GP Training Research Articles

What influences on their professional development do general practice trainees report from their hospital placements? A qualitative study

BackgroundThe clinical learning environment is important in GP specialty training and impacts professional development. Uniquely for GP trainees, about half of their training periods occur in a hospital environment, which is not their final workplace. There is still little understanding of how hospital-based training influences GP's professional development.ObjectivesTo seek the views of GP trainees on how their hospital experience contributes to their professional development as a GP.MethodsThis international and qualitative study seeks the views of GP trainees from Belgium, Ireland, Lithuania, and Slovenia. Semi-structured interviews were performed in the original languages. A joint thematic analysis in the English language resulted in key categories and themes.ResultsFrom the four themes identified, GP trainees were found to experience additional challenges on top of the service provision/education tensions, which are common to all hospital trainees. Despite these, the hospital rotation component of GP training is valued by trainees. A strong finding of our study is the need to ensure that learning from the hospital placements is placed firmly in the context of general practice, e.g. GP placements prior or parallel with the hospital placements, educational activities resourced by GPs during their hospital experience, encouraging hospital teachers to have greater awareness of the educational needs of GPs, including an awareness of their training curriculum.ConclusionThis novel study highlights how hospital placements for GP trainees could be enhanced. Further study could be broadened to recently qualified GPs, which may uncover new areas of interest.

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.

How do the post-graduation outcomes of students from gateway courses compare to those from standard entry medicine courses at the same medical schools?

BackgroundWidening participation (WP) for underrepresented students through six-year gateway courses helps to widen the demographic representation of doctors in the UK. ‘Most students from gateway courses graduate, even though many enter with lower grades than standard entry medicine students.’ This study aims to compare the graduate outcomes of gateway and SEM cohorts from the same universities.MethodsData from 2007–13 from the UK Medical Education Database (UKMED) were available for graduates of gateway and SEM courses at three UK medical schools. Outcome measures were passing an entry exam on the first attempt, Annual Review of Competency Progression (ARCP) outcome and being offered a level one training position from the first application. The univariate analysis compared the two groups. Logistic regressions, predicting outcomes by course type, controlled for attainment on completion of medical school.ResultsFour thousand four hundred forty-five doctors were included in the analysis. There was no difference found in the ARCP outcome between gateway and SEM graduates. Gateway graduates were less likely to pass their first attempt at any membership exam than graduates of SEM courses (39% vs 63%). Gateway graduates were less likely to be offered a level 1 training position on their first application (75% vs 82%). Graduates of gateway courses were more likely to apply to General Practitioner (GP) training programmes than SEM graduates (56% vs 39%).ConclusionsGateway courses increase the diversity of backgrounds represented within the profession and importantly the number of applications to GP training. However, differences in cohort performance are shown to continue to exist in the postgraduate arena and further research is required to ascertain the reasons for this.

Training General Practitioners in Oncology: Lessons Learned From a Cross-Sectional Survey of GPOs in Canada.

Many countries face a significant shortage of medical oncologists. To mitigate this problem, some countries, including Canada, have established training programs for general practitioners in oncology (GPOs), which train family physicians (FPs) in the fundamentals of cancer care. This type of GPO training model may be useful in other countries facing similar challenges. Therefore, Canadian GPOs were surveyed to learn from their experiences and inform the development of similar programs in other countries. A survey was designed and administered to Canadian GPOs to understand the methods and outcomes of GPO training and practice in the Canadian context. The survey was active from July 2021 to April 2022. Participants were recruited through personal and provincial networks and an email list provided by the Canadian GPO network. The survey received 37 responses for an estimated response rate of 18%. Although only 38% of respondents indicated that family medicine training sufficiently prepared them to care for patients with cancer, 90% indicated that GPO training did. Clinics with oncologists were found to be the most effective mode of learning, followed by small group learning and online education. Critical knowledge domains and skills most relevant for GPO training were identified as the treatment of side effects, symptom management, palliative care, and breaking bad news. Participants in this survey felt that a dedicated GPO training program offered value beyond family medicine residency in preparing providers to adequately care for patients with cancer. GPO training can be done effectively through virtual and hybrid content delivery. Critical knowledge domains and skills identified as the most important in this survey may be valuable for other groups and nations implementing similar training programs to increase their oncology workforce.

