An out-of-programme experience in medical education

In this article, we share our experiences as GP trainees in a full time out-of-programme experience (OOPE) in medical education, uniquely situated within the Primary Care Undergraduate Team at Imperial College London. We hope that sharing our experiences in undertaking this post (and discussing the associated benefits and challenges) will give GP trainees insights into an opportunity to further their interest in education and encourage them to seek similar posts.There is a national mandate for half of graduating medical students to select general practice as a career to help support the shift of services from secondary to primary care (Department of Health, 2015; NHS England, 2016). With this changing focus, medical schools have an obligation to provide rich learning opportunities that are designed, led and delivered by passionate and appropriately qualified community clinicians. General practice is an excellent setting for students to learn authentically, with a multitude of patient presentations and opportunities for follow up. This has the potential to promote a generalist mind set for students (Alberti et al., 2017).Teaching is a specialist skill in its own right, and is part of the core postgraduate RCGP curriculum. We need enthusiastic and well-trained educators within general practice to help support the national mandate and to share the joy of general practice with the next generation

Gender differences in hospital admissions for major cardiovascular events and procedures in people with and without diabetes in England: a nationwide study 2004–2014

Abstract Background Secondary prevention of cardiovascular disease (CVD) has improved immensely during the past decade but controversies persist on cardiovascular benefits among women with diabetes. We investigated 11-year trends in hospital admission rates for acute myocardial infarction (AMI), stroke, percutaneous coronary intervention (PCI), and coronary artery bypass graft (CABG) in people with and without diabetes by gender in England. Methods We identified all hospital admissions for cardiovascular disease causes among people aged 17 years and above between 2004 and 2014 in England. We calculated diabetes-specific and non-diabetes-specific rates for study outcomes by gender. To assess temporal changes, we fitted negative binomial regression models. Results Diabetes-related admission rates remained unchanged for AMI (incidence rate ratio (IRR) 0.99 [95% CI 0.98–1.01]), increased for stroke by 2% (1.02 [1.01–1.03]) and PCI by 3% (1.03 [1.01–1.04]) and declined for CABG by 3% (0.97 [0.96–0.98]) annually. Trends did not differ significantly by diabetes status. Women with diabetes had significantly lower rates of AMI (IRR 0.46 [95% CI 0.40–0.53]) and stroke (0.73 [0.63–0.84]) compared with men with diabetes. However, gender differences in admission rates for AMI attenuated in diabetes compared with the non-diabetic group. While diabetes tripled admission rates for AMI in men (IRR 3.15 [95% CI 2.72–3.64]), it increased it by over fourfold among women (4.27 [3.78–4.93]). Furthermore, while the presence of diabetes was associated with a threefold increased rates for PCI and fivefold increased rates for CABG (IRR 3.14 [2.83–3.48] and 5.01 [4.59–5.05], respectively) in men, among women diabetes was associated with a 4.4-fold increased admission rates for PCI and 6.2-fold increased rates for CABG (4.37 [3.93–4.85] and 6.24 [5.66–6.88], respectively). Proportional changes in rates were similar in men and women for all study outcomes, leaving the relative risk of admissions unchanged. Conclusions Diabetes still confers a greater increase in risk of hospital admission for AMI in women relative to men. However, the absolute risk remains higher in men. These results call for intensified CVD risk factor management among people with diabetes, consideration of gender-specific treatment targets and treatment intensity to be aligned with levels of CVD risk