Postgraduate Training For General Practice Research Articles

Development of TOEKAN, a 360° evaluation tool for the clinical learning environment in General Practice postgraduate training

Background The General Practice (GP) postgraduate program exists for 80% out of workplace learning. The quality of the clinical learning environment (CLE) has a direct effect on the quality of training and the professional development of GP trainees. Methodology Participatory research was used to involve all stakeholders in the development process of a 360° evaluation tool that should improve the average quality of GP training practices, guide GP trainees towards the best training practices and detect and remediate GP trainers of lower quality. Results TOEKAN (Tool for Communication and Evaluation of Quality Standards) was developed, which consists of a 72-item questionnaire for GP trainees and GP trainers and an 18-item questionnaire for those who coach and remediate GP trainers. The outcomes of the TOEKAN questionnaires are visualized in an online dashboard. Discussion TOEKAN is the first 360° evaluation tool for CLE in GP education. All stakeholders will complete the survey on a regular basis and have access to the results. By creating intrinsic and extrinsic motivation as well as mediation measures, the quality of CLE will improve. Continuous monitoring of the use and outcomes of TOEKAN will allow to critically review and improve this new evaluation tool as well as support the broader implementation.

Trainees' perceptions of course quality in postgraduate General Practice training in Ireland.

Postgraduate General Practice (GP) training is structured around a formal curriculum set out by the training body. It also includes a "hidden curriculum" of experiential workplace learning in a heterogenous learning environment [1]. There is no formal national annual survey of GP trainees and their views in Ireland. The research aim was to evaluate what the trainee population think of their training environment, and to analyse the contributory factors. A mixed methods cross-sectional survey was distributed to all third- and fourth-year GP trainees (N = 404). The Manchester Clinical Placement Index was adapted for the study. The response rate was 30.94% (N = 125). Questions 1 to 7 provided a description of the characteristics of the study population. The remainder of the questions focused on aspects which relate to constituents of the learning environment. The responses were broadly and convincingly positive and supportive of the good work being done in GP training and by trainers in Ireland today across both qualitative and quantitative findings. One notable exception was in the area of feedback where single handed fourth year practices were found to be underperforming. The current research findings were broadly positive and supportive of the good work being done in GP training and by trainers in Ireland today. Further research will be needed to validate the study instrument and to further refine some aspects of its configuration. The implementation of such a survey on a regular basis may have merit as part of the quality assurance process in GP education alongside existing feedback structures [2].

How are future family doctors in Italy trained? Pilot descriptive study of Postgraduate Training in General Practice.

General practitioner (GP) training programme involves a complex process. In Italy, unlike in other European countries, there is no national core curriculum for the training of GPs and the three-year specific training course in General Medicine (CSFMG) is not equated as a proper specialty. Furthermore, the quality of the CFSMGs is poorly investigated and data are difficult to find/fragment. The aim of this study is to describe and compare GP tranining from two pilot regions (Lombardy and Lazio). The study analysed the white and grey literature. For data collection a descriptive grid was created using the characteristics foreseen by current legislation as comparison indicators; the information came exclusively from official and public written data. The analysis reports indicators: structural-organisational; theoretical activity; practical activity; research/guided study; final thesis. The most evident fact that emerges is the lack of available (show the gap), public and official information on the GP training, therefore the description and comparison of the basic indicators in the pilot Regions suffers. A learning model based more on minimum time requirements (time-based learning) than on competences to be acquired (competencies-based learning) is evident. Furthermore, the professional/academic profiles of the lecturers are not available and thus comparable; finally, no information on the training methodologies of the frontal/research sessions can be found. The limitation to only two Regions and the lack of available data do not allow a comprehensive assessment and it would be useful to extend the study on a national scale. However, there is a clear need for improved transparency and evaluation within the GP's training in different Regions through a periodic monitoring system with specific indicators (quantitative and qualitative). The re-establishment/establishment of an independent national observatory on Training in General Practice would be desirable.

