The learning experiences of general practice registrars in the South East of Scotland

Abstract

To train to be a general practitioner in the U.K. a doctor must spend two years in hospital training posts and one year in general practice as a general practice registrar (GPR). Concern has been expressed in the literature about both the duration and adequacy of general practice training. A literature review identified that there was limited knowledge of and understanding about the learning experiences of GPRs. The aim of the study was to describe and interpret the learning experiences of GPRs in the South East of Scotland during their year in general practice. The methodology was derived from Denzin's concept of Interpretivism and involved in depth interviews over time with GPRs and thick description to capture and interpret the GPRs learning experiences. Two cohorts of 24 GPRs were recruited, cohort one ran from September 2002 to July 2003 and cohort two from September 2003 to August 2004. The GPRs were interviewed on three occasions during their year. In addition to the interviews six GPR focus groups and six GP trainer focus groups were held over the period December 2002 to September 2003. 21 GPRs in cohort one completed all three interviews and 20 GPRs in cohort two. All the participating GPRs completed at least two interviews. The results were interpreted within the educational concept of the curriculum. Four main curricula were identified during the GPR year: these were the formal, assessment, individual and hidden. Each independently contributed to the GPRs learning and also interacted synergistically at various times during the year. In the last quarter of the year there was a tension between the requirements of the assessment and individual curricula. The individual curriculum which was composed of the GPRs clinical experiences and in particular epiphanies was the main driver of GPR learning. Epiphanies were identified by GPRs as having the most significant impact on their learning. Central to this learning was the contribution of their general practice trainer who supported their learning both through the development of the practice learning environment and the promotion of reflection and self directed learning. GPR learning during the year was an iterative process, which involved a reflective and supported interaction between the GPR, their clinical experiences, epiphanies and their trainer. Through this process the GPRs became self directed and reflective learners and developed individual learning networks which led to changes in the way they practiced medicine. This process also led to the socialisation of their learning and promoted their integration into the culture of working general practice, through which they were exposed to the working realities of life as a general practitioner and these experiences had a critical effect on their future career choice. A number of important policy implications were identified which have implications for the present and future direction of training for general practice. The process of thick description and the longitudinal nature of the study allowed for a new interpretation of the learning experiences of GPRs and added to the knowledge and understanding of how GPRs learn during their training.