Paul Main

Innovations and developments

The article focuses on a study which assess the perception of medical teachers on the flipped classroom approach. It discusses the particular concerns of teachers regarding the amount of work and motivation needed by students. It mentions that teachers were also concerned that students feel that the approach would reduce the tutorials and the approach would not work across range of different medical courses.

Consultants' attitudes to the assessment of GP specialty trainees during hospital placements.

This study explored the views and experiences of a sample of hospital consultants using the RCGP e-portfolio, within the wider context of WPBA. Whilst the use of e-portfolios and WPBA in a hospital setting was broadly valued and accepted, issues of e-portfolio functionality often hindered the professional judgement of competencies. Issues relating to training in the use of the RCGP e-portfolio and the need for adequate protected time were identified, together with a reluctance to give negative formative feedback through this format.

Developing the high-flying registrar: a qualitative evaluation of the Severn Deanery education scholar programme.

The introduction of the Education Scholarship and Education Fellowship programmes in the Severn Deanery in 2008 was in response to an emergent need for a more formalised career structure for the most able GPSTs and specifically for identified education scholars to progress over time from a scholar to temporary and substantive training programme director (TPD) posts. As a result, two scholars have progressed to being appointed as fellows (one-year fixed-term TPDs) over the last three years and one of these is now a TPD. This qualitative research study sought to identify the value and acceptance of the scholar scheme within the Severn Deanery and in particular assess the impact of the scholar scheme in terms of educational benefits, impact on professional practice and future career opportunities. It also undertook to examine the key factors affecting the quality of experience of the scholar scheme (e.g.induction, mentorship, autonomous vs. prescribed education opportunities etc.). Findings showed unequivocal and universal support for the scheme.

‘Getting them Early’: The Impact of Early Exposure to Primary Care on Career Choices of A-Level Students – a Qualitative Study

School/college students receive a variety of information about medicine, from personal experience to the national press, and career choice is influenced by many factors. Role models are important in the professional development of students in medical school and earlier exposure to the world of general practice/primary care may increase the likelihood of career intentions in that direction. This work evaluated a sixth-form work experience programme of five two-hour sessions using a variety of active learning modalities. Semi-structured interviews were conducted with 11 students who were contemplating a degree in medicine and participated in the programme prior to application to medical school. We showed that this course significantly increased awareness of issues in primary care and enhanced its attractiveness as a career. Use of patients as teachers in their own homes provided an opportunity to ‘try out’ consultation skills, and students gained an awareness of how social and economic factors impacted on health. Those from nonmedical backgrounds were better able to address the application process for medical schools. Education for Primary Care (2008) 19: 274-84 # 2008 Radcliffe Publishing Limited

General Practice in the Foundation Programme: Feedback from a Year 1 Pilot Rotation

Prior to the changes brought by Modernising Medical Careers, the opportunity to spend time in general practice during the early years of postgraduate training was relatively rare. For those that did get the opportunity, the value of such a placement during these years has been widely acknowledged. The foundation proEducation for Primary Care (2008) 19: 258–64 # 2008 Radcliffe Publishing Limited

Becoming a general practice trainer: experience of higher preparatory training

WHAT IS ALREADY KNOWN IN THIS AREA • Basic training courts for general; practice trainers; do not always meet the demands for the level of ‘professionalition’ expected.• Many regions now run university-accredited teaching bourses, some of which advocate compulsion. WHAT THIS WORK ADDS • This work has shown that a mandatory course is generally accepted by participants.• Organisational infrastructure needs to be efficient. SUGGESTIONS FOR FUTURE RESEARCH • The effects on trainer recruitment need to be monitored and studied.• The effects on further individual continuing professional development in terms of following this initial course towards a diploma or higher degree.

What are the CPD needs of GPs working in areas of high deprivation? Report of a focus group meeting of 'GPs at the Deep End'.

Dear Editor, The paper by MacVicar et al.,[1] on the CPD needs of GPs working in areas of high deprivation is another useful piece of work from the ‘GPs at the Deep End’ group. Having worked in a context of socio-economic deprivation for almost 35 years,[2] we can testify to the accuracy and relevance of this exercise and the resulting prioritised learning needs. Low patient engagement can be partially due to a perceived fatalism with an external locus of control. In terms of Maslow’s hierarchy of needs, there are many more fundamental issues for these patients, for example material poverty, unemployment, low income, poor housing and family strife, which push health off their agenda.[3] Promoting and maintaining therapeutic optimism in our practice was helped by having a strong, supportive and committed primary healthcare team (PHCT) whose members were often motivated by concerns for social justice and/or personal faith. We found EBM to be sadly wanting in the face of multi-morbidity and social complexity where the onset of many chronic conditions was up to 10 years earlier than in more affluent areas. In addition to the multi-morbidity and complexity, we found a major workload came from drugs, alcohol and particularly young single-parent families. Often children were being raised by vulnerable teenage mums in poor housing, still children, emotionally, themselves. Over 25 years ago, in order to provide a high quality of care for our patients, we made a conscious decision to appoint additional partners and hence have a better doctor–patient ratio, which, of course, had implications for our income.[4] We instituted monthly practice-based small-group learning which was totally in-house and facilitated by the partners. These education sessions would include our nurse practitioner partner, our salaried doctor, practice nurses and any trainees or medical students who were in the practice. It was needs-led and often required some pre-session work by all the participants. These sessions frequently involved the extended PHCT. Feedback, verbal and written, was always elicited. Once a year we would devote a whole day off-site to this activity. We came to greatly value the team-building potential of sharing sessions like these across professional boundaries. Our practice population was mainly deprived and consequently we found that as our workload increased with various contract changes we were unable to devote sufficient time to training. We stopped being a training practice after 20 years – a casualty of our deprivation workload. We only maintained our teaching of medical students by making good use of the whole PHCT. The issue of the ability to maintain a high quality of patient care and still find time and energy to train GP registrars and teach medical students in deprived areas is a cause for concern. There is much to be learned by medical students and young doctors from exposure to patients in areas of deprivation, as mentioned by Nicholson and Kelly [5] in their commentary on this paper. But it is important that they see a high quality of care provided by doctors and PHCT who are not exhausted and demoralised by their workload. This is again another aspect of the Inverse Care Law. Put simply, more material resource is needed to enable front-line professionals to give the deprived ‘an average chance of health’.[4] Having retired, we are clear that we would make the same decision to work in a deprived area again, and that what sustained us was the strength of mutual support, across professional boundaries, in our PHCT. We are equally clear that the recurring failure of resource providers to recognise and adequately respond to the needs of professionals working in this context, in terms of resource provision, was, despite everything we could do to educate them, no better when we retired than when we started, over 30 years earlier.