Project objectives

The aim of this project was to identify, summarise and synthesise empirical research evidence on delivering undergraduate medical education in general practice in the United Kingdom to maximise the impact of existing research and to shape future research in this area.  The main review questions were as follows:

• What learning activities have been reported to happen in undergraduate general practice teaching in the United Kingdom terms of: 

a.learning objectives and content?

b. duration, structure and timing of placements?

• Which professional groups are involved in teaching undergraduate medical education in general practice?
•  What learning and practice outcomes have been demonstrated for students, teachers and patients in the domains of cognitive; behavioural; and emotional change or learning as a result of undergraduate placements in general practice?
• What do students, teachers and patients perceive to be the benefits and dis-benefits of undergraduate medical education in general practice?What are the theoretical and conceptual underpinnings of placements described or evaluated within the empirical literature?
• What costs of undergraduate teaching in general practice have been described?

 Changes to project objectives

None reported

Brief summary

The aim of this project is to identify, summarise and synthesise empirical research evidence on delivering undergraduate medical education through general practice teaching.

Objectives

1. Identify the available empirical research literature on undergraduate medical education in general practice;
2. Describe the range of teaching and learning experiences in terms of placement types and key characteristics (timing, duration, profession of teacher, content and learning objectives);
3. Describe the primary research evaluating these teaching and learning experiences;
4. Summarise and synthesise this primary research with a view to determining the effects of delivering undergraduate medical education in general practice on medical students, patients and teachers in the domains of behavioural, emotional and cognitive change.
5. Explore the structural, theoretical and conceptual components that contribute to making placements effective.
6. Describe the costs associated with undergraduate placements in general practice.

Design

Systematic review with meta-analysis and meta-synthesis of available research evidence.

 Methods

Population

Medical students, teachers and / or patients in general practice settings. Medical students will be defined as 'students undertaking a course of study at a medical school in order to reach a primary qualification in medicine, enabling them to practise as doctors'.

Intervention

Undergraduate medical education in general practice. This might be of any length, but must be delivered by general practitioners or in general practice. Within general practice, teaching could be delivered by a range of staff including general practitioners, other healthcare professionals, patients or peers.

Comparator (where relevant).

Any non-general practice based undergraduate medical education. This will include traditional hospital settings, including outpatient and inpatient care and other non-traditional settings, such as community outreach clinics.

Outcomes

Impact on students, teachers and patients in cognitive, behavioural and emotional domains.

Research Team: the team combines a wide range of expertise in medical education, education and healthcare research, supported by an expert steering committee with experience managing large funded projects and conducting a variety of systematic reviews in healthcare, social policy and education.

Hypothesis Aims

The aim of this project is to identify, summarise and synthesise empirical research evidence on delivering undergraduate medical education through general practice teaching.

Specific objectives are to:
1. Identify the available empirical research literature on undergraduate medical education in general practice;
2. Describe the range of teaching and learning experiences in terms of placement types and key characteristics (timing, duration, profession of teacher, content and learning objectives);
3. Describe the primary research evaluating these teaching and learning experiences;
4. Summarise and synthesise this primary research with a view to determining the effects of delivering undergraduate medical education in general practice on medical students, patients and teachers in the domains of behavioural, emotional and cognitive change.
5. Explore the structural, theoretical and conceptual components that contribute to making placements effective.
6. Describe the costs associated with undergraduate placements in general practice. 

Research Questions

1. What learning activities have been reported to happen in undergraduate general practice placements in terms of:

a) Learning objectives and content?

b) Duration, structure and timing of placements?

2. Which professional groups are involved in teaching undergraduate medical education in general practice?

3. What learning and practice outcomes have been demonstrated for students, teachers and patients in the domains of cognitive; behavioural; and emotional change or learning as a result of undergraduate placements in general practice?

4. What do students, teachers and patients perceive to be the benefits and dis-benefits of undergraduate medical education placements in general practice?

5. What are the theoretical and conceptual underpinnings of placements and definitions of ‘active components’ evaluated or described within the empirical literature?

