Experiences of GP trainees undertaking workplace-based assessments for general practice licensing

Problem

Workplace Based Assessment (WPBA) is a component of the Membership of the Royal College of General Practitioners licensing examination for UK general practice. It provides evidence of learning and professional development recorded in the Trainee Portfolio assessed at an Annual Review of Competence Progression (ARCP) panel. Following the ARCP Panel, trainees are awarded an ARCP Outcome. Outcomes 1 and 6 “reflect satisfactory progress in achieving the required capabilities for the stage of training as defined in the curriculum”. Over the past four years there has been an increase in the number of Outcome 2s and 3s (reflecting “that development of capabilities is required”) awarded. Outcome 2 “is used where development is required without additional training time”. Outcome 3 “is used where development and additional training time are required”. We explored experiences of General Practice Speciality Trainee (GPSTs) undertaking WPBA to understand their perceptions of why they felt they had been awarded an Outcome 2 or 3.

Approach

We conducted a qualitative interview study with GPSTs using purposive sampling focussing on those in any stage of UK general practice training with previously recorded outcome 2 or 3 at ARCP. After ethics approval, the study was advertised through the Trainee Portfolio. Following this, participants contacted researchers to express interest and to arrange an appointment for individual interviews. This was enhanced by a snowballing technique, with participants already identified serving as key informants to recruit further eligible participants to the study. Data were collected using semi-structured interviews lasting 40 – 60 minutes. Interviews were recorded, transcribed verbatim and analysed using a grounded theory approach facilitated by NVivo 14 software. Data collection and analysis stopped when data saturation was reached.

Findings

We identified eight themes covering perceived problems: 1. Early intervention and responding to GPSTs’ learning needs as earlier opportunities to support learning were being missed. 2. More guidance on how to avoid achieving an outcome 2 or 3 as GPSTs experienced difficulties and lacked information navigating the e-portfolio. 3. Perceptions of how WPBA reflected trainees’ performance: GPSTs felt their performance was not accurately reflected in the Trainee so far Portfolio which some participants felt was not user friendly, so they lacked trust in the process and felt powerless. 4. Communication difficulties: included lack of support from supervisors and peers. 5. Challenges of the hospital setting: it was felt that hospitals were less than an ideal setting for GP training. 6. Insufficient time completing assessments: GPSTs felt undervalued, while clinical supervisors were too busy to provide time for assessments. 7.Cultural and communication barriers: International Medical Graduates (IMGs) were unfamiliar with UK healthcare systems because of previous study abroad. 8. Deficiencies in clinical supervision: GPSTs felt inadequately supervised and felt the descriptions and explanation of assessments and competencies were not clear.

Consequences

Suggested solutions are aimed at supporting and overcoming potential challenges to undertaking WPBA during GP speciality training.