Professional development and developing new skills

2 October 2020

My poor daughters! Rebecca and Natasha (16 and 13 years old) are hard at learning, back to school. Wisely, their school has decided to be prepared should a repeat of last year’s exam system occur, so they are being tested regularly, often under exam conditions.

"I hate definitions," exclaimed Rebecca at the weekend while trying to get a few physics definitions to stick in her head. I share her contempt. I was a terrible student, both at school and university, and like her I found definitions and dictates hard to keep in my restless mind.

It was only in my latter years at university that a friend from the year above gave me some wise advice: "Learning using the spoken word is as important and valuable as the written". Using this, I was off to the races!

Debating the differential causes of pleural effusions with my house mates helped me ensure that any definitions I learned came from my own words, not ad verbatim from a textbook. Most importantly, it showed I understood the basic concepts. You could say that this grasp of how to learn literally helped me to "wise up!" 

When I started my houseman jobs in Daisy Hill Hospital, Newry, my learning ramped up another gear and I thrived on the range of cases, the hands-on work and the ownership I was trusted with in managing patient care.

Starting as a GP my learning techniques changed again and, while still not good at learning definitions, I remembered cases very clearly, quickly associating a patient’s disease and their personal story. A rare disease would see me joining the information discovery with my patient; they become expert patients, while I became a patient expert.

Continuous personal development

A case a few weeks ago really stuck in my mind. Seamus is a 77-year-old cattle farmer who lives close by. He is part of his land and a true herdsman. While he is no longer fit for the intense physicality of the work, he is always in the yard overseeing work or out at marts buying and selling stock.

Seamus had been unwell for a few months and I could not get a handle on what was wrong. Finally, another set of routine bloods gave me the steer I needed and an ominous sign. His white cell count was 77 and his platelet count was 654. 

Spot test! What do you think is the diagnosis? AML, ALL, CML or CLL? I queried in my referral letter to haematology that I felt he was at risk of CLL, but only because I had looked it up in GP Notebook earlier. I still find recording my CPD for appraisal very difficult.

Do you have a good way to do this? Do you use the Fourteen Fish website? Please feedback so we can share helpful ways to record learning together.

I look forward to learning from my haematology consultant about the causes and best, evidence-based treatments for Seamus' condition. In turn, I hope I too am afforded the opportunity to educate his consultant about the impact potential shielding will do to Seamus’ mental health, and how he will turn to me for support.

Seamus lives on my way home from work, so I will drop in to have a chat with him and his family, answer their questions as best I can and give them all their flu vaccine as early as possible.

Embracing information technology

We are fortunate in RCGPNI to have Dr Johnny Stewart as our IT lead and is currently leading the NI arm of the COVID-19 vaccine trials.

On Tuesday, Johnny and I had a great meeting with Dan West, Chief Digital Information Officer (CDIO) for Health and Care in Northern Ireland at the Department of Health. His role is about using health data and technology to improve health and care experiences. Dan is a fascinating guy and possesses an inquisitive, probing and intelligent mind. He appeared to genuinely 'get' the challenges of general practice but his rebuttal to Johnny and I is a legitimate one.

The country has switched it habits to digital to offer convenience for many services such as online banking, avoiding old methods of walking into branches, parking in town centres, time lost from work etc. With this in mind; should we be looking to improve our patient’s experiences in chronic disease management using the best technology available?

We were able to highlight to Dan that new technology must meet the needs of both our patients and GPs. For both groups, technological solutions must be user friendly and we should be able to easily engage. If we are not involved in developing these systems, we will not use them as intended, rendering them worthless.

IT and data analytics are vital for the future of general practice and we must own this. Have you an interest in IT? Do you know a GP who has these skills and would like to develop them further?

One of our requests to Dan was to afford general practice the same opportunities to support our brightest GPs who have skills in this area to progress and shine. He has taken our critique on board so in the interim if you have an interest in IT and would like to develop it further, please register with us now.

It will be vital to have this network established so we are properly represented, and IT systems are designed with GPs needs at the centre.

GP tutors

I wish to convey a special word of thanks to our brilliant GP tutors. The future of our workforce is literally in your hands and we owe you all an enormous debt of gratitude, particularly in relation to how you responded to the exam changes this summer. As I alluded to before, teaching is not only about getting people to remember facts but mentoring and inspiring. 

Five years ago, I attended a leadership course where one of the breakout sessions concentrated on our career paths.

We were all encouraged to map our journeys, the forks in the road and to cite two or three key individuals who had significantly influenced our career decisions. Many people included their school teachers who helped elevate them to higher things.

I cited my Dad (for obvious reasons!) and Dr Alan Poots my, now, senior partner who showed me what true patient-centred care should look like. At the end of the session the tutor turned it on its head for us all and said: "Now, imagine if someone else is doing this exercise - could you be that person they name?" It was a sobering thought, but an important one to remember.

With all the teaching experiences we have, there are many opportunities to inspire someone else’s career.

Our role in education and training

Adult education can be challenging, and we are so grateful to all practices who have maintained their commitment to both undergraduate and postgraduate training.

We are representing you all in our engagements with both the Health & Social Care Board and the Department of Health about the many issues you face and will keep you updated with any key developments. 

Undergraduate teaching in practices is supported through a fund called the Supplement for Undergraduate Medical and Dental Education (SUMDE). Annually general practice teaching practices receive in the region of £1.8 million, while Trusts receive over £25 million.

We have been meeting with SUMDE leads and continue to press for explanations on the apparent funding discrepancies. We feel the amount of funding to general practice does not fairly reflect the work we do, with students frequently rating the quality of teaching as some of the highest they receive.

We will redouble our efforts to ensure that to teach medical students to become good doctors we must receive appropriate recompense to allow us to do this.

Are you struggling with your ability to teach? If so, please get in touch with us. We are so grateful to all who take this on and want to support you if you are having trouble. It is imperative we do not lose our most precious, valued mentors and role models.

Get involved

The essence of our College should be education, learning and quality. To help us deliver the best education to meet your needs, we are looking for a member to join our RCGPNI Executive Team to advise us how best to do this.

You can access more information about the vacancy, and it you would like to learn more, please get in touch with me.

Finally, for your information, the National Institution for Prevention and Cardiovascular Health (NIPC) is hosting a National Diabetes Care Conference on Saturday 31 October.

You can learn more about the format and book online (917 KB PDF).

Until next week, please keep your passion for learning burning - our patients are relying on us.

Post written by

Dr Laurence Dorman, Chair of RCGP Northern Ireland

Dr Laurence Dorman took office in November 2019 after three years as Deputy Chair of Policy for RCGPNI. A GP principal in Mourne Family Surgery, Kilkeel, Co Down, since 2007, he is the fourth generation of GPs in his family. He was also, until recently, the Chair of Newry and District GP Federation. 

Laurence has particular interests in new ways of working in primary care, cancer care, and inspiring the next generation of GPs. He set up the successful Dear Colleague initiative to improve the interface between primary and secondary care and has been a strategic advocate for interface and communication since September 2017.

During his time as Chair, he wants to support College members to ensure that the future of GP services is protected, supported and sustainable.

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