Anne McKee

The hospital component of training for general practice: the experience and aspirations of general practitioner registrars in the Eastern Deanery of England

The Chief Medical Officer’s review on senior house officer (SHO) training recommends a two-year foundation programme for newly qualified doctors, followed by basic specialist training programmes including general practice as one of the specialties. This gives educationalists a unique opportunity to improve the quality of the GP training, and specifically the hospital component of training. Understanding the views of GP registrars as to what clinical specialties seemmost relevant to their training, and how this should be organised, is important at this time. A questionnaire survey was conducted in the Eastern Deanery in 2001. Three hundred and thirty-nine questionnaires were sent out to GP registrars on 19 vocational training schemes, and 275 were returned (81% response). GP registrars considered accident and emergencymedicine and paediatrics their most relevant training for general practice, and rated the quality of teaching highest in these specialties and in minor specialty posts. They considered dealing with acute conditions to be the most important learning experience in hospital training. When asked about their ideal training, 80% wanted to shift from two years in hospital to 18 months, with shorter periods in a greater number of specialties. Forty percent favoured basing all their training in general practice. Reducing the amount of training in hospital, but experiencing more specialties for shorter periods of time, finds favour with GP registrars. Many want their training to be based in general practice, reflecting the changes suggested in Modernising Medical Careers: the next steps. This will have significant implications for hospital service provision, and a major impact on teaching capacity in primary care.

The Exercise of Professional Judgement in the Context of the Curriculum: The Role of General Practice Trainers – a New Challenge for GP Specialised Training

For the first time general practice has a national curriculum produced by the Royal College of General Practitioners (RCGP). In common with many competency-based curricula, it is an extensive document. GP trainers will play a key role in implementing and developing this curriculum so that it prepares GP registrars (GPRs) for the realities of practice. The trainer’s role is complex and their professional judgement in how to best support learning is both essential and consequential. Often the role of the trainer is misunderstood, undervalued and disregarded. Such oversight threatens to limit the development of the curriculum and its potential for success. In this paper I explore the complexity of the role of the trainer and suggest how an action research approach to training can articulate the professional judgement of GP trainers and enable them fully to participate in the evaluation process intended to develop the new curriculum.

Learning organisations: the challenge of finding a safe space in a climate of accountability

Abstract The effects of health policy reforms over a twenty-five year period have changed the NHS as a place in which to work and learn. Some of these changes have had unintentional consequences for learning in the workplace. A recent King’s Fund contribution to quality improvement debates included an extensive review of NHS policies encouraging change ‘from within’ the NHS and renewed calls to develop learning organisations there. I draw upon an action research project designed to develop learning organisations in primary care to locate quality improvement debates amid the realities of practice. The project identified key challenges primary care practices encountered to protect time and space for this form of work based learning, even when they recognised the need for it and wanted to engage in it. Implications for policy makers, primary care practices and health professional educationalists are identified.

Using action learning sets to support students managing transition into the clinical learning environment in a UK medical school

ABSTRACT This paper reports on a Curriculum Innovation Project to empower third-year Undergraduate Medical students to recognise learning opportunities in their clinical placements and to proactively use them to develop their understanding and practice. The project created action learning sets (ALS) in response to the challenges students face when trying to engage in work-based learning. In particular, how changes to clinical working patterns affect student learning, principally their participation within clinical teams. Learning sets were conducted in 2 teaching hospitals, involving 20- year, 3 medical students over a 10-week period. The students met for one and a half to two hours each week and between meetings engaged in agreed activities and reflections. The project was independently evaluated using student interviews triangulated with facilitators’ systematic reflections on the sessions and student written reflections. ALS were found to provide a valuable and atypical approach to support students through the transition from Academic to Clinical learning settings and lay the foundations for a lifelong learning practice. This included supporting students to ask effective questions, develop participation in practice, present and identify themselves as emergent professionals, reflect upon and manage critical incidents and engage in both self-directed and collaborative learning.

Developing and Assessing Teams Working Collaboratively Across Professions

Team based working is vital to the delivery of high quality care. Most medical and health professionals understand this. However developing and assessing effective collaborative practice remains troublesome. A study to develop and assess multi-professional learning organisations in primary care in the United Kingdom (U.K.) provided an opportunity for detailed examination of how to enable this form of team based learning and assessment in primary care clinical settings. The key findings of the study identify the core competencies needed to enable engagement in cross professional and interdisciplinary learning and assessment and argue for a re-thinking of assessment approaches to collaborative team working. Both policy and practice contexts had a significant impact on engagement in learning and assessment. It is argued that an approach to assessment is needed that takes context into account and re-emphasizes assessment focused on learning and improvement of collaborative working practices.

Assessing Across Domains of Study: Issues in Interdisciplinary Assessment

In the United Kingdom, the design and process of university assessment, particularly at the undergraduate level, has come under intense public scrutiny following the implementation of policy aimed at improving educational standards. The introduction of student fees and national satisfaction surveys has promoted competition between institutions for student numbers with ‘assessment and feedback’ being considered a key indicator of student engagement and overall satisfaction with their experience. This has put assessment at the centre of learning and teaching strategies and innovation. Performance assessment in professional education, particularly in medicine and nursing, is primarily focused on ensuring fitness to practice and has more well defined performance outcomes than more traditional science and social science disciplines. Healthcare students are required to keep a portfolio of knowledge and skills supported with competence assessments. Other disciplines in higher education are now required to keep student portfolios of transferable skills as part of demonstrating ‘employability’. Undertaking formative feedback on student performance, particularly in the work place, is becoming more challenging. Increasingly in the multi-disciplinary and high-service demand environments of the National Health Service, clinical care priorities leave little time for educational activities. In response, profession educators are re-conceptualising forms of feedback and assessment in these contexts. Examine ways in which assessment strategies and methods need to evolve in clinical and higher education to respond to policy, professional body and student expectations, and the implications of this for faculty development in both institutional and work-based contexts. Drawing upon national and institutional data, we have identified key assessment issues, notably the importance and challenge of receiving timely and purposeful feedback. We also offer suggestions for strategic and innovative solutions, for example, advantages of creating curriculum as opportunities for student learning, but viewing curriculum as a set of system-wide development processes.