Exploring perceptions of doctors in GP specialty training with specific learning difficulties undertaking clinical and work place-based assessments for GP licensing: interview study

Problem

Increasing numbers of doctors in training have specific learning difficulties (SpLDs), where failure to provide reasonable adjustments or accommodations can disadvantage them academically. There is limited evidence for how SpLDs affect performance in different types of licensing exams, particularly in Workplace-Based Assessment (WPBA). We explored perceptions of GP speciality trainees (GPSTs) with SpLDs on the challenges of clinical and WPBA for general practice licensing, and strategies for overcoming these.

Approach

We used a qualitative design employing Systematic Grounded Theory using inductive methods aimed towards theory development, involving the three steps of open, axial and selective coding. We recruited GPSTs through a national advert and social media, and following informed consent, interviewed them individually online via Teams using a semi structured schedule, recording and transcribing these verbatim. We interviewed 18 GPs with SpLDs at various stages of training, both male and female, with primary medical training in the UK or overseas, across different UK GP training schemes with dyslexia and comorbid disabilities.

Findings

We identified seven themes: 1. Late detection: Identifying SpLDs in doctors with an overseas primary medical qualification, was sometimes more difficult and often occurred later because of lack of screening in their home country, together with language and cultural barriers. 2. Need for early diagnosis: A formal educational psychological assessment was needed and previous failed exam attempts were not discounted before a formal diagnosis of dyslexia. 3. Difficulties in learning and assessment: Difficulties processing information made training and assessment more difficult. 4. Educational environment: Note taking was challenging in hospital environments where consultants were critical when this was slow, whereas working in a GP setting was more supportive. 5. Emotional impact and wellbeing: GPSTs with SpLDs reported low self-esteem, stress and anxiety. 6. Reasonable adjustments: Extra time was helpful for consultations, exams and workplace assessments, and dictation software helped GPSTs complete the e-portfolio. 7. Solutions: These included, raised awareness and training for educational supervisors on dyslexia to provide appropriate support, reduce stigma and ensure understanding of their trainee’s way of learning; recommendations for peer support such as social forums for trainees with SpLDs; prompts for supervisory check-ins; benefits of disclosing dyslexia to trainers; educational equipment; adaptions to marking schemes “because I can ask a question, and part of the marking scheme is that you don’t repeat because obviously if you repeat, it sounds like you’ve not been listening”; lengthening consultation and exam times, clearer guidance on clinical assessments; and compliance with these highlighting that supervisors were “going against the guidelines for someone with a disability and “not following the recommendations”.

Consequences

This study identified a range of problems and specific strategies required to support and overcome the challenges related to clinical and WPBA of doctors with specific learning difficulties in GP training.