521 Challenging scenarios in primary care – learning opportunities for nurses and allied healthcare professionals
Aims/Objectives To provide educational sessions for qualified nurses, healthcare assistants and primary care allied healthcare professionals to develop or improve their skills in dealing with challenging encounters in the workplace.
Content of Presentation We wrote various scenarios for simulated patients to act. They are based on difficult workplace situations such as dealing with aggressive or over-familiar patients and issues surrounding confidentiality and professional integrity. We facilitated the sessions during which the simulated patients role-played the scenarios with the delegates. We then opened up group discussion after each role play.
Relevance/Impact There is good evidence that simulated scenarios for clinical staff provide effective learning experiences. The sessions provide a safe environment for staff to think through challenging situations and test out their reactions, in order to help them feel better equipped to deal with them when they do arise.
Outcomes This work has received excellent feedback from the Southampton City CCG area where we have run sessions to date and have been asked to provide further future sessions in the same practices for staff who were unable to attend the first session. Further bookings are also now being taken in the West Hampshire CCG region.
Discussion Excellent healthcare depends on developing a caring, compassionate, highly-skilled and educated workforce, working in a supportive culture. This simulation pilot contributes to these aims by building on individual as well as team skill-sets, and promoting confidence in dealing with challenging scenarios in primary care.
522 Belbin & Burnout in GP Trainees
Aims/Objectives To establish whether GP trainees’ Belbin profiles can predict risk of burnout. The aim is to target resource-limited preventative pastoral support to the most vulnerable individuals.
Content 26 trainees in final-year GP training completed a Belbin assessment which, together with observer assessments, categorised each into one of the nine Belbin types. They were also assessed on two measures of burnout level in trainees. The results were compared.
Relevance/Impact Burnout is a recognised syndrome impacting adversely on an individual’s professional and personal life and on patient care. General Practitioners are increasingly experiencing high levels of burnout. Evidence suggests burnout appearing as early as the training years. Recent data from Wessex LMC suggests 5% of GP trainees are talking about burnout.
Certain demographics are known to correlate with higher rates of burnout, but this research could better identify those at risk. This could enable preventative strategies to be better targeted by educators.
Outcomes Of the 26 final-year trainees, 42% (11) scored highly in one or both of the GHQ-12 or OLBI burnout tests – a worrying figure. Separately, 38% (10) of the 26 trainees were Belbin profiled as either Completer-Finisher or Teamworker. The overlap between these two groups was remarkable: 90% (9) of the Completer-Finisher/Teamworker cohort were members of the high-burnout group.
Discussion Results suggest individuals with Belbin profiles of Completer-Finisher or Teamworker are much more likely to experience higher subjective levels of burnout during their training years than those with any of the other seven Belbin profiles. Although a small sample these results are clearly significant.
523 Simulation training in GP emergency management
Dr Olivia O’Connell
AIMS The benefits of simulation training are well established. This course used low and medium fidelity manikins in simulated scenarios, aiming to improve competence, confidence, practical skills and knowledge of GPs when managing emergencies.
CONTENT Questionnaires were used to establish learning needs of GPs in emergency management. The course was developed and directed by a GP, with teaching provided by consultants in Emergency Medicine, Paediatrics and Anaesthetics.
The day involved practical workshops (eg airway management), lectures (eg human factors) and simulated emergencies, with candidates rotating in small groups. Eight emergency simulations used adult or paediatric manikins, with resuscitation equipment and AEDs typically available within a general practice. Simulation scenarios ranged from paediatric meningococcal sepsis, to an MI with cardiac arrest. Each candidate had the opportunity to ‘team lead’ at least one simulation, with supportive debrief and reflection following.
OUTCOMES From post-course feedback questionnaire, all candidates felt more competent and confident in managing emergencies. Comments included: “practical, pragmatic, supportive learning in a non-threatening environment” “high level staff” “tailor-made to needs” “very thorough”“excellent simulation stations”“should be made mandatory training”.
RELEVANCE In the following three months, two GPs volunteered additional feedback about how the course had prepared them for emergencies they had subsequently managed, commenting:“A good example of how a course like this can really boost confidence and competence”, “well prepared” “I felt confident that I had the right kit”Others reported updates to practice resuscitation drugs and equipment.
DISCUSSION This course demonstrates how targeting learning needs can improve confidence, skills, and knowledge. 6 CPD points were accredited. The feedback suggests that emergency simulation training for GPs can potentially improve patient outcome.
