Medical student learning during longitudinal clinical placements in under-served, deprived, community areas: A qualitative study

Abstract

Background
There are national UK general practitioner (GP) shortages, particularly in deprived areas, and an insufficient number of medical students intend to become GPs. Medical students currently have limited exposure to settings which provide care for deprived communities. This research investigates student learning during the Difficult and Deprived Areas Programme (DDAP), an innovative pilot programme which places fourth year students in general practice and community placements in under-served, post-industrial, deprived areas for 14 weeks.

Method
A systematic review investigating the efficacy of undergraduate community placements in under-served areas was completed. A qualitative approach was used collecting data from: DDAP students (n=9) before, during, and end of placement; GP supervisors (n=14), and patients (n=12). Comparison data was collected from peers taking alternative placements to the DDAP (n=16) and students taking an established rural programme (n=6). Semi-structured interviews were conducted to collect data. Data were analysed using framework analysis and the Experience Based Learning theory.

Findings
In total, 85 interviews were conducted over a two and a half year period. The DDAP experience enhanced student knowledge about psychosocial determinants of health, developed compassion, and reinforced clinical skills. Learning was facilitated through independent time with patients, which promoted deeper learning about the role of the doctor. The integrated and immersive DDAP structure gave students an understanding of delivering healthcare for patients with complex deprivation issues. Comparative placement experiences highlighted the importance of having a nurturing supportive supervisor and having an active role delivering healthcare within a community team.

Conclusions
There is increasing evidence on the value and importance of clinical placements in rural and remote communities, but little in regard to other under-served, deprived areas. This research explored medical student learning during an innovative placement in such a setting. The thesis provides evidence of the value of these placements and puts forward a model explaining why these placements are effective, and why they may help to create better doctors for the future.