Yesterday I was a GP registrar and today I am a GP. I believed the mass of questions I put to my trainer surely encompassed everything I would need to know as a GP and allow me to start work with confidence and well equipped for my chosen speciality. Having left the training bubble to enter the world as a ‘real’ GP though, I seemed to generate an enormous further list of questions. Unfortunately, this time, I had to seek out the answers for myself. The transition from training to practising independently can be understandably daunting and I hope this article may ease some anxiety amongst the thousands of new GPs starting work.
Something not to be underestimated is the emotional impact of leaving training. The role of a GP trainee is one that is wonderfully nurtured and supported. Weekly you meet up with your vocational programme counterparts and programme directors for a half-day of teaching, learning, mentoring and debriefing (fitting in a cake-filled tea break of course). This is your opportunity to discuss clinically challenging cases as well as those ‘heart sinks’. Then all of a sudden, you find yourself at work without the daily protection of your trainer across the hallway.
Community GP group
It is still important to have the medium to discuss any case you feel as necessary to gain another perspective and for those of us lucky enough to work in a practice with an ‘open door’ policy, with colleagues who enjoy clinical dialogue, an outlet is easily accessible. For others who are more isolated (locums or those in single-handed practices), arranging a community group with like-minded GPs can be very valuable. It is now commonplace on exiting the training scheme to join such a group, usually filled with those friendly faces you recently trained alongside. It not only provides a forum for clinical discussion but also a sounding board to compare workloads and working expectations. Meeting usually monthly also presents the opportunity for teaching, therefore contributing to annual CPD points, benefitting not only your knowledge but your ever important clinical portfolio, vital to appraisals and revalidation.
The knowledge mountain
Achieving the MRCGP was a monumental relief. It was acknowledged at least on paper that I knew what I was doing. All the revision of guidelines and policies had reaped its benefit. As after any exam though, you may find yourself recoiling from further reading, escaping the haunting thoughts of revision that had occupied your mind for a large proportion of the ST3 year. Following starting work, you may come to realise that you have barely started climbing the knowledge mountain which keeps changing in height (It’s not fair, you spent months getting up to date and now it’s all changed again!) and therefore you must put aside some time each week, whether whilst at work or at home, to continue your scramble up the rock face again. It is amazing the impact increasing your medical knowledge can have on your confidence. Don’t misunderstand me; nothing can replace the value of clinical experience, however theoretical knowledge can give you the solid foundation to build upon daily.
The feeling of being overwhelmed and stressed may be a surprising addition to your day, slowly increasing its appearance as you independently manage perplexing cases alongside a time-pressured, ever-increasing administrative workload. The long days can be exceptionally tiring and a consequence may be the development of a more sedentary lifestyle. The ease of falling into a pattern of work, sleep, work, sleep can almost make this the default position and so it is important to organise recreational activities whether it be the theatre, dinner or a music event to maintain a balance between work and play. Keeping physically active doubtlessly helps spark your spirits and increase your energy levels. As doctors we are sometimes guilty of not following the advice we so readily and heartily give our patients. This can also be a form of house-keeping, allowing you the healthy separation between clinical and personal life.
Am I a trainee or a ‘real’ doctor?
Daily, I still have patients question how young I look and whether I am a trainee or ‘real’ doctor. On paper I am a real doctor, I even have the certificate to prove it but in practice, I am still learning and I will continue to do so. The most important advice I can give others embarking on the same journey is to know that despite no longer wearing the "I’m a trainee" badge, you are still supported and can get advice from many sources including hospital specialists and colleagues. You just have to create your own networks and doing this early will soothe the feeling of uncertainty that may frequent your consciousness as a newly qualified GP.
Dr Franco is a GP in London