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Aim: Functional bowel (constipation and faecal incontinence) and bladder (urinary incontinence and enuresis) problems in children are often treated by paediatricians yet should mostly be managed by general practitioners (GPs). To understand whether the necessary skills and knowledge are being built in general practice, this study aimed to establish the prevalence and associated skills of Australian general practice registrars managing children with functional bowel and bladder problems. Together as paediatricians and GPs, we use these data to determine how best to ensure high quality, equitable care for children. Methods: We drew on 16 rounds of data collection from the Registrar Clinical Encounters in Training (ReCEnT) multi‐site cohort study (2010–2017) of general practice registrars' in‐consultation experience. It included a measure of paediatric consultations in which a functional bowel or bladder problem was managed, as well as demographic information. Results: Out of 62 721 problems/diagnoses for paediatric patients (0–17 years), 844 (1.4%) were coded as functional bowel (n = 709; 1.13% (95% confidence interval, CI: 1.05–1.22)) and/or bladder (n = 135; 0.22% (95% CI: 0.18–0.25)) presentations. Registrars were more likely to prescribe medication for bowel problems (odds ratio (OR) = 2.22 (95% CI: 1.86–2.64)) than for all other problems, but less likely to prescribe medication (OR = 0.31 (95% CI: 0.18–0.52)) for night‐time wetting and more likely to make a specialist referral (OR = 1.99 (95% CI: 1.22–3.25)) compared to all other problems. Conclusions: Only a small proportion of children with functional bowel and bladder problems were seen by registrars despite high prevalence in the community and amenability to management in the general practice setting (i.e. generally low morbidity and low complexity) versus need for specialists. Registrars appeared to be managing functional bowel and bladder problems according to evidence‐based guidelines, but with relatively high levels of referral. Given the inequitable access to specialist care, paediatricians should support local general practice management of these problems. This might include (i) engaging with training programs to ensure appropriate education and (ii) liaising with individual registrars/practices to provide management advice for individual or example cases. [ABSTRACT FROM AUTHOR]

Background: Achieving optimal collaboration between general practitioners and hospital-based critical care doctors is vital yet challenging, necessitating targeted collaborative training during residency. Despite apparent benefits, implementing intraprofessional learning faces constraints. Understanding its occurrence is crucial for engaging and educating residents. Considering boundaries' learning potential, we developed and evaluated an educational programme for general practitioner (GP) and paediatric (P) residents in paediatric emergency care based on Akkerman's Boundary Crossing Theory. The study investigated how intraprofessional learning mechanisms occurred and what learning conditions facilitated or impeded learning of GP and P residents, aiming to optimise educational programme design for intraprofessional collaboration., Methods: We developed an educational programme with three activities: joint medical assessments of paediatric patients in each other's context, mutually mini-Clinical Evaluation Exercises (mini-CEXs) about intraprofessional collaboration skills and educational meetings about collaborative care. We performed a qualitative study with a constructivist approach to explore experiences of the programme. We conducted focus group interviews and analysed mini-CEXs, utilising Boundary Crossing theory for template analysis., Results: Ten GP and eight P residents participated in our study. Learning mechanisms of identification and coordination dominated the joint medical assessments. Mini-CEXs stimulated reflection. Educational meetings with supervisors about intraprofessional barriers initiated transformation. Facilitated learning conditions were bidirectional crossing, enthusiastic supervisors, residents being familiar with each other, clear mini-CEX design and authentic paediatric cases. Unclear mutual expectations during joint medical assessments impeded learning of residents., Conclusions: Working in each other's context triggers learning mechanisms of identification, coordination and reflection, forming the basis for intraprofessional learning in paediatric emergency care for GP and P residents. For development of new collaboration practices, supervisors are necessary to translate reflection into transformation. Mutual responsibilities and expectations should be made more explicit to create a safer intraprofessional learning environment. Our findings extend to other medical training contexts, leveraging boundaries for learning., (© 2024 The Authors. Medical Education published by Association for the Study of Medical Education and John Wiley & Sons Ltd.)

Background: GP registrars (specialist vocational trainees in general practice) are interested in teaching, and there are considerable benefits to teaching during training. There are, however, significant barriers for registrars as teachers, including inadequate funding, time pressures, and limited teacher training. Current evidence does not include medical educator (ME) perspectives or compare teaching settings (e.g. university vs. in-practice). Further evidence is needed to inform programs supporting registrar teaching roles. This project aimed to explore the experiences of Australian GP registrars as teachers in different contexts and from multiple stakeholder perspectives., Methods: A qualitative study with GP registrars, GP supervisors, MEs, and medical students was conducted. Participants were registrars and new (within 12 months) Fellows with teaching experience during training, supervisors who supervised a registrar in the preceding 12 months, Royal Australian College of General Practitioner MEs, and medical students with experiences of being taught by registrars. Recruitment was open to participants nationwide and sampling was purposive, aiming for a maximum variation sample. Data collection was performed via videoconference and analysed using reflexive thematic analysis., Findings: Interviews were conducted with 15 registrars, 10 supervisors, and one ME. Two focus groups involved four MEs and five medical students respectively. Registrar participants taught in a variety of settings, including in-practice, universities, hospitals, and at educational workshop days. Three had experience in GP academic posts and one as a registrar ME. There were four major themes. 1) Near-peer teaching by registrars is valuable - both for medical students and registrars. 2) Teaching makes you a better GP - participants noted the transferability of teaching skills to clinical practice. 3) The importance of the teaching context - this was identified as an important determinant for registrars in teaching roles. 4) Registrar teaching strengthens the GP workforce - participants noted that teaching could elevate general practice as a specialty and increase interest in GP training., Conclusions: Study participants saw teaching as a core skill for GPs, with transferability to their clinical practice. Registrar participants wanted greater promotion and support for teaching opportunities that counted towards attainment of Fellowship. These findings have implications for teaching practices, MEs, universities, and training providers., (© 2024. The Author(s).)

A school's culture has been shown to influence medical students in their choice of future discipline. Therefore, we aimed to explore the culture towards the general practice discipline, as reflected in comments to medical students from their teachers and clinical tutors. Students in their 6th and 11th terms at the Universities of Umeå and Uppsala participated in a questionnaire study. A qualitative analysis of free-text answers of comments was conducted with thematic analysis. The students reported receiving both appreciative and deprecatory comments about general practice and GPs, which altogether ended up in two head themes: work-related factors and opinions about GPs. Appreciative comments included »important«, »varying«, »responsible work«, »broad skills«, and »good working hours«. Deprecatory comments included »stressful jobs«, »unstimulating routine work«, »incompetent doctors«, and »low status«. Considering the present shortfall of GPs, such deprecatory comments are worrying and could hamper the future recruitment of GPs.

