General Practice Specialty Training Research Articles

The effect of specific learning difficulties on general practice written and clinical assessments.

Substantial numbers of medical students and doctors have specific learning difficulties (SpLDs) and failure to accommodate their needs can disadvantage them academically. Evidence about how SpLDs affect performance during postgraduate general practice (GP) specialty training across the different licencing assessments is lacking. We aimed to investigate the performance of doctors with SpLDs across the range of licencing assessments. We adopted the social model of disability as a conceptual framework arguing that problems of disability are societal and that barriers that restrict life choices for people with disabilities need to be addressed. We used a longitudinal design linking Multi-Specialty Assessment (MSRA) records from 2016 and 2017 with their Applied Knowledge Test (AKT), Clinical Skills Assessment (CSA), Recorded Consultation Assessment (RCA) and Workplace Based Assessment (WPBA) outcomes up to 2021. Multivariable logistic regression models accounting for prior attainment and demographics were used to determine the SpLD doctors' likelihood of passing licencing assessments. The sample included 2070 doctors, with 214 (10.34%) declaring a SpLD. Candidates declaring a SpLD were significantly less likely to pass the CSA (OR 0.43, 95% CI 0.26, 0.71, p = 0.001) but not the AKT (OR 0.96, 95% CI 0.44, 2.09, p = 0.913) or RCA (OR 0.81, 95% CI 0.35, 1.85, p = 0.615). Importantly, they were significantly more likely to have difficulties with WPBA (OR 0.28, 95% CI 0.20, 0.40, p < 0.001). When looking at licencing tests subdomains, doctors with SpLD performed significantly less well on the CSA Interpersonal Skills (B = -0.70, 95% CI -1.2, -0.19, p = 0.007) and the RCA Clinical Management Skills (B = -1.68, 95% CI -3.24, -0.13, p = 0.034). Candidates with SpLDs encounter difficulties in multiple domains of the licencing tests and during their training. More adjustments tailored to their needs should be put in place for the applied clinical skills tests and during their training.

Commercial business and partnership aspects of general practice: the learning needs of First5 general practitioners in NHS Scotland–a qualitative study

ObjectivesTo identify the learning needs of recently qualified general practitioners (GPs) (First5) in National Health Service (NHS) Scotland concerning GP partnership and the commercial business aspects of general practice. It...

Exploration of sedentary behaviour among GPs: a cross-sectional study.

BackgroundSedentary behaviour, which may have increased among GPs due to increasing use of telemedicine, is associated with many illnesses and increased all-cause mortality.AimTo explore levels of sedentary behaviour among GPs and General Practice Specialty Trainees (GPSTs).Design & settingSequential, cross-sectional design (initial online sedentary behaviour questionnaire and subsequent thigh-worn accelerometer substudy) of GPs and GPSTs in Northern Ireland.MethodSelf-reported questionnaire data were aggregated and compared with device-measured accelerometry data.ResultsData from 353 participants (17.7% of GPs and GPSTs in Northern Ireland) revealed doctors in general practice self-reported higher workday sedentary time (10.33 hours, SD 2.97) than those in secondary care (7.9 hours, SD 3.43 [mean difference {MD} 2.43 hours; P<0.001]). An active workstation (for example, sit-stand desk), was used by 5.6% of participants in general practice, while 86.0% of those without one would consider using one in future. Active workstation users self-reported lower workday sedentary time (7.88 hours, SD 3.2) than non-users (10.47 hours, SD 2.88 [MD –2.58 hours, P = 0.001]). Accelerometer substudy participants underestimated their workday sedentary time by 0.17 hours (95% confidence interval [CI] = –1.86 to 2.20; P = 0.865), and non-workday sedentary time by 2.67 hours (95% CI = 0.99 to 4.35; P = 0.003). Most GPs (80.7%) reported increased workday sitting time compared to prior to the COVID-19 pandemic, while 87.0% would prefer less workday sitting time.ConclusionGPs have high levels of workday sedentary time, which may be detrimental to their health. It is imperative to develop methods to address sedentary behaviour among GPs on workdays, both for their own health and the health of their patients.

