Concurrent Sessions 4B – 4F 

PLANNING TEACHING SESSIONS IN LESS THAN TEN MINUTES - YOU CAN DO IT

Dr John Buckley

Central And Southern Queensland Training Consortium

 “I don’t have time to plan teaching sessions”. After this workshop you will!

Equipped with the now widely used ‘green card’ you will be able to plan teaching sessions as supervisors and educators more quickly than you had ever expected and see that they will also be better sessions.

This workshop is developed for GP Supervisors but will also be useful for new Medical educators

Content
Participants will work through a planning process in groups in the first hour then create their own teaching session plan in less than ten minutes. This workshop has been run at various Supervisor training sessions around the country. The session will be aimed at an audience who have not done this before but if you want a refresher you are welcome to attend.

Learning objectives
Participants will gain a clearer understanding of planning teaching sessions.
They will gain skills, through practice during the workshop using a simple framework, in educational planning
Participants will gain confidence in their educational planning skills
Each participant will take home a copy of the ‘green card’ as a simple resource tool

BEYOND THE MEDICAL RECORD - CREATIVE WRITING FOR DOCTORS

Dr Hilton Koppe

North Coast GP Training

And now for something completely different…..

As doctors we are involved in writing “stories” every day.  The medical record is our interpretation of our patients’ stories (History) and a summary of our response to this (Examination and Management Plan).

The medical record does not allow for much creativity on the part of the writer, and is very limited in its ability to assist the doctor in making sense of what has gone on for them at a personal level.

To assist in remedying this problem, Dr Hilton Koppe, senior medical educator with North Coast GP Training, is presenting a creative writing workshop. 

The workshop will allow participants an opportunity to experience the use of stories and writing as a means of helping them to make better sense of what it means to be a doctor.

Practical writing exercises will guide participants through a series of creative tasks which assist them in reflecting on the effect the practice of medicine has on their lives with the goal of increasing their enjoyment of medicine and life in general.

Most of all, it will be an opportunity for some light hearted fun with colleagues.

Learning Objectives
By the end of the workshop, participants will have had the opportunity to

• Learn knew skills in creative writing
• Reflect on what it means to be a doctor through the use of structured writing exercise
• Develop skills in using reflective writing as a way of personal debriefing about experiences at work
• Reignite previously lost passions for creativity
• Marvel at the brilliance of their colleagues
• Share some of their creative brilliance with colleagues, if they choose to
• Experience being with medical colleagues in a totally different way to other education events.

PLACEMENT OF LEARNERS IN INDIGENOUS COMMUNITIES - DO LEARNERS BENEFIT IN HAVING INDIGENOUS CULTURAL MENTORS?

Dr Hung Nguyen, Ms Ada Parry

NTGPE

Context:
Educating the health workforce in Indigenous health has been set as a high priority.  Various documents (Committee of Deans of Australian Medical Schools “Curriculum Framework for Indigenous Health” and Australian General Practice Training “Framework for General Practice Training in Aboriginal and Torres Strait Islander Health”) recommended the involvement of local Indigenous community resources for cross-cultural education and training of medical students, junior doctors and GP registrars.

The involvement of Indigenous community members in faculty programs is not without problems from organisation issues to active particpation.

Cultural mentorship is not a new concept and have been implemented with varying success in various sectors mainly outside the medical or health sciences arena.

Objectives:
This workshop will:

Introduce a cultural competence model for faculty, professional bodies and individual learners and how the various levels can assess their role in cultural competent practice.

Introduce a cultural mentorship model and discuss: 1. the motivations of Indigenous community members in engaging in an education activities; 2. the barriers for participation; 3. faculty supports required for their ongoing participation

Allow participants to develop and share strategies towards improving the engagement of community mentors in their programs.

Key Messages:
For culturally safe and informed practice, learners need good mentorship support from the community they are engaged in.  Cultural/community mentorship can be more appropriately provided by key community representatives.

Cultural mentors are motivated by the multiple needs of their community, learners and personal gains.

Faculty need to attend to key, motivation and facilitation factors of potential Indigenous community mentors in their education programs.

Conclusion:
Local Indigenous community members’ active involvement in community based medical education programs are important for credible and improved learners’ knowledge, skills, attitudes and behaviours to and in Indigenous health.

The ideas and strategies developed in this workshop can inform other community mentorship initiatives and are thus not restricted to indigenous communities.

MANAGING INFORMATION OVERLOAD AND EVIDENCE BASED PRACTICE FOR BUSY GP REGISTRARS AND SUPERVISORS

Dr James Turton ^{1, 2}, Dr Belinda Guest ³, Dr Katrina Anderson ^{1, 2}, Dr Cathy Regan ³

¹ Australian National University Medical School, ² Coast City Country Training, ³ General Practice Training Valley to Coast

Registrars often find it challenging to deal with the information overload and large amounts of learning material that characterise GP training. This can also be an ongoing issue for experienced GPs. This small group interactive workshop will explore practical means of addressing the information overload problem and participants will be encouraged to brainstorm and share strategies for managing the issue.

