Catch 22 (original) (raw)
Medical Education, 2004
BACKGROUND Recommendations for medical training have seen a growing drive for undergraduate teaching to take place within the community-primarily in the general practice surgery. In light of the ongoing expansion of medical student numbers, many more general practices will be required to participate in undergraduate teaching. AIM To explore the perceptions of primary care staff on the impact that increasing student numbers will have on them, on their patients and on the students themselves. DESIGN OF STUDY Semi-structured interviews SETTING Three general practices presently involved in undergraduate teaching, 3 practices about to become involved in undergraduate teaching and 1 non-teaching practice, all in the Black Country area of the West Midlands. METHODS Semi-structured interviews with prearranged prompts were undertaken with a variety of practice staff including general practitioners (GPs), practice managers and practice nurses, as well as administrative and reception staff. RESULTS Eleven GPs, 6 practice managers, 4 practice nurses and 6 receptionists ⁄ administrators took part in the interviews. Three main themes emerged relating to the effects on students and reflecting attitudes towards the Black Country, the experience of working among deprived populations and issues around access to the new training locations. The majority of interviewees were of the opinion that patients both enjoy taking part in undergraduate teaching and are able to benefit from the process. Positive impacts on practice infrastructure were also elicited, but when asked about the resource implications for the practice of undergraduate teaching, there was a dichotomy of opinion. CONCLUSION For many practices, involvement in undergraduate teaching is a double-edged sword.
Exploring the tensions of being and becoming a medical educator
BMC Medical Education, 2017
Background: Previous studies have identified tensions medical faculty encounter in their roles but not specifically those with a qualification in medical education. It is likely that those with postgraduate qualifications may face additional tensions (i.e., internal or external conflicts or concerns) from differentiation by others, greater responsibilities and translational work against the status quo. This study explores the complex and multi-faceted tensions of educators with qualifications in medical education at various stages in their career. Methods: The data described were collected in 2013-14 as part of a larger, three-phase mixed-methods research study employing a constructivist grounded theory analytic approach to understand identity formation among medical educators. The over-arching theoretical framework for the study was Communities of Practice. Thirty-six educators who had undertaken or were undertaking a postgraduate qualification in medical education took part in semi-structured interviews. Results: Participants expressed multiple tensions associated with both becoming and being a healthcare educator. Educational roles had to be juggled with clinical work, challenging their work-life balance. Medical education was regarded as having lower prestige, and therefore pay, than other healthcare career tracks. Medical education is a vast speciality, making it difficult as a generalist to keep up-to-date in all its areas. Interestingly, the graduates with extensive experience in education reported no fears, rather asserting that the qualification gave them job variety. Conclusion: This is the first detailed study exploring the tensions of educators with postgraduate qualifications in medical education. It complements and extends the findings of the previous studies by identifying tensions common as well as specific to active students and graduates. These tensions may lead to detachment, cynicism and a weak sense of identity among healthcare educators. Postgraduate programmes in medical education can help their students identify these tensions in becoming and develop coping strategies. Separate career routes, specific job descriptions and academic workload models for medical educators are recommended to further the professionalisation of medical education.
BMC Medical Education, 2008
Background: We analysed the learning and professional development narratives of Hospital Consultants training junior staff ('Consultant Trainers') in order to identify impediments to successful postgraduate medical training in the UK, in the context of Modernising Medical Careers (MMC) and the European Working Time Directive (EWTD). Methods: Qualitative study. Learning and continuing professional development (CPD), were discussed in the context of Consultant Trainers' personal biographies, organisational culture and medical education practices. We conducted life story interviews with 20 Hospital Consultants in six NHS Trusts in Wales in 2005.
Changing postgraduate medical education: a commentary from the United Kingdom
The Medical journal of Australia, 2007
The current changes in postgraduate training in the United Kingdom are largely driven by government rather than the profession, and are aimed at producing a medical workforce more quickly and more fit-for-purpose in a rapidly changing National Health Service. Most aspects of the changes are, as yet, untested. Postgraduate training now consists of a 2-year varied Foundation program, followed by selection to a longer training program within a chosen specialty (often with further selection points to different subspecialties after 2 years). Assessment systems are a combination of workplace-based assessments and national examinations of knowledge and skill. The changing, highly managed and partially privatised health service in the UK presents challenges in terms of providing appropriate clinical experience for training. Postgraduate medical education is now regulated by the Postgraduate Medical Education and Training Board, which sets standards for all aspects of training, and approves ...
