Abstract
Despite all the negativity that currently surrounds general practice I feel that there has not been a more exciting time to be a GP trainee. As I reflect on my time as a recent trainee, I hope to be able to provide some beneficial words for current Associate in Training (AiT) doctors at all stages of their training.
GP training can resemble a minefield; the constant requirements of the ePortfolio, negotiating relevant clinical experience in hospital rotations, completing out-of-hours (OOH) requirements, and the Membership of the Royal College of General Practitioners (MRCGP) examinations, to only name a few demands on your time. It nonetheless provides you with a wealth of opportunities to listen and learn, grow, gain interests, and mature into a skilled generalist, at a time when trainees are being aggressively supported by the Royal College of General Practitioners (RCGP), Health Education England, and many others.
A person who can provide valuable guidance and support during your training journey is your educational supervisor (ES). It is important to arrange an introductory meeting when starting ST1 and to meet at least a few times a rotation. This allows the ES and trainee to get to know each other, thereby improving the productivity and strength of the working relationship over the coming years. Hospital rotations as a GP trainee can sometimes feel like service provision and not very orientated towards general practice. Although it can be useful to be exposed to the full spectrum of secondary care specialities, tailoring it to general practice can make it even more worthwhile. You should discuss this with your clinical supervisor, to ensure that you can attend relevant clinics, book study leave and target those learning needs that can be identified from the RCGP GP curriculum for that current rotation. This may require careful negotiation and perseverance, but by doing so the training experience will be greatly enriched.
The ePortfolio: you either like it or you hate it. I like to see it as an effective tool for learning and developing as a competent generalist. Early engagement with the process is crucial in not getting left behind, and it also provides a space to log the good things that you are doing in your training. A little effort each week will certainly go a long way to smoothly getting through your Annual Review of Competency Progression and achieving a Certificate of Completion of Training (CCT). However, it does not stop once you finish – there is the appraisal portfolio, so building good habits early on will undoubtedly help.
Trainees are fortunate to receive plenty of study leave; however, there are still many trainees who do not take advantage of the full allowance. It requires some early planning and keeping a look out for relevant activities. However, attending conferences, teaching days, self-organised clinics, courses for examinations/diplomas, and health and well-being days will provide a much needed break away from clinical work, broadening your experience and providing you with ideas to improve your own practice and performance.
If you are interested to learn more about leadership roles, there are regional, national and international AiT committees, who I am sure will welcome your enthusiasm. Also, there are various teaching and research opportunities in the form of Academic Clinical Fellow posts in primary care departments of universities. You can also consider an out-of-programme opportunity where, if you have a meaningful case, there is a good chance that you will be supported to do something very different , such as working abroad for a period of time. Near the end of my training, I attended a trainee Balint group and, in hindsight, I think it would have definitely been helpful, in terms of refining my consultation skills and preparing for the Clinical Skills Assessment (CSA), to be part of a regular Balint group when working in practice.
The Applied Knowledge Test (AKT) and the CSA, I feel are designed to represent realistic British general practice. They are fair examinations, but do require robust preparation to get through them first time. I found an AKT course useful in honing my exam technique and practice questions are a great way of building confidence. With regards to the CSA, a slow but steady approach is how I would prepare if I were to do it again. It is vital to be regularly observed by your supervisor in joint surgeries performed early in your ST3 phase, to form a study group with a diverse range of trainees, role play cases from all over the curriculum, and to give yourself time to feel confident and comfortable, thereby enabling the best chance of success. There are monthly sittings now and be wise to choose the right time for you. In addition, there are diplomas that are worth considering if you wish to develop a special interest and have the time.
My Vocational Training Scheme (VTS) provided me with the opportunity to catch up with colleagues, share experiences, and keep up-to-date with the latest training developments. Getting to know other trainees and learning alongside them was, for me, one of the highlights of training. I also felt honoured to be able to represent my colleagues on the regional AiT committee. There is so much that the VTS offers to the trainee and I would urge you to engage with the scheme and the training programme directors (TPDs); where I am sure your feedback would be most welcome.
The final year of training is challenging, but the light soon shines at the end of the tunnel. There are many considerations: getting down to 10 minute consultation times, passing the examinations, completing OOH requirements, partaking in an audit, meeting all the competencies and curriculum coverage on the ePortfolio. This must be done while the workload and responsibility in surgery increases as you get ready to practice independently. The trainers in your practice, your TPDs, and newly qualified GP colleagues will all provide you with pearls of wisdom. I found that staying on top of important dates in order to plan in advance, spacing out OOH shifts, starting an audit early (consider using the very simple RCGP TARGET audit templates), and setting mini-goals on the ePortfolio all help when trying to cover it all.
Only after I had been through the training process, did I appreciate the high quality and standards of GP training that all trainees must go through in order to achieve their MRCGP and subsequent CCT. On occasions you may feel overwhelmed or that you are not doing enough. Be assured that you will not be the only one, and once on the other side you will realise that you have been comprehensively trained and adequately skilled to enter the fulfilling world of general practice.