A qualitative study to explore multiple long-term conditions in the undergraduate medical school curriculum
Introduction
Patients with a chronic physical disease accompanied by other disease types or biopsychosocial factors – multiple long-term conditions (MTLCs) – represent a major clinical challenge.1,2 In total, 17% of the population of England are forecast to have two or more conditions by 2035, while there is a clear correlation with ageing populations, adverse socio-economic circumstances, and use of primary and secondary care.3–5 Preparing medical students to manage this growing patient cohort is a recognised challenge given the prevalence of single-disease model care in medical school curricula, while evidence for the choice and utility of educational interventions in MTLCs is sparse.6–8 Improving the evidence-base for student and doctor needs is crucial for informing the design of educational programmes, intervention, and curricula. The aim of this study was to understand and explore the desirable MLTC-related learning outcomes identified by foundation year 2 doctors (FDs) in the Northern Deanery.
Methods
Sixty-minute, semi-structured focus groups were conducted across sites at NHS trusts in Northern England. All FDs were invited to attend. The semi-structured interview guide was developed following literature review and agreement within the research team. Sessions were recorded and transcribed verbatim. Transcripts were coded and a shared coding framework was developed. A thematic analysis was then applied to identify and organise key themes.9
Results
A total of 26 participants took part across three focus groups. Participants reported clinical experiences from secondary and primary care placements. Two overarching themes were identified: 1) ‘Practice needs’ including issues and support needed for managing patients with multiple health conditions in all care settings, and 2) ‘Education needs’ including missing opportunities and limitations in undergraduate curricula. FDs particularly emphasised the uncertainty felt while managing MTLC patients and the variability of exposure to this cohort throughout their undergraduate careers. They highlighted the roles of experienced senior professionals as sources of support and advice, helping mitigate their lack of experience and the absence of MTLC-focused guidelines.
Conclusion
Newly qualified doctors find multiple facets of working with MTLC patients difficult; there is a dearth of clear guidance for practice and this cumulates in the feeling of ill-preparedness and anxiety. There is a clear need to improve learning opportunities and interventions at undergraduate level to better equip them for modern practice. Suggested improvements include introducing and enhancing inter-professional methods of learning and practice-based teaching. Curricula should enhance the consistency of exposure to MTLC patients across student placements in primary and secondary care.
- © Royal College of Physicians 2023. All rights reserved.
References
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- Garin N
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- Soley-Bori M
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- Hudson JN
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- Whitty CJM
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- Lewis C
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