Medical Matters: Successful group learning scheme for doctors creaking under the strain

 

Do you ever wonder what your GP gets up to out of the surgery? Of course they have their hobbies – some play golf, some jog, some write articles – but it is a fair bet that they all go to small-group learning, known in the medical world as CME.

Now, as the leaves are getting brown and the swallows are getting ready, the invitations go out. In hospital libraries, hotel meeting rooms, doctors’ offices and even in GPs’ homes, we congregate like conspirators for a good workout on the subject of the evening.

CME stands for Continuing Medical Education. It is the process by which doctors surf the uncertain seas of medical research and development. Or, to put it bluntly, keep up.

The world is always changing and today’s truths are tomorrow’s heresies and learning is now lifelong (as if it wasn’t always). The standing army of 3,000 GPs go to small-group meetings. The information is peer reviewed, up-to-date and designed to be relevant to the participants.

There are about 1,200 CME meetings a year, involving practically every GP in the State. The movement is a very much like the Hidden Ireland of long ago, where highly sophisticated culture and learning is disseminated in every village and town, hidden in plain sight.

Tutoring
The CME network is run by about 34 tutors. I have to declare an interest here, as I am a CME tutor – and I find it one of the most rewarding things I have ever done. You are part-facilitator, part-researcher and part-impresario.

Dr Annraoí Finnegan, an international figure in medical education, is chief co-ordinator. That always impressive and friendly organisation, the Irish College of General Practitioners, plays a large role in the network.

The topic of the evening may be an update on the latest drugs or it may be difficult cases. We may do a run through of medical emergencies and the necessary equipment. It may be an introspective meeting, looking at ourselves and our attitudes. We may examine a local issue, like the closure of an A&E department or an outbreak of measles. It is truly amazing to see the way important information can be spread through the network, from Finnegan to the 36 tutors to the 3,000 members, like a bushfire.

The CME network is one of the most holistic, sustainable and community-based organisations you could imagine. The meetings are lively and animated, and information is passed around like a frisbee.

GPs can and should read the journals or join online forums, but they lack that local factor. You may need to find a psychologist for a troubled teen or a decent place for orthotics. The health system here has more tiers than a royal wedding cake and online training, while it has its place, simply can’t match up.

The CME small-group network is one of the great success stories of Irish medicine. It began in west Cork more than 30 years ago, where Dr Michael Boland and Dr Brian Jordan started them to combat medical and social isolation among GPs. The concept spread all over Ireland, to Europe and Scandinavia. Scotland has just developed the model based firmly on the Irish template.


Under strain
The network here though is under a little strain. A couple of years ago, the Medical Council deemed that medical education should be compulsory for all doctors. The CME network, which was already set up and successful, became incredibly popular. This brought problems.

As JRR Tolkien knew, the best number for an effective group is about nine – meetings in the city can now attract more than 20 members.

Some CME tutors, having as many as eight huge groups to manage, have had to close their doors and establish waiting lists. Newly established GPs have difficulty getting into groups. The Irish College of General Practice is looking at ways to help out.

As the group meets in the autumn, there is a warm feeling in the room. These group members are your friends and colleagues.

They swap the on-call with you when you need it, they see your children when they are sick and they work harder than is good for them – and now they come in their time off to learn and share their learning.

They bring the knowledge back to the ill and worried, and this is replicated all over Ireland, affecting hundreds of thousands of people. The value is beyond measure.

Dr Pat Harrold is a GP in Tipperary

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