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At the heart of general practice since 1960

Can’t we just teach trainees to be GPs?

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Many GPs will be enjoying long summer days and evening barbecues, but those in training practices will have their heads buried in paperwork.

Yes, it is time for the brain-numbing experience of trying to manipulate multiple pages of a learning log into evidence that shows how your GP trainee is progressing.

For the uninitiated, educational supervisor, reports are six-monthly reviews undertaken with each trainee under your wing, and many will be due shortly.

I can already hear heckles of ‘but that’s what you’re paid for’ – and that is partly correct. However, the process has taken tick-box exercises to a whole new level and I have yet to hear from a single trainer or trainee who thinks it is a useful exercise. 

I remember my own training days with huge fondness and nostalgia. I had more disposable income than at any other time of my life, socialised two or three times a week and, with the help of my study group, breezed through the optional exams. There was no eportfolio requiring almost daily commentary of my working day, no requirement for lengthy reflections about my ethical conflicts and no six-monthly sieving of verbal diarrhoea to fit three pieces of evidence into each competency area. 

In short, I was more than happy to be an apprentice to my excellent trainer and learn all the skills of the trade on the job. We still had the outlet of a weekly ‘play school’ where we met other trainees, shared thoughts and developed our group learning, but it was not felt necessary to document each cognitive shift with a reflective learning log. 

Without doubt, some kind of periodic review is essential to detect problems early, but the hugely prescriptive nature of the current process is actually counterproductive. It is also weighted hugely against men, who don’t seem to reflect as easily as women. 

The other problem with placing so much emphasis on workplace-based assessments and the CSA, is that it leaves little time actually to be a GP’s apprentice and learn the importance of daily multi-tasking, managerial responsibilities, business skills and, most importantly, resilience. The focus seems to be placed on individual patient consulting, rather than on managing whole surgeries and busy on-calls. 

Through no fault of their own, GPs exit training with little idea about the functions of a partnership, the commissioning agenda or the current political landscape. 

The fall-out from the RCGP adopting this model of training has become all-too apparent in the eight years of the MRCGP. Most recently qualified GPs have little interest in the partnership model; there are obvious political reasons for this, but lack of exposure and training in this area may also contribute. 

But I guess every cloud has a silver lining. After all that reflecting and bean-counting, new GPs should find appraisal and revalidation a walk in the park. 

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Readers' comments (16)

  • Hazel Drury

    "Many GPs will be enjoying long summer days and evening barbecues"

    Really?

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  • I agree with comment above - what a strange opening sentence?

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  • It's poetic license.

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  • Couldn't agree more with comments above. Training GPRs has become more and more laden with 'red tape' and has really taken the enjoyment out of the process - so much so that I have resigned from the training scheme only 3 years after becoming a trainer!

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  • Couldn't agree more with comments above. Training GPRs has become more and more laden with 'red tape' and has really taken the enjoyment out of the process - so much so that I have resigned from the training scheme only 3 years after becoming a trainer!

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  • I agree...my trainer and I have wasted many hours this week filling out paperwork, when we could be looking after patients. I understand the importance of reflection, but forced reflection totally misses the point! Bring on the B-B-Q!

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  • Dr Mustapha Tahir

    The new system has unfortunately driven many trainers out of training. A few trainers who couldn't imagine life in General Practice without being trainers have retired prematurely. Surely the Deaneries must have some statistics on fall in trainers. They should appoint mentors for trainers and invest all it takes in retaining them.

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  • It's the Orwellisation of GP conditions.All being softened up for a salaried worker ant future.The professional model is being serially deconstructed.This has been enabled by most of the profession's leaders signing up to this agenda.The other alarming element is the passivity and lack of independent thought among the new GPs.Salaries and conditions seem acceptable now but they wont sustain when independence finally collapses.The future GPs can then "reflect " on the pay restrained managed drone life; at least training will have prepared them for that.

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  • The sad reality is that after 10 years of general practice you will want to leave but by that time you will have so many financial obligations that you'll have no choice but to soldier on.With such a future it's morally wrong for GP trainers to brainwash young impressionable doctors to continue with general practice.

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  • Ivan Benett

    Don't forget your rose tinted sun glasses when you go into your garden this summer. Being a GP was never as much fun as some people now think, and GP training was never as rigorous. General Practice is changing and many GPs don't seem to realise it. So we need to sell Genral Practice to the young and turn it into a profession that people want to join, with structured training and career progression. Appenticeships are so last century. GP partners will become fewer as young people want flexibility and career breaks and diversity.
    The rose tinted General Practice of many contributors to these columns is a thing of the past. Wake up, the sausages are burning and it's starting to rain.

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