Education Posters 500 – 506
500 Introduction of an educational programme for residential healthcare workers
Background A number of agencies are involved in provision of residential home care. However dedicated training and supervision for care home workers is lacking.
Aims 1. To introduce narrative reflective learning for residential home care provision. 2. To strengthen the networks between the different providers involved in care homes. 3. To increase the education and confidence of care home workers and for this to enhance satisfaction in one’s work.
Methods We introduced a two phase educational programme for residential healthcare workers in our Clinical Commissioning Group (CCG). In phase 1, we delivered a Balint Group, narrative facilitated discussion on sharing emotionally challenging experiences. In Phase 2, we delivered 4 whole days of training sessions on these topics alongside the narrative groups. Written feedback was obtained following all sessions.
Results Phase 1 was delivered to 23 healthcare workers in 4 care homes over seven 2-hour weekly sessions. Feedback was obtained from 21/23 participants. 91% reported that it was useful to discuss stories of residents. 78% reported that it was useful to learn about themselves, 87% reported that it was useful to learn about colleagues, 100% reported that they felt more prepared to carry out their duties.
Conclusion We successfully delivered an multi-disciplinary educational program for residential care home worker. Participating in narrative groups enables care home workers to appreciate their own values, the dedication and value of workers and improve their work and working environment extremely beneficial. This is likely to result in improved patient care and staff morale.
501 Investigations into General Practitioner perceptions on HIV testing in England 2012–2016: a review
Aims/objectives The Halve It campaign has conducted an annual investigation at the RCGP conference since 2012 into GP knowledge, practice, and perceptions on the barriers and solutions to increasing the offer of HIV testing.
Design and methods The Halve It Secretariat surveyed delegates in attendance. Phrasing of the qualitative questions evolved year-on-year based on the data that we received. 2012 and 2013 questions were direct, 2014 and 2015 used case studies where appropriate. Respondents were given the opportunity to provide qualitative commentary on the challenges and solutions to expanding HIV testing in primary care.
Outcomes See attached poster for full results.
Discussion General practitioners report a strong ability to offer tests to MSM in all survey iterations. Each year, a significant proportion of respondents noted that HIV testing could be expanded through improved information and training in general practice. Data suggests that presenting case studies of patients at high risk of living with undiagnosed HIV is effective at gaining insight into the perceptions and behaviour of GPs.
502 A phenomenological study into the essence of transitioning from a surgical career to a career in general practice
The attrition of surgical trainees has been reported as 20%, with less than 66% of trainees continuing their training to consultancy. Regardless of the precipitators for change, little has been explored about the process trainees go through to change career, challenges they encounter and support they receive.
This study explores the meaning and essence of the phenomenon of transitioning from a surgical career to GP, with the aim of capturing the lived experience of this phenomena thus identifying the issues trainees face, and furthermore supporting them through this challenging process.
Using a qualitative approach, the study used in-depth interviews of four doctors who made this transition. A phenomenological method of analysis was used to create seven common themes, which were explored in detail in an attempt to capture their lived experience. Multifactorial reasons for attrition included personal circumstances such as work-life balance, refused entry in to the surgical community, rejection of identity and failure to progress. Bullying was also an issue.
A number of factors were shown to ease the transition, which included a thorough induction, placement in another hospital specialty as the first rotation, support from seniors and family. These issues must be addressed to retain good, ideally with an accessible supervisor available for trainees in difficulty. If a doctor is transitioning to a new career, adequate support should be provided where required. The rotations provided to GPST’s should reflect their previous career to broaden their experience, rather than repeat similar specialties, which provide less benefit to their training.
503 Mindfulness: an appreciative enquiry of GP participants’ reflections on attending an eight week course
BackgroundMindfulness as a means of addressing /managing the stresses of medical practice has, in recent years, become very topical in medical education. It has become well-established across the continuum of medical education in different forms, and there is a burgeoning field of research to evaluate its effectiveness, using a variety of approaches. This evaluation is of an eight-week mindfulness course to support GPs by fostering awareness to stress and strategies for resilience.
Summary-of-Work This study evaluates the experience of the course participants (3 cohorts), explores their understanding of mindfulness and their experience of engaging with mindfulness in their lives. We have used the approach to research ‘appreciative enquiry’ (AE), and conducted interviews to develop an understanding of each particpant’s personal journey on the programme. AE has allowed us to focus our ‘researcher’ gaze on what worked/s for them and possibilities.
