Student-centred GP ambassadors: Perceptions of experienced clinical tutors in general practice undergraduate training

Objective. To explore experienced general practitioner (GP) tutor perceptions of a skilled GP tutor of medical students. Design. Interview study based on focus groups. Setting. Twenty GPs experienced in tutoring medical students at primary health care centres in two Swedish regions were interviewed. Method. Four focus-group interviews were analysed using qualitative content analysis. Subjects. Twenty GP tutors, median age 50, specifically selected according to age, gender, and location participated in two focus groups in Gothenburg and Malmo, respectively. Main outcome measures. Meaning units in the texts were extracted, coded and condensed into categories and themes. Results. Three main themes emerged: "Professional as GP and ambassador to general practice", "Committed and student-centred educator", and "Coordinator of the learning environment". Conclusion. Experienced GP tutors describe their skills as a clinical tutor as complex and diversified. A strong professional identity within general practice is vital and GP tutors describe themselves as ambassadors to general practice, essential to the process of recruiting a new generation of general practitioners. Leaders of clinical education and health care planners must understand the complexity in a clinical tutor's assignment and provide adequate support, time, and resources in order to facilitate a sustainable tutorship and a good learning environment, which could also improve the necessary recruitment of future GPs

"I couldn't do this with opposition from my colleagues": A qualitative study of physicians' experiences as clinical tutors

<p>Abstract</p> <p>Background</p> <p>Clinical contact in the early curriculum and workplace learning with active tutorship are important parts of modern medical education. In a previously published study, we found that medical students' tutors experienced a heavier workload, less reasonable demands and less encouragement, than students. The aim of this interview study was to further illuminate physicians' experiences as clinical tutors.</p> <p>Methods</p> <p>Twelve tutors in the Early Professional Contact course were interviewed. In the explorative interviews, they were asked to reflect upon their experiences of working as tutors in this course. Systematic text condensation was used as the analysis method.</p> <p>Results</p> <p>In the analysis, five main themes of physicians' experiences as clinical tutors in the medical education emerged: <it>(a) Pleasure and stimulation</it>. Informants appreciated tutorship and meeting both students and fellow tutors, <it>(b) Disappointment and stagnation</it>. Occasionally, tutors were frustrated and expressed negative feelings, <it>(c) Demands and duty</it>. Informants articulated an ambition to give students their best; a desire to provide better medical education but also a duty to meet demands of the course management, <it>(d) Impact of workplace relations</it>. Tutoring was made easier when the clinic's management provided active support and colleagues accepted students at the clinic, and <it>(e) Multitasking difficulties</it>. Combining several duties with those of a tutorship was often reported as difficult.</p> <p>Conclusions</p> <p>It is important that tutors' tasks are given adequate time, support and preparation. Accordingly, it appears highly important to avoid multitasking and too heavy a workload among tutors in order to facilitate tutoring. A crucial factor is acceptance and active organizational support from the clinic's management. This implies that tutoring by workplace learning in medical education should play an integrated and accepted role in the healthcare system.</p

The need for evidence-based climate risk and adaptation assessments:Lessons learned from the AGRICA project

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Medical students' and facilitators' experiences of an Early Professional Contact course: Active and motivated students, strained facilitators

Background: Today, medical students are introduced to patient contact, communication skills, and clinical examination in the preclinical years of the curriculum with the purpose of gaining clinical experience. These courses are often evaluated from the student perspective. Reports with an additional emphasis on the facilitator perspective are scarce. According to constructive alignment, an influential concept from research in higher education, the learning climate between students and teachers is also of great importance. In this paper, we approach the learning climate by studying both students' and facilitators' course experiences.\ud \ud In 2001, a new "Early Professional Contact" longitudinal strand through term 1–4, was introduced at the Sahlgrenska Academy, University of Gothenburg, Sweden. General practitioners and hospital specialists were facilitators.\ud \ud The aim of this study was to assess and analyse students' and clinical facilitators' experiences of the Early Professional Contact course and to illuminate facilitators' working conditions.\ud \ud Methods: Inspired by a Swedish adaptation of the Course Experience Questionnaire, an Early Professional Contact Questionnaire was constructed. In 2003, on the completion of the first longitudinal strand, a student and facilitator version was distributed to 86 students and 21 facilitators. In the analysis, both Chi-square and the Mann-Whitney tests were used.\ud \ud Results: Sixty students (70%) and 15 facilitators (71%) completed the questionnaire. Both students and facilitators were satisfied with the course. Students reported gaining [inspiration] for their future work as doctors along with increased confidence in meeting patients. They also reported increased motivation for biomedical studies. Differences in attitudes between facilitators and students were found. Facilitators experienced a greater workload, less reasonable demands and less support, than students.\ud \ud Conclusion: In this project, a new Early Professional Contact course was analysed from both student and facilitator perspectives. The students experienced the course as providing them with a valuable introduction to the physician's professional role in clinical practice. In contrast, course facilitators often experienced a heavy workload and lack of support, despite thorough preparatory education. A possible conflict between the clinical facilitator's task as educator and member of the workplace is suggested. More research is needed on how doctors combine their professional tasks with work as facilitators

Läkare som handledare i klinisk praktik för läkarstudenter. Kunskaper och erfarenheter.

