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North Gwent and South Powys
Core Curriculum for Training in General Practice

 competency based

bulletCurriculum

Introduction:

There are many suggestions for the content of a curriculum for training in general practice. However these are general in content and generic for all contexts and settings. Local specific needs are not considered.

The following core curriculum has been devised from the ideas generated by interviewing the trainers and recent graduates of the North Gwent and South Powys Vocational Training Scheme. Using a modified Delphi technique all ideas were rated in a series of rounds. All items considered important or essential in the final consensus were included in the final curriculum plan in each of the three areas of knowledge, skills and attitudes which are necessary for a doctor to acquire in order to become a good general practitioner.

The findings are important for a number of reasons. First, ownership of guidelines on a local level should help to promote a willingness to show commitment to implementing the principles generated by the group and continued commitment to further educational policy development. A sense of belonging to the group and making a contribution to the guidelines should improve group relationships and encourage more active participation in future trainers' workshops. As all contributions were included for initial rating and all opinions valued, individual members should realise that regardless of their experience and background their opinions are worthwhile.

This was the first occasion where the opinions of recent graduates of the scheme were offered the opportunity to contribute directly towards local policy development at length. This study should represent true viewpoints of both the provider and consumer.

On a more global level, the findings and the curriculum guidelines developed in this study may have a role in other contexts. The curriculum may prove to be a template for other general practice training schemes to adapt to their specific needs. The educational principles generated and some of the modules may prove of value in developing curricula in other settings, such as the education of Pre Registration House Officers in general practice.

PRINCIPLES OF TEACHING AND LEARNING

Considered to be of equal importance to the group were the educational strategies that should be employed in implementing the curriculum. These factors were essential to provide the registrar with the necessary experience to learn in an appropriate environment to promote effective teaching and learning.

These principles of teaching and learning fell into three broad categories as follows:

General Principles of Teaching and Learning

  1. A broad experience of practice should be provided

  2. The necessary time and resources should be provided in practice

  3. Training should be learner directed not teacher led

  4. The registrar’s learning style should be identified and utilised to optimise the learning experience

  5. The trainer should act as a mentor, facilitator and resource manager

  6. The trainer should provide the registrar with the guidance necessary to develop an individual learning plan

  7. The teaching techniques employed should be appropriate to the subject matter and the registrar’s individual learning style

  8. The trainer should provide positive, continuous feedback to the registrar on his achievements and progress

  9. Both registrar and trainer should be aware of the need to evaluate teaching and learning

  10. The trainer and registrar should show a willingness to learn from each other

Planning Education

  1. Joint, honest needs assessment is essential to plan education effectively

  2. Opportunities to apply knowledge and skills should be planned and provided

  3. Opportunistic learning should be utilised to make learning more meaningful

  4. There should be an integrated approach between trainer, course organisers and hospital consultants to provide appropriate training for registrars

The Learning Environment

  1. The learning environment should be safe, supportive and encouraging

  2. The trainer and his partners should be well read and have a positive practice approach and active involvement in continuing medical education

  3. All those involved in teaching should show enthusiasm and motivation to continue to learn from their experiences

  4. Those involved in teaching should be aware of their own teaching style and how this affects the learning experience

  5. Feedback should be provided from the whole primary health care team (via the trainer) to help assess the registrar’s learning needs and monitor progress

  6. There should be mutual respect between registrar and trainer and the educational experience should be considered a partnership in learning rather than a teacher-pupil relationship

Knowledge Skills and Attitudes

All important ideas and concepts were translated into a series of aims in each of three main categories or curricula;

  1. Knowledge
  2. Skills
  3. Attitudes

and each curriculum further divided into subcategories or modules;

bullet

Knowledge Module 1
Medical /Clinical knowledge

bullet

Knowledge Module 2
Knowledge of Management and Administration

bullet

Knowledge Module 3
Knowledge of Research, Audit and Continuing Medical Education

bullet

Skills Module 1
General skills

bullet

Skills Module 2
Specific skills

bullet

Skills Module 3
Self-management and Personal Development skills

bullet

Attitudes Module 1
General attitudes

bullet

Attitudes Module 2
Specific attitudes

bullet

Attitudes Module 3
Attitudes to Personal Development

Each module was developed in a consistent format with

bulletRationale for the curriculum
why the particular curriculum needs to be developed
bulletAims and objectives for the curriculum
what the registrar should know or do by the end of training
bulletSpecific elements derived from each aim and objective with
bulletPerformance Criteria
the boundaries within which the performance should fall if the registrar has reached the required standard of performance
bulletIndicative Content
areas which must be included for the performance to meet the required standard
bulletEvidence indicators
assessment opportunities to ensure that the registrar meets the required standard of performance
e.g. case reviews where actual cases are analysed, problem based cases which are constructed with a specific problem in mind, analysis of the registrar’s own consultations on video, MEQ (modified essay questions) which are constructed to assess specific criteria, MCQ (multiple choice questions) to assess knowledge and reasoning skills and feedback based on direct observation by the trainer or others in real life or simulated settings e.g. surgery simulations or role play.

TITLE: Knowledge Module 1

Clinical/Medical knowledge

RATIONALE: This core module is designed to equip the registrar with the necessary clinical and medical knowledge required to function as an effective general practitioner.

AIMS AND OBJECTIVES:

  1. The registrar should have a working knowledge of the management of common medical conditions as seen in general practice.
  2. The registrar should have knowledge of the major specialities of medicine, surgery, paediatrics, psychiatry and obstetrics and gynaecology as seen in general practice
  3. The registrar should have knowledge of the minor specialities of ENT, ophthalmology, dermatology and rheumatology as seen in general practice.
  4. The registrar should have the necessary knowledge to manage medical emergencies and life-threatening illnesses in the context of general practice.
  5. The registrar should have knowledge of national and local guidelines on the management of specific conditions.
  6. The registrar should have knowledge of the depths of the consultation models.
  7. The registrar should have knowledge of the patient and his illness in his circumstances as a member of the family, community and society.
  8. The registrar should have a working knowledge of the resources available to the GP, primary health care team and the patient in managing patient problems.
  9. The registrar should have knowledge of the principles of team-working in the context of the practice and local community with view to maximising patient care.
  10. The registrar should have knowledge of his own limitations in practice and have a framework to assess these limitations.

ELEMENT 1.1 The registrar should have a working knowledge of the management of common medical conditions seen in general practice.

Performance Criteria:

A registrar should

  1. be able to identify and list the symptoms and signs of common illnesses as seen in practice.
  2. relate the clinical and medical knowledge to the clinical problem once identified.
  3. organise knowledge into a suitable framework for providing a solution to the problem.