Summary of Results Participants interviewed (to date 5) and the MBSR facilitators (n.2) valued the programme in terms of support and strategies to manage daily stressors. They came to the programme with different understandings of mindfulness and different levels of engagement with it. Our presentation will outline the findings of the evaluation and contextualise them in the literature.
Discussion The 8-week programme allowed participants to develop their understanding of mindfulness, it’s potential relevance to them and to embed it’s practices in their lives. It provides a new perspective on the nature of this type of intervention.
Conclusions Participants reported continuing to use the principles and practices, though these were often modified.
504 Leading first – A leadership programme for First5 General Practitioners
Background The GPs of tomorrow will need to embrace new ways of working in order to manage increasing primary care workload and additional roles in service reforms. The RCGP trainee curriculum states that leading and managing improvement in healthcare systems is just as important as acting on behalf of the individual patient. Despite this, the training programme leaves newly qualified GPs facing high expectations to improve organisations with minimal leadership and change management training.
Aims & objectives Create a programme enabling First5 GPs to develop insight into their personal abilities, biases and skills useful to leadership and change management. Use these workshops as a base for continual personal and professional development with live workplace projects encouraged.Promote the importance of leadership skills within general practice.
Methodology The programme consists of four sequential workshops run across the year (February 2016 – September 2016) supported by the local RCGP faculty. Topics covered: developing personal insight into oneself as a leader; an introduction to change management theory; practicalities of service improvement and federations; changing attitudes and practising with mindfulness. The delegates will map their competencies on the NHS Healthcare Leadership Model throughout the programme highlighting their strengths, weaknesses and progression.
Desired results High quality training and mentorship to improve the confidence and ability of First5 GPs in leading and transforming organisations.Raised awareness of the need for leadership training, followed by a change to teaching practice across postgraduate and undergraduate education.
505 Enhancing resilience in training through practice swaps
GP trainees are emerging into the profession at a time of unparalleled pressure, and many of our trainees are choosing to become sessional GPs. Follow up of this newly qualified cohort had highlighted many felt workload intensity and other challenges had been much greater than they had expected. Feedback suggested many would have liked more exposure to these challenges during the final training stages. We were interested in how we could enhance resilience and preparedness and decided to reintroduce practice swaps for our ST3s in their final months of training.
The aim was to allow the ST3s to experience as much as possible ‘the life of a sessional GP’ in a new environment with differing systems and processes. Trainees were expected to manage the usual workload of a sessional GP in that practice, with light touch supervision available from the hosting practice’s educational supervisor.
On completion of the swap feedback was provided to the ST3 and ‘home’ educational supervisor including identification of remaining learning needs. Tailored half day release sessions complemented the swap project and encouraged reflection. Robust qualitative and quantitative evaluation including follow up of the newly qualified GP cohort, as well as educational supervisor feedback, demonstrated a wide range of positive outcomes.
These included increased confidence of working in unfamiliar environments, enhancement of coping strategies and more informed decisions about future career intentions. Our findings strongly support the value of such practice swaps towards the end of ST3 and we would encourage other schemes to consider their introduction.
506 Retrospective review of prescriptions issued by GPs in Training – the results of a pilot study
Aims Individualised evaluation of the prescribing of ten GP associates-in-training (AiTs) Greater understanding of the types of prescribing errors made by GP AiTsEvaluation of individualised prescribing feedback as an educational intervention to reduce prescribing errors and enhance patient safety.
Content of presentation Outline the context of prescribing errors in UK General Practice. Describe the educational intervention of individualised prescribing feedback. Present quantitative and qualitative data.
Relevance/ Impact The GMC PRACtICe study found that prescribing errors in general practices occur in 5% of prescriptions. GP AiTs were highlighted as a group with specific prescribing educational needs. The concept of individualised feedback was supported by focus groups with GP AiTs and trainers.
Outcomes Pooled data from the ten GP AiTs suggested that prescribing errors occurred at a rate higher than that in the PRACtICe study (9%). There was a very high rate of ‘suboptimal prescribing’ (45%), which included aspects of poor practice such as providing incomplete information on a prescription. Analysis of qualitative data suggests that the intervention had an impact on the prescribing practice of not only the GP AiT but also of their trainers.
Discussion The rate of prescribing errors among the ten GP AiTs was almost twice that reported in the PRACtICe study. Caution must be employed before extrapolating these findings to a larger population of GP AiTs. The findings of this pilot study would, however be supportive of the view that GP AiTs may benefit from further help to improve prescribing practice