Uitval en stagnatie in de opleiding tot huisarts

Objective

To investigate which determinants are related to poor performance and forced attrition in the first year residency in general practice (GP).

Design

Observational retrospective cohort study.

Method

We collected data relating to personal characteristics such as age, sex and clinical experience from residents who started the GP training in Utrecht, the Netherlands, in the period March 2005-August 2007. We also collected competence scores from the domains ‘medical expertise’, ‘doctor-patient communication’ and ‘professionalism’, as well as scores on a national GP knowledge test. The outcome measures were ‘poor performance’ and ‘forced attrition’. Multivariate logistic regression was used to analyse correlations between personal characteristics, competence scores on the 3 domains and knowledge scores in the first trimester on the one hand and poor performance or forced attrition on the other.

Results

215 residents started the GP training. In the first trimester a quarter of the residents had an insufficient score in 1 or more of the domains. Competence scores were mutually correlated, but did not correlate with the knowledge score. 18 residents showed poor performance and 3 were forced to stop their training. Poor performance and forced attrition were correlated with age (adjusted odds ratio (OR): 1.1; 95% CI: 1.0-1.3), insufficient knowledge (adjusted OR: 8.9; 3.0-26.3) and medical expertise (adjusted OR: 2.1; 1.1-4.0) at the beginning of the training.

Conclusion

Age, insufficient knowledge of general practice, and insufficient competence in the domain of ‘medical expertise’ at the beginning of the training are risk factors for poor performance by residents and attrition from their GP training.

Conflict of interest: none declared. Financial support: none declared.