Internship spotlight: Sam Rolfe’s path into primary care research

About the author: 

Sam Rolfe is a penultimate year medical student from UCL. He is currently undertaking an NIHR Student Internship with the Nuffield Department of Primary Care Health Sciences. Sam also completed an intercalated BSc in Primary Care Research and Clinical Practice, at the UCL Department of Primary Care and Population Health from 2022- 23. Recently, he was awarded the George Lewith Prize for his dissertation and systematic review on ‘The Total Triage Model in General Practice’. 

About our internships:  

The Nuffield Department of Primary Care Health Sciences offers a range of internship opportunities, including the National Institute for Health and Care Research (NIHR) School for Academic Primary Care Research (SPCR) internships. These programmes are designed to immerse students and early-career researchers in cutting-edge research projects, such as randomised controlled trials and policy analysis in primary care settings. Interns gain valuable experience working alongside leading researchers and clinicians, enhancing their skills in research methodologies and practical primary healthcare applications.  

I’m Sam, a fifth-year medical student at University College London (UCL). This summer I’m excited to be joining the Nuffield Department of Primary Care Health Sciences for a National Institute for Health and Care Research (NIHR) School for Academic Primary Care Research (SPCR) internship with Professor Chris Butler.  

I will be conducting a discrete piece of work using surveys surrounding pneumonia and prescribing antibiotics in primary care over five years and across 18 countries. I will focus on disparities in pneumonia diagnosis, differences in types of antibiotics prescribed and trends of symptomatic treatment. 

Experience in General Practice  

I believe my passion for academic primary care stems from my work as a GP Receptionist. When I was in my second year as a medical student, I started working as a GP receptionist to pay my bills and gain some medical experience. I did not anticipate how much it would change my outlook on medicine, healthcare, and life in general. The frontline experience in the crossroads of enabling service access; the managing complex multi-morbid patients; and coordinating input from secondary care illustrated the all-encompassing nature of primary care.  

My Research   

Having enjoyed my work as a GP Receptionist so much, I developed a burning desire to understand the research behind the differences in practice I had observed and experienced. As such, I undertook an intercalation on the Primary Care and Population Health BSc at UCL. Building upon my first-hand experience of access differences for patients, I chose to complete my dissertation on ‘The Total Triage Model within General Practice’, conducting a systemic review on the model, focusing on both patient and staff experience as well as the implications for general practice.  

I was intrigued to discover a plethora of opinions and narratives, with Triage working well for some patients but not for others, and the same for staff members. The more I researched, the more it became clear that not enough is done to address the challenges of Total Triage and the subsequent implications it may have for the most vulnerable and marginalised patient groups. Completing this systematic review cemented my passion for research and committed me to lifelong learning.   

Why Oxford? 

The NIHR SPCR Internship Programme provides me with the perfect opportunity to develop my research skills, learn new methodologies and collaborate with diverse teams at a new institution.  The opportunity to build experience in randomised controlled trials, secondary analysis and frontline experience at a research-intensive GP practice will be fantastic. I’m excited to build upon my previous research, liaise with researchers and clinicians, seeing how their own research influences their practice, and develop a detailed understanding of the outcomes of different research types – not only to improve my own research, but also to help me add context to my previous research and my future practice of medicine.  

My areas of interest: Policy and critical reflexivity in medical education  

Throughout my research experience, I have found it crucial to align policy and clinical practice through patient and public involvement, whilst also including GP stakeholders. I believe that in order to produce applicable, practical and measured research, becoming advocates for those implicated is key. Often in medical school, there can be a disconnect between policy teaching provided to medical students and tangibility in placements and clinical interactions. Both medical students and future clinicians have the capacity to act as advocates for our patients, using our knowledge of their specific needs, working through and within policy constraints to achieve the best outcomes for our patients. To add further complexity, we work within a system of finite resources and have a responsibility to advocate fairly amongst all our patients and the collective health of the country.  

Critical reflexivity (examining your own beliefs, assumptions, and actions to understand their impact on others and improve practice), is crucial in forming measured rationales for patient advocacy at all levels and help identify gaps where further advocacy might be needed. Comprehensive and reflexive policy teaching enables students to become more active contributors to health policy and assemble crucial skills for future advocacy.   

Advice to potential students  

When I think back to two years ago, I would have never thought I would be doing an internship with the University of Oxford. I always considered myself to be an average student – doing what was needed to pass but not exceeding expectations. Since developing and pursing an interest in academic primary care, I feel like my medical school experience has flourished. Even if academic primary care doesn’t interest you, it plays a key role in frontline healthcare in the UK. It will impact on your future career whatever speciality you decide.  

My advice to any medical student is to always examine the patient in their full context, their journey to the clinical interaction and the barriers they may have already faced or overcome. Consider how research and policy can have real world implications on the exchange between you and the patient.  

For anyone who is considering research or picking a dissertation topic, I would advise you to pick something that truly excites and challenges you. Even on the least productive of days, you’ll find it much more engaging. Conducting research outside of medical school can be the most fulfilling addition to your studies, but sometimes the days you have off can be the most valuable in your progress. It’s still important to take the time to properly recharge, relax and pursue non-medical interests, too.