Simulation-based education (SBE) is widely recognized as an effective method for training healthcare professionals, providing realistic scenarios supported by trained actors and authentic medical tools. However, despite this practical fidelity, the discursive demands placed on participants often diverge from everyday clinical practice. Participants must verbalise reasoning, explicitly introduce medical information that would normally arise naturally, and articulate thought processes that typically remain internal. These requirements may shape how competence is displayed and evaluated in ways not yet fully understood.Data were collected during education of GP in training involving simulation encounters between general practice trainees and trained assessors. Using conversation analysis (CA), we recorded and analyzed the interactional practices through which participants introduced medical information, displayed clinical reasoning, and responded to prompts. Particular attention was given to moments where trainees needed to introduce “unassimilable” information, details not typically elicited by patients in realAnalysis revealed several strategies for introducing unassimilable medical information. When GPs in training independently introduced this information, assessors gained more complete access to their clinical reasoning, supporting more valid competence judgments. Conversely, when assessors supplied the information, insights into trainees’ underlying knowledge and decision-making were only partial, raising concerns about assessment validity. The findings demonstrate that sustaining simulation encounters requires substantial interactional work not present in routine clinical practice.While previous research has examined fidelity and authenticity in SBE, little attention has been given to the discursive work required to sustain simulated interactions.  This study identifies discursive load as an overlooked factor that directly shapes performance and assessment in simulation contexts.Addressing the discursive features of SBE can strengthen educational value and validity, contributing to more meaningful and reliable evaluation practices in GP training.

Virtual Reality (VR) as an educational tool offers immersive, experiential learning that can  strengthen clinical reasoning, patient-centered communication, and teamwork competencies central to general practice. However, evidence on how to integrate VR meaningfully into undergraduate family medicine curricula remains limited. Understanding learners’ and teachers’ expectations, perceived value, and practical needs is essential for effective curriculum integration.The primary objective is to identify students’ and teachers’ educational needs, attitudes, and anticipated benefits regarding VR-supported teaching in general practice. A secondary objective is to determine potential barriers and institutional prerequisites for successful implementation.A pilot cross-sectional online survey will be conducted in January 2026 at three European medical faculties. Two structured, anonymous questionnaires—one for students and one for educators—will assess prior VR experience, preferred primary care learning scenarios, expected learning outcomes, usability and didactic requirements, and perceived implementation challenges. The instruments include Likert-scale, multiple-choice items, and open-ended questions. Quantitative data will be analyzed descriptively, while qualitative responses will be analyzed thematically to identify shared priorities across stakeholder groups. This mixed-methods approach ensures a comprehensive understanding of educational needs and feasibility.(anticipated): The pilot will establish the feasibility, reliability, and content validity of the survey instruments, assess response trends, and identify key thematic categories. Students and teachers are anticipated to value VR for enhancing clinical reasoning, patient-centered communication, and interprofessional collaboration. Participants will likely emphasize the need for realistic scenarios, structured guidance, and meaningful feedback. Barriers may include limited equipment access, motion sickness, technical challenges, and questions of feasibility within dense curricular.(anticipated): By systematically mapping how students and educators conceptualize VR in general practice education, this methodological phase will clarify the pedagogical expectations, perceived relevance, and logistical constraints of immersive technologies in undergraduate medical training. These insights will inform curriculum development and institutional planning, ensuring subsequent study phases are grounded in empirically derived stakeholder needs.This methodological framework provides a structured approach to exploring how VR can address educational needs in general practice training. The results will guide evidence-based development of VR modules and define institutional and pedagogical conditions necessary for sustainable integration of immersive learning into primary care education.

