Experience In General Practice Research Articles

Late-effect awareness and follow-up of cancer in general practice

Objective With increasing cancer incidence and survival rates, follow-up care becomes a major healthcare concern, placing increased demands on general practitioners (GPs). We explored GPs’ awareness of late effects (LEs) after cancer treatment. Their degree of involvement and attitudes towards follow-up care was studied separately for solid cancers and Hodgkin’s lymphoma (HL). Design and setting Mailed questionnaire study in Norwegian general practice. Subjects 185 responding GPs with responsibility for HL survivors, more than 10 years since diagnosis. Main outcome measures and results All GPs reported some awareness of LEs. Increasing awareness of LEs was associated with female sex, being a specialist, having experience from hospital-based cancer care and familiarity with official guidelines on LEs after treatment. The majority of GPs were involved in follow-up care, which increased with patients’ time since treatment and was associated with higher awareness of LEs. GPs with work experience in hospital-based cancer care were more likely to be engaged in HL follow-up. Most GPs were willing to provide follow-up care at some point after treatment. Older and more experienced GPs, and those satisfied with the collaboration with hospital specialists, were more likely to provide follow-up earlier. Conclusion GPs’ awareness of LEs and their willingness to provide follow-up care were related to familiarity with guidelines and experience. GPs more involved in follow-up care also had higher knowledge of LEs. Distribution of guidelines on LEs and follow-up care, and improving collaboration with hospital specialists, might increase GPs’ knowledge and willingness to become involved in follow-up care, especially early in their careers. GPs’ involvement and attitude towards follow-up of survivors of common solid cancers and HL, a rare malignant disease, were similar. KEY POINTS Norwegian general practitioners (GPs) are involved in survivorship care after cancer treatment. We investigated their awareness of late effects (LEs), their involvement and their attitude towards follow-up care of solid cancers and Hodgkin’s lymphoma. • GPs registered as specialists, aware of guidelines and with experience from hospital-based cancer care reported higher awareness of LEs. • GPs with higher awareness of LEs were more frequently involved in follow-up care. • GPs with longer experience in general practice were comfortable with follow-up care at an earlier stage after treatment. • Results were similar for follow-up care of survivors of solid cancers and Hodgkin’s lymphoma.

Identifying threshold concepts in postgraduate general practice training: a focus group, qualitative study

ObjectiveTo identify threshold concepts (TCs) for physicians undergoing postgraduate medical education (PGME) in general practice.DesignAn explorative, qualitative study with 65 min focus group interviews and thematic analysis was used. Participants...

Australian general practice experiences of implementing a structured approach to initiating advance care planning and palliative care: a qualitative study

ObjectivesInitiation of advance care planning (ACP) and palliative care (PC) assessments in general practice is key to quality end-of-life care. The Advance Project promotes a team-based approach to initiating ACP...

General practice experiences of Australia’s COVID-19 vaccine rollout: lessons for primary care reform.

Objective The aim of this research was to explore the experiences of general practice in delivering Australia's coronavirus disease 2019 (COVID-19) vaccine, and the impact on practice finances and workforce. Methods Eighteen semi-structured interviews with owners and practice managers of general practices in Greater Sydney between June and August 2021 were conducted. Results Practices reported early enthusiasm for the vaccine rollout and engaged in large-scale staffing and infrastructure adaptations to manage increased vaccination workload. Although some practices reported increased income related to vaccination, nearly all reported increased costs. Lack of timely and transparent communication between primary care and policymakers was a major concern for practices. Conclusions The success of Australia's COVID-19 vaccine rollout relied on the goodwill of general practices. Participation in the COVID-19 vaccine rollout resulted in increased stress, increased administration workload, and reduced financial viability for many practices.

Experience of General Practice Residents Caring for Dependent Elderly during the First COVID-19 Lockdown-A Qualitative Study.

