Background: General practitioners (GPs) should be skilled in research and lead as well as actively contribute to research to guide high-quality primary health care. The quality of GP research training is, however, still a contentious subject within and outside the discipline.

Aim: To provide an overview of GP research training curricula and programs in Australia and cognate countries.

Methods: Documents on GP research training (including publicly available teaching, learning, assessment, curricula, programs, accreditation and professional standards of research competencies) from English-speaking countries with similar health and educational systems to Australia (Australia, New Zealand, United States of America, Canada, United Kingdom, Denmark, Hong Kong and Singapore) were included in the review. Documents that described GP clinical training only or research training of medical students, postgraduate degree trainees, and trainees of disciplines other than general practice were excluded. Emails with GP training programs and two online interviews with GP specialists were conducted to explore information not publicly available. Data was deductively extracted and analysed.

Results: Entry point and duration of training varied in different countries from post-graduate year 1 to 4, ranging from no mandatory training to training spanning 2 years. Some curricula included core research competency training, and required trainees to complete research projects, publish papers and present at scientific conferences. Most training objectives included enabling trainees to conduct and present medical research, understand and critically appraise scientific literature, and find appropriate information for evidence-based medical practice. In some countries, university academics provided GP research training. Assessments varied considerably from formal examinations to participation in continuing professional development. Most programmes were government-funded whilst some were funded by GP colleges.

Implications: Our findings provide a basis for further development of GP research policies and training in Australia and other countries. Future research should explore GP trainees’ views of their research training.

1. An understanding of the varied GP research training curricula and programs in Australia and cognate countries
2. An understanding of the importance of rigorous research in strengthening the general practice discipline.
3. An understanding of ways to strengthen GP research training and capacity.

Aims
To highlight General practitioners’ reflections on working with patients’ stories of painful and adverse life experiences.

Content
Background: It is well documented that painful and adverse life experiences increase the risk of health problems in a life-course perspective. Little is however known about how General Practitioners’ (GP’s) reflect on and work with such stories.

Method: Focus group discussions among 18 Norwegian and 10 Danish GPs.

Results: When reflecting on their work with patients’ stories of painful and adverse life experiences, GPs did not share a common ground. For one thing, they took two main stances regarding the medical relevance of such stories. The first position, the "confident-accepting stance", was characterized by an explicit acknowledgement of the medical relevance of such stories. The majority of the participating GPs, took the second position termed an "ambivalent and conditional stance" to addressing patients’ stories of painful and adverse experiences. Secondly, GPs also represented two opposing perspectives regarding the purposes of working with patients’ stories of painful and adverse life experiences: the instrumental purposes of story work and the intrinsic values of story work. Lastly, GPs experienced – in a number of different ways - a clash between working with patients’ stories and adhering to guidelines.

Conclusions: GPs’ differing stances in relation to stories of adversity can be associated with indefinite and competing understandings of causality (regularity theory of causation vs causal dispositionalism) within medicine. The concept epistemic injustice, referring to how certain kinds of knowledge (for instance guidelines) is given primacy over others (like stories), can help us understand the clash between stories and guidelines.

Goals
Contribute insight into GPs’ different understandings of the medical relevance of patients’ stories and introduce theoretical concepts (causality and epistemic injustice) that can prove helpful to analyzing the differences.

Key messages

1) GPs do not share a common view on the medical relevance of patients' stories of adversity 2) GPs experience a clash between working with patients' stories of painful and adverse experiences and adhering to guide lines 3) Theoretical concepts (causal dispositionalism and epistemic injustice) can help elucidate the differences

Background:
Continuity is a long-established and fiercely-defended value in general practice. Traditionally referring to longevity and consistency within the individual doctor-patient relationship, its value for patients, professionals, and systems has been repeatedly demonstrated. However, in recent years, UK general practice has seen the introduction of new staff roles and remote and digital approaches to patient access (online platforms and triage-first) and clinical encounters (telephone, video and electronic consultations). These changes may require an extension of how we conceptualise continuity.

Methods
As part of a longitudinal case study between 2021 and 2023 we used strategic, immersive ethnography and semi-structured and narrative interviews to explore continuity in differing geographical, organisational and technological contexts amongst 11 UK general practices as they introduced (or chose not to introduce) digital and remote forms of access and clinical care. We analysed the data using a narrative approach and used this to develop and extend existing theory about continuity.

Results:
Different practices variably defined continuity and achieved it to differing degrees. Its attainment required additional effort and work by individuals and was influenced by aspects of the locality, practice, technical infrastructure, and wider healthcare system. Remote and digital modalities provided opportunities for extending continuity across time and space and for achieving (some) continuity of the record and shared team understanding of a patient and illness episode. The nature and degree of continuity influenced the coherence and witnessing of patients’ illness narratives. Impaired continuity disrupted coherence and fragmented stories, impacting health outcomes, experiences of care, and subsequent interactions with the healthcare system.

Conclusion:
Continuity remains crucial within general practice. However, practices should consider how remote and digital approaches can be used, and individuals supported, to widen how it is conceptualised and operationalised to encourage the coherence of individual narratives.

1. Changes to practises and personnel within general practice may necessitate an extension of the traditional view of continuity beyond the longitudinal relationship of an individual doctor and patient.

2. Enabling the coherence of the patient narrative is an important aim of general practice.

3. Different forms of continuity i.e. relational, episodic, informational, and managerial may enable such coherence across time, space, and teams, and remote and digital approaches and new practice roles should be deployed and supported to encourage this.