Postgraduate training for General Practice (GP) / Family Medicine (FM) is essential for strong primary care systems, yet its organisation varies widely across the WHO European Region. To support workforce development, comparability, and policy planning, a European collaborative project was launched to map and describe GP/FM postgraduate training.To systematically collect and compare national GP/FM postgraduate training programmes, focusing on training time, access requirements, governance, structure, rotation schemes, educational methods, and evaluation procedures.A cross-sectional descriptive study was carried out. Family doctors and trainees were recruited through WONCA Europe networks and WHO Europe as key informants. Each country was asked to submit its official curriculum and a validated dataset prepared jointly by the key informants. Two members of the research team reviewed and verified the submitted information, contacting informants for clarification as required. At the time of interim analysis complete data were available from 23 countries, with 83 key informants from 41 countries confirmed to participate.Across the 23 countries analysed, the duration of GP/FM postgraduate training varied from two to six years, most commonly four. Governance differed considerably: national authorities managed training in 14 countries, universities in 10, and medical chambers or GP/FM associations in six, with shared responsibility in seven. Entry pathways also varied, involving national or university exams (10 countries), interviews (12 countries), curriculum vitae (11 countries), motivation letters (7 countries), and local language proficiency requirements between B1 and C1 level (6 countries). Training was predominantly practice-based, with an overall distribution of 85% practical and 15% theoretical learning. Fixed rotation schemes were used in 19 countries and consistently combined hospital-based rotations with a longer period in FM settings. Evaluation methods were diverse: 17 countries required a final exam, frequently including written, oral, and practical components. Scientific activities such as a thesis, research project, or publication were mandatory in 10 programmes.These preliminary findings highlight the need for improved comparability and shared frameworks to support high-quality GP/FM training and primary care strengthening across the region.GP/FM postgraduate training is well established across Europe but highly heterogeneous in structure, access requirements, governance, and evaluation.

Since Lawrence Weed publications and trainings, maintaining a problem list is a goal for healthcare quality and a core competence of every physician, especially general practionners. It allows to manage multimorbidity and polymedication. This is also particularly important to ensure continuity of care in the current era of chronic disease and summary care record (called SumEHR in Belgium) sharing. But in routine practice, GPs face many pitfalls to obtain a usable problem list: no use of controlled vocabullary, absence of relevant value date, problem duplicates, management of differential diagnosis... In 2019 and 2020, regional reporting shows that SumEHR are not published for every patient and are of uneven quality.The aim of this work was to set up training to learn how to manage a problem list for GP during their first year of residency (postgraduate).The quality of the training was assessed each year through quantitative questionnaires with likert scales and comments from trainers.The training is hosted by the Walloon e-health training platform, which is based on Moodle.In 2021, teachers responsibles for medical informatics in the three (and four since 2024) French-speaking belgian universities decide to set up a joint course. Currently, this annual online course provides training for 273 GP residents, with 15 GP trainers. The course is based on exercises in small groups according to the EHR software that residents use at their internship workplaces. The main aim of the training is to learn how to clean up problems list with their own EHR software in order to publish a SumEHR. Despite the different undergraduate curricula and software limitations, in 2025, 60.5 % are satisfied or very satisfied with the “clean-up exercise”. 69,9% (2024) and 62.2% (2025) had not published any Sumehrs prior to the training.Satisfaction with this training can still be improved in terms of the fluidity of the exercises and consistency between groups. Although generative AI transcription features are becoming widely available in EHRs, maintaining an up-to-date list of issues remains a complex clinical skill that involves technical tasks and clinical reasoning.Future developments towards a blended learning format are planned.

UK General Practice training takes 3 years, including a portfolio of Workplace Based Assessments. Trainees must complete a Leadership Activity and a Leadership Multi-Source Feedback in their final year.  Recent government funding has lead to an increase in non-doctor staff in primary care. GPs immediately after qualification are expected to supervise those roles, and we wanted to explore how our trainees can be best supported to feel confident as new leaders.To answer the question “to what extent do trainees and trainers believe the current local and national leadership training curriculum helps trainees develop confidence and a clear sense of themselves as leaders?”.A mixed-method approach including a survey to GPs, a review of local teaching and collation of 6 months of Leadership Activity assessments.Of the survey responses, the majority agreed that leadership skills are “important” or “very important”, but none felt the current portfolio requirements fully prepares trainees. All but one trainee did not think they had received any formal leadership training, despite confirming this was being provided. Only 24% were aware of leadership toolkits/resources, with only 35% of trainees having had opportunities to engage with leadership roles. 118 leadership activities were completed in 6 months. 51% had a clinical or teaching focus with relatively few focusing on non-clinical practice management.Despite recognition of the importance of leadership skills, trainees report feeling unprepared. They do not feel the current curriculum supports them to fulfil their leadership potential, and trainees/trainers either do not understand the current assessments or are not utilising them effectively. There is a lack of awareness of local teaching, toolkits/resources and opportunities to engage with local leadership. We suggest improved signposting to existing resources, and facilitating trainees to access practical leadership experience.There is a disconnect between the perceived importance of GP leadership skills, and the ability of the current training programme to develop these. Work needs to be done to make the assessments fit for purpose. We need to inspire our trainees to move beyond the “safe sphere” of clinical management and utilise existing resources to fulfil their individual leadership potential.

