General practitioner trainees'' experience of undertaking audit projects: preliminary report from the west of Scotland region.

BACKGROUND. Departments of general practice increasingly provide formal teaching in audit. However, little is known about audit projects carried out by trainees in general practice. AIM. A study was undertaken to ascertain general practitioner trainees' experience of undertaking an audit project in the trainee year, with reference to their understanding of audit theory, perceived usefulness of the project in enhancing clinical knowledge, time taken to do the audit and practice team involvement in the project. METHOD. All 104 trainees in the west of Scotland region completing their trainee year on 31 July 1993 were sent a postal questionnaire that month. The replies to the questionnaire were analysed and compared with the audit project that each trainee had submitted in June 1993 as part of a pilot project for summative assessment. RESULTS. Responses were received from 103 trainees (99%). Seventy trainees (68%) felt strongly that their audit project was relevant to patient care but only 31 (30%) felt strongly that the project was a useful way of enhancing clinical knowledge of the disease process. Data collection was the most time consuming aspect of the audit project, 23% of trainees reporting taking a day or more to complete this stage. Trainees who chose their own audit project were more likely to complete two sets of data collection than those who had not chosen their own project. Seventy nine trainees (77%) indicated that trainers had been involved in their project and 51 trainees indicated that one of the other practice partners had been involved in their project. CONCLUSION. Performing an audit as a trainee is feasible in the time limit of the one year in general practice. The educational benefit appears to be limited to the knowledge of audit process, rather than to clinical knowledge. Audit projects of relevant size and complexity, involving appropriate members of the practice team, are to be encouraged, as is the development of an instrument for assessing trainee audit.     

Fine-needle aspiration cytology of the thyroid: ten years experience in a community teaching hospital

We present our experience of fine-needle aspiration (FNA) cytology of the thyroid in a community hospital setting and discuss the cancer probability of the indeterminate FNA results. There were 1,621 FNAs, 401 of which have follow-up thyroidectomies during a 10-yr period. The initial FNA diagnoses of these 401 cases were benign non-neoplastic (BNN) 159, malignant 34, atypical 33, suspicious 19, follicular neoplasm (FN) 88, follicular lesion (FL) 51, and inadequate 17. There were no false-positive cases. Cancer was found in 11 cases diagnosed as BNN (7%), 6 cases were due to sampling errors (incidental microcarcinomas), and 5 cases were due to failure to identify focal atypia in the smears of a follicular variant of papillary carcinoma. The false-negative rate was 3%, with the exclusion of cases of incidental microcarcinomas. Among the indeterminate FNA results, the follow-up operations revealed malignant tumors in 16 of 33 (48%) cases of atypical, 13 of 19 (68%) cases of suspicious, 29 of 88 (33%) cases of FN, and 7 of 51 (14%) cases of FL. Malignant tumors were also found in 2 of 17 (12%) of inadequate specimens with follow-up. When compared to the cancer rate (3%) for FNA diagnosis of BNN, the likelihood of finding cancer in the thyroidectomy is 5 times more for a FL, 11 times more for a FN, 16 times more for atypical, and 23 times more for suspicious. The sensitivity and specificity are 87 and 100%, respectively.     

The satisfaction, motivation, and future of community preceptors: the North Carolina experience.

PURPOSE: To measure satisfaction and motivation of community-based preceptors, and to examine differences between degree groups of physicians, pharmacists, advanced-practice nurses (nurse practitioners and certified nurse midwives), and physician assistants. METHOD: In spring 2005, the authors mailed a four-page, 24-item survey to all 2,061 community-based primary care preceptors served by the North Carolina Area Health Education Centers system. The survey measured preceptor satisfaction, likelihood of continuing as a preceptor, influence of having students, motivation for teaching, satisfaction in professional practice, satisfaction with incentives, and value of incentives. RESULTS: Response rate was 69.3%, or 1,428 preceptors. Most preceptors (93.0%) reported high satisfaction with their precepting experience, and 90.9% indicated high likelihood of continuing to precept for the next five years. Almost all preceptors (93.7%) reported they were satisfied with their professional life. Many community preceptors (57.2%) were satisfied with incentives. They placed greater value on the intrinsic reasons for precepting (i.e., enjoyment of teaching) rather than extrinsic rewards (such as no-cost online library resources). Degree groups placed differing values on intrinsic and extrinsic rewards. Physicians reported more negativity about the influence of students and regarding aspects of their professional lives. CONCLUSIONS: Tailoring support to better meet individual degree groups' preferences can maximize resources and may encourage preceptor retention. Special attention to physicians' needs may be warranted to avoid decreased preceptor numbers in this at-risk group. Future studies are needed to determine whether these findings are unique to North Carolina, which has a strong infrastructure to support preceptors.     

General practitioner reaccreditation: use of performance indicators.

