General Practitioners Residents Research Articles

Physicians’ and residents’ educational needs regarding shared decision making: A focus group study

ObjectivesTo explore the educational needs of physicians and residents regarding shared decision making (SDM). MethodsWe conducted eight focus groups with 12 general practitioners (GPs), 14 hospital specialists, 12 hospital specialist residents and 13 GP residents in Belgium. We used thematic analysis to guide data analysis. ResultsWe identified five educational needs: (1) the need for a clear understanding of the definition of SDM and its scope; (2) how to deal with a changing professional identity; (3) acquisition of skills to perform SDM; (4) the need for reflective practice in a supportive environment; and (5) sustainable and longitudinal integration in education. ConclusionsThis is the first focus group study emphasizing dealing with a changing professional identity as an educational need, besides the need for SDM-related knowledge and skills. Physicians stated that implementing spiral learning is needed at all stages of medical training, aimed at all specialties to foster interprofessional collaboration. Practice implicationsOur findings can support development of future educational SDM interventions, integrating both competence development and professional identity formation. We provide practical recommendations on didactic formats and strategies, hoping to finally reach better implementation of SDM in daily practice.

An e-Learning Course to Train General Practitioners in Planetary Health: Pilot Intervention Study.

According to the World Health Organization, climate and ecological emergencies are already major threats to human health. Unabated climate change will cause 3.4 million deaths per year by the end of the century, and health-related deaths in the population aged ≥65 years will increase by 1540%. Planetary health (PH) is based on the understanding that human health and human civilization depend on flourishing natural systems and the wise stewardship of those natural systems. Health care systems collectively produce global emissions equivalent to those of the fifth largest country on earth, and they should take steps to reduce their environmental impact. Primary care in France accounts for 23% of greenhouse gas emissions in the health care sector. General practitioners (GPs) have an important role in PH. The course offers first-year GP residents of the Montpellier-Nîmes Faculty of Medicine a blended-learning course on environmental health. An e-learning module on PH, lasting 30 to 45 minutes, has been introduced in this course. The objective of this study was to assess the impact of the e-learning module on participants' knowledge and behavior change. This was a before-and-after study. The module consisted of 3 parts: introduction, degradation of ecosystems and health (based on the Intergovernmental Panel on Climate Change report and planetary limits), and ecoresponsibility (based on the Shift Project report on the impact of the health care system on the environment). The questionnaire used Likert scales to self-assess 10 points of knowledge and 5 points of PH-related behavior. A total of 95 participants completed the pre- and posttest questionnaires (response rate 55%). The mean scores for participants' pretest knowledge and behaviors were 3.88/5 (SD 0.362) and 3.45/5 (SD 0.705), respectively. There was no statistically significant variation in the results according to age or gender. The pretest mean score of participants who had already taken PH training was statistically better than those who had not taken the PH training before this course (mean 4.05, SD 0.16 vs mean 3.71, SD 0.374; P<.001). The PH module of the Primary Care Environment and Health course significantly improved self-assessment knowledge scores and positively modified PH behaviors among GP residents. Further work is needed to study whether these self-declared behaviors are translated into practice.

The Primary Care and Environmental Health e-Learning Course to Integrate Environmental Health in General Practice: Before-and-After Feasibility Study.

Environmental and behavioral factors are responsible for 12.6 million deaths annually and contribute to 25% of deaths and chronic diseases worldwide. Through the One Health initiative, the World Health Organization and other international health organizations plan to improve these indicators to create healthier environments by 2030. To meet this challenge, training primary care professionals should be the priority of national policies. General practitioners (GPs) are ready to become involved but need in-depth training to gain and apply environmental health (EH) knowledge to their practice. In response, we designed the Primary Care Environment and Health (PCEH) online course in partnership with the Occitanie Regional Health Agency in France. This course was used to train GP residents from the Montpelier-Nimes Faculty of Medicine in EH knowledge. The course was organized in 2 successive parts: (1) an asynchronous e-learning modular course focusing on EH knowledge and tools and (2) 1 day of face-to-face sessions. This study assessed the impact of the e-learning component of the PCEH course on participants' satisfaction, knowledge, and behavior changes toward EH. This was a pilot before-and-after study. Four modules were available in the 6-hour e-learning course: introduction to EH, population-based approach (mapping tools and resources), clinical cases, and communication tools. From August to September 2021, we recruited first-year GP residents from the University of Montpellier (N=130). Participants' satisfaction, knowledge improvements for 19 EH risks, procedure to report EH risks to health authorities online, and behavior change (to consider the possible effects of the environment on their own and their patients' health) were assessed using self-reported questionnaires on a Likert scale (1-5). Paired Student t tests and the McNemar χ2 test were used to compare quantitative and qualitative variables, respectively, before and after the course. A total of 74 GP residents completed the e-learning and answered the pre- and posttest questionnaires. The mean satisfaction score was 4.0 (SD 0.9) out of 5. Knowledge scores of EH risks increased significantly after the e-learning course, with a mean difference of 30% (P<.001) for all items. Behavioral scores improved significantly by 18% for the participant's health and by 26% for patients' health (P<.001). These improvements did not vary significantly according to participant characteristics (eg, sex, children, place of work). The e-learning course improved knowledge and behavior related to EH. Further studies are needed to assess the impact of the PCEH course on clinical practice and potential benefits for patients. This course was designed to serve as a knowledge base that could be reused each year with a view toward sustainability. This course will integrate new modules and will be adapted to the evolution of EH status indicators and target population needs.

