GP Training - Teaching undergraduate students in primary care

Teaching medical students in primary care can be a varied and rewarding experience, explains Dr Linda Miller.

General practice offers a wealth of teaching opportunities. GPs may teach medical students, F2 doctors, offer clinical supervision to other doctors (e.g. refugee doctors, or GP returners) or become GP trainers.

Medical students
The modern medical undergraduate curriculum presents several teaching opportunities for GPs.

In the 1980s, medical schools introduced the concept of 'early medical contact' whereby first-year students were given the opportunity to visit patients at home at a time when the majority of the student's timetable was taken up by core basic medical science subjects.

Patients selected were those with a chronic illness, or a family with a child with a long-term illness or disability. Through this students were encouraged to consider coping strategies and the impact of disease on the patient and their family.

This concept has now been widely adopted and medical schools recruit GPs to identify suitable patients and supervise students. Preparation and debrief sessions are essential to help students learn from the experience.

Clinical skills teaching
GPs are a valuable resource for teaching clinical examination. This is best done in small groups focusing on one physiological system at a time.

Students appreciate the opportunity to examine patients with clinical signs providing willing volunteers can be recruited from the practice.

During these sessions students learn how to examine patients sensitively and consider issues such as consent and the use of chaperones.

They are taught to be aware of infection control and hand hygiene, as well as crucial examination skills.

Teaching clinical examination is a good opportunity to review and refresh your own skills.

Primary care attachments
Some medical schools include attachments in primary care at points in the curriculum.

These are invaluable opportunities for students to gain a greater understanding of the role of the GP and teamwork in primary care. Students sit in with nurses, health visitors, pharmacists, receptionists and GPs.

Home visits with GPs or district nurses can be a good experience for students who may be genuinely shocked at the circumstances in which some patients live, compared with their own experience.

The students develop a better understanding of the impact of social deprivation and inequalities in healthcare.

The concept of focused history taking, and the relevance of psychosocial factors, health beliefs and patient expectations can be explored during these attachments.

Students may learn different consulting styles from observing different GPs and practice their history taking and examination skills. They begin to develop an understanding of differential diagnosis, investigation and management.

Communication skills
Many medical schools use audio-visual equipment in small group teaching to develop consultation skills. Students take it in turns to role play consultations with actor patients.

The consultations are discussed in the group with feedback from actor patients, peers and teacher.

GPs find this type of teaching very rewarding and students find this a helpful way to improve their history taking, become more aware of their body language and become more patient centred. They can practice discussing potentially embarrassing issues with patients in a relatively non-threatening environment.

Medical school teaching
One-to-one teaching and small group encounters with patients become rarer in secondary care when there are large numbers of students, therefore such opportunities in general practice are vital.

Rigorous monitoring of student feedback is essential to ensure quality control of primary care teaching and highlight difficulties (for example, language barriers).

Experiences in primary care can influence students' career choice in the future.1

Students also learn about professionalism and applying ethical principles to dilemmas from watching GPs at work.

The importance of learning professionalism is being increasingly recognised and is the subject of research.

Future opportunities
In future, the teaching of specific clinical specialties may be transferred at least in part to a primary care setting.

Psychiatry is one specialty where this has been successful, with students reporting a better appreciation of the patient experience, seeing a broader range of patients, 'normalisation' of mental illness, and increased empathy compared with learning purely in a hospital psychiatry setting.

Chronic diseases such as diabetes and asthma are largely managed in primary care. These conditions can be used to teach students about self-management plans and 'expert patients'.

Courses
For GPs who wish to teach undergraduates, the interprofessional course Introduction to Teaching In Primary Care is an excellent place to start.

The course helps potential teachers identify which courses and students they would like to focus on and is followed by more specific support days and training courses.

In Scotland, the Centre for Medical Education in Dundee runs an equivalent distance-learning course, as does the University of Wales College of Medicine in Cardiff.

To enquire about local courses contact the department of primary care at your local medical school.

  • Dr Miller is a freelance GP, mentor for the London deanery and medical student teacher at Imperial College London

Learning points

1. Be friendly and ask about the student.

2. Establish ground rules: mutual respect, confidentiality, attendance, punctuality and time keeping.

3. Clarify the objectives of the session - find out what they already know.

4. Encourage students to think what reliable resources they could use to find out more.

5. At the end of a session ask students to identify one new thing they have learnt.

Teaching courses

References

1. Oakley C and Oyebode F. Medical students' views about an undergraduate curriculum in psychiatry before and after clinical placements. BMC Med Educ 2008; 8: 26.

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