Practice-based Small Group Learning Research Articles

Practice based small group learning during a pandemic: an evaluation from Defence Primary Healthcare

ABSTRACT The educational benefits of Practice-Based Small Group Learning (PBSGL) are well known. The Ministry of Defence in the United Kingdom employs a salaried healthcare workforce across the globe with staff frequently moving. Given the success of PBSGL in Canada and Scotland, PBSGL was introduced as a large pilot to assess it as a continuous professional development (CPD) resource. A survey gathering quantitative and qualitative was distributed to the pilot population after using PBSGL for 12 months. This showed the favoured types of CPD were PBSGL and taught CPD update courses. Themes identified from free-text comments were: developing professional educational networks during Covid; evolving themes of CPD; applying learning to practice; practical aspects of delivering CPD to Defence promoting a positive learning environment; human interaction is therapeutic. These were similar to educational and non-educational benefits found in previous evaluations, but with the added benefit of providing a professional educational network during the COVID pandemic. Benefits were preserved when the sessions were run remotely using video-conferencing, although some of the human interaction was lost. As CPD, it was highly valued. For Defence, who need to consider the CPD requirements of their workforce, provision of PBSGL alongside taught CPD updates may satisfy the learning needs of the majority of the workforce.

First contact physiotherapists’ perceptions and experiences of practice-based small group learning in NHS Scotland: a qualitative study

ABSTRACT Practice-Based Small Group Learning (PBSGL) is a continuing professional development programme use by various professions in primary healthcare teams in NHS Scotland. Primary healthcare teams have enlarged with the addition of new professions including First Contact Physiotherapists (FCP) who provide services to patients without the need for referral. In 2020 a pilot of FCPs groups using PBSGL was undertaken. The pilot involved volunteers from a FCP team in one large NHS board in Scotland. It lasted for 12 months and groups met in-person, switching to video-conferencing (VC) as a consequence of the pandemic. A grounded theory approach was adopted for the evaluation. Research participants took part in individual interviews held using VC. Interviews were recorded and transcribed. Data was analysed using grounded theory methods with codes and themes being constructed. Two PBSGL groups were formed from 10 participants and 2 facilitators. Ten took part in one-to-one research interviews. Seven main themes were constructed from the data. There was recognition that FCPs had a new role and work context. There was a sense of volunteerism in the pilot and that participants met in their own time. FCPs appreciated the PBSGL learning methods and their meetings fostered peer support and improved professional socialisation. There was a preference for in-person meetings rather than using VC and some participants wanted to join inter-professional groups in the future.

CPD in the remote environment: a role for practice-based small group learning?

BackgroundContinuous professional development (CPD) is recognised as essential and mandated by the Royal College of General Practitioners and other medical professional colleges. However, it can be difficult to maintain when...

Canadian pioneer in continuing medical education

Dr John N. Premi, the family physician who started the practice-based small group learning program, died peacefully on February 19, 2021. Dr Premi attended medical school at the University of Toronto in Ontario, interned at the Hamilton General Hospital, and then became an active family physician

Practice-based small group learning (PBSGL) with mixed groups of general practitioners and secondary care doctors: a qualitative study

ABSTRACT General practitioners (GPs) and secondary care doctors share a common background of learning together whilst at medical school but their learning paths diverge after specialist qualification. Reconnect is an initiative in NHS Grampian in Scotland which offered a variety of shared activities, including learning, to both groups of medical practitioners. One learning activity was of Practice-Based Small Group Learning (PBSGL) which has proved popular with primary care clinicians. Groups drawn from both health care sectors were started and met over a five month pilot period. A qualitative research method was chosen to identify the perceptions and experiences of participants. They were interviewed in one-to-one telephone interviews. Interviews were audio-recorded, transcribed and analysed using grounded theory methods. Two PBSGL groups were formed with a total of 13 members. One group met twice in the pilot period and the other group met only once. Nine participants were interviewed and four main themes emerged from analysis of the data. Reasons for participation were often related to a desire to improve working relationships between the two sectors and to increase understanding. Practitioners learned about how working conditions and team working affected the working lives of the other sector. Participants found the logistics of arranging further meetings challenging and considered they had a lack of shared learning time together. Considerations to the future of the project were positive but this contrasted with the few meetings that had taken place.

