Facilitators and barriers to teaching undergraduate medical students in general practice

Abstract

Introduction
Globally, primary healthcare is facing workforce shortages. Longer and higher quality placements in primary care increase the likelihood of medical students’ choosing this specialty. However, recruitment and retention of community primary care teachers is challenging. Relevant research is predominantly from the 1990s. We seek to understand contemporary facilitators and barriers for GP (general practitioner) 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 have recently stopped. We undertook NVIVO-assisted deductive and inductive thematic analysis of transcripts. COP theory was used to interpret data.

Results
COP theory illustrated that teachers negotiate membership of three communities of practice: clinical practice, the medical school and a community of teachers. Delivery of clinical care and teaching can be integrated or exist in tension. This can depend upon the positioning of teaching and teacher as central or peripheral to the clinical COP. Remuneration, workload, space and expansion of GP trainee numbers impact on this. Teachers did not identify strongly as members of the medical school or a teaching community. Perception of membership was be affected by medical school communication and support. We demonstrate gaps in medical school recruitment.

Discussion
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.