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Biomedical subjects

M N Marshall

Publications and source records attributed to M N Marshall.

30 records · Page 2Linked to original sources
PubMed1999

How well do GPs and hospital consultants work together? A survey of the professional relationship.

BACKGROUND: The professional relationship between GPs and hospital consultants (sometimes referred to as 'specialists') is important in a healthcare system based upon the generalist as the first point of contact for patients and the gate-keeper for hospital services. This relationship has been the subject of considerable interest over the years, but little empirical research. OBJECTIVES: We aimed to compare the attitudes of GPs and specialists to key issues, and to produce a validated objective measure of their ability to work together. METHODS: We conducted a Likert-style survey based upon statements made in qualitative interviews with GPs and specialists working in the South and West of England. The questionnaire was modified and validated during a multi-stage pilot and was distributed to a stratified random sample of 800 clinicians. RESULTS: GPs and specialists demonstrate a good level of agreement, mutual understanding and respect, though there are significant differences between the two branches of the profession in terms of attitude towards financial parity and direct access to special investigations. CONCLUSIONS: A measure of the ability of GPs and specialists to work together has been developed, with acceptable internal consistency and validity. It may be used in other geographical areas to assess a relationship which is central to the efficient and effective operation of the National Health Service.

Analysis of Variance↗
PubMed1998

Qualitative study of educational interaction between general practitioners and specialists.

OBJECTIVES: To identify the main barriers to effective educational interaction between general practitioners and specialists and to suggest ways of overcoming these barriers. DESIGN: Qualitative study using semistructured interviews and focus groups. A content analysis of the data was performed. SETTING: South and West Regional Health Authority. SUBJECTS: 12 general practitioner principals and 12 hospital consultants were sampled purposefully and underwent a semistructured interview; a further 16 general practitioners and 16 hospital consultants similarly sampled made up four focus groups representing the two branches of the medical profession. RESULTS: There was a mismatch between what the general practitioners wanted from specialists in educational terms, and what the specialists were providing. General practitioners wanted to learn information that was directly applicable to their clinical work and to use referrals as two way learning opportunities. They were not sufficiently explicit about their learning needs. Specialists preferred to concentrate on new developments in their subject and would benefit from learning different ways of teaching. The participants were willing to learn from each other. Three models of educational interaction were identified: traditional didactic lectures given by specialists to general practitioners, interactive clinically based teaching, and informal interaction based on referrals. CONCLUSIONS: The two main branches of the medical profession have to address several significant problems before the full potential of teaching and learning together can be realised.

Attitude of Health Personnel↗
PubMed1998

How well do general practitioners and hospital consultants work together? A qualitative study of cooperation and conflict within the medical profession.

BACKGROUND: The professional relationship between general practitioners (GPs) and hospital consultants (sometimes referred to as 'specialists') is important in a health care system based upon the generalist as the first point of contact for patients and the gatekeeper for hospital services. This relationship has been the subject of considerable interest over the years, but little empirical research has been carried out. AIM: To investigate the professional relationship in terms of the balance between cooperation and conflict between GPs and specialists in clinical contact. METHOD: A qualitative study using 24 semistructured interviews and four focus group interviews with a purposeful sample of clinicians working in the south-west of England. A content analysis of the data was performed. RESULTS: There is a high level of mutual respect and cooperation between the two branches of the profession and a strong desire to build a personal relationship over a long period of time. There are few areas of significant disagreement; indeed, most members of both branches of the profession try hard to deal with, or avoid, potential conflict. CONCLUSION: The professional relationship between GPs and specialists is better than the literature and anecdotal stories might suggest.

Data Interpretation, Statistical↗
PubMed1996

The key informant technique.

BACKGROUND AND OBJECTIVE: This article considers the role of the key informant technique as a qualitative research method and examines the potential contribution of the approach to health care research. METHOD: The principles underlying the technique and the advantages and disadvantages are considered, illustrated with examples from a range of social science studies. RESULTS AND CONCLUSION: An example of the author's own use of key informants in a study of the professional relationship between general practitioners and specialists is described.

England↗
PubMed1996

Sampling for qualitative research.

The probability sampling techniques used for quantitative studies are rarely appropriate when conducting qualitative research. This article considers and explains the differences between the two approaches and describes three broad categories of naturalistic sampling: convenience, judgement and theoretical models. The principles are illustrated with practical examples from the author's own research.

Family Practice↗
PubMed1995

Teenage pregnancy: a comparative study of teenagers choosing termination of pregnancy or antenatal care.

A comparative study of 167 pregnant teenagers in Devon attending either antenatal booking clinics or for National Health Service (NHS) termination of pregnancy was carried out to determine differences in their characteristics, use and experience of local family planning services. Teenagers presenting for termination of pregnancy were younger and more likely to say that they had wished to avoid getting pregnant. Whether the teenager was in a stable relationship was strongly associated with the outcome of the pregnancy, with single girls being more likely to choose a termination of pregnancy. The termination of pregnancy group were also more likely to be condom users, and to have learned about their method of contraception from school rather than from health care professionals. Teenagers' frequency of contact with family planning services suggested that teenagers choosing a termination were less likely than antenatal attenders to have attended regularly. This was mainly due to differences in behaviour among teenagers attending their general practitioner (GP) for contraceptive advice: teenagers having a termination were more likely to describe their visit to their GP as embarrassing. These findings have implications for local family planning services attempting to reduce the number of unwanted teenage pregnancies.

Abortion, Induced↗