The status and outcomes of interprofessional health education in sub-Saharan Africa: A systematic review.

The increasing burden of chronic diseases, and shortage of health care workers especially in Low and Middle Income countries (LMICs) requires greater collaborative working between health professions. There is a growing body of evidence that interprofessional education (IPE) and interprofessional continuous education (IPCE) can improve collaborative practice thus strengthening health care delivery in low resource settings. The World Health Organization (WHO) promotes this educational strategy in these regions as part of wider programs to improve health care. The purpose of this systematic review was to summarize IPE and IPCE activities in sub-Saharan Africa (SSA) and its outcomes; including practice, service and patient outcomes. Standard guidelines for conducting and reporting systematic reviews were followed. The online databases searched included MEDLINE, Embase, Education Resources Information Centre (ERIC), the Cumulative Index of Nursing and Allied Health Literature (CINAHL) and Science Direct. The Kirkpatrick model was used to classify IPE outcomes reported from literature. Following full text screening, 41 articles were selected for data extraction. It was found that IPE/IPCE is still a relatively new concept in SSA with 93% of studies published after 2012. Furthermore, IPE is concentrated predominantly in undergraduate institutions and mainly implemented to improve collaborative practice and address important public health concerns. Positive reaction and outcomes of IPE/IPCE were reported in terms of change of attitude and perception toward collaborative practice as well as knowledge and skills acquisition. Few studies in SSA sought to understand and measure the outcomes of IPE/IPCE relating to health care practice. More work in this important potential outcome of IPE/IPCE is recommended.

The Challenges of Visualisation During Delivery and Assessment of Clinical Teaching Under COVID-19: A Reflective Account of Problem Solving.

Whilst the in-person clinical immersion of students in their final years of medical programmes was relatively protected from the impact of COVID-19, the ability to deliver in-person clinical teaching was restricted or heavily altered for early-year students. Our challenge as a 3-year BSc (Hons) in Medicine programme at the University of St Andrew's School of Medicine was to continue to immerse and engage students in their clinical training when in-person access to the authentic environment was impossible, restricted, or completely altered from the original image held by students.In this chapter, we aim to discuss the problems faced, the solutions considered within the contextual restraints and then reflect on the successes and failures of the approaches we took in aiding students to visualise themselves in the clinical environment, or when using altered delivery modes that introduced radically different optics on the learning experience.Whilst there were some limits on what could be practically achieved (specifically remote learning of "hands-on" clinical skills requiring specialist models or equipment), either sole- or hybrid-use of virtual platforms to provide both real-time and student-led mixed-media visualisations provided effective means to ensure appropriate delivery and assessment throughout varying levels of restrictions. In some cases, this mirrored adaptations in the clinical environment (e.g. virtual consultations).Whilst online delivery of teaching and assessment provided some mitigation of COVID-19 impact upon teaching, given the nature of a medical curriculum these cannot offset the lack of hands-on practical experience students require. However, some adaptations made by necessity (e.g. teleconsultations) have mirrored the advances in patient care and have arguably better-equipped students. The full positive and negative impacts of the pandemic on medical education remain to be seen.

'The word that comes to mind is polymath': medical students' perceptions of rural postgraduate careers.

INTRODUCTION: Medical education is essential in strengthening the rural medical workforce globally. Immersive medical education in rural communities guided by good role models and rural-specific curricula promotes rural recruitment of recent graduates. While curricula can be rurally oriented, the mechanism of action is unclear. Comparing different programmes, this study examined medical students' perceptions of rural and remote practice and how these perceptions influence students' intentions to practice rurally. METHODS: The University of St Andrews has two medical programmes: BSc Medicine and graduate-entry MBChB (ScotGEM). Commissioned to address Scotland's rural generalist crisis, ScotGEM employs high quality role modelling, alongside 40-week immersive rural longitudinal integrated clerkships. This cross-sectional study utilised semi-structured interviews with 10 St Andrews students enrolled in undergraduate or graduate-entry medical programmes. We deductively applied Feldman and Ng's 'Careers: Embeddedness, Mobility, and Success' theoretical framework to examine rural medicine perceptions in medical students exposed to different programmes. RESULTS: Structural themes included geographically isolated physicians and patients. Organisational themes included limited staff support in rural practices and perceived inequitable resource allocation between rural and urban communities. Occupational themes included the recognition of rural clinical generalists. Personal themes included the perception of tight-knit rural communities. Medical students' experiences (educational, personal, or working) most profoundly shaped their perceptions. DISCUSSION: Medical students' perceptions align with professionals' reasons for career embeddedness. Perceptions unique to rurally interested medical students included isolation, the need for rural clinical generalists, uncertainty in rural medicine, and tight-knit rural communities. Educational experience mechanisms, including exposure to telemedicine, GP role-modelling, methods on overcoming uncertainty, and codesigned medical education programmes, explain perceptions.

