On Wednesday 7th August, I tweeted ‘And I can now say it: I’m a GP trainee’. Although my road to starting GP training had been slightly rocky, I was finally here, ready to start ST1.
When it came to ranking the hospital jobs on offer for ST1 and ST2, I took the decision making process seriously. I devised my own points system and allocated each set of jobs a score, painstakingly totting up marks for how many on-call shifts I’d have and which wards I’d cover on night shifts.
Unsurprisingly, I was teased by friends and colleagues for using this approach – and they were right. No matter how fancy my algorithm and spreadsheet were, the key question was this: what jobs were going to help me in becoming the best GP I can be?
The answer was pretty simple; I wanted some exposure to women’s health, whether that be via obstetrics and gynaecology or sexual health. Then thinking back to my F2 placement in general practice, and the duty doctor sessions in particular, I remembered that a large proportion of my time was spent reviewing children with rashes, wheezing or abdominal pain. In order to feel like I was fully equipped to enter the world of general practice, I knew I should spend some time in paediatrics – and that’s where I find myself now, two months into ST1.
Starting in paediatrics
Before I started, I was honestly terrified. How would I manage an acutely unwell child? What would I do when handed a floppy baby at a delivery? Could I remember any paediatric or neonatal resuscitation? What I know now is that these feelings are completely natural for those of us who have not worked in paeds or neonatology before, the latter especially being such a step away from adult medicine.
One of the many lovely things I've found about paediatrics, though, is that my colleagues are great. Registrars are supportive and helpful, while consultants are approachable, kind and enthusiastic to teach. I've found that my educational sessions are often geared towards the GP trainees, focusing on presentations and conditions we are likely to face in the community, and how best to manage these.
The novelty of officially being a GP trainee hasn’t worn off yet (it still seems strange writing GPST1 in patients’ notes) and I feel very proud to tell both colleagues and patients’ relatives that this is what I have set out to do. It is wonderful, therefore, to be welcomed with open arms into the paediatric team, with respect for my role, no snide comments about ‘GP Land’, and instead an appreciation for the impact a good GP can have on a child’s health and development.
It is definitely hard at times. Having had a year out of training as a clinical teaching fellow, it was a big shock to the system when I had my first set of nights in 18 months.
September was crazily busy on the post-natal ward, with a never-ending list of babies requiring their newborn checks (it seems that the joke about this time of year being a peak for births following a merry Christmas season is actually no joke). But as my FY2 colleague said to me at the end of a 12-hour shift, 'I know it’s been really busy and hectic – but it was still quite fun, wasn’t it?' And he was right - it was.
Hospital posts as a GP trainee
I did initially have concerns about the 18 months of hospital-based jobs during GP training, and fears that I would be used simply for service provision. But so far, this has not been my experience at all.
I am there to learn from our hospital-based colleagues, experts in the fields of paediatric cardiology, respiratory medicine and neurodisability, so that I can take important lessons and experiences with me into ST3 and beyond. Yes, the rota is tiring; yes, working one in two weekends is a bit rubbish; and yes, four-day stretches of 12-hour night shifts are tough. But I’m learning a lot, and it’s all part of my journey to becoming a good GP.
Lots of people have said to me that they’re surprised paediatrics isn’t compulsory for GP trainees. I can see their point. It is only by spending time observing and assessing many different babies and children that you start to build up confidence in deciding if a child is well.
Can this child go home? Do they need to be admitted? Are there safeguarding concerns? Is this a concerning rash? But I also think that other specialties may argue the same. For example, a study of 1,000 GPs last year found that 40% of GP consultations involve a mental health concern – so should a psychiatry rotation not also be essential?
It’s an interesting conversation, and I’m not sure where I stand. What I do know is that I’m finding paediatrics incredibly useful (and fun) and that when it comes to GP training – so far, so good.
- Dr Brown is an ST1 GP trainee in Gloucestershire