What affects you? A conversation analysis of exploring emotions during reflection sessions in Dutch general practitioner training.

In Dutch training for general practitioners (GPs), reflection on professional practice is key to their training. Such reflection is considered beneficial for professional development, especially when it entails discussing the emotional dimension of practice experiences. In the GP context, invitations to share the emotional side of things, such as "how did that make you feel?" are considered functional; yet, they are also sometimes viewed by participants as 'grilling', 'just too much' or 'too intimate'. Put shortly, putting emotions on the table is institutionally embedded in the GP reflection context, but not always straightforward. Thus, we ask: 'how do teachers and GP residents invite talk about emotions in educational reflection sessions?'. In this study, we explored the Dutch phrase 'raken, geraakt worden' (being affected) as one interactional practice used to initiate emotion talk. We conducted a conversation analytic collection study of instances of this phenomenon based on 40 video recordings of hour-long 'reflection sessions' at the Dutch GP specialty training. During these sessions, approximately ten GPs in training discuss recent experiences from medical practice under supervision of one or two teachers. We found that participants orientated to the relevance of 'being affected' as a topic for discussion. Variations of the form 'what affects you now?' may contribute to putting emotions on the table; they can project a stepwise exploration of the emotional dimension of an experience. The 'what affects you now', often done in interrogative format doing a noticing, in combination with a request, is a powerful tool to instigate transformative sequences. The form is less effective to put emotions on the table when the topic shift it initiates is not grounded in previously presented personal stakes or displayed emotion. The study's findings show how detailed interactional analysis of one sequentially structured practice can benefit education and contribute to theory on emotions and reflection. The mobilizing power of 'what affects you' can serve institutional purposes by doing topical work in relation to educational aims, while its power can also be deflated when prior talk does not project the relevance of unpacking the emotional dimension of an experience. Its interactional workings may translate to other helping contexts as well.

Effects of a short training workshop on the insertion/removal of intrauterine devices and contraceptive implants by general practice residents and their supervisors in France

ObjectivesThe skill of general practitioners (GPs) in performing the insertion/removal of intrauterine devices (IUDs) and contraceptive implants is one of the factors that determines patient's access to these contraceptive devices. In France, GP residents have few opportunities to perform these procedures during their internships. This study aimed to measure the effects of a single short training workshop on the number of residents and supervisors offering these procedures. Study designEach participant attended a unique 2-hour session. After a brief didactic review and video presentations, participants received hands-on training in technical procedures (insertion/removal of IUDs and contraceptive implants) using procedural simulators. The evaluation measured the number of GPs offering these procedures before, 1 month after, and 3 months after the workshops. ResultsFourteen sessions were organized from February 2017 to June 2022. Among the 387 residents and 123 supervisors invited, 143 (37.0%) and 56 (45.5%), respectively, participated in this workshop. Of 199 participants, 66.3% completed all questionnaires. There was a significant increase in the number of GPs inserting IUDs by direct method 3 months after training (20.5% vs 9.0%, p = 0.005). GPs providing information to patients about contraceptive implants were significantly higher at 1 month (80.6% vs 64.8%, p = 0.001) but this increase was no longer significant at 3 months (75.0%, p = 0.07). Residents changed their practices more than their supervisors, and women more than men. ConclusionsA short training workshop increased the number of GPs inserting IUDs, influenced by the gender and the number of years practicing. ImplicationsA single workshop had positive effects on IUD insertion and patient education about contraceptive implants. Repeating several times this training could be an option in the initial and ongoing training of general practitioners. Work on the general practitioners' own feeling of legitimacy in their practice context could also increase the effectiveness of these workshops and the practical implementation of the procedures taught.