Background: Understanding the experiences of general practice (GP) residents caring for dependent elderly people during the first lockdown as part of the countries COVID-19 pandemic strategy. The aim was to explore themes that could explain the gap between the missions and values at the heart of GP practice during this period of strict isolation. Method: Qualitative study using an iterative approach. Semi-structured interviews were conducted with 13 GP residents using a pre-established interview guide. Audio recordings were transcribed verbatim. Data were analyzed according to a coding grid, developed using Nvivo software (NVivo Qualitative Data Analysis Software; QSR International Pty Ltd. Version Release 1.5.1 (940) 2021), to identify emerging themes. Results: Three themes emerged from this qualitative research: cognitive dissonance, psychosocial risks, and fear. General practice residents have lived in the paradox between care and deprivation of liberty of dependent elderly people. Conclusion: The results suggest that the GP residents experienced a form of work-related suffering in this situation of deprivation of liberty of dependent elderly people. The present research serves as a pilot study to explore how GP residents experienced their care of locked-up dependent elderly people.

Impact of clinical placement sites on general practice as a career preference for Australian medical students.

This study investigates whether General Practice placement experience or locations (urban/metropolitan vs non-metropolitan) promote student interest in pursuing general practice. SurveyMonkey was used in the design of the survey. The study was conducted online. A total of 520 and 705 clinical-year students were surveyed in 2009 and 2019, respectively. The study was conducted online, using SurveyMonkey, and the participants were mostly non-indigenous Australian medical students, between the ages of 18 and 30. Students were recruited from the General Practice Students' Network membership database to complete the survey online. Chi-squared testing, Pearson's correlation and a multivariate logistic regression analysis were used to investigate the correlation between general practice placements and intention to become a general practice. The association and causation between general practice placement location, student experience and students' intended career outcomes. In 2009, majority of students rated their general practice experience 'mostly positive' while most metropolitan participants and majority of non-metropolitan placement participants in the 2019 survey responded with 'mostly positive' in 2019. Based on 2009 and 2019 data, general practice placement location had no association with the likelihood of pursuing general practice as a career, while student experience had a stronger positive correlation with the likelihood of pursuing general practice as a career. Our study shows that students' overall experience with their general practice placements significantly encourages medical students to pursue the general practice pathway. As such, increasing both metropolitan and non-metropolitan placement experiences can potentially overcome general practice shortage.

Antibiotic treatment of community-acquired pneumonia: A questionnaire survey in Danish general practice.

Discrepancies exist in Danish guidelines for the treatment of bacterial community-acquired pneumonia (CAP). This study aimed to investigate how general practitioners (GPs) treat adults with CAP and explore associations between GP characteristics and treatment duration. In autumn 2020, GPs in the North Denmark Region were asked to complete an electronic questionnaire on antibiotic prescribing for CAP. Information about GP gender, age, experience and type of practice was obtained. Multivariable logistic regression was used to analyse the association between GP characteristics and treatment duration. A total of 298 GPs were invited to participate of whom 108 completed the survey. Penicillin V was used as first line treatment for CAP by all participants. Treatment duration varied from 5 (54.6%) to 10 days (8.3%). A 5-day course of penicillin was less likely to be prescribed by male GPs (odds ratio [OR] 0.35, 95% confidence interval [CI] 0.13-0.94) and more likely to be prescribed by GPs with 5-9years of experience in general practice (OR 5.03, 95% CI 1.09-23.21) compared to those with 10-19 years of experience. Variation in antibiotic treatment of CAP emphasises the importance of generating solid evidence about the optimal duration regarding both effectiveness and safety.

Dr Allan C. Prentice, MBCHB, CIH, FFOM (1960–2021)

Dr Allan C. Prentice, Lead Physician and Responsible Officer for International SOS (Medical Services) UK Limited, died suddenly and unexpectedly on 20th May 2021, in his 33rd year as an Occupational Health Physician. Allan spent his early years in Shetland and Edinburgh, before attending Madras College in St Andrews for his secondary education. He attended Dundee University, graduating in 1982, after hospital and general practice experience he joined Offshore Medical Support (OMS) in Aberdeen in August 1988 in an approved training post for Occupational Medicine, under the supervision of Dr W J Gunnyeon, obtaining his AFOM in 1989, his MFOM in 1998 and then later becoming FFOM. Allan worked through the many iterations of OMS—Liberty, Aon, Capita Energy Services, Iqarus Limited and more recently International SOS (Medical Services) UK Limited. He worked in all areas of Occupational Medicine but had most involvement in the offshore services, including the Topside Medical Emergency Service and the Diving Medical Service, remaining active in both on-call rotas throughout his professional career. Allan also provided medical advisory services to many of the North Sea operators, as well as to the local councils, the University of Aberdeen and the local paper industry. His advice was universally respected, and he was known for his unflappable nature and his quiet sense of humour.

