I had a really good time at this year's annual conference. It was held at the SECC in Glasgow. The event had some very good (as well as ordinary) speakers and the breakaway sessions were pretty useful. I presented a poster of my CSA consultation template ( available in the Downloads link) and it was well received.



There were some really good posters . I am not sure which ones were judged to be the best as I was not around on the last day. I shall be adding a few more blog entries about a couple of sessions (that are relevant to trainees) from the conference.

I just happened to come across this webpage on the RCGP wesbite. Some how I seem to have missed it so far.

Basically, this is your guide to eLearning and getting good, meaningful entries on to the ePortfolio.
It provides the learning map and also the resources to attain the necessary information. This includes gpnotebook, doctors.net emodules, etc. Brilliant!!!





Check it out here

With effect from January 2010, the requirements for the DFSRH ( previously DFFP) are changing.

The 3-5 day theory course is being replaced by online modules..not dissimilar to the RCGP ePortfolio and then a one day theoray course.

Check out the screenshots below :





The link to the website is here

I have just been informed of an upcoming meeting tailored especially towards GP trainees being held in London. It is being organised by BAMM, British Assoc of Medical Managers who also have trainee wing called BAMMBino




More to follow!!!

The Right Brain is a good website I happened to come across via the Oxford VTS website. There is a lot of artistic talent among medics and this is a good platform to showcase/share it!

The site can be found here

Link

Going by last week's surgery, I think the swine flu cases are going to go up exponentially every day.

A few things have changed re: treatement- infant dose, choice for pregnant women, prescription form,etc.
I think the college has been doing a good job of keepinf us abreast of the changes.



Here is the link

I am headed for the college conference this Novemeber. It is my first time and seems to be an exciting three days. An opportunity to meet colleagues outside of work, PLTs, etc. I am also presening a poster. Better get started the preparation.

There is also a newly quaified doctor's membership ceremony for those of us who have recently passed the exams.
If you haven't booked as yet, it is not too late !!!

I recently came across this website whilst googling for some random things. At first, I thought it was a joke but then realised that this is a well known website, publicised by mention in the Daily Telegraph. It has been started by the guy behind doctors.net. In some ways, it is similar to the NHS Choices website

gp registrar learning resourcesdoctor review by patients

Just when you thought the ePortfolio could take the backstage(after finishing training) , it has reared it's head in the disguise of revalidation and annual appraisal. I personally have nothing against the eportfolio. Infact, it has guided my learning over the past 2 years and after using it for 2 years, I feel I have a hang of it. After initial scepticism, most of us have gotten used to it and use it on an average of twice a week. It has not always been an enjoyable experience. Filling all boxes didactically has been boring at the best of times. Many times, I have learnt something, tried to enter it on my eportfoilo but have felt that I do not need to enter all the boxes. Unfortunately, they have to be filled in order to show "reflective learning". I am sorry but not all my learnings are reflective. Most are but some are straight forward old fashioned reading an article, learning something and hoping to recollect it when faced with the situation the next time.

What did you learn, what will you do differently in the future, what further learning needs did you identify, How and when will you address these? Sometimes this takes away the joy of learning and makes the ePortfolio a laborious task. I am sure there are many trainees who will agree with me on these.

Now with Revalidation around the corner, we will have a new ePortofolio in the next 12 months and we will be back to using the logs. Guess we have an advantage over our seniors in that we have already been initiated.

Going by the RCGP guide to revalidation for GPs ( version 1.0, April 2009), the first year (2009-2010) should not be a lot different from the present annual appraisals. Second year onwards, there needs to be clear evidence of having collected 50 accredited points.


Going through my eportfolio, I find that I have earned 50 credits in 5 months...so rejoice trainees, we are a step ahead of our peers!

gp registrar learning resourcesrevalidation

After watching the episode of The Apprentice featuring the Bee3Pod and reading an article last week in the BMJ lamenting the lack of enthusiasm shown by NHS trusts to embrace the Cycle to Work scheme, a thought came to my mind..what if I went to work on a cycle? I live in Bedford and travel everyday to work (Wellingborough) by car. I spend a good 45 minutes on the road each way. This equates to 3.8 tonnes of carbon emission per year. About 3-4 days a week, I also undertake home visits. If I chose to cycle to my local train station, took a train to work ( 12 minutes) and then cycled to my surgery, the benefits would be:

1. My emission would be 0.4 tonnes ( and that includes taking my car for home visits) , less if I could do the home visits on a cycle
2. My health would improve
3. I can do a bit of reading on the train
4. I do not have to worry about the stress of traffic

Ofcourse, the British weather is a spanner in the works. I do not see myself cycling when it is wet. Even if I did this for 3 months in a year, it would be good.

