Cultural competency of GP trainees and GP trainers: a cross-sectional survey study.

OBJECTIVE: To assess the cultural competence (CC) of GP trainees and GP trainers.Design and setting: A cross-sectional survey study was conducted at the GP Training Institute of Amsterdam UMC. SUBJECTS: We included 92 GP trainees and 186 GP trainers. MAIN OUTCOME MEASURES: We measured the three domains of cultural competency: 1) knowledge, 2) culturally competent attitudes and 3) culturally competent skills. Regression models were used to identify factors associated with levels of CC. Participants rated their self-perceived CC at the beginning and end of the survey, and the correlation between self-perceived and measured CC was assessed. RESULTS: Approximately 94% of the GP trainees and 81% of the GP trainers scored low on knowledge; 45% and 42%, respectively, scored low on culturally competent attitudes. The level of culturally competent skills was moderate (54.3%) or low (48.4%) for most GP trainees and GP trainers. The year of residency and the GP training institute were significantly associated with one or more (sub-)domains of CC in GP trainees. Having >10% migrant patients and experience as a GP trainer were positively associated with one or more (sub-) domains of cultural competence in GP trainers. The correlation between measured and self-perceived CC was positive overall but very weak (Spearman correlation coefficient ranging from -0.1-0.3). CONCLUSION: The level of cultural competence was low in both groups, especially in the knowledge scores. Cultural competence increased with experience and exposure to an ethnically diverse patient population. Our study highlights the need for cultural competence training in the GP training curricula.

General practitioner (GP) trainees find cross-cultural consultations stressful due to a self-perceived lack of cultural competence (CC). The level of CC in general practice is as yet unknown.On average, the level of CC was low for the majority of GP trainees and GP trainers, especially for the scores on knowledge.CC increased with experience and exposure to an ethnically diverse patient population.GP trainees and trainers perceived a lack of covered education on various topics related to the care of migrants.Our study highlights the need for cultural competence training in the GP training curricula.

Nottinghamshire GP Phoenix Programme trainee transition scheme: an innovative education programme supporting GP trainees transition to independent practice.

It is well-established that GP trainees do not feel confident when transitioning to independent practice. In 2019, the Nottinghamshire GP Phoenix Programme Trainee Transition Scheme (TTS) was established to improve this transition and encourage local retention of newly qualified GPs. The TTS has been evaluated by surveying a total of 344 trainees from August 2022 to August 2023 using an electronic Google Form. Two-thirds of the trainees surveyed felt the mix of TTS-led non-clinical topics and trainee-led clinical topics taught during their locality time were useful for their learning. 72% felt that the TTS would influence their decision to remain working locally after qualification. Based on these positive findings, it is proposed that the TTS should be adopted in other areas to improve both transition and retention of newly qualified GPs.

'Bitesize' primary care focused education programme for GP trainees in their hospital component: an evaluation of a national teaching pilot.

There is need for a greater connection between General Practice and GP trainees in their hospital component of training. Currently, in Scotland, there are no national education programmes specifically designed for GP trainees during their hospital component of training. Our aim was to develop and evaluate the feasibility of a national online 'bitesize' education programme delivered live for GP trainees in their hospital component of training. The study also aims to assess the barriers to attending these teaching sessions and whether they made trainees feel more connected to General Practice. Weekly one hour 'Bitesize' teaching sessions, delivered virtually, were organised by NHS Education for Scotland (NES) GP Medical Education Fellows during a four-week period. Eligible attendees were GP trainees (GPST1s and GPST2s) working in the hospital component of their training. An end of program questionnaire, gathering quantitative and qualitative data, was used for evaluation. There was a strong support for this programme from the attendance numbers and the questionnaire feedback responses, with GP trainees feeling more in touch with general practice and more confident in managing primary care focused topics. GP trainees agreed that a weekly, one-hour, online lunchtime session suits them. The most common barrier to attendance were work commitments and conflicts with local teaching. This pilot has emphasised the need for a structured teaching programme for GP trainees in the hospital component of training.

GP trainees as teachers: a rapid review of the barriers, facilitators and outcomes.

