Article Text

Download PDFPDF

‘It's surprising how differently they treat you’: a qualitative analysis of trainee reflections on a new programme for generalist doctors
  1. E Muddiman1,
  2. A D Bullock1,
  3. J MacDonald2,
  4. L Allery2,
  5. K L Webb1,
  6. L Pugsley2
  1. 1Cardiff Unit for Research and Evaluation into Medical and Dental Education (CUREMeDE), Cardiff University School of Social Sciences, Cardiff, UK
  2. 2Cardiff University School of Postgraduate Medical and Dental Education, Cardiff, UK
  1. Correspondence to Dr E Muddiman; MuddimanEK{at}


Objectives An increase in patients with long-term conditions and complex care needs presents new challenges to healthcare providers around the developed world. In response, more broad-based training programmes have developed to better prepare trainees for the changing landscape of healthcare delivery. This paper focuses on qualitative elements of a longitudinal, mixed-methods evaluation of the postgraduate, post-Foundation Broad-Based Training (BBT) programme in England. It aims to provide a qualitative analysis of trainees' evaluations of whether the programme meets its intentions to develop practitioners adept at managing complex cases, patient focused care, specialty integration and conviction in career choice. We also identify unintended consequences.

Setting 9 focus groups of BBT trainees were held over a 12-month period. Discussions were audio-recorded and subjected to directed content analysis. Data were collected from trainees across all 7 participating regions: East Midlands; West Midlands; Severn; Northern; North Western; Yorkshire and Humber; Kent, Surry and Sussex.

Participants Focus group participants (61 in total) from the first and second cohorts of BBT.

Results Evidence from trainees indicated that the programme was meeting its aims: trainees valued the extra time to decide on their onward career specialty, having a wider experience and developing a more integrated perspective. They thought of themselves as different and perceived that others they worked alongside also saw them as different. Being different meant benefitting from novel training experiences and opportunities for self-development. However, unintended consequences were feelings of isolation, and uncertainty about professional identity.

Conclusions By spanning boundaries between specialties, trainee generalists have the potential to improve experiences and outcomes for patients with complex health needs. However, the sense of isolation will inhibit this potential. We employ the concept of ‘belongingness’ to identify challenges related to the implementation of generalist training programmes within existing structures of healthcare provision.

  • EDUCATION & TRAINING (see Medical Education & Training)

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.