Philipp Schorscher is a MBBS (Final Year) student at Brighton and Sussex Medical School and holds an MSc Global Health & Development from University College London.
7,000extra General Practitioners (GPs) are needed within the next five years to avoid a UK medical workforce crisis. However, only a minority of medical students are willing to take on the general practitioner role.1 Coupled with an article by Cottrell et al. highlighting shortcomings in the delivery of undergraduate GP content, this prompted me to reflect, as my five years of medical education are drawing to a close.2
Medical schools should match their curriculum to the needs of their communities. But students’ own experiences and perceptions must be understood for this to work. Currently, GP education constitutes an average of 9.2% of the curriculum, far below the recommended 25%.2 However, simply increasing the amount of GP teaching will have a limited effect on trainee numbers unless underlying barriers are tackled.
Two key reasons that deter graduates from choosing general practice are denigration and perceived lack of intellectual stimulation.
Two key reasons that deter graduates from choosing general practice are denigration and perceived lack of intellectual stimulation.3,4 Denigration of general practice manifests as unfair criticism or attack on reputation via inappropriate portrayal of the clinical GP content, insufficient curriculum time designated to GP, and negative language used toward GP in formal and informal settings. Lack of intellectual stimulation refers to medical students perceiving general practice as mundane, straightforward, or simple.
Reflecting on the “By choice – not by chance” initiative and having encountered several teaching methods throughout my studies, I believe GP-facilitator sessions (GPFS) could contribute towards a solution.5 GPFS are weekly sessions of small group teachings of around 15 students, led and directed by GPs and may take place throughout the undergraduate curriculum. They develop students’ clinical and practical skills and offer an environment to discuss topics in depth. GPFS can be relatively easy to implement, bypassing some of the limitations on human resources and funding, as 90% of universities report easy access to campus-based GP teachers. GPFS thus offer an easily scalable, integrable, and responsive adjunct to existing teaching practices.2
The aim of the sessions is for students both to understand primary health care and gain medical generalist skills. In my experience, the more intimate nature of GPFS allowed us to dive deeper and share personal views about general practice. Students often presented with misconceptions of primary care, making these sessions an excellent opportunity for lively and active discussion, reflection and learning.
Facilitators dispelled misconceptions of “simplicity” and low academic rigour by diving into evidence-based practice, as seemingly simple patient presentations such as “back pain” or “viral vs bacterial throat infection” emerged as challenges. We discussed the intricacies of multimorbidity, chronic disease and the importance of continuity of care, allowing us to appreciate the importance of community-based practice.
Another interesting discussion point was the scope of GP research. Some students join family medicine because it is less research-focused, but many are unaware that GPs can choose to participate in large-scale research. Furthermore, the denigration of the primary care sector was also a topic of conversation. Being able to openly discuss career aspirations with colleagues and academics enabled us to understand and become aware of the systemic stigmatisation of general practice in hidden and informal curricula. [6]
Many [students] are unaware that GPs can choose to participate in large-scale research.
Thankfully, many institutions are moving toward zero-tolerance of denigration and are taking responsibility for their members’ behaviour to moderate it. This effort, however, should start early on, including through GPFS. This would ensure that medical students experience accurate representations of GP practice, allowing them to make an informed specialty choices based on personal preferences and not because of fear of stigmatisation.
GPFS helped me and others to gain a more holistic picture of the nature of general practice. They allowed us to gain experience, understand primary health care and, most importantly, confront the common barriers to recruitment. GPFS can therefore function as an easily integrable method for any university, helping to close the education gap and leading to an increase in GP recruitment.
References
1. The King’s Fund. Closing the gap [Internet]. The King’s Fund. 2020 [cited 14 October 2020]. Available from: https://www.kingsfund.org.uk/publications/closing-gap-health-care-workforce
2. Cottrell E, Alberti H, Rosenthal J, Pope L, Thompson T. Revealing the reality of undergraduate GP teaching in UK medical curricula: a cross-sectional questionnaire study. British Journal of General Practice [Internet]. 2020 [cited 14 October 2020];70(698):e644-e650. Available from: https://bjgp.org/content/70/698/e644.long
3. Sahota K, Goeres P, Kelly M, Tang E, Hofmeister M, Alberti H. Intellectual stimulation in family medicine: an international qualitative study of student perceptions. BJGP Open [Internet]. 2020 [cited 14 October 2020];:bjgpopen20X101045. Available from: https://bjgpopen.org/content/bjgpoa/4/3/bjgpopen20X101045.full.pdf
4. Allsopp G, Rosenthal J, Blythe J, Taggar J. Defining and measuring denigration of general practice in medical education. Education for Primary Care [Internet]. 2020 [cited 14 October 2020];31(4):205-209. Available from: https://www.tandfonline.com/doi/full/10.1080/14739879.2020.1768440
5. By choice – not by chance [Internet]. NHS England. 2020 [cited 14 October 2020]. Available from: https://www.hee.nhs.uk/sites/default/files/documents/By%20choice%20-%20not%20by%20chance%20PDF.pdf
6. Alberti H, Banner K, Collingwood H, Merritt K. ‘Just a GP’: a mixed method study of undermining of general practice as a career choice in the UK. BMJ Open [Internet]. 2017 [cited 14 October 2020];7(11):e018520. Available from: https://bmjopen.bmj.com/content/7/11/e018520
Featured photo by Naassom Azevedo on Unsplash