There will also be some formal exercises to explore specific management tools developed by registrars for registrars.

The Electronic Learning Folder (ELF) concept is a USB flash drive which is preloaded with information of relevance to GP Registrars. The workshop will show how the ELF concept can be extended to be an information management tool that would be of benefit to all GPs.

The “MedBLOG” concept is a way of keeping track of relevant specific information that directly impacts patient care.  MedBLOGs are word processing files which have specific titles and categories of medical interest. These MedBLOG files can be stored in the ELF and form an accessable knowledge base for evidence based general practice.

Ideas for organising information on the net such as the synchronisation of internet browser bookmarks will also be demonstrated. This workshop will be highly interactive and all participants will be encouraged to share their own innovations and ideas that have been of help in the management of information.

At the conclusion of this workshop, participants will be more confident in managing information and will also have a framework for the quick implementation of evidence based general practice.

Paper Presentation Session 4G

ECG WHO AM I?”: AN EDUCATIONAL TOOL TO PROMOTE ECG AND DERMATOLOGICAL SYSTEMATIC INTERPRETIVE SKILLS.

Dr Parker Magin ^{1, 2}, Dr Graeme Horton ²

¹ GPT Valley To Coast, ² Discipline of General Practice, University of Newcastle

Background:
Previous research suggests that experienced clinicians diagnose ECGs by a combination of pattern-recognition and systematic reasoning. Anecdotally, GP registrars rely overly on pattern recognition at the expense of reasoning in this situation and also in diagnosing skin rashes.

 Educational activity:
We developed an educational tool to promote systematic ECG and dermatological interpretive skills. 

“ECG (or skin rash) Who Am I?” combines a well-known game with ECG/dermatological diagnosis.  Registrars interpret ECGs through the eyes of their peers, with each group member being given an ECG/skin rash photo fixed to a party hat which they wear on their head and therefore can’t see. They must formulate a diagnosis based on the systematic description of the ECG/rash by their peers.

Evaluation:
We will outline the process and conduct of the educational activity, and present findings from  evaluations of “ECG Who Am I?” sessions, comparing GP registrars to medical students and junior doctors. From March 2007 to December 2008 we have run six “ECG Who Am I?” activities.   There have been 2 for medical students (n=26), 2 for junior medical officers (n=41) and 2 for general practice registrars (n=44).  Ninety-two participants have completed a self-report evaluation (response rate 81%).

Conclusions:
This learning tool has been rated as informative, enjoyable and encouraging of further learning.  Most participants report increased confidence in reading ECGs following the activity.

“ECG/skin rash Who am I” is an effective way of developing systematic diagnostic skills, and the authors invite other educators to use and critique the method.

REGISTRAR PROJECTS – A RICH ARRAY OF DEVELOPMENTS

Dr Reginald Michael Crampton

Went West

Registrar developed projects have been a compulsory component of the WentWest SGPE
term. Our registrars have demonstrated skill, brilliance and innovation with the array and
complexity of topics, formats and presentations of their projects. In this paper, WentWest
wishes to showcase our registrars and their projects, and to foster their peer presentation
and medical education skills, by way of having each registrar present their project
material. From clinical audits with recommendations arising for changes in practice, to
teaching resources including on-line textbooks and exam questions, to case presentations and patient education web-site developments, WentWest registrars have developed a rich array of resources well worth sharing in the context of Innovations in GP Training.

OPIOID PHARMACOTHERAPY PRESCRIBING BY GP REGISTRARS IN COMPARISON TO EXPERIENCED GPS: A QUALITATIVE STUDY

Christine Longman, William Wong

 VMA

Background 
Opioid dependence is a serious health issue resulting in significant individual and community harms, for which the medications, methadone and buprenorphine, known as opioid pharmacotherapy (OP), is a proven effective treatment. In Australia, medical practitioners must complete a specific training prior to prescribing OP, however the majority of GPs who complete training prescribe to very few or no patients. This study aimed to investigate why this situation exists.

Methods
Using in- depth interviews with 22 GPs, including three GP registrars, this study explored not only the reasons why GPs are unwilling to prescribe, but also the barriers and facilitators which influence GPs in their decisions regarding these issues.

Results
GP registrars showed lower levels of confidence in prescribing OP, compared to more experienced GP colleagues. Where strong support was offered by an OP prescribing GP within their current practice, registrars showed high levels of interest in completing training and prescribing OP. Regular change of training practice was found to be a barrier to OP prescribing.

Conclusions
GP registrars are more likely to train for and prescribe OP to their own patients if individual support and encouragement is provided by GP colleagues within their current practice. Further research is required to identify other facilitators or influences which may encourage registrars to commit to longer term OP prescribing.

