Trends in recruitment into core medical training in the UK – could doing quality improvement projects help?
Editor – Butterworth and colleagues highlight the problems of recruiting and retaining enough medical trainees.1 They also mention there is a similar crisis in general practice. As medical students who were recently encouraged to become general practitioners (GPs) by conducting quality improvement projects in primary care, we would like to share what we learned. We hope it might be of interest to medical specialties.
To start with, we looked at a range of audits that might be useful to the practice and chose topics based on personal interest. We found it exciting for us as students to have the possibility of influencing clinical practice and improving patient care. This made our projects more enjoyable in terms of academic learning.
We found general practice was a friendly and supportive environment for carrying out an audit. Learning how to create our own databases and doing simple statistical analysis made us feel more confident about carrying out future audits exploring the gaps between guidelines and practice.
We discovered a common theme in our audits – the tension between adhering to national guidelines and feasibility in busy, everyday practice. An example of this was one of our audits looking at whether GPs comply with National Institute for Health and Care Excellence guidelines to screen patients with low folate for coeliac disease. With so many patients with low folate, it seemed that clinicians relied on clinical judgement to decide investigation and management plans, often not following guidelines precisely.
This was further exemplified in the audit investigating how often women were given appropriate advice on diet and exercise in their post-natal checks, where we also reflected on the struggle between the doctor's and the patient's agenda. During these sensitive but time-limited appointments, doctors had to decide what information to focus on, balancing patient preference and clinical judgment.
Lastly, carrying out projects such as in our questionnaire survey, showed us how patients differ in their ethnicity, age and body mass index; and how demographic parameters can impact the GP's approach.
It has been suggested that students do not perceive general practice as an academically challenging career choice.2 Conducting quality improvement projects can change this perception.
In their conclusions, Butterworth and colleagues describe important initiatives to enhance the attractiveness of medical specialties.1 Perhaps quality improvement projects for students supervised by an enthusiastic physician role model could also be considered.
- © Royal College of Physicians 2020. All rights reserved.
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