Indicative Content:

A registrar must fulfil the performance criteria for the following illnesses and conditions:

(a)     minor illnesses as seen in practice e.g. sore throat, otitis media, lower respiratory tract infection, acute and chronic sinusitis and minor injuries

(b)     common conditions as seen in practice e.g. angina, hypertension, heart failure, diabetes, asthma, chronic obstructive pulmonary disease, diabetes mellitus, thyroid disease

Evidence Indicators:

Case reviews, problem case reviews, video consultation analysis, MCQ questions.

ELEMENT 1.2 The registrar should have knowledge of the major specialities of medicine, surgery, paediatrics, psychiatry and obstetrics and gynaecology as seen in general practice.

Performance Criteria:

A registrar should

  1. be able to identify and list features of common illnesses in each of the major specialities as seen in general practice.
  2. relate the clinical and medical knowledge to the clinical problem once identified.
  3. organise the knowledge into a suitable framework to define the problem and it’s solution.

Indicative Content

A registrar must fulfil the performance criteria for the following illnesses:

a.     Medical Conditions

Cardiovascular

angina, hypertension, hyperlipidaemia, heart failure, cardiac arrhythmias, and atrial fibrillation, valvular heart disease, endocarditis and pericarditis, myocardial infarction.

Chest Medicine

bronchitis, pneumonia, bronchiectasis cystic  fibrosis, asthma, COPD, pleural effusion, primary/secondary malignancies, alveolitis, pulmonale, tuberculosis

Renal Medicine

urinary tract infection, glomerulonephritis,  acute/chronic renal failure, urinary tract malignancies, diabetic nephropathy, urinary tract obstruction

Neurology

stroke, transient ischaemic attacks, subarachnoid and  subdural haemorrhages, encephalitis, meningitis,  epilepsy, multiple sclerosis, motor neurone disease, myasthenia gravis, Bell’s palsy

Gastroenterology

liver failure, cirrhosis, acute/chronic hepatitis,  inflammatory bowel disease, irritable bowel syndrome, tumours of the colon and pancreas, gastrointestinal infections, malabsorption syndromes, peptic ulcer disease

Endocrinology

diabetes mellitus, thyroid disorders, parathyroid  disorders, Cushing’s syndrome, Addison’s disease, acromegaly, diabetes insipidus, hypopituitarism, obesity

Haematology

anaemia, bleeding disorders, anticoagulation,  acute/chronic leukaemia, Hodgkin’s/non-Hodgkins lymphoma, amyloidosis, myeloma, paraproteinaemias,

Geriatrics

acute confusional states, stroke rehabilitation, urinary  incontinence, hypothermia

b. Surgery

acute abdomen, malignancies of the bladder, breast,  colon, stomach and oesophagus, hernias, haemorrhoids, varicose veins, lumps in the groin, scrotum, neck and thyroid, bowel ischaemia and obstruction

c. Paediatrics

developmental screening, immunisations, viral  exanthemata, malformations, neonatology, the feverish child, meningitis, accidental poisoning, anaemia, purpura, asthma, epilepsy, renal disease, coeliac disease, cystic fibrosis, mental handicap, cerebral  palsy, non-accidental injury

d. Psychiatry

depression, suicide/parasuicide, anxiety neurosis, eating  disorders, dementia, schizophrenia, alcohol and drug dependence, psychotherapies, mental state examination, Mental Health Act

e. Obstetrics and Gynaecology

antenatal care, menstrual disorders, vaginal discharge, screening for cervical cancer and ovarian cancer, gynaecological malignancies, contraception, acute/chronic pelvic pain, bleeding in pregnancy and  the peurperium

Evidence Indicators:

Case reviews, video consultation analysis, MEQ questions, problem cases, MCQ questions

ELEMENT 1.3 The registrar should have knowledge of the minor specialities as seen in general practice

Performance Criteria:

A registrar should

  1. be able to identify and list the symptoms and signs of common conditions of each of the minor specialities as seen in general practice.
  2. relate the clinical and medical knowledge to the clinical problem once identified
  3. organise knowledge into a suitable framework form providing a solution to the problem.

Indicative Content:

A registrar should fulfil the performance criteria for the following common conditions;

a. ENT

deafness and tinnitus, vertigo, nasal obstruction, nasal injuries and foreign bodies, epistaxis, acute/chronic sinusitis, throat infections, dysphagia, ENT tumours, lumps in the neck, facial palsy

b. Ophthalmology

eye movements and squints, the red eye, sudden and gradual visual loss, glaucoma, cataract, retinal detachment, the eye in diabetes and systemic disease, trauma, blindness and partial sightedness, allergic eye disease, drugs and the eye

c. Dermatology

pigmented lesions, warts and veruccas, acne vulgaris, skin infections and infestations, eczema and dermatitis, psoriasis, acne rosacea, leg ulcers, pressure sores, the skin in systemic disease

d. Rheumatology

arthritis including septic arthritis, osteoarthritis, rheumatoid arthritis, crystal arthropathies, spondyloarthridites, connective tissue diseases including systemic lupus erythematosis, polyarteritis nodosum, polymyalgia rheumatica, giant cell arteritis, back pain

Evidence Indicators:

Case reviews, video consultation analysis, MEQ questions, MCQ questions, problem cases

ELEMENT 1.4 The registrar should have the necessary knowledge to manage medical emergencies and life-threatening illnesses in the context of general practice.

Performance Criteria:

The registrar should

  1. be able to identify the symptoms and signs of common medical emergencies.
  2. know the principles of basic resuscitation
  3. have knowledge of the drugs used in acute medical emergencies.

Indicative Content:

A registrar should fulfil the performance criteria for the following emergencies:

  1. cardiorespiratory arrest
  2. anaphylaxis or acute angiooedema
  3. myocardial infarction
  4. psychotic/agitated patient
  5. vomiting due to vestibular disorders
  6. severe pain
  7. acute heart failure
  8. suspected meningitis
  9. severe acute anxiety
  10. respiratory depression
  11. hypoglycaemia
  12. diabetic ketoacidosis
  13. acute asthma attack
  14. acute haemorrhage

Evidence Indicators:

Case reviews, problem based cases, MEQ questions, MCQ questions, observation of performance in simulations or actual emergencies

ELEMENT 1.5 The registrar should have knowledge of national and local guidelines on the management of specific conditions.

Performance Criteria:

A registrar should

  1. have knowledge of national guidelines on the management of important conditions commonly seen in general practice.
  2. relate the guidelines to the problem as seen in practice
  3. have knowledge of the underlying evidence supporting such guidelines.