BACKGROUND: There is a workforce crisis in General Practice (GP) within the United Kingdom (UK). High-quality clinical placement experiences in GP influence medical students' interest and likelihood to enter this speciality. GP trainees often express a desire to teach, yet teaching does not feature significantly within their current practice. This study aims to explore outcomes, barriers, and facilitators of GP trainees teaching medical students through a rapid review of published literature. METHODS: MEDLINE, EMBASE, PsychINFO, Web of Science were searched for articles relating to GP trainees teaching. Studies conducted in the UK and Australia, between January 2000 and October 2022 were included. The Medical Education Research Study Quality Index and the Critical Appraisal Skills Programme checklist were used to assess quality. RESULTS: Twenty-seven publications, 11 qualitative, six quantitative, three mixed-methods and seven opinion pieces, were identified. Many studies have methodological limitations. Empirical studies show that there are benefits of near-peer teaching, but these are limited by trainees' capacity and capability to teach, and GPs' confidence in trainees' teaching. The culture within the practice influenced whether trainees were seen solely as learners or also as teachers for students. DISCUSSION: When GP trainees teach there are positive outcomes for medical students and trainees. Teaching was considered an activity that trainees did in 'addition to' rather than 'part' of' their training. Appropriate teaching opportunities, and relevant training, were key to trainees' competence and confidence in teaching. Resources and recognition and a strong teaching culture are needed to support GP trainees to teach.

Evaluating the impact of a teaching course for GP speciality trainees.

INTRODUCTION: Near-peer teaching offers mutual benefits for clinical trainees and the students they teach. However, General Practice Speciality Trainees (GPSTs) are typically less involved in community-based teaching than their hospital-based peers and often do so without formal pedagogical training. This study details the immediate and longer-term evaluation of a teaching skills course delivered to final year GPSTs. It addresses a gap within existing near-peer literature which, although extensive, is predominantly hospital-based and limited to short-term outcomes. METHODS: The course was designed and delivered to all local final year GPST schemes. Pre- and post-course questionnaires scoring confidence, comfort, and understanding of teaching roles were analysed across two years' delivery. Furthermore, individual interviews of participants 4-6 months after attendance were thematically analysed to explore how GPSTs translated course content into practice. RESULTS: GPSTs reported a decline in their teaching activities as they embarked on their final year of GP teaching. Immediate post-course teaching-related confidence and knowledge scores increased. However, follow-up interviews revealed that GPSTs' initial enthusiasm was short-lived and outweighed by competing demands within an intensive short-duration training scheme. They expressed concerns about their own learner status as they themselves developed competency in a vast and varied speciality, and cited a lack of support from their trainers. CONCLUSIONS: Teaching skill courses alone are insufficient to address the ongoing challenges of enhancing the teaching role of GPSTs. Further work is now needed to explore multi-level interventions to promote the role of GPSTs as near-peer teachers to harness the mutual benefits to all involved.

Peer feedback on video consultations for GPST1s in S.E. Scotland: a pilot study using the Framework Method.

Introduction: Our study explored the educational value and feasibility of small-group peer feedback on video consultations for early-stage GP trainees facilitated by a near-peer.Methods: Ten GP trainees in their first placement shared videos of patient consultations requiring improvement in small groups facilitated by a near-peer using the ALOBA feedback format. Trainees and the facilitator were interviewed by a social scientist immediately post-intervention and asked for written email reflection some weeks later. Analysis of observations, interviews and feedback followed the Framework Method.Results: Six themes incorporated both assumed and unanticipated processes and outcomes. Receipt and production of peer feedback were seen to prompt critical analysis and led to processing of previously received supervisor feedback. Trainees valued the ability to benchmark against peers at the same stage of training. The small groups conferred social support and the opportunity to calibrate complex mental health judgements inherent to primary care with each other and a near-peer.Conclusions: GP trainees can engage with and benefit from structured small-group peer feedback early in training. Sessions offered educational value over and above supervisor feedback, especially for trainees inclined to be anxious and self-critical.

Supporting trainees in challenging learning environments - is there a way?

The working and learning environment within the NHS is challenging. 46% of GPs report emotional exhaustion, and trainees experience burn-out with higher prevalence than expected. Attending Balint groups (BGs) has been suggested to prevent burnout and compassion fatigue, helping GPs to thrive in their jobs. For this pilot service evaluation of BGs for GP trainees we used qualitative research methodology including surveys, participant observation, and semi-structured interviews. Fonagy's concept of resilience was used as the theoretical frame of reference. The data-led analysis identified trainees having burn-out sensations: un-met expectations for their training; their need for more support and the value of attending the BGs. Trainees experienced BG as a safe place, allowing open discussions and honest accounts of anxieties, facilitating clinical learning and learning skills of reflection as an important supplement to normal training. The theory-led analysis showed that BG sessions taught trainees new approaches to improve elements that are assessed as key in the selection process for GP training and as Fonagy described as characteristic for people with resilience. As a result of this project, a number of trainees expressed interest in continuing Balint group work. Trainees were recruited to an ongoing monthly BG, within the GP training scheme. However, due to budget restraints, difficulties with new interest and failing to find a non-training GP facilitator in the local area, the group has floundered.

Preparing for leadership in General Practice: a qualitative exploration of how GP trainees learn about leadership.

