The
appointment of trainers and teaching practices in the Northern Deanery
Doctors intending to become principals in general practice are required to complete satisfactorily a recognised programme of vocational training. This includes a period in a teaching practice where they are expected to learn about the diagnosis and management of acute and chronic illness, the provision of anticipatory care and health promotion. There should be opportunities to learn about practice management, team-work, standard setting and how practices relate to the hospital, social and voluntary services. At the end of training they will be expected to satisfy national Summative Assessment and the MRCGP examination.
Teaching practices
Teaching practices are carefully chosen by the University of Newcastle Education Committee for General Practice (hereafter referred to as the Education Committee). They provide services for patients which reflect the latest clinical, technological, organisational, social and economic advances in primary health care. Consequently such practices furnish registrars with a period of practical experience under the supervision of trainers who are skilled clinicians and teachers. They also provide the facilities and atmosphere which encourage registrars to read critically and widely, and establish their professional values. They provide a "tailor made" educational programme based on each Registrar's specific needs.
Training is a practice commitment. Therefore partners, and other members of practice teams, are expected to contribute to the education of their practice registrar. In this way teaching practices can provide learning experiences which are as rich and varied as possible.
In appointing teaching practices, the Education Committee takes account of the guidelines published by the Joint Committee on Postgraduate Training for General Practice, the requirements of the Royal College of General Practitioners for its Membership examination, and 'Duties of a Doctor' published by the General Medical Council (GMC, 1995).
The teaching practice:
- will normally provide a consulting room dedicated for registrars,
- will enable the registrar to consult near to and normally at the same time as the trainer,
- will provide room for informal discussion and small group teaching,
- will ensure that there is regular, confidential, documented formative assessment of the registrar, and that summative assessment is completed,
- will assign the equivalent of two notional half days per week for teaching, one of which will be in 'protected time', i.e. timetabled, dedicated, uninterrupted time with no other commitments,
- will provide an up-to-date library of books and journals of relevance to general practice on the practice premises, and appropriate bench books in the registrar's consulting room. They will also provide local access to electronic information systems.
- will accept that registrars are selected by the Vocational Training scheme's appointments committee on their behalf,
- will ensure that a partner is nominated and prepared to supervise the registrar in the trainer's absence,
- will ensure that, in practices with two or more trainers, one is clearly responsible for supervision, assessment and co-ordination of training,
- will accept that normally there should be only one registrar appointed to any trainer at any one time,
- will provide a contract of employment for registrars,
- will ensure that the workload of the practice is such that the registrar sees an adequate range of clinical cases. The practice will also be able to function without the services of registrars.
- will keep records that fulfil the current JCPTGP and regional requirements.
- will release the trainer to provide centrally co-ordinated teaching at least four half days each year.
The trainer
Trainers in general practice are expected to be caring, competent and enthusiastic general practitioners. They are expected to have a registerable higher medical qualification such as the MRCGP and to understand the theoretical principles of education. They will have practical skills in curriculum formation, teaching, and assessment. Trainers will be strongly committed to their own professional development both within and outside the practice. They will be willing and able to critically evaluate their own and their colleagues performance as teachers.
Trainers will be familiar with the attributes of the general practitioner as described by the JCPTGP (appendix 1).
Trainers are responsible for the general arrangements for training, and the supervision of registrars in the practice. The educational programme will fulfil both the wants and assessed needs of the registrar.
Trainers and their practices will provide registrars with sufficient experience for them to develop the following essential skills:-
- Professional values
The training practice should provide an explemplary model for registrars. Registrars should practice ethically and professionally as outlined in the GMC document 'Duties of a Doctor' (appendix 2). - The Consultation
Registrars must master consultation skills. Trainers will regularly teach and assess their registrars' consultation skills. Video analysis is the method of choice. Other teaching methods should include random case analysis and problem case analysis. - Clinical Record Keeping
Registrars will learn how to keep good clinical records. It follows, therefore, that the practice records should be exemplary. They must be logical, well ordered and easy to handle, with summaries, drug sheets, demographic data and health promotion data clearly displayed. They must be accessible whether on paper or on computer. Records should justify decisions made. The format should be capable of yielding data for clinical audit. - Prescribing
Registrars will learn the basic skills required for responsible, effective and economic prescribing. They should also be able to interpret prescribing data, justify decisions about prescribing with reference to published literature and be able to develop and modify a practice formulary. - Management
Trainers will ensure that their practices have systems of management which provide an appropriate model for experiential learning. Registrars will be introduced to the principles and skills of personal and practice management. Registrars will develop their interpersonal, teamworking and leadership skills. They should become skilled in time, personal and change management. They must understand and respect other team members' professional status and roles.
Registrars will learn the application of planned care in the management of acute and chronic illness, anticipatory care and health promotion. - Quality
Trainers will ensure that registrars learn the skills required for effective clinical audit and see it as a tool for quality management. Clinical audit should be a routine activity in training practices. Decision making and guideline formation should be evidence based.
Registrars will learn the skills of guideline development. They will be able to organise, carry out and lucidly write up an audit to a standard acceptable to external review. - Specific Skills
The training practice should ensure that the GPR gains experience in Minor Surgery/Child Health Surveillance/Family Planning.
At the end of training those registrars who so wish will have achieved current National Standards and be eligible for Health Authority accreditation. - Out of Hours Care
All GP registrars must gain adequate experience in out of hours care during their general practice attachments. Ideally they should gain practical experience in the different models by which out of hours care is provided in their VTS. e.g., partnership rotas, extended rotas and Co-op care. The degree of supervision needed by registrars will depend on their confidence
and competence and these attributes must be assessed by trainers leading to the point where GP registrars must be able to undertake unsupervised out of hours care at the end of their training. Trainers must be in a position to certify this competence.- Adequate Experience
Several factors will influence trainers in certifying GP registrar competence in out of hours care including their previous experience and the amount of out of hours patient contact which the practice normally experiences. Some trainers may decide that the amount of experience available to the GP registrar will not be adequate during
the time that they are attached to their particular practice and arrangements with a neighbouring practice or Co-op may be advisable.
- Adequate Experience
Conditions of appointment
Any principal may apply to become a trainer. Successful applicants and their practices must comply with the Education Committee's requirements set out in this document.
A doctor who wishes to become a trainer should initially contact their local Associate Director who will advise about necessary personal and practice developments. The Associate Director will visit the intending trainer and the practice to ensure that the appointment criteria are met and to negotiate a contract for further development. He or she will attend a training course for intending trainers, and will satisfactorily complete six months supervised teaching experience in an appropriate practice in the Northern Deanery.
The conditions of appointment in the form of a contract will be agreed with the Education Committee through its trainer appointments' sub-committee. This contract will form a basis for subsequent periodical review and for re-appointment. Trainers must be willing to have their teaching skills evaluated formatively by peers and summatively by the Deanery.
In the case of first appointments, applicants should have a minimum of three years experience as a principal to be eligible. First appointments are normally for two years. Subsequent appointments are normally for three years.
The Education Committee reserves the right to shorten the period of appointment if necessary. The Director of Postgraduate General Practice Education and the Associate Directors may withdraw a registrar from a practice should it not provide a training experience of the required nature and standard.
Trainers are appointed by the Education Committee for General Practice. A
practitioner whose application is rejected has the right to appeal. Details may
be obtained from the Deanery office.
Quality Standards for Medical Records
The Attributes of the General Practitioner
General Practice Postgraduate Institute for Medicine & Dentistry
10/12 Framlington Place
Newcastle upon Tyne NE2 1AB
Tel: 0191 222 6766
Fax: 0191 221 1049