How do medical students and GP trainees differ in their approach to learning and perception of a simulated general practice programme?

Problem

Some aspects of the primary care curriculum are ideally suited to simulation teaching, yet it is infrequently utilised for teaching in primary care. We looked at two simulation teaching programmes, one for medical students and another for GP speciality trainees. As a method of standardising learning and capitalising on the benefits of simulation, KCL has rolled out a simulated General Practice placement for first year clinical students. Health Education England is piloting a simulation teaching session for the speciality trainees of two training schemes.

Approach

Both simulated programmes used a common format with 20 minute simulated activities followed by debriefing. One scenario focusing on professionalism and management of clinical uncertainty was used for both groups. Several other scenarios addressed similar learning outcomes of both cohorts. Data were collected from evaluation questionnaires and focus groups, and both data sets were independently thematically analysed. We reviewed an existing dataset (questionnaire n=440, focus groups n=40) looking at the perceptions of undergraduates to a simulated GP surgery placement and compared this to data obtained from the pilot postgraduate programme (n=80).

Findings

Both cohorts found a simulated primary care experience to be useful for their learning. Whilst undergraduates at times questioned the fidelity of some aspects of scenarios such as the number of clinical signs present in the patients seen, postgraduates identified frequent parallels to normal clinical practice. However, undergraduates found it easier to suspend disbelief and enter into the simulation with greater authenticity. Postgraduates felt less safe in their learning environment and were more cautious of observation by peers at times. Both groups commented on alignment of the experience and its usefulness in preparing them for assessment in the form of medical student OSCEs, or for GPs the Clinical Skills Assessment. Elements that improved learning include receiving multi-source feedback from facilitators and patients.

Consequences

Simulation is useful for both cohorts and would be a valued addition to both undergraduate and postgraduate curricula. It is useful to adapt scenarios to the level of the learner with regards to debriefing and learning outcome. It is important that scenarios are written appropriately so that they can provide a rich source of learning and discussion about the multifaceted requirements of working as a GP. Skilful debriefing is key to helping learners in achieving learning outcomes. There is scope for incorporating simulation across postgraduate GP curricula