The recent rise to prominence of healthcare leadership worldwide has prompted those involved in medical education to consider how to facilitate learning to lead effectively. Research has focused on formal curriculum activities. Curricular theory suggests that trainee doctors may also learn through the informal curriculum but there is a lack of medical education literature on this. We aimed to explore how GP trainees learn about leadership in their GP training practices. Epistemologically grounded in social constructionism, this research involved 15 semi-structured interviews with GP trainees about to complete their training. Interviews were conducted using an online video conferencing method, audio-taped, transcribed and analysed using thematic framework analysis. We identified three learning processes contributing to leadership development; evaluating leadership, formulating views on leadership and constructing a personal leadership identity. Other factors operating within the informal curriculum included leadership terminology, and the quality of relationships and networks. Paradoxically, a role model's fallibility could positively influence leadership learning. Based on our findings, we present a model for the informal leadership learning process. This may enhance the facilitation of leadership learning by trainers and the wider clinical team, and positively influence the delivery and content of formal leadership courses.

Current training provision and training needs in oral health for UK general practice trainees: survey of General Practitioner Training Programme Directors.

BACKGROUND: In the UK the incidence of oral cancers has risen by a third in the last decade, and there have been minimal improvements in survival rates. Moreover, a significant proportion of the population no longer access dental health services regularly, instead presenting their oral health concerns to their General Medical Practitioner. Therefore, General Practitioners (GP) have an important role in the diagnosis of oral health pathologies and the earlier detection of oral cancers. This study aims to understand the current provision of training in oral health and cancer for GP trainees and to identify how unmet training needs could be met. METHODS: A cross-sectional survey of GP Training Programme Directors using an online questionnaire asking about current oral health education training (hospital placements and structured teaching), the competencies covered with trainees and ways to improve oral health training. Quantitative data were analysed using descriptive statistics and content analysis was undertaken of free text responses. RESULTS: We obtained responses from 132 GP Training Programme Directors (GPTPDs), from 13 of the 16 UK medical deaneries surveyed. The majority of respondents (71.2%) indicated that their programmes did not provide any structured oral health training to GP trainees and that ≤ 10% of their trainees were undertaking hospital posts relevant to oral health. GPTPDs were of the view that the quality of oral health training was poor, relative to the specified competencies, and that teaching on clinical presentations of 'normal' oral anatomy was particularly poor. It was envisaged that oral health training could be improved by access to specialist tutors, e-learning programmes and problem-based-learning sessions. Respondents highlighted the need for training sessions to be relevant to GPs. Barriers to improving training in oral health were time constraints, competing priorities and reluctance to taking on the workload of dentists. CONCLUSIONS: This UK-wide survey has identified important gaps in the training of GP trainees in relation to oral health care and cancer detection. Addressing these knowledge and skill gaps, particularly in the identification of oral cancers, will help to improve oral health and, more importantly, the timely diagnosis of oral cancer.

Ethnic minority GP trainees at risk for underperformance assessments: a quantitative cohort study.

BACKGROUND: Recent studies suggest that ethnic minority students underperform in standardised assessments commonly used to evaluate their progress. This disparity seems to also hold for postgraduate medical students and GP trainees, and may affect the quality of primary health care, which requires an optimally diverse workforce. AIMS: To address the following: 1) to determine to what extent ethnic minority GP trainees are more at risk of being assessed as underperforming than their majority peers; 2) to investigate whether established underperformance appears in specific competence areas; and 3) to explore first- and second-generation ethnic minority trainees' deviations. DESIGN & SETTING: Quantitative retrospective cohort design in Dutch GP specialty training (start years: 2015-2017). METHOD: In 2020-2021, the authors evaluated files on assessed underperformance of 1700 GP trainees at seven Dutch GP specialty training institutes after excluding five opt-outs and 165 incomplete datasets (17.4% ethnic minority trainees). Underperformance was defined as the occurrence of the following, which was prompted by the training institute: 1) preliminary dropout; 2) extension of the educational pathway; and/or 3) mandatory coaching pathways. Statistics Netherlands (CBS) anonymised the files and added data about ethnic group. Thereafter, the authors performed logistic regression for potential underperformance analysis and χ2 tests for competence area analysis. RESULTS: Ethnic minority GP trainees were more likely to face underperformance assessments than the majority group (odds ratio [OR] 2.41, 95% confidence interval [CI] = 1.67 to 3.49). Underperformance was not significantly nested in particular competence areas. First-generation ethnic minority trainees seemed more at risk than their second-generation peers. CONCLUSION: Ethnic minority GP trainees seem more at risk of facing educational barriers than the majority group. Additional qualitative research on underlying factors is essential.

How stressful was the COVID-19 pandemic for residents specializing in family practice?. A study of stressors and psychological well-being of physicians in further training specializing in family practice (GP trainees) within a pandemic context.

