Training the Future Doctor: Evaluating General Practice in the HYMS MBBS Curriculum

Problem

Recruitment and retention of General Practitioners is in crisis. The Wass Report highlighted the relationship between GP careers and undergraduate training, emphasising the responsibility of medical schools to provide experience of authentic general practice. HYMS is rightly proud of its primary care teaching, with the largest proportion of any UK medical school curriculum (19%) delivered by GPs and also the largest proportion of time (15%) that students spend learning in a general practice setting. What is not clear is whether the content and methods of delivery are in keeping with recent national guidance. This study aims to define authentic General Practice in the context of undergraduate medical education. It will evaluate if HYMS meets its duty as an educational institution to expose students to authentic General Practice, enabling them to make more informed career choices and potentially helping address the workforce crisis. As far as we know this is a new approach to evaluating an undergraduate curriculum.

Approach

We used the Wass report and RCGP-SAPC curriculum guidance, identifying what a curriculum should contain in order to deliver high quality patient-centred community teaching. We also analysed key curriculum documents from comparable health care systems in Canada, New Zealand and Australia to ensure that themes identified were internationally recognised as crucial to the curriculum of authentic primary care. This structured thematic analysis developed seven core themes on which a novel framework was built to analyse the HYMS curriculum.Our data source included all curriculum documents describing learning outcomes for the MBBS program. We used a modified framework analysis approach to undertake thematic analysis of the data set, identifying the presence/absence of core concepts. For each theme, we described whether the coded entry was fully recognised in content/delivery (marked as green), partially (amber), or not recognised at all (red).

Findings

Our analysis reveals themes comprehensively covered, including person centred care, communication skills and reflective practice. It also highlights potential gaps such as the hidden curriculum, generalist medicine, and methods of delivery. At this point we are not clear if ‘red areas’ represent true curriculum gaps, or are an artefact of the stage 1 study design. Therefore stage 2 will involve semi-structured interviews and focus groups with key stakeholders to further evaluate potential gaps.

Consequences

Medical schools have a key role in exposing their students to authentic general practice during undergraduate training. Although HYMS delivers high volume of teaching in general practice, our analysis reveals that the medical school may not be delivering the recommended content. Our work systematically identifies potential priority areas for the school to address. This model of evaluation may then prove a transferable tool for other medical schools to follow suit.