Medical students Perceptions of General practice Dr K Banner School of Medical Education and Institute of Health & Society

Why am I interested in medical students perceptions of GP?

The Recruitment crisis… NHS England pledge to increase number of graduates entering GP to 50% (3,250 trainees needed per year) (Health Education England, 2016, NHS England 2016). However only 15.3% of foundation year 2 doctors commenced GP training in 2017(UK foundation Programme, 2017) Significant variation in these numbers across medical schools (UKFPO, 2017) Why are graduates not choosing General Practice?

Why might graduates not choose GP? Perceptions: Not as challenging, of a lower status (Supporting medical students towards a career in General Practice, 2016) Good quality university placements, and the importance of role models (Nicholson et al, 2016) Denigration? (Alberti et al, 2017)

Aim Gain an in-depth understanding of medical students’ perceptions of General Practice as a career within the United Kingdom and how these may change following experiences, both at University and at Home.

Method Focus Groups and interviews of 1st and 4th year students at Newcastle University. Three focus groups Five interviews

Results Broad categories identified…

“It’s sometimes portrayed as someone who wants a more of a family/work balance, being able to have time that’s more convenient almost, fewer hours.” “I like the sound of GP in terms of a continuity of patients. In hospital you are see them then never see them again so it would be interesting to be able to continue their care with them and adapt their treatment plan if it’s not working and stuff like that.” “When we were on obs and gynae, all the doctors, midwifes, everyone sat together at lunch and discussed things and it felt like a really nice environment and I don’t feel like a GP gets as much as you are literally in your room all day.” “people don’t like the business side of it. People don’t want to run a business.” “I still think it’s a feminine role, like the sort of motherly GP type of person. I think there is definitely that stereotype” “it comes up in seminars, it comes up in lectures and it will be someone saying, “this is how we deal with it in hospital but in GP land this is what they do”. It just gives it such a bad perception that GP land is a fairy place.” “I am very similar to her and I see how anxious she gets and I worry I would be like that. My GP last year mentioned it to me as well not to be so anxious” during my work experience the GP was saying how she still has to take work home and is up quite late filling in paper work”

First year Perceptions from different sources in early years Early positive hospital experiences (open days, eg neurosurgery) “probably media as well, G.P.s are shown as a boring job whereas with Surgery all the exciting programmes, and you don’t exactly see a high intensity program like Casualty set In a G.P. [surgery]” “I just think being a G.P. would be boring, really, sitting in an office all day, as opposed to being in Surgery, and getting more hands on, and being more proactive maybe”

Fourth year Later, quality university placements Wider experiences, eg practice meetings contribute to understanding “I just think I learnt so much, I learnt more in G.P. I didn’t feel like that with any other specialties.” “like the pressures of costs, and seeing how rushed G.P.s are, and the treatment times, and funding and all that politics it’s made it less appealing career, but then I think to myself whichever career you go into you all have to deal with things like that, “

Next Steps: Part of a wider study using longitudinal audio diaries and interviews at multiple sites. Understanding how perceptions develop, and how this impacts on career intentions,

What does this mean for GP Teaching? More time in GP?! Variety of GP role models. Greater understanding of the GP role: Practice meetings, teaching on business aspect. How do we portray GP to our students?

How do we remove the feeling of “them” and “us”? A Final question? How do we remove the feeling of “them” and “us”?

Many thanks to H.alberti, J. Stewart and J.Cleland Supervisors for this MD

References: Alberti, H., Banner, K., Collingwood, H., Merritt, K., 2017a. ‘Just a GP’: a mixed method study of undermining of general practice as a career choice in the UK. BMJ Open 7, e018520. https://doi.org/10.1136/bmjopen-2017- 018520 Health Education England, 2016a. GP ST1 Recruitment Figures 2016 [WWW Document]. URL https://gprecruitment.hee.nhs.uk/Portals/8/Documents/Annual%20Reports/GP%20ST1%20Recruitment%20Fig ures%202016.pdf (accessed 10.3.17). NHS England, 2016. General Practice Forward View Nicholson, S., Hastings, A.M., McKinley, R.K., 2016. Influences on students’ career decisions concerning general practice: a focus group study. Br J Gen Pract 66, e768-775. https://doi.org/10.3399/bjgp16X687049 UK foundation Programme, 2017. Career destinations report 2017 Supporting medical students towards careers in general practice [WWW Document], 2016. . Health Educ. Engl. URL https://www.hee.nhs.uk/our-work/hospitals-primary-community-care/primary-community- care/supporting-medical-students-towards-careers-general-practice (accessed 1.9.18).

Questions?