Heard, valued, supported? Doctors' wellbeing during transitions triggered by COVID-19.

INTRODUCTION: Supporting doctors' wellbeing is crucial for medical education to help minimise negative long-term impacts on medical workforce retention and ultimately patient care. There is limited study of how doctors' transitions experiences impact wellbeing, particularly socially and culturally. Multiple Multidimensional Transitions (MMT) theory views transitions as dynamic, incorporating multiple contexts and multiple domains. Using MMT as our lens, we report a qualitative analysis of how transitions experienced by doctors during the pandemic impacted on social and cultural aspects of wellbeing. METHODS: Longitudinal narrative inquiry was employed, using interviews and audio-diaries. Data were collected over 6 months in three phases: (i) interviews with doctors from across the career spectrum (n = 98); (ii) longitudinal audio-diaries for 2-4 months (n = 71); (iii) second interviews (n = 83). Data were analysed abductively, narrowing focus to factors important to social and cultural wellbeing. RESULTS: Doctors described experiencing multiple interacting transitions triggered by the pandemic in multiple contexts (workplace, role, homelife and education). Patterns identifiable across the dataset allowed us to explore social and cultural wellbeing crosscutting beyond individual experience. Three critical factors contributed to social and cultural wellbeing both positively and negatively: being heard (e.g., by colleagues asking how they are); being valued (e.g., removal of rest spaces by organisations showing lack of value); and being supported (e.g., through regular briefing by education bodies). CONCLUSIONS: This study is the first to longitudinally explore the multiple-multidimensional transitions experienced by doctors during the COVID-19 pandemic. Our data analysis helped us move beyond existing perceptions around wellbeing and articulate multiple factors that contribute to social and cultural wellbeing. It is vital that medical educators consider the learning from these experiences to help pinpoint what aspects of support might be beneficial to trainee doctors and their trainers. This study forms the basis for developing evidenced-based interventions that ensure doctors are heard, valued and supported.

'The word that comes to mind is polymath': medical students' perceptions of rural postgraduate careers.

INTRODUCTION: Physician shortages in rural and remote areas challenge accessibility and delivery of care to rural and remote communities, including within Scotland. Medical education is a reform priority to establish a sustainable medical workforce. Although there is evidence to support aspects of medical education that enhance the likelihood of practising rurally, the mechanism by which these educational initiatives work is not clearly understood. This study aimed to examine medical students' perceptions of rural and remote practice, how these perceptions motivate their interest to practise rurally, and what aspects of education are thought to influence these perceptions. METHODS: This cross-sectional study utilised semistructured interviews with 10 University of St Andrews medical students enrolled in undergraduate or graduate-entry medical education programs. Feldman and Ng's theoretical framework was deductively applied. Interviews informed additional subthemes, which were integrated into the original framework. The final framework helped examine medical students' perceptions of rural medicine and mechanisms that shape these perceptions. RESULTS: Structural (countrywide) themes included geographical barriers affecting patients and physicians. Organisational themes included perceptions of inequitable allocation of resources between urban and rural areas, as well as limited staff and support in rural practices. Occupational themes included the perception of rural clinical generalists. Personal life themes included the perception of community in rural areas. Mechanisms shaping medical students' perceptions most profoundly were their experiences (educational, personal experience or working). CONCLUSION: Medical students' perceptions align with other professionals' reasons for staying in a particular job. Perceptions regarding rural careers included challenges due to geographical proximity to patients, resource allocation in rural areas, and the potential to subspecialise as a general rural practitioner. Identified mechanisms, which shape perceptions, can be addressed and strengthened by educators, policy-makers and governments to optimise medical education that promotes rural recruitment and retention.

'Having come to university my care was very much in my hands': exploration of university students' perceptions of health care needs and services using the common-sense model of self-regulation.

