General practice in medical education

Newly-appointed Deputy Head of the University of Limerick Graduate Entry Medical School (UL GEMS) Prof Liam Glynn recently chaired the launch of the institution’s U- LEARN General Practice Network.

The U-LEARN Network involves over 130 general practices nationally and approximately 500,000 patients, and the Professor of General Practice said its creation will provide a step-change in capacity in education and research at UL GEMS.

“The idea behind it came from asking our GP tutors, what could we do for them, how could we connect with them more and create a productive learning community between our university and our tutors. The ethos around the UL GEMS medical school is very much on community-based learning and we want to get away from this idea of an ‘ivory tower’ on campus and everything else ‘out there’, away from it. We want to intimately connect things, so that is the idea behind the Network… And it will also develop the problem-solving, research side of general practice,” Prof Glynn explained in an interview with the Medical Independent (MI).

A large percentage of UL GEMS graduates go on to become GPs and it bases 25 per cent of its clinical attachments within general practice — students undertake an 18-week clinical placement attachment in a single general practice.

Prof Liam Glynn (left), Conference Chair and Deputy Head of the UL Graduate Entry Medical School; and Prof David Hirsh, Director of the Harvard Medical School Academy, US

“That is different to most medical schools in the State and around the world. And there is a huge body of evidence showing that the standard block model decreases empathy, decreases professionalism, decreases knowledge acquisition, whereas these longitudinal integrated clerkships (LICs) are a great opportunity to increase all those,” Prof Glynn posited.

“We are really lucky with the high quality of our GP tutors in the U-LEARN General Practice Network and for many of our medical students, these tutors will become some of the most influential medical teachers and mentors in their careers as a result of this continuous relationship over their clinical attachment in general practice and beyond. So we produce more GPs than a lot of other medical schools and I think it is down to that, that really good mentorship and modelling, and when they are in a practice for 18 weeks they end up becoming important members of the practice team. They have their own patients — all under supervision — but they get a real sense of responsibility and the key thing is ownership over their own learning. Once you have ownership, once the student starts to talk about ‘my patients’, ‘my practice’, and ‘my supervisor’, it is a whole different scenario that facilitates a lot of learning.”

In addition, the Mid West GP training scheme is based on-site in UL GEMS, “so there is great potential synergy there to create this continuum of training, from the graduate education programme to the GP training programme. There are a lot of changes ongoing, with the transition of training from the HSE to the ICGP. It is a challenging time for training but there are also opportunities in that too,” Prof Glynn commented.

A long-time Co Clare GP, Prof Glynn is continuing to practice part-time, which he believes is key to his academic role.

“It is great to practice in rural general practice in particular, which has been struggling in recent years in terms of resources and funding, so having that insight is good when you are representing general practice in the [academic] arena… It is really important though to continue in clinical practice when you are in a leadership position, so as not to lose touch with what is happening on the ground.”

<h3>Launch event </h3>

With a record attendance of GP tutors and a theme of collaboration, the U-LEARN Network launch event featured keynote addresses from Prof Dave Hirsh, newly-appointed Director of the HMS Academy Fellowship in Medical Education at Harvard Medical School, US, and Prof Sonia Saxena, Professor of Primary Care at Imperial College in London.

Prof Hirsh leads the LIC programme at Harvard and first called for “continuity” as a key framework for medical education in his seminal New England Journal of Medicine paper in 2007.

He outlined the LIC evidence base with benefits to students in terms of knowledge acquisition, empathy and professionalism and described the 18-week LIC in general practice component at UL GEMS as a tremendous opportunity to deliver on this “continuity” framework.

Prof Saxena lauded the potential of the U-LEARN Network to deliver on the clinical audit and broader professional competence and research requirements for students and GPs alike.