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This study aimed to investigate the performance of a sample of general practitioner (GP) trainers in the multiple choice paper (MCP) of the Membership Examination of the Royal College of General Practitioners (MRCGP) and to obtain their views of the content of the paper and its relevance to general practice using a written knowledge test and self-administered questionnaire. The participants were volunteer GP trainers in the Northern, Wessex, Kent, Surrey and Sussex (KSS) and Northwest deaneries of the UK. The trainers completed a shortened version of an MRCGP MCP paper under examination conditions and provided feedback immediately afterwards. Of 191 trainers invited to participate, 86 (45%) sat the paper and of these, 81 completed the questionnaire. Most trainers believed that the paper assessed knowledge of common or important topics relevant to general practice, that the majority of questions were appropriate, clear and unambiguous and that time pressure was not a problem. Trainers performed significantly better compared to registrars overall, and in questions on medicine related to general practice and practice administration but not research methodology or critical appraisal. They did so without making prior preparation. The findings from this group of trainers lend support to the face validity and content validity of the MRCGP MCP examination as an assessment of applied knowledge of general practice. [ABSTRACT FROM AUTHOR]

The article offers information on the significance of critical appraisal in ensuring the reliability and efficiency of using research evidence in evidence-based medicine in Great Britain. It mentions that the Royal College of General Practitioners (RCGP) introduced its Critical Reading Question paper in 1990. It notes that the evidence-based medicine asks a clinical question, locate the evidence, appraise the evidence, and interpret the evidence in the context of everyday medicine practice.

The article presents a study which identifies that general practice registrars regard the current Membership of the Royal College of General Practitioners (MRCGP) written paper with short answer and Modified Easy Question (MEQ) formats as a valid assessment of approach to practice. The study found that almost 90 percent of the respondents thought that the questions were relevant to every general practice. The study showed that the educational impact of preparing for the paper was high.

The written paper (Paper 1) in the modular MRCGP is due to end in October 2008 as the new MRCGP assessment becomes the compulsory qualification for entry into general practice. As part of quality assurance in the old examination, candidate feedback was sought on the written module immediately after sitting the Spring 2006 paper. This showed high levels of satisfaction with the paper and provides evidence of the validity of the questions set. These results reinforce some of the findings of an original study exploring the views of a cohort of candidates from the Northern Deanery. Further, it supports the idea that the MRCGP written paper has driven educational goals, particularly in the area of critical appraisal skills. It also provides some assurance that the paper did not discriminate against minority groups taking the paper. [ABSTRACT FROM AUTHOR]

The papers and manuscripts of Joseph Du Chesne (1546-1609) were praised by many readers in the 17th century, who often copied extracts from them. Although we are no longer able to trace the original manuscripts, several people are said to have owned them in the 17th century. I try here to put together all the available data on this matter, in order to shed some light on the main possessors of Du Chesne's papers from his death in 1609 up to 1660. [ABSTRACT FROM AUTHOR]

The article reflects on the concept of housekeeping and its application in the field of primary care in Great Britain. Topics discussed include parallelism between housekeeping and keeping oneself in good order, dynamics of the doctor-patient relationship in comparison to that of trainer and trainee, and the context of housekeeping at the educational level. Also mentioned is the role of housekeeping in dealing with a threat to the self or the self-image.

Women in the Netherlands with non-western migration backgrounds experience domestic violence at the intersection of culture and gender, and visit their general practitioners (GPs) with health concerns related to the violence. Drawing on semi-structured interviews with GPs, this paper illuminates how GPs navigate the process of decision-making around intervention in domestic violence, with particular attention to the role of autonomy. Patient autonomy is a core principle in Dutch general practice. The term refers to the principle that GPs must respect that competent adults can make autonomous decisions about the care they do and do not want, and that GPs must respect patients' views, choices, and ways of life. The interview data shows great variation in how GPs respond in situations of domestic violence against women with non-western migration backgrounds. Deploying 'somatechnics of perception', this paper explores how GPs' perceptions of their patients' autonomy are both the agent and effect of a complex and embodied negotiation of gender, race, culture, ethnicity, medical ethics, and morality. In highlighting how these patients' autonomy is rendered (un)intelligible and (il)legible in contextually specific ways, this paper sheds light on how GPs in the Netherlands can better assist women with non-western migration backgrounds who experience domestic violence. [ABSTRACT FROM AUTHOR]

The words used to refer to weight and individuals with large bodies can be used to reinforce weight stigma. Given that most previous research has examined preferred terminology within homogenous groups, this research sought to examine terminology preferences across populations. This paper reports on data gathered with the general public, family physicians, and obesity researchers/practitioners. Participants were asked about the words they commonly: (1) used to refer to people with large bodies (general public); (2) heard in their professional contexts (physicians and obesity specialists); and (3) perceived to be the most socially or professionally acceptable (all samples). Similarities and differences were evident between samples, especially related to weight-related clinical terms, the word fat, and behavioral stereotypes. The results provide some clarity into the differences between populations and highlight the need to incorporate use of strategies that may move beyond person-first language to humanize research and clinical practice with people with large bodies. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM PUBLISHER]

