Addressing multiple long-term conditions in the undergraduate medical school curriculum: a focus group study

Abstract

Background: Patients with a chronic physical disease accompanied by other disease types or biopsychosocial factors- multiple long-term conditions (MLTC)- represent a major and growing clinical challenge. 17% of the population of England are forecast to fit this definition by 2035. The aim of this study was to understand and explore desirable MLTC-related learning outcomes identified by newly graduated doctors in the UK.

Methods: Focus groups were conducted across sites at two NHS trusts in Northern England with doctors in their second postgraduate year (Foundation Year 2 (FY2)). An iterative thematic analysis was applied to transcripts to identify and organise key themes.

Results: Twenty-six participants across three focus groups reported their experience in primary and secondary care placements. The two overarching themes identified were: 1) 'Practice needs' for managing patients with MLTC. 2) 'Education needs' including limitations in undergraduate curricula. FY2s emphasised the concepts of uncertainty and complexity in practice, the variability of undergraduate learning experiences and gaps left by single-disease models of learning. Senior clinicians were highlighted as being key sources of support who modify learning experiences.

Conclusions: Newly qualified doctors find MLTC care challenging and feel ill-prepared to manage patients on entering the medical workforce. Suggested improvements for undergraduate curricula include enhancing interprofessional methods of learning and ensuring consistency of exposure to, and focus on, MLTC patient-related complexity across undergraduate placements and curricula.

Trial registration: Clinical Trial Number: Not applicable.

Keywords: Medical education and training; Multimorbidity; Multiple long-term conditions; Postgraduate; Undergraduate.