Placement
GP 3: Suggested Activities on Primary Care attachment
There have been many changes in primary care since the COVID-19 pandemic, one of which is the number of patients that are coming into the GP practices still tend to be much lower than in pre-pandemic times. We hope, however, that you receive weekly patient contact, face-to-face or virtual (phone/video), offering you authentic experience of general practice consultations.
Your GP tutor should:
email you prior to placement to let you know where to come etc.
introduce you to themselves, the practice, the team, the processes and how things work in general practice
do a learning needs assessment when you first attend the practice
offer you debrief opportunities after seeing patients
offer you a mid-term review
offer you feedback on your clinical, consulting, professionalism
Example timetable
(timings are flexible - but should cover a minimum of 6 hours)
Morning activities
9-9.30 Welcome, preparation for the day
9.30-11.30: Meet patients - face-to-face or remote (opportunity for CEX, DOPS, Continuity Exercise) - see next section
11.30-12.30: Debrief, feedback & filling knowledge gaps
Afternoon activities
13.30-14.30 Tutorial - opportunity to explore student requested themes, or consider one of year 3 clinical themes or vertical threads.
Other activities
Data interpretation session (NB students have a data interpretation exam - blood test results etc)
Time for working on Group Based Assessment
Nurse or other healthcare professional clinic (supervised learning including opportunity for clinical skills e.g. BP, ECG, spirometry, or to assist chronic disease monitoring clinic e.g. diabetes: take histories, review meds, check BP, dip urine, complete template)
Practice meetings (e.g. palliative care, MDT, clinical meetings)
Expert patient (virtual) encounter
Virtual/face-to-face home visit (with member of MDT, or as part of learning e.g. coping with chronic illness)
Role play - patient consultation
15.30 Debrief and Feedback
Meet patients
We suggest Supervised student clinics with minimum of 3-4 acute presentation or F/U each week (30 min appointments)
This might offer opportunities to:
take short histories and do focused examination (virtually or face to face)
complete and sign off in logbook:
CEXs (Clinical Evaluation Exercise - observed history or examination)
DOPs (Directly Observed procedures e.g. taking BP)
Continuity Exercise (follow up a patient seen in clinic later on in the placement (face to face, by phone or review of notes)
Consent (adapted from year 3 guide)
Your role in the third year is to learn with, from and for patients. The key things to remember are that patients need to know who you are and need willingly to give informed consent to help in your learning. The information that they need to enable them to give informed consent includes what will be involved, a true estimate of how long it will take and the fact that it is for your education and whether they say 'yes' or 'no' will not affect their care.
You need to explain that you have the same duty of confidentiality as other professionals, namely that you will not discuss the patient outside of the clinical team or your learning group. Most patients will be happy to help you learn. If the patient prefers that you don’t examine them, thank them very politely and then move on to the next
patient, they might well feel up to it next time you speak to them.
Student: ‘Hello, my name is ***, I’m a third-year medical student attached to Dr ***. I’m currently learning how to take a medical history and I was wondering if you might allow me to talk with you before you see the GP. It will take about 10 minutes It’s just for my learning, so no problem if you say no.’
Obviously, never pressure a patient to allow you to examine them – consent is a gift from the patient and should be given freely. Also, never allow the patient to misunderstand who you are – if they say ‘Yes, of course doctor’, for example, correct them ‘Oh no, I’m not a doctor yet, I’m a student doctor and I’m just here to learn.’ Not only is this the right and ethical thing to do, but it also stops you from getting into trouble if a patient assumes that you are qualified.