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Facilitators and barriers to teaching undergraduate medical students in general practice

Lookup NU author(s): Dr Hannah Marshall, Dr Hannah Randles, Professor Hugh Alberti



This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND).


© 2019 The Authors. Medical Education published by Association for the Study of Medical Education and John Wiley & Sons Ltd. Context: Globally, primary health care is facing workforce shortages. Longer and higher-quality placements in primary care increase the likelihood of medical students choosing this specialty. However, the recruitment and retention of community primary care teachers are challenging. Relevant research was predominantly carried out in the 1990s. We seek to understand contemporary facilitators and barriers to general practitioner (GP) engagement with undergraduate education. Communities of practice (CoP) theory offers a novel conceptualisation, which may be pertinent in other community-based teaching settings. Methods: Semi-structured interviews were undertaken with 24 GP teachers at four UK medical schools. We purposively sampled GPs new to teaching, established GP teachers and GPs who had recently stopped teaching. We undertook NVivo-assisted deductive and inductive thematic analysis of transcripts. We used CoP theory to interpret data. Results: Communities of practice theory illustrated that teachers negotiate membership of three CoPs: (i) clinical practice; (ii) the medical school, and (iii) teaching. The delivery of clinical care and teaching may be integrated or exist in tension. This can depend upon the positioning of the teaching and teacher as central or peripheral to the clinical CoP. Remuneration, workload, space and the expansion of GP trainee numbers impact on this. Teachers did not identify strongly as members of the medical school or a teaching community. Perceptions of membership were affected by medical school communication and support. The findings demonstrate gaps in medical school recruitment. Conclusions: This research demonstrates the marginalisation of primary care-based teaching and proposes a novel explanation rooted in CoP theory. Concepts including identity and membership may be pertinent to other community-based teaching settings. We recommend that medical schools review and broaden recruitment methods. Teacher retention may be improved by optimising the interface between medical schools and teachers, fostering a teaching community, increasing professional rewards for teaching involvement and altering medical school expectations of learning in primary care.

Publication metadata

Author(s): Barber JRG, Park SE, Jensen K, Marshall H, McDonald P, McKinley RK, Randles H, Alberti H

Publication type: Article

Publication status: Published

Journal: Medical Education

Year: 2019

Volume: 53

Issue: 8

Pages: 778-787

Print publication date: 01/08/2019

Online publication date: 23/04/2019

Acceptance date: 22/02/2019

Date deposited: 07/05/2019

ISSN (print): 0308-0110

ISSN (electronic): 1365-2923

Publisher: Wiley-Blackwell


DOI: 10.1111/medu.13882


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