Utility of advanced training skills among GPs: a systematic review
Notice bibliographique
Résumé
INTRODUCTION: Advanced Skills Training (AST) is designed to provide GPs with an opportunity to enhance their clinical practice in a narrower speciality. This is valuable particularly for rural and remote communities that cannot justify narrower specialist services in the local community. ASTs require additional focused training, usually for 12 months, in a selected procedural or non-procedural skill such as anaesthetics, obstetrics, surgery, emergency medicine, paediatrics, adult internal medicine, mental health, Indigenous health or palliative care. Ideally, several practitioners with complementary AST experiences work together to provide a wider range of extended scope practice according to community need. However, experience so far suggests that this goal is not necessarily achieved. Thus, this systematic review aimed to assess the value and fitness for purpose of AST and ensure that it is meeting the growing demand for coordinated care in rural communities. This review addressed three questions: What is the effectiveness of AST programs in improving GPs' knowledge, attitudes and competence regarding rural clinical practice? How do stakeholders - including trainees, patients, management and the community - perceive the impact (value and fitness for purpose) of the AST program in rural clinical practice? To what extent are advanced skills training programs aligned with the needs of the community served? METHODS: This systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A comprehensive search strategy was implemented across six electronic databases (Medline Ovid, CINAHL, Emcare, Scopus, Web of Science and Informit) in December 2024. The quality of the studies was appraised using the Quality Assessment for Diverse Studies tool. Across all the reviewed articles, data on the effectiveness of AST, stakeholder perceptions of its value and extent of alignment of AST with community needs in rural clinical practice were extracted and synthesised using a data extraction template. RESULTS: Sixteen peer-reviewed articles met the inclusion criteria. Of these, 11 employed qualitative study designs (n=11, 68.8%) and five were quantitative (n=5, 31.3%). The majority were conducted in Canada (n=5, 31.3%) and Australia (n=5, 31.3%), followed by the US (n=4, 25.0%) and England (n=2, 12.5%). The findings revealed that the definition and scope of AST varied across the literature. Some defined it as advanced training that involves 12 months full-time equivalent in an accredited training post while others defined it as 'tracks', certificates, extended fellowships, residency programs or placements. Across the literature, participants noted improvements in their knowledge, attitudes and competence regarding their clinical practice. The value and fitness for purpose of the AST program was demonstrated by registrars' continued use of skills after AST training, soft skills development and community engagement opportunities, and rural workforce retention. The challenges reported for those undertaking AST programs were barriers to inclusion on remote visits (eg transportation space, training space), time efficiency and management, workload fluctuation, gaps between training and use of skills, peer acknowledgement, and differences between the hospital settings in which training occurred and the rural contexts in which the skills would be applied. CONCLUSION: Overall, this review provided evidence on the utility of AST for GPs. Despite the value of AST in GP clinical practice, some bottlenecks may be limiting its effectiveness. Current AST opportunities (both training and final practice location) and career pathways are not always aligned, potentially limiting the success of the AST strategy in bridging the gap between urban and rural health service status. Concerted efforts are required to improve alignment of career advice, community needs, training pathways, AST opportunities and final practice location in order to achieve the intended purpose. Further research is required on the impact of AST programs on community health outcomes.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,003 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,004 | 0,000 |
| Bibliométrie | 0,000 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».