The registrar year is a busy one, especially if you are planning to fit in the MRCGP exams on top of summative assessment. Unless you are well organised from the start, you can soon feel overwhelmed.
One of the things you can cover early is your written submission, before the exams approach. The first option is an audit cycle. Hopefully you will have some experience of clinical audit from your previous jobs.
How to choose an audit
In my first two weeks as a registrar I developed the impression that almost every patient I saw was depressed, and I felt badly prepared to deal with it. I therefore set about familiarising myself with the current literature on depression and discussed it with my trainer in tutorials.
While reading around the subject, I found that the relationship between alcohol and depression is far more complex than I had previously realised. Because my training practice provides the national enhanced service for drug and alcohol misusers, this theme was especially pertinent.
A quick look through the notes of several of my patients suffering from depression revealed a lack of any record of their alcohol history. I therefore decided that my audit would be: ‘Do all patients presenting with depression have their alcohol use recorded?’
It makes sense to choose an audit subject that interests you because you will get more out of the exercise, and if it is relevant to your training practice, your colleagues will also appreciate it.
I started by searching the literature for work on alcohol and depression, partly for my own education, but also to provide the background context and appropriate references for my audit write-up. You will need to be able to justify the criteria you have chosen and the standards you have set.
Once you have decided on a theme, you will need to make sure that you are able to extract patient information from the computer records and that you know how to make the computer system find all the relevant patients (in this case, those consulting for the first time with depression over a one-month period).
Because different doctors use different terminology, simply searching for ‘depression’ codes was not enough to ensure I included all the relevant patients.
Also bear in mind that it might be easier to choose a topic for which there are fewer possible codes to search.
Following this, I manually filtered the list of patients to include only those with a new diagnosis, and then read their complete electronic record to find any mention of alcohol consumption. You could save time by choosing an audit with target data that is easier to find (for example, a measurement that is always Read coded).
I presented the first data collection at a practice meeting, and summarised the current evidence to raise awareness as to why the subject was so important.
I also suggested how we could improve on our performance. This involved our reception staff handing out an alcohol questionnaire to every patient, and required the doctors to calculate and record the scores. It is important to consider your practice when you choose your audit, and to think carefully about how you will implement any change.
Second data collection
The second data collection a few months later was easier. Because I had already done most of the writing up as I went along, there was no last-minute panic as the deadline approached.
Submitting your audit under the required headings is very important, or it will be returned to you.
I presented the completed audit at another practice meeting. Significant improvements had been made, and because the audit subject was such a hot topic within the practice, I re-audited again after a year.
Dr Frankland is a salaried GP in Oxfordshire. She qualified as a GP in August 2005
How to get the best from your audit
Start the audit early in the registrar year.
Choose a topic you have an interest in and which is relevant to your practice.
Discuss your ideas with your trainer.
Choose a single criterion to audit to avoid complication and creating extra work for yourself.
Make sure you use the required headings.
Do not let the audit take over your life.