Mentoring to address differential attainment of international medical graduates in GP training.

INTRODUCTION: International Medical Graduates (IMGs) form an important and valued part of the United Kingdom's (UK) medical workforce but many experience difficult transitions into the National Health Service workforce. Mentoring could support IMGs as they transition into their role as General Practice (GP) trainees but there is a lack of evidence about whether mentoring is an effective intervention for this group. AIM: To evaluate the effectiveness of the NHS Education for Scotland (NES) GP mentoring programme from the perspective of mentors and mentees. METHOD: Twelve medical educators (the mentors) provided mentoring to 19 IMG GP trainees (the mentees) who were within their first six months of entering GP training in Scotland. Each mentee received four 60-minute mentoring sessions via video conferencing. RESULTS: Mentoring provided tailored support to assist IMG GP trainees' holistic transition into UK General Practice. Mentees appreciated talking to a non-supervisor, receiving non-judgemental support and protected time with a supportive listener to overcome challenges. This had a positive impact, even for those who did not anticipate the need for such support. Mentors supported diverse needs and tailored meetings, experiencing a distinct shift from previous supervisor roles. Their diverse experience enhanced their role and they developed new skills. CONCLUSION: Mentoring could provide significant support to IMG GP trainees but comes with certain challenges. Future research should evaluate the long-term impact of the NES GP IMG mentoring programme.

Training the trainer in general practice: the perceived value of independent peer feedback for learning activities.

PURPOSE OF THE STUDY: To complete the compulsory training course for prospective GP trainers in Scotland, participants must submit criterion audit and significant event analysis reports and a video of six consultations for independent review by trained peers. This study aimed to determine if feedback provided on these learning activities, using the NHS Education for Scotland peer review model, was perceived to be feasible and acceptable and to have an educational impact. STUDY DESIGN: A mixed methods approach used data from interviews to inform the development of a questionnaire which was sent to all course participants between 2005 and 2007. RESULTS: The number of questionnaires returned was 55/65 (85%). Peer feedback for learning activities was reported to be feasible and acceptable to participating GPs. The number of participants who scored greater or equal to four out of seven in a statement relating to perceived improvements in practice as a result of peer feedback was 37/55 for criterion audit, 42/55 for significant event analysis and 46/55 for videoed consultations. Mean perceived knowledge and skills ratings improved by 1.2 (P < 0.001) for criterion audit, 1.0 (P < 0.001) for significant event analysis and 0.6 (P < 0.001) for video of consulting. CONCLUSIONS: The peer feedback model utilised was perceived to be feasible, acceptable and educationally valuable in the learning and development of potential GP trainers in this survey.

What is a good general practitioner (GP)? The development and evaluation of a multi-source feedback instrument for GP appraisal.

BACKGROUND: Although multi-source feedback (MSF) has been used in primary healthcare, the development of an MSF instrument specific to this setting in the UK has not been previously described. The aims of this study were to develop and evaluate an MSF instrument for GPs in Scotland taking part in appraisal. METHODS: The members of ten primary healthcare teams in the west of Scotland were asked to provide comments in answer to the question, 'What is a good GP?'. The data were reduced and coded by two researchers and questions were devised. Following content validity testing the MSF process was evaluated with volunteers using face-to-face interviews and a postal survey. RESULTS: Thirty-seven statements covering the six domains of communication skills, professional values, clinical care, working with colleagues, personality issues and duties and responsibilities were accepted as relevant by ten primary healthcare teams using a standard of 80 percent agreement. The evaluation found the MSF process to be feasible and acceptable and participants provided some evidence of educational impact. CONCLUSION: An MSF instrument for GPs has been developed based on the concept of 'the good GP' as described by the primary healthcare team. The evaluation of the resultant MSF process illustrates the potential of MSF, when delivered in the supportive environment of GP appraisal, to provide feedback which has the possibility of improving working relationships between GPs and their colleagues.

What are the concerns of prospective responsible officers about their role in medical revalidation?

INTRODUCTION: The Health and Social Care Act 2008 sets out the requirement for the introduction of responsible officers for the NHS. The paper states that these individuals will be responsible for ensuring that doctors who are revalidated meet the required standards. It is not known how well prepared prospective responsible officers are for their new role. METHODS: Semi-structured interviews were conducted with 12 medical directors from Scottish health boards who agreed to participate. RESULTS: Prospective responsible officers remain uncertain about their role in medical revalidation. Specific concerns were raised: (1) What will responsible officers be responsible for? (2) How can appraisal be quality assured? (3) How will the information requirements for revalidation be met? and (4) How can organizations meet the requirement for revalidation? CONCLUSION: We found important issues regarding the arrangements for revalidation which have not previously been described which may impact on the effectiveness of prospective responsible officers.

Acceptability and educational impact of a peer feedback model for significant event analysis.

CONTEXT: A model of independent, external review of significant event analysis by trained peers was introduced by NHS Scotland in 1998 to support the learning needs of general practitioners (GPs). Engagement with this feedback model has increased over time, but participants' views and experiences are largely unknown and there is limited evidence of its educational impact. This is important if external feedback is to play a potential role in appraisal and future revalidation. OBJECTIVE: The study aimed to explore aspects of the acceptability and educational impact of this external feedback model with participating GPs. METHODS: Semi-structured interviews were carried out with nine GPs. Participants were sampled to reflect their level of learning need (low, moderate or high) to gain a range of views and experiences. Transcribed interviews were analysed for content. RESULTS: This system of external peer feedback is generally acceptable to participants. It complemented and enhanced the appraisal process. External feedback had positive educational outcomes, particularly in imparting technical knowledge on how to analyse significant events. Training issues for peer reviewers were suggested that would further enhance the educational gain from participation. There was disagreement over whether this type of feedback could or should be used as supporting evidence of the quality of doctors' work to educational and regulatory authorities. CONCLUSIONS: The findings add to the evidence for the acceptability and educational impact of external review by trained peers. Aligning such a model with the current national appraisal system may provide GPs with a more robust demonstration of participation in reflective learning.