The Perceived Barriers to Implementing Near- Peer, Multilevel Learning in Primary Care

Problem

The 2016 Wass report ‘By Choice – not by Chance’ acknowledged the relative lack of contact undergraduate students have with General Practice trainees when contrasted to their hospital counterparts. It has also been seen that General Practice trainees are less engaged with teaching activities. Lack of exposure to near-peer mentors can affect early career choices and this lack of exposure can negatively influence undergraduate perceptions of General Practice. With an increase in the demand for educational experiences in community settings driven in part by the appreciation that General Practice provides a unique and ideal learning environment comes an opportunity to address this lack of contact. By utilising multi-level learning within community settings we could yield benefit in the educational experiences for all parties. We are looking to bridge the gap between undergraduate trainees and post graduate trainees in these environments.

Approach

The goals were three fold:• Understand the current landscape and crossover between undergraduate and postgraduate education in GP practices• Gain feedback from educators on the perceived benefits of multi-level learning in primary care• Understand barriers that exist to developing multi-level educational experiencesWe sought to obtain qualitative data in order to understand current practices and perceptions. Semi-structured interviews were carried out with educationalists within practices to explore current practices and to discuss the views on involving postgraduate trainees in undergraduate education. Individual structured interviews were chosen in order to gain a deep understanding of local practice and to allow participants time to express their personal views, beliefs and experiences.

Findings

We identified a range of different approaches to involving GP trainees in undergraduate education across our region. In the environments where registrars encountered undergraduate trainees the qualitative feedback received from practices was positive. We identified some practices where any interaction was purely on an ad-hoc basis.The perceived positive impacts of educational programs within practices were felt to be multidirectional. The educationalists we spoke to universally felt that near-peers could play an essential role in undergraduate educational experiences with many identifying social congruence as a positive factor.The barriers identified could be considered to exist as part of 3 major domains: organisational, individual and encultured attitudes.

Consequences

The level to which multilevel learning is utilised in primary care is varied; we identified multiple interwoven factors influencing this. Highlighting the benefits of multilevel learning for all participants is key to supporting registrars to engage in shared educational experiences with undergraduate students in community settings. Developing simple models for application, supporting educationalist to apply these models and ensuring educational support for trainees could yield collective benefit.