AbstractBackgroundMethodsResultsConclusions\nKEY POINTSAccording to the UN Committee Against Torture, all state parties to the Torture Convention have a responsibility to meet the rehabilitation needs of torture victims who have sought asylum within their borders. General practitioners (GPs) can play a crucial role in identifying torture victims and securing rehabilitation when needed. There is a pressing knowledge gap on the knowledge and practices of GPs vis-à-vis potentially tortured patients, and an urgent need for research that investigates GPs’ practices of identification, referral, and rehabilitation – in Norway and beyond. This article presents an exploratory qualitative pilot study that investigates the experiences of GPs in Oslo vis-à-vis this patient group.Semi-structured interviews with five experienced GPs in the greater Oslo area. Interview data was analyzed through thematic analysis and discussed within a theoretical framework seeing GPs as street-level bureaucrats.Issues that emerged in the pilot involve a consistent professional confidence and a particular concern for victims of sexual violence and sexualized torture. The pilot also found a troubling commonsensical reasoning about identification in the asylum process. The GPs asked for the re-establishment of specialist rehabilitation centers for refugees and torture victims to consult in case of need. Alas, the study also confirmed that GPs are a difficult profession to recruit for research.This study indicates that GPs are important actors in terms of identifying torture victims after resettlement, but that there are shortcomings in their training and knowledge, in the overall organization of the healthcare system, and in specialized healthcare, that limit prospects for rehabilitation.To what extent are torture victims met or identified by GPs in resettling contexts? This paper presents a pilot study designed to address this knowledge gap and prepare future studies. We found:GPs were confident in their abilities to identify and meet torture victims in a good way – and in the value that is patient-doctor continuity in general medicine.Troubling commonsensical reasoning about identification in the asylum process and in consultations.A lack of and need for qualified and available expertise to consult with and/or refer tortured patients to.GPs were confident in their abilities to identify and meet torture victims in a good way – and in the value that is patient-doctor continuity in general medicine.Troubling commonsensical reasoning about identification in the asylum process and in consultations.A lack of and need for qualified and available expertise to consult with and/or refer tortured patients to. [ABSTRACT FROM AUTHOR]

This paper reports on the curriculum development for social work student placements in primary health care. Social work in General Practice [GP] is an emerging area for social work practice, able to fill a gap in primary health. The inclusion of social work in GP practices can be complex. Social work placements offer an opportunity for students to become familiar with this practice setting and undertake social work relevant learning; however, they need to be well prepared for such placements and able to articulate and use social work knowledge and processes. They offer an opportunity for GPs to understand what social workers can do and offer to the GP community. We have used available research, support of an active reference group and two surveys to develop a curriculum for social work students in GP practices. We provide an overview of the literature and the methods of developing the curriculum. We describe how feedback and curriculum design principles were used. Core aspects of the curriculum and accompanying resources are outlined. The discussion highlights that the curriculum was a valuable tool in not only inducting students into a GP placement setting but as a meaningful reference guide throughout the entirety of placement. Social work students undertaking placements in GP settings need to be able to understand and articulate the role of social work in primary health care; A curriculum for social work placements in primary health care provides students the opportunity to consider the clinic context, the role of social work in primary health care and getting started in GP settings; Feedback and guidance from a range of interdisciplinary stakeholders is invaluable in developing resources for interdisciplinary work. [ABSTRACT FROM AUTHOR]

Ethically challenging or controversial medical procedures have prompted increasing requests for the exercise of conscientious objection, and caused concerns about how and when it should be practised. This paper clarifies definitions, especially with regard to discrimination, and explores the restrictions, duties, and practical limitations, in order to suggest criteria for its practice. It also argues that a conscientious refusal to treat, where there is therapeutic doubt, is a valid form of conscientious objection. An email survey sent to General Practitioners (GPs), explored the adherence to the suggested criteria, and assessed the outcomes, in terms of acceptability, impact, and difficulties experienced by the GPs, their colleagues and their patients. The results demonstrate high acceptability of conscientious objection, and better outcomes when the suggested criteria are adhered to. The GPs would support education to improve the practice of conscientious objection to a professional level, which could further improve outcomes and acceptability. [ABSTRACT FROM AUTHOR]

The article presents a study which explores the perceptions by general practitioners (GPs) of the benefits of appraisal. The study has undertaken brief review of literature to highlight past studies on the benefits of appraisals as perceived by GPs. Results show that appraisal will help promote reflection by GPs in a consistent way and provide assurance of their fitness to practice.

Shared electric mobility hubs, or eHUBs, offer users access to a range of shared electric vehicles on demand. However, little is currently known about what the characteristics of potential users of this novel type of shared mobility are. This makes it difficult to plan the location of hubs and to provide facilities, which ultimately will determine their success. This paper therefore seeks to identify potential users based on an in-depth case study of a representative sample of the Municipality of Amsterdam population. The analysis employed an attitudinal market segmentation approach supported by the Theory of Diffusion of Innovations (DOI). The analysis identified four specific target groups, each with a different propensity to use eHUBs in the future. In our sample, two groups expressed an interest in using eHUBs. The first group consists of highly educated and non-car owning young adults (19% of the sample), whereas the second group shows a higher level of car ownership and a greater number of households with children (69% of the sample). The two remaining groups comprise the majority of laggards (52%), despite only representing 12% of the sample. They tend to be older, less educated, and live in a household without children. The four groups are further distinguished based on their current shared mobility use, traveler identity, and perceived barriers to using shared electric vehicles. Finally, general recommendations to practitioners and policymakers to increase the uptake of shared mobility, including paying attention to the availability, cost, and convenience of shared mobility options, are provided. [ABSTRACT FROM AUTHOR]

Objective. To identify GPs' attitudes towards sickness certification. Design. Systematic search and narrative review identifying themes around attitudes towards sickness certification. Results. Eighteen papers were identified for inclusion in the review; these included qualitative, quantitative, and systematic reviews. The papers were predominantly from Scandinavia and the UK. Three themes were identified from the literature: conflict, role responsibility, and barriers to good practice. Conflict was predominantly centred on conflict between GP and patients regarding the need for a certificate, but there was also conflict between all stakeholders. Role responsibility focused on the multiple roles GPs had to fulfil, and barriers to good practice were identified both within and outside the healthcare system. Conclusion. Any potential for changing the certification system needs to focus on reducing the potential for conflict, clarification of the roles of all stakeholders, and improving access to specialist occupational health and rehabilitation services. [ABSTRACT FROM AUTHOR]

The article presents evaluations of research related to the professional development of healthcare providers in Great Britain. The critic says that the article "The Training Service Continuum: Exploring the Training Service Balance of Senior House Officer Activities" was an interesting paper, however, it has flaws. In the article "Cross-Cultural Medicine," the critic states that it contains a number of resources. "Teaching Professionalism Artfully" used different media to teach professionalism.

