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European Journal of General Practice

ISSN: 1381-4788 (Print) 1751-1402 (Online) Journal homepage: http://www.tandfonline.com/loi/igen20

General practice vocational trainers in Europe —an overview

Isabel Santos & Vitor Ramos

To cite this article: Isabel Santos & Vitor Ramos (1995) General practice vocationaltrainers in Europe — an overview, European Journal of General Practice, 1:2, 71-74, DOI:10.3109/13814789509160765

To link to this article: https://doi.org/10.3109/13814789509160765

Published online: 11 Jul 2009.

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BACKGROUND PAPER

General practice vocational trainers in Europe - an overview Isabel Santos, Vitor Ramos

Objective: To give a global description of the current functions of general practitioner trainers in Europe. Methods: A survey has been carried out with a ques- tionnaire sent to all members of the European Academy of Teachers in General Practice (EURACT) Council during 1994. Results: In 16 countries general practice trainers have formal status and recognition; 19 countries have explicit procedures for selecting trainers; teacher train- ing programmes or courses are organised in 12 coun- tries; practices are the main training settings where trainers perform their educational work. A one-to-one relationship between trainer and trainee is the usual pattern. General practice trainers are formally remu- nerated in 13 countries. Conclusions: Although in most European countries general practice trainers are now well recognised and established, there are major needs in their training, educational and political support and assessment. Eur J Gen Practice, 1995; 1: 71-4.

Vocational training is an educational process of supervised experience which takes place in accredited practices with relevant hospital- based experience.’ The implementation of general practice vocational training programmes re- quires the development of educational resources, the most important being skilled trainers. The appropriate role model advocated for trainers is the one of facilitators of learning: to help the learner to learn and to enable the learner to engage in self-learning.3

Trainers may provide high-quality education to their trainees in the course of several activities: daily clinical work, critical discussion at scheduled times on off-the job situations, giving lectures, doing small group teaching, helping their trainees through informal counselling and,

Isabel Santos, family physician. Vitor Ramos, family physician. lnstituto de Clinica Geral zona sul, Largo Prof Arnaldo Sampaio, Centro de Satide de Sete Rios, 1500 LisbBa, Portugal. Correspondence to: Dr Isabel Santos.

Submitted: March 24th, 1995; accepted : April 28th, 1995.

from time to time, they should carry out routine appraisals of their trainee’s progre~s.~

According to Cooper and .Palmer trainers should be skilled practitioners who have in common several competencies: to provide an understanding of the nature of professional prac- tice, through the provision of learning opportunities and supportive intervention; to provide an enabling relationship that facilitates another’s personal growth and development; to observe, assess, advise and practise with another to en- able himher to attain professional skills; to enhance learn- ing by teaching, instructing, supervising and role m~delling.~

Hence, several countries have produced guidelines concern- ing the selection, training and evaluation of trainers.6-” These guidelines were explored at the workshop organised by the New Leewenhorst Group in 1987.12

In 1992, the European Union of General Practitioners (UEMO) adopted at its Plenum Meeting in Paris (May 1992) a statement on ‘Criteria for General Practitioner Trainers’. The aim of this statement is to support and en- courage the role of the general practitioner (GP) trainer in Europe because ‘the time spent by a doctor as a trainee in general practice is the most important component of the period of training and is vital in ensuring the acquisition of knowledge, skills and attitudes essential for a high standard of primary health care7.I3 General practitioner trainers are the key-element in the implementation and development of vocational training in general practice. They are a strategic factor in the de- velopment of high-quality general practice/family medi- cine. Hospital training plays a useful role in vocational training programmes but should not be the dominant component in the educational experience of general practitioners. l4

In spite of the importance given to trainers in most voca- tional training literature we do not have a picture of the current situation in each-European country. This paper in- tends to capture a global description of the current posi- tions of general practitioner trainers in Europe in terms of official status, selection, training, educational tasks, re- muneration, assessment and reaccreditation.

Methods This is an exploratory qualitative study done through a questionnaire, with closed and open questions (table l ) ,

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related to the following topics: ‘Status’ of the trainers; Se- lection of the trainers; Training the trainers; Training set- tings; Ratio trainerhrainees; Programme guidelines; Levels of educational involvement; Trainee participation; Remuneration; Assessment of trainers; Reaccreditation of trainers; Other aspects. The questionnaire was distributed twice to the members of the EURACT Council (European Academy of Teachers in General Practice) during the year of 1994. Members of the EURACT Council are general practitionedfamily doctors involved in GP education in their own countries, so it was assumed they could give ac- curate and correct responses. The open questions and the request for additional comments were intended to catch the nuances of the arrangements in each country. The results of the first questionnaire were presented six months later to the respondents in order to elicit more precise informa- tion and a second questionnaire with the same questions was passed in order to get more accurate and comparable infor- mation about each item.

Results The answers relate to 21 European countries and to Israel (ta- ble 1). Only 10% of the information given has been correct- ed from the first to the second questionnaire. The changes related to eight countries: Denmark, Finland, Germa- ny, The Netherlands, Portugal, Israel, Slovenia, Switzerland.

1 . Formal ‘status’ of the general practitioner trainer In 16 countries GP trainers have got formal status and re- cognition. Denmark, Estonia, Finland, Poland and Swit- zerland have not yet reached this situation. Formal status is in some countries recognised by a special government committee or organisation. In other countries it means aca- demic status with links to universities and national med- ical organisations.