524 Developing NHS leaders: the benefits of overseas leadership fellowships
Background Since 2008, 150 NHS employees and trainees from a range of healthcare professions, including general practice, have completed an Improving Global Health (IGH) through Leadership Development Fellowship. Placements are typically for 6 months and Fellows work closely with an overseas partner organisation. Placements are non-clinical, but have a focus on service and quality improvement, and developing capability. The aim of the present study was to explore the impact of completing the programme on past Fellows and identify outcomes for the NHS.
Summary of Work Past Fellows (n.109) from the programme were invited to complete an online questionnaire. Emergent themes in their answers were further explored with a purposive sample of 15 who participated in detailed, semi-structured interviews. The data were analysed by the authors using thematic analysis. Key findings from the analysis are presented, highlighting those with relevance to general practice.
Summary of Results 76 responses were received (70% a response rate). The majority reported that participating in the scheme had had an impact on their view of themselves as leaders, and three themes emerged to capture this: leadership potential, learning transferrable skills and impact on current role. These will be presented on the poster, with additional ones relevant to general practice.
Conclusions /Take home messagesThe IGH programme has provided participating Fellows with a solid foundation from which to continue their development as the NHS leaders of the future.
525 The drama of communication: an interactive workshop to enhance communication skills
Background Traditionally in training programmes for general practice, communication skills are taught by clinicians, enhanced by the use of direct observation techniques and video recordings of the trainee and patients or simulated patients. There are many similarities between a doctor’s communication skills and an actor’s performance abilities, and the workshop described here has been designed to highlight this crossover and thus help trainees develop their interpersonal skills.
Using tried and tested drama techniques, trainees are coached to heighten their response to their patients and extend their communication skills repertoire, without compromising their own authenticity.Summary of WorkA drama-led approach in a workshop environment, looks at specific elements of the doctor and patient interaction. It analyses the relationship at various points and through the use of drama activities and techniques promotes greater awareness of the trainee-patient dynamic.
Summary of Results In this poster we describe how the use of a professional drama coach can enhance learning for trainees by focusing on voice, gesture, the face and overall physicality.Conclusions /Take home messagesCoaching on communication skills using drama training has been well received by trainees, and their trainers, this paper describes how it may be used more widely.
526 Enquiry-Based Learning: innovation through curriculum development
Background In 2012 an innovative programme of facilitated case-based discussions called Enquiry-Based Learning (EBL) started for GP trainees in Southampton and Jersey. Sessions are held monthly with a main clinical topic on a two-yearly cycle. Other vertical curriculum themes run through many sessions, such as consultation skills.
Summary of Work In presenting the innovation to other educators, questions were asked about justifying use of the new programme: how did we know it was ‘teaching’ what the trainees needed to know? How did their learning build up over the three years of training? To explore this, one session based on mental health has been considered. The session has taken place in 2012, 2014 and 2016, and has been evaluated through feedback from learners /facilitators, and a review of the EBL case material.
Results Initial findings of the review concern themes around Resources: better understanding by tutor of how the case material has developed in complexity; Curriculum depth: a wider perspective on areas covered and how they link up across sessions/years. Teaching methods: sharper awareness of facilitator and trainee fatigue – identified scope to better pace session to optimize engagement and learning.
Discussion The EBL approach has allowed educators to move beyond understanding session feedback as isolated events and instead see how it integrates with the programme as a whole. Ongoing development and review sees future steps to involve trainees and facilitators to a greater extent and further examination of the ‘flow of learning.’
Conclusion Evidencing the EBL approach has lead to greater understanding of its evolution, and insight into the learner/facilitator experience. Evaluation has highlighted the ongoing development of case materials, curriculum areas and educational practice.
527 Tai Chi for building resilience
Background In recent years, there has been much interest in how GPs can protect themselves in their everyday practice through building resilience. The impact of wellbeing on the clinical care given and working relationships is now being recognised as important, and ways of building resilience are developing. This poster describes an educational session designed to support GPs by introducing them to the practice of Tai Chi, and how to use it to manage stress.
Summary of Work The aim of the session was to introduce participants to some basic principles and moves in Tai Chi. It comprised a mix of informal discussion of the principles and a practical introduction. Follow up support was provided by a podcast video which demonstrated a short 10 minute practice that could be completed every day. 10 participants attended the session, drawn from a range of roles in general practice. The session was evaluated using a feedback sheet, and a further follow up email evaluation was conducted three months later.
Summary of Results Participants valued the introductory session and rated it as ‘good’ or ‘very good.’ The ‘on-the-day’ feedback reflected their liking for the practical nature of the session and reported seeing how it could be fitted into the working day. The poster will outline the findings of the evaluation and future steps for developing this area of educational support.
Conclusions/Take home messages The session demonstrated that there is a willingness amongst GPs to engage with practical support to manage stress, and the session adds to the existing menu of strategies offered in the area. The evaluation provided useful information for ideas for future development.