The Cohered GP Training Model: A systematic review and complexity-informed synthesis of general practice training
Frank Nyame-Asiamah, Thomas Kyei-Mensah, Sanjiv AhluwaliaAbstract
Background:
General practice (GP) training is central to the development of the primary care workforce but is often described as a bounded educational programme rather than a process shaped by clinical work, workplace culture, and wider service conditions.
Aim:
To examine how GP training is represented in the literature and to develop a complexity-informed conceptual model of GP training.
Design and setting:
Systematic review and complexity-informed synthesis of studies relating to GP training in primary care contexts.
Method:
Empirical and conceptual studies were identified through systematic searching and analyzed using thematic synthesis, informed by complex adaptive systems and Cohered Emergent Theory.
Results:
Three thematic areas were identified: GP–patient interactions, GP–professional interactions, and training intricacies. Four cross-cutting insights emerged: complexity in everyday training, the influence of power and hierarchy, the importance of diversity and adaptability, and the shaping role of wider system pressures. These informed the Cohered GP Training Model, which conceptualizes GP training as a dynamic system in which outcomes emerge from the degree of coherence between trainee formation, educational relationships, patient care encounters, workplace and team ecology, and the wider primary care system.
Conclusion:
GP training is best understood as a relational and system-embedded process rather than a discrete educational intervention. The model may help explain variation in training quality across settings and offers a conceptual basis for improving training environments and workforce development.