1
|
Atmann O, Torge M, Schneider A. The "General practitioner learning stations"-development, implementation and optimization of an innovative format for sustainable teaching in general practice. BMC MEDICAL EDUCATION 2021; 21:622. [PMID: 34915875 PMCID: PMC8680029 DOI: 10.1186/s12909-021-03057-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 12/02/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Teaching general practice in a university setting is still challenging. In our department we have developed a teaching format with content from a previous lecture-style-teaching into an interactive small group format taught by frontline general practitioners (GPs). The "GP learning stations" introduce students to the skills and attributes of a GP working in primary care in a university setting. Our main objective was to understand whether the teaching format had proven itself sustainable in a university setting over eight years. Furthermore, we wanted to better understand the role of the GP as a medical educator. METHODS More than eight years of experience in organizational and staff expenses were collected and analyzed. In addition, the grade point average of the students' evaluation was calculated and their free text answers were categorized and evaluated descriptively. During two teach-the-teacher seminars attending GPs were asked why they teach and if they feel equipped to teach the format. RESULTS The initially high organizational and staff expenses were significantly reduced. The recruitment of GPs, their didactic contribution, and their joint creation of content went smoothly throughout the whole period. A total of 495 students participated in the regular evaluation. The analysis yielded a grade point average of 1.9, on a scale from 1 = very good to 6 = insufficient. In the free text answers students praised the educators, the format and the practical relevance. The interactive transfer of the content, the didactic competence of the educators and the spatial environment were viewed critically. Reasons for GPs to teach were the joy to pass on knowledge and experience, and to make the work of GPs more attractive to students. Most GPs felt prepared to teach through their experience as a physician although some felt unprepared to teach through their lack of didactic knowledge. CONCLUSION Despite reducing the costs of the format, a grade point average of 1.9 could be achieved in the long term. This supports the teaching concept of learning stations and its "mixture of discussion, scientific background and role play, combined with (…) experiences and exciting individual cases from (GPs) everyday life", hopefully making general practice more attractive to the students.
Collapse
Affiliation(s)
- Oxana Atmann
- Technical University of Munich, TUM School of Medicine, Institute of General Practice and Health Services Research, Orleansstrasse 47, 81667, Munich, Germany
| | - Marion Torge
- Technical University of Munich, TUM School of Medicine, Institute of General Practice and Health Services Research, Orleansstrasse 47, 81667, Munich, Germany.
| | - Antonius Schneider
- Technical University of Munich, TUM School of Medicine, Institute of General Practice and Health Services Research, Orleansstrasse 47, 81667, Munich, Germany
| |
Collapse
|
2
|
Yeoh A, Sathiakumar AK, Leung CNY, Hoffman R, Gosbell A, Tan KN. Impact of clinical placement sites on general practice as a career preference for Australian medical students. Aust J Rural Health 2021; 30:95-102. [PMID: 34787946 DOI: 10.1111/ajr.12819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 09/10/2021] [Accepted: 09/22/2021] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE This study investigates whether General Practice placement experience or locations (urban/metropolitan vs non-metropolitan) promote student interest in pursuing general practice. DESIGN SurveyMonkey was used in the design of the survey. SETTING The study was conducted online. PARTICIPANTS 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. INTERVENTIONS 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. MAIN OUTCOME MEASURES The association and causation between general practice placement location, student experience and students' intended career outcomes. RESULTS 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. CONCLUSION 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.
Collapse
Affiliation(s)
- Alexandra Yeoh
- Bond University, Robina, QLD, Australia.,GPSN, Melbourne, Vic., Australia
| | | | | | | | | | - Kang Ning Tan
- GPSN, Melbourne, Vic., Australia.,James Cook University, Douglas, QLD, Australia
| |
Collapse
|
3
|
Sabitova A, Hickling LM, Priebe S. Job morale: a scoping review of how the concept developed and is used in healthcare research. BMC Public Health 2020; 20:1166. [PMID: 32711485 PMCID: PMC7382865 DOI: 10.1186/s12889-020-09256-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 07/14/2020] [Indexed: 11/23/2022] Open
Abstract
Background The job morale of healthcare staff is widely seen as an important factor for the quality of care. Yet, there are different understandings of what constitutes job morale, which hinders systematic research and comparisons. We therefore conducted a scoping review of how the concept of job morale has developed over time and how it is used in healthcare research. Methods A scoping review was conducted to identify relevant literature. Data were gathered on study design and context, objectives, definitions of morale, outcome measures and key findings. Data was synthesised using a descriptive analytical framework. Results Ninety-three unique studies met eligibility criteria for the present review. The literature outlines four main periods of the evolution of the concept of job morale: The First World War and the interwar years; Second World War; Aftermath of the Second World War; and Contemporary period. The concept of job morale originated in a military context and was later applied to and specified in the healthcare literature. The concept has been applied to individuals and groups. The understandings used in healthcare vary, but overlap. Methods for assessing job morale in healthcare include quantitative scales, indirect measurements of consequences and predictors of morale, and qualitative approaches. Existing studies have mainly focused on the job morale of general practitioners, nurses and mental health professionals in high-income countries. Conclusions Although the understandings of job morale in healthcare are heterogeneous and inconsistent, the concept appears to have been useful over longer periods of time and in different contexts. Which precise understanding of job morale is useful, depends on the given research purpose, and studies should make explicit which exact understanding they apply. Systematic research on job morale is required to facilitate measures to improve and maintain high levels of morale across different professional groups, including professionals in low- and middle-income countries.
Collapse
Affiliation(s)
- Alina Sabitova
- Unit for Social and Community Psychiatry, World Health Organisation Collaborating Centre for Mental Health Development, Queen Mary University of London, London, E13 8SP, UK.
| | - Lauren M Hickling
- Unit for Social and Community Psychiatry, World Health Organisation Collaborating Centre for Mental Health Development, Queen Mary University of London, London, E13 8SP, UK.,East London NHS Foundation Trust, Newham Centre for Mental Health, London, UK
| | - Stefan Priebe
- Unit for Social and Community Psychiatry, World Health Organisation Collaborating Centre for Mental Health Development, Queen Mary University of London, London, E13 8SP, UK
| |
Collapse
|
4
|
McCallum M, Hanlon P, Mair FS, Mckay J. Is there an association between socioeconomic status of General Practice population and postgraduate training practice accreditation? A cross-sectional analysis of Scottish General Practices. Fam Pract 2020; 37:200-205. [PMID: 31746981 PMCID: PMC7094817 DOI: 10.1093/fampra/cmz071] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Practice population socioeconomic status is associated with practice postgraduate training accreditation. General Practitioner recruitment to socioeconomically deprived areas is challenging, exposure during training may encourage recruitment. OBJECTIVES To determine the association of practice population socioeconomic deprivation score and training status, and if this has changed over time. METHODS Cross-sectional study looking at socioeconomic deprivation and training status for all General Practices in Scotland (n = 982). Data from Information Services Division, from 2015, were combined with the Scottish Index of Multiple Deprivation to calculate weighted socioeconomic deprivation scores for every practice in Scotland. Scottish training body database identified training practices (n = 330). Mean deprivation score for training and non-training practices was calculated. Logistic regression was used to quantify the odds ratio of training status based on deprivation score, adjusted for practice list size, and compared with a similar 2009 analysis. RESULTS Socioeconomic deprivation score is associated with training status, but is not significant when adjusted for practice list size [OR (adjusted) 0.87, 95% CI: 0.74-1.04]. In contrast, in 2009, adjusted deprivation score remained significant. Mean deprivation score in training and non-training practices remained similar at both time points [2015: 2.98 (SD 0.88) versus 3.17 (SD 0.81); 2009: 2.95 versus 3.19), with a more deprived mean score in non-training practices. CONCLUSIONS General practices in affluent areas remain more likely to train, although this association appears to be related to larger practice list sizes rather than socioeconomic factors. To ensure a variety of training environments training bodies should target, and support, smaller practices working in more socioeconomically deprived areas.
Collapse
Affiliation(s)
- Marianne McCallum
- General Practice and Primary Care, Institute of Health and Wellbeing, Glasgow University, UK
| | - Peter Hanlon
- General Practice and Primary Care, Institute of Health and Wellbeing, Glasgow University, UK
| | - Frances S Mair
- General Practice and Primary Care, Institute of Health and Wellbeing, Glasgow University, UK
| | - John Mckay
- Medical Directorate, West Region, NHS Education for Scotland, Glasgow, UK
| |
Collapse
|
5
|
Shibli-Rahhal A, Brenneman A, McVancel M, Rosenbaum M. A Practical Approach to Integrating Communication Skills and Early Clinical Experience into the Preclinical Medical School Curriculum. MEDICAL SCIENCE EDUCATOR 2019; 29:947-957. [PMID: 34457571 PMCID: PMC8368819 DOI: 10.1007/s40670-019-00779-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
BACKGROUND Effective integration of early clinical experiences (ECE) with preclinical curricula is challenging, given the limited knowledge-base of students and the unpredictability of clinical environments. Integration of ECE with communication skills (CS) training presents an attractive opportunity since CSs apply to all types of clinical encounters and are independent of students' medical knowledge. We present an ECE program that integrates formal CS training with the realities of clinical practice. METHODS Five ECE sessions occur throughout the first year of medical school, each focusing on a specific set of CSs previously introduced in class. Students actively observe preceptors use these skills, briefly practice them, write a critical analysis on each experience, and discuss these in small groups. To identify the perceived usefulness and impact of the ECE on students' CS learning, we analyzed the critical analyses and post intervention evaluations from students and preceptors. Descriptive analyses used SAS for Windows. Thematic content analysis using constant comparison was used to review and code narrative data, and the most commonly referred to impacts, strengths, and limitations of ECE were identified. RESULTS Analysis of the students' critical analyses identified the following main themes: (1) integration between ECE and formal CS teaching, (2) importance of effective CS to the delivery of good patient care, and (3) adaptability of CS to specific clinical contexts. Preceptors did not perceive the program as an added burden. CONCLUSIONS ECE with focused goals, critical analyses, and small group debriefing can be used to effectively teach and reinforce formal classroom CS training.
