Maintaining a Training Practice: Overcoming Obstacles


Added on  2019-09-25

11 Pages5481 Words389 ViewsType: 389
Professional DevelopmentHealthcare and Research
Assignment – Journey of becoming a trainer, rescuing a practice under threat and maintaining good quality of care.My essay is about the journey of becoming a GP trainer. Throughout this journey I would like to comment on 3 main facets of learning, Reflection, perseverance, negotiation and decision making.Reflection:This journey started when I was working as a GP in the army. I was very keen to become a GP trainer as I was a General Duty Medical officer (GDMO) supervisor at that point. General Duty Medical officers are trainee doctors in the army. They have completed their Foundation year training 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 under the supervision of a GDMO supervisor. GDMO supervisor is a GP in the army who has had training. Which involves attending the 3 day course - introduction to medical education. During this course I learnt about who are GDMOs and their role in the army. Teaching methods, giving feedback, 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 the time. Before they arrive I will arrange them an induction package which will include introduction 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 to sit 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 to patients or from failing to understand the patient's behaviour, his perception of his illness or its context“It is paramount to have a consultation style that works for the doctor and also works for the patient as well, to deliver excellent clinical care. As GPs we all consult in slightly different ways and it is good to observe and learn. Following this we will have joint clinics. After each consultation we will discuss about what went well, and is there anything that could have done better. 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. During their training I will encourage them to attend sessions with the regional occupational health team where they conduct medical boards for patients. Also they will attend sessions with physiotherapy department, community mental health department and regional rehabilitation unit. We will also have weekly tutorials. Tutorials will be interactive and will be on a topic that the trainee would like to discuss or anything that I feel trainee’s learning need. We will also have case based discussions sometimes during a tutorial. During their stay in the practice I will 1JGR Howie (1985)
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encourage them to do a full circle audit, a patient satisfaction questionnaire and a 360 feedback. They can successfully conduct these as they will be in the surgery for 2 yrs. Also we will discuss any significant events, complaints or compliments. I really enjoyed supervising these trainees. As they have already had their foundation year training they did have very good clinical skills. They also had other expertise that we as a whole practice 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 the practice. I found doing joint clinics were very rewarding. It has always been a 2 way learning experience. Once, one of my trainees had a very polite manner of consulting. Even he had a higher rank than most of the patients he will always call them very politely and respectfully. He will always shake hands with patients before a consultation and give them enough time to express 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 patients appropriately 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 situation doctors 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 them appropriately so that they can employ their soldiers accordingly. In this situation we have to explain to the patient in a way that they understand and agree and then without breeching confidentiality, give as much information as possible to the chain of command so that they can employ 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 of my 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 to guide them through these skills and to see them flourish. I can remember once, one of my trainees explained the medical situation and the grading process to a patient and then he realised he had given too much information too soon to the patient. Then he apologized and discussed again. For these trainee we had to provide 6 monthly reports recording their progress of learning and development. 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 on their progress. Our Senior Medical Officer at this time was also very supportive and the teaching experience I gained during this period was great. Also we had the opportunity to have regular discussions about teaching and supervising. This experience encouraged me to explore the opportunity of becoming a GP trainer. After discussing with the clinical lead for GP training I was given permission to attend the prospective 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 to continue as a GP trainer. I was not expecting this extraordinary journey, overcoming greatest difficulties that I never expected and at the same time taking me through an extraordinary steep learning curve.
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Perseverance:So I felt so happy with the opportunity of doing the prospective trainers course and managed tosuccessfully complete the course soon after. Unfortunately, the military medical center I worked 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 our senior medical officer, who was very keen on making that practice a training practice, was posted. His successor was not a GP trainer and wasn't keen to have GP trainees. So my efforts unfortunately became to no avail. So I requested a transfer to another practice which was already a training practice. This wasn’t going to happen either. I became very frustrated. This was my first job as a qualified GP. By then I had worked there for 7 yrs. When I started in this practice there were six GPs. But unfortunately there were no continuous professional development (CPD) events happening in this practice and all the doctors were carrying out their normal day-to-day work. There were no clinical meetings or dedicated professional 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 development activities in the practice. I encouraged other doctors to get involved. We had a Senior Medical Officer (SMO)who was just posted and a GP trainer. He was also very keen on professional development and training. With his help I initiated the lunch time clinical meetings. We had a rotation that all of us participated 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 the practice. I could remember for the first time ever when we had a SEA meeting, one of the doctors took it very personally and became very angry towards all of us. We reiterated several times it was all about learning from our mistakes in order to find out what we could do differently for a better outcome for our patients. Gibbs reflective cycle:The reflective cycle (Gibbs 1988)
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When we explained to her Gibbs reflective cycle and discussed the event in a formal way she understood and cooperated.Reflection: Reflection is a key attribute in training. It does break down the experience in to a structure that we 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 to arrange a meeting and discuss in a way that everyone felt as a constructive feed-back., In this situation 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 and Improve and learn. It does help to gain perspective. If it is a bad experience, then you have the opportunity to learn from it. It stops us remunerating, clarifies feelings, and helps us to gain insight. I feel, more powerful the emotion is more powerful the reflection. Reflecting is a good way of taking control of emotions. It is good practice and important piece of evidence to show as a quality improvement tool. It definitely improves patient care. Also it does give the opportunity to acknowledge the negative.
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