Objective Synthesise evidence about the impact of family medicine/general practice (FM) clerkships on undergraduate medical students, teaching general/family practitioners (FPs) and/or their patients. Data sources Medline, ERIC, PsycINFO, EMBASE and Web of Knowledge searched from 21 November to 17 December 2013. Primary, empirical, quantitative or qualitative studies, since 1990, with abstracts included. No country restrictions. Full text languages: English, French, Spanish, German, Dutch or Italian. Review methods Independent selection and data extraction by two authors using predefined data extraction fields, including Kirkpatrick’s levels for educational intervention outcomes, study quality indicators and Best Evidence Medical Education (BEME) strength of findings’ grades. Descriptive narrative synthesis applied. Results Sixty-four included articles: impact on students (48), teaching FPs (12) and patients (8). Sample sizes: 16-1095 students, 3-146 FPs and 94-2550 patients. Twenty-six studies evaluated at Kirkpatrick level 1, 26 at level 2 and 6 at level 3. Only one study achieved BEME’s grade 5. The majority was assessed as grade 4 (27) and 3 (33). Students reported satisfaction with content and process of teaching as well as learning in FM clerkships. They enhanced previous learning, and provided unique learning on dealing with common acute and chronic conditions, health maintenance, disease prevention, communication and problem-solving skills. Students’ attitudes towards FM were improved, but new or enhanced interest in FM careers did not persist without change after graduation. Teaching FPs reported increased job satisfaction and stimulation for professional development, but also increased workload and less productivity, depending on the setting. Overall, student’s presence and participation did not have a negative impact on patients. Conclusions Research quality on the impact of FM clerkships is still limited, yet across different settings and countries, positive impact is reported on students, FPs and patients. Future studies should involve different stakeholders, medical schools and countries, and use standardised and validated evaluation tools.

https://bmjopen.bmj.com/content/bmjopen/5/8/e008265.full.pdf

Impact of family medicine clerkships in undergraduate medical education: a systematic review

Background Hepatitis C is a common infection among injecting drug users and has important implications for general practice. Although several clinical guidelines concerning the infection have been published, their effectiveness has yet to be tested. Aim To assess the effectiveness of a general practicebased complex intervention to support the implementation of clinical guidelines for hepatitis C management among current or former drug users attending general practice. Design of study Cluster randomised controlled trial.

Hepatitis C infection among injecting drug users in general practice: a cluster randomised controlled trial of clinical guidelines' implementation

Objective: In Ireland, general practice is increasingly providing long-term care for injecting drug users, 62–81% of whom are infected with hepatitis C (HCV). Clinical guidelines for the management of HCV among drug users have recently been developed in Ireland, and this study aimed to describe HCV care among drug users attending general practice in the greater Dublin area, prior to the implementation of the clinical practice guidelines. Methods: The clinical records of 196 patients attending 25 general practices in the Eastern Regional Health Authority area of Ireland for methadone maintenance treatment were examined on site and anonymized data collected on HCV care processes. Results: Patients had been attending general practice for methadone maintenance treatment for a mean of 30.7 months, 72% were male and 51% had provided a urine sample testing positive for metabolites of drugs of abuse other than methadone in the previous 3 months. There was evidence that 77%, 69% and 60% had been screened for HCV, ...

Management of hepatitis C among drug users attending general practice in Ireland: baseline data from the Dublin area hepatitis C in general practice initiative.

Objective: Many individuals receiving methadone maintenance receive their treatment through their primary care provider. As many also drink alcohol excessively, there is a need to address alcohol use to improve health outcomes for these individuals. We examined problem alcohol use and its treatment among people attending primary care for methadone maintenance treatment, using baseline data from a feasibility study of an evidence-based complex intervention to improve care. Methods: Data on addiction care processes were collected by (1) reviewing clinical records (n = 129) of people who attended 16 general practices for methadone maintenance treatment and (2) administering structured questionnaires to both patients (n = 106) and general practitioners (GPs) (n = 15). Results: Clinical records indicated that 24 patients (19%) were screened for problem alcohol use in the 12 months prior to data collection, with problem alcohol use identified in 14 (58% of those screened, 11% of the full sample). Of those who h...