Transitions are a period and a process, through which there is a longitudinal adaptation in response to changing circumstances in clinical practice and responsibilities. While the experience of the transition in medical student learning and in hospital-based specialty training programmes are well described and researched, the experience of the transition in community-based postgraduate general practitioner (GP) training has not been described comprehensively., Objective: We aimed to identify, and categorise, the formative experiences of transitions in GP training and their impacts on personal and professional development., Design: We adopted Levac et al 's scoping review methodology. Of 1543 retrieved records, 76 were selected for data extraction. Based on a combined model of the socioecological and multiple and multi-dimensional theories of transitions, data relating to the experiences of transitions were organised into contextual themes: being physical, psychosocial, organisational culture and chronological., Eligibility Criteria: Empirical studies focused on general practice trainees or training, that discussed the transitions experienced in general practice training and that were published in English were included., Information Sources: PubMed, MEDLINE and Web of Science databases were searched in January 2024 with no date limits for empirical studies on the transition experiences of GP into, and through, training., Results: Our findings describe context-dependent formative experiences which advance, or impede, learning and development. Time is a significant modulator of the factors contributing to more negative experiences, with some initially adverse experiences becoming more positive. Identification of the inflection point that represents a shift from initially adverse to more positive experiences of transitions may help moderate expectations for learning and performance at different stages of training., Conclusion: Challenges in training can either advance development and contribute positively to professional identity formation and clinical competency, or detract from learning and potentially contribute to burnout and attrition from training programmes. These findings will assist future research in identifying predictive factors of positive and adverse experiences of transitions and may strengthen existing and nascent GP training programmes. The findings are transferable to other community-based specialty training programmes., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: As healthcare professional trainees, resident physicians are expected to help with COVID-19 care in various ways. Many resident physicians worldwide have cared for COVID-19 patients despite the increased risk of burnout. However, few studies have examined the experience with COVID-19 care among resident physicians and its effects on competency achievement regarding clinical basics and COVID-19 patient care., Method: This nationwide, cross-sectional Japanese study used a clinical training environment questionnaire for resident physicians (PGY-1 and - 2) in 593 teaching hospitals during the General Medicine In-Training Examination in January 2021. The General Medicine In-Training Examination questions comprised four categories (medical interviews and professionalism; symptomatology and clinical reasoning; physical examination and clinical procedures; and disease knowledge) and a COVID-19-related question. We examined the COVID-19 care experience and its relationship with the General Medicine In-Training Examination score, adjusting for resident and hospital variables., Results: Of the 6,049 resident physicians, 2,841 (47.0%) had no experience caring for patients with COVID-19 during 2020. Total and categorical General Medicine In-Training Examination scores were not different irrespective of the experience with COVID-19 patient care. For the COVID-19-related question, residents with experience in COVID-19 care showed a significant increase in correct response by 2.6% (95% confidence interval, 0.3-4.9%; p = 0.028)., Conclusions: The resident physicians' COVID-19 care experience was associated with better achievement of COVID-19-related competency without reducing clinical basics. However, approximately half of the residents missed the critical experience of caring for patients during this unparalleled pandemic in Japan., (© 2024. The Author(s).)

Objective: Explore stakeholder perspectives of the benefits of continuously training general practitioners in the same rural or remote practice in distributed locations via the Remote Vocational Training Scheme (RVTS)., Design, Setting, Participants: Online one-hour semi-structured interviews were conducted with 27 RVTS staff, participants and supervisors from all states and territories between 16 October and 24 November 2023. Data were deductively and inductively coded by stakeholder type and the range of benefits, and the findings were informed by insights from a project reference group and a stakeholder advisory group. Questions explored the benefits of the RVTS - a program which supports doctors already working in rural, remote and First Nations communities to train towards general practice or rural generalist fellowship while remaining in the same practice., Main Outcomes Measures: Perspectives on the nature and spread of benefits., Results: Broad benefits were perceived to flow to four system-level stakeholders: communities, health services, participants and policy makers. Perceived participant and community benefits were doctors staying longer in distributed locations with tailored place-based supports and training, doctors building relationships with patients, and doctors learning through longitudinal care. Health service benefits included reduced reliance on locums, improved continuity of accessible and appropriate services in areas otherwise facing major recruitment and retention issues, and the doctors having more time to contribute to improving service quality and upskilling local staff. Policy-maker benefits were sustaining safe and high quality services for distributed populations with high needs., Conclusion: The RVTS model was perceived to offer diverse benefits for different system stakeholders which could improve quality of learning, service delivery and community care. It also aligned with key policy directions for a distributed and sustainable generalist workforce under the goals of the National Medical Workforce Strategy 2021-2031 and the directions set by the independent review of overseas health practitioner regulatory settings led by Robyn Kruk. However, models like the RVTS largely rely on distribution levers to recruit more doctors to the locations it supports., (© 2024 The Author(s). Medical Journal of Australia published by John Wiley & Sons Australia, Ltd on behalf of AMPCo Pty Ltd.)

Objective: To develop theory about how and why the supervision and support model used by the Remote Vocational Training Scheme (RVTS) addresses the professional and non-professional needs of doctors (including many international medical graduates) who are training towards general practice or rural generalist fellowship while based in the same rural or remote practice., Design, Setting, Participants: We conducted a realist evaluation based on the RAMESES II protocol. The initial theory was based on situated learning theory, networked ecological systems theory, cultural theory and geographical narcissism theory. The theory was developed by collecting empirical data through interviews with 27 RVTS stakeholders, including supervisors, participants and RVTS staff. The theory was refined using a project reference and a stakeholder advisory group and confirmed using individual meetings with experts., Main Outcomes Measures: Theory about how the contexts of person, place and program interacted to address professional and non-professional needs., Results: The RVTS program offers remote access to knowledgeable and caring supervisors, real-time tailored advice, quality resources and regular professional networking opportunities, including breaks from the community. It worked well because it triggered five mechanisms: comfort, confidence, competence, belonging and bonding. These mechanisms collectively fostered resilience, skills, professional identity and improved status; they effectively counteracted the potential effects of complex and relatively isolated work settings., Conclusion: This theory depicts how a remotely delivered supervision and support model addresses the place and practice challenges faced by different doctors, meeting their professional and non-professional needs. The participants felt valued as part of a special professional group delivering essential primary health care services in challenging locations. The theory could be adapted and applied to support other rural and remote doctors., (© 2024 The Author(s). Medical Journal of Australia published by John Wiley & Sons Australia, Ltd on behalf of AMPCo Pty Ltd.)

Objective: To explore continuity of service and longer term retention outcomes of participants of the Remote Vocational Training Scheme (RVTS)., Design, Setting, Participants: Retrospective cohort study of all doctors who participated in the RVTS from 2000 to 2023, many of whom are international medical graduates and are expected to work in the same community for three to four years in remote (Modified Monash Model [MMM] categories 4-7) or rural Aboriginal Medical Services (AMS) streams while undertaking training towards general practice fellowship., Main Outcome Measures: Continuity of service was measured in the pre-program period (period working in same practice before commencing) and during-program period (period completing the RVTS program in same practice as worked in before commencing the program). Retention was measured firstly within two years, and secondly beyond two years (up to 20 post-completion years) based on: working in the same community (relevant to both streams); working in the same region (Remote Stream only); working in any MMM4-7 community (Remote Stream only); or working anywhere rurally (both streams)., Results: From 506 enrolled participants, 373 (73.7%) were international medical graduates. The approximate mean service continuity in the same practice was 1.6 years (standard deviation [SD], 2.2 years) for the pre-program period and 3.6 years (SD, 1.4 years) for the during-program period (mean total, 5.2 years). Two years after completion, 21 out of 43 Remote Stream doctors (49%) and four out of five AMS Stream doctors (80%) remained in the same community. Over the long term, retention in the same community stabilised to 44 out of 242 Remote Stream doctors (18.2%) and seven out of 27 AMS Stream doctors (26%); 72 Remote Stream doctors (29.8%) remained in the same region, 70 Remote Stream doctors (28.9%) were in an MMM4-7 community, and 11 AMS Stream doctors (41%) were in a rural (MMM2-7) community., Conclusion: Strong service continuity outcomes have been achieved by the RVTS, which supports mostly international medical graduates in locations typified by the highest workforce turnover. This suggests that continuity of service could be improved for remote and First Nations communities through place-based retention-focused programs like the RVTS., (© 2024 The Author(s). Medical Journal of Australia published by John Wiley & Sons Australia, Ltd on behalf of AMPCo Pty Ltd.)

Objective: To explore the impact of COVID-19 pandemic disruptions on general practice trainees interdependent learning, from the perspectives of trainees and the whole of the practice team., Setting: Four rural general practices in Queensland that continued to supervise registrars, junior doctors and medical students through the pandemic., Participants: Twenty-three members of the general practice teams, including general practitioners, practice managers, receptionists, practice nurses, registrars, junior doctors and medical students., Design: Audio-recorded semi-structured interviews were conducted with all participants following an initial survey. Thematic analysis and the theory of interdependent learning were used to understand how supervision and training was both disrupted and sustained during the pandemic period. Reporting is informed by the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines., Results: Learning affordances were transformed by the rapid implementation of physical distancing and other infection control measures. Telehealth consultations and remote working impacted on the interdependent relationship between the work environment, supervision team and trainees., Conclusion: Practice staff identified new ways of working that arose through this period, including changes to practice team roles and the supervisory dynamic that enabled patient care and trainee learning to continue. Social connectedness was important to the trainees and the implications for future training need to be further evaluated., (© 2024 The Author(s). Australian Journal of Rural Health published by John Wiley & Sons Australia, Ltd on behalf of National Rural Health Alliance Ltd.)

