GP Training Research Articles

Effect of integrated case-based and problem-based learning on clinical thinking skills of assistant general practitioner trainees: a randomized controlled trial

BackgroundCase-Based Learning (CBL) and Problem-Based Learning (PBL) are popular methods in medical education. However, we do not fully understand how they affect the clinical thinking skills of Assistant General Practitioner (AGP) trainees. This randomised controlled trial aimed to assess the effectiveness of combining CBL and PBL and compare their impact on the clinical thinking skills of AGP trainees with that of traditional lecture-based learning (LBL).MethodsThis randomised controlled trial involved 70 second-year AGP trainees who were randomly assigned to either the CBL-PBL group or the LBL group using a simple randomisation method. The CBL-PBL group engaged in a curriculum that integrated case-based and problem-based learning, whereas the LBL group followed a traditional lecture-based format, as described in the syllabus. To evaluate clinical thinking skills, the participants were assessed using the Clinical Thinking Skills Evaluation Scale (CTSES) and an assistant general practitioner’s professional knowledge test. In addition, this study analysed various factors that influence clinical thinking skills.ResultsCompared with the LBL group, the CBL-PBL group showed significantly improved performance in all domains assessed by the CTSES in post-course tests (p < 0.001). Specifically, the mean scores for critical, systematic, and evidence-based thinking showed notable improvement in the CBL-PBL group. Additionally, the scores on the professional knowledge test reflected a substantial increase in this group. Furthermore, multiple linear regression analysis showed that both CBL-PBL curriculum performance scores and number of weekly article readings significantly influenced the development of clinical thinking skills.ConclusionThe CBL-PBL teaching method positively influenced the clinical thinking skills of assistant general practitioner trainees, with a positive correlation between these skills and course performance in the CBL-PBL curriculum.Trial registrationNot applicable.

Open Disclosure Among General Practitioners as Second Victim of a Patient Safety Incident: A Cross-Sectional Study in Flanders (Belgium).

The impact of a patient safety incident (PSI) on nurses and doctors in hospital settings has been studied in depth. However, the impact of a PSI on general practitioners and how those health care professionals can be supported are less clear. The objective of this study is to investigate the prevalence of GPs (in training) being personally involved in a PSI, as well as the impact, the support needed, and open disclosure in the aftermath of these PSIs. A cross-sectional study, conducted between January 3, 2022, and March 5, 2022, led to a sample of 78 GPs or GPs in training in Flanders (Belgium). Participants filled in more than 80% of a questionnaire that measured the involvement in a PSI during the prior year and their entire career, and the impact in terms of emotional symptoms, attitudes, the support needed, and open disclosure were included. In total, 78 responses of GPs (in training) filled in the questionnaire, of which 87.2% were involved in a PSI over the course of their entire career and 55.1% during the prior year. Often, such a PSI resulted in permanent patient harm or patient death. The PSI that stuck with the GPs the most had many negative consequences for the GP in question, such as hypervigilance (88.2%) and feelings of guilt (82.4%), stress (79.4%), and shame (75.0%). More than half of the respondents involved want substantive clarity (64.4%), and in case of 51.7% of the respondents, an open discussion with the patient and/or family took place afterwards. This study shows that GPs, even in training, can be negatively impacted after a PSI. Only half of the respondents were involved in an open disclosure process, but the ones involved had a positive feeling after disclosure. More support is needed for health care professionals in the aftermath of a PSI in primary care, and this support could enhance their involvement in the open disclosure process.

Integration of a specialist pharmacist-led multidisciplinary team in primary care: preventing strokes in people with atrial fibrillation across North East London

Public Health England outlines a national ambition of anticoagulating 90% of eligible patients with atrial fibrillation (AF) by 2029. In 2019/2020, two out of three boroughs reviewed in this study...