When and how teachers intervene in group discussions on experiences from practice in postgraduate medical education: an interactional analysis

Medical educators constantly make decisions on when and how to intervene. Current literature provides general suggestions about types of teacher interventions. Our study aims to specify that knowledge by describing in detail the actions teachers do when intervening, the interactional consequences of those actions, and how these relate to teacher roles in group discussions. We collected all first teacher interventions (n = 142) in 41 videorecorded group discussions on experiences from practice at the Dutch postgraduate training for General Practice. We analyzed the interventions using Conversation Analysis. First, we described the timing, manner, actions, and interactional consequences of each intervention. Next, we inductively categorized actions into types of actions. Finally, we analyzed the distribution of these types of actions over the group discussion phases (telling, exploration, discussion, conclusion). First teacher interventions were done at observably critical moments. Actions done by these interventions could be categorized as moderating, expert, and evaluating actions. Moderating actions, commonly done during the telling and exploration phase, are least directive. Expert and evaluator actions, more common in the discussion phase, are normative and thus more directive. The placement and form of the actions done by teachers, as well as their accounts for doing those, may hint at a teacher orientation to intervene as late as possible. Since the interventions are occasioned by prior interaction and responded to in different ways by residents, they are a collaborative interactional accomplishment. Our detailed description of how, when and with what effect teachers intervene provides authentic material for teacher training.

Identifying threshold concepts in postgraduate general practice training: a focus group, qualitative study

ObjectiveTo identify threshold concepts (TCs) for physicians undergoing postgraduate medical education (PGME) in general practice.DesignAn explorative, qualitative study with 65 min focus group interviews and thematic analysis was used. Participants...

International graduates' experiences of reflection in postgraduate training: a cross-sectional survey.

BackgroundReflection is a key component of postgraduate training in general practice. International medical graduates (IMG) are thought to be less familiar with reflection, with international medical schools favouring more didactic methods of education.AimTo explore IMGs’ experiences of reflection prior to and during GP training and the support available for developing skills in reflection.Design & settingA cross sectional survey was sent to IMGs undertaking GP training in 12 of the 14 UK regions, from March to April 2021.MethodA pre-tested self-administered online questionnaire was used to collect data on experiences of reflection, both prior to and during GP training, and the support available for developing skills in reflection.ResultsIn total, 485 of 3413 IMG trainees completed the questionnaire (14.2% response rate, representative of national demographics). Of these, 79.8% of participants reported no experience of reflection as an undergraduate and 36.9% reported no formal training in reflection during GP training. The majority (69.7%) of participants agreed that reflection was beneficial for their training and 58.3% reported that the best support in reflection came from their supervisors. Experience of reflection, opinions on the benefits, and best sources of support all varied by where the responders' primary medical qualification (PMQ) was obtained (all P values<0.01).ConclusionMost IMGs have not experienced reflection prior to commencing UK GP training. There is diversity in experience and culture within this group that must be considered when tailoring educational interventions to support IMGs in their transition to UK GP training.

Mid-career graduate practice outcomes of the James Cook University medical school: key insights from the first 20 years.

