An overview and evaluation of the differential attainment champion role in the North West of England GP school.

BACKGROUND AND AIMS: In the Northwest of England, a national allocation of funding to minimise the effects of differential attainment has been used to support experienced GP educators to act as Differential Attainment Champions (DAC) since October 2021. An evaluation of the role's impact was undertaken. METHODS: The evaluation was designed to gather the views and experiences of DACs and their trainees via online semi-structured interviews during the first 12 months following establishment of the intervention programme. RESULTS: Thematic framework analysis identified three main themes: DACs' adaptive approach to support trainees; barriers to fulfilling the DAC role; and the positive impact of the DAC role on training. The following aspects of the DAC role worked well: the freedom to tailor support to the individual needs of the trainees; the targeted and proactive support early on in GP core training; the support of trainees in a wide range of areas including e-portfolio advice, examination preparation, and personal help. Trainees valued one-to-one support when needed. Reported improvements included: improved examination outcomes; portfolio engagement recognised in some cases by Annual Review of Competence Progression (ARCP) panels. CONCLUSIONS: The individualised and adaptive approach works well but it does mean it is difficult to quantify how many trainees can be supported by one DAC and their workload needs to be monitored.

Mentoring to address differential attainment of international medical graduates in GP training.

INTRODUCTION: International Medical Graduates (IMGs) form an important and valued part of the United Kingdom's (UK) medical workforce but many experience difficult transitions into the National Health Service workforce. Mentoring could support IMGs as they transition into their role as General Practice (GP) trainees but there is a lack of evidence about whether mentoring is an effective intervention for this group. AIM: To evaluate the effectiveness of the NHS Education for Scotland (NES) GP mentoring programme from the perspective of mentors and mentees. METHOD: Twelve medical educators (the mentors) provided mentoring to 19 IMG GP trainees (the mentees) who were within their first six months of entering GP training in Scotland. Each mentee received four 60-minute mentoring sessions via video conferencing. RESULTS: Mentoring provided tailored support to assist IMG GP trainees' holistic transition into UK General Practice. Mentees appreciated talking to a non-supervisor, receiving non-judgemental support and protected time with a supportive listener to overcome challenges. This had a positive impact, even for those who did not anticipate the need for such support. Mentors supported diverse needs and tailored meetings, experiencing a distinct shift from previous supervisor roles. Their diverse experience enhanced their role and they developed new skills. CONCLUSION: Mentoring could provide significant support to IMG GP trainees but comes with certain challenges. Future research should evaluate the long-term impact of the NES GP IMG mentoring programme.

Co-designing Entrustable Professional Activities in General Practitioner's training: a participatory research study.

BACKGROUND: In medical education, Entrustable Professional Activities (EPAs) have been gaining momentum for the last decade. Such novel educational interventions necessitate accommodating competing needs, those of curriculum designers, and those of users in practice, in order to be successfully implemented. METHODS: We employed a participatory research design, engaging diverse stakeholders in designing an EPA framework. This iterative approach allowed for continuous refinement, shaping a comprehensive blueprint comprising 60 EPAs. Our approach involved two iterative cycles. In the first cycle, we utilized a modified-Delphi methodology with clinical competence committee (CCC) members, asking them whether each EPA should be included. In the second cycle, we used semi-structured interviews with General Practitioner (GP) trainers and trainees to explore their perceptions about the framework and refine it accordingly. RESULTS: During the first cycle, 14 CCC members agreed that all the 60 EPAs should be included in the framework. Regarding the formulation of each EPAs, 20 comments were given and 16 adaptations were made to enhance clarity. In the second cycle, the semi-structured interviews with trainers and trainees echoed the same findings, emphasizing the need of the EPA framework for improving workplace-based assessment, and its relevance to real-world clinical scenarios. However, trainees and trainers expressed concerns regarding implementation challenges, such as the large number of EPAs to be assessed, and perception of EPAs as potentially high-stakes. CONCLUSION: Accommodating competing stakeholders' needs during the design process can significantly enhance the EPA implementation. Recognizing users as experts in their own experiences empowers them, enabling a priori identification of implementation barriers and potential pitfalls. By embracing a collaborative approach, wherein diverse stakeholders contribute their unique viewpoints, we can only create effective educational interventions to complex assessment challenges.