Collapse
Affiliation(s)
- Amal Shibli-Rahhal
- Department of Internal Medicine, University of Iowa Carver College of Medicine, 1216H MERF, 375 Newton Rd, Iowa City, IA 52242-2600 USA
| | - Anthony Brenneman
- Physician Assistant Program, University of Iowa Carver College of Medicine, Iowa City, IA USA
| | - Megan McVancel
- University of Iowa Carver College of Medicine, Iowa City, IA USA
| | - Marcy Rosenbaum
- Office of Consultation and Research in Medical Education and Department of Family Medicine, University of Iowa Carver College of Medicine, Iowa City, IA USA
| |
Collapse
|
6
|
Barber JRG, Park SE, Jensen K, Marshall H, McDonald P, McKinley RK, Randles H, Alberti H. Facilitators and barriers to teaching undergraduate medical students in general practice. MEDICAL EDUCATION 2019; 53:778-787. [PMID: 31012131 DOI: 10.1111/medu.13882] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 11/30/2018] [Accepted: 02/22/2019] [Indexed: 05/24/2023]
Abstract
CONTEXT 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. METHODS 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. RESULTS 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. CONCLUSIONS 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.
Collapse
Affiliation(s)
| | - Sophie Elizabeth Park
- Department of Primary Care and Population Health, University College London, London, UK
| | - Kim Jensen
- School of Medicine, Keele University, Keele, UK
| | - Hannah Marshall
- School of Medical Education, Newcastle University, Newcastle upon Tyne, UK
| | - Paula McDonald
- Department of Primary Care and Public Heath, Brighton and Sussex Medical School, University of Brighton, Brighton, UK
| | | | - Hannah Randles
- School of Medical Education, Newcastle University, Newcastle upon Tyne, UK
| | - Hugh Alberti
- School of Medical Education, Newcastle University, Newcastle upon Tyne, UK
| |
Collapse
|
7
|
GP speciality training in areas of deprivation: factors influencing engagement. A qualitative study. BJGP Open 2019; 3:bjgpopen19X101644. [PMID: 31366675 PMCID: PMC6662869 DOI: 10.3399/bjgpopen19x101644] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 12/17/2018] [Indexed: 11/24/2022] Open
Abstract
Background GP training practices are less likely to be situated in areas of deprivation; little is known about GP views of postgraduate training in such areas. Aim To explore the views of GPs working in deprived areas about GP speciality training (GPST). Design & setting Qualitative in-depth interviews with GPs working in practices in deprived areas in Scotland. Method Ten in-depth interviews were conducted with GPs in training and non-training practices, to explore views on training. Interviews were audiotaped and transcribed verbatim, and inductive thematic analysis was undertaken. Results The importance of producing ‘well-rounded’ GPs who are able to work in a variety of environments was highlighted. Trainees need exposure to the specific challenges of deprived contexts (such as early multimorbidity, child protection, and addiction) and the benefit of this for trainees was thought to be invaluable. GPs identified many perceived barriers and benefits to training, some generic but some — such as inspiring the next generation (benefit) or overwhelming workload (barrier) — may be more relevant in areas of high deprivation. Overwhelming workload was the main reason for not becoming a training practice, though some would consider it if supported to develop a training culture. All the GPs, including non-trainers, were involved in optional activities which were felt to be important for resilience. Conclusion GPs in areas of deprivation highlighted specific skills that could be gained by undertaking at least a part placement in deprived areas, with different skills likely to be gained from affluent areas. National education bodies should consider GP training rotations ensure a variety of training environments.
Collapse
|
8
|
Deutsch T, Winter M, Lippmann S, Geier AK, Braun K, Frese T. Willingness, concerns, incentives and acceptable remuneration regarding an involvement in teaching undergraduates - a cross-sectional questionnaire survey among German GPs. BMC MEDICAL EDUCATION 2019; 19:33. [PMID: 30683085 PMCID: PMC6347773 DOI: 10.1186/s12909-018-1445-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 12/28/2018] [Indexed: 05/15/2023]
Abstract
BACKGROUND Worldwide, many undergraduate general practice curricula include community-based courses at general practitioners' (GPs') offices. Usually the academic general practice departments collaborate with networks of affiliated teaching practices. To successfully master the challenge of network development and extension, more information is needed about GPs' willingness to be involved in different teaching formats, important influencing factors, incentives, barriers, and the need for financial compensation. METHODS In this cross-sectional study a questionnaire survey was conducted among all GPs working in Leipzig and environs (German postal code area 04). In addition to descriptive statistics, group comparisons and logistic regression were performed to reveal differences between GPs with and without an interest in teaching. RESULTS Response rate was 45.3% with 339 analyzable questionnaires. The average age was 52.0 years and 58.4% were women. Sixty-two participants stated that they were already involved in teaching undergraduates. Altogether 60.1% of all GPs and 53.5% among those who didn't teach yet were basically interested in being involved in undergraduate education. The interested GPs could imagine devoting on average 6.9 h per month to teaching activities. GPs interested in teaching were on average younger, were more actively involved in continuing education and professional associations, and more frequently had pre-existing teaching experiences. The willingness to teach differed substantially among teaching formats. GPs were more willing to teach at their own practices rather than at university venues and they preferred skills-oriented content. Comprehensive organization on the part of the university including long-term scheduling and available teaching materials was rated as most important to increase the attractiveness of teaching. Time restraints and decreased productivity were rated as the most important barriers. Interested GPs appreciated financial compensation, particularly for teaching at university venues, and demanded amounts of money corresponding to German GPs' hourly income. CONCLUSIONS The GPs' interest in undergraduate teaching is generally high indicating a substantial pool of potential preceptors. Recruitment strategies should consider the collaboration with institutions involved in residency and continuing education as well as with professional associations. Comprehensive organization by the responsible department should be promoted and time restraints and decreased productivity should be overtly addressed and financially compensated.
Collapse
Affiliation(s)
- Tobias Deutsch
- Department of General Practice, Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Marcus Winter
- Department of General Practice, Medical Faculty, University of Leipzig, Leipzig, Germany
- Institute of General Practice and Family Medicine, Martin-Luther-University Halle-Wittenberg, Halle/Saale, Germany
| | - Stefan Lippmann
- Department of General Practice, Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Anne-Kathrin Geier
- Department of General Practice, Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Kristin Braun
- Institute of General Practice and Family Medicine, Martin-Luther-University Halle-Wittenberg, Halle/Saale, Germany
| | - Thomas Frese
- Institute of General Practice and Family Medicine, Martin-Luther-University Halle-Wittenberg, Halle/Saale, Germany
| |
Collapse
|
9
|
Ding M, Babenko O, Koppula S, Oswald A, White J. Physicians as Teachers and Lifelong Learners. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2019; 39:2-6. [PMID: 30394937 DOI: 10.1097/ceh.0000000000000228] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
INTRODUCTION Lifelong learning requires sustained motivation for learning. Employing a motivational theory framework, we investigated the relationships of psychological need satisfaction, clinical teaching involvement, and lifelong learning of physicians at different career stages and in various medical specialties. We also examined the associations of physician lifelong learning with stress, burnout, teaching enjoyment, and life satisfaction, all of which are essential for physician well-being and, ultimately, for the provision of quality patient care. METHODS This was a cross-sectional study. Using survey methodology, quantitative data were collected from 202 practicing physicians in Canada. The questionnaire contained validated scales of physician lifelong learning and psychological need satisfaction, measures of clinical teaching (involvement and enjoyment), stress level, burnout frequency, and life satisfaction. Analysis of covariance and correlational analysis were performed. RESULTS On average, participants reported moderate to moderately high levels of lifelong learning, psychological need satisfaction, teaching enjoyment, and life satisfaction. Irrespective of career stage and specialty, physicians' psychological need satisfaction and involvement in clinical teaching were significant in relation to lifelong learning. That is, physicians who experienced greater psychological need satisfaction at work and those who were involved in clinical teaching had, on average, higher lifelong learning scores. Physician lifelong learning had significant associations with life satisfaction and teaching enjoyment but not with stress level and burnout frequency. DISCUSSION Fulfilling physicians' basic psychological needs at work and supporting them in their teaching roles is likely to enhance physician lifelong learning and, ultimately, quality of patient care.
