LAUSR

As thirdand fourth-year medical students respectively, we are both interested in a career in general practice (GP). We recently read the article ‘Do primary care placements influence career choice: What is the evidence?’ by Amin et al. [1] which addresses the problem of fewer medical graduates now choosing GP as a career. The article refers to the recent Career Destination Report which reported that only 20% of the graduates intend to pursue GP, 30% less than the Department of Health’s targets [2]. We write to offer our perspective on this problem based on our medical school experiences. These include a variety of educational formats in primary care. The article discusses how longitudinal placements, compared with traditional block placements (TBP), positively influence medical students to pursue a career in GP. The article concluded that longitudinal placements were superior. To address the recruitment problem, placements needed to be of sufficient quality, quantity and duration. At Warwick medical school, we are fortunate enough to experience both formats; a longitudinal placement, one day a week across 30 weeks, and, in final year, a TBP of 6 weeks. Although we agree with the article’s final conclusion, we propose that, from our own experiences, the quality of placement is the most important factor in encouraging an interest in a career in GP in our fellow undergraduates. When we reflect on which placement was better, the length of time has less bearing; instead we remember the patients we saw, the opportunities offered, and the educational supervision provided. Regardless of the block duration, patient interaction in primary care varied greatly from practice to practice. On many placements, clinics run by medical students are ‘filtered’ to only include patients with very minor ailments. This reduces the diversity of cases and contributes towards the perception of GP as being monotonous. In contrast, when we have been given the chance to experience complex or emergency cases this was more helpful for our learning and encouraged greater interest in a career in GP. An argument put forward by M Amin et al. [1] is that GP is seen as isolating. Although we agree that some students may find it geographically and socially isolating, we believe the perceived separation from hospital medicine makes a far greater contribution to the pursuit of a career elsewhere. In placements that provided an opportunity to follow general practitioners who integrated their work with hospital medicine, for example working a day a week in A + E or performing minor surgeries, made us aware of the possibility to link the two. Demonstrating this in undergraduate placements will help bridge the gap between stereotypical ‘GP land’ and hospital medicine. This is supported by Nicholson et al [3] who in a focus group study found that students were put off a career in GP due to its isolation from hospital medicine. However, they showed that students who had the opportunity to work in a multiple disciplinary team and collaborate with other specialities in hospital medicine valued a GP career far more. Finally, when we reflect on our GP placements, the quality of the teaching had a major effect on our opinions of GP. If the teaching did not reflect our curriculum or the general practitioner lacked enthusiasm, an extended length of placement would most likely negatively influence our thoughts of becoming a general practitioner. We can learn much from Henderson et al. [4] who showed that a general practitioner’s teaching is enhanced by working closely with the academic institution and in a practice that positively fosters a teaching culture for both general practitioner and student. If practices focus on these factors, improving the teaching experience may greatly benefit the GP recruitment problem. Yours sincerely