Implementing HIV teams to improve HIV indicator condition-guided testing in general practitioner centers in the Netherlands

BackgroundHIV indicator condition-guided testing is recommended by guidelines to identify undiagnosed HIV infections. However, general practitioners (GPs) frequently see patients for indicator conditions without testing them for HIV. The aim of this study was to evaluate whether implementing HIV teams, using trained GP ambassadors, promoted local HIV indicator condition-guided testing practices in urban GP centers in the Netherlands.MethodsWe conducted a prospective implementation study between May 2021 and March 2023. Patients ≥ 18 years newly diagnosed with HIV indicator conditions in three GP centers were included. The intervention consisted of HIV expert led education for GPs with a stepwise implementation of point-of-care testing (phase 1), followed by adding peer-to-peer case feedback by trained GP ambassadors (phase 2). Questionnaires were used to assess the experiences and beliefs of HIV indicator condition-driven testing in patients and GPs. The primary outcome was the overall HIV testing rate in patients diagnosed with indicator conditions compared to pre-implementation. Secondary outcomes were HIV testing rate per phase and per indicator condition, HIV positivity rate, and patients’ and GPs’ experiences with this testing strategy.ResultsIn 132,338 patient visits, 846 (0.6%, 95%CI 0.6–0.7%) HIV indicator conditions were diagnosed, including 485 sexually transmitted infections (57.3%). Overall, 215 (25.4%) indicator conditions were tested for HIV after the implementation of HIV teams. The testing rate was comparable between the two phases (25.2% versus 25.9%, p = 0.83). The testing rates pre- and post-implementation were comparable (21.3% versus 25.4%, p = 0.33). The most frequently tested HIV indicator conditions were unexplained weight loss (n = 13, 41.9%), unexplained lymphadenopathy (n = 8, 38.1%), and sexually transmitted infections (n = 161, 33.2%). Three patients (1.4%, 95%CI 0.3–4.0%) tested positive for HIV. Test acceptance in patients was high as was the self-perceived knowledge of GPs on HIV indicator conditions.ConclusionsImplementing HIV teams did not enhance HIV indicator condition-guided testing in urban GP centers from a low HIV prevalence setting. The high patients acceptance rate and self-perceived knowledge among GPs regarding HIV indicator conditions did not manifest in high HIV testing rates. Patients accepted testing, but a gap was found between the self-perceived knowledge of GPs regarding HIV indicator conditions and testing, and the actual HIV testing rate.Trial registrationClinicalTrials.gov NCT05225493 (registration date: 17-01-2022).

‘Death on an industrial scale’- general practice trainees’ perceptions and experiences of dying and death during covid-19: an interpretative phenomenological analysis

Abstract Context The COVID-19 pandemic led to an increase in numbers of patients dying at home in the UK, meaning that general practitioners (GPs) were exposed to more patient death than would be pre-COVID. This project aimed to gain insight into GP trainees’ experiences of patient death between March and July 2020. This insight can inform support for GPs, leading to improved wellbeing, workforce retention and ultimately, better patient-centred care. Methods Interpretative Phenomenological Analysis (IPA) of semi-structured interviews was used to explore GP trainees’ experiences of patient death in one region of England. Results Seven trainees, two male and five female, participated. They were working in both rural and urban community settings and were at different stages of GP training. Group experiential themes related to heightened emotional responses to patient death, managing uncertainty and the increased salience of relationships. Most appreciated positive teamworking and solidarity, though some had felt isolated within their surgery and wider community. There were some unforeseen positive experiences of individual and organisational healthcare changes, including a perceived new appreciation for the NHS workforce equality, diversity and inclusion (EDI) by actions to identify and reduce occupational hazards to at-risk healthcare staff. There were potential effects on career choice with participants feeling that changes during COVID-19 offered new flexibility in working arrangements and opportunity to sub-specialise within GP. Conclusion More support to help navigate the amplified emotional responses to managing dying and death in the community is needed. Some experiences, particularly around managing uncertainty, can cause moral injury if not managed in a safe and supportive environment.

Engagement of general practice preceptors in teaching residents in outpatient settings in China: a national cross-sectional study

