Dealing with patients facing a history of sexual abuse: A cross-sectional survey among Dutch general practitioners

Background: Sexual abuse (SA) is a common problem. As the primary confidant, the general practitioner (GP) has a valuable role in identifying a history of abuse, specifically with regard to the commonly performed pelvic examination for cervical cancer screening.

Objectives: This study focused on GPs’ practice patterns, knowledge, training need and barriers concerning asking patients about SA. Furthermore, it was investigated who performs the cervical smear within the practice and if SA is taken into consideration.

Methods: The authors constructed a 31-item questionnaire, which was sent to a group of 730 Dutch GPs in September 2012.

Results: The response rate was 49.3%. Half of the 357 responding GPs asked their patients about SA sometimes. The majority (76.2%) stated they had some knowledge of SA. The most important barriers for not asking were ‘no angle or motive for asking’ (81.6%), ‘presence of third parties’ (73.1%), and ‘not enough training’ (54.1%). In most practices (84.3%), the nurse practitioner (NP) was assigned to perform the cervical smears, of which 34.8% presumably never ask about SA in advance. Additional training was in need according to 68.6%. GPs desired a clinical practice guideline regarding the counselling of SA (83.5%).

Conclusion: This study showed SA is an under-evaluated problem in general practice, yet GPs are motivated to improve knowledge and counselling skills. NPs perform most of the cervical smears, but the majority never or rarely asked about SA in advance. Educational training and a clinical guideline regarding SA would be appreciated and hence recommended.     

Learning objectives of Belgian general practitioner trainees regarding their hospital training: A qualitative study

BackgroundIn Europe, hospital training is integrated in the postgraduate curriculum of General Practitioners (GPs) according to the European Directives. However, little is known about the specific learning objectives of GP trainees during this training.ObjectivesThis exploratory study investigated GP trainees’ expected learning objectives for their hospital training and the factors influencing the learning process.MethodsSemi-structured interviews were conducted in three focus groups consisting of first-year GP trainees before their hospital training. Data were coded thematically and analysed in NVivo.ResultsA total of 22 Belgian GP trainees (55% females, average age of 26.2 years) were interviewed. Three major themes emerged: learning objectives, factors influencing learning and organisational aspects. GP trainees mainly wanted to improve their knowledge of common conditions by conducting consultations and follow certain patients’ hospitalisation trajectory. Emergency medicine or internal medicine was the preferred specialty. Other GP trainees wanted to learn more about some specific conditions. Conversely, an overloaded work schedule was dreaded to hinder effective learning. Regular meetings and supervision from their hospital trainer were deemed crucial to strengthen GP trainees’ learning trajectory.ConclusionGP trainees wanted to learn more about both common conditions and some specific conditions. Their previous year in a GP setting strengthened their confidence and facilitated purposeful learning. Relieving GP trainees from administrative tasks when working as supplementary doctors could strike a better balance between the continuity of the clinical department and their personal learning objectives.     

Greek experiences with integration of public health aspects into training programmes for general practitioners

Objectives  

Promotion and integration of training in public health into the vocational training schemes for general practitioners in order to fulfill the needs of the expanded role of the general practitioners under the strategy ”Health for All“.     

Attitude changes in the vocational training of general practitioners

This investigation examined the extent to which attitudes of doctors who participated in a one-year training programme for general practice changed in intended directions by training. A large number of questionnaires, validated in earlier research, were administered to 84 trainee general practitioners (GPs) both at the start and at the end of the training year. There appeared to be a strong to very strong shift in the intended direction with regard to the demarcation of work between general practitioners and specialists, the feeling of competence at work, the fear of making mistakes, beliefs about taking risks when making medical decisions, confidence in specialist technical examinations and the way general practice work is experienced. By the end of the training students hardly differed from, or had even gone further in the intended direction than, experienced general practitioners.     

