Education Posters 529 – 535
529 Using Graphic Medicine as a Tool for Reflective Practice
The act of drawing has been used to access deeper cognitive insights because it enables the integration of the conscious and unconscious mind whilst encouraging meaningful self reflection. Jung described it as ‘active imagination’. The process of focussing on an emotion or event and drawing spontaneously, then reflecting with an educational supervisor can lead to new insights.
Graphic tools are being used in medical education in USA but graphic storytelling has been part of our culture as far back as the cave drawings. Dr Ian Williams, author of ‘The Bad Doctor’ created the term ‘graphic medicine’. The book tells the story of a GP with a secret. Actions, thoughts and relationships are depicted frame by frame, like a story board, using foregounding and backgrounding to highlight certain issues. The drawings become phenomenological data representing the relationship between doctor and patient.
The aim of this piece of action research was to explore the benefits of ‘Graphic Medicine’ as a tool for reflective practice. It was important to see if the concept was acceptable way of learning and how to utilise it in GP education both pre and post CCT. Thematic and critical reflection were used to analyse the feedback from the participants. The results of the five workshops suggest that graphic reflections, combined with coaching style supervision, and appreciative enquiry can help us to focus on what makes us good clinicans.Writing reflectively is not appreciated by all GPs and often there is little time but being able to ‘doodle’ a picture of a doctor-patient relationship or event can be appealing. The educational supervisor could utilise this with appreciative enqiuiry to recognise the trainee’s strengths.
530 The learning trajectory of medical appraisers: Community of practice and professional identity in medical appraisal
Background An additional role GPs can take on is as an appraiser in which they provide medical appraisal for revalidation to primary and secondary care clinicians. Whilst clinical and education roles are well defined, appraisers do not, seemingly, have co-presence or are part of a clearly identifiable group. How do GPs construct their professional identifies as appraisers? This study is part of on-going work looking at the role of the medical appraiser in continuing professional development.
Summary of Work The study uses ‘community of practice’ as an analytical framework in order to understand the extent to which members share goals and practice, and develop relationships that join appraisers together into a social entity. More specifically, Wenger’s (1998, p. 73) three dimensional distinctions are applied to provide a framework of codes i.e. mutual engagement; joint enterprise; and shared repertoire. In-depth interviews with appraisers were analysed used Saldana’s (2016) approach to coding and interpretation of qualitative research.
Summary of Results ‘Legitimate peripheral participation’ sheds light on issues encountered as GPs construct their professional identities as appraisers and their evolving learning and practice through interaction with other appraisers (Lave and Wenger 1991). Where appraisers do participate in a community of practice, the study reports on how their professional identity as an appraiser is formed and on common expertise and shared practices.
Conclusions /Take home messages The study helps understand how learning, working relationships, and practices are developed by medical appraisers. It draws out implications for the development of new groups of professionals, as well as synergies with existing ones.
531 Prevention of harmful stress amongst doctors
Background Research to date has shown a link between practitioner stress/burnout and poor patient care. Contributory factors to high stress levels in this professional group (such as heavy workload and economic constraint) and the need for resilience are well documented. Less is known, however, about educational interventions that may help doctors to recognise and manage the harmful effects of stress in their own practice.
Summary of Work The study has three components: A systematic thematic synthesis concerning the pedagogic features of successful educational interventions on stress management for doctors, using EPPI 4 systematic review software.Up to 20 semi-structured interviews with medical educators concerning their experiences and views on workplace stress and interventions of use.An online Delphi exercise to inform and prioritise pedagogic design with approximately 40 contributors. The study gathers knowledge and seeks to build consensus around pedagogy for educational interventions which combat stress for doctors, and are offered as continuing professional development or as part of medical curricula.
Summary of Results The poster will report the results of the evidence synthesis of the national and international research with particular emphasis on 1) the short and/or long-term impact of successful educational interventions, and 2) the features of good pedagogic design that contribute to successful interventions to manage the harmful effects of workplace stress for doctors.
Conclusions /Take home messages The study has produced a database of evidence about successful interventions to inform the development of medical curricula and improving pedagogical practice.
532 Lower sixth form (AS level) work experience in general practice: providing a framework
Background: Work experience is expected from students applying to study healthcare careers. This can be difficult to gain, particularly for those without access to informal medical networks. This is especially true for those attending a state school. GP surgeries are perfectly placed to offer work experience in healthcare delivered by a multi-disciplinary team. Practically, at a time when workload is at an all-time high, getting through the logistics of this can be a deterrent.
Aims: This poster aims to set demonstrate an easily-replicable example for any GP practice offering work experience to their local aspiring workforce. This is also a chance to widen access into healthcare careers by offering these placements within deprived and under-doctored areas. Such work showcases primary care and encourages students to consider a future career in general practice.
Outcomes: The framework offers an easy-to-replicate example: Find/provide host GP practice, disseminate electronic application form to local schools and colleges, invite suitable applicants to a short interview process, appoint successful students with commitment to confidentiality agreement, host placement shadowing clinical and non-clinical staff, closing with feedback and evaluation of the process.