Migration is a core component of population change and is both a symptom and a cause of major economic and social phenomena. However, data limitations mean that gaps remain in our understanding of the patterns and processes of mobility. This is particularly the case for internal migration, which remains under-researched, despite being quantitatively much more significant than international migration. Using the Scottish Longitudinal Study, this paper evaluates the potential value of General Practitioner administrative health data from the National Health Service that can be linked into census-based longitudinal studies for advancing migration research. Issues relating to data quality are considered and, using the illustrative example of internal migration by country of birth, an argument is developed contending that such approaches can offer novel ways of comprehending internal migration, by shedding additional light on the nature of both movers and the moves that they make. [ABSTRACT FROM AUTHOR]

Background: Changes in healthcare practice toward more proactive clinical, organizational and interprofessional working require primary healthcare professionals to learn continuously from each other through collaboration. This systematic review uses realist methodology to consolidate knowledge on the characteristics of workplace learning (WPL) through collaboration by primary healthcare professionals.Methods: Following several scoping searches, five electronic bibliographic databases were searched from January 1990 to December 2015 for relevant gray and published literature written in English, French, German and Dutch. Reviewers worked in pairs to identify relevant articles. A set of statements, based on the findings of our scoping searches, was used as a coding tree to analyze the papers. Interpretation of the results was done in alternating pairs, discussed within the author group and triangulated with stakeholders’ views.Results: Out of 6930 references, we included 42 publications that elucidated who, when, how and what primary healthcare professionals learn through collaboration. Papers were both qualitative and quantitative in design, and focused largely on WPL of collaborating general practitioners and nurses. No striking differences between different professionals within primary healthcare were noted. Professionals were often unaware of the learning that occurs through collaboration. WPL happened predominantly through informal discussions about patient cases and modeling for other professionals. Any professionals could both learn and facilitate others’ learning. Outcomes were diverse, but contextualized knowledge seemed to be important.Discussion/conclusions: Primary care professionals’ WPL is multifaceted. Existing social constructivist and social cognitivist learning theories form a framework from which to interpret these findings. Primary care policy makers and managers should ensure that professionals have access to protected time, earmarked for learning. Time is required for reflection, to learn new ways of interaction and to develop new habits within clinical practice. [ABSTRACT FROM AUTHOR]

This study aimed to identify socio-demographic determinants, risky behaviors and type of drug use, and the association with visiting by general practitioners (GP) in the last 12 months or outpatient service use among people who inject drugs (PWID). Studies in English published before November 1 2021, were searched for on PubMed, Scopus, Cochrane, and Web of Science to identify primary studies on the factors associated with visiting by GP or outpatient service use among PWID. After a detailed assessment of over 17,348 papers, a total of 13 studies met the eligibility criteria. Greater odds of visits to the GP in the last 12 months or outpatient service use was associated with (i) being younger, (ii) being female, (iii) employment status, (iv) having public health insurance, (v) individuals who shared needles, (vi) individuals who were prescribed benzodiazepines, (vii) history of taking prescribed mental health medications, (viii) individuals who got methadone maintenance treatment (MMT) and (X) individuals who had used primary care services. The present research findings highlighted that a significant proportion of the study participants used GP or outpatient service use/outpatient psychiatrist, suggesting that the focus should not be restricted to PWID. [ABSTRACT FROM AUTHOR]

Although people with a migration background (MB) have more unmet mental health needs than the general population, patients with a MB are still underrepresented in mental health care services. Provider bias towards these patients has been evidenced repeatedly but its driving factors remain elusive. We assessed the moderating effect of the individual (e.g. age and ethnicity), interpersonal (e.g. healthcare provider trust), and organisational (e.g. perceived workload) factors on general practitioners (GPs) differential decision-making regarding diagnosis, treatment, and referral for a depressed patient with or without a MB. An experimental study was carried out in which GPs were shown one of two video vignettes featuring adult male depressed patients, one with a MB and the other without. Belgian GPs (n = 797, response rate was 13%) had to decide on their diagnosis, treatment, and referral. Analysis of variance and logistic regression were used to analyse the effect of a MB, adding interaction terms for the explanatory variables. Overall, we found that there were ethnic differences in GPs' decisions regarding diagnosis and treatment recommendations. GPs perceived the symptoms of the patient with a MB as less severe (F = 7.68, p < 0.01) and demonstrated a reduced likelihood to prescribe a combination of medical and non-medical treatments (F = 11.55, p < 0.001). Those differences increased in accordance with the GP's age and perceived workload; at an interpersonal level, we found that differences increased when the GP thought the patient was exaggerating his distress. This paper showed that lower levels of trust among GPs' towards their migrant patients and high GP workloads contribute to an increased ethnic bias in medical decision-making. This may perpetuate ethnic inequalities in mental health care. Future researchers should develop an intervention to decrease the ethnic inequities in mental health care by addressing GPs' trust in their migrant and ethnic minority patients. [ABSTRACT FROM AUTHOR]

