Training environment in General Practice and preparedness for practice

Abstract

This thesis explores the way General Practice trainees and early career General Practitioners describe their training environment in General Practice, the meaning they attach to the notion of preparedness and their perceptions of the impact of the training environment on their preparedness. The study was informed by the interpretivist paradigm. I conducted 27 in-depth semi-structured interviews with 15 early career General Practitioners and 12 General Practice trainees at the end of their training. Interview data were transcribed and analysed thematically, drawing partially on the grounded theory approach of data analysis. Interviewees described their training environment in terms of their sense of being included in the Practice, the Practice ethos, the importance of training within the Practice, the trainer and their relationship with the trainer. There was no unanimous way in which interviewees talked about preparedness, however the meanings attributed to preparedness centred around two central elements ‘confidence’ and ‘adaptability’ and included: working independently and being self directed; knowledge of business and partnership issues; ability to manage patients and workload; good consultation skills and effective time management; and adequate knowledge and passing the RCGP CSA examination. The way the training Practice can impact on trainees’ preparedness was explained drawing on Bandura’s theory of ‘self efficacy’ and Lave and Wenger’s theory of ‘situated learning’. Inclusive training Practices, characterised by less hierarchical relationships between the doctors, particularly vis-à-vis trainees, were better at preparing trainees for their future role by affording them greater opportunities to take part in a wider range of General Practice work. The role of the trainer was also pivotal in preparing trainees through effective teaching. Supervision tailored to trainees’ needs, and guided decision making enhanced confidence of trainees in their ability to work independently.