Learning in practice

Preregistration house officers in general practice: review of evidence

Jan Illing, Association for the Study of Medical Education research fellow, ^a Tim van Zwanenberg, professor of postgraduate general practice, ^a William F Cunningham, general practitioner, ^b George Taylor, director of postgraduate general practice, ^c Cath O'Halloran, curriculum development coordinator, ^d Richard Prescott, consultant physician. ^e

^a (see also p 1011)University of Newcastle upon Tyne, Postgraduate Institute for Medicine and Dentistry, Newcastle upon Tyne NE4 2AB, ^b Corbridge Health Centre, Northumberland NE45 5JW, ^c Department for NHS Postgraduate Medical and Dental Education (Yorkshire), University of Leeds, Leeds LS2 9JT, ^d New Generation Project, South Block, Southampton General Hospital, Southampton SO16 6YD, ^e South Durham Health Care NHS Trust, Bishop Auckland General Hospital, Bishop Auckland, County Durham DL14 6AD

Correspondence to: J Illing

Objectives: To examine the strengths and weaknesses of the national and local schemes for preregistration house officers to spend four months in general practice, to identify any added value from such placements, and to examine the impact on career choices.
Design: Review of all studies that reported on placements of preregistration house officers in general practice.
Setting: 19 accounts of preregistration house officers' experience in general practice, ranging from single case reports to a national evaluation study, in a variety of locations in Scotland and England.
Participants: Views of 180 preregistration house officers, 45 general practitioner trainers, and 105 consultant trainers.
Main outcome measures: Main findings or themes weighted according to number of studies reporting them and weighted for sample size.
Results: The studies were unanimous about the educational benefits of the placements. The additional learning included communication skills, social and psychological factors in illness, patient centred consultations, broadening of knowledge base, and dealing with uncertainty about diagnosis and referral.
Conclusions: Despite the reported benefits and recommendations of the scheme, it is not expanding. General practitioner trainers reported additional supervision that was unremunerated. The reforms of the senior house officer grade may resolve this problem by offering the placements to senior house officers, who require less supervision.

What is already known on this topic Pilot schemes across the country have offered preregistration house officers the opportunity to rotate into general practice Many studies have reported on these rotations, but there has been no review summarising their strengths and weaknesses What this study adds Rotations in general practice are unanimously welcome and offer a valuable training opportunity However, the schemes are not expanding, mainly because of the unremunerated supervisory role of trainers Proposed reforms to the senior house officer grade may help by offering placements to senior house officers instead, who are able to prescribe and require less supervision