Primary Care Education Research Articles

Geneva medical students increasingly identify primary care physicians as role models after introduction of a compulsory clerkship

Background Role modelling is recognised as an important element in career choice. In strongly hospital-based medical education settings, students identify few primary care physicians as positive role models, which might impact their career plans and potentially contribute to primary care workforce shortage. At Geneva Faculty of Medicine (Switzerland), a compulsory final-year clerkship in primary care practices was introduced to strengthen primary care teaching in the curriculum. Objectives To assess the proportion of graduating students identifying a primary care physician as positive role model, before and after the introduction of the clerkship. Methods Cross-sectional survey in four consecutive classes of graduating medical students one year before and three years after the introduction of the clerkship. The main outcome measure was the proportion of students in each class citing a primary care physician role model. Comparisons were analysed using Pearson’s Chi-square test and one-way ANOVA. Results The total sample included 505 students. The proportion of students recalling a primary care physician role model increased steadily from 8% (before introduction of the clerkship) to 13, 16, and 21%, respectively, at 1, 2 and 3 years after the introduction of the clerkship (p = 0.03). Conclusion Our exploratory study suggests that introducing a compulsory primary care clerkship may have contributed to increasing the visibility of primary care physicians as role models. Future research should explore primary care physicians’ awareness of role modelling and its contribution to career choices.

An Exploratory Mixed Methods Study of Experiences of Interprofessional Teams Who Received Coaching to Simultaneously Redesign Primary Care Education and Clinical Practice.

Introduction/Objectives:Coaching is emerging as a form of facilitation in health professions education. Most studies focus on one-on-one coaching rather than team coaching. We assessed the experiences of interprofessional teams coached to simultaneously improve primary care residency training and interprofessional practice.Methods:This three-year exploratory mixed methods study included transformational assistance from 9 interprofessional coaches, one assigned to each of 9 interprofessional primary care teams that included family medicine, internal medicine, pediatrics, nursing, pharmacy and behavioral health. Coaches interacted with teams during 2 in-person training sessions, an in-person site visit, and then as requested by their teams. Surveys administered at 1 year and end study assessed the coaching relationship and process.Results:The majority of participants (82% at end of Year 1 and 76.6% at end study) agreed or strongly agreed that their coach developed a positive working relationship with their team. Participants indicated coaches helped them: (1) develop as teams, (2) stay on task, and (3) respond to local context issues, with between 54.3% and 69.2% agreeing or strongly agreeing that their coaches were helpful in these areas. Cronbach’s alpha for the 15 coaching survey items was 0.965. Challenges included aligning the coach’s expertise with the team’s needs.Conclusions:While team coaching was well received by interprofessional teams of primary care professionals undertaking educational and clinical redesign, the 3 primary care disciplines have much to learn from each other regarding how to improve inter- and intra-professional collaborative practice among clinicians and staff as well as with interprofessional learners rotating through their outpatient clinics.

Realist evaluation of interprofessional education in primary care through transprofessional role play: what primary care professionals learn together

ABSTRACT Interprofessional collaboration (IPC) is vital to primary care. Improving IPC requires cooperation between medical and other healthcare professionals. Transprofessional role plays can enhance the quality of IPC; thus, in this study, we conducted transprofessional role plays, based on existing theories regarding IPC and medical education, with healthcare professionals in primary care. As a study design, the realist approach was used to clarify the effectiveness of transprofessional role plays. Five Likert-scale questionnaires regarding the competency of IPC were used to assess the change in perception of medical and care professionals through educational intervention. The realist approach was employed for the clarification of contexts, mechanisms and outcomes of transprofessional role play using one-on-one interview data. Sixty-two medical care professionals participated in the transprofessional role plays, and 31 participants were interviewed. The difference in the score of the competency scale of IPC was statistically significant in all six competencies (p-value <0.001). Three context, mechanism and outcome theories were clarified from the qualitative analysis of the interviews: reflection on others, realisation of own roles and driving humanistic relationship. Additionally, contextual factors, the mechanisms that facilitated them and the clarified outcomes were identified. Ultimately, in this realist evaluation transprofessional role plays proved to be effective in driving IPC in primary care through improving compassion and reliability across professions. The constant provision of the role play and mutual discussion of each professional’s role can facilitate effective IPC in primary care.

Commitment to Care for the Community and COVID-19: teaching-learning approach to medical education in primary health care in Brazil

The major challenge of the COVID-19 pandemic to all countries has been to their healthcare systems and how to face it with excellence. Medical education can contribute in a short period so that the health system responds effectively to the current challenges imposed by the pandemic. Political implications identification and action are important to show that they can convert ideas into realities. In the middle of the COVID-19 pandemic, literacy in individual, community, and population health is more important than ever. As knowledge about COVID-19 grows rapidly, so does the opportunity to shape more effective interprofessional educational practices. During this pandemic, interprofessional collaborative teams are more crucial than ever in health promotion, mainly at the Primary Health Care.

Age-Friendly Online Training Programs for Long-Term Services and Supports Staff to Improve Care for Older Adults

The purpose of our Geriatric Workforce Enhancement Program is to provide geriatric and primary care education and training to long-term care (LTC) providers and staff, health professions students and community members. Our LTC partners and the communities we serve are often very rural and travel to urban areas for training can be difficult. Therefore, we have developed four online training that are offered free to our partners and rural communities statewide. These programs are designed to integrate the aims of the Age-Friendly 4M’s model (i.e., What Matters, Mobility, Medication, Mentation). The LTC nurse residency program provides gerontological nursing and inter-professional leadership training (all 4M’s), in a synchronous online environment. The asynchronous Alzheimer’s Disease and Related Dementias training modules educate LTC staff and family caregivers about types, diagnosis and care of older adults with dementia (Mentation and Medication). The asynchronous Opioid Use in LTC modules were developed with partners to deliver live at LTC staff trainings about opioid stewardship (Medication). The LTC Learning Communities are monthly tele-health sessions for inter-professional LTC teams to discuss current issues and propose solutions (all 4M’s). We have successfully leveraged different synchronous and asynchronous online modalities to increase educational opportunities for formal and informal caregivers, including those in rural areas whose educational opportunities are geographically limited. To date our programs have reached over 500 individuals across our state, increasing knowledge about geriatric concepts, communication and team leadership. Moving forward, we will continue to develop and refine educational programs that promote the Age-Friendly geriatric-focused health care.

Integrating the ELNEC undergraduate curriculum into Nursing Education: Lessons learned.

Nurses are called to lead and transform palliative care, compelling nurse educators to provide the requisite education to do so. All nursing students need to learn primary palliative care to be prepared to care for the growing number of patients with serious illness and their families. The American Association of Colleges of Nursing (AACN) Competencies And Recommendations for Educating nursing Students (CARES) document outlines 17 palliative care competencies to be attained by graduation from their pre-licensure programs. Integrating standardized primary palliative care education into curriculum remains a challenge for nurse educators. The End of Life Nursing Education Consortium (ELNEC) Undergraduate online modules represent one educational strategy that supports faculty and students in meeting AACN competencies as well as other national guidelines for palliative care education. Despite its ease of use, only about 25% of all undergraduate programs are incorporating these into their programs. Faculty continue to report barriers to implementing palliative care education, including saturated curricula, limited content expertise, and cost. This paper describes lessons learned from palliative care champion nursing schools to help overcome these barriers.

A importância da educação permanente em saúde no âmbito da atenção primária: revisão integrativa

Objetivo: analisar a importância da educação permanente em saúde. Método: revisão integrativa realizada na LILACS, BDENF E MEDLINE, com os seguintes critérios de inclusão: possuir relação do objetivo proposto; ano de publicação de 2008 a 2016; abordar a temática de educação permanente na atenção primária; possuir o texto na í­ntegra disponí­vel online; idioma português, inglês ou espanhol. Seguiu-se a recomendação PRISMA. A busca foi realizada por dois pesquisadores independentes. Resultados: Após a busca, foram analisados e categorizados: "A importância dos EPS aos profissionais"; "Implicações da educação permanente para a saúde coletiva" e "Educação permanente na enfermagem". Conclusão: As evidências mostraram que a educação permanente em saúde proporciona a construção de novos saberes mediante a junção de conhecimentos especí­ficos e de saberes populares.

Reimagining medical education for primary care in the time of COVID-19: a world view

ABSTRACT This article sets out to highlight the challenges and opportunities for medical education in primary care realised during the COVID-19 pandemic and now being enacted globally. The themes were originally presented during a webinar involving educationalists from around the world and are subsequently discussed by members of the WONCA working party for education. The article recognises the importance of utilising diversity, addressing inequity and responding to the priority health needs of the community through socially accountable practice. The well-being of educators and learners is identified as priority in response to the ongoing global pandemic. Finally, we imagine a new era for medical education drawing on global connection and shared resources to create a strong community of practice.