/pdf/psychosocial-interventions-for-problem-alcohol-use-in-2npzjg9xsa.pdf

Psychosocial Interventions for Problem Alcohol Use in Primary Care Settings (PINTA): Baseline Feasibility Data

Background: Across the UK, 13% of undergraduate medical education is undertaken in primary care (PC). Students value their experiences in this setting but uncertainty remains about the extent to which these placements influence their future practice. Aims: To explore the impact of PC based undergraduate medical education on the development of medical students and new doctors as clinicians, and on students’ preparedness for practice. Methods: Mixed method study across two UK medical schools. Focus groups and individual interviews with Year 5 medical students, Foundation Year 2 doctors and GP Specialty Trainees; online surveys of Year 5 medical students and Foundation Year 2 doctors. Results: PC placements play an important part in the development of all ‘apprentice’ doctors, not just those wanting to become GPs. They provide a high quality learning environment, where students can: gradually take on responsibility; build confidence; develop empathy in their approach to patient care; and gain underst...

Creating better doctors: exploring the value of learning medicine in primary care.

Despite the rapid advance of psychedelic science and possible translation of psychedelic therapy into the psychiatric clinic, very little is known about mental health service user attitudes. To explore mental health service user attitudes to psychedelics and psilocybin therapy. A questionnaire capturing demographics, diagnoses, previous psychedelic and other drug use, and attitudes to psychedelics and psilocybin therapy was distributed to mental health service users. Ninety-nine participants completed the survey (52% female, mean age 42 years). The majority (72%) supported further research, with 59% supporting psilocybin as a medical treatment. A total of 27% previously used recreational psilocybin, with a male preponderance (p = 0.01). Younger age groups, those with previous psychedelic experience, and those with non-religious beliefs were more likely to have favourable attitudes towards psilocybin. A total of 55% of the total sample would accept as a treatment if doctor recommended, whereas 20% would not. Fewer people with depression/anxiety had used recreational psychedelics (p = 0.03) but were more likely to support government funded studies (p = 0.02). A minority (5%) of people with conditions (psychosis and bipolar disorder) that could be exacerbated by psilocybin thought it would be useful for them. One fifth of the total sample viewed psychedelics as addictive and unsafe even under medical supervision. Concerns included fear of adverse effects, lack of knowledge, insufficient research, illegality, and relapse if medications were discontinued. The majority supported further research into psilocybin therapy. Younger people, those with previous recreational psychedelic experience, and those with non-religious beliefs were more likely to have favourable attitudes towards psilocybin therapy.

/pdf/psychedelic-perceptions-mental-health-service-user-attitudes-5qzowb432v.pdf

Psychedelic perceptions: mental health service user attitudes to psilocybin therapy

Background
Hepatitis C is a common infection among people who attend GPs for methadone maintenance treatment.

Guidelines for the management of hepatitis C in general practice: a semi-qualitative interview survey of GPs’ views regarding content and implementation

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.

Undergraduate medical students' experience in general practice.

It has been suggested that atypical emotional face processing strategies observed in autism may extend in milder form to the general population. We investigated the relationship between autistic traits (AT) and gaze behaviour in a neurotypical adult sample. Novel naturalistic videos featuring happy, fearful and neutral faces were first validated in a sample of 22 participants. A separate sample of participants (N = 67) then viewed the three videos in counterbalanced order. Eye-tracking data showed that participants looked longer at emotional than neutral faces, and exploration of facial features varied with emotional condition. AT did not influence viewing patterns, time to first fixation or number of early fixations. We conclude that AT in the general population do not affect visual processing of emotional faces.

Yazeed Kelly

Papers

Psychedelic perceptions: mental health service user attitudes to psilocybin therapy

Guidelines for the management of hepatitis C in general practice: a semi-qualitative interview survey of GPs’ views regarding content and implementation

Undergraduate medical students' experience in general practice.

Autistic Traits Do Not Affect Emotional Face Processing in a General Population Sample