The Essential Handbook for GP Training and Education

Ramesh Mehay

• Publisher: CRC Press
• Year: 2021
• eBook ISBN: 9781000477030
• Edition: 1
• Topic: Medicine
• Subtopic: Family Medicine & General Practice

The much anticipated practical educational manual for General Practice (GP) trainers, programme directors, and other teachers and educators in primary care has finally arrived. This extensive, full-colour guide is written by a select group of hands-on educators who are passionate and knowledgeable. The book captures their wisdom and vast experience in an accessible and practical way.

Although it's aimed at GP training, there are many chapters in this book that are relevant and transferrable to teachers and educators in areas outside of General Practice (and worldwide). We are sure that GP appraisers, Foundation Year trainers and other medical/nursing student educators will find the detailed comprehensive explorations inspirational.

Beautifully presented, the chapters cover a wide educational framework employing a variety of presentational methods such as flowcharts, diagrams, conversational pieces, scenarios and anecdotes. Each chapter has a corresponding webpage containing over 300 additional resources - providing practical tools as well as additional reading material.

This book was awarded the Royal College of GP's 'Paul Freeling Prize' in 2013 for merititious work in the field of General Practice education. It is also used as the foundation textbook for the Postgraduate Certificate in Medical Education (PGCE) in at least seven UK universities. The Essential Handbook for GP Training and Education adopts a relaxed, personable approach to primary care education that won't leave you with a headache.

PART ONE GP Training in the UK

DOI: 10.1201/9781846197918-1

1 The Structure of GP Training in the UK

RAMESH MEHAY – TPD (Bradford) & lead author MIKE TOMSON – APD (Yorkshire & the Humber) IAIN LAMB – Associate Advisor (SE Scotland) JAMES MEADE – TPD (Northern Ireland) MALCOLM LEWIS – Director of General Practice (Wales Deanery)

DOI: 10.1201/9781846197918-2

It has been my experience that being relatively young is no barrier to getting involved in medical education. If you are interested, get in touch with people who are (or have been) involved in your training. Talk to them about what it is like to be involved in medical education. You could gain first-hand experience by doing some training. You could run a session at the local training scheme, or apply to the local undergraduate medical school to become involved in some teaching…. Do not be scared to apply – it is a rewarding job.

Sanjiv Ahluwalia, Deputy Head of GP School, London Deanery¹

This chapter is intentionally small because …

1. We don’t want to bore you to death.
2. We don’t think it is too taxing to understand the structure of GP training in the UK.
3. Things might change soon (e.g. with the GP consortia) so there is no point talking about the structure in too much depth.
4. There is more detailed guidance on our website (which we will periodically update). Your deanery will give you specific advice for your region too.

Who cares about the structure of training in the UK?

Many GP Trainers (and some Training Programme Directors) go about their business without knowing much about the structure – and, yes, they do get by. However, knowing about the structure would help them understand the roles and responsibilities different people play, as well as understanding who is accountable to whom.

This information is particularly helpful in situations where advice from others would be most valued. A typical scenario would be where they’re struggling with a trainee in difficulty or a GP trainee making an unusual request for leave.

Red Alert: The structure in Scotland is different to the rest of the UK. NHS Education Scotland is a special health board responsible for supporting NHS services delivered to the people of Scotland by developing and delivering education and training for those who work in NHS Scotland.

Isn′t the structure just overly bureaucratic?

We don’t think so. Trainees deliver much of the NHS service. The quality of the patient care they provide depends on the quality of training they receive. And, none of that matters if there aren’t enough people to do the job in the first place! Therefore, to provide quality patient care, you need a structured organisation to do the following.

1. Ensure recruitment selects enough people to do the job.
2. Ensure recruitment selects the right people for the job.
3. Make sure that we train them up properly (quality training).
4. Double check we have trained them properly (quality assurance).

That’s a heck of a job.

