What's another year? A qualitative evaluation of extension of general practice training in the West of Ireland.

UNLABELLED: Vocational training in general practice has been shown to be effective in developing skilled, competent, independent practitioners. Nevertheless, many commentators have suggested that the traditional three-year training programme in the UK and Ireland does not prepare general practice registrars (GPRs) fully for independent practice and that extension of the general practice component of training would enhance capability development. This study describes the experience of one Irish training programme (the Western Area Training Programme in General Practice) during its transition from a three- to a four-year programme.
METHODS: This study used focus group interviews to compare and contrast the expectations and experiences of three distinct groups: General practitioners (GPs) who completed the traditional three-year training programme and were interviewed after one year of independent practice. GPRs who were the first entrants into the new extended year of training who were interviewed at the beginning and at the end of the year. GP trainers who were the first trainers involved in the extended year of training who were also interviewed at the beginning and at the end of the year.
RESULTS: The registrars who completed the extra year felt better prepared for independent practice than their counterparts who had completed the traditional shorter scheme, due mainly to an increased sense of professional confidence, a broader experience of different practice approaches, a greater knowledge of practice management and the additional career guidance received during their final year. Trainers and registrars described a different type of training relationship in the fourth year. The relationship could be described as more one of mentorship than a traditional trainer-trainee relationship. The customized design of the year provided an easier transition into independent practice than the sudden change experienced in the traditional programme but trainers felt that the flexibility offered could create unrealistic expectations of the reality of finding time for continued learning in general practice. Future research is suggested including followup studies of extended programmes to assess whether the apparent benefits detected in this study influence subsequent personal and practice development. It would also be valuable to explore the effects of the extended programme on the other stakeholders such as the programme directing team, the patients and other training practice team members.