The health care needs and service experiences of higher education students require more research attention, given the increase in students who have a long-term illness, medical condition, or disability ("condition"). It is also important to consider the experiences of rising numbers of international students. This exploratory qualitative study used face-to-face interviews and the common-sense model of self-regulation to investigate students' perceptions and coping behaviours, in a higher education institution in the UK. Thematic analysis was used to analyse the data. Twenty students who self-identified as having a condition were interviewed. This study adds depth to the understanding of the connections between students' health-related experiences and their personal, academic, and post-graduation aspirations and the support needs of students, including international students. To optimise institutional support, innovations in partnerships with local care organisations and within the university, staff training about conditions, peer mentorship, and information outreach especially to international students, should be considered.

Direct observation of weight-related communication in primary care: a systematic review.

BACKGROUND: Primary care is ideally placed to play an effective role in patient weight management; however, patient weight is seldom discussed in this context. A synthesis of studies that directly observe weight discussion in primary care is required to more comprehensively understand and improve primary care weight-related communication. OBJECTIVE: To systematically identify and examine primary care observational research that investigates weight-related communication and its relationship to patient weight outcomes. METHODS: A systematic review of literature published up to August 2015, using seven electronic databases (including MEDLINE, Scopus and PsycINFO), was conducted using search terms such as overweight, obese and/or doctor-patient communication. RESULTS: Twenty papers were included in the final review. Communication analysis focused predominantly on 'practitioner' use of specific patient-centred communication. Practitioner use of motivational interviewing was associated with improved patient weight-related outcomes, including patient weight loss and increased patient readiness to lose weight; however, few studies measured patient weight-related outcomes. CONCLUSION: Studies directly observing weight-related communication in primary care are scarce and limited by a lack of focus on patient communication and patient weight-related outcomes. Future research should measure practitioner and patient communications during weight discussion and their impact on patient weight-related outcomes. This knowledge may inform the development of a communication intervention to assist practitioners to more effectively discuss weight with their overweight and/or obese patients.

The application of the Practitioners in Applied Practice Model during breaking bad news communication training for medical students: a case study.

BACKGROUND AND AIMS: Breaking bad news is a key skill within clinical communication and one which can impact outcomes for both the patient and practitioner. The evidence base for effective clinical communication training in breaking bad news is scarce. Frameworks have been found to assist the practitioner, such as SPIKES; however, the pedagogical approach used alongside such frameworks can vary. This study sought to examine the impact of utilising the Practitioners in Applied Practice Model (PAPM) alongside the SPIKES framework for training undergraduate medical students in breaking bad news. METHODS AND RESULTS: A case study approach is used to highlight the impact of training based on the PAPM and SPIKES on patient-centred communication and simulated patient satisfaction with the clinical communication behaviour. Results showed that following training, both patient-centred behaviour and patient satisfaction improved. With detailed communication behaviour changes, a balance was established between rapport building behaviour, lifestyle and psychosocial talk alongside biomedical information. CONCLUSION: This case study shows how the PAPM could be utilised alongside the SPIKES framework to improve breaking bad news communication in medical undergraduate students and describes the behavioural basis of the improvement. Further research is required to show the generalisability of this training intervention.

National survey of clinical communication assessment in medical education in the United Kingdom (UK).

BACKGROUND: All medical schools in the UK are required to be able to provide evidence of competence in clinical communication in their graduates. This is usually provided by summative assessment of clinical communication, but there is considerable variation in how this is carried out. This study aimed to gain insight into the current assessment of clinical communication in UK medical schools. METHODS: The survey was sent via e-mail to communication leads who then were asked to consult with all staff within their medical school involved in the assessment of communication. RESULTS: Results were obtained from 27 out of 33 schools (response rate 82%) and a total of 34 courses. The average number of assessments per year was 2.4 (minimum 0, maximum 10). The Objective Structured Clinical Exam (OSCE) was the most commonly used method of assessment (53%). Other assessments included MCQ and workplace based assessments. Only nine courses used a single method of assessment. Issues raised included, logistics and costs of assessing mainly by OSCE, the robustness and reliability of such exams and integration with other clinical skills. CONCLUSIONS: It is encouraging that a variety of assessment methods are being used within UK medical schools and that these methods target different components of clinical communication skills acquisition.

The power of animation: encouraging doctors to access support for psychological wellbeing.

