The role of reflexivity in exploring exclusion in GP training: a qualitative study of GP educators

Background: Reflexivity is an under-researched concept in Primary Care education and educators receive no formal training in reflexivity. Evidence from other disciplines suggests that reflexivity can promote patient safety and inclusivity, making it a potentially valuable tool in medical training.

Aim: To examine the use of reflexivity in GP training and how it can be used to explore experiences of exclusion.

Design & setting: A qualitative analysis of GP educators’ perspectives in London and SE England.

Method: Fourteen primary care educators were recruited. Focus groups and semi-structured interviews were conducted. Participants' opinions of reflexivity were explored, focussing on their own reflexivity, and that of their learners and the medical faculty. Data were transcribed verbatim and thematically analysed.

Results: Three key themes were identified: the value of reflexivity; revealing unfairness through reflexivity; tokenistic reflection vs creative reflexivity.

Conclusion: This study indicates GP educators are not familiar with the concept of reflexivity but are keen to consider how it could impact their learners. Moreover, the research demonstrated how issues of diversity, inclusion and exclusion are brought to light through reflexive practice, and how this affects International Medical Graduates learners. The participants identified a lack of organisational reflexivity as a significant factor affecting inclusion and differential attainment, and it was suggested there was an “inverse education law.” The educators called for more diverse leadership, less tokenistic reflection and more reflexive and creative learning tools to address this.