CPD Catch Up

If you’re like me, there’s been too much going on over the Festive period to focus on CPD and e-portfolio. Hopefully this blog will give you some pointers to get back on track!

If you are preparing for the CSA or planning to start soon, don’t miss the short CSA series which started in the December issue. The first article discusses the format of the exam and is followed by Ten Top Tips for the CSA. The second article in the January issue covers the application process and how best to prepare. Good Luck!!

Another useful topic for both VTS and those of you preparing for appraisals, is the article on ‘How to Make Quality Improvement simple’. With regards to appraisals there is no requirement to have an audit anymore, but we have to evidence our quality improvement contributions. This article is a fantastic walk through how best to tackle this.

On a clinical note, Pelvic prolapse is an extremely common problem which can have a profound impact on quality of life. There is a great deal we should be offering in primary care for diagnosis and management. The article in the December issue is a really useful summary alongside what can also be offered in secondary care.

If you have anything related to diabetes listed in your PDP, the November issue is the one for you. There are three great articles. The first on Diabetes in Pregnancy, then an interesting discussion of Foot Sepsis and finally regarding the Cardiovascular Complications of Diabetes.

Finally, I was given a book for Christmas from a good friend about Finding Joy, the main premise being that we have to note the happy things which happen and not just look at the negatives. It struck a chord with me as I fear I might be prone to discussing those things which irritate way before the good things in my day. It seems these authors are not alone with this theory. In the November ‘From the AiT Committee‘ article by the fab @DuncanShrew, he talks about how ending his day explaining what he had enjoyed to the student with him, turned him from feeling slightly stressed to feeling pleased and positive. I think this is something to try to hold on to as much as we can. Especially with the increased criticism and pressure being placed on GPs over the last couple of days, it is as crucial as ever to make a point of noticing the positives for us as an individual. It won’t fix everything, but it might help with the day-to-day.

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Career + Parenting = Guilt

I remember my mother telling me that being a parent involves a lot of guilt, whether it’s not breast feeding for long enough (if at all), not going to the right groups, or, as they get older, not going on such wonderful holidays as other children. Well I can add to all of that. The guilt of also having a career.
I read one of the popular parenting books a few years ago and within the first couple of chapters it became clear that the author felt very strongly that children shouldn’t be in childcare before the age of 4. Huge waves of guilt ensued. My eldest then was only 3 and already I had completely failed him?!
I was ambitious throughout school and university and enjoyed doing the extra bits and pieces where I could. I started my VTS and went on to have 3 children in quick succession. Suddenly I realised I didn’t have the time (or energy) to be quite so keen. I welcomed into my life this new world of Guilt and felt attacked by it on all sides. I was now unable to do those extra audits, CPD sessions or organising (let alone attending) the social nights out.
There was the heavy guilt of dropping the children at nursery at crazy o’clock knowing that they would probably be the last ones to be collected at the end of the day. There was also the mad dash to get there before nursery closed – an extra dollop of guilt towards work colleagues who were still there as I rushed off.
Don’t get me wrong; I can clearly remember the joy of eating my lunch in the canteen undisturbed when I went back to work after number one. There is also some freedom in having another purpose to who I am, earning my own money and being able to walk around unattached to an infant – but then there is the guilt for feeling like that too.
I have found that the children starting school has helped with the guilt slightly.  It isn’t my fault that they have to be at school – I have the law to support me here, (as I have explained to the children vociferously). Although some other mothers have scuppered this by becoming teaching assistants at the school, so even this small bit of support waivers. ‘Mummy, why can’t you be a teacher?’ Well, darling, hmm…..during the summer holidays I think they may have a point.
But this is exactly where being a locum GP can come into its own – due to one word – flexibility. I can fit work around life, not the other way round. When at work, I work hard, I do my best for the patients, I keep up to date, but if one week I want to go to sports day – I can, without the guilt of asking colleagues to swap. Most days, I can start my sessions after school drop off and finish so that I can be back at the school gates at pick up. This has really helped with another portion of guilt – this time towards my husband.  As he works full time too, expecting him to fit in school runs takes a toll on him just as much as me.
As the children get older, I fear the guilt doesn’t stop. The days of tearful nursery drop offs (me mainly) may be gone, but I am sure there will be lots of new ways in which I can let my children down, and never be as committed or quite as involved as I aspire to be at work. I am told the feeling of never doing anything 100% doesn’t leave, but I hope I am getting better at managing it.
Currently I am having a dilemma whether to go to a meeting which I really ought to attend or to make it to collect my children on time from school….probably best to stop writing now so I can let all that guilt set in for whichever I choose not to do.
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This article was first published on Networklocum.com

Catch Up Treats

In case you haven’t had a chance to look inside your Great Green Magazine from last month, here are some sneaky treats.