The COVID-19 pandemic has exacerbated already high rates of poor psychological wellbeing in doctors. Many doctors perceive a stigma associated with acknowledging psychological wellbeing concerns, resulting in a reluctance to seek support for those concerns. The aim of this study was to develop a theoretically-informed and evidence-based composite narrative animation (CNA) to encourage doctors to access support for psychological wellbeing, and to evaluate the acceptability of the CNA.A composite narrative was developed from an evidence-base of interviews with 27 GP participants across Scotland (May-July 2020). The Behaviour Change Wheel was used to identify behaviour change techniques (BCTs) to be embedded within the CNA. The narrative was turned into a script in collaboration with an animation company. A brief animation 'Jane the GP' was developed reflecting specific BCTs.Scottish doctors (n = 83) were asked for their views on acceptability of the CNA concept, and subsequently asked to provide views on the acceptability of the CNA after viewing it. Participants thought the concept of a CNA was novel but may not appeal to all. After viewing the CNA, the widespread view was that it portrayed an authentic experience, could reduce stigma around seeking support for psychological wellbeing, and highlighted formal routes to access such support.CNAs are a novel and acceptable intervention method for encouraging doctors to access support for psychological wellbeing. The use of a theory driven intervention development framework to create the CNA facilitates the link between theory and practice.

Perceptions of postnatal care: factors associated with primiparous mothers perceptions of postnatal communication and care.

BACKGROUND: The aim of this study was to determine whether personality and/or psychological functioning affect mothers' perceptions of postnatal communication and their level of satisfaction with their postnatal care. Mothers' perceptions of the communication with health professionals prenatally and during birth may be affected by their personality traits and psychological functioning and are linked to the level of satisfaction they have in their healthcare. Little is known about factors that are associated with perceptions of communication within postnatal care and the impact this may have on satisfaction with care. METHODS: A cross sectional survey recruited 71 first-time mothers, who had given birth vaginally in the U.K., within the previous 12 months. The questionnaire assessed personality traits using the Big 5 Mini Marker set, levels of anxiety and depression using HADS, perceptions of communication experienced with health professionals and overall levels of satisfaction with postnatal care via the Satisfaction with Care Scale. Covariates such as demographic factors were investigated. RESULTS: Higher ratings of communication were found to be directly correlated with higher satisfaction, as were the personality traits; agreeableness, conscientiousness and emotional stability. Depression significantly lowered participants' ratings of communication experienced with health visitors and total satisfaction. Mothers who breastfed had significantly lower communication and satisfaction ratings. Multiple regression analysis revealed communication ratings explained 71.8% of the variance in the level of satisfaction and none of the remaining predictors significantly directly affected satisfaction ratings. CONCLUSION: Future research should focus on the utility of these findings for improving care for primiparous mothers.

How do United Kingdom (UK) medical schools identify and support undergraduate medical students who 'fail' communication assessments? A national survey.

BACKGROUND: The doctor's ability to communicate effectively (with patients, relatives, advocates and healthcare colleagues) relates directly to health outcomes, and so is core to clinical practice. The remediation of medical students' clinical communication ability is rarely addressed in medical education literature. There is nothing in the current literature reporting a contemporary national picture of how communication difficulties are managed, and the level of consequence (progression implications) for students of performing poorly. This survey aimed to consolidate practices for identifying and processes for managing students who 'fail' communication assessments across all UK medical schools. METHODS: Data were collected via an email survey to all leads for clinical communication in all UK Medical Schools for the UK Council for Clinical Communication in Undergraduate Medical Education. RESULTS: All but two participating Schools reported some means of support and/or remediation in communication. There was diversity of approach, and variance in the level of systemisation adopted. Variables such as individuality of curricula, resourcing issues, student cohort size and methodological preferences were implicated as explaining diversity. Support is relatively ad hoc, and often in the hands of a particular dedicated individual or team with an interest in communication delivery with few Schools reporting robust, centralised, school level processes. CONCLUSIONS: This survey has demonstrated that few Medical Schools have no identifiable system of managing their students' clinical communication difficulties. However, some Schools reported ad hoc approaches and only a small number had a centralised programme. There is scope for discussion and benchmarking of best practice across all Schools with allocation of appropriate resources to support this.

Developing research skills in medical students: AMEE Guide No. 69.

This Guide has been written to provide guidance for individuals involved in curriculum design who wish to develop research skills and foster the attributes in medical undergraduates that help develop research. The Guide will provoke debate on an important subject, and although written specifically with undergraduate medical education in mind, we hope that it will be of interest to all those involved with other health professionals' education. Initially, the Guide describes why research skills and its related attributes are important to those pursuing a medical career. It also explores the reasons why research skills and an ethos of research should be instilled into professionals of the future. The Guide also tries to define what these skills and attributes should be for medical students and lays out the case for providing opportunities to develop research expertise in the undergraduate curriculum. Potential methods to encourage the development of research-related attributes are explored as are some suggestions as to how research skills could be taught and assessed within already busy curricula. This publication also discusses the real and potential barriers to developing research skills in undergraduate students, and suggests strategies to overcome or circumvent these. Whilst we anticipate that this Guide will appeal to all levels of expertise in terms of student research, we hope that, through the use of case studies, we will provide practical advice to those currently developing this area within their curriculum.

