Year: 2012
Type: dissertation
Abstract: The skilful general practitioner – ideals challenged by practice\nBackground and aim: The world organization for general practitioners, Wonca, has formulated\nresearch based core competencies for general practice. However the real performances of GPs are not\nmuch studied in practice. The aim of the first three studies was to investigate and describe the working\nbehaviour of competent general practitioners from the background of the literature of the field, and to\ncompare their working behaviour with the Wonca core competencies. The aim of the fourth study was\nto investigate medical students´ views of general practice and to find out if there were certain views\nassociated with regarding general practice as a possible career choice.\nMethod: The thesis is based on three qualitative studies and one quantitative. In paper 1 data was\ngathered by participant observation and interviews with GPs. In paper 2 data was collected by group\ninterviews. In paper 3 data was collected from reflective writing by final-year medical students. In\npaper 4 data was gathered from a questionnaire among medical students. Data was analyzed using text\ncondensation (paper 1), qualitative content analysis (paper 2 and 3) and statistical descriptions and\ncomparisons (paper 4).\nFindings: Paper 1: Two main categories, dimensions of competence, were constructed: “deliberate\nstrategies” and “personal style”. Common denominators of the overall working behaviour were\nattention to the patient as a person, practicing patient-centred medicine, saving the consultations from\ndisturbances, rejecting taking over responsibilities from the patients and safeguarding own autonomy.\nA well-developed personal style is necessary to obtain the spontaneous interchange between attentive\nlistening and detachment characteristic to patient-centredness.\nPaper 2: Two main categories reflected the competence: “professional readiness” and “working\nbehaviour”. Professional readiness comprises the inclination of understanding and acting based on the\nsubcategories: medical knowledge modified by experience, knowing the patient, involvement and\nuncertainty. Working behaviour describes in a more concrete way the doctoring approach and is\nformed by the subcategories: preparation, the current problem, body attention, cooperation with other\nprofessionals, use of time and taking notes as a work aid.\nPaper 3: Three themes were identified to explain the conditions of a general practitioner (GP). They\nwere: “prerequisites”, “patients’ problems” and “clinical judgment” which reflect the specific features\nof primary care, of the presentation of symptoms by patients and of the way that GPs approach an\nactual encounter. The students regarded the importance of unselected patient problems,\nstraightforwardness in contact and care as being the characteristics of a competent GP.\nPaper 4: The medical students regarded general practice positively. They found work environment\ngood, to be aware of patients living conditions as necessary and that GP work requires medical breadth.\nA statistical association was found between stated intentions to work as a GP in the future with\nstatements about general practice offering good work environment and proposing a major share of\ngeneral practice in undergraduate training. Students negative to working as a GP were also negative to\na major share of general practice in undergraduate training.\nConclusion: The skilful GP: “Through patient continuity and holism the GP can offer patients\nattention in the encounters, closeness to care and clinical breadth. The GP is capable of patientcentredness\nand bodily empathy, being aware of uncertainty and is protecting own autonomy. All the\naspects of competence are integrated into the personal style of the GP”. Our studies provided reality for\nfour out of six Wonca core competencies: commitment to what is most important for the patient,\npreparedness for the unexpected in body examination, seeing the human and the breadth of any clinical\nsituation.
Author: Björn Landström
Language: Swedish
Subfield: Family Practice
Field: Medicine
Domain: Health Sciences
SDG: Quality education
Open Access status: green
OpenAlex ID: W2124817133