The one big question at the back of my mind is the home visits. Is it possilble to do these on a cycle? With the help of the Bee3Pod, I could fit in my doctor's bag on the cycle and Wellingborough is definitely cycleable. Most visits are within a mile of the surgery. Time should be manageable. Are there any doctors that do this? I know many of my hospital colleagues do this. GPs? I am not sure. It would be good to hear from any that do!!!

An interesting article I came across whilst googling for any information was this article in the BMJ more than 30 yrs ago! This Associaition does not seem to exist anymore.

gp registrar learning resourceshome visits

I attended the "Life after GP Speciality Training" day arranged by the East Midlands and Trent deanery for ST2 and ST3s. It was a useful day with sessions on locuming, salaried contract, role of LMC, CV preparation, partnership applications and interviews, finances, etc. Needless to say, it was very appropriate. There were about 50 trainees and the day was divided in workshops.

The interesting thing was that only one trainee had a job in hand two months from finishing training.

To summarize,
1. Most of us will be either locums or salaried GPs or unemployed at the end of our training ( even though we have passed the nMRCGP...the exam that no previous GP in the country had to take to prove their competence and be employable).
2. We will continue to have access to our ePortfolios ( not sure if we would be able to make entries....does anyone actually want to?)
3. Revalidation is coming and we would need to carry on collecting evidence, thus giving us a head start compared to our non nMRCGP colleagues ( which is all the GPs in UK)
4. Point 3 takes us back to point 2 : we would not be able to port data from eportfolio to the annual Appraisal website.
5. Partnerships are rare but apparantly the "pendulum" will swing in our favour in the coming years. There will be a need / demand for partners.
6. Portfolio GPs are on the rise and there are some decent avenues ( academic, etc)

All in all, a good day. I would advise trainees to attend the next one.

gp registrar learning resourceslife after training

My Mac Book is back after repairs and I should be posting again this week !

I have not updated the site in the past 4 weeks. This is due to my MacBook not working. It is being repaired next week and hopefully I will be able to get back in full swing then.

Soon we will be able to apply to PMETB for certification online. Supposedly this should be better then the paper application as the application will only go through if all the paperwork is on order. The fee too can be paid online. It was meant to be online today but it isn't. I called them up and was told that it is still being tested and should be live in a few weeks. Well, I am going to give it a week more. If it is still not live, I will send my application by post. Can't afford not to be employed come August 2009 !

gp registrar learning resourcespmetb

Unbelievable.....I was quite surprised to note this. I guess it was on the cards, but this has come without any imminent warning. In 2007, the banding was cut from 60% to 50% and now it is down to 45%. It will affect all those starting out in GP jobs from this month. Even if you were paid higher banding last year, if you are now in a hospital post then when you get back, you will have a pay cut!!

Did we need this? PMETB has increased their fee. Ok, it is only £25 increase but £805 is a big fee, especially in the current financial climate. Are doctors immune from the economic crises? Not really ! Thanks to the Darzi recommendations, practices are not taking on new partners if they can help. How many trainees will get partnerships? Not many. How many will get desired salaried posts? A few. How many will locum? Most of us.

Anyway, I deviate. The issue is the pay cut for GP Registrars. This is in line with the hospital doctors' pay cut. Is that really happening? I do not know any SHO whose pay is being cut. Wonder if it is because GP registrars are a small minority, working largely in isolation except for the weekly meetings

A COGPED survey done last year caught my eye today. I suspect things are not this bleak . The response rate for this survey was only 40%. Majority of newly qualified GPs did not respond and hence its statistical significance is questionable. The article is cited here as well !

Those of us that are finishing in August 2009 should have received the forms from RCGP/PMETB. If you want to save £25 then post them by Monday, 30th March. The fee is going up to £805 wef April 2009. I just can't afford to pay it now after the AKT and CSA fee and will be paying the extra. Those who can afford, go for it now !

Those that have yet to get their VTR forms signed off, should get them done pretty soon. Forms can be found here

Sat my CSA exam last weekend. Thought I'd share my experience. I will not comment on the exact content of the exam as that would be breaking the rules.

The above picture would be more apt for the AKT exam but hey, Slumdog won the oscar..so why not?

The centre is pretty easy to find. Step out of East Croydon train station, look left and you cannot miss the "50 pence coin shape" building to the left. The exam is held on the top floors ( 18th - 20th ). Smart decor inside. A short induction with tea/coffee and then to the exam. As is well known, each candidate is given a room. I took my equipment in a transparent bag after leaving other belongings in a locker. Unfortunately, the college has decided that we can not take timers / clocks with us anymore. I had been practising with a timer and it was a shame I could not take it to the room. Why? Do not ask me..it did not even make a sound. There is a large clock on the consulting table, well out of the field of vision. I could not look at that clock even in one consultation and was able to finish only 5 out of 13 consultations in time. I felt it was unfair. It is meant to be a real life consultation scenario. How does a timer clock interfere with our assessment? Did not finishing in time affect my results? - read more to find out.

