At the Orchard Practice in North-West Leicestershire, state of the art video recording technology is proving an invaluable GP training tool for GP registrars from across the county.
Seven consulting rooms are equipped with ceiling mounted cameras and microphones to remotely record consultations, activated by a simple wall switch. Each camera is linked back to easily edited DVD or Blu Ray recorders, housed in a review and editing suite at the practice.
The innovatory new system has been introduced to the practice by GP's Dr Nick Foster and Dr Nigel Cartwright, both Programme Directors on the Nottingham GP Specialty Training Programme and MRCGP examiners for the Royal College of General Practitioners. They were looking for a more effective route to developing clinical consultation and communication skills, when they heard about the GBSG bespoke solution that was being used successfully in other practices. Now, the technological solution is being used to drive local training, for both their own practice trainees and for orthers across the country.
The practice has its own regular flow of GP registrars, and with the introduction of the new equipment it now also acts as a training venue through the East Midlands Deanery for trainees from across the county who are part of the Nottingham GP Specialty Training Programme.
The ease of use of the system, which harnesses remote CCTV monitoring technology, instead of the traditional tripod and point camcorder, is helping to improve the long term skills development for those in training, creating better practitioners who are better able to perform in the actual clinical assessment exam.
As the system is much less invasive, patients are more amenable to the idea of filming, and more comfortable as it takes place, with the only visible sign being a wall switch and a discreet ceiling mounted camera and microphone. With the flick of another switch, the system can change to voice only recording, if a patient is undergoing a physical examination that cannot be filmed - unlike a video camera where the only option is to obscure the lens.
Dr Nick Foster of Orchard Practice explains how they use the system and how it is working for them:
"Whilst the requirement of the CSA exam process is that consultations are done now by role play, observed by an examiner, we felt that filmed recordings had an important part in developing clinical skills to the required level.
"Within our own practice we have quite a few GP registrars and have to look at their consultation skills with live patients. We need to do that as part of our own internal review and whilst that could be done by observation, we believe that filming and review is a better option. It makes better use of human resources, as we don't have to sit in with our trainees, and it avoids the third person dynamic which tends to affect how doctor and patient interact.
"The trainee has much more input from us. We can talk them through the consultation and discuss areas for improvement. By analysing the footage, we can help highlight aspects such as how they pick up on visual clues and whether they considered all the management options as well as how they interacted with the patient.
"It also means we can review their performance on a regular basis, using the earlier consultations for comparative purposes. Having footage from the time they become attached to the practice at the beginning of training and reviewing as they progress is invaluable; you can suggest different ways of interacting to become a better consultor and how to improve their communication skills, which is key. The long term review also enables the trainee to reflect on their difficulties and recognise what they have achieved, which is an important part of the learning process.
"We also act as a learning centre for trainees throughout the Deanery. We have special training days when we bring in actors, so it's like the real exam, we film the consultations and then the consultations can be taken away for them to discuss with their trainer."
"The advantage of this new system is that it is far easier to operate and far less intrusive. We also find that the ceiling mounted camera and microphone have overcome the problems we used to have with poor sound recording. It works very well and has been a good investment as it enables us to offer training to the Deanery."
Dr Nick Foster, GP, Orchard Practice.