Torsten Risør

Knee osteoarthritis (OA) is a prevalent condition and public health concern. Guidelines recommend non-surgical treatments - such as education, exercise and weight management - as core elements of OA management; however, uptake remains low. General practitioners (GPs) play a crucial role in delivery, yet little is known about how GPs navigate OA treatments in the Scandinavian context. To explore Danish GPs' perceptions and experiences of knee OA management, focusing on treatments and referral, and to identify key barriers and facilitators to delivering guideline-recommended treatments. Twelve semi-structured online interviews were conducted with GPs and GP trainees. Participants were recruited through a combination of convenience and self-selection sampling. Data were analyzed inductively using thematic analysis. Four themes were identified: (1) knowledge and practice extend beyond guidelines, (2) non-surgical treatments are limited and inconsistently provided, (3) conceptual and relational tensions are negotiated and (4) fostering patient motivation is challenging. GPs displayed generally up-to-date knowledge of core non-surgical treatments, although familiarity with referral criteria was more variable. They held positive attitudes toward exercise and physiotherapy-led treatment, but experienced limited active dissemination of guidelines. Structural barriers, including fragmented pathways and uneven municipal services limited delivery of non-surgical treatments. Weight loss was viewed as effective in relieving joint pain but an unsustainable treatment focus, highlighting the need for a feasible, weight-inclusive approach to weight management. Strengthening cross-sector coordination, developing and implementing multidisciplinary OA services as well as clarifying where responsibility for fostering patient motivation should be placed, may enhance delivery of non-surgical care.

General practice plays a central role in healthcare delivery and holds significant potential to advance sustainability by reducing its environmental footprint and promoting population health. While Denmark has implemented national and regional strategies to enhance sustainability in hospitals and secondary care, comparable initiatives in primary care remain limited, and little is known about general practitioner (GP) views on sustainability in general practice. The aim of the study was to explore GPs' views on sustainability in general practice. Eleven semi-structured interviews were conducted during November and December 2024 with GPs from all regions of Denmark. A qualitative individual interview design using interpretative reflexive thematic analysis was used. Two main themes were constructed (i) Making sense of sustainability: How GPs perceive sustainability in practice, with the subthemes: Abstract threat, concrete practices, Translating sustainability into clinical language, Financial sustainability as a prerequisite, and When social sustainability feels imposed; and (ii) Between responsibility and reluctance: the GP's role in a sustainable future, with the subthemes: Waiting for direction and delegation, and Forming sustainability as part of the professional identity. While most participants recognised sustainability as an important topic, they described challenges in transforming it into something manageable that could be incorporated into everyday clinical practice. This study underscores the need for more research and policy attention to sustainability in Danish general practice. GPs appear willing to support a sustainability transition in health care, but they require further guidance and knowledge.

Background: Emergency departments (EDs) provide urgent care to diverse patients. Medication-related tasks, crucial for safe diagnosis and treatment, often receive inadequate attention. Clinical pharmacists, experts in medication management, can improve outcomes and reduce costs. Objectives: To investigate how the introduction of clinical pharmacists affects ED junior physicians’ work-time distribution, with particular focus on medication-related tasks. Design: A stepped-wedge design was employed, introducing pharmacists across three Norwegian EDs over a 9-month period, with each ED starting at staggered intervals. Methods: Using the Work Observation Method By Activity Timing (WOMBAT) methodology, we observed junior physicians’ activities in three EDs. The pharmacists were encouraged to adapt to the ED setting, integrate into the team, and identify ways to apply their expertise effectively. Medication reconciliation became their primary focus. We recorded 251 h of observation in the period without pharmacists present and 287 h in the intervention period, with pharmacists present. The proportion of time spent on different tasks was compared between the two periods. Results: Junior physicians spent 81.0% of their work time on non-medication-related tasks, 11.6% on standby/movement, and 8.7% on medication-related tasks. There was no evidence that the overall time distribution was affected by the intervention. However, in ED2, the proportion of time spent on medication-related documentation was reduced from 6.1% to 2.5%, while standby time increased from 6.1% to 13% with pharmacists present. Face-to-face interactions with pharmacists accounted for less than 2% of the junior physicians’ work time in all EDs. Conclusion: In three Norwegian EDs, junior physicians’ work time was predominantly spent on non-medication-related tasks, with only 8.7% dedicated to medication-related tasks. The introduction of clinical pharmacists did not significantly impact junior physicians’ overall work-time distribution. Further research should investigate pharmacists’ impact on ED care quality and efficiency.

