Implementing clinical education of medical students in hospital communities: experiences of healthcare professionals.

OBJECTIVES: To explore healthcare professionals' experiences of implementing clinical education of medical students in communities of practice that previously focused on the delivery of healthcare services. METHODS: Seven focus group interviews involving assistant nurses, nurses, and physicians were conducted at a regional hospital in Sweden. A total of 35 respondents participated. Open-ended questions were used to explore respondents' experiences of medical students in their community. Data were analysed using qualitative inductive content analysis. RESULTS: Three main themes emerged: Staff members becoming learners, structural and sociocultural changes due to the implementation, and features designing the settings of the implementation. Reflection and interactive learning processes among staff, patients, and students were found to stimulate individual learning, to improve the learning climate in the organisation, and to enhance the structure of the clinical work. Attitudes to education among staff members as well awareness of how education is organised appeared to be vital for their experiences and approaches. CONCLUSIONS: Implementing clinical education of medical students at a hospital previously focused on delivery of care was acknowledged to not only stimulate learning among staff but also trigger structural and cultural development in communities of practice. Opportunities for interprofessional interaction and reflection are vital to successfully implement a new student group in communities of practice. Addressing conceptions about and attitudes toward the clinical education of students among healthcare professionals are essential to promote their engagement in education.

The characteristics of general practice and the attractiveness of working as a GP: medical students' views.

OBJECTIVE: The aim of the study was to investigate medical students' views on general practice based on their experiences in training, and to find out whether there were certain views associated with the intention to become a GP. METHODS: A questionnaire, based on our earlier studies about GP working behaviour, was handed out to medical students in terms 1, 3, 5, 7, 10 and 11 of undergraduate studies in Gothenburg, Sweden. The analysis comprised statistical descriptions and comparisons. RESULTS: The students regarded general practice positively. They found the work environment good, the GP's awareness of patients' living conditions necessary, and that GP work requires medical breadth. The status of the GP in the medical profession was not considered high. One-fourth of the students strongly agreed with the possibility of a future as a GP. This attitude was statistically associated with support to the statements that general practice offers a good work environment and should be a major component in undergraduate training. Students with a negative attitude to working as GPs were also negative to having a major component of general practice in undergraduate training. CONCLUSIONS: Medical students with a positive stated attitude towards becoming GPs support changes in undergraduate training to include more general practice. The risk of increasing a negative attitude should be considered when changes are discussed.

Attributes of competence -- on GPs' work performance in daily practice.

AIM: The core competencies of general practitioners (GP) are ordinarily formulated by professional bodies and international organisations, like the World Organization of Family Doctors (Wonca). Official documents are sometimes questioned as being too comprehensive and products of the drawing board. The aim was to explore clinically oriented GPs own description of the proficiency used in everyday practice. The study could be essential both for GPs and other professionals who work with consultations. METHOD: Group interviews with GPs selected by regional supervisors and with substantial clinical competence were carried out. The verbatim transcribed sessions were analyzed with a qualitative content analysis approach. RESULTS: Two main categories emerged reflecting the competence: ''Professional readiness'' and ''Working behaviour''. Professional readiness comprises the inclination of understanding and acting based on the subcategories: medical knowledge modified by experience, knowing the patient, involvement and uncertainty. Working behaviour describes in a more concrete way the doctoring approach and is formed by the subcategories: preparation, the current problem, use of time, body attention, cooperation with other professionals, and record keeping as a work aid. CONCLUSIONS: The attributes of competence of GPs empirically have two components: professional readiness and working behaviour. Together they compose a comprehensive picture of the GP's everyday clinical setting.

Working behaviour of competent general practitioners: personal styles and deliberate strategies.

OBJECTIVE: To study how competent GPs perform their work within the consultation and in relation to the team and practice organization. DESIGN: Ethnographic study with thick description. A participant observation of the GP was followed by a personal interview. A substantial description was elaborated that was analysed qualitatively. SETTING: Primary care surgeries in Sweden. SUBJECTS: A number of competent GPs. RESULTS: Two main categories emerged, deliberated strategy and personal style. These categories set up the individual pattern of working behaviour for each GP. A behaviour that is a deliberate strategy for one GP for the other belongs to his or her personal style. Common denominators in the overall working behaviour were attention to the patient as a person, practising patient-centred medicine, saving the consultations from disturbances, rejecting taking over responsibilities from the patients, and safeguarding own autonomy. CONCLUSION: The transition of deliberate, favourable strategies into one's personal style is an important aspect of professional development. A well-developed personal style is necessary to obtain the spontaneous interchange between attentive listening and detachment characteristic of patient-centeredness.