Exploring typologies of consultation performance using authentic clinical experiences to support learning and assessment in postgraduate medical training

Objective: To validate and refine typologies of consultation performance from previous research to identify learning needs associated with each typology. Methods: We performed a qualitative study in a General Practice Specialty Training programme, using a two-stage design. First, we selected four exemplars from 80 videotaped consultations of 7 first-year and 6 third-year trainees that reflected the four typologies. We subsequently held individual interviews with clinical supervisors (N = 20) who observed these consultations to identify recurrent trainee behaviours. Results: The ‘doctor-patient interaction’ dimension from previous research was specified to encompass relationship-building, exploring, structuring, and shared decision-making competencies. Medical expertise was a moderating factor. The attitude and consultation behaviours included in the typologies were validated and we formulated directions for learning based on learning needs identified per typology. Conclusion: Supervisors have a shared frame of reference for the behaviours reflecting proficient consultation performance. Serving as a developmental road map, all learning needs emphasised contextual adaptation, calling for an improved balance between patient-centred relationship building and application of medical expertise. Practice implications: By providing rich and tailored feedback on consultation performance, the refined typologies – albeit subject to additional refinement in future research – may promote the monitoring of individual competence development over time.

Exploration of sedentary behaviour among general practitioners: protocol for a mixed methods study

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Many general practitioners (GPs) are sedentary for most of their working day. Levels of sedentary behaviour may have been exacerbated by increased use of telemedicine in light of the COVID-19 pandemic, as this is traditionally performed while sitting down. Excessive sedentary behaviour is associated with many adverse health outcomes and increased all-cause mortality. This study will gain quantitative data on levels of sedentary behaviour among GPs and general practice specialty trainees (GPSTs), to identify to what extent general practice is a sedentary occupation, as well as qualitative data regarding the barriers and facilitators to reducing sedentary behaviour in the general practice setting.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; The study follows a sequential, mixed-methods model. The first stage will involve the dissemination of a questionnaire survey, where participants self-estimate their sedentary behaviour on a working day and on a non-working day. The second stage will use thigh-worn accelerometers and a sleep/work log to obtain objective data regarding sedentary behaviour among a purposive subset of participants who responded to the questionnaire. The third stage will involve semi-structured interviews with a purposive subset of accelerometer study participants, analysed with the application of a theoretical framework regarding the acceptability of healthcare interventions.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;This paper outlines a protocol for a sequential, mixed-methods study exploring sedentary behaviour among GPs and GPSTs. Findings of this study will shed light on the new ways of working as a result of the COVID-19 pandemic, which will be relevant to clinicians working in similar primary care settings throughout the world.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Trial Registration:&lt;/strong&gt; ClinicalTrials.gov Identifier: NCT04556695. Date of registration: 21&lt;sup&gt;st&lt;/sup&gt; September 2020.&lt;/p&gt;&lt;p class="abstract"&gt; &lt;/p&gt;

Das Allgemeinarztbarometer A – ein Instrument zur Erhebung von primärärztlichen Kompetenzen in der medizinischen Ausbildung

IntroductionThe primary goal of medical education and training is to develop clinical competencies. Competency-based curricula exist for both medical education which – once the current reform is implemented – will be geared more towards primary care, and specialty training for General Practice. The “Allgemeinarztbarometer” is a German-language instrument to assess primary care competencies during specialty training and has so far been mainly used as a self-assessment tool.The aim of this study was (i) to test the application of the “Allgemeinarztbarometer” in the context of medical education as an external assessment tool (in its “Allgemeinarztbarometer A [ABA]” version) and (ii) to evaluate its basic psychometric properties. MethodsPhysicians involved in teaching were asked to assess medical students after a two-week internship in General Practice during their fifth year of study using the ABA (9-item external assessment version). After data processing and displaying basic distributions, we conducted exploratory factor analysis, followed by confirmatory factor analysis. The detected factor structure was then tested for internal consistency. ResultsA total of 150 completed questionnaires were included in the analysis. One item showed a high number of missing values (response option “Not assessable”). Exploratory factor analysis indicated a two-factor structure (“Patient-oriented skills” and “General Practice decision-making”). Three items were not unambiguously assignable and hence erased. Confirmatory factor analysis validated the identified factor structure. The two factors showed a Cronbach's α of 0.73 and 0.84 (moderate to very good internal consistency). DiscussionOur study provides a first analysis of the ABA in the context of medical education. The detected two-dimensional structure shows a high goodness-of-fit when giving up three items still used in this survey. The analysis of missing data showed a high number of “I can’t say” answers when assessing the development of strategies against burnout. ConclusionsThe ABA (6-item version) seems to be a suitable tool for the external assessment of General Practice competencies in the context of medical education. Further studies are needed to evaluate both the completeness of the assessment and the external assessability of certain items in the context of medical education.

