Biomedical subjects
Publications and source records attributed to T S Murray.
The educational credits obtained by general practitioners for the postgraduate education allowance were examined. With over 3 months of the qualifying period remaining, 68.4% had reached the requirement. The educational day attainments show almost a normal distribution, with 4.2% of doctors completing more than double the requirement.
A retrospective analysis of the opinions of vocationally trained doctors was obtained from a postal questionnaire. Ninety-eight doctors who had trained in the West of Scotland before the introduction of new criteria in 1985 for the appointment and reappointment of training practices were compared with 107 doctors who had trained following the introduction of the criteria, looking at their rating of training, the frequency of tutorials, value of teaching and research encouragement. There was a significant improvement in the rating of training, frequency of tutorials, research encouragement and enjoyment of training in the group who trained after the new criteria were adopted. The study demonstrates the benefits of vocational training for general practice when criteria are set and followed. This training model may be applicable in other branches of medicine.
A study was undertaken to investigate the number of doctors attending postgraduate education courses outwith their own region. During the one year study period general practitioners from the west of Scotland obtained 2262.0 half-day sessions accredited for the postgraduate education allowance from 335 different courses outwith their region and 10 different distance learning programmes. Four hundred and thirteen doctors from the west of Scotland region (22.6%) attended courses in other areas and 85 doctors (4.6%) participated in 258.6 half-days of distance learning. More than half of the education sessions (56.0%) were in the category of disease management. Sixty four doctors (3.5%) attended 10 or more half-day sessions outwith their region. Almost half the courses were in England and 32.5% of courses were in south east Scotland. Over the same period 122 doctors outwith the area attended 263 different courses in the west of Scotland region. Despite concern regarding the removal of travel and subsistence contributions for postgraduate education activities, general practitioners are attending education courses outwith their region.
A comparison of accredited education sessions attended by general practitioners in the West of Scotland during 1990-91, the first year of the postgraduate education allowance, and during the previous year is presented. During 1990-91 the mean number of half day sessions attended by each practitioner was 14.0. This is an increase of 36% over the number (10.3) attended during the previous year. The mean number of days attended during 1990-91 includes 5.5 devoted to disease management, 4.4 to service management, and 4.1 to health promotion. Eighty five per cent of practitioners attended a full day devoted to disease management, 78% a full day devoted to service management, and 72% to full day devoted to health promotion; 80% a day in two of these three categories, and 57% a day in all three. The average attendance exceeds the requirement of the new contract. The great majority of practitioners in the Region appear to be achieving the spread of attendance over the three categories required by the regulations.
The characteristics of general practitioners in the west of Scotland who are high attenders at meetings accredited for the postgraduate education allowance were studied. One hundred and seventy one principals in general practice (9.5%) had attended more than 35 half-day sessions of accredited education between 1 April 1989 and 31 December 1990 and 34 doctors (1.9%) had attended more than 45 half-day sessions. The highest percentage of the doctors worked in Greater Glasgow and Lanarkshire. The doctors who were high attenders were relatively more likely to be women, to be members of the Royal College of General Practitioners and to work in a training practice. The majority of the doctors had been qualified for between 10 and 30 years and worked in group practices of three or more doctors. The characteristics of high attenders contrast markedly to doctors who are low attenders. That there were such a large number of high attenders at educational meetings is encouraging.
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OBJECTIVE: To assess the career paths of doctors who completed vocational training in the west of Scotland between 1968 and 1987 and their views on the hospital component of their training. DESIGN: Retrospective analysis of the experience and opinions of vocationally trained doctors obtained from a postal questionnaire. SETTING: West of Scotland. SUBJECTS: 1255 Doctors identified from Glasgow University records who had been vocationally trained in the west of Scotland between 1968 and 1987. MAIN OUTCOME MEASURES: Personal details; employment; jobs held currently; additional professional commitments; importance of hospital posts held in various specialties to respondents currently in general practice; and retrospective choice of hospital posts, based on subsequent experience. RESULTS: 619 Responses were received, 543 initially and 76 after a letter of reminder, from a possible total of 974 (excluding 153 questionnaires returned by the post office and 128 returned because of misunderstanding between the name and address); the overall response rate was therefore 64%. 607/619 (98%) Respondents were employed at the time of the study, of whom 517/607 (85%) were in general practice. A third (202/609) had been unemployed at some point, significantly more of them women (122/243, 50% v 80/376, 21%; chi 2 = 54.8, p less than 0.001). 510/563 (91%) Respondents held one postgraduate qualification or more, and 284/612 (46%) had additional professional commitments. The hospital posts most commonly held were in obstetrics and gynaecology, psychiatry, paediatrics, and medicine. Medicine, obstetrics, paediatrics, and dermatology were considered to be the most relevant hospital specialties by those who had experience of them and were now in general practice. Although ophthalmology and ear, nose, and throat were not rated highly by these doctors, other respondents wished that they had held posts in these specialties (32 and 40 respectively). During the hospital training 354/475 (75%) respondents thought that they were looked on as a junior hospital doctor and not as a trainee for general practice. CONCLUSIONS: Most of those who had entered vocational training were in employment, and most were in general practice. According to them, the most beneficial hospital posts for vocational training are medicine, obstetrics, paediatrics, and dermatology. Trainees should be encouraged to attend clinics in gynaecology, ear, nose, and throat, and ophthalmology.
