A new competency model for general practice: implications for selection, training, and careers.

BACKGROUND: Recent structural and policy changes in the UK health service have significantly changed the job responsibilities for the GP role. AIM: To replicate a previous job analysis study to examine the relevance of current competency domains and selection criteria for doctors entering training. DESIGN AND METHOD: A multisource, multimethod approach comprising three phases: (1) stakeholder consultation (n = 205) using interviews, focus groups and behavioural observation of practising GPs; (2) a validation questionnaire based on results from phase 1 (n = 1082); followed by (3) an expert panel (n = 6) to review and confirm the final competency domains. RESULTS: Eleven competency domains were identified, which extends previous research findings. A new domain was identified called Leading for Continuing Improvement. Results show that, Empathy and Perspective Taking, Communication Skills, Clinical Knowledge and Expertise, and Professional Integrity are currently rated the most important domains. Results indicate a significant increase in ratings of importance for each domain in the future (P<0.001), except for Communication Skills and Empathy and Perspective Taking, which consistently remain high. CONCLUSION: The breadth of competencies required for GPs has increased significantly. GPs are now required to resolve competing tensions to be effective in their role, such as maintaining a patient focus while overseeing commissioning, with a potential ethical conflict between these aspects. Selection criteria remain largely unchanged but with increased priority in some domains (for example, Effective Teamworking). However, there is an urgent need to review the training provision arrangements to reflect the greater breadth of competencies now required.

An evaluation of a training placement in general practice for paramedic practitioner students: improving patient-centred care through greater interprofessional understanding and supporting the development of autonomous practitioners.

OBJECTIVES: To report the extent to which the placement of paramedic practitioner students (PPSs) in accredited general practice (GP) training practices supported their development as autonomous, patient-centred practitioners and fostered interprofessional learning. DESIGN: A case study method was used. Sources of data included semi-structured telephone interviews (eight PPSs, eight GP trainers), an online end of placement survey and placement and assessment documentation. Interview data were transcribed and analysed using the constant comparative method. SETTING: Accredited training practices in South East England. RESULTS: All respondents were positive that the placement provided a high-quality interprofessional learning environment which provided PPSs with learning opportunities based on assessed need, the support of experienced trainers and access to a wide range of patients and learning situations. The placement enabled PPSs to acquire the appropriate skills, knowledge and understanding to act as autonomous, patient-centred practitioners. CONCLUSIONS: The placement provides a sound model for expanding the skills of paramedic practitioners in order to meet the increasing demands for patient-centred, community based health care. It provided them with the skills to treat patients closer to home rather than automatically transporting them to hospital.

Is there a value to case-based discussion?

Case-based discussion (CbD) is a workplace-based assessment which is used formatively to help develop a GP trainee's performance and which will also contribute to the judgement made on a trainee's competence at the end of their training. The views of GP trainers and trainee's in their final year of training were explored quantitively to identify if CbD was of value, its limitations and whether or not it could assess a trainee's performance. The results suggest as an isolated assessment it is not possible to fully assess performance. The feedback received by the trainee did encourage the learner to develop and an improvement in performance in subsequent assessments could be demonstrated. This, however, relied on the skills and confidence of the educator in giving feedback. Further work on the development of feedback skills need to be introduced for the benefits of this assessment to be maximised.

An evaluation of the experience of integrated GP training placements in the Kent, Surrey and Sussex Deanery.

Innovative/integrated training posts (ITPs) are an increasingly established feature of vocational training for GPStRs. They aim to extend exposure to primary care in the early years of specialty training. To date, there has been little evaluation of the post and no studies investigating how ITPs are variously structured. This research of an ITP scheme operated by the Kent, Surrey and Sussex (KSS) Deanery is the first comprehensive study of ITPs across a whole deanery. The registrars on integrated placement, their GP trainers and hospital/community-based education supervisors took part in the study reported here. Participants reported integrated training to be an effective model to develop GPStRs. Early and extended exposure and orientation to primary care were seen as key benefits. The secondary placement component provided relevant specialist training applicable to primary care. ITPs provided GPStRs with relevant learning to support the requirements of the GP curriculum. Problems identified by previous research such as integration within teams were not reported as an issue in this study. Continuity issues were, however, highlighted. Reporting on the different ITP models utilised within the Deanery, we find that GPStRs with greater exposure to primary care perceive the programme as being more effective than those with less exposure.

