Irish Journal of Medical Science ⢠Volume 173 ⢠Number 1. Introduction. A recent trend in undergraduate medical education is the recognition of general practice ...
Undergraduate medical students’ experience in general practice
Undergraduate medical students’ experience in general practice W Cullen, D Langton, Y Kelly, G Bury Department of General Practice, University College Dublin, Coombe Healthcare Centre, Dublin, Ireland
Abstract Background Increasingly, undergraduate medical education is becoming community-based. Logbooks are a useful tool in documenting the range of clinical exposure and learning opportunities available to students during clinical training, particularly where the role of new clinical settings for training medical students is being explored. Aims To describe the clinical experience of medical students during an undergraduate programme in general practice at an Irish University. Methods Medical students in the fifth year of medical school were asked to record data from 20 consecutive consultations during a clinical attachment in general practice. Results A total of 186 students (82% of total) recorded data on 3,710 consultations. The patient population encountered was similar in demography and morbidity profile to other general practice populations, with hypertension, preventive immunisation and cough the most frequently encountered diagnostic labels. Respiratory illness and circulatory illness were the most frequently encountered primary and secondary presentations, respectively. An active role was adopted by students in almost half of all consultations. Conclusions This paper provides evidence that general practice in Ireland is a setting in which medical students can both encounter a wide range of clinical problems and engage in active learning processes.
Introduction A recent trend in undergraduate medical education is the recognition of general practice as an appropriate setting in which to train doctors.1 The role of general practice has expanded and developed, with several medical schools re p o rting undergraduate teaching that is increasingly community based.2,3 Some authors suggest that the community be used as the principal setting for training doctors.4-7 In Ireland, a recent review of the country’s medical schools by the Medical Council has highlighted a lack of opportunities for students to learn medicine in the community, commenting that: "There has been little increase in community exposure for our students with many of the current generation of medical students experiencing only eight to ten days in general practice throughout their entire medical course … the council considers this inadequate."8 Logbooks are established in tracking the activities of students9 and provide a feedback loop for programme planners, ensuring that students are exposed to a suitable range of clinical problems and learning opportunities.10-13 They can help focus students on important learning objectives,14 provide opportunities for continuous assessment and encourage immediate and ongoing interaction between tutors and students.15 It is possible that logbooks, as summary clinical records, may be an important source of epidemiological data. This paper aims to describe the clinical experience of medical students, using student logbooks, during an undergraduate clinical attachment in general practice at an Irish university.
Methods Setting The undergraduate medical degree course at University College Dublin is delivered over six academic years, with the current curriculum divided into preclinical (years one to four inclusive) 30
and clinical (years five and six). During the first year of clinical studies, students are required to complete a lecture course and clinical placement in general practice. The satisfactory completion of both is required before students can sit for university examination in the subject. The Department of General Practice has been responsible for delivering this course since 1991. Core elements include the nature of general practice, communication skills, chronic disease management, the impact of social factors on health, psychology and health, and commonly encountered clinical problems. The course material has traditionally been delivered in lectures to the whole class. In addition, the department has used small group teaching, facilitated by a departmental teaching staff member (two days) and individualised teaching with a GP tutor (eight days), with the latter taking place at the surgery or clinic of one of the department’s panel of tutors. One student is assigned to a GP tutor’s practice at a time. Although the department has tutors practising throughout Ireland, the majority practise in the largest health region — the Eastern Regional Health Authority area (see Table 1). On the final day of their attachment, students attend for a morning of small group teaching. During this session, a member of the departmental teaching staff facilitates a group discussion on the group’s collective experience of the clinical placement. Students are provided with a logbook at the start of each placement and asked to record anonymised data on the first 20 consecutive patients they see from 9am on the fifth morning of the placement. They are encouraged to discuss the content of the log with their tutor and are required to present a summary of the logbook data during the small group feedback session. An academic member of staff facilitates a group discussion on the issues arising from the student presentations, with common themes including the heterogeneous nature of general practice Irish Journal of Medical Science • Volume 173 • Number 1
W Cullen et al
Table 1. Tutor panel composition (by area) during study period Health board area of practice
No. of tutors
No. of students completing placement
19 20 15 6 5 6 2 9 2 4
68 61 56 7 8 6 3 11 2 5
Eastern Regional Health Authority Area (East Coast Area Health Board) Eastern Regional Health Authority Area (Northern Area Health Board) Eastern Regional Health Authority Area (South Western Area Health Board) Midland Health Board Midwest Health Board North Eastern Health Board North Western Health Board South Eastern Health Board Southern Health Board Western Health Board
Table 2. Age distribution of patients and number of consultations encountered by students Age category
Age group
No. of consultations (% of total)
Paediatric (aged