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

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.

GP registrars teaching medical students- an untapped resource?

ABSTRACT Background General practice placements are fundamental to undergraduate medical education but there are difficulties in recruiting teaching practices. Developing “near peer teaching” may help. Health Education England & UCL run a programme in general practice (GP) training schemes with Innovative Training Posts in medical education. Aim To evaluate GP innovative training posts in undergraduate medical education. Design and Setting Focus groups and interviews with GP specialty trainees (“trainees”), medical students & educational stakeholders in London. Method A qualitative study exploring stakeholders’ perspectives of this initiative. Transcribed interviews were analysed thematically. Results We interviewed 26 stakeholders. Students valued trainees’ generalist expertise and making explicit areas of medicine. Trainees adopted student-centred approaches, addressing students’ assessment agendas, in contrast to senior doctors. Trainees also provided career guidance. Trainees expressed benefits to their development; their identity as learners & educators, and clinical knowledge. Teaching & learning for trainees were inter related; as identified by “to teach something well is to understand it well”. Educational leaders were supportive but had to champion such initiatives. Conclusion Near peer teaching in general practice is relatively novel. There are strong educational benefits for learners & teachers clearly influenced by the social context of learning. Positive career roles are modelled by trainees.

Recently-qualified general practitioners’ perceptions and experiences of General Practice Specialty Training (GPST) in deprived areas of NHS Scotland – a qualitative study

ABSTRACTNHS Scotland faces significant challenges in delivering the Scottish Government’s 2020 Strategy for Healthcare. GP recruitment and retention are problematic for deprived area practices (DAPs). Recently-qualified GPs are more likely to join practices in areas where they have trained and so it is important to encourage GP training in deprived areas. This study aimed to identify the perceptions and experiences of recently-qualified GPs who had trained in DAPs. A grounded theory approach was used with 14 GPs interviewed in focus groups and in-depth interviews. Six themes were identified: allocation to training practices in deprived areas and anxieties about working there, positive training experiences, attributes of trainers, consultation differences, preferences for large practice teams and health centres, and future career plans. GPs were very positive about their training experiences in DAPs and appreciated their trainer and training practice. One concern was of the limited experience of patient-centred consulting which they felt weakened their performance in the Clinical Skills Assessment (CSA) component of the MRCGP examination. Rotations between affluent and deprived areas would benefit General Practice Specialty Trainees (GPSTs) particularly with the CSA examination. Training authorities should encourage and support practices in deprived areas to become training practices and encourage GPSTs to train there.

Pediatric rotation in General Practice specialty training: Bridging the gap between Evaluation theory and Practice

Practitioners and Paediatricians occupy the fulcrum of healthcare service delivery for babies, children and young people in any climes. Evaluation of paediatric rotation in general practice specialty training can have a significant impact on the quality general practice trainee and ultimately health care system and service delivery. Stakeholders of both trainee groups can benefit from collaboration and synergy using evaluation model to improve training delivery. The aim of this narrative review is to critically appraise educational intervention in paediatrics rotation of general practice specialty training from the perspective of published theories, models and application of evaluation models. Different evaluation models are reported in association with various underpinning theories and an analysis of how educational programmes and possible collaboration between the two specialties can relate. This paper intends to guide the evaluation of paediatric training in general practice.