Evaluation of GP appraiser development centres using emotional intelligence: can positive learning outcomes be transferred to practice?

This paper describes a longitudinal evaluation of six pilot medical appraiser development centres (ADCs) with GPs held between February and September 2009 in the Kent, Surrey and Sussex Deanery. The ADCs were developed using traditional development centre methods and incorporated the concept of emotional intelligence (El). Initial evaluation results have shown positive short-term outcomes relating to appraiser skills and self-confidence as well as transfer of learning. This paper extends this earlier evaluation by looking at appraiser and appraisee feedback approximately one year after the ADCs using a validated framework for training evaluation. We discuss the long-term affective, cognitive and behavioural learning outcomes and the impact participation in the ADCs has on the broader healthcare system, including effects upon patient care and safety. Limitations of the current project and opportunities for future research are discussed.

Fostering clinical engagement and medical leadership and aligning cultural values: an evaluation of a general practice specialty trainee integrated training placement in a primary care trust.

OBJECTIVES: To report on the extent to which a general practice specialty trainee integrated training placement (ITP) developed the leadership skills and knowledge of general practice specialty trainees (GPSTRs) and on the potential of the ITP to improve clinical engagement. DESIGN: A case study method was used in a Kent primary care trust (PCT). Sources of data included face-to-face and telephone interviews (three GPSTRs, three PCT clinical supervisors, three general practitioner (GP) clinical supervisors and three Deanery/PCT managers), reflective diaries, documentary sources and observation. Interview data were transcribed and analysed using the constant comparative method. RESULTS: All respondents were positive about the value and success of the ITP in developing the leadership skills of the GPSTRs covering three dimensions: leadership of self, leadership of teams and leadership of organisations within systems. The ITP had enabled GP trainees to understand the context for change, to develop skills to set the direction for change and to collect and apply evidence to decision making. The ITP was described as an effective means of breaking down cultural barriers between general practice and the PCT and as having the potential for improving clinical engagement. CONCLUSIONS: The ITP provided a model to enable the effective exchange of knowledge and understanding of differing cultures between GPSTRs, general practice and the PCT. It provided a sound basis for effective, dispersed clinical engagement and leadership.

Using emotional intelligence to facilitate strengthened appraiser development.

This paper describes a new approach to developing strengthened medical appraiser skills prior to the introduction of medical revalidation. We describe how we extended previous skills-based models and competency checklists to produce a behavioural model of effective appraiser performance. Development centre (DC) methods were used to produce a one-day workshop to encourage appraisers to reflect on their current level of ability and to identify and address additional required skills through observation, practice and feedback. In describing the DC, we discuss the impact of using the concept of emotional intelligence (EI) to develop appraiser skills and improve self-awareness. This aimed to support appraisers to effectively influence appraisees' continual professional development (CPD) and review appraisee practice through audit, significant events and patient and colleague feedback, with the ultimate aim of improving patient care. Finally, we provide initial evaluation data for our DC approach.

Implementing a strategy to promote lifelong learning in the primary care workforce: an evaluation of leadership roles, change management approaches, interim challenges and achievements.

OBJECTIVES: To identify and explore leadership roles and responsibilities for implementing the workforce development strategy; to identify approaches used to implement and disseminate the strategy; and to identify and explore challenges and achievements in the first 18 months following implementation. DESIGN: A formative evaluation with qualitative methods was used. Documentary analysis, interviews (n = 29) and two focus groups (n = 12) were conducted with a purposive sample of individuals responsible for strategy implementation. Data were transcribed and analysed thematically using framework analysis. SETTING: Regional health area in Kent, Surrey and Sussex: 24 primary care trusts (PCTs) and 900 general practices. RESULTS: Primary care workforce tutors, lifelong learning advisors, GP tutors, patch associate GP deans and chairs of PCT education committees all had vital leadership roles, some existing and others newly developed. Approaches used to implement the strategy encompassed working within and across organisational boundaries, communication and dissemination of information. Challenges encountered by implementers were resistance to change - evident in some negative attitudes to uptake of training and development opportunities - and role diversity and influence. Achievements included successes in embedding appraisal and protected learning time, and changes in educational practices and services. CONCLUSIONS: The use of key leadership roles and change-management approaches had brought about early indications of positive transition in lifelong learning cultures.