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Promoting reflection on experience and developing students' reflective skills is an important element of curricula across the health professions. Students often do not find reflection easy and educators use a range of approaches to facilitate this. This qualitative study analysed final year medical students' written reflections about important and difficult concepts they had encountered at medical school and personal change. As part of this, students were expected to look back on their written reflections from earlier years of the undergraduate programme. An initial analysis identified 'learning from past reflections' as an important theme. Here we report an in-depth analysis of this theme. Thirty-six final year volunteer students' reflections were analysed and 6 themes identified where students explicitly referred to earlier written reflections. These were: managing emotions; holistic, patient-centred care; uncertainty and ambiguity; self-regulation; growth in identity and sense of self efficacy; and reflective practice changes. Asking students to reflect on past reflections appeared to help students identify personal change, and how their understanding of 'important concepts' and their views and approach to reflective practice have developed. Experienced by students as a motivating, profound, sometimes cathartic process, this activity could be a useful addition to reflective writing training in health professions. [ABSTRACT FROM AUTHOR]

Integrated Training Posts (ITPs) were conceived in the 1990s and have recently increased in the Southwest of England. Most ITP evaluations have been small and undertaken over 13 years ago, so do not reflect the current training landscape. This qualitative study aimed to explore the views and experiences of ITPs amongst general practice trainees and educators. The location has increasing numbers of general practice trainees, International Medical Graduates (IMGs) and less-than-full-time trainees. Semi-structured interviews were undertaken with six trainees and two educators; all had experienced at least one ITP. Recordings were transcribed verbatim and coded. Thematic analysis was undertaken. Three themes were identified: 'The role: expectations versus reality', 'Relevance of ITPs to future GP role' and 'Educational Challenges'. Most trainees valued the additional clinical experiences ITPs offered, as well as being able to trial 'portfolio' working. Trainee and educator expectations varied considerably, particularly whether the role was primarily service or observational. Working across multiple settings could limit contact between educator and trainee and make it difficult to identify a struggling trainee. There is a need to clarify the roles of trainees and educators involved in ITPs and whether and how this might vary between posts. Further studies could explore whether choice of ITP influences retention of general practitioners, and whether all trainees including those working less-than-full-time or IMGs benefit from ITPs. [ABSTRACT FROM AUTHOR]

UK general practitioner (GP) trainees are taught a consultation model which elicits the patients' main reason for consulting 'today'. This approach will often miss important issues for the increasing number of patients with multimorbidity. We developed the SHERPA model as a person-centred biopsychosocial framework for consulting patients with multimorbidity to address this. We aimed to examine GPs trainees' responses to SHERPA when integrated into their vocational training. The research design was qualitative and participants were GPs trainees in vocational training from one UK training location. GP trainees were introduced to the SHERPA model through interactive workshops. Qualitative data were collected from 16 participants, through four hours of teaching observation, 24 feedback templates, six practical applications of SHERPA and eight one-to-one interviews. Data were transcribed, and, using the Framework approach, systematically analysed, focussing on trainees' learning and application of the model. The results demonstrated that all participants engaged well with the teaching sessions, brought observations from their own experience, and reflected on particularly complex consultations. Half of the participants applied SHERPA successfully with their patients, particularly repeat attenders. Barriers to this approach were: selecting appropriate patients; perceived time pressure; lack of familiarity using the model; viewing SHERPA as 'additional', rather than integral, to shared decision-making in complex situations. The SHERPA model was viewed as helpful by these GP trainees for patients with whom they had established a relationship. Earlier introduction and regular support from trainers, where trainees reflect on experience of SHERPA, could increase confidence in using this method. [ABSTRACT FROM AUTHOR]

While undergraduate curricula should reflect populations' priority health needs and promote social accountability, evidence about the impact of such interventions is limited. To gain insights into students' lived experiences of social engagement pathways and associated learning. Medical and dental students spent four days with local organisations working with disadvantaged groups, recording audio-dairies after each session. These were transcribed, coded and analysed thematically. Fourteen students produced 50 audio-reflections. Key themes included emotions, learning and critical reflection. Students reported improved communication skills, better appreciation of others' lives and having their assumptions challenged. They questioned issues underpinning inequalities. Analysis revealed a three-act pathway structure, with students' emotional responses changing as projects progressed. Immersion in new contexts; connecting with others; having their views challenged and plans going wrong appeared to facilitate shifts in thinking, as did experiencing negative emotions. Feedback and support from organisations, facilitators and service users helped students overcome challenges, which was associated with positive emotion. Educators often work hard to make learning 'easier' for students. This study suggests that when exploring the social determinants of health within community settings, supporting students to experience such unsettling contexts and negative emotions may facilitate transformative learning. [ABSTRACT FROM AUTHOR]

Threshold Concepts are fundamental ideas within a discipline which are transformative, integrative, irreversible and usually troublesome. This article describes the threshold concept framework and discusses how it can offer new insights into how we focus teaching and facilitate learning around these concepts, such as uncertainty. Relevant research from a range of health disciplines are explored to consider which concepts may be critical to thinking and practising effectively in primary care. In addition, it is proposed that threshold concepts may have relevance to the GP recruitment crisis. [ABSTRACT FROM AUTHOR]

Professionalism is a core element of curricula in many disciplines but can be difficult to teach and learn. This study used audio-diary methodology to identify professionalism threshold concepts in a small group learning setting in undergraduate medicine and to understand factors that might facilitate students to ‘get’ such concepts. Fifteen students and seven tutors kept audio-diaries over two terms. Data were analysed qualitatively for content. The key themes were then cross referenced to threshold concept criteria (e.g. where language indicated that learning was troublesome, integrative or transformative). Seven potential threshold concepts were identified which centred on students’ developing professional identities including working with uncertainty, considering the bigger picture, not needing to know everything and professional culture. Reflection on workplace experiences within a small group helped students ‘get’ these concepts. The study concludes that threshold concepts and audio-diaries are useful tools for understanding lived experiences of professionalism learning. [ABSTRACT FROM AUTHOR]

The notion of “threshold concepts” is being widely applied and researched in many disciplines but is rarely discussed within medical education. This article is written by three medical educators who regularly draw on threshold concept theory in their work. They explore here the nature of threshold concepts and describe how the theory can offer medical educators new perspectives in terms of how they design curricula, approach teaching and support learners. [ABSTRACT FROM PUBLISHER]