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Is GP training fit for purpose?

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I was thinking about GP training this week. Is it always fit for purpose?  Does it really judge our young medics destined for independent practice fairly and in a way that proves that they are capable of it? Or does it vary greatly scheme to scheme, run at the whim of individuals and each scheme only as good as those very individuals?

There must be a way to empower unhappy trainees to speak without fear

Why do I ponder this? It first struck me when I was training. Having friends that I went to medical school with on neighbouring schemes and those much further afield, leisure time chat often turned to our individual schemes and comparisons between them. The variance seemed huge and although anecdotal, there were some direct comparisons: how attendance was monitored varied from school-type registers with public naming and shaming, through to adult-like trust. The intensity of the residential varied from a relaxed social gathering and team building to a regimented, military exercise with homework beforehand and enforced activity. And some schemes accepted different personalities and the resultant GPs, while others left no room for individuality with those who don’t fit the mould being ostracised and floundering, despite ‘intensive support’.

Certainly the difference in the way training practices approach their trainees is vast. They vary from those, like mine, that constantly support, protect and guide their trainees, offering them experiences wholly designed to steer them safely into independent practice, to those who use the trainee as an extra pair of hands, bombarding them with work, home visits, admin and duty and giving them no time to reflect, grow or learn. Some are so miserable that the experience almost turns them away from general practice – how sad is that? The only consensus was that those having a torrid time feel they have no power to speak out and so they suffer silently and things get worse.

Then the conversation turned to those running the schemes. The experiences of my fellow trainees seemingly covered supportive, guiding and encouraging programme directors to those so fixed on control and producing trainees in their mould that they become overbearing, scary and even bullying to trainees on the edge of the bell curve. There can be favourites who get all the support they need and those less fortunate who are clinically excellent but different. I sadly witnessed this on my scheme, it actually touched me personally but I am older and of strong enough personality to cope. Sadly, most trainees when faced with such situations are too scared of the repercussions to challenge such behaviour and so it becomes embedded.

The conversation left me with many questions: how robust is the GP training system and how meaningful are the checks and balances? How will toxic schemes change and go on to produce great GPs if trainees are too scared to voice their concerns? And importantly, when trainees are talking to friends about these horrific experiences, how many future GPs are being put off applying? Are the panels designed to check and balance truly independent? Can we sit by and see excellent potential trainees turned off and clinically excellent trainees destroyed by failing schemes? I know there is good and bad in everything but there must be a way to find commonality in some of these areas and to empower unhappy trainees to speak without fear.

Dr Renee Hoenderkamp is a first-year qualified GP in north London. You can follow her on Twitter @DrHoenderkamp

 

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Readers' comments (13)

  • Wonderfully written!

    The training system depends on which practice you are allocated to! Some of them are very good, and some are completely opposite.

    Sadly the way training is going here, it is mostly now a days service provision, and learning by yourself.

    And you are completely right - sometimes it does feel we are treated like school children even though we have spent 5-6 years in university and many years in hospital training!

    Excellent conclusion!

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  • GP training is all about the massive tick box - the e-portfolio.

    Nothing else matters. real GP training starts and finishes in the precious few months after the boxes are all ticked.

    New GP's I find are inadequately prepared for any aspect of modern general practice - especially the business side. I talked to a new GP a year ago who was offered huge incentives to join a practice but she was looking for part time shift based work - the world has changed.

    The real issue is not GP training but medical school training - thats where the real failures are

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  • Jo - completely right it is a tick box exercise! Most GP trainees are going part time - RCGP need to wake up!

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  • Vinci Ho

    First of all , live until you are really old and learn until you are really old as Chinese said.
    I learnt most about general practice AFTER (not before and during) the GP vocational training over 20 years ago. Truth is 'pass' or 'fail' system is prescriptive and never really gives you the actual ammunitions to deal with so many real patients and their families who would be attaching to you more than a year or two. Of course , if you wish to move from places to places doing locums, may be you could get away with some basic skills.
    To have 'right' mentality and philosophy is the hardest to achieve ,although being rather abstract . The training authorities need to be a bit more visionary and innovative rather than reverting to a long list of ticking boxes to judge 'competence'. Perhaps the patients are better judges. Call me an ignorant fool.....

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  • In my day (albeit 15 years ago) the 'GP' element of the VTS was fantastic. It was some of the hospital jobs, well specifically obs and gynae that were dreadful.
    As GP trainees we were treated like second class citizens, seen as use for nothing other than assisting at an endless stream of c sections-completely worthless experience for a GP.

    I sat on a GP registrar educational sub-committee at the time and the experience from other trainees doing o and g in other hospitals was similar.
    I don't know if the hospital element of training has improved now?

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  • The real test of success for any scheme is whether 15 years after finishing training the GP is still doing full time work or taken RLE or gone part time.I suspect on that basis most schemes are complete failures

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  • GP training is actually detrimental to the profession. It has created a generation of GP who are unable to stand up for themselves or make a decision. As a result there are a generation of patients who will not take any responsibility for their own health.
    It's a complete disaster.

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  • General Practice is for eunichoid men

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  • Primary care is fast changing, medicine is fast changing but RCGP slogans have not changed. With primary care shifting to huge federations, GP schemes and training needs to change.
    I agree with all views, in the current decade, GP training is not fit for purpose.

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  • GP training. Let's all sit in little groups, not actually seeing patients or dealing with busy once days and reflect on meetings to decide on what meetings we'll have. If you're really inept become involved in the Deanery to fight for your own self-worth, maybe a promotion into the RCGP, if you're really good you can be a fellow of said College (what an honour that is) and leave trains to fill out hundreds of hours of absolute rubbish.
    Training is boring, embarrassing compared to other colleges and MRCGP is simply a way to bring huge money into the College to pay for more dinners and reflective exercises. Leave all those lesser GPs to actually do the real work which has little to do with training and VTS.

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