Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
School of Medicine, University of Cambridge, Cambridge, UK.
Med Teach. 2022 Mar;44(3):319-327. doi: 10.1080/0142159X.2021.1990239. Epub 2021 Dec 3.
In March 2020, UK primary care changed dramatically due to the COVID-19 pandemic. It now has a much greater reliance on triaging, e-consultations, remote consultations, online meetings and less home visits. Re-evaluating the nature and value of learning medicine in primary care has therefore become a priority.
70 final-year medical students placed in 38 GP practices (primary care centres) across the East of England undertook a 5-week clerkship during November 2020. A sample of 10 students and 11 supervising general practitioners from 16 different GP practices were interviewed following the placement. Qualitative analysis was conducted to determine their perceptions regarding the nature and value of learning medicine in primary care now compared with prior to the pandemic.
A variety of models of implementing supervised student consultations were identified. Although contact with patients was felt to be less than pre-pandemic placements, triaging systems appeared to have increased the educational value of each individual student-patient contact. Remote consultations were essential to achieving adequate case-mix and they conferred specific educational benefits. However, depending on how they were supervised, they could have the potential to decrease students' level of responsibility for patient care.
Undergraduate primary care placements in the post-COVID era can still possess the educationally valuable attributes documented in the pre-pandemic literature. However, this is dependent on specific factors regarding their delivery.
2020 年 3 月,由于 COVID-19 大流行,英国初级保健发生了巨大变化。现在,它更加依赖分诊、电子咨询、远程咨询、在线会议,而家庭访问则减少了。因此,重新评估在初级保健中学习医学的性质和价值已成为当务之急。
70 名即将毕业的医学生被分配到英格兰东部的 38 个全科医生实践(初级保健中心),在 2020 年 11 月进行为期 5 周的实习。在实习结束后,对来自 16 个不同全科医生实践的 10 名学生和 11 名监督全科医生进行了抽样采访。进行了定性分析,以确定他们对现在和大流行前在初级保健中学习医学的性质和价值的看法。
确定了各种实施监督学生咨询的模式。尽管与患者的接触感比大流行前的实习少,但分诊系统似乎增加了每个学生与患者接触的教育价值。远程咨询对于实现充足的病例组合至关重要,并且具有特定的教育益处。然而,具体取决于它们的监督方式,它们有可能降低学生对患者护理的责任水平。
在 COVID-19 时代,本科初级保健实习仍然具有大流行前文献中记录的有教育价值的属性。然而,这取决于其交付的具体因素。