'It's surprising how differently they treat you': a qualitative analysis of trainee reflections on a new programme for generalist doctors

Sustained benefits of a generalist training programme for UK doctors: a survey-based follow-up study

OBJECTIVES

The study aimed to conduct a follow-up of all broad-based training (BBT) trainees who participated in the original evaluation completed in 2017. The follow-up study explored the impact of BBT on career decisions, sustained benefits and unintended disadvantages of the programme, and views on the future of training.

DESIGN

Scoping interviews informed the design of an online survey. The interview transcripts were analysed thematically. The survey was piloted with six volunteers and sent out to all former BBT trainees. Data from the survey were transferred to Excel and SPSS for analysis. The open-text comments on the survey were subject to a thematic content analysis.

SETTING

Participants were working in general practice, paediatrics, psychiatry or medicine.

PARTICIPANTS

Eight former BBT trainees participated in the scoping interviews. Interview participants were selected to ensure a diversity of current specialties and to represent all three BBT cohorts. All former BBT trainees were invited to complete the survey (n=118) and 70 replied.

RESULTS

The benefits of BBT were sustained over time: participants were confident in their career decisions, took a holistic approach to care and capitalised on their experiences in other specialties in their current roles. A minority of trainees also experienced temporary challenges when they joined a specialty training programme after completing the BBT. Whatever their specialty, experience in core medicine, paediatrics, psychiatry and general practice was valued. Disadvantages were short-lived (catching up on transition specialty training) or affected a minority (impact on sense of belonging).

CONCLUSIONS

The BBT programme supported the development of generalist doctors. Greater attention needs to be given to training secondary care doctors who take a holistic view of the patient and navigate their specialist care.

Medical student and trainee doctor views on the 'good' doctor: Deriving implications for training from a Q-methods study

PURPOSE

In context of changing patient demographics, this study explores what doctors and medical students believe being a 'good' doctor means and identifies implications for training.

METHOD

Using Q-methodology, a purposive sample of 58 UK medical students and trainees sorted 40 responses to the prompt 'Being a "good" doctor means….' Participants explained their array choices in a post-sort questionnaire. Factor-groups, consensus and distinguishing statements were identified using Principal Components Analysis in R.

RESULTS

Three factor-groups best described shared and divergent perspectives, accounting for 61.64% of variance. The largest, 'patient-centred generalist' group valued patient wellbeing and empowerment, compassion and complex needs. They prioritised knowledge breadth and understanding other specialties. The 'efficient working doctors' group valued good work-life balance, pay and did not seek challenge. Some believed these made a stressful career sustainable. The 'specialist' group valued skills mastery, expertise, depth of knowledge and leadership. Participant-groups were distributed across these factor-groups, all agreeing early specialisation should be avoided.

CONCLUSIONS

The largest factor-group's perceptions of holistic, patient-centred care align with Royal Colleges' curricula adaptions to equip doctors with generalist skills to manage multi-morbid patients. However, curriculum designers should acknowledge implications of generalist approaches for doctors' formulation of professional identities.

'Everyone's nice, but …': A qualitative exploration of trainees' experiences of postgraduate geriatric medicine training in Australia

OBJECTIVE

To understand the experiences of trainees who undertake geriatric medicine advanced training in Australia.

METHODS

In this qualitative study, data were collected through semi-structured interviews with geriatric medicine advanced trainees. Data were analysed using a thematic analysis approach and data collection ceased when thematic saturation was achieved.

RESULTS

Thirteen trainees participated. Trainees enjoyed the training program, supported each other and felt prepared for independent practice as a geriatrician. However, they noted the variability of supervision and feedback practices, and educational opportunities afforded to them across different clinical learning environments. They felt unable to give feedback on their training. The research project and concerns about employment after training were also substantial sources of stress.

CONCLUSION

While geriatric medicine advanced trainees reported positively on much of their training, areas for improvement could include improved training for supervisors, improved support for research projects and more robust mechanisms for providing feedback.

Newly qualified doctors' perceived effects of assistantship alignment with first post: a longitudinal questionnaire study

PURPOSE

Growing evidence supports the role of student assistantships in enhancing graduates' preparedness for practice. However, there is limited evidence concerning the impact of aligning assistantships with graduates' first doctor post. The aims of our study were to determine newly-qualified doctors' views on the value their assistantship experience, effects on anxiety levels, confidence and preparedness for increased responsibilities, exploring change over time and whether effects differ according to assistantship alignment.

DESIGN

We conducted a longitudinal cross-sectional online questionnaire study examining experiences of aligned and non-aligned assistantships across the transition from medical student to newly-qualified doctor. The questionnaire was distributed to final year medical students within Wales, UK (n=351) and those commencing their first post in Wales, UK (n=150) in June 2015 at Time 1 (T1), and repeated in September 2015 (1 month following transition, T2) and January 2016 (T3).

RESULTS

Response rates at T1 were 50% (n=251, aligned=139, non-aligned=112), T2 36% (n=179, aligned=83, non-aligned=96) and T3 28% (n=141, aligned=69, non-aligned=72): 15% (n=73, aligned=36, non-aligned=37) completed all questionnaires. Paired longitudinal analysis was undertaken where possible. Significant differences were observed between participants on aligned and non-aligned assistantships in terms of the value they place on their assistantship experiences, their anxiety, confidence levels and preparedness for responsibility.

CONCLUSION

Although not sustained, aligned assistantships seem to provide graduates with additional benefits during the August transition. Further work is required to establish what it is about the aligned assistantship programme that works and why.

Disciplinary boundaries and integrating care: using Q-methodology to understand trainee views on being a good doctor

BACKGROUND

Rising numbers of patients with multiple-conditions and complex care needs mean that it is increasingly important for doctors from different specialty areas to work together, alongside other members of the multi-disciplinary team, to provide patient centred care. However, intra-professional boundaries and silos within the medical profession may challenge holistic approaches to patient care.

METHODS

We used Q methodology to examine how postgraduate trainees (n = 38) on a range of different specialty programmes in England and Wales could be grouped based on their rankings of 40 statements about 'being a good doctor'. Themes covered in the Q-set include: generalism (breadth) and specialism (depth), interdisciplinarity and multidisciplinary team working, patient-centredness, and managing complex care needs.

RESULTS

A by-person factor analysis enabled us to map distinct perspectives within our participant group (P-set). Despite high levels of overall commonality, three groups of trainees emerged, each with a clear perspective on being a good doctor. We describe the first group as 'generalists': team-players with a collegial and patient-centred approach to their role. The second group of 'general specialists' aspired to be specialists but with a generalist and patient-centred approach to care within their specialty area. Both these two groups can be contrasted to those in the third 'specialist' group, who had a more singular focus on how their specialty can help the patient.

CONCLUSIONS

Whilst distinct, the priorities and values of trainees in this study share some important aspects. The results of our Q-sort analysis suggest that it may be helpful to understand the relationship between generalism and specialism as less of a dichotomy and more of a continuum that transcends primary and secondary care settings. A nuanced understanding of trainee views on being a good doctor, across different specialties, may help us to bridge gaps and foster interdisciplinary working.