Abstract
I finished my GP training with a sense of triumph. At last, after all the years of sweating over pathology textbooks, acute medical rotas, an Applied Knowledge Test (AKT), Clinical Skills Assessment, many a half-day release and patients galore, I could call myself a General Practitioner (GP). Fresh horizons and independence beckoned. There might be choppy seas ahead but I was growing impatient in the calm secure waters of the training harbour. I set sail.
Then the nostalgia hit. It came somewhere between the first rejection (a salaried job, for which I did not get short listed), the third job application (post already filled 2 weeks before closing date) and my first day as a locum (have you ever tried cooking to professional standards in a kitchen in which you have never worked?). I missed my training practice, my training year and my trainer (Yoda). Amid this cloud of separation anxiety, I found time to reflect of the nMRCGP training experience.
The nMRCGP is not without its challenges. It is not easy being the first to sit a new exam. It is a difficult process both for the student and the teacher. While it is helpful to have a curriculum to guide our learning, it does risk the potential danger of becoming prescriptive. Does the process of learning become one of hoop jumping and box ticking in a sprint to cross the finish line?
Certainly, my trainer and I found we were discussing patients in a way that at times felt like it interrupted the learning process. ‘We need to do another Cased Based Discussion (CBD) now.’ Or ‘Two more videos by the end of the week should keep us on target.’ Rather than, ‘Oh, remember Mrs Jones I mentioned last week…’
This is partly a problem of novelty but it also has a lot to do with the fact that trainers are now the predominant assessors. How many hats should a GP wear? My personal experience was that I had to work hard not to see the process of completing the nMRCGP as one big examination. Of course I appreciate the need for assessment and would rather it was done over a period of time than a lump sum at the end.
Like many of my colleagues I found the AKT a chaotic exercise; I am still not sure which of the questions I got right or wrong. I believe that I learnt a lot from studying for the exam, rather than from the examination itself. So what about the big day out in Croydon? With the overnight bags that accompanied trainees from across the UK, the office blinds and views across London, I almost expected to be greeted by Sir Alan Sugar; general practice is still essentially an apprenticeship.
Many trainees describe this day as the ‘Surgery from Hell’. Though in fairness you still find very experienced GPs having a similar emotion in their day-to-day work. (On the plus side I found that there was plenty of retail therapy available on the concrete tram-lined streets of South London.)
For me one of the biggest problems with the training was the ePortfolio, in particular the learning log. There still remains an ambiguity as to how much trainees need to document. When I started my training year, it was a question of using it as much/as little as you like, ‘an aide-memoire’ to accompany learning. Now we are told that it is an integral part. As a Registrar, I felt I could have recorded every patient in my learning log, as I truly believe that at such a stage all patients highlight a learning need. Perhaps getting accustomed to such a bureaucracy, the process of being seen to be learning is the nature of everyday general practice. Ask a GP ‘Where's your Professional Development Portfolio?’ and observe a shudder.
I am pleased to be joining the InnovAiT editorial board. While I hope the journal will continue to help trainees through the nMRCGP, I also hope that we can think beyond MCRGP. In the coming months, we will be using this page to encourage wider debate in general practice. Perhaps touching on some of the issues that a literal reading of the curriculum, coupled with a hard focus on the assessment process, does not do justice.
Enjoy your training; maybe you will miss it when you leave. Since I have started working (I did get a job in the end) I have started to think that my trainer is more akin to Obi-Wan Kenobi than Yoda. For once gone the trainer continues, at times of difficulty, to appear at the trainee's side reiterating lessons once taught but rarely forgotten.
Would you like to contribute an article? Perhaps you have done an interesting audit project? Is there a book or case you are dying to tell colleagues about? All ideas welcome and appreciated.