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Can’t we just teach trainees to be GPs?



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.