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Performance: trainer role - case study
GP registrar
All case studies on this site are fictitious but based on typical situations referred to the CDU.
Dr EK was an exuberant doctor who had previously spent some years in general surgery and A&E. Prior to starting his one year as a GP registrar he had done six months obs/gynae.
He became popular with the receptionists and the other partners when he insisted in cutting short his induction fortnight and even more popular when he reduced the time of his consultations from 20 minutes to 10 minutes. His trainer, Dr GD, remained slightly uneasy and arranged to do a joint surgery. Dr K seemed to have mastered using the computer but his style of consulting reminded Dr D of the sift and sort style associated with A&E.
She explained this to him, suggested he read a couple of books on consultation styles and hoped that the consultation skills work on the VTS day-release course would help. Over the next six weeks a trickle of minor complaints came in: one patient immediately re-booked with another doctor; a district nurse was not happy with the outcome of his visit to a patient; and then one of the partners overheard Dr K speaking impatiently to a patient on the phone, saying 'Well you either take that or lump it'. Tutorials always seemed to focus on management guidelines for chronic diseases or the best technique for joint injections. Dr D set some clear plans for videoing but there were technical difficulties and six weeks later he had still not recorded a surgery.
Dr D decided to share her concerns with her trainers group and was astonished to find that her GP registrar had only been once to the day-release course. She was encouraged to challenge him about this but was told that he preferred to join some friends who were also GP registrars on a London scheme where he was living. Firm plans were made to video his surgeries but 4 weeks later nothing had happened - Dr K said that one time the video tape had snarled up, and another time none of his patients wanted to be videoed. Dr D sat in on his next surgery and was very concerned about his manner with patients. She phoned the VTS course organiser who agreed to do his approaching mid-term assessment himself the following week. During that week the practice received two more formal complaints from patients virtually saying the same thing - he didn't listen.
The mid-term assessment did not go well. Dr K became very defensive and accused Dr D of harassment.
Following the mid-term assessment the VTS course organiser discussed the situation with the GP Associate Director who came to the practice and did a full assessment of the situation, sitting in with Dr K and reviewing Dr D's extensive and detailed training records. The GP Associate Director was concerned about the attitude to his patients that Dr K had demonstrated during the course of the day and wondered whether he was really suited to general practice. He recommended referral to the CDU.
The CDU coach explored Dr K's original career decisions and previous experience at work and it became clear that Dr K really only valued himself as a doctor in a technical role. He preferred doing procedures to talking and found the complexity and uncertainty of general practice difficult. He found it hard to admit that he did not have the interest or communication skills necessary for general practice and did not accept that he had particular learning needs in that area. A performance improvement plan was negotiated which included attendance at a residential consultation skills training course. He dropped out of the course on the second day as he had found it uncomfortable and exposing and his trainer arranged for an early review with the CDU coach. Dr K agreed that he may have made the wrong specialty choice and the CDU arranged for him to have some work experience in ENT. He is now an SHO in ENT and working for his exams.
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