Revitalising interest in general practice: innovative educational strategies to transform medical student perceptions in the UK.

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.

The importance of attentive primary care in the early identification of mild cognitive impairment: case series.

Background: Mild cognitive impairment (MCI) is a condition often preceding Alzheimer's disease and other dementias, characterized by subtle changes in cognitive function. While the importance of early detection is recognised, MCI is frequently underdiagnosed, especially when patients consult primary care physicians for non-cognitive health concerns. The case series aims to investigate the incidental identification of MCI in older patients who visit primary care settings for reasons unrelated to memory issues. Case Description: This is a retrospective case series comprising eight patients, ranging in age from 67 to 77 years, who initially presented in primary care settings for diverse non-memory-related concerns such as headaches, urinary tract infection (UTI) symptoms, and knee pain. Despite the lack of memory-related complaints, incidental findings suggestive of MCI were observed during clinical evaluations. The study explores the distinctions in clinical presentations and diagnostic pathways through thorough history taking and cognitive assessments, including the Montreal Cognitive Assessment (MoCA) and brain magnetic resonance imaging (MRI). Conclusions: The study highlights the critical role that primary care settings can play in the early detection of MCI, even when patients present with non-cognitive complaints. It emphasizes the importance of comprehensive history taking as a tool for incidental identification of cognitive impairment. Although limited by sample size, the study calls for increased vigilance in primary care settings and suggests the need for future research aimed at optimizing early detection and management strategies for MCI in a primary care context.

The multifaceted roles of GP trainers in guiding trainee transition to portfolio general practice.

The journey of transitioning from a GP trainee to a portfolio GP is a complex and transformative process. This article explores the multi-dimensional roles that GP trainers play in guiding trainees through this key transition. This article, also, aims to challenge readers to consider how GP trainers can further enhance their role in minimising barriers and maximising opportunities for trainees, inviting contributions to the educational discussion on this topic.Serving as mentors, GP trainers navigate trainees through the particulars of general practice, ensuring they are equipped with both skills and resilience. They also play the role of confidantes, offering emotional and psychological support in times of doubt and uncertainty. As anchors, GP trainers provide stability, helping trainees find their footing in the vast domain of general practice and instilling core professional values. Furthermore, bridging the gap between academic knowledge and real-world practice, GP trainers guide trainees in effectively applying theoretical knowledge in clinical scenarios.Despite the inherent challenges, the bond between trainer and trainee is rewarding, ensuring a holistic evolution into competent portfolio GPs, thereby significantly influencing the future of primary care and patient outcomes.

Effect of chronic heavy tobacco smoking on ankle fracture healing.

INTRODUCTION: Tobacco smoking is linked to an elevated risk of osteomyelitis and delayed healing in long bone fractures. However, the impact of smoking on bone union and soft tissue recovery following ankle fractures remains unclear. This study presents a retrospective comparative analysis evaluating the effects of chronic heavy tobacco smoking on the healing process and outcomes of ankle fractures after surgical interventions. MATERIALS AND METHODS: We examined 220 consecutive cases of chronic heavy smokers (CHS) with closed ankle fractures who were referred to our unit for further treatment. A control group, consisting of 220 age- and sex-matched individuals (non-smokers with closed ankle fractures), was identified for comparative analysis. We collected clinical data, including pre-existing comorbidities, Lauge-Hansen fracture classification, necessity for surgery, and the surgical procedures performed. The primary outcomes investigated were the time required for fracture union and wound healing. Secondary outcomes included postoperative complications such as prolonged pain, bleeding, swelling, infection, compartment syndrome, and neurovascular impairment, as well as the incidence of delayed union, non-union, and the need for further intervention. Both cohorts were monitored for a minimum of 24 months. RESULTS: Our analysis revealed that the surgical cohort of chronic heavy smokers exhibited a statistically significant delay in fracture union compared to both the conservatively managed smokers and the control group. Further scrutiny of the surgical cohort of chronic smokers indicated a significant correlation between smoking and extended postoperative pain duration, persistent swelling at the fracture site, and both superficial and deep wound infections. Additionally, these patients experienced delays in both fracture union and wound healing when compared to the control group. Similarly, the conservatively managed chronic smokers showed a marginal increase in the incidence of post-injury pain duration, extended swelling at the fracture site, and delayed union compared to the control group. CONCLUSION: Patients who are chronic heavy smokers and require surgical intervention for ankle fractures should be made aware of their increased risk for delayed fracture union and poor wound healing. Orthopedic surgeons should proactively encourage these patients to participate in smoking cessation programs.

Mental Health Polypharmacy in "Non-Coded" Primary Care Patients: The Effect of Deprescribing.

Background: Mental health (MH) polypharmacy, defined as prescribing multiple mental health medications for the same condition, presents significant challenges in clinical practice. With varying prevalence rates and an increasing trend, particularly in the UK, this deprescribing prospective quality improvement project aimed to address the complexities and risks associated with MH polypharmacy. Patients and Methods: A large primary care centre in London was selected for this project. Electronic records of 667 patients (non-coded in mental health lists) were analysed as a result of the absence of a Systematised Nomenclature of Medicine Clinical Terms (SNOMED CT) for mental health. Seventy-two non-coded patients exhibiting "same-class" as well as "adjunctive" and "augmentation" polypharmacy were identified. Their demographic and health data, including MH diagnoses, physical status, and lifestyle habits, were evaluated. This deprescribing prospective project included 68 patients and employed a model inspired by the Plan-Do-Study-Act (PDSA) cycle, focusing on reducing psychotropic, adjunctive, and augmentative medications while monitoring mental health control through face-to-face consultations using the Patient Health Questionnaire-9 (PHQ-9) and Generalised Anxiety Disorder Assessment-7 (GAD-7) scores, alongside physical health parameters. Results: The project revealed a significant decrease in the average number of psychotropic and adjunct medications from initial consultations to the end of the 18-month period. Additionally, a marked reduction in reported side effects and drug interactions was observed. Improvements in mental health control, as evidenced by PHQ-9 and GAD-7 scores, were noted. Physical health parameters, including BMI, blood pressure, heart rate, HbA1c, and cholesterol levels, also showed significant improvements. Educational initiatives for patients and clinicians were successfully implemented, contributing to these positive outcomes. Discussion: The project faced challenges like balancing medication reduction with mental health stability, patient apprehension, and the absence of standardised protocols. However, the successful reduction in medication numbers and the improvement in health outcomes highlight the effectiveness of the model. This project underscores the necessity of a tailored approach to MH polypharmacy, emphasising continuous education, clinical titration, and adherence to guidelines. Future research is needed to develop clear guidelines for medication combination in mental health care and to understand the long-term effects of polypharmacy in mental health populations. Conclusions: This project demonstrates the potential for significant improvements in the management of MH polypharmacy. By carefully managing medication reductions and employing a comprehensive care approach, including patient education and clinician training, the project achieved improvements in both mental and physical health outcomes. These findings suggest a promising direction for future practices in MH polypharmacy management.