Lessons from the UK: Doctors' Views of Changes in Postgraduate Training
Focus on health professional education : a multi-disciplinary journal, 2010
Aims: To explore the views and experiences of trainee doctors and their assessors undertaking competence assessments, in the first year of the new postgraduate programme in the UK. Methods: A qualitative approach using individual, semi-structured interviews with seven first year trainees and seven assessors from across a range of specialties in a large acute hospital Trust in the UK. Results: Assessing competence of newly qualified doctors has the potential to bring important benefits such as fostering relationships between junior and senior staff, building confidence in early days in practice and providing an early warning system for doctors who are struggling. However, certain barriers exist which make the benefits difficult to realise, and collectively undermine the value of assessment. Principally, inadequate preparation for the role of assessor and lack of time for assessment are revealed, together with perceptions of bias and a lack of rigour in the use of assessment tools. Co...
Training the Trainers of Tomorrow Today - driving excellence in medical education
BMJ Quality Improvement Reports, 2013
Training the Trainers of Tomorrow Today (T4) is a new way to deliver "Training for Trainers". Responding to local dissatisfaction with existing arrangements, T4 builds on 3 essential requirements for a future shape of training: 1. Clinical Leadership and a Collaborative Approach 2. Cross-Specialty Design and Participation 3. Local Delivery and Governance Networks Design principles also included: 3 levels of training to reflect differing needs of clinical supervisors, educational supervisors and medical education leader, mapping to GMC requirements and the London Deanery's Professional Development Framework; alignment of service, educational theory and research; recognition of challenges in delivering and ensuring attendance in busy acute and mental health settings, and the development of a faculty network. The delivery plan took into account census of professional development uptake and GMC Trainee Surveys. Strong engagement and uptake from the 11 Trusts in NW London has been achieved, with powerful penetration into all specialties. Attendance has exceeded expectations. Against an initial 12 month target of 350 attendances, 693 were achieved in the first 8 months. Evaluation of content demonstrates modules are pitched appropriately to attendees needs, with positive feedback from trainers new to the role. Delivery style has attracted high ratings of satisfaction: 87% attendees rating delivery as "good\excellent". External evaluation of impact demonstrated improved training experiences through changes in supervision, the learning environment and understanding of learning styles. We have addressed sustainability of the programme by advertising and recruiting Local Faculty Development Trainers. Volunteer consultants and higher trainees are trained to deliver the programme on a cascade model, supported by the Specialty Tutors, individual coaching and educational bursaries. The Trainers are local champions for excellence in training, provide a communication between the programme and local providers, are a repository of expertise in their service, and trouble shoot local barriers to engagement.
Rewards, costs and challenges: the general practitioner’s experience of teaching medical students
Medical Education, 2011
CONTEXT Medical student attachments in general practices play an important role in undergraduate medical education internationally. The recruitment by universities of new teaching practices or an increase in the teaching commitment of existing practices will be necessary to address rising medical student numbers. General practitioners (GPs) are likely to weigh the perceived rewards of practice-based teaching against the perceived costs and challenges in deciding whether to accept a student placement and how to teach. These aspects of the 'lived experience' of the GP-teacher have not been adequately investigated. OBJECTIVES This study aims to enhance understanding of the GP clinical teacher experience in order to inform strategies for the recruitment, retention, training and support of teaching general practices. METHODS Sixty GP clinical teachers in Brisbane-based urban teaching general practices were interviewed individually face-to-face by the principal investigator, using a semistructured interview plan. Representativeness was ensured through quota sampling. The interview data were analysed thematically by two of the investigators independently, following member checking of interview transcripts. RESULTS The results demonstrate a number of key interrelated perceived rewards, costs and challenges of teaching, including intellectual stimulation, cognitive fatigue and student characteristics. CONCLUSIONS The findings extend reports in the previous literature by offering a richer description of current GP-teacher experience. Participants identified teaching rewards in a manner largely consistent with previous research, with the exception of enhanced practice morale and teamwork. Findings confirm that reduced productivity and increased time pressures remain key perceived negative impacts of teaching, but also reveal a number of other important costs and challenges. They emphasise the diversity of GP experience and practice cultures, and the need for teaching to enhance both GP and patient perceptions of consultation quality without increasing the load on the GP-teacher. Recruitment and retention strategies should promote the rewards of teaching, and teacher training should respond to the costs and challenges of practice-based teaching, and facilitate the growth of GPs in their role as clinical educators.