and has been integrated into undergraduate medical programmes. The aim of this study was to provide an overview of GP vocational training and GP trainers in member countries of the World Organization of National Colleges, Academies and Academic Associations of General Practitioners/Family Physicians (WONCA) Europe.MethodWe carried out this cross-sectional study between September 2018 and March 2020. The participants responded to a questionnaire in real-life conversations, video conferences or e-mail exchanges. The respondents included GP trainers, teachers and general practitioners involved in the GP curriculum recruited during European GP congresses.ResultsRepresentatives from 30 out of 45 WONCA Europe member countries responded to the questionnaire. Based on their responses, there is a well-established period for GP internships in undergraduate medical programmes, but with varying lengths. The programmes for some countries offer an internship after students graduate from medical school but before GP specialisation to ensure the career choice of the trainees. After specialisation, private practice GP internships are offered; however, in-hospital GP internships are more common. GP trainees no longer have a passive role during their internships. GP trainers are selected based on specific criteria and in countries, they have to follow some teacher training programmes. In addition to income from medical appointments carried out by GP trainees, GP trainers from some countries receive additional remuneration from various organisations.ConclusionThis study collected information on how undergraduate and postgraduate medical students are exposed to GP, how GP training is organised and the actual status of GP trainers among WONCA Europe member countries. Our exploration of GP training provides an update of the data collected by Isabel Santos and Vitor Ramos in the 1990s and describes some specificities that can inspire other organisations to prepare young, highly qualified general practitioners.

Development of TOEKAN, a 360° evaluation tool for the clinical learning environment in General Practice postgraduate training

Background The General Practice (GP) postgraduate program exists for 80% out of workplace learning. The quality of the clinical learning environment (CLE) has a direct effect on the quality of training and the professional development of GP trainees. Methodology Participatory research was used to involve all stakeholders in the development process of a 360° evaluation tool that should improve the average quality of GP training practices, guide GP trainees towards the best training practices and detect and remediate GP trainers of lower quality. Results TOEKAN (Tool for Communication and Evaluation of Quality Standards) was developed, which consists of a 72-item questionnaire for GP trainees and GP trainers and an 18-item questionnaire for those who coach and remediate GP trainers. The outcomes of the TOEKAN questionnaires are visualized in an online dashboard. Discussion TOEKAN is the first 360° evaluation tool for CLE in GP education. All stakeholders will complete the survey on a regular basis and have access to the results. By creating intrinsic and extrinsic motivation as well as mediation measures, the quality of CLE will improve. Continuous monitoring of the use and outcomes of TOEKAN will allow to critically review and improve this new evaluation tool as well as support the broader implementation.

Trainees' perceptions of course quality in postgraduate General Practice training in Ireland.

Postgraduate General Practice (GP) training is structured around a formal curriculum set out by the training body. It also includes a "hidden curriculum" of experiential workplace learning in a heterogenous learning environment [1]. There is no formal national annual survey of GP trainees and their views in Ireland. The research aim was to evaluate what the trainee population think of their training environment, and to analyse the contributory factors. A mixed methods cross-sectional survey was distributed to all third- and fourth-year GP trainees (N = 404). The Manchester Clinical Placement Index was adapted for the study. The response rate was 30.94% (N = 125). Questions 1 to 7 provided a description of the characteristics of the study population. The remainder of the questions focused on aspects which relate to constituents of the learning environment. The responses were broadly and convincingly positive and supportive of the good work being done in GP training and by trainers in Ireland today across both qualitative and quantitative findings. One notable exception was in the area of feedback where single handed fourth year practices were found to be underperforming. The current research findings were broadly positive and supportive of the good work being done in GP training and by trainers in Ireland today. Further research will be needed to validate the study instrument and to further refine some aspects of its configuration. The implementation of such a survey on a regular basis may have merit as part of the quality assurance process in GP education alongside existing feedback structures [2].