The assessment of vocational training in general medical practice

Since 1982 all medically qualified individuals wishing to become principals in the NHS General Medical Services (that is, family doctors independently contracted to provide a full range of primary health care services) have had to undergo three years vocational training. It comprises two years in hospital posts and one as a trainee in general practice. The establishment of these arrangements as a mandatory legal requirement foe entry into general practice has been widely welcomed. They represent the culmination of several decades of largely voluntary based development, and provide an example of value not only in medicine but also to other professional groups seeking to achieve high standards of competence and consumer service. The processes associated with vocational training may be estimated at some £30 million per annum. It is not certain that the NHS and ‘the taxpayer’ obtain maximum value for money for this considerable investment. It appears, for instance, that all medical graduates wishing to find a vocational training placement are able to do so, and that virtually all receive a certificate enabling them to practice as a principal after spending the prescribed time in training. A recent (1987a) report prepared by a working party of the Joint Committee on Postgraduate Training for General Practice (the JCPTGP – is responsible for standards in this field) concluded that ‘the current approach to assessment (for certification) has been examined and found wanting’. It is against this background that this report seeks to: i) Describe the methods of assessment used by trainers in vocational training of general practitioners and the nature of the qualification and competences gained as a result of such vocational training. ii) Examine the utility of the methods of assessment employed by trainers; to gayjer the views of trainees on vocational training in general practice. iii) Describe the role of the JCPTGP and the Regional Advisers in general practice. iv) Describe and evaluate the effectiveness of the vocational training given to general practitioners in the context of “mental handicap”, and to determine the place of competences (skills, knowledge, understanding and ability in application) relating to people with learning difficulties in the assessment of vocational trainees. v) Identify sources of information and support available to trainers in their assessment role. It begins with an examination of the historical development of general practice in this country, and the structures and regulations which currently exist to support and encourage GP vocational training. This is followed by a brief outline of recent thinking on the assessment of general practice vocational trainees, and the issues for change to be faced. The role of general practitioners and the competences that good medical general practice requires are examined, together with the criteria by which performance may be judged. The report then presents the results of a qualitative survey of the views and experiences of a sample of 15 GP trainers and 14 GP trainees, drawn from an inner city London Family Practitioner Committee area (Lambeth, Southwark and Lewisham, which has a population of some 750,000 people situated in the South East Thames Region). The interviews took place in the first three months of 1988. Finally, conclusions and recommendations based on the above analyses are put forward, and strategies for further evolutionary change are considered. The aims of this section include identifying ways to improve methods of work-based assessment of trainee medical practitioners and deriving points of broad relevance to other higher professionals and/or personnel groups involved in health care. This report draws on material relating to trainer and trainee responses to questions about the needs of individuals with intellectual disabilities (‘mental handicap’). The significance of this last field is that ‘mentally handicapped’ people frequently have all the usual care needs of individuals of the same age plus varying special medical and non-medical support requirements. They typically have communication and allied difficulties common to other groups of people at risk of medical neglect in our community.