Emergency departments are high‑pressure settings with heavy workloads, shifts, and diverse case complexity. These factors impair cognitive performance, increase stress and fatigue, and amplify clinical uncertainty—particularly among first‑year residents (R1s) who combine limited experience with demanding on‑call duties. This study was conducted in a 265‑bed hospital over two months to capture presentations and R1s’ self‑reported uncertainty during shifts.Describe pathologies managed by R1s during emergency on‑call shifts and quantify perceived clinical uncertainty by presentation. Also, assess variation in uncertainty by patient age and sex, shift hour and day type, diagnostic category and severity, and between individual residents; identify implications for training, supervision, and organization.Cross‑sectional observational study (12 February–31 March 2025). Five R1s (four Family and Community Medicine, one Internal Medicine) prospectively recorded 555 consecutive emergency encounters across 58 days. For each case they logged demographics, triage complaint, final diagnosis, disposition, and a self‑rated uncertainty score (0–10), categorized as low (≤3), moderate (4–6), or high (≥7). Diagnoses were grouped into nine clinical categories and stratified by severity. Descriptive statistics and crude odds ratios with 95% confidence intervals were calculated.Mean uncertainty was 5.4 (SD ±2.7); 46.1% of encounters were rated high (≥7). Digestive, respiratory, and musculoskeletal presentations were significantly associated with higher uncertainty (p < 0.05), with some crude ORs >2.4. Adults (14–75 years) had higher odds of high uncertainty than pediatric patients (OR 1.745; 95% CI 1.067–2.854). No significant differences by patient sex or weekday versus holiday shifts were found. Substantial interindividual variability existed among residents.Clinical uncertainty among R1s is common and largely subjective. Higher uncertainty in specific diagnostic groups likely reflects presentation heterogeneity and diagnostic complexity; greater uncertainty with adults may stem from broader differentials and fewer standardized protocols. Personal factors and prior experience influence variability. Limitations include single‑center scope, timeframe, a non‑validated uncertainty scale, and a small number of raters.R1s frequently face high clinical uncertainty in emergency care. Programs should implement targeted diagnostic reasoning training, structured supervision, and organizational reforms to support residents and safeguard care quality. Future research should validate measurement tools and evaluate interventions longitudinally.

During ambulatory general practice placements, clinical supervisors play a key role in identifying and supporting residents experiencing difficulties. When a resident’s validation becomes uncertain, supervisors face tensions between their dual roles as mentors and evaluators, with limited literature exploring their lived experience in such situations.To explore the experiences of general practice supervisors facing residents in difficulty and uncertainty about stage validation, and to identify factors influencing their experience.A qualitative study was conducted in XXX. Semi-structured face-to-face interviews were performed with general practice supervisors who had supervised at least one resident in difficulty. Interviews were transcribed verbatim and anonymised. Data were analysed using an interpretative phenomenological approach. Recruitment continued until data sufficiency.Eight interviews were analysed. Supervisors reported early intuitive detection of resident difficulties, often within the first weeks. Difficulties were multifactorial (clinical knowledge gaps, relational issues, professionalism concerns, psychological vulnerability). They first sought direct discussion with the resident, then collegial exchange within the supervisory team, and finally support from the university department when needed. Two profiles emerged. Empathic supervisors showed strong emotional involvement, greater stress and self-questioning, and a tendency to prioritise support over assessment. Protocol-oriented supervisors relied more on objective criteria, maintaining emotional distance and reporting less distress when issuing a negative evaluation. Positive resident progression and institutional support improved supervision experience, whereas lack of collaboration or institutional backing was associated with feelings of isolation or failure.Uncertain validation situations are emotionally demanding for general practice supervisors, particularly for those with strong relational investment. Collegial evaluation, supervisor support networks, and training in pedagogical decision-making and emotional regulation may help mitigate distress and promote fair, learner-centred evaluation. Single-region recruitment and a small sample limit transferability. Self-selection bias and absence of double coding may have influenced interpretation. Most cases involved first ambulatory placements, limiting insight into end-of-training contexts.Supporting general practice supervisors in their evaluator role and addressing emotional challenges could enhance the evaluation process and contribute to safer, fairer medical training. Including hospital supervisors in future work would provide a broader perspective on supporting residents in difficulty.