Background In Danish GP training we had the ambition to enhance and assess global reflection ability, but since we found no appropriate validated method in the literature, we decided to develop a new assessment tool. This tool is based on individual trainee developed mind maps and structured trainer-trainee discussions related to specific complex competencies. We named the tool Global Assessment of Reflection ability (GAR) and conducted a mixed method validation study. Our goal was to investigate whether it is possible to enhance and assess reflection ability using the tool. Methods In order to investigate acceptability, feasibility, face validity, and construct validity of the tool we conducted a mixed method validation study that combined 1) qualitative data obtained from 750 GP trainers participating in train-the-trainer courses, 2) a questionnaire survey sent to 349 GP trainers and 214 GP trainees and 3) a thorough analysis of eight trainer-trainee discussions. Results Our study showed an immediate high acceptance of the GAR tool. Both trainers and trainees found the tool feasible, useful, and relevant with acceptable face validity. Rating of eight audio recordings showed that the tool can demonstrate reflection during assessment of complex competencies. Conclusions We have developed an assessment tool (GAR) to enhance and assess reflection. GAR was found to be acceptable, feasible, relevant and with good face- and construct validity. GAR seems to be able to enhance the trainees’ ability to reflect and provide a good basis for assessment in relation to complex competencies.

Background: Continuous medical education is essential for the individual patient care, the society, and the wellbeing of the general practitioner. There has been research into the reasons for participation in continuous medical education, but little is known about the barriers to participation. To be able to tailor continuous medical education to general practitioners who are currently deselecting education, we require systematic knowledge of the barriers. Continuous medical education can stimulate job satisfaction, diminish burnout, and reinforce feelings of competence. Delayed retirement is seen among general practitioners who thrive in their job. General practitioners’ mental well-being may have positive implications for their patients and for healthcare expenditures. Educational activities show promise as a strategy to recruit and retain physicians in less attractive specialties. Despite renumeration and a comprehensive continuous education model not all Danish general practitioners participate in continuous medical education. Methods: 243 out of a total of 3440 Danish general practitioners did not apply for reimbursement for accredited continuous medical education in a two-year period. 10 general practitioners were selected for an interview regarding maximum variation in practice form, number of listed patients, seniority as a general practitioner, geography, gender, and age. All 10 selected general practitioners accepted to be interviewed. The interviews were analysed using Systematic Text Condensation. Results: Each of the 10 interviewed general practitioners mentions several barriers for participating in continuous education. The barriers fall into three main categories: · barriers related to the individual general practitioner · barriers related to the clinic · barriers related to the accredited continuous medical education offered Conclusions: Less than 7% of the Danish general practitioners did not participate in accredited remunerated continuous medical education. It corresponds to 400.000 listed patients having a general practitioner who does not participate in accredited continuous education. The barriers for participating fall into three main categories. A knowledge of the barriers for participating in accredited continuous medical education can be used to better target continuous medical education to some of the general practitioners who are currently deselecting continuous education.

Background Continuous medical education is essential for the individual patient care, the society, and the wellbeing of the general practitioner. There has been research into the reasons for participation in continuous medical education, but little is known about the barriers to participation. To tailor continuous medical education targeting general practitioners who are currently deselecting education, systematic knowledge of the barriers is needed. Continuous medical education can in addition to professional growth stimulate job satisfaction, diminish burnout, and reinforce feelings of competence. Continuous medical education may have positive implications for patients and for healthcare expenditures. Despite renumeration and a comprehensive continuous education model some Danish general practitioners do not participate in continuous medical education. Methods From a total of 3440 Danish general practitioners 243 did not apply for reimbursement for accredited continuous medical education in a two-year period. Ten general practitioners were selected for an interview regarding maximum variation in practice form, number of listed patients, seniority as a general practitioner, geography, gender, and age. All ten selected general practitioners accepted to be interviewed. The interviews were analysed using Systematic Text Condensation. Results Each of the ten interviewed general practitioners mentioned several barriers for participating in continuous education. The barriers fell into three main categories: barriers related to the individual general practitioner barriers related to the clinic barriers related to the accredited continuous medical education offered Conclusions Approximately 7% of the Danish general practitioners did not participate in accredited remunerated continuous medical education. A knowledge of the barriers for participating in accredited continuous medical education can be used to better target continuous medical education to the general practitioners.