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Letters

Study did not mention preregistration year in general practice

BMJ 1999; 319 doi: https://doi.org/10.1136/bmj.319.7223.1502 (Published 04 December 1999) Cite this as: BMJ 1999;319:1502
  1. Joe Wilton, trainer of general practitioner preregistration house officers, 1985-95 (joe.wilton{at}lineone.net)
  1. 14 Kingsmeadow Road, Peebles EH45 9EN

    EDITOR—The paper by Stewart et al identifying appropriate tasks for preregistration house officers continues the important debate about defining their job description, in terms of both educational and service components.1 It makes no mention, however, of preregistration house officers in general practice.

    In 1997 the General Medical Council published its new recommendations for the preregistration house officer year.2 The report gives support and guidance specific to preregistration house officers in general practice. In August 1998 over 30 new preregistration house officer rotations in general practice were established in the United Kingdom; they represent a major new educational challenge for general practice.

    Experience in general practice offers several benefits to newly qualified doctors, who can experience independence and responsibility at an early stage of their medical careers. A previous study has suggested that preregistration house officers in general practice spend over half of their working week in one to one contact with patients.3 The hours are less exhausting than in hospital, and there is more time for study and reflection. General practice has a tradition of individual teaching. This is ideal for a newly qualified doctor experiencing for the first time a responsible and demanding job, as it gives ample opportunity for clinical supervision, pastoral care, and career guidance.

    The paper identifies and lists tasks of preregistration house officers. From these lists it is clear that some skills are best learnt in hospital but others might be best learnt in general practice. An improved educational model would be an integrated educational year of four months' medicine, four months' surgery, and four months' general practice.

    Communication skills are central to general practice. A general practitioner trainer will observe a doctor in training in consultation with patients, by sitting in with them or using video recordings, or both This might be the last time in his or her professional lifetime that the doctor could receive feedback on his or her communication skills with patients. Other core skills, not addressed in this study, could also receive attention in general practice, such as gaining an understanding of the social and emotional influences on health and the natural course of diseases.

    It will be interesting to see if future studies on this important year of medical education take a wider view of core skills in the preregistration house officer year and include a discussion on where best these skills might be gained—in hospital, in general practice, or elsewhere.

    References

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