Evaluation and Development of a New Community Based Medicine attachment at The University of Nottingham Medical School

Problem

The Primary Care Education Unit at The University of Nottingham Medical School has developed a new Community Based Medicine (CBM) attachment for students in the penultimate year of their course. The General Medical Council is keen to see a greater proportion of undergraduate education occur in the primary care setting: mirroring the movement of patient care into the community. Additionally, there is increasing evidence of an association between the quantity of undergraduate clinical teaching in primary care and entry into General Practice training. Therefore, it is timely to be increasing the quantity of undergraduate teaching in primary care at The University of Nottingham. The four week CBM attachment, introduced in September 2016, doubles the duration of time that students were previously exposed to primary care in their senior clinical years. The aim of the attachment is to facilitate students to develop their consultations skills, gain a better understanding of primary care and to improve their understanding of the role of other healthcare professionals in this setting. Students spend most of the week in clinical practice and receive one day of facilitated small group teaching, focusing on advanced consultation skills and long term condition management.

Approach

The Primary Care Education Unit are evaluating the CBM attachment in terms of student and tutor feedback in order to make suitable adjustments and improvements for future student cohorts. Feedback has been gathered in a variety of methods, including:• Free text feedback questionnaires from students and GP tutors• Focus group sessions with students and small group tutors • Voluntary completion of ‘Careers’ outcomes-based questionnaires pre and post attachment Questionnaire-derived feedback has been systematically analysed for emergent themes. Focus groups were audio-recorded and transcribed verbatim. Data will be analysed using a constant comparative approach.

Findings

To date, feedback has been largely positive. Students have valued their time spent in primary care – specifically the experience of developing differential diagnoses and management plans under supervision of a senior clinician. Small group teaching sessions were also praised, although some students would have preferred a more succinct approach.

Consequences

The final cohort of students will complete their CBM attachment in April. We will continue to collect feedback and convene focus groups until this point. Students have reported the benefits of an additional four weeks of meaningful exposure to primary care, which came at a ‘cost’ for some of the secondary care exposure that students had previously been receiving. The CBM module will be modified as a result of feedback received. We plan to work with students progressing into the final year of their course: exploring how this placement has impacted their professional development.Lessons learned may be useful to other schools contemplating an increase in primary care teaching exposure.