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At the heart of general practice since 1960

Why there's no need to fear the regulation of the regulators

A fourth-year medical student recently did a student selected component in stroke/TIA as part of an attachment to a practice in Oldham ­

Dr Anita Sharma describes the benefits the practice received as a result

I am a singlehanded GP with 3,200 patients, so I consider myself lucky if I am able to get a regular locum.

With more emphasis now being placed on clinical placements in community settings, the demand on GP educationalists is on the increase.

More GPs than ever are involved in educating medical students, a trend that looks set to continue.

Personally I believe as many GPs as possible should involve themselves in teaching, in the hope that from an early stage we can encourage students to look at general practice as a career option.

In our local (Manchester) curriculum, students acquire a common core of knowledge and skills through problem-based learning and the clinical skills programme, both of which run through the main modules.

These modules alternate with Student Selected Component (SSC) ­ the new name for what used to be called the Special Study Module.

During years three and four students are required to do a minimum of one SSC in a district general hospital and one in the community.

The objectives, which are set by the University of Manchester, are:

·To acquire an in-depth knowledge of skills about a specialty or aspect of medicine linked to the core module. This could be relating to a patient, a patient group, a family or a community health care service.

·To critically appraise published research and understand research methodology.

·To broaden the education and understanding from personally defined objectives.

·To communicate clearly in writing.

·To be self critical.

Any GP wishing to get involved in the scheme should write to the undergraduate medical education teaching co-ordinator and the hospital dean.

The university will then send a copy of the SSC guidelines with student's learning objectives, components of the objectives, learning methods and the dates and deadline for submitting the report.

The title of the SSC is usually chosen by the student, but you can help if they are indecisive. The written report is assessed by you, the supervisor. It will also be assessed by another assessor where the student is awarded an 'unsatisfactory' by yourself.

What about time input from the practice?

·Total input is about four hours. Choosing a topic can be difficult at times. Some students know what they want to do, others are a complete blank and need your help and guidance. Aims of the written report demonstrating in-depth understanding of pathophysiology, rationale, investigations and management, multidisciplinary team work and requirements regarding the font size, total number of words, minimum number of references and how to present in a folder should be discussed in the first meeting.

·Total practice manager time explaining the computer system, how to use templates, how to look into the prescribing screen can take up to half an hour.

·Assessment of written report is under headings of work habits , performance,written report and overall assessment. Filling those boxes takes less than five minutes.

So what do you need as a practice? The following are indispensable:

·A good practice manager.

·A well-ventilated room with a computer.

·Your time.

·Plenty of (non-alcoholic) hydration!

·Sandwiches for the student!

I was keen to participate because I have always been interested in teaching and this was a perfect opportunity to get involved.

Oldham is suffering from a major recruitment and retention crises, and I am prepared to do anything I can to help encourage students look at general practice as a career option.

Choice of topic

Wherever possible, real medical issues or problems rather than extract theory should be studied. The student will have to be proactive and must not expect to be spoon-fed.

After the first week you, as a supervisor, should discuss the student's progress and the learning possibilities available.

If the student's learning expectations are not met, this should be rectified as soon as possible. The new GMS contract gives us a wide range of clinical areas to choose from.

The disease areas where the practice has not performed well may be the ideal topic to choose.

The last medical student attached to the practice chose secondary prevention of stroke and TIA in primary care.

Why TIA/stroke?

The aim was to establish a system for creating and updating a stroke register. We wanted to be systematic and proactive in maintaining care and take prime responsibility for secondary prevention.

Risk factor management, tighter control of blood pressure, cholesterol, antiplatelet therapy, advice on smoking cessation and other behavioural risk factors ­ weight, excessive alcohol intake and poor diet ­ was looked into.

Although not included in the official stroke quality indicators, the proportion of patients who have received pneumococcal vaccine was also recorded.

Personal rewards

·Benefit to the practice towards improving the quality targets next year.

·Remuneration from the university. This is a set amount of £695 for year three and £520 for year four, more than enough to cover your locum.

·Further financial gain to the practice. This is in the area of tighter BP control, cholesterol targets and antiplatelet therapy. Next year each point is £125 and we are hoping to improve our figures by £1,250.

·Seeing the student making improvement and gaining confidence is a very satisfying experience.

·Encourages the GP to look up and relearn things possibly forgotten years ago.

·Helps with the professional development plan.

Learning points for the practice

·The practice should take primary responsibility for secondary prevention for stroke and TIA

·We now have a list of patients with no BP recording, poorly-controlled BP and cholesterol, smokers and high-BMI patients ­ the practice nurse is going to target these patients

·Housebound patients with stroke who were forgotten due to lack of time and poor resources, especially towards nursing hours, have now been handed over to the district nursing team

Anita Sharma is a GP in Oldham, Lancashire

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