The Training of Undergraduate Medical Students in General Medical Practice and Primary Health Care: A Scoping Review

Abstract

Background: Undergraduate medical students are trained to acquire a general medical practice overview on qualifying. This training forms a foundation for primary health care service or further training towards a specialty of choice. Objective: The aim of the study was to determine the scope of published scientific literature on the training of undergraduate medical students in “general medical practice” and “primary health care,” exploring how these two concepts are understood, the pedagogical approaches employed by the trainers, the training platforms and the challenges encountered during the training. Methods: The review followed the five steps recommended by Arksey and O’Malley. Using the specified eligibility criteria, the research team systematically screened titles, abstracts, and full articles. Data were entered into Google Forms spreadsheets, which was followed by inductive data analysis of key themes. Results: 130 articles were eligible for inclusion in the study. Thematic analysis yielded eight themes: definition of “general medical practice” and “PHC”, pedagogical approaches (conventional, PBL, teams and CBME), training platforms (tertiary and rural), medical students’ trainers (faculty, GPs and patients), training content, trainers’ and trainees’ perceptions, and challenges encountered. Conclusion: This scoping review has revealed that general medical practice and primary health care are approaches to holistic patient care taught at undergraduate medical training. Primary health care and general medical training are mainly undertaken in GP practices and rural settings. Competency-based medical education is emerging as an appropriate pedagogical method towards ‘fit-for-purpose’ training. The inclusion of patients as trainers in general medical practice and primary health care is yielding positive results.

Understanding of ‘generalist medical practice’ in South African medical schools

“… 36 In this way, student preceptors were taking the students through the ZPD to the level of expertise in patient care. 25 …”

“…63 Dealing with an undifferentiated patient provides students the opportunity to learn clinical reasoning, which entails synthesising the acquired information and skills to reach new conclusions about a patient’s condition. 25 In this manner, Vygotsky’s ‘scaffolding’ principle becomes demonstrable, whereby students are taken through clinical conditions of gradual complexity. 21…”

“…26 The researchers of this study found this design appropriate as it allowed the participants to contribute to the development of new knowledge (medical students and their preceptors’ understanding of ‘generalist medical practice’) in the training of UG medical students. At the time when this study was conducted, the researchers of this study had conducted a scoping study on the training of UG medical students on general medical practice and primary health care 25 and did not find studies that reported on what medical students and their trainers understood by ‘generalist medical practice’. Most literature addressed some aspects of this subject at postgraduate medical training.…”

“…The understanding of the more senior students on the subject compared to their junior counterparts was explored to find out the extent to which the former had moved further towards ‘full participation’ in the CoP. 25 …”