Learning at the frontier: the experiences of single-handed general practitioners

Abstract

Single-handed general practitioners represent a significant portion of the primary care workforce in many countries. There have been well publicised concerns regarding the quality of care offered by these practitioners, yet little attention has been paid to how they maintain their professional competence. This chapter reviews the current state of knowledge in relation to the ongoing learning of professionally isolated general practitioners and describes what is known about the most effective ways of supporting single-handed doctors in maintaining their competence. The chapter identifies several problems that beset the continuing learning of these practitioners including: (a) a lack of opportunities for normative comparison founded on interpersonal engagement with medical colleagues; (b) inadequate self-assessment of learning and developmental needs and (c) a lack of support in interpreting and making sense of dilemmas and patterns in their own practice. The literature provides examples of well-evaluated solutions including (i) web-based moderated forums that facilitate collegial interaction; (ii) approaches that ensure “informed” self-assessment of developmental needs; (iii) online access to information scientists who provide customised answers pertinent to features of individual cases; and (iv) usage of self-administered assessments of decision-making, judgement and knowledge in the context of complex cases. When addressing the ongoing learning of isolated general practitioners, it is important to pay attention to overcoming intra-personal resistance to change and navigating the delicacies of interpersonal communication amongst doctors. The resource implications of implementing supportive strategies for the professional development of isolated general practitioners are significant but arguably worthwhile in terms of sustaining socially isolated doctors whilst ensuring that their practice meets acceptable standards.