Education Posters 507 – 513
507 Medical students’ views on careers in primary care: considering institutional prejudice
GMC data indicate that our medical school has one of the lowest proportions of graduates that subsequently train in primary care, far less than the 50% expected by HEE. At the 2015 RCGP conference there was reference to “blatant bigotry” on the part of unnamed schools towards primary care. Could this apply to our medical school? We adopt a mixed methods approach to study the attitudes of medical students towards a career in primary care including: Questionnaire data from 750 students after a six-week placement in general practice. Survey data from 300 medical students in their final two years, exploring career choices and influencing factors.
We investigate the hypothesis that there is institutional prejudice against general practice in our medical school, but acknowledge our data is confined to students’ perceptions. In particular we ask how different groups, including hospital consultants and GPs, have influenced students’ views towards primary care, and who, if anyone, has encouraged or discouraged them in pursuing a career in primary care.
In the context of Energising Primary Care it is essential the profession recruits as many students as possible from all medical schools. Our findings will be discussed in the context of the current GP recruitment crisis and we anticipate will provoke lively debate.We believe our findings will be of wide interest to the College, HEE, the GMC and all medical schools, and may be generalizable to those schools in which a low proportion of graduates progress to primary care.
508 GP Extensivist Training Pilot in Dorset
‘Extensivists’ are clinicians who manage vulnerable complex poly-morbid patients who are at high risk of hospital admission and have high healthcare costs. The extensivist initially manages patients in the community and if admission is required they become the lead physician during the admission. The extensivist coordinates safe and timely discharge of the patient back to the community.
In Caremore patients in the USA, this extensivist model reduced the number of hospital admissions and reduced the average length of hospital stays from eleven to four days. The NHS Five Year Forward View and Roland Report recommend integrated care and team working across primary and secondary care. ‘Building the Workforce – the New Deal for General Practice’ recommends improving the breadth of training by funding an ST4 year in areas with difficulty recruiting trainees, such as West Dorset.
Health Education Wessex has piloted GP ‘Extensivist’ Fellowships of six sessions per week in Dorset from August 2015 to August 2016. There are currently no other extensivist training programmes in the UK to our knowledge. Two newly qualified GPs were appointed to posts in Poole and Bournemouth. We have produced a workplace based assessment tool by combining competencies for the RCGP and RCP geriatrics curricula. Trainees have shown improvement in all 16 competencies.
We have collected case reports of patients who avoided admission to hospital. Further evaluation of the educational and service impact of these posts is underway and will be presented at the conference.
509 Promoting a career in general practice: the work experience programme
Aims/objectives To understand how career decisions of school and college pupils can be influenced. To understand successful work experience interventions from conception to delivery. To understand how to successfully engage and collaborate with stakeholders.
Content GPs already provide outreach and work experience in practices across the UK but they are often under-supported and under-resourced. Our research has shown that GPs who are currently involved in providing work experience see it as an extension to their role but that they experience barriers.
By helping to remove these, GPs are empowered to provide valuable opportunities with considerable benefits. This session will inform GPs about exciting new initiatives as well as provide practical solutions to the perceived barriers and toolkits to support their work. We will showcase two initiatives, one well established in Yorkshire and the other being introduced in Wales.
Relevance/impact The focus will be on the journey of applicants to medical school and how interventions can help to promote General Practice.
Outcomes Our work has shown that applicants to medicine are already starting to make career choices prior to entering university and that timely interventions can help influence these. As well as promoting General practice as a positive career choice at this impressionable age, applicants also develop transferable skills including communication skills and insight into the NHS and their possible role within it.
Discussion Practical resources will be discussed to empower practices to provide short, high impact interventions that provide positive outcomes for both the pupils and the practice teams.
510 ‘Ending up a GP’. Institutional slang and general practice at two UK universities
Aims: General practice in the UK is facing a recruitment crisis. The hidden curriculum is recognised to play an important role in shaping the career choice of medical undergraduates. This study investigates institutional slang around primary care at two UK universities producing differing proportions of graduates who enter primary care, aiming to identify who is doing the bashing of primary care, what the content is, and whether it differs between the two universities.
Content: Purposive sampling was used to select final year students and faculty at both institutions with a range of backgrounds to take part in semi-structured interviews to identify examples of badmouthing, as well as analysing the natural language of the interviews.Interviews were recorded and transcribed. The transcripts were anonymised and analysed using thematic analysis with NVivo. The transcripts were coded and grouped into themes.
