Facilitators and barriers to teaching undergraduate medical students in primary care: The GPs’ perspective.

Problem

Some medical schools are experiencing an increasing challenge to recruit GP teachers in practices facing increasing, competing demands from service and simultaneous expansion of postgraduate training. The length and quality of medical students’ exposure to primary care influences their choice of specialty so failure to recruit and retain GP teachers threatens NHS England’s aim to increase GP numbers by 5000 GPs by 2020. There has been no research on UK GP motivation to teach since the 1990s. We seek to identify and understand contemporary motivators and barriers for primary care engagement with undergraduate education in the UK.

Approach

Semi-structured interviews were undertaken with 25 GP teachers at four UK Medical Schools representing urban and rural locations and modern and more traditional curricula. Three participant groups were purposively sampled: GPs who have recently commenced teaching in a practice or are increasing their commitment, established GP teachers and GPs who have recently stopped teaching or are decreasing their commitment. Interviews were audio-recorded and transcribed. NVIVO was used to facilitate thematic analysis using both deductive and inductive approaches.

Findings

Key motivators reported by GPs were keeping up-to-date, enjoyment and variety. GPs perceived medical schools as facilitators by providing prompt feedback. Analysis shows a distinction between partner and salaried/locum GP perspective on barriers to teaching related to autonomy over time and funding. Partners described a lack of autonomy due to ever increasing service demand and decreasing pay, which is insufficient to replace lost clinician time, as a fundamental reason to stop teaching. Conversely, salaried and locum doctors mentioned greater autonomy over working hours as a major reason to teach. Multiple practices have stopped undergraduate teaching in favour of postgraduate GP training because of service contribution of, and a longitudinal relationship with, trainees. Some teachers had proactively contacted medical schools demonstrating that current recruitment practices miss potential recruits. GPs suggested a broader range of recruitment methods.

Consequences

This study highlights crucial factors which influence GPs’ decisions to teach undergraduates including the negative effect workload pressures and inadequate funding are having on undergraduate education in primary care. Ongoing lobbying by the RCGP and SAPC is crucial to support recent recommendations by the 2016 Health Select Committee that the ‘government accelerate their work to create a payment mechanism which reflects the true cost to GP practices of teaching medical students.’ There is untapped teaching capacity in general practice and medical schools must consider reviewing recruitment methods to ensure full coverage of an ever changing workforce comprising increasing numbers of salaried/locum GPs who may be excluded from current communication with practices. Social media may offer solutions. A clearer understanding of the barriers and facilitators that have emerged in our study will aid medical schools to recruit and retain GP teachers.