Predictors of weight discussion in primary care consultations: A multilevel modeling approach.

OBJECTIVE: To understand how primary care weight-related communication processes are influenced by individual differences in primary care practitioner (PCP) and patient characteristics and communication use. METHODS: Two multilevel logistic regression models were calculated to predict the occurrence of 1) weight-related discussion and 2) weight-related consultation outcomes. Coded communication data (Roter Interaction Analysis System) from 218 video-recorded consultations between PCPs and patients with overweight and obesity in Scottish primary care practices were combined with their demographic data to develop the multilevel models. RESULTS: Weight-related discussions were more likely to occur when a greater proportion of PCP's total communication was partnership building and activating communication. More discrete weight discussions during a consultation predicted weight-related consultation outcomes. Patient BMI positively predicted both weight-related discussion and consultation outcomes. CONCLUSION: This work demonstrates that multilevel modeling is a viable approach to investigating coded primary care weight-related communication data and that it can provide insight into the impact that various patient and PCP factors have on these communication processes. PRACTICE IMPLICATIONS: Through the increased use of partnership building and activating communications, and by engaging in shorter, but more frequent, discussions about patient weight, PCPs may better facilitate weight-related discussion and weight-related consultation outcomes for their patients.

Supporting doctors' well-being and resilience during COVID-19: A framework for rapid and rigorous intervention development.

This paper aims to outline the development of a theoretically informed and evidence-based intervention strategy to underpin interventions to support the well-being of doctors during COVID-19 and beyond; delineate new ways of working were employed to ensure a rapid and rigorous process of intervention development and present the resulting novel framework for intervention development. The research comprised four workstreams: literature review (WS1), qualitative study (WS2), intervention development and implementation (WS3) and evaluation (WS4). Due to time constraints, we employed a parallel design for WS1-3 with the findings of WS1-2 informing WS3 on a continual basis. WS3 was underpinned by the Behaviour Change Wheel. We recruited expert panels to assist with intervention development. We reflected on decisions taken to facilitate the rapid yet rigorous process of intervention development. The empirical output was a theoretically informed and evidence-based intervention strategy to underpin interventions to support doctors' well-being during COVID-19 and beyond. The methodological output was a novel framework that facilitates rapid and rigorous development of interventions. The intervention strategy provides a foundation for development and evaluation of tailored interventions to support doctors' well-being. The novel framework provides guidance for the development of interventions where the situation demands a rapid yet rigorous development process.

Communication skills: an essential component of medical curricula. Part I: Assessment of clinical communication: AMEE Guide No. 51.

This AMEE Guide in Medical Education is Part 1 of a two part Guide covering the issues of Communication. This Guide has been written to provide guidance for those involved in planning the assessment of clinical communication and provides guidance and information relating to the assessment of various aspects of clinical communication; its underlying theory; its practical ability to show that an individual is competent and its relationship to students' daily performance. The advantages and disadvantages of assessing specific aspects of communication are also discussed. The Guide draws attention to the complexity of assessing the ability to communicate with patients and healthcare professionals, with issues of reliability and validity being highlighted for each aspect. Current debates within the area of clinical communication teaching are raised: when should the assessment of clinical communication occur in undergraduate medical education?; should clinical communication assessment be integrated with clinical skills assessment, or should the two be separate?; how important should the assessment of clinical communication be, and the question of possible failure of students if they are judged not competent in communication skills? It is the aim of the authors not only to provide a useful reference for those starting to develop their assessment processes, but also provide an opportunity for review and debate amongst those who already assess clinical communication within their curricula, and a resource for those who have a general interest in medical education who wish to learn more about communication skills assessment.

Medical Curriculum: How Do We Manage Incidental Findings in Educational Settings?

Medical curricula encompass two practical-based teaching categories with likelihood of identifying incidental findings (unexpected and previously undiagnosed findings with potential health implications) in live models for demonstration purposes. One relates to clinical skills involving peers and simulated or volunteer patients. The other involves laboratory sessions, with live models, for the purposes of demonstrating scientific principles. As educationalists, it is our professional and ethical duty to have guidance on how to manage incidental findings. In this commentary, we have outlined our best practice guidelines formalised as a written policy exploring consent, debriefing, and the teachers' role. Our aim was to develop an 'easy-to-follow' standardised mechanism.

