Abstract
It was not all that long ago that I decided to pursue GP specialty training instead of continuing with specialist training in internal medicine. And perhaps just like some of you, I was unsure what to expect and burdened with concern about whether I would manage to jump through all the hoops in such a short time of training. Thankfully these fears, in the following few months and years, proved groundless.
Like many current GP trainees, as an international medical graduate I was trained in a different medical system and used to different roles and boundaries within and between primary and secondary care. For example, I was then spending 40 minutes with every new patient in some internal medicine clinics, and obsessed with the thought: ‘How can I ever be trained to see a patient in 10 minutes?’
I was unsure how I would adapt to the unique setting of NHS general practice, which was completely new to me. And how was I to adapt to unfamiliar cultural values, which seemed to differ from one part of the UK to another, let alone from where I came from? Does this sound familiar? Well, you are not alone.
What to expect
Having had posts in internal medicine and paediatrics within the UK, as well as internal medicine rotations in the USA, I was impressed with the one-to-one training and support built around GP training during GP posts. I was delighted with the weekly, rather than monthly, educational meetings. Even more surprising was the fact that I was working next door to an educational supervisor with an open-door policy and twice daily educational discussion that at first went through every case. This learner-centered strategy is part of the good reputation of GP training in the UK (Gavriel et al., 2014).
Additionally, there was extra support available from the Postgraduate School of General Practice to help ‘bridge’ the gap between my previous experiences and my new role. To be honest, at first, I was unsure why I was targeted with an offer to attend an extra course about communication skills, later I understood this was part of real efforts to support trainees from different backgrounds (Ahluwalia et al., 2019). I reminded myself that engaging with all available support had always been one key to my previous success. This helped me to recognise and enjoy the challenge I had set myself, and to understand some of the reasons why GPs trainees enjoyed high job satisfaction (Watson et al., 2011). This is not to say life is perfect in GP training.
In the hospital posts, I found the ‘duty of service provision’ could take a trainee’s focus away from training more than other training settings I had experienced (e.g. in the USA), Sometimes I found myself ‘sucked-in’ to working hard to maintain adequate service provision, occasionally made worse by absences (e.g. covering for a sick colleague). Though some hospital departments did appreciate the training needs of GP trainees more than the others, at the end of the day, as patient safety comes first, I had to rise to these demands often.
It is therefore very important to use your time in hospital rotation wisely as a GP trainee. The best advice I can give is to ‘stay primary care-focused’ during hospital placements. It is important to plan your hospital rotation properly. Do not be afraid to ask for the experience you need: ‘Yes I will assist in major surgeries if and when it is absolutely necessary, but I also need to learn skills that are transferable to primary care, for instance in out-patient clinics’. Of course, all service provision can be an important source of experience in clinical learning, but keeping the focus on the capabilities described in the general practice curriculum is vital to maximise the relevant learning from hospital posts.
To ensure quality of training, there is also an innovative e-portfolio that helps you track your progress against the GP curriculum. Although it is by no means perfect, fully engaging with it from the beginning lays the foundation for a good overall educational experience. I remember sometimes sitting at the end of the day during a quiet moment, reflecting on what I had done well and what could have gone better. A key to success is to allow time for this self-reflection that helps direct your educational needs (Van Der Gulden et al., 2020). Though it does not come naturally to everyone, it gets easier and is important to avoid the pressure of falling behind.
I wish you every success in your educational endeavors and future careers. If I was able to be successful, I am sure you will be too.
