Intended for healthcare professionals

Careers

A general practice taster programme for foundation doctors

BMJ 2015; 350 doi: https://doi.org/10.1136/bmj.h1347 (Published 23 March 2015) Cite this as: BMJ 2015;350:h1347
  1. Iolanthe Fowler, GP tutor1,
  2. Ben Jackson, senior clinical teacher (formerly lead for postgraduate GP education, South Yorkshire, Health Education Yorkshire and the Humber)2
  1. 1South Yorkshire, Health Education Yorkshire and the Humber
  2. 2Academic Unit of Primary Medical Care, University of Sheffield, Yorkshire
  1. Iolanthe.fowler{at}yh.hee.nhs.uk

Abstract

Iolanthe Fowler and Ben Jackson describe the outcomes of a taster programme set up to try to improve recruitment rates to training posts in general practice

General practice is struggling to recruit enough applicants to fill vacancies on specialty training programmes at a time when there is already a shortage of general practitioners (GPs) and service reconfiguration is increasing demand on primary care services and expecting GPs to be more involved in commissioning.12 Medical educators therefore need to consider any measure that could encourage young doctors to choose general practice as a career.

Only around 20% of current medical graduates express a clear preference for general practice one year after qualification.3 However, around 50% of graduates include general practice as one of their top three career choices, and short periods of exposure to primary care have been shown to increase the likelihood of medical students choosing a career in general practice.34 We therefore wanted to look at the potential impact on future career choice of offering foundation trainees additional experience of working in general practice.

Between 2012 and 2014, 175 of the 372 (47%) foundation trainees completing the destination survey in South Yorkshire had general practice as part of their rotation (with 112 (30%) completing this placement before applications for specialty training were required). The offer of additional experience in general practice before application was thought to be important to those without such experience, so that they could consider their choices fully.

Taster weeks

To address this, in 2012 a programme of taster weeks in general practice was started for foundation trainees in South Yorkshire who did not have general practice as part of their rotation before applications for specialty. These taster weeks are intended to allow trainees to experience a specialty not included in their rotation to help them reflect on their career choice5 and are commonly available in hospital specialties, but before this programme they were not available in Yorkshire and the Humber for general practice.

Trainees were offered up to five days in practices. The tasters were offered at the end of the first year or at the start of the second year of the foundation programme, to coincide as closely as possible with the application deadlines. Only practices approved for postgraduate training were invited to take part, and, in accordance with national guidance,5 a specified menu of desired activity was developed.

Twenty eight taster placements were undertaken in 2012 and 2013 with an average duration of only three days as trainees reported difficulty with rotas and obtaining leave. We hope that any such barriers will be overcome in future.

An online questionnaire was used to evaluate the placements and their impact, with 20 trainees completing the survey (71% response rate). Qualitative data was also obtained through free text comments and a follow-up email shot to hosting GP trainers. Finally, the foundation school destination survey was examined to assess the future career choice of the relevant trainees.

All 20 trainees said that their placement had allowed them to explore what a career in general practice entails in terms of skills, behaviours, and aptitudes. In addition, 14 reported time spent discussing GP training with a current trainee (including issues around work-life balance, career choice, and entry into training), and 13 discussed work-life balance and other issues relating to a career in general practice with a senior GP. When asked about the effect on career choice, 18 out of the 20 indicated they were more likely to choose general practice as a career after the placement.

The qualitative responses showed that most trainees felt that the taster week was a positive experience, and comments were made on the flexibility, friendliness, and approachability of the doctors and of the wider teams in general practice.

The trainees reported being exposed to the bulk of the variety of work in general practice, including visits, palliative care meetings, debriefing sessions, and minor surgery, as well as to standard surgeries and clinics. They saw consultations undertaken by different GPs and so were able to witness different consulting styles.

The trainees also said that the opportunities to speak openly to GPs about what a career in general practice was like had helped them gain insight into the everyday professional life of GPs. They were able to talk to trainees in different stages of their training about working life, training in general practice, and how to apply to train in general practice.

How to improve the tasters

When trainees were asked about what could be done to improve the tasters they made several suggestions. Those who had placements of two or three days because of problems with rotas said that they would have liked longer, although they still reported that the shorter placement was valuable and worthwhile. Other themes that arose were more time with trainees to watch them at work and to discuss their role; training; and work-life balance. Some trainees said that they would have liked to have been able to see patients independently and for the placement to have had a more structured or timetabled approach.

Six of the nine trainers from the 2012 cohort responded to an online questionnaire regarding the usefulness and practicality of the taster programme. The trainers said that they thought the programme was valuable and that the main challenges of the taster sessions were logistical, with short notice, space, and time being the main issues raised.

Results

The destination survey shows that 15 (54%) of the trainees who did the taster weeks are now in general practice training programmes. Six are currently not working in the UK, three are training in psychiatry (although one of these applied to general practice as a first choice), two are in service posts, one has started for core medical training, and one is training in paediatrics

The pilot programme served its primary function as all trainees felt that they were able to explore what a future career in general practice would entail, and the programme has now been rolled out across the other foundation schools across Yorkshire and the Humber. We recommend that the promotion or expansion of such additional opportunities in general practice should form part of the overall strategy of local education and training boards in addressing workforce demand.

Footnotes

  • Competing interests: We have read and understood BMJ’s policy on declaration of interests and declare that we have no competing interests.

References