Tackling differential attainment in specialist GP training in England and Scotland.

In this article NHS England and NHS Education for Scotland describe practical ways we are tackling differences in the attainment of people training as general practitioners (GPs).Trainees from minority ethnic groups and international medical graduates are less likely than others to qualify as GPs. It is difficult to change systemic inequalities, but over the past five years we have made practical changes to GP speciality training. Educators recognise there is an issue and are trying to tackle it.For example, people who had not successfully qualified had an opportunity to return to GP training. When we provided individualised targeted support, the proportion who completed training significantly increased (76%).This was a catalyst for reviewing unconscious bias in GP training. We implemented a national programme to tackle differential attainment and system-level bias. Educators now work with all GP trainees to identify their individual needs. Supervisors are trained to recognise bias and provide targeted support. There is mental health support and regular reviews to see whether trainees are ready to sit exams. Trainee representatives are championing the learner voice in national committees. Exams are being altered to reduce unconscious bias. We are monitoring attainment over time.The key message is that differential attainment should not be in the 'too hard basket'. The narrative is changing from 'can't do' to 'must do', supported by appropriate leadership, promotion and resourcing. There is much more to do, but we are making changes, evaluating and applying our learning. We have moved from talking to taking action.

Enhancing Primary Care Learning in a Referral Hospital Setting: Introducing Veterinary Clinical Demonstrators.

With the majority of veterinary graduates entering primary care practice (PCP), there is increasing recognition of the importance of preparing students to practice across a broad spectrum of care (SoC). The traditional model of veterinary training focused on the referral hospital environment, can make this challenging. In 2018, Bristol Veterinary School recruited five primary care (PC) veterinary surgeons as veterinary clinical demonstrators (VCDs) who collaborated with rotation-specific specialists to help enhance student focus upon day-one skills and to emphasize SoC relevance of the referral caseload. To evaluate the initiative, two separate online surveys were disseminated to clinical staff and final year veterinary students. The survey was completed by 57 students and 42 staff members. Participants agreed that VCDs helped students feel prepared for a first job in primary care practice (students 94.7%; staff 92.7%); helped students to focus on the primary care relevance of referral cases (students 96.5%; staff 70.8%); helped students develop clinical reasoning skills (students 100%; staff 69.3%), practical skills (students 82.4%; staff 72.5%), and professional attributes (students 59.6%; staff 71.4%). Thematic analysis of free-text comments revealed the benefits and challenges associated with implementing the role. The data gathered helped to guide the role's ongoing development and to provide recommendations for others who may be looking to implement similar educational initiatives to help prepare graduates to practice across a spectrum of care.

Prevalence and associated skills of Australian general practice registrars seeing children with functional bowel and bladder problems.

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.

Climate change and Australian general practice vocational education: a cross-sectional study.

BACKGROUND: Climate change is a rapidly progressing threat to global health and well-being. For general practitioners (GPs) currently in training, the effects of climate change on public health will shape their future professional practice We aimed to establish the prevalence and associations of Australian GP registrars' (trainees') perceptions of climate change as it relates to public health, education, and workplaces. METHODS: A cross-sectional questionnaire-based study of GP registrars of three Australian training organizations. The questionnaire assessed attitudes regarding adverse health effects of climate change (over the next 10-20 years), and agreement with statements on (i) integrating health impacts of climate change into GP vocational training, and (ii) GPs' role in making general practices environmentally sustainable. RESULTS: Of 879 registrars who participated (response rate 91%), 50.4% (95% CI 46.8%, 54.0%) perceived a large or very large future health effect of climate change on their patients, and 61.8% (95% CI 58.6%, 65.0%) agreed that climate health impacts should be integrated within their education programme. 77.8% (95% CI 74.9%, 80.4%) agreed that GPs should have a leadership role in their practices' environmental sustainability. Multivariable associations of these attitudes included female gender, training region, and (for the latter two outcomes) perceptions of future impact of climate change on patient health. CONCLUSIONS: GP registrars are motivated to receive climate health education and engage in environmentally sustainable practice. This may primarily reflect concern for future practice and patient care.

Issues and solutions of general practice education for international medical students in China / 中华医学教育探索杂志

Under the background of internationalization of medical education in China, the general medical education for foreign students started relatively late. At present, there are still some problems in it, such as imperfect curriculum system, lack of unified and standardized textbooks, inadequate language skills of community teachers, difficulties in carrying out practical courses, and cultural differences. Based on the current situation of general practice education for international students in China, this article proposes the following solutions: to insist on standardizing quality management and construct scientific training schemes; to understand the present situation of primary medical and health services in their country of origin, promote cultural integration, and actively explore the fit between training and demand; to write bilingual textbooks suitable for practical needs; to overcome language barriers and build a team of community teachers that speak English; to adopt flexible and diversified teaching modes and comprehensively improve the quality of general practice teaching for international students, so as to promote the communication and dissemination of basic medical and health concepts in China.

