Strengthening general practice by extending specialty training?

Abstract

European legislation obligates member states to have a full-time postgraduate GP specialty training for ≥3 years, with a minimum of 6 months spent in general practice. Across Europe, GP specialty training varies from 3 years (for example, in the UK and the Netherlands) to 6 years (Finland), with training time in general practices varying between 6 months (Austria) and 4 years (Norway). Recently, across Europe a strong movement in favour of extending the minimum duration of GP specialty training from the current 3 years to 4 or even 5 years has developed. 1,2 Supporters of this measure state that this will 'build the same level as specialty as other disciplines' and therefore strengthen GPs' standing across Europe. 3,4 This is important because a strong primary care is needed to have a high-quality healthcare system accessible for all citizens, in which GPs function as key stakeholders. 5,6 However, not every country values GPs in this way. Across Europe GPs' positions vary from being a strong gatekeeper with free access for patients to easily accessible secondary care and paid GP visits. Another argument for extending the duration is that more time spent in training will give trainees 'greater exposure to real world setting', and therefore better developed competencies important for future GPs. 2 Recently, extension of GP training programmes in Scotland and the West of Ireland reported positive results, whereby trainees from these programmes felt better prepared for independent practice. 7,8 The extended period of general practice training in particular (2 years instead of 1) was valued by the trainees. Although we recognise that becoming a GP takes time and requires the mastery of a broad range of competencies, 2,4 in this editorial we will argue that merely extending GP specialty training might not be the right measure to better prepare trainees or to enhance GPs' standing.

General practice undergraduate and vocational training: ambulatory teaching and trainers’ curriculum and remuneration – a cross-sectional study among 30 member countries of WONCA Europe

“…Our results offer an overview of GP training and options to help shape a fourth year of GP specialisation in France while meeting the trainees' educational needs. This approach could facilitate developing revalidation and reliable, high-quality guidelines [17] that produce wiser, qualified general practitioners willing to start their own practices. In France, a recent cohort study highlighted that training supervision is associated with an increase in the density of general practitioners in the municipality of practice.…”

Learning objectives of Belgian general practitioner trainees regarding their hospital training: A qualitative study

“…Sometimes during the hospital training, GP trainees felt like they ought to fill staff shortages [ 25 , 29 ]. Additionally, time pressure, multitasking, denial of study leave and difficulties in scheduling learning moments are considered barriers to learning [ 4 , 12 , 28 ].…”

“…In Europe, the duration of hospital training in GP postgraduate programmes varies between six months and four years [ 4 , 5 ]. It is generally accepted that the GP hospital training should include ‘aspects of clinical work relevant to GP’ and should be ‘in conjunction with other health establishments or structures concerned with general medicine’ [ 1 , 2 , 6 ].…”

An exploratory study on the mode and method of general education and training for general practice undergraduates: a narrative review

“…Utilizing the skills and energy of graduate students or seniors as near-peer teachers is a simple and effective means to improve the training of both undergraduate medical students and their near-peer teachers. Evidence suggests that most teachers are eager to improve their teaching, while undergraduate medical students attach great importance to the teaching of their peers (19,20). Near-peer teaching can reduce the time pressure on teachers and help them to stay up-to-date, which can bring economic benefits to the business.…”