Professional identity and GP trainers as educational leaders.

GP training in the UK has a long history of success, however that is measured. That success is in part due to the formality and credentialling that underlies preparation to take on that role of a GP teacher, which is somewhat under current threat due to workforce pressures. We identify three important factors associated with the GP trainer function [leadership, professional identity and clinical care improvement] that are not often analysed but are at some risk if preparation for the GP trainer role is reduced or devalued. Of particular note are the differing ways that GPs conceptualise their professional roles as teachers and clinicians, despite the transferable skills between them, the demonstrably improved patient care that occurs in practices that teach, and the necessary connections between educational theory and practice. We suggest that these areas define a research agenda ripe for exploration.

Knowing me, knowing you: evaluation of the impact of trainer involvement at an enhanced induction programme for International Medical Graduates (IMGs).

Addressing differential attainment between International Medical Graduates (IMGs) and their peers who hold UK Primary Medical Qualifications remains one of the most significant challenges facing postgraduate General Practice (GP) training. Enhanced Induction programme, such as the Scottish Trainee Enhanced Programme (STEP), is one tool designed to try and facilitate transition into training and reduce this inequity. The STEP course is attended by both the trainee and their educational supervisor, and aims to lay the foundations of a successful and supportive supervisory relationship. Previous work has evaluated this programme from the perspective of the trainee. Through the use semi-structured interviews, we evaluated the impact and the benefits of the programme from the perspective of the educational supervisors, building on the literature on interventions to support inequity in medical education.

Humanities and GP training: the perception of GP trainers towards using medical humanities to teach GP trainees primary care.

PURPOSE: The benefits of medical humanities in medical education have been extensively cited. The aim of this research was to explore the perspectives of UK GP trainers towards using medical humanities to teach GP trainees in primary care. METHOD: Phenomenological, qualitative research designed was used. Semi-structured interviews were conducted with eight GP trainers from across the UK, between April and May 2020. Poems were used as discussion prompts for those participants who lacked experience using medical humanities to teach GP trainees. RESULTS: Emerging themes were that all participating GP trainers recognised the benefit of medical humanities to GP training, yet only 50% of them were actually using medical humanities in their teaching. An overburdened GP curriculum, a lack of funding and a lack of clinically relevant art and literature resources were identified as barriers for the inclusion of medical humanities into GP training. Furthermore, GP trainers identified the need for peer networks and medical humanities conferences to encourage the use of medical humanities in GP training. CONCLUSION: This study provides the perspective of UK GP trainers towards using medical humanities in teaching GP trainees in primary care. GP trainers identified sustainable funding to develop a resource bank of art and literature, peer network events and medical humanities conferences as key interventions to facilitate medical humanities teaching in GP training. Recommendations for future research include robust studies focusing on the effectiveness of various techniques used to integrate medical humanities into GP training, such as poetry.

Linguistic coaching: a pilot study of one-to-one near-peer coaching for international GP trainees in Yorkshire.

INTRODUCTION: International medical graduates (IMGs) have a higher rate of examination failure and are more likely to be referred to the regulator for professional performance issues than their UK-trained counterparts. Support for IMGs to reduce differential attainment takes many forms. A pilot study to assess the feasibility and utility of early intervention to increase the support available for IMGs entering general practice (GP) training was undertaken. METHOD: IMGs entering GP training in one UK region were offered one-to-one, near-peer linguistic coaching during their first two weeks of training. A session focusing on cultural acclimatisation, local accent and dialect using mock patient consultations was delivered and evaluated. RESULTS: The coaching was valued by the trainees and the intervention allowed very early identification of a trainee who needed further support. It was possible to identify such trainees using a non-medical volunteer student coach. DISCUSSION: Use of a non-medical, near-peer coach for one-to-one linguistic support has not previously been described for IMGs. This pilot study confirms the acceptability and utility of this approach. Early identification of trainees requiring enhanced support allows targeted interventions in a time-pressured speciality training programme. Further study with a larger-scale and longer-term coaching programme, assessing trainee feedback and uptake of early supportive intervention is recommended.

