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The
scheme for Specific Skills Training in General Practice has been operating
in the Eastern Deanery for a number of years and similar schemes operate
in other parts of the UK.
The scheme allows
a GP Registrar (having passed his/her Summative Assessment) to spend 6
months working part time in general practice and part time in another
area of medicine relevant to general practice. Funding comes from the
Deanery. In the Eastern Deanery GP Registrars on the scheme have gained
experience in a wide range of specialities including clinical audit, child
and adolescent psychiatry, dermatology, and public health.
Another benefit of
the scheme is that it allows one to continue to work in General Practice
under supervision, without the stresses of Summative Assessment and MRCGP
examination.
Why
I chose care of the older patient
During my registrar year I had become aware of many issues affecting the
care of older people which I had not encountered during my hospital training,
such as altered physiology, social issues, falls assessment and specific
health promotion issues. Realising that hospital medicine was becoming
increasingly specialised, I felt that geriatric medicine was in a position
to transcend any boundaries thus created, and was therefore very relevant
to general practice. The National Service Framework for Older People aims
to improve the care of older adults; it is important that GPs have the
clinical skills to implement this.
Before my GP Registrar
year I had worked for 6 years in a variety of hospital SHO posts, including
A&E, general medicine, psychiatry, ENT, ophthalmology, dermatology,
palliative care, and obstetrics and gynaecology. I had also worked as
an SHO, and later a Registrar, in paediatrics. My experience of caring
for older people was limited.
What
I did
In collaboration with the consultants of the Department of Medicine for
the Elderly at Addenbrooke’s Hospital in Cambridge, I constructed
a weekly timetable which exposed me to as wide a breadth of experience
possible over a 3 day week. This included an acute ward round with multidisciplinary
meeting; assessment of inpatient referrals from orthopaedics for rehabilitation;
a community hospital session including falls clinic and rehabilitation
ward round; weekly postgraduate educational meeting and radiology conference;
fortnightly tutorial on aspects of medicine for older people; and a general
geriatric outpatient clinic with some sub-specialisation in Parkinson’s
disease. I also took it upon myself to provide support to the junior medical
staff on the acute ward whenever time allowed. Although limited in my
experience of old age medicine, my general experience proved useful here.
Outcome
I found all members of the department very welcoming, allowing me to settle
in quickly.
I learned how the department operates, how it liaises with other hospital
departments and what subdivisions it has (e.g. orthogeriatrics, a sub-speciality
I had not previously been aware of!).
Increasingly I became aware of the critical interface between the DME
and every other department (with the exceptions of Paediatrics and Maternity).
I learned about the availability and function of a variety of local services
for older people such as alternatives to hospital admission, rapid response
teams, intermediate care and other rehabilitation facilities. I also became
aware of contact with consultants for advice rather than referral. My
clinical skills in all areas have improved, especially the assessment
of patients with Parkinson’s disease, and falls.
Some of what I learned
is hard to quantify – an increased awareness of elder abuse and
some understanding of the psychology of ageing. I have also learned the
value of becoming more pro-active in offering services to people who may
be reluctant to ask for them, and I gained confidence that sometimes not
investigating or actively treating may be appropriate.
Overall I now gain
more satisfaction from dealing with older patients. I prescribe more Calcium
and Vitamin D too!
What
will I do with this enhanced knowledge?
At the moment I hope I provide better care for my older patients and I
would consider working as a GP with a Special Interest in older people
(GPwSIOP) in the future. I am better equipped to take a lead within the
Primary Care Trust in implementing the NSF for Older People, and my skills
and knowledge will be of benefit when taking the Diploma in Geriatric
Medicine.
Who
should do Specific Skills Training?
I believe that anyone training in general practice would benefit from
this experience, especially those who aspire to a GPwSIOP post. The attachment
should be tailored to the applicant’s requirements and interest.
But whether one aspires
to a Special Interest post or not, the skills learnt on these programmes
are all very relevant in day to day general practice,
Aileen
Lambie
with support from Dr Duncan Forsyth, Dr Claire Nicholl and Dr
Rory O’Shea
Department of Medicine for the Elderly at Addenbrookes Hospital, Cambridge
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