Empathy maps in communication skills training.

BACKGROUND: Empathy is a cornerstone of patient-centred care. However, empathy levels among health care professionals and medical students are currently suboptimal. An empathy map is a tool which aids in understanding another person's perspective. Empathy maps have up until now not been used in a medical education setting. OBJECTIVE: To assess the attitudes towards, applicability and usefulness of empathy maps as part of medical student's communication skills training. METHODS: Empathy map training was introduced to first-year medical student communication skills training at two UK-based medical schools. Twenty-eight participants in total agreed to be interviewed about their experiences using the empathy map, including sixteen students and twelve patient partners who assisted with communication skills training. RESULTS: Medical students and patient partners perceive value in empathy map training. Medical students stated that the empathy map training impacted on their views of empathy and patient-centredness by highlighting the importance of patient-centred care. Medical students and patient partners enjoyed the experience of completing the empathy map and had suggestions for how it could be improved in the future. CONCLUSIONS: Empathy maps could provide a cost-effective way to encourage empathic and patient-centred care in medical education. Furthermore, there is no reason why empathy maps would not aid in any caring profession. Further research is needed to confirm that empathy maps do increase empathy.

Interventions for the well-being of healthcare workers during a pandemic or other crisis: scoping review.

OBJECTIVES: The aim of this scoping review was to identify pre-existing interventions to support the well-being of healthcare workers during a pandemic or other crisis and to assess the quality of these interventions. DESIGN: Arksey and O'Malley's five-stage scoping review framework was used to identify the types of evidence available in the field of well-being interventions for healthcare workers during a pandemic. PubMed, PsycINFO, Embase, Scopus, Web of Science, CINAHL and ERIC databases were searched to find interventions for the well-being of doctors during pandemics. Owing to a lack of results, this search was expanded to all healthcare workers and to include any crisis. Databases were searched in June 2020 and again in October 2020. INCLUSION/EXCLUSION CRITERIA: Articles were included that studied healthcare workers, reported an intervention design and were specifically designed for use during a pandemic or other crisis. Well-being was defined broadly and could include psychological, physical, social or educational interventions. RESULTS: Searching produced 10 529 total academic references of which 2062 were duplicates. This left 8467 references. Of these, 16 met our inclusion criteria and were included in data extraction. During data extraction, three more papers were excluded. This left 13 papers to summarise and report. Of these 13 papers, 6 were prospective studies and 7 were purely descriptive. None of the interventions were theoretically informed in their development and the quality of the evidence was generally deemed poor. CONCLUSIONS: There are no high-quality, theory-based interventions for the well-being of healthcare workers during a pandemic or other crisis. Given that previous pandemics have been shown to have a negative effect on healthcare workers well-being, it is imperative this shortcoming is addressed. This scoping review highlights the need for high-quality, theory-based and evidence-based interventions for the well-being of healthcare workers during a pandemic.

Primary care patient and practitioner views of weight and weight-related discussion: a mixed-methods study.

OBJECTIVE: To understand the beliefs that primary care practitioners (PCPs) and patients with overweight and obesity have about obesity and primary care weight management in Scotland. SETTING: Seven National Health Service (NHS) Scotland primary care centres. PARTICIPANTS: A total of 305 patients and 14 PCPs (12 general practitioners; two practice nurses) participated. DESIGN AND METHODOLOGY: A cross-sectional mixed-methods study. PCPs and patients completed questionnaires assessing beliefs about obesity and primary care weight communication and management. Semi-structured interviews were conducted with PCPs to elaborate on questionnaire topics. Quantitative and qualitative data were synthesised to address study objectives. RESULTS: (1) Many patients with overweight and obesity did not accurately perceive their weight or risk of developing weight-related health issues; (2) PCPs and patients reported behavioural factors as the most important cause of obesity, and medical factors as the most important consequence; (3) PCPs perceive their role in weight management as awareness raising and signposting, not prevention or weight monitoring; (4) PCPs identify structural and patient-related factors as barriers to weight communication and management, but not PCP factors. CONCLUSIONS: Incongruent and/or inaccurate beliefs held by PCPs and patient may present barriers to effective weight discussion and management in primary care. There is a need to review, standardise and clarify primary care weight management processes in Scotland. Acknowledging a shared responsibility for obesity as a disease may improve outcomes for patients with overweight and obesity.