David Pearson

Challenges to professionalism: Social accountability and global environmental change

Abstract This article explores the concept of professionalism as it relates to social change and social accountability, and expands on them in the light of global environmental changes. Professionalism in medicine includes concepts of altruism, service, professional knowledge, self-regulation and autonomy. Current dialogues around social accountability suggest that medical schools should re-orientate their strategy and desired education, research and service outcomes to the health needs of the communities they serve.This article addresses the following questions: •u2003How do we reconcile ideas of medical professionalism with the demands of creating a more equal, just, sustainable and socially inclusive society? •u2003What new challenges do or will we face in relation to environmental degradation, biodiversity loss, ecosystem health and climate change? •u2003How can medical schools best teach social and environmental responsiveness within a framework of professionalism? •u2003How do medical schools ensure that tomorrow’s doctors possess the knowledge, skills and attitude to adapt to the challenges they will face in future roles?We offer ideas about why and how medical educators can change, recommendations to strengthen the teaching of professionalism and social accountability and suggestions about the contribution of an emerging concept, that of “environmental accountability”.

Patient perceptions of their role in undergraduate medical education within a primary care teaching practice

CONTEXTnThe importance of patient involvement as a positive contribution to both undergraduate and postgraduate medical education is now widely acknowledged. Patient contact has become an integral component of teaching, learning and assessment strategies. Research has considered the pedagogic advantage; however, a view from the patient on structure, process and outcome of their contribution has gone largely unexplored. The role of real patients in medical education is changing from passive to a more active involvement. Various commentators have called for more research into patients perceptions of their role and involvement across a spectrum of educational activities and settings. This study offers an in-depth exploration of the patient perspective from primary care; a setting increasingly important for undergraduate medical education. The aim of this study is to explore patients perceptions of their role in undergraduate medical education within a UK primary care setting.nnnMETHODnA case study approach with an emphasis on data from in-depth interviews of 18 volunteer patients conducted within a purposively selected single teaching practice. The study captures patient perceptions of their experience, process and an evaluation of their involvement in medical student education.nnnRESULTSnFindings highlight four key themes of involvement that reflect the existing literature but provide additional insights. The themes are; reflections on level of involvement and organisational support; benefits to students; perceived benefits to patients themselves; and wider benefits to medical education and educators.nnnCONCLUSIONnPatient perceptions of their involvement in clinical teaching support their key intended role within the educational process. Patients identified perceptions of benefit for students, educators and themselves. The implications of these findings are explored within the context of educational practice.

Carbon footprint of patient journeys through primary care: a mixed methods approach.

BACKGROUNDnThe NHS has a target of cutting its carbon dioxide (CO2) emissions by 80% below 1990 levels by 2050. Travel comprises 17% of the NHS carbon footprint. This carbon footprint represents the total CO2 emissions caused directly or indirectly by the NHS. Patient journeys have previously been planned largely without regard to the environmental impact. The potential contribution of avoidable journeys in primary care is significant.nnnAIMnTo investigate the carbon footprint of patients travelling to and from a general practice surgery, the issues involved, and potential solutions for reducing patient travel.nnnDESIGN AND SETTINGnA mixed methods study in a medium-sized practice in Yorkshire.nnnMETHODnDuring March 2012, 306 patients completed a travel survey. GIS maps of patients travel (modes and distances) were produced. Two focus groups (12 clinical and 13 non-clinical staff) were recorded, transcribed, and analysed using a thematic framework approach.nnnRESULTSnThe majority (61%) of patient journeys to and from the surgery were made by car or taxi; main reasons cited were convenience, time saving, and no alternative for accessing the surgery. Using distances calculated via ArcGIS, the annual estimated CO2 equivalent carbon emissions for the practice totalled approximately 63 tonnes. Predominant themes from interviews related to issues with systems for booking appointments and repeat prescriptions; alternative travel modes; delivering health care; and solutions to reducing travel.nnnCONCLUSIONnThe modes and distances of patient travel can be accurately determined and allow appropriate carbon emission calculations for GP practices. Although challenging, there is scope for identifying potential solutions (for example, modifying administration systems and promoting walking) to reduce avoidable journeys and cut carbon emissions while maintaining access to health care.

Medical student perspectives of what makes a high-quality teaching practice

Primary care has seen increasing involvement in undergraduate medical education following recommendation from the GMC in Tomorrows Doctors. This is also influenced by an increasing number of medical students and changing patterns of health care. The variety of practices involved in delivering undergraduate primary care placements poses a challenge for the quality of these placements. The variety of learners in primary care may also affect this. To reflect this, Cotton et al in 2009 produced a national consensus list of quality criteria for community-based education using a variety of medical education stakeholders. This paper seeks to explore the medical student perspective of what makes a high-quality teaching practice. This study uses focus group interviewing to explore student perspectives of the range of factors that can contribute towards the quality of a primary care placement. Previous research into student perspectives of teaching in primary care has revealed a strong focus on tutor quality. Students in this study again highlighted the important of good GP tutors and organisation of placements. However, one novel finding was the emphasis that students placed on involving patients in teaching and the vital role that they play in this.

