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

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.

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.

Appreciative assessment

In this article, we propose a new 'appreciative' attitude towards assessment, on two grounds. Firstly, in order to accommodate and benefit from diversity, in both medical practice and medical education; and secondly in order to promote critical thinking, self awareness and capability in trainees more generally. Appreciative assessment requires a dialogic approach - an approach which is already well established in the context of educational supervision, but which we argue is just as applicable to assessment.