The experiences of becoming a general practice registrar: a qualitative study

For many registrars, general practice is regarded as a compromise between the more exciting work in hospitals and a compromise for a life outside medicine. There are, nevertheless, known significant stresses experienced by registrars in general practice training. The aim of this qualitative study of 32 semi-structured interviews with registrars (six as pilot) and one focus group of 11 registrars was to investigate the problems faced on becoming a GP registrar and how the trainer and practice help or fail to help. It was found that registrars felt a sense of a jump in knowledge and skills needed to cope with general practice. Expressions of isolation were common including the isolated nature of general practice work, problems within specific practices, isolation from peers and the isolating experience of responsibility for making decisions. Challenges came from clinical situations and not from formal teaching. The registrar was helped through these potential difficulties by good relationships with trainers, feeling part of the practice and meeting peers outside the practice. Poor confidence and the need to maintain feelings of competence in front of patients and trainers were often apparent. More than one registrar in a practice and specific steps to increase involvement within the practice may alleviate isolation. Poor relationships with trainers occurred occasionally and should be identified early.