Collapse
Affiliation(s)
- Mao Ding
- Ms. Ding: Undergraduate Student in the Faculty of Science, University of Alberta, Alberta, Canada. At the time of this research, Ms. Ding worked as a Summer Research Student, leading this research study under the supervision of Dr. Babenko at the Department of Family Medicine, University of Alberta, Alberta, Canada. Dr. Babenko: Assistant Professor, Medical Education, Department of Family Medicine, University of Alberta, Alberta, Canada. Dr. Koppula: Associate Professor, Director of Faculty Development, Department of Family Medicine, University of Alberta, Alberta, Canada. Dr. Oswald: Associate Professor, Division of Rheumatology, Department of Medicine, University of Alberta, Alberta, Canada. Dr. White: Professor, Endowed Chair of Surgical Education, Department of Surgery, University of Alberta, Alberta, Canada
| | | | | | | | | |
Collapse
|
10
|
Jones MM, Bashir N, Purushotham N, Friel R, Rosenthal J. Universities and primary care organisations working together to recruit GPs: a qualitative evaluation of the Enfield clinical teaching fellow programme. BJGP Open 2018; 2:bjgpopen18X101361. [PMID: 30564703 PMCID: PMC6181075 DOI: 10.3399/bjgpopen18x101361] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 10/29/2017] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND General practice recruitment is in difficulty in the UK as many experienced GPs retire or reduce their commitment. The numbers of junior doctors choosing to specialise in the discipline is also falling, leading to primary care workforce issues particularly in 'hard to serve' areas. AIM To evaluate an academic service collaboration on GP recruitment between a primary care organisation (PCO), Enfield CCG, and a university, University College London (UCL). DESIGN & SETTING Evaluation of an academic service collaboration in the Enfield CCG area of north east London. METHOD An action research method utilising qualitative methodology was used to evaluate a local service intervention, undertaken by the participants themselves. The qualitative data were analysed by one researcher but themes were agreed by the whole team. Enfield CCG, an NHS PCO, funded a collaboration with UCL to employ five GPs as clinical teaching fellows to work in Enfield, to increase patients' access, to provide input to CCG development projects, and to provide undergraduate medical student teaching in practice. RESULTS Five teaching fellows were employed for ≤2 years and provided 18 266 extra appointments, engaged with development projects, and delivered local undergraduate teaching. The themes identified by stakeholders were the challenges of these organisations working together, recruiting GPs to an underserved area, and perceptions of the model's value for money. CONCLUSION The evaluation showed that the collaboration of an NHS PCO and a higher education institution can work, and the prestige of being associated with a universty and clinical variety ensured GP recruitment in an area that had previously struggled. However, the project's costs were high, which affected perceptions of its value.
Collapse
Affiliation(s)
- Melvyn, M Jones
- Senior Lecturer in General Practice, Research Department of Primary Care and Population Health, UCL Medical School (Royal Free Campus), London, UK
- GP and GP Trainer, Warden Lodge Surgery, Cheshunt, UK
| | - Nadia Bashir
- GP, Morecambe Surgery, London, UK
- Clinical Teaching Fellow, Research Department of Primary Care and Population Health, UCL Medical School (Royal Free Campus), London, UK
| | - Neetha Purushotham
- GP, Apollo Health Armadale, Armadale, Australia
- Clinical Teaching Fellow, Research Department of Primary Care and Population Health, UCL Medical School (Royal Free Campus), London, UK
| | - Rachel Friel
- GP, Carlton House Surgery, Enfield Town, UK
- Clinical Teaching Fellow, Research Department of Primary Care and Population Health, UCL Medical School (Royal Free Campus), London, UK
| | - Joe Rosenthal
- Department Head of Teaching and Sub-Dean for Community Based Teaching, Research Department of Primary Care and Population Health, UCL Medical School (Royal Free Campus), London, UK
- GP, Partnership Primary Care Centre, London, UK
| |
Collapse
|
11
|
Alberti H, Atkinson J. Twelve tips for the recruitment and retention of general practitioners as teachers of medical students. MEDICAL TEACHER 2018; 40:227-230. [PMID: 28845726 DOI: 10.1080/0142159x.2017.1370082] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
BACKGROUND Primary care physicians have become a fundamental aspect of teaching in modern medical school curricula worldwide with a significant proportion of undergraduate teaching taking place in primary care. There are calls for this to increase with more patient care occurring in the community but teaching capacity in primary care is a potential challenge. Medical schools, therefore, need strategies to be able to increase their primary care physician teaching workforce. METHODOLOGY We asked all Heads of General Practice Teaching in UK medical schools to share their three top tips for recruiting and retaining GPs to teach undergraduate students. The majority (two-thirds) of medical schools responded and we have summarized the answers into the following twelve tips. RESULTS Although the twelve tips are varied and comprehensive, including broad topics such as finances and training, one clear theme running through the majority of tips is good communication and relationships between education teams and GPs. CONCLUSIONS The solutions to recruiting and retaining GPs to teach undergraduate medical students are clearly multifactorial and complex. We hope that by presenting suggestions from UK GP heads of teaching as these twelve tips provides some helpful, thought-provoking ideas and inspiration for both the UK and internationally.
Collapse
Affiliation(s)
- Hugh Alberti
- a School of Medical Education , Newcastle University , Newcastle upon Tyne , UK
| | - Jane Atkinson
- a School of Medical Education , Newcastle University , Newcastle upon Tyne , UK
| |
Collapse
|
12
|
Schiekirka-Schwake S, Anders S, von Steinbüchel N, Becker JC, Raupach T. Facilitators of high-quality teaching in medical school: findings from a nation-wide survey among clinical teachers. BMC MEDICAL EDUCATION 2017; 17:178. [PMID: 28962568 PMCID: PMC5622577 DOI: 10.1186/s12909-017-1000-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 09/05/2017] [Indexed: 05/28/2023]
Abstract
BACKGROUND Clinical teachers in medical schools are faced with the challenging task of delivering high-quality patient care, producing high-impact research and contributing to undergraduate medical education all at the same time. Little is known on the gap between an 'ideal' environment supporting clinical teachers to provide high quality teaching for their students and the reality of clinical teaching during worktime in the clinical environment. Most quantitative research published so far was done in a wide range of medical educators and did not consider individual academic qualifications. In this study, we wanted to survey clinical teachers in particular and assess the potential impact of individual academic qualification on their perceptions. METHODS Based on qualitative data of focus group discussions, we developed a questionnaire which was piloted among 189 clinical teachers. The final web-based questionnaire was completed by clinical teachers at nine German medical schools. RESULTS A total of 833 clinical teachers (569 junior physicians, 264 assistant professors) participated in the online survey. According to participants, the most important indicator of high quality teaching was "sustained student learning outcome" followed by "stimulation of interest in the subject matter". Lack of time was the main factor impeding effective teaching (78%). Among the factors facilitating high-quality teaching, protected preparation time during working hours (48%) and more recognition of high-quality teaching within medical schools (21%) were perceived as most helpful. Three out of four teachers (76%) were interested in faculty development programmes directed at teaching skills, but 60% stated they had no time to engage in such activities. With regard to evaluation, teachers preferred individual feedback (75%) over global ratings (21%). Differences between assistant professors and junior physicians were found in that the latter group perceived their teaching conditions as more difficult. CONCLUSIONS Lack of time is a major barrier against planning and delivering good clinical teaching in medical schools. According to our findings, the situation at German medical schools is particularly challenging for junior physicians. Creating an institutional culture in which teaching is regarded as highly as patient care and research is a prerequisite for overcoming the barriers identified in this study.
Collapse
Affiliation(s)
- S. Schiekirka-Schwake
- Division of Medical Education Research and Curriculum Development, Study Deanery of Göttingen Medical School, Göttingen, Germany
| | - S. Anders
- Department of Legal Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - N. von Steinbüchel
- Institute of Medical Psychology and Medical Sociology, University Medical Centre Göttingen, Göttingen, Germany
| | - J. C. Becker
- Department of Medical Education, Medical Faculty, University of Münster, Münster, Germany
| | - T. Raupach
- Division of Medical Education Research and Curriculum Development, Study Deanery of Göttingen Medical School, Göttingen, Germany
- Department of Cardiology and Pneumology, University Medical Centre Göttingen, Göttingen, Germany
| |
Collapse
|
13
|
Jones EA, Simpson V, Hendricks SM. Enhancement of Professional Development of Front-Line Nurse Preceptors in a Dedicated Education Unit. J Contin Educ Nurs 2017; 48:40-46. [DOI: 10.3928/00220124-20170110-09] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 09/27/2016] [Indexed: 11/20/2022]
|
14
|
Delavari S, Arab M, Rashidian A, Nedjat S, Souteh RG. A Qualitative Inquiry Into the Challenges of Medical Education for Retention of General Practitioners in Rural and Underserved Areas of Iran. J Prev Med Public Health 2016; 49:386-393. [PMID: 27951631 PMCID: PMC5160132 DOI: 10.3961/jpmph.16.062] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 10/17/2016] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES General practitioners (GPs) retention in rural and underserved areas highly effects on accessibility of healthcare facilities across the country. Education seems to be a critical factor that affects GPs retention. Thus, the present study aimed at inquiry into medical education challenges that limit their retention in rural and underserved areas. METHODS A qualitative approach was applied for the aim of this study. Data were gathered via 28 semi-structured interviews with experts at different levels of Iran's health system as well as GPs who retained and refused to retain working in rural settings. Interviews mainly were performed face-to-face and in some cases via telephone during 2015 and then coded and analyzed using content analysis approach. RESULTS Iran's medical education is faced with several challenges that were categorized in four main themes including student selection, medical students' perception about their field of study, education setting and approach, curriculum of medical education. According to experts this challenges could results in making GP graduates disinterested for practicing in rural and underserved areas. CONCLUSIONS Challenges that were found could have negative effects on retention. Modification in student's perception about rural practice could be done via changing education setting and approach and curriculum. These modifications could improve GPs retention in rural and underserved areas.
