Tensions in the Curriculum

The curriculum is written principally for GPs. As a GP you might use it to ask yourself how you personally need to change in order to become or stay a good GP, or how the profession needs to develop in order to foster good generalists. This requires that you understand the content and balance of the curriculum.

The GP core curriculum is split into parts but much effort is made to show how these parts do not operate independently but are integrated within everyday practice. What is less evident is that in clinical practice there is repulsion as well as attraction between these parts and to be a good GP you need to understand the tensions so that a reasonable balance can be achieved.

As a GP you will use all parts of the core curriculum in relation to virtually every patient problem but the balance between these elements will change depending on many factors including the nature of the problem, expectations, availability of resources etc. Because of this, the GP curriculum can define and illustrate the parts, but cannot prescribe an appropriate balance – this will be up to the professional judgement of the doctor.

To illustrate the tensions further:

Some concepts have conflict and balance as part of their make up. In medical ethics, for example, autonomy and social justice vie with each other, and when ‘respecting diversity’ the doctor’s respect for one community or approach may be in conflict with respect for another.

Different curricular areas of competence may directly affect each other. For instance, the ‘person-centred approach’, where the individual patient is the prime concern of the GP, is in tension with the ‘community orientation’ of the doctor, where the wider needs of the practice population need to be addressed. Rationing is another clear example and a particular threat to person-centred care, requiring such decisions as which drugs and treatments to provide, which referrals can be authorised or how to carve up limited time, perhaps with less time in face-to-face consultation and more time providing telephone access to the larger community.

Social expectations and the changing political environment of healthcare create tension by challenging the curriculum through influencing the balance between its elements.

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