Professionals’ perspectives on factors affecting GP trainees’ patient mix: results from an interview and focus group study among professionals working in Dutch general practice

Abstract

IntroductionSeeing and treating patients in daily practice forms the basis of general practitioner (GP) training. However, the types of patients seen by GP trainees do not always match trainees’ educational needs. Knowledge about factors that shape the mix of patient types is limited, especially with regard to the role of the professionals who work in the GP practice.AimWe investigated factors affecting the mix of patients seen by GP trainees from the perspective of professionals.Design and settingThis qualitative study involved GP trainees, GP supervisors, medical receptionists and nurse practitioners affiliated with a GP Specialty Training Institute in the Netherlands.MethodsTwelve focus groups and seven interviews with 73 participants were held. Data collection and analysis were iterative, using thematic analysis with a constant comparison methodology.ResultsThe characteristics of patients’ health problems and the bond between the doctor and patient are important determinants of GP trainees’ patient mix. Because trainees have not yet developed bonds with patients, they are less likely to see patients with complex health problems. However, trainees can deliberately influence their patient mix by paying purposeful attention to bonding with patients and by gaining professional trust through focused engagement with their colleagues.ConclusionTrainees’ patient mix is affected by various factors. Trainees and team members can take steps to ensure that this mix matches trainees’ educational needs, but their success depends on the interaction between trainees’ behaviour, the attitudes of team members and the context. The findings show how the mix of patients seen by trainees can be influenced to become more trainee centred and learning oriented.

General practice residents’ perspectives on their professional identity formation: a qualitative study

“…Clinical experiences gained during progressively independent practice were perceived by residents as the cornerstones of their PIF. This is in line with earlier studies on PIF in UGME,21 43 which revealed the importance of experience gained from direct encounters with patients; it also echoes what is known about how residents learn 44–46. Our findings about residents’ learning on the job and from the job, and their move to full participation, provide empirical evidence for what has been theorised on PIF previously 9 11 12 36.…”

“…This is in line with earlier studies on PIF in UGME, 21 43 which revealed the importance of experience gained from direct encounters with patients; it also echoes what is known about how residents learn. [44][45][46] Our findings about residents' learning on the job and from the job, and their move to full participation, provide empirical evidence for what has been theorised on PIF previously. 9 11 12 36 It supports the assertion that PIF is most effectively influenced through 'situations, not subjects', that is, that residents' professional identity is more likely to be influenced by doing the work than by being taught about it.…”

Complaint-driven preferences & trust: patient’s views on consulting GP trainees

“…Moreover, another study by our research group investigating the view of professionals on trainees' patient mix indicated that trainees could become the preferred doctor of patients with long-term conditions. Repeated visits and the trainee's behaviour were important in establishing the relationship [16] The influence of trust on patients' willingness to see a trainee is another important finding. Patients needed to trust trainees before they would consider consulting with them.…”

“…Other topics were the influence of the complexity of a condition, prior experiences with trainees, knowledge about a trainee and the impact of the characteristics of a trainee (like gender or age) on a patient's decision to consult the trainee. The topic list was based on findings from our earlier study on the perspectives of professionals working in general practice [16], additional literature [14,[17][18][19] and discussions within the research team. The topic list can be found in Appendix I.…”

Cherry‐picking learning tasks in the orchard of postgraduate medical education ‐ a socio‐cultural perspective

“…3 However, other members of the healthcare team also have an active role in this. Proposing learning opportunities has been documented as an activity of medical receptionists, 16 advanced practice professionals 16,17 and nurses. 4 On the flipside, healthcare team members can also actively withhold learning opportunities from trainees.…”