A medical student in private practice for a 1-month clerkship: a qualitative exploration of the challenges for primary care clinical teachers

Abstract

Purpose

The predicted shortage of primary care physicians emphasizes the need to increase the family medicine workforce. Therefore, Swiss universities develop clerkships in primary care physicians’ private practices. The objective of this research was to explore the challenges, the stakes, and the difficulties of clinical teachers who supervised final year medical students in their primary care private practice during a 1-month pilot clerkship in Geneva.

Methods

Data were collected via a focus group using a semistructured interview guide. Participants were asked about their role as a supervisor and their difficulties and positive experiences. The text of the focus group was transcribed and analyzed qualitatively, with a deductive and inductive approach.

Results

The results show the nature of pressures felt by clinical teachers. First, participants experienced the difficulty of having dual roles: the more familiar one of clinician, and the new challenging one of teacher. Second, they felt compelled to fill the gap between the academic context and the private practice context. Clinical teachers were surprised by the extent of the adaptive load, cognitive load, and even the emotional load involved when supervising a trainee in their clinical practice. The context of this rotation demonstrated its utility and its relevance, because it allowed the students to improve their knowledge about the outpatient setting and to develop their professional autonomy and their maturity by taking on more clinical responsibilities.

Conclusion

These findings show that future training programs will have to address the needs of clinical teachers as well as bridge the gap between students’ academic training and the skills needed for outpatient care. Professionalizing the role of clinical teachers should contribute to reaching these goals.

Keywords:

• clinical teacher
• clinical teachers’ training
• clerkship in private clinical practice
• supervision
• primary care

Supplementary material

Interview guide of the focus group

1. Recall a specific supervisory moment with your student (focus on the student) during the clerkship that was particularly satisfying and tell us why.

   • What surprised you in a good or bad way during the clerkship?

   • What are the main strengths that you identified in your students?

2. What were the main difficulties that you encountered with regard to your student?

   (sub-questions referring to the conceptual framework)

3. How did you feel?

   • What did you do about those feelings?

   • What strategy(ies) did you use to deal with the difficulty you encountered with regard to your student?

4. How would you describe the main difficulties that you encountered as a tutor?

   • During the various teaching moments? (referring to different moments such as when discussing particular cases, when the patient was present, when observing the student, in relation to the structure of the private practice, or regarding the processes in place for making the supervision easier).

5. How did you react?

   • What strategy(ies) did you use with this teaching difficulty?

6. What would you say the training tools and needs for future clerkships are?

7. Would you reiterate/repeat your experience as a tutor in the future?

   Comment: questions 1–3 focus on the student, and questions 4–7 focus on the clinical teacher.

Acknowledgments

We thank the clinical teachers who participated in the study. We also thank Cédric Gillabert for his contribution to study design and recruitment of participants. We are grateful to Lionel Voirol for transcribing the audiotaped focus group.

This study received a grant from CUS SUK-Programm P-10 “Konsolidierung von Lehre und Forschung im Bereich Hausarztmedizin/medizinische Grundversorgung” in the context of the master plan for primary care.

Author contributions

MCA, ACPM, VMJ, AR, and JS designed the study. MCA, ACPM, and VMJ conducted the focus group. All authors contributed toward data analysis, drafting and critically revising the paper, gave final approval of the version to be published, and agree to be accountable for all aspects of the work.

Disclosure

The authors report no conflicts of interest in this work.