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Stress of training forces four in ten trainees to consider quitting

Exclusive GP trainees are becoming disillusioned with ePortfolios, long working hours and excessive time spent filling secondary care service gaps, to the extent that many have considered quitting training over the past 12 months, a Pulse survey has revealed.

The survey of 282 GP trainees found 38% have considered abandoning their courses in the past year. However, it also found that – on the whole – trainees are satisfied with the GP training they receive, while there is a split over whether a fourth year of training, based in general practice, would be beneficial.

But GP trainees’ reasons for considering leaving training were linked to ‘stressful’ bureaucracy and problems with secondary care placements, rather than the general practice elements of training.

Dr Aisha Mukhtar, a GPST2 currently in a hospital post, said she had contemplated quitting ‘due to the ePortfolio learning log requirements’, which she said were ‘exhausting’.

She added: ‘It takes away from our time to focus on learning/clinical needs. Any time I have left when I get home is used to do a learning log showing “reflection”, and I am left with no time to look up or read stuff that I think is clinically important.’

One GPST1 from Hertfordshire said: ‘The training is very ePortfolio-heavy and the pressure that causes is very offputting and stressful’, while a GPST2 from Somerset said ‘the GP ePortfolio is still archaic’.

gp trainees figures box

gp trainees figures box 580x, August issue

A GPST2 from the west of England said: ‘I don’t feel like I’m training to be a GP – just an SHO filling gaps in the hospital rotas, working under consultants who specialise in a different field and aren’t interested in general practice.’

After a landmark review last year found medical students were being deterred from general practice by tutors who see it as a ‘low status’ option, the Pulse survey found 80% of trainees who answered the question had experienced denigration of the profession at medical school.

And this continues in specialist training, with 29% experiencing denigration by consultants every week, and a further 37% saying they had experienced consultants badmouthing general practice once or twice a month.

Dr Mukhtar said: ‘I was complemented on how good I was and asked why I wanted to be a GP and told that “it is a waste”. Another time, one of the consultants said to me “I am sorry for you, you are going to join a truly horrible group of people”. I was hurt and it made me doubt the path I chose.’

However, trainees expressed satisfaction with the training they received in general practice. A total of 62% of respondents said it sufficiently prepares them for their career, while almost 90% said the clinical work they are required to perform is appropriate for their stage of training.

At the same time, 39% expressed support for an extra year of training, with an equivalent proportion disagreeing.

The RCGP has been pushing for a fourth year of training, with former chair Professor Clare Gerada recently going as far as to suggest a five-year programme.

Pulse also revealed last month that the RCGP has commissioned the Health Professional Assessment Consultancy to undertake a review of the MRCGP.

Read more from Pulse’s special on trainees here

 ‘We do the shifts hospitals can’t fill’

‘I have considered quitting – although GP training is great. The GP sessions are good fun, the teaching focused and appropriate.

‘However, for most, 50% of the GP programme involves working as an SHO in a hospital post. These have become heavily service provision-oriented.

‘For example, in an emergency medicine post you do three times as many night shifts as you might have only seven or eight years ago as emergency department rota managers cannot employ staff at other grades for these.

‘The bosses claim that is essential for training. You can try to raise the issue with training programme directors but as a trainee your voice falls on deaf ears.

‘I’m looking forward to ending my time as an SHO.

I just felt like I had to suck up these jobs and get on with it.’

GPST2, west of England

 

Readers' comments (19)

  • I have some sympathy with Prof Gerada's view. But then she came from the pre-eportfolio era when prospective GPS figured out for themselves what specialities they needed to do (not difficult) and chose where they wanted to do those service jobs. It was not perfect but far more humane than the present system.

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  • I am sorry to say that some of the GP trainees think that they are doing a favour to the hospital forgetting the fact that they are being paid and there is duty of service provision attached to the training.This attitude has to change.
    Equally the hospital specialties have to involve the GP trainees more and shouldnt neglect them as the GP trainees are not specialty trainees. This behaviour has to end.

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  • IT is somewhat comforting to know thet the newer generation trainees are also struggling with the intense micromanagement of e portfolios and constant reflection and logging just for the sake of it.... many are having to suffer the same with appraisals and revalidation and I am sure a majority who can have retired or left because of it .... the more who struggle with it and complain the better .. otherwise it is a self fulfilling prophesy and HR academics will celebrate it as a huge success

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  • Moosa .. do not call it a training post if it is 90% service provision
    Advertise the jobs as service jobs
    and stop abusing trainees

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  • I have to say my supervisors, both hospital based and in general practice, were outstanding and went out of their way to make things relevant to GP. It sounds like I may have been lucky. The eportfolio was a real waste of time- it needed streamlining because i agree with the comment above i spent so long refecting it neglected actual learning

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  • Moods it is easy for GPSTs to figure which training/service attachments are likely to be of value to them in their chosen career. Many GPSTs are allocated to specialist departments which have limited value for them. They are all aware that the cost of experience and education is service provision, so supplying that service under poorly paid and appalling work conditions without the likelihood of professional development is a fraud. They are by definition intelligent (if possibly a bit credulous) but they learn fast. So now many have seen enough.

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  • Most GP trainees think e-portfolio is largely a waste of time as do the trainers. SO why do we still have it? The grassroots needs some have some power restored to it as many aspects of our life seem controlled by disconnected academics. Want to boost GP training numbers, bin the portfolio is a good start.

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  • E-portfolios are an unevidenced experiment, that like so much medicine needs to be consigned to history (will they never learn?). The rot set in with MMC/MTAS which has never really left us. In a few years we will look back on all this 'competency' and 'reflection' based work and wonder what the hell we were doing.

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  • .. so don't prolong the agony by prolonging GP training; as bothprospective and actual GP's have to update themselves as and when; Ok, call it PUNS and DENS, but don't torture the young ones into unnecessary extended training.. they will never finish. The young's we have do show brightness, up datedness so that helps us senile ones. If the St2's can handle a reasonable number of patients in GP land, long before their registrar year, then it could problem based (dare i say QOF based) don't need 6mths of O and G at all) Dear RCGP/HEE pls consider what you are doing.

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  • Wolf | GP Partner/Principal04 Aug 2017 1:00pm

    i don't think we need a wait to ask the question what the hell have we done.

    However those who have spent years developing the above systems are in power across many deaneries. One thing they will never do is accept that their career objectives have been a failure.

    The heads of various deaneries/CQC and Royal Colleges have played a major part in changing medical school admissions/ supported MTAS and now E-portfolios. Even with all the evidence in front of them they cannot see the hugely negative impact of what they have done.

    In science, huge effort in developing drugs/experiments and theories are often blown away when evidence shows they do not work.
    In a social science such as medical education this does not apply - dogma rules, and when there is evidence that treads on egos - the trick is to ignore the evidence.

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