Does telemedicine reduce the carbon footprint of healthcare? A systematic review.

In the rapidly progressing field of telemedicine, there is a multitude of evidence assessing the effectiveness and financial costs of telemedicine projects; however, there is very little assessing the environmental impact despite the increasing threat of the climate emergency. This report provides a systematic review of the evidence on the carbon footprint of telemedicine. The identified papers unanimously report that telemedicine does reduce the carbon footprint of healthcare, primarily by reduction in transport-associated emissions. The carbon footprint savings range between 0.70-372 kg CO2e per consultation. However, these values are highly context specific. The carbon emissions produced from the use of the telemedicine systems themselves were found to be very low in comparison to emissions saved from travel reductions. This could have wide implications in reducing the carbon footprint of healthcare services globally. In order for telemedicine services to be successfully implemented, further research is necessary to determine context-specific considerations and potential rebound effects.

Understanding the fundamental elements of global health: Using the sen capability approach as the theoretical framework for a health needs assessment in deprived communities.

Background: The health needs in poor communities are often dictated by data that is not relevant to the community. The capabilities approach (CA) offers a philosophical and practical way to frame and analyse data and apply it to a community using the World Health Organisation socioeconomic framework. This was part of the NHS Health Education England East Midlands Global Health Exchange Fellow Programme. Methods: A team of 2 Kenyan and 2 UK community clinicians worked together in deprived communities in Kenya and the UK using qualitative research methods to facilitate the communities to define and prioritise their health needs and to explore their potential resources and how they might achieve their needs sustainably. The CA was used in the data collection and data analysis phases. Results: The team of fellows gained personal understanding of the reality of the impact of social determinants on health experiences and outcomes. The CA offers the health systems and services a way to engage hard to reach communities with issues that they know to be important and are then able to prioritise. Clinicians who are taught in the evidence based style need to reframe their understanding of community needs if they are to be effective in their work. Working in this way can challenge their own values and beliefs. With planned support this can be a powerful developmental process and the CA is a set of principles that can be used to facilitate the empowerment of communities, the service planners and providers.

Developing a set of quality criteria for community-based medical education in the UK.

CONTEXT: General practices educate increasing numbers of learners at various stages. Criteria for educational provision exist, but practices supporting learners at different stages and from different institutions might face different criteria. METHODS: Criteria for practice-based teaching were developed at a workshop at a national conference. An online Delphi questionnaire invited educationalists to label these criteria as 'essential', 'desirable' or 'unnecessary' for 'occasional', 'intensive' and 'foundation year' teaching. Two rounds of the Delphi were completed. The views about the criteria of a range of stakeholders were explored using focus groups and telephone interviews. RESULTS: We generated 76 criteria in five domains; physical environment, learning environment, tutor characteristics, patient involvement and departmental responsibilities. Stakeholders' views differed concerning the merits of criteria and which should take greatest priority. None felt that developing such a list was inappropriate. They proposed no new criteria to add to those identified in the Delphi process. CONCLUSION: To the best of our knowledge this is the first nationally derived list of criteria, capable of being used in both undergraduate and postgraduate practice-based medical education. These criteria can provide a benchmark against which to set local criteria.

The GP curriculum: three years, five years, or life?

The NHS needs an adequate supply of competent generalist doctors working in primary care. In the modern NHS these doctors are required to deliver across the clinical and managerial range and from a personal to a population focus. It is important that the required time is provided to learn to deliver the content in the most relevant context. The professional opinion based on growing evidence is that the length of training required to achieve independent (competent) status should be increased from three to five years.

A UK-wide postal survey to evaluate palliative care education amongst General Practice Registrars.