BackgroundOutpatient training is crucial for the standardized residency training of General Practitioners (GPs) in China. However, there is concern that General Practice (GP) preceptors may lack the willingness and capacities to teach residents in outpatient settings. Understanding how GP preceptors practice routine outpatient training and their views is essential for designing strategies; however, this issue has not been well studied. Thus, our study aimed to investigate the extent of GP preceptors’ engagement in teaching residents in outpatient settings and to identify the factors associated with their practice of providing guidance in China.MethodsIn this cross-sectional study, we distributed a self-administered questionnaire to 417 GP preceptors. Participants were selected from 142 hospitals across 24 provinces and had participated in the National GP Preceptor Training Program in early May 2024 in Hangzhou, China. A descriptive analysis was used to assess the extent of GP preceptors teaching residents in outpatient settings and their perceptions of outpatient training. Logistic regression analysis was employed to identify the associated factors of GP preceptors’ engagement in teaching residents in outpatient settings.ResultsOf the 297 participants included in the final analysis, 64.3% were female, with a mean age of 41.8 years (range: 29–56). A majority (63%) of GP preceptors expressed confidence in their ability to conduct outpatient training, and 68.7% indicated a willingness to increase their teaching efforts. While over 70% reported “always” or “often” providing helpful guidance to residents, only about a third consistently encouraged residents to take medical histories, perform physical examinations, and make preliminary clinical decisions. Logistic regression analysis shows that GP preceptors’ frequent outpatient training, more medical experience, longer preceptorship, and confidence and determination were positively correlated with offering helpful guidance to residents, whereas concerns about reduced consultation efficiency and income were negatively associated with this guidance.ConclusionAlthough most GP preceptors in China report a strong willingness to engage in outpatient training, their actual teaching practice falls short of expectations in some respects and is correlated with their prior experiences and perceptions of such training. Strategic interventions that offer incentives, support, and increased opportunities for engagement in outpatient training are essential to enhance teaching practices.

Yorkshire and the Humber GP trainee perspectives on incomplete evidence outcomes at ARCP.

June 2023 saw an exceptionally high proportion of Outcome 5s (incomplete evidence) issued at the annual review of competency progression (ARCP) for GP Trainees in Yorkshire and the Humber (Y&H) Deanery. These outcomes created considerable time, administrative and financial costs for the deanery. Additionally, it was believed that receiving non-standard outcomes at ARCP would be detrimental to trainee wellbeing. All GP Trainees in Y&H Deanery who received an Outcome 5 at their ARCP in June 2023 were surveyed. They were asked to report their experience of receiving this outcome with reference to their wellbeing. The survey also sought to understand the reasons for this rise in non-standard outcomes to guide quality improvement work within the deanery. Trainee perspectives revealed through this survey have guided reforms within the deanery to the structure and content of teaching and resources for GP trainees. It is believed these findings may be of similar value to other educators. 47% of eligible trainees responded to the survey. It was significantly reported that receiving an Outcome 5 felt stressful. However, trainees also reported that the time and instruction given upon receiving Outcome 5 was adequate, and they felt well supported by their educational supervisors. Preparation for ARCP was described as a neutral activity. The most frequent causes for receiving Outcome 5 were as follows: accessing and evidencing Basic Life Support (BLS) training, misunderstanding Safeguarding Requirements, incorrectly completing Form R and portfolio evidence not being seen by assessors. Further detail on these issues is described in the report below.

Unravelling the art of developing skilled communication: a longitudinal qualitative research study in general practice training.

Doctor-patient communication is a core competency in medical education, which requires learners to adapt their communication flexibly to each clinical encounter. Although conceptual learning models exist, information about how skilled communication develops over time is scant. This study aims to unpack this process of communication learning and to identify its facilitators. We conducted a longitudinal qualitative study employing a constructivist grounded theory approach in a General Practice training setting. Over a 6-month period, we closely monitored 8 first-year and 5 third-year trainees (n = 13) by means of clinical observations, stimulated recall interviews and audio diaries. In an iterative process of data collection and analysis, we triangulated these sources across trainees (horizontal analysis) and over time (vertical analysis) to identify how themes evolved. This analysis led us to the construction of a six-stage cyclic conceptual model during which trainees: (1) have an impactful experience; (2) become aware of own communication; (3) look for alternative communication behaviours; (4) experiment with new behaviours; (5) evaluate the effectiveness; and (6) internalise the new communication behaviours. Additionally, conditions were found to support learning and reflection. Becoming a skilled communicator seems to require a continuous approach, with repeated practice and reflection to adapt and internalise communication in the clinical encounter. Consequently, we recommend that trainees be supported with tailoredfeedback to strengthen their communication repertoire. Ideally, they should be guided by supervisors who serve as coaches in a safe learning environment with regular, planned learning activities.

Perspectives of general practitioners and practice nurses on nurse-led patient consultations and dose changes of permanent medications-results of a focus group study.

