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Our new medical school offers hope for both present and future GPs

The new Anglia Ruskin medical school’s focus on general practice will not only help inspire the future workforce but also create hope for GPs working in the area, writes Dr Roger Tisi

roger tisi sq crop

It might seem odd for the GP lead of the new Anglia Ruskin School of Medicine to admit he has a problem with the idea of channelling medical students into general practice, but I do.

Trust an Essex boy to spoil the mood music but I’m simply not sold on the idea that we can or should attempt to engineer the careers of our students in ways that they will quickly see through and possibly resent.

So, what to do instead? Well, for one, give them chances to see that some of their brightest and best future colleagues choose to work in primary care because they believe in it and because it allows them to make a difference.

Putting students into general practices from year one and involving working GPs in delivering campus-based teaching will help to achieve this, as there is nothing like a bit of role-modelling to stir the imagination.

Our intention is not to drag our students to the watering hole of general practice but persuade them it is somewhere to consider going for themselves

I have been impressed, in every sense of the word, by the capability and enthusiasm of GP colleagues who want to contribute to our teaching, most particularly those who are early in their career and looking for opportunities to spread the love. So much for talk of a profession that is often reported as being demoralised to the point of despair.

In addition, it helps for our School to generate a positive culture around general practice from the outset. Health Education England’s 2016 report ‘By choice not by chance’ points to endemic, casual denigration of GPs in medical schools, so an important part of my role is to call this out where I see it; whilst it is yet to be seen whether our new school will do any better, I think it might.

We encourage a view of general practice as an intellectually robust discipline, signposting our students to the evidence base that demonstrates its effectiveness in relieving human suffering, both on an individual and population level. To counter negativity and prejudice, our curriculum encourages students to engage in conversations with their supervisors and peers that will challenge notions of what it is to be a professional; as a spoiler alert, this will include considering the pervasive effect of ‘banter’ on building respect between colleagues. Heaven knows, they will be busy enough fielding off the ‘hilarious’ jokes about Essex.

We do not plan to shy away from the terms ‘general practice’ or ‘primary care’ when describing to students the contributions GPs make to patient care, in the process reminding them of where the patient journey usually begins and ends. Our integrated course will enable students to compare and contrast the delivery of care in Trusts and in the real world, allowing students to understand the processes of decision-making and the consequences of intervention.

Presenting general practice as the seat of problem-solving and thoughtfulness should make it an attractive place for those who value these aptitudes. To misuse an old analogy, our intention is not so much to drag our students to the watering hole of general practice as to persuade them that it is somewhere they should consider going for themselves.

As I walk around our rather wonderful new building, I am struck by the juxtaposition of our state-of- the art simulation facilities with the more down-to-earth GP Suite (which, frankly, needs a few faded health promotional posters on the wall to make it look entirely authentic). We have the opportunity to do great things in both.

Will the Anglia Ruskin School of Medicine solve the GP recruitment crisis in Essex at a stroke? Of course not, but it will make a difference, potentially a life-saving one. Not just by training doctors who may be inspired to join our workforce in the future but also, crucially, by creating some hope and opportunity for those already working in general practice in our area at a time when both seem in short supply. Enthusiasm is catching and magnetising. If this sounds like an advertisement for the Essex Tourist Board then you are not far wrong.

Dr Roger Tisi is GP lead in general practice at Anglia Ruskin University School of Medicine

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Readers' comments (14)

  • Fantastic.To avoid denigration, just institute segregation."Polytechnic Medicine", I'm sure will abolish all such sniping. Great idea also to use young fresh GPs who have a vast number of years experience under their belt.Love it.

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  • Roger, what a hero and role model you are. Judging by the above comment its not only hospital doctors who want to denigrate general practice which remains the best job in the world. Best of luck!

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  • the trouble is it just dosent help. all power to you with your institution, no denigration from me.

    but there are no doctors now,those thatare here are getting tired of dodging the bullets of our toxic blame and litigation culture for dwindling income. im retiring at 55

    there wont be any general practice in a few years, much has disappeared already

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  • BTW im a coastal Essex GP (not a partner any more )

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    I’m simply not sold on the idea that we can or should attempt to engineer the careers of our students in ways that they will quickly see through and possibly resent.

    Damn right
    This has been going on for a long time now
    See "Problem based learning"

    Those with parants already in medicine
    knew what was needed to do well
    later in postgraduate pathways
    they went it alone

    The others who had no clue
    floundered in the desert of
    left to learn yourself

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  • Second class University
    Second class degree
    Second class job

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  • What are some of these comments??

    Frankly we need more doctors and I'm of the opinion that today's 18 year olds are adults who have worked incredibly hard to get a place and know what they're getting themselves in for.

    As for the comment above "Great idea also to use young fresh GPs who have a vast number of years experience under their belt." - I'm sure many of these "inexperienced" young GPs have teaching qualifications and enthusiasm that far outweigh what experience may bring to the table. Particularly when you're talking about training first and second year medical students. I'm sure they would love stuffy old GP stories, but frankly I think people who have gone through medical school more recently are likely to be much more helpful when it comes to teaching history taking and examination...

    All credit to you Roger I wish you all the best with it.

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  • TheRoadWarrior @4.11pm.