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].

Reconsidering ‘problematic’ polypharmacy: an opportunity for developing advanced generalist skills

Managing problematic polypharmacy is a complex area of clinical practice and is increasingly recognised as an educational need for newly qualified and experienced GPs. The RCGP curriculum includes this area as a requirement for completion of training, but how this is achieved is devolved to trainers and trainees working in their local training programmes. GPs at all career stages continue to report feeling unconfident in this important, but complex, area of practice. This article aims to address some of these concerns. We will outline the evidence about barriers preventing clinicians from reducing problematic polypharmacy in practice. We will introduce evidence from the Tailor report describing how these barriers can be overcome and focus on the role of trainees and newly qualified GPs in managing problematic polypharmacy. The Tailor report is a recently published synthesis of the evidence surrounding the management of polypharmacy. In particular we will focus on a key output from the report – the DExTruS framework. This has potential applications in GP training and provides a useful structure for developing the skill of deprescribing by AiTs.

‘Family court…sucks out your soul’: Australian general practitioners’ experiences supporting domestic violence survivors through family court

BackgroundDomestic violence is a significant public health issue with survivors experiencing short- and long-term physical, sexual and psychological health issues. Given this, survivors of domestic violence use healthcare services at an increased rate compared to the general population. Therefore, general practitioners (GPs) are well placed to support survivors of domestic violence. However, many practitioners do not feel ready to address this complex issue of domestic violence. Further, there is no research exploring GPs’ role in supporting families through family court in the context of domestic violence.MethodsThis study used qualitative methods. Fifteen GPs participated in individual in-depth interviews. The interviews were audio recorded with consent, transcribed verbatim and thematically analysed.ResultsThe majority of participants were female GPs working in metropolitan settings. Four themes were generated from the data: on different planets, witnessing legal systems abuse, weaponizing mental health in family court and swinging allegiances. Participants had negative perceptions of family court and felt that it operated on a different paradigm to that of general practice which caused difficulties when supporting patients. Participants supported survivors through instances where the court was used by perpetrators to further their abusive behaviour or where the court acted abusively against survivors. In particular, perpetrators and the family court used survivors’ mental health against them in court proceedings, which resulted in survivors being reluctant to receive treatment for their mental health. Participants struggled with their allegiances within their patient family and usually opted to support either the mother, the father, or the children.ConclusionsImplications of these findings for GP training are evident, including curriculum that discusses the intersection of mental health diagnoses and legal proceedings. There may also be a place for health justice partnerships within general practice.

Levelling up or left behind? are GP training opportunities in northern Ireland widening or closing the gap on health inequalities?

Increasing the GP workforce will not necessarily level up healthcare provision: instead increasing GP training numbers could worsen health inequity and inequalities. This is especially true if there are fewer opportunities to learn, train and build confidence in under-served, socioeconomically deprived areas. To investigate the representation of socioeconomic deprivation in postgraduate GP training practices in Northern Ireland (NI). Socioeconomic deprivation indices and scores of GP practices in Northern Ireland were calculated. We compared the socioeconomic deprivation indices and scores of GP postgraduate training practices against general practice in NI by examining the representation of practices whose patients live in areas of blanket deprivation, higher deprivation and higher affluence. Of 319 practices in NI, 171 (54%) were registered as postgraduate training practices with a mean deprivation score of 3.02 (95% CI 2.91-3.12) compared with non-training practices' higher mean deprivation score of 3.2 (95% CI 3.01-3.33), P-value <0.05. The proportion of training practices with blanket deprivation and higher levels of deprivation was underrepresented, with the current postgraduate GP training practices having more affluent populations. Postgraduate training practices had a statistically significant lower deprivation score and did not fully reflect the socioeconomic make-up of wider NI general practice. The results, however, are more favourable than in other areas of the UK and better than undergraduate teaching opportunities in general practice. Health inequalities will worsen if the representation of general practice training in areas of greater social economic deprivation is not increased.