OBJECTIVES: To evaluate the content of General Practice Registrars' (GPRs) palliative care education in the U.K. METHODS: Postal questionnaires were sent to 492 eligible GPRs across six purposively sampled U.K. postgraduate deaneries. RESULTS: GPRs were satisfied with their course coverage on control of pain, other symptoms and communication skills, and were also moderately confident in applying the knowledge gained in these areas. They showed a high level of knowledge in the management of cancer-related pain. There was less satisfaction with the coverage given to syringe driver use (38%) and bereavement care (36%), with fewer expressing confidence in applying their knowledge to these areas. CONCLUSIONS: GPRs have mixed perceptions about their palliative care education. Future educational packages should ensure that GPRs receive planned systematic training in bereavement care and some practical experience in the use of syringe drivers. Both Postgraduate General Practice Education departments and specialist palliative care providers should explore ways of working more closely together to provide GPRs with more expertize in palliative care.

Impact on patients of expanded, general practice based, student teaching: observational and qualitative study.

OBJECTIVES: To compare patients' enablement and satisfaction after teaching and non-teaching consultations. To explore patients' views about the possible impact that increased community based teaching of student doctors in their practice may have on the delivery of service and their attitudes towards direct involvement with students. DESIGN: Observational study using validated survey instruments (patient enablement index--PEI, and consultation satisfaction questionnaire--CSQ) administered after teaching consultations and non-teaching consultations. Ten focus groups (two from each practice), comprising five with patients participating in prearranged teaching sessions and five with patients not participating in these. SETTING: Five general practices in west Suffolk and southern Norfolk, England, that teach student doctors on the Cambridge graduate medical course. PARTICIPANTS: 240 patients attending teaching consultations (response rate 82%, 196 patients) and 409 patients attending non-teaching consultations (response rate 72%, 294 patients) received survey instruments. Ten focus groups with a total of 34 patients participating in prearranged teaching sessions and 20 patients not participating in these. MAIN OUTCOME MEASURES: Scores on the patient enablement index and consultation satisfaction questionnaire, analysed at the level of all patients, allowing for age, sex, general practitioner, and practice, and at the level of the individual general practitioner teacher. Qualitative analysis of focus group data. RESULTS: Patients' enablement or satisfaction was not reduced after teaching consultations compared with non-teaching consultations (mean difference in scores on the patient enablement index and consultation satisfaction questionnaire with adjustment for confounders 2.24% and 1.70%, respectively). This held true for analysis by all patients and by general practitioner teacher. Qualitative data showed that patients generally supported the teaching of student doctors in their practice. However, this support was conditional on receiving sufficient information about reasons for doctors' absence, the characteristics of students, and the nature of teaching planned. Many patients viewed their general practice as different from hospital and expected greater control over students' presence during their consultations. CONCLUSIONS: Patients' enablement and satisfaction are not impaired by students' participation in consultations. Patients generally support the teaching of student doctors in their general practice but expect to be provided with sufficient information and to have a choice about participation, so they can give informed consent. Recognising this when organising general practice based teaching is important.

Developing an educational curriculum in primary care with practitioner and manager involvement: the governance shackle.

This article describes what happened when we attempted to set up an educational development project to design a syllabus and implementation strategy for GP education in England. Grounded in good practice our approach involved consultations with a range of relevant professionals. Because we adopted a rigorous approach to the definition of our plans and to the recording of data collected we attracted research ethics and research governance attention. The governance processes involved were cumbersome. Requirements were inconsistent and there was also much replication. Considerable resources were consumed. We question some of the implications of our experience for educational development projects in terms of quality assurance, resources and professional inclusivity.

The East Anglia Deanery Communication Skills Teaching Project-six years on.

This paper describes the Cascade Communication Skills Teaching Project, which is a programme of facilitator training enabling communication skills teaching in the consultation to general practitioners to be cascaded throughout the former East Anglia Deanery. The paper also explores the project's educational and organizational effectiveness. The programme is based on an ongoing training programme for a cohort of around 30 district-based communication skills facilitators, and was set up in the autumn of 1995. These facilitators are now able to act as a resource to cascade high-quality communication skills teaching into vocational training schemes, trainer education and the continuing professional development of established general practitioners throughout each district in the region. The project has now been extended into medical student teaching, specialist teaching at junior and senior level, and multi-disciplinary teaching.