Medical and pharmacy students' perspectives of remote synchronous interprofessional education sessions.

BACKGROUND: Interprofessional education (IPE) at university level is an essential component of undergraduate healthcare curricula, as well as being a requirement of many associated regulatory bodies. In this study, the perception of pharmacy and medical students' of remote IPE was evaluated. METHODS: A series of IPE sessions took place via Zoom and students' feedback was collected after each session. Both qualitative and quantitative data were collected and analysed. RESULTS: 72% (23/32) of medical students strongly agreed that the sessions had helped to improve their appreciation of the role of pharmacists, whereas 37% (22/59) of pharmacy students strongly agreed, reporting a median response of 'somewhat agreeing', that their appreciation of the role of general practitioners had improved. This difference was found to be statistically significant (p = 0.0143). Amongst students who responded, 55% (53/97) identified remote teaching as their preferred mode of delivery for an IPE session. CONCLUSIONS: The survey demonstrated that the students valued the development of their prescribing skills as well as the ancillary skills gained, such as communication and teamwork. Remote IPE can be a practical means of improving medical and pharmacy students' understanding of each other's professional roles, as well as improving the skills required for prescribing.

GP registrars teaching medical students- an untapped resource?

BACKGROUND: General practice placements are fundamental to undergraduate medical education but there are difficulties in recruiting teaching practices. Developing "near peer teaching" may help. Health Education England & UCL run a programme in general practice (GP) training schemes with Innovative Training Posts in medical education. AIM: To evaluate GP innovative training posts in undergraduate medical education. DESIGN AND SETTING: Focus groups and interviews with GP specialty trainees ("trainees"), medical students & educational stakeholders in London. METHOD: A qualitative study exploring stakeholders' perspectives of this initiative. Transcribed interviews were analysed thematically. RESULTS: We interviewed 26 stakeholders. Students valued trainees' generalist expertise and making explicit areas of medicine. Trainees adopted student-centred approaches, addressing students' assessment agendas, in contrast to senior doctors. Trainees also provided career guidance. Trainees expressed benefits to their development; their identity as learners & educators, and clinical knowledge. Teaching & learning for trainees were inter related; as identified by "to teach something well is to understand it well". Educational leaders were supportive but had to champion such initiatives. CONCLUSION: Near peer teaching in general practice is relatively novel. There are strong educational benefits for learners & teachers clearly influenced by the social context of learning. Positive career roles are modelled by trainees.

Promoting general practice in medical schools. Where are we now?

In November 2016, the Medical Schools Council and Health Education England published a joint report chaired by Professor Val Wass: 'By choice - not by chance' to raise the profile of general practice as a positive career choice for medical students. We sought to evaluate the impact of the report by firstly, asking the views of Heads of GP teaching at UK medical schools whether and how the report has supported them in raising the profile of general practice and secondly, describing the initiatives developed by medical schools in a national survey. There was a perception reported by heads of GP teaching that the report has been highly influential in facilitating the promotion of general practice as a career to medical students. We describe multiple specific initiatives developed in response to the report's recommendations. The national survey confirmed that whilst there is significant variation across medical schools in their response to the specific recommendations in the report, definite progress is being made. A number of areas that need particular consideration have been highlighted and we would recommend that future surveys are completed at appropriate time intervals to review further progress.

Near peer teaching in general practice: option or expectation?

General Practice (GP) trainees who teach medical students do so as near peers with established educational benefits for all concerned. Through teaching, GP trainees consolidate their own knowledge and skills whilst students value the experience of learning from teachers closer in age and stage. Importantly, involving GP trainees as teachers increases primary care teaching capacity and promotes GP as a potential career option for undergraduates. However, whilst junior doctors are often to be found teaching on hospital wards and in clinics, GP trainees based in primary care appear to have fewer opportunities to teach. This article encourages the promotion of near peer teaching in primary care on several levels. We make practical suggestions of potential benefit to the individual GP trainee, trainer and practice. We also discuss ways in which key stakeholders, including medical schools and those organising post-graduate primary care training programmes, may promote near peer teaching in GP. We propose that all medical students should have experience of being taught by GP trainees, and that all future general practitioners should have training and experience of teaching undergraduate medical students.

Is there a role for GPs in teaching neurology to medical students? A qualitative evaluation.

