Effect of extension of postgraduate training in general practice on the acquisition of knowledge of trainees.

BACKGROUND: Postgraduate training in general practice aims to develop clinical competence. However, little is known about its effect on trainees' development of competence. OBJECTIVE: Our aim was to investigate whether 3 years of postgraduate training in general practice leads to a higher level of knowledge than 2 years training while maintaining the same structure and educational objectives. METHODS: This retrospective study had a mixed longitudinal design. Trainees of the Dutch postgraduate training in general practice participated. Knowledge was assessed by written progress testing of knowledge relevant to general practice embedded in real life situations. Test results were collected from 1992 to 1999. The results of trainees who received the 2-year and 3-year curriculum were compared. RESULTS: Both curricula started with the same entrance level and showed the largest acquisition of knowledge at the start and towards the end of training. Both curricula showed stagnation in growth at the end of the training period in which trainees rotate through hospitals, nursing homes and mental health institutions. The level of knowledge at the end of training was significantly higher for the 3-year curriculum. CONCLUSION: This study shows that postgraduate training contributes to an increase in knowledge and that a 3-year programme leads to a higher level of knowledge than a 2-year programme. The stagnation in growth found at the end of rotations through hospitals, nursing homes and mental health institutions questions the impact of these rotations on the development of competence and the efficacy of the training as a whole. Further study is needed to draw more firm conclusions.

Acquisition of clinical skills in postgraduate training for general practice.

BACKGROUND: Postgraduate training in general practice aims to develop clinical competence. However, little is known about its effect on trainees' development of clinical skills. AIM: To assess the acquisition of clinical skills during a 3-year training programme and to evaluate whether a satisfactory level is achieved towards the end of training. DESIGN OF STUDY: Cross-sectional design. SETTING: Dutch postgraduate training in general practice from 1995 to 1998. METHOD: Clinical skills were assessed using a written knowledge test of skills and by an Objective Structured Clinical Examination (OSCE). The written test was administered to trainees in all 3 years. Trainees at completion of their training took the OSCE. The results of both tests were compared with a standard of adequacy and to a reference group of general practitioner (GP) trainers. RESULTS: An increase in the level of clinical skills and pass rate was found throughout the training, being most prominent during the first 6 months. At completion of their training, trainees scored higher than the GPs on the written test (48% versus 39%) and on the OSCE (69% versus 63%). Eighty-eight per cent of the trainees would have passed the written test against 70% of the GPs and 94% would have passed the OSCE against 80% of the GPs. CONCLUSION: A 3-year postgraduate training period in general practice contributes to a satisfactory acquisition of clinical skills. Further research into when and where acquisition takes place, and the role of the GP trainer, is needed.

What influences the quality of educational encounters between trainer and trainee in vocational training for general practice?

This study of educational encounters between a trainer and a trainee in vocational training for general practice investigates the quality of the encounter. The study focuses on the relation between the quality of the encounter and elements such as presence of feedback, duration, use of media, etc. A quality measure based on the Gagné and Briggs model for the design of instructional events was developed. The quality score was correlated with other elements of the encounter as reported in a log diary completed by trainees. In the log diary 45 trainees registered 314 encounters. Quality predictors included duration of the encounter, the number of media (files of patients, professional guidelines) used, the number of follow-up activities and feedback by the trainer on the performance of the trainee. Several elements were identified as contributing to the educational quality of the encounter, such as presence of media, follow-up activities and positive feedback. The trainer can easily control these elements.