In early 2020, when the first COVID-19 cases were confirmed in Switzerland, the federal government started implementing measures such as national stay-at-home recommendations and a strict limitation of health care services use. General practitioners (GPs) and their at-risk patients faced similar uncertainties and grappled with subsequent sensemaking of the unprecedented situation. Qualitative interviews with 24 GPs and 37 at-risk patients were conducted which were analyzed using thematic analysis. Weick's (1993) four sources of -resilience – improvisation, virtual role systems, attitudes of wisdom and respectful interaction – heuristically guide the exploration of on-the-ground experiences and informal ways GPs and their at-risk patients sought to ensure continuity of primary care. GPs used their metaphorical Swiss army knives of learned tools as well as existing knowledge and relationships to adapt to the extenuating circumstances. Through improvisation, GPs and patients found pragmatic solutions, such as using local farmer apple brandy as disinfectant or at-home treatments of clavicle fractures. Through virtual role systems, GPs and patients came to terms with new and shifting roles, such as "good soldier" and "at-risk patient" categorizations. Both parties adopted attitudes of wisdom by accepting that they could not know everything. They also diversified their sources of information through personal relationships, formal networks, and the internet. The GP-patient relationship grew in importance through respectful interaction, and intersubjective reflection helped make sense of shifting roles and ambiguous guidelines. The empirical analysis of this paper contributes to theoretical considerations of sensemaking, resilience, crisis settings and health systems. [ABSTRACT FROM AUTHOR]

Scotland is faced with pernicious health inequalities, which stem from inequalities in living conditions and the societal structures that create them. While action is needed to address the wider structural causes of health inequalities, the role of general practitioners (GPs) merits attention due to health care's potential to mitigate or exacerbate health inequalities. Minimal research, however, has explored how GPs understand the fundamental causes of health inequalities nor how they conceptualise their role in mitigating these. This paper aims to fill this gap using in-depth qualitative interviews with 24 GPs working in some of Scotland's most socio-economically disadvantaged, urban areas. Using Raphael's SDH discourse framework, this paper found clear linkages between GPs' perceptions of their patients, how they defined the 'problem' of health inequalities, and what they thought could be done to tackle them in disadvantaged areas. In general, there was convergence on how interviewees viewed their role in mitigating health inequalities through their work with individual patients. However, greater variation was found when describing the boundaries of their role and how far these extended beyond individual encounters. Specifically, only those GPs fluent in discussing structural causes of health inequalities discussed obligations to change local systems via strengthening community linkages and to influence higher level policies related to the SDH. This suggests that while there is a degree of what Metzl and Hansen deem 'structural competency' amongst some GPs working in disadvantaged areas, the scope remains to deepen this competency more broadly. [ABSTRACT FROM AUTHOR]

The introduction of a market mechanism into the National Health service in the UK was underpinned by the belief that decentralised purchasing would both improve the quality of health care provision and restrain spiralling costs, through purchasers exercising their ability to choose between alternative providers. Focusing on budget holding General Practitioners, that is those practices responsible for purchasing hospital services for their practice populations, this paper explores the evolving purchasing behaviour of these professional intermediaries. Drawing on empirical evidence gathered as part of a broader study of the purchasing behaviour of GP Fundholders in Scotland, specifically it examines the key information sources and decisional criteria utilised by these professional intermediaries in selecting health care providers for their practice population. Utilising relational models of market behaviour, it addresses both the contextually specific issue of whether the market mechanism within the NHS is achieving the twin objectives of improving health care provision and restraining cost pressures, and the broader conceptual issue of the purchasing behaviour of professional intermediaries within a service sector environment. [ABSTRACT FROM AUTHOR]

The purpose of this paper is to explore the impact of country of origin (COO) on the prescription behaviour of metro and A class cities of doctors. It also aims to study if the category of doctors like consulting physician differs from general practitioners on their prescription behaviour due to the COO. The primary, as well as secondary research data, was used to achieve the study objective. A total of 400 respondent doctors (Allopathic General Practitioner including various specialty practice and Multispecialty practice consultants) from metro and A-class cities were selected for the study. Results showed that the COO does not influence the prescription behaviour of metro and A-class cities doctors. Both GPs and CPs from the metro and class A cities have no significant difference in prescribing locally available brands (Indian) and global innovator brands. More emphasis should be given on brand equity to differentiate the brands. COO need not be an important point of differentiation. Marketers should be aware of the fact that physicians are influenced by many other factors than the brand's original country image. This research work has extended prior COO research to influence of the same on prescription behaviour of doctors in metro and A-class cities in emerging markets like India. This research fills an identified gap in the literature as it helps to get an understanding of COO in the pharmaceutical industry with respect to metro and A-class cities doctors. [ABSTRACT FROM AUTHOR]

The Irish General Practitioner Training (GP) Programme is currently moving to Competency-Based Medical Education (CBME), facilitated by Programmatic Assessment (PA) and Entrustable Professional Activities (EPAs). These new assessment and feedback mechanisms may provide a rich and much sought-after dataset. However, given the possible number of feedback and assessment events, and the variety of modalities used, aggregating and interpreting these can be costly and difficult. Dashboard implementations (DI) have been purposed as a solution to bridge the gap between the large datasets and the training community at all levels. To explore the Irish GP training community's perceptions on how an EPAs DI could facilitate the delivery of GP training in Ireland. A qualitative approach was taken, using a focus group representative of different groups in the training community. Concurrently, an EPAs DI was developed. Focus group transcripts were analysed in an iterative fashion using Template Analysis to generate themes and subthemes. Numerous advantages were seen in relation to the implementation of an EPAs DI around entrustment decisions, constructive alignment and summative decision-making. These advantages, however, need to be tempered with the realisation that the EPAs DI is not and should not be misinterpreted as being the learning analytic panacea for GP training. This paper outlines the perceptions from a postgraduate medical education training community on an EPAs DI, which would be applicable to other training communities considering introducing similar mechanisms. [ABSTRACT FROM AUTHOR]

The article discusses the most effective approaches for the medical practitioners in writing for publication in Great Britain. Publishing a certain work is considered as an important role of being a teacher and researcher. Writing should start in determining the reasons and criteria in writing, as well as should meet the requirements needed by the publication.