    Are we talking about the young GPs who have passed MRCGP where clinical examination with pathology present is not scrutinised? The same ones who have also not been examined on basic science (apart from during their own undergraduate teaching and finals), who may flounder when asked about the pathophysiology of an ailment by a first/second year medical student, the knowledge of which allows a return to first principles, and an understanding of which is essential for when they are thrown into service provision in secondary care with their colleagues who have been to a more typical medical school? How do you envision the curriculum to be in the first and second year of undergraduate teaching in this institution, and what exactly will be the GPs role here as quite clearly teaching basic science (the usual components of 1st and 2nd MB/BM) will not be their forte? What do these young GPs really have to offer beyond their teaching qualifications on paper- earned at the expense of frontline experience, which ultimately is what they are preparing the students for? The corollary ie stuffy old GPs, would be even more poorly suited to teaching in such an institution but surely an able teacher should have a decent bedrock of experience to draw upon, which can underpin the nuances of the craft?

    I think the system of teaching medicine at the undergraduate level needs to change across the board but I am less than convinced that the current proposal as outlined above is the answer. The process of training GPs in particular, with the death-knell of the general physician and no looming prospect of the return of this essential role, needs to be much more robust because a great amount of pathology is not picked up upon in primary care in a timely fashion because the GPs lack the ability to think on their feet by returning to first principles based on pathology and physiology, integrating the full spectrum of anomalies evident and then detecting the clinical signs.

    The scheme above will foster division, and given enough time will denigrate general practise further, and the first inkling of this will turn out to be a nominal difference in the name of the degree awarded which may not be apparent initially but will come to pass. If I were a surgeon I would be non-plussed if a graduate from an institution which focussed on general practise, or psychiatry, were to be awarded the same BS/ChB degree when the focus of their studies gave much less import to this. Forgiveable? Perhaps not, but understandable.

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  • This article does not make any comment about the experience level of the GPs providing teaching - I can't see any mention of 'young' GPs here.

    In addition, the intention to provide exposure to General Practice from Year 1 does not necessarily equate to a dilution of teaching in the traditional biomedical sciences. Such exposure could mean only a few days each term visiting a GP practice and in the form of GP-led tutorials at the medical school. This was my experience at KCL medical school.

    Indeed, both criticisms may well be valid but this is speculation. There is insufficient information in this article to denigrate the medical school's curriculum.

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  • Cobblers

    This quote

    "Putting students into general practices from year one and involving working GPs in delivering campus-based teaching will help to achieve this, as there is nothing like a bit of role-modelling to stir the imagination"

    could have come straight from the prospectus of Southampton Medical School circa 1974. 50/50 split male/female, older studenets encouraged and GP lectures, with attendances in GP Surgeries from the start.

    How did it turn out? About 50% went into GP, including me, not far from the average of the older medical schools.

    So Dr Tisi you may not get what you are trying to design into your new Med school. Give the students the facts, let them decide. Keep your mucky, manipulative, mitts off.

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  • Moniker @ 5.02pm.

    The article mentions GPs who are early in their careers providing campus-based teaching, and from this I inferred young and of limited experience. Perhaps this was in accurate and if so, I apologise.

    I would be keen to see a follow-up article from Dr Tisi perhaps addressing some of what has been seen in the replies here, especially some more concrete details of how this institution will differ from the traditional medical school and the GPs enhanced role .

    I think General Practice is a seriously difficult job to do well and my endless carping is not primarily to wind up my fellow GPs (but admittedly it does make for some good discussions!);I know that I would feel hopelessly prepared to do this job with the training that most GPs get and my points reflect this, rather than any lack of ability amongst my peers, who simply work with what they have.

    Any institution which purports to train a generation of new GPs to do a quality job in 10 minute appointments with the current training in terms of depth and tragically it seems scope too (ie GPs who have not done any secondary care psychiatry or only 3 months COTE and 3 months rehab as their general medical experience) is bound to fail.

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  • @IDGAF

    If I have understood you correctly, your entire first paragraph amounts to "young GPs should not be teaching first prinicipals, and basic A&P" and the second and third amount to "first priniciples and A&P across general practice is poor.

    With regard to your first point, I am glad that you agree that the "stuffy old GP" stereotype would be even worse. Therefore in the absecne of an alternative, I think we can agree that young GPs are the best suited working clinicians.

    I would absolutely agree that a lot of these principles should be taught by academics whose primary focus is this. To be fair to Dr Tisi I don't think he ever said that students would be taught exclusively by doctors. They should be taught first principles in their first two years by people trained to do so, I agree, and I think they will be.

    However in the current climate the flavour is for integrated courses whereby people get clinical exposure early, and as said above, young keen GPs seem an excellent way to do this. Whether you agree with that priniciple is a different matter, but certainly I think (and I know a lot of academics agree) that having a practical framework to hang your first principles off of engages students more and improves their happiness and one would hope ultimately improve them as clinicians.

    You say about young GPs that they have their teaching qualifications at the expense of experience, well which do you want? You either get an anatomy expert with zero experience but incredibly knowledge, or a working GP with a mixture of the two. The older the GP, the more the experience, sadly the less fresh the knowledge. (and to be absolutely clear I say this not to denigrate my more experienced colleagues in any way at all). Can't have it both ways I am afraid.

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  • @Cobblers

    Frankly that's just rude.

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  • Cobblers

    @TheRudeWorrier 5:08pm

    Which bit?

    Mucky, Manipulative or Mitts?

    I am assuming the previous paragraphs being a statement of fact would not be rude.

    Dr Tisi wishes to train the students in such a way as to get them to see the Damascene light and become GPs. So I think 'manipulate' and 'mitts' fair game.

    Mucky is a moot point. I do think slanting the training programme to favour GP when there is the gamut of medicine out there for them to choose is wrong and, based on the Southampton training, doomed to fail.

    And frankly I hope it does too as GP should be gone into with eyes wide open as the current sh!tfest is more political than anything.

    GP can be a wonderful job.

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