Assignment - Journey Of Becoming A Trainer
Added on - 25 Sep 2019
Assignment – Journey of becoming a trainer, rescuing a practice underthreat and maintaining good quality of care.My essay is about the journey of becoming a GP trainer. Throughout this journey I would like tocomment on 3 main facets of learning, Reflection, perseverance, negotiation and decisionmaking.Reflection:This journey started when I was working as a GP in the army. I was very keen to become a GPtrainer as I was a General Duty Medical officer (GDMO) supervisor at that point. General DutyMedical officers are trainee doctors in the army. They have completed their Foundation yeartraining and before they start their speciality training they have to do general duties in the armyfor 2 yrs. As these doctors are not fully qualified general practitioners, they should work underthe supervision of a GDMO supervisor. GDMO supervisor is a GP in the army who has hadtraining. Which involves attending the 3 day course - introduction to medical education. Duringthis course I learnt about who are GDMOs and their role in the army. Teaching methods, givingfeedback, assessing the trainees. We engaged in group work and role playing.As a GDMO supervisor you will be supervising up to 2 trainees at a time. I had 2 trainees at thetime. Before they arrive I will arrange them an induction package which will includeintroduction to the building, to the computer system, and all the areas of the medical centre,the reception, pharmacy treatment room and clinics. During the induction I encourage them tosit with all GPs in the practice in order for them to see their consultation styles.“1Bad consultations result from having insufficient clinical knowledge, from failing to relate topatients or from failing to understand the patient's behaviour, his perception of his illness or itscontext“It is paramount to have a consultation style that works for the doctor and also works for thepatient as well, to deliver excellent clinical care. As GPs we all consult in slightly different waysand it is good to observe and learn. Following this we will have joint clinics. After eachconsultation we will discuss about what went well, and is there anything that could have donebetter. During the consultation, if I felt there is something that would have affected patient careI would intervene at that time. Following joint clinics, they will start their own clinics. Duringtheir training I will encourage them to attend sessions with the regional occupational healthteam where they conduct medical boards for patients. Also they will attend sessions withphysiotherapy department, community mental health department and regional rehabilitationunit. We will also have weekly tutorials. Tutorials will be interactive and will be on a topic thatthe trainee would like to discuss or anything that I feel trainee’s learning need. We will alsohave case based discussions sometimes during a tutorial. During their stay in the practice I will1JGR Howie (1985)
encourage them to do a full circle audit, a patient satisfaction questionnaire and a 360feedback. They can successfully conduct these as they will be in the surgery for 2 yrs. Also wewill discuss any significant events, complaints or compliments.I really enjoyed supervising these trainees. As they have already had their foundation yeartraining they did have very good clinical skills. They also had other expertise that we as a wholepractice could benefit from. Once one of my trainees were an Advanced Life Support (ALS)provider. So we managed to use his expertise to arrange a Basic Life Support training for thepractice. I found doing joint clinics were very rewarding. It has always been a 2 way learningexperience. Once, one of my trainees had a very polite manner of consulting. Even he had ahigher rank than most of the patients he will always call them very politely and respectfully. Hewill always shake hands with patients before a consultation and give them enough time toexpress themselves. I thought this is a really good way of having a good rapport with patients.Part of military general practice did involve occupational health i.e. grading patientsappropriately so that they will be employed appropriately. During joint clinical sessions,conducting medical boards I found very useful for me as a trainer/Supervisor. In this situationdoctors need to have extremely good communication and negotiation skills. Patients do not liketo be down-graded due to medical problems as it will affect their promotions and development.On the other hand, chain of command and their line managers wants us to down grade themappropriately so that they can employ their soldiers accordingly. In this situation we have toexplain to the patient in a way that they understand and agree and then without breechingconfidentiality, give as much information as possible to the chain of command so that they canemploy them appropriately. In the mean time we have to discuss with the regional