There has been increasing debate about reaccreditation of general practitioners over the last few years with contributions from the General Medical Services Committee, the Royal College of General Practitioners and the National Association of Health Authorities and Trusts. The implications of proposals in terms of cost, logistics and organization are discussed in this paper, in light of experience with the introduction of summative assessment for general practitioner registrars (trainees) and a programme of training practice visits in West Midlands Region. A model for reaccreditation for all general practitioners is proposed which is professionally led and sensitive to the needs of patients and health service managers. The basic proposition is that publicly owned family health services authority data could be used as initial performance indicators for professional competence. The model is dependent on the rebuttal of the null hypothesis: there is no link between the competence of a general practitioner and his or her achievements in the suggested performance indicators. If the performance indicators (educational commitments, prescribing data, health promotion activity and immunization targets, and service elements) can be shown to correlate with possession of the attributes for independent practice as defined by the General Medical Council, then a relatively inexpensive and simple system of reaccreditation could be envisaged. General practitioners who are recorded as achieving set performance indicator targets would be accorded automatic reaccreditation. Only substandard practitioners would be required to be assessed further by a visiting team of local general practitioner peers and, if appropriate, a remedial education strategy introduced. This method would complement the General Medical Council scheme for assessing an individual doctor's persistent poor performance, which could then be invoked as a last resort.     

General practitioner registrars'' views about a career in general practice.

BACKGROUND. Current low morale in general practice and the fall in the number of general practitioner registrars (trainees) has led to concern about the decline in popularity of general practice as a career. AIM. A study was performed to evaluate the career intentions of general practitioner registrars and the factors underlying their decisions. METHOD. An anonymous postal questionnaire seeking both quantitative and qualitative data was sent to 138 registrars during June 1993. All were registrars at practices in the south west region of England. Outcome measures used were the popularity of different types of general practice work and identification of variables and emergent themes considered important in career choice. RESULTS. A total of 101 registrars returned questionnaires (73%). Of the respondents, 96% expressed an interest in general practice as a career. However, registrars expressed considerable uncertainty about the future of general practice and therefore their career. Continuity of care and a holistic approach were considered valued aspects of work in general practice. Increased workload, increased out-of-hours work and erosion of professional autonomy emerged as negative aspects of a career in general practice. Of the respondents, 91% considered time for leisure activities an important factor when considering future career, 72% would have been glad to do away with 24-hour cover and 99% agreed that general practitioners increasingly fear litigation. CONCLUSION. Although registrars were interested in general practice as a career they had many concerns and expressed uncertainties. The future popularity of general practice is likely to depend on addressing these concerns and on the clarification of the future direction of the profession.     

General practitioners and their possible role in providing spiritual care: a qualitative study.

We interviewed the general practitioners (GPs) of 40 patients with life-threatening illnesses over the course of the last year of life. We asked them to identify their patients' holistic needs, and to discuss whether they considered that they had a role in providing 'spiritual care'. The GPs varied greatly in their understanding of their patients' experiences and needs. Most said that they had a role in providing spiritual care, but hesitated to raise spiritual issues with patients, mentioning lack of time, a feeling that they should wait for a cue, or being unprepared or unskilled.     

浅谈PBL在护理本科生理学教学中运用的一些体会

现代科学技术的进步对教学任务提出了更高的要求。PBL(prob lem based learn ing)适应于这一要求,鼓励学生以问题为中心,在学习过程中探索问题,解决问题。将PBL灵活运用于生理学课堂教学,通过精心设计课堂提问、组织基于问题的专题讨论以及结合实验示教等多种方式,活跃课堂教学气氛、激发学生的探索热情,并充分培养学生的创造性思维能力,从而提高课堂教学质量。     

General practitioners' continuing education: a review of policies, strategies and effectiveness, and their implications for the future.

BACKGROUND: The accreditation and provision of continuing education for general practitioners (GPs) is set to change with new proposals from the General Medical Council, the Government, and the Chief Medical Officer. AIM: To review the theories, policies, strategies, and effectiveness in GP continuing education in the past 10 years. METHOD: A systematic review of the literature by computerized and manual searches of relevant journals and books. RESULTS: Educational theory suggests that continuing education (CE) should be work-based and use the learner's experiences. Audit can play an important role in determining performance and needs assessment, but at present is largely a separate activity. Educational and professional support, such as through mentors or co-tutors, has been successfully piloted but awaits larger scale evaluation. Most accredited educational events are still the postgraduate centre lecture, and GP Tutors have a variable role in CE management and provision. Controlled trials of CE strategies suggest effectiveness is enhanced by personal feedback and work prompts. Qualitative studies have demonstrated that education plays only a small part in influencing doctors' behavior. CONCLUSION: Maintaining good clinical practice is on many stakeholders' agendas. A variety of methods may be effective in CE, and larger scale trials or evaluations are needed.