2. Selection of trainers Nineteen countries have explicit procedures for selecting trainers. The exceptions are Austria and Estonia. There is considerable variation in these procedures. They range from very detailed assessments involving performance re- view to qualification based only on years in practice and/or to declared interest, motivation and availability for train- ing other colleagues. In Spain selection focuses on health centres rather than on individual trainers (accredited train- ing centres). In several countries the trainer’s attendance at specific teaching training courses is obligatory.

3. Training programmes Teacher training programmes or courses are organised in 12 countries. This educational requirement varies from short courses or day-release courses to a continuing pro- cess of meetings and workshops linked to the acquisition of training skills (Ireland, UK, Sweden).

4. Training settings GP practices are the main training settings where trainers perform their educational work. In countries with national

health services or similar systems, the community health centres and ‘polyclinics’ are important training settings for vocational training (Spain, Estonia, Finland, Israel, Nor- way, Poland, Portugal, UK, Slovak, Slovenia, Sweden, Croatia). With the exception of Belgium, Estonia, Spain and Poland, hospitals are not training settings for general practitioner trainers.

5. Ratio trainerltrainees A one-to-one relationship between trainer and trainee is the usual pattern. Small training groups of one trainer and two to six trainees (sometimes in different training years) exist in Spain, Estonia, Finland, Ireland, Portugal, Sweden and Croatia. In Belgium and Norway there are bigger training groups consisting of one to 15 trainees.

6. Programme guidelines Written programmes and guidelines exist in 17 countries. In some countries this type of document is in preparation. There is considerable variation in the content of the guide- lines, ranging from statements of general aims to detailed specific training objectives and syllabus (Israel, Portugal, UK, The Netherlands).

7. Trainee participation In general, trainees have a relatively passive role in shap- ing their training programmes, although in some countries their active involvement is encouraged (Belgium, Estonia, Finland, Hungary, Ireland, Norway, The Netherlands, Portugal, Sweden, Switzerland and UK). In Denmark, Hungary, Ireland, The Netherlands, Poland, Portugal and the UK, they participate in the assessment of their trainers.

8. Remuneration GP trainers are formally remunerated in 13 countries. The amount and the contractual conditions of these payments vary considerably from country to country. The source of funding is the government or the social security organisa- tion (Belgium, Spain, Estonia, Portugal, UK, Sweden), the university (Croatia, Hungary, Poland), the health care in- stitution (Slovenia) or the medical association (Germany, Norway, The Netherlands).

9. Assessmentlevaluation of trainers Denmark, Finland, Hungary, Ireland, The Netherlands, Norway Poland, Portugal, Slovenia and the UK have es- tablished continuing assessment of the educational per- formance of trainers but not all do it on a systematic ba- sis. In the UK assessment of trainers has been a mandatory process since January lst, 1993.

10. Reaccreditation of trainers Only Belgium, The Netherlands and Slovenia have a formal system for the reaccreditation of GP trainers. In the UK reaccreditation is done every two to three years.

1 1 . Levels of educational involvement of trainers In 16 countries some general practitioner trainers may be

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simultaneously involved in vocational training, under- graduate education and continuing education.

12. Other aspects In several countries strong efforts are being made to im- prove the conditions of trainers and legislation is expect- ed to support this development.

Discussion and conclusions Professional training is a sub-system of each health care system and the great diversity in the organisation of these systems all over Europe makes comparisons very difficult. The answers to the questionnaires reflect in some respects the personal perspective and the interpretation of each re- spondent about hisher country’s situation at one point in

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time and may have been influenced by value judgements, social or professional pressures.

Many terms used in the questionnaire do not have the same meaning for all countries and, sometimes, they are linked to different realities. In spite of all these problems and difficulties the authors believe that there is a set of common characteristics which must be considered funda- mental for the development of a GP trainers’ profile in Eu- rope:

1. Although in most European countries GP trainers are now well recognised and established, there are major needs relating to their training, educational support and assessment.

2. Since GP trainers have a key-role in the development of general practice/family medicine, they should be considered a priority when deciding on investments in human resources in the health care sector.

3. The interchange of information between countries can promote these processes.

4. Research on the educational performance and efficiency of GP trainers under different conditions and on the im- pact of GP vocational training on the quality of health care is needed.

Acknowledgements The authors are very grateful to the EURACT Council members for their collaboration: Dr Gertraud Rothe, Austria; Professor Jan Heyrman, Belgium; Professor Antun Budak, Croatia; Dr Ivar Ostergaard, Denmark; Dr Margus Lember, Estonia; Professor Marten Kvist, Finland; Dr Bernard Gay, France; Professor Michael Kochen, Germany; Professor Csaba Arnold, Hungary; Dr Michael Boland, Ireland; Dr Yonah Yaphe, Israel; Dr Victor Thielens, The Netherlands; Dr Dag Sovik, Norway; Dr Adam Windak, Poland; Dr Yvona Tisonova, Slovak; Dr Igor Svab, Slovene; Dr Dolores Fores,

Spain; Dr Anna Kallkvist, Sweden; Professor Werner Ringli, Switzerland and Dr Justin Allen, United Kingdom.

Author information Isabel Santos: coordinator of GPVT, deputy-director of ICGZS, Executive Council Member of E URACT. Vitor Ramos: Vice-president of UEMO.

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