Before the exam, I wasn't very sure as to what to wear. I hate wearing ties and feel as if someone is suffocating me. I wore a full sleeve shirt, khaki trousers and a jacket. Most of the guys were dressed to impress and looked smart in their suits. Two or three were tie-less. The girls almost all wore a smart suit with a few exceptions. Overall, no fixed dressing etiquette.

Once the exam started, time flew. 7 cases finished in a blink of an eye. A ten minute break that I used to go to the loo, have a glass of water and just walk about. The helpers were very friendly and easily approachable. It was good to be able to chat to others to realise that nobody was finishing the cases in 10 minutes. We were not allowed to talk about the cases and frankly speaking, I did not feel like talking about the cases. The next 6 cases also passed pretty quickly and the next thing I know, I had done the CSA. Phew! What a relief is an understatement. The cases were varied and almost all of my cases were typically representative of UK general practice. I am 6 months into my primary care experience and I doubt if I would have been able to successfully take the exam any sooner. 6-9 months into general practice placement is a good time to take it. In the end, it seemed like a fairer exam than the AKT.

Found out yesterday that I passed both my AKT and CSA. Passed 11/12 stations and the one I failed was a clear fail .
So, despite not finishing the majority of the stations in the exam, it is possible to pass it. Once you pass it, It feels like a big burden is off the shoulders. Am I a better GP after passing it? I am not sure.

My tips for passing the CSA would be ( in order of decreasing importance) :

1. See as many patients as you can - all cases were real life cases. One particular difficult case in my exam was similar to one I had seen in surgery and discussed with my trainer a month ago.
2. Video your consultations at least once a week and see them with your trainer. My trainer gave me some fantastic tips. My data gathering was all over the place to start with and my explanations sounded garbled. I would forget to share management options. Repeated comments from my trainer made me tweak these things and I found this very helpful in my exam. He would use a marking sheet that looked at all 3 domains tested in CSA.
3.Practice cases with a friend / spouse. Fortunately my wife is a GP and took the first CSA in October 2007. It was helpful to practice 10 minute CSA mode consultations with her acting as a patient. Thank you, Navita
4. Go on a CSA preparatory course - One might think after paying almost an arm and a leg in exam fee, there is no scope for a preparatory course. Problem is, the CSA is a new exam and many trainers have only had one or two trainees who have taken it in the past. Their experience in advising about CSA might be limited and this is where a good, inexpensive course is handy.
5. Sit for the AKT and CSA together- yes, it is do-able. I did it and felt that the preparation for the AKT helped me with the data gathering and clinical management domains. Not everybody would like this idea and to each his own.

Good luck to those taking the exam. May the force be with you!!!

We all have different learning styles and these are dependent on our learning needs and meeting them are partly dictated by the available resources. Whilst there is no substitute ( in my opinion) to learning from real patients , we do rely on a lot of other resources. Having worked in General Practice for six months only, I found myself searching for new information every day. A lady on SSRIs finds out she is pregnant and wants me to tell her what is the best course of action from here on, a middle aged man presents with a painful shoulder and I am thinking " is this frozen shoulder or rotator cuff? ", a teenager on COC presents with headache - what do I do ? , a diabetic gentleman on treatment for prostatism presents with impotence. These are the bread and butter presentations of general practice, but as a new trainee I feel lost at times. Hospital medicine does not always prepare you for these cases. After working for six years in paediatrics I thought I would not need any further learning in this field but I was rightly (and thankfully) proved wrong in the first month itself. Six months down the line I feel slightly more comfortable with similar cases and I have learnt it all in the surgery with the help of my trainer during tutorials, talking to other partners who cover me during surgeries and from the nursing staff.

These are some of the resources that I find most useful and easy to digest :

1. GP Notebook : This is well known and often used. The best thing about this is that it is available online and gives you most of the information at the click of the mouse whilst you are consulting. I found myself asking the patients if they would mind me looking up the latest evidence online and none of them seemed to mind, though at times it did disrupt the consultation. There are times when you do not want to be picking up the phone for the nth time that day and this almost never fails. The added benefit is the link to the relevant NICE guideline and patient leaflet on the topic page. Hats off to the folks behind this website. Brilliant !

