General practice has always been the only option for me. A career with a variety of diseases, ages and populations, uncertainty of what's coming through the door next and the scope to be an independent practitioner with responsibility and autonomy early on in my career all attracted me to general practice. As general practitioners (GPs), we have the opportunity to care for patients longitudinally throughout their lives, to work on prevention of disease as well as treatment of symptoms and it is the one specialty that gives you experience across all specialties! Since starting the VTS, general practice is without a doubt the correct choice.
People often see GPs as a ‘Jack of all trades and master of none’ but I resent this comparison. To be a good GP is perhaps the hardest career path of all. Keeping up to date with NICE guidelines, current best practice and abreast of changes across all specialties in medicine is no easy feat. We are often the first health professional that patients will see and the challenge of this is hugely rewarding. Combined with the support we get from our secondary care colleagues and allied health professionals within the community we can strive for optimal patient care.
GP recruitment is now a highly competitive process with a ratio of approximately three applicants for every ST1 position in August 2008.1 The selection process is in four stages.2 Stage 1 is the determination of eligibility where certain entry requirements need to be met. Stage 2 comprises two exam papers focusing on clinical problem solving and professional dilemmas. Once Stage 2 has been passed the candidate would be invited to attend Stage 3 at a selection assessment centre and three exercises are observed and assessed. Finally, Stage 4 is the allocation and offer stage.
There are 16 deaneries throughout the UK and within each deanery there are several schemes. The London Deanery has 28 training programmes situated in different areas. At present, the GP VTS training is three years post foundation year training and theoretically should take five years in total post qualification. There are some pilots being run in the UK where the schemes are four years long and there are talks about extending the training to five years in the future.
The Royal College of General Practitioners (RCGP) has devised a new curriculum which came into force in August 2007.3 As trainees we need to complete and pass the nMRCGP to achieve our Completion of Certificate of Training (CCT) which is essential for registration on the General Medical Council's GP register. The nMRCGP includes an Applied Knowledge Test (AKT), a Clinical Skills Assessment (CSA) and Work-place Based Assessments (WPBA). The RCGP's site also has the link for the e-portfolio essential for our training including completion of WPBAs and assessments.
The VTS consists of a minimum of 18 months in various hospital posts and up to a year and a half as a GP registrar. The programmes vary between schemes and the hospital rotations are comprised of either four-month posts or six-month posts to give us maximum exposure to a variety of specialties, usually spanning two years. The experience of the GP registrar year equips us with the necessary skills and exposure to working life after the VTS.
As VTS trainees, we have an educational supervisor who is part of the VTS scheme. They meet with us throughout each training year and are responsible for the Educational Supervisor's Report. They provide us with support and guidance and are often our first point of contact for advice and concerns. Together with the other scheme organisers and supervisors, they are in charge of the weekly VTS teaching afternoons. In each post, we also have a clinical supervisor, normally our consultant, who gives us clinical guidance and assists in our assessments.
The St Marys' VTS is excellent and this is evident by the number of happy non-complaining trainees (in comparison to other specialties)! Wednesday afternoons are our bleep free teaching sessions aimed at covering parts of the curriculum. We normally have a knowledgeable speaker on a subject of interest and to date a variety of topics, including but not limited to renal failure, shoulder examination and statistics, have been covered. This is followed by a specialist trainee presentation, ballint group and then a business session giving us the opportunity to raise any concerns and make future plans.
So far, one of the highlights has been the GP residential – an educational forum spent in Cumberland Lodge in Windsor! The two days were filled with seminars on the Mental Health Act, different ethical scenarios, team building skills and various aspects of communication. Not only was it very informative, but the fun atmosphere ensured that we bonded well as a group in lovely surroundings with great food!
So as I finish my first six month rotation and start the next I am excited at the prospect of learning new skills and acquiring more knowledge. I am aware of the fact that my training will not cover all specialties but I embrace this opportunity to learn more, making the most of the resources that are available to me. I would truly recommend a career in general practice if you are empathic, want to provide continuity of care throughout a patient's life, and are able to practice holistically picking up on the cues that patients often give but don't say. To be a good GP you have to be a master of all trades and a specialist of none!