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Letter of the week: As GP trainers, we can’t make up for undergraduate failings

As a trainers group that meets regularly to discuss issues with GP training in Shropshire, we have spent much time recently discussing the suitability of trainees entering vocational training.

First, we have had some concerns over the standard of undergraduate teaching from certain universities – sometimes even in the EU – where basic examination techniques and medical knowledge have not been thoroughly taught. 

Can we as GP trainers really be expected to cover the whole MRCGP curriculum, language and communication issues as well as teaching all basic examination skills and medical knowledge in the two to three hours' teaching time we have each week? 

These problems might be avoided by a more detailed look at the candidate's undergraduate experience before allowing them to start vocational training. Perhaps for those deemed to have potential, a preparatory clinical period could be arranged before joining the usual three-year scheme.

Second, we have found some trainees do not possess the necessary communication and interpersonal skills to pass the clinical skills assessment part of the nMRCGP. Statistically, it has been shown that certain groups of doctors are more likely than others to repeatedly fail the CSA – as we have witnessed locally. 

A trainee who has grown up in the UK must be at an advantage in understanding and using not only the words of the English language, but also the colloquialisms and nuances of speech, as well as appreciating broader cultural aspects. 

We understand that the UK does rely heavily on filling posts with doctors from overseas. But if the UK continues to award training places to doctors who may later struggle – despite their best efforts – we feel it would only be fair to offer increased support with language and communication skills when they are accepted by the NHS, or at the latest when they start their specialist training. 

However, some of us doubt if this can easily be taught. We wonder if the situation is similar throughout the rest of the country.

The selection process already seems to have altered locally, as the West Midlands Deanery did not fill all its vacancies on the GP training scheme in 2011 in order to avoid taking doctors who were unlikely to succeed. 

We would invite further discussion regarding these issues, as we feel at present some trainees may have been treated unfairly. 

The consequences for them as individuals will be life-long, as they will be unable to work in general practice or retrain for any other specialty.


From Dr Sheelin Newton and local GP trainers

Ellesmere, Shropshire