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

BJGP Open ◽  
2018 ◽  
Vol 2 (1) ◽  
pp. bjgpopen18X101361 ◽  
Author(s):  
Melvyn, M Jones ◽  
Nadia Bashir ◽  
Neetha Purushotham ◽  
Rachel Friel ◽  
Joe Rosenthal
Keyword(s):  
Primary Care ◽  
Student Teaching ◽  
Clinical Teaching ◽  
Undergraduate Teaching ◽  
Junior Doctors ◽  
Development Projects ◽  
Teaching Fellows ◽  
North East ◽  
Working Together ◽  
Service Collaboration

BackgroundGeneral 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.AimTo evaluate an academic service collaboration on GP recruitment between a primary care organisation (PCO), Enfield CCG, and a university, University College London (UCL).Design & settingEvaluation of an academic service collaboration in the Enfield CCG area of north east London.MethodAn 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.ResultsFive 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.ConclusionThe 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.

scholarly journals The Effect of Teaching Family Medicine Clerkship Students on Preceptor Productivity

PRiMER ◽  
2020 ◽  
Vol 4 ◽  
Author(s):  
Tomoko Sairenji ◽  
Samuel Griffin ◽  
Misbah Keen
Keyword(s):  
Primary Care ◽  
Medical Student ◽  
Family Medicine ◽  
Student Teaching ◽  
Primary Care Physicians ◽  
Clinical Teaching ◽  
Medical Student Education ◽  
Billing Data ◽  
Medicine Clerkship ◽  
Number Of Patients

Introduction: High-quality, experiential learning in outpatient settings is indispensable for medical student education; however these settings are difficult to recruit and retain. The majority of primary care physicians are employed by organizations and are under pressure to increase their relative value unit (RVU) production. Although the common perception that teaching medical students decreases productivity is unproven, it is likely a barrier for primary care physicians pursuing clinical teaching. We sought to investigate whether medical student teaching affects clinical productivity. Methods: We recruited 15 family medicine (FM) clerkship sites to participate in our study via email and at an in-person meeting. For each preceptor, we collected billing data in the form of current procedural terminology (CPT) codes for all patient encounters and the number of patients seen per half-day for when the preceptor had a student and when they did not. We converted CPT codes to RVU data. We compared differences in productivity for each individual preceptor, and we used a paired t test to examine collective data with and without a student. Results: Ten preceptors at six FM clerkship sites provided reliable data. The average RVU per half-day without a student was 10.84, and it was slightly higher at 11.25 when a student was present (P=.74). The average number of patients seen per half-day without a student was 8.32 and it was slightly lower at 7.87 when a student was present (P=.58). Conclusion: This study shows promising data that teaching students in the outpatient setting does not decrease preceptor productivity. This pilot study can lead to a larger-scale exploration of family medicine preceptor productivity in different settings and institutions.

Establishment of Primary Care Continuity Experiences in Community Pediatricians' Offices: Nuts and Bolts

PEDIATRICS ◽  
1993 ◽  
Vol 91 (6) ◽  
pp. 1185-1189
Author(s):  
Janice R. Sargent ◽  
Lucy M. Osborn ◽  
Kenneth B. Roberts ◽  
Thomas G. DeWitt
Keyword(s):  
Primary Care ◽  
Medical Education ◽  
Professional Education ◽  
Primary Care Physicians ◽  
Clinical Training ◽  
Clinical Teaching ◽  
Tertiary Care ◽  
Ambulatory Training ◽  
Lengths Of Stay ◽  
Tertiary Care Centers

During the past 30 years, there has been an increasing awareness of the importance of ambulatory care training in medical education. The discrepancy between education and practice was pointed out in the General Professional Education Panel report that indicated training was based largely in hospital settings even though the vast majority of doctor-patient encounters do not result in hospitalization.1 Perkoff,2 noting changes in hospital care such as shorter lengths of stay, increased outpatient care, and the need for well-trained primary care physicians, stated that programs need to make a major effort to emphasize clinical teaching in outpatient settings. Recognizing the need for these changes, the Accreditation Council on Graduate Medical Education (ACGME) has increased dramatically the requirement in primary care specialties for clinical ambulatory training.3 For pediatrics, these requirements have progressed from the suggestion that clinical training should be obtained in outpatient clinics (1961) to requiring clinical training in primary care clinics weekly for 3 years (1985). The problems in providing good training in ambulatory settings have been well described.2-4 In comparison inpatient teaching, training students and residents in an outpatient clinic is inefficient and costly. One of the methods suggested to address these problems has been to move ambulatory training out of tertiary care centers to community sites.5-9 Many pediatric programs are now using community sites for at least a portion of resident education.10 Alpert et al10 and Greenberg et al,11 although encouraging the use of these sites to reduce the gap between pediatric education and the service delivery system, pointed out that there are no standards for use of community sites.

