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International Medical Graduates (IMGs) represent a substantial proportion of the medical workforce globally and are known to face difficulties in their working lives, including differential attainment in assessment. This scoping review explores existing literature relating to IMGs' experiences of clinical competency assessments and identifies gaps in current knowledge. Following the Arksey and O'Malley framework for scoping reviews we examined peer-reviewed literature published between 2009 and 2025, without language restrictions. Three independent reviewers contributed to each stage of the process. The British Education Index, the Education Resources Information Center (ERIC), PubMed, Psych Info, Scopus, and Soc Index were searched. Forwards and backwards citation searching and a grey literature search were also performed. We identified 44 publications which met the inclusion criteria. These described the experiences of over 7200 IMGs, who had received their primary medical qualifications in 54 named countries, spanning all 6 world regions as defined by the World Health Organisation. Most sources were from the United Kingdom, Australia, and Canada. The review identified three headline categories which summarise the factors that impacted on IMGs' assessment experiences: internal and personal factors; external and social factors; and institutional and systemic factors. Notable evidence gaps included the impact of age, gender, country of primary medical qualification, years since last in practice, and lower levels of language proficiency on IMGs' experiences of assessment. Our review reveals the need for further research from a broader range of medical specialties and from a wider geographic spread to improve our understanding of this important topic. This scoping review maps the experiences of IMGs in relation to clinical competency assessment and offers useful insights highlighting both positive and negative influences, which could inform future assessment methodologies and support interventions for IMGs. By creating fairer and more supportive assessment pathways, healthcare systems can harness the full potential of IMGs, ensuring their valuable skills and diverse experiences are retained for the benefit of all patients.

An international medical graduate (IMG) is a doctor who has received their basic medical qualification from a medical school located in a different country from that in which they practice or intend to practice. IMGs are known to face difficulties in their working lives, including differential attainment in assessment. The objective of this review is to map key concepts and types of evidence in academic and gray literature relating to international medical graduates’ experiences of clinical competency assessment and to identify knowledge gaps on this topic by systematically searching, selecting, and synthesizing existing knowledge. All studies will relate to IMGs. The concept of interest will be IMGs’ experiences of assessment. The context will be postgraduate, licensing or credentialing medical assessments of clinical competence. This review will be conducted in accordance with the Joanna Briggs Institute (JBI) methodology for scoping reviews. Seven electronic databases will be searched for literature published between 2009 and 2024: the Australian Education Index, British Education Index, ERIC, PubMed, PsycINFO, Scopus, and SocINDEX. Gray literature will be searched using Google, Google Scholar, and published reports from postgraduate training bodies and medical licensing organizations. Documents will be independently screened, selected, and extracted by two researchers using a piloted data-extraction tool. Data will be analyzed and presented in tables and in a narrative format. Trial resgistration: Scoping review registration: Open Science Framework: https://osf.io/8gdm7 .

BackgroundPharmacists are increasingly incorporated into general practice teams globally and have been shown to positively impact patient outcomes. However, little research to date has focused on determining general practitioners’ (GPs’) perceptions of practice-based pharmacist roles in countries yet to establish such roles.ObjectivesTo explore GPs’ perceptions towards integrating pharmacists into practices and determine if any significant associations were present between GPs’ perceptions and their demographic characteristics.MethodsIn June 2022, a survey was disseminated to GPs in Ireland via post (n = 500 in Munster region), Twitter, WhatsApp, and an online GP support and education network. Quantitative data were captured through multiple option and Likert-scale questions and analysed using descriptive and inferential statistics. Qualitative data were captured via free-text boxes, with the open comments analysed using reflexive thematic analysis.ResultsA total of 152 valid responses were received (24.6% response to postal survey). Overall, GPs welcomed the role of practice-based pharmacists and perceived that they would increase patient safety. Most agreed with practice pharmacists providing medicine information (98%) vs. 23% agreeing with practice pharmacists prescribing independently. Most agreed they would partake in a practice pharmacist pilot (78.6%). The free-text comments described current pressures in general practice, existing relationships with pharmacists, funding and governance strategies, potential roles for pharmacists in general practice, and anticipated outcomes of such roles.ConclusionThis study provides a deeper understanding of GPs’ perceptions of integrating pharmacists into practices and the demographic characteristics associated with different perceptions, which may help better inform future initiatives to integrate pharmacists into practices.

