Countdown to Practice
Introduction
There has been increasing recognition over the past years that the needs of our GPST's change as they near the end of their training, specifically in the last ST3 year and for the few years after their training has been completed.
Their independence, professionalism and readiness to practice are fast developing and so far these needs have not always been fully addressed or met. Previous schemes such as the VTA and NPP and current schemes such as the Academic ST4 Scheme and the Darzi fellowships all have realised the importance of an additional year of training to allow new additional skills to develop while still providing ongoing support and mentoring. However the benefit of an additional year in training is not commonplace to all and so novel innovative ways of providing similar opportunities and support for these GPs in transition have been developed.
This new exciting "Countdown to Practice" project will hopefully allow Trainees, Trainers, PD's and GP tutors to work synergistically to help prepare Trainees for their future careers and for independent practice. It is hoped therefore that the transition from a pre CCT Trainee to post CCT GP is a smooth and enjoyable one for all, creating a seamless handover between from PD's and Trainers and the GP tutors.
This project contains a series of Resource packs that could be used as part of the ST Half Day Release, in conjunction with Trainers in tutorials or may form part of any self directed learning set pre or post CCT. The Resource packs aim to cover topics and skills that any new GP or those involved in their training, would find useful to draw upon during a protected teaching session.
Quick links
Teaching skills for GP Trainees
Negotiation skills Resource pack
The Must do Resource Pack
GMC ensure you pay by Direct debit to avoid any gaps in payment
Indemnity insurance ensure again you pay by Direct debit and they are fully aware of any change in working circumstance especially trainee to post CCT
BMA will be able to offer advice on Contracts etc
RCGP you need to be a member to use your nMRCGP qualification
Hep B Status/BLS
Performers list inclusion
Contact your local GP Tutor - What a local GPT can offer to new GPs? and Who is your local GP Tutor? PDs could invite the local GPT to hold a QA session at the half day release or at a post CCT study group.
Annual GP Appraisals and Revalidation- could invite a local appraiser to come in and discuss local appraisal guidelines, update or Revalidation and how to become an appraiser yourself.
Doctors Support
- BMA Counselling and Doctors for Doctors service
- Med net Deanery led service to support Doctors in difficulty
- Doctors support network self help group for doctors with mental illnesses 0870 321 0642
- The Sick Doctors Trust Confidential service for doctors addicted to alcohol or other drugs
- Practioner Health Programme (PHP) Free confidential service for Doctors living in London
The CPD Resource pack
Trainee's educational needs so far have been charted by use of the Eportfolio. Now entering independent practice they should consider ways they can not only keep up to date effectively but also track their career intentions in a meaningful way. By understanding how they learn and what motivates them, it will hopefully allow them to engage in learning activities that suit their style and career together.
Learning styles: using a LS Inventory - How do we really learn? Could be individual exercise, trainer-trainee, Half day or post CCT learning set activity. Trainees could complete the inventory then use large group to discuss what the findings mean in practice for an individual’s learning activities. There are many theories around learning in existence that explore how we learn and what motivates us to learn.
Learning Trajectory: Exploring how and why they have learnt since childhood. Ideally this is a 1-1 interview with a PD, Trainer or another trainee. What has worked well/hasn’t worked well for them since their schooling and why? How does this relate to their learning now as an adult? This paired activity with facilitated feedback will look at how past experiences as a teacher or learner can impact future activities they engage in.
How to write a SMART PDP – What is one and how do you write one? Trainees could work in pairs and facilitate each other into writing a meaningful PDP as they exit their training and beyond. Allows experience in writing a PDP but also mentoring skills.
The Deanery runs a Mentoring service where you can get involved as a Mentor or Mentee. Judy McKimm has written an article on Mentoring skills that Educators or trainees may find interesting to read. There is also a useful article on Mentoring skills in formal and informal settings on the RCGP website.
Self directed Learning Groups: There are many advantages to setting up of your own SDLG both whilst in training and for many years afterwards. This could be with friends made on the ST Scheme or with other likeminded newly qualified GPs in the area. Contact your GPT or contact your local First Five lead to find out if any such groups are running in your area. The First Fives have set up a database of SDLGs giving details of local groups and allows you to add any new SDLGs on too. Such groups allow you to keep up to date and offer the support of peers in a safe confidential environment.
The RCGP has set up a First Five initiative which focuses on the needs of Newly Qualified GPs in their first five years of independent practice. There is some useful guidance of how to set up your own Self directed Learning group and how to chair peer meetings.
The GP Careers Resource pack
This could be part of the Half Day for just ST3's although the whole ST group could benefit from this as perhaps an Away day activity. GP Tutors could also use this Resource pack for new GPs in an area looking for Substantive posts.
Suggestions for group activities:
1. Top tips for finding a job: Divide into 5 groups. Set each group a task, they have to compile a list of 10 top tips on the following topics which they then feedback to the large group.
- How and where to look for a job
- Informal pre-interview visits/calls
- Writing a winning CV/application: winning CV by Sam McErin, BMJ 2004, outlines a successful formula. There are many templates you can use to write a CV, here is just one example.