scholarly journals Managing an Integrated Project - Experiences from the Realigning Agriculture to Improve Nutrition project

2016 ◽  
Vol 3 ◽  
pp. 5035 ◽  
Author(s):  
Kai Matturi ◽  
Chris Pain
Keyword(s):  
Project Management ◽  
International Development ◽  
Project Manager ◽  
Management Approach ◽  
Development Projects ◽  
Donor Funding ◽  
New Approach ◽  
Working Together ◽  
Common Goals ◽  
Integrated Project

Over the last number of decades there has been a tendency within the international development sector to privilege the management of projects in a siloed manner. This translates to projects managed in a narrow way according to pre-defined parameters of say the education or health sectors. As a project manager you are held accountable for delivering education or health outputs. A shift in donor funding to focus on development projects that are considered easy to administer partly explains this siloed approach to project management within the development sector. However, there is a gradual kick back against the siloed project management approach. Instead we are seeing a return to an integrated managerial approach.An integrated managerial approach involves bringing together various technical specialists to work on common objectives in a coordinated and collaborative manner. A growing number of development actors such as Concern Worldwide are embracing this ‘new approach’. For Concern Worldwide integrated projects are interventions which address multiple needs through coordination across a variety of sectors and with the participation of all relevant stakeholders to achieve common goals. Integrated projects are about sector projects working together with the same target group in the same area in a coordinated manner. This paper reflects on Concern’s experience and evidence to date with integration drawing on the agency’s work in Zambia. The Realigning Agriculture to Improve Nutrition project in Zambia highlights the practical challenges and lessons of managing an integrated project.   

scholarly journals Whys and hows of patient-based teaching

2005 ◽  
Vol 11 (3) ◽  
pp. 223-231 ◽  
Author(s):  
Monica Doshi ◽  
Nick Brown
Keyword(s):  
Medical Education ◽  
Government Policy ◽  
Clinical Teaching ◽  
Curriculum Planning ◽  
Junior Doctors ◽  
Patient Relationship ◽  
Patient Assessment ◽  
Doctor Patient Relationship ◽  
Recent Developments ◽  
Uk Government

Recent developments in medical education and in UK government policy for the training and service commitment of junior doctors have highlighted the need to examine clinical teaching. There is growing evidence of the effectiveness of more structured approaches to patient-based teaching. The scope of what can be taught includes the three domains of knowledge, skill and attitudes. There are proven models to deliver teaching not only of patient assessment and management but also of all aspects of the doctor–patient relationship. The application of patient-based teaching is entirely consonant with the rigours of the outcome-based approach to curriculum planning and delivery. The successful, thoughtful adoption of patient-based teaching is part of the ‘professionalisation’ of education in psychiatry that in turn begs questions about the learning, accreditation and reward of those involved as teachers at all levels.

scholarly journals Vignette research on messy and confusing problems in primary mental healthcare

2017 ◽  
Vol 13 (2) ◽  
pp. 300-313 ◽  
Author(s):  
E. H. (Dineke) Smit ◽  
J. J. L. (Jan) Derksen
Keyword(s):  
Primary Care ◽  
Mixed Method ◽  
Healthcare Professionals ◽  
Mental Healthcare ◽  
Complex Dynamic ◽  
Negative Feedback Loops ◽  
Norms And Values ◽  
The Family ◽  
Mixed Feelings ◽  
Working Together

The average primary care psychologist feels an ever-widening gap between objective, measurable reality as described and the complex and dynamic reality they experience. To obtain a better understanding of this complex dynamic reality, we conducted an exploratory mixed-method study of primary care psychologists. We asked our participants to write vignettes about messy and confusing problems in the complex context of mental healthcare. We then examined the data in portions, exposed the patterns in the data, and subsequently analysed all in conjunction. The 113 vignettes showed experiences of psychologists dealing not only with the patient, but also with the family of the patient and/or employers, working together with other healthcare professionals, struggling with dilemmas and having mixed feelings. However, using the Cynafin Framework, 36% of the vignettes were still rated as simple. Was it because those vignettes contained fewer words (p = .006)? Or because it is difficult to grasp complexity when cause and effect are intertwined with emotions, norms and values? In the discussion, we suggest examining a complex dynamic system in terms of both the consistency of its various elements and the dynamics of the system. We also discuss how to optimize the system’s adaptive self-organizing ability and how to challenge ourselves to invent negative feedback loops that can keep the complex system in equilibrium.