PREDICTORS OF OCCUPATIONAL VIOLENCE EXPERIENCE AMONG GP REGISTRARS

Ms Jessica Swain ^1,2, Dr Parker Magin ^1,3, Prof Maureen Dollard ²

¹ The University Of Newcastle, ² The University of South Australia, ³ General Practice Training - Valley to Coast

Background:
Occupational violence is a significant occupational health issue for general practice. Violence has been linked to disillusionment with medicine and has been implicated as a contributing factor to the current shortage of medical professionals in Australia. Studies indicate that the 12-month prevalence of violence amongst Australian GPs is 48-64.7%. Violence has been associated with lesser years experience as a practitioner and younger age, suggesting GP registrars may be at increased risk. As registrars may be particularly vulnerable to violence and its effects, further exploration of this issue is warranted.

Method:
Seven NSW-based Regional Training Providers (RTPs) and 140 of their enrolled registrars were recruited. An anonymous cross-sectional survey was distributed to registrars via mailout or RTP workshop distribution. Information collected included registrars experience of violence in the past six months (during their last full term in general practice), the effects of violence and feelings of control over personal safety. 

Results:
During their last full GP term 70.5% of registrars experienced violence. The most common forms of violence experienced were verbal abuse (58.7%) and threats (29%). Statistical analysis revealed younger age and practice socio-economic disadvantage predicted the experience of violence. Personality characteristics of the registrars including openness and agreeableness were also found to be predictive of violence experience.

Conclusion:
Workplace violence is a particularly significant problem for early-career GPs. Observed prevalence rates suggest registrars may be at increased risk for occupational violence relative to more established GPs.

WHERE ARE THEY NOW? A FOLLOW UP OF GPS WHO COMPLETED AN ACADEMIC POST DURING THEIR TRAINING

Dr Rachel Lee

University Of Melbourne

General Practice Education and Training funds elective ‘Academic Posts’ for registrars to gain experience and skills in research and teaching during their training. The goal of the posts is to provide “training in an academic setting and the structure to contribute to research, teaching, professional service and leadership.”(1)

This research project followed up people who had successfully applied for the post with a 27 question survey.  A mix of likert rating scales for opinions and experiences, multichoice questions and free text responses were used. The survey explored their experiences and opinions about the post and to determine if they are still involved in academic general practice. The research was designed to explore if the posts were an effective way to build capacity in research and education and to gather feedback for program improvement.

Those who participated between 2002 and 2008 were targeted as their names were listed with GPET. The response rate was 39% (22) with 3 additional respondents from prior to 2002. None of the applicants who did not complete the post responded.

 Analysis is still in progress but preliminary work shows 15 respondents had no experience when starting the post. Only two respondents had not been involved in any further teaching or research and 18 were currently involved in teaching. The feedback about the posts was overwhelmingly positive. One outlier had very poor experiences during their post (and had not been involved in any further academic practice).  33% of the applicants found the application process very difficult.

The response rate makes it difficult to generalise from this dataset and further research is required. However, the data paints a rich picture of the respondents research and teaching experiences before, during and after their academic post.

1. GPET Academic Post Selection Committee, Guidelines on Academic Posts in the Australian General Practice Training program, General Practice Education and Training Ltd 2007. Available at http://www.agpt.com.au/TrainingPosts/Academictraining/ accessed  28/2/09

EVALUATION OF ECT VISITS BY REGISTRARS.

Dr Karen Flegg ¹

¹ ANU Medical School, ² Coast City Country RTP

Aims and purpose:
To evaluate the value of External Clinical Teacher visits (ECTVs) from the perspective of the registrars themselves.

Design and methods:  
As for all Registrars, those in the Coast City Country Training (CCCT) Program are subject to a number of ECTVs during their training. CCCT uses these visits as educational tools rather than assessment visits. The Medical Educators of the Canberra South East NSW local training group of CCCT decided to seek feedback from registrars regarding the value of each ECTV from their perspective. The educators also sought ideas about what makes the visits good value and how they could be improved. A one page questionnaire was designed. This was given to the registrar by the visiting Medical Educator and faxed back to the office of CCCT.

Results:  
In 2008, 84 ECTVs were conducted in our LTG area for registrars at all stages of training. Feedback was received on 48 visits. For over 90% of the visits, registrars found the experience helpful or very helpful as a learning tool. For those who set learning objectives for the visit, over 90% felt their objectives has bee achieved. Registrars appreciated the practical help provided by the educators, for example, help with learning plans, exam preparation and case by case teaching/ feedback as well as assistance with difficult cases. They valued the mentorship and felt written reports assisted as a reminder of discussions on the day. Comments were received with ideas for improving visits.

Conclusions:
While the ECTV is a mandatory component of registrar training and CCCT uses it as an educational not assessment tool, there is significant value according to registrars.