Exploring how a patient encounter tracking and learning tool is used within general practice training: a qualitative study.

It has become a new lifestyle of using social media (SM) to acquire all kinds of information. The objectives of this study were to determine general practitioner (GP) trainers' current use of SM and their beliefs and attitudes regarding use of SM. A cross-sectional questionnaire survey was taken during a 1-week GP trainers' training program. Data probing GP trainers' use of SM and attitudes toward SM use in clinical work and education were collected and analyzed. Four hundred seven respondents participated in the survey, and the response rate was 61.4%. All the respondents reported that they have at least an SM account. A total of 99.3% of respondents replied that they would add a colleague as a friend via SM; however, only 68.6% of them would add a patient. More than half of the respondents have been contacted by a patient more than five times per year, whereas 67.2% of them attempted to contact a patient by SM less than three times per year. One hundred forty of 407 (34.4%) respondents used SM daily to explore medical information, whereas 42 of 407 (10.3%) contributed new information via SM on a daily basis. Nearly 50% of respondents believed that SM was useful and beneficial. SM is widely used among GP trainers from 11 provinces of China. Most of the participants believed that SM is useful and beneficial to their work. However, there are still some problems for them to use SM in healthcare and medical education, including separating personal and professional use of SM, SM policy, and the quality of information from SM.

Objectives:To investigate if the psychometric qualities of an OSCE consisting of more complex simulated patient encounters remain valid and reliable in the assessment of postgraduate trainees in general practice.Methods:In this intervention study without control group, the traditional OSCE was formally replaced by the new, complex version. The study population was composed by all postgraduate trainees (second and third phase) in general practice during the ongoing academic year. Data were handled and collected as part of the formal assessment program. Univariate analyses, the variance of scores and multivariate analyses were performed to assess the test qualities.Results:A total of 340 students participated. Average final scores were slightly higher for third-phase students (t-test, p=0.05). Overall test scores were equally distributed on station level, circuit level and phase level. A multiple regression analysis revealed that test scores were dependent on the stations and circuits, but not on the master phase.Conclusions:In a changing learning environment, assessment and evaluation strategies require reorientation. The reliability and validity of the OSCE remain subject to discussion. In particular, when it comes to content and design, the traditional OSCE might underestimate the performance level of postgraduate trainees in general practice. A reshaping of this OSCE to a more sophisticated design with more complex patient encounters appears to restore the validity of the test results.

PurposeAntibiotic prescription is a central public health issue. Overall, 90% of antibiotic prescriptions are delivered to patients in ambulatory care, and a substantial proportion of these prescriptions could be avoided. General Practitioner (GP) trainers are similar to other GPs in terms of sociodemographic and medical activities, but they may have different prescription patterns. Our aim was to compare the antibiotic prescribing rates between GP trainers and non-trainers.MethodsThis observational cross-sectional study was conducted on administrative data claims from the French National Health Insurance. The antibiotic prescribing rate was calculated. The main independent variable was the training status of the GPs. Prescribing rates were adjusted for the various GPs’ characteristics (gender, age, location of the practice, number of visits per GP and the case-mix) in a multiple linear regression analysis.ResultsBetween June 2014 and July 2015 the prescribing patterns of 860 GPs were analysed, among which 102 were GP trainers (12%). Over the year 363,580 patients were prescribed an antibiotic out of 3,499,248 visits for 1,299,308 patients seen over the year thus representing around 27.5% of patients. In the multivariate analyses, being a trainer resulted in a significant difference of 6.62 percentage points (IC 95%: [-8.55; -4.69]; p<0.001) in antibiotic prescriptions comparing to being a non-trainer, corresponding to a relative reduction of 23.4%.ConclusionThese findings highlight the role of GP trainers in antibiotic prescriptions. By prescribing fewer antibiotics and influencing the next generations of GPs, the human and economic burden of antibiotics could be reduced.

Which barriers affect morbidity registration performance of GP trainees and trainers?

In our roles as General Practice (GP) fellows working within the Supported Return to Training (SuppoRTT) programme, we evaluated the current experiences of GP trainees in Wessex with regard to SuppoRTT. SuppoRTT was developed to enable trainee doctors who have time out of training to have a safe and supported return to work. GP trainees are in a unique position in that they can return to various hospital placements as well as GP placements. Therefore, their needs can vary significantly from other trainees. We wanted to find out whether the programme was meeting its aims and to explore whether it could be improved using feedback from trainees. An anonymous online survey was sent to all current GP trainees in Wessex. Sixty per cent of GP trainees reported that returning to training was a positive experience, with many trainees accessing SuppoRTT and finding it helpful. Five main themes were identified to guide further improvements. These included lack of awareness of the programme, improving administrative processes, a desire for better wellbeing support on returning, a request for a GP specific return to work course, and increased planning prior to taking time out of training and flexibility on return. We identified that with some adjustments to how and what is delivered such as clearer documentation, and perhaps the delivery of a GP specific return to work course, the programme can better meet their needs.