Previous studies have demonstrated early-career James Cook University (JCU) medical graduates are more likely to practise in regional, rural and remote areas than other Australian medical practitioners. This study investigates whether these non-metropolitan practice location outcomes continue into mid-career, and identifies the key underlying demographic, selection process, curriculum and postgraduate training factors associated with JCU graduates choosing to currently practise in regional, rural and remote areas of Australia. This study used the JCU medical school's graduate tracking database to identify 2019 Australian practice location data for 931 JCU medical graduates across postgraduate years (PGY) 5-14. This data was sourced primarily from the Australian Health Practitioner Regulation Agency, and then categorised into Modified Monash Model (MMM) rurality classifications using the Department of Health's DoctorConnect website. For these mid-career (PGY5-14) cohorts, multinominal logistic regression was undertaken to identify specific demographic, selection process, undergraduate training and postgraduate career variables found to be associated with a 2019 practice location in a regional city (MMM2), large to small rural town (MMM3-5) or remote community (MMM6-7). Additional multinominal logistic regression analysis was then used to determine the key independent predictors of mid-career JCU medical graduates working in regional cities (MMM2), rural towns (MMM3-5) and remote communities (MMM6-7) in 2019. Around one-third of mid-career (PGY5-14) JCU medical graduates were working in regional cities during 2019, mostly in North Queensland, with a further 14% in rural towns and 3% in remote communities. These first 10 cohorts were undertaking careers in general practice (n=300, 33%), as subspecialists (n=217, 24%), rural generalists (n=96, 11%), generalist specialists (n=87, 10%) or hospital non-specialists (n=200, 22%). Key statistically significant, independent predictors of JCU MBBS graduates practising in MMM3-5 and MMM6-7 locations in 2019 were, respectively, being awarded a rurally bonded Australian Government undergraduate Medical Rural Bonded Scholarship (MRBS) (p=0.004, prevalence odds ratio (POR)=3.5; p=0.017, POR=7.3); graduation from the JCU postgraduate general practice training program, JCU General Practice Training (p=0.001, POR=3.9; p<0.001, POR=20.1) and internship training in a hospital located in a regional city (p=0.003, POR=2.4; p=0.049, POR=4.3) or in a rural or remote town (p=0.033, POR=5.0; p=0.002, POR=54.6). JCU MBBS graduates practising in MMM3-5 locations was also predicted by a rural hometown at application to the medical school (p=0.021, POR=2.5) and choosing a career in general practice (p<0.010, POR=4.4) or in rural generalism (p<0.001, POR=26.4), while JCU MBBS graduates practising in MMM6-7 locations was also predicted by undertaking an extended 20- or 35-week undergraduate rural placement during year 6 (p=0.014, POR=8.9). The findings show positive outcomes from the first 10 cohorts of JCU medical graduates for regional Queensland cities, with a significantly higher proportion of mid-career graduates practising in regional areas of Queensland than the percentage of the overall Queensland population. The proportion of JCU medical graduates practising in smaller regional and remote towns is similar to the overall Queensland population. The recent establishment of the postgraduate JCU General Practice Training program for vocational generalist medicine training and the Northern Queensland Regional Training Hubs for building local specialist training pathways should further strengthen the retention and recruitment of JCU and other medical graduates across the northern Australia region.

A dermatology E-learning programme is perceived as a valuable learning tool in postgraduate general practice training.

ObjectivesThis study aims to explore GP residents' knowledge retention and residents' and clinical teachers' perception on the learning value of a dermatology E-learning programme. MethodsThe study used a mixed-method design with a convergent parallel collection of data. GP residents (n=21) were selected through purposive sampling and were randomized to an E-learning group (n=12) or a traditional teaching methods group (n=9). The pre-and post-intervention knowledge tests of the E-learning group were compared using paired-samples t-tests. Post-knowledge tests scores of both groups were compared using independent t-tests. Cronbach's coefficient α was used to calculate the internal consistency of the questions used in the knowledge tests. Individual semi-structured interviews and clinical teachers (n=16) were conducted and analyzed using King's template analysis. ResultsThe E-learning group showed a significant increase in mean knowledge test scores from 58.92% (SD=9.55%) to 64.92% (SD=13.65%) (t(11)=2.258, p=0.045, Cohen’s d=0.51). The pre-knowledge test consisted of 46 items (Alpha=0.78), and the post-knowledge tests consisted of 45 items (Alpha=0.90). Interview data showed that the E-learning programme aided GP trainees' learning process and favoured a mixed-method teaching design, in which E-learning is used in parallel to the traditional teaching methods. ConclusionsA dermatology E-learning programme appeared an effective strategy in resident's knowledge acquiring. The key users' perceptions, both residents and clinical teachers, indicated that E-learning was feasible and helpful for learning processes. Further research is required to evaluate the implementation of E-learning programmes in parallel to regular teaching programs.

