GPs can look to Limerick for inspiration

The graduate entry scheme at Limerick University has a special emphasis on primary care-centred learning

It was a bitter-sweet week in my office. We were sad because Gaia, our resident medical student for the past 18 weeks, had completed her attachment in general practice and was leaving us.

There was much to be glad about . She had availed of every learning opportunity presented to her spectacularly well, but we, the staff and the patients, will miss her sunny nature and youthful enthusiasm.

Gaia is a GEM – one of the graduate entry medical students from Limerick University, which has a special emphasis on primary care-centred learning. Third-year medical students are placed with us for over four months, which admittedly is a long time. I am always a bit apprehensive before they come and sorry when they go. If you get a real treasure like Gaia, then 18 weeks can pass all too quickly.

Most are from Ireland, the UK and Canada. They all have obtained a degree before they start medicine. They could have been a historian, an actor, a nurse or a vet in a former life, but now they are students again and there is always something about contact with students, and exams and lectures that keeps you young.

Questions

They also keep you on your toes. Questions such as “why do you do that?”; or “why do you do it that way?” can leave you stumped. You might have forgotten, or never really thought about it. The standard reply if you are stuck is “look it up” but you usually look it up yourself before they do. You are also very aware you are setting an example and take care not to miss cues, and follow all trails. You try to practise good, scientific-based medicine, with good evidence for everything, and give your best.

There is an added value in that country doctors like me are able to take part in research, teaching and academia. The teaching slows you down at first, but you are amply repaid towards the end of the attachment, when the student can take blood samples, do an ECG and gather the relevant details, and present the history to you in a sensible manner.

The patients love them. You try to find the “teachable patients”, the one who has long-term illness such as diabetes, the mother of a child with special needs, or the AA member who will explain exactly what their life is like. I have a few of these teachable patients who, no matter the complaint that brings them in, are kind enough and keen to help educate a doctor of the future.

The students can find it bewildering at first; all the acronyms, the shorthand of medical professionals, the computer system, why somebody is deemed sick and an ambulance is called immediately and another is sent home, reassured, not to mention the ethos, heritage and culture of Irish general practice.

It does not matter what they are interested in, from surgery to psychiatry, they will see plenty of their favourite subject in a GP’s office. They will see many a condition in a hospital as well, but in a GP practice it is easier to appreciate that you are dealing with a person who happens to have a condition. When the patients are in a hospital bed, it can be difficult for a beginner to see them as an individual.

Teaching students can make you immortal. I still remember the young doctor, now a grey-haired consultant, who showed me exactly how to put up a drip. Maybe my ghostly voice will whisper in a student’s ear long after I am gone as I show them how to steer a consultation back on track, how to listen, how to be honest with a patient and with themselves and how to write an effective letter

The University of Limerick Graduate Medical School celebrated its 10th birthday recently. It has been a spectacular success. There are 600 medical students in training. When they qualify they will contribute to filling the places in training schemes for general practice and hospital medicine. They are an important part of a huge network of community-based research, a collaboration between the Mid West Hospital Group and the university. This can only be good for patient welfare.The newly-appointed professor of general practice, Prof Liam Glynn, combines being an academic with being a rural practitioner.

Students such as Gaia may not opt for general practice, or even stay in Ireland, but wherever they go they will carry with them the ethos and skills learned in an Irish GP’s office. That is something to celebrate.