'How was it for you?' - GP trainees' experiences of a novel practice swap.

Newly-qualified General Practitioners (GPs) are underprepared for the challenges of working as independent GPs. This study describes a practice swap - an innovative experiential learning opportunity to increase confidence amongst final year GP trainees for the challenges of future work. The effectiveness of the practice swap was evaluated across two separate GP training areas using questionnaires for GP trainees, practice managers, educational supervisors and newly-qualified GPs. In addition, GP trainees were interviewed in focus groups. The results demonstrated the positive educational value of the practice swap. GP trainees reported increased confidence in the ability to work as independent GPs specifically as a locum doctor, improved Information Technology (IT) competence, clinical knowledge and time keeping. The practice swap helped to inform the trainees on future career choices. Practice swapping has become one of the building blocks of a wider programme to equip newly-qualified GPs for the numerous challenges of being a GP, with a series of workshops on self-employment, job applications, practice management and IT training. The arrangements and benefits of practice swapping are transferrable to other GP Training Schemes across the UK and possibly internationally.

The role of nicotine replacement therapy for temporary abstinence in the home to protect children from environmental tobacco smoke exposure: a qualitative study with disadvantaged smokers.

BACKGROUND: Nicotine replacement therapy (NRT) has recently been licensed to help smokers to abstain from smoking for short time periods and recent studies have shown that 8-14% of smokers are regularly using NRT to cope when they cannot or are not allowed to smoke. These data suggest that, potentially, NRT for temporary abstinence might be an acceptable method to help smoking caregivers, who are not able to stop smoking completely, to avoid smoking whilst inside their home in order to protect their children from the harms of environmental tobacco smoke (ETS). The aim of this study was therefore to explore the concept of using NRT for temporary abstinence in the home, to protect children from exposure to ETS. METHODS: Qualitative in-depth interviews were conducted with thirty six disadvantaged smoking parents who were currently, or had recently stopped smoking in the home with at least one child under the age of five. Parents were recruited from Children's Centres and Health Visitor Clinics in Nottingham, UK. Interviews were audio recorded and transcribed verbatim. Data were coded and analysed thematically to identify emergent main and subthemes. RESULTS: Overall, participants responded negatively to the concept of attempting temporary abstinence in the home in general and more specifically to the use of NRT whilst at home to reduce children's exposure to ETS. Many parents would prefer to either attempt cutting down or quitting completely to make a substantial effort to change their smoking behaviour. There was limited interest in the use of NRT for temporary abstinence in the home as a first step to quitting, although some parents did express a willingness to use NRT to cut down as a first step to quitting. CONCLUSION: Disadvantaged smoking parents were reluctant to initiate and maintain temporary abstinence with or without NRT as a way of making their homes smoke free to protect their children's health. More education about the specific risks of ETS to their children and the utility of NRT for use in the home might be needed to have a public health impact on children's health.

The motivators and barriers to a smoke-free home among disadvantaged caregivers: identifying the positive levers for change.

INTRODUCTION: The aims of this study were to explore home smoking behaviors and the motivators and barriers to smoke-free homes among a group of disadvantaged caregivers for young children and to identify the positive levers that health care professionals can utilize when supporting smoking behavior change. METHODS: In-depth qualitative interviews were conducted between July and September 2009, with 22 disadvantaged smoking caregivers, accessing Children's Centre Services in Nottingham, UK. Interviews were audiorecorded and transcribed verbatim. Data were coded and analyzed thematically to identify emergent main and subthemes. RESULTS: Caregivers had some general understanding of the dangers of secondhand smoke (SHS), but their knowledge appeared incomplete and confused. All interviewees described rules around smoking in the home; however, these tended to be transient and fluid and unlikely to be effective. Caregivers were often living in difficult and complex circumstances and experienced significant barriers to creating a smoke-free home. The motivators for change were more strongly linked to house decor and smell than children's health, suggesting that visible evidence of the harm done by SHS to children might help promote smoke-free homes. CONCLUSIONS: Findings suggest that further tailored information on the effect of SHS is required, but to instigate caregiver behavior change, providing demonstrable evidence of the impact that their smoking is having on their children's health is more likely to be effective.