How does the introduction of a new year 3 curriculum affect future commitment to teach? A realist inquiry of third year GP clinical teachers at Newcastle University

The problem

The recruitment and retention of General Practice (GP) clinical teachers are problematic for medical schools and may be barriers to the expansion of undergraduate primary care teaching. Newcastle University recently increased the amount of teaching delivered in GP in year three as part of wider curricular reform.  Feedback has suggested dissatisfaction amongst some GP clinical teachers since the changes were introduced. 

Your approach

This study applies the realist philosophy of science using realist inquiry.  It seeks to understand which aspects of the new year three GP curriculum affect future teaching commitment, in what contexts this occurs, how and why.  As a starting point, a candidate theory of how the new curriculum may affect future teaching commitment was developed.   Data collection and analysis then used semi-structured interviews of ten GP teachers, using analytical techniques consistent with realist principles, to refine the candidate theory and generate a final Programme Theory.

The learning

In certain contexts, some aspects of the new curriculum result in reduced future teaching commitment, e.g.  increased teaching workload negatively affects commitment if a GP lacks practice support. Other aspects of the curriculum result in increased commitment e.g. opportunities to take on certain new roles and teach primary care-orientated medicine.  Numerous mechanisms are identified, including alterations to autonomy, sense of responsibility and value.  Different GP teachers are affected in different ways, influenced by practice and individual contexts. 

Why it matters

This study explains how curricular change may affect teacher engagement and commitment, thus improving our understanding of factors that affect GP teacher retention and retention.  We make several recommendations, including: a whole practice team -based approach to undergraduate primary care teaching as the norm; paying attention to maintaining teacher autonomy; consideration of the future role of the GP teacher; and efforts to strengthen teacher identity and connectedness.

Presenting author: Michael Harrison, School of Medical Education, Faculty of Medical Sciences, Newcastle University, e-mail: Michael.harrison@doctors.org.uk, twitter: @Michael77780648

Co-authors: Hugh Alberti, School of Medical Education, Faculty of Medical Sciences, Newcastle University, hugh.alberti@newcastle.ac.uk