The consultation room is not enough: A collaborative and participative research project to explore and redesign a lifelong learning ecology to support present and future GPs in developing an entrepreneurial mindset

The profession of general practice is impacted by rapid transformations in the broader healthcare system. GPs are expected to be change agents for healthcare challenges. At present, GPs are not sufficiently equipped for a role in inducing and sustaining change. This role asks for transformative agency, which involves a mindset of actively participating in solving challenges in healthcare services. However, traditional ways of teaching are insufficient to foster transformative agency. As the future context is uncertain and continuously changing, we need a novel general practice learning ecology. Designing a sustainable learning ecology promoting the development of transformative agency is challenging. Moreover, such learning needs to happen just-in-time, asking for lifelong learning across generations. This collaborative and participative project aims to develop knowledge on creating a sustainable learning ecology that supports educators, learners, GPs and policy makers to employ transformative agency. This will help to create the conditions for guiding pro-active participants in healthcare change and sustainability processes. We will use the case study of Continuity of Care (CoC), an urgent problem in healthcare. Our research question is: How to design and establish a lifelong learning ecology that supports collaborative learning of practicing physicians, GP residents, and medical students for transformative agency? First, we explore the literature about developing transformative agency. To build our conceptual framework, in the analysis we use four perspectives on the learning ecology: spatial, temporal, instrumental, and social. Next, we will run a sequential series of Change Lab sessions for which we educate facilitators and develop material. Using the case example of CoC, participants will create new models for the healthcare system. Discourse analysis and Video Stimulated Recall interviews will enlighten the development of transformative agency of sessions’ participants. Next, we broaden our view and look at networks for learning about becoming a change agent. Finally, all findings will be included in co-design sessions for the development of a learning ecology, with intergenerational stakeholders, ranging from medical students and GP trainees to experienced GPs. This project will lead to design principles for building a learning ecology for intergenerational lifelong learning. In addition, our project will cultivate knowledge regarding transformative agency. Participants will take the lead in bringing this further by using their networks, thus influencing the healthcare system. Finally, the outcomes of the Change Lab sessions, will be innovative ideas and models for sustaining CoC. Our studies will have impact on learning within the health care system, because major stakeholders are involved in all phases of the project. The aims in
our study are not attainable if we only focus on the next generation or the previous one. Thus, within our project, we focus on age-based diversity. GPs of all generations contributing to a healthcare system as change agents, promoting collaborative care at the local, regional, and national levels, will lead to increased job satisfaction, fewer medication errors, reduced hospital admissions, decreased emergency department visits, lower healthcare utilization, less overdiagnosis, decreased healthcare costs. This could potentially create significant opportunities for optimal redistribution of scarce healthcare resources and, consequently, contribute to the much-desired future-proof primary care system. Also, as our studies use existing theory as well as develop theory on lifelong learning between generations, which will impact the national and international knowledge base. Thanks to the educational and organizational strategies to support GPs’ transformative agency, GPs will likely take an active role in processes for change of the healthcare system at all levels.

GPs should not only provide good patient care but also contribute to innovations in a changing healthcare system. Training programs pay little attention to this. How can GPs learn to improve the care system at the local, regional, and national levels? How can educators support this learning? This participatory project explores how GPs at every stage of their career, from medical students to lifelong learners, can create a learning environment that supports them in improving healthcare. We use the example of continuity of care for this purpose. Patients are less likely to have a designated GP. This is crucial because patients receiving care from the same healthcare provider live longer and use less unnecessary care. Also, continuity of care increases patient and doctor satisfaction. With our results, GPs will develop into entrepreneurial agents of change in the healthcare system.