Catch 22

These are challenging times for health care delivery. Population demands on clinicians are increasing. Concomitantly recruitment to the workforce falls. As both factors join to demotivate doctors this creates a Catch 22 situation. Negativism inevitably then invades the workplace deterring potential students and graduates. The recruitment crisis is exacerbated rather than rescued [1]. As the Lancet commission on ‘Health Professionals for a New Century’ conceptualises, population needs drive both health and education which are intertwined [2]. Add in cutbacks to training budgets and, it is perhaps inevitable that, when we urgently need to explore alternative avenues for delivering education, the impetus to research and write on education is the front-line casualty. At a time when health care moves increasingly into the community to address the needs of an aging population, so must education. As the Lancet report states. ‘20th century educational strategies are unfit to tackle 21st century challenges’ [2]. At this journal, we are concerned that the pressures on the workforce are impeding our capacity to nurture innovation and research to build evidence for change.

It was therefore heartening to join Dr Eliot Rees (an aspiring GP currently doing a PhD in medical education) to run a workshop with the young members of TASME (Trainees in the Association for the Study of Medical Education). The predominant participant feeling about getting published was ‘excited’- seconded though by ‘nervous’, ‘difficult’ and ‘tired’. This is a key time to encourage the young to innovate, ask questions, research and write in both undergraduate and postgraduate education but they need support. Overcoming the pressures currently deterring them is crucial. I assume the same pressures impact on trainers and educators across primary care. We are in discussion with UK COGPED (Committee of GP Education Directors) and COGMED (Conference of Postgraduate Medical Deans) to explore ways of supporting research at this crucial time.

It is indeed an exciting time to explore and publish. In undergraduate education the emergence of five new medical schools in England, aiming to recruit, train and retain in the under doctored UK rural and coastal areas, must open avenues for innovation. As does the increasing use of longitudinal clerkships and wider NHS contexts for training; the ScotGEM project is an example [3]. It is good to see in this issue a literature research from Dublin on CPD for doctors in rural areas. This opens exploration of any impact extending education into these areas may have. A leading article on global standards, developed by the World Organisation of Family Doctors (WONCA), to support and quality assure CPD for GPs, furthers our international understanding.

We offer some developing ideas for vocational training. An evaluation article reports outcomes from a Scottish Primary Care Paediatric Scholarship; an exciting move to develop joint postgraduate training between primary care and paediatrics. I invited commentary from Health Education South London who are also piloting joint training schemes between GP and Paediatric trainees [4]. Keeping abreast assessment is also a must. Current formats should not be set in stone. Another Irish group, in Cork, has looked critically at research related to the UK MRCGP Clinical Skills Assessment (CSA). An invited commentary from John Norcini sets this in the international context.

To return to our young TASME trainees keen to publish. Developing an impact factor for the journal remains a high priority. This requires quality research which can be accessed, disseminated and cited. Embracing social media and increasing our altmetrics is a further aim. We rely on authors both to access and use their 50 free downloads and submit any twitter handles we can use to disseminate. Please help us with this.

Wikipedia defines Catch 22 as ‘a paradoxical situation from which an individual cannot escape because of contradictory rules [5].’ We need to overcome the inevitable pressures and conflicts within the NHS and nurture our young trainees. They appear keen to research innovative ways to resolve negativism and move Education for Primary Care forward. After all, most Nobel Prize researchers were productive between 20 and 30 years of age. Medical students and trainees may therefore offer us the way out of the paradox.

Val Wass
[email protected]