An evaluation of a new practice-based small group learning (PBSGL) initiative in Wales

ABSTRACT In 2018, a new practice-based small group learning (PBSGL) pilot initiative was launched in Wales to promote interprofessional learning among different primary care professionals. The aim of this study was to evaluate the initiative in order to identify its strengths and areas for improvement. Data were collected through focus groups with PBSGL groups in Wales and analysed thematically. Participants generally held positive views of PBSGL and were impressed with the variety and overall relevance of the learning materials, although concern was raised about the relevance of all learning materials to the Welsh context. The interprofessional component was valued for reducing feelings of isolation and all participants were able to contribute to discussions, an outcome helped by existing relationships among group members. Many participants reflected on occasions where they had made changes to their practice as a result of PBSGL activity. Time and funding were cited as potential barriers to continuing participation in PBSGL and there is scope to tailor material more to the context of the healthcare system in Wales.

Academic Half-Days: Facilitated Small Groups to Promote Interactive Learning.

Medical educators have expressed interest in using less didactic and more interactive formats for academic half-days (AHDs) in postgraduate residency training. We assessed the feasibility and effectiveness of implementing a practice-based small-group learning (PBSGL) process as one part of AHDs. A mixed-methods approach was used. Over a two-year period, family medicine residents at the University of Calgary took part in PBSGL sessions during their AHDs, discussing clinical cases presented in evidence-based educational modules and reflecting on clinical experiences with the guidance of a trained peer facilitator. Data sources to explore experiences with the PBSGL process included an evaluation questionnaire, a practice reflection tool (PRT; documenting patient management plans) and individual interviews (n=19) with residents and faculty preceptors. Of 148 residents, 139 (93%) agreed to participate. Participants were divided into groups of 14-16 members to discuss 12 different module topics. Participants indicated that ongoing small-group interactions were helpful in meeting learning needs and provided opportunities to share and learn from experiences of others in a safe environment. Group facilitation by residents was successful. Level of resident participation and time to preread modules were factors contributing to successful small-group interactions. Modules were rated as effective learning tools, and sample cases were perceived as representing typical cases encountered in practice. Although participants intended to apply their learning to practice, follow through was hindered by lack of relevant clinical cases. Ongoing small-group learning facilitated by residents, coupled with evidence-based educational materials, was a feasible approach to AHDs.

The future of CPD for general practitioners, registered pharmacy staff and general practice nurses in Scotland - qualitative responses from a national survey

ABSTRACTIn the United Kingdom, undertaking continuing professional development (CPD) is required for revalidation with regulatory authorities for general practitioners, general practice nurses and registered pharmacy staff – pharmacists and pharmacy technicians. A survey of CPD preferences and activities of these four professions has been published and this paper focuses on one qualitative question in the survey: ‘Please describe any changes that you anticipate in the way in which you will undertake CPD over the next 12 months.’ Responses were analysed using content analysis, then codes and themes were developed into a coding framework. 1,159 respondents provided comments to the question and five themes were identified: options for learning, time, appraisal and revalidation, people in transition and use of technology. There was a desire for face-to-face courses, for interactive learning and for variety of learning methods. Respondents valued learning with others and Practice-Based Small Group Learning was considered to be flexible and promoted inter-professional learning and socialisation. Lack of time for learning was seen as a barrier for respondents. Respondents considered that CPD was needed to support them as their roles developed in primary healthcare.

