Radical solutions are needed to meet the challenge of medical student placement capacity in primary care

Simon Thornton; Hugh Alberti; Joe Rosenthal; Joanne Protheroe

doi:10.3399/bjgp23X735597

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Radical solutions are needed to meet the challenge of medical student placement capacity in primary care
Howard D. Skinner

Published on: 15 January 2024
Meeting the challenge of medical student placement capacity in primary care by rewiring later career GPs
Mona Aquilina and Pamela Martin

Published on: 08 December 2023

Published on: (15 January 2024)
Page navigation anchor for Radical solutions are needed to meet the challenge of medical student placement capacity in primary care
Radical solutions are needed to meet the challenge of medical student placement capacity in primary care
Howard D. Skinner, GP Educator, Hull and York Medical School
The authors’ presentation of Must/Should (MoSCoW prioritisation tool) for making placements compulsory occurs in stark contrast to the perceived wisdom of examinations of the GP workforce crisis like Jefferson and Holmes’ BJGP leader¹ which highlights the importance of autonomy and the ability to assert control over one’s work environment for a profession in existential distress.

Imposing a compulsory diktat is liable to be counterproductive in accelerating a loss of GPs from the profession, adversely impacting on learning climate through introducing anxiety and eliciting psychological defence in many of the most vulnerable GPs and potentially exposing our learners to significant risks. Those working to deliver primary care undergraduate placements will be familiar with the tensions created by the need to generate capacity whilst quality assuring placements safely. Any increase in undergraduate primary care capacity needs to be matched with the resources to manage the complications the intervention might provoke. I believe this is a could proposal for that reason.

The authors highlight their proposal as radical but in essence, it’s an expedient and first order intervention to resolve tension created by an unrealistic ask. By contrast, the proven value of longitudinal contact in primary care, as highlighted by the authors, affords the opportunity to realise some efficiencies in intensity and process whilst rewarding teacher...
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The authors’ presentation of Must/Should (MoSCoW prioritisation tool) for making placements compulsory occurs in stark contrast to the perceived wisdom of examinations of the GP workforce crisis like Jefferson and Holmes’ BJGP leader¹ which highlights the importance of autonomy and the ability to assert control over one’s work environment for a profession in existential distress.

Imposing a compulsory diktat is liable to be counterproductive in accelerating a loss of GPs from the profession, adversely impacting on learning climate through introducing anxiety and eliciting psychological defence in many of the most vulnerable GPs and potentially exposing our learners to significant risks. Those working to deliver primary care undergraduate placements will be familiar with the tensions created by the need to generate capacity whilst quality assuring placements safely. Any increase in undergraduate primary care capacity needs to be matched with the resources to manage the complications the intervention might provoke. I believe this is a could proposal for that reason.

The authors highlight their proposal as radical but in essence, it’s an expedient and first order intervention to resolve tension created by an unrealistic ask. By contrast, the proven value of longitudinal contact in primary care, as highlighted by the authors, affords the opportunity to realise some efficiencies in intensity and process whilst rewarding teachers and students with enhanced experience. The challenge for educationalists is to revisit educational design and strategy and create anew. We have educational research and know-how at our disposal to bring to bear on this essential redesign but the unrealistic nature of the task asserted ironically on a background of the conspicuous long-term neglect of workforce planning, should implore us to prioritise sustainability over immediate gratification of want. I believe the challenge needs to be met within this context not shared with the most distressed and vulnerable amongst our profession who might reasonably expect advocacy not imposition.

Reference

1. Jefferson L, Holmes M. GP workforce crisis: what can we do now? Br J Gen Pract 2022; 72(718):206-207. doi: 10.3399/bjgp22X719225.
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Competing Interests: None declared.
Published on: (8 December 2023)
Page navigation anchor for Meeting the challenge of medical student placement capacity in primary care by rewiring later career GPs
Meeting the challenge of medical student placement capacity in primary care by rewiring later career GPs
Mona Aquilina, retired GP partner and GP trainer, Chair of RCGP LCARM group 2019-2022
Other Contributors:
Pamela Martin, retired GP partner and previous undergraduate medical teacher, South London
Thornton et al¹ have missed a potentially significant way to increase medical student placement capacity in primary care and simultaneously help with GP retention. The Later Career and Retired members group (LCARM) of the RCGP has, for a long time, been encouraging the development of “portfolio careers” for older GPs.² Diversifying the role of later career GPs can enable them to remain clinically engaged whilst also developing and using other skills.

A promising way forward for maximising GP engagement with teaching would be for teams of teachers to be organised at Primary Care Network (PCN) level, with outreach to GPs considering reducing their clinical sessions. Often GPs have difficulty negotiating reduced hours with their practice, but the provision of funding to replace their clinical time will help. “Jobshare” roles shared between later career and younger GPs incorporating teaching can also be developed. The GPs within the teaching teams could be spread around all the practices within a PCN, working to consistently high standards and acting as ambassadors for teaching.

Rather than even thinking of adding mandatory teaching to the workforce that is already recognised as pressured and overstretched, medical schools could develop a previously untapped resource.

References
1. Thornton S, Alberti H, Rosenthal J and Protheroe J. Radical solutions are needed to meet the challenge of...
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Thornton et al¹ have missed a potentially significant way to increase medical student placement capacity in primary care and simultaneously help with GP retention. The Later Career and Retired members group (LCARM) of the RCGP has, for a long time, been encouraging the development of “portfolio careers” for older GPs.² Diversifying the role of later career GPs can enable them to remain clinically engaged whilst also developing and using other skills.

A promising way forward for maximising GP engagement with teaching would be for teams of teachers to be organised at Primary Care Network (PCN) level, with outreach to GPs considering reducing their clinical sessions. Often GPs have difficulty negotiating reduced hours with their practice, but the provision of funding to replace their clinical time will help. “Jobshare” roles shared between later career and younger GPs incorporating teaching can also be developed. The GPs within the teaching teams could be spread around all the practices within a PCN, working to consistently high standards and acting as ambassadors for teaching.

Rather than even thinking of adding mandatory teaching to the workforce that is already recognised as pressured and overstretched, medical schools could develop a previously untapped resource.

References
1. Thornton S, Alberti H, Rosenthal J and Protheroe J. Radical solutions are needed to meet the challenge of medical student placement capacity in primary care. Br J Gen Pract 2023, DOI: https://doi.org/10.3399/bjgp23X735597.

2. Aquilina M, Beyond the clinical coalface: utilising the transferable skills and expertise of former GPS within the NHS. Br J Gen Pract 2021, DOI: https://doi.org/10.3399/bjgp21X714761.
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Competing Interests: None declared.