Clinical encounters of Australian general practice registrars with paediatric patients.

BACKGROUND: Whether general practitioner (GP) registrars have adequate exposure to, and feel confident in, managing children's health during training is unknown. OBJECTIVES: To determine the prevalence and associations of GP registrars' paediatric vs. non-paediatric consultations. METHODS: Cross-sectional analysis from a cohort study of Australian GP registrars' 2010-2014 consultations. RESULTS: 889 registrars contributed details for 26,427 (21.8% (95% CI: 21.4-22.2) paediatric consultations. Paediatric patients were more likely to be male and new to the practice. Although paediatric patients were less likely to have a chronic disease (OR 0.38, 95% CI 0.36, 0.40) and presented with fewer problems (OR 0.59, 95% CI 0.57, 0.61), registrars were more likely to seek in-consultation advice (OR 1.25, 95% CI 1.19, 1.31) and generate learning goals (OR 1.12, 95% CI 1.07, 1.18) for paediatric consultations. DISCUSSION: GP registrars appear to feel less confident in managing paediatric compared with adult consultations, suggesting an unmet training need.

Discussion on the Training Mode of General Practice Education in Contemporary Medical Colleges and Universities / 中国医学伦理学

At present,the training mode of general practice education in medical colleges and universities in China has the characteristics of common and personality.Although there is a great change in the form of “classroom instruction”,it is still one of the main modes of training of general medical education in medical colleges and universities.In addition,many colleges and universities explore the mentor type,team type,humanistic type,practice type and other general medical education training mode.A variety of training mode has accumulated a lot of valuable experience and achievements,but there are many problems.Currently,the overall quality of general practitioners in our country has yet to be improved and the training mode of general medical education needs further exploration and innovation.

Variation in the use of point-of-care ultrasound in general practice in various European countries. Results of a survey among experts.

BACKGROUND: Before implementing point-of-care ultrasound in general practice in Denmark, we sought inspiration from other countries/regions. OBJECTIVES: To collect information about the use and organizational aspects of point-of-care ultrasound in general practice in different European countries/regions. METHODS: Fifteen key persons with knowledge about the use of ultrasound in general practice in Austria, Catalonia, Denmark, Finland, Germany, Greenland, Iceland, the Netherlands, Norway, Scotland, Sweden, and Switzerland were included. Participants received a link to a web-based questionnaire. The primary outcome measures were educational aspects regarding the use of point-of-care ultrasound; clinical application and use; financial aspects; and main barriers to using ultrasound in general practice. RESULTS: In eight out of 12 countries/regions there were national societies for the use of ultrasound in general practice. The respondents from three countries/regions reported that the use of ultrasound was integrated into undergraduate medical education. In nine of the countries/regions, there was formalized training for general practitioners, but only three reported this to be part of the specialization to become a general practitioner. In seven out of 12 countries/regions, general practitioners received payment for ultrasound scans. However, the payment and the requirements for reimbursement differed between countries. Lack of time, lack of training, and financial aspects were important common barriers across countries/regions. CONCLUSION: There were significant differences regarding the use and organizational aspects of point-of-care ultrasound in general practice in Europe. Lack of time and training as well as financial aspects were important barriers to the use of point-of-care ultrasound in general practice.[Box: see text].

Dyslexia in general practice education: considerations for recognition and support.

Dyslexia is a common developmental learning difficulty, which persists throughout life. It is highly likely that those working in primary care will know, or even work with someone who has dyslexia. Dyslexia can impact on performance in postgraduate training and exams. The stereotypical characteristics of dyslexia, such as literacy difficulties, are often not obvious in adult learners. Instead, recognition requires a holistic approach to evaluating personal strengths and difficulties, in the context of a supportive relationship. Strategies to support dyslexic learners should consider recommendations made in formal diagnostic reports, and aim to address self-awareness and coping skills.

Comparison and enlightenment on the general practice education between Britain and Aus-tralia / 中华医学教育探索杂志

General practice education at higher medical university is the foundation of the general practice educational system. It has close relationship with the cultivation quality of the general practitioners. By taking British and Australian medical colleges as examples, the paper introduced the current situation of British and Australian general practice education for undergraduate medical stu-dents and elaborated their theory learning content, their practice learning content ,their education re-form and research progress and their education target and effect. General practice education in Britain and Australia sheds light on how to set theory course, arrange practice part and improve educational research, which general practice education in China can draw lessons from.

A day in the life of a british general practitioner.

General Practitioners are key providers of patient related services in National Health Service (NHS) in United Kingdom. The general practitioner have enjoyed enormous trust from the general public. Author shares his day today work giving an interesting insight into the model of care general practitioners engage with in UK.

Thinking of General Practice Education in Higher Medical School / 中华医学教育探索杂志

The author reviewed the development of general practice education in our country,deliberated and summarized the problems about the construction of curriculum system,the ranks of teachers and practice base in general practice education in higher medicine colleges.