Determinanten der Teilnahme an Seminartagen eines Weiterbildungsprogramms: eine qualitative Studie mit Ärztinnen/Ärzten in Weiterbildung Allgemeinmedizin

BackgroundGermany is facing a shortage of primary care physicians (general practitioners, GPs). To improve post-graduate training in general practice, competency centres were established across Germany. The core of their work is a seminar programme. It was observed that some GP trainees constantly participate, while others are seldomly seen. The aim of this study was to explore what helps and what hinders constant participation. MethodsGP trainees of the Verbundweiterbildungplus Baden-Württemberg (2008 – 2017), predecessor of the KWBW Verbundweiterbildungplus© program (2017 – present), were included in the study. First, participation in the years 2014 and 2015 was analysed. We recruited the very active as well as the no-show participants for semi-structured telephone interviews. Content analysis was performed by three independent scientists. ResultsParticipation of n=353 trainees was analysed. N=30 trainees participated in the study (including n=13 no show). The average interview length was 25minutes (13–36minutes). Trainees felt motivated by practice-oriented, varying and learner-oriented subjects. They highlighted the professional and personal interaction and its networking effects. Participants favoured lecturing during working days, topics structuring daily training and supporting every day practice. The seminar moderators’ treasure trove of experience and their teaching competencies were regarded as essential. The fact that employers do not regularly grant time away from work to attend the training programme was cited as a major inhibiting factor. Other reasons given for non-attendance included long travel distances, repeat topics or an imbalance between gain of knowledge and social interactions, and finally, a high individual level of work strain, given the dual burden on those trying to combine work and family life and taking on the main responsibility for children. ConclusionsThe main enablers (motivators) of participation were practice- and learner-oriented topics and beneficial social interactions. During the seminars, participants experience group membership and the enthusiastic (learning) atmosphere boosts trainees to proceed with their training and follow their career paths in general practice. Continuous participation requires protected time. Competence centres for postgraduate medical education should take these findings into consideration for quality management and programme planning, and, if possible, should initiate and evaluate appropriate countermeasures.

Train the trainer course for general practice trainers in ambulatory care: the Berlin model.

Objective: Demands for a stronger competence orientation of specialty postgraduate medical training require the expansion of the didactic qualifications of those responsible for postgraduate medical training. In the context of the foundation of the Berlin competence center for postgraduate general practice training, a train the trainer basic seminar was designed together with the Berlin chamber of physicians. The seminar aims to convey formal-legal aspects in close connection with the development of didactic competences of the general practice trainers. This article presents the didactic concept, focal points and the schedule of the one-and-a-half-day seminar to be able to adapt it to one's own context. Methodology: After the seminars, participants filled out an evaluation form. The questionnaire included the subjective experiences of increased competence, the relevance of the contents, and the satisfaction with the structure and methods of the seminar. The data were analyzed descriptively. Results: Since June 2018, 46 general practice trainers have participated in one of three train the trainer seminars. 97.6% of the participants were very satisfied or satisfied with the overall seminar and felt that the timeframe was right, 92.7% would recommend the seminar to colleagues. 68.3% fully agreed that by attending the seminar they were able to improve their didactic skills, 90% were confident that they could integrate what they had learned into their work as general practice trainers. 85.4% stated that they had reflected on their role as trainers. In particular, the atmosphere, the high degree of interactivity and the protected framework for collegial exchange were positively emphasized. Conclusion: Together with the Berlin chamber of physicians, we succeeded in designing a train the trainer seminar which, on the one hand, met the needs of the general practice trainers for clarification of formal-legal questions of their further training activities and, on the other hand, allowed the further development of didactic skills. At the moment, a modular program is being planned in order to give general practice trainers the opportunity to expand their didactic competence and regularly exchange ideas with colleagues.