Did the general practice residents well adapt to real public health prevention --a study from the COVID-19 prevention training in China.

OBJECT: GP residents's has the obligation to take task with the public health prevetion. GP residents receive the public health training during their college study period and the residents training. The sudden outbreak of the COVID-19 epidemic, highlight the importance and competence of the community prevention as the front line of epidemic prevention and control, pushing the general practitioner (GP) residents into the front team of epidemic prevention and control. Residents' participation in epidemic prevention and control is not only a field workload participation in public health disease prevention and control, but also a rare and value-oriented training experience. This study aims to explores the research on the training content, ability improvement and cognitive load of the resident, and to demonstrate past and future training effects of epidemic prevention and control. METHODS: Object cognitive load scale (NASA-TLX scale) and self-developed questionnaires were adopted to conduct a questionnaire survey on resident doctors who were in GP training program from West China Hospital of Sichuan University, and finally 190 questionnaires were collected. SPSS 23.0 statistical software for statistical analysis of data. RESULT: Most indicators of cognitive load NASA scale are at a "moderate" level by the GP residents, generally indicating that the intensity of on-site epidemic prevention and control (training) can be tolerated. The chi-square test is used to study the status of "How responsible you are for epidemic prevention and control in a community in the future", the residents grade shows no significant difference while " how many months after the outbreak when you participated in the epidemic prevention" shows significant difference, the result show that GP residents already have konwledge and skills for the public health prevetion, they need more attitude and mental preparation. Continuing education will have a significant positive relationship with the GP residents's confidence of the prevetion ofpublic health prevetion. CONCLUSION: Former medical school education and training at the regulatory training stage have a good effect for residents to master the ability of epidemic prevention and control, and to prepare for the needs of epidemic prevention and control physically and mentally. After this stage, the epidemic prevention and control training under the real situation will make a great contribution to the self-assessment and performance improvement of the final general practitioners.

Case-Based Discussion in United Kingdom General Practice Training: A Critical Analysis.

Case-based discussion (CbD) is a form of workplace-based assessment to assess the progress of learning in general practice trainees in the United Kingdom. We aim to identify the need and rationale behind CbD. The usefulness of CbD in the trainee's learning will be analyzed with the help of well-recognized parameter such as utility equation. It will also be considered whether the assessment delivers what it is supposed to in actual practice. The current pitfalls will be identified with suggestions for potential improvements.

'It clarified a lot': GP trainees as peer role players in a formative Clinical Skills Assessment (CSA).

INTRODUCTION: The MRCGP Clinical Skills Assessment (CSA) is a high stakes examination which a significant proportion of candidates fail on first sitting. To address this, deaneries have introduced candidate preparation, such as formative CSAs (f-CSA). One way to maximise the gains from a f-CSA is to use GP trainees as peer-role players (VRPs) instead of professional actors. Our aim was to explore trainee experiences of, and educational gains from, the VRP role. METHOD: This qualitative study used semi-structured interviews to explore 15 VRPs' perceptions of peer roleplay. Questions were generated from the literature and from informal discussions with f-CSA organisers. Analysis was inductive and thematic. RESULTS: Analysis identified three main themes. Role play gave participants insight into the exam in terms of what to expect and how to approach the exam. They commented on learning the importance of communication skills and acknowledging the patient's perspective. Finally, there were gains in terms of professional development, particularly in terms of observing good feedback. DISCUSSION: GP trainees who role played patients in a formative CSA reported increased confidence and educational gains from their experience. Whether these perceived gains will be transferred to their own CSA performance later in training remains to be seen.

