GP trainees' values and knowledge regarding global health competencies.

Globalisation is having a significant impact on health through the increasingly interconnected nature of our world, population movement and effects of political and environmental issues. In response, medical educators are urged to review postgraduate training programmes to ensure that doctors are up-to-date with training in contemporary global health issues. Positioned on the frontline of healthcare provision, GPs have an integral role to play in addressing local and global health inequities. However, GP trainees in the UK currently receive little formal education on global health. We sought to investigate GP trainees' understanding and perceived competence in relation to global health issues and cross-cultural practice and their views regarding whether it is indeed time for GP postgraduate training to 'go global'. We invited trainees across Health Education England: Wessex (N = 476) to complete an anonymous online questionnaire. The majority of respondents either 'agreed' or 'strongly agreed' that 'it is important for doctors training to be GPs in the UK to have education on global health' (89%). Similarly, the majority either 'agreed' or 'strongly agreed' that 'it is important for doctors training to be GPs in the UK to develop intercultural competence' (93%). In contrast to the high degree of importance that GP trainees placed on establishing proficiency in these domains, approximately half (45-54%) reported their current level of competence as only being 'average'. Our findings indicate a mismatch and unmet need for further training in the postgraduate setting, with strong GP trainee support for a shift in curriculum design and delivery, towards more globally competent general practice.

Refugee, Migrant and Asylum Seekers' Experience of Accessing and Receiving Primary Healthcare in a UK City of Sanctuary.

The World Health Organisation estimate there are about 1 billion migrants in the world today. The scale of population movement and a global refugee crisis presents an enormous challenge for healthcare provision, and too often the specific health needs of refugees and migrants are not met. This study assessed refugee, asylum seeker and vulnerable migrants' (AMRs') experience of front line primary healthcare in a region of the United Kingdom designated as a 'City of Sanctuary'. A questionnaire study explored the views of people seeking refuge and third sector workers supporting them. The majority of AMRs were registered with a GP and positive about their consultations. The views of third sector workers provided a less favourable window into their experience of primary care. In conclusion, the work highlighted patchy experience of primary care, even in a region of the UK designated as a 'City of Sanctuary' for people seeking refuge. There is a need for further education of rights to care in the UK, information for people on how to navigate local healthcare systems, consistent access to routine health checks and translation services.

The value of 'expert trainees' in primary care postgraduate education.

Peer-led teaching is well established within many undergraduate medical courses but relatively underutilised in postgraduate training, despite the fact it can be useful for both teachers and learners. A significant number of doctors training to be GPs bring expertise and experience from other specialities and in this paper we explore the potential of using 'expert trainees' to teach their peers on postgraduate GP training programmes. A GP trainee with expertise in Lifestyle Medicine taught alongside local and national experts and delivered workshops to her peers. Questionnaires were used to establish the acceptability and quality of 'expert trainee' peer-led education. This was a positive experience for the 'expert trainee' who felt valued both as a trainee and as someone with expert knowledge, and for her peers with excellent feedback on her workshop. The knowledge and skills of 'expert trainees' represent an untapped resource which could be more systematically and effectively used within GP education.

Can the arts enhance postgraduate GP training?

The value of arts-based medical education is becoming increasingly well established in undergraduate curricula. However, little is known about its value, and acceptability, to qualified doctors undertaking postgraduate training. In this work we examined GP trainees' views on whether arts-based education was useful for their professional development and, if so, what they perceived its value to be. All first and second year GP trainees on the Dorset Vocational Training Scheme attended a one day course which showcased how the arts (film, poetry, painting, photography, theatre) could enhance their professional development as doctors. GP trainees rated the day as interesting, enjoyable and thought proving. The majority felt that the arts could contribute to making them more competent and humane doctors. Following this, we ran a mandatory six months arts based course for six GP trainees, and evaluated their feedback through qualitative analysis of a focus group discussion. Overall, GP trainees found the course enjoyable and valuable to their learning. It not only gave them a deeper appreciation of the patient's perspective, but also encouraged them to think about their own health and wellbeing.

GP trainees' experience, knowledge and attitudes towards caring for refugees, asylum seekers and undocumented migrants.

Context: According to the World Health Organisation 'more people are on the move now than ever before with an estimated 1 billion migrants in the world today and 68 million forcibly displaced people'. GPs are on the frontline of healthcare in the UK and have a responsibility to provide free and equitable access for everyone. Aim: The main aim of our work was to assess GP trainees' current experience, knowledge and attitudes towards caring for refugees, asylum seekers and undocumented migrants. Description: 30 final year GP trainees on the Dorset Vocational Training Scheme (VTS) were asked to participate by completing a questionnaire. Outcomes: The results show that GP trainees lack knowledge regarding migrants health needs, rights to care, including whether there is a duty to disclose an illegal immigrant and what to do if a patient could not provide proof of identification. They lacked experience and confidence in caring for this group of patients, with the biggest perceived challenge being language barriers. Conclusions: Education in primary care needs to respond to meet the challenge of population movement (5), and this project highlighted a need to improve education on migrants' rights to care, local support groups, as well as common health problems. In response, we have reviewed our curriculum and introduced an education session on refugee health for all our GP trainees in Dorset.

Using photography to enhance GP trainees' reflective practice and professional development.

