Who wants to be a GP?

#GPFUQ 171 Who wants to be a GP?  Surveys of UK medical graduates show that in the 1970s, over one-third of all newly-qualified doctors wanted careers in general practice, rising to 44% in 1983, but falling to 20% in 1996. A study in 2011 of cohorts of 2000, 2002, 2005, 2008, and 2009 showed the percentages of doctors who expressed an unreserved first choice for general practice in the first year after qualification, in the successive five cohorts, were 22.2%, 20.2%, 23.2%, 21.3%, and 20.4%. Percentages who expressed any choice for general practice, whether first, second or third, were 46.5%, 43.4%, 52.6%, 49.5%, and 49.9%. Three years after qualification, an unreserved first choice was expressed, in successive cohorts, by 27.9%, 26.1%, and 35.1%. Doctors from newly established English medical schools showed the highest levels of choice for general practice.

Information about early career preferences matters because early choices for general practice are highly predictive of eventual careers. For example, in previous cohorts 82% of doctors who specified that they wanted to become GPs in year 1, and 92% who specified this in year 3, eventually practised as GPs.

#GPFUQ 172 How do medical graduates choose a career?  We don’t know but likely influences  include,  student perspectives of the demands, rewards, and prestige of the specialty; national dialogue about health care reform; turbulence in the economic environment; lifestyle issues; the advice in medical school, the impact of faculty role models, peer group pressures and the availability of opportunities.

#GPFUQ 173 Will we have enough GPs in the future?  We can hope. The production of all doctors and GPs in particular remains insufficient to meet the current and anticipated need to support the UK's NHS infrastructure.’

#GPFUQ  174 How does learning happen in general practices Most learning in small organisations takes place in the workplace through work processes. It is multi episodic, mostly informal, usually problem based and takes place on a just in time basis. Despite the reality of how we actually learn, most organised learning on offer still tends to be based on a traditional model with modules, lectures and seminars and these are increasingly transferred from face to face interactions to onscreen interactions, but still keep the standard tutor/student relationship and the reliance on formal and standardized course material and curricula. Reviews of the effectiveness of  "traditional" style e-learning in health care show that there is little evidence of change in behaviour or improved patient care and suggest that change in behaviour requires a social /collaborative approach that allows the exchange of explicit and tacit knowledge. Such social/collaborative approaches applied face-to-face have been shown to work when bringing together professionals to share their experiences and learn together using problems based on their own working experience However, attempts to introduce online collaborative learning have often failed, perhaps due to a lack of understanding of the health care context and user requirements.

#GPFUQ 175 What is Bellman medicine? The belief that repetition is a form of validation. It’s from The Bellman in Louis Carroll’s The Hunting of the Snark. It’s the continued presentation of discredited data, or the disregard of data from an another study which comes to a different conclusion

#GPFUQ 176 What’s the latest in educational reform? Three generations of educational reforms characterise progress during the past hundred years. The first generation at the beginning of the 20th century taught knowledge from a science-based curriculum.  Around the mid twentieth century, the second generation introduced problem-based learning, and taught any relevant knowledge that would help solve the problem.  The next generation is now evolving.  This is systems sourced solving and is will provide a work environment in which core professional competencies get automatic support and teaching in specific contexts, whilst drawing on global knowledge to improve the performance of health systems