Collapse
Affiliation(s)
- Sajad Delavari
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Arab
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Arash Rashidian
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Saharnaz Nedjat
- Department of Epidemiology and Biostatistics, School of Public Health, Knowledge Utilization Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | | |
Collapse
|
15
|
Ingham G, Fry J, O'Meara P, Tourle V. Why and how do general practitioners teach? An exploration of the motivations and experiences of rural Australian general practitioner supervisors. BMC MEDICAL EDUCATION 2015; 15:190. [PMID: 26511843 PMCID: PMC4625577 DOI: 10.1186/s12909-015-0474-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Accepted: 10/22/2015] [Indexed: 05/16/2023]
Abstract
BACKGROUND In medical education, a learner-centred approach is recommended. There is also a trend towards workplace-based learning outside of the hospital setting. In Australia, this has resulted in an increased need for General Practitioner (GP) supervisors who are receptive to using adult learning principles in their teaching. Little is known about what motivates Australian GP supervisors and how they currently teach. METHODS A qualitative study involving semi-structured interviews with 20 rural GP supervisors who work within one Regional Training Provider region in Australia explored their reasons for being a supervisor and how they performed their role. Data was analysed using a thematic analysis approach. RESULTS GP supervisors identified both personal and professional benefits in being a supervisor, as well as some benefits for their practice. Supervision fulfilled a perceived broader responsibility to the profession and community, though they felt it had little impact on rural retention of doctors. While financial issues did not provide significant motivation to teach, the increasing financial inequity compared with providing direct patient care might impact negatively on the decision to be or to remain a supervisor in the future. The principal challenge for supervisors was finding time for teaching. Despite this, there was little evidence of supervisors adopting strategies to reduce teaching load. Teaching methods were reported in the majority to be case-based with styles extending from didactic to coach/facilitator. The two-way collegiate relationship with a registrar was valued, with supervisors taking an interest in the registrars beyond their development as a clinician. CONCLUSION Supervisors report positively on their teaching and mentoring roles. Recruitment strategies that highlight the personal and professional benefits that supervision offers are needed. Practices need assistance to adopt models of supervision and teaching that will help supervisors productively manage the increasing number of learners in their practices. Educational institutions should facilitate the development and maintenance of supportive supervision and a learning culture within teaching practices. Given the variety of teaching approaches, evaluation of in-practice teaching is recommended.
Collapse
Affiliation(s)
- Gerard Ingham
- Beyond Medical Education, PO Box 3064, Bendigo, 3554, VIC, Australia.
| | - Jennifer Fry
- Beyond Medical Education, PO Box 3064, Bendigo, 3554, VIC, Australia.
| | - Peter O'Meara
- College of Science, Health and Engineering, La Trobe Rural Health School, La Trobe University, Bendigo, 3350, VIC, Australia.
| | - Vianne Tourle
- Charles Sturt University, Panorama Avenue, Bathurst, NSW, 2795, Australia.
| |
Collapse
|
16
|
Park S, Khan NF, Hampshire M, Knox R, Malpass A, Thomas J, Anagnostelis B, Newman M, Bower P, Rosenthal J, Murray E, Iliffe S, Heneghan C, Band A, Georgieva Z. A BEME systematic review of UK undergraduate medical education in the general practice setting: BEME Guide No. 32. MEDICAL TEACHER 2015; 37:611-630. [PMID: 25945945 DOI: 10.3109/0142159x.2015.1032918] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
BACKGROUND General practice is increasingly used as a learning environment in undergraduate medical education in the UK. AIM The aim of this project was to identify, summarise and synthesise research about undergraduate medical education in general practice in the UK. METHODS We systematically identified studies of undergraduate medical education within a general practice setting in the UK from 1990 onwards. All papers were summarised in a descriptive report and categorised into two in-depth syntheses: a quantitative and a qualitative in-depth review. RESULTS 169 papers were identified, representing research from 26 UK medical schools. The in-depth review of quantitative papers (n = 7) showed that medical students learned clinical skills as well or better in general practice settings. Students receive more teaching, and clerk and examine more patients in the general practice setting than in hospital. Patient satisfaction and enablement are similar whether a student is present or not in a consultation, however, patients experience lower relational empathy. Two main thematic groups emerged from the qualitative in-depth review (n = 10): the interpersonal interactions within the teaching consultation and the socio-cultural spaces of learning which shape these interactions. The GP has a role as a broker of the interactions between patients and students. General practice is a socio-cultural and developmental learning space for students, who need to negotiate the competing cultures between hospital and general practice. Lastly, patients are transient members of the learning community, and their role requires careful facilitation. CONCLUSIONS General practice is as good, if not better, than hospital delivery of teaching of clinical skills. Our meta-ethnography has produced rich understandings of the complex relationships shaping possibilities for student and patient active participation in learning.
Collapse
|
17
|
Von Below B, Haffling AC, Brorsson A, Mattsson B, Wahlqvist M. Student-centred GP ambassadors: Perceptions of experienced clinical tutors in general practice undergraduate training. Scand J Prim Health Care 2015; 33:142-9. [PMID: 26158585 PMCID: PMC4834502 DOI: 10.3109/02813432.2015.1041826] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To explore experienced general practitioner (GP) tutor perceptions of a skilled GP tutor of medical students. DESIGN Interview study based on focus groups. SETTING Twenty GPs experienced in tutoring medical students at primary health care centres in two Swedish regions were interviewed. METHOD Four focus-group interviews were analysed using qualitative content analysis. SUBJECTS Twenty GP tutors, median age 50, specifically selected according to age, gender, and location participated in two focus groups in Gothenburg and Malmö, respectively. MAIN OUTCOME MEASURES Meaning units in the texts were extracted, coded and condensed into categories and themes. RESULTS Three main themes emerged: "Professional as GP and ambassador to general practice", "Committed and student-centred educator", and "Coordinator of the learning environment". CONCLUSION Experienced GP tutors describe their skills as a clinical tutor as complex and diversified. A strong professional identity within general practice is vital and GP tutors describe themselves as ambassadors to general practice, essential to the process of recruiting a new generation of general practitioners. Leaders of clinical education and health care planners must understand the complexity in a clinical tutor's assignment and provide adequate support, time, and resources in order to facilitate a sustainable tutorship and a good learning environment, which could also improve the necessary recruitment of future GPs.
Collapse
Affiliation(s)
- Bernhard Von Below
- Correspondence: Bernhard von Below, MD, Department of Public Health and Community Medicine/Primary Health Care, The Sahlgrenska Academy at University of Gothenburg, PO Box 454, SE-405 30 Gothenburg, Sweden, E-mail:
| | - Ann-Christin Haffling
- Department of Clinical Sciences, General Practice/Family Medicine, Lund University, Malmö, Sweden
| | - Annika Brorsson
- Department of Clinical Sciences, General Practice/Family Medicine, Lund University, Malmö, Sweden
| | - Bengt Mattsson
- Department of Public Health and Community Medicine/Primary Health Care, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Mats Wahlqvist
- Department of Public Health and Community Medicine/Primary Health Care, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| |
Collapse
|
18
|
Ramanayake RPJC, De Silva AHW, Perera DP, Sumanasekera RDN, Athukorala LACL, Fernando KAT. Training medical students in general practice: a qualitative study among general practitioner trainers in Sri Lanka. J Family Med Prim Care 2015; 4:168-73. [PMID: 25949960 PMCID: PMC4408694 DOI: 10.4103/2249-4863.154623] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Worldwide Family Medicine has gained an important place in the undergraduate medical curriculum over the last few decades and general practices have become training centers for students. Exposure to patients early in the disease process, out patient management of common problems, follow up of chronic diseases and psychosocial aspects of health and disease are educational advantages of community based training but such training could have varying impact on patients, students and trainers. This study explored the views of General Practitioner (GP) trainers on their experience in training students. METHODOLOGY This qualitative study was conducted among GP trainers of the faculty of medicine, University of Kelaniya, Sri Lanka, to explore their experience on wide range of issues related to their role as GP trainers. The interviews were recorded and transcribed verbatim. Themes expressed were identified. RESULTS Altruistic reasons, self-satisfaction, self-esteem and opportunity to improve their knowledge were the motivations for their involvement in teaching. Teachers were confident of their clinical and teaching skills. They perceived that patients were willing participants of the process and benefited from it. There was a positive impact on consultation dynamics. Time pressure was the major problem and ideal number of trainees per session was two. They were willing to attend teacher training workshops to update their knowledge. CONCLUSIONS GP trainers driven by altruistic reasons were willing participants of student training process. The perceived advantages of involvement of teaching for trainers and patients were an encouragement for potential trainers. University should organize training sessions for trainers which will boost their knowledge, confidence and teaching skills which will eventually benefit students.
Collapse
Affiliation(s)
| | - A. H. W. De Silva
- Department of Family Medicine, Faculty of Medicine, University of Kelaniya, Sri Lanka
| | - D. P. Perera
- Department of Family Medicine, Faculty of Medicine, University of Kelaniya, Sri Lanka
| | - R. D. N. Sumanasekera
- Department of Family Medicine, Faculty of Medicine, University of Kelaniya, Sri Lanka
| | | | - K. A. T. Fernando
- Department of Family Medicine, Faculty of Medicine, University of Kelaniya, Sri Lanka
| |
Collapse
|
19
|
McCullough B, Marton GE, Ramnanan CJ. How can clinician-educator training programs be optimized to match clinician motivations and concerns? ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2015; 6:45-54. [PMID: 25653570 PMCID: PMC4309549 DOI: 10.2147/amep.s70139] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
BACKGROUND Several medical schools have implemented programs aimed at supporting clinician-educators with formal mentoring, training, and experience in undergraduate medical teaching. However, consensus program design has yet to be established, and the effectiveness of these programs in terms of producing quality clinician-educator teaching remains unclear. The goal of this study was to review the literature to identify motivations and perceived barriers to clinician-educators, which in turn will improve clinician-educator training programs to better align with clinician-educator needs and concerns. METHODS Review of medical education literature using the terms "attitudes", "motivations", "physicians", "teaching", and "undergraduate medical education" resulted in identification of key themes revealing the primary motivations and barriers involved in physicians teaching undergraduate medical students. RESULTS A synthesis of articles revealed that physicians are primarily motivated to teach undergraduate students for intrinsic reasons. To a lesser extent, physicians are motivated to teach for extrinsic reasons, such as rewards or recognition. The key barriers deterring physicians from teaching medical students included: decreased productivity, lack of compensation, increased length of the working day, patient concerns/ethical issues, and lack of confidence in their own ability. CONCLUSION Our findings suggest that optimization of clinician-educator training programs should address, amongst other factors, time management concerns, appropriate academic recognition for teaching service, and confidence in teaching ability. Addressing these issues may increase the retention of clinicians who are active and proficient in medical education.
