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We wholeheartedly agree with Dr Razai1 that there are flaws in the current training system and if we were devising the GP training programme today, we would not implement the current model. As the countryman in the joke giving directions to a passing motorist advised ‘Well, sir, if I were you I wouldn’t start from here”.
Where, therefore, would we start from and could that therefore help us direct us now?
Twenty-five years ago, Oswald2 pioneered a radical and innovative experiment in undergraduate medical training in which students spent a 15-month attachment in general practice with hospital clinical experience based on specific patients registered with the practice. This longitudinal primary care based rotation has developed into internationally recognised and acclaimed LICs (longitudinal integrated clerkships) with educational backing based on the principles of spaced learning and interleaving.3 Perhaps the ideal training programme would consist of the trainee spending three (or four or five) years based in one practice with simultaneous tailored attachments in areas of learning need and interest. These may involve some specific hospital-based learning (e.g. outpatient clinics) as well as other areas such as teaching, research, CCG/PCN leadership, etc.
So does that help direct us from where we are now? We agree that trainees can benefit considerably from undertaking training in sec...
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Dr Razai unfortunately shines a light onto what is happening all too frequently. GP's in training being used as clerks and given less than adequate teaching. Having read many e-portfolios I have seen excellent examples of teaching and feedback being given by consultants. Such examples are not in the majority though. There certainly is a case for complaint by GP's in training where they are given poor teaching and little time for attending training. Having come from a time of working 1 in 2 and 1 in 3 junior doctor jobs there has been great progress in reducing excessive working hours. There now comes a need to address poor quality health education without which we will not get the quality GP's that we desperately need.
Competing Interests: None declared.