Benefits and challenges of multi-level learner rural general practices – an interview study with learners, staff and patients

Abstract

BackgroundGeneral practices vary in the provision of training and education. Some practices have training as a major focus with the presence of multi-level learners and others host single learner groups or none at all. This study investigates the educational benefits and challenges associated with ‘multi-level learner’ practices.MethodsThis paper comprised three case studies of rural general practices with multiple levels of learners. Qualitative data were collected from 29 interviews with learners (n = 12), staff (n = 12) and patients (n = 5). Interviews were initially analyzed using open and axial coding and thematic analysis.ResultsThematic analysis showed ‘multi-level learning’ in general practices has benefits and challenges to learners and the practice. Learner benefits included knowledge exchange, the opportunity for vertical peer learning, a positive learning environment and the development of a supportive network. The presence of multi-level learners promoted sharing of knowledge with all staff, a sense of community, an increase in patient services and enthused supervisors. Challenges for learners included perception of decreased access to supervisors, anxiety with peer observation, reduced access to patient presentations and patient reluctance to be seen by a learner. Practice challenges were administration requirements, high learner turnover, infrastructure requirements and the requirement for supervisors to cater to a range of learner level needs.ConclusionsThe presence of medical students, interns and registrars in general practice has educational benefits to the learners extending to the other stakeholders (staff and patients). Multi-level learners present challenges to the learners and the practice by increasing pressures on resources, staff (administrative and supervisors) and infrastructure.

The role of vertically integrated learning in a rural longitudinal integrated clerkship

“…In alignment with previous research outside an LIC context, participants expressed that all levels of learners can benefit from VI, recognising that each level of learner has unique knowledge and skills to share [12, 14, 34]. This sharing of teaching and learning roles may be particularly enhanced where LIC programs occur, as over time students have been found to develop strong trusting relationships with their supervisors, colleagues and patients [15, 18].…”

Factors related to rural general practitioners supervising general practice registrars in Australia: A national cross-sectional study

“…2,[14][15][16] At a practice level, supervising has been related to an organisational teaching and learning culture and a part of improving access to sufficient local GPs in rural areas. 14,15,17,18 However, other studies have focused on supervision from the perspective of the registrar only; many are small-scale and are not focused on rural areas. [19][20][21][22] This research aimed to use nationalscale data to explore the factors related to rural GPs participating in registrar supervision.…”

A systematic review of the approaches to multi-level learning in the general practice context, using a realist synthesis approach: BEME Guide No. 55

“…Five of the Australian papers come from one research group in northern New South Wales; three of their papers relate to one research study (Ahern et al 2013;Silberberg et al 2013; and two relate to a national survey (van de Mortel et al 2014;van de Mortel et al 2016). Two further Australian papers report data from one research study in Victoria (Morrison et al 2014;Brown et al 2015) and two English papers report different aspects of a research study in Yorkshire and Humber (Nagel et al 2011;Kirby et al 2014). The oldest paper, an exploratory pilot study, was published in 2003 (Johnson et al 2003) indicating the relative infancy of MLL in the primary care setting.…”

“…Several studies used qualitative methods only: semistructured interviews (Ahern et al 2013;Silberberg et al 2013;Kleinitz et al 2014;Morrison et al 2014;Thomson et al 2014;Brown et al 2015) or interviews and case reports (Harris 2009)). Others used mixed methods: a survey and semi-structured interviews (Gaby et al 2014;Kirby et al 2014); a survey and focus group discussions (Johnson et al 2003); or a survey collecting predominantly quantitative data, with some qualitative free text responses (Williams and Amiel 2012;van de Mortel et al 2014;van de Mortel et al 2016).…”

“…Shared teaching and learning across all medical learner stages is one proposed strategy. This approach has been referred to as multi-level learning (MLL) (Morrison et al 2014) and also as a vertical component of learning or vertical integration (Supplementary Appendix 1 Glossary of Terms) in medical education (Dick et al 2007;Hays 2013;O'Regan et al 2013;GPSA 2014;Thomson et al 2014). For this report, we use the term MLL to refer to shared teaching and learning that occurs between the four stages of general practice training, i.e.…”