Nurturing Innovation

What has medical education to offer?

Prof Walter Cullen

UL Graduate Entry Medical School

Outline

• Medical education activity in general practice

• What does the policy say?

• UL and implementing this policy

• What have we learned?

• And how is this relevant to implementing innovation in practice?

“Extending GP training should not be confined to specialty training, but should reach before and after it. Clinical and non-clinical competencies need to be incorporated much more explicitly in the undergraduate curriculum and revisited through a spiral training curriculum that builds expertise both in particular contexts and across broader contexts. This enhanced undergraduate experience of generalism should encourage more trainees to consider a career in primary care.” (BJGP, June 2012)

Context…Ireland 2007

• More graduates• Access: Graduate entry • Innovative learning

approaches: PBL • New clinical settings:

general practice / primary care

• Increased capacity: new school…

Graduate-Entry Medical School at UL

• First intake 2007

• First graduates 2011

• Last year…

Graduate-Entry Medical School at UL

• First intake 2007

• First graduates 2011

• Last year…

Implementing policy: new approaches to learning to be a doctor

929317

255

217

196

What have we learned? • 41% Male

• Mean age 27 years, (range: 22-32)

• 84% EU citizens

• 84% Science/Life Science primary degree

• 41% intend to pursue a career in GP

• 72% more likely to pursue a career in GP after placement

O’Donoghue et al, 2013

General Practice Large Hospital Network

Distant Hospitals

Total DREEM Score (max score = 200)

147 139 138

Perception of Learning(max score = 48)

34.9 34.2 32.6

Perception of Teachers(max score = 44)

35.1 (*) 32.0 31.6

Academic Self-Perception(max score = 32)

22.4 21.0 21.3

Perception of Atmosphere(max score = 48)

36.0 (*) 33.2 33.4

Social Self-Perception(max score = 28)

18.5 18.6 18.5

What have we learned?

Finucane et al, 2012

What have we learned? Active learning!

Two way feedback

Assist with procedures

Parallel consulting

Formative feedback

Feeling responsible

Practice tutorials

Diverse patients / problems

Clinical supervision

House calls

Practice nurse

Co-op

Audit

Self directed study

Observing

Practice meetings

Logbook

Organisational tasks

PCT members

50

13

What have we learned?

• ‘Everyone’s a teacher and a learner’

• Wider benefits for practices

• ‘Learner fatigue’ • Importance of coordination

‘It is a good catalyst for growth in the

practice because you have fresh blood coming through’

‘The GP is the conductor

of an orchestra’

O’Regan et al, Ed Prim Care, 2013

What have we learned?

Lane et al, IMJ, 2013

Implementing innovation in Irish General Practice

• Policy a pre-requisite

• Make it feasible

• Clearly state what you want to achieve

• Evaluate and capture feedback

• Next steps?

• Data, education the key enablers?

“I have patients who go to the Midlands, Limerick and Ballinasloe who all have their own way of doing things”

“often they have multiple problems so a GP will often pick up on things when they come in for diabetes check”

Mental disorders in general practice• Cross sectional study at affiliated

practices in Midwest• 49/300 randomly sampled patients not

actually attending practice• Of 251 ‘active’ patients, 51(20%) had

documented mental disorder• Of whom:

– 43(84%) were prescribed pharmacological treatment

– 17(33%) referred to / attended specialist mental health services

– 29(57%) received a psychological intervention

Jamali, Konkin, Lin et al, National Primary Care Conference Newbridge, 2013

‘We must continuously emphasise … that the ultimate beneficiaries of this improved educational experience are not ourselves but our patients – the people who

matter most.’

Thank youwalter.cullen@ul.ie