More counselling for end-of-life decisions by GPs with own advance directives: A postal survey among German general practitioners

Background: Although general practitioners (GPs) are among the preferred contact persons for discussing end-of-life issues including advance directives (ADs), there is little data on how GPs manage such consultations.

Objectives: This postal survey asked German GPs about their counselling for end-of-life decisions.

Methods: In 2015, a two-sided questionnaire was mailed to 959 GPs. GPs were asked for details of their consultations on ADs: frequency, duration, template use, and whether they have own ADs. Statistical analysis evaluated physician characteristics associated with an above-average number of consultations on AD.

Results: The participation rate was 50.3% (n?=?482), 70.5% of the GPs were male; the average age was 54 years. GPs had an average of 18 years of professional experience, and 61.4% serve more than 900 patients per three months. Most (96.9%) GPs perform consultations on living wills (LW) and/or powers of attorney (PA), mainly in selected patients (72.3%). More than 20 consultations each on LWs and PAs are performed by 60% and 50% of GPs, respectively. The estimated mean duration of consultations was 21?min for LWs and 16?min for PAs. Predefined templates were used in 72% of the GPs, 50% of GPs had their ADs. A statistical model showed that GPs with ADs and/or a qualification in palliative medicine were more likely to counsel ≥20 patients per year for each document.

Conclusion: The study confirmed that nearly all German GPs surveyed provide counselling on ADs. Physicians with ADs counsel more frequently than those without such documents.     

现阶段我国全科医生培养模式探讨

全科医生的培训是我国现阶段社区卫生服务发展的当务之急。本文对目前国内几种全科医生培养模式进行了分析，探讨适宜我国国情和教育现状的全科医生培养模式，以促进我国全科医学教育和社区卫生服务的健康、稳定发展。     

Familial colonoscopic screening: how do French general practitioners deal with patients and their high-risk relatives. A qualitative study

BackgroundScreening of colorectal cancer (CRC) can reduce incidence and mortality. First-degree relatives (FDRs) of patients with CRC or advanced adenoma before the age of 65 (index patients) are at increased risk of CRC; however, the guidelines for screening of FDRs by colonoscopy are poorly followed.ObjectivesThe present study, conducted in the context of the COLOR3 interventional study project, aimed to explore the positioning of general practitioners (GPs) in familial CRC screening in France.MethodsFrom February 2020 to April 2021, 35 semi-structured interviews with GPs of index patients and/or their FDRs were conducted by telephone. The full-data transcribed corpus was subjected to horizontal thematic analysis.ResultsKnowledge and compliance with the guidelines vary greatly between GPs. Although initiating the diagnostic process, GPs do not consider themselves as actors in the flow of information concerning familial risk. Their accompaniment of index patients in this role varies. GPs should overcome barriers to implementing colonoscopic screening for FDRs. They underline the importance of exploring family history, but they lack the time and doubt the reliability of the information given by FDRs.ConclusionChallenges include circumventing gaps in knowledge, adherence to guidelines and improving family history updates. The GPs interviewed suggested personalised guidelines in specialists'' reports to initiate information campaigns raising awareness of familial risk, and to enhance coordination between organised screening and familial screening.     

Experience of intimate partner violence among women and men attending general practices in Dublin,Ireland: A cross-sectional survey

This cross-sectional study examined women's and men's reported experience of intimate partner violence in general practice in the greater Dublin region. A high prevalence of reported experience of controlling behaviour and violent incidents was found. Although the reported prevalence of both was higher in men, women were more likely to have reported fear of a partner and a severe level of violence.

Conclusion: The findings demonstrate that intimate partner violence is a major problem among the men and women surveyed.     

