Teaching in practice: a qualitative factor analysis of community-based teaching

Introduction In response to Tomorrow's Doctors, the use of primary care as a teaching base has been extended in many medical curricula. Previous repor ts have largely been speculative, looking at the theoretical possibilities and concerns of general practitioner teachers; in order to validate such st udies, it is now important to evaluate the experience of those actually eng aged in new teaching opportunities. In addition, curriculum developers need to go beyond descriptive studies to weight the factors which may help or h inder new teaching. Aim The aim of this qualitative study was to use the context of a substanti ve increase in community-based teaching to evaluate the perspective of key general practice tutors on factors related to recruitment and retention, im pact and outcomes, curriculum delivery, training and support, and quality a ssurance of the course. Methods Data were collected by written questionnaires to a sample of 45 gen eral practitioners, plus semi-structured interviews with 15 general practit ioners (33% of total sample). The data were purposively analysed to seek ke y factors, which were weighted by 'force field' analysis to show the balanc e of positive and negative factors. Results The data demonstrate important factors which may facilitate or impa ir community-based teaching at the levels of tutor, student, practice, and academic context. Discussion A 'cycle of satisfaction' is described, where personal motivatio n, shared team responsibility for teaching, and an enhanced professional se lf-image may all be crucial interdependent contributors. Suggestions are dr awn from the data on key elements of effective academic support and possibl e practical quality indicators.