Medical student and trainee doctor views on the ‘good’ doctor: Deriving implications for training from a Q-methods study

Abstract

Purpose

In context of changing patient demographics, this study explores what doctors and medical students believe being a ‘good’ doctor means and identifies implications for training.

Method

Using Q-methodology, a purposive sample of 58 UK medical students and trainees sorted 40 responses to the prompt ‘Being a “good” doctor means….’ Participants explained their array choices in a post-sort questionnaire. Factor-groups, consensus and distinguishing statements were identified using Principal Components Analysis in R.

Results

Three factor-groups best described shared and divergent perspectives, accounting for 61.64% of variance. The largest, ‘patient-centred generalist’ group valued patient wellbeing and empowerment, compassion and complex needs. They prioritised knowledge breadth and understanding other specialties. The ‘efficient working doctors’ group valued good work-life balance, pay and did not seek challenge. Some believed these made a stressful career sustainable. The ‘specialist’ group valued skills mastery, expertise, depth of knowledge and leadership. Participant-groups were distributed across these factor-groups, all agreeing early specialisation should be avoided.

Conclusions

The largest factor-group's perceptions of holistic, patient-centred care align with Royal Colleges’ curricula adaptions to equip doctors with generalist skills to manage multi-morbid patients. However, curriculum designers should acknowledge implications of generalist approaches for doctors’ formulation of professional identities.

Keywords:

• Q-methodology
• Q-sort
• doctors training
• generalist doctors
• patient-centred care
• broad-based training

Acknowledgements

The broad-based trainees who participated were recruited as part of work commissioned by the Academy of Medical Royal Colleges and funded by Health Education England. The authors acknowledge this funding and also the contribution of members of that project team (Katie Webb, Lynne Allery, Lesley Pugsley and Janet MacDonald) to the organisation of the collection of data from those participating in the BBT evaluation. The authors extend their gratitude to all the study participants who gave generously of their time in data gathering activity.

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this article.

Additional information

Notes on contributors

Jennifer Coventry

Dr Jennifer Coventry, MBBCh, BSc, PGCert, is currently a junior doctor working as an Education Fellow in Medicine based in Bristol. She has an interest in medical education and Leadership in Healthcare.

Jennifer May Hampton

Dr Jennifer May Hampton, PhD, MSc, BSc, is a senior research officer at the Office for National Statistics and former Research Associate of the Wales Institute of Social and Economic Research and Data (WISERD). Jennifer has a background in statistics and quantitative social science, working in the linkage and statistical analysis of large scale and administrative data.

Esther Muddiman

Dr Esther Muddiman, PhD, MSc, BSc, is a Lecturer in Education at the Cardiff University School of Social Sciences with a special interest in learner identities, youth activism and intergenerational justice.

Alison Bullock

Alison Bullock, PhD, PGCE, BA, is professor of medical and dental education and Director of the Cardiff Unit for Research and Evaluation in Medical and Dental Education (CUREMeDE) at Cardiff University. Her research focuses on the postgraduate and continuing education of healthcare professionals.