Producing a socially accountable medical school: AMEE Guide No. 109

Abstract Health systems worldwide are confronted with challenges due to increased demand from their citizens, an aging population, a variety of health risks and limited resources. Key health stakeholders, including academic institutions and medical schools, are urged to develop a common vision for a more efficient and equitable health sector. It is in this environment that Boelen and Heck defined the concept of the “Social Accountability of Medical Schools” – a concept that encourages schools to produce not just highly competent professionals, but professionals who are equipped to respond to the changing challenges of healthcare through re-orientation of their education, research and service commitments, and be capable of demonstrating a positive effect upon the communities they serve. Social Accountability calls on the academic institution to demonstrate an impact on the communities served and thus make a contribution for a just and efficient health service, through mutually beneficial partnerships with other healthcare stakeholders. The purpose of this Guide is to explore the concept of Social Accountability, to explain it in more detail through examples and to identify ways to overcome obstacles to its development. Although in the Guide reference is frequently made to medical schools, the concept is equally applicable to all forms of education allied to healthcare.

What do tomorrow’s doctors need to learn about ecosystems? – A BEME Systematic Review: BEME Guide No. 36

Abstract Background: Human health is fundamentally determined by the health of ecosystems. Guidance is lacking about how to address the topic of ecosystems within medical education. Aims: To determine the nature of discussions around ecosystems in the educational, medical and medical education literature. To identify learning needs of tomorrow’s doctors. Methods: A narrative synthesis approach was used. Systematic searches were completed in 14 databases. Two independent reviewers screened results. Preliminary synthesis included textual descriptions and quality appraisal. Data were analysed using the Education for Sustainable Healthcare framework and thematic analysis. Relationships between studies were explored. Best evidence synthesis, contacting authors of primary studies and critical reflection reinforced robustness. Results: Six thousand seven hundred and fifty-three abstracts and 123 full texts were screened. Twenty-seven studies were included. Many studies lacked clear reporting. Medical students and doctors displayed knowledge about ecosystems, but lacked confidence to enact sustainable practices. Education about causes and consequences of environmental change is required. Few studies proposed specific learning objectives. Conclusions: To prepare for roles as health care workers and leaders, medical students must learn about relationships between ecosystems, health and health care. The Education for Sustainable Healthcare framework outlines essential knowledge and attitudes but requires addition of practical competencies. Further research should explore the framework’s relevance in different contexts, in order to structure training accordingly.

Innovations and developments

We have two items this time. First we hear about something that could arguably be described as heroic. In these straitened times, the Leeds Unit of Primary Care has been running an innovative BSc in primary care. Not a luxury or a folly, surely, but heroic. Our second item comes from Glasgow and is about the CARE Approach for learning about consultations and compassionate care. The Approach is described in some detail and there is a link to the manual. There is much that is novel about this method.

Creating better doctors exploring the value of learning medicine in primary care

Abstract Background: Across the UK, 13% of undergraduate medical education is undertaken in primary care (PC). Students value their experiences in this setting but uncertainty remains about the extent to which these placements influence their future practice. Aims: To explore the impact of PC based undergraduate medical education on the development of medical students and new doctors as clinicians, and on students’ preparedness for practice. Methods: Mixed method study across two UK medical schools. Focus groups and individual interviews with Year 5 medical students, Foundation Year 2 doctors and GP Specialty Trainees; online surveys of Year 5 medical students and Foundation Year 2 doctors. Results: PC placements play an important part in the development of all ‘apprentice’ doctors, not just those wanting to become GPs. They provide a high quality learning environment, where students can: gradually take on responsibility; build confidence; develop empathy in their approach to patient care; and gain understanding of the social context of health and illness. Conclusions: The study suggests that for these results to be achieved, PC placements have to be high quality, with strong links between practice-based learning and teaching/assessment in medical school. GP tutors need to be enthusiastic and students actively involved in consultations.

To proudly go

Twenty years since originally starting as a GP partner, after a rewarding career across educational and academic leadership, I have taken the distinctly unfashionable step of returning to the front line of clinical care. At present, becoming a GP partner on England’s east coast doesn’t get much more front line, or more unfashionable. Like colleagues across the country we are understaffed, under pressure, and underfunded, lacking the encouragement of trainee GPs wanting to join our ranks. The days are long, the work is intense, and demands are rising. So, why the move?nnI made the move because I strongly believe our highly skilled generalist clinician role is central to an efficient, equitable, patient-centred, and holistic health service.nnDespite the pressures, our job is …