There is a helpful article outlining the essential info about Postmenopausal bleeding and Endometrial Cancer. One of my learning points was that any significant bleeding change in a woman over 40, should also be considered at a similar risk for referral, alongside other risk factors such as obesity or PCOS. I also hadn’t appreciated the increased risk from tamoxifen use and it was useful to read about strategies for prevention of endometrial cancer.

The next article is on Testicular cancer with a really simple, handy guide for how to differentiate the types of scrotal swellings. Did you know that being taller is a risk factor for testicular cancer?

If you are starting to prepare for your AKT it would be worth reading the short summary of where to begin by Virginia Head who is an ST3.

It’s that time of year again when antibiotic requests are ever present – unless that is, you have a very well-trained patient group! I have tried hard to search through the evidence base that’s out there so I can confidently justify why I am not issuing them. We have had several great AKT questions on this subject in InnovAiT. I also came across this summary table of infection guidance for primary care, endorsed by the RCGP, which includes details of clinical criteria. Having your local CCG guidance to hand is also helpful.

As a trainee it can be tricky if the GPs in your practice have different prescribing habits. However, it can be really constructive to discuss these with your trainer so that you feel comfortable in what you are prescribing.

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Be who you want to be: GP+ Travel Medic

For this edition we are very lucky to have guest blogger Claire Davies tell us about her amazing career path, Claire usually writes for the Network Locum blog. Thank you Claire!

These days, the demands of clinical practice have never been greater.  Many GPs go home on Friday night to lick their emotional wounds inflicted by workload intensity, unfriendly political fire and the odd grenade thrown in by the media.  For many, working as a portfolio GP is not just a life raft but also a career enhancer.  With the new trend for doctors to find alternative roles outside of clinical practice, the opportunities have never been greater.  

But where to begin?  Do you look and see what’s available or should you try and make something more tailored to you?

My portfolio career in travel and tropical medicine seemed to grow by accident at the time but looking back, it was subconsciously by design.  As a starting point, I knew what I was passionate about.  I believe that, if we define and articulate what we want, opportunities tend to gravitate towards us.  It began in Uganda when I was a medical officer on an expedition for Raleigh International.  While supervising volunteers building a medical centre in a remote mountain village, it struck me that, the nearest doctor was still four hours walk away and that perhaps I could do something more worthwhile.

Three years later I did the diploma in tropical medicine at The London School of Hygiene and Tropical Medicine – an excellent course with inspiring speakers, one of whom, Professor Eldryd Parry, arranged for me to spend a year in Ethiopia working in a chronic disease management programme.  I also did a 3 month stint with the WHO as polio eradication volunteer in India.  

Returning from Ethiopia, I reached an impasse.  Using the Medical Forum career review, I eventually decided that being a GP would allow me to continue being a clinician while giving me the option to maintain my other interests – as well as pursuing my other passion for writing.

I was surprised how much I enjoyed general practice and remained contented for a good number of years as a salaried GP.  A challenge to drive across the Sahara in a car bought for less than £100 rekindled my travelling interests.  Within a few months of returning, I had found a job working 2 sessions a week at InterHealth Worldwide, a travel medicine clinic offering face to face and remote services to the humanitarian aid and mission community.  Feeling part of the effort during global crises such as the Haiti earthquake was addictive.    The demands of the field were high for our patients and I dealt with malaria, the whole gamut of psychological problems and even gave medical advice on hostage situations. Eventually I was promoted to leader of the medical team and the role also took me to Kenya where I helped set up Nairobi’s first travel medicine clinic tailored to the humanitarian sector.

Being the charity sector, there were the usual issues with scarce resources. I spent much of my own time consumed with trying to wipe up the overspill from work. Inevitably – like many aid workers – I ran out of energy after 8 years and decided to move on.  All this time I had maintained a few sessions in general practice.  Deep down, I always had a feeling that the most good I had achieved had been through the long term relationships of traditional general practice.

