Clare Wedderburn

Follow the yellow brick road: integrated care – can we do better?

‘Follow the yellow brick road’. That’s what patients are supposed to do. Embark on a pathway, follow it and reach their destination, medical care achieved. Well, doctors have difficulty with this concept. Pathways often become rigid and prescriptive, sometimes the actual path taken is a winding convoluted yellow brick road, with multiple stops and deviations. Patients deserve better. A quick smooth route, where each step in the actual pathway is linked together, where the destination of health and recovery is reached directly and efficiently. Enthusiasts point out that improving patient care by providing a pathway based on national guidelines, has clear advantages. Others would state that pathways are simply a crude guide for the inexperienced, a basic map for the unfamiliar? Fixed pathways should deliver gold standard health care, through best practice. Local areas adapting to achieve the ultimate safe, efficient, and cost-effective goal of patient care. This is integrated health care. But is this actually happening? Gaps exist within healthcare systems, which prevent patient pathways from being smooth and direct. Patients can disappear off the pathway for days, deviating from the path, lost in the system. Examples are daily.1 Mrs Smith, admitted by default with a treatable at home chest infection, on a Friday night, has a delayed discharge because of the absence of social care and physiotherapy access, then picks up a urinary tract infection, leading to a DVT on the ward, followed by problems with coordinating INR management at home. While the pathway may be good in principle the practical organisation and implementation is not always smooth.1 Issues occur in both primary care, secondary care, social care, private care, and voluntary care. Each sector can see the problems. However sectors are not, as yet, consistently working effectively together in an integrated way to share these …

The PMETB National Trainee Survey: is it a useful tool?

The Postgraduate Medical Education and Training Board (PMETB) has recently published the third National Trainee Survey of trainee doctors’ attitudes towards training, conducted online, with the fourth survey due out this April. The PMETB, an independent statutory body, has pioneered a way forward for deaneries to closely monitor training. The survey was intended to contribute towards improving the quality of training, but have they got it right? Criticisms are: too much data, too many confusing reports, a website that is hard to navigate, and information not always specific enough for deaneries to act upon at a local level. Is this just an embryonic stage? Do our local deanery teams and trainee doctors simply require education on website navigation and data interpretation? Or is it actually a waste of time?

Using photography to enhance GP Trainees’ reflective practice and professional development

The capacity and the commitment to reflect are integral to the practice of medicine and are core components of most general practitioners (GP) training programmes. Teaching through the humanities is a growing area within medical education, but one which is often considered a voluntary ‘add-on’ for the interested doctor. This article describes an evaluation of a highly innovative pedagogical project which used photography as a means to enhance GP trainees’ reflective capacity, self-awareness and professional development. Photography was used as a tool to develop GP trainees’ skills in recognising and articulating the attitudes, feelings and values that might impact on their clinical work and to enhance their confidence in their ability to deal with these concerns/issues. We submit that photography is uniquely well suited for facilitating insight and self-reflection because it provides the ability to record ‘at the touch of a button’ those scenes and images to which our attention is intuitively drawn without the need for—or the interference of—conscious decisions. This allows us the opportunity to reflect later on the reasons for our intuitive attraction to these scenes. These photography workshops were a compulsory part of the GP training programme and, despite the participants’ traditional scientific backgrounds, the results clearly demonstrate the willingness of participants to accept—even embrace—the use of art as a tool for learning. The GP trainees who took part in this project acknowledged it to be beneficial for both their personal and professional development.

Developing the system for GP trainer re-approval in Dorset: a pilot

Dear Editor, We are writing to share an innovative pilot in the way training practices are approved in Dorset, UK. Literature exploring the process of practice visiting as part of trainer approval is sparse [1–4] but generally indicates that the process is valued by trainers for both the formative aspects as well as for managerial purposes. The context of the change we report here arose from the volume of approvals and the large size of Dorset. Dorset currently supports over 100 qualified general practice (GP) trainers for GP specialty training and in excess of 150 GP trainees spread across all three year groups. In our pilot, instead of the ‘visitors’ going out to the practices, groups of trainers and key practice staff were invited to visit the Dorset GP Education patch office based at Bournemouth University (BU), and to spend a half day engaged in educational reflection and development, as well as completing the requirements for re-approval. Educators were keen to maintain the personalised, face-to-face aspects of meeting the training team, as well as to manage the re-approval of a number of GP trainers at one time. Facilitating trainers in meeting colleagues and to share ideas about good practice were also a priority, and so too was the opportunity for members of the practice administration team to meet the patch administrators in order to help improve communication between them. Prior to the re-approval meeting, GP trainers were required to complete the standard Wessex re-approval documentation, and to submit it as they would normally.1 The re-approval half day was introduced by a welcome and explanation session given by the Associate Dean (AD). After this, the GP trainers and lay visitor moved around several ‘meeting stations’ where they discussed particular areas of the re-approval process with training programme directors (TPDs), following the sections they had completed in the re-approval documentation (for example ‘The GP Trainer’, ‘The GP Learner’) as well as discussing specific aspects of training such as the ePortfolio and Educational Supervisors’ Reports. In addition, trainers were asked to bring along a video recording of a teaching session and this was reviewed in a small group setting with one TPD and groups of 2–4 GP trainers. Time was allocated for a TPD to meet the GP trainee and to gather feedback about their experience of training, and for the AD and administration team to meet the practice managers to discuss the management of GP training, paperwork and any other training issues. Evaluative data was gathered for three of these sessions over a month – involving 32 participants from 15 practices. All participants were asked to complete an online questionnaire before and after the re-approval meetings. The results indicated that the advantages of the new format included:

Doctors and child care

Clare Wedderburn considers the options

The new GP curriculum

Bill Irish and Clare Wedderburn have mixed feelings about new guidance