What is the role of 'theory' in training GP trainers?

A recent evaluation paper of the London General Practitioner Trainer Course by Knight et al questions the importance of educational theory in preparing GPs to become trainers and asks 'how much educational theory do GP trainers need to know in order to train effectively?' This paper places the authors' question under consideration, arguing that before the relationship between the theory and practice of education can be considered, the nature of 'educational practice' needs examination. There then follows a discussion of the work of Della Fish which presents two conceptualisations of educational practice in the context of postgraduate medical education in order to shed light on the different inferences contrasting epistemological and ontological conceptions can have, and the implications for curricula. This discussion is illustrated by offering the reader connections to papers in the field as evidence. At the heart of the paper is a conclusion that curriculum development and enquiry need to be sensitive to epistemological and ontological positionality as well as experiences and perceptions.

A GP fellowship project looking at whether the multi-source feedback and the educational supervisor's report can be used to identify trainees at risk of difficulty.

As a Wessex General Practice (GP) fellow working within the annual review of competency progression (ARCP) team, we wanted to identify trainees at an early stage of GP training who might be at risk of difficulty during their training scheme. Early identification would allow more time for these trainees to access additional training and wider deanery support. This project aimed to identify retrospectively whether the multi-source feedback (MSF) and the educational supervisor's report (ESR) completed in the first year of speciality training (ST1) could be used to identify trainees at risk of needing additional time in training beyond the three-year training programme. For the purposes of this project, a trainee at risk of difficulty is one who received a developmental outcome 3 (OC 3) at their final ARCP in their last year of GP speciality training (ST3) where the desired outcome is an outcome 6 (OC 6). This fellowship project demonstrated it is possible to use the first MSF in GP training alongside the ESR before their ARCP in ST1, to identify a large proportion (88%) of trainees who may be at risk of difficulty further in their training.

GP trainees' values and knowledge regarding global health competencies.

Globalisation is having a significant impact on health through the increasingly interconnected nature of our world, population movement and effects of political and environmental issues. In response, medical educators are urged to review postgraduate training programmes to ensure that doctors are up-to-date with training in contemporary global health issues. Positioned on the frontline of healthcare provision, GPs have an integral role to play in addressing local and global health inequities. However, GP trainees in the UK currently receive little formal education on global health. We sought to investigate GP trainees' understanding and perceived competence in relation to global health issues and cross-cultural practice and their views regarding whether it is indeed time for GP postgraduate training to 'go global'. We invited trainees across Health Education England: Wessex (N = 476) to complete an anonymous online questionnaire. The majority of respondents either 'agreed' or 'strongly agreed' that 'it is important for doctors training to be GPs in the UK to have education on global health' (89%). Similarly, the majority either 'agreed' or 'strongly agreed' that 'it is important for doctors training to be GPs in the UK to develop intercultural competence' (93%). In contrast to the high degree of importance that GP trainees placed on establishing proficiency in these domains, approximately half (45-54%) reported their current level of competence as only being 'average'. Our findings indicate a mismatch and unmet need for further training in the postgraduate setting, with strong GP trainee support for a shift in curriculum design and delivery, towards more globally competent general practice.

An evaluation of the virtual simulated surgery assessment for the induction and return to practice scheme.

This paper reports on the development of the virtual Simulated Surgery assessment for the Induction and Return to practice (I&R) scheme and how it was used in the assessment of clinical and consultation skills. The evaluation examines the reliability and consistency of the virtual Simulated Surgery with the face-to-face assessment and reports feedback from the participants (candidates, administrators, marshals, examiners and role-players), highlighting what is lost and/or gained by the difference in format. Finally, the paper discusses the benefits and problems of remote assessment generally and looks at how this mode of assessment may be used in the future.

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.

The experience and professional development of medical appraisers.

This article explores the experiences of General Practitioner (GP) appraisers working in a unfamiliar setting (Jersey) with appraisees new to the process. Findings were interpreted using the learning theory, 'situated cognition', to shed light on the experience of appraisers working with new appraisees more generally and contribute to new understandings of workplace learning. Rich qualitative data derived from transcripts of nine in-depth interviews with GP appraisers were analysed thematically in a rigorous and iterative manner process. GP appraisers working in an unfamiliar environment shared a common sense of culture shock and discomfort. Initially, they needed to work much harder than usual to establish rapport and credibility, but by the second round of appraisals, appraisers were reminded of the power of appraisal. The innovative application of 'situated cognition' helps to explain why appraisers felt like 'novices' in Jersey and how they were required to reconstruct their professional knowledge. This is the first time appraiser development has been considered in this way and appraisers can be helped to develop professionally if they are offered a mix of appraisal-related activities in new places and with new people. Such implications for educational support apply internationally where doctors are involved in a process of peer review as part of on-going professional development.

