Perimenopause management in defence primary healthcare: exploring GPs' knowledge and confidence.

BACKGROUND: The average age of the menopause in the United Kingdom is 52 but symptoms of the perimenopause (PMP) can start at 40 or earlier. The UK Armed Forces (UKAF) has a young demographic but women serving over the age of 40, potentially with PMP symptoms, has increased. Recent evidence suggested PMP management by Defence GPs was satisfactory but variable. Because of small numbers, Defence GPs have less exposure to the PMP than NHS GPs, a problem exacerbated for Uniformed GPs who have reduced clinical contact time due to military duties. AIM: This study aimed to explore Defence GP knowledge and confidence in managing the PMP, identifying factors contributing to disparities. METHOD: This study used a sequential mixed-methods approach. A survey with self-rating questions and vignettes was undertaken, followed by semi-structured interviews of selectively sampled respondents. RESULTS: 164 out of 542 Defence GPs responded to a survey, which identified reasonable knowledge (91.3% managing cases per guidelines) but reduced confidence (54.3%). Regression analysis identified case exposure to the PMP, education, and gender as significant factors affecting confidence in PMP management. Themes identified from interviews which were felt to affect knowledge and confidence included: Characteristics of the GP (such as gender); lifelong learning and reflective practice; professional exposure to, and awareness of, the PMP; the changing demographic of Defence; an integrated PMP service to provide experiential learning. Case exposure and experiential learning emerged as the main drivers for confidence. For Uniformed GPs, this was affected by limited clinical time, but confidence returned once exposed to just a few PMP cases. CONCLUSION: Establishing an integrated PMP service in Defence was seen as crucial for improving care as well as providing educational opportunities through experiential learning for Defence GPs.

Serving through the perimenopause: Experiences of women in the UK Armed Forces.

Perimenopause is a hot topic in the UK mainstream media, with celebrities championing the cause and a new selection of books being published on the topic. Little is known, however, about the experiences of women serving in the UK Armed Forces while transitioning through perimenopause. This mixed-methods survey aimed to evaluate women's current experiences to determine what future research or policy is required to support this phase. It highlighted seven themes where the impact of the perimenopause was the greatest: coping in the workplace, fearing the effect on careers, accessing healthcare, the management of perimenopause by primary care, physical effects, psychological and cognitive effects, and physical activity. It shows that issues felt by those in the perimenopause are exacerbated for those working in male-dominated environments. Policy changes in the delivery of primary healthcare, occupational health and employment could improve the situation for women in all similar workplaces.

Evaluation of eConsult use by Defence Primary Healthcare primary care clinicians using a mixed-method approach.

INTRODUCTION: eConsult has recently been introduced into Defence Primary Healthcare to allow Service Personnel of the British Armed Forces and their dependants improved access to healthcare. This review sought the views of primary care clinicians using eConsult. METHOD: An 18-item survey was constructed after an initial scoping survey. This was then distributed to primary care clinicians in Defence Primary Healthcare to assess the broader applicability of the themes identified. Data synthesis of this alongside free-text responses from respondents was undertaken to explore advantages and disadvantages of eConsult. RESULTS: Four themes were identified: accessibility, effects on working practices, impact on the dynamics of the consultation and training/administrative support. eConsult did not save time for clinicians but was generally more convenient for patients. eConsult was often used in conjunction with telephone and face-to-face follow-up, forming a 'blended consultation'. Accessibility was improved, but cultural factors may affect some patients engaging. CONCLUSIONS: eConsult improves accessibility for patients but does not reduce workload. It should be used alongside conventional access methods, not instead of. It was found to be useful for straightforward clinical and administrative problems but less useful for more complex cases unless part of a 'blended consultation'. Future use could be modified to provide greater data gathering for occupational health and chronic disease monitoring and should be monitored to ensure it is inclusive of all demographic groups.

Practice based small group learning during a pandemic: an evaluation from Defence Primary Healthcare.