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A retrospective analysis of the experience and opinions of doctors receiving vocational training in general practice was obtained by postal questionnaire. Questionnaires were received by 974 doctors who had been vocationally trained in the west of Scotland between 1968 and 1987. The response rate was 64%. It was found that 94% of the respondents had enjoyed their trainee period, 82% had been given a choice of training practice and 86% had spent 12 months in a training practice. Only 81 respondents had trained in two practices. The most common method of monitoring the trainee's consultation was the trainer sitting in on the consultation; half of the doctors had experience of this (51%). For the majority regular tutorials were commonplace, but for 41% of respondents this was not so. However, those training after 1979 were significantly less likely to have never had tutorials than those training earlier. Nearly half of the doctors (49%) felt that certain aspects had been poorly covered or omitted from their training, notably practice management and finance. Again, this was significantly less likely among those training after 1979. When asked to give a rating of the training they had received 21% of the respondents rated it as excellent, 37% as very good, 30% as fairly good and 12% as poor/fairly poor or very poor. Notably, significantly fewer respondents training after 1979 rated their training as poor/fairly poor or very poor. Very few respondents had participated in a practice exchange but virtually all of those who had felt it had been beneficial.(ABSTRACT TRUNCATED AT 250 WORDS)
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A survey of 12,425 trainee consultations is reported. Chronic illness only constituted 19.4% of their workload. The greatest number of consultations occurred with younger patients in the 20-30 age group. Only a small proportion of consultations involved anticipatory care and health education (0.3% and 1.1% of total workload respectively). Women patients showed a strong preference to consult a female doctor with twice as many seeing a lady trainee in preference to a male doctor. The study has implications for teaching and learning during the trainee year in general practice.
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A postal questionnaire was sent to all 140 trainers in the west of Scotland region and to the 102 trainees who had completed their training three months prior to the survey. The aim of the study was to identify the types of trainee assessment in use, the proportion of trainers using the various methods, the attitudes of trainers and trainees to the assessment methods employed, and their views on a regional assessment programme. Response rates of 89% for trainers and 71% for trainees were obtained. Almost all respondents reported the use of some from of assessment. The mean number of assessment types reported by trainees was 3.7 and by trainers 5.2. The most commonly used method was videotaping of trainee consultations, used by 76% of respondents, and the least common the use of hard data, for example prescribing statistics or referral rates. Videotaping was also rated the most useful method by both groups. Those with experience of the assessment methods gave them a higher score for usefulness than those without such experience. Approximately half of the respondents favoured a regional protocol for assessment. This study has shown that if trainers and trainees can be encouraged to use assessment methods they will find them helpful. However, universal assessment will only become a reality when it becomes a requirement for accreditation as a trainer.
Nifedipine has been used in hypertension, mainly as a third-line drug for rapid blood pressure reduction, for over 10 years. More recently it has been shown to be effective and safe in reducing mild to moderate blood pressure when used alone in a slow release formulation. A placebo-controlled study investigating the efficacy and safety of nifedipine in comparison with cyclopenthiazide-potassium has now been carried out by 4 general practitioners in the Glasgow area. Ninety-four patients were entered into the study. After a 4-week placebo run-in phase, patients were randomly allocated to receive either slow-release nifedipine 20 mg b.d., or cyclopenthiazide 0.25 mg with 8.1 mmol potassium daily. The dose was doubled at week 8 for non-responders, and at week 12 the alternative drug was added if there was still no response. The patients were studied for up to 28 weeks. Nifedipine was found to have similar blood pressure lowering efficacy to cyclopenthiazide-potassium, but withdrawals from nifedipine due to side-effects at an early stage were more common.
A new approach to continuing medical education by distance learning has been implemented. A series of six patient-management problems or challenges were posted to 20 000 doctors throughout Britain. Each doctor had to decide on the diagnosis, investigations, and treatment of the patients described. The challenges covered problems that were important in the doctor's day-to-day work and were designed so that he could obtain immediate feedback about his decisions and compare his own responses with those of a specialist and those of his colleagues. Additional information was available by telephone and by post on request. The series has been well received and is being widely used.
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Recording booklets have been introduced for students during their course of general practice teaching at the University of Glasgow. The booklets guide the students with patients in the community who have chronic and complicated diseases. Each case history in the booklet was marked and this provided an evaluation of the teaching. This showed an improvement in the students' overall ability but was most marked in the areas of social history and problem list, thus fulfilling the aims of the teaching.
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