广州市全科医学教育社区卫生服务实践基地卫技人员调查分析

目的:了解广州市全科医学教育社区卫生服务实践基地卫技人员队伍现状,为促进全科医学教育师资队伍建设提供依据.方法:采用问卷调查的方式对广州市全科医学教育社区卫生服务实践基地的在岗卫技人员进行普查.结果:广州市19家全科医学教育社区卫生服务实践基地共有卫技人员1849名,平均每家拥有卫技人员97人,公卫医师占6.00%;卫技人员中25～54岁占80.53%;大专以下学历人员占66.47%;高级职称、中级职称、初级、无职称人员分别占5.25%,17.85%,67.65%,9.25%;医(仅全科医师)护比为1∶0.95.结论:广州市全科医学教育社区卫生服务实践基地卫技人员队伍中,护士和公卫医师数量不足,学历、职称偏低,人力资源结构有待改善.     

Development of the EMAP tool facilitating existential communication between general practitioners and cancer patients

Background: General practice recognizes the existential dimension as an integral part of multidimensional patient care alongside the physical, psychological and social dimensions. However, general practitioners (GPs) report substantial barriers related to communication with patients about existential concerns.

Objectives: To describe the development of the EMAP tool facilitating communication about existential problems and resources between GPs and patients with cancer.

Methods: A mixed-methods design was chosen comprising a literature search, focus group interviews with GPs and patients (n?=?55) and a two-round Delphi procedure initiated by an expert meeting with 14 experts from Denmark and Norway.

Results: The development procedure resulted in a semi-structured tool containing suggestions for 10 main questions and 13 sub-questions grouped into four themes covering the existential dimension. The tool utilized the acronym and mnemonic EMAP (existential communication in general practice) indicating the intention of the tool: to provide a map of possible existential problems and resources that the GP and the patient can discuss to find points of reorientation in the patient’s situation.

Conclusion: This study resulted in a question tool that can serve as inspiration and help GPs when communicating with cancer patients about existential problems and resources. This tool may qualify GPs’ assessment of existential distress, increase the patient’s existential well-being and help deepen the GP–patient relationship.     

Group training of general practitioners: evaluation based on participants'' expectations of an educational programme

Since 1985, the Norwegian Medical Association (NMA) has offered a 5-year specialist training programme in general practice. For two of these years the doctors take part in a group-based educational programme with bi-weekly meetings of 3 hours' duration. The evaluation study reported here had a dual purpose: to provide the groups with a method for exploring the group members' expectations of the programme, and to measure to what extent the programme had actually met these expectations within the first of the 2 years. Thirty-one of 38 groups, first established in spring 1986, responded on a postal inquiry where they were asked to list up to 10 features they expected to find in the educational programme. These expectations were rated by the groups on a five-point scale, where 5 denoted a fully met expectation. The four most frequent features analysed were: (1) increased comprehension of the characteristics and practice of general medicine; (2) good group collaboration; (3) facilitating the acquisition of medical knowledge; and (4) evaluation of clinical problems and patient management. Expectations for the first two of these features were nearly fully met, while the two others were met to a lesser degree. This type of evaluation seemed to be a useful tool for improving the group's way of functioning.     

Knowledge,competencies and attitudes regarding external post-mortem physical examination: A survey among German post-graduate trainees in general practice

Background: The external post-mortem examination (EPME) is an important medical, legal and socio-economic task with far-reaching relevance; however, due to discrepancies between findings from EPMEs and actual cause of death, improvements in accuracy and quality are needed.

Objectives: To investigate knowledge, competencies and attitudes regarding EPME in general practitioner (GP) post-graduate trainees.

Methods: Before four post-graduate training courses on the EPME for general practitioner trainees, organized in 2014 in the German federal state of Baden-Wuerttemberg, a questionnaire on the EPME was distributed by the lecturer, completed by the GP post-graduate trainees and returned to the lecturer. The questionnaire consisted of 19 items related to three main categories: knowledge, competencies and attitudes.

Results: Out of 380 GP post-graduate trainees, 128 completed and returned the questionnaire (response rate 33.7%). Less than 18% felt adequately confident in identifying a natural cause of death and less than 5% felt adequately confident in identifying an unnatural cause of death. Only 33% consistently fully uncover the corpse for the EPME.

