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Introduction: There is a trend towards GPs diversifying their role by working in health areas beyond general practice. However, little is known about whether this trend is apparent among early-career GPs once they make the transition from training to independent practice.Aim: To describe the prevalence of and characteristics associated with early-career GPs providing other medical work.Methods: A cross-sectional questionnaire-based study of GPs (‘alumni’) who had fellowed within the past 2 years from three of Australia’s nine regional training programs. The outcome factor was provision of medical work in addition to clinical general practice. Associations of independent variables (encompassing alumni demographics, current practice characteristics and vocational training experience) with the outcome were estimated using univariate and multivariable logistic regression.Results: Of 339 responding alumni, 111 (33%) undertook other regular medical work. Sixty-five (59%) of these were in medical education. In multivariable analysis, factors associated with providing other medical work were having a spouse/partner not in the workforce (odds ratio (OR) 5.13), having done any training part-time (OR 2.67), providing two or more of home visits, nursing home visits and after-hours care (OR 2.20), working fewer sessions per week (OR 0.74), and currently working in an area of lower socio-economic status (OR 0.84). Having dependent children (OR 0.27), and being female (OR 0.43) were associated with not providing other medical work.Discussion: In this study, many early-career GPs are providing other medical work, particularly medical education. Acknowledging this is important to general practice workforce planning and education policy.

Background General Practice training in Australia is delivered through the apprenticeship model. General Practice supervisors support trainees transitioning from hospital-based work towards competent independent community-based practice. The timing and manner in which support should be provided is still not well understood. This study aimed to establish the variation in clinical and educational experiences and behaviours, and location, of general practice trainees’ consultations by stage of their vocational training. It was hypothesised that change is greater in earlier stages of training. Methods A cross-sectional analysis of data (2010–2018) from the Registrar Clinical Encounters in Training (ReCEnT) study, an ongoing cohort study of Australian GP registrars’ in-consultation clinical and educational experience and behaviours. Multinomial logistic regression assessed the association of demographic, educational, and clinical factors in different stages of training. The outcome factor was the training term. Results Two thousand four hundred sixteen registrars contributed data for 321,414 patient consultations. For several important variables (seeing patients with chronic disease; new patients; seeking in-consultation information or assistance; ordering pathology and imaging; and working in a small or regional practice), odds ratios were considerably greater for comparisons of Term 1 and 3, relative to comparisons of Term 2 and 3. Conclusion Differences experienced in demographic, clinical and educational factors are significantly more pronounced earlier in registrars’ training. This finding has educational and training implications with respect to resource allocation, trainee supervision and curriculum design. Sociocultural learning theory enables an understanding of the impact of transitions on, and how to support, general practice trainees and supervisors.

The Implicit Association Test (IAT) is a validated tool used to measure implicit biases, which are mental associations shaped by one's environment that influence interactions with others. Direct evidence of implicit gender biases about women in medicine has yet not been reported, but existing evidence is suggestive of subtle or hidden biases that affect women in medicine. To use data from IATs to assess (1) how health care professionals associate men and women with career and family and (2) how surgeons associate men and women with surgery and family medicine. This data review and cross-sectional study collected data from January 1, 2006, through December 31, 2017, from self-identified health care professionals taking the Gender-Career IAT hosted by Project Implicit to explore bias among self-identified health care professionals. A novel Gender-Specialty IAT was also tested at a national surgical meeting in October 2017. All health care professionals who completed the Gender-Career IAT were eligible for the first analysis. Surgeons of any age, gender, title, and country of origin at the meeting were eligible to participate in the second analysis. Data were analyzed from January 1, 2018, through March 31, 2019. Measure of implicit bias derived from reaction times on the IATs and a measure of explicit bias asked directly to participants. Almost 1 million IAT records from Project Implicit were reviewed, and 131 surgeons (64.9% men; mean [SD] age, 42.3 [11.5] years) were recruited to complete the Gender-Specialty IAT. Healthcare professionals (n = 42 991; 82.0% women; mean [SD] age, 32.7 [11.8] years) held implicit (mean [SD] D score, 0.41 [0.36]; Cohen d = 1.14) and explicit (mean [SD], 1.43 [1.85]; Cohen d = 0.77) biases associating men with career and women with family. Similarly, surgeons implicitly (mean [SD] D score, 0.28 [0.37]; Cohen d = 0.76) and explicitly (men: mean [SD], 1.27 [0.39]; Cohen d = 0.93; women: mean [SD], 0.73 [0.35]; Cohen d = 0.53) associated men with surgery and women with family medicine. There was broad evidence of consensus across social groups in implicit and explicit biases with one exception. Women in healthcare (mean [SD], 1.43 [1.86]; Cohen d = 0.77) and surgery (mean [SD], 0.73 [0.35]; Cohen d = 0.53) were less likely than men to explicitly associate men with career (B coefficient, -0.10; 95% CI, -0.15 to -0.04; P < .001) and surgery (B coefficient, -0.67; 95% CI, -1.21 to -0.13; P = .001) and women with family and family medicine. The main contribution of this work is an estimate of the extent of implicit gender bias within surgery. On both the Gender-Career IAT and the novel Gender-Specialty IAT, respondents had a tendency to associate men with career and surgery and women with family and family medicine. Awareness of the existence of implicit biases is an important first step toward minimizing their potential effect.

