Development and Evaluation of Four Week Attachments in General Practice at the University of Glasgow

Morrison, Jillian Margaret (1994) Development and Evaluation of Four Week Attachments in General Practice at the University of Glasgow. PhD thesis, University of Glasgow.

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There is an increasing consensus that a considerable proportion of undergraduate clinical medical education could be shifted into community settings, primarily general practice. This would help to solve many of the difficulties facing hospital teaching of medical students, and enable the aims of the Education Committee of the General Medical Council to be reached more fully. Against this background, it was decided to introduce a compulsory four week attachment in general practice, at the University of Glasgow, for the first time, starting in April 1992, for students undergoing their final clinical rotation. The aims of this thesis are: firstly, to describe the organisation of the attachments, the tutors and practices involved, the course objectives and tasks, the effect of the attachments on student attitudes, and its effect on patient attitudes; secondly, to examine in detail an experiment in problem based learning and an audit project which were used as teaching methods during the attachment and; finally, to evaluate all aspects of the attachments in order to produce recommendations, to improve the future learning opportunities for students. The methods used to complete this research were: detailed postal questionnaires applied to the general practitioner tutors, before and after the attachments, and face-to-face discussions with large groups of tutors; detailed questionnaires applied to the students, at the start and at the end of the attachments, and tape recorded interviews with 25% of the class and; simple questionnaires applied to patients three months before the attachments, immediately before a consultation and immediately after a consultation, where a student was present. 111 [90%] of the tutors, who had expressed an interest in the attachments, replied to an initial questionnaire, before the attachment, and 72 [72%] of those, who taught the course, replied to a follow-up questionnaire, after the attachment. Two hundred students [97.1% of the class] completed an initial student questionnaire, at the start of the attachment, and 190 [92.2%] completed the follow-up questionnaire, at the end. Evaluative questionnaires about the attachment, the problem based learning and the audit project were completed by 89.3%, 65% and 85.6%, respectively, of the students who took part. 25% of the class contributed to semi-structured, tape recorded interviews. 681 patients completed a questionnaire three months before the attachments started. 469 patients completed a questionnaire immediately before a consultation with their general practitioner, where a student would be present, and 759 patients completed a questionnaire immediately after a consultation, where a student was present. It was found that there is a large pool of enthusiastic tutors willing to teach medical students in the community. However, it is recommended that these tutors receive adequate support to enable high standards of clinical teaching to be maintained. The objectives for the attachment were found to be appropriate and it was recommended that the possibility of producing common general objectives, for undergraduate teaching in general practice, should be explored by United Kingdom medical schools. The tasks of the attachment were found to be useful and relevant, and it was possible to produce a profile of the content of an ideal attachment according to student opinion. The attachment promoted a positive attitude among students, towards general practice, and acted as a positive vocational opportunity. However, it is recommended that this cohort of students should be followed up to discover if their stated preference for general practice, as a career, is maintained. Patient opinion was generally favourable towards the presence of medical students in the consulting room. It was therefore recommended that educators in medical schools could be reassured about the case-mix seen in general practice, and general practitioner tutors reassured about the acceptability to patients, of students in the consulting room. The problem based learning group work was a qualified success, according to student opinion. It was therefore recommended that this method of learning should be refined for further use in this course, and its use promoted in United Kingdom medical schools. The audit project increased students' self-reported knowledge about audit but it was recommended that, in order to produce a more Interesting and useful learning experience, the students should be given more ownership of the project in the future. It is further recommended that teaching about audit should be promoted in the general practice setting, in the United Kingdom. The advantages and shortcomings of the methods, which were used to assess the students, are discussed and it is recommended that a more objective measure, such as a modified essay question or an observer structured clinical examination, should be included in the future assessment of students undergoing this attachment. The evaluative information given by the students about their attachment provided evidence that the majority of them enjoyed it very much. They found it useful for learning about general medicine, psychiatry and communication skills, and many of them were impressed by the standard of teaching received. However, they wanted to conduct more personal consultations and practical procedures, and they also suggested improvements to the Department course. Information from this research can be used to shape a course which is responsive to the requirements of Glasgow medical students, the University of Glasgow and the recommendations of the General Medical Council, and to support the shift of more undergraduate medical education into the setting of general practice, in the United Kingdom.

Item Type: Thesis (PhD)
Qualification Level: Doctoral
Additional Information: Adviser: T S Murray
Keywords: Medicine, Health education
Date of Award: 1994
Depositing User: Enlighten Team
Unique ID: glathesis:1994-74929
Copyright: Copyright of this thesis is held by the author.
Date Deposited: 27 Sep 2019 15:08
Last Modified: 27 Sep 2019 15:08

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