'Creating health': evaluation of three arts for health training events for GP trainees.

BACKGROUND: General practitioners (GPs) and other health professionals have a key role in signposting their patients to appropriate opportunities for engaging in arts and creative activities for the health and wellbeing benefits they may bring. Training is needed to ensure that GPs are aware of the evidence supporting the role of the arts, and the local availability of 'creative arts for health' activities for their patients. AIM: This article describes the content and evaluation of three arts and health training events for trainee GPs conducted over the period 2016-2019. They took place in association with Guy's and St Thomas, Hillingdon and York and Scarborough General Practice Vocational Training Schemes (GPVTS). METHODS: Evaluation was undertaken for the London events using a specially constructed questionnaire, with rating scales, completed before and after the training events. For the York event, a simple bespoke evaluation questionnaire was employed at the end of the training day. All participants gave consent for photography and filming during the events. RESULTS: Feedback from GPs on the training events revealed increased awareness of the evidence for arts and health interventions, and more positive attitudes towards the role of creative arts in primary care in promoting the health and wellbeing of patients. An additional finding was a recognition by GP trainees that creative activities can enhance a holistic approach to patient care and play a positive part in supporting their own wellbeing. CONCLUSION: Training events of the kind described, with opportunities for creative participation for GP trainees, can enhance awareness of the benefits of creative activity for patient health and wellbeing, and may motivate future GPs to signpost patients towards opportunities for engaging in creative activities. This training model is applicable for any health worker who can refer patients to arts for health activities and has potential to be scaled up nationally.

Interprofessional education and collaboration between general practitioner trainees and practice nurses in providing chronic care; a qualitative study.

BACKGROUND: Effective interprofessional collaboration (IPC) is essential for the delivery of chronic care. Interprofessional education (IPE) can help support IPC skills. This makes IPE interesting for GP practices where chronic care is delivered by GPs together with practice nurses, especially for GP trainees who have to learn to collaborate with practice nurses during their training. The aim of this study is to gain insights in how IPE and IPC occur between GP trainees and practice nurses during the delivery of chronic care in GP training practices. METHODS: We conducted a qualitative research using semi structured focus groups and interviews with GP trainees, practice nurses and GP supervisors. All respondents were primed to the subject of IPE as they had followed an interprofessional training on patient-centred communication. The verbatim transcripts of the focus groups and interviews were analysed using thematic analysis. RESULTS: Despite the overall positive attitude displayed by respondents towards IPE and IPC, the occurrence of IPE and IPC in GP training practices was limited. Possible explanations for this are impeding factors such as limited knowledge, prejudice, lack of role models and a hierarchical organisational structure. Contributing to IPE and IPC use was the integration of IPE in daily practice, e.g. via recurring scheduled meetings. CONCLUSION: We found a limited occurrence of IPE and IPC in GP training practices. Our results show a discrepancy between respondents enthusiasm for IPE and IPC and their actual behaviour. IPE activities have to be initiated in GP training practices, otherwise, despite good intentions, IPE and IPC will be ineffective.

How does GP training impact rural and remote underserved communities? Exploring community and professional perceptions.

