Active learning in clinical undergraduate GP placements: A qualitative exploration of debrief interactions during parallel surgeries

The problem

Parallel surgeries are a widely-used teaching tool in primary care medical education for both undergraduate and speciality training. In undergraduate placements students independently consult, then debrief with the GP before the patient leaves. Though this teaching format is a mainstay of clinical supervision in the UK there is no literature that studies its use in medical education. The aim of this study is to explore how these workplace-based debrief interactions shape learning.

Approach

We used a mixed methods qualitative approach, drawing upon Wenger’s situated learning theory (Lave and Wenger, 1991). Sampling was purposive, and interviews of 5 students, 4 GPs and 14 patients were recorded and transcribed. Videos of their debrief interactions across multiple clinical consultations in four different GP surgeries were obtained. IRAS ethics approval was granted.

Interviews were categorised using framework analysis. We used preliminary themes from the interviews to guide a ‘whole to part’ inductive approach to video analysis (Derry 2010). This involved multiple viewings by multiple researchers and agreement on major events and themes.  Our analysis focused on participant experiences. These were interpreted and categorised as ‘embodied cognition’ of video subjects (Streeck, 2014)

Learning

Format and facilitation of the parallel surgery debriefs varied widely. The main domains that affected the active learning of the student were:

Allowing the student to rehearse the role of a doctor.
Contextualising the learning environment for the student (including where the debrief took place).
Giving time for the student to respond to a question.
Legitimising the student’s presence.
Seat positioning: dyadic or triadic.

All of these domains had an impact on the major events of the consultation and the active learning embodied by the student.

Why it matters

A deeper understanding of the complex interactions that take place during workplace supervisory encounters can inform GP teachers decision-making, improve preparation and delivery of workplace-based teaching, and maximise opportunities for patient-based learning in this setting.

Presenting author: Ashika Dhondee; Newcastle University, A.Dhondee@newcastle.ac.uk

Co-authors: David Tan, dtan@doctors.net.uk; Katie Munro, katie.munro@newcastle.ac.uk; and Hugh Alberti, hugh.alberti@newcastle.ac.uk: Newcastle University, Sophie Park, sophie.park@ucl.ac.uk: UCL.