Background and aim. Clinical tutors and work place learning are essential resources in modern undergraduate medical education. The aim of this thesis is to increase the knowledge of physicians’ perspective when serving as clinical tutors by studying and analysing their experiences of clinical tutorship. Aim of Study one was to evaluate and analyse the experiences of students and tutors at a new Early Professional Contact course and to illuminate tutors’ working conditions. Aim of Study two: to seek a deeper understanding of the experiences of clinical tutors. Aim of Study three: to analyse experienced general practitioner tutors’ perceptions of a skilled clinical tutor. Aim of Study four: to identify factors encouraging junior doctors to engage as long-term clinical tutors in undergraduate medical education. Methods. The thesis is based on one quantitative and three qualitative studies. Study one: A questionnaire to students and tutors of the course, and a statistical analysis of the answers. Study two: Interviews with twelve experienced clinical tutors using the analytic method of systematic text condensation. Study three: Focus group interviews of twenty general practitioners using the analytic method of qualitative content analysis. Study four: Accounts written by twenty-seven junior doctors were analysed with a qualitative content analysis method. Results. Study one: Both clinical tutors and students were satisfied with the course. Tutors found their task inspiring but experienced a greater workload, less reasonable demands and less support, than students. Study two: five main groups of clinical tutors’ experiences emerged: Pleasure and stimulation, Disappointment and stagnation, Demands and duty, Impact of workplace relations and Multitasking difficulties. Study three: To describe a skilled clinical tutor in a primary health care setting, three main themes emerged: Professional as a general practitioner and ambassador to general practice, Committed and student-centred educator, and Coordinator of the learning environment. Study four: An overarching theme emerged:”Let me develop my skills in a supportive workplace, give me feedback and merits, and I will continue tutoring”. Findings of the thesis are, that clinical tutorship is appreciated by the tutoring physicians and provides pleasure and stimulation. Tutors are motivated and have the ambition to give students their best but also a loyalty to their profession. Counteracting factors have been found: time pressure, heavy workload, and difficulties in combining the many duties as a physician with that of a tutor, especially combining meeting patients and students. Factors encouraging tutorship are acceptance and support from clinical management, colleagues and staff, adequate time, feedback, and merits, as well as preparatory and continuing tutor’s training. Conclusion. Clinical tutors play a crucial role in today’s undergraduate medical education. Tutors’ experiences were complex, providing both pleasure and stimulation, but also time pressure and conflicts when combining different roles as physicians. A sustainable tutorship and a satisfactory learning environment require a time frame, clear support from leaders, colleagues and workplace professionals along with feedback and merits. Clinical education and tutor’s key role need to be acknowledged and integrated as essential parts of the health care system. Keywords: Undergraduate medical education, clinical education, clinical tutor, clinical clerkships, preceptorship, workplace, workplace learning, Sweden ISBN: 978-91-629-0125-7 (Print), 978-91-629-0126-4 (PDF

The Effect of Changing School Laws on Educational Inequalities Between the German States

Eine wichtige zwischen den Bundesländern variierende schulrechtliche Regelung ist die Verbindlichkeit der Schullaufbahnempfehlung beim Übergang von der Grundschule auf die weiterführenden Schulen. Während sie in einigen Bundesländern bindend ist, wird in anderen Bundesländern den Eltern die letztendliche Entscheidung überlassen, auf welche Schulform sie ihr Kind schicken. In der vorliegenden Studie wird untersucht, wie sich die Abschaffung bzw. Einführung von verbindlichen Übergangsempfehlungen auf die absolute Beteiligung an gymnasialer Bildung einerseits und soziale Disparitäten beim Gymnasialübergang andererseits auswirkt. Unter Verwendung des Difference-in-Differences-Ansatzes wird der kausale Effekt von 13 Reformen zwischen den Schuljahren 1949/50 und 2009/10 analysiert. Hierzu werden Daten des Statistischen Bundesamtes sowie die Mikrozensen herangezogen. Die Ergebnisse zeigen, dass die schulrechtlichen Reformen über die Zeit und Länder hinweg keine einheitliche Wirkung haben. In den meisten Fällen findet sich zwar der erwartete Effekt auf absolute Bildungsungleichheiten zwischen den Bundesländern. Allerdings sind die Resultate zu sozialen Ungleichheiten beim Gymnasialzugang größtenteils unerwartet