Multi-disciplinary training hubs in North West England: the training hub lead perspective.

Introduction: Increasing the capacity of Primary Care to meet the challenge of providing future complex and multi-disciplinary care in England has led to the increasing establishment of 'Training Hubs' [TH]. Other terms are used interchangeably to refer to TH activity: Advanced Training Practices, Enhanced Training Practices and Community Education Providers. The aim of this study was to gather the perceptions of TH Leads in North West England on how they established their TH and lessons learned. Methods: Five semi-structured telephone interviews were undertaken with TH Leads. Thematic analysis of the transcripts was undertaken. Findings: Four themes were identified: Motivation and Expectations of Establishing THs; Benefits to Learners and Practice Staff; Implementation Challenges and Barriers to Scale-Up; Sustainability and Wider Implementation. Discussion: TH Leads highlighted that the establishment of THs enhanced the multi-disciplinary learning experience. However, several barriers for sustaining the quality of the TH learning environments were identified. Difficulties recruiting 'Spoke Practices' were greater than expected. Findings identified the following factors for consideration for wider implementation: the maintenance of TH Lead support networks; appropriateness of funding to encourage practices who may be reluctant to take on this additional responsibility; the importance of communication channels between THs and HEIs; careful management of students numbers.

An investigation of factors affecting the outcome of the clinical skills assessment (CSA) in general practice specialty training.

Identifying general practice trainees at risk of failing the CSA early in their training is important so that supportive measures can be put in place to ensure training progression. The aim of this study was to determine aspects of the trainee's learning portfolio activity which might predict performance in the CSA. From the Mersey School of General Practice records, details were obtained for trainees who had completed their ST3 year between 1 August and 31 December 2012 with respect to the numbers of entries for the Mini Clinical Evaluation Exercise (Mini-CEX), case-based discussions (CBDs), directly observed procedures (DOPS), learning logs and personal development plans (PDPs) that they had carried out in each of their ST1 and ST2 years. Gender, university of qualification and years since qualification were also recorded. Records were obtained for 116 trainees (94 had passed their CSA). ST1 number of CBD and ST1 number of DOPS, university of qualification, gender, and shorter time since qualification were significantly associated with CSA pass. A multivariate model indicated that graduation from a European university and being female were both associated with an increased chance of passing. Longer time since qualification, non-European university graduation and male gender are the strongest predictors of failing the CSA. Portfolio activity is not a predictor of CSA outcome.

Achieving a consensus on educational objectives and assessments for extended specialty training programmes for licensing in general practice.

This research aimed to define and agree a consensus on the overall aims, educational objectives and assessments for extended GP training. It used a modified Delphi technique to achieve a consensus of opinions from a representative group of stakeholders and assessment content experts. Existing curriculum gaps that could be developed further in a period of extended training were defined. The study showed a very strong consensus for a 'gateway' assessment-to-a-standard at the current ST3 endpoint before progression to extended GP training with those years of extended training giving 'added value'. The current MRCGP summative components of the applied knowledge test (AKT) and clinical skills assessment (CSA) are considered fit for purpose as an appropriate 'gateway' standard; with more robust workplace-based assessments to demonstrate continued progression during extended training. The results informed and provided the evidence base for the development of a proposed programmatic assessment model, which has been critically appraised. This paper reports in detail on the Delphi study and comments on the importance of further work developing assessments.