Consider this scenario – a patient complains to their GP that their lung cancer diagnosis was delayed. In the subsequent significant event analysis the practice discovers that the trainee doctor involved in their care was unaware of NICE guidelines on early investigation of cancers, including lung cancer.
Who may be ultimately responsible for the trainee’s gap in knowledge (and the potential consequences of this), and should trainers have a checklist of ‘must know’ topics to cover in the early stages of GP training?
General practice (GP) is an apprenticeship-based training which is short and intense. For trainers and trainees to successfully prepare a trainee for practice in the 18 months that they are exposed to a GP environment, they must focus on learning needs. The learning needs between trainees can vary greatly depending on prior experience, every trainee therefore requires a bespoke ‘needs-led’ training.
Most educational supervisors (ES) use a checklist of important areas covered for the trainee’s induction and tick these off as they are covered satisfactorily.
It is also worth considering key ‘red flag’ topics to cover. It would also seem sensible to document that key areas have been covered if the trainee does not already do this as part of their portfolio. These include referrals (acute and non acute referral guidance e.g. refHelp), prescribing systems/safe prescribing (e.g. use of joint formularies), common medical emergencies/ practice emergency equipment, safe management of results (e.g. Docman), cancer red flags (e.g. NICE guidelines) and key paperwork (e.g. death certification).
Risk often increases as training progresses and the trainee starts to see patients with less supervision, as they must do to develop as independent practitioners.
Trainers use numerous checking systems including random case analysis, review of prescriptions and review of referrals along with the tools of workplace based assessment (WPBA). It is important that the ES doesn’t train in isolation. GP training is a team effort and it is essential that all members of the team communicate concerns promptly to the ES.
A GP makes approximately 50-60 clinical decisions a day that could go wrong. It is inevitable that a GP specialty trainee (GPST) will be involved in decisions which lead to adverse outcomes. It is important that the GPST learns to be open about these events and for them to perform significant event analysis. A culture of openness and support is important. Collusion helps no one and the vast majority of GPSTs seek honest, objective feedback to allow them to improve their craft.
Risk in medical training cannot be removed but can be reduced. Training the GPs of tomorrow is essential and GPSTs are typically a real asset to a practice.