GPs consider opting out as pay rule change bites
for the practice
For some time now we have provided clinical placements for final-year medical students. They come for six-week attachments and stay at our local district general hospital.
Financially the work is well paid with a grant of £2,000 per placement, £1,000 set-up costs to cover extra equipment and the provision of a laptop for the use of the student. And having the students is worthwhile and very satisfying.
The fact is that many medical schools are desperate to find good-quality practices to work with in providing clinical placements for students. This is because general practice has assumed increasing importance within the undergraduate curriculum of most medical schools.
Medical courses now have large clinical elements where students are based not just in teaching hospitals but increasingly on placements in primary care settings. Here they can obtain better, and more relevant, clinical experience often linked to more effective teaching from experienced clinicians.
There is more exposure to clinical problems in real settings requiring more complex management skills.
Pressure for placements also comes from rising undergraduate numbers, a 50 per cent increase over the last few years nationally, with several new medical schools coming on stream. Student attachments are now sought almost everywhere in the country.
The aim of all this is to produce more and better doctors. It represents an opportunity for interested practices to get involved and help shape tomorrow's doctors.
Cracking the hospital mould
Getting a good understanding of primary care is important for any student, whatever specialty he or she may end up in. But exposure to primary care also offers GPs an opportunity to show students what our specialty can offer, to help 'crack' the hospital mould, show them what 'real' medicine is all about and help recruitment into general practice.
The challenge for medical schools is to find appropriate practices. Enthusiasm on the part of the GPs and being prepared to spend time with the student are the most important qualities sought. Being 'academic', having specific qualifications or teaching and training experiences are definitely not essential.
Most medical schools will offer a training package to involved GPs and there will be guidance and support from more senior colleagues. There will almost certainly be opportunities to 'network' with other GPs regionally undertaking similar work.
The types of student a practice may find attached fall into two main categories. Those in their early years who are likely to need a more planned and structured environment. They may be in larger groups and visit for specific learning objectives.
Often they will attend more 'specialised' teaching practices. More commonly practices will be involved with students in their later years who fit more easily into typical practice routines.
Specific guidance will be given by the medical school, but in general the aims of the attachment are to show students how the practice and associated primary care team members work and deliver care.
They will also have experience of history taking and clinical examination and develop skills in clinical problem solving and team working. Perhaps for the first time in their studies they will get a clear picture of what it is like to work as a doctor!
In practical terms the practice team needs to agree to receive student placements and for most to be willing to get involved with teaching. Often this teaching just involves the student shadowing the team member or sitting in on consultations.
He or she can look up the 100-odd causes of headache in the textbook but needs to see how the patient was assessed in 10 minutes and how the GP negotiated a management strategy with the patient. So often our students have commented that it is the first time they have had the chance to develop simple clinical examination skills.
The student will need to be able to see some patients on their own so some thought should be given about how space for this can be found. Patients will also need to be told that a student is with the GP or nurse and their permission sought.
Our experience is that prolonged consultations hardly ever pose a problem and most patients agree. Indeed, if the right individuals are selected they positively enjoy a more prolonged consultation with the student before they see the GP.
Students also value the opportunity to follow a patient with a particular problem at several points during their attachment to get the 'feel' of managing a patient.
Evaluation of student feedback after such placements shows how much they are enjoyed and valued by students. Locally we have had comments such as 'I felt part of the team' and 'I was amazed at what I learned'.
My practice takes final-year students from the University of Cardiff. On average there are three placements each year over the winter months. We take one student at a time and, as I have said, the work is well paid and satisfying. Paperwork is minimal, but this may be different with other universities. We get support from the local student placement manager who organises accommodation and some hospital-based activities.
Toe dipping in acadaemia
Apart from the financial gain the practice benefits from contact with the university, the GPs have honorary tutor status with access to university facilities, we feel part of a wider network with a 'toe' dipping into academia. Most of all there is the satisfaction of being involved in teaching new entrants to the profession which keeps us on our toes and can be fun.
Practices interested in taking students should make contact with the undergraduate department of general practice at their local medical school or the clinical tutor at their DGH. Don't be afraid to make contact with more distant medical schools if what is being asked does not fit with what you think you can deliver.