The core values of general practice/family medicine (FM) provide a framework for the professional role and responsibilities of general practice (1). They have been described by various international scientific societies, including the World Organization of National Colleges, Academies, and Academic Associations of General Practitioners/Family Physicians (WONCA). Within different countries, FM core values are ranked differently but pertain to the same nexus (2–4). The professional definition of the German College of General Practitioners and Family Physicians (DEGAM) outlines a set of FM core values, including a bio-psycho-social approach, unselected patients, preventable dangerous or irreversibly harmful course of disease, wait-and-see attitude, experienced anamnesis, and hermeneutic case understanding. In 2022, the Göktaş definition of family medicine/general practice emphasized the value of hermeneutic case understanding by adding the broad authority and perspective it offers to the family physician, complementing the core competencies and principles outlined in the previous WONCA definition (6). Furthermore, the CanMED role model plays an important role in FM and medical education (5).

There is limited evidence about the knowledge of FM core values and principles among FM trainees. The FM core principles are typically taught through reflection and practice (7), as well as in seminars built around overarching topics (8). Teaching principles and values in general are outlined for basic medical education (9, 10), with a suggestion for a practical and theoretical model (11).

Defining and vocalizing core values is an important foundation for using these values in daily evidence-based FM routines (12) and can help maintain course in a constantly changing world (13). Knowledge of the core principles of FM is listed as a learning objective in the postgraduate training curriculum of the German Federal Medical Association (14). The deep learning and decisive application of FM core principles in daily practice can make healthcare systems more efficient and effective (12).

The German education guidelines for family physicians (14) require 5 years of training with mandatory on-ward training in internal medicine (12 months) and training at an FM surgery (24 months), as well as 24 months of further training in other elective rotations and in patient-related specialist rotations (15). Graduates from other specialties, such as surgery, neurology, or internal medicine, may enter FM training through lateral entry with a 2-year curriculum (16). The KWBW Verbundweiterbildung PLUS© is the first German voluntary competency-based training program to offer a seminar curriculum including educational compact interventions (17–20) as well as structured mentoring and the possibility of regional clinical rotations across Baden-Württemberg for FM trainees (21). At the beginning of this program, attendees have to participate in a 2-day starter course with two seminars (2 × 90 min) about FM core values and principles.

Within this cross-sectional study, mixed methods were used to achieve the aim of this study. These were

To the best of the authors’ knowledge, this is the first study to analyze the knowledge of FM core values among trainees in Germany. The study showed that education in FM principles and values at medical school and during postgraduate training cannot be taken for granted and needs to be implemented in the curricula. An educational course on principles and core values was widely accepted and rated well. All the objectives of the study were achieved.

There was a strong implicit understanding of FM core principles and values, while, on the other hand, there was a lack of explicit knowledge of specific terms that define these core principles and values. In the authors’ view, explicit knowledge and vocation help to internalize and reflect principles and values and promote advocacy for FM. This phenomenon is also described in nursery education (24). Full explicit knowledge of FM core values can serve as a valuable guidance for general practitioners. Explicitly naming FM core principles as a learning objective, such as in the postgraduate training curriculum of the German Federal Medical Association (14), seems both progressive and desirable to us. In sum, we lack implementation of teaching FM core principles and values in medical education.

The data show that not all participants experienced comprehensive education in FM core principles and values during medical school. The majority of participants are in the advanced status of their training, and various FM trainees report no previous specific training in FM core principles and values. We can therefore conclude that explicit training in the core values of FM cannot be taken for granted, and it would be wrong to presume knowledge of FM core values as known (8). Rarely specific teaching of FM core values and principles is described, which underlines the importance of the seminar. Educational interventions focused on FM core values can increase explicit and specific knowledge, skills, and attitudes in FM. Cost-effective and time-efficient educational compact interventions on a variety of topics have proven successful in fostering the competencies of FM trainees (17–20). The educational compact intervention about core values was well-evaluated especially in the categories of practical relevance and confirmation to become an FM doctor. Considering the four stages of competence (25), it is important to learn the core principles and values at the level of conscious incompetence as well as at the level of conscious competence. This approach ensures the development of full knowledge at the level of unconscious competence level for future FM doctors.

The explicit knowledge of FM core values enables more specific personal reflection, which can be a relevant factor in becoming a reflective family physician (26). Having a specific framework of FM principles can be a helpful reference at the beginning of the FM rotation where a transformation from a clinical attitude toward a primary care attitude is needed (27). Furthermore, it could foster advocacy for FM (1). The World Federation for Medical Education (WFME) training curriculum for FM trainers needs to integrate core principles and concepts of FM (28). There are also indications for new values, for example for employed FM doctors (29). At KWBW Verbundweiterbildung plus, we have specific training in FM core principles and values, and references are continually made during the whole 5-year program.

There is an ongoing constructive and valuable discussion about identifying and ranking the core principles and values of FM (30). In this study, we used the German definition and assumed that, with a different definition in another country, a similar gap between implicit and explicit knowledge would likely be shown. In view of this, together with the good rating in terms of practical relevance, we see a need for further implementation of the teaching of core values at both pre- and post-graduate levels.

We think that longitudinal medical curricula based on core principles and values, with educational compact interventions at the beginning and corresponding further learning objectives, can also be effective in other disciplines and other settings with correlating specific values. We suggest that such longitudinal curricula can also be integrated into existing medical curricula in other countries. Further didactic implementation can be an integration of a spiral curriculum, practice- and case-based learning, and longitudinal reflection (31, 32).

In conclusion, to support professional identity formation in FM, it is necessary to ensure explicit learning, discussion, and reflection on FM core values during training. A compact educational intervention in FM core values and principles was well evaluated by FM trainees, especially in the category of practical relevance. The results of this study align with the research objectives and provide comprehensive insights into training FM core values and core principles.

Awareness of the core principles and values of FM can empower trainees, encourage advocacy for FM, and enhance its reputation. Training programs in FM should implement the core principles of FM into seminars at the very beginning of the training curriculum and should recur to them later. Educators should integrate reflection on core values and principles alongside the teaching of knowledge and skills. This allows for continuous self-reflection during the postgraduate training as well as an ongoing, lifelong process. Policymakers should support the development and implementation of longitudinal curricula that emphasize core values and principles, evidence-based medicine, and professional identity formation.

Future studies should investigate the implementation of FM core values in curricula at medical school, during training, and in continuous medical education. Further interventions should prioritize the implementation of longitudinal curricula that focus on professionalism and attitudes. Studies should focus on a pre–post design with follow-up on knowledge and professional identity formation, attitudes toward core principles and values, and potential effects on self-reflective practice. A longitudinal evaluation with a built-in progression model of attitudes toward core values and principles and professional identity formation could assess long-term effects. In addition, its possible long-term effects on daily primary care practice need to be examined. Longitudinal and qualitative studies are needed to further explore how successful interventions support FM trainees to gain FM core values and principles as unconscious competence in the daily practice of FM.