The learner’s perspective in GP teaching practices with multi-level learners: a qualitative study

BMC Medical Education

Nicholas Glasgow¹  Amanda Barnard²  Emily Haesler³  Katrina Anderson³  Jennifer S Thomson³ 

[1] Medical School, College of Medicine, Biology & Environment, Australian National University, Acton, ACT, Australia;Rural Clinical School, Medical School, College of Medicine, Biology & Environment, Australian National University, Acton, ACT, Australia;Academic Unit of General Practice, Medical School, College of Medicine, Biology & Environment, Australian National University, Acton, ACT, Australia

关键词: Learning culture;    Multi-level learning;    Vertical integration of GP education;    Teaching innovation;    General Practice Education;    Workplace based learning;    Postgraduate training;   

Others  :  1118183
DOI  :  10.1186/1472-6920-14-55

 received in 2013-05-28, accepted in 2014-03-13,  发布年份 2014

【 摘 要 】

Background

Medical students, junior hospital doctors on rotation and general practice (GP) registrars are undertaking their training in clinical general practices in increasing numbers in Australia. Some practices have four levels of learner. This study aimed to explore how multi-level teaching (also called vertical integration of GP education and training) is occurring in clinical general practice and the impact of such teaching on the learner.

Methods

A qualitative research methodology was used with face-to-face, semi-structured interviews of medical students, junior hospital doctors, GP registrars and GP teachers in eight training practices in the region that taught all levels of learners. Interviews were audio-recorded and transcribed. Qualitative analysis was conducted using thematic analysis techniques aided by the use of the software package N-Vivo 9. Primary themes were identified and categorised by the co-investigators.

Results

52 interviews were completed and analysed. Themes were identified relating to both the practice learning environment and teaching methods used.

A practice environment where there is a strong teaching culture, enjoyment of learning, and flexible learning methods, as well as learning spaces and organised teaching arrangements, all contribute to positive learning from a learners’ perspective.

Learners identified a number of innovative teaching methods and viewed them as positive. These included multi-level learner group tutorials in the practice, being taught by a team of teachers, including GP registrars and other health professionals, and access to a supernumerary GP supervisor (also termed “GP consultant teacher”). Other teaching methods that were viewed positively were parallel consulting, informal learning and rural hospital context integrated learning.

Conclusions

Vertical integration of GP education and training generally impacted positively on all levels of learner. This research has provided further evidence about the learning culture, structures and teaching processes that have a positive impact on learners in the clinical general practice setting where there are multiple levels of learners. It has also identified some innovative teaching methods that will need further examination. The findings reinforce the importance of the environment for learning and learner centred approaches and will be important for training organisations developing vertically integrated practices and in their training of GP teachers.