This article reports that the general practitioners (GP) have developed a syllabus for evidence-based medicine (EBM) after an exercise involving GP educators in the Eastern Deanery. Their survey suggested that 30 hours should be devoted to the EBM syllabus over a three-year vocational training programme. Some respondents thought that it would be difficult to devote this amount of time to one aspect of general practice training. The papers appraised often relate to clinical topics being studied, for example appraising a paper on psychological approaches to treat attention deficit hyperactivity disorder as part of a session on behavioral disorders in children. The study of a clinical topic is used to underpin critical appraisal skills, which enhances learning in both. It also means time need not be specifically devoted to learning EBM skills alone.

Research suggests that health care can be improved and patient harm reduced when health professionals successfully collaborate across professional boundaries. Consequently, there is growing support for interprofessional collaboration in health and social care, both nationally and internationally. Factors including professional hierarchies, discipline-specific patterns of socialization, and insufficient time for teambuilding can undermine efforts to improve collaboration. This paper reports findings from an ethnographic study that explored the nature of interprofessional interactions within two general and internal medicine (GIM) settings in Canada. 155 hours of observations and 47 interviews were gathered with a range of health professionals. Data were thematically analyzed and triangulated. Study findings indicated that both formal and informal interprofessional interactions between physicians and other health professionals were terse, consisting of unidirectional comments from physicians to other health professionals. In contrast, interactions involving nurses, therapists and other professionals as well as intraprofessional exchanges were different. These exchanges were richer and lengthier, and consisted of negotiations which related to both clinical as well as social content. The paper draws on Strauss' (1978) negotiated order theory to provide a theoretical lens to help illuminate the nature of interaction and negotiation in GIM. [ABSTRACT FROM AUTHOR]

A survey was undertaken of the application and reapplication forms used by all the UK deaneries for general practice (GP) specialty training. The aim of the survey was to identify similarities and differences between deaneries in terms of the content and nature of the information requested, and the relationship of that information to the Postgraduate Medical Education and Training Board's (PMETB) Quality Assurance Framework (QAF). The details requested on the application forms were compared to the guidance set out in Generic Standards for Training,1 in order to see if they reflected the areas and standards required by the PMETB for the quality assurance of medical education and training. Although many similar areas of information were requested in the application process, great variation was found across some items which were not attributable to regional or contextual differences. The survey also found that the majority of domains of Generic Standards for Training1 are not well covered in the paper application process. Although deaneries may view their application processes for trainer approval as robust, this paper makes a number of recommendations and argues for the development of a standardised form for the appointment of general practice specialty training (GPST) trainers across the UK, based upon the PMETB QAF. [ABSTRACT FROM AUTHOR]

The article offers a review of various articles related to family medicine. It notes the move of the American public to become a model of medical care that occupies with the patient where they can direct their care with their chosen providers. It mentions the vitality of critical thinking to assist all clinicians in the processes of decision-makings. The move of physicians towards a structured interview for training posts is also cited.

This paper, written by a General Practitioner (GP) with interest in genetics, and a Professor of Cancer Genetics, has two broad aims. First, to highlight the importance of recognising people who might have an increased predisposition of developing specific cancers, estimated from their family history, and secondly to outline how these people may be managed both in primary and secondary care and by the regional genetics unit. The paper covers why it is important to be concerned about a family history of cancer, and provides key facts about familial breast, colorectal and ovarian cancer, with relevant NICE guidelines. There is discussion about how to ascertain relatives at risk of cancer, and once these relatives have been identified, how they might be managed through the National Health Service. The two key threads of the paper are the importance of good communication between the patient and physician, and the need for close collaboration between primary and secondary care and the regional genetics units. [ABSTRACT FROM AUTHOR]

International recruitment now forms an important part of the government's policy to increase capacity in the NHS.1 By 2003, 89 general practitioners (GPs) had been recruited from countries of the European Union (EU), and in particular, Spain and France.2 The ability of the NHS to retain these GPs will, in part, depend on the support that they receive during the transition to work. In order that this can be achieved, the Department of Health recommend that all overseas doctors should participate in a thorough and comprehensive induction programme and receive support until they are fully integrated into the NHS.3 This paper describes the stages that we went through to develop an induction programme for EU GPs and reports on the programme evaluation. Evaluation of the programme has largely been positive, with most GPs suggesting that they would never have come to work in London general practice without the support of a formal programme that facilitated their transition to work in the NHS. Some components of the programme, for example facilitated peer support, provided unexpected outcomes, offering participants the opportunity to develop a supportive, cohesive team. Other aspects of the programme, for example the clinical placements, sometimes provoked an initial loss of confidence as participants found it difficult to move into a learning role, having previously been practicing ‘unwatched’ for many years. Programme evaluation also indicated that French GPs are generally not accustomed to self-directed continuing education or professional development. In order to maximize learning from the induction programme, therefore, participants tend to require clear direction regarding private study. At the time of writing this paper, 33 GPs have attended the programme, 26 (79%) of whom have taken up employment in London general practice. [ABSTRACT FROM AUTHOR]

