Planning And Organising Teaching
“Everyone was really keen to teach. There was time to teach and to learn.”
— Junior doctor
Introduction
Planning and organising learning has become an essential component of the VI or ML learner teaching practice. An increased number of learners, each with different educational needs, has meant that teaching needs to be organised. Making a teaching plan helps to ensure it takes place, and also increases the likelihood that the teaching is effective and meets the needs of the learners.
As part of their business functions, some general practices have developed strategic and business plans for their overall practice activities, both clinical and educational. Most practices have implemented some degree of planning for their teaching program. The Colleges now require evidence that such planning meets standards for teaching practices, and a teaching program is a component of the accreditation process.
The principal supervisor usually takes responsibility for developing a teaching plan, although practice managers are often responsible for implementing details of any plan.
Planning takes place at two levels—a practice level and an individual level. At the practice level, there is an overall plan for supervision and teaching within the practice. At the individual level, the individual learner has a plan mapped to their learning needs, supervision needs, and the curriculum and assessment requirements of their training program. At both levels, such learning may or may not be formally documented.
This page focuses on planning and organisation at the practice level. Planning and organisation requires consideration of the two key elements of teaching in a practice—the teachers and the arrangements by which they teach.
The practice teaching team
“You require a team around you that is quite committed.”
As the number and diversity of learners within a practice increases having sufficient teachers with appropriate skills has become an important capacity issue. A team of teachers is now identified in most VI practices.
These teams may include GPs, GP registrars, practice nurses, practice managers, allied health professionals and, in some contexts, Aboriginal health workers and cultural mentors. Medical students are increasingly viewed as both teachers and learners, as the concept of ML learning and teaching is evolving. Near-peer teaching of medical students by GP registrars is increasing and has been shown to have a positive impact on the learning experience.
In many practices, patients are also involved in teaching, and could therefore be considered as part of the teaching team.
GP teacher and supervisor
The role of teacher/supervisor team leader may include:
The GP has been the traditional teacher in the general practice setting. Indeed, the Royal Australian College of General Practitioners’ (RACGP) curriculum states that the term ‘doctor’ is based on the Latin word meaning to teach. 1. The RACGP curriculum recognises that GPs teach medical students, GP registrars, peers, other health professionals, as well as their own patients. Learning objectives for the GP teacher are outlined in the curriculum. The Australian College of Rural and Remote Medicine (ACRRM) primary curriculum 2. also contains objectives for teaching and clinical supervision of students in health fields, junior doctors and other health professionals.
The current challenges are increasing the number of GPs participating in the teaching endeavour, as well as retaining those that are already teaching.
The GPs who are practice owners and/or principal GP supervisors are usually designated as leaders of their practice teaching teams. Principal GP supervisors determine the models of teaching being utilised within the practice, influence the teaching and learning culture of the practice, and are often the ones that both allow and encourage others in the practice to be teachers.
GP teachers are also nominated as supervisors of learners in the practice, be they medical student, junior doctor, GP registrar or international medical graduate. As such, GP teachers have the responsibility for ensuring that quality clinical care is being provided to patients by all learners under their auspice. As nominated supervisors, GP teachers are often responsible for undertaking assessment of the learners. These roles are in addition to any structured teaching role and, as such, need to be recognised in terms of the time and resources that they demand.
Some new initiatives have evolved for the GP teacher and supervisor in VI practices.
Consultant GP supervisor model
The consultant GP supervisor model mirrors the role of the consultant doctor in a specialist clinic outpatient session, in which the senior clinician is responsible for the oversight of all the registrars, junior doctors and medical students working in the clinic in that session. This person would be supernumerary to patient care, that is, has no booked patients directly themselves.
Semi-retired GPs as teachers
Some practices are now continuing to engage their retiring GPs in a teaching role as the retiree decreases their clinical load. These GPs are often willing to take on a greater teaching load, as well as greater responsibility for the more time-consuming planning and organisational functions of supervision.
Team of supervisors
In most VI practices, learners are exposed to several supervisors, usually with supervisors timetabled to specific learners for different sessions. Learners often seek out GPs with particular skills or knowledge to obtain specific advice. Sharing the load of supervision amongst all GPs in the practice, including GP registrars, can ease the load on everyone and is a more sustainable supervision model.
Most senior supervisors enjoy the role they undertake in teaching learners, and believe they learn from their teaching experiences.
GP registrar
The role of the registrar in teaching most often includes:
As discussed, a GP registrar as a teacher is an important, new and evolving role, particularly in a VI practice.
Practice nurse
The role of the practice nurse in teaching might include:
Practice nurses have become an accepted part of the general practice clinical team. The role of the nurse as an educator has been identified as one of the core responsibilities of a registered nurse. Practice nurses are involved in teaching other nurses, practice reception staff, allied health professionals and both junior and senior doctors, as well as playing an important role in teaching patients.
