Training for Audit: Lessons Still to Be Learned

Background: Audit is a criterion for training in general practice, and registrars are reliant on their trainers' teaching of basic audit methods. Their ability to teach this had been assumed, but registrars' projects submitted as part of summative assessment offered an opportunity to test this.

Aim: To test trainers' knowledge of basic audit methods. Their knowledge was based on an ability to recognize key audit criteria using a marking schedule that they had helped to create.

Method: All 158 trainers in the west of Scotland were asked to mark five general practice registrar audit projects using a marking schedule consisting of five independent criteria. Each project had one criterion that was below a level of minimum competence, as agreed by a group of 'expert' assessors.

Results: A total of 114 trainers (72%) completed the marking exercise of five audit projects. Three (3%) correctly identified the five criteria that were below minimum competence. They did this by highlighting many other criteria not below minimum competence. For all trainers, there was a direct relationship between the number of criteria they correctly identified as being below minimum competence and the total number of other criteria that they incorrectly identified.

Conclusion: Trainers are failing to recognize basic audit methodology using a marking schedule they themselves helped to design. This has implications for their ability to teach audit to their registrars and may explain some of the difficulty in implementing audit.