The practical training of medical students in General Medicine: Important characteristics of teaching practices

BackgroundComprehensive general medical care is endangered by the socio-demographic development of the population as well as by recruitment problems in general medicine. Medical students' interest in general medicine increases if they experience their internships positively. However, the characteristics of teaching practice important to medical students have not been systematically investigated. MethodsWe conducted four focus groups with a total of 22 students. The group discussions were recorded, transcribed, and evaluated by means of qualitative content analysis. ResultsStudents who rated their internship positively also expressed greater interest in becoming a family doctor. Variables that mattered to students were: Instruction and supervision by the owner's teaching practice and feedback behavior, being treated with respect, opportunity to work independently, the broad spectrum of diseases and the varied daily work when working as a family doctor, long-standing doctor-patient relationships, and good work-life balance. Variables that decreased students' interest in becoming a family doctor were the economic risk of starting a business, and being self-employed, referring patients to specialists for interesting findings and a poor work-life balance. ConclusionThe practical training of medical students in teaching practices has the potential to increase students' interest in working as a family doctor. This requires motivated teaching practice owners, who give students a positive insight into everyday practice

The Multidimensional Prognostic Index in general practice: One-year follow-up study

Background Older patients' health problems in general practice (GP) can often not be assigned to a specific disease, requiring a paradigm shift to goal-oriented, personalised care for clinical decision making. Purpose To investigate the predictive value of the comprehensive geriatric assessment (CGA)-based Multidimensional Prognostic Index (MPI) in a GP setting with respect to the main healthcare indicators during the 12 months following initial evaluation. Methods One hundred twenty-five consecutive patients aged 70 years and older were enrolled in a GP and followed up to one year. All patients underwent a CGA based on which the MPI was calculated and subdivided into three risk groups (MPI-1, 0-0.33 = low risk, MPI-2, 0.34-0.66 = moderate risk and MPI-3, 0.67-1, severe risk). Grade of Care (GC), hospitalization rate, mortality, nursing home admission, use of home care services, falls, number of general practitioner contacts (GPC), of geriatric resources (GR) and geriatric syndromes (GS) during the 12 months following initial evaluation were collected. Results The MPI was significantly associated with number of GS (P < .001), GR (P < .001), GC (P < .001) as well as with the average number of GPC per year (mean 10.4, P = .046). Interestingly, the clinical judgement of the general practitioner, in this case knowing his patients for 16 years on average, was associated with adverse outcomes to a similar extent than the prediction offered by the MPI (GP/adverse outcomes and MPI/adverse outcomes P < .001). Conclusion The MPI is strongly associated with adverse outcomes in older GP patients and strongly predicts the number of GPC up to one year after initial evaluation. Considering the feasibility and the strong clinimetric properties of the MPI, its collection should be encouraged as early as possible to disclose risk conditions, implement tailored preventive strategies and improve cost-effectiveness of healthcare resources use