- Tips and techniques for interviews
- Contracts - Salaried GPs / The Model Contract without Tears
2. Hot Seat Job Interviews: where trainees interview trainees using real BMJ adverts with the rest of the group observing. Allows experience of both sides of the interview process including why and how questions are set, and thinking about person specifications/criteria. Ask 3-4 trainees to act as the "interview panel" interviewing another volunteer trainee run this cycle a few times, using real BMJ adverts for each interview cycle. Elitham Turya has written a useful atricle on CV/Interview techniques in the BMJ that may provide useful follow-up reading after this activity.
-Ask the interview panel to really think about what questions they want to ask and why, what criteria are they asking the candidate to demonstrate?
-Ask the trainee being interviewed, why they might want this job and how they might fit their strengths and experience to this new job. Think about not only what they say but how they say it. Consider their body language or Body talk.
-Introduce ground rules early on before conducting mock interviews with trainees. Allow time for feedback, asking the interviewee, panel then observers to reflect on the interview process. Think about the process of giving feedback during this part of the exercise.
3. PDP activity: Could use this activity to help focus career aims, Trainees could work in pairs and facilitate each other into writing a SMART PDP. Allows experience in writing a PDP but also mentoring skills.
4. GP career options:
National Association of Sessional GPs (NASGP) - A website designed by sessional GPs with lots of useful tips and updates.
5. Trainer/Practice swaps: This Could be a suggested follow on activity after the half day or away day on Careers. Encourage ST3s nearing the end of their year to spend from a full day to a week at a neighboring training practice on there scheme. The swaps can be coordinated by the trainees themselves trying to swap into a practice with different patient demographics/size etc to their own giving them a flavour of how different practices run and function. They could spend time speaking with Practice Manager and sitting in on a GP’s surgery or a Practice Meeting if there for just a day or seeing patients and doing visits if at the Practice for a full week.
6. Career planning: Educators could complete an eLearning module on how best to support trainees with there career planning.
7. Many new GPs will opt to work as an independent Locum GP, which has it advantages and challenges. The advice pack for Freelance GP Locums produced by the RCGP looks at ways to enjoy this type of working while staying safe.
Teaching skills for GP Trainees
Getting involved: There are many ways trainees and new GPs can get involved in the undergraduate or postgraduate education of students or Doctors/nurses. There are a number of short courses the Deanery Faculty development offers and information of how to become a GP trainer is on the London Deanery website. Furthermore Teaching skills are part of the RCGP curriculum. There are many Educational skills that can be developed during and after training and some reading around Teaching and facilitating small groups may be useful too perhaps before the Half day or an away day when some of the activities below could be used. Here is a list of some useful reading in this area followed by some suggested group activities.
Useful reading
1. Educational skills in GP trainees
2. Teaching and facilitating small groups: there is an eLearning module and four related articles around this topic.
Suggested group activities:
1. Divide into small group to discuss “best and worst teaching experiences” looking back at their experiences from school age until present, either as a teacher or student and trying to extract in their groups what made the experiences so good or bad and why? Ask then each group to feedback, trying to fit the emerging themes into the 7 stage model, which outlines the "6 ingredients" of good teaching".
2. Teaching Observations: Ask a PD or a Trainee to observe another Trainee in a teaching session providing constructive feedback using observation sheets to help guide the process.
3. Role plays: Using the 6 stage model we have looked how there are various ingredients to any successful teaching session. This exercise deals with two of those essential ingredients “context” and “group dynamics”. It must be stressed that the usual rules of role playing as a teaching tool should be observed, namely all roles should be voluntary, there should be space for “time out” at any time and a chance for all in the role play to debrief before the observers give their feedback.
Exercise 1: Playing with Context
Exercise 2: Dealing with Difficult group Dynamics
4. Giving and receiving feedback: The art of giving and receiving feedback is a useful one to master. It has uses in a teaching context but the skills could equally be used with patients or working in a GP practice.
5. Some trainees may be interested in Educational Research – there is an interesting elearning module providing a useful introduction to this.
6. Although a lot of teaching in General Practice is in small groups there are times when we need to give presentations or lectures to large groups and there is a useful eLearning module on this.
Negotiation Skills Resource Pack
“If you can learn a simple trick, Scout, you'll get along a lot better with all kinds of folks. You never really understand a person until you consider things from his point of view, until you climb into his skin and walk around in it."
(To kill a Mockingbird, Harper Lee 1960)
Why and When?
Good negotiation skills allow you to reach the best possible solution for you and your interests in any given situation, these aren’t just “work” skills but they are “life” skills that can be used anywhere, in the workplace, at home with your family/children, when buying/returning goods in shops and of course everyday with our patients.
Negotiating is reaching an agreement acceptable to both parties, it is different from other forms of reaching agreement such as persuasion, accommodating or confronting. So…good Negotiation is a marriage of attributes (body language etc) and behaviours.
