The challenges of joint undergraduate teaching at the primary-secondary care interface: learning from the educator experience

BACKGROUND: To create a workforce fit for 21st century healthcare, the importance of integrating more primary care teaching into the medical undergraduate curriculum has been repeatedly highlighted; yet has been slow to realise. AIM: To explore the lived experience of educators working together to integrate teaching at the primary-secondary care (PSC) interface and identify facilitators and barriers to achieving change. METHOD: A constructivist research philosophy using qualitative methodology explored the experiences of educators involved in integrating general practice teaching into the undergraduate curriculum. Purposive sampling identified suitable primary, secondary care and pre-clinical educators who consented to semi-structured interviews remotely via Microsoft Teams. Transcripts were coded using qualitative data analysis software and themes generated through iterative and inductive analysis. RESULTS: Ten educators (5 General Practitioners, 3 Hospital Consultants, 2 Pre-Clinical) took part. Four main themes emerged: (i) The sociocultural context, (ii) Understanding the interface, (iii) Tensions at the primary/secondary care interface, (iv) Challenges in managing educational change. Although supporting the rational for change, a strong sense of loss of traditional teaching formats, lack of communication, and misunderstandings related to clinical work and differentiating between generalist and specialist roles were found. CONCLUSION: This study is unique in revealing a complex educational landscape, with many interconnected factors to consider if general practice is to be better integrated into the undergraduate curriculum. Hidden medical education sociocultural themes require further exploratory study in terms of both interface working and curriculum development.