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HSE-South East Training Scheme for General Practice

25 September 2020
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HSE-South East Training Scheme for General Practice

HISTORY & DEVELOPMENT

HSE-South East Training Scheme for General Practice (formerly South Eastern Health Board) was established in 1991, when the first significant expansion in General Practice Training in Ireland took place since 1981. Along with two other Schemes established at that time, it brought the number of training posts available nationally to 42, since increased to 160. 

Among the factors which led to its establishment was the existence of an enthusiastic and committed General Practice body in the form of the five ICGP faculties in the area, and the commitment of HSE to developing General Practice education.

While the scheme was modeled on existing Vocational Training Schemes, this scheme has been innovative in its educational approach in preparing Trainees for the unprecedented developments in General Practice over the past twenty five years.

 

LOCATION & DEMOGRAPHY

HSE-South East serves a population of over 434,000 people, covering counties Carlow, Kilkenny, Waterford, Wexford and South Tipperary. There are approx. 220 General Practitioners in the area, 90% of whom have contracts with HSE South through the GMS scheme.

University Hospital Waterford is located at Dunmore Road, Waterford, and it is here that the Training Programme's Office and teaching facilities are currently located. As a University Hospital it also avails of SHO Training Posts in Kilkenny, Wexford and South Tipperary Hospitals. Training Practices are located throughout HSE-South East Area.

GENERAL:

This is an integrated 4-year Scheme which combines 24 months spent at SHO level in relevant hospital specialties integrated with 24 months in two or more Training Practices. The 2 Programme Directors, together with 3 Assistant Programme Directors, facilitate learning on the day-release programme. All are actively involved in full-time general practice in the region. The educational planning and organization of teaching in the Scheme is the responsibility of the Programme Director. The General Practice Teaching Unit is based at the University Hospital, Waterford. 

Overall administration is vested in a Steering Committee; representative of those involved in General Practice Education. This includes Consultants from participating hospitals, General Practitioners and representatives of HSE-South and Irish College of General Practitioners. Trainees are also represented on the Steering Committee. It meets three times per annum and is responsible for policy development and ensuring liaison between the various elements of training. The Southeast Scheme has expanded in recent years and now has capacity for intake of 15 - 18 Trainees p.a.

 

ELEMENTS OF TRAINING

Special Features:

  • 2 of the 4 years are spent in general practice
  • First years spend an additional 4 weeks in General Practice
  • The programme may include a 4 month post in Malawi (this was postponed in 2020 due to Covid pandemic)
  • The Programme has developed a video consultation skills assessment module. This is used in the general practice rotation in 2nd and 3rd year. A secure web based application to facilitate easy upload and streaming of patient consultations is now live and being piloted in two Schemes
  • Where possible we try to allocate trainee posts based on their prior experience
  • Mix of rural and urban practices all of whom are covered by CAREDOC for out of hours care

The Scheme seeks to integrate important educational elements of training:

  • Hospital SHO posts 
  • General Practice posts 
  • Day Release Programme 
  • Personal Study.
  • Special skills learning
  • Supervised research
  • Video Consultation Skills module
  • Personal development module

HOSPITAL POSTS:

Trainees are appointed to a series of Hospital Senior House Officer posts over the initial three years of training. 

During year 1, two six month posts chosen from: 

  • Medicine,
  • Pediatrics
  • Ophthalmology 3/12 & Medicine 3/12

During Year 2, two four month hospital posts chosen from:

  • Emergency Dept
  • Psychiatry
  • Palliative Medicine

and 4 months in general practice

During Year 2 GP rotation trainees complete clinical attachments in:

  • ENT
  • Ophthalmology
  • Dermatology

During year 3, one four month hospital post in palliative medicine or O&G and eight months in general practice, this may include an overseas rotation in Malawi. A previous rotation to Australia is currently in abeyance due to unacceptable administrative difficulties with the Australian Medical Council. 

Year 4 - 12 months in general practice.

The curriculum for 4th year day release is defined by individual learning needs. Five main modules included in the 4th year curriculum are:

  • Research
  • Audit
  • Professional Development
  • Practice Management
  • Communication Skills

4th years have an opportunity to work with a consultant in a "clinical assistant" capacity in the following areas:

  • Palliative Care/Home Care
  • Rheumatology
  • Surgical skills/minor ops
  • Breast disease
  • STI
  • Women's Health
  • Methadone Level 2 clinics

Trainees will normally spend 12 months at University Hospital, Waterford, and twelve months in one of the three General Hospitals located at Clonmel, Kilkenny and Wexford. Specialty SHO posts are chosen because of their relevance to the discipline of General Practice.

GENERAL PRACTICE POSTS

There is a structured and incremental approach to working in General Practice. In year 1 each trainee will spend two by two week periods in two different training practices. In years two and three each trainee will spend a four month rotation followed by an eight month rotation in the same practice learning the core skills of general practice, consulting and delivery of care.

In year 4, GP Registrars will take an increased role in the delivery of general practice care. This will be combined with a research/audit project and an in-depth study of the business side of general practice.

 

TRAINERS

General Practitioner Trainers have been selected not only for the high standard of care they afford their patients, but also for their commitment to education. Trainers ongoing evaluation of clinical and educational standards is facilitated through a Trainers Workshop which meets monthly at the General Practice Training unit. These meetings have taken place via Zoom since onset of Covid pandemic.

TRAINING PRACTICES:

Attached to our Training Programme are 25 teaching practices. These are located in the HSE South area to facilitate attendance at Day Release Programme. 

Trainers and teaching practices are selected according to criteria approved by the recognized institutions (ICGP/Medical Council.)

Current Trainers

Dr. Austin Byrne, Tramore, Co. Waterford.

Dr. Brian Morrissey, Western House, Clonmel.

Dr. Dave Mahony, Dungarvan, Co. Waterford.

Dr. Dave Slattery, Waterford

Dr. Dermot Nolan, Tramore, Co. Waterford

Dr. Elaine Bolger, Carlow

Dr. Geoff Plant, Ferrybank, Waterford.

Dr. Sinead Wright, Dungarvan, Co. Waterford

Dr. Finbarr O'Leary, Tramore, Co. Waterford.

Dr. John Cox, Fethard on-Sea, Co. Wexford.

Dr. Kevin Kelly, Clonmel, Co. Tipperary.

Dr. Liam Meagher, Killenaule, Co. Tipperary.

Dr. Marie Burke, Tramore, Co. Waterford

Dr. Mark Walsh, New Ross, Co. Wexford

Dr. Mike Quirke, Clonmel, Co. Tipperary.

Dr. Richard Roche-Nagle, Carrick on-Suir, Co. Tipperary.

Dr. Sean McBrinn, Waterford.

Dr. Peter Harrington, Gorey, Co. Wexford

Dr. Tom Lynch, Castlecomer, Co. Kilkenny.

Shared Training Practices

Dr. