Students In General Practice Research Articles

Addressing closed and limited enrolments in general practices in Aotearoa New Zealand: a mixed-methods study.

To ascertain the reasons for and impacts of closed books in general practices in Aotearoa New Zealand and report recommendations for mitigation. A mixed-methods approach was used. A first round of interviews with experts in the primary care sector was conducted, followed by a survey across general practices and, finally, a second round of interviews. Data reported here are qualitative data from the interviews and open-ended questions in the survey. Qualitative data were analysed using a general inductive approach. The key reasons for not enrolling new patients included workforce shortages, high workloads and staff burnout, funding issues, concerns about quality of care and insufficient physical space. These were exacerbated during the COVID-19 pandemic. The impacts included no access or delayed access to primary care, worsening health conditions, undiagnosed or untreated diseases and less or no access to preventive care. Recommendations included recruiting more staff including administrative staff, resolving the pay disparity between general practice and hospital staff, having a longer placement period for students in general practice, utilising a multidisciplinary workforce and revising the funding formula. There is an urgent need to resolve key issues so that general practices can accept all who wish to enrol.

Career of postgraduate students in general practice in Saint-Étienne between 2014 and 2020

Le concept de responsabilité sociale des facultés de médecine et son consensus mondial de 2010 demandent de former des professionnels compétents en rapport avec les besoins en santé des populations principalement en soins de santé primaire et en santé publique. Une évaluation de ce rôle est prévue1. La démographie médicale est une question qui fait régulièrement l’actualité. L’atlas démographique du Conseil national de l’Ordre des médecins (CNOM) de 2021 décrit un index de renouvellement insuffisant pour les médecins généralistes : - 0,9 vs + 7 % pour les autres spécialistes2.

‘They never mentioned this in medical school!’ A qualitative analysis of medical students’ reflective writings from general practice

Objective The aim of the study was to identify final-year medical students’ experiences with thought-provoking and challenging situations in general practice. Design setting and subjects We conducted a qualitative analysis of 90 reflective essays written by one cohort of Norwegian final-year medical students during their internship in general practice in 2017. The students were asked to reflect upon a clinical encounter in general practice that had made a strong impression on them. A primary thematic content analysis was performed, followed by a secondary analysis of encounters that stood out as particularly challenging. Main outcome measures Clinical scenarios in general practice that make students feel professionally ‘caught off guard’. Results The analysis identified several themes of challenging student experiences. One of these was ‘disorienting encounters’ for which the students felt totally unprepared in the sense that they did not know how to think and act. Five different scenarios were identified: (1) patients with highly distracting appearances, (2) ‘ordinary consultations’ that suddenly took a dramatic turn, (3) patients who appeared unexpectedly confrontational or devaluating, (4) scornful rejection of the young doctor’s advice, and finally, (5) confusion related to massive contextual complexity. Conclusions Disorienting encounters stood out as particularly challenging clinical experiences for medical students in general practice. These scenarios evoked an acute feeling of incapacitation: not knowing what to think and do. Further curriculum development will focus on preparing the students to ‘know what to do when they don’t know what to do’.

Teaching medical students in general practice when conducting remote consults: a qualitative study

ABSTRACT Background Telehealth involves real-time communication (telephone or video-call) between patients and health providers. The COVID-19 pandemic propelled general practitioners to conduct most consultations remotely, seeing patients face-to-face only when required. Placement opportunities and experience for medical students were reduced. Initially online learning programmes replaced clinical attachments. Subsequently, clinical teachers supervised students to engage in remote consultations, either in clinics or from their homes. This study aimed to explore the experience of New Zealand general practitioners undertaking clinical teaching with medical students when telehealth consulting. Methods Semi-structured interviews with general practitioners who had taught medical students whilst consulting remotely. General inductive thematic analysis of transcribed interviews. Results Six female and four male participants aged 40 to over 65 years. Participants often focused on general practicalities of telehealth consultations and effects on the patient-doctor relationship, and needed direction to consider remote consultations with students, which added to the interactions. Four themes were identified: changes needed in teaching delivery format; direct comparison with face-to-face; challenges and advantages to remote teaching, each with subthemes. Discussion Clinicians needed to determine practical logistics and develop skills for both remote consulting and teaching. New format and structures of consultations needed planning. Differences from face-to-face teaching included scene-setting for the consultation and supervision factors. Telehealth teaching conferred new opportunities for learning but also challenges (e.g. consent, cues, uncertainty). Remote consultations are likely to remain a significant mode for doctor-patient interactions. Preliminary guidelines for teaching and learning using telehealth need to be developed and embedded into medical programmes and then evaluated.

Formation des étudiants en pharmacie d’officine et en médecine générale à la communication interprofessionnelle : évaluation d’un programme de simulation

The objective of this work is to assess the impact of a simulation session on the ability of pharmacy and medicine students in general practice to communicate in the resolution of patient-facing situations. The evaluation of the impact of the session on the representation of the professions used a questionnaire to be completed before and after the session by the students. The evaluation of the impact of the session on the perception of communication and associated skills was based on an audio recording of the debriefings, which, after transcription and thematic analysis, was used as a preliminary analysis for the drafting of a questionnaire proposed the following year. This questionnaire focused on the issues of interprofessional communication and on the seminar process. During the 2018 and 2019 seminars, 518 students attended, 39% were pharmacy students (n=201) and 61% were medical students (n=317). The majority of medical students initially responded that physician-pharmacist communication was confraternal and rare. More pharmacy students felt that the quality of the physician-pharmacist relationship was poor. However, there was a marked improvement for all students on this aspect of communication after the seminar. Both groups also generally agreed that this relationship could be improved. The evaluation shows that an interprofessional simulation program improves the ability of pharmacy and general practice students to communicate in patient-facing situations.

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.

‘GP Live’- recorded General Practice consultations as a learning tool for junior medical students faced with the COVID-19 pandemic restrictions

ABSTRACT Background First year medical students value doctor and patient contact. However, it can be challenging to achieve positive exposure to primary care on a large scale. The COVID-19 pandemic has placed even greater pressure on placing students in General Practice (GP). Aim To assess the feasibility and acceptability of showing Year 1 medical students authentic recorded consultations between GPs and patients, and then explore what they gained from this. Method Using Panopto® Video Platform, we pre-recorded real Primary Care consultations, with patient and GP consent, which were then processed securely using the University of Aberdeen server. These were shown to all Year 1 medical students who immediately debriefed these consultations in small groups with a GP tutor. Subsequently two focus groups were held with 11 students to evaluate what they had learnt. Learning outcomes The consultations were easy to record and play during the teaching session, although there were some issues with sound quality. All students in the focus groups enjoyed the experience. They gained new knowledge about the skills of GPs, and recognised GPs as positive role models. Students were able to identify a variety of communication and consultation skills used by the GP, which reinforced their teaching on these delivered elsewhere in the course. Conclusion Using pre-recorded consultations as a teaching tool is reproducible, time-efficient and beneficial to students. We propose that this model of using authentic ‘live’ interactions between GPs and patients represents a valuable undergraduate educational opportunity and could be utilised by medical schools internationally.

Social prescribing by students: the design and delivery of a social prescribing scheme by medical students in general practice

ABSTRACT Background Social prescribing is a means of enabling primary care professionals to refer people to a range of local, non-clinical services. Medical students at a large GP surgery in Corby designed, implemented and led a social prescribing service for the practice’s patients. Through the project students gained an understanding of social prescribing in an authentic setting. Methods During a 12 week GP placement students collated information on local organisations, charities and schemes into a social prescribing directory. A clinic was set up and a social prescribing protocol created to enable suitable patients to be referred to the service. Students educated staff and collected feedback on how the service should run. Patients referred to the service were seen by medical students, who identified suitable social prescribing opportunities. Follow up was arranged to encourage patient engagement with services. The student-led service has been successfully integrated with the work of the new PCN link worker. Outcome Medical students were able successfully identify social prescribing opportunities for patients referred to them in primary care. Experential learning enabled them to develop an understanding of social prescribing and its place in healthcare. Discussion Medical students successfully designed and delivered a social prescribing intervention providing authentic educational experience in real-life clinical practice. The introduction of a Primary Care Network link worker enhanced this work and student input has continued in the ongoing service. It is hoped the scheme will be rolled out across the Primary Care curriculum in Leicester.

Australian medical student expectations of work-life balance as a doctor.

This article was migrated. The article was marked as recommended. Objectives: To explore the perceptions of medical students on achieving good work-life balance after graduation, and their opinions on parenting having an impact on their future careers. Methods: Cross-sectional cohort study of an online survey was distributed to students from all medical schools in Australia through the General Practice Students Network. Main outcome measures: Medical student perceptions on the effects of their future careers on the ability to maintain work-life balance and whether future parenting would impact their careers. Both quantitative and qualitative responses were collected. Results:The majority of survey respondents believed their careers would have a moderate or significant impact on the ability to achieve work-life balance. Thematic analysis revealed medical students perceived medical careers as lacking flexibility, being time-consuming, and potentially detrimental to health. Surveyed students indicated both parenting goals and specialty choice needed to be considered when planning their career. Conclusions: Australian medical students expressed significant concerns about their ability to juggle parenting and achieve work-life balance within the realities of a medical career.

The real costs of teaching medical students in general practice: a cost-collection survey of teaching practices across England.

Current funding arrangements for undergraduate medical student placements in general practice are widely regarded as outdated, inequitable, and in need of urgent review. To undertake a detailed costing exercise to inform the setting of a national English tariff for undergraduate medical student placements in general practice. A cost-collection survey in teaching practices across all regions of England between January 2017 and February 2017. A cost-collection template was sent to 50 selected teaching practices across all 25 medical schools in England following the development of a cost-collection tool and an initial pilot study. Detailed guidance on completion was provided for practices. Data were analysed by the Department of Health and Social Care. A total of 49 practices submitted data. The mean cost per half-day student placement in general practice was 111 GBP, 95% confidence interval = 100 to 121 (146 USD), with small differences between students in different years of study. Based on 10 sessions per student per week this equated to around 1100 GBP (1460 USD) per student placement week. The costs of undergraduate placements in general practice are considerably greater than funding available at time of writing, and broadly comparable with secondary care funding in the same period. The actual cost of placing a medical student full time in general practice for a 37-week academic year is 40 700 GBP (53 640 USD) compared with the average payment rate of only 22 000 GBP (28 990 USD) per year at the time this study was undertaken.

Evaluation of Perceived Technical Skill Development by Students During Instruction in Dental Extractions in Different Laboratory Settings-A Pilot Study.

In veterinary general practice, dental extractions are common procedures that require a specific set of surgical skills. Veterinary medical educators are tasked with preparing students for general practice, equipping them with medical knowledge and surgical skills. Results of this pilot study demonstrate students' preference for circle-based laboratory setup, a perceived high value of immediate feedback when performing laboratory exercises, and a lack of preference for timing of the laboratory relative to the relevant material provided in lecture. The impact of lecture, supplemental information, and laboratory setup on development of these surgical skills are explored.

Facilitators and barriers to teaching undergraduate medical students in general practice

Globally, primary health care is facing workforce shortages. Longer and higher-quality placements in primary care increase the likelihood of medical students choosing this specialty. However, the recruitment and retention of community primary care teachers are challenging. Relevant research was predominantly carried out in the 1990s. We seek to understand contemporary facilitators and barriers to general practitioner (GP) engagement with undergraduate education. Communities of practice (CoP) theory offers a novel conceptualisation, which may be pertinent in other community-based teaching settings. Semi-structured interviews were undertaken with 24 GP teachers at four UK medical schools. We purposively sampled GPs new to teaching, established GP teachers and GPs who had recently stopped teaching. We undertook NVivo-assisted deductive and inductive thematic analysis of transcripts. We used CoP theory to interpret data. Communities of practice theory illustrated that teachers negotiate membership of three CoPs: (i) clinical practice; (ii) the medical school, and (iii) teaching. The delivery of clinical care and teaching may be integrated or exist in tension. This can depend upon the positioning of the teaching and teacher as central or peripheral to the clinical CoP. Remuneration, workload, space and the expansion of GP trainee numbers impact on this. Teachers did not identify strongly as members of the medical school or a teaching community. Perceptions of membership were affected by medical school communication and support. The findings demonstrate gaps in medical school recruitment. This research demonstrates the marginalisation of primary care-based teaching and proposes a novel explanation rooted in CoP theory. Concepts including identity and membership may be pertinent to other community-based teaching settings. We recommend that medical schools review and broaden recruitment methods. Teacher retention may be improved by optimising the interface between medical schools and teachers, fostering a teaching community, increasing professional rewards for teaching involvement and altering medical school expectations of learning in primary care.

Patient consent to medical students in general practice

BackgroundInformed consent is required for active participation of patients in medical education. At Keele Medical School, we require practices to advertise that they teach undergraduate students and to obtain appropriate patient consent at various stages of the patient journey.AimThe study aimed to explore patients’ experience of consent to involvement in undergraduate medical education in general practice.MethodDuring the final year at Keele University Medical School, students undertake a patient satisfaction survey. A questionnaire was attached to the reverse of this survey during the academic year 2016–2017. The questionnaire explored the stage of the patient journey consent was obtained, whether they were offered an alternative appointment and how comfortable they were with medical students being involved in their care.ResultsA total of 489 questionnaires were completed covering 62 GP practices. 97% of patients reported that consent was obtained at least once during their encounter and the majority reported that this occurred at booking. 98% of patients were comfortable or very comfortable with a medical student leading their consultation. However, 28% of those surveyed stated that they were either not given the option of not seeing the student or there was no other alternative appointment available.ConclusionThe results indicate that in the vast majority of cases patient consent is obtained at least once during their attendance. Patients expressed a high level of satisfaction with medical students’ involvement in their care. Further work is required to evaluate the role of the data as a marker of individual practice teaching quality.

Évaluation théorique et pratique de la connaissance d’utilisation des dispositifs inhalés dans l’asthme chez les internes en médecine générale et les étudiants en pharmacie de Lille

Asthma is a potentially serious chronic respiratory disease impacting patients quality of life. Satisfactory control requires proper use of inhaled devices. This study assesses general medical residents and pharmacy students knowledge about proper use of inhaled asthma devices. We evaluated knowledge of 43general practice students and 43pharmacy students in Lille for three inhaler devices (metered-dose inhaler, Turbuhaler® and Diskus®) during individual interviews. Students were assessed on 8proper use criterias for each device. General practice and pharmacy students are unfamiliar with proper use of inhaler devices. However, pharmacy students get better average scores than general practice students for all devices included in this study: 6.3/8respected criterias against 5/8for metered-dose inhaler; 5.3/8against 3.2/8for Turbuhaler®; and 6/8against 4.3/8for Diskus®. Pharmacy students more frequently perform a demonstration of proper use to patients when a device is first prescribed or when a prescription is renewed; general practice students more frequently ask patients themselves to perform a demonstration of proper use. Introducing trainings workshops for inhaler devices to pharmacy and general practice students appears appropriate in order to promote therapeutic patient education, to increase asthma control and better patients life quality.

The condition of interdisciplinary communication among various Educational and Research Departments of Isfahan University of Medical Sciences.

BACKGROUND:The study aimed to assess interdisciplinary communication among various Educational and Research Departments of Isfahan University of Medical Sciences (IUMS) in clinical medical sciences using social network analysis.MATERIALS AND METHODS:The study was carried out using scientometrics method and interdisciplinary communication network analysis. Interdisciplinary network of 1298 articles in medical sciences published in Journal of Isfahan Medical School was evaluated using macro- and micro-level criteria of network analysis. Ravar Matrix, UCINET, and VOSviewer software were used to analyze the interdisciplinary network of medical sciences articles.RESULTS:Findings showed that “Students Research Committee” and “School of Medicine,” the affiliations of the medical students in general practice with scores of 272 and 197, “Epidemiology and Biostatistics,” “Community Medicine,” and “Internal Medicine” with 170, 101, and 99, respectively, possessed the first ranking of productivity index in scientific communication. Furthermore, in betweenness centrality index, “Epidemiology and Biostatistics” (3427.807), “Students Research Committee” (2967.180), and “Community Medicine” (1770.300) have an appropriate position in the network. Based on the centrality index, “Epidemiology and Biostatistics” (22.412), “Students Research Committee” (22.185) as well as “Community Medicine” and “School of Medicine” (both 21.554) acquired the least amount of distance with other nodes in network.CONCLUSION:Given the increased specialization in medical fields in recent years, communication between researchers with various specializations and creation of interdisciplinary or multidisciplinary departments had turned into an undeniable necessity. Therefore, communication between educational or research departments can facilitate the flow of information between researchers; and consequently, the top ranking departments in this study had more participation in scientific production of IUMS and getting more scores in annual evaluation by scientometrics department. This network analysis showed that researchers in various medical fields closely collaborate with each other and are able to connect with <2 intermediates.

Developing sustainable placements: nursing students in general practice

Developing sustainable placements: nursing students in general practice

Is three a crowd? Impact of the presence of a medical student in the general practice consultation.

To determine the impact of the presence of a medical student on the satisfaction and process of the general practice consultation from the perspective of the general practitioner (GP), patient and student. An observational study was conducted in regional general practices accepting third-year medical students. General practitioners, patients and medical students were asked to complete a questionnaire after each consultation. The main outcome measures were: patient satisfaction; GPs' perceived ability to deliver care; medical students' satisfaction with their learning experience; length of consultation; and patient waiting times. Of the 26 GP practices approached, 11 participated in the study (42.3%). Patients returned 477 questionnaires: 252 consultations with and 225 without a student present. Thirteen GPs completed 473 questionnaires: 248 consultations with and 225 without a student. Twelve students attended 255 consultations. Most patients (83.5%) were comfortable with the presence of a student. There were no significant differences between consultations with and without a student regarding the time the patients spent in the waiting room (p = 0.6), the patients' perspectives of how the GPs dealt with their presenting problems (100% versus 99.2%; p = 0.6) and overall satisfaction with the consultation (99.2% versus 99.1%; p = 0.5). Despite these reassuring findings, a significantly higher proportion of patients in consultations without students raised sensitive or personal issues (26.3% versus 12.6%; p < 0.001). There were no statistically significant differences in the lengths of consultations with and without students (81% versus 77% for 6-20 minutes consultation; p = 0.1) or in the GPs' perceptions of how they effectively managed the presenting problem (95.1% versus 96.0%; p = 0.4). Students found that the majority (83.9%) of the 255 consultations were satisfactory for learning. The presence of a medical student during the GP consultation was satisfactory for all participant groups. These findings support the ongoing and increased placement of medical students in regional general practice. Medical educators and GPs must recognise that patients may not raise personal issues with a student present.

Highlighting the value of mentoring students in general practice

Mentoring students in general practice can be beneficial for all involved. Gill Boast highlights the pros and cons and provides some tips for mentors

Funding the teaching of medical students in general practice: a formula for the future?

(2015). Funding the teaching of medical students in general practice: a formula for the future? Education for Primary Care: Vol. 26, No. 4, pp. 215-219.

Learning in underserved UK areas: a novel approach.

There is an insufficient number of medical students intending to pursue general practitioner (GP) careers. The undergraduate curriculum has traditionally prioritised teaching in large hospital settings despite most National Health Service patient contact occurring in primary care. Primary care is faced with providing health care for an ageing population with high levels of co-morbidities. Patients who live in deprived areas suffer many disadvantages affecting their health and additionally tend to be underserved. Globally, there has been an initiative to provide medical students with extended clinical placements in rural and remote areas. These placements have identified many beneficial outcomes; however, little is known about placements in other underserved, deprived areas. This paper describes an innovative pilot programme to address these issues. The North East of England has a large proportion of the most deprived communities and worst health care outcomes in England. In Teesside, Phase 1 Medicine at Durham University provides the pre-clinical curriculum. Durham students then join Newcastle University for Phase 2 Medicine, the clinical years. The Difficult and Deprived Areas Programme (DDAP) places fourth-year students in general practice and community settings in post-industrial, deprived areas for 14 weeks, thus adopting and applying principles from rural initiatives (continuity and immersion) to other deprived settings. The DDAP allows students to learn about psychosocial determinants of health and to pursue community interests whilst gaining an excellent clinical grounding. There is an insufficient number of medical students intending to pursue general practitioner careers The DDAP provides a model for educators seeking to implement initiatives in similar underserved, deprived settings, which may potentially alleviate GP workforce shortages.