How should we approach / operationalise Generalism in Medical Education? A narrative review of International Policy and Mission Documents

Problem

Whilst generalists are essential for healthcare, there is a lack of understanding about what generalism means and how to support training of doctors. This review forms part of a larger project seeking to articulate the nature of generalism.

This review aims to examine how generalism is characterised within undergraduate and postgraduate medical education in health policy documents from across the UK, Canada and North America and how doctors should be trained.

Approach

Systematic searches were conducted in Medline, Psycinfo, Socioindex, EMBASE, OVID Healthstar, Scopus and Web of Science. Search terms included ‘generalism’, generalist’, ’internal medicine’, ‘surgeon’, ‘paediatrics’ and ‘psychiatry”. Grey literature was also explored.

Texts from 1999–present were included. This review limited inclusion to English language policy or mission documents. Forward citation searches and hand-searching references of relevant documents was also undertaken.

We began by familiarising ourselves with documents and identifying relevant sections. An iterative process of deductive and inductive analysis was then performed to answer our research questions.

Findings

So far 31 relevant documents have been identified. Whilst the period covered spans a number of years, there seems to be little shift over time. Some differences have emerged in how generalism is described by primary care professionals and specalists; Speciality-based texts position generalism in terms of ‘breadth’ and ‘basic training’. Family medicine texts, highlight a number of additional characteristics, or elements of ‘generalist expertise’.

Common themes include a mission to increase applications for postgradaute generalist training, similar barriers to recruitment, a need to have generalists as role models for students and descriptions of stigma against generalism. There also seems to be a paradox, that whilst generalist training is valued, it can be seen as a basis for further training, rather than expert or specialist knowledge in its own right.

Early results suggest there is little information about how generalism is ‘done’. Whilst the different organisations seem to concur that ‘excellent generalist care’ should be valued and there is an imperative to increase generalist training, it is not clear exactly how this should be achieved.

Consequences

Our review will set out recent descriptions of generalism. It will comment on key characteristics, challenges and how doctors should be trained. It will also identify gaps in current literature and consider future directions.