Survey of the career experience and postgraduate training of the 1965 and 1970 graduates of the Scottish university medical schools

A survey of the career experience and postgraduate training of the 1965 and 1970 graduates of the Scottish university medical schools was carried out in 1975. The duration of training for the specialties of medicine and surgery and for obstetrics and gynaecology was in general longer than for anaesthetics, psychiatry and radiology; the implications of varying periods of training for postgraduate education are discussed. Attention is drawn to a number of factors which influenced career choice. The 1970 graduates who became principals spent longer in training for general practice than those of 1965. Some married women with children had difficulty in finding suitable part-time work; this may be a serious problem for those seeking accreditation of higher specialist training and for training for general practice. It was estimated that, of the British nationals, about 11% of the 1965 and 8% of the 1970 graduates had emigrated. General practice was the discipline most commonly chosen by doctors working overseas.     

Career preference enquiry among Queen's University medical undergraduates and graduates: a follow-up

Questionnaires were distributed in 1979 to fourth-and final-year students and to doctors who graduated in 1977 in the second leg of a longitudinal career preference enquiry at Queen's University medical school. Replies were obtained from 98.5 and 92.3% respectively of the undergraduates and from 74.1% of the graduates. While approximately half fourth- and final-year were consistent with their first preference made two years previously for broad fields of practice, less than a quarter of fourth- and a third of final-year were consistent in their preference of specialty. The proportion of Ulster-born students intending to remain rose by 20%. All 103 graduate respondents were working except two. Almost half either did not intend to continue in their present discipline or were undecided. Forty-five per cent were practising the specialty they had elected as final year students indicating that stability of career choice was greater between final year and SHO grading than between fourth and final year. More respondents in anaesthetics and surgery than in any other specialty were consistent in their choice. Eighty-eight per cent of the Ulster-born respondents were resident here at the time of completing the questionnaire. Sixty per cent intended to practise here ultimately, an increase of 15% on 1977.     

Pre-registration posts in general practice

Though the UK Medical Act of 1978 made the creation of pre-registration house officer posts in general practice in the UK a serious proposition there have been few attempts to explore the possibility. The absence of agreed educational objectives for the year makes it impossible to conduct the properly evaluated experiments that might assuage existing doubts about the appropriateness of introducing general practice as a setting in an objective way. Experience so far shows that carefully designed schemes are both feasible and worthwhile in the opinion of those involved. The implications for general practice are explored, the need for new educational thinking is discussed and suggestions about criteria for the approval of practices are put forward.     

Improving communication: a practical programme for teaching trainees about communication issues in the general practice consultation

This paper describes a teaching programme, for use in general practice vocational training, which provides a theoretical and practical framework for exploring key aspects of the consultation with trainees. A particular emphasis is on the educational or 'cognitive' outcomes of the consultation and skills for improving them. The five stages of the programme are described and an example of experience of each stage is given. The paper concludes with an evaluation of the programme by the trainers, trainees and social scientist involved.     

Acquisition of communication skills in postgraduate training for general practice

PURPOSE: The evidence suggests that a longitudinal training of communication skills embedded in a rich clinical context is most effective. In this study we evaluated the acquisition of communication skills under such conditions. METHODS: In a longitudinal design the communication skills of a randomly selected sample of 25 trainees of a three-year postgraduate training programme for general practice were assessed at the start and at the end of training. Eight videotaped real life consultations were rated per measurement and per trainee, using the MAAS-Global scoring list. The results were compared with each other and with those of a reference group of 94 experienced GPs. RESULTS: The mean score of the MAAS-Global was slightly increased at the end of training (2.4) compared with the start (2.2). No significant difference was found between the final results of the trainees and the reference group. According to the criteria of the rating scale the performance of both trainees and GPs was unsatisfactory. CONCLUSION: The results of this study indicate that communication skills do not improve in a three-year postgraduate training comprising both a rich clinical context and a longitudinal training of communication skills, and that an unsatisfactory level still exists at the end of training. Moreover, GPs do not acquire communication skills during independent practice as they perform comparably to the trainees. Further research into the measurement of communication skills, the teaching procedures, the role of the GP-trainer as a model and the influence of rotations through hospitals and the like, is required.     