Why do Danish junior doctors choose general practice as their future specialty? Results of a mixed-methods survey

Background: A well-staffed and an efficient primary healthcare sector is beneficial for a healthcare system but some countries experience problems in recruitment to general practice.Objectives: This study explored factors influencing Danish junior doctors’ choice of general practice as their specialty.Methods: This study is based on an online questionnaire collecting quantitative and qualitative data. Two focus-group interviews were conducted to inform the construction of the questionnaire to ensure high content validity. All Danish junior doctors participating in general practice specialist training in 2015 were invited to participate in the survey, from which both qualitative and quantitative data were collected. The data was analysed using systematic text condensation and descriptive statistics.Results: Of 1099 invited, 670 (61%) junior doctors completed the questionnaire. Qualitative data: junior doctors found educational environments and a feasible work–life balance were important. They valued patient-centred healthcare, doctor–patient relationships based on continuity, and the possibility of organizing their work in smaller, manageable units. Quantitative data: 90.8% stated that the set-up of Danish specialist-training programme positively influenced their choice of general practice as their specialty. Junior doctors (80.4%) found that their university curriculum had too little emphasis on general practice, 64.5% agreed that early basic postgraduate training in general practice had a high impact on their choice of general practice as their specialty.Conclusion: Several factors that might positively affect the choice of general practice were identified. These factors may hold the potential to guide recruitment strategies for general practice.

Evaluating reflection in postgraduate GP training post Bawa-Garba: a qualitative approach

BackgroundIt has been suggested that reflection within healthcare training bears little resemblance to theoretical approaches to reflective practice described in academia. Concerns have been raised about students producing artificial entries rather than an honest review of incidents encountered. The Bawa-Garba case is anticipated to have had a significant impact on the reflective practice of postgraduate medical trainees.AimTo evaluate the use of reflective learning logs in postgraduate general practice training in the context of the recent Bawa-Garba case.MethodUsing constructivist theory, a phenomenological approach to qualitative research was applied. During February to June 2018, 11 participants were recruited — seven trainees and four trainers — from the Doncaster GP Training scheme. Semi-structured interviews were performed and the data collected was transcribed for thematic analysis as described by Attride Sterling.ResultsDifficulty and challenge were identified as common themes for reflective log entries. There is support for previous findings regarding artifice, which commonly occurred in the context of evidencing curriculum coverage. All trainees expressed anxiety about the confidentiality of their reflective entries, with many describing a defensive approach to reflection following the Bawa-Garba case. International medical graduates (IMGs) were identified as being at a significant disadvantage in the current training scheme due to difficulties with language, cultural barriers, and previous experience of reflection.ConclusionA global theme identified from the data was that reflection within GP training needs to change in order to remove bias and prevent further devaluation of reflective learning.

Supporting Students With Electronic Health Record-Embedded Learning Aids: A Mixed-Methods Study.

BackgroundStudents often perceive workplace-based learning as disconnected from what they learn in medical school. Interventions that deal with this issue regularly involve feedback and/or learning aids. Feedback has frequently been encouraged in previous research, whereas the use of aids is less understood.ObjectiveThis study aims to investigate the added value of learning aids in making the connection and enhancing the transfer of learning between medical school and workplace-based learning.MethodsFirst-year students in postgraduate general practice training participated in a mixed-methods study. Within a quasi-experimental design, two conditions were investigated: (1) students having access to electronic health record (EHR)–embedded learning aids and feedback and (2) students only receiving feedback. Semistructured interviews were conducted and analyzed according to the thematic analysis approach.ResultsForty-four students participated in this study. No significant difference was found between the two conditions (t42=–0.511, P=.61, 95% CI –4.86 to 2.90). Nevertheless, students used the aids frequently and found them useful. Given that the aids were familiar to students and contained practice-based instructions in an easily accessible format, they were perceived as feasible to use during workplace-based learning. They also appeared to stimulate transfer of learning, self-confidence, reflection, and interaction between student and supervisor.ConclusionsAccess to EHR-embedded learning aids offers additional support during, but also before and after, patient encounters. The aids can be easily implemented into workplace-based learning.

