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Professor Walter cullen, Professor of General Practice, University of Limerick

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

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Professor Walter cullen, Professor of General Practice, University of Limerick

  1. 1. Nurturing Innovation What has medical education to offer? Prof Walter Cullen UL Graduate Entry Medical School
  2. 2. 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?
  3. 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. 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. 5. Graduate-Entry Medical School at UL • First intake 2007 • First graduates 2011 • Last year…
  6. 6. Graduate-Entry Medical School at UL • First intake 2007 • First graduates 2011 • Last year…
  7. 7. Implementing policy: new approaches to learning to be a doctor
  8. 8. 196 217 929 317 255
  9. 9. 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
  10. 10. 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
  11. 11. 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
  12. 12. What have we learned? • • • • ‘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
  13. 13. What have we learned? Lane et al, IMJ, 2013
  14. 14. 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?
  15. 15. “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”
  16. 16. 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
  17. 17. ‘We must continuously emphasise … that the ultimate beneficiaries of this improved educational experience are not ourselves but our patients – the people who matter most.’
  18. 18. Thank you walter.cullen@ul.ie

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