INTRODUCTION: The purpose of this study was to evaluate whether GPs can support medical students in learning basic neurology in the context of a traditional hospital neurology attachment. METHOD: This was a qualitative evaluation using routinely collected data from stakeholders, consisting of qualitative data in the form of student evaluation questionnaires, course documentation and correspondence from faculty staff. RESULTS: The addition of GP teaching to the programme increased availability of patients with neurological problems accessible to students and provided a safe, supportive environment for students to learn their fundamental clinical skills. Students gained valuable insights into the impact of neurological disease from the perspective of patients, their families and carers. GP teaching of neurology was well regarded by students. Some GP tutors felt they lacked adequate experience to teach more technical aspects of neurology, and some students shared this concern. Concepts of professional boundaries between generalists and specialists were not observed, but GP teaching was perceived to be 'other' or outside normal medical school activity. CONCLUSIONS: General practitioners can successfully facilitate students' access to patients with neurological disease and employ their generalist to enhance neurological learning. Some GPs were initially uncomfortable with teaching skills such as detailed neurological physical examination.

Do primary care placements influence career choice: What is the evidence?

BACKGROUND: The NHS is struggling with GP recruitment. The Health Education England (HEE) Wass Report (By Choice not by Chance), among its recommendations to boost GP numbers, highlighted undergraduate (UG) GP placement experience as an important influence on future career choice. Aim To explore the UG influences on GP career choice. METHODS: Two junior doctors produced a pragmatic rapid appraisal of the literature on the UG influences on GP career choice for the Wass Report. The search strategy was supported by librarians and focused on rapidly accessing and summarising relevant literature. Databases searched, including Medline, EMBASE, HMIC & grey literature, revealed 294 items. Data extraction and synthesis was pragmatic. RESULTS: The international evidence suggests that UG GP experience can positively influence students towards a primary care career. Longitudinal placements are more influential than traditional blocks. UK literature is limited, but there are consistencies with the international evidence. The relevant studies identified are observational with risk of bias, but this is unavoidable within this research context. DISCUSSION: The implications of these results for medical school curricula are discussed with particular reference to Government plans to expand medical student numbers and establish new medical schools with explicit aims to produce more GPs.

"You kind of want to fix it don't you?" Exploring general practice trainees' experiences of managing patients with medically unexplained symptoms.

BACKGROUND: Much of a General Practitioner's (GP) workload consists of managing patients with medically unexplained symptoms (MUS). GP trainees are often taking responsibility for looking after people with MUS for the first time and so are well placed to reflect on this and the preparation they have had for it; their views have not been documented in detail in the literature. This study aimed to explore GP trainees' clinical and educational experiences of managing people presenting with MUS. METHOD: A mixed methods approach was adopted. All trainees from four London GP vocational training schemes were invited to take part in a questionnaire and in-depth semi-structured interviews. The questionnaire explored educational and clinical experiences and attitudes towards MUS using Likert scales and free text responses. The interviews explored the origins of these views and experiences in more detail and documented ideas about optimising training about MUS. Interviews were analysed using the framework analysis approach. RESULTS: Eighty questionnaires out of 120 (67%) were returned and a purposive sample of 15 trainees interviewed. Results suggested most trainees struggled to manage the uncertainty inherent in MUS consultations, feeling they often over-investigated or referred for their own reassurance. They described difficulty in broaching possible psychological aspects and/or providing appropriate explanations to patients for their symptoms. They thought that more preparation was needed throughout their training. Some had more positive experiences and found such consultations rewarding, usually after several consultations and developing a relationship with the patient. CONCLUSION: Managing MUS is a common problem for GP trainees and results in a disproportionate amount of anxiety, frustration and uncertainty. Their training needs to better reflect their clinical experience to prepare them for managing such scenarios, which should also improve patient care.

A BEME systematic review of UK undergraduate medical education in the general practice setting: BEME Guide No. 32.

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.

Use of primary care data for detecting impetigo trends, United kingdom, 1995-2010.

Using a primary care database, we identified a major increase in impetigo in the United Kingdom during 1995-2010. Despite a doubled rate of primary care consultations, this increase was not identified by routine surveillance. Primary care databases are a valuable and underused source of surveillance data on infectious diseases.