Colleagues expressed concern that I was abandoning my travel medicine career.  I was also a little fearful and felt like I was jumping off a cliff but I also had a sense that things would probably just work out.

Contacts mean a lot and to my surprise, other roles in travel medicine kept popping into my inbox. Eventually, a flyer appeared in my in-tray advertising a CCG role to lead on TB in Hackney and design pathways for a new local clinic in infectious diseases.  As I write this, the role is now nearing completion but it was an important lesson to me that the right opportunities are there if you want them.  

There are many ways and opportunities into travel medicine.   But I think the real learning from this journey is to define what it is you want, as opposed to fitting yourself around the adverts in the BMJ.  Only one of my roles in the last 10 years was ever advertised.  Express your interests to other people and ask, ask, ask.  Eventually what you want will appear – even if it takes a long time.  The world has a funny way of making it happen.  

Resources

Both Tropical Medicine schools in London and Liverpool run excellent diplomas

Faculty of Travel Medicine (RCP Glasgow)

www.travelhealthpro.org.uk.  Up to date country advice and disease outbreaks plus list of educational events

British Global and Travel Health Association

Expedition medicine, repatriation medicine and writing travel health chapters for guidebooks are also potential ways in

Dr Claire Davies, portfolio GP, London

www.drclairedavies.com

@clairedocdavies

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InnovAiT Writing Competition – Fancy a Go?

Last year we were so impressed with the brilliant entries to the InnovAiT Writing Competition that we thought we would do it again. The winner from last year was Dr Samuel Finnikin who wrote about ‘Seven Days that Changed Nothing?’ closely followed by Dr Kymberlee Merritt who wrote ‘Seeing through the eyes of a GP’ which if you haven’t done so already, they are available to read for free online.

This year there are two categories which you can enter. The first is if you have had a particularly challenging case, or which is emotionally or clinically interesting . The second is if through working together with a team you have improved a patient’s or group of patients’ experience. The entry should be 500 words and submitted by 11th November to mc.manuscriptcentral.com/innovait.

The winner will be published in the journal and runners up will be selected for the Online blog.

It is a great opportunity to try your hand at writing and we are really excited to read your entries.

For more information see this flyer https://uk.sagepub.com/sites/default/files/n16j0865_ino_advert_web.pd

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Switching Off

Our lives are hectic. Work is all consuming in itself, but whether it’s having families or other interests such as doing triathlons  – which a scary number of my friends seem to be doing at the moment – there is always something to do even when we’re not thinking about work.
I really admire those people who can just switch off. Having had what should be a relaxing two weeks off, I realised that it was only during the last few days that I didn’t always have the feeling that there was something else that I should be doing (or rather ten things).
I think this can have a big effect on who we are. Some good friends (both GPs) just had their first baby and the wife noticed that despite the usual associated sleep deprivation, she was pleased to find that she had her old husband back. He was on paternity leave and wasn’t thinking about work and she hadn’t seen him like that for a long time.
I am pretty certain both my patients and my family benefit from when I have managed to switch off a bit by hopefully then being calmer and happier and more able to take on their problems.
I think I am beginning to see the point of those personal statements we had to write to get into med school. Outside interests can be our saviour and allow us therefore to be better at the day job too.
It isn’t quite an outside interest, but it is an amazing and inspiring opportunity available at the moment: To experience a different culture of primary care. The RCGP are funding 38 places to do an observational exchange within any of 10 European countries including France, Croatia, Germany Greece, Italy and Spain. This is available to AiTs and First5s with more information from http://vdgm.woncaeurope.org/content/about-hippokrates
Application statements of fewer than 500 words outlining the reason for applying, including learning objectives and outcomes with a CV can be sent by email to erasmusplus@rcgp.org.uk
Right, having finally achieved ‘Switching Off’, I need to switch back on again, back to work tomorrow…
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Who wants to be a Doctor?

