McWhinney's first principle of family medicine states that GPs 'are committed to the person rather than to a particular body of knowledge, group of diseases, or special technique'. While indeed committed to the person, we propose that the 'special technique' of general practice exists in the form of core clinical concepts for managing uncertainty (e.g. time as a tool, therapeutic examination, safety netting and doctor as drug). Managing clinical uncertainty calls for GPs (and trainees) to operate in a 'corridor of uncertainty', a cricketing analogy where the batter is unsure whether to play a defensive or attacking shot. For students to recognise and value these concepts requires longitudinal learning and simulation. Here we describe a GP module at Brighton medical school where core concepts are 'drip fed' through small group sessions across year 4. Formative simulated surgeries constitute a 'corridor of uncertainty' where simulated patients drive students into using concepts in practice (e.g. through shared management plans). Although recognised in postgraduate training, these concepts should be taught formally within the undergraduate curriculum. Doing so helps students distinguish general practice from hospital generalism and prepares them for clinical placements in general practice. These concepts are inherently 'soft' and founded upon the GP paradigm of understanding medicine. In the eyes of the specialist, they risk being unacknowledged, misinterpreted as ignoring guidelines or, worse still, as bad medicine. Soft core concepts constitute the tools to prepare students for managing clinical uncertainty and serve to inscribe the art of medicine within the undergraduate curriculum.
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http://dx.doi.org/10.1080/14739879.2021.1996276 | DOI Listing |
Alzheimers Dement
December 2024
Brigham and Women's Hospital and Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
The most recent Alzheimer's clinical trials, including those which reported successful outcomes, use neuroimaging biomarkers of both amyloid and tau for screening participants and demonstrating a treatment effect on pathology. Some of these trials, notably Lecanemab, hint at a potential sex bias in treatment outcome, alluding to major implications for clinical practice when recommending treatment options. Sex differences in treatment response are not surprising given that women are at greater risk of progression to AD dementia, particularly if they carry APOEe4.
View Article and Find Full Text PDFAlzheimers Dement
December 2024
Universidade Federal de São Paulo (UNIFESP), São Paulo, São Paulo/SP, Brazil.
Background: Dementia awareness and education are currently limited among healthcare workers and the general public, contributing towards the generation and propagation of stigma and discrimination against people with dementia worldwide. It is crucial to promote evidence-based anti-stigma interventions with a focus on stigma reduction.
Method: This is a randomized and controlled feasibility trial of a group intervention aimed at improving knowledge and reducing stigma related to dementia among Community Health Workers (CHWs) (Trial Registration: RBR-10xp637m).
Alzheimers Dement
December 2024
German Center for Neurodegenerative Diseases e.V. (DZNE), Site Rostock/Greifswald, Greifswald, Germany.
Background: Previous trials reported that collaborative Dementia Care Management (cDCM) could be effective for patients and caregivers and cost-effective for healthcare systems in the short term. However, long-term evidence is lacking. Therefore, the study's objective was to determine the long-term efficacy and cost-effectiveness of cDCM compared with usual care.
View Article and Find Full Text PDFAlzheimers Dement
December 2024
CIUSSS de L'Estrie-CHUS, Sherbrooke, QC, Canada.
Background: In the province of Quebec, Canada, primary care management of Alzheimer's disease is provided by the Family Medicine Group with the support of the Ministerial Initiative on Alzheimer's Disease and the collaboration of specialized memory clinics. The COVID years have severely strained health resources in all areas, including cognitive intervention resources. We describe the reorganization of regional support in the Eastern Townships.
View Article and Find Full Text PDFAlzheimers Dement
December 2024
Michigan Alzheimer's Disease Research Center, Ann Arbor, MI, USA.
Background: The integration of Large Language Models (LLMs) like ChatGPT-4 in clinical settings offers potential enhancements in medical practice, particularly in neurology and dementia care. There is rising public usage of ChatGPT-4 for preliminary information gathering. This study aims to evaluate the effectiveness of ChatGPT-4 in responding to neurology-focused queries, with an emphasis on Alzheimer's Disease (AD).
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