Horses for courses, or Courses for horses?

I just got back from beautiful Fremantle (Perth) – completed the REST (Remote Emergency Skills Training) course and then spent a day running an introduction to ED Bedside US for rural GPs.  So I got to be on both sides of the educational table this week.

Whilst there I had the chance to catch up with Dr Tim Leeuwenberg (@KangarooBeach ) and we chewed the fat over the value of these rather pricey and time-consuming courses in the context of FOAMed.  So I thought I would write my opinion: where are we at with “ongoing professional development”?  Including a review of the REST course and my own “ED USS for GPs” course.  I know – how could I be biased – well read on….

The REST course was designed to be a 2 day intensive training course for rural & remote doctors.  It is really intended for the PGY2 – 4, the newly arrived OTD or even the city doc who is contemplating a semi-retirement in locum land – servicing the remote communities of Australia.  As a rural ED / Proceduralist type of Doc it was not really what I had expected after reading the comprehensive, if slightly dated manual pre-course.  The basis of the REST course is sound – DRSABC….primary, secondary surveys –  a structured and safe platform for dealing with sick and traumatized patients.  And there was even an inkling of “newer practices”.

The REST course is taught well by the ACRRM crew – a big ask for such a diverse group of students and a lot to cram into 2 days.  The atmosphere was nice, friendly and open for discussion – though the pressure of time was evident.  The use of simulation was OK, however I thought it could have been made more complex / realistic, forcing the students to think and think again.

Now for the downside – I have concerns – the REST course is designed to get new country docs “up to speed”, however the syllabus is really not in touch with modern practice.  I think if you were a new grad or OTD going bush for the first time and RESTed on your ‘REST laurels’ – you would end up being competent, but the experienced nurses you would go out into the bush and work alongside will be practicing (and expecting you to practice) a more evidence-based, up to date version of emergent care.

REST is like most “resus guideline” based courses – it follows simple algorithms that are really designed for the layperson or volunteer to apply in the community – once we walk into a modern ED we practice very differently.  Resuscitation is about prioritization and resource management – it relies on a practical skill set also which are not really covered in the REST course.

In fairness the REST course is up for a review this year.  However, I think it might be impossible to cater to all levels of training in the current format. 

REST is an entry-level course and certainly has its place as the minimum requirement for remote practice.  For more experienced rural doctors though there really is not a course that offers contemporary training in Emergent care in the GP sphere.  More on this to come….

When I was asked to run a full-day workshop for novice US users I had to think long and hard about the format, the audience and the material.  I decided to offer a superficial taste of all the modalities that I find useful or “life-saving” in my practice.    In the era of FOAMed I think that the role of the face-face workshop is to correct and perfect the hands-on minutia of US – the learning can all be done online in advance.  The individual needs to commit to a long, uncomfortable period of trial in practice to learn technique once the basics have been taught.  The workshop really just acts as a focus – a date , a place, a commitment to learn.

My goal was to try to inspire my colleagues by showing the enormous advantage of US in common clinical scenarios – to try and spread the US bug and encourage them to engage in their own online learning.  I am not convinced many would have walked away with much in the way of usable skills – but hopefully some got the bug – a desire to try to improve care with bedside US.

OK, so it seems a bit bleak!  So how do I see the future of GP education?

Well this gets right at the heart of why I started this blog in the first place.  I don’t believe there should be any distinction between patient care based on geography, who is at the bedside or what “specialty” covers their disease process.  If there is a g0od answer to a problem, evidence-based therapy then it should be delivered no matter when, where or who.  So how does this apply to GP education?

There are 2 basic options available to us:

(1)  develop great, competitive, evidence-based and cutting edge training opportunities for GPs –

(2) Join in on the specialist education – take our place at the table and eat up the knowledge these docs have.  Who knows – we might even have a bit to offer ourselves!

Up until recently I was a fan of option (1) – but now I am leaning to option (2).  The power of FOAM has shown me how applicable specialist knowledge and practice can be to us as remote generalists. 

Next March in Sydney there will be a conference not quite like any other – there will still be beer, but this time we (the GPs) will be there – learning and sharing our collective wisdom.  In case you have been living under a rock – check out SMACC 2013 at . For me this is the answer to our educational woes – a chance to get involved and learn how to deliver great care anywhere.  SMACC is the physical manifestation of all the great free, online education that has exploded over the past few years. 

Hope to see you there.  Casey


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