TY - JOUR

T1 - Training needs for staff providing remote services in general practice: a mixed-methods study

AU - Greenhalgh, Trisha

AU - Payne, Rebecca

AU - Hemmings, Nina

AU - Leach, Helen

AU - Hanson, Isabel

AU - Khan, Anwar

AU - Miller, Lisa

AU - Ladds, Emma

AU - Clarke, Aileen

AU - Shaw, Sara E

AU - Dakin, Francesca

AU - Wieringa, Sietse

AU - Rybczynska-Bunt, Sarah

AU - Faulkner, Stuart D

AU - Byng, Richard

AU - Kalin, Asli

AU - Moore, Lucy

AU - Wherton, Joseph

AU - Husain, Laiba

AU - Rosen, Rebecca

N1 - © The Authors.

PY - 2024/1

Y1 - 2024/1

N2 - BACKGROUND: Contemporary general practice includes many kinds of remote encounter. The rise in telephone, video and online modalities for triage and clinical care requires clinicians and support staff to be trained, both individually and as teams, but evidence-based competencies have not previously been produced for general practice.AIM: To identify training needs, core competencies, and learning methods for staff providing remote encounters.DESIGN AND SETTING: Mixed-methods study in UK general practice.METHOD: Data were collated from longitudinal ethnographic case studies of 12 general practices; a multi-stakeholder workshop; interviews with policymakers, training providers, and trainees; published research; and grey literature (such as training materials and surveys). Data were coded thematically and analysed using theories of individual and team learning.RESULTS: Learning to provide remote services occurred in the context of high workload, understaffing, and complex workflows. Low confidence and perceived unmet training needs were common. Training priorities for novice clinicians included basic technological skills, triage, ethics (for privacy and consent), and communication and clinical skills. Established clinicians' training priorities include advanced communication skills (for example, maintaining rapport and attentiveness), working within the limits of technologies, making complex judgements, coordinating multi-professional care in a distributed environment, and training others. Much existing training is didactic and technology focused. While basic knowledge was often gained using such methods, the ability and confidence to make complex judgements were usually acquired through experience, informal discussions, and on-the-job methods such as shadowing. Whole-team training was valued but rarely available. A draft set of competencies is offered based on the findings.CONCLUSION: The knowledge needed to deliver high-quality remote encounters to diverse patient groups is complex, collective, and organisationally embedded. The vital role of non-didactic training, for example, joint clinical sessions, case-based discussions, and in-person, whole-team, on-the-job training, needs to be recognised.

AB - BACKGROUND: Contemporary general practice includes many kinds of remote encounter. The rise in telephone, video and online modalities for triage and clinical care requires clinicians and support staff to be trained, both individually and as teams, but evidence-based competencies have not previously been produced for general practice.AIM: To identify training needs, core competencies, and learning methods for staff providing remote encounters.DESIGN AND SETTING: Mixed-methods study in UK general practice.METHOD: Data were collated from longitudinal ethnographic case studies of 12 general practices; a multi-stakeholder workshop; interviews with policymakers, training providers, and trainees; published research; and grey literature (such as training materials and surveys). Data were coded thematically and analysed using theories of individual and team learning.RESULTS: Learning to provide remote services occurred in the context of high workload, understaffing, and complex workflows. Low confidence and perceived unmet training needs were common. Training priorities for novice clinicians included basic technological skills, triage, ethics (for privacy and consent), and communication and clinical skills. Established clinicians' training priorities include advanced communication skills (for example, maintaining rapport and attentiveness), working within the limits of technologies, making complex judgements, coordinating multi-professional care in a distributed environment, and training others. Much existing training is didactic and technology focused. While basic knowledge was often gained using such methods, the ability and confidence to make complex judgements were usually acquired through experience, informal discussions, and on-the-job methods such as shadowing. Whole-team training was valued but rarely available. A draft set of competencies is offered based on the findings.CONCLUSION: The knowledge needed to deliver high-quality remote encounters to diverse patient groups is complex, collective, and organisationally embedded. The vital role of non-didactic training, for example, joint clinical sessions, case-based discussions, and in-person, whole-team, on-the-job training, needs to be recognised.

KW - Anthropology, Cultural

KW - Clinical Competence

KW - Family Practice

KW - General Practice

KW - Humans

KW - Surveys and Questionnaires

U2 - 10.3399/bjgp.2023.0251

DO - 10.3399/bjgp.2023.0251

M3 - Article

C2 - 38154935

VL - 74

SP - e17–e26

JO - British Journal of General Practice

JF - British Journal of General Practice

SN - 1478-5242

IS - 738

ER -