ARTICLES

Dr Karena Hanley, National Director for GP Training at the ICGP, looks at the impact of COVID-19 on training for the next generation of GPs

Has it happened to you too? On the occasional chance to watch a film or TV series from the time before that spiky rolling virus? Have you felt the pangs of envy and nostalgia as the characters travel freely through the countryside, go to the cinema, meet in busy restaurants, have a few jars together? At this stage of the pandemic, we are beginning to realise that we may never be fully back to the world we left so abruptly last March. Coronavirus will keep its crown and we must negotiate the best governance to live alongside its rule.

The negotiations have been constant – we are all a little tired of them. But let’s take a step back and look at what we have achieved. My view is of GP training. I am proud of how the Irish GP training community has adapted so well to a challenge that would have terrified us, had we known in advance how big it would be.

Shortlisted applicants for the 2021 intake into GP training will have a different interview experience this year. The ICGP, led by a dedicated group of talented GP programme directing staff, have developed a standardised objective competency-based interview.

All involved in recruitment into GP training have invested their time and energy in a system based soundly on fairness and on choosing the best candidate. This year the content stays the same, but interviews will occur virtually, with each interviewer and the candidate in different locations, connected by their laptops. 

The ICGP and recruitment leads have been beavering away since last July, testing, designing and quality controlling the system so that the experience will simulate the face-to-face interview. Candidates cannot use paper or phones while undertaking the interview, and if necessary they will be asked to use their laptop camera to show the interviewers their desk and room surrounds during the interview.

In this technical adaptation, the way was paved for the recruitment team by the hardworking exams committee who pioneered an online structure. A computer entry marking system for the interview has been developed, and training of the interviewers has been delivered. It is remarkable what has been achieved.

How has GP training changed?

GP training is not quite the same as it used to be. The caseload has changed, presenting conditions are different. Competency-based training was recognised as the way forward by the ICGP prior to the pandemic, and this work is proving to be vital for monitoring of the trainee experience. For example, while current trainees will be expert at telephone triage and telephone communication skills, they may see fewer skin complaints.

The competency framework (called EPAs: Entrustable Professional Activities), scans the competency spectrum, notes areas of accomplishment and identifies learning needs. Our training community, trainers and programme directors, retain close contact with our trainees, looking after learning needs, using the ICGP core curriculum as a guide. Programme directors and trainers support and take care of their trainees. Day release is all online, but it is continuing, and that connection, teaching and guidance is crucial. 

The exams have all been adapted – the paper exams are delivered to trainees sitting in their own homes or workplaces, and even the hands-on clinical skills assessment has been adapted for a virtual delivery. The ICGP was prompt in producing guidelines on how to alter the continual assessment aspect of GP training to cause the least interruption to the training pathway and to demonstrate satisfactory acquisition of the necessary competencies.

All in all, the ICGP has managed to lead the way in adaptation of training in a pandemic so that our trainees are less impacted than the trainees of all the other training bodies.

But there have been some individuals who, despite our best efforts, have had their training adversely affected by the restrictions. Some trainees have special circumstances, medical vulnerabilities or are pregnant. Trainees may, for health reasons, have to alter the planned pathway through training.

For a small minority that means that training must be paused for a period or training lengthened. The first priority of the ICGP is patient safety, which means that being satisfied that clinical competence has been achieved by each trainee. 

GP trainees are losing out on the volume of face-to-face peer meetings that are so helpful in establishing the bonds and camaraderie of undergoing training together. As the vaccine rolls out, it is hoped and planned that some of those meetings will take place, but the unfettered mingling of all the trainees on a scheme is unlikely to return immediately. While the vaccine helps, we must reduce the volume of virus mixing, so as to avoid the rise of more threatening mutations.

Online meetings for the day release will continue for some time. Our programme directors are aware of the greater risk that our trainees may feel isolated and unconnected, and are doing their best to mitigate this.

One blessing is that the evidence base for blended learning is well established, as we are likely to need this into the future for GP training.

Blended learning is an approach to education that combines online educational materials and opportunities for interaction online with traditional face-to-face learning. One advantage of blended learning is that the trainee can interact with some of the asynchronous parts of the course in their own time, and in gaps and down periods in the day. Geography becomes less constraining with blended learning and the range of media that can be used adds variety and stimulation.

The trick for Irish GP training is to do what we do so well in Irish general practice: adapt to the conditions, embrace technology and follow the evidence. And sometime, we’ll all meet again in a busy restaurant!