Due to a demographic shift, among others, more general practitioners will be needed in Denmark in the future. In this study, we examine Danish medical trainees’ intention to pursue a career in general practice as they gain firsthand work experience during postgraduate education. The expanded conceptual framework of medical students’ primary care career choice was used in the selection of variables related to the medical trainees’ career intentions and work experience and in the interpretation of the results. The study was a prospectively conducted longitudinal cohort study using cross-sectional time-series data. A questionnaire specific to the Danish context was used for data collection among a national cohort of medical trainees before they entered their first postgraduate training year and again after 15–17 months. Data was analyzed descriptively, and the effect of time on the intention to pursue a career in general practice was assessed using mixed models. Results showed significantly more medical trainees intended to pursue a general practice career at follow-up compared to baseline. Also, the group of medical trainees with that intention included the highest proportion of participants who were parents at follow-up. The intention to pursue a career in general practice was, among others, associated with an interest in regular work hours and the opportunity to work part-time and be self-employed at baseline and follow-up. Applying the conceptual framework to the results suggests that medical trainees already at medical school graduation had gained an authentic and sufficient perception of general practice characteristics and that the shifts in specialty intentions during the follow-up period were driven by changes in personal characteristics.

Background: There is a growing presence of digital technologies in clinical learning environments. However, there is little research into how such technologies shape embodied teaching and learning for health professional students. This study aims to explore current teaching practices in health disciplines to illuminate how digital technologies are used to facilitate the development of embodied knowledge during student learning of physical examination. Methods: A qualitative interpretive approach was undertaken, sensitised by body pedagogics as a theoretical frame. In‐depth interviews with 18 clinical educators across the disciplines of medicine, physiotherapy, midwifery and nursing were held. These interviews explored their current practices for teaching physical examination. The data was analysed using reflexive thematic analysis combined with a ‘thinking with theory’ approach, in which the theoretical framework of body pedagogics was central to guiding the reflexive and interpretative process. Results: We interpreted a framework of five approaches where digital technologies are used to develop bodily knowledge: for sensate knowing; for modelling; for rehearsing; for guiding practice and for providing feedback information. Conclusion: Findings suggest that in current teaching practices, digital technology may be used to facilitate multiple essential elements of physical examination instruction. We conceptualised a framework that extends body pedagogics, where we recognise the multiple roles of digital technology for developing bodily knowledge in the context of physical examination.

The presence of digital technologies in clinical learning environments is increasing. However, there is little research into how technologies influence the interplay between touch and the acquisition of physical examination skills by health professional students. In this study, we aimed to explore how digital technologies feature in clinical educators’ accounts of current physical examination teaching in practice. A qualitative interpretive design was used. Data was collected via in-depth interviews with 18 clinical educators from the disciplines of medicine, physiotherapy, midwifery, and nursing to investigate the current perspectives and practices used in teaching physical examination. We interpreted three themes within the data: Polarised perspectives of digital technology use in physical examination teaching, the integration of digital technologies into the teaching of physical examination, and the invisibility of digital technologies in physical examination teaching. Digital technologies have been extensively integrated into the teaching of physical examination. However, the perceptions of the participating clinical educators have not evolved at the same pace. We suggest that clinical educators re-examine their assumptions and attune themselves to the dynamic relationship between hands-on skills and digital tools.

This paper aims to provide knowledge on medical trainees' considerations about specialisation as they move from undergraduate to postgraduate medical education; especially their interest in general practice compared to other specialities. We developed and content-validated a questionnaire to examine medical trainees' speciality considerations and conducted a descriptive, cross-sectional study. All medical trainees initiating their internship in Denmark in 2022 (N = 1,188) were invited to participate in the study. Medical specialities were categorised as hospital service specialities, internal medicine specialities, primary care, psychiatry specialities and surgery and emergency specialities. Descriptive statistics were used to describe the cohort and examine the participants' speciality considerations by assigning them to one of the following three orientations: committed, undecided or non-committed to a speciality. The response rate was 38.8% (n = 461), and participants' mean age was 27.4 years with a majority of females (68.1%). Nearly 25% of the participants had general practice as speciality preference, and only 13.9% had excluded general practice for future specialisation. Overall, around half of the participants had general practice as a first, second or third preference for specialisation. Danish medical trainees show considerable interest in general practice at the time of their transition from undergraduate to postgraduate education. However, to meet future demands on the primary care, further recruitment of general practitioners is still needed. This knowledge of the specialities' recruitment potential will likely be of interest to medical educators and healthcare planners alike.

In contemporary policy discourses, data are presented as key assets for improving health‐care quality: policymakers want health care to become ‘data driven’. In this article, we focus on a particular example of this ambition, namely a new Danish national quality development program for general practitioners (GPs) where doctors are placed in so‐called ‘clusters’. In these clusters, GPs are obliged to assess their own and colleagues’ clinical quality with data derived from their own clinics—using comparisons, averages and benchmarks. Based on semi‐structured interviews with Danish GPs and drawing on Science and Technology Studies, we explore how GPs understand these data, and what makes them trust—or question—a data analysis. The GPs describe how they change clinical practices based on these discussions of data. So, when and how do data for quality assurance come to influence their perceptions of quality? By exploring these issues, we carve out a role for a sociological engagement with evidence in everyday medical practices. In conclusion, we suggest a need to move from the aim of being data driven to one of being data informed.