EDITOR—Elwyn et al's article on general practice training carries a sense of foreboding.1 The current training structure has many strengths, though increased time in general practice is undoubtedly needed; but any model suggested as an alternative has to be deliverable.

The Joint Committee for Postgraduate Training for General Practice has laid down criteria for training, some of which are couched in woolly terms. The aim of each criterion is to provide the very structure for training that Elwyn et al state is lacking. The problem is in the implementation of these criteria. Formative assessments, carried out throughout the three years of vocational training, should allow any problem identified to be dealt with at an early stage. Communication skills as taught by formative video recording of consultations is an integral part of general practice training. Two surveys before and after the implementation of a pilot system for summative assessment in the west of Scotland showed the practice of using three formative videos in the training year increase from 76% to 94%. 2 3

The audit project is part of the “onerous requirement” to which registrars have to submit themselves. It can be carried out at any time during the three years of training, but until last year all audits were completed in general practice. As a result of 67 hospital reaccreditation visits in the west of Scotland, which produced 10 audits, it was decided that all senior house officers on the scheme should submit a completed audit cycle or a significant event analysis in each of their six month posts. In the first six months to 31 July 1998, 21 completed audit cycles were submitted, 15 of which passed summative assessment. Much of the trainer's report could similarly be devolved to the hospital component of training.

The only references relating …