Practice-Based Small Group Learning (PBSGL) in Scotland: the past, the present and the future

ABSTRACTPractice-based Small Group Learning (PBSGL) originated in Canada and transferred to Scotland in 2003 with a successful pilot involving 45 general practitioners (GPs). The Scottish programme has grown considerably since then and now has 3,400 members drawn from GPs, GP nurses, pharmacists and other professions. Members get together in small groups and discuss case presentations written by authors who have drawn on their own experiences with real patients. The group review a distillation of the current evidence base included in the module and propose changes to their own practice. Members make a commitment to change and log these changes in a shared document.In Scotland, 34% of groups are inter-professional, reflecting the dynamic changes to the primary health care team as it meets the health care needs of the Scottish population. Professional (and inter-professional) socialisation is a key feature of many PBSGL groups. Some groups have peer support as a central function to their meetings.The programme has recruited a small team of module writers and authors and most modules are now produced in Scotland by primary health care members. In addition, over 1,000 members have been trained up to be peer facilitators for their small group. The PBSGL programme in Scotland has ensured that continuing professional development of the primary health care team is available to teams across Scotland and that PBSGL groups can control the content and logistics of their own meetings.

How do clinicians use implementation tools to apply breast cancer screening guidelines to practice?

BackgroundImplementation tools (iTools) may enhance uptake of guidelines. However, little evidence exists on their use by primary care clinicians. This study explored which iTools clinicians used and how often; how satisfied clinicians were with the tools; whether tool use was associated with practice changes; and identified mediators for practice change(s) related to breast cancer screening (BCS).MethodsCanadian primary care providers who are members of the Practice-Based Small Group Learning Program (n = 1464) were invited to participate in this mixed methods study. An educational module was discussed in a small group learning context, and data collection included an on-line survey, practice reflection tools (PRTs), and interviews. The module included both the Canadian Task Force on Preventive Health Care revised guideline on BCS and iTools for clinician and/or patient use. After discussing the module and at 3 months, participants completed PRTs identifying their planned practice change(s) and documenting implementation outcome(s). Use of the iTools was explored via online survey and individual interviews.ResultsSeventy participants agreed to participate. Of these, 48 participated in the online survey, 43 completed PRTs and 14 were interviewed. Most survey participants (77%) reported using at least one of seven tools available for implementing BCS guideline. Of these (78%) reported using more than one tool. Almost all participants used tools for clinicians (92%) and 62% also used tools for patients. As more tools were used, more practice changes were reported on the survey and PRTs. Interviews provided additional findings. Once information from an iTool was internalized, there was no further need for the tool. Participants did not use tools (23%) due to disagreements with the BCS guideline, patients’ expectations, and/or experiences with diagnosis of breast cancer.ConclusionThis study found that clinicians use tools to implement practice changes related to BCS guideline. Tools developed for clinicians were used to understand and consolidate the recommendations before tools to be used with patients were employed to promote decision-making. Mediating factors that impacted tool use confirmed previous research. Finally, use of some iTools decreased over time because information was internalized.

The recruitment of new members to existing PBSGL small groups: a qualitative study

ABSTRACTIntroduction Practice-Based Small Group Learning (PBSGL) is a learning programme widely adopted by primary healthcare professions (general practitioners, general practice nurses and pharmacists) in Scotland and other countries in the UK. PBSGL groups recruit members and decide on meeting dates and venues.Study aims To determine how groups recruit new members and discern what are the important attributes of the new members.Method A grounded theory approach was used with purposive sampling to recruit PBSGL groups to the study. Focus groups drawn from established PBSGL groups were conducted by two researchers following an iterative process, with interviews audio-recorded and transcribed, and codes and themes constructed. Data saturation was achieved.Results and conclusions Four themes were identified that affected group recruitment: group formation and purpose; group culture and ethos; experience and seniority range of group members; professional socialisation and cross-fertilisation. Groups whose main purpose was learning encouraged diverse membership, while groups that were stricter with recruitment often prioritised friendship, group safety, trust and peer support over learning. The variation in group’s openness to recruitment may make it difficult for potential members to find a group and this may affect the development and expansion of the PBSGL programme.