Inadequate smoking cessation interventions by physicians have been attributed to lack of training, and it is generally thought that additional education will improve patient care. However, interventions aimed at increasing knowledge and practical skills only address one determinant of behavior (capability). This prospective study assessed how much a teaching session for general practitioner (GP) trainees enrolled in Vocational Training Schemes in England also affected two other determinants (motivation and opportunity) specified by the COM-B theory of behavior. Between October and December 2015, GP trainees were given a 3.5-h training session in the theory and practice of smoking cessation. Questionnaires addressed motivation, capability, and opportunities to provide evidence-based brief advice to smokers at the beginning and end of the session, and 3 months later. They also looked at the recollection of previous teaching as well as knowledge, skills, intervention frequency, and perceived barriers against providing interventions. Participants (n = 123) remembered little previous training on the subject and self-reported presession knowledge was minimal. Motivation was high throughout while capability and opportunity increased considerably during the session. No further change in these parameters was noted at 3 months. The proportion of participants stating they provided evidence-based brief advice to >50% of smokers increased from 25.2% before the session to 57.7% at follow-up. Lack of time remained a commonly cited barrier. Training elicited an immediate and sustained effect on capability, perceived opportunity, and behavior itself. While perceived barriers referring to capability were greatly reduced, barriers referring to opportunity (eg, lack of time) persisted. This is the first study evaluating a GP training session on smoking cessation with regard to the COM-B model. In a pre-post design with 3-month follow-up, we observed substantial and sustained changes in GP trainees' perceived capability and opportunity to provide evidence-based very brief advice, and these increases were paralleled by favorable changes in practice behavior.

BackgroundPostgraduate General Practice (GP) training is structured around a formal curriculum set out by the training body. It also includes a “hidden curriculum” of experiential workplace learning in a heterogenous learning environment [1]. There is no formal national annual survey of GP trainees and their views in Ireland.MethodsThe research aim was to evaluate what the trainee population think of their training environment, and to analyse the contributory factors. A mixed methods cross-sectional survey was distributed to all third- and fourth-year GP trainees (N = 404). The Manchester Clinical Placement Index was adapted for the study.ResultsThe response rate was 30.94% (N = 125). Questions 1 to 7 provided a description of the characteristics of the study population. The remainder of the questions focused on aspects which relate to constituents of the learning environment. The responses were broadly and convincingly positive and supportive of the good work being done in GP training and by trainers in Ireland today across both qualitative and quantitative findings. One notable exception was in the area of feedback where single handed fourth year practices were found to be underperforming.ConclusionsThe current research findings were broadly positive and supportive of the good work being done in GP training and by trainers in Ireland today. Further research will be needed to validate the study instrument and to further refine some aspects of its configuration. The implementation of such a survey on a regular basis may have merit as part of the quality assurance process in GP education alongside existing feedback structures [2].

BackgroundGeneral Practitioners (GPs) are increasingly affected by stress-related complaints and burnout. Although many studies have addressed this issue, little is known about the stress burden and burnout rates of postgraduate trainees specialising in General Practice (GP). This cross-sectional study was performed to explore the prevalence and risk of depression, stress and burnout in a large cohort of GP trainees.MethodsAll GP trainees enrolled in the postgraduate training programme KWBW Verbundweiterbildungplus© in southwest Germany were invited to participate. A paper-based survey for the purpose of psychosocial screening was used: Prevalence of depression, perceived stress and burnout were measured with the depression module of the Patient Health Questionnaire (PHQ-9), Perceived Stress Questionnaire (PSQ-20) and Maslach Burnout Inventory (MBI). Additionally, linear regression models were used to analyse the association between sociodemographic characteristics and mental health scales.ResultsN = 211 GP trainees participated in this study (response rate 95%). 75.3% (n = 159) of the participants were female and median age was 34 (IQR 32; 39). GP trainees had a mean PHQ-9 sum score of 5.4 (SD 3.4). Almost 11% (n = 23) reported symptoms of a moderate or moderately severe depression. PSQ-20 revealed moderate level of distress, whereas 20.8% (n = 42) showed a high level of perceived stress with a sum-score higher than .59. GP trainees showed moderate rates of burnout and only 2.5% (n = 5) scored high in all three dimensions of the MBI score. GP trainees showed increased levels of depression, perceived stress and burnout when compared with age-matched general population. Being a woman led to a higher PHQ-9 sum score (p < .05). Higher age was associated with less depersonalisation in the MBI (p < .05).ConclusionsThe results of our study suggest that GP trainees considerably suffer from stress. Some GP trainees were even affected by depression or burnout. To detect and support colleagues at risk, trainees should be supported by early preventive measures such as anti-stress or resilience trainings and mentoring during their training. Prospective longitudinal studies are needed to understand the character and the course of the stress burden among GP trainees.

The capacity and the commitment to reflect are integral to the practice of medicine and are core components of most general practitioners (GP) training programmes. Teaching through the humanities is...

