The future of GP specialty training: enhanced and extended

Evaluation of a Web-Based ADHD Awareness Training in Primary Care: Pilot Randomized Controlled Trial With Nested Interviews

BACKGROUND

Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder affecting up to 5% of children and adults. Undiagnosed and untreated ADHD can result in adverse long-term health, educational, and social impacts for affected individuals. Therefore, it is important to identify this disorder as early as possible. General practitioners (GPs) frequently play a gatekeeper role in access to specialist services in charge of diagnosis and treatment. Studies have shown that their lack of knowledge and understanding about ADHD can create barriers to care.

OBJECTIVE

This pilot randomized controlled trial assesses the efficacy of a web-based psychoeducation program on ADHD tailored for GPs.

METHODS

A total of 221 participants were randomized to either a sham intervention control or an awareness training intervention and they completed questionnaires on ADHD knowledge, confidence, and attitude at 3 time points (preintervention, postintervention, and 2-week follow-up). Participants in the intervention arm were invited to participate in a survey and follow-up interview between 3 and 6 months after the intervention.

RESULTS

The responses of 109 GPs were included in the analysis. The knowledge (P<.001) and confidence (P<.001) of the GPs increased after the intervention, whereas misconceptions decreased (P=.04); this was maintained at the 2-week follow-up (knowledge, P<.001; confidence, P<.001; misconceptions, P=.03). Interviews and surveys also confirmed a change in practice over time.

CONCLUSIONS

These findings demonstrate that a short web-based intervention can increase GPs' understanding, attitude, and practice toward ADHD, potentially improving patients' access to care.

TRIAL REGISTRATION

International Standard Randomized Controlled Trial Number ISRCTN45400501; http://www.isrctn.com/ISRCTN45400501.

General practice is "different": a qualitative study of adaptation experiences of East Staffordshire general practice speciality trainees

BACKGROUND

Undergraduate medical education and foundation training are still largely hospital based. General practice trainees also spend nearly half of their speciality training in hospitals. Aims: To explore adaptation experiences of general practice speciality trainees throughout the training. Method: Semi-structured participant-observer interviews with 18 purposively selected trainees on the East Staffordshire vocational training scheme, observation, stakeholder discussions and concurrent inductive thematic analysis. Results: Undergraduate and early general practice experience during speciality training, general practice trainer role modelling and mastering core general practice skills, facilitated transition. An inclusive and supportive general practice environment, facilitating engagement with a community of practice involving peers, general practice trainers and vocational training programme fostered belongingness. A reduced sense of belongingness during hospital rotations impacted on training and work. Building bridging social connections, personal agency initiatives to bring general practice relevance into hospital training, signposting to general practice relevant duties and mastery of secondary care relevant competencies helped gain belongingness in hospital. While some international graduates required assistance in specific areas; overall, general practice trainees had optimistic views of their future. Conclusion: The main contribution of this study was to relate the adaptation experiences of trainees to learning and practice based on Wenger's communities of practice to enable a better understanding of how they can be influenced to enhance training.Abbreviations: CoP: Community of practice; GP: General practice; GPST: General practice speciality trainee; M: Male; F: Female; ST1: First-year GPST; ST2: Second-year GPST; ST3: Third-year GPST; UKG: UK-based primary medical qualification; IMG: Non-UK primary medical qualification.

Extended training to prepare GPs for future workforce needs: a qualitative investigation of a 1-year fellowship in urgent care

BACKGROUND

It has been argued that UK general practice specialist training should be extended to better prepare GPs for the challenges facing 21st-century health care. Evidence is needed to inform how this should occur.

AIM

To investigate the experience of recently trained GPs undertaking a 1-year full-time fellowship programme designed to provide advanced skills training in urgent care, integrated care, leadership, and academic practice; and its impact on subsequent career development.

DESIGN AND SETTING

Semi-structured interviews conducted longitudinally over 2 years augmented by observational data in the West Midlands, England.

METHOD

Participants were interviewed on at least three occasions: twice while undertaking the fellowship, and at least once post-completion. Participants' clinical and academic activities were observed. Data were analysed using a framework approach.