Resources have been developed to support and train nurse educators in general practice. The nurse as teacher role often has specific emphasis on teaching medical students and GP registrars in wound management, immunisation, practice standards and chronic disease management. GP registrars and medical students clearly value the nurse as a teacher in the practice environment, and an increasing number of practices appear to be recognising and adopting nurses in the teaching role.
Practice manager
The role of the practice manager in teaching might include:
Practice managers are important members of the teaching team. Their role is central to the organisation of teaching events, such as tutorials or one-on-one teaching. Practice managers also arrange medical student, junior doctor and GP registrar placements in the practice, and often take responsibility for finances and payments. The have an important role in directly teaching GP registrars about practice management, billing systems, practice policies and procedures and business arrangements in running a practice
Teaching co-ordinator
Some practices have developed a specific teaching co-ordinator role, usually undertaken by an administrator or nurse. This person takes responsibility for ensuring teaching sessions are organised and that each member of the team is aware of their timetabled responsibilities. The teaching coordinator may also arrange medical student, junior doctor and GP registrar placements with the relevant training organisations.
Allied health professionals
Larger practices may also have allied health professionals as part of the health care delivery team. While the role for allied health professionals in teaching medical learners is currently limited, they may be responsible for supervising and teaching some students within their own health discipline who are undertaking placements in the practice. At times, allied health professionals participate in practice based clinical teaching meetings. Some practices have involved allied health professionals outside the practice (for example, the local pharmacist) in the practice teaching program.
Aboriginal health workers and cultural mentors
Aboriginal and Torres Strait Islander health services form an increasing number of VI training practices. In this context, the Aboriginal health workers and cultural mentors are important members of the teaching team. They are essential in teaching cultural competency and ensuring cultural safety of the learners in the health services.
A rural practice has four full-time GPs (three with hospital appointments), one part-time GP, two GP registrars at different levels of training and one long-term medical student. The practice also has two full-time practice nurses, a full-time practice manager and a part-time teaching coordinator. A psychologist and dietitian also work on a sessional basis at the practice.
The practice prides itself as a teaching practice and promotes this to its patients and the community at large. The practice has recently invested in additional infrastructure to ensure it has the physical capacity to teach.
One of the GP principals has the role of principal accredited GP supervisor for GP training. Another has the role of supervisor of the medical student, and this GP is a secondary accredited supervisor for GP training. All GPs are interested in having some involvement in teaching, particularly in their special interest areas.
The principal supervisor of the registrar is responsible for weekly ML tutorials at which all participants take turns in presenting, either a topic or a case. GPs with special interest areas present on these topics. Practice nurses are included in these tutorials.
The registrar supervisor is responsible for supervision of registrars and one-on-one teaching sessions. However, all GPs in the practice have scheduled teaching times with the GP registrars in which they provide education on their areas of expertise.
The principal supervisor of the medical student is responsible for setting up parallel consulting arrangements for the medical student, and also organises for senior GP registrars to teach medical students on a fortnightly basis for a session of parallel consulting with their patients. GP registrars also have some involvement in medical student teaching when the registrars undertake clinical sessions at the local rural hospital accident and emergency department.
Medical students are rostered to spend time with nurses in immunisation clinics, wound clinics and chronic disease management assessments.
Practice managers are responsible for orientation of all learners to the practice and spend time teaching medical software skills, practice policies and procedures, and billing arrangements.
The practice encourages the teaching team to undertake training in their teaching roles. The two GP supervisors regularly attend professional development as supervisors and encourage their GP registrars to attend the GP registrar teacher training workshops. The practice also has educational resources available for the teaching team. A GP supervisor handbook is available, and the practice nurses have a copy of a resource kit for practice nurses who teach.
Practice teaching plan
The development of a documented practice teaching plan can clearly outline the arrangements and expectations for learning in a practice. With a regular rotation of new learners through a practice, a documented teaching program can give new members of the practice team a clear indication of the teaching and supervision arrangements for everyone.
The documented teaching plan is provided to all new learners in the practice as part of the orientation process. It should be a living document that is changed as needed. Usually a practice manager is responsible for maintaining the plan’s currency. Some suggested details of content for such a plan are provided here.
A template for developing and documenting such a teaching plan is provided in the Resources section.
A documented practice teaching plan could include:
Teaching team: introduction of team members, including their roles and responsibilities. Some suggestions for roles of teaching team members have been provided above.
Details of staff and their special clinical interests: include team members with procedural qualifications or special interests such as women’s health or sports medicine.
An orientation checklist: Orientation of any staff member or learner to a general practice is an important component of any learning planning.