The capacity and the commitment to reflect are integral to the practice of medicine and are core components of most general practitioners (GP) training programmes. Teaching through the humanities is a growing area within medical education, but one which is often considered a voluntary 'add-on' for the interested doctor. This article describes an evaluation of a highly innovative pedagogical project which used photography as a means to enhance GP trainees' reflective capacity, self-awareness and professional development. Photography was used as a tool to develop GP trainees' skills in recognising and articulating the attitudes, feelings and values that might impact on their clinical work and to enhance their confidence in their ability to deal with these concerns/issues. We submit that photography is uniquely well suited for facilitating insight and self-reflection because it provides the ability to record 'at the touch of a button' those scenes and images to which our attention is intuitively drawn without the need for-or the interference of-conscious decisions. This allows us the opportunity to reflect later on the reasons for our intuitive attraction to these scenes. These photography workshops were a compulsory part of the GP training programme and, despite the participants' traditional scientific backgrounds, the results clearly demonstrate the willingness of participants to accept-even embrace-the use of art as a tool for learning. The GP trainees who took part in this project acknowledged it to be beneficial for both their personal and professional development.

Contrasting effects of repetition across tasks: implications for understanding the nature of refractory behavior and models of semantic memory.

We describe a patient (J.M.) who showed "refractory" behavior in picture-word matching tasks--that is, his performance became poorer when items were repeated. This contrasts with the facilitatory effects of repetition usually observed in normal participants. We show for the first time that there can be facilitatory effects of repetition on some tasks, even though refractory behavior is shown on the same items in other tasks. In particular, in Experiments 1 and 2, we demonstrate that J.M. showed contrasting effects of repetition across different components of the language system: There were facilitatory effects of repetition priming on lexical decision but refractory behavior on picture-word matching. In Experiments 3 and 4, we demonstrate that J.M. showed contrasting effects of repetition within the same system (semantic memory). His performance became refractory when items were repeated in picture-word matching (Experiment 3), but it was facilitated when items were repeated in superordinate categorization (Experiment 4). These contrasting patterns of facilitation and interference from repetition priming have implications for understanding the nature of refractory behavior and for constraining theoretical accounts of semantic memory.

The role of local and global processing in the recognition of living and nonliving things.

We report a study on a patient (DW) with integrative visual agnosia and a category-specific recognition impairment for living things. We assessed DW's local and global processing and tested if his integrative agnosia could have led directly to his category-specific impairment. The main findings were: (i) DW was faster at identifying local compared to global letters. (ii) DW showed no local-to-global (or global-to-local) interference effects in selective attention tasks. (iii) DW showed a congruency effect in a divided attention task, suggesting that, when his attention was cued to both levels, he could process information simultaneously and integrate local and global information. (iv) Controls were poorer at naming nonliving compared to living things when presented with silhouettes. These data suggest that local and global information are differentially weighted in the visual recognition of living and nonliving things, and that an impairment in processing the overall shape of an object can lead to a category-specific deficit for living things. Crucially, this implies that category-specific impairments do not necessarily reflect damage to the semantic system, and models of semantic memory based on this assumption need to be revised.

Is oral spelling recognition dependent on reading or spelling systems? dissociative evidence from two single case studies.

Recognition of orally spelt words is an unusual task, not commonly encountered in everyday life, but it can be surprising well preserved in patients with brain damage. There is, however, considerable debate over the cognitive abilities that are required to successfully perform this task. The main controversy has centred on whether oral spelling recognition is parasitic on the processes normally involved in spelling aloud or in reading. We describe a patient (FL) who showed a similar pattern of performance on reading and oral spelling recognition and was better at both tasks relative to spelling. We describe a second patient (FK) who was good at reading and reasonable at spelling but poor at reverse spelling. The patient data are not consistent with either of the following hypotheses: that oral spelling recognition is dependent either on a reading system that is functionally separate from a spelling system, or on a spelling system that is functionally separate from reading. We propose that the findings can, however, be accommodated by a model in which spelling and reading are not functionally independent systems, but share important cognitive components such as a graphemic buffer.

Naming a giraffe but not an animal: Base-level but not superordinate naming in a patient with impaired semantics.

We report data on patient FK, who presented with a marked deficit in accessing semantic knowledge about objects when tested across a range of input and output modalities. FK also showed a high degree of item-specific consistency in object identification, over and above effects due to object familiarity. We show that, despite being better at naming some objects than others, FK was equally poor at discriminating the superordinate categories of the stimuli. Also, he tended to be better at matching nameable items to a base-level label than to a superordinate-level label. We discuss the implications of the data for models of semantic memory.

Food allergy in young adults: perceptions and psychological effects.

Although food allergy can have serious health consequences, little is currently known about people's perceptions of food allergy. The present study examined the differences in awareness and perceptions of food allergy and anxiety between young people with and without a food allergy. Participants completed a questionnaire which asked about their perceptions and knowledge of allergies, perceived health competence and anxiety. Of the 162 participants 24 reported they were allergic to at least one food; these people perceived that their allergy had significantly less of an impact on their lives than others believed it would. Allergy status interacted with perceived health competence to affect anxiety. People with an allergy and with high health competence reported the greatest anxiety levels. Very few of the sample knew the meaning of the term 'anaphylaxis'. Findings are discussed in terms of health education implications and possibilities.