Objective: This study assesses the impact of personalized health education on elderly patients with chronic diseases in a general practice setting. The rationale behind the incorporation of personalized health education stems from the growing recognition of the need for patient-centered care approaches, particularly in geriatric populations, where such interventions could lead to improved health outcomes. Our study aims to evaluate the effects of personalized health education on elderly patients with chronic diseases in a general practice context. The initiation of this study is grounded in the increasing acknowledgment of patient-centered care's significance, especially in geriatric demographics. We hypothesize that personalized health education interventions could significantly enhance health outcomes in this patient group., Methods: We conducted a randomized controlled trial involving 126 elderly patients with chronic diseases, assigning them equally to receive either standard care or standard care supplemented with personalized health education. The effectiveness of this education was measured through outcomes related to cognition, self-care, health literacy, psychological and physical health, quality of life, and prognosis. In our study, we executed a randomized controlled trial encompassing 126 elderly patients diagnosed with a range of chronic diseases. These participants were evenly divided into two groups: one receiving standard care and the other receiving standard care enhanced with personalized health education. The study spanned over a specified period, during which the impact of the personalized health education was meticulously evaluated. To comprehensively measure the effectiveness of the personalized health education, we employed a variety of tools and scales. These instruments were specifically chosen to assess changes in cognition, self-care abilities, health literacy, and psychological and physical health. Additionally, we evaluated the quality of life and prognosis of these patients, aiming to capture the holistic impact of the intervention. This approach ensured a thorough and nuanced understanding of how personalized health education influences the health outcomes of elderly patients with chronic diseases., Results: The intervention group demonstrated significant improvements across all measured outcomes compared to the control group, highlighting the efficacy of personalized health education in enhancing comprehensive health parameters in geriatric patients with chronic conditions. In our study, the intervention group, which received personalized health education, exhibited notable improvements in several key areas compared to the control group. Specifically, there was a marked enhancement in cognition and health literacy, with patients showing improved understanding and management of their conditions. Additionally, significant gains were observed in the quality of life, indicating that the tailored health education effectively addressed the holistic needs of geriatric patients with chronic diseases. These specific findings underscore the substantial impact of personalized health education in improving critical health outcomes in this patient population., Conclusion: Personalized health education in geriatric chronic disease management significantly betters disease comprehension, health literacy, self-care, psychological well-being, and physical health while also lowering the risk of adverse events. This study underscores the value of patient-centered educational strategies in chronic disease care for the elderly.Our study conclusively demonstrates that personalized health education plays a pivotal role in managing chronic diseases among the elderly. It significantly improves disease comprehension, health literacy, self-care capabilities, psychological well-being, and physical health. Furthermore, it contributes to a reduced risk of adverse health events. These findings emphasize the critical importance of integrating patient-centered educational strategies into general practice care for the elderly. By doing so, we can enhance their overall well-being and quality of life, making personalized health education an essential component in the holistic care of elderly patients with chronic conditions. This approach not only aligns with the principles of modern geriatric care but also sets a benchmark for the future of chronic disease management in older populations.

Introduction: As a workforce crisis is causing recruitment and retention issues for new to practice GPs, we designed Catalyst, a one-year pilot career development program aiming to help new to practice GPs develop the skills of advanced generalist practice and build capacity for the complex work of primary care. In this paper, we report the findings of our evaluation of Catalyst., Methods: We used normalization process theory to investigate how Catalyst was contributing to the participants' understanding and implementation of generalist practice. We conducted 36 interviews and six focus groups investigating the participants' clinical practice and experience with the program and analyzed data using framework analysis., Results: Establishing a shared language and reframing professional identity helped GPs develop an understanding of their role through generalist lenses. Generalist practice was legitimized by access to scientific evidence and facilitated interactive learning. Integration of scientific, applied knowledge and quality improvement work fostered the enactment of such practice. Structured reflection and research-informed quality improvement projects contributed to the participants' awareness of the primary care context., Discussion: Knowledge creation activities observed through interactive learning and the integration of different types of knowledge facilitated the implementation of advanced generalist practice. The participants valued the community of practice gained through the program and would come to rely on programs designed to encourage networking and enable peer support. Finally, research-informed quality improvement projects built to analyze problems and monitor solutions are crucial for an early career physician to develop a sense of agency that shapes their primary care practice., Competing Interests: Disclosures: The authors declare no conflict of interest., (Copyright © 2024 The Alliance for Continuing Education in the Health Professions, the Association for Hospital Medical Education, and the Society for Academic Continuing Medical Education.)

Objective: Teaching by trainee doctors is also established practice in general practice in English-speaking countries. This study examines the involvement of trainee doctors in the supervision of students in German general practices and the acceptance of trainee doctors as teachers from the perspective of physicians with a license for post-graduate training (PLT) and the trainee doctors themselves., Methodology: Semi-structured qualitative interviews were conducted with 9 PLTs and 9 trainees. The interview guide was developed based on the Theoretical Framework of Acceptance. Interviews were recorded, transcribed and evaluated using Kuckartz's qualitative analysis., Results: Trainee doctors are involved in student supervision in GP teaching practices to varying degrees and often in unstructured ways. Supervision by trainees is considered advantageous as they are closer in terms of hierarchy, possess more up-to-date knowledge and are less far ahead in terms of knowledge and function as role models. However, professional uncertainty or revealing knowledge gaps to patients and students is experienced as difficult by some trainees. Competing for time with patient care is seen as a challenge. Better time planning and didactic preparation could avoid pressure in this area. Teaching is seen as part of the GP profession, especially by trainee doctors. However, a potential obligation to teach is seen as more of a hindrance to encouraging the next generation of doctors by both trainee doctors and PLTs., Conclusion: The inclusion of trainee doctors in student teaching is frequently practiced by those surveyed, which suggests a high level of acceptance but is not consistently implemented. Structured organization of teaching in real life, didactic qualifications and offering credits for teaching activities might further improve inclusion and acceptance., Competing Interests: The authors declare that they have no competing interests., (Copyright © 2024 Gehrke-Beck et al.)

Background: General hospitals in China have been establishing General Practice Departments (GPD). Although General Practice Nurses (GPNs) are an important part of this medical system, their training has not been synchronised. This study explored the working status of nurses in GPDs in general hospitals in Beijing to provide a theoretical basis for the training and development of GPNs in China., Methods: We conducted in-depth, individual interviews with outpatient nurses at 19 hospitals in Beijing between March and April 2021. We employed a qualitative analysis to interpret participant narratives and used a codebook thematic analysis to analyse the interview data and extract themes., Results: The analysis revealed four themes: (i) a lack of full-time GPNs in GPDs of most tertiary hospitals, (ii) the inability of GPNs to fully express their potential and skills owing to their limited roles, (iii) insufficient standardised patient education provided by nurses in GPDs, and (iv) a lack of systematic and relevant training for nurses working in general practice settings., Conclusions: To promote the development of GPNs, GPDs in general hospitals in China should hire full-time GPNs, define their job duties in alignment with their values, and provide standardised training to strengthen their core competencies., (© 2024. The Author(s).)

