Master of Medical Science - Research
Graduate School of Medicine
Dijkmans-Hadley, Bridget, Expectations and experiences of Phase 1 medical students and General Practice (GP) preceptors in early primary care placements, Master of Medical Science - Research thesis, Graduate School of Medicine, University of Wollongong, 2013. http://ro.uow.edu.au/theses/4194
Background: Traditionally, the first few years of a medical curriculum comprises of an intensive focus on medical sciences delivered by experts in a discipline-specific or integrated format. During the last few decades medical education programs in Australia have seen many changes. Initially with the introduction of problem based learning, then the introduction of the General Medical Council 1993 recommendations for early primary care placements and finally with the increased availability in the number of postgraduate medical programs. A comprehensive review of the literature focused on the expectations and experiences of medical students and GP preceptors on early primary care placements has identified dispersed perspectives rather than comparing and contrasting the experiences of both. The current literature also focuses more on an international perspective, rather than an Australian perspective. This study therefore, focuses on an Australian perspective and investigates medical students’ expectations and experiences of early primary care placements and compares them with GP preceptors’ experiences of early primary care placements.
Methods: Participants in this study included a cohort of Phase 1 medical students and GP preceptors associated with the first 18 months of the Graduate School of Medicine MBBS degree at the University of Wollongong, Australia. This study comprised a mixed-methods design and was conducted in three parts. Part one involved an audit of the of the Phase 1 GP preceptor handbook to investigate the primary learning objectives for medical students while on placement. Part two comprised of cross-sectional surveys (i.e. pre-placement and follow-up surveys)which investigated medical students’ expectations and experiences while on early primary care placements, as well as cross sectional surveys of the GP preceptors’ experiences of these early placements. Part three of the study involved one-on-one qualitative interviews with a subset of medical students and GP preceptors who had completed the cross sectional surveys in part 2.
Results: The results from this study showed that the majority of the learning objectives in the current Graduate School of Medicine GP preceptor handbook focused on communication and the development of basic physical examination skills. For the most part, the experiences of the medical students in this regard were similar to the GP preceptors expectations. Despite this, medical students expected that not only would they be involved in interacting with patients through communication and conducting basic physical examinations, but that they would be involved in conducting sophisticated procedures, as well as making clinical decisions for patients. This was different from the perspectives of their GP preceptors, who felt that the early primary care placements gave medical students an opportunity to interact with patients on a fairly superficial level (in most cases) and that their real learning would be mainly derived from observing patient interactions, being mentored by their GP preceptors, reflecting on patient consultations and by developing professional relationships with their GP preceptors. GP preceptors believed that each of these learning strategies would contribute to building medical students’ confidence and their understanding of the practical application of the theoretical components that they had learnt at university.
Conclusion: This study provides an Australian perspective about expectations and experiences of medical students and GP preceptors on early primary care placements. This study found that the medical students and the GP preceptors’ had different perspectives about what early primary care placements would entail. Despite these mismatched perspectives, it was found that reflective discussions between the GP preceptor and the medical student provided key learning opportunities for both of them. The current study also provides new evidence into how Australian GPs adapt their practices to enable learning opportunities for medical students. It further details evidence of how transformative learning is encouraged and supported during early primary care placements.