Perspectives of general practitioners towards their supervisors over the past ten years in China

ObjectivesDoctors who wish to become general practitioners (GPs) in China are required to attend and complete general practice resident training. In the early stages of the standardized GP training system, GP training supervisors play important roles. This study aims to explore how GP residents perceive their GP supervisors, factors that affect GP residents’ satisfaction level, as well as to offer suggestions based on the implications of this study.DesignWe conducted a mixed quantitative and qualitative study. Firstly, with respect to the quantitative research, we conducted a survey to investigate training satisfaction through questionnaires, then extracted and analyzed the factors that influence training satisfaction. In the qualitative study, we conducted in-depth, semistructured interviews using qualitative research criteria (COREQ)––a 32-item checklist for interviews.ParticipantsParticipants in the quantitative survey included 1172 GPs whose training time wasbetween 2008 and 2017. Afterwards, 100 participants were selected from this sample , filtered by stratified random sampling and by having provided extreme answers on the quantitative survey (less than 5% of the total sample). They were chosen for the qualitative research to conduct a more detailed investigation., This stratified random sampling was based on residents’ grades, regions, and training levels (city level or county level). Extreme answers were identified as answers of “extremely good” or “extremely bad” to questions from the initial comprehensive survey of 1172 participants. Consequently, 30 participants with extreme answers were found, while the remaining 70 participants in the interviews were selected by stratified random sampling. Ultimately, this sample of participants met our information collection and sample estimation requirements.ResultsThe results show that satisfaction with GP theoretical training supervisors, GP hospital-based training supervisors, and GP community-based training supervisors differed. Considering long-term averages, the hierarchy of satisfaction is as follows: GP theoretical training supervisors > GP community-based training supervisors > GP hospital-based training supervisors.GP hospital-based training supervisors need to improve their conception of GPs, teaching methods and conscientiousness. GP community-based training supervisors need to improve their teaching methods, knowledge of clinical theory and practice ability.ConclusionsOn the one hand, teams of GP supervisors in China have gradually been established over time. On the other hand,the satisfaction tendencies of residents with respect to their GP supervisors are quite different, and teams of GP supervisors must be promoted and improved.

Evaluation of a multicomponent intervention consisting of education and feedback to reduce benzodiazepine prescriptions by general practitioners: The BENZORED hybrid type 1 cluster randomized controlled trial.

Current benzodiazepine (BZD) prescription guidelines recommend short-term use to minimize the risk of dependence, cognitive impairment, and falls and fractures. However, many clinicians overprescribe BZDs and chronic use by patients is common. There is limited evidence on the effectiveness of interventions delivered by general practitioners (GPs) on reducing prescriptions and long-term use of BZDs. We aimed to evaluate the effectiveness of a multicomponent intervention for GPs that seeks to reduce BZD prescriptions and the prevalence of long-term users. We conducted a multicenter two-arm, cluster randomized controlled trial in 3 health districts in Spain (primary health centers [PHCs] in Balearic Islands, Catalonia, and Valencian Community) from September 2016 to May 2018. The 81 PHCs were randomly allocated to the intervention group (n = 41; 372 GPs) or the control group (n = 40; 377 GPs). GPs were not blinded to the allocation; however, pharmacists, researchers, and trial statisticians were blinded to the allocation arm. The intervention consisted of a workshop about the appropriate prescribing of BZDs and tapering-off long-term BZD use using a tailored stepped dose reduction with monthly BZD prescription feedback and access to a support web page. The primary outcome, based on 700 GPs (351 in the control group and 349 in the intervention group), compared changes in BZD prescriptions in defined daily doses (DDDs) per 1,000 inhabitants per day after 12 months. The 2 secondary outcomes were the proportion of long-term users (≥6 months) and the proportion of long-term users over age 65 years. Intention-to-treat (ITT) analysis was used to assess all clinical outcomes. Forty-nine GPs (21 intervention group and 28 control group) were lost to follow-up. However, all GPs were included in the ITT analysis. After 12 months, there were a statistically significant decline in total BZD prescription in the intervention group compared to the control group (mean difference: -3.24 DDDs per 1,000 inhabitants per day, 95% confidence interval (CI): -4.96, -1.53, p < 0.001). The intervention group also had a smaller number of long-term users. The adjusted absolute difference overall was -0.36 (95% CI: -0.55, -0.16, p > 0.001), and the adjusted absolute difference in long-term users over age 65 years was -0.87 (95% CI: -1.44, -0.30, p = 0.003). A key limitation of this clustered design clinical trial is the imbalance of some baseline characteristics. The control groups have a higher rate of baseline BZD prescription, and more GPs in the intervention group were women, GPs with a doctorate degree, and trainers of GP residents. A multicomponent intervention that targeted GPs and included educational meeting, feedback about BZD prescriptions, and a support web page led to a statistically significant reduction of BZD prescriptions and fewer long-term users. Although the effect size was small, the high prevalence of BZD use in the general population suggests that large-scale implementation of this intervention could have positive effects on the health of many patients. ISRCTN ISRCTN28272199.

