Registrars are required to gain experience of working out of hours as part of the nMRCGP.
This is done predominantly in the GP setting, although some hours may be organised with other bodies, such as NHS Direct or the ambulance service, at the discretion of the deanery.
Although there is no fixed amount of time to be 'signed off', the accepted minimum is 72 hours during the registrar year.
This time should allow a registrar to encounter a wide variety of medical problems, gain experience of consulting in unfamiliar primary care centres and patients' homes, and become skilled at telephone triage.
A registrar should have exposure to the challenges facing the out-of-hours GP, for instance being able to prioritise a number of cases arriving simultaneously and understand how he or she can access medical support and specialist help.
In most deaneries, it is left to each registrar to organise their own out-of-hours training. For some this is quite straightforward as many GP trainers regularly complete out-of-hours time themselves, however the quantities vary enormously.
Some registrars do not do any out-of-hours at all, leading to difficulty in organising and completing their requirement. Some registrars have had to extend their ST3 training in order to complete the out-of-hours requirement alone.
This is not only frustrating for an otherwise competent GP registrar but also has an impact on the deanery in terms of finding and financing a suitable placement in which training can be completed.
One solution is to seek an out-of-hours supervisor. The registrar can accompany the supervisor on out-of-hours sessions and the hours spent together count towards their nMRCGP.
Out-of-hours supervisor training courses are run by many deaneries. The course is a mandatory requirement for anyone keen to take a role as an out-of-hours supervisor who does not have prior formal GP educational training.
The out-of-hours supervisor's training course consists of two sessions six weeks apart.
The first session serves to introduce the formal elements of out-of-hours experience that are required in order to satisfy nMRCGP criteria.
The role of the out-of-hours supervisor alongside other members of a registrar's support network is examined and some of the strategies to help maximise an individual's out-of-hours sessions are discussed.
The follow-up session is designed to occur after some initial supervising shifts have taken place. It allows supervisors to discuss their experiences, brainstorm any problems that have arisen and make provision for minimising future problems.
It is easy to forget that out of hours can be quite a daunting proposition for a registrar, so methods to minimise anxiety and help a new doctor feel comfortable in an unfamiliar workplace are discussed.
Arranging to arrive at the out-of-hours venue together for the initial session, accompanying a colleague to the correct area and introducing them to the out-of-hours team are simple initial steps that may be overlooked.
The supervisor's role
An out-of-hours supervisor's role goes beyond that of simply overseeing someone else's work and policing their hours.
Patient safety is vital, as is ensuring the needs of the primary care organisation in terms of service provision are adequately met. The goal is to satisfy both of these elements while maximising a registrar's learning potential during their out-of-hours experience.
Learning should be needs-based where possible. Time should be spent discussing previous experience. Using tools such as the RCGP Npep self-rating tool to identify strengths and areas of less confidence help to establish the unique goals that a registrar is hoping to achieve.
Some registrars will complete all their out-of-hours training with one supervisor, others will spend time with a variety of GPs.
A supervisor will often decide to lead initial sessions with a registrar sitting in on consultations. This can provide an ideal opportunity for a registrar to be in charge of data entry, becoming familiar with the computer system while listening and contributing to the consultation.
As both registrar and supervisor gain confidence, an increasing amount of responsibility passes to the trainee.
In some cases final sessions are run completely by the registrar with the supervisor available remotely for telephone back-up and able to be called in as required. However, many choose to remain on site for ongoing support, ad hoc discussion and teaching opportunities as time allows.
At the end of each out-of-hours session, time should be allowed for debriefing. This provides a chance for a registrar and their supervisor to review the session, identify areas of success and look at how problems may be dealt with and minimised in the future.
A Pendleton-type approach encourages a registrar to lead feedback, drawing on the positive aspects foremost. Further sessions can also be planned.
The final task for a supervisor is to complete a registrar's logbook. Although the ePortfolio has technically replaced the old Committee of GP Education Directors logbook, many deaneries encourage both forms of record and supervisors will often be asked to help with this.
Spending time as an out-of-hours supervisor has not only had the benefit of increasing provision for training local GP registrars in out-of-hours but is also a valuable learning experience for a new educator.
It is an ideal introduction to the principles of adult learning and is a great start for someone planning to become a trainer in the longer term.
1. GP registrars must gain out-of-hours experience to pass the nMRCGP.
2. An out-of-hours supervisor training course is mandatory for anyone wishing to become an out-of-hours supervisor without formal GP education training.
3. Supervisors are accountable for their trainees and should structure sessions to suit their level of confidence.
4. Allow time at the end of each session to debrief and to work on the trainee's ePortfolio or logbook.
- Dr Cumisky is an out-of-hours supervisor and GP locum in Bath
- This topic falls under section 3.7 of the curriculum 'Teaching, Mentoring and Clinical Supervision', www.healthcarerepublic.com/curriculum.