Do UK military General Practitioners feel adequately skilled in the provision of care to the acutely unwell or injured patient?

Abstract

Background: General Practice training in the civilian and military environments follows a common training pathway, yet the scope of practice of a military General Practitioner (GP) varies significantly. A level of care for the acutely unwell and traumatically injured patients is frequently provided in austere environments remotely located from definitive medical care. This qualitative service needs evaluation scopes current level of trauma and acute care training and requirement for further training within military GPs and GP trainees. The transition to contingency operations increases the likelihood of medical officers being deployed to remote, austere locations, and it remains important to be fully skilled to manage any acute medical or trauma situation.

Aims and objectives: The aim of this project is to identify how to maintain skills in prehospital and acute care within the military general practice. The specific objectives are (1) to assess the current level of training and experience across military GPs and military GP trainees in the domain of prehospital and acute competencies; (2) to assess satisfaction with the current level of training in these domains; (3) to assess the current deficiencies in training in this domain; and (4) to suggest possible changes or enhancements to the current military GP training pathway.

Methods: Qualitative data was collected using a combination of focus groups and semistructured interviews. An initial focus group gathered codes and concepts. A topic guide generated from the initial focus group informed six semistructured interviews. A final focus group was used for validation purposes. Data were analysed using the constructivist grounded theory approach. Concurrent observational data were also collected from military and civilian courses pertinent to the research topic.

Results: Focus groups (n=2, total participants=14) and semistructured interviews (n=6) suggest that military GPs and trainees feel their level of trauma and acute care training generally diminishes over time, with significant interservice variation, and is of generally a lower level than desired. Qualified GPs suggest that maintaining clinical currency in prehospital emergency care (PHEC) for short-notice deployments is difficult. Modification to the current military GP training programme and easier access to training courses are suggested as potential solutions to the perceived shortfall in training in these areas.

Conclusions: Prehospital care and care of the acutely unwell patient remain an area of significant anxiety within military primary care doctors. While most military GPs may not want or choose to spend much of their time exclusively managing trauma and acute care, it is accepted that there is a professional requirement to provide this level of care on a frequent basis. The study suggests that there is an appetite for a higher level of training, both within the military GP specialist training pathway and postqualification. Suggested solutions to this challenge include (1) modification of the current military general practice specialty trainee residential course and (2) modification of military GPs' terms of reference to include PHEC experience during the working week.