Background: Health professions education (HPE) research in the General Practice domain (GP-HPE) is vital for high-quality healthcare. Collaboration among GP-HPE researchers is crucial but challenging. Formulating a research agenda, involving stakeholders, and fostering inter-institutional collaboration can address these challenges and connect educational research and practice., Methods: We used Q-methodology to explore perspectives on GP-HPE research of participants from all Dutch postgraduate GP training institutes. Participants individually sorted statements based on the relevance of future GP-HPE research for educational practice. Data analysis comprised inverted factor analysis, rotation, and qualitative interpretation of configurations of all statements. The National Meeting on Educational Research took a participatory approach., Results: We included 73 participants with diverse involvement in GP-HPE research. We identified five distinct perspectives, each representing a research focus area for developing and innovating GP education: the clinician scientist, the socially engaged GP, the specific GP identity, the GP as an entrepreneur, and the GP engaged in lifelong learning., Discussion: The resulting five perspectives align with General Practice hallmarks. Q-methodology and a participatory approach facilitated collaboration among stakeholders. Successful inter-institutional collaboration requires a common goal, neutral leadership, participant commitment, regular meetings, audit trail support, process transparency, and reflexivity. Future research should address evidence gaps within these perspectives., Conclusion: Using Q-methodology turned out to be valuable for compiling a national research agenda for GP-HPE research. The research process helped to cross boundaries between researchers in different institutions, thus putting inter-institutional collaborative advantage center stage. Our approach could provide a conceivable procedure for HPE researchers worldwide., (© 2024. The Author(s).)

Purpose: Professional Identity Formation (PIF) is crucial for high-quality patient care and physician well-being. Few empirical studies examined PIF in residency from the perspective of supervisors. In GP residency, residents are supervised with an 'end in mind' that remains unexplored. To encourage supervisors to reflect on their teaching behaviours, this study investigated GP clinical supervisors' perceptions of PIF outcomes in GP residency., Methods: Applying qualitative description, focus group interviews were conducted between spring and autumn 2019. Using a semi-structured interview guide, supervisors' perceptions of PIF outcomes were explored. In an iterative coding process applying constant comparison, a thematic analysis was performed of focus group transcripts., Results: We conducted eight focus groups with 55 supervisors at four training institutes across the Netherlands. Half of the supervisors were female. GP supervisors tend to address the 'poor GP' when prompted to address the 'good GP'. PIF outcomes in GP residency should revolve around taking ownership in patient care, self-care and the persistence of GP as a profession., Conclusion: PIF can be challenged by a lack of positive language. Supervisors' strong beliefs regarding ideals of the profession potentially compromise PIF when they do not resonate with residents' beliefs, resulting in poor educational alliance.

Background: In Rwanda, a nationwide shortage of surgeons necessitates general practitioners (GPs) perform many common procedures and minor surgeries. However, GPs only receive a 1-year internship to prepare them to provide this care. We performed a Delphi survey of practicing GPs to assess essential content for a surgical curriculum for Rwandan interns to better prepare them for general practice., Methods: We invited 56 practicing GPs to participate in a two-round anonymous electronic survey in February 2023. The first round assessed demographics and solicited free-text responses to gather knowledge and procedural content suggestions for the curriculum. The second round refined these responses into key content areas., Results: Thirty-one GPs responded to both rounds of the Delphi survey. They provided insight into the most commonly performed procedures, most important technical skills, and the top areas of surgical knowledge necessary for general practice. They expressed a need for more exposure to a variety of surgical pathologies and interventions across multiple specialties, highlighting the value of foundational skills in trauma, obstetrics and gynecology, and orthopedics, both at the beginning of their internship, as well as at the beginning of their general practice., Conclusions: GPs emphasized the importance of broad exposure to common acute surgical pathology and interventions across several surgical subspecialties, as well as a need for foundational technical skills and surgical knowledge. The results of our study underscore the necessity of a surgical education providing a solid basis in the foundational knowledge and techniques of surgical care., (© 2024 International Society of Surgery/Société Internationale de Chirurgie (ISS/SIC).)

Objective: Many countries experience challenges in recruiting and retaining general practitioners (GPs) as supervisors for medical students in clinical placements. We aimed to investigate the opportunities, capacities and limitations of Norwegian GPs to become supervisors., Design: Web-based cross-sectional questionnaire study., Setting: Norwegian general practice., Subjects: All GPs in Norway, including locums and those on leave, both active supervisors, and GPs who are not presently supervising medical students., Main Outcome Measures: GPs' terms of salary, office facilities, limiting factors, capacity and needs for becoming or continuing as supervisors., Results: Among 5145 GPs, 1466 responded (29%), of whom 498 (34%) were active supervisors. Lack of a dedicated student office was the most reported limitation for both active supervisors (75%) and other GPs (81%). A high proportion (67%) of active supervisors reported that they could host more students per year, given financial support for equipped offices and higher salaries. With this kind of support, 48% ( n  = 461) of the GPs who were not supervisors for medical students were positive about a future supervisor role. By adjusted regression analysis, female GPs had lower likelihood of being supervisors, OR (95% CI) 0.75 (0.59-0.95) than male colleagues. GPs in the North, Mid and West regions had higher odds (OR 3.89, 3.10 and 2.42, respectively) than those in the South-East region. Teaching experience also increased the odds (2.31 (1.74-3.05)., Conclusions: There seems to be capacity among both active and potential supervisors if increased salaries and financial support for office facilities are made available.

Purpose: There is a shortage of generalist physicians globally impacting health equity and access to care. An important way in which medical schools can demonstrate social accountability is by graduating learners interested in careers in generalism. While generalism is endorsed as a matter of principle in medical education, how this translates into curricula is less clear. The aim of this study was to identify how generalism is understood and supported by family physician educational leaders in undergraduate medical education (UME) in Canada., Methods: We conducted a qualitative study, interviewing 38 family medicine leaders in UME across all 17 Canadian medical schools. We examined the data with template analysis, informed by the iceberg model of systems thinking., Results: Four themes were identified: (1) Teaching and learning strategies in support of generalism-a consistent range existed across UME curricula; (2) Curriculum patterns-changes in leadership and curriculum reform created positive or negative feedback loops that promoted or hindered initiatives to support generalism; (3) Curriculum structures-organ-system-based curricula and availability of generalist faculty presented particular challenges to teaching generalist approaches; (4) Mental models and ways of knowing-the preponderance of biomedical frameworks of thinking in curricula unconsciously undermined generalist approaches to patient care., Conclusions: UME programmes promoted generalism through a range of teaching activities and strategies, but these efforts were countered by curriculum structures and mental models that perpetuate epistemic inequity between biomedical approaches to medical education and generalist models of care. Novel curricular frameworks are needed to align undergraduate programmes' commitment to social accountability with community-based need., (© 2024 The Author(s). Medical Education published by Association for the Study of Medical Education and John Wiley & Sons Ltd.)

Background: Herpes zoster (shingles) is normally diagnosed clinically. Timely diagnosis is important so that antiviral treatment can be started soon after rash onset., Aim: To assess whether a practice-level educational intervention, aimed at non-clinical patient-facing staff, improves the timely assessment of patients with shingles., Design and Setting: This was a cluster randomised study within a trial (SWAT) with nested qualitative study in general practices in England., Method: Practices were cluster randomised 1:1, stratified by centre and minimised by practice list size and Index of Multiple Deprivation score. Intervention practices were sent educational materials, highlighting the common presenting features of shingles and what action to take if suspected. The primary and secondary outcomes were the mean proportion of patients per practice seen within 72 and 144 h of rash onset, respectively. Comparison between groups was conducted using linear regression, adjusting for randomisation variables. Semi-structured interviews with practice staff in intervention practices explored views and opinions about the intervention., Results: In total, 67 practices were enrolled; 34 randomised to the intervention and 33 to the control. The mean difference in proportion of patients seen within 72 and 144 h was -0.132 (95% confidence interval [CI] = -0.308 to 0.043) and -0.039 (95% CI = -0.158 to 0.080), respectively. In intervention practices, 90.9% reported distributing the educational materials; however, engagement with these was suboptimal. Twelve participants were interviewed, and the poster component of the intervention was said to be easiest to implement., Conclusion: Our educational intervention did not improve the timely assessment of patients with shingles. This may be the result of poor intervention engagement., (© The Authors.)