Indicative Content:

A registrar should fulfil the performance criteria for the following guidelines in practice:

  1. management of chest pain
  2. referral criteria for investigation of angina
  3. British Hypertension Society Guidelines
  4. British Hyperlipidaemia Society Guidelines
  5. British Thoracic Society Guidelines for the management of asthma and chronic obstructive pulmonary disease
  6. local guidelines for referral of breast lumps
  7. local guidelines for referral of eye emergencies
  8. local guidelines for management of infections in the community
  9. local guidelines for direct access to radiological investigations
  10. British Diabetic Association guidelines on the management of diabetes in general practice

Evidence Indicators:

Case reviews, problem based cases, video consultation analysis, MEQ questions, MCQ questions

ELEMENT 1.6 The registrar should have knowledge of the depths of the common consultation models.

Performance Criteria:

A registrar should

  1. be able to outline the common consultation models of the GP consultation.
  2. be able to identify aspects of such models in his own consultations.

Indicative Content:

A registrar should fulfil the performance criteria for at least one of the following consultation models:

  1. Stott and Davis Model
  2. Byrne and Long Model
  3. Neighbour’s the Inner Consultation
  4. Heron’s Model
  5. Gray’s Consultation Model

Evidence Indicators:

Case reviews, video consultation analysis, problem based cases, simulated surgeries, role play, MEQ questions, MCQ questions

ELEMENT 1.7 The registrar should have knowledge of the patient and his illness in his circumstances as a member of the family, community and society.

Performance Criteria:

A registrar should

  1. identify the patients problem in terms of physical, psychological and social parameters.
  2. identify the effects of the family, community and society in contributing to the patient’s problem and in defining a solution to it.
  3. identify the effects of the patient’s illness on himself, his family, community and society.

Indicative Content:

A registrar must fulfil the performance criteria in the following settings:

  1. listing the physical, psychological and social factors contributing to the patient’s illness
  2. identify the patient’s own role in the family, community and society
  3. use knowledge of the patient in his own environment to identify factors which may hinder recovery from illness

Evidence Indicators:

Case reviews, problem based cases, video consultation analysis, simulated surgeries, role play

ELEMENT 1.8 The registrar should have a working knowledge of the resources available to the GP, primary health care team and the patient in managing patient problems.

Performance Criteria:

A registrar should

  1. be able to list the resources available within the primary health care team in terms of skills mix and knowledge to help manage the patient’s problems.
  2. identify local resources in the community such as hospitals, community care facilities, social services and voluntary agencies which may help in managing patient problems.
  3. have knowledge of how to access facilities to aid patient care.

Indicative Content:

A registrar must fulfil the performance criteria in the following patient circumstances:

  1. the provision of appropriate resources to manage medical emergencies and acute medical conditions
  2. the provision of day-care for a variety of groups including the elderly, those with chronic illnesses such as mental health problems, the role of day hospitals, day centres and resource centres in providing such facilities
  3. arrangements for providing respite care for a variety of groups such as the elderly, the mentally ill and those with physical or mental handicap
  4. appropriate referrals to local district hospitals, tertiary referral centres, social services voluntary agencies and charities
  5. appropriate referrals within the primary health care team, utilising the individual member’s knowledge and experience

Evidence Indicators:

Case reviews, problem based cases, video consultation analysis, MEQ questions, feedback from primary health care team members and others.

ELEMENT 1.9 The registrar should have knowledge of the principles of teamworking in the context of the practice and the local community with view to maximising patient care.

Performance Criteria:

A registrar should

  1. identify the roles of teams within the practice and the community and his own role in relation to these teams.
  2. be able to identify features of effective teamworking in practice.

Indicative Content:

The registrar should:

  1. make appropriate contributions to team meetings and try to identify his niche in the practice
  2. identify when the practice team is working effectively and areas for improvement in teamworking
  3. have some knowledge of his own potential role as a team member or team leader
  4. have knowledge of how his personality and experience affect his interactions with other team members

Evidence Indicators:

Practice team meetings, case reviews, feedback from primary health care team members, simulations, role play

ELEMENT 1.10 The registrar should have knowledge of his own limitations in practice and have a framework to assess these limitations.

Performance Criteria:

The registrar should

  1. identify when patients’ needs are unmet and what his own educational needs are from his everyday practice
  2. identify useful tools to assess his own learning needs
  3. identify when he needs to refer patients to medical colleagues or other agencies

Indicative Content:

The registrar should

  1. demonstrate knowledge of his own deficiencies in his everyday work using a variety of techniques e.g. PUNs and DENs, reflective diary of practice etc.
  2. identify such assessment tools and understand their value in practice
  3. identify appropriate ways of addressing his educational needs according to his preferred learning style
  4. refer appropriately to others to maximise patient care

Evidence Indicators:

Uses appropriate tools to assess learning needs, case reviews, review of referrals, willingness to approach others for guidance

TITLE: Knowledge Module 2

Knowledge of Management and Administration

RATIONALE: This module is designed to equip the registrar with the core knowledge of practice management and administration necessary to function as a principal in general practice.

AIMS AND OBJECTIVES

  1. The registrar should have knowledge of the medicolegal principles of practice
  2. The registrar should have knowledge of the administrative preparation necessary to become a principal in practice
  3. The registrar should have a working knowledge of his terms of service in his duty to care for patients

ELEMENT 2.1 The registrar should have knowledge of the medicolegal principles of practice.

Performance Criteria:

The registrar should

  1. have knowledge of the principles of confidentiality and the patient’s right to respect and dignity
  2. understand the concept of informed consent
  3. demonstrate understanding of the rules governing the advertising of doctor’s services
  4. have understanding of the need for good communication with patients, colleagues and other professionals
  5. demonstrate understanding of the ethical considerations in difficult circumstances in practice e.g. in caring for patients with HIV and AIDS

Indicative Content:

The registrar should fulfil the performance criteria in a variety of circumstances:

  1. demonstrate understanding of the need for good communication between the doctor and patient and the doctor and other professionals
  2. show respect for the rights of patients and involves them in decisions about their care
  3. ensure that his personal beliefs do not prejudice patient care
  4. avoid abusing his position as a doctor
  5. treats every patient with politeness and consideration
  6. listen to patients and respects their views
  7. give patients information in a way they can understand
  8. recognize the limits of his professional competence and duty to keep up to date
  9. work with colleagues in ways that best serve patients’ interests

Evidence Indicators:

Case reviews, problem based cases, MEQ questions, video consultation analysis, feedback from primary health care team members, patients and others

ELEMENT 2.2 The registrar should have the appropriate knowledge of the administrative preparation necessary to become a GP principal.

