Health inequalities education is increasingly recognised as essential in healthcare training, particularly for generalist and primary care practice, yet undergraduate provision is inconsistent, shallow and often tokenistic. Students report limited opportunities to apply learning meaningfully in clinical settings. This study explores healthcare students' experiences and preferences for pedagogy to inform curriculum development relevant to primary care. An online survey, informed by literature and student collaborators, collected data from 50 students across more than 10 healthcare programmes. Descriptive frequency analysis guided questions for a student-led virtual focus group (n = 5). Focus group data underwent reflective thematic analysis to identify pedagogical preferences transferable to primary care education. Most respondents (78%) agreed health inequalities education is relevant to future practice, and 86% wanted more teaching. Only 34% reported consistent coverage, and 56% felt teaching applied to clinical practice. Students strongly preferred hearing from patients and service users (92%) and favoured interactive formats over lectures. Thematic analysis revealed four insights: teaching often lacks authenticity; case scenarios risk reinforcing stereotypes; reflective practice and patient narratives enhance understanding; and educator preparedness and positionality influence learning. Students highlighted the need for practical skill development, authentic stories and safe, critically reflective learning spaces. Students want education to move beyond theoretical awareness towards application, reflection and authentic engagement. Optimal pedagogy should prioritise co-produced patient narratives, interactive learning, realistic scenarios, educator preparation and aligned assessment. Curriculum reform must focus on better design rather than more content, equipping students to address inequities in primary care.
Clinical reasoning is a critical skill for all healthcare practitioners. Learners aspiring to independent practice in primary care are further challenged where diagnostic uncertainty and patient preferences frequently intersect. This case study describes the assessment of a 72-year-old man presenting with unilateral leg swelling following total knee replacement. Although his Wells' score and a raised d-dimer suggested possible deep vein thrombosis (DVT), contextual evidence indicated that d-dimer levels remain elevated for weeks postoperatively. The patient also preferred to avoid unnecessary hospital visits. Through shared decision-making, safety netting and reflective clinical reasoning, the practitioner concluded that the presentation was most likely post-surgical swelling rather than acute DVT. This case highlights the challenges of balancing protocols with clinical judgement, the need to interpret diagnostic tests in context, and the value of communication skills in aligning management with patient preferences. Whilst the context of this case applies to the supervision of an advanced practitioner in primary care, the discussion considers implications for the education of all independent practitioners, particularly in consultation skills, interpreting evidence and clinical reasoning in the context of complexity.
BACKGROUND:Social prescribing involves connecting people to community-based resources to address non-medical determinants of health. Central to its delivery are link workers; their effectiveness depends, in part, on the availability and quality of training. Despite rapid expansion of the link worker role on an international scale, training provision for this workforce remains fragmented and poorly mapped. AIM:To identify and describe training programmes for link workers reported in the published and grey literature. METHODS:We followed the Joanna Briggs Institute methodology on scoping reviews. Six electronic databases were searched alongside targeted grey literature searching. Sources were included if they described or evaluated training specifically for link workers (or equivalent roles). Data were extracted on training characteristics, content, delivery, duration, assessment methods and costs and synthesised narratively. RESULTS:Sixty-four sources describing 39 training programmes were included. Most were delivered in the United Kingdom, with others identified in Canada, the United States of America, Singapore, Portugal, Ireland and Australia. Training varied widely in duration (2.5- 329 hours), delivery mode (predominantly online or blended), cost and stated objectives. Common content areas included communication skills, personalised care, understanding social prescribing systems, working with community resources/groups/organisations and managing personal boundaries and resilience. CONCLUSIONS:Training for link workers is inconsistently described, reflecting variation in role expectations and workforce backgrounds. While many core competencies were addressed across reviewed programmes, comprehensive and inclusive training offers remain limited. Future research should examine training effectiveness, learner experiences and the development of targeted content for marginalised populations.
INTRODUCTION:Combat Medical Technicians (CMTs) are central to military primary care but have limited opportunity for clinical exposure. Simulated patients offer a controlled method to maintain clinical currency. Advances in conversational artificial intelligence (AI) enable realistic and interactive simulated consultations. We present our evaluation of the feasibility, acceptability and educational impact of AI-simulated patients for CMT training. METHODS:Five military primary care simulated patients were developed and hosted on the SimFlow.ai platform and delivered during a development course. Participants completed pre- and post-simulation surveys assessing confidence across 12 clinical domains alongside perceptions of realism, usability and educational value. Quantitative analysis used Wilcoxon signed-rank tests and Spearman rank correlations. RESULTS:Twenty CMTs completed both simulations and surveys. Statistically significant improvements were observed in 10 of 12 clinical domains, including core consultation skills such as comprehensive history taking, identifying key symptoms, adapting questioning and formulating a management plan, and differential diagnoses (all p < 0.002). Evaluation of the simulations demonstrated positive perceptions of medical accuracy, patient narratives and overall educational value. Technical performance received mixed feedback, with response lags identified as the primary barrier. No associations were found between outcomes and CMT demographics which suggests equitable benefit across the cohort. CONCLUSION:AI-simulated patients are feasible to implement and are associated with meaningful improvements in consultation confidence among CMTs. Despite technical constraints, AI-simulated patients represent a scalable, standardised adjunct to support clinical currency across the CMT workforce. Further research should evaluate objective competence outcomes and explore broader uses of this technology.
