Developing a career as a GP educationalist: contemporary challenges and workforce solutions

GP educationalists are crucial in training the future medical workforce and in developing and advancing the field of primary care medical education, yet opportunities in the UK are patchy and varied. In this article, a group of GP educationalists summarise the challenges facing the sustainability of this particular group of clinical academics and outline opportunities available at each career stage, from medical students through to senior GP educationalists. Recommendations to support the growth of this workforce include the development of a nationally recognised framework for GP educationalist careers, collaboration with professional and educational bodies and taking steps to level out opportunities in order to reduce existing inequity

Employee Covenants Not to Compete: Where Does Virginia Stand?

Courts for some time now have been forced to deal with the validity of covenants not to compete as contained in employment contracts. Considered to be a restraint against trade, these covenants under common law were viewed with disfavor, if not hostility, both nationally and in the Commonwealth of Virginia, as being contrary to the American ideals of individual freedom, competition, and the free flow of commerce. As such they were seldom upheld. It was only after the courts recognized that employers had legitimate concerns and interests worthy of protections that reasonable covenants not to compete began to be enforced by injunction following a breach

Correlative light electron microscopy using small gold nanoparticles as single probes

Correlative light electron microscopy (CLEM) requires the availability of robust probes which are visible both in light and electron microscopy. Here we demonstrate a CLEM approach using small gold nanoparticles as a single probe. Individual gold nanoparticles bound to the epidermal growth factor protein were located with nanometric precision background-free in human cancer cells by light microscopy using resonant four-wave-mixing (FWM), and were correlatively mapped with high accuracy to the corresponding transmission electron microscopy images. We used nanoparticles of 10 nm and 5 nm radius, and show a correlation accuracy below 60 nm over an area larger than 10 um size, without the need for additional fiducial markers. Correlation accuracy was improved to below 40 nm by reducing systematic errors, while the localisation precision is below 10 nm. Polarisation-resolved FWM correlates with nanoparticle shapes, promising for multiplexing by shape recognition in future applications. Owing to the photostability of gold nanoparticles and the applicability of FWM microscopy to living cells, FWM-CLEM opens up a powerful alternative to fluorescence-based methods

Promoting general practice in medical schools. Where are we now?

In November 2016, the Medical Schools Council and Health Education England published a joint report chaired by Professor Val Wass: ‘By choice – not by chance’ to raise the profile of general practice as a positive career choice for medical students. We sought to evaluate the impact of the report by firstly, asking the views of Heads of GP teaching at UK medical schools whether and how the report has supported them in raising the profile of general practice and secondly, describing the initiatives developed by medical schools in a national survey. There was a perception reported by heads of GP teaching that the report has been highly influential in facilitating the promotion of general practice as a career to medical students. We describe multiple specific initiatives developed in response to the report’s recommendations. The national survey confirmed that whilst there is significant variation across medical schools in their response to the specific recommendations in the report, definite progress is being made. A number of areas that need particular consideration have been highlighted and we would recommend that future surveys are completed at appropriate time intervals to review further progress

‘They say’: medical students’ perceptions of General Practice, experiences informing these perceptions, and their impact on career intention—a qualitative study among medical students in England

Objectives The number of UK graduates choosing General Practice training remains significantly lower than the current numbers required to meet the demands of the service. This work aims to explore medical students’ perceptions of General Practice, experiences which lead to the development of these perceptions, and the ultimate impact of these on career intention. Design This mixed-methods, qualitative study used focus groups, semistructured interviews, longitudinal audio diary data and debrief interviews to explore and capture the experiences and perceptions of students in their first and penultimate years of university. Setting Three English medical schools. Participants Twenty students were recruited to focus groups from first and fourth/fifth year of study. All students in these years of study were invited to attend. Six students were recruited into the longitudinal diary study to further explore their experiences. Results This work identified that external factors, internal driving force and the ‘they say’ phenomenon were all influential on the development of perceptions and ultimately career intention. External factors may be split into human or non-human influences, for example, aspirational/inspirational seniors, family, peers (human), placements and ‘the push’ of GP promotion (non-human). Driving force refers to internal factors, to which the student compares their experiences in an ongoing process of reflection, to understand if they feel General Practice is a career they wish to pursue. The ‘they say’ phenomenon refers to a passive and pervasive perception, without a known source, whereby usually negative perceptions circulate around the undergraduate community. Conclusion Future strategies to recruit graduates to General Practice need to consider factors at an undergraduate level. Positive placement experiences should be maximised, while avoiding overtly ‘pushing’ GP onto students

