Small group learning keeps GPs up to date

MEDICAL MATTERS:How doctors stay alive to rapid developments

DO YOU ever wonder how your GP keeps up to date with the rapid developments in different branches of medicine? It requires a lot of time, usually well in excess of the minimum hours legally required since last year by the Medical Council. A combination of journal reading, skills courses, formal conferences, and increasingly, online resources are used by family doctors.

But a key method of learning involves being a member of a small group learning scheme along with fellow GPs. Organised by the Irish College of General Practitioners with funding from the Health Service Executive, these continuing medical education (CME) groups are run by a network of tutors under a national director, Dr Annraoi Finnegan.

A huge strength of the scheme is its emphasis on experiential learning, in which individual doctors discuss real challenges from day-to-day practice. Because of the small group structure, the learning is much more active than that available from most formal talks. And the topics are meticulously prepared to include the very latest in the management and treatment of patients.

To give an example, one of the two CME tutors for north Dublin, Dr Mary Davin-Power, prepared an educational package on sexually transmitted infection (STI) for small group learning earlier this year. Her objectives were “to help GPs improve their recognition of sexually transmitted disease symptoms, investigate them appropriately . . . to know when (and how) to treat and when to refer”. In addition she set out to update doctors on how the epidemiology of these diseases is changing.

Some 11,000 cases of STI’s were reported in the Republic last year. The most common was chlamydia infection, which accounted for just over half of cases notified to the Health Protection Surveillance Centre; genital warts came next at 16 per cent, with genital herpes infection accounting for 9 per cent of cases.

Chlamydia trachomatis infection has been increasing here in recent years; it is the most common treatable bacterial STI in Ireland. If you are under 25, have a new sexual partner or had more than one partner in the last year and do not use condoms consistently, you are at risk of chlamydia infection. Probably one of the reasons infection rates are rising is how often it causes no symptoms in either men or women.

For men who do have symptoms these can include pain passing urine, testicular pain or discharge from the urethra. Women may notice a vaginal discharge, pain passing urine and abdominal pain. They may also experience pain during sex or notice vaginal bleeding after intercourse.

Untreated infection can have devastating consequences for fertility. Persistent chlamydia infection may cause pelvic inflammatory disease, ectopic pregnancy, and infertility. It has been estimated that 10-20 per cent of women with pelvic inflammatory disease will develop infertility as a result.

For men, complications include inflammation of the epididymis (the fluid-carrying tube in the scrotum) and the testicle as well as sexually acquired arthritis. And for men having sex with men, symptoms include rectal inflammation and discharge.

In pregnancy, chlamydia infection is associated with premature rupture of membranes and premature delivery. The baby may weigh less than expected, have an infection of the eye (neonatal conjunctivitis) or develop pneumonia.

The good news is that treatment is both simple and effective. A single oral dose of the antibiotic azithromycin (1g) is highly effective – more than 95 per cent of those treated are negative for chlamydia after four weeks. However, for pregnant women, their infection is probably best managed by a specialist.

It’s really important that a sexual partner of someone with chlamydia is tested and if necessary, treated. Patients should avoid sex (or use a condom) for seven days after they start treatment to avoid the risk of reinfection.

My thanks to Dr Davin – Power for allowing me to share her material. And thanks to the CME tutors for helping keep doctors up to date.