Nurturing Innovation through READ (Research, Education, Auditing and development)

1. Nurturing Innovation
What has medical education to offer?
Prof Walter Cullen
UL Graduate Entry Medical School

2. Outline
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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?

3. “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)

4. Context…Ireland 2007
• More graduates
• Access: Graduate entry
• Innovative learning
approaches: PBL
• New clinical settings:
general practice / primary
care
• Increased capacity: new
school…

5. Graduate-Entry Medical School at UL
• First intake 2007
• First graduates 2011
• Last year…

6. Graduate-Entry Medical School at UL
• First intake 2007
• First graduates 2011
• Last year…

7. Implementing policy: new approaches
to learning to be a doctor

9. 196
217
929
317
255

10. What have we learned?
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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

11. What have we learned?
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
Finucane et al, 2012

12. What have we learned? Active learning!
PCT members
Organisational tasks
Logbook
Practice meetings
Observing
Self directed study
Audit
Co-op
Practice nurse
House calls
Clinical supervision
Diverse patients / problems
Practice tutorials
Feeling responsible
Formative feedback
Parallel consulting
Assist with procedures
Two way feedback
0
5

13. What have we learned?
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‘It is a good catalyst
for growth in the
practice because you
have fresh blood
coming through’
‘Everyone’s a teacher and a learner’
Wider benefits for practices
‘Learner fatigue’
Importance of coordination ‘The GP is the conductor
of an orchestra’
O’Regan et al, Ed Prim Care, 2013
13

14. What have we learned?
Lane et al, IMJ, 2013

15. Implementing innovation in Irish
General Practice
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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?

16. “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”

17. Mental disorders in general practice
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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

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

19. Thank you
walter.cullen@ul.ie