Performance Criteria:

The registrar should

  1. have knowledge of the appropriate qualifications necessary to become a GP e.g. to pass Summative Assessment and hold a JCPTGP certificate
  2. have knowledge of the criteria he must fulfil to be eligible for the FHSA list of principals and other lists such as minor surgery, child health surveillance and obstetrics
  3. have knowledge of the basic elements of a partnership agreement and understand what constitutes a fair agreement
  4. have knowledge of his legal responsibilities as an employer in terms of the rights of his staff
  5. have knowledge of the requirements to have adequate medicolegal insurance and appropriate registration with the GMC

Indicative Content:

The registrar should fulfil the performance criteria in appropriate settings in practice

  1. demonstrate knowledge of his medicolegal requirements to practice in general and to be eligible to become a principal in particular
  2. demonstrate understanding of his duties to his staff in terms of employment law, health and safety law etc.
  3. demonstrate understanding of the partnership agreement of his training practice and knowledge in discussing issues arising from it

Evidence Indicators:

Problem bases cases, direct observation of interaction with staff, feedback from staff

ELEMENT 2.3 The registrar should have a working knowledge of his terms of service in his duty to care for patients.

Performance Criteria:

The registrar should

  1. demonstrate knowledge of his duty to put the care of the patient as his first concern
  2. have knowledge of his requirement to be available to patients personally or make suitable arrangements to provide continuous care
  3. show understanding of his responsibility to decide where, when and how a patient should be seen
  4. have knowledge of local arrangements for the provision of out of hours care
  5. ensure he has knowledge of local resources available to care for patients and refers appropriately to other professionals and agencies

Indicative Content:

The registrar should fulfil the performance criteria in a variety of settings in practice

  1. show willingness to put the patient’s needs before his own when appropriate
  2. demonstrate knowledge gathered when assessing urgency of patients demands in prioritising workload
  3. refer patients appropriately to colleagues and other professionals or agencies

Evidence Indicators:

Case reviews, video consultation analysis, problem based cases, MEQ questions, direct observation or feedback from others

Knowledge Module 3

Knowledge of Research, Audit and Continuing Medical Education

RATIONALE

This module is designed to provide the registrar with the basic knowledge of the possible roles of research and audit as tools to improve patient care and his own performance and to have a framework for identifying his own learning needs throughout his professional life.

AIMS AND OBJECTIVES

  1. The registrar should have knowledge of the relevance of audit and reflecting on activity and performance to improve patient care.
  2. The registrar should have knowledge of the available techniques to plan his own future educational needs.

ELEMENT 3.1 The registrar should have knowledge of the relevance of audit and reflecting on activity and performance to improve patient care.

Performance Criteria

A registrar should:

  1. Demonstrate an understanding of the concept of the audit cycle and the relevance of setting standards to improve ones own performance.
  2. Evaluate his own performance and seek to improve his standards to optimise patient care.

Indicative Content

A registrar should demonstrate this knowledge in practice by:

  1. Carrying out an audit project of an aspect of practice relevant to patient care.
  2. Examining standards set by others and decide which are appropriate to his own practice.
  3. Showing willingness to acknowledge his own performance deficiencies in the light of gold standards and understand the need to improve these standards.
  4. Critically analysing audits of activity carried out by others.

Evidence Indicators

Carry out audit project, keeps diary of experience in practice, examines own performance and deficiencies in practice.

Element 3.2 The registrar should have knowledge of the available techniques to plan his own future educational needs.

Performance Criteria

A registrar should:

  1. Demonstrate understanding of his responsibility to keep up to date and identify his learning needs.
  2. Understand the tools available to him to identify his learning needs.
  3. Demonstrate the ability to plan his own needs during his training and use the educational resources available to him appropriate to his learning style and preferred methods of learning.

Indicative Content

The registrar should fulfil the performance criteria in a variety of settings.

  1. Demonstrate the ability to identify his own learning needs using his everyday work e.g. using PUNs and DENs technique, reflecting on problem patients/difficult situations or using referral letters as a basis for assess learning needs.
  2. Show understanding of the potential roles of more formal tools for needs assessment e.g. confidence rating scales, phased evaluation plans, etc.
  3. Demonstrate knowledge of the educational resource available to him.
  4. Understand how to develop a personal education plan.
  5. Identify his preferred learning methods and his individual learning style.

Evidence Indicators

Case reviews, keeps diary of practice learning needs, using confidence-rating scales, write own educational plan.

Skills Module 1

General Skills

RATIONALE

The aims of this module are to provide the registrar with the core skills required of him to function as an effective, caring general practitioner.

AIMS AND OBJECTIVES

1.

The registrar should have the necessary skills to apply his medical knowledge.

2.

The registrar should have the diagnostic skills appropriate to general practice.

3.

The registrar should have the necessary communication and listening skills to interact effectively with patients, PHCT members and professionals to provide high standards of patient care.

4.

The registrar should have the appropriate skills to manage medical emergencies and life-threatening illnesses in the context of the general practice setting.

ELEMENT 1.1 The registrar should have the necessary skills to apply his medical knowledge.

Performance Criteria

A registrar must

1.

Develop analytical skills to organise the symptoms and signs presented to him by patients to make a working diagnosis for every problem presented to him.

2.

Use reasoning skills to make a diagnosis considering the prevalence of certain illnesses in the community and the laws of probability.

3.

Demonstrate skills in collecting the necessary facts to solve problems, not only in physical terms, but also psychological and social terms.

4.

Possess the ability to make a management plan to solve problems using the available resources to him.

Indicative Content

The registrar must fulfil the performance criteria in a variety of settings.

a.

Demonstrate problem solving ability in well-structured problem cases.

b.

Demonstrate the ability to define real patient problems globally.

c.

Demonstrate the ability to formulate the appropriate management plan for every problem presented to him.

Evidence Indicators

Case reviews, problem-based cases, video consultations, MEQ questions, medical records with a clear and logical management plan.

ELEMENT 1.2 The registrar should have the diagnostic skills appropriate to general practice.

Performance Criteria

The registrar should

1.

Demonstrate expertise in physical examination and detection of clinical signs and in taking a psychosocial history.

2.

Use appropriate equipment to aid diagnosis.

3.

Show ability to use all the data elicited clinically to make an appropriate diagnosis based on the patients condition and the prevalence of illness in the community.

Indicative Content

The registrar should demonstrate the performance criteria in a number of settings.

a.

Demonstrate expertise in examining all systems and correctly eliciting abnormal and relevant normal clinical signs.

b.

Use appropriate equipment to aid diagnosis such as auriscope, ophthalmoscope, stethoscope, vaginal speculum, etc.

c.