Collapse
Affiliation(s)
- Brendan McCullough
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- Correspondence: Brendan McCullough, Faculty of Medicine, University of Ottawa, 451 Smyth Road, Ottawa, ON K1H 8M5, Canada, Tel +1 613 883 6701, Email
| | | | | |
Collapse
|
20
|
Chew BH, Cheong AT, Ismail M, Hamzah Z, A-Rashid MR, Md-Yasin M, Ali N. A nationwide survey on the expectation of public healthcare providers on family medicine specialists in Malaysia-a qualitative analysis of 623 written comments. BMJ Open 2014; 4:e004645. [PMID: 24919639 PMCID: PMC4067837 DOI: 10.1136/bmjopen-2013-004645] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Revised: 05/08/2014] [Accepted: 05/27/2014] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE To examine the expectation of public healthcare providers/professionals (PHCPs) who are working closely with family medicine specialists (FMSs) at public health clinics. DESIGN Cross-sectional study. SETTING This study is part of a larger national study on the perception of the Malaysian public healthcare professionals on FMSs. PARTICIPANTS PHCPs from three categories of health facilities, namely hospitals, health clinics and health offices. MAIN OUTCOME MEASURES Qualitative analysis of written comments of respondents' expectation of FMSs. RESULTS The participants' response rate was 58% (780/1345) with an almost equal proportion from each public healthcare facility. We identified 21 subthemes for the 623 expectation comments. The six emerging themes are (1) need for more FMSs, (2) clinical roles and functions of FMSs, (3) administrative roles of FMSs, (4) contribution to community and public health, (5) attributes improvement and (6) research and audits. FMSs were expected to give attention to clinical duty. Delivering this responsibility with competence included having the latest medical knowledge in their own and others' medical disciplines, practising evidence-based medicine in prehospital and posthospital care, better supervision of staff and doctors under their care, fostering effective teamwork, communicating more often with hospital specialists and making appropriate referral. Expectations ranged from definite and strong for more FMSs at the health clinics to low expectation for FMSs' involvement in research; to mal-expectation on FMSs' involvement in community and public health programmes. CONCLUSIONS There were some remarkable differences in expectations on FMSs from the three different PHCPs. These ranged from being clinically competent and administratively available for patients and staff at the health clinics, to mal-expectations on FMSs to engage in public health affairs. Relevant parties, including FMSs themselves, could take appropriate self-improvement initiatives to enhance public practice of family medicine and patient care. TRIAL REGISTRATION NUMBER NMRR ID 08-12-1167.
Collapse
Affiliation(s)
- Boon-How Chew
- Department of Family Medicine, Faculty of Medicine and Health Science, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Ai-Theng Cheong
- Department of Family Medicine, Faculty of Medicine and Health Science, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Mastura Ismail
- Health Clinic Seremban 2, Ministry of Health, Seremban, Negeri Sembilan, Malaysia
| | - Zuhra Hamzah
- Department of Family Medicine, Faculty of Medicine, University Kebangsaan Malaysia, Cheras, Kuala Lumpur, Malaysia
| | - Mohd-Radzniwan A-Rashid
- Department of Family Medicine, Faculty of Medicine, University Kebangsaan Malaysia, Cheras, Kuala Lumpur, Malaysia
| | - Mazapuspavina Md-Yasin
- Primary Care Medicine Discipline, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia
| | - Norsiah Ali
- Health Clinic Tampin, Ministry of Health, Tampin, Negeri Sembilan, Malaysia
| |
Collapse
|
21
|
Thomson J, Haesler E, Anderson K, Barnard A. What motivates general practitioners to teach. CLINICAL TEACHER 2014; 11:124-30. [DOI: 10.1111/tct.12076] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Jennifer Thomson
- Australian National University Medical School; Canberra Australia
| | - Emily Haesler
- Australian National University Medical School; Canberra Australia
| | - Katrina Anderson
- Australian National University Medical School; Canberra Australia
| | - Amanda Barnard
- Australian National University Medical School; Canberra Australia
| |
Collapse
|
22
|
Dybowski C, Harendza S. "Teaching is like nightshifts …": a focus group study on the teaching motivations of clinicians. TEACHING AND LEARNING IN MEDICINE 2014; 26:393-400. [PMID: 25318036 DOI: 10.1080/10401334.2014.910467] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
BACKGROUND To ensure the highest quality of education, medical schools have to be aware of factors that influence the motivation of teachers to perform their educational tasks. Although several studies have investigated motivations for teaching among community-based practitioners, there is little data available for hospital-based physicians. PURPOSES This study aimed to identify factors influencing hospital-based physicians' motivations to teach. METHODS We conducted 3 focus group discussions with 15 clinical teachers from the Medical Faculty at Hamburg University. Using a qualitative inductive approach, we extracted motivation-related factors from the transcripts of the audio-recorded discussions. RESULTS Three main multifaceted categories influencing the motivation of teachers were identified: the teachers themselves, the students, and the medical faculty as an organization. Participants showed individual sets of values and beliefs about their roles as teachers as well as personal notions of what comprises a "good" medical education. Their personal motives to teach comprised a range of factors from intrinsic, such as the joy of teaching itself, to more extrinsic motives, such as the perception of teaching as an occupational duty. Teachers were also influenced by the perceived values and beliefs of their students, as well as their perceived discipline and motivation. The curriculum organization and aspects of leadership, human resource development, and the evaluation system proved to be relevant factors as well, whereas extrinsic incentives had no reported impact. CONCLUSIONS Individual values, beliefs, and personal motives constitute the mental framework upon which teachers perceive and assess motivational aspects for their teaching. The interaction between these personal dispositions and faculty-specific organizational structures can significantly impair or enhance the motivation of teachers and should therefore be accounted for in program and faculty development.
Collapse
Affiliation(s)
- Christoph Dybowski
- a Department of Internal Medicine , University Medical Center Hamburg-Eppendorf , Hamburg , Germany
| | | |
Collapse
|
23
|
May M, Mand P, Biertz F, Hummers-Pradier E, Kruschinski C. A survey to assess family physicians' motivation to teach undergraduates in their practices. PLoS One 2012; 7:e45846. [PMID: 23029272 PMCID: PMC3461037 DOI: 10.1371/journal.pone.0045846] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2011] [Accepted: 08/24/2012] [Indexed: 11/19/2022] Open
Abstract
Background In Germany, family physicians (FPs) are increasingly needed to participate in undergraduate medical education. Knowledge of FPs’ motivation to teach medical students in their practices is lacking. Purpose To describe a novel questionnaire that assesses the motivation of FPs to teach undergraduates in their practices and to show the results of a subsequent survey using this instrument. Methods The questionnaire was developed based on a review of the literature. Previously used empirical instruments assessing occupational values and motivation were included. A preliminary version was pretested in a pilot study. The resulting 68-item questionnaire was sent to 691 FPs involved in undergraduate medical education. Reliability was assessed and subgroups were analyzed with regard to differences in motivation. Results A total of 523 physicians in n = 458 teaching practices participated (response rate 75.7%). ‘Helping others’ and ‘interest’ were revealed as the predominant motives. Responses showed a predominantly intrinsic motivation of the participating FPs. Their main incentives were an ambition to work as a medical preceptor, to generally improve undergraduate education and to share knowledge. Material compensation was of minor importance. Time restraints were indicated as a barrier by some FPs, but were not a general concern. Conclusion German FPs involved in medical education have altruistic attitudes towards teaching medical students in their practices. Motivational features give an important insight for the recruitment of FP preceptors as well as for their training in instructional methods.
Collapse
Affiliation(s)
- Marcus May
- Institute of Clinical Pharmacology, Hannover Medical School, Hannover, Germany.
| | | | | | | | | |
Collapse
|
24
|
Wenrich MD, Jackson MB, Ajam KS, Wolfhagen IH, Ramsey PG, Scherpbier AJ. Teachers as learners: the effect of bedside teaching on the clinical skills of clinician-teachers. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2011; 86:846-52. [PMID: 21617505 DOI: 10.1097/acm.0b013e31821db1bc] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
PURPOSE To assess the impact on full-time faculty's own clinical skills and practices of sustained clinical skills bedside teaching with preclerkship students. METHOD This was a longitudinal, qualitative study of faculty who provide dedicated ongoing bedside clinical skills teaching for preclerkship medical students. Interviews were conducted during 2003 to 2007 with 31 faculty of the Colleges program at University of Washington School of Medicine. Content analyses of interview transcripts were performed. RESULTS Teachers perceived a strong positive impact of teaching on their own clinical skills. Six themes were associated with the influence of bedside teaching on teachers' skills and practices. One related to deterrents to change (e.g., reliance on tests/specialists) that narrowed teachers' practice skills prior to starting bedside teaching. Three related to expansion of the process of clinical care resulting from bedside teaching: expanded knowledge and skills, deconstructing the clinical experience (e.g., deepening, broadening, slowing one's practice), and greater self-reflection (e.g., awareness of being a role model). Two were perceived outcomes: improved clinical skills (e.g., physical examination) and more mindful practices (e.g., self-confidence, patient-centered). CONCLUSIONS Teachers perceived profound positive impact on their clinical skills from teaching preclerkship students at the bedside. Further studies are needed, including comparing teaching preclerkship students with teaching advanced students and residents, to assess whether teaching at other levels has this effect.
