Monthly Archives: July 2018

Threats, challenges and opportunities in planning programs of training

I was doing my due diligence as a College member, reading the statements from and interviews with candidates for the RACGP presidency and I noticed one saying that one of the most important issues was the college’s resumption of GP training.  He noted several issues including that the college “needs to defend and strengthen the apprenticeship model of training in the face of pressure from cheaper online or classroom-based teaching. Supervisors and registrars need to be supported and nurtured through the process”  http://medicalrepublic.comau/college-hystings-dr-bruce-willett/15384?utm_source=TMR%20List&utm_campaign=Of3d397085-Newsletter_June_30_06_18&utm_medium=email

This is certainly recognition of some of the threats to GP training (already in process) and of the challenge in the transfer of training – that is, if it is to be done well rather than assuming business as usual.  There are other things at the top of my list when I think of general practice as a whole but that is not the focus of my blog.  On the other hand, it is right up there when you think of the opportunities for the colleges and for training, at this juncture.

It would be good to build on previous quality and strengths rather than just on our laurels.  There is much that the College used to do in training twenty years ago.  Phrases such as “Education Evaluation” and “flexibility in training” come to mind.  They were also moving to regional training. It would be a step forward if the colleges (and the managers of training) were able to interrogate the concepts of quality and success more seriously (and in an evidence-based way) and to do this educationally rather than corporately – a distinction that still remains (just).  Numbers are not the only important outcomes.

Why is good training important?  I will go back to a point I made in a recent presentation that there is a connection between the way training is structured, the sort of GP we produce and the way they then go on to educate others.  This will then impact on the care received by patients and the health of the community.

The presentation was a Pecha Kucha I delivered at a medical education meeting (and which I mentioned a couple of posts ago when I was preparing it).  I learned a few things from the experience and had other impressions confirmed including (but not limited to): Pecha Kucha may pack a punch for one good idea or one short story; it’s probably good if we assume a short attention span of the audience; it’s good for engaging the audience but not so good for engaging WITH the audience; it’s not as good for getting across complex ideas; I am not primarily a performer; I’ve always struggled to learn lines and we strive to entertain rather than educate at times.  This was also supported by the written feedback I was handed!   Similar analysis should be applied to models of training – not all models and methods suit all contexts or all desired outcomes.

As my presentation was about the challenges for future GP training I might discuss a couple of the thoughts in subsequent posts.  The first point I made was that such transitions (such as the transfer of training) involve looking both back and forwards like the Roman God after whom January was named.  Some will want training to return to what they perceived as a mythical golden age and others will wish to move forwards with all the trendy disruption and technical innovation that is available.  Either approach should consider the evidence.  The greatest disappointment would be if there was no change at all and all the changes of the last 18 years (good or bad) were accepted as givens. 

This includes the move to corporatism. 

The most recent changes have resulted in a loss of corporate memory and knowledge in many areas.  As Santayana said “Those who can’t remember history are condemned to repeat it” or even as Hegel wrote “what we learn from history is that we don’t learn from history.”  Training programs are not just exercises in efficiency.  Neither are they pure academic exercises. They are affected by politics and ideology.  However, keep in mind that the learning environment we are setting in place now will affect future generations