2. Oxford Handbook of General Practice : This is the bible of general practice. This was the first book I bought and probably the most useful as well. There was a stage when I was not using it as I relied a lot more on gpnotebook and it was lying on the back seat of my Polo for a few weeks. As I began my AKT / CSA preparation, I found myself attracted to it thanks to its layout and succint coverage of topics. The one thing which made me not use it earlier was that the NICE guidelines were taking over my life and this was not uptodate enough. But I now realise that 99% of information , esp regarding diagnosis is very relevant and it never ever gets boring. And when the internet is down or you are on a visit, it is there with you. One of the co-authors is now on the editorial team of Innovait. For the technically inclined, it is also available for PDAs. The Palm and Pocket PC versions install on the PDA but Blackberry and iPhone users have to use the online access through Unbound Medicine. If one can afford it, the £20 for the PDA version would be worth it, especially if you have 3G on your phone. WiFi access is useless as most patients do not have wi-fi at homes and the practices block wi-fi access due to security issues.

3. Innovait : Atlast a journal for trainees. If you ever subscribe to one journal through your GP training, let it be this one. At less than £30 for 12 issues, this is worth every penny. It is totally trainee focussed, the topics are in keeping with the curriculum and the presentation easy to digest. There are AKT questions for those sitting the exams and you are able to do more questions online ( free web access to all issues included ) on the website. I believe trainees can contribute articles as well. Infact, with Revalidation coming soon for all GPs, I would not be surprised if it is used by non trainees as a useful resource to keep up to date.

4. RCGP News ( and the main journal) : The RCGP News is more of a newpaper of the college but hidden in it are real gems of clinical importance in the guise of "Clinical Updates". These are short articles by various professionals on different topics. I got my answer regarding anti-depressants in pregnancy from one such article. It takes no more than 10 minutes to read an update and this can be entered as a reading in the eportfolio as well. It comes free with the journal but those who do not get the journal can access it free online ( link provided). The main journal appeals to me for its " Backpages" as there are always interesting articles and blogs. The most useful clinical thing was a one page article called "Top Tips" and this was a good digest to print off and keep on the pin board in your consulting room. Unfortunately, the last few issues have not featured this.

5. BNF : Unsurprisingly, BNF is the most frequent resource I use. Everyday. Whilst it guides prescription, it also contains clinical information on the relevant condition. Things like fungal infections, Angina, psychotropic drugs and anti-coagulants are pretty well covered. AKT features atleast 2 questions straight out of the BNF.

6. BMJ : There are only so many journals one can read. I do not read most of the articles, but the " 10 minute consultations" are directly relevant to GPs and on the whole it is a readable journal with some good articles on ethics, etc.

This is my list of frequently used resources of learning. This might change with time but at present I do not find myself looking for others. There are many other very good journals and books. It would be nice to know what others read / use.

gp registrar learning resourcesnmrcgp, gp trainee vts

These are pictures of East Croydon taken from my phone as I was returning from the CSA exam that never happened. The building in the first picture is where the exam is held. Heavy snow ensured that all the trains / buses / trams to East Croydon were cancelled. It was a real let down as I was psyched up to take the exam that day. I seem to have lost some of the steam, as I am sure have the rest whose exam was postponed. We are taking it in two weeks hopefully.

The failure rate seems reasonably high and reading the college feedback, the areas where candidates are failing seem to be related to " recognizing patient's agenda, not picking up cues, and formulating a shared management plan". I had been worried about getting the diagnosis right and examining correctly but those do not seem to be the problem.

Need to work on these now. Good luck to all taking the exam !!!

I also sat my AKT a week ago. Took it at Pearson Vue in Milton Keynes. I have to comment on the exam centre..Very friendly staff and there were good sized lockers to keep our things. What was not good were the computer screens and the very uncomfortable chairs. To sit on them non- stop for 3 hours made me sympathize with all the folks who come to see us with disabling back pain. To make things worse, we were not allowed any water. In order to get some water, we had to leave the room escorted, go to our lockers, take out our bottles, finish drinking there, relock them and then return to the exam room. Atleast 2 minutes wasted, if not more. I finished my exam with 20 seconds to spare. This was really mind boggling. Why the *&%£ are we not allowed water with us? Apparantly it is to prevent us from damaging the keyboards lest we should spill some water. Give us a break !!!

As for the exam itself, it was the strangest exam I have taken. The first 30 minutes I had no clue as to what I was doing. Then it eased up a bit until I came across a lot of funnel and forest plots. Statistics was well catered for and the questions were such that one could either score 100% in statistics or 0%. There was no in between. There were 3 other candidates at my centre ( more than a 1000 take it across UK) in the afternoon and they all felt the same about the exam. Speaking to the guys who passed it the last time, this is a similar theme. Fingers crossed. I used Passmedicine.com for revision and Innovait ( the college journal) for in depth reading on a few topics. Passmedicine used to be free of charge but £20 for 4 months is still the best value for money in my opinion.

Came across this website by a Welsh GP who reviews comics with medical themes. I have read a few of these comics and I think his reviews are pretty spot on. Check it out here !

check them out here on this site run by a GP who is also a pretty good artist.

Been busy with the holiday period and now upcoming AKT and CSA this month. Not done much updating, but should be back on track next month.