An ECTV reflection by Penny Ramsay, Medical Educator with NTGPE
As I sit back in the small single engine plane, climbing into the clouds away from the little East Arnhem community of Milingimbi I think admirably of the resilient GP registrar who is wrapping up their day in the clinic on the ground below. I have just spent several hours sitting in on her consultations. I have watched her assess and manage a variety of patients, most of whom spoke very little English and accompanied her to the home of a dying patient with the clinic’s Aboriginal health worker and watched her assess a seriously dehydrated child and organize a medical evacuation. During the day we had many interesting discussions about the patients she saw and the many rewards and challenges she faces working in Milingimbi and Gove Hospital 300km away. In the course of the day I also shared lunch with the clinic staff, had a chat with the registrar’s GP supervisor and was shown around the clinic and community. All that remains for me to do is to write a short report of the visit.
I have just completed an External Clinical Teaching Visit, known in the trade as an ‘ECTV’. GP Registrars participate in five compulsory ECTVs during the course of training, in which an experienced GP Medical Educator from outside of the practice spends half a day watching them consult with patients. Time is taken between patients to discuss each consultation, focusing particularly on the process of the consult and communication issues. The GP visitor tries to be a ‘fly on the wall’, not interfering with the consultation process in any way. This gives a more accurate idea of how the Registrar operates from day to day. At some point during the visit the educator meets with the GP Supervisor to discuss the Registrar’s progress and any issues or concerns. A report of the visit is sent to the Registrar and Supervisor.
ECTVs are one of the few tasks I have continued to do since cutting back on my hours as a Medical Educator with NTGPE a few years ago. Watching such a variety of doctors consult highlights the range of styles, skills and approaches we have as GPs. ECTVs provide a welcome opportunity to get to know registrars and supervisors and give very interesting insights into other practices. The practice settings range from mainstream general practices and remote aboriginal clinics to Australian Defense Force clinics all over the NT. It is great to see the same Registrar at different times over the course of their training, as their skill base and experience increases. The visits also provide a valuable opportunity to help Registrars with general issues and concerns.
I find it a privilege to work at this level GPs in training, helping them reflect on the consultation process, their style and habits. Observation and reflection allows us to mentally re-live the consultation with its many twists and turns, exploring alternative meanings, missed opportunities, consideration of patient concerns and hidden agendas which may not have been addressed. Acquiring the skill of reflective practice sets up GP Registrars for a lifetime of rewarding patient interactions and increasing effectiveness as GPs.
So what skills do you need to be an ECT Visitor? Basically any experienced GP who enjoys working with Registrars and has an interest in the GP consultation can be trained to do these visits. Why not add variety to your work as a doctor and talk with NTGPE about this opportunity.
For more information regarding ECT visits please write to us at education@ntgpe.org