BACKGROUND: Substantial government funding has been invested to support the training of General Practitioners (GPs) in Australia to serve rural communities. However, there is little data on the impact of this expanded training on smaller communities, particularly for smaller rural and more remote communities. Improved understanding of the impact of training on underserved communities will assist in addressing this gap and inform ongoing investment by governments and communities. METHOD: A purposive sample of GP supervisors, GP registrars, practice managers and health services staff, and community members (n = 40) from previously identified areas of workforce need in rural and remote North-West Queensland were recruited for this qualitative study. Participants had lived in their communities for periods ranging from a few months to 63 years (Median = 12 years). Semi-structured interviews and a focus group were conducted to explore how establishing GP training placements impacts underserved communities from a health workforce, health outcomes, economic and social perspective. The data were then analysed using thematic analysis. RESULTS: Participants reported they perceived GP training to improve communities' health services and health status (accessibility, continuity of care, GP workforce, health status, quality of health care and sustainable health care), some social factors (community connectedness and relationships), cultural factors (values and identity), financial factors (economy and employment) and education (rural pathway). Further, benefits to the registrars (breadth of training, community-specific knowledge, quality of training, and relationships with the community) were reported that also contributed to community development. CONCLUSION: GP training and supervision is possible in smaller and more remote underserved communities and is perceived positively. Training GP registrars in smaller, more remote communities, matches their training more closely with the comprehensive primary care services needed by these communities.

Exploring educational integrated training posts in general practice: a phenomenological study of trainees' perspectives.

This study explores the experience of undertaking an educational integrated training post (ITP) in general practice. There are problems with General Practice (GP) recruitment and retention in the UK and worldwide. It is thought that integrated training programmes (ITPs) within GP training may offer a new and appealing way of training, which may address this problem. Health Education England North East (HEENE) has been running educational integrated training posts for over 5 years. Integrated training schemes such as this have been rarely studied and in particular the trainees' perspectives. In order to improve understanding of these posts and their potential for aiding GP recruitment, we undertook a qualitative study to explore trainees' perceptions of the experience of undertaking an educational ITP. The study takes an interpretive phenomenological approach using focus groups and one-to-one interviews which were audio-recorded, transcribed and thematically analysed. Emerging themes from the data captured participants' views of their experience of undertaking the posts, as well as the factors influencing their decisions to undertake the posts. The overarching theme found centred on identity formation. The study draws upon social learning theories to help understand and explain the themes identified and the influence on the individuals. For the interested stakeholder, this provides an insight into the individuals' experience and highlights important areas that could be targeted and utilised in the development of future general practice training models.

The value of 'expert trainees' in primary care postgraduate education.

Peer-led teaching is well established within many undergraduate medical courses but relatively underutilised in postgraduate training, despite the fact it can be useful for both teachers and learners. A significant number of doctors training to be GPs bring expertise and experience from other specialities and in this paper we explore the potential of using 'expert trainees' to teach their peers on postgraduate GP training programmes. A GP trainee with expertise in Lifestyle Medicine taught alongside local and national experts and delivered workshops to her peers. Questionnaires were used to establish the acceptability and quality of 'expert trainee' peer-led education. This was a positive experience for the 'expert trainee' who felt valued both as a trainee and as someone with expert knowledge, and for her peers with excellent feedback on her workshop. The knowledge and skills of 'expert trainees' represent an untapped resource which could be more systematically and effectively used within GP education.

The impact of localised general practice training on Queensland's rural and remote general practice workforce.

BACKGROUND: The diverse rural medical education initiatives that have been developed in Australia to address the medical workforce maldistribution have been less successful in many smaller and remote communities. This study explored the factors that attract and retain GP registrars and supervisors and the impact that localised training (i.e., rural and remote workplace-based training and support) has on both GP registrars and supervisors, and the GP workforce in rural and remote underserved areas. METHODS: A purposive sample of 79 GP registrars, supervisors, practice managers, health services staff and community representatives living and working in areas of low GP workforce in rural and remote Australia were invited to participate in semi-structured interviews and one focus group divided over two phases. Thematic analysis was used to explore themes within the data. FINDINGS: Attractors and barriers to rural and remote practice were identified as the main themes. Attractors include family and community lifestyle factors, individual intrinsic motivators, and remote medicine experiences. In contrast, barriers include work related, location, or family factors. Further, localised GP training was reported to specifically influence GP registrars and supervisors through education, social and financial factors. CONCLUSION: The current study has provided a contemporary overview of the issues encountered in expanding GP training capacity in rural and remote communities to improve the alignment of training opportunities with community and workforce needs. Strategies including matching scope of practice to registrar interests have been implemented to promote the attractors and lessen the barriers associated with rural and remote practice.

