PBSGL, peer support and resilience.

Looking Back: Evaluating PBSGL in Salisbury Plain (2017)

As we timetable the 100th meeting of the Salisbury Plain PBSGL group, it feels timely to revisit my first formal evaluation of the group, undertaken in 2017. At that point, PBSGL was already well established locally, but there had been little structured examination of its educational or pastoral impact within a mixed Defence primary care setting.

In 2017, I undertook a small service evaluation to explore the perceived educational effects of participation in PBSGL. For those unfamiliar with the model, PBSGL is a structured, peer-led educational approach grounded in problem-based learning, with an emphasis on facilitated discussion and reflection (see NHS Scotland PBSGL and PBSGL England). The evaluation used qualitative thematic analysis of free-text questionnaire responses from group members.

While educational benefit was expected and widely reported, what emerged most strongly was the role of PBSGL in peer support and professional resilience. The dominant thematic nodes identified were: morale, negative feelings, pastoral role, positive role models, seeking advice, sharing best practice, and social network. Notably, the evaluation had not been explicitly designed to explore wellbeing, yet support and morale appeared repeatedly and unprompted.

The Salisbury Plain group was, and remains, unusual in its composition. Alongside established GPs and GP Trainers, it included GP Specialty Trainees (GPSTs) and General Duties Medical Officers (GDMOs). GDMOs are typically early-career doctors working across a broad portfolio of military and clinical roles, spending a significant proportion of their time in primary care under supervision while preparing for postgraduate examinations.

This mixed professional demographic shaped the learning environment in important ways. Doctors intending careers in hospital specialties brought different approaches to risk, uncertainty and decision-making, informed by their anticipated professional trajectories. Exposure to the uncertainty inherent in general practice, and to peer discussion within PBSGL, appeared to enrich discussion and challenge assumptions across the group.

Participants consistently described PBSGL as offering more than conventional CPD. Several comments explicitly framed the group as a source of pastoral support:

“It goes beyond the purely medical and offers a degree of pastoral care – knowing that others also have the same challenges and difficulties.” (GP)

“It’s a brilliant idea and not only improves clinical knowledge and changes practice, it also brings doctors together and improves morale.” (GP Trainer)

Senior members highlighted the value of a wider peer reference group beyond the immediate practice:

“The key improvement is the wider group within which to gauge opinion.” (GP Trainer)

Junior members were unanimous in their positive views on peer support and shared learning:

“A mixed experience group allows for the fusion of youthful exam-based knowledge with matured clinical acumen.” (GDMO)

“Hearing different opinions on the same topic has been useful—previously I might have asked one person and taken that as gospel.” (GPST)

These findings aligned closely with existing literature on problem-based and practice-based small group learning, which emphasises cooperative learning, constructive cognitive conflict and peer support as central mechanisms for learning and professional development¹. Similar benefits have been demonstrated in PBSGL groups involving GP trainees² and established GPs³.

In retrospect, the relationship between peer support and resilience is particularly noteworthy. Evidence suggests that peer support within small group learning environments can help build resilience among physicians⁴. Given increasing workload, workforce shortages and system pressures in primary care, resilience is recognised as both necessary and multifactorial⁵⁻⁶. Although resilience was not measured explicitly in the 2017 evaluation, it likely contributed to the positive responses observed.

Looking back, one of the key insights from this early evaluation was that PBSGL functioned as more than an educational intervention. Alongside its established role in knowledge exchange and practice change, it provided a structured, legitimised space for shared uncertainty, mutual support and professional affirmation—particularly valuable for GPSTs and GDMOs, for whom formal support structures were less well developed at the time.

As the group approaches its 100th meeting, this early evaluation feels less like a snapshot and more like a foundation. Many of the pressures described in 2017 have intensified rather than diminished. That PBSGL continues to be valued for its supportive function may be as important now as its educational impact—and perhaps inseparable from it.

References
1. Onyon C. Problem-based learning: a review of the educational and psychological theory. Clin Teach. 2012;9(1):22–26.
2. Rial J, Scallan S. Practice-based small group learning (PBSGL) for CPD: a pilot with general practice trainees to support the transition to independent practice. Educ Prim Care. 2013;24(3):173–177.
3. Bruce S, Conaglen H, Conaglen J. Burnout in physicians: a case for peer-support. Intern Med J. 2005;35(5):272–278.
4. Jensen PM, Trollope-Kumar K, Waters H, et al. Building physician resilience. Can Fam Physician. 2008;54(5):722–729.
5. Matheson C, Robertson HD, Elliott AM, et al. Resilience of primary healthcare professionals working in challenging environments: a focus group study. Br J Gen Pract. 2016;66(648):e507–e515.
6. Robertson HD, Elliott AM, Burton C, et al. Resilience of primary healthcare professionals: a systematic review. Br J Gen Pract. 2016;66(647):e423–e433.