6. What are the costs of undergraduate placements in general practice?

Plain English summary

We are conducting an NIHR School for Primary Care Research funded Best Evidence in Medical Education (BEME) systematic review about undergraduate UK general practice medical education. This project aims to summarise and bring together the existing research evidence delivering undergraduate medical education in general practice.  It focuses upon 3 different areas of outcome: patient; student; and teacher. This review has been conducted by a multi-disciplinary and multi-institutional team, including user representatives.

 We have produced 3 major outcomes relevant to patient involvement:

 A descriptive summary of educational activities in undergraduate general practice teaching, including the emotional, behavioural and cognitive changes or learning for patients as an outcome.

 A summary of quantitative independent outcome measures assessing the impact of general practice teaching on patient emotional outcomes and student behavioural and cognitive outcomes

 A meta-ethnography considering the perspectives of students and patients involved in undergraduate medical education

The descriptive review summarises students, patients and general practitioners views on the  benefits and dis-benefits of undergraduate medical education in the general practice setting.  Students described gaining an understanding of illness in the community, gaining confidence in clinical skills, and receiving feedback from general practice tutors.  However, students, especially those on rural placements, sometimes felt isolated and experienced less patient contact.  Patients involved in general practice teaching sometimes experienced a sense of enjoyment from participating in teaching, but teaching could also generate feelings of anxiety and embarrassment.  General practitioners described how teaching undergraduate students allowed them to maintain their knowledge base, and led to feelings of enjoyment and well-being through an increased variety to their clinical work, however, this was balanced against the increased time pressures and workload associated with teaching.

An in-depth review of quantitative papers showed that medical students learned clinical skills as well or better in general practice settings as shown by scores on Objective Structured Clinical Examinations (OSCEs).  Students receive more teaching in the general practice setting. Patient satisfaction and enablement are similar whether a student is present or not, however, patients experience lower relational empathy with their GPs during teaching consultations.   

We used a method called meta-ethnography to synthesise papers for the in-depth qualitative review, focusing on student and patient experiences.  The meta-ethnography led to four main findings.  Firstly, the GP has a powerful role as a broker of the interactions between patients and students within the teaching consultation.  Secondly, general practice is a socio-cultural and developmental learning space where students can make links between disease-specific learning and whole-person medicine.  Thirdly, students need to negotiate the competing cultures between hospital and general practice settings, and may need support to address their perceptions about general practice.  Lastly, patients are transient members of the learning community in general practice, and their role within the teaching consultation and transformation to a member of the learning community requires careful facilitation.

Dissemination

Published articles

A systematic review of UK undergraduate medical education in the general practice setting: BEME Guide No.32. Park S, Khan N, Hampshire M, Knox R, Malpass A, Thomas J, et al. 2015. Taylor & Francis Online. Journal of Medical Education.  http://doi.org/10.3109/0142159X.2015.1032918

Public involvement

This project has developed  further work in patient involvement in medical education research through the PatMed project.  The PatMed project seeks to directly translate and develop findings from the meta-ethnography developed in this review. Through focus groups and interviews, we hope to facilitate an exchange of perspectives between participants and the empirical literature. We anticipate that this will facilitate contemporary service users’ involvement in the interpretation and development of relevant research findings and inform recommendations for future policy and practice.

Impact

We have presented the findings of this work in several different settings.

• Conferences: The review findings have been presented at the following conferences:

- Association for Medical Education in Europe (AMEE), Prague 2013

- Society for Academic Primary Care (SAPC), Nottingham 2013

- Canadian Conference for Medical Education, Ottawa 2014

• Heads of Medical School Teaching; The provisional findings of the review were presented to the Heads of Teaching group in December 2013.
• General Practice Medicine Society UCL: The review findings were presented to undergraduate medical students at UCL
• Bristol GP tutors meeting: SP has been invited to present a plenary about the review, then facilitate two workshops to develop discussion of the findings and their implications for practice

We are taking the results of the meta-ethnography to patients and students to test our findings in the empirical field.  This new project is titled ‘Patient Participation in UG medical education in general practice’ (PatMed) and is funded by the NIHR. 

This project was funded by the National Institute for Health Research School for Primary Care Research (project number 169)

Department of Health Disclaimer

The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the NIHR School for Primary Care Research, NIHR, NHS or the Department of Health.