General Practice Specialist Training Research Articles

General practice in the German Democratic Republic (1949-1990) : Adiscipline between threat and professionalization.

In the 1950s the socialist health policy in East Germany did not follow aclear-cut course with regard to outpatient medical care. Whilst state-run policlinics gradually took the place of doctors in private practice, the required qualifications of physicians working in outpatient care remained unclear. After preparatory lobbying by committed physicians from the outpatient sector, the 1960 Weimar Health Conference finally paved the way for the preservation and professionalization of general practice in East Germany. The article analyzes the formation of general practice as aspecialty in East Germany between 1945 and 1990. We scrutinize the status of general practitioners and their field in the socialist health system as well as the foundation of their medical society. Our paper aims to contribute to abroader history of general practice in Germany. We draw on literature from that time, unpublished archival material, and interviews with contemporary witnesses. After the establishment of standards for specialist training in the early 1960s, general practice was introduced as afield of specialty in 1967. By this, East Germany had acompulsory specialist training in general practice much earlier than West Germany. In 1971, aspecialist society for general practice was founded in East Germany. However, institutionalization at the medical faculties was still lacking. Meanwhile, the nationalization of outpatient care continued. In the years that followed, primary medical care was increasingly provided in policlinics. In 1989, of 40,000 physicians in the GDR, only about 340 were still practicing in their own offices. Within the nationalized GDR health system acommitted group of physicians, under difficult political circumstances, pushed for professionalization of general practice and its recognition as afield of specialty. When general medicine was recognized as aspecialty in 1967, this happened earlier than in other countries and constituted an important milestone.

Family medicine and international cooperation in the North: A step ahead

International cooperation contributed to the development of family medicine in the North of Russia, it was characterized by a system approach and interdisciplinary interaction. The article presents the results of Russian-Norwegian projects that were developed with the active participation of the Department of Family Medicine of NSMU (Arkhangelsk), as well as the main aspects of the projects: significance for practical health care, research, and educational components.
 Several complementary projects aimed at the development of primary health care, such as Reform of Arkhangelsk Region Health Care System with a special emphasis on primary care, System approach to NCD prevention and Suicide prevention in the Arkhangelsk region were implemented together with the Norwegian Directorate of Health. The POMOR Program specialist training in general practice in Northern Russia project (together with the University of Troms The Arctic University of Norway, Norwegian Medical Association, and Norwegian Centre for Rural Medicine) facilitated the development of tutorship in family medicine in the Arkhangelsk and Murmansk regions. Better interaction between psychiatrists and general practitioners in the mental health sphere became an essential area of international collaboration (Integrating mental health into primary care in the Arkhangelsk County, Russia: the Pomor model in psychiatry project together with the University of Troms The Arctic University of Norway and University Hospital of North Norway, Troms). The education component of the projects got a sequel in the continued medical education system of NSMU while the scientific one was continued in the form of publications in international and Russian journals, and masters thesis defense of public health degrees. The project's results were consistently presented at the international and Russian forums. General practitioners education is a cross-cutting theme for the cooperation on the path from a beginner to an expert and plays a special role in support of GPs during the COVID-19 pandemic.

"A real eye opener" - development, implementation and evaluation of a seminar on interprofessional teamwork in GP specialty training.

Introduction: The successful treatment of a multitude of chronic diseases is largely dependent on effective interprofessional collaboration. In Germany, many healthcare employees feel unprepared for the challenges of interprofessional teamwork. Can a seminar designed by an interprofessional team for an interprofessional target group improve mutual understanding and provide the basis for successful interprofessional collaboration?Methodological approach: For the development of the seminar, Kern’s model for curriculum development was used, which includes the following six steps: problem identification, needs analysis, goal definition (learning objectives and learning content), educational strategies, implementation and evaluation. The all-day event brought together physiotherapists, pharmacists, medical assistants and doctors undergoing specialist training in family medicine. Representatives of the various professions were recruited through multiple channels (associations, pharmacist societies, alumni-networks, etc.). Practical examples and role-play were used to develop a better understanding of each other’s professions and to support goal-oriented and appreciative communication among them. The seminar belongs to the curriculum provided by the Hesse Competence Center for Specialist Training in General Practice and has so far taken place three times. The evaluation was carried out by means of a detailed, self-designed questionnaire with five open and 20 closed questions. The statistical analysis was mainly descriptive (mean value, minimum, maximum and SD).Results: Overall, 29 persons have participated in the workshops (eleven doctors undergoing specialist training, six physiotherapists, six pharmacists, six medical assistants). Overall, the seminar was rated very highly. Individual aspects of the seminar’s design, such as relevance and practice-orientation, as well as an assessment of whether the seminar contributed towards increasing participants’ ability to collaborate with other professionals, were rated positively. In addition, a pre-post comparison of self-assessed ability to collaborate interprofessionally showed significant improvement.Discussion: This highly interactive one-day seminar design contributed towards improving understanding for other professions and communication skills. In order to achieve a broad-based improvement in interprofessional collaboration over the long term, this or similar concepts should be employed more extensively.Conclusions: The results suggest that participants in interprofessional seminars consider them to improve interprofessional collaboration.

