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GP Specialty Training during and after the COVID Pandemic - an opportunity for flexibility

29 April 2020

It is popularly reported that the Chinese word for crisis means both danger and opportunity.  The COVID-19 pandemic has most certainly brought danger and with that, unimagined courage and altruism, but also significant change.  As we continue to strive to provide excellent care in these challenging and uncertain times, we are witnessing, yet again, how adaptable and flexible general practice is.

 

In a matter of days, once the scale, impact and risks of COVID-19 were known, general practice moved to phone and on-line/ video consulting, hot and cold clinics and working with the wider team to identify and provide care to vulnerable groups of patients.  I don’t think I ever thought I’d be doing a full clinic from home with full access to records, whilst interacting with my practice team throughout. By some estimates more than 90% of current consultations are “remote”.  Of course, this new way of working was expedited by necessity and has been greatly assisted by years of personal relationships and continuity; the value of which should not be underestimated.

During this time, the way formal education sessions are being delivered changed dramatically across all specialties and our incredible GP trainees stepped up, many “running towards danger”. E-learning opportunities have multiplied, the process for recognising trainee experience has been adapted, and flexible training pathways have been developed to facilitate the return of trainees.

There is an opportunity for such flexible approaches to be developed further throughout recruitment, training, examination and clinical practice, recognising the need to create even more rewarding and adaptable careers.

Considering the future of General Practice, it is probably unlikely that the COVID-19 model of relying almost exclusively on remote methods of consulting will remain as it is equally unlikely that the model will revert to the pre-COVID era. Patients and colleagues alike have experienced the freedom and opportunity of multiple consultation modalities and the flexibility of consulting from different locations. A new balance between the different consultation models will ensue which will better reflect the value of face-to-face consultations, relational care and continuity in certain contexts.  

 

So, what does this mean for GP Specialty Training? Firstly, our trainees need to be valued for stepping up so professionally and altruistically, and we need to work together to support them. Primary Care Deans and GP Directors across the UK are working on the GPST recovery plan.  We will target resources.  But also, we must train for the future not the past!  The content of the RCGP curriculum has recently been refreshed. It is the delivery and assessment that must now reflect and serve the new norm. It is time for much greater flexibility.  Our learning and its assessment should be as flexible, if not more so, than our working practices. If many consultations are remote, how do we train for those? What does excellence in remote consulting look like? How does remote supervision work? There are already group learning sessions on Teams, Skype and Zoom and we will need to build on these.  So, what of assessments? One of the key elements of assessment that seems to have fallen out of favour is ‘face validity’.  Assessment needs to reflect learning of and in the real world and it needs to feel like it does.  This should be our springboard for change. Our trainees need to be valued and supported and they must have confidence that their training and assessment are as valid and flexible as they can be, so that they feel ready and excited for their future careers.

Posted by Professor Simon Gregory, HEE Deputy Medical Director

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