BACKGROUND: The coronavirus pandemic poses many challenges for medical personnel. During the first phase of the pandemic, psychological stress became increasingly apparent. This was a complex and difficult situation, especially for physician residents specializing in family practice (GP trainees), who were not yet able to draw on years of practical experience. In this context, the Kompetenzzentrum Weiterbildung Allgemeinmedizin Sachsen (Competence Center for Continuing Education in General Medicine Saxony) (KWASa) developed a survey on how to deal with the concerns and challenges perceived at the time. The purpose of the study was to obtain information on psychological well-being in the pandemic context, as well as on expectations, fears, and protective measures in everyday work. The aim was to identify stress factors for general practice (GP) trainees during a pandemic situation to be able to consider the support needs in the design of future residency training programs, especially for GP trainees. METHODS: An online questionnaire was distributed from May 5, 2020 to June 4, 2020 among GP trainees enrolled in KWASa since 2018. The questionnaire consisted of standardized items, which were evaluated descriptively, and open-ended items with free-text answers, which were evaluated according to the principle of qualitative content analysis. RESULTS: The results show the relevance of the topic as 61% of respondents indicated that they were concerned about the coronavirus. Most GP trainees also gave an affirmative response regarding emotional challenges. In this context, various stressors could be identified within both the professional and personal environments. There were four particularly salient factors: (1) the fear of infecting one's family as well as patients with the SARS-CoV-2 virus; (2) missing or insufficiently existing protective measures; (3) an increased need for consultation due to unpredictable patient behavior as well as uncertainties in patient treatment; and (4) communication difficulties within the collegial environment. CONCLUSIONS: The study aimed to identify the support needs of GP trainees in crisis situations such as the COVID-19 pandemic. The results of the survey can be used for the development of suitable continuing education programs for physicians in further training.

Clinical empathy in GP-training: Experiences and needs among Dutch GP-trainees. "Empathy as an element of personal growth".

OBJECTIVE: Clinical empathy has been described as a key component of effective person-centeredness in patient-physician communication. Yet little is known about general practitioner (GP) trainees' experiences and opinions regarding clinical empathy, empathy-education and the development of empathic skills. This study aimed to explore trainees' experiences with clinical empathy during GP training. METHODS: This study used focus group interviews. GP trainees at two Dutch universities were approached by e-mail. Focus groups were conducted between April and November 2018. Six focus groups were conducted: two with starting trainees, two with trainees at the end of their first year and two with trainees at the end of their 3 years' training. Two experienced qualitative researchers analyzed the focus groups. During the thematic analysis the differences and similarities between the various stages of education were taken into account and a framework for the identified themes and subthemes was developed. RESULTS: Thirty-five GP trainees took part. Four main themes could be identified. Starting trainees experienced frictions regarding the influence of personal affective reactions on their medical competencies. Trainees at the end of their first year indicated that they reached a balance between empathic involvement and their responsibility to carry out relevant medical tasks, such as following GP guidelines. Trainees at the end of their three years' training recognized the mutual relationship between the development of the behavioral part of clinical empathy and personal growth. All trainees stated that their needs concerning education changed during their GP training and proposed changes to the curriculum. CONCLUSIONS: GP trainees face various obstacles in developing empathic skills and behavior. Particularly they mention handling personal affective reactions. Trainees express a clear wish for clinical empathy, in its theoretical as well as its skill and emotional aspects, to play a central role in the curriculum. PRACTICE IMPLICATIONS: More explicit attention to be paid to empathy by embedding theoretical education, explicit attention to skill training and assessment of empathic behavior by patients and supervisors.

GP Trainees experience of learning opportunities and support mechanisms on the GP training programme: a qualitative study.

This article was migrated. The article was marked as recommended. Background: General Practice (GP) is the cornerstone of the NHS and has faced workload and workforce issues for many years. Enabling GP trainees to successfully complete their training and become independent practitioners is crucial to addressing these challenges. There is limited previous research exploring the postgraduate training experience specific to General Practice. Aim: To explore GP Trainees' experience of learning opportunities and support available during the three-year vocational training programme in the Southampton GP Education Unit. Design and Setting: 15 semi structured interviews were undertaken December 2016-2018 with participants recruited from four cohorts. Telephone interviews lasting between 30-60 minutes were audio-recorded and transcribed verbatim; and analysed using inductive thematic analysis. Results and Conclusion: Two themes were identified as affecting the training experience: 'Developing clinical competence' and 'Sources of support'. Trainees perceived developing competencies relevant to General Practice was key. Busier hospital rotations with limited time for formal teaching were viewed less favourably. Trainers and peers were the main sources of support. Despite seeking a broad range of participants, interviewing trainees in difficulty was hard to achieve.