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.

Family Violence Curricula in Europe (FAVICUE): a cross-sectional descriptive study protocol

IntroductionFamily violence (FV) is a widespread public health problem of epidemic proportions and serious consequences. Doctors may be the first or only point of contact for victims who may be...

Strukturiert und unterstützt durch die Weiterbildung Allgemeinmedizin: Evaluation eines hessenweiten Mentoringprogramms für Ärzte/innen in Weiterbildung Allgemeinmedizin

IntroductionDue to the growing shortage of general practitioners (GPs), solutions are being sought to improve the structure and attraction of specialist training in general practice. In 2012, the Competence Center for Specialist Training in General Practice was set up in the federal state of Hesse, Germany, in order to provide a seminar- and mentoring program to complement standard specialist training. The present paper examines whether the mentoring program, which was based on needs assessment, supports doctors in training (DiT) to become specialists in general practice. MethodsA mixed-methods design was used for the evaluation of the mentoring program. The pilot cohort monitored in this study was surveyed using a guideline-based interview. The cohort consisted of the first cohort of participants in the Specialist Training Academy (n=21), which was divided into two mentoring groups. Responses were evaluated with the help of the MAXQDA 11 program and qualitative content analysis to structure content. Furthermore, all 16 group meetings were assessed by means of evaluation sheets (n=132) and analyzed descriptively using the statistics program SPSS (IBM statistics, Version 20). ResultsOf the 21 DiTs of the total sample that took part in the interviews, two-thirds of the surveyed mentees were female (71.4 %). The mentoring and seminar programs encouraged the mentees in their decision for and their identification with specialist training in general practice and helped them overcome any doubts about their choice. The decisive factors in the mentoring process were interacting with like-minded people, discussing organizational questions and having a fixed contact person in case of questions and doubts.The evaluation sheets made it clear that the mentees regarded the mentoring as supportive (99.3 % positive). Compared to the other mentoring group, participants in the one group felt they were better supported by mentoring, found the interaction with other DiTs more helpful, the interaction between mentors and the group exactly right, and the topics they discussed more relevant. ConclusionThe provided mentoring program fulfilled the expectations of the DiTs in general practice. Combined with the Specialist Training Academy's seminar program, the two programs complement each other and are an important step towards making specialist training in general practice more attractive.

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

BackgroundIt has been argued that UK general practice specialist training should be extended, to better prepare GPs for challenges facing 21st-century health care. Evidence is needed to inform how this should occur.AimTo investigate the experience of recently trained GPs undertaking a 1-year full-time fellowship programme; in particular, workforce impact and career development potential. The fellowship was designed to provide advanced skills training in urgent care, integrated care, leadership, and academic practice.MethodSemi-structured interviews conducted longitudinally over 2 years, augmented by observational data in West Midlands, England. 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.ResultsSeven 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 the fellowship made general practice a more attractive career option for newly qualified doctors.ConclusionThe 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. The fellowship model appears appropriate to prepare GPs for portfolio roles. Its impact on NHS service delivery continues to be investigated by Health Education England.

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

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

The benefits of educational release of hospital-based general practice specialist training registrars into general practice

In Denmark, specialist training for family medicine consists of 2.5 years training in general practice and 2.5 years training in specific hospital departments. The hospital training programme contains mandatory release time (return days) whereby GP trainees leave their hospitals in order to work with patients in their teaching GP surgeries for one day every month. The goals are to develop and maintain a family medicine perspective during the hospital training and to maintain contact with the family medicine environment. In order to explore the benefits of going back to general practice for one day per month during hospital training, we carried out a qualitative study comprising three focus group interviews with trainees and one focus group with trainers. Return days are important for the development of a professional identity and they can ensure the provision of a useful/necessary breathing space in a turbulent education. If properly organised, return days have the potential to strengthen professional competences due to a stronger focus on the family medicine perspective during training. The process strengthens transferability of skills. A focus on better educational management is needed. Trainers' commitment and trainees' ownership of and responsibility for the educational process are prerequisites for success.

ENT 2–Week Wait audit

Interested in the effectiveness of the 2-Week Wait (2WW) referral system, we undertook an audit while doing our ear, nose, and throat (ENT) ST2 rotations for our general practice specialist training. We were surprised by some of our findings. Of the 177 patients referred using the GP 2WW pathway during a 7-month period, 100% were meeting targets to be seen within 2 weeks, but only 6% (13/177) of these referrals were consequently diagnosed with head and neck cancer. …

Questionnaire for Quality Management of General Practice Specialist Training

Questionnaire for Quality Management of General Practice Specialist Training

General Practice Trainers’ Views on the Newly Introduced General Practice Specialist Training Programmes in Scotland

General Practice Trainers’ Views on the Newly Introduced General Practice Specialist Training Programmes in Scotland