Co-design and validation of a tool for monitoring and improving the quality of general practice learning environments

BACKGROUND: Continuous quality improvement of general practice learning environments is critical for training the next generation of general practitioners (GPs). An evidence-based framework (the General Practice Clinical Learning Environment Framework or GPCLE Framework) describes six elements which are important for best practice learning in general practice. However, there is no validated tool to guide the implementation of quality learning. This research aimed to draw from the GPCLE Framework to develop and validate a tool with specific criteria and evidence-based standards, one that is useful and practical for benchmarking and developing higher quality general practice learning environments for general practice registrars. METHODS: This national study applied co-design methods (June 2023-June 2024) engaging various stakeholders, including practice managers, GPs and general practice supervisors (trainers), registrars (trainees), medical educators and training directors, across three stages. In phase 1, the draft tool was developed using a broad literature review, Delphi-style workshop and expert review. In phase 2, a survey involved field testing concepts across the general practice training sector to inform refinements to the criteria and standards. In phase 3, the tool was pilot tested in two general practices, comparing an online self-assessment process with an objective on-site evaluation by the research team, coupled with interview feedback to inform relevance, practicality, and feasibility. RESULTS: The final GPCLE tool comprised demographic questions and eleven criteria with associated evidence-based standards, self-assessed as ‘yes/no/unsure/not applicable’ based on the available evidence. These provide a performance rating on a three-point continuum, from satisfactory to commendable and then exemplary. The tool aligned with the original GPCLE Framework. When piloted, it took around 20 min to complete and practices found it relevant, practical, and feasible. CONCLUSION: The GPCLE tool could be useful for practices to undertake in-practice reviews of the quality of the learning environment for general practice registrars. This could stimulate more specific planning and improvements for practices to strive towards achieving higher performing standards, above and beyond meeting minimum requirements as a training practice. Further, it could also be applied to planning for accreditation, or identifying practices delivering best practice training which can provide exemplars to the sector.