Possible issues with new GP trainees who have no experience of general practice in the NHS

Possible issues for the new GPR

  • No driving licence – and no car.
  • Accommodation problems
  • They may experience anxiety between appointment and starting the job due to delays in getting registration and other appropriate documentation – e.g. GMC/MDU/MPS
  • Separation from family
  • No experience of:
    • NHS ‘culture’
    • Primary care structure and function
    • Secondary care structure and function
    • Support and partner services
  • Different educational paradigm:
    • No experience of PBL
    • No experience of ‘reflective practice’
    • No experience of appraisal
    • Reluctant to ‘challenge’ (the teachers/ the evidence)
    • Hierarchy in own educational structure – ‘teacher is always right’
    • They often fear that other people might not approve of their plans, whereas in general practice training it is not wrong tbe wrong, simply part of the expected learning journey
    • Own culture may dictate management of conditions (societal values) e.g. Care of elderly by family rather than in a ‘home’
    • There are many clinical situations they have simply have not seen before.
    • Need to discuss every case
    • Difficulty when not able to make a diagnosis
    • Difficulty saying “I don’t know”
    • Long lists of questions sometimes leaving trainer and other doctors in the practice feeling overwhelmed
    • Difficulty acknowledging their feelings in the consultation
    • Recognising psychological aspects of patients’ problems
  • Language
    • Medical language = English; Conversational language = Own
    • They may struggle with local communication skills and assertiveness
  • Culturally and religious driven attitudes
    • E.g. Approach to colleagues/patients of the opposite sex

All of these can combine in a rather vicious circle tcreate problems. As a result the GPR may quickly lose all their confidence and be finding the whole experience very difficult.

Clearly some of these ‘problems’ are common and normal areas for phase 1 GPRs to address, but it appears tbe the degree and extent of the difficulties that can come as a shock to Trainers.

Suggestions that trainers may wish to consider

  • Go slower
  • Talk to us or someone who has “done it”
  • Review your induction – Longer?
    • perhaps, more on learning styles, more shared surgeries, more about managing uncertainty and being a “good-enough” doctor
  • Lots of attachments to outside/partner agencies
    • e.g. Social Services/Hospital departments/PCT etc.
  • Review curriculum
    • Subjects of first seminars to include e.g;
      • Attitudes
      • Reflective practice
      • P.B.L
      • Principals of adult learning
      • Expectations
      • Working in teams
      • Communication skills
      • Plus those listed in “GPR issues” section above
  • Use a “Discomfort Log”
  • Regular performance review – use our Tool Kit for assessing their performance, available through the scheme office
  • Keep regular written records of observations/progress/performance.
  • BMJ articles (see below)
  • Directed reading (see below)

Some resources for trainers:

  • BMJ of 3.4.04-the whole issue was on health in South Asia. The initial editorials were the most useful especially Postgraduate Medical Education in South Asia. Other articles gave general insight into the culture of health here -very different from the UK.
  • Have a look at this web site:http://www.pgmd.man.ac.uk/interdocs/HandbookforOverseasDrs.PDF
  • Undertake an assessment of their knowledge-in-theory early by completing the PEP CD-ROMs. The results of these tests will then dictate the next steps.

Strategies to suggest for the GPR:

  • Read a very basic book about the consultation in General Practice (such as Clinical Method – A GP Approach, by Robin Fraser)
  • Read a book about emergencies in general practice such as Handbook of Emergencies in General Practice – Lawrence et al
  • Further exploration about how the NHS works either by reading A Textbook of General Practice by Stephenson or Health and Health Care in Britain by Rob Baggott

Recognising that the registrar is struggling

This is not always easy, as their prior training may have taught them thide their struggle. However if you feel that there is a problem then speak tthe scheme organiser or one of us – ‘sooner’ rather than ‘later’

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