Background: Generalist approaches can help address several challenges facing today's primary care. However, GPs report insufficient support to deliver advanced generalist medicine (AGM) in daily practice, struggling within a healthcare system that imposes strict adherence to single-disease focused guidelines., Aim: To examine the professional and educational experiences of newly qualified GPs attending a course on AGM to understand how to redesign primary care systems to support their generalist work., Design and Setting: This was a qualitative study focusing on AGM in UK general practice (England), conducted in the context of the research evaluation of an online career development programme on AGM., Method: We conducted 36 interviews and six focus groups with newly qualified GPs attending an online career development programme on AGM, and analysed data using framework analysis., Results: Three tensions experienced by the participants were identified: tension between realistic and idealistic practice; tension between different decision-making paradigms; and tension in the formation of the GPs' professional identities. These were owing to grey areas of practice deeply rooted in primary care systems - namely areas of work not adequately addressed by current education and service design., Conclusion: Our findings have implications for tackling the general practice workforce crisis, highlighting that solutions targeting individual problems will not suffice by themselves. By making visible the grey areas of everyday general practice, we describe the changes needed to target tensions as described by the GPs in this study to ultimately enable, enhance and make visible the complex work of generalist medicine., (© The Authors.)

Background: To address the declining numbers of general practitioners (GPs) in rural areas and a lack of medical students pursuing a career in primary care, a general practice-based curriculum coupled with additional university admissions for students has been established at three universities in Hesse, Germany. This study aims to analyze potential topics which students striving to become a GP will benefit from. Teaching such topics will prepare them for their chosen career and working in rural areas. We aimed to explore the views of both specialists and GPs on chief topics and necessary skills in primary care., Methods: In our study we used semi-structured interviews with outpatient specialists and specialists in clinical practice and semi-structured group interviews with GPs in training. The topic guide addressed contents of the curriculum for medical students with an extracurricular focus (addressing additional topics) on primary care. Data analysis was carried out using qualitative content analysis according to Mayring., Results: GPs in training and specialists agreed on the importance of knowledge in the fields of medical history, physical examination, communication as well as common diseases in primary care. Essential competences mentioned were: inducing medical treatment, decision-making and triage, conducting structured conversations, having patient knowledge (hard skills) as well as an interest in continuous learning, empathy, personal commitment, listening and down-to-earthness (soft skills). Case reports, symptom-based learning, practical training, lessons with simulated patients and the integration of role models were regarded as useful teaching methods., Conclusions: General practice-based curriculums should not only focus on the transfer of knowledge. Equally important is the training of soft and hard skills to prepare future GPs for their work in primary care. Special teaching methods as well as practical training should be the heart of a newly established curriculum., (© 2024. The Author(s).)

Background This study aims to assess the effectiveness of a structured audio-visual educational session for people on asthma symptoms management during a general practitioner visit. Methods We conducted this single-centre intervention study in a general practice clinic in Queensland, Australia. There were 78 intervention and 78 control participants in this study. We followed 1:1 randomisation to allocate study intervention between two groups of participants with asthma. The intervention group received an audio-visual demonstration of asthma, its symptoms, triggers, and how to use inhalers correctly, along with the standard asthma management by a physician on enrolment. The control group received only the standard asthma management by a physician. We assessed the 'Asthma Control Test' score on enrolment and after 90days and compared the changes across the groups. Results Participants were, on average, 28years old (range: 6-60, 60% women). The intervention group showed a 1.9-unit increment, and the control group showed a -0.5-unit increment in 'Asthma Control Test' score from baseline to endline. The difference of differences between the intervention and control groups was 2.4 units (P =0.016) after adjusting for potential confounders. In age-stratified analysis, the children (6-17years) showed a significant difference (mean difference of 2.5 between intervention and control groups) in their asthma control score. Conclusions Structured educational sessions involving audio-visual media along with standard management for people with asthma during general practice visits would be effective for better asthma control. However, a further multi-centre study with a larger sample is needed to see its efficacy.

Background: Securing access to sufficient and focussed learning experiences is a perennial challenge for medical trainees. This challenge was accentuated during the COVID-19 pandemic lockdowns and with physical isolation processes that decreased in-person patient presentations and a shift to telehealth consultations. This situation has prompted the need to optimise the available experiences and educational responses to overcome the limitations in the number, quantum and range of available clinical learning experiences., Methods: Semi-structured interviews were conducted with medical practice teams in four rural general practices to understand how medical trainees' education in rural general practices can be sustained in such circumstances., Findings: Key considerations included optimising the available experiences to assist medical trainees to generate the kinds of mental models needed by trainees to conduct medical work, and particularly, when it became even more restricted through remote or physically distanced consultations. It also identified lessons learnt during COVID-19 pandemic lockdowns to inform and improve the provision of trainees' experiences in such practices., Discussion: Providing experiences for trainees to participate fully in clinical activities is imperative. A sequenced set of experiences was proposed to incrementally prepare trainees to engage in and conduct clinical consultations remotely using digital technologies., Conclusion: Such an approach may not always be easy or possible to enact but offers a pathway of experiences most likely to lead to positive outcomes for the trainees whilst maintaining patient care and safety considerations., (© 2024 The Authors. The Clinical Teacher published by Association for the Study of Medical Education and John Wiley & Sons Ltd.)

Introduction: Supervision of trainees in the health care professions is recognised internationally as core to safe and effective patient care. A supervisor workforce in general practice (GP) is critical to the profession and to the communities where they work and can be demanding as general practitioners incorporate workplace-based education and support of their trainees into their daily consulting work. Little is known about how this is experienced by new supervisors; therefore, this research sought to understand factors that play a significant role in the first semester of becoming a supervisor., Methods: An exploratory multi-case study design was used; new general practice supervisors were the unit of analysis. Four data sources were captured longitudinally: semi-structured interviews at the beginning and end of the semester, audio diaries throughout and a mid-semester focus group. Template analysis was used, sensitised by a community of practice theoretical framework., Results: Seven new supervisors participated. Five interdependent key factors played a significant role in general practitioners becoming supervisors: (1) making meaning of the role, (2) reconciling multiple roles, (3) building a relationship with the trainee, (4) receiving support from the training practice and the training programme and (5) joining peer communities of new and experienced supervisors., Conclusion: Becoming a general practice supervisor is situated in the context of a workplace delivering clinical services, a training programme and personal life circumstances. It can be challenging and rewarding. Insufficient support may result in unintended attrition. Learning in this role is facilitated by enabling the new supervisor to find meaning in the role; structured allocation of time to engage effectively; a positive trainee-supervisor relationship; administrative support by practices; information, advice and remuneration from the training programme; and interactions with new and experienced supervisor peers., (© 2024 The Authors. The Clinical Teacher published by Association for the Study of Medical Education and John Wiley & Sons Ltd.)

Background: Basic sciences are crucial for clinical medicine, yet studies focusing on their perceived utility among general practitioners (GPs) are sparse. Considering the broad scope of GPs' practice, an in-depth understanding of basic sciences is fundamental for making informed clinical decisions. This study evaluated GP registrars' retention and perceptions of the utility of basic sciences in clinical practice., Methods: Using sequential explanatory mixed methods study design, knowledge retention was assessed by a multiple-choice question (MCQ) examination followed by interviews on the perception of the relevance and utility of basic sciences among GP registrars at James Cook University's (JCU) General Practice Training (GPT) program. Descriptive and inferential statistical analyses were conducted on the MCQ exam data, while thematic analysis was employed for the qualitative interview data., Results: Sixty-one GP registrars participated in the MCQ exam, while 11 of them were involved in the interviews. The highest mean score was obtained in biochemistry (75.1 ± 2.23) while the lowest mean score was in anatomy (56.07 ± 3.16). Key performance predictors included the formative clinical examination scores (β = 0.83, 95% CI: 0.45 to 1.2, p < 0.001) and gender (β = -9.7, 95% CI: -17 to -2.3, p = 0.011). The qualitative data analysis revealed five themes, including the backbone of clinical medicine, varying utility over time and by specialty, clinical synthesis integrates encapsulated knowledge, professional pressures hinder revisitation of knowledge and knowledge renewal enhances updates., Conclusion: Basic sciences were considered relevant in clinical practice. Development of continuing professional development (CPDs) sessions and clinically relevant online resources were measures proposed to enhance the retention of knowledge. Future research could focus on innovative educational strategies for GPs., (© 2024. The Author(s).)