【 授权许可】

   
2014 Thomson et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Roberts RG, Hunt VR, Kulie TI, Schmidt W, Schirmer JM, Villanueva T, Wilson CR: Family medicine training — the international experience. Med J Aust 2011, 194(11):84-87.
• [2]Thistlethwaite J, Kidd M, Hudson J: General practice: a leading provider of medical student education in the 21st century? Med J Aust 2007, 187:124-128.
• [3]Thistlethwaite J, Leeder S, Kidd M, Shaw T: Addressing general practice workforce shortages: policy option. Med J Aust 2008, 189:118-121.
• [4]Williams C, Cantillon P, Cochrane M: The clinical and educational experiences of pre-registration house officers in general practice. Med Educ 2001, 35:774-781.
• [5]Martin A, Laurence C, Black L, Mugford B: General practice placements for pre-registration junior doctors: adding value to intern education and training. Med J Aust 2007, 186:346-349.
• [6]Pearce R, Laurence C, Black L, Stocks N: The challenges of teaching in a general practice setting. Med J Aust 2007, 187:129-132.
• [7]General Practice Education and Training (GPET): A Framework for Vertical Integration in GP Education and Training. Canberra: GPET; 2003.
• [8]Spencer JA, Jordon RK: Learner centered approaches in medical education. BMJ 1999, 318:1280-1283.
• [9]Maudsley R: Role models and the learning environment: essential elements in effective medical education. Acad Med 2001, 76:432-434.
• [10]Stewart TJ: Learning environments in medical education. Medical Teacher 2006, 28:387-389.
• [11]Smith V, Wiener-Ogilvie S: Describing the learning climate of general practice training: the learner’s perspective. Educ Prim Care 2009, 20:435-440.
• [12]Dick ML, King D, Mitchell G, Kelly G, Buckley J, Garside S: Vertical integration in teaching and learning (VITAL): an approach to medical education in general practice. Med J Aust 2007, 187:133-135.
• [13]Thomson J, Allan B, Anderson K: GP interest in teaching junior doctors: does practice location, size and infrastructure matter? Aust Fam Physician 2009, 38:1000-1002.
• [14]Laurence C, Docking D, Haydon D, Cheah C: Trainees in the practice - practical issues. Aust Fam Physician 2012, 41:14-17.
• [15]van de Mortel T, Silberberg P, Ahern C: Shared learning in general practice: facilitators and barriers. Aust Fam Physician 2013, 42:147-151.
• [16]Brumpton K, Kitchener S, Sweet L: Learning styles in vertically integrated teaching. Clin Teach 2013, 10:282-286.
• [17]Thomson J, Haesler E, Anderson K, Barnard A: What motivates general practitioners to teach. Clin Teach 2014, 11:124-130.
• [18]Rosenthal D, Worley P, Mugford B, Stagg P: Vertical integration of medical education: Riverland experience South Australia. Rural Remote Health 2004, 4:228. (Online) Available: http://www.rrh.org.au/articles/subviewnew.asp?ArticleID=228 webcite (accessed 21 March 2014)
• [19]Morrison T, Brown J, Bryant M, Villanueva E, Kassell L, Nestel D: Multi-level learners in general practice. In Proceedings of the GPET Convention. Melbourne; 2012.
• [20]Anderson K, Barnard A: Enhancing GP registrar confidence and competence through vertically integrated teaching. In Proceedings of 13th Ottawa International Conference on Clinical Competence (OZZAWA). Melbourne; 2008.
• [21]Anderson K, Thomson J: Vertical integration: reducing the load on GP teachers. Aust Fam Physician 2009, 38:907-910.
• [22]Thomson J, Anderson K, Mara P, Stevenson A: Supervision - growing and building a sustainable general practice supervisor system. Med J Aust 2011, 194(Suppl 11):101-104.
• [23]Dowling M: From Husserl to van manen: a review of different phenomenological approaches. Int J Nurs Stud 2007, 44:131-142.
• [24]Burnard P, Gill P, Stewart K, Treasure E, Chadwick B: Analysing and presenting qualitative data. Br Dent J 2008, 204(8):429-432.
• [25]Carne A, Howard S, Bywood P: Summary Data Report of the 2010–2011 Annual Survey of Divisions Of General Practice. Adelaide: Primary Health Care Research & Information Service, Discipline of General Practice, Flinders University, and Australian Government Department of Health and Ageing; 2012.
• [26]Britt H, Miller GC, Charles J, Henderson J, Harrison C, Bayram C, Chambers T, Pan Y, Pollock AJ, O’Halloran J, Valenti L: A decade of Australian General Practice Activity 2001–2 to 2010–11. Sydney: Sydney University Press; 2011. [General practice series no 30]
• [27]Department of Health: Primary Care Infrastructure Grants 2010-2011. Canberra: Australian Government; 2010. http://www.health.gov.au/internet/main/publishing.nsf/Content/pacd-gpsuperclinics-pcigg2010 webcite (accessed 21 March 2014)
• [28]Laurence C, Black L, Cheah C, Karnon J: Is different better? models of teaching and their influence on the net financial outcome for general practice teaching posts. BMC Med Ed 2011, 11:45. BioMed Central Full Text
• [29]Alan B: Broadening conceptions of learning in medical education: the message from teamworking. Med Educ 2006, 40:150-157.
• [30]Halestrap P, Leeder D: GP registrars as teachers: a survey of their level of involvement and training. Educ Prim Care 2011, 22:310-313.
• [31]Silberberg P, Ahern C, van der Mortel T: Learners as teachers in general practice: stakeholders’ views of the benefits and issues. Educ Prim Care 2013, 24:410-417.
• [32]Tran P, Laurence J, Weston K, McLennan P: The effect of parallel consulting on the quality of consultations in regional general practice. Educ Prim Care 2012, 23:153-157.
• [33]Swanwick T: Informal learning in postgraduate medical education: from cognitivism to ‘culturism’. Med Educ 2005, 39:859-865.