1. Ask questions!
Whenever you change to a different specialty, ward, practice or department, much will be new to you. Some procedures will be specific to a particular ward, for example – such as where forms are kept – while each consultant or GP trainer you work with may have their own particular ways of working. If there is anything you are unsure of, don’t be scared to ask. It is important to overcome any reserve or embarrassment about asking, so that you can do your job properly rather than pretend you know what to do or where to go and then cause problems.
When you start your first post in a GP practice, you will likely face a number of processes you have never dealt with before – the electronic record systems, home visits, arranging admissions – and it is important to ask questions so you can learn the local policies and procedures, and how the systems in that practice work.
You may also have questions about the various assessments during training, what to expect in different hospital rotations, MRCGP assessments, or the contract in GP practices, which is not the same as in hospital jobs. Ask other doctors in your specialty training scheme for advice, and consider joining some of the national Facebook groups that are relevant to GP training – often you will get rapid answers as well as a range of views. Groups relevant for trainees include: GP Training Support; Tiko’s GP group; and Resilient GP.
2. Familiarise yourself with the e-portfolio
Try to spend some time early on learning how to navigate the e-portfolio and get used to putting in regular learning logs. Find out the recommended number of entries per week or month and set aside time to record entries as you go, so you don’t end up trying to log them all at once just before your ARCP.
A simple framework for learning log entries is to think about the following questions each day.
- What did you do? For example, a case you saw, a tutorial you attended, an article you read.
- What did you learn? A summary of the key learning points.
- What will you do next? Record any further reading and learning you plan, and how you might change future practice.
You also need to stay on top of the minimum requirements and complete all the assessments to get through the Workplace Based Assessment (WPBA) part of your MRCGP – remember this starts from ST1 and continues throughout the whole of training. By getting to grips with it early in ST1, you will set yourself up for the rest of your rotation.
The requirements in ST1 are:
- Case-based discussions (CbD) – three per six months
- Multi-source feedback (MSF) – two separate cycles – five clinicians for each one (plus five non-clinicians if done in GP)
In hospital only
- Clinical Evaluation Excersise (MiniCEX) in hospital – three per six months
- Clinical supervisors report (CSR) – one for each hospital post
In GP only
- Consultation observation (COT) in GP – three per six months
- Patient satisfaction questionnaire (PSQ) – one cycle of 40 patients
- Out of hours (OOH) time – varies according to scheme, usually 36 hours in six months or 24 hours in four months
3. Plan ahead for the year
With no MRCGP exams to think about in ST1, you might take the opportunity to use your study leave to gain new skills such as joint injection, minor surgery or fitting coils and implants. Sometimes these courses get booked months in advance, so if you don’t plan ahead you may miss out – unused study leave cannot usually be carried forward to the ST2 year.
Try to meet with the other junior doctors early on and plan any dates when you need someone to cover your on call so you can attend a course or practical session.
If possible, plan and book your holiday well in advance – knowing you have something to look forward to will help you get through those tough shifts or difficult weeks.
4. Think about life after training
There may be specialties that are not part of your rotation that would be helpful once you complete your training – you may be able to use some of your study leave to attend relevant courses or pursue an additional qualification to boost your knowledge. For example, if you do not have a women’s health job in your rotation, attending a women’s health update course or doing the DRCOG might be one way to cover key knowledge and improve your confidence. Don’t pursue additional qualifications just for the letters, as they make little difference in terms of career prospects – do them if you are interested or because they will help you do your job more effectively.
If you have specific areas of interest, you may be able to go on a short course to get exposure – I did the RCGP drug misuse certificate (part 1) during training, and have since found it helpful for work as a prison GP, and also my role in a community detox unit.
When in GP posts, you also get one session per week for self-directed learning – you could use this to attend clinics to broaden your exposure to other specialties.
5. Watch out for yourself and your colleagues
We all know that working in general practice can be stressful, and GP training is no different. Many hospital rotations have gaps in the rota and there are workload pressures in both primary and secondary care. Comparatively high numbers of doctors suffer from conditions such as depression, stress, harmful drinking and drug dependence during GP training. As well as looking after yourself and ensuring you seek help from your own GP if you feel you are becoming unwell, also watch out for any signs that your trainee colleagues might need support.
You have to look after yourself before you can look after others, so if you are sick, take the time off you need to seek help and to recover rather than trying to ‘be heroic’ and going in.
If you are having difficulties with your workload or finding certain tasks challenging, discuss it with a member of your team and ask for support early. Contact your training programme director for advice – they may be able to signpost you to additional sources of support.
The ST1 year is the start of your journey in GP – try to enjoy it, and make the most of the opportunities open to you.
Dr Mahibur Rahman is a portfolio GP with an interest in medical education. He is the medical director of Emedica (www.emedica.co.uk) and the administrator of the GP Training Support Facebook group