Have skills in organising the relevant normal and abnormal physical findings and psychosocial information to make a reasonable diagnosis based on findings and probability.

Evidence Indicators

Case review, problem case analysis, video of consultations, medical records.

ELEMENT 1.3 The registrar should have the necessary communication and listening skills to interact effectively with patients, the PHCT members and professionals to provide high standards of patient care.

Performance Criteria

The registrar should

  1. Demonstrate the ability to communicate with people from different social and professional groups.
  2. Demonstrate the ability to listen to patients concerns and give patients information in a way that they can understand.
  3. Demonstrate the verbal and written skills necessary to interact efficiently with fellow professionals within the practice and in the community.

Indicative Content

The performance criteria should be evident in a number of settings.

(a)   Sensitive, clear communication with those who are of different ethnic groups or who have difficulties in communication due to physical or mental disability.

(b)   Active listening skills in communicating with patients, PHCT members and fellow professionals.

(c)   Clear, concise referral letters to colleagues and other agencies.

Evidence Indicators

Case reviews, problem case analysis, role play, simulations, video of consultations, referral letters, feedback from PHCT members and other professionals and agencies.

ELEMENT 1.4 The registrar should have the appropriate skills to manage medical emergencies and life-threatening illnesses in the context of the general practice setting.

Performance Criteria

The registrar should

  1. Demonstrate a SAFE approach to medical emergencies i.e. Short Access available help, Approach with care, Free from danger, Evaluate assessing breathing and circulation.
  2. Demonstrate basic life support skills in cardiopulmonary resuscitation.
  3. Demonstrate the ability to carry out the Heimlich Manoeuvre.
  4. Demonstrate the ability to put an unconscious patient in the recovery position.
  5. Demonstrate skill in carrying out a head to toe examination to establish the source of life threatening illness.
  6. Demonstrate the ability to use an airway and cannulate patient.
  7. Demonstrate the ability to give an injection by the appropriate route.
  8. Clearly communicate findings verbally or in writing to those in secondary care who will take on the patient care.

Indicative Content

The registrar should be able to demonstrate these skills in a variety of settings.

(a)   by demonstrating CPR skills on a model or in simulation.

(b)   by giving injections by a variety of routes to patients in an emergency.

(c)   by demonstrating skills in acute medical emergency management.

(d)   by making written records of such emergencies available to appropriate others and documenting events in his own records.

Evidence Indicators

Case review, simulations, problem-solving analysis, direct observation of performance in an acute emergency, feedback from others on performance.

Skills Module 2

Specific Skills

RATIONALE: In order to effectively function as a general practitioner, there are certain skills which a doctor must acquire in order to provide a high standard of patient care.

AIMS AND OBJECTIVES:

1. The registrar should have the appropriate skills to carry out minor surgery in practice safely and effectively.

2. The registrar should have the appropriate skills to critically and selectively read medical information pertaining to patient management in general practice.

3. The registrar should have the skills necessary to deal with difficult patients and situations in the context of general practice.

4. The registrar should have the appropriate skills in patient education on self help and appropriate management of problems.

ELEMENT 2.1 The registrar should have the appropriate skills to carry out minor surgery in practice safely and effectively.

Performance Criteria:

The registrar should demonstrate

  1. aseptic technique in carrying out minor surgical procedures.
  2. the ability to obtain informed consent from the patient prior to carrying out a procedure.
  3. skill in using the relevant basic equipment as appropriate to the procedure
  4. skill in a variety of procedures including excisions, incision and drainage, joint injections, cryocautery etc. appropriate to the procedure to be performed.
  5. skill in suturing using the appropriate materials for the procedure.
  6. skill in counselling the patient with regard to follow up.
  7. selectivity in carrying out procedures within his level of skills and experience.

Indicative Content:

The registrar should demonstrate the performance criteria in a number of situations:

  1. in practical simulations using models, computer programmes etc.
  2. carrying out minor surgical procedures under supervision in the practice or in other settings e.g. hospital clinics, casualty etc.

Evidence Indicators:

Direct observation of skills in surgery, feedback from supervisors in other settings, examination of patient records, audit of complications of minor surgery carried out

ELEMENT 2.2 The registrar should have the appropriate skills to critically and selectively read medical information pertaining to patient management in general practice.

Performance Criteria:

The registrar should

1. demonstrate selective reading of medical literature using the available resources.

2. demonstrate the ability to critically analyse a research paper.

3. demonstrate skill in locating sources of information to solve patient problems.

Indicative Content:

The registrar should fulfil the performance criteria through

  1. demonstrating the ability to access relevant medical information using MEDLINE, Cochrane Data Base, Internet etc.
  2. demonstrating the ability to critically read a research paper using a suitable framework of reference e.g. READER acronym, or uses his own framework of reference in critically appraising literature.
  3. using facilities within the practice and locally to select relevant literature to solve problems.

Evidence Indicators:

Carries out a MEDLINE search , can use the Internet to access information, analyses the medical literature in terms of quality and relevance to his own practice

ELEMENT 2.3 The registrar should have the skills necessary to deal with difficult patients and situations in the context of general practice.

Performance Criteria:

The registrar should

1. demonstrate the ability to identify potentially difficult situations and the effects of his own behaviour on the outcome of these situations.

2. demonstrate appropriate assertiveness skills in dealing with angry or aggressive patients.

3. demonstrate the ability to delegate effectively to those with the appropriate skills and responsibility for dealing with such situations within the practice.

Indicative Content:

The performance criteria should be evident from a variety of sources:

  1. skills in identifying potentially difficult situations
  2. awareness of practice complaints procedure and of the skills designated person(s) to deal with these situations must have
  3. ability to deal assertively and not aggressively with difficult people
  4. ability to diffuse situations appropriately with patients or others by active listening and reading non verbal cues

Evidence Indicators:

Problem case analysis, role play, video consultation analysis, direct observation of behaviour in difficult situations

ELEMENT 2.4 The registrar should have the appropriate skills in patient education on self help and appropriate management of problems.

Performance Criteria:

The registrar should

1. demonstrate understanding of his role in helping patients to solve their own problems through pointing out appropriate management options but letting the patient make his own decision.

2. demonstrate awareness of his own personal beliefs and prejudices but not let them interfere his advice to patients.

3. demonstrate skills in identifying local resources and in referring appropriately to them.

4. communicate such information to patients in a way they can understand..

Indicative Content:

The registrar should demonstrate these skills in a variety of settings:

  1. identify and explain self help methods during the consultation in a manner appropriate to the patient’s level of understanding
  2. demonstrate the ability to identify in the patient’s lifestyle factors which put him at risk of developing or aggravating illness and communicating this effectively to the patient.
  3. help the patient to define his own problem and possible solutions so that he can be actively involved in managing his own problem
  4. educate patients on the nature and extent of practice services and other agencies so that they may use them effectively.