Collapse
Affiliation(s)
- Marjorie D Wenrich
- Department of Medical Education and Biomedical Informatics, University of Washington School of Medicine, Seattle, USA.
| | | | | | | | | | | |
Collapse
|
25
|
Strasser R, Neusy AJ. Context counts: training health workers in and for rural and remote areas. Bull World Health Organ 2010; 88:777-82. [PMID: 20931063 DOI: 10.2471/blt.09.072462] [Citation(s) in RCA: 87] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2009] [Revised: 02/09/2010] [Accepted: 03/18/2010] [Indexed: 11/27/2022] Open
Abstract
Access to well trained and motivated health workers is the major rural health issue. Without local access, it is unlikely that people in rural and remote communities will be able to achieve the Millennium Development Goals. Studies in many countries have shown that the three factors most strongly associated with entering rural practice are: (i) a rural background; (ii) positive clinical and educational experiences in rural settings as part of undergraduate medical education; and (iii) targeted training for rural practice at the postgraduate level. This paper presents evidence for policy initiatives involving the training of medical students from, in and for rural and remote areas. We give examples of medical schools in different regions of the world that are using an evidence-based and context-driven educational approach to producing skilled and motivated health workers. We demonstrate how context influences the design and implementation of different rural education programmes. Successful programmes have overcome major obstacles including negative assumptions and attitudes, and limitations of human, physical, educational and financial resources. Training rural health workers in the rural setting is likely to result in greatly improved recruitment and retention of skilled health-care providers in rural underserved areas with consequent improvement in access to health care for the local communities.
Collapse
Affiliation(s)
- Roger Strasser
- Northern Ontario School of Medicine, Sudbury, Ontario, ON, P3E 2C6, Canada.
| | | |
Collapse
|
26
|
van Weel C, Mattsson B, Freeman GK, de Meyere M, von Fragstein M. General Practice based Teaching Exchanges in Europe. Eur J Gen Pract 2010; 11:122-6. [PMID: 16671316 DOI: 10.3109/13814780509178252] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
This paper reviews the experience of international exchange of medical students for general practice. The experience is based on the EU Socrates programme 'Primary Health Care' that offers, since 1992, clinical attachments and research electives in primary care. This programme involves 11 university departments of general practice/primary care in eight countries: Austria - Vienna; Belgium - Gent; Germany Düsseldorf; Italy - Monza, Udine; Netherlands Nijmegen; Slovenia - Ljubljana; Sweden - Göteborg; and the UK - Edinburgh, Imperial College London and Nottingham. More than 150 students have taken part in the programme, most in the last four years. For clinical attachment communication to patients is essential, and students should be able to speak the language of the host university. A research elective in primary care is less demanding and requires students' ability to communicate in English. Despite marked differences in health care structure in the countries involved, it is quite possible to provide a valuable teaching environment in general practice, and the experience gained by students in the exchanges more than equals that what they would gain at home. The added value is in experiencing the influence of another health care system and of working in another academic primary care centre. A substantial number of research electives have been published in international peer reviewed scientific journals with the student as first (occasionally second) author and staff members of the student's host and home university as co-authors. A further benefit of the exchange programme lies in the transfer teaching innovations between universities.
Collapse
Affiliation(s)
- Chris van Weel
- Department of General Practice, University Medical Centre, Nijmegen, The Netherlands.
| | | | | | | | | |
Collapse
|
27
|
Laurence CO, Black LE. Teaching capacity in general practice: results from a survey of practices and supervisors in South Australia. Med J Aust 2009; 191:102-4. [DOI: 10.5694/j.1326-5377.2009.tb02704.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2009] [Accepted: 05/27/2009] [Indexed: 11/17/2022]
Affiliation(s)
- Caroline O Laurence
- Adelaide to Outback GP Training Program, University of Adelaide, Adelaide, SA
- Discipline of General Practice, University of Adelaide, Adelaide, SA
| | - Linda E Black
- Adelaide to Outback GP Training Program, University of Adelaide, Adelaide, SA
| |
Collapse
|
28
|
Smith P, Cotton P, O'Neill A. 'Can you take a student this morning?' Maximising effective teaching by practice nurses. MEDICAL EDUCATION 2009; 43:426-433. [PMID: 19422489 DOI: 10.1111/j.1365-2923.2009.03308.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVES Little is known about the contribution nurses make to medical student learning. This study set out to explore the nature of practice nurse teaching during the general practice clerkship and to investigate ways in which the teacher and learner (the practice nurse and the medical student) can be best supported to maximise learning. METHODS Mixed focus groups were conducted with general practitioner educational supervisors and practice nurses. Further focus groups were conducted with students on completion of clerkships. RESULTS There is wide variation in the delivery, organisation and expectations of practice nurse teaching. Although there is some evidence of a passive learning experience, the learning dynamic and the student-nurse relationship are regarded highly. CONCLUSIONS Time spent with practice nurses is an important part of the clerkship in general practice. The nature of the practice nurse-medical student relationship differs from that of the educational supervisor-medical student relationship and can be built upon to maximise learning during the clerkship. The experience for the practice nurse, medical student and supervisor can be enhanced through formal preparation for delivering teaching.
Collapse
Affiliation(s)
- Pat Smith
- Department of General Practice and Primary Care, University of Glasgow, Glasgow, UK.
| | | | | |
Collapse
|
29
|
Ashley P, Rhodes N, Sari-Kouzel H, Mukherjee A, Dornan T. 'They've all got to learn'. Medical students' learning from patients in ambulatory (outpatient and general practice) consultations. MEDICAL TEACHER 2009; 31:e24-31. [PMID: 19330660 DOI: 10.1080/01421590802464445] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
BACKGROUND The dynamics of effective teaching consultations need to be better understood. AIM Find from medical students, patients and doctors how to optimize learning in ambulatory consultations. METHODS Patients and students independently gave semi-structured exit interviews after 25 ambulatory teaching consultations during a clinical attachment set up experimentally to strengthen students' ambulatory learning. The results of an abbreviated grounded theory analysis were checked in three focus group discussions with teachers and students. RESULTS Patients and students identified strongly with one another and benefited from teaching consultations in parallel ways yet defaulted to passive roles. Patients deferred to professional expertise whilst students were uncertain what was expected of them, feared harming patients and feared being showed up as ignorant. The educational value of consultations was determined by doctors' ability to promote student-patient interaction. CONCLUSIONS In the most effective teaching consultations, doctors promoted a level of participation that realized patients' and students' mutual sense of responsibility by orientating them to one another, creating conditions for them to interact, promoting and regulating discourse, helping students to perform practical tasks and debriefing them afterwards. Those broad conclusions translate into 18 practical recommendations for supervising a medical student in an outpatient clinic or surgery.
Collapse
|
30
|
von Below B, Hellquist G, Rödjer S, Gunnarsson R, Björkelund C, Wahlqvist M. Medical students' and facilitators' experiences of an Early Professional Contact course: active and motivated students, strained facilitators. BMC MEDICAL EDUCATION 2008; 8:56. [PMID: 19055727 PMCID: PMC2614986 DOI: 10.1186/1472-6920-8-56] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2008] [Accepted: 12/02/2008] [Indexed: 05/11/2023]
Abstract
BACKGROUND Today, medical students are introduced to patient contact, communication skills, and clinical examination in the preclinical years of the curriculum with the purpose of gaining clinical experience. These courses are often evaluated from the student perspective. Reports with an additional emphasis on the facilitator perspective are scarce. According to constructive alignment, an influential concept from research in higher education, the learning climate between students and teachers is also of great importance. In this paper, we approach the learning climate by studying both students' and facilitators' course experiences.In 2001, a new "Early Professional Contact" longitudinal strand through term 1-4, was introduced at the Sahlgrenska Academy, University of Gothenburg, Sweden. General practitioners and hospital specialists were facilitators.The aim of this study was to assess and analyse students' and clinical facilitators' experiences of the Early Professional Contact course and to illuminate facilitators' working conditions. METHODS Inspired by a Swedish adaptation of the Course Experience Questionnaire, an Early Professional Contact Questionnaire was constructed. In 2003, on the completion of the first longitudinal strand, a student and facilitator version was distributed to 86 students and 21 facilitators. In the analysis, both Chi-square and the Mann-Whitney tests were used. RESULTS Sixty students (70%) and 15 facilitators (71%) completed the questionnaire. Both students and facilitators were satisfied with the course. Students reported gaining iiration for their future work as doctors along with increased confidence in meeting patients. They also reported increased motivation for biomedical studies. Differences in attitudes between facilitators and students were found. Facilitators experienced a greater workload, less reasonable demands and less support, than students. CONCLUSION In this project, a new Early Professional Contact course was analysed from both student and facilitator perspectives. The students experienced the course as providing them with a valuable introduction to the physician's professional role in clinical practice. In contrast, course facilitators often experienced a heavy workload and lack of support, despite thorough preparatory education. A possible conflict between the clinical facilitator's task as educator and member of the workplace is suggested. More research is needed on how doctors combine their professional tasks with work as facilitators.
