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Enhancing the quality and safety of care through training generalist doctors: a longitudinal, mixed-methods study of a UK broad-based training programme
  1. Alison Bullock1,
  2. Katie Louise Webb1,
  3. Esther Muddiman1,
  4. Janet MacDonald2,
  5. Lynne Allery3,
  6. Lesley Pugsley2
  1. 1 School of Social Sciences, Cardiff Univeristy, Cardiff, UK
  2. 2 School of Postgraduate Medical and Dental Education, Cardiff University, Cardiff, UK
  3. 3 School of Medicine, Cardiff University, Cardiff, UK
  1. Correspondence to Professor Alison Bullock; bullockad{at}


Objective Changing patient demographics make it ever more challenging to maintain the quality and safety of care. One approach to addressing this is the development of training for generalist doctors who can take a more holistic approach to care. The purpose of the work we report here is to consider whether a broad-based training programme prepares doctors for a changing health service.

Setting and participants We adopted a longitudinal, mixed-methods approach, collecting questionnaire data from trainees on the broad-based training (BBT) programme in England (baseline n=62) and comparator trainees in the same regions (baseline n=90). We held 15 focus groups with BBT trainees and one-to-one telephone interviews with trainees post-BBT (n=21) and their Educational Supervisors (n=9).

Results From questionnaire data, compared with comparator groups, BBT trainees were significantly more confident that their training would result in: wider perspectives, understanding specialty complementarity, ability to apply learning across specialties, manage complex patients and provide patient-focused care. Data from interviews and focus groups provided evidence of positive consequences for patient care from BBT trainees’ ability to apply knowledge from other specialties. Specifically, insights from BBT enabled trainees to tailor referrals and consider patients’ psychological as well as physical needs, thus adopting a more holistic approach to care. Unintended consequences were revealed in focus groups where BBT trainees expressed feelings of isolation. However, when we explored this sentiment on questionnaire surveys, we found that at least as many in the comparator groups sometimes felt isolated.

Conclusions Practitioners with an understanding of care across specialty boundaries can enhance patient care and reduce risks from poor inter-specialty communication. Internationally, there is growing recognition of the place of generalism in medical practice and the need to take a more person-centred approach. Broad-based approaches to training support the development of generalist doctors, which is well-suited to a changing health service.

  • broad-based training
  • generalist doctors
  • holistic care
  • patient-centred care

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  • Contributors AB and LP designed the study. AB, KLW, EM, JM, LA and LP contributed to the design of data gathering instruments. Under the overall direction of the study lead, AB, data were collected by KW, EM, JM, LA and LP with KW and EM taking primary responsibility. Data analysis was largely undertaken by KW and EM with the oversight of study lead AB. AB drafted the paper. LP, EM, KW and LA made revisions. AB, KW, EM, JM, LA and LP have given their final approval of the version to be published and have agreed to be accountable for all aspects of the work including any issues related to accuracy or integrity.

  • Funding This work was commissioned by the Academy of Medical Royal Collages and funded by Health Education England.

  • Competing interests None declared.

  • Patient consent Detail has been removed from this case description/these case descriptions to ensure anonymity. The editors and reviewers have seen the detailed information available and are satisfied that the information backs up the case the authors are making.

  • Ethics approval Research ethical approval was obtained from Postgraduate Medical and Dental Education Ethics Committee, Cardiff University, UK (02/10/2013).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Participants have not given their permission for data sharing outside of the research group. Thus, no additional data are available.