Medical students’ perceptions of General Practice and its impact on career intentions

Abstract

Background The past decade has seen an increase in General Practice workload (Kings Fund, The, 2011), yet there has been a reduction in full time equivalent GP’s since 2015 (“General Practice Workforce,” NHS digital 2021). In response to this, the UK government has pledged 6000 new GP’s by 2024, and created 1000 new GP training places (Iacobucci, 2019), however there is a lack of UK graduates taking these posts. Existing literature has shown that some medical students perceive that General Practice may be repetitive, unfulfilling and have a high administrative load (Barber et al., 2018; “Destination GP,” 2017; Rodríguez et al., 2012). These perceptions may stem from experiences inside or outside of university. The aim of this study was to conceptualise the factors influencing medical students’ perceptions of General Practice, and how these perceptions may impact upon the decision to consider a career in General Practice. Methodology This mixed methods study used questionnaires, focus groups, interviews and audio diaries to capture rich longitudinal data regarding students’ experiences, and the impact this had upon their perceptions of General Practice. 29 students from three UK universities were recruited into the focus group or interview sections of the study, and six of these went onto the six-month longitudinal diary study. Narrative analysis (Jeong-Hee, 2015) was performed, to present and understand the stories of the longitudinal participants. Further analysis of narratives then identified themes within this and the focus group data (Polkinghorne, 1995; Sharp et al., 2018). Results A number of themes were identified as contributing to the student’s perception of General Practice: External human influencers Conversations and practical experiences with people may influence students’ perceptions of GP. This may be with a medical colleague, such as an inspirational senior, or non-medics such as family or friends. External non-human influencers Such as placements, optional additional educational experiences, the media, and overpromotion of GP. “They say” Refers to the passive and pervasive phenomenon of perceptions held by students of general practice, with no basis in lived experience. These perceptions may cascade, as they are shared within the medical student community. Driving force The above experiences led to a process of reflection, whereby the student compares their experiences and perception with their ethos and values, their intrinsic desire to follow a particular career path, and the practicalities of pursuing that path. This process is a continuum, whereby students continue to reflect upon their experiences and career intention, with the end point at which the student becomes fixed on a career path difficult to ascertain. Discussion Through narrative analysis this study enabled understanding of the individual, continuous processes of undergraduate students. And the events which had either a positive or negative impact on their intention to pursue a career in GP. Through further analysis generalisable themes were identified, which may suggest changes in medical education to optimise students’ experiences with regards to General Practice. Further research is needed to fully understand the "They say" phenomenon, and to evaluate if any suggested changes to the undergraduate curriculum could improve recruitment into GP training.