IntroductionCultural competency, cultural safety, cultural humility and transcultural care have developed as frameworks to better equip medical professionals towards a more culturally appropriate healthcare system. The aim of this scoping review is to map the use of these cultural models within general practice/general practitioner (GP) training. We have elected to use the term ‘GP’ to encompass all trainee doctors within general practice/family medicine.Methods and analysisThis scoping review will be conducted in accordance with the Scoping Review Methods Manual by the Joanna Briggs Institute and the Arksey and O’Malley framework for scoping studies and reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. Searches were conducted in EMBASE, MEDLINE and Web of Science Core Collection, with the support of a subject librarian. Published literature on cultural competence, cultural safety, cultural humility and transcultural care related to GP training will be included. There will be no restriction placed on language. References will be managed on EndNote, and titles and abstracts will be screened against the inclusion criteria by two independent reviewers. Potentially relevant sources will be retrieved in full and their citation imported into Rayyan. Data will be extracted on the year, type of study, country or countries of affiliated authors, characteristics of participants, research design and setting, cultural model being examined, definitions used, attitudes, outcome and application of the model, and purpose of the study. We aim to use basic qualitative content analysis for data extracted to map the landscape of the published literature around cultural competence, cultural humility, cultural safety and transcultural care.Ethics and disseminationEthics approval was not required for this Scoping Review protocol. Findings will be disseminated through conference presentations and publication in a scientific journal.

Background Malnutrition and poor dietary intake are major health challenges today. There are well-established benefits of nutrition interventions, but a lack of formalized nutrition training in medical school and residency. There is also little published information regarding nutrition training impact on residents. Physicians lack knowledge, skills, confidence, and training to effectively counsel in daily practice. Consequently, there is urgent need to improve nutrition training in medicine. Methods This pre-post study evaluated the impact of an online nutrition course provided to family medicine residents. Time was provided at Academic Half Day to complete the course as well as pre- and post-course surveys with knowledge tests through SurveyMonkey. Descriptive statistics were used to evaluate responses. The project was approved by the University of Saskatchewan Behavioural Research Board (Beh 4433). Results Thirteen residents completed the pre-course questionnaire (response rate = 54%). Of these, ten (77%) felt they had received inadequate nutrition training, and all thought patients would benefit from improved nutrition counselling. Six residents completed the post-course questionnaire (response rate = 24%). All post-course respondents thought the course was beneficial and that it should be offered to all Canadian family medicine residents, with majority believing it should be mandatory. Respondents’ nutrition knowledge, confidence, beliefs on importance of nutrition counselling, and nutrition counselling in practice appear to increase/improve after training. Conclusions Implementation of formal nutrition training during residency is important and has the potential to positively influence family medicine residents’ nutrition knowledge, attitudes, and rates of nutrition counselling. Recommendations Future research with larger sample sizes is needed to support these conclusions and improve nutrition training during residency. Future studies should look at nutrition training in other specialties as well as examine the rate and quality of nutrition counselling after residency completion.

COVID-19 outbreak has significantly changed all aspects of general practice in Europe. This article focuses on the academic challenges for the discipline, mainly in the field of education, research, and quality assurance. The efforts of the European Region of the World Organisation of National Colleges, Academies, and Academic Associations of General Practitioners/Family Physicians (WONCA Europe) to support academic sustainability of the discipline in the time of pandemic are presented. Medical education was affected by the pandemic, threatening both its productivity and quality. Emerging new educational methods might be promising, but the results of their rapid implementation remain uncertain. A relatively small number of publications related to COVID-19 and general practice is available in the medical literature. There is a shortage of original data from general practice settings. This contrasts with the crucial role of GPs in fighting a pandemic. COVID-19 outbreak has opened widely new research areas, which should be explored by GPs. Maintaining the quality of care and safety of all patients during the COVID-19 pandemic is the utmost priority. Many of them suffer from poor access or inadequate management of their problems. Rapid implementation of telemedicine brought both threats and opportunities. The COVID-19 pandemic also challenged doctors' safety and well-being. These aspects will require discussion and remedy to prevent deterioration of the quality of primary care. WONCA Europe is making a multi-faceted effort to support GPs in difficult times of the pandemic. It is ready to support future efforts to uphold the integrity of family medicine as an academic discipline.

