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Table 4 Key constructs of success and failure

From: Modelling successful primary care for multimorbidity: a realist synthesis of successes and failures in concurrent learning and healthcare delivery

  Key constructs of success Key constructs of failure
Health care delivery •Collaborative working practices •Repeated/prolonged hospital admissions
•Holistic and transparent goals developed through negotiation •Clinician reluctance to look beyond biomedical markers
•Integration of medical and experiential knowledge regarding diseases and impact •Negative corollaries of the described constructs of success [1,13,24,26,37,44,57,61-65]
•Professional sharing of best practice
•Transformative learning through trusted relationships between patients and practitioners to enable self-management [1,10,12,24,26-28,37,44-48,51,52,57,61,63-69]
Experiential learning in workplaces •Learning to engage in and benefiting from collaborative working •Contexts which reduced students and patients to passive roles
•Reciprocal learning: viewing learning as a shared social process •Negative workplace cultures
•Learning from direct interaction with patients •Lack of exposure to multimorbidity with excessive focus on single-disease frameworks
•A supportive environment for the appropriate mix of responsibility, challenge and scaffolding to permit a safe but legitimate role in practice •Overreliance on guidelines often not developed on evidence applicable to patients with multimorbidity in primary care [27,28,50,65]
•Physical space to allow interactions between patients and trainees
•Patients and practitioners needed to learn how to make personalised trade-offs between risks and benefits in multimorbidity and to manage competing priorities which could change over time [10-12,26,27,47,48,50-53,56-59,64,68-75]