Editorial introductions

Editorial introductions

The role of primary care providers in oral health education for patients with diabetes

ObjectiveIn this manuscript, we provide information and guidance on oral health education for diabetes care management, which will be beneficial to primary care providers and educators as it serves to fill a current knowledge gap. ResultsThere is a lack of awareness on the relationship between diabetes mellitus and oral health complications along with less frequent dental visits by adult patients with diabetes, which can be attributed to the great variation in the volume and intensity of training on oral health information between current diabetes education programs. ConclusionsThere is a general lack of reliable oral health assessment tools incorporated in diabetes education curricula in addition to a lack of familiarity and time to complete the existing tools among diabetes patient educators in the busy primary care setting. Practice implicationsWe propose a simplified, more feasible oral health assessment tool that can be incorporated in office visits of primary care educators and providers. The intention of this manuscript is to generate sufficient awareness to motivate a follow-up effectiveness study to test the validity and use of the proposed tool.

Primary care education in the time of COVID: embodiment, identity and loss

Over the course of 2020, the landscape of general practice has changed almost beyond recognition due to the exigencies of the COVID-19 pandemic. The challenge for educators is to keep pace with the...

A feasibility pragmatic clinical trial of a primary care network exercise and education program for people with COPD

BackgroundPulmonary rehabilitation is an important component of chronic disease management in chronic obstructive pulmonary disease (COPD) and has been shown to improve shortness of breath, exercise capacity, quality of life, and decrease hospitalizations. However, pulmonary rehabilitation capacity is low. Primary care may be an effective method for delivering disease management services to this population. The objective of this feasibility pragmatic clinical trial was to evaluate enrollment and completion of a primary care network exercise and education program for people with COPD.MethodsCOPD patients (N = 23; mean age = 65 ± 9 years; FEV1 = 68 ± 20% predicted) were recruited after referral to a primary care network exercise program in Edmonton, Alberta. Participants self-selected either an 8-week 16-session supervised exercise program or an 8-week unsupervised exercise program where they received three visits with an exercise specialist. Both groups self-selected education sessions with clinicians for disease management support. Referrals, completion, and program outcomes (physical activity, exercise capacity and health status) were measured before (T1), immediately after (T2), and 8 weeks following the program (T3).ResultsForty-three referrals were received in 10 months, where a minimum of 50 was required in order for the program to be considered feasible. Twenty-three participants provided baseline data, and twenty participants started the exercise program (10 in each exercise group), 16 of which completed the exercise program (80%). On average, 48% of the recommended education sessions were completed by participants.ConclusionsEnrollment into a COPD exercise and education program in a primary care network was low indicating the need for improved referral processes from physicians. Completion rates by participants were adequate for exercise but not education. The low referral rate and the lack of enrollment in COPD education by the patients indicate that a large-scale trial of the program as designed is not feasible.

Preparing Advanced Practice Registered Nursing Students to Provide Primary Palliative Care.

Advanced practice registered nursing students need primary palliative care education to care for the growing number of patients with serious illness and their families and to fill the serious resource gaps in specialty palliative care. There has been a lack of primary palliative care education in most graduate nursing programs and little direction as to competencies and essential content. In an effort to support faculty to teach palliative care content, the End-of-Life Nursing Education Consortium (ELNEC) has created an online curriculum that meets the new American Association of Colleges of Nursing Graduate-Competencies and Recommendations for Educating Nursing Students in primary palliative care for master's degree and doctor of nursing practice students. During the first 9 months of its release, more than 170 nursing programs have accessed the ELNEC Graduate curriculum, and there have been more than 200 student completions. Primary palliative care education is essential for all advanced practice nursing students. The new ELNEC Graduate curriculum offers the opportunity to provide quality education remotely.

Pattern and Features of Pediatric Endocrinology Referrals: A Retrospective Study in a Single Tertiary Center in Italy

Introduction: The knowledge of the pattern and the features of pediatric endocrinology referrals is crucial to optimize resources and guide public health interventions. We explored the numbers and the reasons for referral to a pediatric endocrinology outpatient clinic and investigated their features in terms of assignment of priority ranks, sex, age differences, the prevalence of pathological findings among referred cases, and the agreement among referrals, final diagnosis, treatment, and follow-up.Methods: Retrospective study with data collection for pediatric endocrinology first visits between November 2012 and February 2019 in a tertiary center.Results: A total of 1930 first visits were performed with an overall number of referrals of 2,165, and an increasing trend over the years. The most frequent referral reasons were slow growth, precocious puberty, and obesity; 14% of visits were classified as “urgent” (<7 days), 35% as “deferrable” (<30 days), and 51% as “planned” (<180 days). Sex and age differences among referrals were detected, with criticality in the appropriate timing for referral. Thirty-eight percent of patients had pathological findings. In 4% of the cases the final diagnosis was not concordant with the reason for referral. Treatment was prescribed in 35% of cases, and 67% returned at least for one follow-up visit.Conclusion: The study highlighted the need to target medical education of primary care on the definition of priority ranks, the need for more extended observation periods for subclinical or para-physiological conditions, the appropriate timing for referral, based on the definition of conditions or the best window of intervention.

