9 years ago

What do they expect from us? What do we expect from them? What do our patients and staff think of it all? These are increasingly important questions as more and more students escape, however briefly, from the ivory towers that are tertiary hospitals and universities.

It has been said that an average size General Practice contains virtually the entire medical curriculum. Therefore it seems logical to try to tap into it. However, General Practice is first and foremost a service industry. The reasonable needs of our patients must be placed first, they are our “raison d’etre”.

That doesn’t mean that teaching and service provision are mutually exclusive. The reverse is true. The word doctor means teacher. Explaining conditions and planned procedures to patients teaches the medical student, and vice versa. A better informed patient is more likely to comply with their management. Aspects of patient management can be delegated to students within the consultation, anything from recording basic observations, Point of Care Testing, recording ECG’s and spirometry, to Smoking Cessation counselling. Naturally, the student’s capabilities must first be assessed, but that doesn’t take long, and instruction in specific procedures can often be delegated to Practice Nurses.

A busy GP can gain valuable time within a consultation to think ahead or laterally or both, whilst some of the patient’s basic needs are being met by the medical student.(Practice Nurses are also capable of filling these roles). It can be very easy to lose sight of the patient’s “big picture” whilst attending to their multiple specific needs such as prescriptions, referrals, pathology and radiology requests. It’s very easy to have a Level C Consultation without actually asking the patient how they feel and what might be bothering them most in life! There is also time to ask about other family members and discern whether or not there is a hidden agenda needing discovery and exploration.

Hands on involvement by students is completely consistent with the apprenticeship model of learning about General Practice. It is far more stimulating than sitting passively in a corner quietly watching an incomprehensible consultation. Learning must be stimulating to be effective. That also brings rewards to the teacher who derives increased satisfaction from their working life. Patients mostly enjoy the experience, but naturally must always be given the opportunity to see their GP alone. In a busy teaching practice patients will often enjoy the larger audience. They know that their future doctors have to learn, and what better place is there than on them! Some of my patients take great delight in quizzing students about their origins before starting the recruitment process for Rural General Practice!

There are financial disincentives to hosting student involvement in General Practice. However, careful planning can reduce these as ways are found for students to “value add” to the Practice. The non-financial rewards can be considerable. Every student is a potential future colleague. Succession Planning starts here, even before the GP Registrars come for their placements!

Dr John Kramer

  1. Toby Waters

    Dear Dr Kramer, well done on training the next generation of doctors. If any of you students need accomodation, we have a very clean and quiet 2 bedroom fully self contained flat to rent in Emerald Beach. If anyone is interested they an have a look at it on air bnb. It is right on the headland at 63 Dammerel Crescent.
    We are both school teachers but have several friends who have recently finished their training and are now working as doctors. We would be happy to help others achieve this important calling. I hope you are well, thanks again, cheers Toby.

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