Crisis, change and the future for teaching and learning in general practice.

OBJECTIVES: The aim of this study was to explore the decisions and decision-making strategies employed by academic GPs tasked with adapting the delivery of undergraduate general practice education curricula to virtual platforms during the Covid-19 pandemic. We sought to investigate how their experiences of this adaptation might influence the development of future curricula. METHODS: Recognising our 'insider' positions and constructivist paradigm preferences, we approached the study from a constructivist grounded theory (CGT) perspective and participants participated in semi-structured interviews. RESULTS: Nine participants from three university GP departments in Ireland described the transition to online delivery of the curriculum as a 'response approach'. Participants described seeking collaboration both within and between institutions. The value and limitations of student feedback as a driver for change differed between participants and recognised the impact of limited social engagement between peers on social determinants of learning. Participants with prior experience in e-learning were inclined to recommend some level of continuation. Two institutions plan to continue to incorporate aspects of blended learning. CONCLUSION AND IMPLICATIONS: All participants recognised a level of value (efficiency, social engagement and continuity) in online learning, they were less clear on the specific educational value and impact of this (e.g. on knowledge, skills and attributes). We need to consider which elements of undergraduate education can be delivered effectively online. Maintaining the socio-cultural learning environment is of critical importance but must be balanced by efficient, informed and strategic educational design.

Educational change in a crisis: what has changed and what is here to stay in undergraduate teaching and learning in General Practice.

OBJECTIVES: The aim of the study was to explore the decisions and decision-making strategies employed by academic GPs tasked with adapting the delivery of undergraduate general practice education curricula to virtual platforms during the COVID-19 pandemic and to investigate how their experiences of this adaptation might influence the development of future curricula. METHODS: Approaching the study from a constructivist grounded theory (CGT) perspective, we recognised that experiences shape perception, and an individual's 'truths' are socially constructed. Nine academic GPs from three university GP departments participated in semistructured interviews conducted via Zoom©. Anonymised transcripts were iteratively analysed, generating codes, categories, and concepts using a constant comparative approach. The study was approved by the Royal College of Surgeons in Ireland (RCSI) Research Ethics Committee. RESULTS: Participants described the transition to online delivery of the curriculum as a 'response approach'. The elimination of in-person delivery necessitated the changes rather than any strategic development process. With varying levels of experience in eLearning, participants described the need for and engagement with collaboration both internally within institutions and externally between institutions. Virtual patients were developed to replicate learning in a clinical environment. How these adaptions were evaluated by learners differed across the institutions. The value and limitations of student feedback as a driver for change differed between participants. Two institutions plan to incorporate aspects of blended learning going forward. Participants recognised the impact of limited social engagement between peers on social determinants of learning. CONCLUSION AND IMPLICATIONS: Prior experience in eLearning appeared to colour participants' perceptions of its value; those experienced in online delivery were inclined to recommend some level of continuation post-pandemic. We now need to consider which elements of undergraduate education can be delivered effectively online into the future. Maintaining the socio-cultural learning environment is of critical importance but must be balanced by efficient, informed and strategic educational design.

Study protocol for a process evaluation of a cluster randomised controlled trial to reduce potentially inappropriate prescribing and polypharmacy in patients with multimorbidity in Irish primary care (SPPiRE).

Background: Multimorbidity (the presence of two or more chronic conditions) is associated with poorer health outcomes, particularly for patients with significant polypharmacy (≥15 medications), due to the higher risk of adverse events and drug interactions. The SPPiRE study will assess the effectiveness of a complex intervention to support general practitioners (GPs) to reduce potentially inappropriate prescribing and consider deprescribing in older people with multimorbidity and significant polypharmacy. The aim of the SPPiRE process evaluation is to understand how and why the intervention is effective or ineffective and to explore the potential for system wide implementation of the intervention using the Medical Research Council general themes of context, implementation and mechanism of impact. Methods: The SPPiRE study is a clustered randomised controlled trial (RCT), aiming to recruit 55 general practices and 400 patients (≥65 years) on ≥15 medications throughout the Republic of Ireland. This mixed-methods process evaluation of the SPPiRE study will integrate both quantitative and qualitative data. Quantitative data will be collected on use of the intervention elements and from GP questionnaires. Qualitative data will be collected from semi-structured telephone interviews with all intervention GPs and a purposeful sample of patients from intervention practices. The topic guide will explore barriers and facilitators to participation and implementation of the intervention. Quantitative data will be analysed using descriptive statistics. Interviews will be transcribed and analysed using thematic analysis. Quantitative and qualitative data will be then be integrated. Discussion: The SPPiRE cluster RCT will provide evidence regarding the effectiveness and practicability of delivering a structured medication review in reducing polypharmacy and potentially inappropriate prescribing for patients with multimorbidity. This process evaluation will provide information on how the intervention was implemented, how it was or was not effective and the potential for a system wide implementation. Trial registration: ISRCTN 12752680, registration: 20/10/2016.