The educational benefits of Practice-Based Small Group Learning (PBSGL) are well known. The Ministry of Defence in the United Kingdom employs a salaried healthcare workforce across the globe with staff frequently moving. Given the success of PBSGL in Canada and Scotland, PBSGL was introduced as a large pilot to assess it as a continuous professional development (CPD) resource. A survey gathering quantitative and qualitative was distributed to the pilot population after using PBSGL for 12 months. This showed the favoured types of CPD were PBSGL and taught CPD update courses. Themes identified from free-text comments were: developing professional educational networks during Covid; evolving themes of CPD; applying learning to practice; practical aspects of delivering CPD to Defence promoting a positive learning environment; human interaction is therapeutic. These were similar to educational and non-educational benefits found in previous evaluations, but with the added benefit of providing a professional educational network during the COVID pandemic. Benefits were preserved when the sessions were run remotely using video-conferencing, although some of the human interaction was lost. As CPD, it was highly valued. For Defence, who need to consider the CPD requirements of their workforce, provision of PBSGL alongside taught CPD updates may satisfy the learning needs of the majority of the workforce.

Use of Web 2.0 tools and social media for continuous professional development among primary healthcare practitioners within the Defence Primary Healthcare: a qualitative review.

INTRODUCTION: Alongside traditional attendance at learning, general practitioners use social media and Web 2.0 tools in the UK for continuous professional development (CPD). Research has demonstrated, however, barriers to their uptake and use, as well as a requirement for training. Primary care doctors working for the Defence Primary Healthcare (DPHC) use similar technologies, but it is not known what factors affect the uptake. This qualitative research aimed to explore the knowledge and attitudes of this demographic further. METHODS: An online questionnaire was distributed to DPHC doctors via email and a social networking service (SNS) tool. Questions included demographic and open free-text response boxes. These were subjected to thematic analysis to identify initial concepts subsequently grouped into categories. RESULTS: DPHC doctors are already using Web 2.0 and social media for education. The benefits of convenience are recognised, but protected time is required to maximise impact. They also identified attendance at learning events, better quality information technology (IT) and further training as important enablers for their CPD. CONCLUSIONS: The results reaffirmed previous findings that while there is engagement with online learning and Web 2.0 technologies, training in Web 2.0 use and substandard IT infrastructure were barriers to greater uptake. Attended learning events are also popular due to the peer-to-peer networking that takes place, but also as they allow protected time out of the office. The use of Web 2.0 for CPD and of SNS should be given equal status to allow the development of a DPHC doctors' 'community of practice'.

Determining the educational impact of the introduction of practice-based small group learning within an intraprofessional group of doctors.

INTRODUCTION: Practice-Based Small Group Learning (PBSGL) is a system for continuing professional development introduced into Wessex Region Defence Primary Healthcare (DPHC) as the Salisbury Plain PBSGL group in 2012. This is a mixed intraprofessional group comprising general practitioners (GPs), GP trainers, general practice specialist registrars (GPSTs) and general duties medical officers (GDMOs). METHODS: An anonymised online questionnaire and thematic analysis was undertaken to assess the educational impact of PBSGL in such a mixed-role group reflecting military general practice. RESULTS: A positive effect of PBSGL was demonstrated and further enhanced by the intraprofessional composition. Positive peer support effects were demonstrated for all members of the cohort regardless of role. CONCLUSION: PBSGL is an essential pillar for supporting all doctors working within DPHC. Further qualitative evaluation of cohorts of GDMOs, GPSTs and mixed-role groups as well as the development of standardised questionnaires is recommended.

Smartphone and Web 2.0 tools for CPD amongst General Practitioners in Wessex. A qualitative review.

This article was migrated. The article was marked as recommended. There is increasing ownership of smartphones in the UK. These provide a portable and convenient way to access the Internet and to run a variety of applications. Amongst under- and post-graduate students they are used increasingly for educational purposes. Despite widespread ownership, barriers may exist preventing General Practitioners from using their smartphones for education. This service evaluation confirmed there is high smartphone ownership amongst GPs with a sizeable cohort using them for medical education and CPD. There remains, however, a reluctance to use Web 2.0 tools for CPD.