Isolation, flexibility and change in vocational training for general practice: personal and educational problems experienced by general practice registrars in Australia

Background. GP registrars, in common with other doctors, frequently experience high levels of stress; however, little is known about the nature and outcomes of personal and educational problems experienced during vocational training for general practice. Objectives. The purpose of our study was to elicit the nature, causes and effects of more severe problems experienced during vocational training for general practice from the registrar's viewpoint and put these into the context of their personal circumstances and background. Methods. This qualitative study used detailed semi-structured telephone interviews with a selected subgroup of 33 of the 1999 entry cohort of general practice registrars in Australia who had reported serious self-defined problems during an earlier longitudinal questionnaire study. Registrars were asked about the nature, antecedents and outcomes of problems experienced during GP training, actions taken to resolve the problem, and their perceptions of what might have helped prevent or minimize the problem. Results. Problems reported by registrars fell into five major themes: isolation (structural isolation, social isolation and professional isolation); flexibility and choice (administrative issues and balancing work with personal life); change and uncertainty (within general practice and training, intergenerational changes); teaching problems; and work conditions. Actions taken and effects of problems are also discussed in the light of workforce imperatives. Results have been used to develop a list of suggestions for the providers of general practice training. Conclusions. Registrars commonly experience problems during vocational training. These may be related to structural, social and professional isolation, or a lack of flexibility in training arrangements and balancing work and other commitments. Some of these problems may be amenable to relatively simple solutions involving term placements, selection of training practices and administrative adjustments.