I have recently completed my GP training and during the last couple of months I have been thinking about the time I’ve spent in training. I have learnt a lot but I think that, as with anything, there is room for improvement.
Although the number of doctors applying to general practice has increased in recent years this does not necessarily mean that these doctors will go on to become GPs, or that they will ultimately be retained within the NHS. There are pressures within general practice and one of the aims of the training programme should be to adequately support doctors on their journey to becoming GPs and equip them for life as a GP after they qualify.
The length of the training programme
Currently the training programme is three years and some argue that this is not long enough. I agree that there does need to be more training - but this needs to be within general practice and not in hospital posts.
From my personal experience the hospital posts I had were useful. But in some posts I was not exposed to anything significantly beneficial to my training as a GP and they made me feel I was simply a service provider.
For me, this time would have been better used to understand more about CCGs, networks, the financial aspects of general practice and QOF targets, or to take part in quality improvement projects and audits within general practice.
Every vocational training scheme (VTS) is different and therefore the content and quality of teaching will vary. However, I think the programme should include more on general practice itself and what doctors need to know when they become GPs. If this happened then there may not be the need for courses and webinars on topics such as the GP contract.
I also think that teaching should, in some cases, be split into groups - for example, some training may not be applicable to ST3s, but beneficial to ST1/2s. This would allow everyone to benefit and make the most of sessions.
Sufficient teaching sessions should also be used for exam preparation. Some VTS groups employ the use of actors – not just for one session, but for several or mock exams – this means candidates don’t have to pay for this themselves or seek out expensive courses to undertake this preparation.
As with any training programme, providing trainees with support is essential. Again, support is variable and sometimes pressures experienced by supervisors and programme directors may mean that they cannot completely support their trainees.
If trainees feel that supervisors and programme directors are not approachable they may not always ask for advice. It is essential that trainees know where to find help if they need it.
Exams at any point during training are stressful and it can be difficult deciding when the best time is to sit them. I believe that allowing trainees to sit the AKT during ST1 would be beneficial.
The CSA is an exam that can be passed comfortably but adequate preparation, timing and understanding is key. However, it is a highly subjective exam. This cannot be helped as ultimately it is a human, not a computer, marking the candidate. Would using two examiners or employing video recording be a useful way to change marking? This may also help candidates who could be put off by someone sitting in close proximity (sometime in their eye line) marking them.
I also believe the CSA recording used for quality control should be made available to candidates as a form of feedback, whether they have failed or passed. The feedback statements as they currently stand, while useful, are often generic and candidates and their trainers can be left guessing about what was actually meant by them.
There are also strict criteria for appealing a result and the cost of appealing an exam result currently sits at £800. A review for errors in marking also costs, setting you back by £60. Are these charges really proportionate?
I enjoyed my reflective logs and updating my portfolio. But it is time consuming and the template for logging entries is very rigid. The ability to create an entry with can create your own headings would be useful.
I spent a large proportion of my time out of clinical hours updating my portfolio and this encroached upon my time for ‘me’, which is crucial to morale and mental and emotional wellbeing. Although trainees can use their educational time for portfolio entries I don’t think this is enough - and they may also need to use that time for audit, quality improvement projects or preparing presentations.
Overall, I think that while the training programme is good, there is much that could be done to improve it. I believe that listening to as many trainers and trainees as possible is the key to ensuring more trainees enjoy and succeed within the programme - and that they go on to become confident and enthusiastic GPs.
- Dr Patrice Baptiste is a London-based portfolio GP. She has also founded a medical careers company called DreamSmartTutors.