Assessment of Vocational Training for General Practice Before and After the 1990 Contract

Health education, Medicine

Kelly, Diane Rutherford

University:University of Glasgow

关键词: Health education, Medicine;   

Others  :  http://theses.gla.ac.uk/74921/1/11007841.pdf

来源: University of Glasgow

【 摘 要 】

Vocational training has existed in the west of Scotland since 1968 and became a legal requirement in the United Kingdom in 1979. A literature review revealed few studies pertaining to vocational training; some evaluated one area of training and others, which were more global, involved small numbers. The aim of this thesis is to evaluate vocational training in the west of Scotland on a scale and to a degree which had not hitherto taken place. The objectives were: (i) to assess training since it began in the region by questioning 619 doctors who trained over the twenty year period and make comparisons of training over that time. (ii) to study in more detail a smaller sub-group of doctors from within the large group with particular emphasis on the effect of the 1990 general practitioner contract. (iii) to make a full assessment of the hospital component among the most recent trainees, with particular regard to the educational content of the posts. The method employed to address these objectives was a series of retrospective questionnaires and a semi-structured telephone interview. (i) The large scale study which assessed vocational training from 1968 emphasised the value of out-patient attendance during hospital training and showed that there was a need for more posts in medicine, paediatrics and dermatology. It found that 94% enjoyed their trainee year, 49% felt some aspects had been omitted from their general practice training but only 12% rated their training as poor. The comparison of different time periods demonstrated that the training rating improved, respondents felt less had been omitted from training, more were permitted to take study leave and to gain experience in general practice research. This study, described in Chapter 1, was a large historical study and the issues it raised allowed the author to develop methodologies which were then used to address the more recent developments and issues in Vocational Training. The study described in Chapter 2 compared training before and after the adoption of new criteria for trainer selection. The purpose of this was to evaluate the effect of this intervention on training. (ii) The study involving a sub-group of doctors revealed that respondents did not feel well prepared for the 1990 contract. Those who trained from 1989-92 felt more prepared for health promotion, paediatric surveillance and minor surgery than those training from 1981-88. However, they too felt poorly prepared to compile a practice report, perform audit or use a computer in general practice. Both groups considered themselves well prepared for clinical patient care except in the area of disease prevention. The evaluation of the educational content of training found that during the hospital component teaching took place very occasionally or never for over 40% of respondents from both training periods (1981-88 and 1989-92). When it did occur it was usually orientated towards the specialty, not general practice. A day-release course during hospital training was attended by only a third of respondents compared to over 97% during general practice training. Audit and research were more likely to feature as tutorial topics among those who trained from 1989-92 than from 1981-88. Trainee assessment underwent change as the use of video and the objective structured clinical examination (O.S.C.E) greatly increased. The number of trainees who had no assessment fell between 1981-88 and 1989-92. (iii) The educational content of current hospital posts in the west of Scotland was found to be generally poor, particularly paediatric and obstetrics/gynaecology posts. The exception to this was psychiatry posts. Overall, protected time for study and teaching was lacking in the vast majority of posts. In conclusion, this thesis has demonstrated that vocational training in the west of Scotland has undergone many changes since it began in 1968. These changes have been positive and have resulted in many improvements to the general practice component of training. However, significant educational deficiencies exist in the hospital component of training and need to be addressed. Vocational training must remain sensitive to the needs of general practitioners and should reflect the changing content of general practice.