Professional identity formation in becoming a GP trainer: barriers and enablers

Figures & data

Figure 1. Participant selection.

Table 1. Summary of participants pre-interview data.

Participant	Age	Gender	Ethnicity	Holds MRCGP	Holds FRCGP	Number of years as a trainer	Commenced GP training at established GP trainer practice
1	57	Male	British Asian	Yes	No	>10	Yes
2	39	Male	White British	Yes	No	<5	Yes
3	34	Male	White British	Yes	No	Contemplating	Practice not a training practice
4	61	Male	White British	Yes	Yes	>10	Yes
5	34	Male	White British	Yes	No	TT	Yes
6	43	Male	White British	Yes	Yes	>10	Yes
7	40	Female	White British	Yes	No	5–10	No^†
8	57	Female	White Scottish	Yes	No	5–10	No^†
9	70	Male	White British	Yes	Yes	>10	No^†
10	51	Female	White British	Yes	Yes	>10	Yes
11	70	Male	White Scottish	Yes	Yes	>10	Yes
12	41	Male	White Scottish	Yes	No	5–10	No^†
13	80	Male	White British	Yes	No	>10	No^†
14	42	Female	White Scottish	Yes	Yes	5–10	Yes
15	51	Female	White British	Yes	Yes	<5	Yes
16	42	Female	White British/Irish	Yes	No	5–10	Yes

TT, Trainer Training in progress.

† Indicates participant.

Table 2. Interview schedule.

		Provisional rationale/RQ link
Opening questions
	You’ve told me that you studied at … … … school. What influences if any did this have on your choices to be a doctor? Where there any other influences?	Relax the participant
	What were the biggest influences on you and your learning and development as a doctor at medical school?
	And so following graduation at … … … . University tell me what jobs did you do then?
	And so when did you decide to become a GP?
	What do you think were biggest influences on you and your development as a GP?
Transition questions
	Tell me about your current role is and how long you have been doing that?
	What does the term ‘identity’ mean to you, if anything? When or where have you heard this term?	Exploring understanding of identity
	So thinking about identities? When you hear the term ‘GP trainer’ what does being a GP trainer mean to you?	Exploring understanding of identity
Key questions
	How important is your role as a GP trainer? Does it enhance or detract from your role as a GP?	Understanding of role Salience of role
	How has your identity as a trainer evolved over time?	Growth and development
	What would help strengthen your identity as a trainer?	Enablers
	What would weaken this identity as a trainer?	Barriers
	Has GP training changed during your time as a trainer? Probes for MRCGP, FRCGP, further Med Ed if not already discussed, MAP Probes for established training practice	Future directions
	What do you think a GP trainer should be like in the future? Probes for sessional commitment	Future directions
Final questions
	Of all the points discussed related to the role of a GP trainer which seems the most important to you?
	Is there anything else you feel we should talk about in relation to this issue which we haven’t?
Closure
	We will have to draw things to a close Explain what will happen next – clarify for member checking Thank participants

Table 3. Summary of documentary sources.