Conclusion: We found an important uncertainty in GP post-graduate trainees regarding their EPME knowledge and competencies.     

Prevention in the elderly: A necessary priority for general practitioners

Prevention is viewed as a key issue for general practice, yet there is a lack of evidence regarding general practitioners’ interventions in both middle-aged and elderly people. This is despite the fact that recommendations and key indicators for monitoring the use of clinical preventive strategies aimed at these groups are available and that both the World Health Organization and European Commission endorse the importance of interventions for healthy and active ageing. This paper draws on two keynote presentations given at the 2015 autumn meeting of the European General Practice Research Network (EGPRN) in Edirne, Turkey (17–20 October 2015). According to the EU2020 strategy, general practitioners should design and implement prevention services and programmes to promote healthy and active ageing. Their primary focus should be on interventions on multimorbid patients, either by improving prescribing and adherence to medical plans or by targeting to fall and frailty prevention and vaccination uptake.     

Medical Training in Community Medicine: A Comprehensive, Academic, Service-Based Curriculum

The University of Pennsylvania's Family Practice Residency includes a significant community medicine component in order to accomplish the goals of addressing the health-related needs of the university's neighbors; exposing residents to the knowledge, skills and attitudes necessary to address the health needs of a community; and encouraging health careers with a community focus. It is my belief that these goals further the agenda of the National Institute of Medicine and Healthy People 2000 and 2010. Longitudinal and block community medicine experiences were established to accomplish these goals. This article describes and discusses three measurable outcomes of this curriculum: (1) individual resident projects, (2) resident class projects and (3) significant career foci in community medicine among resident graduates. I believe that our community medicine program exemplifies medical training in a community setting and furthers the national health agenda.     

Frequency and management of emergencies in primary care offices: A cross-sectional study in northwestern Germany

BackgroundLittle literature exists on emergencies within primary care offices.ObjectivesWe aimed to study the occurrence of emergencies and confidence in dealing with them among primary care physicians (PCPs) in Germany.MethodsWe conducted a cross-sectional study among all PCPs with licences to practice with an own office (n = 915) in a northwestern region in Germany in 2019. Participants were asked to estimate the frequency and type of emergencies that occurred in the last 12 months in their office and about their confidence in managing emergency situations.ResultsAnswers from 375 PCPs could be analysed (response: 41.0%); 95.7% reported at least one emergency in their office within the last 12 months (mean 12.9). PCPs from rural offices reported more emergencies (on average 13.7 vs. 9.6). Acute coronary syndrome, cardiac arrhythmia and dyspnoea were the most common emergencies. A greater likelihood of feeling more confident in managing medical emergencies was found among male physicians, general internists, PCPs additionally qualified as emergency physicians and those with previous training in the emergency department and intensive care unit. In contrast, more general practitioners felt secure treating paediatric emergencies than general internists (highest level of confidence 22.1% vs. 16.3%).ConclusionIn Germany, emergencies in primary care offices occur on average once a month and more often in rural than urban areas. While most PCPs are confident in managing medical emergencies, some differences related to the training path became apparent. Ongoing training programmes may be tailored to improve emergency skills.     

广东省全科医学教育社区实践基地卫生人力资源现状研究

目的:了解广东省全科医学教育社区实践基地卫生人力资源现状,为促进实践基地建设提供参考依据.方法:拟定统一的调查表,由各实践基地统一填报,并分为经济发达及欠发达地区进行统计分析.结果:广东省全科医学教育社区实践基地共87所,职工7233人,其中卫技人员占84%,硕士研究生占1.1 %,本科占26.5%;师级及以上占56.3%;临床医学和护理专业占58.6%,预防医学专业占3.1%;全科医学培训率28.2%.经济发达地区高学历高职称所占比例、接受全科医学培训率均高于欠发达地区.结论:广东省全科医学教育社区实践培训网络逐步形成,但部分实践基地规模小,学历偏低、职称不高,专业结构尚需改善.