The management of chronic diseases, in the context of an ageing population and increasing life expectancy, is one of the major challenges facing the Irish health system. In 2020, a chronic disease management programme [CDM] was introduced in Irish general practice as part of a transformation in health policy to meet the changing needs of the population. To explore GPs' experiences and perceptions of the impact of the introduction of CDM on general practice in Ireland. 18 semi-structured interviews were conducted with GPs in clinical practice from across Ireland. GPs were purposefully recruited to capture the differing experiences faced by GPs in large and small practices in both urban and rural settings. Interviews were analysed using reflexive thematic analysis. GPs were enthusiastic about aspects of CDM, which they felt provided an improved framework for their approach to the management of chronic diseases. However, they described several challenges to implementation, especially around capacity constraints. CDM could have unintended consequences for aspects of routine GP care. GPs described how practice nurses had taken on a central role in both clinical and administrative aspects of the programme. GPs value the framework provided by CDM for their approach to the management of chronic disease. However, challenges around practice capacity and its impact both on the delivery of CDM and aspects of routine care highlight the importance for policy makers to provide continued support to strengthen the general practice infrastructure.

Background: General Practitioners (GPs) play a central role in caring for people with dementia. There is a growing demand for GP-led community-based dementia care, as advocated in the Irish National Dementia Strategy (INDS). However, there is a paucity of research exploring GPs' views on dementia care since publication of the INDS. The aim of this qualitative study is to develop a deeper understanding of how to improve the quality of dementia care in General Practice, explored from the perspective of Irish GPs. Methods: Semi-structured interviews were conducted with GPs. GPs who completed the “Dementia in Primary Care” CPD module at University College Cork in Ireland were purposively recruited. Interviews were audio-recorded, transcribed, and analyzed by thematic analysis. Results: 12 interviews were conducted with 7 female and 5 male participants. Experience in General Practice ranged from 3 to 32 years. Most GPs practiced in mixed urban-rural settings ( n = 9) and had nursing home commitments ( n = 8). The average interview length was 45 minutes. Six major themes emerged from the data set, including resourcing primary care, addressing disparities in secondary care, community-centered care as patient-centered care, linking a dementia network, universal access to care, and raising public awareness. Conclusion: GPs find dementia care to be a complex and challenging aspect of primary care. While education and training is advocated by GPs, service delivery must be reconfigured. This will necessitate adequate financial resourcing and the restructuring of community-based dementia care services.

Despite significant evidence supporting the Human Papillomavirus (HPV) vaccine in the prevention of cervical cancer, uptake of this vaccine is below target in many countries. HPV uptake in Ireland has declined from 87% in 2014-15 to 51% in 2016-17 and currently remains suboptimal at 64.1% in 2017-18. This study aimed to explore parental views of the HPV vaccine; elucidate specific concerns relating to this vaccine and to identify relevant influences on the decision to vaccinate against HPV to inform strategies to optimise uptake. An in-depth qualitative study, using semi-structured interviews was conducted among parents of 11-13-year-old girls (n = 18) who had not yet been offered the HPV vaccine. Convenience sampling was used. Interviews, conducted in the Republic of Ireland over six-months in 2018, were audio-recorded, transcribed, and analysed by thematic analysis. Eighteen interviews were conducted (14 female and 4 male participants). Parents favoured HPV vaccination to protect their daughters and prevent disease. Barriers to vaccination included; the fear of long-term side effects, lack of knowledge and the risk versus benefit ratio. General practitioners (GPs) were identified as having a strong influence over parental vaccination decisions, as did media reports and the recent cervical screening programme controversy in Ireland. This study suggests that significant parental concerns remain to the HPV vaccine. More comprehensive information on the research surrounding this vaccine's safety profile is required. GP's may play a pivotal role in HPV vaccination going forward.

Background A new class of antibody-based drug therapy with the potential for disease modification is now available for Alzheimer’s disease (AD). However, the complexity of drug eligibility, administration, cost, and safety of such disease modifying therapies (DMTs) necessitates adopting new treatment and care pathways. A working group was convened in Ireland to consider the implications of, and health system readiness for, DMTs for AD, and to describe a service model for the detection, diagnosis, and management of early AD in the Irish context, providing a template for similar small-medium sized healthcare systems. Methods A series of facilitated workshops with a multidisciplinary working group, including Patient and Public Involvement (PPI) members, were undertaken. This informed a series of recommendations for the implementation of new DMTs using an evidence-based conceptual framework for health system readiness based on [1] material resources and structures and [2] human and institutional relationships, values, and norms. Results We describe a hub-and-spoke model, which utilises the existing dementia care ecosystem as outlined in Ireland’s Model of Care for Dementia, with Regional Specialist Memory Services (RSMS) acting as central hubs and Memory Assessment and Support Services (MASS) functioning as spokes for less central areas. We provide criteria for DMT referral, eligibility, administration, and ongoing monitoring. Conclusions Healthcare systems worldwide are acknowledging the need for advanced clinical pathways for AD, driven by better diagnostics and the emergence of DMTs. Despite facing significant challenges in integrating DMTs into existing care models, the potential for overcoming challenges exists through increased funding, resources, and the development of a structured national treatment network, as proposed in Ireland’s Model of Care for Dementia. This approach offers a replicable blueprint for other healthcare systems with similar scale and complexity.

