Operationalising generalism in medical education: a narrative review of international policy and mission documents

Ramanathan, A., Clarke, N., Foster, M., Pope, L. , Hart, N., Cheung, S., Kelly, M. and Park, S. (2023) Operationalising generalism in medical education: a narrative review of international policy and mission documents. Education for Primary Care, (Early Online Publication)

Abstract

Introduction: Despite moves across medical education to increase learning of generalist principles, a lack of clarity about what generalism means and how we should train doctors as ‘generalists’, has remained. This study explores how international, undergraduate and postgraduate, policy and educational mission documents characterise the practice and learning of generalism and how this can inform physician training. Methods: A narrative literature review was conducted based on policy and mission documents identified through grey literature searches and a wider systematic review looking at empirical texts. Texts published between 1999 and present and related to ‘generalism’ were eligible for inclusion. Texts were coded and codes were reviewed and grouped into key themes. Results: Thirty-four documents were included. Definitions vary: some described generalism as a basic skill, whilst others emphasised expertise. Factors which support learning generalism include: favourable financial outcomes; ageing populations; coordination of multidisciplinary care; demand for doctors with transferable skills; and patient expectations. Barriers to learning about generalism include: preference for specialisation; structure of undergraduate teaching and assessment; and the hidden curriculum. Solutions may include re-imagining generalists and specialists as being on a continuum as well as increasing exposure throughout medical education. Discussion: Whilst generalism is consistently positioned as valuable, less clarity exists about how best to operationalise this in medical education. Fundamental ideological and structural changes within teaching curricula and assessment, are necessary to improve generalist learning and to promote sustainable practice. Medical education needs careful, considered planning to ensure workforce expertise is meeting population needs.

• Item Type: Articles
• Status: Early Online Publication
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Pope, Professor Lindsey
• Authors: Ramanathan, A., Clarke, N., Foster, M., Pope, L., Hart, N., Cheung, S., Kelly, M., and Park, S.
• College/School: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > General Practice and Primary Care
• Journal Name: Education for Primary Care
• Publisher: Taylor & Francis
• ISSN: 1473-9879
• ISSN (Online): 1475-990X
• Published Online: 19 December 2023
• Copyright Holders: Copyright © 2023 The Authors
• First Published: First published in Education for Primary Care 2023
• Publisher Policy: Reproduced under a Creative Commons licence