Document type	Title	Author/Source
Policy	A Framework for the Professional Development of Postgraduate Medical Supervisors Guidance for Deaneries, Commissioners and Providers of Postgraduate Medical Education	Academy of Medical Educators
Policy	Fit for the Future – A Vision for General Practice	RCGP
Policy	From the Frontline – The Changing Landscape of Scottish General Practice	RCGP Scotland
Policy	General Practitioner Recruitment and Retention: An Evidence Synthesis – Final Report February 2016	Policy Research Unit in Commissioning and the Healthcare System
Policy	Promoting Excellence: Standards for medical Education and Training	GMC
Policy	Quality Management of GP Speciality Training in Scotland Terms of Reference and Standard Operating Procedures for Educational Supervisor and Training Practice Approvals	Regional Policy Management Groups
Policy	RCGP Scotland Scottish Blueprint for General practice	RCGP
Policy	Recognising and Approving Trainers: The Implementation Plan	GMC
Policy	Shape of Training. Securing the Future of Excellent Patient Care	Final Report of the Independent Review Led by Professor David Greenaway
Policy	SPESC Generic Guide	SPESC
Policy	The RCGP Curriculum 1: Introduction and User Guide	RCGP
Policy	The RCGP Curriculum: Core Curriculum Statement 1.00: Being a General Practitioner	RCGP
Policy	The RCGP Curriculum: Professional & Clinical Modules 2.01–3.21 Curriculum Modules	RCGP
Policy	The Trainee Doctor	GMC
Policy	Teaching General Practice – Guiding Principles for Undergraduate General Practice Curricula in UK Medical Schools	Society for Academic Primary Care
Legislation	GMC Web Clippings on GP Trainer Legislation/Medical Act 1983	GMC
Legislation	Medical Act 1983	UK Government
Legislation	NHS Vocational Training Act 1973	UK Government
Information updates	General Practice Forward View – April 2016	NHS England
Information updates	Medical Directorate Education Research and Innovation Group Annual Report 2019	NES
Information updates	National Training Survey Scotland 2016	GMC
Information updates	National Training Survey Scotland 2016 – Key Findings	GMC
Information updates	National Training Survey Scotland 2013	GMC
Information updates	National Training Survey 2013: Summary Report for Scotland	GMC
Information updates	National Training Survey 2014 Key Findings	GMC
Information updates	National Training Survey Key Findings from the Pilot Survey of Trainers	GMC
Information updates	Postgraduate Medical Education Annual Report 2013	NES
Information updates	Postgraduate Medical Education Annual Report 2014	NES
Information updates	Postgraduate Medical Education Annual Report 2015	NES
Information updates	Postgraduate Medical Education Annual Report 2016	NES
Information updates	Postgraduate Medical Education Annual Report 2017	NES
Information updates	Postgraduate Medical Education Annual Report 2018	NES
Information updates	Quality Annual Report – The Scottish Deanery – 2017	NES
Information updates	Quality Annual Report – The Scottish Deanery – 2018	NES
Information updates	Scotland Deanery News 2017	NES
Information updates	Scotland Deanery News 2018	NES
Information updates	Scotland Deanery News Spring 2018	NES
Information updates	Scotland Deanery News Summer 2018	NES
Information updates	Scotland Deanery News Winter 2018	NES
Information updates	Scotland Deanery News Winter 2019	NES
Information updates	Local GP Trainers Annual Conference Update	NES
Information updates	The National Training Survey 2015 Infographic Overview	GMC
Information updates	Training Environments 2017 – Key Findings from the National Training Surveys	GMC
Information updates	Training Environments 2018 – Key Findings	GMC
Information updates	Training Environments 2018–4 Country Breakdowns	GMC
Website information	About Us – Scotland Deanery	NES
Website information	GP trainer and training practice accreditation	NES
Website information	Key Dates & Events	NES
Website information	Quality Management – Trainer Information – Scottish Deanery	NES
Website information	Quality Management – Trainer and Trainee Surveys	NES
Website information	Recruitment – Scottish Medical training	NES
Website information	Scotland Deanery – NHS Education for Scotland	NES
Website information	Scottish Trainer Framework – Scotland Deanery	NES
Website information	SPESC – Scotland Deanery	NES
Website information	SPESC – Orientation	NES
Website information	SPESC – Application Form	NES
Website information	Trainer Information – Scotland Deanery	NES
Website information	Trainee Information – Scotland Deanery	NES
Website information	www.scotlanddeanery.nhs.scot~quality~approving	NES
Website information	www.scotlanddeanery.nhs.scot~quality~enhanced-monitoring	NES
Website information	www.scotlanddeanery.nhs.scot~quality~framework	NES
Website information	www.scotlanddeanery.nhs.scot~quality~governance	NES
Website information	www.scotlanddeanery.nhs.scot~quality~improving	NES
Website information	www.scotlanddeanery.nhs.scot~quality~monitoring	NES
Website information	www.scotlanddeanery.nhs.scot~quality~quality-workstream	NES
Website information	Your Development ~ Scotland Deanery	NES
Miscellaneous	BMA GP Contract 2016 – Principles	BMA/Scottish Government
Miscellaneous	BMA GP Contract – Joint Letter to GPs	BMA/Scottish Government
Miscellaneous	By Choice not by Chance Web Final	NHS Education for Health
Miscellaneous	Gender in the NHS 2018	NHS Employers
Miscellaneous	GMC-National-Review – Scotland-national-report-2018	GMC
Miscellaneous	NHS Education for Scotland Performance Support Unit	NES
Miscellaneous	Primary Care Workforce Survey 2017	NHS National Services Scotland
Miscellaneous	RCGP Assessment Blueprint June_2012	RCGP
Miscellaneous	RCGP Scotland manifesto 2015	RCGP
Miscellaneous	Quality Outcomes Frameworks Guidance Documents 2016–17	BMS/NHS
Miscellaneous	SAPC Letter EURACT Dec 2018	Society for Academic Primary Care
Miscellaneous	Scotland Deanery ES Training Practice Eligibility Criteria	NES
Miscellaneous	Training Practice Accreditation Application	NES

