Learning or leaving? An international qualitative study of factors affecting the resilience of female family doctors

Background: Many countries have insufficient numbers of family doctors, and more females than males leave the workforce at a younger age or have difficulty sustaining careers. Understanding the differing attitudes, pressures, and perceptions between genders toward their medical occupation is important to minimise workforce attrition. Aim: To explore factors influencing the resilience of female family doctors during lifecycle transitions. Design & setting: International qualitative study with female family doctors from all world regions. Method: Twenty semi-structured online Skype interviews, followed by three focus groups to develop recommendations. Data were transcribed and analysed using applied framework analysis. Results: Interview participants described a complex interface between competing demands, expectations of their gender, and internalised expectations of themselves. Systemic barriers, such as lack of flexible working, excessive workload, and the cumulative impacts of unrealistic expectations impaired the ability to fully contribute in the workplace. At the individual level, resilience related to: the ability to make choices; previous experiences that had encouraged self-confidence; effective engagement to obtain support; and the ability to handle negative experiences. External support, such as strong personal networks, and an adaptive work setting and organisation or system maximised interviewees’ professional contributions. Conclusion: On an international scale, female family doctors experience similar pressures from competing demands during lifecycle transitions; some of which relate to expectations of the female's ’role’ in society, particularly around the additional personal pressures of caring commitments. Such situations could be predicted, planned for, and mitigated with explicit support mechanisms and availability of workplace choices. Healthcare organisations and systems around the world should recognise this need and implement recommendations to help reduce workforce losses. These findings are likely to be of interest to all health professional staff of any gender

The "unknown territory" of goal-setting: Negotiating a novel interactional activity within primary care doctor-patient consultations for patients with multiple chronic conditions.

Goal-setting is widely recommended for supporting patients with multiple long-term conditions. It involves a proactive approach to a clinical consultation, requiring doctors and patients to work together to identify patient’s priorities, values and desired outcomes as a basis for setting goals for the patient to work towards. Importantly it comprises a set of activities that, for many doctors and patients, represents a distinct departure from a conventional consultation, including goal elicitation, goal-setting and action planning. This indicates that goal-setting is an uncertain interactional space subject to inequalities in understanding and expectations about what type of conversation is taking place, the roles of patient and doctor, and how patient priorities may be configured as goals. Analysing such spaces therefore has the potential for revealing how the principles of goal-setting are realised in practice. In this paper, we draw on Goffman’s concept of ‘frames’ to present an examination of how doctors’ and patients’ sense making of goal-setting was consequential for the interactions that followed. Informed by Interactional Sociolinguistics, we used conversation analysis methods to analyse 22 video-recorded goal-setting consultations with patients with multiple long-term conditions. Data were collected between 2016 and 2018 in three UK general practices as part of a feasibility study. We analysed verbal and non-verbal actions for evidence of GP and patient framings of consultation activities and how this was consequential for setting goals. We identified three interactional patterns: GPs checking and reframing patients’ understanding of the goal-setting consultation, GPs actively aligning with patients’ framing of their goal, and patients passively and actively resisting GP framing of the patient goals. These reframing practices provided “telling cases” of goal-setting interactions, where doctors and patients need to negotiate each other’s perspectives but also conflicting discourses of patient-centredness, population-based evidence for treating different chronic illnesses and conventional doctor-patient relations

Massive open online courses for continuing professional development of GPs

Continuing professional development (CPD) is essential for the maintenance and improvement of the knowledge and skills of healthcare professionals. GP registrars are required to evidence CPD in their ePortfolio and likewise, GPs are mandated to accrue and evidence a minimum of 50 hours CPD for their annual appraisal. CPD can be delivered in many ways, with an increasing movement towards online learning. Technology-enhanced learning (TEL) encompasses online learning and is ever changing. This article will discuss a type of TEL known as massive open online courses (MOOCs) and the role of MOOCs in delivering CPD

Setting goals with patients living with multimorbidity: qualitative analysis of general practice consultations

