An evaluation of community placements for GP registrars in Yorkshire and the Humber: ‘a home visit… not to a patient but to the community’

ABSTRACT

Background

GP registrars are required to demonstrate capabilities in ‘community orientation’, reflecting skills in developing and working with services that respond to community needs. These skills have sometimes been seen as vague and difficult to obtain. In the Yorkshire and the Humber Deanery of Health Education England we developed a novel programme of community placements to overcome this. Registrars spent two half-days with a community organisation of their choosing, working in their practice area.

Aim

To evaluate if and how community placements enabled registrars to develop capabilities in community orientation.

Methods

All registrars completing placements were invited to participate in the evaluation; 13 (7%) accepted. Semi-structured, face-to-face and telephone interviews explored registrars’ perceptions and experiences of the programme. Interviews were audio-recorded, transcribed verbatim and analysed thematically.

Results

The majority of participants reported that placements enabled them to attain a range of capabilities in community orientation. Registrars described an improved understanding of their practice community and the social determinants of health. Placements impacted their clinical practice by stimulating a holistic approach to the assessment and management of health needs. Our analysis described five key mechanisms for this learning: building confidence, building communities and networks of practice, gaining novel perspectives, generating a hunger for general practice and experiential learning.

Conclusion

Community placements enabled GP registrars to attain capabilities in community orientation. Further research is required to determine the transferability of our findings and further evaluate mechanisms of learning through placements outside of training and their role in the development of professional practice.

KEYWORDS:

• General practice
• medical education (graduate)
• community medicine
• social accountability
• social determinants of health

Acknowledgments

We thank participants, the relevant training programme directors and scheme administrators, who supported the recruitment of registrars. We thank the third sector organisations for hosting the registrars, for giving up their time, and sharing their expertise.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Ethical statement

Ethical approval was sought and obtained from the Hull and York Medical School Research Ethics Committee (Approval number: 1941).

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.