The unifying theme that emerged from respondents' experience of teaching and training was a boost to their morale. The data are presented in terms of the two dimensions of teaching and training. Respondents mentioned several issues that were perceived as uniformly negative for morale and that hindered successful teaching. These issues are presented separately as organisational problems.
Effects of teacher training
Support and feedback from peers—Teacher training boosted morale because of networking with peers and sharing problems. Teachers who had suffered from isolation within general practice and teaching developed a peer group of fellow teachers with whom they could develop a new identity as general practitioner teachers.
Developing clinical skills—Anxiety about the adequacy of clinical skills was common. Teachers thought that "short cuts" in their clinical examination of patients were not appropriate for students to learn. Performing examinations and discussing clinical problems with other teachers and hospital specialists allowed participants to compare, contrast, and improve skills. Improvements in clinical knowledge, skills, and clinical practice led to an improvement in morale and were most often cited in neurology and otorhinolaryngology, which had been targeted by several of the training programmes. Seven teachers reported no changes.
Developing teaching skills—Teachers who were not postgraduate trainers were insecure about teaching skills. Training reassured teachers that it was appropriate for them to teach, allowed them to calibrate their skills against those of their peer group, and gave them additional skills to deal with students. The improvement in skills noted was empowering and improved morale. Some experienced teachers noted that they did not gain much from the sessions, but they recognised the usefulness for others.
| The effects of training for teaching "It has improved this [morale]—the sessions prevent isolation" (GP 26) "Getting together with peer group—challenges of students can be shared" (GP 12) "I was worried about whether I was up to date—would I teach the right material. The sessions reassured me. It helped calibrate me" (GP 21) "It has renewed and refreshed my clinical skills—I now examine patients without cutting corners" (GP 23) "Learned more about obstetrics—feedback from the hospital consultants has helped" (GP 4) "I feel more thorough and can do full neurological examinations for example" (GP 19) "I felt much more confident—this is the first time that I have had real training for teaching, although I am an experienced teacher" (GP 27) "I learned less than the others. My main confidence comes from being up to date" (GP 14) |
Effects of teaching
Broadening horizons—The experience of teaching added variety to the week, and teachers felt they were involved in an activity that transcended usual practice routine. Isolation was reduced by the presence of keen students, with increased morale for the whole practice.
Contact with students—Positive feedback from students was important for teachers' morale, and sessions that were not well attended or were poorly received led to anxiety.
Contact with patients—Longer contact with selected patients during teaching was positive for teachers, and patients were thought to benefit from this in addition to a thorough clinical review, learning more about their condition, and revealing new personal information to students.
Improving clinical practice—A renewed enthusiasm for clinical work was attributed to three factors: the contact with enthusiastic students; an increase in time spent with patients; and greater confidence in clinical skills and knowledge. Changes in clinical skills and practice were reported as a result of teaching and were attributed to increased reading and reflection on practice; information from students; challenging questions from students; and more time with patients. Changes in practice included being more methodical in clinical examination; specific changes in patient management; developing a clinical subspecialty role within the practice; and disseminating information through the practice.
Improving teaching skills—Teaching led to improvements in confidence and morale as the preparation time for sessions reduced and teachers felt able to cope with challenging students.
Improving the image of the practice—The image of the practice was positively affected by teaching, influencing practice staff and general practitioner colleagues. Some practices invested in their premises to provide extra teaching facilities and most bought extra equipment, ranging from textbooks to improved information technology links.
| The effects of teaching "There is a whole world outside general practice and other options for a GP....has sustained me" (GP 28) "Good feedback from the students is good for morale. They often thank me and this helps" (GP 23) "It is fun—students keep you young, stimulated and they are non-cynical. Renews my enthusiasm for medicine" (GP 9) "It cements my relationship with my patients" (GP 29) "It has improved my coil fitting skills. Students ask about the progesterone only injection—I had to look this up. I have also designed a new history taking protocol for students and the practice" (GP 4) "Student questions (unknowingly perceptive) have changed my approach to managing diabetes in antenatal patients" (GP 6) "Explaining issues to students helps me re-evaluate my practice" (GP 29) "I am more methodical, less generalised, neater at note taking, more rigorous and can justify what I am doing" (GP 8) "My partner had not come across Weber’s test—I was able to update him" (GP 2) "I see more patients with ENT and dermatology problems—my partners refer them to me" (GP 20) "It has helped me to be more selective with my referrals" (GP 4) "As teaching has gone on my confidence has developed" (GP 13) "A major refurbishment—top flat has been converted to a teaching suite" (GP 5) "We have acquired auroscopes, ENT examination kit, link to the internet, clinical examination book" (GP 10) |
Organisational problems
Time pressures led to anxiety for teachers because of loss of clinical time due to teaching and preparation. Assistants or locums were employed by some practices to do clinical work but this caused concern. Some premises lacked space, and in group practices some partners were not supportive. Six teachers found that funding for teaching was inadequate, although most concluded that it was cost neutral.
Finding appropriate patients was time consuming, and patient fatigue and effects on the doctor-patient relationship were mentioned by experienced teachers. Many teachers had hoped that teaching would result in better communication with hospital specialists from teaching. This was realised in some cases, particularly when teachers had both clinical and teaching contact with a hospital. Many thought that relationships were unchanged on the clinical front but were disappointed by insufficient feedback about their teaching, possibly indicating a search for affirmation of the teachers role.
| Organisational problems "Preparation time is important—initially time consuming but now getting easier" (GP 7) "[[Teaching]] decreases my accessibility—when I am teaching I am only available for dire emergencies—it is hard to balance conflicting priorities for a single handed GP" (GP 15) "[Problems are] patient fatigue. Finding suitable patients. It is important to manage the doctor-patient relationship" (GP 7) "We don’t refer to (hospital). No real change as consultants are hard to get hold of (GP 16) "It has improved—better communication with consultants at (hospital)" (GP 6) |