Educational training requirements for general practice/family medicine specialty training: recommendations for trainees, trainers and training institutions

ABSTRACTHigh-quality training is a prerequisite to teaching future general practitioners. To inspire and guide all countries to implement General Practice (GP) specialist education and training and bring it to the highest standards, we aimed, within the European context, to produce a collaborative document entitled ‘Educational Requirements for GP Specialty Training’. Through an iterative process existing documents from the European Academy of Teachers in GP and Family Medicine (EURACT) and the World Organization of Family Medicine Doctors (WONCA) were collated. Other reports, grey literature about specialty GP training and requirements for trainees, trainers and training institutions were included. State-of-the-art GP specialty training ‘core’ competences, characteristics and essential features of GP are described. General principles and specified tools for training and assessment are summarised. Recommendations on the duration and place(s) of training and selection of trainees are provided. Trainers should be accredited teachers and quality training institutions are essential. New insights, existing gaps and issues for debate have highlighted areas for further research. This document was produced in the specific context of Europe but its general principles are relevant to GP training in all countries.

Developing excellent leaders - the role of Executive Coaching for GP specialty trainees

ABSTRACTGiven an increasingly complex healthcare environment, doctors need to rise to the challenges of leadership. Executive coaching offers innovative and workable means of realising excellence in leadership. Coaching creates an empowering, ‘high challenge, high support’ environment for significant growth. This study sought to determine general practice (GP) specialty trainee (ST3) knowledge of coaching, views on leadership training, and reflections on the experience of receiving coaching. All GP ST3s in one UK region completed a questionnaire about coaching and developing leadership abilities. Six received professional coaching sessions, followed by a semi-structured interview. Baseline knowledge of coaching was sparse. Trainees felt under-equipped for leadership, but were keen to develop themselves. The short intervention appeared to result in a shift in leadership mind-set in four key areas: courage, passion, impact, and vision. A new enthusiasm was apparent, as well as a willingness and desire to increase leadership responsibilities. This is the first UK study examining professional executive face-to-face coaching as an educational method for doctors. Coaching helps provide leadership ‘language’ and ‘identity’. It appears to ‘name’ clients as ‘leaders’ and challenges ‘imposter phenomenon’. Coaching provided bespoke, deep, experiential learning, with transferable benefits not otherwise available in the Specialty Training programme.

Unpacking the dark variance of differential attainment on examinations in overseas graduates.

Differential performance in postgraduate examinations between home medical graduates and those who qualified outside their country of practice is well recognised. This difference is especially marked in the practical component of the UK Membership of the Royal College of General Practitioners (MRCGP) examination. The potential causes of such disparities are not well understood. Data were available for 1874 international medical graduates who applied for general practice (GP) specialty training in the UK in 2008-2012. The primary outcome was performance in the Clinical Skills Assessment (CSA) OSCE component of the MRCGP. The main predictors were performance on a situational judgement test (SJT) and clinical problem-solving test (CPST), a test of applied clinical knowledge, used in the selection for GP training. Data relating to demographic characteristics and English language fluency were also available. To better understand the relationship between the predictors, the selection measures and the outcome, a series of univariable and multivariable models were developed and tested, concluding with a structural equationmodel to explore causality. The CSA rating was more strongly predicted by SJT scores (standardised beta, 0.26) than by performance on the CPST (standardised beta, 0.17). There was a relationship between English language fluency and CSA score that was mainly mediated via SJT performance. These findings demonstrate that performance on an SJT predicts performance in a high-fidelity clinical simulation (the CSA) in international medical graduates. Although the constructs tested by SJTs are debated, and are likely to vary across settings, culturally appropriate knowledge of interpersonal competence is likely to be evaluated. Improving the confidence of doctors in this area through targeted educational interventions, rather than focusing on increased clinical knowledge, is likely to be more effective at reducing disparities observed in postgraduate examination performance. Thus, there are important implications for the design of specialty selection and licensing assessments globally.

General practice tasters for foundation doctors.

