Situating general practice training in the general practice context

Goldie and Morrison¹ are right to emphasise the importance of the general practice context for postgraduate general practice training. In 1919 Sir James Mackenzie stated ‘the teacher of practical matters must be one who experiences what he teaches. We all recognise that the best teacher for one who wants to be a shoemaker is the man who is in the habit of making shoes. Unfortunately, this common-sense idea is rarely applied to medical education’.²

In 1952, the same year that our college was founded, the first integrated general practice training scheme pilot was set up in Inverness. Senior house officer level trainees had a 2-year contract to train concurrently in hospital and general practice. They were based for that whole period in one general practice. They started full-time in the practice for a few weeks and then spent 2–4 half-days every week in the same practice. The rest of the time was spent as a supernumerary experiencing different hospital departments and clinics according to their educational needs. They reported valuing the range and flexibility of the scheme.³

The compulsory postgraduate training for general practice that started in 1982, requiring at least 2 years post full GMC registration in hospital and 1 year in general practice, seems in retrospect, almost a regression from the Inverness scheme of 30 years earlier.

Goldie and Morrison make important and relevant contextual observations about reflective practice, being part of a community of practice, and progressing through the Dreyfus model of skill acquisition. Current trends moving the delivery of care formerly given in hospital, to the community, and the super-specialisation of hospital departments, make this an opportune time to remove GP training from hospital, where what can be learned becomes less relevant to the future GP.

If the proposed 4-year trajectory of training for general practice that is currently mooted, becomes accepted, then there will be a real opportunity for trainees to spend, at the very least, 2 years training within general practice, in the community of practice in which their futures will be spent.