Evidence Indicators:

Case reviews, problem cases analysis, video consultation analysis, MEQ questions.

Skills Module 3

Self Management and Personal Development Skills

RATIONALE: In order to perform effectively as a general practitioner, the registrar must develop self management and personal development skills to ensure he works efficiently but does not put his own health at risk.

AIMS AND OBJECTIVES:

1. The registrar should have effective time management skills to maximise his working potential.

2. The registrar should have the necessary skills to deal with his own stress and preserve a balance between health, home and his professional life.

3. The registrar should have the ability to work independently and cope with the uncertainties of everyday general practice.

ELEMENT 3.1 The registrar should have effective time management skills to maximise his working potential.

Performance Criteria:

The registrar

1. understands the need to dedicate time for planned and unplanned time demands.

2. identifies tasks to be performed and prioritises workload according to the degree of importance and urgency.

3. demonstrates the ability to form clear objectives of what he is trying to achieve in his daily work.

4. displays appropriate mechanisms to deal with unnecessary interruptions, controlling paperwork etc.

5. delegates appropriately to others.

Indicative Content:

The registrar should demonstrate these skills in a variety of ways:

  1. ability to prioritise day to day workload and take responsibility for deciding on the urgency of tasks.
  2. clearly demonstrates understanding of what performance can be reasonably expected from him in a given period of time.
  3. demonstrates the ability to delegate efficiently to those within the practice.

Evidence Indicators:

Case review, video consultation analysis, feedback from staff and others, role play, simulations.

ELEMENT 3.2 The registrar should have the necessary skills to deal with his own stress and preserve a balance between health, home and professional life.

Performance Criteria:

The registrar should

1. identify signs of stress in himself and others.

2. demonstrate strategies to minimise stress and coping mechanisms to deal with stressful situations.

3. recognise his responsibilities to maintain his own health and family life as well as his professional responsibilities to patients.

4. demonstrate the ability to delegate effectively and to involve appropriate others in managing patient problems.

5. demonstrate the ability to enjoy his time away from the practice whilst ensuring patient care is continuous through appropriate involvement of others.

6. set himself realistic goals and realise his own limitations in his professional life.

Indicative Content:

The registrar should demonstrate these skills in a variety of settings:

  1. realises the effects of stress on his own health and can identify causes of stress and ways of dealing with them effectively.
  2. demonstrates the ability to minimise stress through effective delegation and time management.
  3. demonstrates a willingness to set limits on his expectations of his own performance based on his experience and the resources available to him.

Evidence Indicators:

Case reviews, role play, video consultation analysis, problem case analysis.

ELEMENT 3.3 The registrar should have the ability to work independently and cope with the uncertainties of everyday practice.

Performance Criteria:

The registrar should

1. demonstrate the ability to work alone when necessary but use the relevant resources available to him appropriately.

2. demonstrate an understanding of his own limitations in solving every problem presented to him.

3. demonstrate confidence in his abilities appropriate to his experience, knowledge and skills.

4. recognise that uncertainty is a fact of every patient contact and develop strategies to put this fact in perspective to avoid stress and unrealistic expectations.

5. demonstrate the ability to use time as a clinical tool.

Indicative Content:

The registrar should demonstrate these skills in a variety of settings:

  1. demonstrates the ability to make realistic management plans for patients using his skills in identifying the resources available to him.
  2. demonstrates the ability to work independently in consultations both during normal working hours and out of hours.
  3. identifies elements of uncertainty in the patient’s management and seeks the necessary help and resources to minimise these uncertainties to avoid poor patient management.
  4. realises that time is often the only tool which will eventually reveal the underlying nature or cause of the patient’s illness and its natural progression.

Evidence Indicators:

Case reviews, problem case analysis, role play, video consultation analysis

Attitudes Module 1

Attitudes

RATIONALE: Attitudes are important in treating patients and staff with respect and in developing a sense of responsibility towards professional life. Some general attitudes are essential to acquire before effective practice is possible.

AIMS AND OBJECTIVES:

1.The registrar should have a positive attitude towards general practice as a career and maintain enthusiasm for it.

2. The registrar should have a sense of responsibility to colleagues, patients and staff and show commitment to his practice whilst maintaining humility in dealing with others.

3.. The registrar should show empathy towards the patient treating him as a person and not an illness.

4. The registrar should have respect for patient confidentiality .

5. The registrar should maintain his role as the patient’s advocate as an essential professional responsibility.

ELEMENT 1.1 The registrar should have a positive attitude towards general practice

as a career and maintain enthusiasm for it.

Performance Criteria:

The registrar should

1. show willingness to participate in practice activities appropriately.

2. consider his future career in general practice.

3. demonstrate motivation to learn in practice and make the most of resources available to him as learning tools.

4. identify the GP’s role in continuing patient care and demonstrate respect for his role in providing care whether problems are of a physical or psychosocial nature.

Indicative Content:

The registrar should demonstrate

  1. a positive attitude to the nature of his work even when he is pressured and uses  appropriate means to deal with his workload
  1. a positive attitude to choosing his future career considering general practice as a  possibility and having valid reasons for his future career choice.
  2. ability to utilise practice and community resources as aids to learning and use them  appropriately.
  1. a positive attitude towards his role in providing patient care regardless of the  nature of the problem and attempts to understand the patient’s health seeking  behaviour.
  2. an appropriate response to extrinsic motivators and have intrinsic motivation.

Evidence Indicators:

Case reviews, video consultation analysis, feedback from primary health care team,  participation in practice meetings.

ELEMENT 1.2 The registrar should have a sense of responsibility to colleagues, patients and staff and show commitment to his practice whilst maintaining humility  in dealing with others.

Performance Criteria:

The registrar should show

  1. respect for patients, colleagues and staff.
  2. concern for the patient as being his own prime concern.
  3. consideration for the views of others and a willingness to listen to them.
  4. courtesy in dealing with others.
  5. respect for the roles of others within the primary health care team and other  professionals in caring for patients.
  6. avoidance of abusing his position as a doctor.
  7. willingness to work with colleagues in a constructive way which best serves  patients interests.

Indicative Content:

The performance criteria should be fulfilled in a variety of setting

  1. willingness to function as a member of the primary health care team.
  2. listens to patients, colleagues and staff and respects their views.
  3. puts patients first and shows consideration towards the workload of primary health care team members and others so as to avoid misusing their time and skills.
  4. sees his role as a team member and as a team leader when appropriate.