RESULTS

Seven GPs participated in the pilot scheme. The fellowship was highly rated and felt to be balanced in terms of the opportunities for skill development, academic advancement, and confidence building. GPs experienced enhanced employability on completing the scheme, and at follow-up were working in a variety of primary care/urgent care interface clinical and leadership roles. Participants believed it was making general practice a more attractive career option for newly qualified doctors.

CONCLUSION

The 1-year fellowship provides a defined framework for training GPs to work in an enhanced manner across organisational interfaces with the skills to support service improvement and integration. It appears to be well suited to preparing GPs for portfolio roles, but its wider applicability and impact on NHS service delivery needs further investigation.

Views of newly-qualified GPs about their training and preparedness: lessons for extended generalist training

BACKGROUND

General practice is becoming increasingly complex due to an ageing population with multiple morbidities and the shift of services from secondary to primary care, yet GP training remains largely the same. Extended training is now recommended, initially proposed as a fourth GP specialty trainee year, but more recently as a broad-based 4-year specialty training programme.

AIM

To explore the views of newly-qualified GPs about their training and preparedness for specific aspects of the GP's role.

DESIGN AND SETTING

Qualitative study with newly-qualified GPs who qualified with Severn Deanery between 2007 and 2010.

METHOD

Semi-structured interviews with 18 GPs between November 2011 and April 2012.

RESULTS

Gaining experience in a variety of primary care environments widens insight into patient populations as well as helping GPs develop adaptability and confidence, although this is not routinely part of GP training. However, alongside variety, having continuity with patients in practice remains important. Opportunities to be involved in the management of a practice or to take on substantial leadership roles also vary widely and this may limit preparedness and development of generalist skills.

CONCLUSION

Extended training could help prepare GPs for the current challenges of general practice. It could ensure all trainees are exposed to a greater variety of primary care settings including those outside GP practice, as well as experience of business, finance, and leadership roles. Collectively, these changes have the potential to produce GPs with both generalist and enhanced skills, who are better prepared to work collaboratively across the organisational boundaries between primary, secondary, and community care.

Evaluation of a programme in population health management for GP trainees

OBJECTIVES

There is an increasing focus on improving outcomes for populations. General practice has a key role to play in achieving better patient outcomes. A programme in population health management was developed for GP trainees in their fourth year. The objective was to evaluate this educational intervention for impact upon learners, and lessons learned in the delivery of this innovative programme.

METHODS

The evaluation approach combined qualitative and quantitative approaches involving GP trainees, GP trainers, and faculty.

RESULTS

Involvement in the programme had a positive impact upon trainees' knowledge of population health management, developed transferable skills, and encouraged a shift in mindset to considering the needs of a practice population. The impact upon patients and practices is also described. Lessons learned for enhancing the programme are explained.

CONCLUSIONS

Encouraging GP trainees to become involved with population health has significant benefits for their professional development. The Royal College of General Practitioners (RCGP) curriculum should consider incorporating population health competencies.

International work and leadership in UK general practice

Purpose

– The purpose of this paper is to present an exploration of the leadership competencies developed by UK GPs through having undertaken international work and the ability to transfer these competencies back to the UK.

Design/methodology/approach

– The approach taken is a cross-sectional survey.

Findings

– A total of 439 UK-based, ranging from GP specialty trainees to retired GPs who had worked overseas, responded to an online survey of UK general practice and international work. Doctors were asked to report competency development through international work using the domains of the Medical Leadership Competency Framework (MLCF). The most common competencies developed, to a “moderate or significant” degree, related to “personal qualities” (89 per cent) and “working in teams” (87 per cent). To a lesser extent Doctors developed competencies in “setting direction” (60 per cent), “managing services” (59 per cent), and “service improvement” (56 per cent), and found these competencies harder to transfer back to the UK. A common reason for limited transfer of competency was the lack of leadership opportunities for Doctors when returning to UK locum roles. Overseas posts were more common in low/middle income countries, and these Doctors reported a greater range of leadership roles, including in health policy, management and teaching, compared to high-income countries. Most doctors felt that they were able to develop their clinical skills overseas whilst relatively few Doctors performed research, especially in high-income countries.

Originality/value

– To the authors' knowledge this is the first cross-sectional survey exploring the international work of UK GPs and leadership development using the MLCF domains.