Alex Burrell is a GP in Bristol and Associate Editor at BJGP Open.
Yonder: a diverse selection of primary care relevant research stories from beyond the mainstream biomedical literature.
Pattern disruption
When dealing with undifferentiated care in the community, pattern recognition is a crucial tool for patient assessment. It can, however, lead to diagnostic errors brought about by cognitive shortcuts, particularly in atypical or evolving presentations. This educational study describes pattern disruption, an ‘intervention to strengthen cognitive flexibility in GP trainees’ by adding plausible unexpected diversions into routine learning scenarios.1 This was developed by GP educators on the Imperial GP Specialty Training scheme using disruption prompts in case discussions, simulated consultations with branching encounters rather than linear scripts, micro-disruptions in real clinics, and subsequent reflections on these methods in their e-portfolio. The authors suggest this method ‘offers a practical way to operationalise calls for explicit clinical reasoning teaching in general practice training.’ This seems like an interesting and innovative method and is worth a read particularly for educators.
Health inequalities in GP training
Staying on the topic of GP training, this study considers how health inequalities are addressed and conceptualised for registrars in educational documents.2 Sources including documents from the Royal College of General Practitioners, the Royal College of Physicians, the British Medical Association, the General Medical Council, and UK Government were analysed thematically. Inequalities were described as social problems that can be changed but were depoliticised and naturalised with phrasing such as ‘people who may have health disadvantages’ erasing causality. Inequalities are explained as a risk factor for poor health outcomes, with the authors feeling this represents ‘biomedical appropriation of social phenomena [… that] strips away the sociopolitical roots of health disparities.’ They suggest incorporating a more explicit and structural understanding of health inequalities into medical education.
Waiting for mental health treatment
The time between being referred to mental health services and being seen can be long and difficult for patients and their families. For adolescents and their parents/carers, this can be particularly difficult. This Australian study explores how services could be redesigned to address the psychological needs of adolescents during the wait time between referral and mental health specialist assessment and treatment.3 Co-led by young people with lived experience of waiting for treatment alongside input from GPs and the industry consulting firm Deloitte Digital Australia, a ‘While We Wait’ service was introduced that reconceptualised the delay in specialist input from being seen as a delay before treatment to a ‘distinct and potentially therapeutic phase of the care pathway’ using digital tools and peer support. There’s quite a bit of management jargon and it’s tricky to unpick exactly what the pathway looked like, but with long waits for treatment unlikely to go away, innovation may be necessary to address this issue.
Shared decision making
Shared decision making (SDM) is a core component of personalised care that supports patient involvement in decisions about their health and wellbeing while recognising that patients’ preferences for involvement may vary. This study aimed to develop and refine a complex intervention to facilitate the involvement of older people living with multiple long-term conditions in SDM in primary care.4 This involved patient and GP educational materials, inviting patients to voice their preferences for involvement, exploring their priorities, communicating clinical uncertainty, and incorporating these steps into collaboratively made decisions. I would hope most of us in primary care are doing this anyway, but the authors advocate for specific outcome measures to assess the effectiveness of SDM interventions.
References
1. Jerjes W, Majeed A. Pattern disruption in GP speciality training: a practical intervention to enhance cognitive flexibility and diagnostic reasoning. Educ Prim Care 2026; DOI: 10.1080/14739879.2026.2634248.
2. Grant L, Park S. Framing health inequalities in general practice education: a critical documentary analysis. Educ Prim Care 2026; DOI: 10.1080/14739879.2026.2654134.
3. O’Dea B, McNamara R, Ma IC, et al. Addressing the psychological needs of adolescents during the wait time for mental health treatment: service design study. JMIR Form Res 2026; 10: e87067.
4. Butterworth JE, Campbell JL, Pitchforth E, Richards SH. Shared decision-making in general practice: development of a complex health care intervention targeting multiple long-term conditions. Patient Educ Couns 2026; 149: 109640.
Featured photo by Bhautik Patel on Unsplash.
