Generalist learning in specialist environments: Third year medical student perceptions of General Practitioner facilitated teaching during hospital placements

Problem

In the UK and elsewhere, the epidemiological context of healthcare is changing towards an ageing society with greater multimorbidity. It is widely recognised that we need more physicians with generalist knowledge and skills and a patient-centred approach [generalist physicians] to manage these needs and that all undergraduate medical students, regardless of final career choice, need a sound generalist medical education to prepare for future clinical practice. With increasing medical specialization and shorter patient stays in hospital, the traditional model of students rotating through short speciality-based placements in hospitals is becoming increasingly less likely to support medical students to develop the generalist skills they will need to support the healthcare needs of our changing society.

Approach

GP facilitated teaching sessions were delivered each week during medical student hospital placements to small groups of 6-8 students for 90 minutes for six weeks. Students discussed and reflected on real patient cases that they encountered on their placements. The teaching focused on generalist clinical reasoning skills development, professional development and exploring the patient journey before and after hospital admission. Evaluation of learning outcomes was conducted through a student questionnaire using Likert scales with free text boxes for additional explanation. Focus groups were conducted to gain a more in-depth understanding of student perspectives.

Findings

Three key aspects of the teaching emerged as important to the positive educational outcomes for students: Patient-based learning, General Practitioner facilitation and Continuity of small group. Students expressed that patient-based learning helped them to develop generalist clinical reasoning skills and a patient-centred approach. The breadth of clinical expertise provided by General Practitioner facilitation enabled them to broaden the clinical discussion and to consider the patient journey across the primary and secondary care interface. Small group learning with continuity of facilitator made the learning more memorable, engaging and encouraged them to reflect on ethical and professional practice.

Consequences

Our findings support existing literature that demonstrates the educational benefits of continuity in the learning environment and focusing clinical learning around real patient-cases. Our study also shows how using General Practitioners as a resource for hospital placement teaching can maximise generalist learning outcomes for medical students during increasingly specialised hospital environments. The additional exposure to GPs role-modelling generalist clinical reasoning with a holistic approach may also help support students to develop career aspirations as GPs.