Teaching general practice

Andrew Blythe’s recent editorial on teaching general practice reminds us of the opportunities to teach diagnostic reasoning, the management of uncertainty, and therapeutics, which appear under-taught in many schools.^1,2 There is also an opportunity here for a patient safety focus in consulting, in terms of discussing diagnostic reasoning, how diagnostic errors arise, and how to manage diagnostic uncertainty more safely.^3–5

The World Health Organization states that ‘Trainees would benefit from explicit training in clinical reasoning, patient safety, human factors, critical thinking, managing uncertainty, cognitive heuristics and biases, test limitations, probability concepts, reliability science and systems thinking. Training focused on the causes and impact of diagnostic error might help providers become more competent in error prevention. Simulations and feedback can be a helpful way to learn.’³

Communication skills teaching is a core subject in undergraduate medical education, whereas teaching future doctors about the need to adopt a patient safety-focused approach to the clinical assessment, diagnosis, and management of patients receives surprisingly little attention. Consultation skills teaching should include not only communication skills but also the principles of practices of safer consulting, including risk assessment in clinical decision making, managing diagnostic uncertainty, and safety-netting skills.^4,5 An online educational programme that covered diagnostic reasoning and how to reduce the risk of diagnostic errors, along with methods of managing diagnostic uncertainty safely, could be developed by the RCGP/SAPC to support both GP teachers and students on their primary care attachments, and has the potential to deliver safer doctors to the workplace.