I would like to bring to mind an alternative viewpoint to that brought up in the May Focus regarding length of GP training ‘schemes’.1 Length of training for a GP is compared unfavourably with those elsewhere, on the basis that it involves only 3 years (2 in hospital and 1 in ‘registrar’ posts) compared to longer, far more defined schemes in other specialties. I am not sure that this very short standard GP training scheme is in fact the standard, and I am not sure the ‘standard’ differs so very much really from that in other specialties in Britain.
GP training has always been more flexible than other speciality schemes, allowing trainees far more opportunity for more mature self-evaluation, self-directed learning, and practical experience organisation. It may be possible to satisfy the requirements of the nMRCGP/JCPTGP exam by demonstrating only 2 years in hospital posts, plus 1 year in GP-land, plus passing the exam, BUT many trainees in practice recognise that this is a basic core requirement, not a maximum requirement, and indeed, so do many potential GP-employers.
Until very recently, secondary care specialists (in other words, all specialists other than GPs) were appointed by people outside of their speciality, or even outside of medicine, but new GPs were appointed by other, senior, GPs, well-versed in their same speciality (except of course in ancient times, when anyone who failed to successfully complete medical or surgical training could set up as a GP, but even then might not do so well at it!). Still, even now, the majority of new GPs are employed by more senior fellow professionals, who supervise them to a varying extent (according to need) for varying periods of time. Most new partners start their partnership life as junior partners. But back to training length. I am not sure I know any of my contemporaries who went from a minimum length training scheme into a senior GP job!
I myself did two posts as house doctor of very good experience level I believe, followed by an additional 6 months in A&E, before entering a ‘3-year’ scheme; following that I took additional posts in general medicine, A&E, a full year in paediatrics with O&G, 22 months in joint A&E with medicine, rehab, and a little surgery at senior hospital doctor level, and then 18 months locum GP work. I then joined a (training) practice part-time while still doing locum work for another year, before becoming full-time in a rural training practice with responsibility for covering A&E and acute care, later moving to include in my portfolio posts, as representative on the LMC and RMC. If I were looking for a new partner for our practice now, I would be looking for well-rounded and additional experience beyond the minimum required to ENTER for the nMRCGP exam. Of course, now the exam includes modules in audit and videoing, it is often found that trainees cannot complete all the modules during the ‘minimum-duration’ scheme, and very many do additional posts while completing the exams. Taking into account the recent changes that mean all medical graduates now do 2 years at pre-registration level, I think this means that many will complete GP qualification with experience and study similar to that of hospital specialties, if not more. Trainees are putting in a lot of extra work towards examinations in their own time, and gaining experience outside of approved scheme posts, because they feel it is needed (and so do their potential employers). With this situation driving the quality, and indeed the (un-measured) length of an actual GP's training, I feel the preservation of flexibility in the system is a huge bonus: it encourages maturity in self-directed learning and evaluation (at least when properly encouraged) that fits trainees well for the continual educational development they will face in real general practice.
An argument used all along against lengthening GP training is the fact that hospitals want to hijack the extra compulsory time to get more cheap service provision work out of trainees, while I, and many others, remain convinced that this is still a significant risk.
- © British Journal of General Practice, 2010.