Shifting tasks from General practitioners (GPs) to practice nurses (PNs) could help address the shortage of GPs in Europe. Internationally, PN-led care (PNLC) is feasible and offers similar health outcomes to usual care. However, PN-led consultations (PN-cons) or as PN-led dosage changes for permanent medication (PN-DCPM) are uncommon in German general practice offices (GPO). To explore GPs' and PNs' views on the feasibility and acceptability of PN-cons and PN-DCPM in GPOs. In this exploratory, qualitative online focus group study, we recruited GPs, GP trainees, PNs and specialized PNs (APN) currently working in German GPO using a qualitative sampling plan. We used a semi-structured self-developed interview guide. Separate focus groups (FGs) were performed for each profession, with audio and video recordings, and the transcripts were analysed using thematic analysis. Two FGs comprising 15 GPs and three FGs with 26 PNs revealed four major themes: (i) Attitudes towards PN-cons and PN-DCPM, revealing that participants were generally open towards a PN-cons, but were more reserved towards PN-DCPM. (ii) Acceptable reasons for encounters for PN-cons, e.g. diabetes or hypertension, and acceptable medications for PN-DCPM, e.g. antidiabetics, antihypertensive drugs. (iii) Conditions mentioned for implementing PN-led care were e.g. adequate qualification and supervision concepts. (iv) Perceived chances were e.g. time savings and increased quality of care and perceived risks were e.g. fear of treatment errors. Participants showed openness towards PN-cons and were more reserved towards PN-DCPM in German GPO. Further quantitative studies should assess how acceptance and rejection of PN-led care are distributed among patients, GPs, and PNs.

Exploring learning characteristics and progression ofGPtrainees based in regional, rural and remote settings:Aqualitative study.

Globally, most doctors train and work in metropolitan areas but a key strategy for developing the rural health workforce is expanding rural training. The aim of this study was to describe the scope and quality of learning along with skill acquisition of GP trainees based in regional, rural, and remote settings. Regional, rural and remote settings in Queensland Australia excluding Brisbane. Thirty-seven general practice trainees who had undertaken their first community placement were recruited from regional, rural and remote learning settings within Queensland. Qualitative descriptive methodology based on constructionist epistemology was employed which allowed for the exploration of current GP trainees' experiences. Trainees were interviewed and data were thematically analysed as to the scope and quality of learning by the setting of training. Learning experiences were then mapped against the Dreyfus and Dreyfus model to explore skill acquisition. In terms of the scope and quality of learning, rural and remote trainees mainly focused on the diverse and unique (sometimes challenging) experiences their setting offered compared with regionally based trainees. Mapping of the trainee comments to the Dreyfus model of skill acquisition demonstrated that regardless of setting, equivalent learning occurred by GP trainees. This exploratory study provides evidence that rural and remote learning may provide a more diverse and challenging experience. It suggests an equivalence of quality of education and skill acquisition across settings rural, regional and remote. This suggests that the training distribution policies may not disadvantage GP trainees and the scope and quality of more remote learning may increase uptake of remote placements.

Factors influencing the decision to become a supervisor: A qualitative study of early-career general practitioners and rural generalists.

General practitioner (GP) training in Australia relies on accredited GP supervisors facilitating workplace-based training for GP registrars. There is a shortage of supervisors that is likely to worsen. This research aimed to elucidate the perspectives of early-career GPs and ruralgeneralists (RGs) about the barriers, motivators andenablers to becoming a GP supervisor. Qualitative descriptive methodology was used in the study. Transcripts from three focus groups and six semistructured interviews with 11 RGs (four registrars andseven new Fellows) and 13 GPs (all new Fellows) were analysed thematically. The following key themes were identified: being a good supervisor; motivated by past experiences of supervision; financial implications of being a supervisor; factors unique to rural settings; new models of supervision; and becoming a supervisor - how and when? The findings highlighted personal and professional barriers to becoming a GP supervisor and some enabling strategies to mitigate these barriers.

Exploring residents’ perspectives on their professional identity in general practice residency in the Netherlands: a qualitative study

ObjectivesEducational initiatives in residency may lack alignment with residents’ learning objectives. Furthermore, they may overlook residents’ struggle to find fulfilment in their work. Professional identity formation (PIF) is a conceptual...

Exploring the introduction of remote external clinical teaching visits into Australian general practice.