Impact of interprofessional embedding of physical therapy in a primary care training clinic

ABSTRACT Musculoskeletal pain is a prominent complaint in primary care resulting in increased referrals to physical therapy (PT); however, the referral system often results in delays and discontinuation of care. Several models have been developed to improve the referral process including integrating PT into primary care clinics. The Veterans Health Administration (VHA) Center of Excellence in Primary Care Education (CoEPCE), which educates post-graduate trainees in interprofessional teams, began (in 2015) embedding physical therapists into primary care clinics enabling patients to see a physical therapist during their primary care visit. To evaluate the efficacy of this model we tracked the numbers of PT referrals, the number of completed referrals, and the length of time between referral and completion. PT referral parameters from PT-integrated trainees in the CoEPCE were compared to two traditional primary care training clinics at the same VHA site (Firm A and Firm B). Results indicate that the CoEPCE placed and completed more PT referrals and did so with a shorter turnaround time than was seen in the other two clinics. Further analysis suggests that the decreased turnaround time can be attributed to the integration of PTs into the primary care clinic. The results support extending the use of interprofessional clinics that integrate PT into primary care settings.

Are Internal Medicine Residents Meeting the Bar? Comparing Resident Knowledge and Self-Efficacy to Published Palliative Care Competencies.

There is a need for improved primary palliative care (PC) education and resident comfort with providing end-of-life care. Utilize a new instrument derived from published PC competencies to assess baseline Internal Medicine (IM) resident knowledge and self-efficacy in PC to identify educational gaps and create new PC curricula. We created a 2-part instrument including a Knowledge Test (KT) and a Self-Efficacy Inventory (SEI) addressing 18 PC resident competencies across 5 domains: Pain and Symptom Management (PSM), Communication (COMM), Psychosocial, Spiritual, and Cultural Aspects of Care (PSC), Terminal Care and Bereavement (TCB), and Palliative Care Principles and Practice (PCPP). The instrument was emailed to IM residents at our institution during academic years 2015-2016 and 2016-2017. Basic descriptive statistics were performed for the KT and SEI. Mean Rank Analysis and One-way ANOVA were utilized for the KT and SEI, respectively. Congruence was calculated between knowledge and self-efficacy. The mean score on the KT was 73% (range 33-80%). There was no significant difference in knowledge among post-graduate year cohorts. Self-efficacy scores were lower for interns overall and in PCPP, TCB, and COMM domains. Knowledge was concordant with self-efficacy in 42% of participants, higher than self-efficacy in 10% of participants, and lower than self-efficacy in 48% of participants. For approximately half of respondents, high self-efficacy in PC did not correlate with high PC knowledge. A more focused curriculum is needed to help IM residents facilitate mastery of PC competencies by graduation.

Case simulations for permanent education in Primary Care – School of Patients DF

Abstract Background In scenarios of vulnerability that include triple charge of diseases, permanent education in Primary Care and university is fundamental to allow greater access, efficiency and safety for users and health teams. Objectives The School of Patients DF was created as a tool for popular and technical health education, including case simulations for practice. It consists of standard technical content (Chapters), categorized by conditions and diseases, shared by Google Drive and used primarily in selected primary care units of Brazil's capital city. Results Technical simulations are performed in pairs, 1 participant acts as “patient” with script in hand (topics of the training) while the other acts as “health professional” as if in a regular visit. Simulations are timed for 10 minutes for consultation and 5 for feedback, boosting learning. Contents are based on guidelines and protocols from the Ministry of Health, Secretary of Health and Brazilian Community and Family Medicine Society. Since 2016 there have been realized over 1400 simulations, including weekly classes for last term medical students at the capital city federal university. Conclusions Simulations optimize the time necessary for permanent education (15 minutes blocks), avoiding limiting access for triage and consults, allowing smaller groups to train with greater focus and independent of computers or projectors. Key messages Standardizing training and practice bring benefit to patient care and safety. Simulations with structured physical examination are important both for professional as well as students.