Validity of the scan of postgraduate educational environment domains (SPEED) questionnaire in a rural general practice training setting

BackgroundThe educational environment is critical to learning and is determined by social interactions. Trainee satisfaction translates to career commitment, retention and a positive professional attitude as well as being an important factor in assessing the impact of the training program. This study aimed to validate the Scan of Postgraduate Educational Environment Domain (SPEED) tool and assess its appropriateness in evaluating the quality of General Practice (GP) rural postgraduate educational environment.MethodsA questionnaire containing the 15-item SPEED tool was administered to GP registrars to examine their perceptions of the educational environment. Principal component analysis (PCA) and exploratory factor analysis (EFA) were used to gather evidences of the validity of the instrument based on its internal structure. Additional validity evidence and reliability estimates were obtained using many-facet Rasch model analysis (MFRM).ResultsThe survey was completed by 351 registrars with a response rate of 60%. Parallel analysis performed using principal component analysis and exploratory factor analysis suggests that the SPEED tool is unidimensional. The MFRM analysis demonstrated an excellent degree of infit and outfit for items and training sites, but not for persons. The MFRM analysis also estimated high reliability levels for items (0.98), training sites (0.95) and persons within training sites (ranging from 0.87 to 0.93 in each training sites). Overall, the registrars agreed that the educational environment had high quality, with most (13 out of 15) of the items rated above 4 out of 5.ConclusionsThis study demonstrated a high degree of validity and reliability of the SPEED tool for the measurement of the quality of the educational environment in a rural postgraduate GP training context. However, when applied in a new setting, the tool may not function as a multidimensional tool consistent with its theoretical grounding.

Early predictors of summative assessment performance in general practice post-graduate training: A retrospective cohort study

Background: Success in summative general practice (GP) training assessments is one indicator of competence for practice. Early-training factors predictive of outcomes would facilitate targeted interventions aimed at preventing candidate failures.Methods: We undertook a retrospective cohort study of Australian GP trainees in two training organizations over five years. Associations of pre-training and early-training predictors with summative examination scores in an Applied Knowledge Test (AKT), Key Features Paper (KFP), and Objective Structured Clinical Examination (OSCE), plus failure on any one of these, were tested via univariate and multivariable regression. Predictors were program-entry selection-score decile, pre-training-commencement multiple choice assessment (MCQA), direct observation of practice performance, and clinical supervisor reports.Results: On univariate analyses, selection decile and MCQA were associated with all outcomes except AKT. There were no associations of other predictors with any outcomes. On multivariable analysis, selection decile and MCQA performance were predictive of OSCE performance. MCQA performance was also predictive of KFP performance. On multivariable analysis, no predictors were associated with AKT performance or failing any examination.Conclusions: Selection decile and pre-commencement MCQA performance were predictive of performance in some summative assessments. These findings could inform selection policies and targeted early interventions for trainees at most risk for exam failure.

Online Platform as a Tool to Support Postgraduate Training in General Practice - A Case Report.

Objective: Physicians in postgraduate training (PPT) in General Practice (GP) typically have very little interaction with their peers, as there is usually only one resident physician working in their respective department or GP office at a given time. Therefore, the online platform KOLEGEA, presented here, aims to support postgraduate training in general practice (PT in GP) in Germany through virtual interaction.Methodology: In 2012, the interdisciplinary research project KOLEGEA set up an online platform that any physicians in PT in GP can use for free after registration with their unitary continuous education number (Einheitliche Fortbildungsnummer, EFN). It offers problem-based learning and allows to discuss self-published anonymized patient cases with the community that can be classified and discussed with experienced mentors (specialists in general practice - GPs) in small virtual groups.Results: An anonymous online survey carried out as part of the 2014 project evaluation showed a good acceptance of the platform, even though shortage of time was mentioned as a limiting factor for its use. Data analysis showed that KOLEGEA was used by PPT in GP in all federal states. Patterns of passive use were predominant (90%). This report also describes the further development of the platform (in 2015 and 2016) that integrates an activity monitor as part of a gamification concept.Conclusions: Due to a low response rate of the 2014 online survey and the preliminary evaluations of usage patterns we could identify only initial trends regarding the role of KOLEGEA in supporting PPT. The platform was perceived as a helpful supplement to better structure PT in GP.