The therapeutic value of history and physical examination has long been recognised but little evidence exists to support its teaching in the undergraduate context. This article describes demonstrating therapeutic examination to year four students at Brighton and Sussex Medical School. A student volunteer is invited to be the patient. The presentation is clearly marked as a 'middling case' of sore throat, i.e. one where the condition is painful but not dangerous. In this example I explain that the patient has a Centor score of 2-3 and that my examination seeks to be therapeutic to the patient and the GP. The demonstration highlights the importance of practical preparation (one's clinical equipment laid out), physical touch (e.g. starting with the hands/pulse as non-threatening), some 'technology' (e.g. pulse oximeter), demonstrating thoroughness and using reassuring language during the examination. Students are reminded that therapeutic examination may elicit important clinical signs, e.g. atrial fibrillation or hypertension. The session consistently receives positive quantitative and qualitative feedback. The latter reveals that some students would prefer teaching focused on specific diagnoses (rather than their absence). Here I present my own model of the 'craft' of general practice called TPAP: Trust built upon implementing the Process (history, examination, basic tests, incremental management etc), Art (thinking strategically) and Practice ('knowing one's tools') of medicine. Finally, this article considers the important notion of 'conserving clinical energy' and makes the claim that effort expended upon the physical examination reaps benefits later in the consultation and in forging long term therapeutic relationships.
The use of Generative Artificial intelligence (GenAI) in both health care and medical education has generated great excitement and a plethora of research. However, little work has been done in the area of undergraduate general practice education. We aimed therefore to explore the experiences and views of students and teachers of GenAI use in medical education. This was a multi-method UK study involving a national survey of GP heads of teaching, focus groups of medical students and interviews with GP teachers and heads of GP teaching. Interviews and focus groups were transcribed verbatim and thematically analysed. Only 5 of 19 GP heads of teaching (40% response rate) who responded report formal use of GenAI, with 11 of 19 reporting informal use within their institutions. Three overarching themes were constructed from the qualitative results. Firstly, positivity towards GenAI use: teachers and students demonstrated enthusiasm for generative AI, with improved efficiency and time-saving consistently identified as the most significant benefits across both groups. Secondly, concerns about GenAI use: these included inaccuracies, de-skilling, data protection and the environmental impact. Thirdly, a shared view that AI should complement rather than replace human expertise. Our study has revealed consensus between GP teachers and students acknowledging AI's unavoidable role in the future of medical education and healthcare, alongside a variety of challenges. A number of current uses are presented specific to the undergraduate GP education context. The underlying consensus emphasised complementing rather than replacing the doctor's role when implementing AI into practice.
WHAT WAS THE EDUCATIONAL CHALLENGE?:Primary care remains under-represented in undergraduate curricula, and academic general practice has limited visibility. Traditional educational forums such as 'Grand Rounds' rarely focus on general practice, reducing opportunities for students to explore the breadth, intellectual challenge, and diversity of contemporary GP careers. WHAT WAS THE EDUCATIONAL SOLUTION?:We developed an online primary care seminar series explicitly modelled on the 'Grand Round' format, but updated for a temporally and geographically flexible, learner-centred audience. Crucially, the series was co-produced with students and featured GPs and academic GPs presenting narrative-based accounts of innovative and evolving areas of primary care. Sessions were delivered live and made available asynchronously. WHAT LESSONS WERE LEARNED?:Survey and focus group feedback indicated that participants valued exposure to unfamiliar aspects of primary care, speakers' personal career narratives, and insight into portfolio and academic careers. The online format supported accessibility and broad participation, although some participants expressed a desire for greater interactivity. WHAT ARE THE NEXT STEPS?:Future iterations will refine opportunities for interaction, broaden topic coverage, and continue evaluation. Longer-term impacts on career decisions were not measured and represent a gap for future work.
