Better training in musculoskeletal conditions for trainee GPs
Although arthritis accounts for one in five visits to a doctor, musculoskeletal training provided to GP trainees is inadequate to equip them for their daily clinical work, a recent survey revealed.
This lack of knowledge about arthritis among family doctors is a major source of concern to the Arthritis Research Campaign (arc) whose second major remit, apart from research, is the education of the medical profession - as well as the public.
arc is already funding workshops and training sessions for existing GPs in practices in London and Bristol to try and fill this yawning knowledge gap. And now the charity has embarked on two more ambitious projects which aim to provide better, more specific education about arthritis and the musculoskeletal system for GPs - while they are still training.
One of the projects will identify which musculoskeletal disorders are most commonly encountered by GP registrars (trainee GPs) during their training, and the difficulties they have in treating them - before doing something about it. The other offers three GP registrars in Yorkshire one-year training posts in musculoskeletal medicine so that as well as working alongside GPs, they also train with osteopaths and chiropractors, gaining greater specialist knowledge and obtaining more skills to help them treat arthritis more effectively.
Dr Elspeth Wise, a newly qualified GP, has been awarded a four-year part-time educational research fellowship of £153,250 to establish the most common musculoskeletal disorders faced by GP registrars, and to produce a learning package for GP trainees which could be taken up by training schemes across the country. She will also evaluate arc 's learning guide for GP registrars, produced three years ago, but not widely used.
Junior doctors who want to go into general practice spend three years on a vocational training scheme, of which 12 to 18 months is spent in general practice. During this time they see many patients with musculoskeletal problems.
"GP registrars don't get to see many people with musculoskeletal problems in hospital where they train, then suddenly they go into general practice and are expected to know how to manage back pain, for example, or to know about aches and pains like tennis elbow and plantar fasciitis, and when to refer someone for physiotherapy," explains Dr Wise. "In a hospital we see acute conditions, not chronic ones."
Since the majority of cases in musculoskeletal problems are seen with dealt with on general practice, training should take place during the GP registrar's time in general practice so that they can learn how to manage these problems.
Dr Wise will be working with GP registrars at the Northumbria vocational training scheme in Newcastle, one of the biggest GP training schemes in the UK. Selected registrars will keep a diary of cases they have seen over a period of a year, and others will be interviewed about particular difficulties they have experienced when seeing patients in primary care.
From the information gathered, Dr Wise will then produce a learning package focusing on these difficulties, which will be tested on a new group of trainees to assess its effectiveness in helping them to understand and manage musculoskeletal conditions.
If it works it could be used by other training schemes around the country. Producing the learning package, in combination with a formal evaluation of arc 's learning guide, will provide a strong argument for the Royal Collage of General Practitioners to incorporate musculoskeletal information into its training scheme as a matter of some urgency.
In the meantime, arc 's second's educational project is offering some very hands-on experience for GP registrars in the Yorkshire area. Two GP registrars are currently in post in surgeries in Bradford and Cross Hills, near Skipton, where they are taught by osteopaths, chiropractors, physiotherapists and podiatrists, on the best ways of managing common musculoskeletal conditions. A third post in Scarborough is yet to be filled.
One of the doctor behind this project, Adrian Dunbar, who is also associate director of post graduate education at the University of Leeds, says his Damascene conversion to the urgent need for GPs to learn more about musculoskeletal conditions came when a simple knee complaint was unrecognised by both his GP and orthopaedic surgeon, leading to an unnecessary arthroscopy. He is now committed to improving what he describes as the "woeful" state of affairs in GP training, and would like to see in future all vocational training schemes in Yorkshire able to offer at least one such training post.
Colleague Philip Helliwell, a Bradford-based rheumatologist with a strong interest in education, goes further. "If we can demonstrate that these GP registrars obtain skills and knowledge of musculoskeletal conditions beyond that or the normal registrar then I think every training scheme in the country will be interested in offering these posts as an option."