Collapse
Affiliation(s)
- Bernhard von Below
- Department of Public Health and Community Medicine/Primary Health Care, The Sahlgrenska Academy at University of Gothenburg, PO Box 454, SE-405 30 Gothenburg, Sweden
- Floda Primary Health Care Center, Southern Älvsborg County, Rurik Holms väg, S-448 30 Floda, Sweden
- Research and Development Unit, Primary Health Care, Southern Älvsborg County, Sven Eriksonsplatsen 4, plan 2, S-503 38 Borås, Sweden
| | - Gunilla Hellquist
- Department of Public Health and Community Medicine/Primary Health Care, The Sahlgrenska Academy at University of Gothenburg, PO Box 454, SE-405 30 Gothenburg, Sweden
| | - Stig Rödjer
- Department of Public Health and Community Medicine/Primary Health Care, The Sahlgrenska Academy at University of Gothenburg, PO Box 454, SE-405 30 Gothenburg, Sweden
- Section of Hematology, Department of Medicine, Sahlgrenska University Hospital, S-413 45 Gothenburg, Sweden
| | - Ronny Gunnarsson
- Department of Public Health and Community Medicine/Primary Health Care, The Sahlgrenska Academy at University of Gothenburg, PO Box 454, SE-405 30 Gothenburg, Sweden
- Research and Development Unit, Primary Health Care, Southern Älvsborg County, Sven Eriksonsplatsen 4, plan 2, S-503 38 Borås, Sweden
| | - Cecilia Björkelund
- Department of Public Health and Community Medicine/Primary Health Care, The Sahlgrenska Academy at University of Gothenburg, PO Box 454, SE-405 30 Gothenburg, Sweden
| | - Mats Wahlqvist
- Department of Public Health and Community Medicine/Primary Health Care, The Sahlgrenska Academy at University of Gothenburg, PO Box 454, SE-405 30 Gothenburg, Sweden
| |
Collapse
|
31
|
Quince T, Benson J, Hibble A, Emery J. Clinical competence through teaching students: appetisers, main dishes and digestives. CLINICAL TEACHER 2008. [DOI: 10.1111/j.1743-498x.2007.00197.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
32
|
Ottenheijm RPG, Zwietering PJ, Scherpbie AJJA, Metsemakers JFM. Early student-patient contacts in general practice: an approach based on educational principles. MEDICAL TEACHER 2008; 30:802-8. [PMID: 18608956 DOI: 10.1080/01421590802047265] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
BACKGROUND Clinical teaching and learning is generally seen as an educationally sound approach, but the clinical environment does not always offer optimal conditions to facilitate students' learning processes. AIMS To show how insights on constructing a good learning environment for student-patient contacts in real practice can be translated into an undergraduate clinical general practice programme in Year 3 and to study its feasibility. METHOD Literature search, yielding starting points for the development of the new programme and questionnaire evaluation of the programme. RESULTS Six starting points for a good learning environment for early student-patient contacts: continuing exposure to patients,transformation of experience into knowledge, active role of students, supervision and feedback, time and space for teaching and teacher training were translated into a the new programme. The evaluation showed that the programme was feasible and well received by students and GPs, although some improvements are possible. CONCLUSION In a curriculum with clear goals for early student-patient contacts, it is feasible to implement an early clinical programme in general practice based on educational principles.
Collapse
Affiliation(s)
- Ramon P G Ottenheijm
- Department of General Practice, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.
| | | | | | | |
Collapse
|
33
|
Ratanawongsa N, Howell EE, Wright SM. What motivates physicians throughout their careers in medicine? ACTA ACUST UNITED AC 2007; 32:210-7. [PMID: 17918306 DOI: 10.1007/bf02698065] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Motivation provides direction and purpose in physicians' work, and motivating factors vary during different career stages. Motivation theories divide sources of motivation into those intrinsic to the work, such as the opportunity for self-expression and intellectual challenge, and those extrinsic to the work, such as salary and time. Although much attention has focused on minimizing negative extrinsic factors, the authors argue that career resilience requires that physicians reflect on and define the sources of their own intrinsic motivation. Opportunities to maximize self-awareness may allow physicians to structure their work in ways that maximize meaning and fulfillment over the long-term.
Collapse
Affiliation(s)
- Neda Ratanawongsa
- Division of General Internal Medicine, Johns Hopkins Bayview Medical Center, Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA.
| | | | | |
Collapse
|
34
|
Jacobson L, Hawthorne K, Wood F. The 'Mensch' factor in general practice: a role to demonstrate professionalism to students. Br J Gen Pract 2006; 56:976-9. [PMID: 17132396 PMCID: PMC1934070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023] Open
|
35
|
Grant A, Robling M. Introducing undergraduate medical teaching into general practice: an action research study. MEDICAL TEACHER 2006; 28:e192-7. [PMID: 17594545 DOI: 10.1080/01421590600825383] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Following the publication of Tomorrow's Doctors and as a result of increasing numbers of students recruited to medical school it is necessary to involve more general practitioners (family physicians) in undergraduate medical education. Students have responded positively regarding experiences in general practices with a broad spectrum of clinical conditions to be seen and greater involvement in clinical decision-making. This action research study followed a small group general practice in South Wales through the required preparation for undergraduate medical education and its first year of teaching. Preparatory work for the practice focused mainly on summarizing patient notes, setting up a practice library and arranging accommodation for the students. Members of the Primary Health Care Team (PHCT) found that having students in the practice gave them a sense of achievement and enhanced self-worth. Individuals within the practice felt more confident in their professional role and the team ethic within the practice was strengthened. Doctors' anxieties regarding the adequacy of their clinical skills proved unfounded. Patients were reported to feel more included in their care and to have enjoyed hearing their condition being discussed with the students. Students valued the one-to-one teaching, seeing common illnesses and a variety of consulting styles. It is hoped that this paper will be of value to those responsible for recruiting GP practices into undergraduate teaching. It demonstrates benefits for the primary health care team in terms of improved morale and sense of professional self-worth. Patients felt more involved in their care. Generalization from these findings is limited by only one practice having been involved. Undergraduate teaching offers advantages, particularly in terms of professional self-esteem and team morale.
Collapse
Affiliation(s)
- Andy Grant
- Department of General Paractice, Cardiff University, Lanedeyrn Health Centre, Maelfa, Llanedeyrn, Cardiff CF23 9PN, UK.
| | | |
Collapse
|
36
|
Abstract
OBJECTIVE This study was undertaken to assess the evidence of whether new forms of medical training, where substantial training takes place in general practice, will be acceptable to GPs. In particular, we asked the questions: Are GPs willing to act as trainers and supervisors in their practices? Do GPs have the appropriate skills to be trainers? Do practices have the infrastructure and resources to support placements? And, are patients happy to be seen by medical students and General Practice Registrars? DESIGN Key Australian and international databases, key Australian journals and key Australian websites were searched for literature on general practice-based training of medical students and General Practice Registrars. RESULTS In the international and Australian literature, we found that many GPs consider training medical students and General Practice Registrars to be intrinsically satisfying. They vary in their skills, and most medical schools have made significant investments in training and support activities. Many practices do not have the necessary infrastructure, and investments need to be made if extended placements are to be successful. Many patients are happy to be seen by students and Registrars, but careful thought needs to be given to implementing appropriate models so that students have good learning opportunities, patients are not disadvantaged and general practices can operate efficiently. CONCLUSION The success of this new model of clinical placements is dependent on medical schools having a detailed understanding of the needs and expectations of GPs.
Collapse
Affiliation(s)
- Karen Larsen
- Centre for Equity and Primary Health Research in the Illawarra and Shoalhaven (CEPHRIS), Faculty of Medicine, University of New South Wales, Wollongong DC, NSW 2500, Australia.
| | | |
Collapse
|
37
|
Adshead L, White PT, Stephenson A. Introducing peer observation of teaching to GP teachers: a questionnaire study. MEDICAL TEACHER 2006; 28:e68-73. [PMID: 16707288 DOI: 10.1080/01421590600617533] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
In medical education programmes which rely on clinical teachers spread across diverse sites, the application of peer observation of teaching offers the potential of both supporting teachers and maintaining quality. This paper reports on a questionnaire survey carried out with general practitioner (GP) teachers of medical undergraduate students from King's College London School of Medicine at Guy's, King's College and St Thomas' Hospitals. The aim of the study was to determine GP teachers' views on a proposed programme of peer observation of their teaching. The majority of GP teachers identified benefits of the proposed scheme with 69% saying it would help improve the education of future doctors. However, despite seeing the benefits, less than half wished to take part in the programme. Two thirds cited time and paperwork as major disincentives to taking part and 62% said that they felt it would make them feel under scrutiny. No associations were found between measures of workload and willingness to take part. This suggests that a fundamental fear of scrutiny and criticism may be the main hurdle to be overcome in implementing the scheme. Imposing peer observation on GP teachers in the form proposed could create suspicion and distance between the university department and practice-based GP teachers and may even result in a loss of teachers. The introduction of peer observation is more likely to be successful if GPs' apprehensions are addressed. Using peer observation to strengthen the process of quality assurance may undermine its role in the support and development of clinical teachers.
Collapse
Affiliation(s)
- Lesley Adshead
- King's College, London School of Medicine at Guy's, King's College and St Thomas' Hospitals, UK
| | | | | |
Collapse
|
38
|
Mathers J, Parry J, Lewis S, Greenfield S. What impact will an increased number of teaching general practices have on patients, doctors and medical students? MEDICAL EDUCATION 2004; 38:1219-28. [PMID: 15566532 DOI: 10.1111/j.1365-2929.2004.02014.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
BACKGROUND Recommendations for medical training have seen a growing drive for undergraduate teaching to take place within the community - primarily in the general practice surgery. In light of the ongoing expansion of medical student numbers, many more general practices will be required to participate in undergraduate teaching. AIM To explore the perceptions of primary care staff on the impact that increasing student numbers will have on them, on their patients and on the students themselves. DESIGN OF STUDY Semi-structured interviews. SETTING Three general practices presently involved in undergraduate teaching, 3 practices about to become involved in undergraduate teaching and 1 non-teaching practice, all in the Black Country area of the West Midlands. METHODS Semi-structured interviews with prearranged prompts were undertaken with a variety of practice staff including general practitioners (GPs), practice managers and practice nurses, as well as administrative and reception staff. RESULTS Eleven GPs, 6 practice managers, 4 practice nurses and 6 receptionists/administrators took part in the interviews. Three main themes emerged relating to the effects on students and reflecting attitudes towards the Black Country, the experience of working among deprived populations and issues around access to the new training locations. The majority of interviewees were of the opinion that patients both enjoy taking part in undergraduate teaching and are able to benefit from the process. Positive impacts on practice infrastructure were also elicited, but when asked about the resource implications for the practice of undergraduate teaching, there was a dichotomy of opinion. CONCLUSION For many practices, involvement in undergraduate teaching is a double-edged sword.
