Training for the future

The one real object of education is to have a man in the condition of continually asking questions. [1]

The Lancet report on Health Professionals for a New Century [2] highlights the importance of education as a driver for workforce change. If training strategies for primary care are to respond to the rapid advancement of global health care we must continue to look forward and ask questions. An openness and sensitivity to learner expectations from initial experience at medical school through to revalidation is essential; a perspective this journal very much aims to achieve. Through EPC we can help strengthen the argument, and most importantly, the evidence for change. The United Kingdom Foundation Programme Office’s most recent figures [3] suggest that only 22.8% of doctors exiting from the residency two year Foundation Programme enter vocational training for primary care. This remains a stark contrast to the 50% general practitioner workforce contribution the government is aiming for.

Work currently in progress to understand how medical students view General Practice (GP) as a career, highlights the need for a strong future vision for Primary Care. Within the culture of UK Health Care the status of primary care is perceived as low compared to secondary care; indeed the available literature suggests this is a wide spread international problem. Medical students want to see a stronger competitive profile for GP training which would place a career in primary care on equal footing with secondary care. Why does it take only three years to train a GP but seven years to become a surgeon? Why are students still being told they are too bright to be a GP? Where are the academic pathways in primary care which those heading for secondary care are so keen to achieve? Hobbs et al. [4] have now definitively demonstrated the change in GP workload in the UK and its increasing complexity. It is time to take stock, listen to the views of those who will be practising in future and attract the brightest and best into primary care.

To achieve this, a serious review of the image primary care vocational training offers to the young may be needed. I am delighted that Graham Easton, as a member of our Editorial Board, has offered a guest editorial which argues for a vision for GP training more rooted in a culture of scholarship and research. This connects completely with expectations of our academically gifted medical students who are telling us they want primary care perceived to be on par with secondary care. The figures speak for themselves: in the UK there are only 200 GPs with academic posts alongside their clinical responsibilities compared to 3000 clinical secondary care academics. Students are telling us this must change.

So it is good to see that the articles we are being offered for the journal look forward and embrace the continuum across undergraduate and postgraduate training. The leading articles cover the need for more exposure to longitudinal attachments in UG training, strategies to strengthen skills training in GP and an argument for more human factor training to address risks to patient safety. They reference literature on which to build the evidence for evaluation and research to provide a foundation for change. The peer reviewed articles now distinguish clearly between ethically approved research and evaluation and all highlight areas where more evidence is needed. Indeed in this issue the commentary on an article from Joffe et al. raises many interesting questions on traits and gender difference in personality and how these may impact on GP training. At the same time the journal’s International perspective is widening. Indeed we are grateful to Professor Ruki Kassai for his enlightening Three Papers review from Japan. This is timely as it coincides with the green review of Roger Neighbour’s new book. Ruki and Roger have been working closely to further GP vocational training in Japan.

So plenty of food for thought offering much fodder from which to build the scholarship and research Easton et al. argue for. If we are to address the current crisis in GP recruitment then there is a clear message that to engage students in a career General Practice we much continue to ask questions of our educational strategy.

Val Wass
[email protected]