New paths in post-graduate medical training in general practice - 8 years of experience with the pilot project Verbundweiterbildungplus Baden-Württemberg.

Background: In face of the looming shortage of general practitioners, primary healthcare providers and post-graduate training in general practice are increasingly becoming part of the political agenda in Germany. In 2009 the program “Verbundweiterbildungplus Baden-Württemberg” (VWBplus BW) was developed by the Competence Center for General Practice in Baden-Wuerttemberg to ensure primary healthcare in the future by enhancing the attractiveness of general medicine. This paper describes the experiences that have been gathered in developing a post-graduate training-program for physicians undergoing specialist training in general practice.Project description: The Competence Center for General Practice in Baden-Wuerttemberg supports the organization of regional networks dedicated to post-graduate medical education. First core element of the VWBplus BW program is a special seminar series for physicians pursuing post-graduate training. This seminar program is aligned with the German competency-based curriculum in general medicine and is meant to promote medical expertise and other related competencies, such as business and medical practice management and communication skills. Mentoring and advising the physicians regarding professional and personal planning form the second core element. The third core element is seen in the train-the-trainer seminars that address the competencies of the trainers. In order to focus the program’s content closely on the needs of the target groups, scientifically based evaluations and research are carried out.Results: Since starting in 2009, 685 physicians have entered the program and 141 have passed the examination to become medical specialists (as of December 2016). In total, 31 networks, 60 hospitals and 211 general practices have participated. The seminar sessions have been rated on average with 1.43 on a six-point Likert scale by the physician trainees (1=extremely satisfied, 6=extremely dissatisfied). Alongside the medical training, these physicians viewed the exchange of information and experiences with other physicians as very positive and important. In 185 seminars lasting 90 minutes each, the seminar program has presently covered 250 out of 320 units in the competency-based curriculum for general medicine. A total of 281 trainers have been trained in 13 train-the-trainer courses and have rated this course on average with 1.36 on a six-point Likert scale. Above all, the trainers emphasized the exchange of information and experiences with other trainers as very positive. In 2013 the DEGAM concept for its Verbundweiterbildungplus program was developed based on that of the VWBplus BW. Since 2008 over 40 articles on the topic of post-graduate medical education have been published.Conclusion: The steadily increasing number of participants over the years demonstrates that the VWBplus BW is relevant for recent medical graduates and contributes to the attractiveness of general practice. The consistently excellent evaluations of the training program and the train-the-trainer course affirm the focus on the needs of the target groups. The post-graduate VWBplus BW program advances structured, competency-based and quality-oriented specialist training and fosters professional sharing between physicians – something that could also be relevant for other fields. The increasing numbers of participating physicians and specialists in general practice in Baden-Württemberg lead to the conclusion that the VWBplus BW program positively influences the number of general practitioners.

Self-Assessment of competence during post-graduate training in general medicine: A preliminary study to develop a portfolio for further education.

Awareness of one’s own strengths and weaknesses is a key qualification for the specialist physician. We examined how physicians undergoing specialist training in general medicine rate themselves in different areas.For this purpose, 139 participants receiving post-graduate training in general practice offered by the Medical Association of Westfalen-Lippe assessed themselves regarding their subjective confidence in 20 core competencies and 47 situations involving patient counseling in general practice. Their self-assessments were recorded on a five-point Likert scale. The study questions addressed acceptance and practicability of self-assessment, mean values, reliability, stratification and plausibility of the results in group comparison.On average participants rated their subjective confidence with 3.4 out of 5 points. The results are self-consistent (Cronbach’s alpha >0.8), although there are considerable differences among competencies and among participants. The latter can be explained partly by biographical data, which supports the plausibility of the data.Participants stated that regularly gathering data on subjective learning needs and the discussion of these needs with mentors and trainers contributes to improving their specialist training.Elements for self-assessment are suitable for integration into a postgraduate training portfolio. These should be supplemented by formative assessment procedures.

Improving Italian general practice training: the role of academia.

