Biomedical subjects
T S Murray
Publications and source records attributed to T S Murray.
An experiment in problem-based learning.
Problem-solving skills are important for medical students and problem-based learning (PBL) is especially suited to general practice. Therefore an experiment using a form of PBL was introduced into a new 4-week course in general practice for final rotation students at the University of Glasgow in the session 1992-93. The experiment aimed to introduce students to an alternative method of learning to the traditional one previously used by them in their course, to encourage teamwork and to encourage the use of alternative methods of obtaining information. The method, centred around allowing the students to investigate problems they choose themselves, is described. The evaluation of the course by written standard form, free written comments and audiotape recorded interviews with a one in four sample of the class is presented. The students selected many interesting problems and used many different and unusual sources of information in researching them. This method of learning was compared with the parallel lecture course and was thought by the students to be more interesting but less relevant than the lecture course. The experiment showed that it is possible to introduce a problem-based form of learning into a new course in parallel with more traditional methods of teaching and for it to be at least partially successful for students much more used to a traditional didactic curriculum. Ways of improving the course in the future to make it more sensitive to the students' learning needs are discussed.
An innovative course: 'vers l'Europe 1992'.
A course in using French in the consultation is described. This proved a popular exercise with many general practitioners wishing to attend. A previous knowledge of French was essential for acceptance. The course consisted of 10 meetings with homework. Both formal and informal assessment of the course showed the success both from a group and an individual point of view.
Coordinating and standardizing long-term care: evaluation of the west of Scotland shared-care scheme for hypertension.
BACKGROUND: The long-term management of patients with chronic conditions such as hypertension presents problems for the health services. Shared care addresses these by coordinating care and defining responsibilities. AIM: This study set out to investigate the feasibility, acceptability and cost effectiveness of shared general practitioner-hospital care for well-controlled hypertensive patients in an urban area by comparing three matched groups of patients. METHOD: A total of 554 outpatient clinic attenders, considered suitable for shared care by their consultant, were randomly allocated to shared care or follow up in the outpatient clinic; a third group of 277 patients was selected from a nurse practitioner clinic. Main outcome measures were the proportion of patients in the second year of follow up who had undergone a complete review (blood pressure measurement, serum creatinine level result and electrocardiograph report), acceptability to patients and general practitioners as assessed by questionnaire, and cost per complete review in year two (National Health Service and patient costs). RESULTS: After two years 220 (82%) shared care patients had had a complete review compared with 146 (54%) outpatient clinic attenders and 202 (75%) nurse practitioner clinic attenders. Blood pressure control was similar in each group. Of 297 general practitioners invited, 85% wished to participate in the study; 61% of questionnaire respondents subsequently wanted shared care to continue while 25% were unsure. Half of the patients receiving shared care preferred this method of follow up. The rank order of cost-effectiveness ratios was shared care, nurse practitioner care and conventional outpatient care, relative differences being most marked when only patient costs were considered. CONCLUSION: Shared care for hypertension is feasible in an urban setting, acceptable to the majority of participants and is a cost-effective method of long-term follow up.
General practitioners' views on continuing medical education.
BACKGROUND: The 1990 contract for general practitioners altered the provision of continuing medical education. AIM: This study set out to examine doctors' experiences of postgraduate education before and after the contract and their preferences for the provision of postgraduate education. METHOD: In 1991 a structured questionnaire was sent to 1959 doctors registered on the database held by the west of Scotland postgraduate office. RESULTS: An 82% response rate was obtained. Eighty eight questionnaires had to be excluded. Of 1523 respondents, 74% were entitled to study leave under the terms of their practice agreement, an increase of 15% since the introduction of the contract. When attending courses 11% reported that they always employed a locum (32% occasionally). Those who did so were more likely to be general practitioners in rural areas than in urban or mixed areas. Almost all respondents (1485, 98%) had participated in postgraduate education since April 1990. Lectures remained popular (47% of respondents indicated it was their preferred or most preferred choice) while distance learning and practice based learning were least preferred. Evening meetings and afternoon meetings were the most popular, and Wednesday and Thursday were reported to be the most suitable days for educational meetings. CONCLUSION: Organizing education for a large number of people is difficult, but individuals' preferences and difficulties have emerged which must be taken into account when doing so. In terms of attendance, postgraduate education seems to have been a success although its value in influencing quality of care is more doubtful. Perhaps the development of personal education plans may make learning more useful and relevant.
Leicester assessment package.
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Pass rate in MRCGP examination. Depends on selection of candidates.
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General practitioners' performance.
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Survey of minor surgery in general practice in the west of Scotland.
Since April 1990 certain minor surgical procedures have attracted an item-of-service payment for general practitioners (GPs). A postal survey was undertaken to obtain information about minor surgery in general practice in the West of Scotland and to find out whether further postgraduate education is required in this field. From a random stratified sample of 356 GPs, 311 (87.4 per cent) responded. Practitioners on health board minor surgery lists have increased minor surgery activity since April 1990; they prefer to perform the less technically demanding and time-consuming procedures on the eligible list. It is concluded that there is scope for increasing postgraduate education in minor surgery for GPs.