The current GP training system, in a nutshell

• There is a common set of guidelines and regulations covering all medical training (including GP). This is commonly called the Gold Guide (or even GG) though formally titled A Reference Guide for Postgraduate Speciality Training in the UK. There’s more about this later, and you can find a link to it from our website.
• All GP trainees must complete three years of an approved training programme of which 18 months has to be in GP land (this may in time become five years). The 3 years are often referred to as ST1, ST2 and ST3 (ST = specialty training year). When a trainee joins a programme, they are given a National Training Number (NTN) which stays with them until they complete their training.
• During the three years, the trainee receives Clinical and Educational Supervision. Clinical Supervision is about helping them to acquire clinical knowledge, skills and attitudes (and thus gain competence) as they rotate through the posts. Educational Supervision focuses on their educational development (through learning gaps) and helps keep them on track for their training programme overall.
• Throughout the training programme, the trainee is assessed using Workplace-Based Assessments (WPBA) – things like case-based discussions (CBDs), multi-source feedback (MSF) from colleagues, direct observation of procedural (clinical) skills (DOPS) and so on. The trainee needs to demonstrate competency progression throughout their training period through these WPBA assessments and a log of their learning/clinical experiences. All of this is kept in an electronic folder called the ePortfolio.
• Towards the end of every ST year, an independent panel called the Annual Review of Competency Progression (ARCP) panel assesses each trainee’s ePortfolio. If progress is good, the panel will give an ‘Outcome 1’ and allow them to proceed to the next year. If the panel has some concerns, but progress is still good enough for the trainee to carry onto the next job, an ‘Outcome 2’ is likely to be given. On the other hand, if there are concerns about the trainee’s progress such that the panel feels repeating a training period would be beneficial, an ‘Outcome 3’ is given.
• By the end of training, the trainee is required to have taken and successfully passed two examinations. One is a multiple-choice paper testing knowledge (called the Applied Knowledge Test or AKT), and the other is a special OSCE type exam where they are tested on a variety of clinical and communication skills using simulated patients (called Clinical Skills Assessment or CSA).
• When the ST3 trainee has successfully completed everything and is deemed competent, they receive a certificate to signpost that they’ve reached the level required for independent safe general practice (called the Certificate of Completion of Training – CCT; also known as ARCP ‘Outcome 4’).

Top Tip: Don’t worry about all the acronyms and outcomes, especially if you’re new to GP training. They will come to you naturally after a few months.

Who decides what is what?

The General Medical Council (GMC)

The GMC is ultimately ‘top dog’: it is the independent regulator for doctors in the UK. Its statutory purpose is ‘to protect, promote and maintain the health and safety of the public’, and its powers are set out in the Medical Act 1983.² In brief, this is what it does:

The Medical Act 1983

• It determines the principles and values that underpin good medical practice.
• It has a general function to promote high standards and coordinate all stages of medical education.
• It is responsible for (and actually sets) the standards of postgraduate medical education and training.
• It quality assures that these standards are being met by approved training programmes and institutions (e.g. through its visiting programme).
• It certifies doctors who apply for their CCT and makes that doctor eligible for inclusion on the GMC’s Specialist or GP Register.

The Medical Royal Colleges

The Medical Royal Colleges/Faculties are ‘deputy dogs’. They develop entry criteria, curricula and exit criteria for their particular specialty in accordance with the guidance set by the GMC. The GMC reviews these criteria. Once approved, the colleges (via college tutors/regional advisors) work with deaneries to help them deliver the curricula at a local level (and help to quality assure and manage them).

The deaneries

The deaneries are independent organisations whose aim is to ensure a training programme is delivered to specialty doctors in training according to GMC standards. At the head of the deanery sits the Postgraduate Dean and his or her team, but more about them later. The deaneries cover all medical specialties, not just general practice (although general practice comprises a large part of their work). The deaneries work closely with the Royal Colleges and local education providers, and employ Training Programme Directors (TPDs) in order to deliver the programmes. (Yes! The medical specialties have TPDs too – not just general practice.)

Training Programme Directors

The TPDs are the people who make things happen at a shop floor level – developing a training programme across local educational provider units (hospital departments and GP posts).

Higher specialist training is managed by more than one organisation

We hope you have not come to the conclusion that one organisation simply dumps their training objective over to the organisation beneath them. What actually happens is that a number of representatives from each of the organisations above meet and work with one another through deanery specialty training committees. A useful analogy is to think about the construction of a house. The GMC and RCGP are a bit like the local council who, through their policies and permissions, say what you can and cannot do. The deanery and TPDs are the architects who have to design something that fits in with these policies and permissions. Finally, the TPDs, Clinical and Educational Supervisors are the builders who start making the plans come to life. Once it is built the trainees, of course, become the new tenants.

The Gold Guide³

Th...

Table of contents

• Cover Page
• Title Page
• Copyright Page
• Dedication
• Table of Contents
• Preface
• Why developing teaching skills is important
• How to use this book
• About the editor
• Dedication
• Acknowledgements from the Editor
• Part One: GP Training in the UK
• Part Two: The Fundamentals of Teaching
• Part Three: Educational Theory That Matters
• Part Four: Teaching Groups of People
• Part Five: Taking Centre Stage
• Part Six: Special Areas of Training
• Part Seven: The Consultation
• Part Eight: MRCGP, Supervision and Assessment
• Part Nine: The Trainee in Difficulty
• Part Ten: Management and I.T.
• Index