Trainer Workshop 18/01/99

The task of the evening was to discuss ways in which we teach those aspects of General Practice that are not strictly essential for Summative Assessment but which may be essential for the MRCGP and certainly could be useful for a Registrar entering General Practice. What prompted this discussion were the recent changes in Child Health Surveillance and talk in other circles, such as BASICS, regarding accountability and who is qualified to teach which area. The evening was broken down into different sub-headings including Child Health Surveillance, C.P.R./BASICS, Minor Ops., Family Planning, G.P. Maternity unit work/Obstetric List, Police Work, and Occupational Health.

1.Child Health Surveillance:

Due to recent Paediatric/Health Authority guidelines in the Region G.P.'s have been advised that Health Visitors may now perform all child development checks. This has implications when it comes to signing up the Registrar for the CHS part of the MRCGP application form, which states that the Trainer has observed Registrars performing the three main checks (6-8 weeks, 6-9 months, 36-48 months). From the ensuing discussion it was clear that some G.P.'s are now only performing six week checks and not any of the others, while some are observing the Registrar with the Health Visitor, and others are still doing all checks themselves. With this swing towards only Health Visitors performing these checks, there was some concern voiced as to whether we will become de-skilled in this area and therefore less capable of assessing Registrars. On reviewing the guidelines from the Royal College, it seems apparent that Trainers can ask Health Visitors to sign the CHS Assessment forms and these should then be countersigned by the Trainer if he/she is satisfied. In this Scheme, Registrars are taught CHS in three VTS half-day release sessions and they should then observe two 6week and 3&half year old checks following which they are observed performing the same. It was decided that T.W. would write to the Royal College seeking their views on this matter and as to any suggested solutions.

2. C.P.R./BASICS:

The group discussed the different methods used to teach CPR for the purposes of the MRCGP exam as well as for general use if needed. Various methods seem to be used at present including opportunistically, in tutorials, hospital training sessions, BASICS courses, external agencies (such as St. Johns Ambulance), and most commonly the VTS half-day release session, when the certificates for the MRCGP are signed. These can be signed by anyone suitably qualified (though the College reserves the right to enquire into the credentials of those issuing the certificates) and discussion was then entered into as to whether we had enough experience/qualifications to do this. In most Practices it was felt that CPR was not often done and in some defibrillation was never done. The more rural/far-flung Practices seemed to have more going on in the way of BASICS, which was then offered opportunistically to the Registrars. Courses were discussed and thought to be encouraged but costs can often be prohibitive. Those in CUEDOC seem to have regular training sessions once per year to which the Registrars are invited.

3. Minor Surgery:

This is another area which is not essential to passing the Summative Assessment papers but which is certainly useful and probably expected by most Practices the Registrar may hope to join. Training is mainly the responsibility of the Trainer though most Registrars are encouraged to and do go on the Minor Surgery Course in the North East. Most seem to show the Registrar one and then observe the him/her doing one before being let loose. It was uniformly felt that most will not be happy doing a number of the procedures on the Minor Op. list (e.g. piles/varicose veins etc. ) but would be happy to do some. Other areas where this has been taught is in hospital jobs such as Casualty.

4. Obstetric List/Maternity:

At Birbeck, there is a fair degree of exposure to ante-natal care as well as intra-partum care in the G.P. Unit at PNH during the Practice attachment. Most other GPR's tend to simply have experience that is gained through their SHO Obs. & Gynae. Post. Discussion was then entered into regarding what should happen if they have not been able to gain this experience. According to the Green Book Regulations if they had not held an SHO post within the last 10 years, they should undertake a refresher course or spend at least two weeks on an obstetric unit under supervision, or have had some experience within the previous two years some experience on an obstetric unit which would include not less than 20 normal deliveries, 10 abnormal and attendance at 10 ante-and post-natal clinics. However most GPR's do fulfil the criteria automatically.

5. Family Planning:

Discussion was entered as to the level of experience we each had as to whether
we felt competent to teach family planning especially the fitting of coils. However most GPR's were encouraged to attend the Family Planning and IUCD-fitting courses held in Newcastle as these gave the greatest amount of experience.

6. Police Work

The few practices that undertake Police work do expose GPR's to this work in variable ways but generally by getting them to accompany the Trainer on Police visits. There are no formal teaching sessions on this area and whether the GPR' gets involved seems to be a bit variable. Those practices with Police Surgeons would be happy to show those GPR's not involved in this area what the work involved but it was felt that this would be unrealistic to achieve in practice.

7. Occupational Health:

One or two practices were involved in various areas of occupational health medicine and it was suggested that those not involved might like to visit and sample this area of work although a trip to a local factory is generally organised for one of the VTS half-day release sessions.