Primary care in the world of integrated care systems: education and training for general practice.

Here, we discuss the required education and training for the emergent and evolving roles of GPs and other healthcare professionals within Integrated Care Systems (ICSs). We underscore the importance of collaborative skills for all medical specialties, and the need for interprofessional education and leadership development in undergraduate and postgraduate medical training. We also argue for a paradigm shift in medical education, away from traditional siloed approaches and toward comprehensive training that prepares practitioners to excel in integrated and multidisciplinary healthcare environments, within which expert generalists (GPs) and specialists collaborate in individual patient care and concurrently co-develop innovative system pathways for chronic medical conditions, including complexity and frailty. We highlight the need to align workforce development with evolving healthcare systems and the existing obstacles hindering this alignment.

Teaching about medically unexplained symptoms at medical schools in the United Kingdom.

BACKGROUND: Medically unexplained symptoms (MUS) are very common in primary and secondary care. They are often inappropriately managed, resulting in potential harm to patients as well as wasted resources. To bring about change, it is important that newly qualified doctors are equipped with the skills to manage MUS effectively. We do not know if and how this topic is currently taught at U.K. medical schools. AIM: To document whether, how and when this topic is currently taught in U.K. medical schools. To assess potential barriers to this teaching and consider how it can be improved. METHODS: A questionnaire survey emailed to GP and psychiatry teaching leads at all 31 U.K. medical schools. RESULTS: Responses received from 24/31 schools showed that MUS teaching across U.K. medical schools is very variable in terms of amount, method, assessment and integration of the teaching within the curriculum. Most respondents identified a need for a greater quantity of cross-discipline teaching and for greater value to be attributed to the topic. CONCLUSION: Inconsistent and disparate teaching across medical schools may lead to very variable practice amongst qualified clinicians. In order to overcome this, consensus is needed as to how and where in the undergraduate curriculum there should be teaching about MUS.

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

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

Revealing the reality of undergraduate GP teaching in UK medical curricula: a cross-sectional questionnaire study.

BACKGROUND: Time in general practice offers medical students opportunities to learn a breadth of clinical knowledge and skills relevant to their future clinical practice. Undergraduate experiences shape career decisions and current recommendations are that 25% of undergraduate curriculum time should be focused on general practice. However, previous work demonstrated that GP teaching had plateaued or reduced in UK medical schools. Therefore, an up-to-date description of undergraduate GP teaching is timely. AIM: To describe the current picture of UK undergraduate GP teaching, including the amount of time and resources allocated to GP teaching. DESIGN AND SETTING: A cross-sectional questionnaire study across 36 UK medical schools. METHOD: The questionnaire was designed based on a previous survey performed in 2011-2013, with additional questions on human and financial support allocated to GP teaching. The questionnaire was piloted and revised prior to distribution to leads of undergraduate GP teaching in UK medical schools. RESULTS: The questionnaire response rate was 100%. GP teaching constituted an average of 9.2% of medical curricula; this was lower than previous figures, though the actual number of GP sessions has remained static. The majority (n = 23) describe plans to increase GP teaching in their local curricula over the next 5 years. UK-wide average payment was 55.60 GBP/student/session of in-practice teaching, falling well below estimated costs to practices. Allocation of human resources was varied. CONCLUSION: Undergraduate GP teaching provision has plateaued since 2000 and falls short of national recommendations. Chronic underinvestment in GP teaching persists at a time when teaching is expected to increase. Both aspects need to be addressed to facilitate high-quality undergraduate GP teaching and promotion of the expert medical generalist role.

Your life in their pocket: students' behaviors regarding confidential patient information.

BACKGROUND AND OBJECTIVES: Physicians are sometimes poor at observing patient confidentiality. Medical students have access to patients and their medical records, but there is little known about how well students respect patients' confidentiality. Our objective was to study how medical students deal with confidential patient information. METHODS: Qualitative research methods (focus groups, semi-structured interviews, and direct peer observation of student activity) were used to explore the approach of medical students to patient confidentiality in a British medical school. RESULTS: We interviewed 32 students, held focus groups involving 24 students, and undertook direct observation of student activity. The main themes derived from the data included the context within which students practice, variation in students' attitude and behavior toward patient confidentiality, and the dissonance between confidentiality theory and practice. CONCLUSIONS: While many students practiced in a professional manner, several reported markedly suboptimal performance in themselves or others. These behaviors appear to be driven by students' own professionalism and behavior learned from senior colleagues. While new technologies pose some particular threats to confidentiality, paper records seem just as vulnerable.

