Informing undergraduate medical education: A systematic review of international policy and mission documents to identify how generalism is described

Problem

The need for generalist clinicians is well endorsed by professional bodies across the specialties, and educating graduates with a generalist skill base is a key undergraduate outcome. Despite the large number of position statements on the importance of generalism, the pragmatics of educating for generalism remain unclear. For example, what core concepts of generalism should be integrated into curricula and how can these be taught and learned? Challenges include a plethora of definitions alongside tensions about how Generalism transcends or is located within a particular discipline. Professional bodies (e.g. Internal Medicine, Family Medicine, Surgery) advocate for increased attention to ‘generalism’, but are the principles and nature of these situated practices the same or different? Further, physician roles in many healthcare settings are increasingly delegated to allied healthcare professionals. What might this mean for generalist practice and training?

Approach

This review aims to understand how generalism is described within international healthcare medical education mission and policy documents. It asks: 1. How is generalism described in the policy and mission texts across physician clinical specialities? 2. What facilitators and challenges are identified in relation to practising generalism? 3. How might these findings inform physician training? Eight Health and Educational databases, and grey literature websites were searched. Inclusion criteria included ‘physician’ and ‘generalism’ or ‘generalist’; 1999-present; English-language only. A thematic analysis was used to map how and in what context, the terms are used.

Findings

Documents provide a strong imperative for generalism. They describe the need for generalism to deliver effective and efficient patient care, and the need to maintain and develop a workforce able to provide and sustain this. A number of challenges have, however, been identified. These include:a) For learning – what ‘knowledge’ and ‘skills’ should training focus on and provide; and how should generalism work across boundaries of medical disciplines and across multi-disciplinary teams. b) For culture – how to challenge a continued hierarchy which preferences specialised ‘expert’ work; and a pubic paradox which values and preferences specialised knowledge, while requiring generalism to support an effective healthcare system.c) For organisation structures – contending on-going organisational change; and related shifts in roles, responsibilities and opportunities for generalism.

Consequences

This review highlights how policy and mission texts advocate educating healthcare professionals as Generalists, but remain ambiguous about what this means. The identified challenges will inform a subsequent review of empirical literature, as well as development of recommendations for future spaces in medical education to support generalism across disciplines.