Outcomes: Bashing of general practice occurred at both universities from a wide range of sources including patients, family, the media, lecturers, peers and hospital staff. The badmouthing centred on the skills and personality of GPs, perceived job content and prestige. There were no examples of badmouthing from lecturers at the university that produces a higher proportion of GPs.
Discussion: Badmouthing of general practice results in it being seen as a stigmatising career choice among medical students that they often hide from teachers and peers.
Relevance: We need to directly challenge the badmouthing of general practice that occurs in our universities, evolving beyond the tribalism that exists between different areas of medical practice.
511 The Cardiff GP short course in palliative medicine
Cardiff University has run a world renowned Postgraduate Diploma and MSC Programme in Palliative Medicine / Care for more than 25 years. The 2 day GP short course was developed by the Cardiff team in 2009 to equip GPs in Wales with basic skills to deliver palliative care of a high standard. The course provides education in managing common symptoms experienced by palliative patients in the community including pain, nausea & vomiting, confusion, dyspnoea, constipation & bowel obstruction.
The courses are run with small groups all over Wales, often in local hospices and are highly interactive allowing ample opportunity to discuss medical management, practical issues and local service arrangements. Afternoon sessions take the form of breakout groups and work through common scenarios often provided by the participants.
The course is facilitated by MacMillan GP facilitators, local palliative medicine physicians and community specialist nurses and is supported by the tutors from the MSc Programme. The course has been commissioned by several health boards and out of hours services in Wales. Over 350 GPs have attended including a significant number from England who often state difficulty sourcing similar education locally.
Course fees have so far been kept to a minimum to cover costs. Feedback has shown the content to be highly relevant, peer interaction was valued and speakers are credited for their first hand knowledge of working in a primary care and community setting. We would like to present our experience of the short course and potential development ideas for the future.
512 Introducing Gen-Equip: equipping european primary care health professionals to deal with genetics
Aims The aim of the Gen-Equip project is to provide support for primary care practitioners (PCPs) that will improve their genetics competences by developing a novel model of accessible, free online training and resources for clinical care.
Content of presentationResults on a needs assessment, based on a systematic review of genetics educational initiatives and a stakeholder workshop, will be reported and the proposed programme for the Gen-Equip project will be introduced.
Relevance Genetics education is only very slowly starting to become a common part of medical curricula and continuing medical education. In the age of genomics, PCPs will be increasingly involved in recognition, diagnosis, preventive care and organization of relevant surveillance of patients affected by or at risk of genetic conditions.
Outcomes Systematic review: long-term impact of genetics educational initiatives on patient management and policy has been poorly assessed and there is a dearth of high quality RCTs to provide a strong evidence base for educational practice Gen-Equip: education focused on 10 case-based modules, accessible online and set in primary care as well as a series of online webinars on core topics. Training and resources will be translated and delivered in six countries and available beyond the project duration.
Discussion By building on our experience of offering effective courses on genetics to PCPs, an interactive online course will offer maximum educational benefit if taken using synchronous technology. The Gen-Equip project will therefore have a potential to equip European PCPs to deal with genetics in daily practice.
513 Learning to be a doctor through the Arts: Reflection through photography
Aims and Objectives Self-awareness is recognised as a fundamental skill in the core curriculum for General Practitioners in the UK. “As a GP you should understand how your attitudes, feelings and values are important determinants of how you practice” (RCGP Curriculum). GP trainees typically develop their skills in self reflection and reflective practice through talking or writing in their eportfolios. In this project, we offered GP trainees a highly innovative opportunity to reflect through photography.
Outline of workshops GP trainees in Dorset attended a series of 3 photography workshops, each led by a GP and a photographic artist. Participants were introduced to the idea that what we photograph and the way we photograph it can provide us with a means to self awareness. Participants took a series of photographs over 3 months, and were asked to write a piece of reflective prose on their learning.
Outcomes GP trainees photographs were dominated by images of paths branching and aspirational pictures of a brighter place in the future. There was a notable absence of enjoying the ‘here and now’ or of people in their photographs.
Discussion Our take home message is that photography can be used as a tool for self reflection. The themes that were ‘leaking out’ through the trainees photographs created a rich discussion about what was important in their lives and their careers as GPs.
Relevance The Arts are an under-utilised resource that can enrich medical training. We will present the photographs as part of our poster presentation.