Teaching new dogs old tricks

Leaving my GP training scheme role has prompted me to reflect on education in general practice

“Education is an admirable thing, but it is well to remember from time to time that nothing worth knowing can be taught.” Oscar Wilde

When I first started teaching GP registrars 17 years ago, I used to ask GPs at the end of their career how they had learned their craft. I doubted my ability to teach and wanted to compile a list of tips and tricks. One wise man asked me if I had ever seen anyone teach a hen to lay eggs.

“You can teach medicine,” he said, “but you can’t teach anyone how to be a GP. You either have it, or you don’t.”

Now, as my role as Assistant Programme Director (APD) in the south-east GP training scheme comes to an end, I am grateful to this man for being honest and forthright. His words have helped me to stay curious and humble, and offer encouragement and support when I feared that my teaching was not effective.

In 2018, the transfer of the GP training schemes from the HSE to the ICGP began. This process is near completion. Many long-term programme directors (PDs) and APDs have chosen to retire, creating opportunities for new teachers. My decision to retire was not taken lightly, as it means an end to an important part of my life’s work. Reflecting on this work, I know that I have not taught any medicine beyond what is contained in textbooks, guidelines, and journals. I have not created new knowledge or published any cutting-edge research (or any research at all for that matter) and I have no evidence of the effectiveness of my endeavours. Do I, and others like me, make a difference? Do we teach doctors to become GPs?

My imminent departure has created a sense of urgency to impart every piece of my hard-earned wisdom to the groups that I facilitate on Zoom every Wednesday. I imagine that when I leave, I will remember all the things I should have said; crumbs to guide these young doctors through the forest. But then, I remind myself that the birds ate the crumbs and Hansel and Gretel had to find their own way in the end.

General practice is a forest that is growing denser year by year. While general surgeons and physicians have been replaced by urologists, breast and vascular surgeons, respiratory physicians, old age consultants, and many other specialists, the GP is still the general practitioner with responsibility for all diseases, treatments, and drugs, alongside certification, vaccination, contraception, screening, and every opportunistic intervention imaginable, for all the patients on their list.

The curriculum for general practice is endless and perhaps this is why my friend said it could not be taught. But I suspect his words held more profound meaning. As I prepare to leave, I have noticed how often I see, hear or read something that I mentally file as “useful for teaching”. I have incorporated much of my own learning, reading, and life experiences into the teaching modules that line my bookshelves. As I begin to cull these modules, I remember the hours of thinking and preparation that went into each one and the many times I shared them with registrars. Workshops on communication skills, “finding flow,” “character strengths”, “positive identity”, “art observation and medicine”, effective listening, and others that would be unlikely to be included in a medical curriculum.

I recall how each teaching session was different, depending on the group, how well they participated and how curious they were about the subject. Each workshop was tweaked every time it was shared, depending on what worked well and what did not. But most of all, I remembered how discussions such as these only worked in a group that felt safe, valued, and respected, and how they helped us feel part of a profession that was as rewarding as it was challenging.
I always thought of these Wednesday meetings as a cauldron, where week after week, ingredients were added and, little by little, doctors became GPs.

I will miss being an ingredient in the mix, where, from time to time, magic happened – though I have no evidence of this. The pandemic meant a swift segue to online teaching. As a facilitator, I did not feel as safe and connected as previously and some of the magic disappeared.

But it is time to move on. There is now an empty space on my bookshelves that mirrors the space I feel within myself, that, for the moment, I am reluctant to fill. I am grateful to have been part of this community of GP teachers and registrars. I have learned a lot and had many laughs, even if I am still wondering if I managed to impart “anything worth knowing”. Wishing all retired and soon-to-be GP teachers every best wish for the future.