Determining the educational impact of the introduction of practice-based small group learning within an intraprofessional group of doctors

IntroductionPractice-Based Small Group Learning (PBSGL) is a system for continuing professional development introduced into Wessex Region Defence Primary Healthcare (DPHC) as the Salisbury Plain PBSGL group in 2012. This is...

Practice-Based Small Group Learning (PBSGL) in Scotland – a survey of registered pharmacy staff and general practice nurses

Introduction: Practice-based small group learning (PBSGL) has grown in primary healthcare in Scotland, and is used regularly by 2244 GPs and GP specialist trainees. The programme has been available to general practice nurses (GPNs) and pharmacy staff since uni-professional and inter-professional pilot studies were considered successful. Growth has been slower compared to GPs uptake but has now reached significant levels. It seemed timely to evaluate the use of the programme by these professions. Method: A questionnaire previously used by GPs was adapted. It consisted of 16 questions and two free text questions asking respondents what had motivated them to join PBSGL, and what encouraged them to maintain membership. The questionnaire was converted into an electronic format and emailed to pharmacy and GPNs in Scotland who were PBSGL members. Results: A range of pharmacy staff and GPNs were involved in PBSGL and the mean number of modules studied by pharmacy staff was 3.93 and 4.48 by GPNs in the last year. A high percentage were likely or very likely to continue with membership (pharmacy staff – 95.6%, GPNs – 90.1%). The dominant reasons to join and stay in the programme related to learning issues: meeting learning needs, learning from peers and professional socialisation.

Development of an interface-focused educational complex intervention

Background: In many countries, the medical primary-secondary care interface is central to the delivery of quality patient care. There is prevailing interest in developing initiatives to improve interface working for the benefit of health care professionals and their patients. Aim: To describe the development of an educational intervention designed to improve working at the primary-secondary care interface in NHS Scotland (United Kingdom) within the context of the Medical Research Council framework for the development and evaluation of complex interventions. Methods: A primary-secondary care interface focused Practice-based Small Group Learning (PBSGL) module was developed building upon qualitative synthesis and original research. A ‘meeting of experts’ shaped the module, which was subsequently piloted with a group of interface clinicians. Reflections on the module were sought from clinicians across NHS Scotland to provide contextual information from other areas. Findings: The PBSGL approach can be usefully applied to the development of a primary-secondary care interface-focused medical educational intervention.

Ten years of practice-based small group learning (PBSGL) in Scotland – a survey of general practitioners

Introduction: Practice-based small group learning (PBSGL) has grown in Scotland since its pilot in 2004. There are now over 2,100 clinicians in 370 groups across the UK. The programme is used by all 14 territorial health boards in NHS Scotland. It seemed timely to undertake an evaluation of the programme. Method: A questionnaire was developed and piloted. It consisted of 16 questions with two free text questions asking respondents what had motivated them to join PBSGL, and what encouraged them to stay. The questionnaire was converted into an electronic format and emailed to all qualified general practitioners (GPs) in Scotland. Results: A wide range of GPs were involved in PBSGL and the mean number of modules studied per year was 6.8. The vast majority (589 (88.2%)) of respondents met in their own home or practice and were either very likely (549 (82.2%)) or likely (93 (13.9%)) to continue with the programme. The dominant reasons to join and stay with the programme related to learning issues: meeting learning needs, learning from peers and issues of peer support. Conclusion: PBSGL has become an established continuous professional development resource for many GPs in Scotland. It is well-received and likely to continue.