Development of the Veritas plot and its application in cardiac surgery: an evidence-synthesis graphic tool for the clinician to assess multiple meta-analyses reporting on a common outcome.

BACKGROUND: Meta-analyses may be prone to generating misleading results because of a paucity of experimental studies (especially in surgery); publication bias; and heterogeneity in study design, intervention and the patient population of included studies. When investigating a specific clinical or scientific question on which several relevant meta-analyses may have been published, value judgments must be applied to determine which analysis represents the most robust evidence. These value judgments should be specifically acknowledged. We designed the Veritas plot to explicitly explore important elements of quality and to facilitate decision-making by highlighting specific areas in which meta-analyses are found to be deficient. Furthermore, as a graphic tool, it may be more intuitive than when similar data are presented in a tabular or text format. METHODS: The Veritas plot is an adaption of the radar plot, a graphic tool for the description of multiattribute data. Key elements of meta-analytical quality such as heterogeneity, publication bias and study design are assessed. Existing qualitative methods such as the Assessment of Multiple Systematic Reviews (AMSTAR) tool have been incorporated in addition to important considerations when interpreting surgical meta-analyses such as the year of publication and population characteristics. To demonstrate the potential of the Veritas plot to inform clinical practice, we apply the Veritas plot to the meta-analytical literature comparing the incidence of 30-day stroke in off-pump coronary artery bypass surgery and conventional coronary artery bypass surgery. RESULTS: We demonstrate that a visually-stimulating and practical evidence-synthesis tool can direct the clinician and scientist to a particular meta-analytical study to inform clinical practice. The Veritas plot is also cumulative and allowed us to assess the quality of evidence over time. CONCLUSION: We have presented a practical graphic application for scientists and clinicians to identify and interpret variability in meta-analyses. Although further validation of the Veritas plot is required, it may have the potential to contribute to the implementation of evidence-based practice.

Medical student mentoring programs: current insights.

Medical school mentoring programs incorporate a wide range of objectives. Clinical mentoring programs help to develop students' clinical skills and can increase interest in under-subscribed specialties. Those that focus on teaching professionalism are integrated into medical school curriculums in order to overcome the "hidden curriculum". Positive mentoring plays a part in reversing the decline of academic medicine, by sparking interest through early research experiences. It also has an important role in encouraging recruitment of under-represented minority groups into the medical profession through widening access programs. The aim of our review of the literature, is to analyze current trends in medical student mentoring programs, taking into account their objectives, execution, and evaluation. We outline the challenges encountered, potential benefits, and key future implications for mentees, mentors, and institutions.

Universities and primary care organisations working together to recruit GPs: a qualitative evaluation of the Enfield clinical teaching fellow programme.

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.

Pharmacological manipulations of arousal and memory for emotional material: effects of a single dose of methylphenidate or lorazepam.

Benzodiazepines produce robust impairments of memory alongside global decreases in physiological and subjective arousal. Recently one benzodiazepine (triazolam) has been found to disproportionately impair memory for emotionally arousing material (Buchanan et al., 2003). The extent to which this effect may be mediated by the drug's sedative action is unclear. The present study aimed to assess how pharmacologically decreasing physiological arousal with a benzodiazepine and increasing arousal with a stimulant impact on memory for emotional material. A double-blind placebo controlled trial with 48 volunteers was used to investigate the effects of methylphenidate (40 mg) and Lorazepam (1.5 mg) on incidental memory for emotional material in Cahill and McGaugh's (1995) slide-story task. The slide-story was presented to participants administered either active drug or placebo and retrieval was assessed one week later. Methylphenidate produced stimulant effects and Lorazepam produced sedative effects. Significantly enhanced memory for emotional material was observed in participants given placebo, but not in those given either methylphenidate or Lorazepam. Despite producing opposite effects upon arousal, both methylphenidate and Lorazepam lessen the impact of emotionally arousing material on memory. The effects of Lorazepam add to a growing literature that benzodiazepines may exert their clinical, anxiolytic effects in part via altering emotionaL cognitive function.