Background Increasing numbers of family carers are providing informal care in community settings. This creates a number of challenges because family carers are at risk of poor physical and psychological health outcomes, with consequences both for themselves and those for whom they provide care. General Practitioners (GPs), who play a central role in community-based care, are ideally positioned to identify, assess, and signpost carers to supports. However, there is a significant gap in the literature in respect of appropriate guidance and resources to support them in this role. Methods A scoping review was undertaken to examine clinical guidelines and recommendations for GPs to support them in their role with family carers. This involved a multidisciplinary team, in line with Arksey & O’Malley’s framework, and entailed searches of ten peer-reviewed databases and grey literature between September-November 2020. Results The searches yielded a total of 4,651 English language papers, 35 of which met the criteria for inclusion after removing duplicates, screening titles and abstracts, and performing full-text readings. Ten papers focused on resources/guidelines for GPs, twenty were research papers, three were review papers, one was a framework of quality markers for carer support, and one was an editorial. Data synthesis indicated that nine (90%) of the guidelines included some elements relating to the identification, assessment, and/or signposting of carers. Key strategies for identifying carers suggest that a whole practice approach is optimal, incorporating a role for the GP, practice staff, and for the use of appropriate supporting documentation. Important knowledge gaps were highlighted in respect of appropriate clinical assessment and evidence-based signposting pathways. Conclusion Our review addresses a significant gap in the literature by providing an important synthesis of current available evidence on clinical guidelines for GPs in supporting family carers, including strategies for identification, options for assessment and potential referral/signposting routes. However, there is a need for greater transparency of the existing evidence base as well as much more research to evaluate the effectiveness and increase the routine utilisation, of clinical guidelines in primary care.

To review the empirical evidence on approaches used by Primary Care Physicians (PCPs) in fitness to drive (FtD) consultations with people living with cognitive impairment. Scoping review of empirical literature focused on primary studies of any design. Primary care practice. PCPs or their equivalent and/ or individuals with cognitive impairment across the spectrum of mild cognitive impairment to dementia. Systematic search of Medline, Cinahl, PsychINFO, Academic Search Complete, Psychological and Behavioural Sciences Collection, SocIndex and Social Sciences FT were conducted. Records screened by two reviewers against agreed inclusion criteria. Mixed studies (qualitative and quantitative) were synthesized within overarching themes. Eighteen studies met our inclusion criteria. Synthesized data showed PCPs have mixed feelings on the appropriateness of their role in FtD assessments, with many feeling particularly uncomfortable and lacking confidence in the context of possible cognitive impairment. Reasons include lack of familiarity with legal requirements and local resources; fear of damaging the doctor-patient relationship; and impact on the patient's quality of life. Patients voiced their desire to maintain agency in planning their driving cessation. Studies evaluating pragmatic educational programmes suggest these can improve physician confidence in FtD consultations. The increasing number of older people affected by cognitive impairment, for whom driving may be a concern, has implications for primary care practice. Addressing the reasons for PCPs lack of comfort in dealing with this issue is essential in order for them to better engage in, collaborative discussion with patients on plans and preferences for driving cessation.

Pharmacists in general practice have been shown to enhance patient care and are becoming increasingly prevalent worldwide. Yet, little is known about general practitioners' (GPs') perceptions of pharmacists prior to potentially working alongside them in this setting. Therefore, this study aimed to investigate these GP perceptions to inform future efforts to integrate pharmacists into general practice. Semi-structured interviews were conducted with GPs practising in the Republic of Ireland between October and December 2021. Content analysis was used to identify the most relevant Theoretical Domains Framework (TDF) domains that affected the theoretical integration of pharmacists into general practice. Fifteen GPs were interviewed. Five TDF domains were found to be most relevant in affecting pharmacist integration: (1) 'environmental context and resources' (space, government funding, information technology, current workplace pressures, increasing patient complexity, indemnity, moves towards group practices); (2) 'skills' (GP mentors, practical in-service training, consultation skills development); (3) 'social professional role and identity' (role definition, clinical governance, pharmacist prescribing, medication review and monitoring); (4) 'beliefs about consequences' (patient safety, cost savings, workload); and (5) 'knowledge' (pharmacists as medication experts, lack of knowledge of pharmacist undergraduate training). This is the first qualitative interview study to focus on exploring GPs' perceptions of pharmacists working in general practice outside of private practice settings. It has provided a deeper understanding of GPs' considerations regarding the integration of pharmacists into general practice. In addition to informing future research, these findings should help optimise future service design and aid pharmacist integration into general practice.