General practice (GP) is currently not viewed positively as a career choice, compared with other specialties, with GP training programmes struggling to fill posts. Opportunities to change this mindset in the early years of training are limited. Trainees may find themselves applying for entry into GP specialty training just 3-4months after completing Foundation Year1 (FY1), yet there are few GP attachments during FY1 that can provide experience of primary care and positively inform career choice. To help ameliorate the current crisis in GP, recruitment and retention initiatives are needed to provide relevant experience of GP early in medical careers so that more doctors can make an informed decision to choose GP as a career. FY1 doctors have been given the opportunity to shadow final-year GP specialty trainees (GPST3) in clinical practice (for between 3 and 5days). The voluntary scheme has run successfully since 2014. This paper describes the taster programme and its evaluation. The programme has been positively received by both FY1s and GPST3 mentors. The GPST3s are enthusiastic about GP, which appeared to 'rub off' on the FY1s. FY1s find it helpful to have a trainee's perspective, gaining an overview of what to expect, including the opportunities available to them. General practice is currently notviewed positively as a career choice IMPLICATIONS: Using GPST3 trainees as mentors for FY1 doctors is educational for both groups and can have a positive impact on GP recruitment. The taster demonstrated how varied GP is, and challenged some negative perceptions of primary care. GPST3s gained confidence in their knowledge about GP and greater insight into educational roles.

An evaluation of the views of GP Specialty Trainees on their involvement in medical student teaching

BackgroundA recent survey in the North East of England (now Health Education England in the North East) revealed that General Practice Specialty Trainees (GPSTs) wished for more opportunities to teach. The Royal College of General Practitioners (RCGP) states that GPSTs are ideally placed to deliver undergraduate teaching.The aim of this study was to investigate to what extent GPSTs perceived a pilot of teaching medical students to be useful in their development.MethodsEthical approval was granted by Newcastle University. Purposive sampling was used to identify GPSTs to teach fourth year medical students. Semi-structured interviews took place with the GPSTs and data were thematically analysed.ResultsAll five GPSTs involved in the pilot were interviewed. The overall theme was that they felt this to be a valuable opportunity that would inspire them to become involved with education in the future. The study highlighted the need for formal sessions on ‘how to teach’ for the GPSTs.DiscussionAn understanding of the benefits of this teaching pilot will allow Newcastle University and local GP Training Programmes to develop opportunities for GPSTs to be involved in education during their training. This may in turn attract GPs into education and inspire medical students to become GPs.

The implementation of a quality system in the Dutch GP specialty training: barriers and facilitators; a qualitative study

BackgroundQuality assurance programs in medical education are introduced to gain insight into the quality of such programs and to trigger improvements. Although of utmost importance, research on the implementation of such programs is scarce. The Dutch General Practice (GP) specialty training institutes used an implementation strategy to implement a quality system (QS), and we aimed to study the success of this strategy and to learn about additional facilitators and barriers.MethodsSeventeen structured interviews were conducted with the directors and quality coordinators (QCs) of the eight Dutch GP training institutes. A five-stage process model of implementation was used to structure these interviews and analyze the data. Two researchers analyzed the data with a framework approach.ResultsThe strategy supported the institutes in implementing the QS. However, after the introduction of the QS, staff experienced the QS as demanding, although they noticed almost no concrete short-term results. Moreover, they experienced difficulties in integrating the QS into their local situation. Collectively working with the QS and following common deadlines did create a sense of commitment towards each other that appeared to be a true stimulus to the introduction of the QS.ConclusionsThe implementation strategy focused mainly on the introduction of the QS in the GP specialty training, and it was, as such, rather successful. An important barrier concerned the acceptance of the QS and the integration of the QS into local structures, which suggests that there is a need for guidance on the translation of the QS to local contexts. All in all, we recommend more focus on the benefits of a QS.

An enhanced induction programme for general practice specialty training: a qualitative study of trainee perceptions and experience

Background: Following a Judicial review brought by the British Association of Physicians of Indian Origin, greater expectation is now being placed upon Health Education England Local Offices and Deaneries across Scotland, Wales and Northern Ireland to identify doctors who may go on to experience difficulties in general practice specialty training – and who may benefit from educational support at an early stage. NHS Education for Scotland West region has offered an enhanced induction programme for trainees who were identified as being at risk of difficulty in training. Aims: To capture the experience of an enhanced induction programme; exploring insight towards potential difficulties in training; and the feelings relating to being identified as a trainee at risk of difficulty. Method: Interviews with trainees who attended the enhanced induction programme. Transcripts were analysed by a basic thematic analysis approach. Results: All non-UK Doctors completed 17 interviews. The term ‘at risk’ was accepted and the intervention was well received. Participants showed insight into the common areas of difficulty in trainees. The workshops helped to develop understanding of cultural differences, use of the ePortfolio, and gave participants an opportunity to practice their communication skills. Conclusions: This enhanced induction programme has provided targeted training to a group of trainees identified at risk of difficulty.