Allan C Prentice

Allan C Prentice spent his early years in Shetland and Edinburgh, before attending Madras College in St Andrews for his secondary education. He attended Dundee University, graduating in 1982. After...

Medical students and clinical placements - a qualitative study of the continuum of professional identity formation

ABSTRACT Background: To explore graduates’ perceptions of significant factors affecting professional identity formation (PIF) throughout their graduate medical school education journey and early practice years. Methods: A qualitative study with medical graduates using non-probability sampling. Data collected with graduates via face to face and telephone interviews. Interviews (n = 9) completed with medical graduates of the School of Medicine, University of Limerick. Results: Graduates described their experiences in general practice, during the early patient contact programme and the longitudinal integrated clerkship (LIC) as highly influential. The lasting impact of positive role models was highlighted. The importance of socialisation and entering a community of practice were identified as drivers of professional development. Role modelling and mentorship between students and GP tutors were pivotal as part of early clinical years and clinical LIC. This seemed to have a positive influence on graduate’s consideration of general practice as a future career pathway. Conclusion: Professional identity formation occurs for medical students who participate in early patient contact programmes and longitudinal integrated clerkships in GP. Factors such as positive role modelling, good mentorship, communities of practice and a positive learning environment appear to be the main contributors to this process. Experiences as part of longitudinal integrated clerkships are meaningful for graduates, regardless of postgraduate specialisation choices. Educators should acknowledge this when designing medical curricula to ensure that students’ professional identity formation is optimally facilitated. Training should be available to support the educators involved in longitudinal integrated clerkships, as they become role models and mentors to students.

Medical applicant general practice experience and career aspirations: a questionnaire study

BackgroundIncreasing access to general practice work experience placements for school students is a strategy for improving general practice recruitment, despite limited evidence and concerns surrounding equity of access to general practice experiences.AimsTo examine the association between undertaking general practice experience and the perceptions of general practice as an appealing future career among prospective medical applicants. To identify socioeconomic factors associated with obtaining general practice experience.Design & settingCross-sectional questionnaire study in the UK.MethodParticipants were UK residents aged ≥16 years and seriously considering applying to study medicine in 2019/2020. They were invited to take part via the University Clinical Aptitude Test (UCAT). Questionnaire data were analysed using a linear regression of general practice appeal on general practice experience, adjusting for career motivations and demographics, and a logistic regression of general practice experience on measures of social capital and demographics.ResultsOf 6391 responders, 4031 were in their last year of school. General practice experience predicted general practice appeal after adjusting for career motivation and demographics (b = 0.37, standard error [SE] = 0.06, P<0.00001). General practice experience was more common among students at private (odds ratio [OR] = 1.65, 95% confidence interval [CI] = 1.31 to 2.08, P<0.0001) or grammar schools (OR = 1.33, 95% CI = 1.02 to 1.72, P = 0.03) and in the highest socioeconomic group (OR = 1.62, 95% CI = 1.28 to 2.05, P<0.0001), and less likely among students of ‘other’ ethnicity (OR = 0.37, 95% CI = 0.20 to 0.67, P = 0.0011).ConclusionHaving general practice experience prior to medical school was associated with finding general practice appealing, which supports its utility in recruitment. Applicants from more deprived backgrounds were less likely to have had a general practice experience, possibly through lack of accessible opportunities.

Thomas Acheson Harden Carter

After graduating Thomas Acheson Harden Carter (“Harden”) gained his membership of the Royal College of Physicians, worked in paediatrics in New Zealand, returned to Scotland to train in general practice...

The cardiology training needs of general practice-based pharmacists.