How can educators support general practice (GP) trainees to develop resilience to prevent burnout?

CONTEXT: Burnout impacts adversely on professional and personal life, and holds implications for patient care. Current research on burnout mainly focuses on established general practitioners but it is unclear how early the signs of burnout really start. This work seeks to identify whether specific GP trainee groups are particularly at risk of burnout and the aspects of training they find stressful. METHODS: A longitudinal cohort study, collecting qualitative and quantitative data through a single mode of data collection (questionnaire) took place with trainees from all GP training years (ST1-3), across a vocational training scheme (n = 48). Data gathered included the Oldenburg Burnout Inventory (OLBI). RESULTS: Higher than anticipated levels of burnout were displayed by all trainees. A sub-group self reporting higher levels of burnout comprised all-female, UK-trained-at-undergraduate GP trainees, with a partner but no children. Top reported stressors included knowledge/uncertainty, workload/time pressures and ePortfolio. Less than 50% of trainees perceived their burnout levels to be as high as their OLBI showing potential lack of insight. CONCLUSIONS: This research demonstrates that high levels of burnout are experienced in GP trainees as early as the first year of training. Early identification of burnout amongst trainees is essential by GP educators to help protect the future GP workforce.

Learning from the GP-consultant exchange scheme: a qualitative evaluation.

Collaborative working across primary and secondary care is crucial to providing high quality patient care. There is still a lack of communication and understanding between primary and secondary care, which can impede collaborative working. The experience of observing colleagues in a different speciality can prompt insight, improve morale and promote collaborative working. The GP-Consultant Exchange Scheme aimed to improve professional understanding, foster deeper partnerships, and ignite opportunities for innovation and/or quality improvement (QI) with co-owned local solutions. This paper gives an overview of how the scheme works and sets out some of the outcomes reported by some 200 Consultants and GPs participants to date. Overall, the participants found the scheme an enjoyable way to reconnect clinicians and allowed them to learn about the challenges faced in different areas within the NHS. This low-cost intervention needs motivated individuals to drive the project forward and make it sustainable, but it can be replicated within any organisation or profession in the NHS.

GP trainees' experiences of training.

BACKGROUND: Understanding the experience of training in an authentic and rich way can be a powerful driver to reviewing teaching and learning practice. GP educators in the Health Education England Wessex region decided to take this a step further and examine the equity of the experience of training, including trainees' thoughts and views about how that experience could be improved. METHOD: An online questionnaire survey was developed covering topics such as the perceived support needs of IMG (international medical graduate) trainees, trainees' experiences of discrimination, and their ideas for improvement. The survey focused on areas that were within the power of local educators to change, thereby enabling the results to drive improvement. The survey link was emailed to all trainees in our deanery via their training patches. Responses were anonymous. RESULTS: One hundred and eighty-seven responses were received from a cohort of approximately 530 trainees-a response rate of 35%. Responses ranged from a limited awareness of additional support needs for trainees from different backgrounds, through to those who had experienced uncomfortable situations and those with clear ideas about improvements. The data have been used to trigger improvement discussions within patch teams and facilitate changes in practice. CONCLUSIONS: The outcome of the work has led to change-from providing additional courses and support to raising awareness of trainees' experiences. The results have also been fed back to senior educators who manage training across the region.

General practice tasters for foundation doctors.

BACKGROUND: General practice (GP) is currently not viewed positively as a career choice, compared with other specialties, with GP training programmes struggling to fill posts. Opportunities to change this mindset in the early years of training are limited. Trainees may find themselves applying for entry into GP specialty training just 3-4 months after completing Foundation Year 1 (FY1), yet there are few GP attachments during FY1 that can provide experience of primary care and positively inform career choice. CONTEXT: To help ameliorate the current crisis in GP, recruitment and retention initiatives are needed to provide relevant experience of GP early in medical careers so that more doctors can make an informed decision to choose GP as a career. INNOVATION: FY1 doctors have been given the opportunity to shadow final-year GP specialty trainees (GPST3) in clinical practice (for between 3 and 5 days). The voluntary scheme has run successfully since 2014. This paper describes the taster programme and its evaluation. The programme has been positively received by both FY1s and GPST3 mentors. The GPST3s are enthusiastic about GP, which appeared to 'rub off' on the FY1s. FY1s find it helpful to have a trainee's perspective, gaining an overview of what to expect, including the opportunities available to them. General practice is currently not viewed positively as a career choice IMPLICATIONS: Using GPST3 trainees as mentors for FY1 doctors is educational for both groups and can have a positive impact on GP recruitment. The taster demonstrated how varied GP is, and challenged some negative perceptions of primary care. GPST3s gained confidence in their knowledge about GP and greater insight into educational roles.

