An increasing number of General Practice (GP) Doctors are entering training with limited prior experience of working within the country in which they choose to train. Many are international medical graduates and doctors from non‑primary care settings. They bring valuable skills and perspectives but often require additional support to adapt to local healthcare structures, professional expectations, and the culture of general practice.Recognising this transition challenge, we developed and piloted a Structured Learning Programme to support GP trainees with fewer than six months experience working in the country at the start of their training. The pilot provided a 4-month placement where trainees had some of their clinical time replaced with additional education time on key GP domains and contextual topics.This pilot demonstrates that a structured, early orientation programme and contextual learning can ease the transition for trainees new to the country and improve their confidence and engagement.Evidence from national training data highlights differential attainment among these Doctors, reflecting multifaceted influences such as unfamiliarity with the national systems, differing cultural and communication norms, and variations in prior learning experiences. Recognising and addressing these challenges is key to ensuring equitable training outcomes. Structured orientation programmes and inclusive educational practices can help bridge early gaps in confidence and understanding, support diversity within the GP workforce, and promote equitable progression and culturally competent patient care.Structured learning intervention can support new trainees with limited local experience, improving early adaptation and well-being. Further evaluation with larger cohorts will help refine content and assess long-term impact on performance and patient care.

The evolution of medical demographics and practice patterns prompts reflection on the professional aspirations of general practice residents, who are training within a changing healthcare system.This study aimed to explore the representations of first-year general practice residents’ envisioned professional pathways.Individual interviews were offered during their first general practice rotation to all residents who began their general practice training program in November 2023 in the university of XXX. We conducted a phenomenologic analysis of the interview transcripts, allowing a theory to emerge, as well as a descriptive statistical frequency analysis of some of their characteristics.68 interviews were conducted between February and October 2024. The professional pathways of first-year general practice residents can be conceptualized as two interrelated dimensions: the development of a professional identity and the construction of a professional projection. Identity development begins with the choice of general practice, followed by adaptation to a new status as residents, while gradually becoming aware of the existential dimension involved in shaping their medical identity. In parallel with this identity-building process, their professional project emerges. Initially as an idealized vision, then through encounters with real world conditions, enabling progress in envisioning one’s future professional practice.The construction of professional identity, an evolving process throughout medical training, is essential for achieving job satisfaction. This study is the first to question professional projects of an entire university cohort of general practice residents. It is limited to the views of early-stage students, though it aims to continue throughout their academic pathway. Ongoing research is tracking how students' professional projects evolve throughout their studies. Furthermore, a qualitative study is currently being carried out through interviews with the 2024 cohort.Understanding the professional pathways of residents is crucial to support them throughout their training and their transition into local practice.

Medical education evolves in response to societal imperatives. From Enlightenment ideals of liberty and collective responsibility to modern pressures of social accountability and workforce shortages, training paradigms have shifted under external influence. Today, with over 6.5 million Canadians lacking access to a family physician and many graduates opting for focused practice, questions about how supervision during residency prepares physicians for comprehensive care are increasingly urgent.To explore how supervision of senior family medicine residents is enacted during the final months of training and how these practices align with educational theory and societal expectations for readiness for independent practice.A qualitative design using interpretive description methodology was employed. Semi-structured interviews were conducted with recent graduates (n=5) and experienced preceptors (n=6) from the Dalhousie Family Medicine program. Data were analyzed thematically, informed by sociocultural learning theory and concepts of entrustment.Supervision practices varied widely, oscillating between close oversight and distant mentorship. Decisions about autonomy were shaped by trust, perceived risk, and institutional norms rather than rigid competency frameworks. While benchmarking tools emphasized independence by month 18, participants described persistent ambiguity around what “independence” meant in practice. Both residents and preceptors highlighted the importance of authentic clinical responsibility and expressed a strong desire for structured mentorship beyond residency.Findings reveal a tension between theoretical ideals—competency-based education, entrustable professional activities—and the lived reality of supervision. Entrustment emerged as a relational process, echoing Rousseau’s notion of a social contract: balancing liberty (autonomy) with collective responsibility (patient safety). The Soviet Union's launch of Sputnik in 1957 led to the development of competency-based education, the dominant paradigm of recent decades. Similarly, current pressures for social accountability amidst inequities in access and physician shortages mean we must prioritise preparing graduates for comprehensive community practice. This study argues that readiness for practice requires more than technical competence; it demands adaptive expertise, confidence, and solidarity within a community of practice.Curriculum design should integrate opportunities for supervised independence, mentorship beyond graduation, and future-facing assessment strategies that prioritize adaptability and confidence. These reforms are essential to ensure graduates are not only competent but truly prepared for the complexities of independent practice.

