Abstract
I'm pleased to report that I'm currently working in a long-term locum job and they've just offered me a few sessions as a permanent salaried GP. I was aware that there might be a job at the end of the locum period so the last 8 weeks have felt like the longest job interview ever. When they asked me if their new GP registrar could sit in with me, I was eager to help. I thought that this would ensure that the interest in teaching stated on my CV was not ‘all talk and no trousers’.
I've alluded, in previous articles, to the deskilling that can happen when you are a locum. I was suddenly paranoid that I'd lost all of those techniques that I had previously religiously practised for the Clinical Skills Assessment (CSA). The registrar would undoubtedly be watching out for all sorts of missed cues. Prior to the surgery, I had a very sleepless night
Hayley, the GP registrar, was bright and early that morning. I arrived, muttering about the absurdity of having to de-ice my car in March, with a few minutes to go before starting surgery. She informed me that she was looking out for a particular consultation skill. She had explained that this skill, which she wasn't going to reveal until after the surgery, is her weak point. She wanted to see what techniques experienced GPs used. Experienced GPs?! I started to giggle and she looked bemused. I asked her whether she had realized that I had only been qualified 6 months. She said that qualifying felt a long time off for her.
So the busy surgery commenced and continued with the usual hitches, children vomiting on the floor, elderly ladies taking half an hour to get undressed and then dressed again and epic consultations about ear wax with an Arabic interpreter. The usual in this busy inner city practice. I came to the last patient and tried to remember whether I'd enquired about ideas, concerns and expectations with any of my patients. I couldn't specifically remember so ended the surgery with a foreboding feeling that I was providing a ‘what not to do’ experience for Hayley.
On the contrary. She had been looking out for examples of assertiveness. This is definitely a skill I've learnt and not one that has come naturally—so again my heart sank. She explained that her trainer said she was too timid when asking to examine patients and that her explanations lacked assertiveness. I have no recollection of saying this but I say ‘let's take a good look at that and see what's going on’ prior to examining all my patients. She liked it and was going to try and start using it as a phrase.
It was wonderful to have someone, albeit inexperienced, comment on my consultation skills. It may not feel like it now but the assessments you do within your training are really helpful and keep your skills fresh. It is easy to rest on your laurels and not use these techniques once the video camera is no longer in your room. Consultation skills assessments begin again within trainers training but there is little formal evaluation during the average GP's appraisal. I hope that this experience will encourage me to value those skills I have and continue to develop them.