This questionnaire was sent to all UK graduates qualifying in 1999 and 2000. Oxford and Cambridge has Iow levels of graduates seeking a career in general practice, whereas this is high in Birmingham and Leicester. There was also variation in choice in hospital specialties. Factors included choice prior to going to medical school, and their experiences (especially of teachers) within specific departments. [ABSTRACT FROM AUTHOR]

Keywords: Family Physicians; Guidelines; Post-Acute Covid; Pulmonary rehabilitation; SARS-COV-2 EN Family Physicians Guidelines Post-Acute Covid Pulmonary rehabilitation SARS-COV-2 1 5 5 11/14/22 20221201 NES 221201 The coronavirus disease 2019 (COVID-19) is a frequent respiratory infection disease, as of November 16 SP th sp , 2021, 254728728 COVID-19 infections, and 5125685 COVID-19-related deaths (2.01%) had been reported worldwide (https://www.worldometers.info/coronavirus/). Therefore, an alternative including the CRR "minimal advice" that a GP should provide to long COVID-19 patients, seems to be necessary to respond to the needs of GPs to face their involvement with long COVID-19 patients. General practitioners should provide the cardiorespiratory rehabilitation' "minimum advice" for long COVID-19 patients Indeed, general practitioners (GPs) are on the front line in the management process of long COVID-19 patients because as the pandemic evolves, more and more long COVID-19 patients will be in need of treatment/assistance [[14]]. [Extracted from the article]

The history of proximal fibular osteotomies for medial compartmental knee osteoarthritis is long. The paper ' I Open-wedge HTO with absorbable -TCP/PLGA spacer implantation and proximal fibular osteotomy for medial compartmental knee osteoarthritis: New technique presentation' i presents this method. [Extracted from the article]

This paper introduces an integer programming model for planning primary care facility networks, which accounts for the interests of different stakeholders while maximizing access to health care. Physician allocation to health-care facilities is explicitly modelled, which allows consideration of physician incentives in the planning phase. An illustrative case study in the Turkish primary care system is presented to show the implications of focusing on patient or physician preferences in the planning phase. A discussion of trade-offs between the different stakeholder preferences and some recommendations for modelling choices to match these preferences are provided. In the context of this case, we found that using an access measure that decays with distance, and incorporating nearest allocation constraints improves performance for all stakeholders. We also show that increasing the number of physicians may have adverse affects on access measures when physician preferences are addressed. [ABSTRACT FROM AUTHOR]

Objective: This paper investigated patients’ experiences of disease and self-care as well as perceptions of the general practitioner’s role in supporting patients with impaired self-care ability. Design: Qualitative interviews with 13 patients with type 2 diabetes, concurrent chronic diseases, and impaired self-care ability assessed by a general practitioner. We analyzed our data using systematic text condensation. The shifting perspectives model of chronic illness formed the theoretical background for the study. Results: Although most patients experienced challenges in adhering to recommended self-care activities, many had developed additional, personal self-care routines that increased wellbeing. Some patients were conscious of self-care trade-offs, including patients with concurrent mental disorders who were much more attentive to their mental disorder than their somatic diseases. Patients’ perspectives on diseases could shift over time and were dominated by emotional considerations such as insisting on leading a normal life or struggling with limitations caused by disease. Most patients found support in the ongoing relationship with the same general practitioner, who was valued as a companion or appreciated as a trustworthy health informant. Conclusion: Patient experiences of self-care may collide with what general practitioners find appropriate in a medical regimen. Health professionals should be aware of patients’ prominent and shifting considerations about the emotional aspects of disease. Patients valued the general practitioner’s role in self-care support, primarily through the long-term doctor-patient relationship. Therefore, relational continuity should be prioritized in chronic care, especially for patients with impaired self-care ability who often have a highly complex disease burden and situational context. Key points:   Little is known about the perspectives of disease and self-care in patients with a doctor-assessed impaired ability of self-care.   • Although patients knew the prescribed regimen they often prioritized self-care routines that increased well-being at the cost of medical recommendations.   • Shifting emotional aspects were prominent in patients’ considerations of disease and sustained GPs’ use of a patient-centred clinical method when discussing self-care.   • Relational continuity with general practitioners was a highly valued support and should be prioritized for patients with impaired self-care. [ABSTRACT FROM AUTHOR]

Following my progression and development from an undergraduate sports science student to my present position as a lecturer in Coaching and Performance, I sought to reflect upon this journey and how each significant stage of my development has either challenged, developed, or influenced my career. In attempting to articulate and disseminate such information I have utilised reflective accounts that were recorded throughout this time. Consequently, the current paper seeks to present a reflective account of key stages within my own career and development, from the initial stages of a newly graduated sports science intern, into a novice practitioner undertaking a PhD before finally attaining a full-time position in academia. I hope that these insights into my own personal and professional development may help anyone seeking employment or working in the sports science industry. [ABSTRACT FROM AUTHOR]

