October 2006, Vol 28, No. 10

What constitutes effective Family Medicine training?

Kwok-keung Ng 吳國強

HK Pract 2006;28:401-402

These are my problems. I don't know if you feel the same.

Some years back when I passed my exit examination and fulfilled the criteria to be elected as a Fellow of the Hong Kong Academy of Medicine, I applied to become a clinical supervisor. I was accepted. However, without having had any introductory programmes to become one or given briefing sessions, I was not sure what I could do to be an effective trainer.1-4

Theoretically a trainer should become better and better after accumulating more and more teaching and coaching experience. But two years have passed, and I still cannot convince myself about my effectiveness in giving training. Was I on the correct track? Although I had encouraged feedback from my vocational trainees, which were both positive and negative, I always felt doubtful how "genuine" that feedback were. Would my trainees worry about negative consequences if I was not happy with their comments and criticisms? Perhaps I would never know the answer unless their comments were anonymous.

On the other hand, what was in the trainee's mind when a trainee entered training? To have a stable job? Aiming for an attractive income? A chance to enter a training post for practising holistic care? Or just to get a postgraduate qualification? Without exploring our trainees' objectives and difficulties,5 I find it difficult to know how to motivate them to change their styles of practice and I feel the training given to them is far from being ideal.

Even if the trainees were motivated to learn, what was the training environment like? Supportive? How much time could they give to each patient? Could follow-up appointments be arranged? Any protected time for handling difficult consultations? How about continuity of care?

Can I make it more effective? Or should I make it more effective?

The trainer

Before becoming a formal trainer, will there be any briefing sessions for the potential candidate? When a new trainer starts supervising his trainees, are there channels to receive genuine feedback from the trainees? Can any constructive feedback be converted to motivation for the trainer to learn and to grow? Will there be any peer review among the trainers themselves, through videotaping, or sit-in sessions, etc? Will there be collaboration between the younger trainers and the academic institutions, where there are a number of experienced teachers and professors? Similarly will there be collaboration between the younger trainers and the experienced trainers?

The trainee

The job security and work prospect of Family Medicine trainees are beyond our present scope of discussion. However, in the past few years, it was regrettable to note that trainees with good experience and qualification had not accordingly been rewarded financially. The current employment contract for Family Medicine trainees in the Hospital Authority only enables them to complete their basic training. It would be better if training posts offered to trainees can cover the whole training programme, including higher training. This can help them to concentrate mainly on their training and not think about other matters.

Part-time training

Most of the trainee secondments sent to my clinic are 12 hours per week for six months. I would say neither a 12-hour week nor a six-months' duration is sufficient for effective training.6 For a patient with chronic diseases who visit our clinic at two to three monthly intervals, each trainee can only have a chance to see him twice, or at most three times. If the secondment lasts for only three months, the trainees sometimes are not different from relieving or locum doctors. How can good rapport be established between patient and carer? How can continuity of care be learnt and practised? Can this situation be changed?

It is not uncommon to note that, some training sessions even have to be cancelled or postponed because of service need. Can this be changed and the training time be protected?

For the rest of the week, trainees will stay in the General Outpatient Clinics (GOPCs) seeing 90 patients, or even more, in a day. It would be unfair to comment on the feasibility to practise any kind of patient-centred consultation in just four minutes, but surely this would be extremely difficult for young trainees to achieve. Besides, many of them will have difficulties arranging follow-up appointments for those patients in need. Thinking about the 90 patients per day in a GOPC, with comprehensive computerization, limited assess to arrange follow-up appointment and an increasing amount of clerical work, the Family Medicine training will hardly be enhanced if not already been jeopardized. Again, can this be changed?

These are my problems. Probably I am too simple-minded, sometimes naive, and impractical. However, if many of you have similar feelings, will there be room for us to make the Family Medicine training more effective?7-9

Kwok-keung Ng, MBChB (CUHK), FRACGP, FHKCFP, FHKAM (Fam Med)
Deputy Editor, The Hong Kong Practitioner.

Correspondence to : Dr Kwok-keung Ng, /F Ngau Tau Kok Polyclinic, 60 Ting On Street, Ngau Tau Kok, Kowloon, Hong Kong.

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