Collapse
Affiliation(s)
- Jonathan Mathers
- Health Impact Assessment Research Unit, Department of Public Health and Epidemiology, University of Birmingham, Birmingham, UK.
| | | | | | | |
Collapse
|
39
|
Simon SR, Davis D, Peters AS, Skeff KM, Fletcher RH. How do precepting physicians select patients for teaching medical students in the ambulatory primary care setting? J Gen Intern Med 2003; 18:730-5. [PMID: 12950482 PMCID: PMC1494919 DOI: 10.1046/j.1525-1497.2003.20838.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To study how clinical preceptors select patients for medical student teaching in ambulatory care and to explore key factors they consider in the selection process. DESIGN Qualitative analysis of transcribed interviews. SETTING Harvard Medical School, Boston, Mass. PARTICIPANTS Nineteen physicians (14 general internists and 5 general pediatricians) who serve as clinical preceptors. MEASUREMENTS Responses to in-depth open-ended interview regarding selection of patients for participation in medical student teaching. MAIN RESULTS Preceptors consider the competing needs of the patient, the student, and the practice the most important factors in selecting patients for medical student teaching. Three dominant themes emerged: time and efficiency, educational value, and the influence of teaching on the doctor-patient relationship. These physicians consciously attempt to select patients whose participation in medical student teaching maximizes the efficiency of the clinical practice and optimizes the students' educational experiences, while minimizing any potential for harming the relationship between preceptor and patient. CONCLUSIONS These findings may help validate the frustration preceptors frequently feel in their efforts to teach in the outpatient setting. Becoming more cognizant of the competing interests-the needs of the patient, the student, and the practice-may help physicians to select patients to enhance the educational experience without compromising efficiency or the doctor-patient relationship. For educators, this study suggests an opportunity for faculty development programs to assist the clinical preceptor both in selecting patients for medical student teaching and in finding ways to maximize the efficiency and educational quality of the outpatient teaching environment.
Collapse
Affiliation(s)
- Steven R Simon
- Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, 133 Brookline Avenue, 6th Floor, Boston, MA 02215, USA.
| | | | | | | | | |
Collapse
|
40
|
Walters K, Buszewicz M, Russell J, Humphrey C. Teaching as therapy: cross sectional and qualitative evaluation of patients' experiences of undergraduate psychiatry teaching in the community. BMJ 2003; 326:740. [PMID: 12676843 PMCID: PMC152635 DOI: 10.1136/bmj.326.7392.740] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To explore the impact of participating in undergraduate teaching in general practice for patients with common mental disorders. DESIGN Questionnaire survey and qualitative in-depth interviews. SETTING Community based undergraduate teaching programme for fourth year students at a London medical school doing a psychiatry attachment. PARTICIPANTS Questionnaire survey: all patients involved in the teaching programme over one academic year. In-depth interviews: 20 patients, 14 students, and 12 general practitioner tutors participating in the programme. RESULTS The questionnaire showed high levels of satisfaction with teaching encounters for participating patients, which were corroborated in the interviews. Many patients and general practitioners reported specific therapeutic benefits for patients from contact with students, including raised self esteem and empowerment; the development of a coherent "illness narrative"; new insights into their problems; and a deeper, more balanced, and understanding doctor-patient relationship. For a few patients the teaching caused some distress, which may relate to a lack of insight into their condition or deficits in students' interviewing skills. CONCLUSIONS Participation in teaching can have additional positive therapeutic outcomes for selected patients with common mental disorders, although a small minority report negative effects. Testing in a larger sample is needed to determine the characteristics of patients in these two subgroups and establish whether these effects persist.
Collapse
Affiliation(s)
- Kate Walters
- Department of Primary Care and Population Sciences, Royal Free and University College Medical School, London N19 5LW.
| | | | | | | |
Collapse
|
41
|
Abstract
INTRODUCTION Despite several unique aspects of the medical teacher's role compared to other teachers in higher education, there has been little research in this area. In particular there have been few studies which have explored teachers' perspectives on their role. This study aimed to elicit teachers' perceptions of the teaching environment in a single medical school at a time of curriculum change. METHODS As part of an ethnographic study to explore the culture of the school, 22 teachers took part in in-depth, semi-structured interviews to ascertain their views and experiences of teaching. Additional data were collected through participant observation of curriculum meetings, and informal data collection. The data were analysed using a grounded approach, which resulted in over 200 analytic codes being assigned, which were later grouped into six main themes. RESULTS The strongest themes to emerge were teachers' concerns about the students, the infrastructure for teaching and their relationship with the medical school. These included concerns about the lack of student clerking activity, insufficient monitoring of students, poor support or recognition of teaching and a perceived lack of inclusion in the medical school. DISCUSSION The structure and culture within the medical school and associated hospital trust appeared to offer little support for doctors in their teaching role. This suggested that teaching was not highly valued. Teachers were preoccupied with the practical issues of teaching, leaving little time to consider more fundamental educational issues. These findings have implications for the quality of teaching and implementation of curricular change.
Collapse
Affiliation(s)
- M A Seabrook
- Department of Medical & Dental Education, Guy's, King's & St Thomas' School of Medicine, Guy's Hospital, London, UK.
| |
Collapse
|
42
|
Haffling AC, Håkansson A, Hagander B. Early patient contact in primary care: a new challenge. MEDICAL EDUCATION 2001; 35:901-908. [PMID: 11555229 DOI: 10.1046/j.1365-2923.2001.01001.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
BACKGROUND The Medical School of Lund University, Sweden, has introduced an early patient contact course, including training in communication and examination skills. The course runs parallel with theoretical subjects during the students' first two-and-a-half years. General practitioner (GP) participation is gradually increasing, and in the last half-year of the course GPs in all health centres in the area are involved. Little is known about the GPs' interest, competence and time for this new task. AIM To describe the GPs' attitudes towards teaching and the rewards and problems they experience. SUBJECTS 30 GPs teaching third-year medical students. METHOD Semistructured interview study. Data analysis by a method described by Malterud. RESULTS The attitude towards teaching was mostly positive and the teachers were confident about teaching examination procedure. Among rewards of teaching, improved quality of clinical practice was the main theme, but imparting knowledge to others, contact with enthusiastic students, and gains in self-esteem were also mentioned. Problems with teaching were mostly due to external factors such as lack of time and space, but concern about a negative effect on patient care was also recognized. Educational objectives of the course were not completely accepted. GPs were not fully aware about what to expect from the students, with subsequent problems concerning how to assess students' performance and how to give effective feedback. CONCLUSIONS The teaching of junior medical students is maintained by the GPs' enthusiasm for teaching. However, teacher training is required and the crucial issues of time and space have to be considered.
Collapse
Affiliation(s)
- A C Haffling
- Department of Community Medicine, Lund University, Malmö, Sweden
| | | | | |
Collapse
|
43
|
Baldor RA, Brooks WB, Warfield ME, O'Shea K. A survey of primary care physicians' perceptions and needs regarding the precepting of medical students in their offices. MEDICAL EDUCATION 2001; 35:789-795. [PMID: 11489108 DOI: 10.1046/j.1365-2923.2001.00980.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
OBJECTIVE To assess the interest, perceptions, and needs of primary care physicians with regard to office-based precepting of medical students. DESIGN Random survey. SETTING The New England region of the United States (Maine, New Hampshire, Vermont, Massachusetts, Rhode Island, Connecticut). PARTICIPANTS Family physicians, general internists and paediatricians. MAIN OUTCOME MEASURES These included: (1) practice and preceptor demographics; (2) Likert scale agreement or disagreement with various positive and negative perceptions about precepting students; rating (from unimportant to necessary) of potential benefits from medical schools associated with the support of precepting in the office setting, and (3) comparisons among physician groups to determine differences in perceptions and needs. RESULTS There is a high level of interest in precepting regardless of primary care specialty, practice structure, payment mechanism, or precepting experience. Negative impacts included decreased productivity and increased length of the day by a median of 60 minutes. Positive impacts included keeping one's own knowledge up-to-date and enhanced enjoyment of practice. Benefits such as academic appointments, continuing medical education credits, faculty development, computer linkages for clinical information and medical library access are rated highly. Monetary payment, whether as a modest honorarium or as compensation for lost time/income, was felt to be important by half of our sample. CONCLUSION A significant interest in precepting medical students on a regular basis is expressed by primary care physicians in the ambulatory medicine setting. The results of this survey can be used by medical schools to address negative perceptions and to develop appropriate benefits packages to recruit and retain these primary care preceptors.
Collapse
Affiliation(s)
- R A Baldor
- Department of Family Medicine and Community Health, University of Massachusetts, Worcester, Massachusetts, USA
| | | | | | | |
Collapse
|
44
|
Wallace P, Berlin A, Murray E, Southgate L. CeMENT: evaluation of a regional development programme integrating hospital and general practice clinical teaching for medical undergraduates. The Community-Based Medical Education in North Thames. MEDICAL EDUCATION 2001; 35:160-166. [PMID: 11169090 DOI: 10.1046/j.1365-2923.2001.00763.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
OBJECTIVES To determine the feasibility and effectiveness of shared hospital and general practice clinical teaching for medical undergraduates. DESIGN A multifaceted approach employing quantitative and qualitative techniques. SETTING All medical schools in North Thames Region. SUBJECTS Students, GP tutors and hospital specialists. RESULTS The model was successfully adopted in a broad range of clinical specialties in all of the participating medical schools, resulting in a doubling of the involvement of general practice in clinical teaching. Participating students provided an overwhelmingly positive evaluation of the attachments and there was a clear perception of benefit amongst the participating GPs. However, the views of the participating hospital clinicians were less positive and the true nature and extent of the educational impact proved difficult to assess. CONCLUSIONS This model of collaborative clinical teaching between hospital and general practice can be implemented in accordance with the project's key aims, but the enthusiastic involvement of hospital clinicians may be difficult to secure.
Collapse
Affiliation(s)
- P Wallace
- Department of Primary Care and Population Sciences, Royal Free and University College Medical School, University College London, UK
| | | | | | | |
Collapse
|