Medical Education, 1976,10, 374-377
Attitudes towards the content of general practice teaching
D. R . HANNAY, J . H. BARBER A N D T. S. M U R R A Y Department of General Practice, University of Glasgo w
In a study of attitudes towards the content of general practice teaching, it was found that there was good agreement between fifth year medical students and their general practitioner tutors. The social aspects of illness were considered the most important by students and both groups emphasized the value of seeing patients in their homes with time for discussion of cases. These findings are discussed in the context of the development of teaching in general practice at Glasgow University.
Key words : GENERAL PRACTICE/*edUC; *EDUCATION,
PERSONNEL ; CURRICULUM; QUESTIONNAIRES;
MEDICAL, UNDERGRADUATE ; *ATTITUDE OF HEALTH
TEAcHING/methods ; PHYSICIAN-PATIENT RELATIONS ;
Over the past few years there has been an increasing awareness that teaching in general practice should be included in the medical curriculum. Since 1972 such teaching at Glasgow University has been developed and evaluated on a voluntary basis with students in the old 6 year curriculum (Hannay & Strang, 1972; Barber, 1973; Barber & Haraldsson, 1975).
In the new 5 year curriculum, teaching in general practice will for the first time be a formal part of the course. The teaching is organized by the new Department of General Practice and will take place during the fourth year, with extensions in the third and final years.
The purpose of this paper is to present the results
Correspondence: Dr D. R. Hannay, University of Glasgow Department of General Practice, Woodside Health Centre, Barr Street, Glasgow G20 7LR.
of a survey comparing the attitudes of students and general practitioner tutors towards the content of general practice teaching. The study is part of a continuing evaluation of such teaching, leading up to the first formal course in 1976.
During the autumn and spring terms of the 1974/76 session, 197 fifth year students in the old 6 year curriculum were exposed to teaching in general practice. Twenty-eight general practitioner tutors took part and the students were divided between the two terms, so that each student had one after- noon of general practice teaching for 8 consecutive weeks. Every tutor therefore had a group of three or four students a term. The aims of the teaching were defined for all the tutors, who were also sent a suggested list of medical conditions (Barber & Haraldsson, 1975). An emphasis was placed on students seeing patients in their own homes (Barber,
At the end of the teaching a short questionnaire was given to both students and tutors asking them to evaluate various aspects of the course (Appendix). The questions related to the specific content of general practice teaching and respondents were asked to score the value of each activity between 0 and 5. Due to the intervention of examinations there was no teaching during the last week of the second term and about a quarter of the students questionnaires had to be sent to their home address.
The results of the questionnaire are shown in Table I , which gives the mean scores for each activity or
Attitudes towards fhe content of general practice teaching 375
Activity or content Students (n = 114) Tutors (n = 28)
Mean Rank SD Mean Rank SD
Patients seen in surgery Patients seen at home Group discussion after seeing patients Clinical content of course Social aspects of illness Psychological aspects of illness Time to interview patients Time for discussion about management
2.84 4.36 4.18 3.38 4.43 3.84 3.78 4.00
8 1.54 2.92 2 0.11 4.15 3 0.75 4.43 I 1.01 3.25 1 0.85 3.96 5 I .08 3.84 6 1.20 3.86 4 0.96 3.98
8 1.09 1 0.59 2 0.63 I 0.65 4 0.64 6 0.65 5 1.01 3 0.95
There is no significant difference between the mean scores of students and tutors at the 0.05 leve1,using the Wilcoxonmatched- pairs signed ranks test.
content for both students and tutors, together with the rank order and standard deviation of the means.
In addition, several students made favourable comments about other parts of the teaching of which the following were the most common: (i) appreciation of visits arranged by tutors (e.g. Rehabilitation Centres, Eventide and Childrens Homes, Social Work Departments, Remploy, etc.) ; (ii) emphasis on psychological and social aspects of illness; (iii) discussion with health visitors, district nurses and social workers; (iv) importance of following-up patients in their own homes; (v) videotape and tape-slide presentations.
A few students wanted to sit in on ordinary surgeries, and one or two felt that they were left too long with patients. Several thought that the course should have been extended.
In general, the teaching seemed to be well received. The attendance rate over the two terms was 83%, which is high considering the course was on a free afternoon and was not a formal part of the curri- culum.
Several students commented on how well prepared the tutors were, and expressed appreciation for the thought which had been given to the teaching and for the opportunities for informal discussion. As one student put it A very good impression of general practice and how it varies greatly from hospital
medicine. It broadened my outlook on medicine in relation to the community. or another student, A most worthwhile course. A breath of fresh air amidst the rest of the curriculum.
As well as the questions in Table 1, the tutors were also asked how they would rate the importance of certain aspects of teaching general practice, scoring between 0 and 5. The results are shown in Table 2.