Can colleagues', patients' and supervisors' assessments predict successful completion of postgraduate medical training?

Workplace-based assessments (WPBAs) are widely used in postgraduate training programmes internationally. WPBAs can function as both an assessment and an educational tool. Although some WPBAs are a mandatory requirement of approved curricula (as in the UK), little previous research has explored the extent to which such assessments are associated with adverse outcomes in postgraduate training. The present study examines whether the assessment element of Multisource Feedback, Patient Satisfaction Questionnaire and Educational Supervisors Review ratings can indicate if a trainee is likely to experience difficulty in successfully completing their planned training programme (i.e. fail one of their licensing assessments or need additional training time). Data were collected for trainees undergoing a General Practice specialty training placement in Health Education East Midlands (UK). Multivariate analyses were used to examine the predictive validity of the WPBAs and the outcome measures (n = 327 to 329) and t-tests to calculate whether there were significant differences in performance between trainees who received low versus high WPBA ratings (t = 4.03 to 10.27, p < 0.01). Multisource Feedback, Patient Satisfaction Questionnaire and Educational Supervisor's Review ratings were significantly correlated with subsequent performance in licensing exams (r = 0.14 to 0.47, p < 0.01), and in addition explained significant variance in the likelihood of requiring additional training time (15.6% to 25.6%, p < 0.01). Based on the findings, we assert that Multisource Feedback, Patient Satisfaction Questionnaire and Educational Supervisor's Review ratings have validity for predicting performance during training and are thus a useful tool for identifying trainees who are more likely to experience difficulty and could benefit from early additional support.

Understanding patient safety performance and educational needs using the ‘Safety-II’ approach for complex systems

Participation in projects to improve patient safety is a key component of general practice (GP) specialty training, appraisal and revalidation. Patient safety training priorities for GPs at all career stages are described in the Royal College of General Practitioners’ curriculum. Current methods that are taught and employed to improve safety often use a ‘find-and-fix’ approach to identify components of a system (including humans) where performance could be improved. However, the complex interactions and inter-dependence between components in healthcare systems mean that cause and effect are not always linked in a predictable manner. The Safety-II approach has been proposed as a new way to understand how safety is achieved in complex systems that may improve quality and safety initiatives and enhance GP and trainee curriculum coverage. Safety-II aims to maximise the number of events with a successful outcome by exploring everyday work. Work-as-done often differs from work-as-imagined in protocols and guidelines and various ways to achieve success, dependent on work conditions, may be possible. Traditional approaches to improve the quality and safety of care often aim to constrain variability but understanding and managing variability may be a more beneficial approach. The application of a Safety-II approach to incident investigation, quality improvement projects, prospective analysis of risk in systems and performance indicators may offer improved insight into system performance leading to more effective change. The way forward may be to combine the Safety-II approach with ‘traditional’ methods to enhance patient safety training, outcomes and curriculum coverage.

Consistency and reliability of judgements by assessors of case based discussions in general practice specialty training programmes in the United Kingdom

Case based discussions (CbDs) are a mandatory workplace assessment used throughout general practitioner (GP) specialty training; they contribute to the annual review of competence progression (ARCP) for each trainee. This study examined the judgements arising from CbDs made by different groups of assessors and whether or not these assessments supported ARCP decisions. The trainees selected were at the end of their first year of GP training and had been identified during their ARCPs to need extra training time. CbDs were specifically chosen as they are completed by both hospital and GP supervisors, enabling comparison between these two groups. The results raise concern with regard to the consistency of judgements made by different groups of assessors, with significant variance between assessors of different status and seniority. Further work needs to be done on whether the CbD in its current format is fit for purpose as one of the mandatory WPBAs for GP trainees, particularly during their hospital placements. There is a need to increase the inter-rater reliability of CbDs to ensure a consistent contribution to subsequent decisions about a trainee’s overall progress.