BackgroundAustralian General Practitioners (GPs) are generous prescribers of antibiotics, prompting concerns including increasing antimicrobial resistance in the community. Recent data show that GPs in vocational training have prescribing patterns comparable with the high prescribing rate of their established GP supervisors. Evidence-based guidelines consistently advise that antibiotics are not indicated for uncomplicated upper respiratory tract infections (URTI) and are rarely indicated for acute bronchitis. A number of interventions have been trialled to promote rational antibiotic prescribing by established GPs (with variable effectiveness), but the impact of such interventions in a training setting is unclear. We hypothesise that intervening while early-career GPs are still developing their practice patterns and prescribing habits will result in better adherence to evidence-based guidelines as manifested by lower antibiotic prescribing rates for URTIs and acute bronchitis.Methods/designThe intervention consists of two online modules, a face-to-face workshop for GP trainees, a face-to-face workshop for their supervisors and encouragement for the trainee-supervisor dyad to include a case-based discussion of evidence-based antibiotic prescribing in their weekly one-on-one teaching meetings.We will use a non-randomised, non-equivalent control group design to assess the impact on antibiotic prescribing for acute upper respiratory infections and acute bronchitis by GP trainees in vocational training.DiscussionEarly-career GPs who are still developing their clinical practice and prescribing habits are an underutilized target-group for interventions to curb the growth of antimicrobial resistance in the community. Interventions that are embedded into existing training programs or are linked to continuing professional development have potential to increase the impact of existing interventions at limited additional cost.Trial registrationAustralian New Zealand Clinical Trials Registry, ACTRN12614001209684 (registered 17/11/2014).Electronic supplementary materialThe online version of this article (doi:10.1186/s12875-016-0470-7) contains supplementary material, which is available to authorized users.

Strukturiert und unterstützt durch die Weiterbildung Allgemeinmedizin: Evaluation eines hessenweiten Mentoringprogramms für Ärzte/innen in Weiterbildung Allgemeinmedizin

ABSTRACTInvolvement in teaching activities is a curriculum requirement for GP Speciality Trainees (GPSTs). There are numerous potential benefits to involving GPSTs in teaching, including mutual educational benefit for both GPST and learner. However, GPSTs on placement in primary care may be less involved in teaching activities than hospital-based trainees. The reasons for this are not fully understood. This multi-site study aimed to explore the perceptions of GP trainers of the barriers to involving GPSTs in teaching in primary care. Focus groups of General Practice (GP) trainers from four regional GP training programmes across Northern England were conducted. Data were analysed thematically. Trainers cited barriers relating to the trainee (e.g. capacity and capability), practice (e.g. capacity), and teaching (e.g. appropriateness of teaching methods). Underlying these barriers, there appeared to be a cultural attitude towards GPST involvement in teaching: trainers viewed teaching as an extraneous rather than integral part of GP training, considered teaching to represent a deviation from the norm and felt that the GPST was restricted to a learner role. Whilst attempts to address the practical barriers identified in this study are required, a cultural shift in which the role of the GPST as a teacher becomes normalised is urgently needed.

BackgroundSwitzerland, like many other countries, has a shortage of General Practitioners (GPs). Optional GP training modules in GP practices were offered during the at least 5-year GP training program to increase student and trainee interest in becoming a GP. The training modules had not yet been evaluated. We determined how many Swiss GP trainees became practicing GPs after they completed optional training modules, and if longer modules were associated with higher rates of GP specialization.MethodsIn this population-based cohort study, we included GP trainees who chose an optional GP training module in GP practice, provided by the Foundation to Promote Training in General Practice (WHM) between 2006 and 2015. GP trainees were invited to complete an online survey to assess the primary outcome (becoming a practicing GP by 2016). Data on non-responders was collected via an internet search. We calculated univariate time-to-event curves to become a practicing GP, stratified by trainee’s gender, length, part-time training, and number of years after graduation until training modules were completed. We used a multivariate model to adjust for characteristics of participants, training, and satisfaction with training modules.ResultsWe assessed primary outcome for 351 (92.1%) of 381 former GP trainees who participated in a WHM program between 2006 and 2015. Of these 218 (57%) were practicing GPs by 2016. When focusing on the trainees who had completed training between 2006 and 2010, the rate of practicing GPs was even 73%. Longer (p = 0.018) and part-time training modules (p = 0.003) were associated with higher rates of being a practicing GP. Most (81%) practicing GPs thought their optional GP training module was (very) important in their choice of specialty.ConclusionGP trainees who spent more time training in a GP practice, or who trained part-time were more likely to become practicing GPs. Most (80%) rated their training module as (very) important in their choice of career, highlighting that these modules effectively encourage the interests of those already inclined towards the GP specialty. Longer GP training modules and more opportunities for part-time training may attract and retain more interested trainees, and possibly increase the number of practicing GPs.

Perceived Palliative Care Education Needs of GP Trainees: A National Study.

ObjectivesFailure to recruit sufficient applicants to general practice (GP) training has been a problem both nationally and internationally for many years and undermining of GP is one possible contributing factor....