Traditional and behavioural models of the tutorial

Template 1: The traditional paradigm

Aims and objectives

  • To demonstrate competence in the clinical skills of general practice.
  • To make a diagnosis in physical, psychological and social terms.
  • To develop consulting skills.
  • To make and implement appropriate management plans.
  • To understand the use of time in general practice.
  • To be able to work independently but also ….
  • ….to function as a member of the primary health care team.
  • To cope with the basic administration of general practice.
  • To demonstrate an understanding of practice management.
  • To identify own learning needs and appreciate the need to continue learning throughout a career.
  • To demonstrate an active commitment to the promotion of health in the patient as well as society.
  • To have a public style of living consonant with advice given to patients.
  • To show a sensitivity to emotions and an ability to use personal awareness of feelings for the therapeutic benefit of the patient.
  • To show an understanding of the evaluation of scientific evidence, research as applied to general practice, and statistics.
  • To be aware of the philosophical and ethical issues involved in the care of patients.
  • To be able to recognise stress within oneself and to develop mechanisms to cope with it. To value medical audit.
  • To demonstrate knowledge of the wide range of interventions available and the appropriate usage of other agencies.
  • To demonstrate understanding of how family dynamics can cause illness or alter its presentation, course and management.
  • To safely manage acute problems and emergencies.
  • To live with and manage uncertainty.
  • To be able to design guidelines.
  • To develop an ability to evaluate.
  • To develop an ability to delegate.
  • To develop evidence-based thinking and practice.
  • To take postgraduate exams.
  • To pass summative assessment.
  • To boldly go …..

Induction arrangements

  • Negotiation of educational contract.
  • Curriculum planning.
  • Shadow trainer initially then controlled separation.
  • Sit in with other partners.
  • Meet other members of the primary health care team.
  • Explain the vagaries of local hospitals.
  • Give practice information pack containing list of useful telephone numbers, practice leaflet, map of the area, timetable and on-call arrangements.
  • Locate and make friends with the computer.
  • Bond!

Learning and assessment

  • Negotiate together the structure for learning and frequency of the various types of formative assessment used.
  • Discuss the shift from trainer to registrar directed learning as the year progress.
  • Outline the assessment methods that will be used to plan future teaching eg.
    • Multiple choice questions
    • Modified essay questions
    • Project/audit
    • Personality profiles
    • Consultation observation eg video taping, joint surgeries.
  • Hot topics.
  • Prescription analysis.
  • Local confidence rating scales.
  • Manchester rating scales.
  • Follow-up slip system.
  • Phased evaluation programmes.
  • Log book.
  • Registrar’s rolling assessment diary.
  • Simulated surgeries.
  • Attitude questionnaires.
  • Random and problem case analysis.
  • Discuss the format and frequency of tutorials with specific reference to the generation of suitable topics. These may arise as a result of
    1. the registrar’s perceived need
    2. assessment
    3. a patient with a problem
    4. from a previously negotiated list of topics.
  • The registrar will be encouraged to investigate in detail areas found particularly interesting.

Practicalities

  • Timetable
  • Study leave arrangements
  • Library
  • Domestic conditions.

Template 2: The behavioural model

Registrar will

  • Provide P45, MDU/MPS certificate and proof of full registration.
  • Sign a service contract.
  • Be punctual.
  • Read current literature.
  • Do consultations at 15-20 minute lengths initially, building up to 10 minutes when trainee feels comfortable.
  • Attend the half-day release course.
  • Attend practice meetings.
  • Undertake out-of-hours work.
  • Keep a list of books read.
  • Use the log diary.
  • Be registered with a doctor other than the partnership.
  • Provide own portable equipment for use whilst home visiting.
  • Raise topics/patients where uncertainty arises.
  • Call for help if in difficulty with a situation.
  • Accept regular assessments and discuss the results, repeating the assessment if necessary.
  • Log out books from library.
  • Develop their own clientele.
  • Use the course organiser as a mediator in the case of difficulty.
  • Be enthusiastic about being videoed!
  • Be entitled to 30 days study leave per year and pro rata for shorter periods.
  • Be in residence within a certain area when on-call.
  • Hold a valid driving licence.
  • The registrar may be asked to complete a health questionnaire and also give the trainer/course organiser permission to approach the registrar’s GP for a pre-employment medical.
  • Keep consulting room tidy and well stocked.

Practice will

  • Encourage the trainee to sit in with all other partners at least once during attachment.
  • Follow the regional guidelines for training practices.
  • Take note of suggestions/recommendations of previous re-approval visits.
  • Do everything possible to welcome the new registrar and make them feel part of the team.

Trainer will provide

  • Safe environment.
  • Adequate cover both on call and in the surgery.
  • Protected time for tutorials, reading and learning.
  • Regular debriefing after surgery.
  • Adequate updated library.
  • Study leave.
  • Trainee’s own well-equipped consultation room.
  • Equipment such as ECG, nebuliser, sonicaid, sphygmomanometer etc.
  • Drugs for the bag.
  • Support and advice about available courses.
  • A weekly timetable which will be negotiated between the trainer and registrar and reviewed at regular intervals.
  • Help with the production of CV.
  • References when required.
  • Access to all meetings.
  • Opportunities to visit other practices.
  • Another partner to act as educational supervisor when trainer is absent.
  • A record of all formal assessments.
  • The trainer will be available to act in a more personal way as counsellor should the registrar so wish.
  • Attend trainers’ workshop and keep his/her own CME up to date.

What makes a good tutorial?

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