GP and pharmacist inter-professional learning – a grounded theory study

Background: Practice Based Small Group Learning (PBSGL) is an established learning resource for primary care clinicians in Scotland and is used by one-third of general practitioners (GPs). Scottish Government and UK professional bodies have called for GPs and pharmacists to work more closely together to improve care. Aim: To gain GPs’ and pharmacists’ perceptions and experiences of learning together in an inter-professional PBSGL pilot. Design and setting: Qualitative research methods involving established GP PBSGL groups in NHS Scotland recruiting one or two pharmacists to join them. Method: A grounded theory method was used. GPs were interviewed in focus groups by a fellow GP, and pharmacists were interviewed individually by two researchers, neither being a GP or a pharmacist. Interviews were audio-recorded, transcribed and analysed using grounded theory methods. Data saturation was achieved and confirmed. Results and conclusion: Three themes were identified: GPs’ and pharmacists’ perceptions and experiences of inter-professional learning; Inter-professional relationships and team-working; Group identity and purpose of existing GP groups. Pharmacists were welcomed into GP groups and both professions valued inter-professional PBSGL learning. Participants learned from each other and both professions gained a wider perspective of the NHS and of each others’ roles in the organisation. Inter-professional relationships, communication and team-working were strengthened and professionals regarded each other as peers and friends.

Continuous professional development for GPs: experience from Denmark

Background and objectivesContinuous professional development (CPD) for Danish general practitioners (GPs) is voluntary and based on funded accredited activities. There is an ongoing discussion on how to improve this current...

Scottish pharmacists’ perceptions and experiences of a practice-based small group learning pilot: a qualitative study

CPD is an important feature of healthcare professions and regulatory bodies consider it mandatory. Studies of CPD activity of pharmacists showed that 10% were undertaking no CPD. Practice-based small group learning (PBSGL) is a well-received and popular learning resource for GPs in Scotland. From 2011, a pharmacy pilot was undertaken: pharmacists were trained as peer-facilitators and existing PBSGL modules were adapted. Four NHS boards took part and this study aimed to explore the perceptions and experiences of pharmacists. A qualitative research approach was adopted using focus groups and in-depth interviews. Interviews were audio-recorded and transcriptions made. Transcripts were coded and themes developed using grounded theory methods. Participants welcomed PBSGL: it was a feasible learning method, acceptable and had educational impact. They appreciated its interactive nature and discussions founded on their experiences in practice. Participants liked the self-reliance of PBSGL in that they were not dependent on specialist practitioners. There were logistical challenges that impacted on the success of group discussion; some pharmacists were less familiar with small group work. Pharmacists felt isolated during work and appreciated peer discussion. There was a tentative welcome to inter-professional learning but group composition and module topics might impact on the success of this. Pharmacists were able to change their learning practice in uni-professional PBSGL groups and were able to learn from each other. There may be further learning opportunities if pharmacists participate in inter-professional groups.

Practice-based small group learning (PBSGL) for CPD: a pilot with general practice trainees to support the transition to independent practice

The paper describes a small-scale enquiry with UK-based general practice specialty trainees (GPSTs) at the time of transition from training to independent practice. It aimed to identify whether they were supported in making this transition through attending practice-based small group learning (PBSGL) sessions. Participants in the study reported that the sessions helped them to consolidate their learning from their third year of training (GPST3), improved their ability to identify and use evidence in practice, and shifted the focus of their learning needs away from the two UK general practice postgraduate exams (applied Knowledge Test or aKT; and Clinical Skills assessment or CSa) and towards 'real world' practice. The two pilot groups have become established as means of peer support and continue to meet, with small changes in composition. The work has led to the wider roll out of PBSGL for newly qualified GPs across Wessex.

Supporting educational supervisor development at the interface: evaluation of a pilot of PBSGL for faculty development

Practice-based small group learning (PBSGL) is an established approach for continuing professional development (CPD) for GPs in Scotland. This paper describes an extension of the PBSGL approach to support the learning and development of educational supervisors from both hospital and general practice, working together in peer-facilitated small groups to address topic-specific, evidence-based educational modules. Four groups met on three occasions each and qualitative data were gathered from interviews with the facilitators and the participants. This was supplemented with observational data of the group process and function. Both GPs and consultants enjoyed the format and were very positive about the experience of working together in this way. Commitment to change educational practice and reported actual changes in practice were evident.