Muddiman E, Bullock A D, MacDonald J, Allery L, Webb K L, Pugsley L
Cardiff Unit for Research and Evaluation into Medical and Dental Education (CUREMeDE), Cardiff University School of Social Sciences, Cardiff, UK.
Cardiff University School of Postgraduate Medical and Dental Education, Cardiff, UK.
BMJ Open. 2016 Sep 6;6(9):e011239. doi: 10.1136/bmjopen-2016-011239.
An increase in patients with long-term conditions and complex care needs presents new challenges to healthcare providers around the developed world. In response, more broad-based training programmes have developed to better prepare trainees for the changing landscape of healthcare delivery. This paper focuses on qualitative elements of a longitudinal, mixed-methods evaluation of the postgraduate, post-Foundation Broad-Based Training (BBT) programme in England. It aims to provide a qualitative analysis of trainees' evaluations of whether the programme meets its intentions to develop practitioners adept at managing complex cases, patient focused care, specialty integration and conviction in career choice. We also identify unintended consequences.
9 focus groups of BBT trainees were held over a 12-month period. Discussions were audio-recorded and subjected to directed content analysis. Data were collected from trainees across all 7 participating regions: East Midlands; West Midlands; Severn; Northern; North Western; Yorkshire and Humber; Kent, Surry and Sussex.
Focus group participants (61 in total) from the first and second cohorts of BBT.
Evidence from trainees indicated that the programme was meeting its aims: trainees valued the extra time to decide on their onward career specialty, having a wider experience and developing a more integrated perspective. They thought of themselves as different and perceived that others they worked alongside also saw them as different. Being different meant benefitting from novel training experiences and opportunities for self-development. However, unintended consequences were feelings of isolation, and uncertainty about professional identity.
By spanning boundaries between specialties, trainee generalists have the potential to improve experiences and outcomes for patients with complex health needs. However, the sense of isolation will inhibit this potential. We employ the concept of 'belongingness' to identify challenges related to the implementation of generalist training programmes within existing structures of healthcare provision.
患有长期疾病且有复杂护理需求的患者数量增加，给发达国家的医疗服务提供者带来了新的挑战。作为回应，已制定了更广泛的培训计划，以使学员更好地为不断变化的医疗服务格局做好准备。本文重点关注对英格兰研究生基础后广泛培训（BBT）计划进行纵向、混合方法评估的定性要素。其目的是对学员对该计划是否实现其培养善于管理复杂病例、以患者为中心的护理、专科整合以及职业选择信念的从业者的意图的评估进行定性分析。我们还确定了意外后果。
在12个月的时间里，对BBT学员进行了9次焦点小组讨论。讨论进行了录音，并进行了定向内容分析。数据收集自所有7个参与地区的学员：东米德兰兹；西米德兰兹；塞文；北部；西北部；约克郡和亨伯；肯特、萨里和苏塞克斯。
来自BBT第一批和第二批学员的焦点小组参与者（共61人）。
学员的证据表明该计划正在实现其目标：学员重视有额外的时间来决定他们未来的职业专科，拥有更广泛的经验并形成更综合的观点。他们认为自己与众不同，并认为与他们一起工作的其他人也认为他们与众不同。与众不同意味着受益于新颖的培训经历和自我发展的机会。然而，意外后果是孤独感和职业身份的不确定性。
通过跨越专科之间的界限，实习全科医生有潜力改善有复杂健康需求患者的就医体验和治疗结果。然而，孤独感将抑制这种潜力。我们运用“归属感”的概念来确定与在现有医疗服务提供结构内实施全科医生培训计划相关的挑战。
