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Is GP training fit for purpose?



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