A comparative evaluation of quality and depth of learning by trainee doctors in regional, rural, and remote locations

BackgroundAn equitable supply and distribution of medical practitioners for all the population is an important issue, especially in Australia where 28% of the population live in rural and remote areas. Research identified that training in rural/remote locations is a predictor for the uptake of rural practice, but training must provide comparable learning and clinical experiences, irrespective of location. Evidence shows GPs in rural and remote areas are more likely to be engaged in complex care. However, the quality of GP registrar education has not been systematically evaluated. This timely study evaluates GP registrar learning and clinical training experiences in regional, rural, and remote locations in Australia using assessment items and independent evaluation.MethodsThe research team retrospectively analysed GP trainee formative clinical assessment reports compiled by experienced medical educators during real-time patient consultations. Written reports were assessed using Bloom’s taxonomy classified into low and high cognitive level thinking. Regional, rural, and remotely located trainees were compared using Pearson chi-squared test and Fisher’s exact test (for 2 × 2 comparisons) to calculate associations between categorical proportions of learning setting and ‘complexity’.Results1650 reports (57% regional, 15% rural and 29% remote) were analysed, revealing a statistically significant association between learner setting and complexity of clinical reasoning. Remote trainees were required to use a high level of clinical reasoning in managing a higher proportion of their patient visits. Remotely trained GPs managed significantly more cases with high clinical complexity and saw a higher proportion of chronic and complex cases and fewer simple cases.ConclusionsThis retrospective study showed GP trainees in all locations experienced comparable learning experiences and depth of training. However, learning in rural and remote locations had equal or more opportunities for seeing higher complexity patients and the necessity to apply greater levels of clinical reasoning to manage each case. This evidence supports learning in rural and remote locations is of a similar standard of learning as for regional trainees and in several areas required a superior level of thinking. Training needs to seriously consider utilising rural and remote clinical placements as exceptional locations for developing and honing medical expertise.

Genomic prediction of rice mesocotyl length indicative of directing seeding suitability using a half-sib hybrid population.

Direct seeding has been widely adopted as an economical and labor-saving technique in rice production, though problems such as low seedling emergence rate, emergence irregularity and poor lodging resistance are existing. These problems are currently partially overcome by increasing seeding rate, however it is not acceptable for hybrid rice due to the high seed cost. Improving direct seeding by breeding is seen as the ultimate solution to these problems. For hybrid breeding, identifying superior hybrids among a massive number of hybrids from crossings between male and female parental populations by phenotypic evaluation is tedious and costly. Contrastingly, genomic selection/prediction (GS/GP) could efficiently detect the superior hybrids capitalizing on genomic data, which holds a great potential in plant hybrids breeding. In this study, we utilized 402 rice inbred varieties and 401 hybrids to investigate the effectiveness of GS on rice mesocotyl length, a representative indicative trait of direct seeding suitability. Several GP methods and training set designs were studied to seek the optimal scenario of hybrid prediction. It was shown that using half-sib hybrids as training set with the phenotypes of all parental lines being fitted as a covariate could optimally predict mesocotyl length. Partitioning the molecular markers into trait-associated and -unassociated groups based on genome-wide association study using all parental lines and hybrids could further improve the prediction accuracy. This study indicates that GS could be an effective and efficient method for hybrid breeding for rice direct seeding.