Evidence Indicators:

Case reviews, problem based cases, video consultation analysis, feedback from  primary health care members and others.

ELEMENT 1.3 The registrar should show empathy towards the patient, treating him as a person not an illness.

Performance Criteria:

The registrar should:

  1. demonstrate a holistic approach to defining the patient’s problems in physical,  psychological and social terms.
  2. seek understanding of the patient’s beliefs and concerns regarding his illness and  clarifying any misconceptions arising from them.
  3. demonstrate consideration for the impact of the patient’s illness on his physical and psychological well-being as well as on his social circumstances as a member of a  family, community or other social group.

Indicative Content:

The performance criteria should be fulfilled in a variety of circumstances:

  1. the registrar makes a clear, concise attempt to define the patient’s problems in the  clinical records.
  2. the registrar seeks appropriate information from the patient with regard to his  social circumstances and his psychological problems.
  3. the registrar considers the patient as a person firstly and examines his illness in the  light of the individual’s circumstances.

Evidence Indicators:

Case reviews, video consultation analysis, problem case analysis, MEQ questions,  Feedback from patients and others.

ELEMENT 1.4 The registrar should have respect for patient confidentiality

Performance Criteria

The registrar should

  1. demonstrate understanding of the principles of confidentiality.
  2. demonstrate responsibility for confidential information and protect this information from improper disclosure.
  3. demonstrate understanding of the circumstances in which he must breach  confidentiality.
  4. make sure he informs patients whenever information about them is likely to be  disclosed to others involved in their health care and give the patient the opportunity  to refuse permission.
  5. demonstrate responsibility in disclosing information to other health care  professionals and ensure that they understand the information is given in confidence.
  6. be willing to disclose confidential information when necessary but be prepared to  explain and justify his decision to do so.
  7. ensure that when patients give consent to disclose information about them, that  they understand what will be disclosed and the likely consequences.
  8. demonstrate understanding of the Data Protection Act.

Indicative Content:

The registrar must fulfil the performance criteria in a variety of settings:

  1. show respect for the recording of confidential information and sensitivity in discussing these issues with patients and others.
  2. clearly explain to patients when confidential information needs to be disclosed; e.g.  infectious diseases, Mental Health Act, in a Court of Law, to the coroner etc.
  3. shows understanding of the principle “ for the good of the many and protection of  others” in breaching confidentiality
  4. seeks appropriate advice from colleagues or medical defence organisations when in  doubt of his position with regard to confidential information.

Evidence Indicators:

Case reviews, video consultation analysis, role play, review of patient records,  problem case analysis.

ELEMENT 1.5 The registrar should maintain his role as patient’s advocate as an  essential professional responsibility.

Performance Criteria:

The registrar should:

  1. demonstrate understanding of his role in caring for patients and providing them  with the best possible care with the available resources.
  2. even in difficult circumstances and conflict put the patient’s best interests before his own or those of others.
  3. demonstrate tenacity in organising and mobilising the necessary resources on the  patient’s behalf.

Indicative Content:

The registrar must fulfil the performance criteria in a number of settings:

  1. appropriately refer patients to colleagues or other agencies, indicating the nature  and urgency of the problem and what help he feels is appropriate.
  2. show willingness to expedite and follow up services appropriately on the patient’s  behalf.

Evidence Indicators:

Review of case notes, case reviews, video consultation analysis, feedback from  patients and others.

Attitudes Module 2

Specific Attitudes

RATIONALE: In addition to general attitudes to his professional responsibilities,  there are specific attitudes which help the doctor to work effectively as a team  member and good communicator.

AIMS AND OBJECTIVES:

  1. The registrar should show a willingness to consider and listen to the views of  others.
  2. The registrar should show encouragement for and promote multidisciplinary  teamworking.
  3. The registrar should show sensitivity in dealing with patients of differing beliefs,  cultures and ethnicity.

ELEMENT 2.1 The registrar should show a willingness to consider and listen to the  views of others.

Performance Criteria

The registrar should

  1. demonstrate listening skills in dealing with patients, staff, primary health care team  members and other professionals and respect their views
  2. treat others with courtesy and politeness.
  3. value contributions made by primary health care team members and other  professionals in facilitating provision of patient care
  4. demonstrate understanding of and respect for the roles of others in practice and of  other professionals and use their skills to best serve the patient’s interests
  5. listens to patients’ views on their illnesses and involves them appropriately in  managing their problems

Indicative Content:

The performance criteria should be fulfilled in a variety of settings

  1. the registrar demonstrates a willingness to seek and receive advice from primary  health care team members and other professionals to provide optimum patient care.
  2. the registrar seeks patient’s ideas regarding his problems and involves him  appropriately in management plans.
  3. the registrar communicates effectively with patients and others.
  4. the registrar shows respect for the experience and skills of others and values their  contribution to patient care.

Evidence Indicators:

Case review, problem case analysis, video consultation analysis, feedback from  patients, primary health care team members and others, contributions to team meetings.

ELEMENT 2.2 The registrar should show encouragement for and promote  multidisciplinary teamworking.

Performance Criteria:

The registrar should

  1. show understanding for the principles of effective teamworking and recognise the  need to provide patient care through a multidisciplinary approach.
  2. demonstrate the ability to work constructively with such teams and to respect the  skills and contributions of others
  3. ensure that team members respect patient confidentiality and share confidential  information with them appropriately and sensitively.
  4. demonstrate a willingness to delegate appropriately to team members and others.
  5. demonstrate willingness to act as a team member or team leader when necessary in  the patient’s best interests.

Indicative Content:

The registrar should fulfil the performance criteria in a variety of settings:

  1. actively participate in multidisciplinary meetings and contribute to them  appropriately
  2. delegate effectively to others considering their skills and experience.
  3. involve multidisciplinary team members appropriately in providing patient care and  respect their contributions.

Evidence Indicators:

Participation in team meetings, feedback from primary health care team members and  other professionals, review of case notes, MEQ questions, problem case analysis.

ELEMENT 2.3 The registrar should show sensitivity in dealing with patients of differing beliefs, cultures and ethnicity.

Performance Criteria

The registrar should:

  1. acknowledge the contribution of the patient’s beliefs, cultural and ethnic  background towards his ideas on the causes of his problems and views on  management.
  2. show sensitivity in communicating with the patient, giving him information in a  way which he can understand, using the resources available to him.
  3. demonstrate respect for the patient’s right to be fully involved in decisions about  his care.
  4. involve appropriate others in giving information to patients where communication  is difficult whilst ensuring confidentiality.