The voice of the self: a typology of general practitioners’ emotional responses to situational and contextual stressors

Objective To develop a comprehensive typology of emotional reactions associated with stress among general practitioners (GPs), grounded in their own experiences. Design Data was generated using observations and unstructured interviews, using Straussian grounded theory as the overarching methodology. The typology was built using multidimensional property supplementation. Setting Eleven health care centres in urban and rural communities in four Swedish regions. Subjects Sixteen GPs and GP residents. Main outcome measures Characteristics of GPs’ emotional reactions in everyday work situations. Results Accounts of negative emotions connected to stress revealed four principal personal needs of the GP: trust, efficacy, understanding, and knowledge. Simultaneous threats to more than one of these needs invariably increased the level of tension. From these more complex accounts, six second-order needs could be identified: integrity, judgment, pursuit, authority, autonomy, and competence. The most extreme encounters, in which all four principal needs were threatened, were characterised by the experience of being reduced into an assistant. Conclusion The considerable resilience of GPs may belie some of the pressures that they are facing while being far from a fail-safe defence against being diverted from purposeful and morally responsible action. Our typology distinguishes between different forms of stress that may affect how GPs carry out their work, and connects to the vast literature on GP wellness. The results of this study could be used to develop tools for self-reflection with the aim of countering the effects of stress, and are potentially relevant to future research into its causes and consequences. Key points What is known •Stress among GPs may have severe consequences for themselves and their patients, and levels of stress appear to be increasing. What this article adds •Stressful situations threaten at least one of four principal needs of the GP: trust, efficacy, understanding, and knowledge. •More complex threats increase the level of tension and bring out second-order needs: integrity, judgment, pursuit, authority, autonomy, and competence. •The wealth of literature on GP stress can be clearly understood through the lens of our four-dimensional typology.

217 - Video group supervision of general practitioners residents by CL psychiatrists: A qualitative study

The financial impact of cancer on patients in the UK is poorly understood. We assessed financial burden (FB), defined as financial impact on patient at diagnosis and financial toxicity (FT), defined as financial impact throughout treatment, in patients with upper gastrointestinal UGI), pancreatobiliary (PB) and lower GI (LGI) cancers.Patients enrolled in 5 clinical trials (REAL-3, RAINFALL, ESPAC-4, QoL BIL and CAPITAL) at the Christie, Manchester, were identified. FB at baseline and FT throughout treatment were defined according to answers to the EORTC QLQ-C30 questionnaire (EQ) Q28 to which patients score financial difficulty relating to disease/treatment from 1 (not at all) to 4 (very much).141 patients were identified, 68.1 % were male; median age was 62 years (range 39–94). 15 (10.6 %) patients had LGI, 85 (60.3 %) PB and 41 (29.1 %) UGI cancer. 62 % had no FB, 25 % ‘a little’, 9% ‘quite a bit’ and 5% ‘very much’. 63.5 % experienced no FT, 19.8 % worse FT and 16.7 % improved FT. Multiple regression analysis showed that younger age, lower index of multiple deprivation (IMD) and tumour type were independent predictors of FB. Significant covariates included escalating IMD (OR 0.78, 95 %CI 0.68−0.92, p = 0.002), age above vs. below median (OR 0.10, 95 %CI 0.04−0.24, p < 0.001) and PB cancers (OR 3.66, 95 %CI 1.34–10.03, p = 0.012). Escalating IMD was associated with better OS (HR 0.90, 95 %CI 0.84−0.98, p = 0.010).We report the first study of FB and FT in cancer patients in the UK, identifying independent baseline parameters predicting FB and the prognostic role of IMD.

GPs' motivation for teaching medical students in a rural area-development of the Motivation for Medical Education Questionnaire (MoME-Q).