Discussion: General practice has an opportunity to provide work experience to the aspiring future healthcare workforce from all backgrounds. Encouraging practices to engage with local schools, colleges and communities will not only help to reduce inequalities of access to education but allow them to ‘grow our own’ workforce. Using this easy-to-replicate example, more practices can offer work experience placements to boost admissions and recruitment.
533 Collaborative learning between GP registrars and undergraduate pharmacists
Introduction: Primary care will increasingly be delivered in synergy by various healthcare individuals.Aims: To understand the benefits and challenges of inter-professional learning in two groups of learners within a GP setting: GP registrars and final year pharmacy undergraduates.
Method: Three pairs of pharmacy undergraduates were randomly allocated to sit with two GP registrars during two routine clinical surgeries to observe the consultations and subsequently discuss medicines management issues. All learners were asked to complete a post-event evaluation questionnaire. Thematic analysis of open ended questions was applied.
Outcomes: To rate the experience, a scoring scale of 1-5 (1=not helpful and 5=extremely helpful) was used. Both GP registrars rated 5. Five pharmacy undergraduates rated 5 and one as 4. Thematic analysis highlighted the GP registrars found the experience allowed for better integration of patient care, bringing together the pharmaceutical and clinical care aspects. It also developed their small group teaching skills. The pharmacy undergraduates reported significant improvement in their understanding of communication and listening skills, and thought that more interactivity during their session would have improved their learning experience. Both learning groups identified added value to the session and would like to increase the time allocated to this style of learning.
Conclusion: This study highlights the benefits to inter-professional learning. There are challenges especially when the learners are at different stages but with the correct planning it can be an invaluable learning opportunity for all parties involved. Through working collaboratively and focussing on inter-professional learning, excellent clinical care can be delivered.
534 Interested in a career in General Practice (GP)? Near-peer GP Taster Programme between final year GP trainees and Foundation Year One (FY1) doctors
Aims/Objectives: A longitudinal evaluation of a taster programme developed for FY1 doctors to learn about training and life in GP from near-peer mentors (GPST3 trainees). Content of Presentation: FY1 doctors were given the opportunity to shadow GPST3 trainees in clinical practice (3-5 days). The scheme ran successfully for the first time in 2015 (n=30), and a further one is currently underway (n=28). An electronic feedback survey was distributed to both groups following the taster. The follow up data for the 2015 cohort considers wider influence on career choice. The Kirkpatrick model of educational outcomes was used to frame the results.
Relevance/Impact: The government aspires to increase the GP workforce amidst the current crisis in GP recruitment and retention; initiatives are required to enable more doctors to make an informed decision to choose GP as a career. Currently opportunities are limited for FY1 doctors to explore GP as a career.
Outcomes: The taster programme was positively received by both FY1s and GPST3 mentors. The GPST3s were enthusiastic about GP, which appeared to ‘rub off’ on FY1s. FY1s found it helpful to have a trainee’s perspective of GP, gaining an overview of what to expect, including opportunities available to them. The taster demonstrated how varied GP is, and challenged some negative perceptions of primary care. GPST3s gained confidence in their knowledge about GP and greater insight into educational roles.
Discussion: Using GPST3 trainees as mentors for FY1 doctors is educational for both groups and may have a positive impact on GP recruitment.
535 The Audio-COT (Consultation Observation Tool) a telephone consultation work place based assessment (WPBA) for General Practice (GP)
RCGP WPBA Core Group
Aims/Objectives: The integration of the Audio-COT telephone consultation assessment tool in the RCGP ePortfolio, to capture the nuances of trainee telephone use without adding to assessment burden.
Content of Presentation: The current RCGP COT supports holistic judgements about a trainee’s ability to consult. The Audio-COT has been specifically designed to assess telephone consultations during training using the same assessment methodology. An accompanying list of performance criteria was constructed, along with guidance on gaining appropriate consent. The tool has been developed in conjunction with GP trainers and trainees, evaluated and further refined in a national pilot to ensure its validity and reliability.
Relevance/Impact: The use of telephone triage and consultations in healthcare is increasing, requiring trainees to acquire telephone communication skills in addition to face-to-face. It can be challenging for trainers to find ways to teach and assess telephone skills in an authentic way. The Audio-COT enables all trainees to be assessed on their telephone consultation skills.
Outcomes: The Audio-COT is due to be integrated into the RCGP ePortfolio in Autumn 2016. There will be no increase in trainer/trainee assessment burden as Audio-COT(s) will be directly substituted for COTs.
Discussion: The Audio-COT provides an additional effective, user-friendly supervised learning event to formally assess and develop the clinical competence of trainees’ telephone consultation skills, ensuring patient safety and enhancing satisfaction and preparing the trainee for their GP career. The tool may have other applications such as training by out of hours providers or established GPs wishing to refresh their telephone consulting skills.