As the role of the general practice clinical pharmacist (GPCP) evolves, there has been a shift towards patient-facing roles across multiple conditions. This study aimed to measure the self-reported cardiology training needs of GPCPs. An online survey was developed. Participants were shown a list of statements on cardiac conditions and medication across seven sub-domains. Participants self-reported their knowledge against each statement using a Likert Scale. Participants were considered to require training in that topic where they had 'disagreed', 'strongly disagreed' or expressed a 'neutral' rating in ≥3/7 areas. Participants were shown a list of single statements around cardiology test result knowledge and clinical assessment skills. Respondents who 'disagreed', 'strongly disagreed' or declared a 'neutral' position with the statement were judged to need training in that topic. Seventy-three out of 135 (54%) GPCPs responded. Acute coronary syndrome had the highest training requirement (38/73, 52%) within conditions. Fifty-nine out of 73 (81%) required training on sacubitril/valsartan and 57/73 (78%) with ivabradine. Fifty-four out of 73 (74%) and 44/73 (60%) required training on how to interpret natriuretic peptides and troponin, respectively. Fifty-nine out of 73 (81%), 48/73 (66%) and 55/73 (75%) required training on interpreting ECG, echocardiogram and coronary angiography, respectively. Reduced length of experience in general practice (<2 years) was commonly associated with increased training needs. There are areas of unmet cardiology training needs within GPCPs that require further support. As the GPCP role evolves, discussion is needed with national pharmacy stakeholders to decide how to incorporate this learning into routine training programmes.

Do access, quality and cost of general practice affect emergency department use?

Limited access, poor experience, and high out-of-pocket (OOP) costs of primary care services may lead to avoidable emergency department (ED) presentations. But, the evidence has been limited with most of the studies using surveys conducted in EDs. Using detailed health survey data of Australian women linked to multiple administrative datasets, we extend the literature by estimating the effects of access, costs, and experience of general practice (GP) services on the probability of ED attendance while accounting for a large set of health and socioeconomic covariates. Our findings suggest that improvements in access to primary care services can significantly reduce the demand for low acuity ED presentations. We also show that the impact of increased accessibility of GP services is expected to be the highest for socioeconomic vulnerable populations and patients whose access is the poorest. This evidence can be useful for the design of targeted policies aimed at improving access to doctors in particular areas that are socioeconomically disadvantaged and where medical skill shortages are significant. However, policies aimed at reduction in primary care OOP costs or improvement in the perception of GP quality are less likely to be effective in reducing the number of non-urgent ED presentations.

Experiences of general practice of children with complex and palliative care needs and their families: a qualitative study

ObjectivesTo investigate the views and experiences of general practice of children with life-limiting and life-threatening conditions, and their family members, through secondary analysis of a qualitative serial interview study. Thematic...

General practice is “different”: a qualitative study of adaptation experiences of East Staffordshire general practice speciality trainees

ABSTRACT Background Undergraduate medical education and foundation training are still largely hospital based. General practice trainees also spend nearly half of their speciality training in hospitals. Aims: To explore adaptation experiences of general practice speciality trainees throughout the training. Method: Semi-structured participant-observer interviews with 18 purposively selected trainees on the East Staffordshire vocational training scheme, observation, stakeholder discussions and concurrent inductive thematic analysis. Results: Undergraduate and early general practice experience during speciality training, general practice trainer role modelling and mastering core general practice skills, facilitated transition. An inclusive and supportive general practice environment, facilitating engagement with a community of practice involving peers, general practice trainers and vocational training programme fostered belongingness. A reduced sense of belongingness during hospital rotations impacted on training and work. Building bridging social connections, personal agency initiatives to bring general practice relevance into hospital training, signposting to general practice relevant duties and mastery of secondary care relevant competencies helped gain belongingness in hospital. While some international graduates required assistance in specific areas; overall, general practice trainees had optimistic views of their future. Conclusion: The main contribution of this study was to relate the adaptation experiences of trainees to learning and practice based on Wenger’s communities of practice to enable a better understanding of how they can be influenced to enhance training. Abbreviations: CoP: Community of practice; GP: General practice; GPST: General practice speciality trainee; M: Male; F: Female; ST1: First-year GPST; ST2: Second-year GPST; ST3: Third-year GPST; UKG: UK-based primary medical qualification; IMG: Non-UK primary medical qualification.

