| dc.description.abstract | Introduction General practitioners (GPs) play a crucial role in delivering primary care; however, there is a shortage of GPs and a recruitment crisis in many parts of the world. Additionally, GPs often work under high pressure due to increasing societal demand for their services, resulting from the aging population, increasingly complex patient cases, climate change, pandemics, and other factors. Initiatives such as changes in medical technology, new ways of treating patients, and increasing allied healthcare professionals' involvement are attempting to address these challenges. Therefore, the role of GPs is changing, and new approaches to recruitment and training are required. This thesis explores different typologies of education and training pathways for GPs and their characteristics. Methods The study consisted of two sequential phases. In phase 1, a scoping review used search terms such as ‘General practice’ or ‘Family medicine’ and ‘medical education or training’ in Ovid Medline, EmBase, and ERIC. It identified studies published in English since 2010, describing education and training pathways for GPs. Three typologies based on GPs’ roles in healthcare systems were developed. In phase 2, semi-structured interviews with 28 stakeholders in the training process for GPs helped to extend understanding of the three typologies. The stakeholders were located in three countries (Vietnam, UK, and the USA) selected as representative of each typology. Results In phase 1, 90 articles were included in the scoping review, of which 47 discussed both undergraduate and postgraduate programmes. The different roles of GPs within the health care system were reflected in distinct education and training pathways. Three typologies were developed: ‘Gatekeeper’ (where patients cannot access secondary or tertiary services without GP referral), ‘Doctor of Choice’ (where patients can choose to see a GP or specialist and can access secondary or tertiary care directly), and ‘Team member’ (where patients can access a network of health professionals in the community). In phase 2, three main themes related to the typologies emerged: (i) characteristics of training pathways, (ii) influencing factors, and (iii) stages of the training pathway. Training pathways were diverse and changed over time. Five influencing factors to GP training were: programme design (curriculum, pedagogy, assessment), culturally and historically established structures (e.g., duration and training settings), changing role of GPs, changing expectations of patients and society, and changing health needs. There were three main stages of training pathways: entering the pathway as medical students, continuing the pathway as trainees, and exiting the pathway as GPs. The significant distinctions of the three stages between the typologies were reflected. Discussion The study offers a provisional typology with typical characteristics and factors influencing GP training. These findings highlight: (1) diversity and complexity in education and training for GPs; (2) a strong connection between training pathways with practice settings and types of primary care provision in countries; (3) that a ‘one size fits all’ approach is not appropriate in designing and developing GP training programmes; (4) that barriers exist to the mobility of GPs between countries. Therefore, the typology provides a reference for medical educators and policymakers. Conceptualising the diversity in education and training pathways can inform the implementation of educational and training transformation for GPs in different countries. | en_GB |