Who are the providers of postgraduate medical education?
The view, background and motivation of providers of medical education was studied using a structured questionnaire which was sent to all those who organized courses for the Postgraduate Education Allowance in the West of Scotland. Two hundred and twenty-five replies were received from 254 course providers, giving an 88.6% response rate; 51.8% of course providers were general practitioners, 24.1% hospital consultants, 2% were from the pharmaceutical industry, 3.6% from commercial companies, 2.6% health board administrators, 1% general practitioners also running commercial companies, 14.9% others. Only 29.3% had training for organizing courses, although 68.7% thought special training was important. 43% used a combination of GPs and hospital consultants at their courses and a considerable number continued to organize lecture style courses. 32.8% used pre-course material and 50.7% used post-course assessment. 21.5% of providers had to provide their own secretarial back-up. The provision of continuing medical education is haphazard. The new contract has increased the amount of education available without addressing the needs of the providers. Proper training, planning and evaluation of courses, adequate funding, protected time and good secretarial back-up are required for good, meaningful and relevant continuing medical education.
Summative assessment: a pilot project in the west of Scotland.
In the autumn of 1991 the Committee in General Practice of the west of Scotland region appointed a working party to investigate the possibility of developing a credible, valid and reliable programme of summative assessment for general practitioner trainees. The working group formulated a four-part package consisting of a multiple true-false paper, a trainee audit project, the trainers' judgement, and analysis of videotaped consultations. The reasons for the use of this selection of methods are discussed. It is suggested that a summative assessment process for trainees should make use of the trainers' considerable knowledge of the trainee, have an external component, be criterion referenced, have an element of continuous assessment, and involve direct assessment of clinical competence. A pilot study of assessment of clinical competence using videotapes of routine trainee consultations by 25 volunteer general practitioner assessors is described. A rating instrument for use in differentiating the competent from the not yet competent trainee is discussed. The working group and the group of videotape assessors came to the provisional conclusion that the use of videotaped consultations may be a valid and feasible method of assessing the competence of general practitioner trainees as part of a balanced summative assessment programme.
Demographic characteristics of general practitioners attending educational meetings.
There are many factors which influence general practitioners' behaviour with regard to attendance at education meetings. The demographic characteristics of general practitioners in the west of Scotland attending educational meetings were studied over a two year period. A total of 1672 doctors had attended sufficient sessions to claim their postgraduate education allowance and of these 1551 (93%) responded to the questionnaire. Overall attendance at meetings did not vary between age groups, but older doctors (those born before 1935) attended the highest mean number of education sessions on disease management and the lowest mean number on service management and health promotion. Doctors in rural areas attended fewer meetings than those in urban areas with the largest difference in the disease management category. Doctors from smaller practices attended significantly fewer sessions on service management than those from larger practices. There was no difference between sexes regarding the mean total number of education sessions attended but men attended significantly more sessions on service management and women attended more on health promotion. Full-time doctors attended more service management sessions than part-time doctors. Those who were widowed or divorced attended fewer sessions in total, the differences being greatest in service management and health promotion. Multiple regression analysis showed that location of practice, whether working full time or part time and marital status had a small but statistically significant bearing on overall attendance at meetings. Although the differences are small, these factors should be noted by education providers, negotiators and government.
Postgraduate education allowance: educational attainment of subscribers and non-subscribers to a centrally organized educational scheme.
The educational attainment of general practitioners in the west of Scotland region who subscribed to a centrally organized educational scheme for the postgraduate education allowance was compared with that of their colleagues who did not subscribe to the scheme. During the year studied (1990-91) 1712 of the 1830 principals in general practice in the region had sufficient sessions to claim their postgraduate education allowance. Of these 1712 doctors the 1353 who subscribed to the educational scheme attended a mean of 15.7 educational half day sessions during the study year in comparison with a mean of 12.5 half days attended by the 359 doctors who did not subscribe to the scheme. This difference was observed in all three categories of education--disease management, service management and health promotion--and was greatest in health promotion where subscribers attended a mean of 4.7 half days and non-subscribers 3.1. The doctors who were members of the scheme had achieved a better balance of education. A higher number had attended an educational day in each of the three categories, with the increase being 10.5% for subscribers versus non-subscribers for disease management, 20.0% for service management and 39.1% for health promotion. The differences between the two groups were greater for combinations of categories and 66.6% of subscribers had attended an educational day in each of the three categories compared with 40.9% of non-subscribers. A centrally organized educational scheme for a region can give a balanced spread of education and is likely to meet the educational requirements of the new contract for general practitioners.
Continuing medical education and the education allowance: variation in credits obtained by general practitioners.
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.
An assessment of vocational training.
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.
Postgraduate education allowance: general practitioners' attendance at courses outwith their region.
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.
Postgraduate education allowance: a regional analysis of the first year.
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.
Characteristics of general practitioners who are high attenders at educational meetings.
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.