Dr Rachel Birch, Medicolegal Consultant at Medical Protection, looks at the valuable contribution sessional GPs can make to teaching and learning within primary care.
Doctors as teachers
As doctors, we are encouraged to share our knowledge and expertise with others, for the benefit of good patient care. In fact, the word “doctor” is derived from the Latin word “docere”, which means “to teach”. The original father of medicine, Hippocrates, taught his students in the shade of a big plane tree. Nowadays teaching locations may not always be so exotic, but the sentiment remains - an important part of the role of being a doctor is to teach medicine.
The General Medical Council advises doctors that they should be:
- “prepared to contribute to teaching and training doctors and students”
- “willing to take on a mentoring role for more junior doctors and other healthcare professionals”
Whilst “see one, do one, teach one” is rarely sufficient training in the modern medical world, there is no doubt that the most effective learning opportunities can come from our peers or senior colleagues.
Many doctors enjoy teaching and learning, which can be considered as two sides of the same coin. Often teaching promotes self-learning, as preparing for a teaching session can involve acquiring new information. Learning for yourself can also lead to teaching, for example by sharing your experience and knowledge.
Learning opportunities in practice
Every day is a learning day in general practice. We are constantly learning from patients, members of the primary care team, and our secondary care colleagues. If a patient comes in with a Google print out about their symptoms, be sure to read it! It may reveal something about a diagnosis that you did not know, even if you do not believe that the condition is necessarily the cause of the patient’s symptoms.
When letters come in from secondary care, take a moment to consider what the patient has been prescribed - is this a new treatment development? A lot of this is already done subconsciously, but take time to write down anything new you learn each day, as well as any learning needs you have identified.
Opportunities for formal group training may be infrequent, so it is important that practices have good systems in place to share learning and to learn from significant incidents. If there is an adverse outcome for a patient, or a “near miss” incident, those involved in the care should reflect and consider why it happened, and what steps can be taken to reduce the chance of it happening again. Regular significant event meetings for all relevant practice staff are recommended so that everyone can learn - salaried and locum GPs should be made to feel welcome at such meetings.
Coffee time (although I appreciate it doesn’t happen in every practice) can be a good time to reflect on your day and discuss interesting cases and learning with colleagues.
Learning from locums
Both salaried and locum GPs have so much to offer their primary care colleagues, in terms of learning. Many salaried GPs have portfolio careers, working in other practices or in secondary care clinics as GPs with Special Interests (GPSI). Locum GPs are likely to have experience of working in many different practices, with different protocols, computer systems and ways of working, as well as sometimes a totally different patient population and demographic. They are in a unique position to be able to share their knowledge and experiences with other practices, and may well be asked to do so.
As a locum GP, you may find that a GP registrar or practice nurse approaches you for advice about one of their patients. Even if you are only at the practice for a day, this will not matter to the GP or nurse - they will appreciate your time and expertise. You may also be asked to provide teaching to medical students or student nurses, perhaps by allowing them to sit in on your consultations. This can be rewarding, and their questions may well leave you with learning needs of your own.
Locum GPs can be a fresh pair of eyes when reviewing a regular GP’s patient, since they may not have met the patient before and can therefore consider the patient’s presentation from the beginning. You may suspect a diagnosis that the regular GP has not considered, or you may have seen a treatment used effectively in a different setting. Regular GPs often value the input of locum GPs and the learning opportunities that they bring.
Opportunities for teaching
Many sessional GPs like the idea of a portfolio career, and find that it fits in with their work-life balance. There may be opportunities for teaching both within and outside of practices. If you have identified that you would like to do more teaching, the following may be helpful:
Ask to attend Significant Event Analysis meetings and provide feedback on any incidents or near misses you may have been involved in. These meetings provide a good opportunity for discussion about how to learn from such events.
Share any interesting cases or unusual presentations with the clinical team.
Express your interest in teaching medical or nursing students or GP registrars. Often they get to sit in on consultations with a variety of clinicians in their training, so you may wish to offer them the same.
If you have a particular area of interest, you may wish to offer teaching this to students or trainees, but make sure that any tutorials are included within your sessional hours.
Consider if there is anything you would have wanted to know when you first started at the practice as a locum. Share this with the practice manager in order to help other future locums.
Outside the practice:
If the practice or locality has protected learning time, consider offering to give a talk on your area of particular interest.
Locum chambers and sessional GP groups are an excellent source of peer support as well as education. They often have educational programmes and would most likely welcome a presentation by you. They may also have regular meetings to discuss best practice, cases and significant adverse events.
As a more established locum, you may wish to offer to provide mentorship to a new locum. This is something that you could discuss within the locum chambers, in the first instance.
If you do take part in teaching activities, you should discuss this and reflect on it at your annual appraisal. You should also contact your medical defence organisation to ensure that you have appropriate indemnity in place.
Writer and editor at MPS. MPS’s educational risk management workshops, ‘Mastering Professional Interactions’ and ‘Medical Records for GPs’ provide further information on the risks to patients and doctors when patient care passes between doctors, and on good record-keeping. They are free as a benefit of membership to MPS members too.