The COVID-19 pandemic changed the way education was delivered. In Australian general practice training, external clinical teaching visits (ECTVs) had to be done remotely. This research explored that phenomenon from the point of view of the participants to answer questions about feasibility, acceptability and effectiveness. The experiences of ECTV visitors, registrars, supervisors and practice managers were invited initially by survey and then through interview and focus groups. Data were analysed using a constant comparative method giving four major themes and several subthemes. Remote ECTVs were well accepted by all participants. They are different to ECTVs done face to face, with both advantages and disadvantages. Remote ECTVs are feasible and effective and are likely to become part of the ongoing Australian general practice teaching program.

Guest editorial: Times of change and opportunity for Australian general practice training.

Guest editorial: Times of change and opportunity for Australian general practice training.

Consultation skill tips for new general practice registrars: An update.

The consultation is the vehicle by which general practitioners (GPs) 'ply their trade'. Consultation skills comprise the range of skills that underpin the effective and safe doctor-patient encounter and include communication skills, relationship building, data gathering, identifying the patient agenda, shared decision making, time management and follow-up. Development of consultation skills isafundamental element of Australian general practice training. We build upon a previous article and discuss a number of additional practical tips to support new (and not so new) registrars to navigate the general practice consultation safely and effectively. We address consultation tips across arange of aspects of the consultation, including preparation, building rapport, patient-centred care, data gathering, managing uncertainty, management planning, follow-up and time management.

Exploring the educational journey: perspectives of ethnic minority GP-trainees in Dutch GP-specialty training - a qualitative interview study

BackgroundPrevious research highlights persistent differential attainment by ethnicity in medical education, wherein the perceived inclusiveness significantly influences ethnic minority students’ and trainees’ outcomes. Biased organizational practices and microaggressions exacerbate the challenges faced by ethnic minorities, leading to lower academic performance and higher dropout rates. Consequently, understanding ethnic minority GP-trainees’ experiences and perspectives regarding relevant educational aspects is crucial for addressing these disparities and cultivating a more inclusive environment within medical education.Research questionWe aimed to investigate the experiences of minority GP-trainees throughout their educational journey in Dutch GP-specialty training, emphasizing their challenges, sources of support, and suggestions for enhancing their learning environment.MethodWe conducted semi-structured, in-depth interviews with minority GP trainees, employing purposive convenience sampling to ensure diversity across multiple dimensions. These included gender, age, ethnicity, social background, migration generation, educational stage, encountered challenges, sources of support, and the GP training institute attended. The analysis involved iterative, open and axial coding, followed by generating, reviewing, and defining themes. For a structured analysis of encountered microaggressions, we adopted Sue's Taxonomy of Microaggressions.ResultsAll fourteen ethnic minority interviewees had faced educational barriers stemming from misunderstandings and stereotyping in a predominantly 'white' organization. These barriers impacted various aspects of their education, including professional identity formation, application, admission, assessment procedures, social networks, course content, and expert guidance. Microaggressions permeated throughout their educational journey, hindering their full expression and potential. Their ideal GP-specialty training emphasized uniqueness of all trainees, comprehensive staff engagement in inclusivity, robust diversity, equity, and inclusion (DEI)-policies, individual mentorship, transparent standards, concise language usage in test questions, and bias elimination through mandatory DEI staff training.ConclusionEthnic minority GP-trainees in the Netherlands face significant challenges like biased assessment and admission, stereotyped course content, inadequate support networks, and microaggressions, putting them at risk for underperformance outcomes. They emphasize the need for inclusive training with robust DEI-policies to eliminate bias.

Optimising the treatment of chronic ischemic heart disease by training general practitioners to deliver very brief advice on physical activity (OptiCor): protocol of the systematic development and evaluation of a complex intervention