Learning in a real-life escape room: an explorative study on the supervisory relationship in GP residency during the COVID-19 pandemic

BackgroundThe relationship between supervisors and residents plays a prominent role in the professional development of general practice (GP) residents. When disruptions occur in the normal course of healthcare, due to effects of e.g. war or emerging epidemics, we need to consider how this may affect the training of the next generation of general practitioners. As both supervisors and residents face new and unprecedented challenges that impact overall quality of the training. In this study, we examined the characteristics of the supervisory relationship in GP training during the disruptions early on during COVID-19. Our aim was to understand better how resident learning is affected in these circumstances, which is a first step in enabling supervisors, residents and faculty to anticipate disruptive situations better in the future.MethodsWe conducted a qualitative case study with a constructivist approach. Seven GP residents at the start of their second placement, and their 10 supervisors participated in this study. Participants came from a University Medical Centre in the Netherlands. Semi-structured interviews were held between September 2020 and February 2021. The subjects were (1) interviewed individually about what they had learned regarding COVID-19, and (2) they were interviewed in supervisory pairs about how they had learned. Data were iteratively analysed; thematic analysis for (1) and template analysis in (2).ResultsWe identified notable changes in the supervisor-resident relationship attributable to COVID-19. Supervisors and residents were confronted with an all-encompassing uncertainty in the workplace, and disruptive changes in patient care and learning opportunities for residents. Supervisors and residents addressed these emerging workplace challenges through three types of collaboration, (1) getting the job done; (2) residents’ learning; and (3) collective learning. Each type had a different focus and distinctive characteristics of the supervisory relationship.ConclusionWith the outbreak of COVID-19, supervisors and residents were faced with disruptive uncertainty. In these circumstances, learning occurred not only between residents and their supervisors, but also with non-supervising GPs and assistants in collective learning. We propose to complement collective learning in the workplace with reflection between residents and supervisors at the training institution.

Celebrating 50 years of general practice training programs in Australia.

Celebrating 50 years of general practice training programs in Australia.

Doping with testosterone and androgenic/anabolic steroids: Impact on health, screening tools and medical care

Doping in elite or amateur athletes with testosterone, androgens and anabolic steroids (A/AS) has as a main objective to develop muscle strength and mass to improve sports performance. Massive doping is a worldwide public health issue insufficiently known by physicians in general and by endocrinologists in particular. Yet, its prevalence, probably underestimated, would be between 1 and 5% at the international level. Numerous deleterious effects associated with A/AS abuse have been identified: inhibition of the gonadotropic axis responsible for hypogonadotropic hypogonadism and infertility in men, and masculinization (defeminization), hirsutism and anovulation in women. Metabolic (very low HDL cholesterol), hematological (polycythemia), psychiatric, cardiovascular and hepatic complications have also been documented. As a result, anti-doping agencies have developed increasingly effective techniques for detecting A/AS, both to identify and punish cheating athletes and to protect the health of the greatest number of them. These techniques use a combination of liquid and gas chromatographic methods coupled with mass spectrometry, known respectively by the acronyms LC-MS and GC-MS. These detection tools have a remarkable sensitivity and specificity to detect natural steroids and synthetic A/AS of known structure. Furthermore, by distinguishing isotopes, it is also possible to distinguish natural endogenous hormones, testosterone and androgenic precursors from those administered for doping purposes. For elite athletes, a “biological passport” has also been introduced. It consists of monitoring the evolution of steroids and their metabolites, as well as other biological parameters in the blood and urine over time after having established a basal state athlete signature, established, a priori, without doping. Better training of health professionals, general practitioners and specialists should be a priority for academic institutions and medical societies. It would provide them with better knowledge of the populations at risk and the clinical and biological semiology of male and female doping, including withdrawal syndrome associated with anxiety and depression following cessation of chronic A/AS use. The ultimate goal is to provide these physicians with the keys to treating these patients while combining medical rigor and empathy. These points will be addressed in this short manuscript.

Evaluation of the Application of Undergraduate Pre-Clinical Removable Prosthodontic Laboratory Teaching in General Dental Practice

