Topics
GPs in training and specialists noted communication to be a central topic for students, especially structured conversation and consultation in primary care.
“And it’s not just about how do you do a good medical history, but also how do you handle someone who cannot get to the point? How do you treat people blowing up your office hours with their consultations? Not just this part of medical history, where you ask since when it started and where the pain is located. But also what do I do with someone who does not stop talking?” (F-4-CO)
Furthermore, a recurring topic requested by interviewees was common or widespread diseases in primary care. Here especially psychosomatic diseases were mentioned.
“When I started and my boss told me two thirds of consultations are of a psychic or psychosomatic background, I could not believe it really. But it is a lot and you have to deal with it.” (F-7-UK)
For somatic diseases, common diseases in primary care – such as back pain, high blood pressure or diabetes – as well as typical specialists’ diseases were mentioned. In case of ophthalmology, this was a cluster of diagnoses referring to the “red eye”, chronic or acute loss of sight as well as high sensibility towards light. Furthermore, the surgeons named hemorrhoids, acute abdomen and wound healing deficiency. Orthopedists described back pain to be common, as well as joint infections and traumatic injuries. Urologists mentioned bloody urine, urinary retention, urinary stones and prostatic diseases to be a recurring topic in primary care. The otorhinolaryngologists named ear pain, upper respiratory infections, sudden loss of hearing and other emergency treatments.
“And concerning treatment or primary care of various clinical pictures, I believe emergency treatment of this specialty needs to be a part of university teaching, because it also defines the intersection with other specialties. Even if you won’t be an otorhinolaryngologist you should definitely know how to treat a nose bleed, which are the key symptoms of an otitis media or of a peritonsillar abscess or of a beginning mastoiditis.“ (P-6-MS)
Most interviewees described both medical history and physical examination to be important aspects of existing curricular teaching, yet appealed for further highlighting and inclusion in extracurricular teachings.
“And medical history before the physical examination. (…) How can you reach the core of the problem with focused questions in a short timeframe? Here you can get lost easily and imagine the worst. But maybe you can break down the contact to what is mostly 10 or 15 minutes.” (F-6-JM)
Competences
Concerning competences, hard skills as well as soft skills were mentioned in the interviews.
Referring to soft skills, the interviewees considered empathy, personal commitment, listening, down-to-earthness and interest in continuous learning as important factors in primary care.
„A GP has to be humane. He has to care. In the end the patient must have the feeling that he is in good hands.” (P-7-SGa)
Of interest to all interviewees were the hard skills as well. Recurring topics were decision making and triage in primary care under the condition of limited time for consultation, which results in high need for attentiveness in patient care. To decide upon the necessity of specialist involvement, to detect banalities easily treated in practice instead of sending them to a special clinic with long wait and to detect red flags and dangerous adversive outcomes were the main hard skills mentioned.
“But this is a singular outstanding attribute of primary care. We are gatekeepers. Most patients we see do not have the most severe progression or any alarming red flags. But to sieve those that do, that is our duty. (…) The majority has a cough or cold and wants a sick leave from work. And those patients don’t believe their sickness to be threatening and neither do I, yet it is self-evident to check for any red flags nonetheless. And then the patient is content and happy to go home. But to always stay alert.” (F-3-FR)
Also being able to induce medical treatment and having good patient knowledge (including an understanding of their living situation and their medical knowledge) were considered as important hard skills in primary care.
“Well I would say he needs to know his people. That is something I know and value about good general practitioners in my environment. They can assess common settings and I think that is central, or important, to know where your patients are coming from. In cities that is a bit harder nowadays, compared to rural areas where you know the family and understand the context. But for me it is a very important aspect. To be able to assess a situation. Where does it come from? What is the context? This is a quality I would appreciate in a general practitioner.” (P-8-JBe)
Course structure
The interviews showed differences in course topics described, as specialists naturally described mostly topics of their own subject as important for GPs, such as an orthopedics course or a seminar on the red eye. One interviewed surgeon also suggested lessons on explaining important surgeries to patients. This course would, for example, help a GP explain not only the methods with which a specialist will treat an illness, but also help the GPs explain the width or consequences of a surgical treatment.
An interest in interprofessional cooperation as a course topic was expressed by one of the specialists.
One participant mentioned an existing course at the University of Marburg in which case reports or common diseases are worked up in groups to describe evidence-based treatment options and differential diagnostic procedures.
“Clinical Reasoning (...) A case report is presented together with differential diagnoses and therapeutic options. The case is not necessarily clarified in the end. You just follow. Well the teacher has to vary according to what the students answer and it is (.…) You start out with chest pain and in the end you get the idea of gastritis as a diagnosis and then you discuss the treatment options. It’s an interactive course and I loved it. You think about the case as one would in practice. And that’s the closest we can get to a first line patient consultation in primary care.” (F-1-HU)
Besides course topics also specific teaching methods were named. This included popular methods already existing in teaching modules in university, such as case reports, symptom-based learning and practical training (internships as well as learning practical skills at university).
On top of that, several GPs in training agreed that especially lessons with simulated patients had been a helpful method in their studies.
“You have to stay flexible in your thinking (….) A lesson with simulated patients and then there can be anything happening. To have patients that are not selected by subject beforehand. One has an itch without a cause. Another patient is the one-year-old infant with fever. Next comes the 90-year-old patient who hasn’t had a doctor’s visit in ten years and is to be treated palliatively. To portray this in University. A course with simulated patients that is as messy as family practice.” (F-1-HU)
In two interviews, interviewees described how role models in primary care influenced their career paths and expressed interest in implementing this into the curriculum.
“And what I always found especially exciting were the couch talks, where a random doctor came to talk about everyday life in practice. To me these personal topics were extremely important, to have a role model. Because with many specialties I thought: ‘Oh god, if you end up like this it’s over!’ And in general practice I met people where I thought: ‘Hey, this is pretty cool.’ And they invited me out for lunch during the internships and I thought that was… Well the personal aspect is so important to hang on. To have these role models and to get an insight beyond professional aspects to stay motivated, to say ‘I want to do this too.’” (F-3-FR)