Context Recent recommendations from the RCPCH and the RCGP have highlighted the need for General Practice curricula to include more focused paediatric training.
Problem Children comprise 40% of a typical GP’s workload yet only 55% of GP trainees undertake hospital-based paediatric placements.
Assessment of problem and analysis of its causes We carried out a questionnaire of GP trainees in our region to assess confidence with Paediatrics and interest in focused paediatric education.
Intervention We hypothesised a novel three-tiered education programme would address this imbalance.
Study design We designed a curriculum-mapped educational programme for qualified GPs and GP trainees. The programme focuses on acute Paediatrics and is delivered using a variety of modalities:
Strategy for change
CCAP: A Crash Course in Acute Paediatrics – 2 day course for GP trainees: an overview of acute Paediatrics.
STrAP: Simulation Training in Acute Paediatrics – in-situ simulation for GP trainees during hospital paediatric placements.
GP Paediatric Refresher Days – Simulation for qualified GPs.
1. A Crash Course in Acute Paediatrics An intensive 2-day Crash Course in Acute Paediatrics (CCAP). Delivered by Paediatric registrars and nurses, this uses tutorials, workshops, skills stations and simulation to cover essential knowledge and skills. It offers an overview of assessment, and common presentations, as well as the opportunity to consolidate knowledge with relevant practical skills. The course has a strong focus on effective assessment, initial management within a primary care setting and safe transfer of patients to secondary care.
2. STrAP: Simulation Training in Acute Paediatrics A simulation programme covering common acute paediatric presentations delivered to trainees weekly and run real-time in ward areas. Simulations utilise all members of the multidisciplinary team with high-situational fidelity being achieved through use of a manikin and visual media. This gives trainees realistic exposure to assessment, diagnosis and management of an acutely unwell child.
3. GP Refresher days A Paediatric simulation programme delivered to qualified GPs at regional Refresher days. Delivered by Paediatric registrars, the programme comprises acute paediatric simulations run in real-time using equipment available in a GP surgery. The focus is on assessment, initial management and communication within the primary care environment.
Measurement of improvement CCAP candidates completed feedback questionnaires immediately following the course. All candidates felt the content was appropriate for their future careers and reported increased confidence. Feedback was almost unanimously positive, with candidates enjoying the mix of theoretical and practical learning.
STrAP candidates completed confidence questionnaires after scenarios and a basic knowledge questionnaire before and after their placements. The same questionnaires were completed with a control group of candidates not undergoing regular simulation-training. Our results showed candidate’s confidence scores increased by an average of 2 points (Likert scale 1–5) following simulation-training. Overall confidence scores reached a higher plateau 6–8 weeks sooner than the control group. Knowledge assessment results showed greater appreciation of non-specific presenting features of acute illness in the intervention group, and clearer ability with managing acute paediatric illness.
Feedback from the pilot GP simulation refresher day showed that 100% of candidates agreed or strongly agreed that the scenarios were useful and increased confidence and knowledge of acute paediatric presentations.
Effects of changes We feel our novel three-tiered education programme and its unique cross-specialty, cross-discipline delivery has improved the ability of our qualified GPs and trainees to manage acutely unwell children.
Lessons learnt Our programme addresses the imbalance of Paediatric experience in GP training when compared to the Paediatric proportion of a typical GP’s workload.
Message for others We feel the programme would benefit to GP trainees across the country and could easily be introduced in other deaneries.
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