Indicative Content:

The performance criteria should be fulfilled in a variety of settings:

  1. the registrar should communicate appropriately with patients and try to ensure that  there are no misconceptions or misunderstandings in the information given.
  2. the registrar should demonstrate sensitivity in dealing with issues which are at odds  with his own beliefs and cultural background and not unduly influence the patient’s  right to hold these views.
  3. show due respect for the use of chaperones and interpreters in accordance with the  patient’s cultural and ethnic norm.

Evidence Indicators:

Case reviews, problem case analysis, role play, simulations, video consultation  analysis, feedback from patients, feedback from primary health care team members and others.

Attitudes Module 3

Attitudes to Personal Development

RATIONALE: In order to maintain a standard of excellence in his practice and keep  knowledge up to date, the registrar must acquire essential attitudes to personal  development during training. He must be aware of his own position of influence and  develop insight into his own beliefs and performance and how they affect his  interaction with patients and others.

AIMS AND OBJECTIVES:

  1. The registrar should have a positive attitude towards and commitment to continuing  medical education and maintain a critical attitude towards his own practice.
  2. The registrar should maintain a confident attitude to coping with general practice as  a career.
  3. The registrar should possess an awareness of his own prejudices and how they  affect his professional interaction with others and maintain a neutral , objective and non-judgmental stance in dealing with patients.

ELEMENT 3.1 The registrar should have a positive attitude towards and commitment to continuing medical education and maintain a critical attitude towards his own performance.

Performance Criteria:

The registrar should

  1. demonstrate a willingness to reflect on his own performance and identify his  learning needs.
  2. demonstrate an ability to address his learning needs appropriately considering his preferred learning style and the resources available to him.
  3. recognise the limits of his own professional competence.
  4. engage in learning activities appropriate to his needs.
  5. demonstrate an ability to reflect on his experiences and learn from his mistakes.

Indicative Content:

The registrar should fulfil the performance criteria in a number of settings:

  1. use day to day experience to monitor his performance and identify gaps in his  knowledge and skills.
  2. realises when he has reached the limits of his competence and refers the patient  appropriately to other or seeks advice.
  3. considers methods of addressing his own educational needs and puts an education  plan into action.

Evidence Indicators:

Case reviews, problem case analysis, MEQ questions, formulates an education plan, attends medical meetings or engages in personal learning on a regular basis.

ELEMENT 3.2 The registrar should maintain a confident attitude to coping with general practice as a career.

Performance Criteria:

The registrar should:

  1. demonstrate flexibility in his approach to problem solving depending on the resources available to him.
  2. realise that he has a valuable contribution to make to patient care but that the skills of others should be used appropriately.
  3. remain open to change and new ideas in an ever changing health service.

Indicative Content:

The registrar should fulfil the performance criteria in a number of settings:

  1. show versatility and flexibility in his approach to problem solving using the resources available in the practice and the community.
  1. b. demonstrates a willingness to listen to new ideas and respond appropriately to them.
  2. demonstrates an ability to identify stresses in practice and puts mechanisms in place to deal with them, e.g. appropriate time management skills, effective delegation skills, etc.

Evidence Indicators:

Case reviews, MEQ questions, feedback from primary health care team members and others.

ELEMENT 3.3 The registrar should possess an awareness of his own prejudices and how they affect his professional interactions with other and maintain a neutral, objective and non-judgemental stance in dealing with patients.

Performance Criteria:

The registrar should:

  1. recognise his own prejudices and beliefs and the impact they potentially have on his interaction with others.
  2. ensure that his personal beliefs do not prejudice his patients’ care by respecting their views and rights to be involved in decision making
  3. avoid abusing his position as a doctor to influence patients decisions inappropriately.
  4. demonstrate a positive attitude to his role as giving information to patients, so that they can make informed decisions regarding their health and problems.

Indicative Content:

The registrar should fulfil the performance criteria in a number of settings:

  1. listen respectfully to patients’ views and respect their rights in his interaction with them.
  2. demonstrates awareness of his own views on ethical dilemmas and sensitive issues.
  3. communicate information to others honestly and without allowing his own prejudices to influence the process.
  4. show respect for the patient’s decision in managing problems when they are at odds with his own.

Evidence Indicators:

Case reviews, problem case analysis, video consultation analysis, MEQ questions, feedback from patients, primary health care team members and others.

The overall aim of this project, to develop a core curriculum for general practice training using a modified Delphi technique, was achieved.

The Delphi method provided the anonymity and confidentiality required for participants to express their honest opinions and rate the groups' ideas. This method was more successful than previous attempts to obtain a group consensus in the past by using other techniques such as brainstorming and small group work. Participants felt the method was neither cumbersome nor time consuming and contributions were readily to the process.

The findings led to the development of a core curriculum for training in general practice. This was defined in terms of the knowledge, skills and attitudes which a registrar should have acquired by the end of training. The ideas generated were similar to previous research in this area, for example, The Samuel System, but the context was more specific to local practice.

The contributions of both trainers and locally trained new principals represents a broader view of general practice training than the opinions of educators alone. Both groups held remarkably similar views on the subject and ratings of individual items were similar for both groups.

A large number of ideas was generated on the teaching and learning principles which should be employed in implementing the curriculum. These principles are not considered in detail in the published research of others in this area of education, such as The Havelock System.

The findings are relevant in a local context as the curriculum represents a consensus of opinion of local educators and recent consumers of the educational experience. The curriculum is owned by all contributors and a consensus was reached with relative ease. The detailed contribution made by non trainers should promote future participation of registrars in planning their own education.

The curriculum may find a place in the education of registrars in other settings, such as in other regions.

Some of the ideas and principles may be applicable to the training of health professionals in other settings, for example, the training of pre registration house officers in the community.

The principles of teaching and learning outlined are valuable in education in any context.

It is important that this curriculum is evaluated if it is to evolve and become a useful document for the future of general practice training. This could be achieved by internal verification by the participants in the study on the curriculum's relevance to training in a local context. External verification by trainers elsewhere may increase the validity of this curriculum outside the local setting and it may be possible to generalise the findings to other contexts. Registrars could confirm whether or not the principles of teaching and learning suggested by the group are practised. The views of educators outside of the locality could also be sought and compared.

A more long-term evaluation of the effectiveness of the curriculum plan would be to assess if future doctors acquire the necessary knowledge, skills and attitudes to become effective practitioners and develop the ability to plan and address their own educational needs.

This curriculum will be modified in time in the light of the feedback received from participants in it's initial development, consumers of the educational experience and educators in medicine and other disciplines with an interest in curriculum development.

Source:

 Curriculum for Vocational Training
Julie Keely
Course Organiser, North Gwent and South Powys VTS
(with input of trainers, associate advisor and newly qualified GPs from the scheme)

 

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