Opinion
Raising the prestige of general practice: A student’s perspective
The culture that exists within medical student placements needs to shift if the GP workforce is to improve, writes hospital intern, Dr Phoebe Blaxill.
Dr Phoebe Blaxill presenting at the recent RACGP WA’s ‘University Think Tank: Raising the Prestige of General Practice’.
At the recent RACGP WA University Think Tank, Dr Phoebe Blaxill, 2023 RACGP WA Council Student Representative, shared her experiences and perceptions of general practice from her time in medical school, position on the RACGP WA Council, and the development of a general practice medical student supervisor guide.
A recent graduate from Curtin University, now an intern at Sir Charles Gairdner Hospital, the self-described ‘budding advocate for all things general practice’ shares her story.
Let’s start from the very beginning.
Pretty soon after starting medical school, I felt drawn to general practice as a specialty. I loved the holistic, patient-centred approach to medicine that general practice emulates. I liked the way all the different body systems, as well as the patient’s social and environmental circumstances must be considered in every patient interaction. And the myriad of career paths in general practice also appealed to me as someone interested in rural and Indigenous medicine.
During the pre-clinical component of my degree, I had some fantastic tutors and lecturers who were GPs, which I believe was foundational to my positive impression of general practice. Their generalist approach to medicine, expertise in problem solving and patient-centred communication provided me with a great foundation before leaving the classroom.
During my clinical years at medical school, I had a mix of general practice experiences, many of which shaped my career choices.
Unfortunately, for most medical students, general practice is a dreaded rotation.
Far too many learn more about being a pot plant in the corner of a GP’s office than clinical medicine. An example from my experience was when I had week-long placement in a remote community a week before my end of year exams. For 12 hours a day, I would listen to the GP tell every patient his life story and I learnt more about his personal life than examinable or life-applicable content.
Thankfully for me, however, this was my only negative experience in general practice. I had a fascinating three weeks in Karratha through the John Flynn Placement Program seeing the diverse skills of a rural generalist.
During my rural clinical school year in Kalgoorlie, I had fantastic GP mentors who shared their expertise in weekly teaching sessions, and worked with a number of them in both the GP clinic and the hospital. I also did three weeks of my elective in an Aboriginal Medical Service in Far North Queensland seeing how effective community run health services can be and the unique challenges and joys of working in Aboriginal and Torres Strait Islander health.
And my general practice rotation in Perth far exceeded my expectations – my supervisor gave me opportunities to sit in with different GPs, to see my own patients and be involved in procedures and home visits (shout out to Belridge Medical). It was through these experiences that I fell in love with the idea of being a GP, particularly a rural generalist.
By contrast, during my rotations in the metropolitan hospital system I often felt belittled when I expressed my desire to be a GP. I feel there is an undercurrent in the hospital culture that hospital specialists are somehow superior – and this isn’t helped by offhand digs at GPs that are far too common on the hospital wards.
When we spend the majority of our medical school placements and early junior doctor years in the hospital surrounded by this culture, it’s hardly surprising that the appeal for general practice is declining.
In my final year, I was fortunate enough to have the opportunity to be RACGP WA Council Student Representative.
I enjoyed meeting a diverse group of GPs who welcomed me with open arms and showed a zeal and passion for their profession. I also had the opportunity to learn about the challenges and joys of general practice and be involved in advocating for GPs and their patients. For example, I attended an advocacy session with Senator Jordan Steele-John and engaged in hearty debate about up-and-coming GP issues in monthly Council meetings. In my role, I also supported some eager Curtin Uni students as they re-established the General Practice Students Network (GPSN) group.
These experiences and influences have been fundamental in fostering my passion for general practice. I’m grateful for the huge range of opportunities I’ve had inside and outside of university and the myriad of GPs who continue to inspire and mentor me.
As we all know, many students don’t have the same experiences I’ve had, and many don’t even consider a general practice career.
When preparing to share my story, I thought about what is fundamental in promoting general practice in our universities, based on both my positive and negative experiences.
I believe promoting general practice in our universities boils down to the following:
- Having inspiring GP tutors and mentors at universities
- Offering diverse and engaging general practice placements, like the many I’ve been able to do
- Creating opportunities for student leadership in the general practice field, eg through the RACGP, GPSN, rural health clubs
- A positive attitude towards GPs modelled by university and hospital staff
I want to briefly dive a bit deeper into my second point – how can we make general practice placements engaging, educational and inspiring for medical students?
General practice placements offer students the chance to see the fundamentals of medicine in practice and fantastic learning opportunities for clinical reasoning, chronic disease management, pharmacology and so much more.
In my experience, so much of the medical school curriculum can be reinforced in a GP learning environment. Yet many students seem to miss out on these opportunities. That’s why I’ve been working with RACGP WA to develop a guide for GPs to optimise learning opportunities for the students they host.
Acknowledging that every student, every hosting GP and every medical practice is different, I’ve compiled some ideas on how to engage a medical student in a GP rotation.
There is no ‘one right way’ to do this, but I’ve consulted fellow students, GPs and research papers to brainstorm strategies which have proven effective.
For example, the guide gives an overview of the parallel consulting model, as well as encouraging GPs to involve students in history taking, teaching on the go, patient counselling, procedures and so much more. It also gives ideas on how GPs can get to know the interests and expectations of their students to give them the best experience possible. The aim is that this guide can equip GPs to provide students with educational and inspiring GP placements whilst acknowledging the additional stressors that can come with hosting a student.
The guide is currently being reviewed by RACGP WA but we look forward to circulating it to universities and the general practice community in the coming months.
I truly hope it proves useful in delivering engaging placements and make a difference in the attitudes towards general practice among medical students.
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