Medical Education Capacity in General Practice in Scotland Working Group: interim report

Annex 2: General Practice teaching models across institutions

University of Aberdeen

• General Practice teaching is integrated into the year 1 and 2 curriculum within small-group teaching session taught by GPs in their own practices, focussed on case based learning and digital remote consultations. It includes school visits and an inequality teaching session.
• Year 3 includes a recently developed preclinical General Practice course delivered by 22 GP tutors. This covers a range of activities designed to prepare the students for their General Practice clinical placements.
• All Year 4 students have five weeks placed in General Practice surgeries across three Health Boards and Year 5 students have seven weeks placed in General Practice across seven Health Boards. These placements have been under pressure from other programmes in addition to other capacity challenges. Final year General Practice placement length is being reduced from seven weeks to four weeks, offset by a new dedicated General Practice teaching centre. This will be subject to NES funding decisions, due shortly. New resilient models of placements have taken place, notably in Shetland, working with the local Board and Director of Medical Education.
• Students are also exposed to General Practice during student selected components (SSCs), electives and specialty choices including out of hours. GPs are significantly involved in admissions, assessment, objective structured clinical examinations (OSCEs) and open days.

University of Dundee

• Students at the University of Dundee have exposure to GPs and teaching in General Practice across all five years of the curriculum.
• Years 1-3 are mainly campus based with one afternoon per week protected for General Practice teaching. It blends sessions with GP tutors, GP/primary care led workshops and experiences within the community e.g. visiting patients in their own homes (patient journey) or Primary Schools or General Practice clinical placements. Primary care teaching content runs in parallel with the MBChB Years 1-3 systems-based teaching.
• In parallel, mainly in Years 1-3 but with some sessions in Years 4 and 5, clinical communication skills (CCS) is led by the General Practice team and mainly delivered via GPs. There are supplementary options for SSCs which are primary care clinician led in Years 2, 3 and 5.
• Years 4 and 5 have placement-based General Practice blocks totalling four weeks each at a time. Year 4 commences with a transition block of two weeks to which General Practice also contributes. Within the clinical blocks, arrangements are made for an out of hours General Practice session.
• Complementing this, the School of Medicine employs integrated teachers (IT) who deliver sessions throughout Years 1-5 on a variety of topics. However, whilst many are GPs, the Year 4 ITs are all GPs specifically, to allow for integrated coverage of topics whilst Year 4 are on clinical placements of any nature; examples of topics covered: multi-morbidity, complex consultations, prescribing, journal club.
• Overall, General Practice contribution currently represents ~20% of the contribution to the medical curriculum. General Practice placements are spread across six Health Boards and delivered via ~100 practices.

University of Edinburgh & HCP-Med

• Students at the University of Edinburgh, on the undergraduate MBChB course have exposure to GPs and teaching in General Practice across five years of the six-year curriculum. This starts with group work and meeting a patient in their own home in first year and then in second year being based in a practice to learn basic examination and consultation skills. Third year is an intercalated year in Edinburgh and around 15 students a year undertake a BMed Sci degree in primary care. In Year 4 as the students rotate through clinical placements, they have two four-week clinical placements in the same GP practice and in Year 6 have a further four-week placement in a different practice with very small numbers undertaking a remote placement. There is also a central teaching team who organise and teach the students in most of these years including communication and case-based tutorials. Recent innovations include working with NHS Lothian to provide placements in other community settings including out of hours General Practice and long-term care facilities. This includes a degree of overlap between primary and secondary care teaching.
• Additionally, there is the HCP-med course when trained healthcare professionals can undertake a medical degree. These students work part-time for the first three years and are based in a GP practice for tutorials and clinical sessions. This is year-round in years 1 and 2 of the course and then a 10-week community placement in Year 3. These students join the main cohort for their Year 4 and have a further 4-week GP placement in Year 5.
• Overall, General Practice contribution currently represents about 10% of the contribution to the medical curriculum (HCP excluded). General Practice placements are spread mainly across 2 Health Boards, NHS Lothian and NHS Borders (with the exception of HCP placements and the self-selected rural placements in Year 6). This is about 100 GP Practices. However, this may change with an ongoing curriculum review and increased funding pressures.

University of Glasgow

• Students at the University of Glasgow have exposure to GPs and teaching in General Practice across all five years of the curriculum.
• In the early years, this is mostly campus-based teaching delivered by GP tutors. There is some early clinical contact with GPs in practices.
• Third year students undertake clinical practice in the community, a practice-based General Practice attachment over four days. From the second part of third year onwards, students rotate through hospital and General Practice placements with General Practice currently comprising five weeks of this teaching.
• Complementing this, GPs are often involved in teaching communication and clinical skills and delivering case-based virtual tutorials.
• Most recent innovations include introduction of teaching in out of hours General Practice and development of a number of digital innovations to enhance learning in and about General Practice.
• In 2018, Glasgow introduced the Community Oriented Medical Experience Track (COMET) programme which provides up to 30 students per year with the opportunity to experience an enhanced, immersive experience in General Practice. This augmented the portfolio of SSCs available to students.
• Overall, General Practice contribution currently represents 10% of the contribution to the medical curriculum. General Practice placements are spread across six Health Boards and delivered via over 200 practices and 300 educators. However, this may change with an ongoing curriculum review and increased funding pressures.

University of St Andrews – Scottish Graduate Entry Medicine (ScotGEM) and Scottish Community Orientated Medicine (ScotCOM)

• Students at the University of St Andrews have exposure to GPs and community orientated teaching across all years of the BSc (Hons) and across the five years of the new MBChB (ScotCOM) curriculum.
• In the early years, this is campus-based teaching delivered by GP tutors, and early clinical contact in a range of community settings, including GP practices and community hospitals. In the later years this is more placement based, and for the MBChB in the Health Boards of NHS Fife, NHS Forth Valley and NHS Borders.
• MBChB (ScotCOM) is designed around community based clinical exposure, blended with secondary care placements, and is centred around a hub and spoke model; with the hub being a community hospital. The first graduates from the new ScotCOM model are expected to graduate in 2028.
• Overall, in phase one of the MBChB (i.e. for the BSc (Hons)), community placements form the majority of our clinical placement provision. Exact proportions for the MBChB overall will be calculated over time as the timetables for the later years evolve and are implemented, but high community representation is observed, compared to more traditional programmes.
• For ScotGEM, GP led teaching and experience is significant, as a remote and rural, generalist programme. In first and second year the Clinical Interactions Course is GP led with students also having a day a week in GP practice. In third year (longitudinal integrated clerkship) they spend the academic year based in a GP practice supported by a GP tutor (this year 83 placements in 62 practices). Their fourth (final year) is secondary care focused but some do General Practice SSCs/electives. Overall General Practice currently represents ~ 50% of the curriculum.
• These are the closest models to delivering a curriculum substantially based in General Practice — though serving relatively small student cohorts (55–70 per year).