Background: We previously reported the impact of general practice/family medicine training on postgraduate training in Japan using evaluation criteria standardized nationwide. However, there is a possibility that new insights may be gained by analyzing the reflective reports written by these residents., Methods: Junior residents who participated in one-month general practice/family medicine training at one of five medical institutions with full-time family medicine specialists between 2019 and 2022 were enrolled in this study. They were assigned to submit a reflective report on their experiences and thoughts every day during the training. We analyzed these reflective writings using text mining and created a co-occurrence network map to see the relationship between the most frequently used words., Results: Ninety junior residents participated in the study. The words that appeared most frequently in the sentences referring to clinical ability included "symptoms," "medical examination," "consultation," "treatment," and "examination." The words of "family" and "(patient) oneself" showed strong association in the co-occurrence network map., Conclusion: It was suggested that general practice/family medicine training greatly contributes to the acquisition of clinical abilities and deepens the learning of junior residents not only about patient care but also about family-oriented care.

Aims and Objectives: To evaluate: (a) the effectiveness of an infographic poster compared with an e-learning program on general practice nurses' knowledge about chronic kidney disease risk factors and best practice screening procedures and (b) the effectiveness of an infographic poster compared with an e-learning program on general practice nurses' learning time and learning efficiency., Background: The screening and early detection of chronic kidney disease is essential in reducing its burden on the health system and those affected by it. General practice nurses are well-positioned to assist in its early detection., Design: Parallel-group, single-blinded, pre-post interventional randomised control design., Method: This study was reported in accordance with the Consolidated Standards of Reporting Trials (CONSORT). Participants were registered or enrolled nurses working in general practice settings across Australia. The intervention group (n = 173) received an infographic poster about chronic kidney disease risk factors and best practice screening procedures, whereas the control group (n = 170) received an interactive e-learning program. Data were collected using an 8-item pre-post knowledge evaluation instrument. Time spent learning were collected through a self-reported log and a login/logout method., Results: The overall intervention effect demonstrated no statistical significance in knowledge scores from the baseline scores between the intervention and control group. The intervention group demonstrated higher learning efficiency in comparison to the control group., Conclusion: The study demonstrated an infographic poster is as effective as an e-learning program on improving knowledge scores. However, in comparison to an e-learning program, an infographic poster is a more efficient way of learning., Relevance to Clinical Practice: Infographic posters can be an efficient educational modality to enhance healthcare professionals' knowledge and could be used as public health campaigns in clinical settings to educate the community., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier Ltd.)

Background: Giving students more responsibility for real patients during medical school may help prepare them for their transition to clinical practice. Student-led clinics (SLCs) may facilitate this. Within SLCs, students take the lead role in delivering patient care while being supported and supervised by qualified clinicians. A general practice SLC was established in Dundee, with four final-year medical students and one GP involved in each clinic., Aim: This study aimed to explore students' and educators' experiences and perceptions of this SLC., Method: This was an exploratory case study. Semi-structured interviews were conducted with 11 students and three educators, and 18 hours of observation were conducted over six clinics. Interview transcripts and fieldnotes were integrated and thematically analysed., Results: Overall, students' and educators' experiences and perceptions were positive. Students thrived in their lead role in patient care, gaining a sense of empowerment and developing confidence in their abilities. Both students and educators felt comfortable with students having this level of responsibility due to the students' stage of training and the supervision provided by educators. Teaching within the SLC involved individual discussions and group debriefs. Students felt a sense of belonging as a result of their relationships with their peers and educators. Challenges arose when the clinic ran behind schedule due to unexpected complex patients or lengthy individual discussions., Conclusion: The findings suggest that giving students responsibility for real patients is beneficial and feasible when adequate support is provided, and that it is possible for one GP to supervise multiple students successfully., (© British Journal of General Practice 2024.)

Background: GP confidence and competence in relation to gender diversity and the discussion of related matters remains relatively unknown. Despite increasing demand on primary care in dealing with matters of gender identity; contention and confusion are unfortunately widely reported amongst doctors., Aim: We sought to formally evaluate the level of GP training and gauge desire for further training in relation to the discussion of pronouns with patients., Method: We used a structured questionnaire that was sent out to GPs in Oxfordshire, facilitated by a mailing list used by the Primary Care Undergraduate Teaching Department at the University of Oxford. Additionally, we performed structured individual interviews with GPs in Oxford, who provided their contact details and expressed interest when completing the questionnaire., Results: Fourty-four GPs responded and completed the questionnaire, five of whom agreed to participate in a structured interview. Most GPs (61%) had not received any formal training. Despite this, 68% of GPs did not want more formal training in the field of gender incongruence and pronoun usage. Only one GP routinely asked patients their pronouns (2%)., Conclusion: Our findings highlight that a significant proportion of GPs have no formal training in relation to discussing pronouns and gender incongruence. We believe GPs should have the skills necessary to appreciate, understand and provide structured support to those with concerns in relation to their gender identity. With waiting times for gender clinics frequently exceeding 2 years, our findings emphasise the increasing importance of GP specific training in the field of gender identity., (© British Journal of General Practice 2024.)

Background: There exists a significant body of literature on the benefits of Peer Assisted Learning (PAL). Near-peer (NP) teaching can be defined as teaching delivered by senior students to younger year students. There are numerous examples in the literature of PAL projects in a non-clinical setting but little research in a clinical setting and even less in primary care. Postgraduate literature suggests that potential benefits include promotion of general practice as a career as well as increasing teaching capacity.A successful pilot led to the development of a new undergraduate NP teaching Student Selected Component (SSC) in a primary care setting., Aim: To explore the experiences of medical students and GP tutors who participated in this SSC., Method: Semi-structured interviews were carried out with year 5 NP student teachers, GP tutors, and year 3 students. Thematic analysis was used to analyse the qualitative data generated., Results: As well as increasing teaching capacity and consolidating their own knowledge, the findings suggest an impact on the professional identity formation of NP student teachers helping them to prepare to be future doctors. The NP teaching fostered an environment of psychological safety for all students, although there was an additional element of risk management and supervision when teaching with patients., Conclusion: Undergraduate NP teaching has advantages for student learners, NP student teachers, GP tutors, and practices. The increased teaching capacity has implications for recruitment of practices for teaching and may promote general practice as a future career., (© British Journal of General Practice 2024.)

Background: Recruitment and retention of undergraduate (UG) GP educators is vital, they are essential to educating the next generation of doctors. The expected loss of GPs as they retire and leave the profession means clinical delivery is under tension; adding to the strain on the number of GP educators. With GP educators numbers decreasing and student numbers increasing, the pressure on the system is growing., Aim: To explore the experience of the GP educator, investigate the impact participation in UG medical education has, the barriers there are, and what support educators need to continue., Method: This qualitative study uses individual semi-structured interviews of four active GP educators with at least 4 years of experience teaching medical students in a primary care setting; these were then transcribed and thematically analysed., Results: One of the most surprising results showed that GPs' enjoyed their work as educators as it allowed them t'o be seen and heard' . One participant stated; I want ' my blood, sweat and tears to mean something to somebody [the students] '. It also allowed the GPs' to reflect on their life's work and gave them a platform to demonstrate this., Conclusion: The Wass report, 2016 showed that students' exposure to GPs in UG education plays a significant role in choosing a career in general practice. This exposure needs GPs to act as positive role-models. Further research is required to examine the GP educators' need to ' be seen and heard ', and if this can be used to recruit/retain GP educators., (© British Journal of General Practice 2024.)

