title: The development of integrated audit for the training of general practice registrars
Creators: name: Lough, James Murray
Publisher: name: University of Glasgow
Year: 2002
Subjects: subject: Health education, general practice, health care management.

description: In 1991 the Joint Committee on Postgraduate Training for General Practice (JCPTGP) issued a new criterion for training practices stating that they "must provide opportunities for trainees to become familiar with the principles of medical audit and to participate in medical audit; and they must be able to demonstrate their trainees have actually done so." It is possible that no training practice in the west of Scotland could have implemented this criterion. This thesis considers the development of a model appropriate for a training environment which overcame the difficulty in interpreting whether the criterion was being implemented. This required clear learning objectives to be set integrated into a system where competence in achieving these objectives could be assessed. In order to provide support for the trainers and to maximise the opportunities for trainees to participate in audit a programme for the region was constructed covering organisation of appointment systems, chronic disease management and significant event analysis with educational objectives set out for each area. Progress in implementing the programme was assessed at each reaccreditation visit and evaluations were completed in 1998 and 2001. All areas of the programme showed modest improvements between the evaluation dates although few reached statistical significance. The time involved in and the cost of collecting data for audit purposes were evaluated by offering ten training practices audit support staff to collect their data for parts of the audit programme. The costs were compared with the hypothetical use of a practice receptionist or the practice nurse. The conclusion was that data collection carries significant costs both in time and expense for a practice and the need to agree on appropriate use of practice staff is vital. Between 1996 and 1997 an increasing number of registrars was evaluating the change they had proposed in their audit project. There was also a significant increase in the proportion of trainers who felt that a completed audit cycle should now define the audit project. An increase to eight criteria followed with two assessors being used to screen the projects without compromising sensitivity or specificity. Registrars were therefore now expected to demonstrate their competence as defined by evaluating rather than proposing change. Significant event auditing added a qualitative format for an audit project. The analysis of such an event involved addressing four specific questions with two assessors reviewing each analysis. The integration of quantitative and qualitative methods encouraged training practices to think more broadly about different approaches to teaching the assessment of quality of care. Between 1998 and 2001 all senior house officers on vocational training schemes were asked to submit a criterion audit cycle or a significant event analysis in each post. Teaching and support were provided. The output ranged from 28% (accident and emergency) to 45% (geriatrics) of the total number of projects expected. The JCPTGP revised its criterion for audit in training practices in 2000 proposing a model based on the work in this thesis. The lessons learned have implications for the non-training environment of general practice. (Abstract shortened by ProQuest.).