The effect of problem-based learning after coronary heart disease \u2013 a randomised study in primary health care (COR-PRIM)

BackgroundCardiac rehabilitation is effective after coronary heart disease (CHD). However, risk factors remain, and patients report fear for recurrence during recovery. Problem-based learning is a pedagogical method, where patients work self-directed in small groups with problem solving of real-life situations to manage CHD risk factors and self-care. We aimed to demonstrate the better effectiveness of problem-based learning over home-sent patient information for evaluating long-term effects of patient empowerment and self-care in patients with CHD. Hypothesis tested: One year of problem-based learning improves patients’ empowerment- and self-efficacy, to change self-care compared to 1 year of standardised home-sent patient information after CHD.MethodsPatients (N = 157) from rural and urban areas in Sweden between 2011 and 2015 (78% male; age.68 ± 8.5 years) with CHD verified by percutaneous coronary intervention (PCI) (70.1%) or coronary artery by-pass surgery (CABG) and CABG+PCI or myocardial infarction (29.9%) were randomly assigned to problem-based learning (experimental group; n = 79) or home-sent patient information (controls; n = 78). The problem-based learning intervention consisted of patient education in primary care by nurses tutoring groups of 6–9 patients on 13 occasions over 1 year. Controls received home-sent patient information on 11 occasions during the study year.ResultsAt one-year follow-up, the primary outcome, patient empowerment, did not significantly differ between the experimental group and controls. We found no significant differences between the groups regarding the secondary outcomes e.g. self-efficacy, although we found significant differences for body mass index (BMI) [− 0.17 (SD 1.5) vs. 0.50 (SD 1.6), P = 0.033], body weight [− 0.83 (SD) 4.45 vs. 1.14 kg (SD 4.85), P = 0.026] and HDL cholesterol [0.1 (SD 0.7) vs. 0.0 mmol/L (SD 0.3), P = 0.038] favouring the experimental group compared to controls.ConclusionsThe problem-based learning- and the home-sent patient information interventions had similar results regarding patient empowerment, self-efficacy, and well-being. However, problem-based learning exhibited significant effects on weight loss, BMI, and HDL cholesterol levels, indicating that this intervention positively affected risk factors compared to the home-sent patient information.Trial registrationNCT01462799 (February 2020).

The state of family medicine training programmes within the Primary Care and Family Medicine Education network.

The 2019 Primary Care and Family Medicine Education network (Primafamed) meeting in Kampala, Uganda, included a workshop that aimed to assess the state of postgraduate family medicine training programmes in the Primafamed network. Forty-six people from 14 African and five other countries were present. The evaluation of programmes or countries according to the stages of change model was compared to a previous assessment made 5 years ago. Most countries have remained at the same stage of change. Two countries appeared to have reversed their readiness to change as Rwanda moved from relapse to pre-contemplation and Mozambique moved from action to contemplation. Malawi, Zambia and Zimbabwe increased their readiness to change and moved from contemplation to action. Countries in the region remain quite diverse in terms of their commitment to family medicine training. Within Primafamed, it is possible for countries with a more advanced stage of change to assist countries with an earlier stage. Primafamed is also supported by a variety of partners outside of Africa. Five years after the previous country-level assessment, family medicine in Africa continues to span across all levels of the stages of change model. Stage-matched interventions aligned with the needs of individual countries should follow. Consequently, this workshop report will serve as a mandate and compass for Primafamed’s actions over the next few years, aimed at designing and delivering these interventions. As reiterated in the 2019 Kampala commitment, we should continue developing the discipline of family medicine (the medical ‘specialty’ of primary care), through alignment of our training programmes to the health needs in the African region.

SERIES: eHealth in primary care. Part 3: eHealth education in primary care

Background Education is essential to the integration of eHealth into primary care, but eHealth is not yet embedded in medical education. Objectives In this opinion article, we aim to support organisers of Continuing Professional Development (CPD) and teachers delivering medical vocational training by providing recommendations for eHealth education. First, we describe what is required to help primary care professionals and trainees learn about eHealth. Second, we elaborate on how eHealth education might be provided. Discussion We consider four essential topics. First, an understanding of existing evidence-based eHealth applications and conditions for successful development and implementation. Second, required digital competencies of providers and patients. Third, how eHealth changes patient-provider and provider-provider relationships and finally, understanding the handling of digital data. Educational activities to address these topics include eLearning, blended learning, courses, simulation exercises, real-life practice, supervision and reflection, role modelling and community of practice learning. More specifically, a CanMEDS framework aimed at defining curriculum learning goals can support eHealth education by describing roles and required competencies. Alternatively, Kern’s conceptual model can be used to design eHealth training programmes that match the educational needs of the stakeholders using eHealth. Conclusion Vocational and CPD training in General Practice needs to build on eHealth capabilities now. We strongly advise the incorporation of eHealth education into vocational training and CPD activities, rather than providing it as a separate single module. How learning goals and activities take shape and how competencies are evaluated clearly requires further practice, evaluation and study.