Doctors with dyslexia: strategies and support.

BACKGROUND: Looking beyond dyslexia as an individual doctor's issue requires adjusting a working environment to better serve the needs of doctors with dyslexia. With an increasing number of doctors disclosing dyslexia at medical school, how can educators best provide this support? Our research looks at the impact of dyslexia on clinical practice and the coping strategies used by doctors to minimise the effect. METHODS: Qualitative data were collected from 14 doctors with dyslexia using semi-structured interviews and by survey. 'In situ' demonstration interviews were conducted in order to understand how dyslexia is managed in the workplace from first-hand experience. Employers and educators who have responsibility for meeting the needs of this group were also consulted. RESULTS: Even in cases of doctors who had a diagnosis, they often did not disclose their dyslexia to their employer. Study participants reported having developed individual ways of coping and devised useful 'workarounds'. Support from employers comes in the form of 'reasonable adjustments', although from our data we cannot be sure that such adjustments contribute to an 'enabling' work environment. Supportive characteristics included the opportunity to shadow others and the time and space to complete paperwork on a busy ward. How can educators best provide support [for doctors with dyslexia]? DISCUSSION: Doctors with dyslexia need to be helped to feel comfortable enough to disclose. Educators need to challenge any negative assumptions that exist as well as promote understanding about the elements that contribute to a positive working environment. As a result of the research there is now practice available for educators to identify evidence-based strategies and resources.

Innovative training posts: trust-attached general practice registrars.

WHAT IS ALREADY KNOWN IN THIS AREA • Research suggests that traditional GP. SHO education has little or no contact with general practice during the hospital years, something viewed negatively by GP trainees. It also Suggests that the quality of training is variable, due, among other things, to heavy service commitment, and the lack of structured educational input and support. WHAT THIS WORK ADDS • This study reports a pilot of an innovative training programme that sought to address the problems previously identified with traditional GP SHO training. The posts were found to be popular and successful, offering integrated training between primary and secondary care' during the SHO years. SUGGESTIONS FOR FUTURE RESEARCH • Innovative training posts offer a much-needed way to extend the menu of training opportunities for general. practice, and further work is needed 18 explore-how they can be developed forther, as well as to continue to monitor the quality and development of the trust-attached posts now in existence in Severn and Wessex.

The benefits of appraisal: a critical (re)view of the literature.

It has been acknowledged that little is known about the impact of general practice (GP) appraisal on clinical and professional practice, as may be demonstrated by identifiable or 'hard' outcomes, and further, that the way in which appraisal informs professional development is unclear. In spite of this acknowledgement and the existence of a substantial number of studies about GP appraisal, to date an overview of the field of enquiry which maps what is known, has been lacking. In this leading article we present the first extensive thematic narrative synthesis of the literature on appraisal. In it we highlight the issues and tensions around research into appraisal, based on what we found (or didn't find) in our review. Key conclusions concern the focus of existing research - which has tended to report the perceptions of change from individual appraisees, rather than specific examples of change captured from other sources and perspectives - and the scope of research - which has been limited to certain data collection methods. Based upon our review, we draw out implications for research and researchers in the future.

Clinicians with dyslexia: a systematic review of effects and strategies.

BACKGROUND: For educators, an awareness of the impact of dyslexia on learners in the clinical workplace is vital: first, to be able to identify whether dyslexia may underlie certain traits and behaviours; and second, to be able to provide appropriate advice and support when dyslexia is identified. We reviewed the primary research evidence concerning the effects of dyslexia on clinicians (in or after training) in the workplace, and adaptive strategies ('workarounds') that are presently in use. METHODS: A systematic search of literature was undertaken, followed by a narrative review of studies selected as meeting the inclusion criteria. The review used a priori research questions and focused on studies based on primary research evidence. RESULTS: The review identified five key studies on qualified doctors or nurses with dyslexia. The impact of dyslexia on doctors can include: writing and calculating prescriptions, writing patient notes, and prioritising and making referrals. Strategies to minimise the effects of dyslexia include the use of adaptive technologies, the need for more time for mentors and supervisors, and an awareness of 'enabling' and 'disabling' environments. An awareness of the impact of dyslexia on learners in the clinical workplace is vital DISCUSSION: The difficulties associated with dyslexia are varied and may be unexpected. Medical educators must therefore be aware of dyslexia and its impact. When supporting a trainee with dyslexia, there is guidance available but educators may struggle to identify strategies and resources that are evidence based, so further research is required.