General practice is 'different': qualitative study of acculturation experiences of East Staffordshire general practice specialty trainees.

Abstract

Undergraduate medical education and postgraduate foundation training are largely secondary care based. General practice trainees also spend nearly half of their training in hospital rotations. Little is known about factors that support effective transition into general practice specialty training or belongingness experiences throughout training. To explore the reported experiences of general practice trainee transition into general practice, training in hospital settings, and views of the future. Semi-structured interviews with 18 purposively selected trainees plus observation and stakeholder discussions by a visiting Sri Lankan general practice trainee attending the vocational training scheme in a participant observer role. Mastering core skills of general practice, undergraduate and early experience in general practice during specialty training, and general practice trainer guidance and role modelling facilitated transition. 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, and secondary care affiliative behaviours were adaptive strategies. Allocation to more general practice relevant duties was thought to create value within the hospital team. General practice trainees are thriving with the support of general practice trainers and colleagues, vocational training scheme, and good work/life balance. International graduates require additional support in specific areas. Adequate support towards transition into general practice and fostering belongingness in hospital settings is important due to the wider impact on training, patient care, and primary/secondary care integration. We propose a theoretical explanation based on Wenger's social learning model, which may have useful practical implications.