Training doctors to manage patients with multimorbidity

Background

Multimorbidity is defined as the presence of two or more chronic diseases in an individual patient. It presents significant clinical, organisational, and educational challenges which are increasingly being addressed by academic and clinical bodies. The overall aim of this project was to assess the training needs, if any, of doctors managing patients with multimorbidity, and to develop an intervention aimed specifically at addressing these needs. The objectives were to thoroughly examine the published literature relating to management of patients with multimorbidity; to robustly assess the relevant learning needs of doctors; and to develop and implement an intervention to address any gaps in training.

Methods

A comprehensive review of the multimorbidity literature, and a systematic review of the educational literature, were completed. An electronic survey and focus groups of volunteers were carried out to assess the learning needs of GP and physician trainees in multimorbidity. Integrating the results of the survey with data collected from focus groups of trainees in general practice resulted in the proposal of a curriculum for training, and the development, feasibility study, and evaluation of a training intervention for general practitioners (GPs) using the Medical Research Council (MRC) Guidelines for Developing and Evaluating Complex Interventions.

Results

The quantitative findings demonstrated a need for training in management of patients with multimorbidity: Only 36% of survey respondents reported experiencing dedicated multimorbidity training, and 75.3% expressed an interest in attending such training if it was available. This was reflected in the qualitative results which revealed perceived deficiencies in training in relation to multimorbidity. A workshop was developed and a feasibility workshop involving fifteen GPs was completed. The well-received workshop suggested that the format was acceptable to the target audience of working GPs, and though numbers were small, feedback from participants was uniformly encouraging.

Conclusions

This study demonstrated a gap in training in management of patients with multimorbidity and proposes a curriculum and workshop to address these training needs. Further research is required to implement training on a broader scale and to develop robust evaluation tools to ensure that training is relevant, efficient and, most of all, effective in improving outcomes in patients with multimorbidity.