Jessica Watson

Examining the practice of generalist expertise: a qualitative study identifying constraints and solutions.

Objectives Provision of person-centred generalist care is a core component of quality primary care systems. The World Health Organisation believes that a lack of generalist primary care is contributing to inefficiency, ineffectiveness and inequity in healthcare. In UK primary care, General Practitioners (GPs) are the largest group of practising generalists. Yet GPs fulfil multiple roles and the pressures of delivering these roles along with wider contextual changes create real challenges to generalist practice. Our study aimed to explore GP perceptions of enablers and constraints for expert generalist care, in order to identify what is needed to ensure health systems are designed to support the generalist role. Design Qualitative study in General Practice. Setting UK primary care. Main outcome measures A qualitative study – interviews, surveys and focus groups with GPs and GP trainees. Data collection and analysis was informed by Normalisation Process Theory. Design and setting Qualitative study in General Practice. We conducted interviews, surveys and focus groups with GPs and GP trainees based mainly, but not exclusively, in the UK. Data collection and analysis were informed by Normalization Process Theory. Participants UK based GPs (interview and surveys); European GP trainees (focus groups). Results Our findings highlight key gaps in current training and service design which may limit development and implementation of expert generalist practice (EGP). These include the lack of a consistent and universal understanding of the distinct expertise of EGP, competing priorities inhibiting the delivery of EGP, lack of the consistent development of skills in interpretive practice and a lack of resources for monitoring EGP. Conclusions We describe four areas for change: Translating EGP, Priority setting for EGP, Trusting EGP and Identifying the impact of EGP. We outline proposals for work needed in each area to help enhance the expert generalist role.

Raised inflammatory markers

What is the evidence for using C reactive protein, erythrocyte sedimentation rate, and plasma viscosity in diagnosis?

Alcohol Badly Affects Eye Movements Linked to Steering, Providing for Automatic in-Car Detection of Drink Driving

Driving is a classic example of visually guided behavior in which the eyes move before some other action. When approaching a bend in the road, a driver looks across to the inside of the curve before turning the steering wheel. Eye and steering movements are tightly linked, with the eyes leading, which allows the parts of the brain that move the eyes to assist the parts of the brain that control the hands on the wheel. We show here that this optimal relationship deteriorates with levels of breath alcohol well within the current UK legal limit for driving. The eyes move later, and coordination reduces. These changes lead to bad performance and can be detected by an automated in-car system, which warns the driver is no longer fit to drive.

Motivation for career choice and job satisfaction of GP trainees and newly qualified GPs across Europe: a seven countries cross-sectional survey

What is already known in this area Recruitment and retention of general practitioners is a major concern in many European countries. Previous studies looking at motivation revealed a perception that general practice had an inferior clinical content but superior lifestyle than hospital medicine, with the choice of general practice as a career often based on negative judgements. What this work adds Current trainees and newly qualified GPs across seven European countries choose general practice for positive reasons such as ‘compatibility with family life’ and ‘the challenging medically broad discipline’. Overall levels of career satisfaction are high. suggestions for future research Differences between countries in motivation and satisfaction should be explored further with qualitative studies.

Investigating fatigue in primary care.

Tiredness is a common presentation in general practice, but how useful are investigations, and what tests should be done and how soon?

Fit for the future? The place of global health in the UK's postgraduate medical training: a review.

Objectives That health is now global is increasingly accepted. However, a ‘mismatch between present professional competencies and the requirements of an increasingly interdependent world’ has been identified. Postgraduate training should take account of the increasingly global nature of health; this paper examines the extent to which they currently do. Design Trainees across 11 medical specialties reviewed the content of their postgraduate curriculum. Setting Not relevant. Partcipants None. Main outcome measures Competencies were coded as ‘UK’ (statement only relevant to UK work), ‘global’ (statement with an explicit reference to aspects of health outside the UK) or generic (relevant both to the UK and international settings). Results Six of the 11 curricula reviewed contained global health competencies. These covered the global burden or determinants of disease and appropriate policy responses. Only one College required trainees to ‘be aware of the World Health Organization’, or ‘know the local, national and international structures for health care’. These cross-cutting competencies have applicability to all specialties. All 11 curricula contained generic competencies where a global health perspective and/or experience could be advantageous, e.g. caring for migrant or culturally different patients. Conclusion Trainees in all specialties should achieve a minimum requirement of global health awareness. This can be achieved through a small number of common competencies that are consistent across core curricula. These should lead on from equivalent undergraduate competencies. Addressing the current gap in the global health content of postgraduate medical curricula will ensure that the UK has health professionals that are trained to meet the health challenges of the future.

Global health in UK postgraduate medical training

728 www.thelancet.com Vol 380 August 25, 2012 methodological training for members of the trial team and for research ethics committee members. Kenter and Cohen request that trial applications be reviewed by competent experts, while acknow ledging that such expertise is unlikely to be evenly distributed within the EU. They do not suggest how this gap should be fi lled. This challenge has been a major issue for one of the subgroups of our OECD Global Science Forum Working Group. We recommend the development of global core competencies as a compendium of required knowledge and skills for investigators and other members of the clinical trials team, research ethics committees, regulatory bodies, and sponsors. These training programmes should be open to the general public. Standardised, internationally recognised accredited qualifi cations in patient-oriented research should be defi ned in connection with these competencies. In this way, we can improve the training of everybody involved in clinical trials.

'I'm fishing really' - inflammatory marker testing in primary care: a qualitative study

Background Inflammatory markers can be helpful as part of the diagnostic workup for specific diseases or for monitoring disease activity. A third use is as a screening and/or triage tool to differentiate between the presence or absence of disease. Most research into inflammatory markers looks at diagnosis of specific diseases and comes from secondary care. Qualitative studies to explore when and why clinicians use these tests in primary care are lacking. Aim To identify clinicians’ approaches to inflammatory marker testing in primary care. Design and setting Qualitative study with 26 GPs and nurse practitioners. Method Interviews were conducted using a semi-structured topic guide. Clinicians reviewed recent cases of inflammatory marker testing in their pathology inbox. Interviews were audiorecorded and transcribed. Qualitative analysis was conducted by two of the authors. Results Clinicians are uncertain about the appropriate use of inflammatory markers and differ in their approach to testing patients with undifferentiated symptoms. Normal or significantly elevated inflammatory markers are seen as helpful, but mildly raised inflammatory markers in the context of non-specific symptoms are difficult to interpret. Clinicians describe a tension between not wanting to ‘miss anything’ and, on the other hand, being wary of picking up borderline abnormalities that can lead to cascades of further tests. Diagnostic uncertainty is a common reason for inflammatory marker testing, with the aim to reassure; however, paradoxically, inconclusive results can generate a cycle of uncertainty and anxiety. Conclusion Further research is needed to define when inflammatory marker testing is useful in primary care and how to interpret results.

Proliferation of private online healthcare companies

Should the NHS try to keep up?

Junior response to the global health editorial

As trainees and new GPs, we warmly welcome BJGP s new International Advisory Board and plans to increase its emphasis on the international perspective of primary care.1 We also read with interest the editorial highlighting the role that primary health care can play in the field of global health.2 This comes at a moment when the need for undergraduate and postgraduate education in global health is increasingly recognised, such as by the recent Lancet Commission on the education of health professionals for the 21st century3 and BMJ s editorial on training programmes …