Objectives and Students' learning in general practice

Student views of objectives and learning, during 4 weeks spent in general practice in the fifth year, are compared to those of the GPs to whom they were attached. Relationships between these views are discussed, together with their implications, for the wider contributions made by general practitioners to the undergraduate curriculum.     

In-training assessment in postgraduate training for general practice

Assessment within general practice training curricula is necessary to both guide learning and to make certification decisions about competence to practise without supervision in the community, but there is a risk that the two roles could become confused. This paper proposes a conceptual framework that explains the relationship between formative assessment, in-training assessment and end-point assessment, as adopted by the Royal Australian College of General Practitioners Training Programme. The literature is reviewed to suggest assessment formats that could provide a means of making decisions about progress through training without harming the important role of providing feed-back to guide learners.     

Advanced training in general practice in the UK for overseas postgraduates

The strengths of general practice in the UK as a training environment for overseas doctors intending to implement the World Health Organization strategy 'Health for All by the Year 2000' in primary care are identified. A course of advanced training for teachers and administrators of primary care is described and evaluated in terms of participants' academic achievements and wider issues, including influence upon the development of primary care in their countries of origin.     

Assessment of undergraduate general practice teaching

Final-year medical students at the University of Bristol were asked to outline a plan of management for an elderly female patient who presented with several problems. These problems were presented in the form of a 'patient management questionnaire'. This questionnaire was completed before and again after a 9-week course that included a 3-week attachment to two general practitioners. The patterns of answers were compared to look for modifications in the plan of management that could be attributed to the teaching. The results indicate a broader plan of management after the course with more students considering the physical, social and family needs of the patient, rather than the clinical problems alone. Nevertheless, further experience of this method of assessment is needed before the technique can be considered a useful tool in the evaluation of general practice teaching.     

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.     

Review of undergraduate small group teaching with television in general practice

To help new part-time lecturers to develop skill in undergraduate small group teaching, videorecorded seminars conducted by each lecturer were reviewed at a series of staff meetings using analyses produced by experienced full-time staff. One year later a second series of comparable seminars was recorded and, using a simple method of communication analysis, the lecturers were found to be less opinionated and more non-directive towards students.     

A life-cycle conference series: education for general practice

An all round educational programme for general practice trainees involving a conference and seminar curriculum was developed, based on a life-cycle concept. In addition to emphasizing the study of usual life stresses and crises for individuals and families, the programme encouraged the contribution of resource people from many related medical disciplines and also from the non-health sciences. Detailed planning allowed the structuring of the conference over an academic year. Clearly defining the objectives for each meeting led to effective evaluation and enhanced the educational process.     

Clinical factual recall and patient management skill in general practice

A battery of assessment measures, including MCQ measures of factual recall, MEQ measures of problem-solving skills, measures of attitudes, intelligence and ability, and personality factors, was administered to the trainee intakes of a number of post-graduate training courses for general practice on a pre-course/post-course basis (trainee sample N = 80). The tests were administered in parallel to a similar number of registered general practitioners ( N = 88). The trainees in the sample were also regularly assessed by their teachers, hospital consultants and registered general practitioners by means of rating scales described below. In this paper, attention is focused on the MCQ and MEQ measures.
The results show significant improvement in post-test scores, particularly among the poorer students and particularly in the crucial area of problem-solving skills. This was related to the organizational structure of the courses: the poorer students gained greatest benefit from courses which featured the regular and frequent use of seminars and group teaching methods. Below we have given the correlations between the pre- and post-test scores for both the best students and poorest students as determined by the in-course performance measure, the rating scales used by the consultants and general practitioner tutors.     

The market and educational principles in continuing medical education for general practice

In an attempt to increase participation by established general practitioners (GPs) in continuing medical education (CME) the Department of Health in 1990 created an allowance (the Postgraduate Education Allowance, PGEA) to be spent by GPs on the educational provision of their choice. Although the PGEA has increased attendance by established GPs at educational activities, the market created in CME provision has favoured low cost activity of questionable value. This paper examines criteria for the validation of general practice CME, based on the principles of adult learning, which could be used to manage this market. Failure to adopt an appropriate validating process could lead to the PGEA becoming discredited and the imposition of periodic reaccreditation as a means of enforcing participation by GPs in CME.     

