Interns learn more in GP surgeries than on hospital wards

HSE programme: Interns who train with general practitioners have a greater sense of patient responsibility than those training in a hospital setting who see themselves as "high tech secretaries", according to a new report.

Irish interns are for the first time getting the opportunity to complete part of their pre-registration year in GP surgeries and the participants of this pilot project say they are learning more than on the hospital wards.

An evaluation of the Donegal-based Interns in General Practice Programme launched last Friday by the president of the Medical Council, Dr John Hillery, found that those working with GPs have more responsibility for patients than those on the wards who are regarded as being "bottom of the junior doctor hierarchy fulfilling a mainly administrative role".

To date, six interns have taken part in the programme established following Medical Council-driven changes to the Medical Practitioners Act which allows interns to complete their training in specialities other than medicine and surgery and in settings other than hospitals.

Dr Peter Cantillon, a lecturer in general practice at NUI Galway and one of the programme directors, recommended it now be extended to all HSE regions because of the positive feedback of the interns involved.

He stressed that the interns worked under the strict supervision of GPs and were not allowed to write prescriptions but still got much more responsibility for patient care than they did on the wards.

He said the nature of the hospital work was that the intern did much of the "donkey work" including tasks such as arranging X-rays and taking bloods but did not get the opportunity for the more responsible aspects of patient care as an intern in a surgery did.

The GP-based interns also said there was more responsibility for one-to-one learning in the surgeries and more feedback than in hospitals where they had to learn on the job.

One intern reported that an average day in a hospital involved "a lot of high-tech secretarial work" while those on the pilot programme reported that in general practice, patients viewed them as another GP, a factor that did carry an extra burden.

The interns said they valued the opportunities to take individual responsibility for patient care under guidance in general practice whereas they appeared to operate at the bottom of a decision-making hierarchy in hospital medicine.

They also described the relationship between the working environment and the learning environment as being more blurred in general practice in that they were working and learning at the same time.

One intern said no real learning occurred on ward rounds.

Dr Cantillon said one of the most interesting findings was that interns felt that the insight they gleaned in general practice helped them later when dealing with people admitted to hospital.

Interns reported feeling more capable of evaluating patients being admitted to hospital because of the confidence built up in the GP surgery where they had to take histories and do examinations.

The evaluation noted that one of the advantages of the GP placements seemed to be the opportunity offered to consult alone, to practise clinical skills and to make decisions with patients.

Such "direct responsibility for patient care does not appear to routinely happen in hospital-based internship", it added.

The interns also reported that the GP experience was like being constantly "on call" whereas in hospital they did one on-call shift a week.

The HSE in the northwest in collaboration with the Department of General Practice at NUI, Galway established the programme in July 2004 for interns or graduates of NUI, Galway which allows them to spend three months of their 12 month pre-registration year in training practices in Donegal.