Several tutors commented on the importance of bringing ancillary workers into the teaching, and laid emphasis on the management of patients in the community. A few suggested further training in small group teaching for tutors. It was pointed out that some students were involved in a lot of travelling in order to reach the practices and this sometimes cut down the attendance. Another point was made that the afternoon was not the best time for patients, because schoolchildren and those at work were not available until later in the day.
The questions were answered by all the tutors and over half the students. This was mainly because comparatively few of the questionnaires which had to be sent to the students at their home address were returned. If those who were circulated by post are excluded the student response rate rises to 77 %.
Questions Mean SD
Clinical (broad spectrum of illness within the community) 4.20 0.89 Behavioural (personal and social factors in ill-health) 4.20 0.15 Vocational (the opportunities and satisfactions of general practice) 3.20 I .43
376 D. R. Hannay, J. H. Barber and T. S. Murray
It is therefore likely that the student non-response rate reflects the low yield from a postal question- naire rather than a lack of interest which would significantly bias the results.
There is good agreement between the values placed by students and tutors on the content of the teaching as shown by Table 1, the main difference being that students placed most emphasis on the social aspects of illness. Otherwise there was little difference of opinion between the two groups about the relative value of the various activities. In particular, both students and tutors emphasized the importance of seeing patients in their homes with time for dis- cussion about the cases seen.
Both students and tutors attached least importance to seeing patients in the surgery, although this caused most disagreement within the groups as indicated by the standard deviations. A few students and one or two tutors commented on the need to sit in on surgeries to see how a practice works, but this was not the view of the majority as represented by one student who wrote Our tutor taught us by taking us to see various kinds of patients in the home setting which I personally find far more helpful than sitting in at a normal surgery.
Gaining experience of general practice at work is more a vocational approach which is really part of postgraduate training. In the undergraduate period there are elective attachments to general practice which are being expanded in the summer months immediately after the fourth-year teaching. It is also interesting that the general practitioner tutors did not rate the vocational aspect of undergraduate teaching as highly as the clinical or behavioural aspects as shown by Table 2.
In fact, during the third year of the new curriculum at Glasgow, students are attached to practices in a surgery setting, In order to gain experience of history taking from patients and of the early presentation of common complaints. But this is a more structured approach with definite aims, than just sitting in on a routine surgery. The latter can be very passive from the students point of view, and of limited educational value.
The active involvement of students in a learning situation is being further emphasized by introducing a recording booklet for the home visits. In this way
the students have to take a history and examine patients in their homes and record the findings with a summary of the problems and management. These booklets can then be used as a basis for discussion and assessment.
It seems important that the development of such teaching in general practice should be evaluated. Inevitably attempts to do so will be imperfect but it is essential that evaluation should be a continuing part of the process. The present study looks at one aspect of this development in medical education at a time when much is changing, but surprisingly little has been written about the direction and value of these changes.
Although exposure to general practice is being extended to include computer simulation, emergency work and collaborative teaching in paediatrics, psychiatry and geriatrics, the emphasis of the formal course at Glasgow University remains firmly with the students seeing patients in their own homes. It is in this setting, with the active involvement of small groups of students under a general practitioner tutor, that the reality of medicine in the com- munity is most effectively taught. This is the challenge of general practice and the impact of this approach is best summed up by a fifth year student: Probably for the only time in our medical course we were shown that if a patient has to go into hospital, then the time spent there is only a small part of the whole clinical picture which involves the GP, family, relatives and many other people. This is something which we as medical students, and I think many consultants, tend to forget.
Our thanks are due to the general practitioner tutors and fifth year medical students who took part in this study.
BARBER, J.H. (1973) A teaching course in general practice. British Journal of Medical Education, 7, 165.
BARBER, J.H. & HARALDSSON, E.T. (1975) Development and evaluation of teaching course in general practice. British Journal of Medical Education, 9, 42.
HANNAY, D.R. & STRANG, J.R. (1972) Medical students and general practice. Update. October, 899.
Attitudes towards the content of general practice teaching 377
FIFTH YEAR TEACHING COURSE 1974/75
So far the teaching in general practice has been on a voluntary basis, but next year it will become a formal part of the new fourth year syllabus in the Whitsun term. We are, therefore, anxious to get the reactions of the tutors who have been involved in developing this teaching.
Please could you score the questions below between 0 and 5 (0 = lowest and 5 = highest score). If you do not know leave a blank rather than a 0. We would wel- come any other comments for which there is a space at the bottom of the page.
How valuable do you think the following were to the students you have been teaching? (Score)
Patients seen in surgery ............................................................ Patients seen at home .............................. Group discussion after seeing patients.. ........................................ Clinical content of course.. ... ........ ........ ......... Social aspects of illness.. .......................................................... Psychological aspects of illness.. ........ ..................................... Time to interview patients.. ....................................................... Time for discussion about management.. .....................................
How would you rate the importance of the following aspects of teaching general practice? (Score)
Clinical (broad spectrum of illness within the community). .............. Behavioural (personal and social factors in ill health) ..................... Vocational (the opportunities and satisfactions of general practice). .... .--