Figure 1
Danish General Practice Specialist Training Programme.
The figure illustrates the overall organisation of the general practice (GP) specialist training, comprising a predefined sequence of four major phases. While the duration of these overarching phases is fixed, the specific configuration of hospital rotations including their length, order, and departmental composition varies between programmes. This example represents a typical, but not prescriptive, trajectory through the programme. The shaded segments indicate the hospital-based rotations that constitute the focus of the present study.
Table 1
Participant information.
| FIELD OBSERVATIONS | GROUP INTERVIEWS | ||
|---|---|---|---|
| GP trainees | GP trainees | ||
| Male | 4 | Male | 13 |
| Female | 5 | Female | 31 |
| Speciality | Speciality | ||
| Internal Medicine | 5 | Internal Medicine | 19 |
| Psychiatry | Psychiatry | 10 | |
| Paediatrics | 2 | Paediatrics | 1 |
| Gynaecology | Gynaecology | 1 | |
| Emergency medicine | 2 | Emergency medicine | 13 |
| Participants in total | 9 | Participants in total | 44 |
Table 2
The analytical process.
| PHASE | ACTION | DESCRIPTION |
|---|---|---|
| 1. | Familiarisation; reading and initial coding of group interviews | All authors independently read and initially coded the same three group interview transcripts, noting potential areas of analytical interest. At the first meeting, group interviews were reviewed paragraph by paragraph, and early interpretations were discussed. |
| 2. | Development of codes and themes | Five additional group interview transcripts were read, building on the preliminary areas of interest identified earlier. These were organised into broader conceptual categories, forming a preliminary coding framework. In addition, two of the authors (TLK and JEM) analysed the field notes to incorporate observational data. The analysis of categories continued until consensus was reached on the final themes and coding framework. |
| 3. | Final coding | Two authors (SP and FR) read all group interview transcripts in their entirety to ensure a comprehensive understanding of the material. Subsequently, the five last authors individually coded the transcripts. This process resulted in a shared coded dataset, which served as the foundation for drafting the results section. |
| 4. | Writing | All authors took part in writing the final analysis. |
Table 3
Results.
| THEME | SUB-THEMES | BRIEF DESCRIPTION OF THE THEMES |
|---|---|---|
| Finding meaning away from home | Experiencing distance from general practice | GP trainees described how hospital rotations created a sense of distance from “home” in general practice, prompting frustration about lost continuity as well as deliberate efforts to maintain a GP perspective. |
| The relevance of hospital rotations | GP trainees expressed ambivalence regarding the relevance, describing both valuable foundational learning for future general practice and frustration with tasks perceived as poorly aligned with their anticipated role. | |
| Contextualising relevance through supervision and objectives | The relevance was shaped by supervisors’ ability to contextualise learning and by the alignment of learning objectives and activities with general practice needs. | |
| Learning in frequent transitions | Navigating new environments | Repeated transitions were experienced as demanding, with time and energy initially devoted to navigating local systems rather than to professional learning. |
| Adapting to new roles and responsibilities | Frequent transitions required continual adjustment to shifting roles, responsibilities, and hierarchical positions, making it difficult to establish professional footing and a sense of belonging. | |
| Seeking continuity and belonging through GP peer relations | Relationships with GP peers provided continuity, mutual support, and a sense of belonging that helped GP trainees navigate frequent transitions. | |
| Working and learning at the margins | Fitting in and having a place | Learning and well-being were shaped by the extent to which GP trainees were recognised, included, and given a place within hospital teams, with belonging requiring active effort rather than being taken for granted. |
| The challenge of balancing educational needs and service demands | High service demands often took precedence over educational needs, making it difficult to balance learning with clinical workload. |
Appendix 1
Interview guide, GP trainees.
| THEMES | QUESTIONS |
|---|---|
| Introduction to the project and interviewer | The group interview concerns your experiences of the hospital rotation, which is part of your specialist training in general practice. It forms part of a research project exploring GP trainees’ hospital-based training. In addition to interviews with GP trainees, we have conducted field observations. Participation is voluntary. You will be pseudonymised in all written material. It is also important to emphasise that what is said here stays within this group — please do not discuss what others have said outside the interview. The interview will be audio-recorded and transcribed, and the interviewer will take notes during the session. It will last approximately one hour. I have prepared an interview guide in advance. Please remember that there are no “right” or “wrong” answers — I am interested in your individual perspectives and in bringing multiple viewpoints into the discussion. You do not have to agree with each other. Any questions before we begin? |
| Participant introduction | Please begin by briefly introducing yourself: your name, your current hospital department, and a short outline of your training so far. |
| Initial reflections | To begin with: If you were to tell a new GP trainee about the hospital rotation, what would you tell them? |
| Before the hospital rotation – expectations | What expectations did you have before starting your hospital training? Why? What stories or experiences had you heard from others before you started? For example, are there particular reputations or shared “stories” about certain departments? (Encourage interaction: “Does that sound familiar to the rest of you?”/“Would anyone see it differently?”) |
| During the hospital rotation | From your perspective: What is the main purpose of having a hospital rotation as part of GP specialist training? What, for you, makes a hospital rotation a good learning experience? Can you give examples of departments that succeed, and perhaps some that do not? Are there situations where you are assigned a different role or function than other trainees in the department? In clinical work or meetings? Are there functions where your generalist skills as a GP trainee are particularly used or valued? In what ways do you think GP trainees contribute to hospital departments? Can you provide examples of departments that successfully integrate GP trainees? We know from previous research that the transitions between departments can be challenging. How have you experienced these? What makes them difficult or manageable? |
| Workplace community | How do you experience being part of the hospital team as a GP trainee? How do you think others in the department see you? Is it ever explicitly mentioned that you are GP trainees? How do you see your own role? Do you feel that your learning is prioritised on an equal level with other trainees?Can you think of examples where it has — or has not — been the case? (Encourage reflection: “Do others recognise this experience?”/“Is that similar across departments?”) |
| Learning potential | Overall, what do you think you learn most from your hospital rotation? What experiences do you think will be most useful in your future GP practice? |
| Closing reflections | Apart from what we have discussed, is there anything you think could be improved in the hospital rotation? Is there anything important that we have not talked about but that you think I should know? |