Karen Mattick | How can medical education better support GPs working under challenging conditions?

so I'm going to be talking about I'm gonna be bringing medical education training into the discussion slightly but in particular I'm talking as kopi eye on project also funded by the National Institute of Health Research which court is called care under pressure which looked looks at doctors mental ill-health so I'll be thinking about mental health of a very particular group so the first thing I'm going to say a little bit more build on what Chris has said something about the changing face of general practice and the impact that that has on general practitioners GPS and then I'm going to sneak in some findings from our current research project and then by just starting the conversation about how medical education might help so this this talk is very much focused on doctors but of course it's the mental health of doctors is important to doctors and their families but it's critically important to patients and I hope that comes through strongly through the talk so this is the theory this is how we think general practice is supposed to work people in the community if they suffer ill house can visit a GP and who will either be able to work with them and manage those problems themselves or they can refer on to a number of different professionals whether they're physiotherapist talking therapies social care of some sort so that that patient is seen by the right professional in a timely way so that's the theory but we've we know from for many sources and we've heard today about the increasing demand for GP services and this is a really important report from July 2014 and these bullet points are the real headlines from their executive summary but it's saying that growth in the GP workforce hasn't kept pace with the demand for for the services or with the population growth and that means that the GP workforces under terrible strain and as the demand increases the numbers of GPS are not increasing it's actually proving quite difficult to get GP trainees coming through the pathway and I mean there's almost a vicious cycle going on because that puts more pressure on the GPS in practice so if we go back to my nice simple diagram we're going to layer on some complexity now because we've got a lot of people in the community wanting to access GPS and those patient problems are not easy these are complex problems older people stress anxiety addiction malnutrition obesity poor housing homelessness domestic abuse etc etc etc and you can see how this links to the themes of this conference how the nature of the patient problems might be changing over time they've got a short time in which to try and resolve these problems and some of these therapies are either not available or the GP knows there's a very long waiting time so if they refer them to these specialist services that that may not provide the timely service that they they might hope and sometimes they some of the problems will then come back to the GP so even if they do refer they will come back to them unresolved so there is that so is that there could be that frustration and I know through the destress project there was talk of the frustration felt by GPS that sometimes being the gatekeeper the person who had to decide where the people could access certain funds so all of this is putting pressure on GPS either workload pressure or some frustration in the nature of their role now this is another really interesting study this was Doran a child from 2016 so relatively recently and they interviewed GPS who were leaving GP practice and they talked about these cumulative aspects that developed into a decision to leave being a GP the analogy which I'm not sure if I like or not was is boiling frogs the idea being that if you drop a frog into boiling water they hop straight out if you put them into warm water and gradually raise the temperature they will stay in that that in that environment for much longer and they are the analogy made in this paper is that is is that GPS this this system that they've been working within has the the temperatures been rising over time and interesting some of the things they're talking about you know a increase additional tasks as well as the workload it's the nature of the work which changes what they thought being a GP was about less time with patients and that affects their perhaps less sense of professional autonomy values so it just it affects their job satisfaction and one bit that I thought was really interesting it was also the negative media portrayal of the work they were doing and that was making them feel vulnerable to burnout ill health and ultimately towards decisions of GPS so if your interest in this area that's a really neat paper to look at so there is undoubtedly a problem with doctors mental health not just doctors health across healthcare professionals but our research has focused on doctors for various reasons talked about issues of recruitment and retention but I just wanted to mention absenteeism and presenteeism so absenteeism when doctors are sick and are not at work either for a short time or a longer period and of course the impact that it makes on patients but also on other people within the healthcare teams but also presenteeism arguably just as bad doctors being at work when really they're unwell and perhaps they shouldn't be at work and unwell doctors increasingly there's a literature that shows unwell doctors can harm patients this quotes from the House of Lords Select Committee it says we're concerned by the absence of any comprehensive national long-term strategy to secure the appropriately skilled well-trained and committed workforce the health and care system will need over the next 10 to 15 years in our view this represents the biggest internal threat to the sustainability of the NHS so quite you know quite a strong quote there so moving on very quickly to give you to in some insights into the research that we're doing so this is very much this is a project ongoing we finish in April and we're trying to understand first of all how mental ill-health in doctors develops so this isn't just GPS this is all doctors and all career career stages and of course my personal interest particularly those earlier stages so interested in how it develops and we're interested particularly in the interventions that people put in place to support develop retain doctors we're interested in the ones that work the ones that don't work why they work why they don't work things we could be doing things we could be doing better so that's that's the research and it's in collaboration with colleagues in Hull and in Oxford this is the team they do this because they hate me showing their photo so I always do and this is our published protocol so this is showing what we are doing but not with the results of this stage and just to give you a sneak preview it's interesting we've talked about root causes quite a lot in in the sessions that's the thing that's come through for me so I think what we're doing gives some insight into root causes for doctors Elyse so here's an insight just a couple of insights here's one when doctors have more responsibility but less control over their work they may feel undervalued and frustrated or experienced a tension between their expectations of what it means to be a doctor and the daily experience of clinical work leading to them to experience less meaning in their work which may lead to mental ill health and it was interesting before lunch where people were talking about worthwhile work and meaning because because that's my particular interest I've been thinking about the implications of some of these things for medical education whether that's undergraduate postgraduate or beyond and I think we need to provide learners with much more opportunities to dis these tensions and the compromises that people make the reality of the daily experience I also think we could empower learners more give them opportunities to even if it's a tiny change have some kind of control of making things better in in their mini environments here's a second finding so when formal and informal opportunities for collaboration and dialogue are available doctors feel a greater sense of connectedness to their colleagues and their profession leading to improve learning and support and an increased capacity to work under pressure so again some themes with with this conference thinking about the group's the connectedness being part of something worthwhile implications for medical education small group activities this is something we already rely on very heavily in our undergraduate program at Exeter but small groups are so important to build a sense of belonging whether it's to a group of students or whether it's to a GP practice whether it's to the profession of medicine but small group discussions and then being able to prioritize opportunities to engage in mutual learning and support and I think that's particularly hard for people who are no longer officially trainees you know when they are fully qualified how do you protect time and prioritize it to engage in those discussions etc so in summary and general practice is undoubtedly changing it's broader it's more complex there's a higher workload then I think Chris's point about the wider healthcare team is an important one because something I haven't talked about which is undoubtedly happening and this offers lots of opportunities is the roles that other people within that healthcare team can take on and are taking on but certainly GPS are providing care under pressure but I mean I think but some of the discussions through this but certainly through our research I think the more nuanced our understanding of what the problem is and what the strategies to address the problem terms are working which ones aren't working why they working when are they working that's going to help us to understand what to do next and I just wanted to introduce the idea that medical education but all education has an important role to play thinking of medical education we need to prepare medical students for the realities of practice and I'm thinking about what Richard said about the consultation and how we prepare medical students to become GPS and have those really productive conversations with patients but also supporting trainees who have qualified through the various transitions of in their career and finally sustaining GP throughout their careers and that worth sustaining you know keeping them going keeping them energized keeping them invigorated and in in their practice of medicine so quick thank you to my colleagues on the care under-pressure team and to acknowledge the funding and provide some contact details there and those are the references that I've cited in the talk thank you very much [Applause]

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