Doctor-patient communication is a core competency for General Practice (GP) trainees and is addressed through generic communication-skills training. However, learning communication in the workplace requires a contextualised and flexible approach known as ‘skilled communication’. Learning skilled communication involves adapting and monitoring communication to the needs of each encounter. Although previous cross-sectional research suggests that workplace communication challenges can trigger learning, the nature and development of these challenges remain unclear.This study aims to identify which communication challenges act as triggers for learning and to explore how these challenges evolve over time to support educators in providing targeted coaching. Our research question is: ‘Which communication challenges do learners encounter during their longitudinal learning journey to develop skilled doctor-patient communication?’We conducted a longitudinal qualitative study using a phenomenological approach and Crowther’s principles to craft stories illustrating the communication challenges learners encounter in the workplace. Over six months, we collected clinical observations, interviews, and audio-diaries from eight first- and five third-year XXX GP trainees. Analysis followed a twofold process: thematic content analysis with data triangulation, after which findings were used to craft stories.Thirteen GP trainees generated a dataset of 26 interviews, 26 clinical observations, and 115 audio-recordings, averaging nine audio-recordings per trainee over six months. One story was crafted for each training year group. First-year trainees focused on the effectiveness of patient-centred communication skills. Third-year trainees took a more reflective perspective, using self-monitoring skills to develop a personalised style, adapt communication to patients’ needs, and work collaboratively, driven by curiosity about the patient’s broader context.Our findings underscore that workplace learning is often implicit and informal, causing challenges to go unrecognised. Consistent with earlier studies, a safe, collaborative environment supports learners in recognising and sharing difficulties and successes. This study further shows that the nature of communication challenges evolves over time and differs across training stages.We identified workplace communication challenges that trigger the development of skilled communication. Learners benefit from a safe environment and scaffolded guidance from educators that helps them recognising communication challenges, turning implicit challenges into explicit learning, and fostering self-monitoring skills throughout their learning journey.

Ethnic minority trainees in Dutch GP-specialty training disproportionately face underperformance judgments, microaggressions, and exclusion. These attainment gaps are not solely explained by academic or socio-demographic factors, but rather by systemic dynamics in training environments. Addressing these inequities is essential to ensure diverse GP-workforces capable of delivering accessible, culturally responsive care.This thesis aimed to answer the following questions: To what extent do ethnic minority GP-trainees experience inequitable educational outcomes? How do they describe and navigate their learning experiences and professional identity formation? Which institutional practices foster more inclusive training environments and equitable opportunities?This mixed-methods thesis combined quantitative and qualitative approaches. Retrospective analysis of trainee files (n=1,870, seven institutes) examined underperformance risk using multilevel logistic regression. Semi-structured interviews (n=14) explored educational experiences and coping strategies. Participatory action research engaged trainees, supervisors, management, and policymakers in twelve focus group sessions to co-design feasible, broadly supported recommendations, which informed a national implementation plan.Ethnic minority trainees had a significantly higher likelihood of being assessed as underperforming, independent of competence domain. Interviews revealed limited support networks, culturally biased curricula and assessments, microaggressions, exclusion, and challenges in professional identity formation. Coping involved problem-solving, emotional regulation, and relying on social support, yet could inadvertently constrain learning (e.g., reduced openness in reflective groups). Stakeholders identified seven DEI-strategies; three were prioritized for implementation: appointing DEI-ambassadors across organizational levels; amplifying minority trainee input in program development; and mandating DEI-training for staff and supervisors.Strengths of this research include its mixed-methods design, triangulation across multiple data sources, and extensive stakeholder involvement. Limitations involve retrospective quantitative data and a modest qualitative sample size. While the findings align with international literature on differential attainment, hidden curricula, and microaggressions, this thesis contributes novel insights into structural determinants of inequitable outcomes and clarifies institutional responsibilities within GP-specialty training. It presents one of the first nationally coordinated DEI-strategies in European medical education, supporting transferability to other specialties and international contexts. Future research should assess long-term impact, investigate intersectional experiences, and evaluate broader scalability.This thesis reframes underperformance as an institutional issue, provides actionable strategies to advance inclusive medical education, and strengthens culturally responsive GP-workforces.