scholarly journals Cerebellar Syndromes: A Medical Student Guide

2013 ◽  
Vol 1 (1) ◽  
pp. 37-42
Author(s):  
Claudia K. Sellers ◽  
Suvankar Pal
Keyword(s):  
Medical Student ◽  
Student Teaching ◽  
Relevant Literature ◽  
Functional Anatomy ◽  
Common Disease ◽  
Junior Doctors ◽  
Final Exams ◽  
Medical Student Teaching ◽  
Cerebellar Anatomy ◽  
Cerebellar Syndromes

The cerebellum is central to normal motor function and co-ordination, and can be frequently affected in a number of common disease processes. However, medical student teaching relating to cerebellar anatomy and pathology is lacking, leaving many graduates with a significant knowledge gap. Junior doctors need to be able to recognize ‘cerebellar syndromes’ on presentation to hospitals, and to identify and manage reversible causes rapidly and effectively. After review of relevant literature, a simple approach to the functional anatomy and practical classifications of common cerebellar pathology is presented here, with a focus on symptoms, signs and examination techniques essential to medical school final exams.

scholarly journals Bedside teaching: an invaluable tool in undergraduate medical education

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S154-S154
Author(s):  
Kenneth Ruddock
Keyword(s):  
Medical Education ◽  
Student Learning ◽  
Student Teaching ◽  
Undergraduate Medical Education ◽  
Course Design ◽  
Clinical Teaching ◽  
Bedside Teaching ◽  
Invaluable Tool ◽  
Cox's Model ◽  
Difficult Subjects

AimsBedside teaching is one of the most important modalities in medical education. Sir William Osler stated, “Medicine is learned by the bedside and not in the classroom”. Despite this, the use of bedside teaching in the undergraduate curriculum has been declining, potentially due to changes in course design, increasing clinical workloads and reducing inpatient numbers. In my role as a Clinical Teaching Fellow (CTF), I have aimed to maximise bedside teaching and promote it as the primary approach for student learning.MethodAs a CTF, I deliver teaching to students from the Universities of Glasgow and Edinburgh during their placements in NHS Lanarkshire. Weekly teaching is provided to groups of 2-4 students, with around 50% of sessions delivered ‘at the bedside’.Within psychiatry, there is a vast range of potential bedside teaching topics. Given the length of time required to conduct a full psychiatric history and mental state examination (MSE), teaching sessions instead focus on one specific component of the patient interview, for example, assessing perceptual abnormalities or delusions, conducting a substance use history or exploring social circumstances and the functional impact of illness. This approach allows for more focussed feedback and teaching. Session structure is based upon Cox's model of bedside teaching, which I have modified slightly for the psychiatry setting.Student feedback has been collected via an anonymous electronic end-of-block questionnaire.ResultQualitative feedback reveals that students in NHS Lanarkshire value bedside teaching, with one student describing it as “informative, comprehensive and relevant for upcoming exams and clinical practice”.There are a number of potential barriers to consider when delivering bedside teaching in psychiatry. These include issues identifying suitable patients who can provide informed consent to participate and the ethical concerns regarding exploring difficult subjects such as suicide risk assessment with patients for purely educational purposes.These issues can be overcome; in inpatient units, there is usually a small cohort of patients who are able to consent and engage in student teaching, and difficult subjects can alternatively be addressed during role-play or simulation sessions.ConclusionDespite its challenges, bedside teaching can be an enjoyable and rewarding approach in undergraduate medical education, with feedback revealing it is positively received in NHS Lanarkshire. By utilising Cox's model and focussing on specific aspects of MSE and history-taking, bedside teaching is more accessible and an invaluable tool for psychiatric teaching. Clinicians and educators are encouraged to keep the patient at the centre of student learning.

The Medical Reception Station: a new primary care capability for 3 Commando Brigade

2016 ◽  
Vol 102 (1) ◽  
pp. 4-7
Author(s):  
D McMenamin ◽  
J Baker ◽  
M Middleton
Keyword(s):  
Primary Care ◽  
General Practitioner ◽  
Large Scale ◽  
Care Facility ◽  
Junior Doctors ◽  
Medical Facility ◽  
Potential Utility ◽  
Military Operations ◽  
Primary Care Facility ◽  
First Time

Abstract3 Commando Brigade’s delivery of pre-hospital (Role 1) care has until now largely been based around junior doctors delivering trauma-based resuscitation and limited primary care from small self-contained Regimental Aid Posts (RAPs). With the drawdown of large scale operations in Iraq and Afghanistan, and the diversity of potential future military operations, the deficiency of General Practitioner(GP)-led care in the deployed setting has become more evident, and this has driven the requirement for a deployable primary care facility in the form of a Medical Reception Station (MRS). This paper describes the evolution of this project, the realities of deploying a new medical capability for the first time, some of the issues faced, and the potential utility of such a medical facility in future.

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