Table 4. Summary of the thematic analysis.

Theme title	Description	Example
External influences	Key influences out with the GP and their practice namely: SPESC, the Deanery, OOH, politics and the GP trainer group	‘ … the department of general practice [before NES] was, supportive and continued to take an interest … your GP training came from a mixture between the department of general practice and the NHS as it was then … ’ (P13) ‘ … The new arrangements build on the existing procedures by which we approve the GP trainers of GP registrars … ’ (Policy – General Medical Council (2012)
The GP practice	The relationship between the GP trainer and their training practice	‘ … so it’s the practices, that’s what GP to me means. It means that we are getting new people from time to time. From the point of view of a recruitment crisis in general practice, it makes a massive difference … ’ (P12) ‘ … GP Trainees are also hosted within general practices … individual Training Practice Agreements covering training arrangements. The nature of these arrangements require a bespoke QM-QI approach, including the requirement for approval by the regulator of both the training environment (the training practice) and the educational supervisors (ES) … ” (Policy – Quality Management of GP Training in Scotland (2015)
Characteristics of the GP trainer (self)	The GP trainer and their characteristics or attributes that they expressed, or are required to demonstrate	‘ … I think being a trainer makes you think about very much the way you consult as a person and to maintain standards within the consulting room … but I think originally I was worried that I probably wasn’t clever enough … ’ ‘ … The General Medical Council’s (GMC) Generic Standards for Training requires that: Trainers with additional educational roles must be selected and demonstrate ability as effective trainers … ’ (Policy -A Framework for the Professional Development of Postgraduate Medical Supervisors (2010)
Time	Time to perform the roles and responsibilities of the GP trainer	‘ … I think you’ll probably find the majority would probably stop doing it because of the huge workload … ’ (P16) ‘ … Organisations responsible for managing and providing education and training must monitor how educational resources are allocated and used, including ensuring time in trainers’ job plans … ’ (Policy – Promoting excellence: standards for medical education and training (2015)
The relationship with the GP trainee	The importance of the relationship, often akin to apprenticeship between the GP trainer and their trainee	‘ … he’s got other things going on and that’s been a challenge for us as well to think well how we adapt what we’ve been used to and as a trainer I’m thinking how would I adapt to that and I know, I think that comes from a good relationship with the trainee … ’ (P5) ‘ … to provide clinical and educational supervisors with a clear structure for identifying and addressing any difficulties … ’ Policy – NES Postgraduate Med Ed Training Report (2017)
The role of the GP trainer	The dual roles, and role modelling of clinician and teacher	‘ … To a certain extent, I wanted to help other young doctors who maybe had a similar experience to me, to understand that medicine is not just about the science, it’s all about art. The art of caring for people … ’ (P9) ‘ … In addition to providing care and keeping our health services running in challenging times, trainers teach, mentor and inspire future generations of doctors … ’ Policy – NES Postgraduate Med Ed Training Report (2017)