Figure 4

This model represents the highest level of abstracted interpretation achieved during the synthesis. There is no pre-defined starting point in this model as it is intended to represent complex, non-linear, fluid social interactions between patients, doctors (in this instance, GPs) and trainees. These three groups are interdependent in generating responses to the challenges of multimorbidity, that at the most constructive will produce a form of transformative learning for all three groups. At the centre of the model are represented each of the groups, with their most pertinent concerns, as identified in this synthesis. The inner loop surrounding this suggests potential mechanism for achieving optimal learning. The outer loop represents the potential for cycles of new understanding and new ways of being which are triggered by disruptions secondary to the ever changing impact of multimorbidity, combined with ‘readiness for change’ in the three groups. This model should be considered as representative of the level of theory development possible from current literature, as synthesised, and viewed in conjunction with Figure 3.