This evening I read some Enid Blyton to my children and in the book, she talked about how lucky people are to be suited to such a wonderful career as Medicine or Nursing. With the A-level results released today, it reminded me of when I was applying to Medical School having, amongst other things, been completely inspired by the ‘Doctors To Be’ series.
I couldn’t wait to be one of those Medical Students. I knew it was going to be hard work but I relished the challenge. I loved that you would be part of this big team doing something that was interesting, worthwhile and respected by others.
Perhaps I’m being nostalgic, but I wonder if it still holds the same appeal? Or has the impact of the negative press finally taken effect? It is sad to hear that places at medical schools are available through clearing, rather than being oversubscribed as it used to be year after year.
It is a waste, and wrong. Despite massive difficulties currently, Medicine has so much to offer as a career. A huge range of options are available after qualifying. The best thing for me though, is all the brilliant, funny, interesting and enthusiastic colleagues and friends that I have met along the way. And now, as a GP, still being part of a fantastic team, getting to know patients and their families in situations requiring empathy and all the knowledge we have gained through the years, there is still so much offered to us. I hope we can begin to inspire the future doctors once again.
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Contraception and CSA Preparation Survey

I get slightly muddled about which type of progesterone is safer for women. Perhaps selecting the cocp that I’m most familiar with is ok for those younger, lower risk women. But once the patient’s age is increased, being able to take account of this in choice of oral contraceptive could be more crucial.
The article by Doctors Carslaw and Cosh in the August edition of InnovAiT, explains this really well with a useful table for reference as well as other contraceptive considerations in the older woman.
Also in this August edition there is a useful article all about the contraceptive implant. If you are preparing for CSA it is great to feel slick with all the information that a patient may ask to hand. This will be a great straightforward resource for you.
If you are just starting to think about the CSA it would definitely be worth looking at the survey and findings by a group of ST2s in Northamptonshire. This is available OnlineFirst and is all about the best way to prepare for the CSA. There were some really interesting findings – for example preparing for more than 4 months was associated with a 6 times higher failure rate!
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How to make the most of InnovAiT

This is an article written by Kunal Chawathey but I thought it was so useful to remember all the things which InnovAiT offers, he kindly agreed to let me add it to one of our blogs – Thank you Kunal!

One of the journals that made a regular appearance through my letterbox when I became a GP trainee was InnovAiT. Great! I thought to myself, now I don’t just have to read the BMJBritish Journal of General Practice and The Lancet, I have to read InnovAiT as well! However, I slowly discovered that not only was InnovAiT more tailored to my needs as a GP trainee, it soon became the go-to source of information and inspiration when it came to primary care pathology and management.

InnovAiT is published in a 3-year cycle. This means that over the 3-year period as a GP trainee, it covers a multitude of topics spread across the entire GP Curriculum. All articles are published bearing in mind the educational and clinical needs of a primary care clinician.

InnovAiT takes into account various learning requirements of the AiT, including preparation for the nMRCGP. Information is well structured with use of tables and boxes in each article, making it a great resource for the written part of the MRCGP examination, the Applied Knowledge Test (AKT). There are a couple of AKT questions in each issue of InnovAiT designed to stimulate further learning, and many more online. These are checked regularly by the RCGP examiners to ensure they mirror the real AKT examination in style and degree of difficulty.

You will find tips on how to prepare for your exams in Crammer’s Corner. This section is written by experienced GP trainers and assessors. InnovAiT also publishes non-clinical articles to foster all round development, for example articles on presentation skills, interview preparation and career advice.

‘10 Minutes’ has been one of my favourite sections of the InnovAiT. It deals with difficult scenarios, such as medical ethics and professionalism. The scenarios can be used with your trainer to promote discussion, or for small group learning. From May 2016, you can also contribute to discussions about 10 Minute scenarios on the InnovAiT 10-minutes discussion forum, available through the RCGP On-line Learning Environment. Discussions are summarized monthly and posted, together with past 10 Minutes scenarios on the InnovAiTwebsite. This is an excellent resource to generate high-quality learning, which could find a place not just in your ePortfolio, but also in daily practice!

how to make the most of innovaitLast but not the least, the section on news and views helps the reader to stay up-to-date with the latest clinical and non-clinical developments.

A GP is expected to have sound basic knowledge of all specialty areas and this can be a Herculean task to achieve in a 3-year programme. InnovAiT articles have helped me plug gaps in my knowledge, especially in those specialty areas where I did not have much clinical experience. Now as a GP trainer, I find InnovAiT articles useful to conduct tutorials for GP trainees, as well as to refresh my own knowledge base.

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What you need to know about E-cigarettes

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I have never used an e-cigarette but have been asked my thoughts and advice about them by many patients. If, like me, you’re not sure of the different types, what evidence we have about them – whether they are better for the user than smoking, how much they cost, how they are regulated then our Ask the Experts: Electronic Cigarettes article is here to help.

Image kindly from www.vaping360.com<http://www.vaping360.com

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