Most practices have checklists for orientation of new staff or students. Some practices have different orientation plans based on the staff or student delegation (for example, the medical student orientation may include different components than the GP registrar orientation).
Details of services: Outline the services provided in the practice, including special clinics
Details of services provided outside the practice: Detail any external services provided by the practice, such as visits to nursing homes, hospital work and outreach work.
Organisation of supervision: Describe which teaching team members are principally responsible for supervision of which learners, including assessment responsibilities. Include a timetable of supervisors if there are multiple supervisors involved.
Organisation of teaching: Provide a schedule for teaching that includes time of day, time of week, who is involved, the style of the teaching session, expectations about the amount of direct observation and video consultations, et cetera.
Resources in the practice: Provide an overview of the practice teaching/learning resources (for example, practice library, subscriptions, internet access, reputable evidence-based practice online resources, reputable online resources for patients).
Assessment arrangements: Describe the assessment arrangements in the practice (for example, formative assessments or other mandated clinical assessments, exam preparation sessions et cetera).
Other interesting activities: Describe any activities unique to the practice (for example, teaching with the physiotherapist located close to the practice, visits with local palliative care nurses or other community nurses).
Connection to local medical networks: Outline how the practice engages with the local hospital, primary health care network or other professional bodies.
Connection to local community events: Provide new staff with an overview of the practice in the community setting.
Quality improvement in teaching
Any teaching and learning processes should be reviewed on a regular basis to ensure that they remain relevant and effective.
Some ML learner practices engage in formal quality improvement review of their ML teaching processes. Evaluation has usually taken the form of a practice meeting of all staff and learners in which the group considers what components of the teaching program and learning activities are working well and what might be improved in the practice.
As a result of undertaking a review of their teaching processes, some practices document an action plan for change or improvement.
Practice action plans
An action plan documents agreed changes or improvements to the teaching and learning activities in a practice. The action plan may be a simple one-page document. A template of a practice action plan is provided in the Resources section.
Some examples of quality improvement planning from teaching practices are provided in case studies 2 and 3.
A practice team discussed ways of improving the teaching co-ordination in the practice. The teaching team decided to appoint an education co-ordinator who would have responsibility for administering and organising all the education activities in the practice (for example, medical, nursing and allied health staff et cetera). The role was developed to include the following tasks:
- 1. Establish fortnightly tutorials involving GP registrars, junior doctors, medical students, GP
supervisors and other practice staff. Organise timetabling to enable all the above staff to
take turns presenting a topic or case for discussion.
- 2. Develop a mini-syllabus for the practice to assist learners in developing their personal
learning plans on arrival at the practice.
- 3. Utilise learning plans as a teaching template, accessible to the whole team.
- 4. Develop a list of patients willing to be involved in teaching.
- 5. Organise GP registrar/medical student structured teaching sessions.
- 6. Encourage GP registrars as teachers of medical students.
- 7. Establish an inter-practice tutorial (that is, trial a monthly arrangement where all GP
registrars in the local region participate in a two-hour joint tutorial, with GP supervisors
from the practices involved taking turns to deliver the tutorials. Medical students and
junior doctors could also join these tutorials.
- 8. Establish an interdisciplinary tutorial series with nurses and allied health professionals.
After reviewing their teaching processes, a practice teaching team decided to trial some unique innovations and approaches to teaching. The practice action plan included the following initiative:
- Weekly ‘out of practice’ tutorials: Lunchtime tutorials in which supervisor, registrar and medical
student go for a walk or meet over lunch outside the practice. The time will be spent discussing
patient cases. Taking teaching outside the practice aims to achieve uninterrupted teaching time
and provide an opportunity to incorporate learning with mental and physical health.
- The patient as teacher: This practice planned to develop and train a group of patients who
would participate in planned teaching sessions with learners.
Suggested further reading
CoastCityCountry GP Training (CCCGPT). Resource Kit for General Practice Nurses who Teach. Canberra: CCCGPT. [http://nursingkit.ccctraining.org/index.htm][0] (accessed March 2017)
This is an excellent resource for practice nurses who are engaged in teaching in a general practice.
General Practice Supervisors Australia. Vertical and Horizontal Learning Integration in General Practice. General Practice Supervisors Australia, 2016. [http://gpsupervisorsaustralia.org.au/guides/][1] (accessed March 2017).
This is a basic guide to VI learning that has been developed by some experienced supervisors. It provides some practical tips and examples of teaching teams, as well as planning for learning.
Essential Elements of a Multi-Level Teaching Practice
Looks broadly at the essential elements of a ML learning environment and defines what helps to create success.
Patients as Teachers
Considers the crucial role patients play in the training of doctors and places them at the heart of the general practice learning environment.