Background: This study aims to determine the satisfaction and future training needs of general practice residents participating in a novel model of ambulatory teaching aligned with the specifications for standardized residency training in outpatient management issued by the Chinese Medical Doctor Association (CMDA)., Methods: A cross-sectional survey of the satisfaction and training needs was conducted among general practice residents at West China Hospital, Sichuan University. Patient characteristics and preceptors' feedback on the residents' performance were also analyzed., Results: The study involved 109 residents (30.28% men) and 161 patients (34.78% men; age: 52.63 ± 15.87 years). Residents reported an overall satisfaction score of 4.28 ± 0.62 with the ambulatory teaching program. Notably, residents scored lower in the Subjective-Objective-Assessment-Plan (SOAP) evaluation when encountering patients with the greater the number of medical problems (P < 0.001). Residents encountering patients with a shorter duration of illness (< 3 months) achieved higher scores than those with longer illness durations (≥ 3 months, P = 0.044). Residency general practitioners (GPs) were most challenged by applying appropriate and effective patient referrals (43/109; 39.45%). GPs expressed a strong desire to learn how to make decisions when facing challenging patient situations (4.51 ± 0.63)., Conclusion: This study suggests selecting patients with multiple comorbidities for ambulatory teaching and enhancing training on practical problem-solving abilities for GPs. The findings provide insights for the development of future ambulatory teaching programs., (© 2024. The Author(s).)

Background: General practitioner interns need to acquire the expected clinical, communication, personal and professional competencies. Internship evaluations use qualitative evaluation tables to assess competency acquisition. However, there is no standardised evaluation table used in France. Some faculties use the exhaustive, precise, and manageable Exceler evaluation tool. We aim to evaluate opinions of General practice interns in Brest about the acceptability and feasibility of using the Exceler evaluation tool to monitor competency acquisition during internships., Methods: This qualitative study used intern focus groups. Six-open ended questions with optional follow-up questions were asked. Cards from the Dixit® game were used to guide and facilitate discussion. Open, axial, then integrative analysis of the verbatim was performed., Results: This is the first study to evaluate intern opinions about GP internship evaluations using focus groups. Participants felt that the quality of existing evaluations was insufficient, and it was difficult to monitor their progress. Adapting evaluations to individual profiles and backgrounds seemed necessary. Exceler appeared to be a possible solution due to its content validity, flexibility of use and accessibility. However, there were comments about possible modifications., Conclusions: Analysing opinions of tutors, supervisors and other practice centers could help identify potential barriers and reveal solutions to facilitate its implementation and use., Trial Registration: Not applicable., (© 2024. The Author(s).)

Problem: Approximately 100,000 individuals in the United States have sickle cell disease (SCD). These individuals face multiple barriers to equitable care. At Brigham and Women's Hospital, existing health inequities for these patients were compounded by admitting, rounding, and team structures that assigned patients with SCD to multiple medicine teams with a hematologist attending, leading to delays in patient care and gaps in residents' hematology knowledge., Approach: A hematology-general medicine hybrid team was created in September 2021 to enhance trainee knowledge, skill, and confidence in managing hematology conditions and improve the quality of care delivered to individuals with SCD. This allowed for regionalization of patients with classical hematology conditions to specific hospital floors under the care of one team with a hematologist as the attending of record., Outcomes: From October 1, 2021, to January 11, 2022, the majority (745/824, 90%) of in-hospital days for patients with a primary hematology diagnosis were under the care of the hematology-general medicine hybrid team. Regionalization to the home floor of the hybrid team was achieved on 331 (40%) of these 824 hospital days, consistent with regionalization rates for other teams. From October 1, 2021, to September 30, 2022, there were 128 unique patients with SCD admitted over 511 encounters and cared for by approximately 78 residents and 12 medical students. Feedback from residents reported improved knowledge in the management of hematology conditions, especially SCD., Next Steps: The authors are working on a comprehensive analysis of the hybrid team's impact on trainee skill and confidence in managing SCD. The authors believe that this model can be replicated at other institutions to optimize trainee education, consolidate care, and address implicit bias against patients with SCD, even with the hematology attending as a consultant instead of as the attending of record., (Copyright © 2024 the Association of American Medical Colleges.)

Background: Sexual assault (SA) is a highly prevalent issue, with significant adverse health sequelae. Given that general practitioners (GPs) may serve as the first point of contact for many SA victims, their awareness of post-SA care and appropriate understanding of referral pathways to a sexual assault treatment unit (SATU) are critically important. This study evaluated GP trainees' knowledge of and comfort with post-SA care., Methods: Educational intervention study using a didactic teaching session was delivered by a specialist forensic examiner on post-SA care. A pre and post-study questionnaire was implemented to assess participants' knowledge and comfort levels with subject material. Significance was set at p-value below 0.05., Results: Seventy-five GP-trainees attended the teaching session. Fifty-three completed the pre-teaching questionnaire and 50 completed the post-teaching questionnaire. Only a minority of trainees had received prior teaching in post-SA care as a medical student (13.2% n = 7) or as a postgraduate (28.3% n = 15). After the teaching session, there was a significant improvement trainees' comfort levels in explaining a forensic examination (p < 0.0001), referral pathways to a SATU (p < 0.0001) and offering advice in relation to emergency contraception (p < 0.0001). There was also a significant improvement in understanding HIV post-exposure prophylaxis (PEP) (p < 0.001) and forensic examination (FE) time-lines (p < 0.001)., Conclusion: This study reveals that GP-trainees have had limited exposure to teaching on post-SA care. Additionally, significant improvements were observed following a 1-h didactic teaching session on post-SA care. Trainees demonstrated increased understanding of SATU referral pathways, understanding of immediate medical care after SA, including PEP and FE timelines., (© 2023. The Author(s), under exclusive licence to Royal Academy of Medicine in Ireland.)

Objectives: To investigate the views of the general practice training sector about responding to recruitment challenges, with the aim of identifying effective initiatives and other solutions., Study Design: Qualitative study; focus group discussion of recommendations from a medical educator workshop., Setting, Participants: An initial online appreciative enquiry workshop for medical educators followed by focus group discussions by a broader selection of people involved in general practitioner training (Royal Australian College of General Practitioners fellows, supervisors, practice managers, medical educators, registrars)., Main Outcome Measures: Key overarching themes and major recommendations for increasing recruitment derived from focus group responses to workshop recommendations, based on qualitative descriptive analysis., Results: The 26 medical educators at the workshop made four major recommendations: increase the number of student and junior doctor clinical placements in general practice; increase exposure of students and junior doctors to general practitioner teachers and educators; improve general practitioner trainee pay and entitlements; and improve the integration of general practice and hospital patient care and professional relationships. Thirty-four semi-structured focus group participants broadly supported the recommendations, provided that supervisors and training practices were adequately compensated for the effects on workloads, income, and patient care. Two overarching themes infused participant responses: "rescuing the profession we love" (reflecting participants' passion for general practice and their sense of threat), and "no idea what general practitioners do" (perceptions of being misunderstood and misrepresented by hospital-based practitioners)., Conclusions: Clinicians, educators, and policy makers should work together to increase the number of high quality, adequately supported student and junior doctor placements in general practice, improve intra-professional relationships, and trial new models of general practitioner trainee payment and conditions., (© 2024 The Authors. Medical Journal of Australia published by John Wiley & Sons Australia, Ltd on behalf of AMPCo Pty Ltd.)

The landscape of general practice has experienced notable transformations in recent decades, profoundly influencing the working conditions of general practitioners (GPs). This study aimed to examine the most salient changes affecting GPs' daily practices. Through semi-structured qualitative interviews with 15 end-of-career GPs, the study explored how these changes affected work organization, equipment, working hours, work-life balance, job satisfaction, training, patient relationships, and reputation. The interviews revealed that these changes were perceived as barriers, opportunities, or a complex interplay of both for general practice. While the interviewed GPs valued technological advancements and reported positive developments in working conditions, challenges included a gradual reduction in the range of tasks, growing administrative burdens, and less practical training for young physicians. Other changes, such as new doctor-patient dynamics, the transition from single to group practice, and differing professional expectations of the younger generation, were seen as both challenging and strengthening for general practice. By combining these factors and trade-offs observed by end-of-career GPs in our study over the past few decades with general societal changes, we provide ideas for the design of future framework conditions in general practice that might enhance the attractiveness of the profession. These insights offer key considerations that can guide future strategies for general practice and medical education., (© 2024. The Author(s).)

