Towards vertical integration in general practice education: literature review and discussion paper

Abstract

Recent developments in medical education in Ireland, such as the increase in medical school clinical placements in general practice and postgraduate GP training and the introduction of new competence assurance requirements offer an important opportunity to further inform how vertical integration can support increased educational activity in general practice. Describing this model, recognising its benefits and challenges and supporting its implementation in practice are priorities for medical education in Ireland.

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

“…The presence of multi-level learners can enable vertical integration, which is a topic of increasing interest in literature. Vertically integrated training comprises of "continuous educational pathways, all stages in GP education, supporting the continuing educational/professional development needs of learners at each stage and effective curriculum planning and delivery" [ 20 ]. Of the seventeen Regional Training Providers (RTPs) of general practice education in Australia, eleven identified they have undertaken vertical integration initiatives [ 21 ].…”

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

“…This review includes 15 papers providing primary evaluation data from individuals and practices that had experienced MLL in the community-based general practice setting. The majority of these papers have been published subsequent to several previous reviews relating to vertical integration or MLL in general practice (Rushforth et al 2010;GPET 2011;O'Regan et al 2013;GPSA 2014).…”

“…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.…”

“…Existing literature reviews provide valuable perspectives on aspects of MLL in general practice, including its benefits and challenges (O'Regan et al 2013); the role of registrars as teachers (Rushforth et al 2010); and an overview of vertical integration of learning and teaching and how it can be developed, delivered, and adapted to various contexts (GPET 2011). These reviews provide an overview of articles hypothesizing about various aspects of MLL, with some referring to a small number of studies with primary evaluation data on the experience of MLL.…”

“…Overall, our findings are consistent with many of the benefits and challenges of MLL suggested in the literature. Proposed benefits include efficiencies for the practice (Glasgow and Trumble 2003;Dick et al 2007;O'Regan et al 2013), broadening of the range of learning experiences and teachers (Birks et al 2004;Dick et al 2007) including learning from teachers who are closer and possibly more connected to their situation (Glasgow and Trumble 2003), improved morale and collegiality (Glasgow and Trumble 2003;O'Regan et al 2013), enhanced teacher enthusiasm and satisfaction (Glasgow and Trumble 2003), the enhancement or acquisition of teaching skills for registrars and GP trainers (Dick et al 2007), and the capacity to supervise increased learner numbers (Dick et al 2007). Proposed challenges include limited physical and financial resources, learners' variable prior learning experiences (Glasgow and Trumble 2003), differing commitment and teaching skills of GPs and learner-teachers, and ensuring fair teaching loads and remuneration for non-salaried registrars (Dick et al 2007).…”