The Development of a Competency Assessment Standard for General Practitioners in China.

This paper describes the development of a competency assessment standard for General Practitioners in Shenzhen, China. The standard is to be used for developing and delivering the training curriculum for General Practitioners and to enable rigorous assessment of the mastery of the standards by GP trainees. The requirement for the training of General Practitioners in China is mandated by government policy requires an international standard curriculum to meet the needs of patients and the community. A modified Delphi process was employed to arrive at a curriculum consensus. An expert panel and 14 expert working groups derived from the expert panel were established to review and evaluate national and international competency standards for General Practice and develop a set of standards, through a modified Delphi methodology. Forty three experts were involved in the project. The project resulted in a detailed curriculum statement. The curriculum was then used in 2017 and 2018 where pilot examinations of GP trainees (n = 298 and n = 315, respectively) were conducted to assess the trainee's competencies against the Standards. The examination included two modules, a written test (Module A) and a practical test (Module B). The success rate for participants was relatively low with the majority not successfully completing the assessments. The assessments will be further refined in subsequent work. The project achieved its goal of developing a rigorously evaluated standard to support clinical practice and the training and assessment of GPs.

Understanding the relationship between GP training and improved patient care - a qualitative study of GP educators.

INTRODUCTION: Previous research has highlighted the benefits of receiving care in a postgraduate GP training practice including improved patient satisfaction, more appropriate secondary care usage, cancer diagnosis, and antibiotic prescribing. Whilst the influence of being registered in a postgraduate GP training practice on patient outcomes is modest relative to other factors such as deprivation, disease burden, demography, and ethnicity, the reasons for this benefit is not clear. AIM: This study explores how GP trainers perceive engagement with clinical education influences patient care. METHODS: Socio-cultural theories were used as a framework for guiding the research. Semi-structured interviews were conducted with 11 GP educators. Interviews were recorded and transcribed verbatim. Data analysis involved thematic analysis. RESULTS: GP educators identified four overarching themes that, for them, seemed to explain how clinical education mediates its influence on patient care. These included: influencing through (i) educational leadership; (ii) learners; (iii) the educational process; and (iv) educational standards. DISCUSSION: Findings suggest that GP trainees have a significant effect on the learning environment, professional development of GP trainers, and patient care. The nature of the relationship between GP trainers and trainees appears far more bilateral than acknowledged in the apprenticeship model.

Can the arts enhance postgraduate GP training?

The value of arts-based medical education is becoming increasingly well established in undergraduate curricula. However, little is known about its value, and acceptability, to qualified doctors undertaking postgraduate training. In this work we examined GP trainees' views on whether arts-based education was useful for their professional development and, if so, what they perceived its value to be. All first and second year GP trainees on the Dorset Vocational Training Scheme attended a one day course which showcased how the arts (film, poetry, painting, photography, theatre) could enhance their professional development as doctors. GP trainees rated the day as interesting, enjoyable and thought proving. The majority felt that the arts could contribute to making them more competent and humane doctors. Following this, we ran a mandatory six months arts based course for six GP trainees, and evaluated their feedback through qualitative analysis of a focus group discussion. Overall, GP trainees found the course enjoyable and valuable to their learning. It not only gave them a deeper appreciation of the patient's perspective, but also encouraged them to think about their own health and wellbeing.

Key writings in GP specialist training in Ireland.

Key writings are those texts which represent a timeless contribution to the academic basis of general practice. We surveyed the 14 GP Specialist Training Programmes in Ireland and undertook focus group interviews with teachers and trainees in order to understand the extent to which such texts are currently used and whether they are valued in teaching. Our results indicate that traditional reading lists are not common in Irish GP training, that there are many barriers to trainees engaging with such literature but that both teachers and trainees see merit in providing access to a body of key writings. We suggest how this might be undertaken.