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Clinical skills - Learn an unfamiliar procedure

Observing an intervention is good for widening your clinical knowledge. By Professor Ruth Chambers

Spirometry test: you need to observe it to be able to tell your patients in detail what to expect (Photograph: SPL)
Spirometry test: you need to observe it to be able to tell your patients in detail what to expect (Photograph: SPL)

As a GP, it is imperative that you make a constant effort to stay up to date.

This is not only with new approaches to clinical management, but also with practical interventions that may not have been available or part of everyday practice when you qualified. Examples of these might be telehealthcare, pulse oximetry or spirometry.

Sometimes you need to describe specific interventions or diagnostics to patients so they know what to expect. To do so in detail, you need to see the intervention being performed.

Bear in mind that as GP-led commissioning takes hold, further opportunities will be taken to cut costs by shifting the delivery of care to general practice settings. Consortia may also insist that practice teams provide all the care classed as being within what their 'core' contract may specify when the reforms come into full operation.

It seems unlikely that consortia will tolerate practices referring patients to hospital or community services for interventions that other practices carry out, such as fitting vaginal ring pessaries or inserting intrauterine systems for menorrhagia.

Interventions to observe
As a GP, you have a limited time for CPD and must prioritise your learning. So your reasons for giving priority to watching an intervention or diagnostic process may be that:

  • It is part of a main care pathway for primary care, such as pulse oximetry or use of a defibrillator or nebuliser.
  • Patients are often anxious about the intervention and turn to you, their GP, to discuss options.
  • The intervention is new and there is limited information about its effectiveness or risks. For example, this may apply to telehealthcare equipment in patients' homes.
  • Competence is expected of all GPs in certain fields, such as refitting vaginal ring pessaries, according to the RCGP's expectations of GP registrars who have completed their training.
  • You are considering taking on further training to provide an enhanced service.

Having reflected on your priorities, discuss your intentions with your practice team. Some members may already be doing the intervention you want to observe or, possibly, the development of an enhanced service needs to be a viable part of your practice development plan.

Record your observations
You can complete this template to record your learning for your appraisal or revalidation portfolio
Before observing the intervention
Insert details
1.    What intervention will you observe?  
2.    Why do you want to observe this intervention? Why is it a priority for your learning or service development?  
3.    Is it part of an agreed care pathway? Which one?   
4.    How do you know the person you will watch performing this intervention is competent?   
5.    What do you expect to be able to do as a result of observing the intervention?   
6.    Has the patient concerned given informed consent to your presence?  
After observing the intervention  
7.    What did you learn from watching and discussing it with the person doing it? For example, the patient’s reaction, how easy/difficult the intervention was and the potential pitfalls.  
8.    What went well and/or what could have been improved?   
9.    What will you do now? Change your clinical practice? Undertake the intervention/get accredited training? Apply to provide the service and/or buy the necessary equipment?  

Find a local expert
If you want to observe an intervention so you can discuss it in a well-informed way, find a local expert who is willing to demonstrate the procedure.

With some minor interventions you observe you can perform them yourself the next time they are indicated or after a competent person has initially supervised you.

There are specific recommendations in relation to clinical competence for some interventions or diagnostics, such as undertaking spirometry.

For other interventions you expect to undertake, you will need to become accredited. To be classed as a competent practitioner in defibrillator use, for example, you may need to attend an updating session.

If you want to undertake some of the more complex interventions, such as minor surgery or fitting contraceptive implants, you will need to go on formal training courses.

Gain from your learning
If the intervention was important enough for you to prioritise observing it, put your learning to work and update your practice.

You can do this by giving patients a confident description of the intervention or by persuading others at the surgery to invest in extending your services or purchasing necessary equipment.

Make sure you have got any risks covered so that you do not expose yourself to any complaints about lack of expertise or accreditation - get advice from your medical defence organisation or professional indemnity insurer.

Think through any consequence that might be generated by the intervention. Could starting a screening programme possibly trigger an avalanche of costly investigations or additional costs of subsequent treatments that have not been factored into your annual budget for secondary care services or medication?

  • Professor Chambers is a GP in Stoke-on-Trent and an honorary professor at Staffordshire University

These further action points may allow you to earn more credits by increasing the time spent and the impact achieved.

  • Check where the intervention fits in the relevant Map of Medicine algorithm and update your knowledge of the Map (see www.mapofmedicine.com).
  • Write a simple patient guide to the intervention that you can distribute when discussing and arranging it.
  • Get accredited training in the procedure and enhance your expertise.

Save this article and add notes with your free online CPD organiser at gponline.com/cpd

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