How can GP registrars be supported to develop capabilities in community orientation?

Problem

GP registrars are required to demonstrate capabilities in ‘community orientation’, reflecting an understanding of their practice community and the social determinants of health and developing and working with services that respond to needs of the practice population. These skills are often viewed as vague and difficult to obtain by both registrars and their supervisors, and the evidence base of how best to support this learning is lacking. In the Yorkshire and the Humber (UK) deanery a novel scheme of community placements was developed, in which all first-year registrars spent two half-days with a community or voluntary organisation of their choosing, working in their practice area. Our study sought to establish if community placements enabled registrars to develop their skills in community orientation and if so, through what mechanisms of learning they were able to achieve this.

Approach

We conducted a qualitative evaluation study with the goal to determine ‘merit and worth’ in regard to attaining capabilities in community orientation. All GP registrars who undertook the placement were eligible and invited to take part. Face-to-face or telephone semi-structured interviews were conducted with the registrars who responded. Interviews were audio-recorded, anonymised and transcribed verbatim. Interviews were analysed using thematic analysis with a constant comparative approach to describe key themes.

Findings

Twelve of the thirteen interviewees reported that their placements enabled them to attain capabilities in community orientation, including an improved understanding of their practice community and the social determinants of health and by stimulating a more holistic approach to the assessment and management of health needs. Our analysis described five key mechanisms for this learning: building confidence, building networks of practice, gaining novel perspectives, generating a hunger for general practice and through experiential learning. Registrars related the depth of their learning to the ability to learn alongside service users and volunteers in novel contexts. The mechanisms of learning were common to all registrars, regardless of their age, gender, or the deprivation index of their practice. Registrars connected the nature of their learning to their previous experiences in training, with international graduates reporting a substantial amount of novel learning about the context specific determinants of health and services available.

Consequences

Community placements enabled registrars to develop competencies in community orientation through a number of mechanisms of action for learning. This study highlights the value of placements outside of conventional training for the development of holistic professional practice. Educators should consider the role of such placements, which provide opportunities for experiential learning with local organisations supporting communities with issues that are relevant to registrar’s everyday practice. Further research should consider the differential needs of registrars in this area and examine the perspectives and experiences of the third sector organisations and service users participating in such programmes.