The History of the RCGP
The Future General Practitioner-
Learning and Teaching by a Working Party of The Royal College
of General Practitioners. RCGP. 1972.
The Working Party
John Horder [Chairman]
Patrick Byrne
Paul Freeling
Conrad Harris
Donald Irvine
Marshall Marinker
"Those who
are enamoured of practice without science are like a pilot who goes
into a ship with rudder or compass." Leonardo da
Vinci.
The training of
doctors is one of many factors determining the quality of medical
care, but it is fundamental and far-reaching. It is scarcely
necessary to underline how vital to patients is the quality of the
general practitioner’s work. This book is about his early
postgraduate (Vocational") training. It is written to stimulate the
thinking of general practitioners teachers. It should also prove
useful to doctors who are learning, to organisers of training
schemes and to specialists who take part in the training of general
practitioners. It appears at a time when there is a rapid and
encouraging development of training schemes for general practice
all over the country, and against a wider background of constant
changes in society, in the biological and behavioural sciences, in
the pattern of illnesses and therefore in medical practice of all
types.
The role of the
general doctor among specialists has become clearer in the last
twenty years and many new ideas have been introduced and translated
into action. These are reflected in this book. There are also new
ideas about education which we believe to be valuable to general
practitioner teachers. These too find an important place. The book
therefore covers a very wide field. This is both inevitable and
right, because the range of the work of the general practitioner is
very wide. Indeed this is the very feature which, above all others,
ensures his relevance and value to patients in an age which favours
specialisation.
Specialists in other fields of medicine, if they read the
chapters which follow, may well find that much of what we say
applies to the good doctors in any field. With this we agree,
because general practice partly overlaps every speciality and many
of the qualities of a good doctors or a good teacher are the same
in whatever speciality they are applied.
There are two short College reports to which the book is
intimately related The Educational Needs of the Future General
Practitioner (1969) and The Future General Practitioners.
Problems of Organizing His Training (1971). The first of these
was an introduction both to the second and to the present book. The
second was separated from the book because it seemed urgent to
publish it quickly, so that organisers of schemes might benefit
from each other’s experience.
The book itself has six chapters. The first , Educational
Processes, discusses educational aims and objectives. The second
and third are about the medical consultation and analyse the way in
which a relationship is formed, information is gathered, problems
are defined, how they are solved, and what actions are taken. The
process of consultation cannot be taught or learned unless it is
first analysed and understood. Chapter IV is the longest; in it we
attempt to set down the content of general practice for educational
purposes and divide this into the five areas which were outlined in
the report of 1969.
- Clinical Practice – Health and
Diseases.
- Clinical Practice - human
Development
- Clinical Practice – Human
Behaviour
- Medicine and Society
- The Practice
Clinical practice is not confined to area 1. In the consultation
the doctor draws equally on the first three areas. Area 4 is also
partly clinical. Area 5 is about practice organisation – knowledge
and skills of a different kind, which provide a sub-structure for
the consultation. Thus everything included in the chapter on the
content of vocational training has a direct bearing on the central
medical act, the consultation. In it we draw selectively on other
disciplines, both inside and outside medicine, but chiefly on the
experience of doctors who provide personal, primary and continuing
care to patients. The content of general practice is thus defined
in detail for educational purposes, so that this chapter might be
said to beat the bounds of general practice within the larger
territory of medicine as a whole.
Chapter V, Educational Methods, reflects our experience of
working with educationalists. The concluding chapter discusses
human experience as something which can and must be shared by
patient and doctor, learner and teacher.
This book is about learning and teaching rather than about
practice of medicine, but since it is the practice of medicine that
has to be learned, it is inevitably about this too. The education
purpose is marked by the emphasis on major educational aims and
detailed educational objectives. Detailed objectives are stated in
terms as practical and concise as possible – what the doctor is
learning should be able to do – so that it may be easy to test
whether the aim or objective has been achieved. The emphasis on
education is partly responsible for the small emphasis on general
practitioner research. Research is, of course, as important to
general practice as to any other discipline in medicine and beyond
it, but it is the subject of another book published by the College
in 1966. Nevertheless, a great deal of what is said here is the
outcome of research already achieved.
Compared with other college reports, this book is long.
Compared with what general practitioners actually know and do, it
is short. Even so it does not attempt to recapitulate what will
have been learned during the undergraduate period. It concentrates
on topics what are unlikely to have been learned before
registration as a doctor, but which are essential to general
practice.
Since undergraduate education in most schools gives chief
important to the physical aspects of medicine, we give
proportionately less space to these and more to the psychological
and social aspects. But we do not underestimate the importance of
organic disorders and physical investigations in general
practice.
Medical readers sometimes find the
language of educational theory, psychology and sociology daunting.
We have tried, wherever possible, to convert new or unfamiliar
terms into plain English. But there are some contexts where new
terms are more appropriate, provided they are defined; there are
others where there is no possible alternative to their use. No
subject is richer in technical terms than medicine. Being
accustomed to them, we can easily forget this.
There are some who say that doctors should be trained for
general practice by being thrown in at the deep end. They may see
this book as a large body of theory which will fail to educate the
practical man who has to make quick decisions. The writers do not
agree with this view, because they see the whole process of
learning, in whatever branch or stage of medicine, as a constant
interplay between theory and practice. Learning should be by doing,
certainly, but not without theoretical guidance and some
supervision by doctors who have greater experience. One of the main
purposes of medical education is that at the end of the training
period the doctor should be ready to assume full responsibility,
but the volume of knowledge and the importance of some of the
decisions that have to be made demand a gradual, guided process.
The apprentice system is still the main teaching method which
applies to the content here described. Its value has been
excellently described by Lord James: "This element of
apprenticeship which still dominated higher education in medicine,
by which the young doctor, if he is fortunate, works with
successive masters of his craft whom he can often come to admire as
people, is surely giving him one of the truest educational
experiences anyone can have." This book owes much to innumerable
masters of the craft of medicine as a whole and of general practice
in particular. It will have succeeded if it contributes something
to the mastery of what and how to teach.