The history of vocational training for general practice

We feel that it is worth recording the story of how vocational training for general practice was first proposed, how the earliest experiments were started, and how this prolonged exercise in teamwork developed throughout the UK. It is appropriate to do this now that Parliament has recently voted that this training should be an obligation for all doctors who wish to work as general practitioner principals in the NHS. Moreover, the first person to exert a crucial influence, Henry Cohen (Lord Cohen of Birkenhead) has recently died.

We write this account in historical sequence, not comprehensively, but selecting what in retrospect we believe to have been of chief importance. We describe initiatives at first unrelated to each other, but all contributing to one end. As the story unfolds, so does coordination in the common effort. The account ends at 1970.

     

Twenty years of vocational training in the west of Scotland: the practice component.

A retrospective analysis of the experience and opinions of doctors receiving vocational training in general practice was obtained by postal questionnaire. Questionnaires were received by 974 doctors who had been vocationally trained in the west of Scotland between 1968 and 1987. The response rate was 64%. It was found that 94% of the respondents had enjoyed their trainee period, 82% had been given a choice of training practice and 86% had spent 12 months in a training practice. Only 81 respondents had trained in two practices. The most common method of monitoring the trainee's consultation was the trainer sitting in on the consultation; half of the doctors had experience of this (51%). For the majority regular tutorials were commonplace, but for 41% of respondents this was not so. However, those training after 1979 were significantly less likely to have never had tutorials than those training earlier. Nearly half of the doctors (49%) felt that certain aspects had been poorly covered or omitted from their training, notably practice management and finance. Again, this was significantly less likely among those training after 1979. When asked to give a rating of the training they had received 21% of the respondents rated it as excellent, 37% as very good, 30% as fairly good and 12% as poor/fairly poor or very poor. Notably, significantly fewer respondents training after 1979 rated their training as poor/fairly poor or very poor. Very few respondents had participated in a practice exchange but virtually all of those who had felt it had been beneficial.(ABSTRACT TRUNCATED AT 250 WORDS)     

History of vocational training for general practice: the 1970s and 1980s.

During the 1970s and 1980s, vocational training for general practice developed from experimental beginnings to become established nationwide. Committees were set up nationally and regionally and methods devised for the approval of training practices. Important publications related to the discipline of general practice and to educational methodology appeared. The problems that remain include the absence of a compulsory assessment prior to entering general practice and the low remuneration for course organizers.     

The career outcomes for doctors completing general practice vocational training 1990-1995.

BACKGROUND: While much has been published about the career outcomes of doctors who completed general practice vocational training prior to 1990, no evidence is currently available about those who have qualified since that time. AIM: To obtain information about the career paths of doctors who had completed general practice vocational training since 1990, and to compare the results with previously published data. METHOD: Postal questionnaire survey of all doctors completing vocational training during the period 1990-1995 in three regions of the United Kingdom. The study examined current work status, career path since completion of training, desire for and experience of part-time training, degree of difficulty in choosing and following a career, and the degree to which certain factors impeded career choice. RESULTS: The overall response rate was 64.8%, although there was a significant difference between the response rates for men and women. While virtually all responders were employed, with the majority working in general practice, women were significantly less likely than men to be working as principals in general practice, for all cohorts. These results were very similar to those cohorts described in earlier studies. The career paths of doctors only became stable after about four years. Of those working in general practice, about 20% found it difficult to choose their career, and about 10% found it difficult to follow their career. Out-of-hours work was the major factor impeding career choice. CONCLUSION: Although they are taking longer to reach, the final career destinations of doctors completing vocational training since 1990 are no different from those of earlier cohorts.     

Integrating hospital and family practice posts in vocational training for family medicine

Postgraduate training programmes for family medicine are developing simultaneously in many different parts of the world. In the UK continuity of care is highly valued but vocational training schemes have not been able to provide continuity of care for patients throughout a three-year training course.

In Puerto Rico a vocational training scheme exists in which residents are enabled to integrate their hospital and family practice work throughout a three-year course. This arrangement is described and compared and contrasted with vocational training in the UK.

     

Occupational medicine and training for general practice.

The inclusion of occupational health topics in vocational training for general practice is limited-principally by course overload, and by a lack of local contact between occupational physicians and general practitioners (GPs). There is a need for the Royal College of General Practitioners and the Faculty of Occupational Medicine to review communication and training opportunities between the specialties.     

An evaluation of direct access radiology in general practice

An analysis of the use of direct access to radiology by 71 general practitioners in Scotland is described and is based on 2,596 x-ray examinations in 2,409 patients during a period of six months. Almost half of the patients had to travel more than five miles for their examinations, but time lost in travelling was a much less important factor than the interval elapsing before the requested examination was completed. Nearly one third waited at least two weeks. Referral for diagnosis was by far the commonest reason and direct access was estimated to save 270 hospital outpatient appointments per month. I believe that general practitioners under-use rather than abuse radiology, which might be extended by a selective system of appointments.