Topical corticosteroids (TCS) are essential treatments for inflammatory skin diseases, yet inappropriate prescribing and insufficient counselling may lead to preventable adverse effects. In both primary care and hospital settings, limited knowledge of potency selection, duration of therapy, formulation choice, and potential side effects may result in suboptimal outcomes and contribute to steroid-related anxiety described as TOPICOP. Understanding the awareness and prescribing attitudes of residents from different specialties is necessary to identify training needs and guide educational strategies.To evaluate residents’ knowledge, awareness, and prescribing attitudes related to TCS use and to identify corticosteroid-related concerns influencing clinical decisions.This cross-sectional study was conducted between July and October 2024 in a tertiary hospital. A total of 210 residents from Family Medicine, Internal Medicine, Obstetrics & Gynecology, Pediatrics, and Emergency Medicine participated. A structured 32-item questionnaire assessed knowledge of TCS indications, potency ranking, formulation selection, application amount, treatment duration, and awareness of adverse effects. Internal consistency of the knowledge section was high (Cronbach’s alpha = 0.82). Total scores ranged from 0–32. Statistical analyses included chi-square tests, ANOVA, and t-tests, with significance set at p<0.05.Among the participants, 53.8% were female. The mean knowledge score was 18.3 ± 5.6, and only two residents achieved full scores. While general awareness of TCS side effects was high (95.2%), knowledge of specific adverse effects such as glaucoma (24.8%) and rosacea (25.7%) remained low. Family Medicine and Pediatrics residents showed lower hesitation in prescribing TCS (p<0.001). Internal Medicine residents reported the highest dermatology referral rate due to fear of adverse effects (31.4%, p<0.001). Knowledge of potency hierarchy, formulation choice, and application amount was significantly higher among Family Medicine residents than among Internal Medicine and Obstetrics & Gynecology residents (p<0.01). Awareness of hirsutism, acne, and Cushing syndrome was lowest in Obstetrics & Gynecology (p0.05).Inter-specialty differences in knowledge and prescribing behaviors suggest that steroid-related fear influences clinical decision-making and contributes to unnecessary referrals.Targeted, structured educational programs are essential to improve residents’ competence in TCS prescribing, reduce corticosteroid-related anxiety, and ultimately enhance patient safety and treatment quality.

Residents’ motivation is a key driver of learning, professional identity development, and well-being. According to Self-Determination Theory (SDT), autonomy-supportive supervision fosters self-determined motivation, yet little is known about how residents perceive supervisory motivational style across clinical settings, including general practice, in XXX.To examine the association between residents’ perception of their clinical supervisor’s motivational style and their self-determined motivation to engage in clinical placements, and to explore variations across specialties and training settings.A nationwide cross-sectional online survey was conducted among XXX residents (postgraduate years ~1–3) between October and December 2024. Motivational style was assessed using the Learning Climate Questionnaire (LCQ), and motivation using the Global Motivation Scale with calculation of the Self-Determination Index (SDI). Pearson correlation explored associations between perceived motivational style and SDI. ANOVA examined variations according to gender, specialty, stage of training, and practice setting.A total of 918 residents participated. Mean LCQ score was 3.66 (SD 0.84), and mean SDI was 5.31 (SD 4.86), indicating moderate perceived autonomy support and self-determined motivation. Perceived autonomy support was moderately and positively correlated with SDI (r = 0.376, p < 0.001). Higher autonomy support and SDI were observed in specialties emphasizing continuity and patient-centred care, including general practice, paediatrics, and oncology, and in ambulatory settings. Lower scores were observed in procedural and protocol-driven specialties. Female residents reported higher SDI than male residents. No difference in motivational style was found by residency phase.Residents who perceived supervisors as autonomy-supportive reported more self-determined motivation. Ambulatory settings appeared particularly favourable for motivation, possibly due to closer supervision and formal supervisor training in teaching skills. Findings suggest that fostering autonomy-supportive supervision may enhance learning, engagement, and interest in teaching careers in primary care. Cross-sectional design prevents causal inference. Self-selection bias and unequal representation across specialties may limit generalisability. Motivation and supervisory style were self-reported, and supervisor perspectives were not assessed.Autonomy-supportive clinical supervision is associated with stronger self-determined motivation among residents. Integrating autonomy-supportive strategies into faculty development programmes, particularly in hospital settings, may promote learner well-being and support high-quality clinical training in general practice.