Background: Pre-clinical removable prosthodontic training is an integral part of undergraduate curriculum. The objectives of the study were to evaluate the application of pre-clinical removable prosthodontic laboratory training in general dental practice and relevance of its teaching in undergraduate curriculum. Methods: A descriptive questionnaire was developed to assess the extent of practice of pre-clinical removable prosthodontic lab skills in their dental practice. The responses were evaluated and statistically analyzed with a significance value of p&amp;lt;0.05. Three hundred-fifty-seven general dental practitioners participated in the study. Results: 91% with 20 years of dental practice responded positively on the application of prosthodontic training in their practice. 55.7% with two years of training agreed to dedicate more time to clinical prosthodontics training. Conclusions: 52.9% of the respondents agreed that it would be better to dedicate more time on clinical prosthodontics training rather than pre-clinical removable prosthodontics lab training as a part of the undergraduate prosthodontic curriculum, among which more than 60% of the study participants had two or more years of removable prosthodontics pre-clinical training during dental school. Practical implications: Clinical expertise of dental graduate is an essential component in the general dental practice. Hence, there is a need to revisit removable prosthodontic curriculum content and time distribution in undergraduate dental program.

Harnessing fast and slow thinking to ensure sustainability of general practice and functional universal health coverage in Australia.

Harnessing fast and slow thinking to ensure sustainability of general practice and functional universal health coverage in Australia.

Follow-up survey of general practitioners in Zhejiang Province post-completion of position transition training in 2017–2020

BackgroundPosition transition training for general practitioners in Zhejiang Province started in 2017 and has since been held once a year. By the beginning of 2022, four training sessions were completed. The purpose of this survey was to establish the current situation of trainees after their graduation and provide reference for the evaluation of the training effect.MethodsOf the 738 trainees who completed the training, 253 were contacted and followed up. A self-designed questionnaire was used to conduct the survey through online filling in. The content included questions to elucidate the following information: whereabouts after the training, registration as a general practitioner, undertaken general practice teaching and scientific research work, current occupational environment, improvement of post competence after receiving position transition training, willingness to complete survey, willingness to participate in future training programs, etc.ResultsA number of 253 valid questionnaires were collected with a recovery rate of 100%. Notably, 93.68% of the participants successfully completed their training and obtained the Training Certificate of General Practitioners. Further, 83.4% were registered as general practitioners, 82.94% of which added on the basis of the original registered scope of practice. Currently, most of them work in primary health care institutions, primarily occupied with medical treatment, chronic disease management, COVID-19 prevention and control, health education, and prevention and health care. Of them, 27.01% were currently undertaking teaching work, and only 3.32% of them were conducting scientific research work related to general practice. The overall satisfaction of the trainees in the three theoretical training bases was above 90%, with no statistically significant difference among them (P > 0.05). Importantly, 84.11% of the followed-up personnel hoped to continue to participate in similar training in the future to improve their general practitioner core competences.ConclusionThe position transition training in Zhejiang Province has achieved good results, but the details of training and the implementation of policies in individual regions need to be improved. Most of the graduates were willing to continue their education, especially in general practitioners with special interests.

Assessment of the knowledge of basic first aid of acute poisoning among medical students at Imam Abdulrahman bin Faisal University, KSA

ABSTRACT Background In a poison emergency, responders should assess the condition and begin treatment immediately. Training general practitioners in clinical toxicology can help manage patients with acute poisoning cost-effectively. Aim Assessment of Imam Abdulrahman bin Faisal University (IAU) medical students’ knowledge of dealing with toxicological emergencies. Methods This is a cross-sectional study carried out from December 2022 to February 2023 at IAU, KSA. Results 201 undergraduate medical students participated: 20.4% fourth graders, 30.8% fifth graders, 32.3% sixth graders, and 16.4% interns. 79.1% attended a first aid training program, and 19.9% received emergency department (ED) training in managing acute poisoning. Most students have moderate knowledge of risk assessment (70.6%), as indicated by correct answers about importance of patient characteristics, type of poison, psychological background, time, and type of exposure. Incorrectly answering about source of information and reliance on drug-level screening. Participants demonstrated moderate knowledge (53.7%) of the initial management of poisoned patients, which is recognized by correct answers about maintaining an adequate airway, breathing, and circulation, meaning and mechanism of decontamination, indication and time of gastric lavage, and action of activated charcoal. Correctly disagree with the priority of induction of vomiting and offering gastric lavage to all patients. Recognize the meaning of corrosive poisoning but incorrectly respond to methods of its treatment while correctly agreeing about the appropriateness of oral liquid administration. Incorrectly respond to the availability of an antidote for every toxicity. Advancements in student education, first aid training, and ED training insignificantly impacted knowledge of risk assessment while significantly improving knowledge of the initial management of acute poisoning. Conclusion Most participating students had suboptimal knowledge of risk assessment and management of toxicological emergencies. Education levels, first aid training, and ED training, while improved knowledge of initial management, have a low impact on knowledge of risk assessment of acutely poisoned cases.