Background The insufficient number of general practitioners (GPs) is a major challenge facing China’s healthcare system. The purpose of the GP transfer training programme was to provide training for experienced doctors to transition to general practice. However, research on the competencies of GP transfer training trainers in teaching skills in China is limited. This cross-sectional study aimed to examine the baseline familiarity with teaching skills among Chinese GP transfer training trainers. Methods An online survey was conducted among trainers who participated in the 2021 Sichuan Province General Practice Training Trainer Program. The survey collected data on participants’ characteristics and familiarity with 20 skills in three essential teaching knowledge areas: the core functions of primary care (five questions), preparation for lesson plan (four questions), and teaching methods (11 questions). Results In total, 305 participants completed the survey. Familiarity rates were generally low across all three essential teaching knowledge areas. No significant differences were observed in familiarity rates between the tertiary and secondary hospitals. Conclusion This study revealed gaps in the teaching skills of GP transfer training trainers in China. These results suggest the necessity for targeted training programs to enhance the teaching skills and competencies of trainers.

Background Community-based education (CBE) is strategically important to provide contextual learning for medical students. CBE is a priority for countries striving for better primary health care. However, the CBE literature provides little curriculum guidance to enhance undergraduate medical education with the primary health care context. We aim to develop a CBE framework for undergraduate medical education (from macro, meso, and micro curriculum levels) to engage students and teachers with better, more meaningful learning, within primary health care settings. Methods We used a grounded theory methodology by interviewing eight medical educationalists and ten CBE teachers, followed with the coding process by sensitizing the concepts of ‘medical education’ and ‘primary care’, to explore any new concepts. The primary data originated from a developing country where the paradigm of high-quality primary health care is mostly unfamiliar. Three senior researchers from international associations of general practices from different countries provided validation to the results. Results We identified a new framework for a community-based educational program. The micro-curriculum should offer opportunities for small group activities, ranging from simple to complex learning, emphasizing clinical skills, leadership, and teamwork to improve self-directed and collaborative practice. Sufficient role models and constructive feedback within primary care contexts are robust facilitators. For the meso-curriculum, comprehensive coordination on teacher-training and CBE program is needed. To ensure the sustainability of the program, faculty leaders and managers should include the macro-curriculum with a national postgraduate general practice curriculum and provide strong commitment. Conclusions We designed a ‘CBE-tree’ model for the undergraduate medical curriculum. By using the CBE framework developed in this study, students and teachers may better comprehend the essential of primary health care.

Background Artificial intelligence (AI) chatbots have demonstrated proficiency in structured knowledge assessments; however, there is limited research on their performance in scenarios involving diagnostic uncertainty, which requires careful interpretation and complex decision-making. This study aims to evaluate the efficacy of AI chatbots, GPT-4o and Claude-3, in addressing medical scenarios characterized by diagnostic uncertainty relative to Family Medicine residents. Methods Questions with diagnostic uncertainty were extracted from the Progress Tests administered by the Department of Family and Community Medicine at the University of Toronto between 2022 and 2023. Diagnostic uncertainty questions were defined as those presenting clinical scenarios where symptoms, clinical findings, and patient histories do not converge on a definitive diagnosis, necessitating nuanced diagnostic reasoning and differential diagnosis. These questions were administered to a cohort of 320 Family Medicine residents in their first (PGY-1) and second (PGY-2) postgraduate years and inputted into GPT-4o and Claude-3. Errors were categorized into statistical, information, and logical errors. Statistical analyses were conducted using a binomial generalized estimating equation model, paired t-tests, and chi-squared tests. Results Compared to the residents, both chatbots scored lower on diagnostic uncertainty questions ( p  < 0.01). PGY-1 residents achieved a correctness rate of 61.1% (95% CI: 58.4–63.7), and PGY-2 residents achieved 63.3% (95% CI: 60.7–66.1). In contrast, Claude-3 correctly answered 57.7% ( n  = 52/90) of questions, and GPT-4o correctly answered 53.3% ( n  = 48/90). Claude-3 had a longer mean response time (24.0 s, 95% CI: 21.0-32.5 vs. 12.4 s, 95% CI: 9.3–15.3; p  < 0.01) and produced longer answers (2001 characters, 95% CI: 1845–2212 vs. 1596 characters, 95% CI: 1395–1705; p  < 0.01) compared to GPT-4o. Most errors by GPT-4o were logical errors (62.5%). Conclusions While AI chatbots like GPT-4o and Claude-3 demonstrate potential in handling structured medical knowledge, their performance in scenarios involving diagnostic uncertainty remains suboptimal compared to human residents.