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The new General Practice registrar; future primary care leader
“Tell me and I will forget, Show me, and I may not remember, Involve me, and I will understand”Euan A Ashley
I was reminiscing recently with an elderly patient on the anniversary of his diagnosis of a leaking “AAA” one year earlier. The medical student, who was actively engaged in the consultation, was awestruck by the life saving moments of general practice and appreciated the team of professionals who had been involved in the care of this very fortunate man. It is not surprising that medical students from University of Auckland (UoA) are indicating an interest in General Practice (GP) as a chosen speciality. Over the past two years, medical students in 4th and 5th years have responded favourably to a survey conducted by the Department of General Practice about interest in pursuing GP.
The Royal New Zealand College of General Practitioners (RNZCGP) focuses on the undergraduate as they begin to transition into the next cohort of post-graduate learners. The shared catered lunches with discussions facilitated by Registrars and GPs about general practice including remuneration, training duration, and life style are sponsored by the College and well received by undergrads. “When you are in medical school it is so difficult to see the other side” and “this discussion has helped to dispel the myth of GPs making less than $100,000” are a few of the comments recorded.
Preliminary research conducted by the Department of General Practice indicates that community-based learning environments offer substantially better learning opportunities for students, registrars and general practice teams. These experiences, coupled with the observed apprenticeship model, may be some of the reasons for the shift to General Practice. The hospital environment is becoming increasingly difficult to sustain as a learning environment with the present model: Increasing numbers of students, registrars and house officers, working under pressure of timely patient discharges and appropriately reduced hospital stays, have added to the challenge. Students are unable to place their patients in context—the family and community recede into the background. Students are now seeking community-based learning to enhance their history taking, practice their skills and procedures and to be more fully engaged in medical care. They inherently understand the importance of the learner-centred model.
The RNZCGP in keeping with the changing face of primary care delivery is developing a learning model more aligned with the delivery system and the patient in context. Vocationally registered GPs are poised to lead the country as health care reform gains prominence and the health of New Zealanders improves. GPs are positioned within communities and understand the contemporary forces impinging on their patients and the families. “Coughs and colds” have been relegated to an educational role as GPs step up to a leadership position within the team of primary care. “Prevention and promotion”, the most challenging of all the health care issues will be well positioned now that collaboration and team-working has been recognized and anointed with the power to heal and change.
The Workforce Taskforce report, recently released, recognises the importance of the leadership position of Vocationally Registered General Practitioners and the CTA has increased the number of fully funded registrar positions to 104 with incremental increases over the next few years. This is good news for all New Zealanders. The General Practice Education Programme (GPEP 1 and GPEP 2), over a three year period, will place registrars in learning environments, Cornerstone-ready or fully accredited, providing an apprenticeship model of mentoring and recognizing the talents and skills all learners bring to the team. The learners will be nurtured as they engage in real clinical situations and will be acknowledged for their personal investment in the clinical outcome. Reflection on practice will close the loop of learning. A new model, interprofessional learning, will involve medical students, PGY 1s/2s, registrars, nurses, community-health workers, physician assistants, and doctors fully integrated and working across sectors for the care of all people. It is an intuitively sensible approach and promises to provide better care.
We understand that knowledge is everywhere and ‘best evidence’ is no longer difficult to access. However, improved health outcomes usually lie outside the scope of any single practitioner even with a newly found piece of knowledge. A recent study* in Oxford showed that one consequence of established multiprofessional improvement teams in general practices was increased collaboration and focus on planning and strategy within practices. Measurable improvements for patients you serve are a powerful incentive for Best Practice.
The GPEP1 and 2 programme is vertically nestled among undergraduates and junior doctors and stretches into the continuing professional development (CPD) world in the context of interprofessional collaboration. It includes a detailed curriculum with well-defined competencies; it is appropriately assessed, and quality-assured. It provides scope for engaging with communities and setting up projects that address community needs. The Boards of Education, Assessment and Quality of the RNZCGP oversee the programme and liase with the NZMC to recommend vocational registration. To quote Professor Bruce Arroll, “teaching GPs are the happiest GPs” and “learning environments have potentially the best quality of care”.
“Never the Same Day Twice” is a DVD produced by the RNZCGP to showcase three outstanding GPs who discuss their work, their passion for clinical care and the work-life balance that each of us struggles with. It captures the true essence of who we are as professionals. There are many more who can validate the professional satisfaction and offer an invitation to join the professional rise of the General Practitioner. See the DVD at the College conference in Rotorua.
Tana Fishman
Chair, Board of Education, RNZCGP
Senior Lecturer and Director, Undergraduate Medical Education, UoA, Department of General Practice and Primary Health Care
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*Lawrence M, Packwood T. Adapting total quality management for general practice: evaluation of a programme. Qual Health Care 1996; 5: 151-158 [Abstract]