occupationalhealth team as well, making sure we have done the right thing. I could see initially in some ofmy trainees that they didn’t have adequate negotiating and communicating skills, specially withtheir military background and they thought this is a challenging situation. It was a pleasure toguide them through these skills and to see them flourish. I can remember once, one of mytrainees explained the medical situation and the grading process to a patient and then herealised he had given too much information too soon to the patient. Then he apologized anddiscussed again.For these trainee we had to provide 6 monthly reports recording their progress of learning anddevelopment. Every 6 months we will have a meeting and discuss their experience, concerns,learning needs. We will agree on a personal development plan. I will give them feed-back ontheir progress.Our Senior Medical Officer at this time was also very supportive and the teaching experience Igained during this period was great. Also we had the opportunity to have regular discussionsabout teaching and supervising. This experience encouraged me to explore the opportunity ofbecoming a GP trainer.After discussing with the clinical lead for GP training I was given permission to attend theprospective trainers course. This is how I started my journey. Here I am now after almost 3yrs.later working in an NHS practice, becoming the senior partner of the practice and hoping tocontinue as a GP trainer. I was not expecting this extraordinary journey, overcoming greatestdifficulties that I never expected and at the same time taking me through an extraordinarysteep learning curve.
Perseverance:So I felt so happy with the opportunity of doing the prospective trainers course and managed tosuccessfully complete the course soon after. Unfortunately,themilitary medical center Iworked at that time wasn’t a training practice. So I had to use GDMOs as my trainees.I was really keen to make that practice a training practice. In the meantime, unfortunately oursenior medical officer, who was very keen on making that practice a training practice, wasposted. His successor was not a GP trainer and wasn't keen to have GP trainees. So my effortsunfortunately became to no avail. So I requested a transfer to another practice which wasalready a training practice. This wasn’t going to happen either. I became very frustrated. Thiswas my first job as a qualified GP. By then Ihad worked therefor 7 yrs.When I started in this practice there were six GPs. But unfortunately there were no continuousprofessional development (CPD) events happening in this practice and all the doctors werecarrying out their normal day-to-day work. There were no clinical meetings or dedicatedprofessional development time. We didn't have any trainees either. During this time I was doingmy membership exam and I was very keen on having continuous professional developmentactivities in the practice. I encouraged other doctors to get involved. We had a Senior MedicalOfficer (SMO)who was just posted and a GP trainer. He was also very keen on professionaldevelopment and training.With his help I initiated the lunch time clinical meetings. We had a rotation that all of usparticipated in presenting an important topic every week.In the mean-time, I was very keen to bring in Significant Event Analysis (SEA) and Audits to thepractice. I could remember for the first time ever when we had a SEA meeting, one of thedoctors took it very personally and became very angry towards all of us. We reiterated severaltimes it was all about learning from our mistakes in order to find out what we could dodifferently for a better outcome for our patients.Gibbs reflective cycle:The reflective cycle (Gibbs 1988)
When we explained to her Gibbs reflective cycle and discussed the event in a formal way sheunderstood and cooperated.Reflection:Reflection is a key attribute in training. It does break down the experience in to a structure thatwe could constructively analyse the situation and come up with a constructive action plan.In this situation I could see the negative aspects of reflection clearly. It was time consuming toarrange a meeting and discuss in a way that everyone felt as a constructive feed-back., In thissituation this particular doctor felt insecure and, unsettling to discuss the event. She initially feltthat she was judged by others.For me reflection is a therapy it makes me feel better. Reflection helps you to develop andImprove and learn. It does help to gain perspective. If it is a bad experience, then you have theopportunity to learn from it. It stops us remunerating, clarifies feelings, and helps us to gaininsight. I feel, more powerful the emotion is more powerful the reflection. Reflecting is a goodway of taking control of emotions. It is good practice and important piece of evidence to showas a quality improvement tool. It definitely improves patient care. Also it does give theopportunity to acknowledge the negative.