Communication; cancer; existential; spiritual; religious; general practitioners; vocational training; continuing medical education. Design: The UK Medical Research Council's (MRC) framework for complex intervention research was used as a guide for course development and evaluation and was furthermore used to structure this paper. The development phase included: identification of existing evidence, description of the theoretical framework of the course, designing the intervention and deciding for types of evaluation. In the evaluation phase we measured self-efficacy before and after course participation. To explore further processes of change we conducted individual, semi-structured telephone interviews with participants. Subjects and setting: Twenty practising GPs and residentials in training to become GPs from one Danish region (mean age 49). Results: The development phase resulted in a one-day vocational training/continuing medical education (VT/CME) course including the main elements of knowledge building, self-reflection and communication training. Twenty GPs participated in the testing of the course, nineteen GPs answered questionnaires measuring self-efficacy, and fifteen GPs were interviewed. The mean scores of self-efficacy increased significantly. The qualitative results pointed to positive post course changes such as an increase in the participants' existential self-awareness, an increase in awareness of patients in need of existential communication, and an increase in the participants' confidence in the ability to carry out existential communication. Conclusions: A one-day VT/CME course targeting GPs and including the main elements of knowledge building, self-reflection and communication training showed to make participants more confident about their ability to communicate with patients about existential issues and concerns. [ABSTRACT FROM AUTHOR]

A quality system (named GEAR; acronym for Combined Evaluation Audit Round in English), has been introduced in eight institutes of the Dutch general practitioner specialty training. This paper focuses on the local and national effects of GEAR. Seventeen semi-structured interviews were conducted with the directors and quality co-ordinators. At a local level, GEAR provided the institutes with insights into their current practice. The institutes designed and implemented several improvement plans based on feedback. Furthermore, GEAR addressed quality management more systematically, and it enhanced the quality culture. At a national level, the institutes formulated national priorities. In addition, GEAR stimulated collaboration as a result of more frequent contacts. Institutes differed in their perception of the extent to which GEAR offered added value. Integrating the quality system into the local policy was sometimes a problem. Despite some scepticism at the start, GEAR provoked enthusiasm that can contribute to the quality of medical education. [ABSTRACT FROM AUTHOR]

Background: This paper draws on a 2015 study in New Zealand that examined perceptions of registered nurses (RNs) and general practitioners (GPs) regarding the role of Nurse Practitioners (NPs) in long-term aged care facilities (LTACF). Aim: To explore the attitudes of RNs and GPs regarding the role of NPs in LTACFs. Design: A descriptive, mixed methods design with a survey and invitation to interview was used. RNs and GPs who provided hospital-level care were invited to participate. Findings: The findings showed RNs and GPs are open to considering the NP role in aged care. However, there remains a lack of understanding of what NPs do. Conclusions: This study suggests a shift in attitude towards accepting the NP role by RNs and GP working in LTACFs. [ABSTRACT FROM AUTHOR]

In recent years, Medical Illustration at University Hospitals Bristol (UHBristol) NHS Foundation Trust has seen a steady increase in photography requests, including the need for out of hours photography provision. This paper details how Medical Illustration at UHBristol decided to manage an out of hours clinical photography service. [ABSTRACT FROM AUTHOR]

Recruitment of general practitioners (GPs) in the UK has been suboptimal. There is a wealth of literature exploring recruitment into general practice and opinions of general practice, set in many contexts. This paper aims to synthesise all the elements and extract mechanisms to explain what works, for whom in what circumstances, to create a comprehensive understanding and highlight potential target areas for improvement to improve understanding and fuel interest in general practice careers. A realist review of literature and contemporary data was conducted in line with RAMESES standards. Analysis and synthesis were aided by NVivo. An initial program theory was developed following discussion with expert informers. Sections of text from included literature relating to program theory were extracted and synthesised into a final program theory using a realist logic of analysis in which recurring Context-Mechanism-Outcome configurations (CMOCs) were identified. Searches identified 27 relevant documents. Twenty recurring CMOCs were extracted, explaining how student perceptions of General Practice were influenced by placement experiences, comments from hospital doctors, medical school faculty, peers, GPs, student perceptions of lifestyle and the media. The GP placement environment plays an important role in the formation of opinions about the speciality. The impact of social influence varies depending on the student's desire to belong to a reference group and their level of self-monitoring behaviour. The 'GP lifestyle' was judged to be compatible with many students' needs. This realist review provides recommendations on how curricula can adapt to provide an accurate insight into general practice. [ABSTRACT FROM AUTHOR]

Chronic spontaneous urticaria (CSU) is a debilitating inflammatory skin condition, often impacting quality of life. International guidelines recommend omalizumab, an anti-immunoglobulin E antibody, for second-line treatment. Our objective was to understand patient characteristics associated with prescription of omalizumab, and assess real-world outcomes in patients with CSU treated with omalizumab. We analyzed data from the Adelphi Real World CSU Disease Specific Programme, a cross-sectional survey with retrospective data collection (December 2020–October 2021) from physicians and patients with CSU in the United States. Data from allergists (n = 45), dermatologists (n = 51), and primary care physicians (PCPs; n = 20) were included. At the time of data collection, one-third of patients were receiving omalizumab (n = 220) and 67% were eligible for but not receiving omalizumab (n = 455). Using logistic regression, the odds of receiving omalizumab were higher in patients whose entire bodies were affected by hives [odds ratio (OR) = 2.551; 95% confidence interval (CI) 1.502–4.333; p < 0.001] or with deteriorating/unstable prognoses at treatment initiation [OR = 2.219; 95% CI 1.031–4.777; p = 0.042], and lower in patients managed by PCPs [OR = 0.276; 95% CI 0.130–0.584; p < 0.001]. Estimates from an inverse probability weighted regression adjustment model indicated that patients receiving omalizumab had higher treatment satisfaction, improvements in itching, hives, angioedema, insomnia, and anxiety, and lower impact on work productivity, compared with patients not receiving omalizumab. Around two-thirds of patients with CSU considered eligible for omalizumab were not receiving the guideline-recommended therapy. Patients receiving omalizumab had better real-world outcomes compared with patients not receiving omalizumab. Ensuring patients receive the most appropriate treatment could benefit patients with CSU. People with a skin rash known as chronic spontaneous urticaria (also called long-lasting hives) have itchy spots that last longer than 6 weeks. People with long-lasting hives may be treated with a medicine called omalizumab to help their itching. We asked doctors why they gave some people omalizumab. We found that only one out of every three people with long-lasting hives were given omalizumab. Doctors gave some people omalizumab because they had long-lasting hives on their whole body or their hives were getting worse. Other people received omalizumab because they were seeing a specialist doctor (allergist) instead of a primary care physician (also called a general practitioner). When compared with people who received other medicines, people being treated with omalizumab had reduced itching, less anxiety, and better well-being. These findings could help doctors choose the right medicine for people with long-lasting hives. [ABSTRACT FROM AUTHOR]