So...good Negotiation is a marriage of attributes (body language etc) and behaviour. There are four phases of any negotiation process and the "styles" of negotiation that one can adopt can be broadly divided into "soft", "hard" and "principled". The following theory could be presented at the start of a session or after some of the activities below have been tried out.
Negotiation phases and styles
The four phases of negotiation
- Preparation and planning before the discussion takes place
- Discussion and debate
- Proposals offered by both sides
- Bargaining and summarising at the end
Negotiation style – ‘soft
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Here one aims for resolution and avoids conflict at costs
- often the likely result is feeling (and even being) exploited
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Bargaining is likely to revolve around aiming for agreement, making offers you don't really want to make and disclosing your “bottom line” to the other party early on.
Negotiation style – ‘hard
- Here there is a battle of viewpoints, where there is a winner and loser.
- The main tactic involves taking a particular position and not budging from it.
- However the likely result might be victory but damage to the relationship, an equally hard response, or total deadlock between the two warring parties.
- The bargaining involves aiming for complete and total victory
Negotiation style - Principled
- Here you aim for 'fairness', seeking to decide on issues on merits rather than haggling
- This style involves an 'exchange' and mutual gain, share the different interests that may underpin your differing positions in the argument
- Treat the different positions as a shared objective - i.e. problem solving
- Possible solutions are then shared by both parties, consistent with common values they might hold,
- make sure the other side takes part in finding the final common solution to the problem
- Explore a variety of solutions before deciding on which is the best one.
- Listen often and try to put yourself in their shoes
Based on the Harvard Negotiation project, drawing upon Fisher and Ury's "Getting to yes"
Suggested Group Activities
1. Small group work
Think about any recent negotiations you have had in your personal or professional lives…discuss in small groups of 2-3. This activity is best done at the start of the session and then the supporting theory above is presented.
Then “snowball” with another group, trying to extract themes of what works and doesn’t work and why, when negotiating.
Feedback these themes to the large group after about 20mins, trying to relate these themes to the phases of negotiation and the preferred style of being "principled"
2. The sliding doors role plays….
Ask the group to watch the following three role plays and see how the three differing “negotiation styles” have very different outcomes.
The setting could be a ST3 asking their trainer for leave to attend their VTS away day on Negotiation. If possible it is best done with the PDs acting the two roles out, each role play lasting just a few minutes each. The "trainee" (played by a PD) in role play first plays a Soft Negotiation style, then Hard then "Principled" negotiating with their Trainer (played by another PD). Each role play should last no longer than 2-3 minutes. After watching the three role plays back to back, there should be time for discussion on each of the styles soon using the theory to underpin the themes
Trainer: Underlying interests: feels they are low on cover due to sick/annual leave, they are a new partner under pressure from the other partners for them and their registrar to “pull their weight”. The Trainer plays a consistent role in each of the three role plays playing firm but open to the changing negotiation tactics of the trainee. Their position: I don't want you to go
Trainee: Underlying interests: Really wants to attend, as they have an interview next week. All their peers are going and they are fed up with being used to “cover” sessions: Their position: I want to go
Role play 1: Trainee negotiates in a "soft" style to try and get study leave to attend the awayday
Role play 2: Trainee negotiates in a "hard" style
Role play 3: Trainee negotiates in a "Principled" style
3. The impact of Micro politics: Micro politics game
Objective: to understand how hierarchy and power can play a part in the workplace and can influence negotiations and your negotiation style. Also to have an awareness that success to negotiation lies beyond these traditional roles and lies more in the success of being able to use “skills” not “status”.
The “Micro politics game”: The setting is a practice meeting to discuss organising the Practice Christmas Party. This is best done in groups of 8-10 each with a facilitator, but could also work with 8-10 acting in the centre of the room and the rest of the group observing the dynamics as the game is played out.
Stick these roles listed below to their foreheads so they are unaware of who they are, but others can see them. Roles to assign
- ST1
- GP Registrar
- Practice Nurse
- Student nurse
- Locum
- Salaried Doc
- Senior Partner
- Practice manager
- Receptionist
Ask the role players to talk to each other in this mock meeting, knowing everyone else's role but not their own, they have to guess who they are according to how others talk/behave with them. Eg patronising tone when talking to the student nurse. Run game for 20mins in total. Ask everyone to then guess who they think they were and why. Spend some time at the end thinking about how such status/power differences may not just effect your communication style with others but also your negotiation style.
4. The goldfish bowl role plays
Ask for a pair to volunteer to role play a negotiation scenario that one of them has recently been in. Ask them to spend a few minutes familiarising themselves with the scenario, and the “negotiator” may choose to act it out as they did recently or to try out a different angle or stance. Eg one plays out buying a car from a dealer trying to bargain over the price. The rest of the group to watch and to act as observers.
The pair in the role play, the observers or the PD can at any time raise their hand to “freeze” the scenario, to ask questions such as” what's going on” “what have you noticed” “what could you do differently” try to refrain from offering suggestions or criticisms, but allow the "negotiator" to think of ways of tackling the scenario differently.
Try running through 2-3 times with a different pair and scenario each time.