Improving the Quality of Dementia Care in General Practice: A Qualitative Study.

Background: General Practitioners (GPs) play a central role in caring for people with dementia. There is a growing demand for GP-led community-based dementia care, as advocated in the Irish National Dementia Strategy (INDS). However, there is a paucity of research exploring GPs' views on dementia care since publication of the INDS. The aim of this qualitative study is to develop a deeper understanding of how to improve the quality of dementia care in General Practice, explored from the perspective of Irish GPs.Methods: Semi-structured interviews were conducted with GPs. GPs who completed the “Dementia in Primary Care” CPD module at University College Cork in Ireland were purposively recruited. Interviews were audio-recorded, transcribed, and analyzed by thematic analysis.Results: 12 interviews were conducted with 7 female and 5 male participants. Experience in General Practice ranged from 3 to 32 years. Most GPs practiced in mixed urban-rural settings (n = 9) and had nursing home commitments (n = 8). The average interview length was 45 minutes. Six major themes emerged from the data set, including resourcing primary care, addressing disparities in secondary care, community-centered care as patient-centered care, linking a dementia network, universal access to care, and raising public awareness.Conclusion: GPs find dementia care to be a complex and challenging aspect of primary care. While education and training is advocated by GPs, service delivery must be reconfigured. This will necessitate adequate financial resourcing and the restructuring of community-based dementia care services.

Performance in practice; exploring trainer and trainee experiences of user-designed formative assessment tools

ABSTRACT Introduction General Practice training in Ireland currently has various methods of formative assessment and feedback delivered to trainees. In 2018 the Irish College of General Practitioners commissioned the generation of two new user-designed formative feedback tools that would allow trainee feedback to drive learning. These tools became known as the Performance in Practice (PiP) tools. Aims To explore the experiences of General Practice (GP) trainers and trainees having completed a pilot of using the PiP tools for 4 months. Methods An explorative phenomenological approach was taken to understand the experiences of trainers and trainees. One to one interviews were conducted, and the transcripts analysed for themes and sub-theme via Template analysis. Results User experiences focused on two main areas; educational value and acceptability. In relation to educational value, the PiP tools were seen as an improvement over established forms of formative feedback, as they were centred around the curriculum and therefore reflected the unique multifaceted requirements of an independently practising GP. Acceptability primarily focused around data governance and structures, as well as practical issues such as ease of software use. Conclusions Overall, the experience of using the PiP tools was positive for both trainers and trainees. Future plans to further explore implementation of the PiP tools have been significantly informed by this research.

‘Challenges in experiential learning during transition to clinical practice: A comparative analysis of reflective writing assignments during general practice, paediatrics and psychiatry clerkships’

Introduction This study explored the reflective writing (RW) of senior medical students across a co-ordinated reflection education programme in General Practice, Paediatrics and Psychiatry clerkships during their transition to clinical clerkships. The study compared RW themes from within and across three clerkships in order to understand the influence clerkships had on experiential learning and developing professional identity. Methods All medical students in their penultimate year were invited to participate in the study. 135 reflection assignments were analysed. A qualitative thematic analysis of students’ RW was performed. An inductive approach was used and data saturation was achieved. Results Clerkship specific themes were the intimacy of the experience in General Practice, the powerlessness students felt and the challenge of delivering family centred care in Paediatrics and the sense of perceived risk in Psychiatry. Common themes across the three clerkships were of emotional struggles in developing a professional identity. Conclusion There is an educational need for developmental space for students during General Practice, greater focus on preparing students for relationship building during Paediatrics and addressing stigma and personal safety issues in students during the Psychiatry clerkships. Across clerkships there is a need for better use of evidence based pedagogies to support emotional development.

Alison E Mack

Alison Mack, who died aged 83,was a determined and enthusiastic innovator in improving the healthcare of women. This was matched only by her dedication to her family. Alison graduated MBChB in 1960, achieving a distinction in surgery in her finals examination. She gained experience in school health and general practice before she and the family accompanied her husband, Alistair, to Kenya, where he had been seconded to help establish …