BACKGROUND:Home and community visits are widely used in undergraduate primary care education, yet reported educational effects may combine objective performance with students' self-reported confidence, skills, or attitudes. AIM:To synthesise educational outcomes and learning mechanisms, and examine how measurement, supervision, and reflection shape interpretation. METHODS:A PRISMA-informed mixed-methods systematic review included 36 full-text studies. Quantitative measures were classified as objective or observer-assessed, validated or standardised self-report, or locally developed or unvalidated self-report; qualitative and mixed-methods data were analysed thematically. Visit delivery and reflective approaches were also extracted. RESULTS:One controlled study showed large improvements in objective functional-status knowledge (SMD 1.73, 95% CI 1.06-2.40) and observer-assessed OSCE performance (SMD 2.72, 95% CI 1.93-3.51). Most favourable findings for attitudes, teamwork, confidence, and perceived skills relied on self-report. Fifteen studies described clinician- or professional-accompanied visits, 13 student-led visits without a clinician physically present, and eight mixed or unclear arrangements; none directly compared these models. Empathy and patient-centredness were prominent in qualitative accounts but inconsistent on standardised scales. Detailed learning accounts most often came from structured written reflection followed by facilitated discussion or debriefing, although no reflective approach was compared directly. CONCLUSION:Home and community visits can support contextual and functional learning, but confidence in effects depends on how outcomes are measured. Supervision, narrative space, reflection, and assessment should be matched to the intended educational purpose.
Cultural models aim to support equitable and culturally meaningful healthcare. Cultural competence, cultural humility, and cultural safety are key examples of these models, equipping medical professionals with tools for effective patient care that extend beyond knowledge and skills. Importantly, the use of cultural models fosters an understanding that encourages individuals to reflect on how care is delivered. This reflective practice helps develop awareness of power imbalances and may contribute to reducing health inequities. The Traveller community, an indigenous ethnic minority with documented discrimination and excess health inequities, is an example of a group where culturally informed practice is essential. Limited research explores undergraduate medical students' understanding of cultural models generally or Traveller health as an example of culture specifically. In previous work completed by the authors, we identified an 'unlearning' needed in postgraduate medical training around cultural models and thus aimed to explore if this could be avoided at the undergraduate stage. We designed an educational workshop, and piloted delivery alongside a cultural mentor for the Northern Ireland Traveller community, to explore understanding of cultural models and cultural mentorship. Despite low engagement, feedback demonstrated that cultural mentorship and structured exploration of cultural models can prompt reflective learning among medical students. Participants identified a need for ongoing self-reflection when working with minority communities and highlighted gaps in prior knowledge of health amongst Traveller communities. Low uptake underscores challenges in attracting students to unfamiliar topics and in engagement with culturally informed education.
General practice placements are facing increasing pressure from global clinician shortages, rising workload and limited physical space. Meanwhile, medical school cohorts continue to expand to support the global clinician shortfall. This mismatch creates a growing bottleneck for authentic patient-based learning and has intensified interest in digital placement models of education. Livestreamed Clinical Experiences (LCEs) - real-time broadcast consultations between clinicians and patients - offer a potential way to extend access to clinical learning, increase exposure to diverse cases and enable participation by rural or underserved communities. However, despite growing interest, educators currently lack practical guidance on how to implement LCEs in general practice in ways that are ethically robust, technically feasible and pedagogically purposeful. Drawing from educator experience, literature and pilot data, we outline key practical considerations across five themes: planning and governance, technical setups, patient-centred consent, pedagogically purposeful delivery, and sustainable evaluation and scale-up. Our aim is to provide a concise, practice-oriented narrative reflecting what worked, what proved challenging and what may support others to implement effective LCEs. We include a practical implementation checklist and an LCE facilitation model to guide educators through the planning, ethical and technical stages of delivery.
General practice trainees are routinely encouraged to explore patients' psychosocial context as part of patient-centred care. However, educators frequently observe that this exploration can become superficial or formulaic, with questions about work, home life, or concerns functioning as tick-box exercises that do not meaningfully inform clinical decision making. Trainees may gather contextual information without understanding its relevance to patient priorities or to the development of tailored management plans.This article describes the use of IMP (Impact, Meaning, Priorities) as a practical educational intervention to support trainees in discovering psychosocial context with purpose. IMP provides a simple scaffold to help trainees explore how illness affects patients' lives (Impact), what personal significance patients attach to their symptoms (Meaning), and how this shapes what matters most to them at that point in time (Priorities). By foregrounding impact and meaning, IMP is intended to help illuminate patient priorities and support the creation of patient-centred, negotiated management plans.Drawing on established consultation models and informed by Helman's Folk Model of Illness, IMP has been used in GP training teaching sessions and simulated consultations as a complement to existing frameworks. This paper describes the educational rationale for IMP, outlines how it has been used in GP training and reflects on educators observations when used in teaching practice. It reflects on educators' observations regarding trainee confidence, depth of psychosocial exploration, and use of contextual information in clinical management.
