Determining the training needs of planners.

Since the NHS Planning System was formally introduced in 1976 both it and the NHS itself have undergone a succession of changes and reorganisations. To facilitate the introduction of the Planning System an integrated programme in training for planning was established by the DHSS. Over the years since then, training in planning has developed in a less integrated manner and by the late 1980s it was felt that the situation should be reviewed to meet the challenges of the forthcoming round of strategic planning. Accordingly, the Health Services Management Centre was commissioned to carry out a study into the training needs of planners. Because of the restricted timescale a workshop approach was adopted and leading planners and managers from all tiers and all professions from different parts of England and Wales were invited to participate. The project had two main foci which are discussed here. Firstly, current and future changes in the NHS and its environment which might or will impact on health care planning and, secondly, the identification of the groups which require training in planning, the skills and competencies they require and possible methods of acquisition.     

Involving doctors in management. A survey of the management development career needs of selected doctors in NHS Wales

Reports the results of a survey of 209 senior registrars and 269 consultants throughout Wales to identify the management development needs of doctors and ascertain their views of the value and utility of current management development course offerings in Wales. Finds that, currently, management development for doctors in Wales is unstructured and uncoordinated but, despite this, many doctors, especially senior registrars, appeared keen to increase their future involvement in management and held positive views regarding management and management development. The questionnaire also required doctors to rank order six managerial topics and their elements: financial, human resource, strategic, operational, service quality and self-management. Of these, self-management issues were rated highest and there was some congruity in the rankings of the six topics by senior registrars and the other three consultant categories. Overall, managing a budget, medical and clinical audit, negotiating skills and leadership skills were ranked highest for inclusion in management development while project management, quality circles and equal opportunities received the lowest ratings.     

The emergency medicine training needs of rural general practitioners

This study aimed to identify the emergency medicine training needs of rural general practitioners (GPs) in the catchment area of the Hunter Rural Division of General Practice. The GPs were surveyed using a questionnaire in which they were asked about their confidence levels in a number of specific emergency medicine skills, and about the areas of emergency medicine that they saw as priorities for upskilling. More than a third of GPs who were responsible for on-call work at the hospital indicated that they had low levels of confidence in a number of their emergency medicine skills, in particular skills relating to paediatric emergencies, cardiovascular emergencies, and respiratory emergencies. These emergency medicine domains were also seen as high priorities for upskilling by the majority of the respondents. The study shows that rural doctors need the opportunity to access emergency medicine training that provides upskilling not only in the management of clinical problems, but also in practical procedures.     

Acquisition of communication skills in postgraduate training for general practice

PURPOSE: The evidence suggests that a longitudinal training of communication skills embedded in a rich clinical context is most effective. In this study we evaluated the acquisition of communication skills under such conditions. METHODS: In a longitudinal design the communication skills of a randomly selected sample of 25 trainees of a three-year postgraduate training programme for general practice were assessed at the start and at the end of training. Eight videotaped real life consultations were rated per measurement and per trainee, using the MAAS-Global scoring list. The results were compared with each other and with those of a reference group of 94 experienced GPs. RESULTS: The mean score of the MAAS-Global was slightly increased at the end of training (2.4) compared with the start (2.2). No significant difference was found between the final results of the trainees and the reference group. According to the criteria of the rating scale the performance of both trainees and GPs was unsatisfactory. CONCLUSION: The results of this study indicate that communication skills do not improve in a three-year postgraduate training comprising both a rich clinical context and a longitudinal training of communication skills, and that an unsatisfactory level still exists at the end of training. Moreover, GPs do not acquire communication skills during independent practice as they perform comparably to the trainees. Further research into the measurement of communication skills, the teaching procedures, the role of the GP-trainer as a model and the influence of rotations through hospitals and the like, is required.     

Preparatory graduate professional training in general practice by using the 'experiential learning' framework

Background

General practitioners (GPs) in Indonesia are medical doctors without formal graduate professional training. Only recently, graduate general practice (GP) is being introduced to Indonesia. Therefore, it is important to provide a framework to prepare a residency training in general practice part of which is to equip GP graduate doctors to deliver person-centered, comprehensive care in general practice. Experiential learning theory is often used to design workplace-based learning in medical education. The aim of this study was to evaluate a graduate professional training program in general practice based on the ‘experiential learning’ framework.

