An examination and evaluation of mental health teaching and learning in “multi-level learner” general practices

Abstract

Background: This study was designed to identify the appropriateness of the rural multilevel general practice learning environment for mental health education.Methods: Individual semi-structured interviews were conducted with a purposive sample of 56 practice personnel at five practices in Victoria and South Australia. Interviews were transcribed verbatim and input into N-Vivo qualitative analysis software. Data were analysed against a template derived from open coding merged with basic themes derived from a literature review. Results:Practice personnel in this study found the multi-level learning environment particularly well suited to mental health teaching but highlighted that learners sometimes had difficulty attaining the most suitable learning level. The study indicated that medical learners need further education about mental health, with exposure to mental health patients and scenarios emphasised as the most valuable ways to learn. An underutilisation of local mental health professionals as teachers was highlighted. Conclusion:The general practice multi-level learner environment can provide positive outcomes for learning about mental health because it offers diverse opportunities for educators to effectively facilitate group learning.

A systematic review of the approaches to multi-level learning in the general practice context, using a realist synthesis approach: BEME Guide No. 55

“…Several studies used qualitative methods only: semistructured interviews (Ahern et al 2013;Silberberg et al 2013;Kleinitz et al 2014;Morrison et al 2014;Thomson et al 2014;Brown et al 2015) or interviews and case reports (Harris 2009)). Others used mixed methods: a survey and semi-structured interviews (Gaby et al 2014;Kirby et al 2014); a survey and focus group discussions (Johnson et al 2003); or a survey collecting predominantly quantitative data, with some qualitative free text responses (Williams and Amiel 2012;van de Mortel et al 2014;van de Mortel et al 2016). A postal questionnaire collecting only quantitative data was reported in one study (Nagel et al 2011).…”

“…Study aims were diverse. One study investigated the benefits and challenges of teaching mental health using a MLL format (Gaby et al 2014), while the two English papers (Nagel et al 2011;Kirby et al 2014) focused on determining the extent of junior doctor and GP trainee involvement in teaching and attitudes to such a role. Most Australian papers looked at the experiences of multiple stakeholders using MLL teaching and learning in the general practice setting.…”

“…This is helped by GP teachers getting to know the learner and/or learner-teacher capabilities (C) (van de Mortel et al 2016), being aware of each learner's curriculum (Brown et al 2015), and recognizing not all learners are suitable for all MLL activities (C). One-to-one teaching is seen by some as important to address individual learning needs (Ahern et al 2013;Gaby et al 2014) and various learners and GP teachers believe that a mix of learning methods is most effective (Ahern et al 2013;van de Mortel et al , 2014. GP teachers need to be skilled to manage the educational and mentoring challenges of a group of learners with differing clinical knowledge, experience, and needs (C) Mechanism 4: Exposure to a range of teachers and learners using diverse teaching and learning methods…”

“…Exposure to a range of teachers and learners using diverse teaching and learning methods (M) can enhance knowledge exchange for learners and staff (O). Varied personal and clinical experiences, skills, and backgrounds (C) provide different perspectives and currency of knowledge (Harris 2009;Ahern et al 2013;Silberberg et al 2013;Gaby et al 2014;Morrison et al 2014;Thomson et al 2014) and can also "stretch" learners (Gaby et al 2014) by extending their thinking and skills (O). The benefits can extend to practice staff who may learn from increased discussion and interaction (Morrison et al 2014).…”

“…For example, parallel consulting can provide learners with opportunities for autonomy in patient care and one-on-one teaching experience (Thomson et al 2014). Shared educational sessions such as MLL tutorials can provide opportunities for equal partnerships in learning (O) (Harris 2009;Thomson et al 2014), a supportive learning environment (O), and the opportunity to revise and update knowledge (O) (Harris 2009;Ahern et al 2013;Silberberg et al 2013;Gaby et al 2014;Morrison et al 2014;Thomson et al 2014;Brown et al 2015;van de Mortel et al 2016). "Supernumerary GPs" (GPs who are not seeing any/many of their own clinical patients during the time they are supervising and teaching) (C) provide learners with timely access to an experienced GP (Thomson Table 5.…”