Purpose: 'Low-value' clinical care and medical services are 'questionable' activities, being more likely to cause harm than good or with disproportionately low benefit relative to cost. This study examined the predictive ability of the QUestionable In Training Clinical Activities Index (QUIT-CAI) for general practice (GP) registrars' (trainees') performance in Australian GP Fellowship examinations (licensure/certification examinations for independent GP)., Methods: The study was nested in ReCEnT, an ongoing cohort study in which Australian GP registrars document their in-consultation clinical practice. Outcome factors in analyses were individual registrars' scores on the three Fellowship examinations ('AKT', 'KFP', and 'OSCE' examinations) and pass/fail rates during 2012-21. Analyses used univariable and multivariable regression (linear or logistic, as appropriate). The study factor in each analysis was 'QUIT-CAI score percentage'-the percentage of times a registrar performed a QUIT-CAI clinical activity when 'at risk' (i.e. when managing a problem where performing a QUIT-CAI activity was a plausible option)., Results: A total of 1265, 1145, and 553 registrars sat Applied Knowledge Test, Key Features Problem, and Objective Structured Clinical Exam examinations, respectively. On multivariable analysis, higher QUIT-CAI score percentages (more questionable activities) were significantly associated with poorer Applied Knowledge Test scores (P = .001), poorer Key Features Problem scores (P = .003), and poorer Objective Structured Clinical Exam scores (P = .005). QUIT-CAI score percentages predicted Royal Australian College of General Practitioner exam failure [odds ratio 1.06 (95% CI 1.00, 1.12) per 1% increase in QUIT-CAI, P = .043]., Conclusion: Performing questionable clinical activities predicted poorer performance in the summative Fellowship examinations, thereby validating these examinations as measures of actual clinical performance (by our measure of clinical performance, which is relevant for a licensure/certification examination)., (© The Author(s) 2024. Published by Oxford University Press on behalf of Fellowship of Postgraduate Medicine.)

Background: A recent study found that ethnic minority General Practice (GP)-trainees receive more negative assessments than their majority peers. Previous qualitative research suggested that learning climate-related factors play a pivotal role in unequal opportunities for trainees in post-graduate medical settings, indicating that insufficient inclusivity had put minority students at risk of failure and dropout., Study Objectives: We aimed to develop broadly supported strategies for an inclusive learning climate in Dutch GP-specialty training., Methods: We employed Participatory Action Research (PAR)-methods, incorporating Participatory Learning and Action (PLA)-techniques to ensure equal voices for all stakeholders in shaping Diversity, Equity, and Inclusion (DEI)-strategies for GP-specialty training. Our approach engaged stakeholders within two pilot GP-specialty training institutes across diverse roles, including management, support staff, in-faculty teachers, in-clinic supervisors, and trainees, representing ethnic minorities and the majority population. Purposeful convenience sampling formed stakeholder- and co-reader groups in two Dutch GP-specialty training institutes. Stakeholder discussion sessions were based on experiences and literature, including two relevant frameworks, and explored perspectives on the dynamics of potential ethnic minority trainees' disadvantages and opportunities for inclusive strategies. A co-reader group commented on discussion outcomes. Consequently, a management group prioritized suggested strategies based on expected feasibility and compatibility., Results: Input from twelve stakeholder group sessions and thirteen co-readers led to implementation guidance for seven inclusive learning environment strategies, of which the management group prioritized three: • Provide DEI-relevant training programs to all GP-specialty training stakeholders; • Appoint DEI ambassadors in all layers of GP-specialty training; • Give a significant voice to minority GP-trainees in their education., Conclusion: The study's participatory approach engaged representatives of all GP-specialty training stakeholders and identified seven inclusive learning climate strategies, of which three were prioritized for implementation in two training institutions., (© 2024. The Author(s).)

Background: Understanding how the general practice medical workforce defines cultural safety may help tailor education and training to better enable community-determined culturally safe practice. This project seeks to explore how Australian general practice registrars define cultural safety with Aboriginal and Torres Strait Islander patients and alignment with an Australian community derived definition of cultural safety., Methods: This mixed method study involved a survey considering demographic details of general practice registrars, questionnaire, and semi-structured interviews to explore how general practice registrars defined cultural safety and a culturally safe consultation., Results: Twenty-six registrars completed the survey. Sixteen registrars completed both the survey and the interview., Conclusion: This study shows amongst this small sample that there is limited alignment of general practice registrars' definitions of cultural safety with a community derived definition of cultural safety. The most frequently cited aspects of cultural safety included accessible healthcare, appropriate attitude, and awareness of differences., (© 2024. The Author(s).)

The drivers for medical students' decision making when considering which Student Selected Component (SSC) to undertake is poorly understood. Furthermore, it is unclear why students undertake a specific SSC allowing them to have an extended placement in GP in their final year. It is known that high quality GP placements encourage students to subsequently choose GP as their career, therefore if the decision-making process of students in this area can be better understood, then this may help inform medical school actions to encourage a greater uptake of these extended placements.Semi-structured interviews were conducted with final year medical students at a Scottish University. Students were selected to provide a mixture of those who had and had not chosen to undertake the extended placement. The data was transcribed and analysed using thematic analysis to generate themes which represented the data.This showed that career intention was a major factor driving SSC choice. Additionally, students sought peer feedback and tended to avoid specific SSCs if they felt a lack of internal motivation. Considering the choice for the extended placement, students tended, again, to choose based on career intentions, and they also based their decision on previous experiences of GP.Career intention and prior experience are key factors in student choice of SSC and whether to undertake an extended GP. In order to address the national shortage of GPs medical schools need to consider how they might influence these drivers.

GP training in the UK has a long history of success, however that is measured. That success is in part due to the formality and credentialling that underlies preparation to take on that role of a GP teacher, which is somewhat under current threat due to workforce pressures. We identify three important factors associated with the GP trainer function [leadership, professional identity and clinical care improvement] that are not often analysed but are at some risk if preparation for the GP trainer role is reduced or devalued. Of particular note are the differing ways that GPs conceptualise their professional roles as teachers and clinicians, despite the transferable skills between them, the demonstrably improved patient care that occurs in practices that teach, and the necessary connections between educational theory and practice. We suggest that these areas define a research agenda ripe for exploration.

Background: The UK faces a decline in medical students' interest in general practice (GP), crucial for its healthcare system. This trend endangers primary care sustainability and broader healthcare infrastructure, necessitating innovative educational approaches to improve perceptions of general practice., Objective: To assess the impact of a pilot programme integrating innovative educational strategies on medical students' perceptions of general practice, aiming to highlight potential reforms for medical education and primary care's future in the UK., Methods: A longitudinal pilot study with eighteen fifth-year medical students from Queen Mary University of London employed a diverse educational approach over thirty-six months. The programme encompassed mentorship, storytelling, community home visits, interactive patient cases, and GP speciality clinics, covering six GP practice domains. Data were collected through mid-placement and end-of-placement questionnaires to evaluate students' perceptions and interest in GP careers., Results: The programme significantly improved students' perceptions of general practice. Mentorship and storytelling saw an 83% to 94% increase in appreciation for GP complexities and impact. Community home visits enhanced cultural sensitivity and holistic health views among 67% to 89% of participants. Interactive patient cases and GP speciality clinics notably advanced understanding of GP's multidisciplinary nature. Exposure to GP-led research and business initiatives heightened awareness of entrepreneurial and innovative opportunities within general practice., Conclusions: Innovative educational strategies can substantially influence medical students' perceptions and interest in general practice. The study suggests that enriching medical education with real-world experiences, mentorship, and comprehensive general practice exposure can counter declining interest, showcasing general practice as a dynamic and fulfilling career.