The modern Italian national health service is a Beveridgean system centred around GPs and funded by central taxation.1,2 In order to become eligible to work as a GP, Italian doctors need to undertake a 3-year postgraduate training in general practice.3–6 The latter training — governed nationally by the Italian Ministry of Health and locally by the various Italian regions — is organised by the primary care establishment.3–6 By contrast, all other postgraduate medical specialties in Italy are organised by universities and are governed by the Ministry of Education, University and Research (MIUR). On successful conclusion of the above GP training, Italian doctors are awarded a certificate of completion of training which is then mutually recognised in all member states of the European Union (EU).3–5 Italian doctors in postgraduate university specialty training (that is, non-GP trainees) had not benefited from any financial support from the government during their training until 1991. From 1992 until 2000 a tax-free monthly studentship of about 960 000 Italian Lira was introduced to support non-GP trainees; the latter bursary then became approximately €960 from 2000 to 2006 (after the introduction the Euro currency to Italy). Proper working contracts with an annual gross salary of €22 700 (a variable monthly amount of €1600–1700 after taxes) for this category of specialist trainees started in 2007. As a result, the Italian Supreme Court recently ordered the Italian government to pay compensation to Italian doctors training for medical specialities governed by the university authority from 1 January 1983 onward, in compliance with the Directives of the Council of the EU regarding stipends of doctors during postgraduate specialist training. The latter directives were accompanied by related decisions of regional tribunals. Unfortunately, these decisions concerned only doctors in training in secondary care specialties (that is, non-GP trainees), while Italian GP trainees currently still lack working contracts for their postgraduate clinical training in …

Aktiv in Forschung und Lehre in der Weiterbildung Allgemeinmedizin – Perspektiven der nachrückenden Ärztegeneration

BackgroundAcademic institutions of general practice at German medical faculties have grown during the past years. This leads to an increase in the need of qualified young researchers and teachers in general practice (GP). Little is known about the interest in research and teaching skills and their training among general practice trainees and young GPs. Research questionThis cross-sectional survey among GP trainees and young GPs examined 1. if there is an interest in the training in research and teaching skills during post-graduate GP training, 2. which fostering and hindering factors have an effect on this interest and 3. which roles are attributed to academic institutions of general practice. MethodsA web-based cross-sectional study was performed among members of “Verbundweiterbildungplus”, a network of GP trainees, as well as “Junge Allgemeinmedizin Deutschland”, the German network of young GPs. Descriptive analysis was conducted. Results148 GP trainees and young GPs participated in the study, 76% (n=109) of them were GP trainees. There was interest in a position in research and teaching during post-graduate GP training among 55% (n=78). Factors associated with the interest in a position in research and teaching during post-graduate GP training were (MV 5-point Likert scale ± SD): compatibility of clinical work and research/teaching and of family and career (4.4±0.8; 4.7±0.6 respectively). The roles of academic institutions of general practice were attributed to training of medical students (4.6±0.6), post-graduate GP training (4.5±0.7) and research (4.5±0.7). GP trainees assessed the importance of training in research and teaching skills during post-graduate GP training and of the compatibility of family and career differently from young GPs (3.7±1.0 vs. 4.1±0.8 p=0.027; 4.8±0.5 vs. 4.3±0.9, p=0.016). Those interested in a position in research and teaching during post-graduate GP training showed a stronger interest in specific training in research skills (3.7±1.1 vs. 2.8±1.1, p<0.001), a future clinical position in a research practice (3.8±1.2 vs. 2.5±1.2, p<0.001) and as a lecturer at an academic institution of general practice (4.3±0.9 vs. 3.9±1.1, p=0.04). DiscussionThere is an interest in professional involvement in research and teaching during post-graduate GP training among GP trainees and young GPs. For those interested, structured concepts (e.g. “clinician scientist”) need to be developed in order to facilitate the combination of clinical work and a position in research and teaching during post-graduate GP training. In doing so, the existing potential could be better exploited and more future GPs could be involved in research and teaching.