Developing a career as a GP educationalist: contemporary challenges and workforce solutions

GP educationalists are crucial in training the future medical workforce and in developing and advancing the field of primary care medical education, yet opportunities in the UK are patchy and varied. In this article, a group of GP educationalists summarise the challenges facing the sustainability of this particular group of clinical academics and outline opportunities available at each career stage, from medical students through to senior GP educationalists. Recommendations to support the growth of this workforce include the development of a nationally recognised framework for GP educationalist careers, collaboration with professional and educational bodies and taking steps to level out opportunities in order to reduce existing inequity

Effects of stratosphere-troposphere chemistry coupling on tropospheric ozone

A new, computationally efficient coupled stratosphere-troposphere chemistry-climate model (S/T-CCM) has been developed based on three well-documented components: a 64-level general circulation model from the UK Met Office Unified Model, the tropospheric chemistry transport model (STOCHEM), and the UMSLIMCAT stratospheric chemistry module. This newly developed S/T-CCM has been evaluated with various observations, and it shows good performance in simulating important chemical species and their interdependence in both the troposphere and stratosphere. The modeled total column ozone agrees well with Total Ozone Mapping Spectrometer observations. Modeled ozone profiles in the upper troposphere and lower stratosphere are significantly improved compared to runs with the stratospheric chemistry and tropospheric chemistry models alone, and they are in good agreement with Michelson Interferometer for Passive Atmospheric Sounding satellite ozone profiles. The observed CO tape recorder is also successfully captured by the new CCM, and ozone-CO correlations are in accordance with Atmospheric Chemistry Experiment observations. However, because of limitations in vertical resolution, intrusion of CO-rich air in the stratosphere from the mesosphere could not be simulated in the current version of S/T-CCM. Additionally, the simulated stratosphere-to-troposphere ozone flux, which controls upper tropospheric OH and O3 concentrations, is found to be more realistic in the new coupled model compared to STOCHEM. © 2010 by the American Geophysical Union

General practice and the Medical Licensing Assessment

From 2024/2025, all UK medical students will sit the Medical Licensing Assessment (MLA),1 a mandated national exam comprising: a written applied knowledge test (AKT) in single best answer (SBA) format; and a clinical and professional skills assessment (CPSA). Here we consider the implications for primary care, and for those involved in teaching primary care to medical undergraduates, including GPs and other primary care professionals

Location, Quality and Choice of Hospital : Evidence from England 2002–2013

We investigate (a) how patient choice of hospital for elective hip replacement is influenced by distance, quality and waiting times, (b) differences in choices between patients in urban and rural locations, (c) the relationship between hospitals' elasticities of demand to quality and the number of local rivals, and how these changed after relaxation of constraints on hospital choice in England in 2006. Using a data set on over 500,000 elective hip replacement patients over the period 2002 to 2013 we find that patients became more likely to travel to a provider with higher quality or lower waiting times, the proportion of patients bypassing their nearest provider increased from 25% to almost 50%, and hospital elasticity of demand with respect to own quality increased. By 2013 average hospital demand elasticity with respect to readmission rates and waiting times were −0.2 and −0.04. Providers facing more rivals had demand that was more elastic with respect to quality and waiting times. Patients from rural areas have smaller disutility from distance

Students’ and tutors’ experiences of remote ‘student–patient’ consultations

Background: Remote consulting has become part of the medical student clinical experience in primary care, but little research exists regarding the impact on learning. Aim: To describe the experiences of General Practitioner (GP) educators and medical students in using student-led remote consultations as an educational tool. Method: A qualitative, explorative study conducted at four UK medical schools. GP educators and medical students were purposively sampled and interviewed. Results: Nine themes arose: practical application, autonomy, heuristics, safety, triage of undifferentiated patients, clinical reasoning, patient inclusion in student education, student–patient interaction, and student–doctor interaction. Discussion: Remote consulting has become part of the clinical placement experience. This has been found to expose students to a wider variety of clinical presentations. Verbal communication, history-taking, triage, and clinical reasoning skills were practised through remote consulting, but examination skills development was lacking. Students found building rapport more challenging, although this was mitigated by having more time with patients. Greater clinical risk was perceived in remote consulting, which had potential to negatively impact students’ psychological safety. Frequent debriefs could ameliorate this risk and positively impact student–doctor relationships. Student autonomy and independence increased due to greater participation and responsibility. Pre-selection of patients could be helpful but had potential to expose students to lower complexity patients