Undergraduate general practice

Covid-19 

Considering the challenge and uncertainty posed by Covid-19, undergraduate general practice has been severely affected, with many community placements being cancelled across the UK. RCGP and SAPC believe it is important that medical students are provided with support and resource to further their learning at this time and have decided to accelerate the publication of their most recent work entitled ‘Learning general practice’ a comprehensive learning and teaching aid for medical students and GP tutors alike. Below you’ll find examples of this work which can be used during these difficult times. Please note, these resources are in draft form, further work is required to ensure the resource is complete ahead of August 2020. Despite not being complete, the resources on offer are comprehensive and will provide valuable learning opportunities for medical students at this time. Further examples of good practice and self-directed learning resources for medical students can be found below.

If you have any queries or questions regarding the resources on offer, please contact Prof. Joe Rosenthal or Prof. Alex Harding, Co-Chairs of SAPC’s Heads of GP Teaching Group. 

If you have any queries regarding Covid-19 specifically, please email Covid19@rcgp.org.uk or refer to our dedicated web page.


Guiding principles for undergraduate general practice in the UK

General practice underpins the whole of our National Health Service, making the greatest proportion of patient contacts and providing essential continuity by holding patients' medical records for their life course. Now more than ever we need to promote the expert medical generalist role as we plan for the future. To paraphrase the Chief Executive of NHS England, Simon Stevens, 'there is arguably no more important role in modern Britain than that of the family doctor.'

Medical schools have a responsibility to educate and prepare approximately half of all their graduates for careers in general practice - this guide shows how best to place emphasis on teaching and promoting general practice as a career which is professionally and intellectually rewarding. It has been consciously aligned to the 'By Choice - not by chance' report which was produced by HEE/MSC in 2016, and is a forward-looking document, describing guiding curriculum principles that will take medical students forward into healthcare for the next decade and beyond.

The Society for Academic Primary Care (SAPC) and the Royal College of General Practitioners (RCGP) have collaborated to produce this guidance on the design and delivery of general practice learning and teaching in UK medical schools.

The guidance is based on published evidence and current best practice in UK medical schools and has been refined through consultation with the Medical Schools Council (MSC), General Medical Council (GMC) and the MRCGP Curriculum Development Group. It aims to support implementation of the recommendations of the recent Health Education England (HEE) and the Medical Schools Council 'By choice - not by chance' report on raising the profile of general practice at medical schools.

It does not propose a one-size-fits-all curriculum or syllabus, but rather a set of guiding principles providing ample space for individual undergraduate programmes to adapt and innovate. We recommend that medical schools use this document to inform thinking around the quantity, content and process of general practice teaching, both on placements and on campus. This process should integrate with local medical school curricula and also broader GMC curriculum outcomes.


Curriculum development process

Curriculum development is an ongoing and active process involving meaningful interaction between teachers and students in a continuous cycle of quality improvement. Therefore, in generating this guidance we have: 

  1. Undertaken an extensive review of the literature relevant to curriculum development in classroom and work-based learning contexts. 
  2. Consulted and debated widely within the general practice teaching community, with regular meetings at a national level where curriculum is discussed to gain consensus of curriculum content and delivery methods.
  3. Reviewed curriculum documents from all UK medical schools, outlining what is currently taught in or about general practice and how it is taught. 

Our guidance does not cover principles of assessment, not least because a national licensing exam is currently under development. However, following widely adopted educational principles this curriculum document is fully amenable to mapping onto assessment criteria.

These undergraduate guidelines aim to complement guidance offered in the RCGP curriculum for postgraduate general practice training. They are also informed by an extensive BEME systematic review of UK undergraduate medical education in general practice settings. We see this guidance very much as a starting point for further development and continuing debate.


A framework for undergraduate teaching

For the purpose of undergraduate learning we define general practice as follows:

General practice comprises the practical and scholarly aspects of delivering highly effective personalised care to individuals, their families and populations in primary care and community settings.

This simple, working definition encompasses three broad areas of enquiry that can be delivered in both university and work-based placement contexts:

  1. Person-centred care
  2. Population-centred care
  3. Effective delivery of care

Teaching general practice - guiding principles for undergraduate general practice in the UK [PDF]


Learning and teaching principles 

General practice must work with all other disciplines to produce excellent generalist physicians guided primarily by the GMC’s Outcomes for Graduates. To practise effectively in the NHS, both RCGP and SAPC believe all graduates should understand the core elements of general practice, as outlined below.

Each of the following principles is complemented with a learning and teaching aid that aims to support medical students and GP tutors alike. Each resource aims to provide the following:

1. An introduction to the principle
2. A summary of the ‘need to know’ information
3. Examples of practical learning
4. Resource and references to further learning

The following resources have been developed in conjunction with SAPC Heads of GP Teaching.


Recommendations

Our resource aims to provide detailed guidance on the design, development and delivery of general practice learning and teaching at UK medical schools. It is based on best available evidence and wide consultation, including GP teaching leads at all UK medical schools. Whilst we believe that each school must have freedom to develop the details of its own general practice curriculum according to local circumstances, we urge all schools to consider the general principles outlined in this guidance. The need to provide sufficient quantity and quality of GP teaching must be addressed in order both to promote general practice as a positive career choice and to ensure that future hospital specialists are equipped to work in an increasingly community-based National Health Service. To this end we conclude with the following five specific recommendations:

  • All medical schools should review annually the balance they provide between clinical placements in general practice and in hospital, working towards a goal of delivering a minimum of 25% of their clinical placements in general practice.
  • A significant amount of dedicated general practice academic content should be delivered on medical school campus which should also be reinforced on clinical placements. This teaching should communicate the importance of scholarship, a generalist approach to medicine, and the rich research base of general practice.
  • General practice teaching should encompass three broad areas of enquiry:
  1. Person-centred care
  2. Population-centred care
  3. Providing care in a highly efficient way in community settings
  • General practice teaching, both in practice and on campus, should be provided by a range of GPs with different clinical and academic interests in order to demonstrate the breadth and depth of the discipline.
  • All medical school curricula should reflect the recommendations contained within the HEE/MSC 'By choice - not by chance' report on raising the profile of general practice at medical schools.

Further information

For more information on the guidance document or to receive a copy, please contact discovergp@rcgp.org.uk.

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