Methods

This was a pre-posttest study. The participants were 159 GPs who have been practicing for a minimum of 5 years, without formal graduate professional training, from two urban cities of Indonesia (Yogyakarta and Jakarta). A 40-week curriculum called the ‘weekly clinical updates on primary care medicine’ (WCU) was designed, where GPs met with clinical consultants weekly in a class. The participant’s knowledge was assessed with pre-posttests involving 100 written clinical cases in line with each topic in the curriculum. Learning continued with a series of group discussions to gain reflection to reinforce learning.

Results

Participants’ knowledge regarding clinical problems in general practice was moderately increased (p?<?0.05) after the training from a mean score of 50.64–72.77 (Yogyakarta’s doctors) and 39.37–51.81 (Jakarta’s doctors). Participants were able to reflect on the principles of general practice patient-care. Participants reported satisfaction during the course, and expressed a desire for a formal residency training.

Conclusions

A graduate educational framework for GP based on the ‘experiential learning’ framework in this study could be used to prepare a graduate GP training; it is effective at increasing the comprehension of general practitioners towards better primary care practice.

     

Effect of extension of postgraduate training in general practice on the acquisition of knowledge of trainees

BACKGROUND: Postgraduate training in general practice aims to develop clinical competence. However, little is known about its effect on trainees' development of competence. OBJECTIVE: Our aim was to investigate whether 3 years of postgraduate training in general practice leads to a higher level of knowledge than 2 years training while maintaining the same structure and educational objectives. METHODS: This retrospective study had a mixed longitudinal design. Trainees of the Dutch postgraduate training in general practice participated. Knowledge was assessed by written progress testing of knowledge relevant to general practice embedded in real life situations. Test results were collected from 1992 to 1999. The results of trainees who received the 2-year and 3-year curriculum were compared. RESULTS: Both curricula started with the same entrance level and showed the largest acquisition of knowledge at the start and towards the end of training. Both curricula showed stagnation in growth at the end of the training period in which trainees rotate through hospitals, nursing homes and mental health institutions. The level of knowledge at the end of training was significantly higher for the 3-year curriculum. CONCLUSION: This study shows that postgraduate training contributes to an increase in knowledge and that a 3-year programme leads to a higher level of knowledge than a 2-year programme. The stagnation in growth found at the end of rotations through hospitals, nursing homes and mental health institutions questions the impact of these rotations on the development of competence and the efficacy of the training as a whole. Further study is needed to draw more firm conclusions.     

Effects of the vocational training of general practice consultation skills and medical performance

The effects of the vocational training of general practitioners in the Netherlands on the consultation skills and medical performance of junior doctors were studied. Results obtained at a training institute providing systematic training in these skills (Nijmegen) were compared with those at an institute taking a problem-based learning approach (Groningen). Trainees (n = 63) audiotaped consultations and recorded their medical performance at the start and at completion of training. The skills were evaluated with the aid of validated criteria and medical 'protocols'. Data on 631 pre-training and 624 post-training consultations were compared. Changes in consultation skills and medical performance occurred at both institutes and proved more marked at the institute providing systematic training. Improved medical performance was found to be associated with improved consultation skills. Enhanced clinical knowledge was found to be related to improved medical performance and consultation skills. The most profound changes were found in junior doctors who had started at a lower level of consultation skills and medical performance.     

导师与新毕业护士对基础护理技术培训需求差异的研究

目的研究导师与新毕业护士对基础护理技术培训需求的差异及其影响因素,探讨这种差异对培训的影响。方法自行设计调查问卷对导师和新毕业护士进行调查,内容包括84项基础护理技术项目,通过多重响应分析对每一项目进行分类,按个案百分比的不同分为共识项目和非共识项目,然后对两种项目数量的差异进行卡方检验,得出两组调查对象关于基础护理技术培训需求的差异。结果两组调查对象的培训需求存在明显差异(P<0.001),导师组的需求较集中(共识项目数量多),主要是一般基础护理技术,而新毕业护士组的需求分散在各专科基础护理技术(共识项目数量少)。导师组的工作年限和第一学历对培训需求有影响(P<0.001),而新毕业护士的学历没有影响(P=0.081)。结论对新毕业护士培训时,需充分考虑导师和新毕业护士的不同需求,扎实基础,循序渐进。