BackgroundThe establishment of a medical education program in the rural area of Siegen is planned to be the first step against a shortage of physicians in this region. General practitioners (GPs) will be extensively involved in this program as Family Medicine (Allgemeinmedizin) will become a core subject in the curriculum nationwide. Based on this situation we aim to figure out GPs motivation to participate in medical education. For this purpose, we had to construct and test a new questionnaire.MethodsA survey was conducted among general practitioners (GPs) in the region of Siegen-Wittgenstein regarding their motivation to participate in medical education. For this purpose, the Motivation for Medical Education Questionnaire (MoME-Q), a 24-item questionnaire, was developed. Structural characteristics of GPs, the Maslach Burnout Inventory (MBI) and the Work Satisfaction Questionnaire (WSQ) were used for validation purposes.ResultsA representative number of GPs took part in the study (53.8%). Although the majority had no connection to a university (86%), 83% can imagine participating in the education of medical students. The items of the MoME-Q load on two factors (commitment and personal benefit). The confirmatory factor analysis shows a good model fit. Subscales of the MoME-Q were able to differentiate between physicians with and without authorization to train GP residents, between practices with and without a specialized practice nurse, and between physicians with and without previous experience in medical education. The MoME-Q subscale “commitment” correlated significantly with all three subscales of the MBI. Correlations were in the medium range around |.30|.ConclusionThe MoME-Q seems to be an appropriate tool to assess motivation to participate in medical education of GPs. In our sample, a large number of GPs was motivated to participate in the education of medical students. Future studies with larger number of GPs should be carried out to validate and confirm our findings. Whether the MoME-Q is also appropriate for other specialties should also be shown in further empirical studies.

Psoriasis and comorbidities: general practitioners’ awarenes

Systemic inflammatory diseases such as psoriasis, systemic lupus erythematosus (SLE), and rheumatoid arthritis (RA) are associated with an increased prevalence of cardiovascular diseases (CVD) and other comorbidities. The primary aim of this study was to assess the screening practices of general practitioners (GPs) with regard to the most frequent comorbidities in patients with psoriasis. We adapted, with permission, a questionnaire that was used by Parsi et al. in 2012, which was then distributed to GP residents and consultants. Overall, 372 questionnaires were collected. Significantly more physicians screen for CV risk factors in patients with RA and SLE than in patients with psoriasis. There was no statistically significant difference between GP residents in the initial and final phase of residency, or between GP residents and consultants regarding awareness of increased prevalence of CVD in psoriasis or comorbidity screening practices in psoriasis patients. Most GP residents and consultants that participated in this study are not aware of an increased CV risk in patients with psoriasis and assign greater importance regarding this risk to other inflammatory diseases such as RA and SLE.

Education improves referral of patients suspected of having spondyloarthritis by general practitioners: a study with unannounced standardised patients in daily practice

ObjectivesTo evaluate the practice performance of general practitioners (GPs) and GP residents in recognising and referring patients suspected for having axial or peripheral spondyloarthritis (SpA), and to investigate the influence...

The practice of standardized training of general practitioners in Zhongshan Hospital

Objective To review the standardized training of General practitioners (GPs) in Zhongshan Hospital since 2010. Methods Sixty seven GP trainees were recruited by Zhongshan Hospital since 2010.A retrospective analysis was carried out about the training methods, training content, assessment methods and training management. Results The pass rate of hospital examination was 100.0%.Sixteen out of nineteen GP residents of grade 2010 passed both the final examination and medical licensing examination, and completed the training plan; the remaining 3 trainees did not pass the licensing examination, among whom 2 extended the training and passed the exam eventually, and 1 dropped off.Sixteen out of seventeen in grade 2011 passed the medical licensing examination and were preparing for 2014 graduation examination.The training mode of human-centered and competency-based assessment system was established. Conclusion Zhongshan Hospital has accumulated rich experience in standardized training of GPs, established a system of training and assessment, and it will be continuously improved in the future. Key words: Training; Education, medical; General practitioner

How competent do general practice residents feel and why?

General practice residency aims to produce competent general practitioners (GPs) who will practice independently, i.e. who demonstrate adequate levels of actual and self-perceived competence. To measure self-perceived competence in GP residents at our institution and explore potential determinants. We conducted a cross-sectional study of our GP residents. Self-perceived competence was measured in four domains. Independent variables included gender, postgraduate year, patient contacts, on-call duties, practice of specific tasks, self-assessed effort and knowledge. Between 1.6 and 37.8% of GP residents assessed their competence as less than average. Self-perceived competence was not consistently linked to any of the hypothesised factors. A significant proportion of residents reported less than satisfactory levels of self-perceived competence. Longitudinal studies should be conducted as well as qualitative studies focusing on the role of other factors in the development of high levels of self-perceived competence during general practice training.