BackgroundChronic ischemic heart disease (IHD) is one of the leading causes of morbidity and mortality. Physical activity (PA) is an effective secondary preventive strategy in IHD management. The German treatment guideline recommends that general practitioners (GPs) deliver PA advice to patients. This recommendation seems inadequately implemented, often due to GP’s insufficient specific training. International guidelines recommend training GPs in how to deliver such advice effectively and efficiently. Evidence is lacking on whether such training can enhance the frequency and quality of PA advice in routine care. The OptiCor project aims to develop and evaluate a GP training in the delivery of very brief PA advice to optimise the treatment of patients with IHD in general practice.MethodsOptiCor comprises three study phases according to the Medical Research Council recommendations for developing and evaluating complex interventions.Phase 1 (needs analysis): A nationwide representative household survey will be conducted to collect data on the receipt of GP-delivered PA advice in people with IHD. Qualitative interviews and group discussions with GPs and people with IHD will help to explore, e.g., attitudes, experiences with, and barriers and facilitators of PA advice implementation or reception, respectively. Findings will inform the training development.Phase 2 (pilot): A pragmatic cluster randomised controlled trial (cRCT) on the effectiveness of the developed training on proportions of GP-delivered PA advice during routine care of IHD patients will be piloted.Phase 3 (evaluation): A full pragmatic cRCT will be conducted with patient-reported proportions of GP-delivered PA advice as primary endpoint. Collection of health economic and process-related data will facilitate a potential future broad implementation and health economic evaluation of the training.DiscussionIf the developed training successfully improves proportions and quality of GP delivered PA advice to patients with IHD, it could serve as a low-threshold and sustainable strategy for implementing PA recommendations in the secondary prevention of IHD in routine GP practice.Trial registrationWork package (WP) 1, WP5, and WP6 have been prospectively registered at German Clinical Trials Register (WP1: DRKS00031304, 19/06/2023; WP5: DRKS00034641, 10/07/2024; WP6: DRKS00034642; 10/07/2024).

Screening doctors in training for dyslexia: the benefits of an inclusive screening approach.

There is a lack of suitable screeners for dyslexia for doctors in training, as the typical adult screeners do not cater for the needs of capable medical graduates. The aim of this research is to create an inclusive screening and training process for doctors with undiagnosed dyslexia. This involved working with doctors to co-create a new dyslexia screener tool. We designed an innovative holistic dyslexia screening, assessment, and support system as part of a 3-year longitudinal study. Qualitative data was collected through the use of a dyslexia screener and case-study interviews with trainees in general practice and psychiatry. Interviews were thematically analyzed to explore dyslexic trainees' experiences of an inclusive approach to dyslexia screening and assessment. Out of the 103 trainees that were screened, 10 were found to have dyslexia, one dyspraxia, and another ADHD trait. Dyslexia-specific coaching, exam, and workplace accommodations were beneficial in dispelling stigma about dyslexia as well as supporting examination success. International Medical Graduate (IMG) trainees were also supported in this process. The case study participants' progression was tracked over 3years, and all subsequently passed their examinations. We recommend that all trainees are given access to this inclusive, holistic, medical-focused dyslexia screening process. Specifically, this can enable newly diagnosed trainees to access support and exam accommodation. In particular, greater understanding of dyslexia helps dispel stigma and enable better support, which has a positive impact on trainee well-being as well as progression.

Medical certificates: More than just paperwork.

Medical certificates communicate the needs and conditions of a person to (often) non-medical entities or other stakeholders. Medical certificates can have a profound effect on patients' access to social and financial support, and therefore wellbeing. However, general practitioners (GPs) are not formally trained in effective completion of medical certificates, leaving opportunity for workforce development. This article discusses the significant role of medical certificates in patient care and the challenges GPs face in completing medical certificates. Medical certificates are often the only mode of communication between GPs and non-medical entities. The tone, comprehensiveness and content of medical certificates can influence the document's utility. There are limited guidelines and formal education for GPs on how to write an effective medical certificate. Designing and implementing guidelines along with appropriate training for GPs will likely result in better patient outcomes in line with their support needs.

General practitioner professional identity formation: Much needed, (still) oft forgotten.

Professional identity formation (PIF) as a general practitioner (GP) enhances the experience of meaning at work, reduces burnout, promotes patient-centred decision making and strengthens advocacy for the unique role of family medicine within the healthcare system. Unfortunately, there is insufficient emphasis on PIF in GP residency programs; it often remains a hidden curriculum. External factors limiting GP trainees' exposure to their own general practice community of practice further impede PIF. Thus, fostering general practice PIF requires deliberate, focused efforts; however, there is little empiric evidence on the GP professional identity or how to foster it. The aim of this paper is to discuss strategies for effective GP PIF in family medicine residency. The authors recommend explicit attention to PIF in three key areas: curriculum; teaching and learning; andfaculty development. Additionally, the authors encourage GPs tounite as a community to provide continuing and coordinated support for GP residents ontheir PIF journey.