Dr Patrice Baptiste offers tips on how trainees can get the best out of the time they spend in out of hours.
When I was a trainee I really enjoyed seeing patients in the out-of-hours setting. It was quite gruelling at times because of the hours and number of sessions required but I learned a lot.
Below are a few things that you might find helpful in maximising your time spent in out of hours. The box at the bottom of this article also highlights information relating to out-of-hours placements from the RCGP.
Use tutorials wisely
For me, depending on the tutor I had during out of hours, I would either discuss the cases I saw or generate a topic to discuss. Having the time to discuss the patients you’ve seen is really useful (depending on what time during the session you have your tutorial) and you can use it in a number of ways.
You can reflect on how the evening went, or use it as a pit stop to re-evaluate and see if there is anything you need to adjust for the remainder of the session, this could be in history taking or management.
I also used my tutorial to practise cases for the CSA in the lead up to my exam. During the end of my training I used the time to think about my new career as a GP and gained really useful careers advice. Take some time to think about what you really need help with and use the time for that.
Ask for help if needed
Whether you are an ST1 or an ST3, you should never feel like you can’t ask the supervisor for help. Sometimes it is useful to get a second opinion, discuss differentials or various ways to manage the patient.
During the latter part of my training I asked for help less because I was more confident. However, I was always aware of my limitations and was never shy to ask for help if needed. I eventually realised that even as a qualified GP I could always seek a colleague’s advice and would not necessarily be on my own.
Experience a variety of settings
Again this depends on the area but ensure you obtain experience in different out-of-hours settings such as telephone triage. It was unfortunate for me that the telephone triage service was no longer available during my training so I only managed to complete one session before the service closed. The session was really useful but looking back I would have benefited from doing more sessions in this environment.
Try and do a combination of different types of work during your training if you can.
Spread the sessions out
I completed a lot of my out-of-hours requirements during the first half of ST3 and, although it felt good to complete them early on, it did drain me physically. So, while you may think it’s a good idea to get this done early so you can focus on other areas, it is worth considering spreading them out. This way you will not burn yourself out and can really make the most of the sessions.
Record and reflect on your cases early
After a long day and long week, reflecting on the cases you’ve seen in out of hours may not be at the forefront of your mind. However, do not leave the reflection for long because you may forget crucial pieces of information.
I made as many detailed notes as I could during the sessions and tried to write them up as early as I could. I was still able to reflect well on the cases I wrote about some time after the session because of the detailed notes I’d made earlier. It’s also a good idea to upload your signed sheets as early as possible, or at least taking a photo of them, just in case it they get lost.
Unscheduled care and out of hours in GP training
- In some areas of the UK, GP trainees will have a contractual requirement to complete a specified number of urgent and unscheduled care (UUC) or out-of-hours sessions/hours.
- The RCGP says that ‘fulfilling this contractual requirement should not be seen as equivalent to meeting the curriculum capabilities. Trainees will still need signed off as competent in these capabilities by their educational supervisor and this may require more hours than the contractual requirement.’
- Experiences of and learning from individual cases in UUC and out of hours should be recorded in the trainees learning log and linked to the clinical experience group for urgent and unscheduled care.
- From August 2020 educational supervisors will not be required to sign a statement that the trainee has met their out of hours session requirements. The capabilities required to provide urgent, unscheduled and out-of-hours care will be assessed as part of the overall educational supervisor report.
- More information on UUC/out of hours in GP training is available on the RCGP website here.
Written for Gp Online