INTRODUCTION:Programmatic assessment is being increasingly used in medical education with an expanding evidence base. The aim of the study was to explore student and teacher perspectives of a novel clinical, programmatic assessment model set within a Longitudinal Integrated Clerkship (LIC) across both primary and secondary care settings. METHODS:An explorative, interpretative approach was taken to explore participants' views and experiences of the assessments, including focus groups of undergraduate medical students and interviews of faculty. RESULTS:A total of 14 students participated in two focus groups and nine faculty members were interviewed: four based in primary care and five in secondary care. In general, the new assessment model was perceived by teachers and students to be a positive step, with both benefits and challenges highlighted. Three key themes emerged: the impact on student well-being was complex and variable; predominantly positive attitudes towards programmatic assessment; and challenges of exam practicalities. DISCUSSION:Our study has explored student and teachers' views of a novel, clinical, programmatic assessment; both sets of participants generally valued increased opportunities for feedback and positive impacts on well-being due to the reduced stress of lower-stakes assessments. However, there was some acknowledgement that it 'spread the stress' throughout the clinical year and that there were some challenges related to the introduction of a new form of assessment. We would commend this and similar forms of programmatic assessment to colleagues in other undergraduate healthcare professional institutions.
When patients cannot be reached yet risk exists, GP trainees must make proportionate safety decisions without the stabilising anchor of a live consultation. This 'unreachable patient' problem is common in results handling, radiology follow-up, medication monitoring, and safeguarding, but is rarely taught explicitly as a clinical skill. The Unreachable Patient Algorithm (UPA) is a structured educational intervention that trains trainees to treat reachability as a variable in clinical reasoning. It combines rapid risk stratification, a graded action ladder, and a documentation standard that supports confidentiality, accountability, and loop closure. Supervisors introduce a single trigger (for example, a critical laboratory alert, abnormal imaging report, or safeguarding concern) and ask trainees to state the risk tier, the minimum safe action, the escalation threshold, and the fallback plan if contact remains unsuccessful. Teaching occurs through inbox simulation, case-based tutorials, and supervised 'pause and plan' moments in real clinics. A one-page note template and brief portfolio prompts reinforce consistency across placements. Early reflections suggest trainees escalate more appropriately, write clearer contingency plans, and rely less on vague statements such as 'tried to call'. UPA is low-cost, fits routine GP training, and offers a replicable method to reduce avoidable harm when contact fails in practice.
AIM:To explore solutions and innovations implemented by medical schools in high-income countries to teach the general practice and primary care components within their medical programmes. METHODS:This qualitative study involved semi-structured interviews with academic leaders of general practice curricula at their medical school about the nature of their medical programme, how general practice is taught each year, specific longitudinal integrated clerkships, benefits to teaching, challenges to delivering the programme and solutions. Data were coded, categorised and themes developed in an inductive process. RESULTS:Interviews involved 44 medical schools: 16 Australian; 15 English; 6 Irish; 4 Canadian; 3 Nordic. Range of curricula from traditional to integrated, problem-based to spiral with undergraduate or postgraduate entry or both. Five themes were developed: curriculum organisation; non-clinical patient engagement; authentic GP experiences; exposure to GP teacher role-models; simulation and information technology. DISCUSSION:How the general practice curriculum is organised within a medical programme is not uniform. Placements may occur at the beginning, end or throughout; may range from half-days to full-time year-long placements. GP-led curricula exposing students to GPs as teachers and role-models may counter negative stereotypes and increase interest in general practice careers. Growing use of simulation, remote consulting and the use of IT innovations provides alternatives to traditional parallel general practice consulting model for teaching and learning. The findings from this study will inform the development of our redesigned curriculum at the University of Auckland.
The Inverse Care Law continues to define inequity in health systems, with those communities experiencing the greatest burden of ill-health often receiving the least medical resource. Alongside this, two further dynamics reinforce inequity: the inverse distribution of education, and the inverse distribution of the permanent workforce. This article reports the findings of an independent evaluation of a five-year, London-wide intervention led by the Primary Care School London (PCSL). The programme sought to address these barriers by targeting educational placements, educator development, and retention support to boroughs with the greatest population health need. The evaluation drew on a mixed-methods design, combining surveys, focus groups, independent observation of decision-making, and analysis of workforce data. It found that clinical placement capacity, educator numbers, and early-career retention all increased over the period studied. Between 2018 and 2023, the number of GP educational supervisors rose by 49%, while GP trainee numbers increased by 24%, with a substantial proportion placed in boroughs of high deprivation. General practice nursing training also expanded, while the SPIN retention scheme supported more than 500 doctors and multi-professional fellows into permanent posts, many in high-need areas. Although downstream population health outcomes were not yet measurable, the programme demonstrated that education and workforce policy can be deliberately re-aligned with deprivation and health need. These findings complement the conceptual argument set out in our linked leading article and underline the role of education and retention strategies as structural levers for health equity.