The bombing campaign by terrorists in Indonesia was a significant historical event that can be viewed from many perspectives. This paper focuses on the forensic evidence that was discovered during the examinations. It describes the physical and trace evidence, including the chemistry of the explosive mixture used. It describes a diverse range of evidence and acknowledges the important role of the ‘general practitioner’ for its recognition. The paper also reflects on the importance of ‘forensic intelligence’ and the need for sensitive information to be disseminated to the general practitioners. [ABSTRACT FROM AUTHOR]

The analysis presented in this paper is part of a larger study, the aim of which is to describe the GPs’ everyday taken-for-granted working life. The study is based on multi-sited anthropological fieldwork in Danish general practices. This paper analyses consultations where children are vaccinated and the analysis shows the way these consultations differ from other consultations in relation to flow and communication. Neither parents nor doctors question the value of the vaccination, but the manner in which they talk about it and handle it in the flow of the consultation points to them experiencing it as being problematic. Taking inspiration from Mary Douglas’ theory on cultural classification the injection is interpreted as ‘matter out of place’. The analysis identifies the infliction of pain and the discomfort this brings to the doctor and the parent as problematic as well as a breach of the doctor–patient relationship. The aim of vaccination is to prevent potential diseases in the future, but its function in the consultation, besides being fulfilment of national guidelines, is not immediately apparent. It has no real function in the consultation and this makes it problematic in the present, causing the ambiguity that both doctors and parents express. [ABSTRACT FROM PUBLISHER]

In contemporary times, evidence-based medicine is used as the basis for clinical decision-making. For a great number of diseases, surveillance guidelines, which are informed by evidence-based medicine, have been drawn up with much input from specialists in their relevant fields. However, these guidelines are implemented in general practice where different rationalities are brought to bear on clinical decision-making. This qualitative study interviewed both specialists and General Practitioners in New Zealand about their use of surveillance guidelines for colorectal cancer. Tension between both groups of medical professionals was apparent with regard to referral practices, with specialists advocating a rational approach to risk. However, the socio-cultural context within which General Practitioners' clinical decision-making takes place demands a more reflexive process. This paper argues the need to explore power within medical practice as the devolution of power to one group, specialists, who are constructed as the knowledge 'elite', sidelines other groups, in this case General Practitioners, who have to deal with the more qualitative aspects of health service delivery. [ABSTRACT FROM AUTHOR]

Healthcare systems in industrialised countries have been criticised for a number of years. Rising costs, dissatisfied patients and increasing economic pressure represent only part of the problem. A shortage of medical personnel as well as the emigration of physicians has forced hospitals to reconsider HR strategies. To recruit qualified physicians, hospitals must be attractive employers. Within the German healthcare sector, the deployment of performance management systems and variable pay for performance components is traditionally underdeveloped. Such management tools require workforce support to succeed. Studies determining exactly what contributes to a positive employer image among physicians, however, are absent from the literature. This paper addresses this by investigating the expectations of physicians regarding employer attractiveness, including the role of the pay system. The paper starts with a summary of the current situation in the German healthcare market, with a particular focus on the unique position of anaesthetists, who have a vital function within every surgical team. Based on theories about employer attractiveness, motivational theories and concepts from SHRM literature, propositions are developed to analyse the abovementioned issues. A small sample of anaesthetists from a German hospital is used in a first step to test the developed propositions. The paper concludes with a discussion. [ABSTRACT FROM AUTHOR]

This paper describes the development and on-going management of an email-based teledermatology service, providing General Practitioners in the metropolitan area of Cardiff, UK, with rapid access to a hospital-based Consultant Dermatologist. The paper describes the ethos behind the establishment of the service, details the equipment and methods used to deliver it, and presents results from the first four years of operation. It also discusses the lessons learnt in moving from an initial pilot to a supported service. [ABSTRACT FROM AUTHOR]

Primary Care clinics in the United States continue to incentivize doctors to adhere to clinical guidelines regarding record keeping and managing specific patient disorders. This paper offers a case study of a US physician working in a system of total compliance. This narrative will illustrate how a specific system has emerged that pays doctors an end-of-year bonus for achieving compliance in four specific areas: record keeping, service hours, customer satisfaction surveys, and maintaining tight control of diabetic patients. In particular, special attention is paid to the emphasis on 'the numbers' within the corporate compliance model, and specifically, the relative value units (RVUs) used for structuring billing, labeling patients, and organizing the day-to-day activities of doctors. Although incentivized models of compliance have proved effective in managing both doctors and patients, especially in the UK, 'gaming' the system can occur. This paper identifies one example of how patients assume a hidden risk within this model by potentially being labeled noncompliant by having the wrong numbers, even when receiving good clinical care and acting medically compliant. [ABSTRACT FROM AUTHOR]