Joint undergraduate and postgraduate teaching in general practice: a case study of the continuum of medical education in practice

Pope, Lindsey M. (2018) Joint undergraduate and postgraduate teaching in general practice: a case study of the continuum of medical education in practice. DHPE thesis, University of Glasgow.

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Despite a large body of literature on teaching in general practice, the majority of this focuses on a single learner level. The Australian literature frequently refers to the concept of Vertical Integration (Dick et al., 2007), while UK policy refers to “a continuum approach”, yet no formal definition of the latter exists.
This is an exploratory study of the reality of the continuum of medical education as it occurs in the context of general practice (family medicine) in the West of Scotland. Through a better understanding of the reality, this study aimed to contextualise the rhetoric through the following research questions:
1. How does Activity Theory enable us to understand the activity of teaching in GP practices with multilevel learners?
2. What are the tensions experienced by GPs in multilevel learner practices in relation to their teaching?
3. How have these tensions shaped the activity of teaching in multilevel learner GP practices?
4. How does Activity Theory enable understanding of continuum of medical education in GP practices with multilevel learners?
A collective case study approach was used to address the research questions and this comprised of two phases: an online questionnaire of 180 GP teachers (response rate 60%) and 17 semi-structured interviews. A combination of Activity Systems Analysis (ASA) and Thematic Analysis was used for interview analysis.

Five themes were identified in the interviews:
1. General practice in 2017 – The current context of workload pressures and recruitment problems in general practice impacted teaching at every level of the continuum of medical education. Recruitment to general practice was shown to be a bidirectional continuum problem.
2. External relationships - Working with at least two external organisations presented challenges for GPs. Different expectations, processes and communication channels all added to the complexity and volume of work for GP teachers in multilevel learner practices.
3. The joint teaching practice – Common facilitating factors for teaching across the continuum were a practice teaching culture and good organisation of teaching. The impact on GPs and their practices of the tension between teaching and service delivery was described and strategies to minimise this identified.
4. GP as a Teacher – The teaching, organisational and assessment tools which support teaching delivery in multilevel learner practices were highlighted. The motivators for teaching across the continuum were identified while the stress of multilevel teaching was demonstrated.
5. Near peer teaching (NPT) - In contrast to some areas, NPT in the practices in this study was relatively underdeveloped. The uncertainty related to this is described and the local and external barriers to further development of NPT presented.
The use of a sociocultural approach to study the continuum of medical education enabled the importance of the current context of general practice to be appreciated and facilitated identification of key teaching-related tensions and the learning possible from these.
Through the use of ASA, this study conceptualised the current GP recruitment crisis as a bidirectional challenge spanning across the continuum of medical education. Identifying relevant tensions within the systems (e.g. the expanding practice team as both a teaching opportunity and a threat) enables innovative practice and learning to be identified.
While a structural continuum existed, the practices in this study did not fit with the Australian definition of Vertical Integration. This study suggested that this lack of a continuum approach originates in the separate organisational structures for postgraduate and undergraduate education. For meaningful widespread adoption of a continuum approach, these organisational tensions would need to be addressed.
This study demonstrated a gap between the rhetoric of “a continuum approach” and the reality of “a continuum”, provided evidence why that might be and presents suggestions as to how that might start to be addressed more widely.

Item Type: Thesis (DHPE)
Qualification Level: Doctoral
Keywords: general practice, continuum, medical education, family medicine.
Subjects: L Education > LC Special aspects of education
R Medicine > R Medicine (General)
Colleges/Schools: College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
Supervisor's Name: Jamieson, Professor Susan and Morrison, Professor Jill
Date of Award: 2018
Depositing User: Dr Lindsey Pope
Unique ID: glathesis:2018-30643
Copyright: Copyright of this thesis is held by the author.
Date Deposited: 09 Jun 2020 06:01
Last Modified: 09 Jun 2020 06:16

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