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Equipping junior doctors for a career in primary care

Why was the initiative launched?
What was done?
Has it made a difference?
Tips for success
To find out more contact

Finding ways to improve the quality of senior house officer posts around Portsmouth

Why was the initiative launched?

The last five years have seen the introduction of better educational structures for house officer and registrar grades but there have been no equivalent developments for the senior house officer grade. At this level the service commitment starts to overshadow the educational component of training posts. The publication in 1999 by the GMC of The Early Years was an attempt to describe what should be done. The real challenge is in making change happen.

The need for change was particular evident in general practice training. But the problems are often anecdotal and attempts to introduce change have been hampered by lack of information about each specific senior house officer post. The aim of this project was to improve the training by developing a mechanism for securing the views of SHOs on existing training posts.

What was done?

The work was based in two district general hospitals in Portsmouth. The first step involved the appointment of a course organiser in 1993 responsible for senior house officers training in general practice. Time (one session per week) was set aside specifically to enhance the general practice contact with, and improve the educational content of, senior house officer posts on general practice vocational training schemes. The work was overseen by the associate director and director of general practice education and the dean of postgraduate education.

From the beginning it was clear that a mechanism was required to assemble information about the posts and views on the quality of training provided. Comparisons over time and between posts would be essential. Current routine systems could not provide the information required so a questionnaire was designed which could be used six-monthly i.e., at the end of each posting. The design was based on experiences reported by others and the local design was piloted and assessed for validity and reliability.

SHO Questionnaire


Based on SHO Educational Audit Project (SEAP) questionnaire

Following the successful pilot, the questionnaire has been applied in the same format since 1994: it continues to be applied every six months. Data is assembled by Joan Dunleavy of the Wessex Research Network and reviewed by Mark Mullee of the Department of Computing and Statistics at Southampton University. Second mailings and telephone reminders achieve response rates of 95 to 100% where appropriate. Anonymised data is fed back in a variety of ways, by tables, bar charts etc. Data from the questionnaire is used alongside information collected from statements from senior house officers, consultants, course organisers, and clinical tutors and data available from other sources such as attendance register. So far 64 SHOs have taken part in the work as they rotated through sixteen different posts on the GP vocational training scheme.

Selected responses (1994-1998)
  1994 1996 1998
Number 21 26 22
Induction arrangements 48 27 72
Personal educational targets 24 65 45
Met GP trainer six monthly 52 46 95
Named educational supervisor 86 73 91
First appraisal 23 58 59

Problems suspected in posts have been confirmed such as low rates of induction, appraisal systems and contact with general practice. New problems that emerged were difficulty in obtaining study leave, low rates of consultation before contract changes, lack of clarity about routes for complaints, and lack of awareness about stress support. The system now in place allows information about the training posts to be provided on a regular basis to the course organisers and consultants involved. Care has been taken to ensure that the reports cover positive messages, where posts were doing well, as well as evidence of the need for change.

Has it made a difference?

Some examples of the changes, which have followed the introduction of the system, are:

♦ Introduction of GP orientated teaching sessions for all SHOs on a training rotation.
♦ Regular contact by almost all (95% ) of SHOs with their GP trainers.
♦ Reintroduction of teaching sessions to a post where this had been discontinued.
♦ An increase in appraisal (from 25% to 59%) of SHOs after consultants appraisal training.
♦ An increase in attendance at teaching sessions from 41% to 65%.

Since the completion of the development work, the questionnaire has been taken up by Southeast Scotland Region under Dr William Patterson as Director of Education and in other centres in the South and West. There has also been an increase in the number of course organisers being given specific responsibility for senior house officers training in general practice (scheme organisers) locally.

Tips for success

√ Leadership is important, and the appointment of one person to manage SHO training will increase the chance of success.
√ Build systems to provide reliable information about the nature and scale of problems.
√ Comparisons over time will be essential, so that the effect of interventions can be assessed and followed up.
√ Make sure that your ‘communications' are effective so that those who need to know do know about problems in training.
√ Help people to change by providing opportunities for discussion and where necessary further information about the justification for change.
√ Explicit statements of expected standards are needed to maintain momentum for change.

To find out more contact

Dr Mark Rickenbach
Course Organiser
School of Postgraduate Medicine
University of Portsmouth
St Mary's Hospital
Milton Road
Portsmouth PO3 6AD

Telephone 01703 252915

An information pack is available; including leaflets on the New Deal and Education Agreement for Wessex, a job description, questionnaire, study leave guidance, appraisal guidance, and an induction pack for SHOs. The pack includes also other recommended reading.

ImpAct bottom line

Make sure that you know what needs to change before making detailed plans. Don't rely on anecdotes. Make sensible use of questionnaires.


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