Postgraduate attachment to general practice : influence on doctors’ future career intentions

Recruitment of medical graduates to general practice careers in the UK, as in other developed countries, remains challenging. Currently general practice attracts fewer doctors than health care planners anticipate will be needed to meet the burgeoning health needs of an ageing population. Understanding the factors that influence doctors in their career choices is important to manpower planners, the profession and society as a whole. A two year postgraduate foundation programme for all doctors was introduced into the UK in 2006. One of its main intentions was to provide doctors with postgraduate clinical attachments that would assist them in making informed career choices. This has resulted, for the first time, in large numbers of recent medical graduates experiencing several specialties before applying for specialty specific training programmes. The main aim of this thesis was to assess the influence of a four month postgraduate attachment in general practice in the second foundation year on doctors’ career intent. It was hypothesised that the attachment would have a positive impact on recruitment to general practice careers. This hypothesis was tested using a combined quantitative and qualitative approach. A literature review examined career decision making in medicine. It was divided chronologically into sections covering decision making at school, university and in the early postgraduate years. In addition a section focussed on decision making in careers other than medicine. A validated career inventory (sci 59) measuring change in career preference was selected for use in this study. The output is in the form of career rankings among 59 medical specialties. In addition, a semi-structured interview questionnaire was developed based on themes emerging from the literature review and was refined following piloting. Interviews were recorded, transcribed and thematically analysed using NVivo 7. The study was conducted in the Kent, Surrey and Sussex Deanery between 2005 and 2008. Participants (n=225) included all doctors whose second foundation year programme included a four month attachment in general practice. They were sent a sci 59 questionnaire at the beginning of their attachment and a further questionnaire at the end. Those responding to both questionnaires were invited to take part in an interview. 112 participants completed sci 59 questionnaires at the beginning and end of their 4 months attachment. Initial analysis demonstrated a small, statistically non-significant improvement in career intent towards general practice. Using a measure that reflects movement in ranking between the two questionnaires, further analysis showed a small, statistically significant, improvement in the ranking of general practice among participants who had low initial rankings for general practice. 30 participants were interviewed. Placements in general practice during the second foundation year were generally regarded in a very positive light. Doctors particularly valued ongoing relationships with patients as well as involvement with local communities. They commented on the high quality of supervision and the structured learning environment of their attachments. General practice was also seen as a better lifestyle option than other main specialties as well as offering flexible working opportunities. New findings included the observation that career ranking for general practice improved following a four month postgraduate attachment in general practice among those less inclined to general practice as a career in the first place. Thematic analysis of transcribed interviews revealed enhanced respect, among foundation doctors, for general practice as a career option irrespective of their own eventual career intent. This improved regard for general practice among doctors intent on specialising may be important in the context of persisting disparagement of general practice by some students, clinicians and teachers. It may also be helpful in engendering mutual respect and more effective working relationships between specialists and generalists in the future.