General practice trainees' telehealth use during the COVID-19 pandemic: a cross-sectional study.

Prompted by the COVID-19 pandemic, remuneration was introduced for Australian general practice telehealth consultations. General practitioner (GP) trainees' telehealth use is of clinical, educational, and policy importance. The aim of this study was to assess the prevalence and associations of telehealth versus face-to-face consultations amongst Australian GP registrars (vocational GP trainees). Cross-sectional analysis of data from the Registrar Clinical Encounters in Training (ReCEnT) study, from 2020 to 2021 (three 6-month terms), including registrars in 3 of Australia's 9 Regional Training Organisations. In ReCEnT, GP registrars record details of 60 consecutive consultations, 6 monthly. The primary analysis used univariate and multivariable logistic regression, with outcome of whether the consultation was conducted via telehealth (phone and videoconference) or face-to-face. 1,168 registrars recorded details of 102,286 consultations, of which 21.4% (95% confidence interval [CI]: 21.1%-21.6%) were conducted via telehealth. Statistically significant associations of a telehealth consultation included shorter consultation duration (odds ratio [OR] 0.93, 95% CI: 0.93-0.94; and mean 12.9 versus 18.7 min); fewer problems addressed per consultation (OR 0.92, 95% CI: 0.87-0.97); being less likely to seek assistance from a supervisor (OR 0.86, 95% CI: 0.76-0.96) while being more likely to generate learning goals (OR 1.18, 95% CI: 1.02-1.37); and being more likely to arrange a follow-up consultation (OR 1.18, 95% CI: 1.02-1.35). That telehealth consultations were shorter, with higher rates of follow-up, has GP workforce/workload implications. That telehealth consultations were less likely to involve in-consultation supervisor support, but more likely to generate learning goals, has educational implications.

Exploring the Irish general practice training community’s perceptions on how an entrustable professional activities dashboard implementation could facilitate general practice training in Ireland

ABSTRACT Background The Irish General Practitioner Training (GP) Programme is currently moving to Competency-Based Medical Education (CBME), facilitated by Programmatic Assessment (PA) and Entrustable Professional Activities (EPAs). These new assessment and feedback mechanisms may provide a rich and much sought-after dataset. However, given the possible number of feedback and assessment events, and the variety of modalities used, aggregating and interpreting these can be costly and difficult. Dashboard implementations (DI) have been purposed as a solution to bridge the gap between the large datasets and the training community at all levels. Aims To explore the Irish GP training community’s perceptions on how an EPAs DI could facilitate the delivery of GP training in Ireland. Methods A qualitative approach was taken, using a focus group representative of different groups in the training community. Concurrently, an EPAs DI was developed. Focus group transcripts were analysed in an iterative fashion using Template Analysis to generate themes and subthemes. Results Numerous advantages were seen in relation to the implementation of an EPAs DI around entrustment decisions, constructive alignment and summative decision-making. These advantages, however, need to be tempered with the realisation that the EPAs DI is not and should not be misinterpreted as being the learning analytic panacea for GP training. Conclusion This paper outlines the perceptions from a postgraduate medical education training community on an EPAs DI, which would be applicable to other training communities considering introducing similar mechanisms.

Vaccine coverage for recommended vaccines among splenectomised patients in Apulia, South Italy: a retrospective cohort study

ObjectiveSplenectomised/asplenic patients have a 10–50 fold higher risk than the general population of developing overwhelming postsplenectomy infection. To control this risk, these patients have to receive a specific immunisation schedule,...