Background Establishing patient goals is widely recommended as a way to deliver care that matters to the individual patient with multimorbidity, who may not be well served by single-disease guidelines. Though multimorbidity is now normal in general practice, little is known about how doctors and patients should set goals together. Aim To determine the key components of the goal-setting process in general practice. Design and setting In-depth qualitative analysis of goal-setting consultations in three UK general practices, as part of a larger feasibility trial. Focus groups with participating GPs and patients. The study took place between November 2016 and July 2018. Method Activity analysis was applied to 10 hours of video-recorded doctor-patient interactions to explore key themes relating to how goal setting was attempted and achieved. Core challenges were identified and focus groups were analysed using thematic analysis. Results A total of 22 patients and five GPs participated. Four main themes emerged around the goal-setting process: patient preparedness and engagement; eliciting and legitimising goals; collaborative action planning; and GP engagement. GPs were unanimously positive about their experience of goal setting and viewed it as a collaborative process. Patients liked having time to talk about what was most important to them. Challenges included eliciting goals from unprepared patients, and GPs taking control of the goal rather than working through it with the patient. Conclusion Goal setting required time and energy from both parties. GPs had an important role in listening and bearing witness to their patients' goals. Goal setting worked best when both GP and patient were prepared in advance

Goal-setting with patients with multi-morbidity. Finding a way to achieve ‘what really matters’

It can be a challenging task for GPs to find the best approach to providing care for patients with multiple medical conditions (multi-morbidity). Most care focuses on the management of single diseases; however, adopting a patient-centred focus may be better for patients with multi-morbidity. This is encouraged in recent health policy and guidance. However, it is not always clear how this should be put into practice. This article describes how GPs might use ‘goal-setting’ during consultations with patients with multi-morbidity, to help achieve more effective care that is better suited to patient’s needs

Can goal-setting for patients with multimorbidity improve outcomes in primary care? Cluster randomised feasibility trial

Introduction: Goal-setting is recommended for patients with multimorbidity, but there is little evidence to support its use in general practice. Objective: To assess the feasibility of goal-setting for patients with multimorbidity, before undertaking a definitive trial. Design and setting: Cluster-randomised controlled feasibility trial of goal-setting compared to control in six general practices. Participants: Adults with 2 or more long term health conditions and at risk of unplanned hospital admission. Interventions: General Practitioners (GPs) underwent training and patients were asked to consider goals before an initial goal-setting consultation and a follow-up consultation six months later. The control group received usual care planning. Outcome measures: Health-related quality of life (EQ5D5L), capability (ICEpop CAPability measure for Older people (ICECAP-O)), patient assessment of chronic illness care (PACIC) and health care use. All consultations were video or audio-recorded, and focus groups were held with participating GPs and patients. Results: Fifty-two participants were recruited with a response rate of 12%. Full follow-up data were available for 41. In the goal-setting group, mean age was 80.4 years 54% were female and the median number of prescribed medications was 13, compared to 77.2 years, 39% female and 11.5 medications in the control group. The mean initial consultation time was 23.0 minutes in the goal-setting group and 19.2 in the control group. Overall 28% of patient participants had no cognitive impairment. Participants set between one and three goals on a wide range of subjects, such as chronic disease management, walking, maintaining social and leisure interests, and weight management. Patient participants found goal-setting acceptable and would have liked more frequent follow-up. GPs unanimously liked goal-setting, felt it delivered more patient-centred care and highlighted the importance of training. Conclusions: This goal-setting intervention was feasible to deliver in general practice. A larger, definitive study is needed to test its effectiveness

Professional learning during the transition from trainee to newly qualified general practitioner

The transition from training to qualified practice is inherently challenging. Structured support following training was once available, but this no longer exists and the current climate of primary care places increasing demands on GPs. Professional learning, and the transition to independent practice, may thus be problematic

Shifting end of life care back into the community

National evidence shows that around 60% of patients would prefer to receive end of life care and die at home, but in 2005 in North Derbyshire only 20% of patients were supported to do so. This article discusses the tools used to improve end of life care services in the community and explores the enablers and barriers