The organization of a postgraduate training course for medical advisers in the pharmaceutical industry

A postgraduate training and education course for physicians working in the field of pharmaceutical medicine is described. The course proved welcome and acceptable to the participants and provided valuable experience for the organizers. The scientific content and information gained in organizing the course have been incorporated in the planning of a postgraduate diploma course in pharmaceutical medicine.     

Integrated medical student teaching. A combined course in community medicine, general practice, geriatrie medicine and mental health

In order to provide 'horizontal' integration of related clinical subjects, a combined teaching course in community medicine, general practice, geriatric medicine and mental health has been devised. The course lasts 12 weeks and is divided between joint teaching of topics of common interest and clinical clerkships in individual disciplines. A joint assessment takes place at the end of the course. The course was popular with students who all felt that it covered topics not encountered in other parts of the medical curriculum. A course of this type leads to a better integration of clinical subjects and avoids repetition or omission of topics which are not clearly the responsibility of any individual department.     

An experimental assessment carried out in an undergraduate general practice teaching course (OSCE examination)

Professional examinations should be fair, comprehensive, objective, and appropriate to the discipline above all. If at the same time they can be made administratively easier, interesting and in themselves a teaching/learning experience, so much the better. General Practice is a difficult subject to examine in the traditional subjective manner, yet unless students and their courses are assessed then the subject loses credibility and respect in the frenetic run-up to Finals. The Objective Structured Clinical Examination seemed a more appropriate examination than any tried so far and an experiment was mounted to instruct the Liverpool University Medical School Department of General Practice Tutors in the technique and to test several station 'formats'. At this first attempt many snags were found, but some interesting lines of enquiry and further study were opened up. No attempt was made to produce an accurate mark for individual students in this test, although all were given an insight into strong and weak areas. The experiment demonstrated that an OSCE in Primary Care or General Practice is possible and can be organized. The examiners can be taught the technique reasonably quickly and need have no previous experience of formal examinations. A working Health Centre can be used.     

An evaluation of a course for undergraduate teaching of general practice

This paper presents an evaluation of the undergraduate fifth year course of teaching in general practice in the Queen's University, Belfast. Two Modified Essay Question papers were randomly selected from those used for some years past in the Department of General Practice, as learning aids and class tests. These were administered to twelve randomly selected groups of students before and after completion of a five week course of teaching. Results show that the composite mean MEQ scores doubled between pre- and post-course tests. The correlation coefficients tabulated do not indicate that the marked improvement in mean scores before and after the course in general practice was influenced to any extent by knowledge acquired in other disciplines. The overall findings clearly establish the value of small group clinical teaching of general practice based on a problem orientated approach to learning. They suggest that the intellectual skills and attitudes required in the 'holistic' approach to problem solving in general practice may differ in some ways from the skills required in specialized areas of medicine. The evaluation justifies the time spent on clarifying the undergraduate educational objectives.     

Integrating general practice tutors into an undergraduate programme

Eighteen tutors appointed to the Department of General Practice at Dundee were visited. They provided information for a study to determine the degree of their involvement in the Department. A structured questionnaire standardized the interview and the results are described. The study showed a considerable level of success in integrating this group of practitioners into the teaching activities of the Department. Results also suggested that some educational objectives were not clearly defined, and surprisingly there appeared to be an underuse of this group of motivated teachers.     

A course on collaboration between social workers and general practitioners during their vocational training

The educational programme reported was an experiment in the vocational training scheme of the Department of General Practice, Erasmus University, Rotterdam, Holland, and is now part of the course. The programme focused on the training in team function (co-operation) given to trainee GPs and social workers. It became clear that both groups during their professional training develop markedly different attitudes and views about patient (client) care. These differences form a fundamental handicap in any discussion about teamwork.
During the programme the students were made aware of this divergence of viewpoint and were taught how to handle these resulting handicaps and, if possible, to eliminate them.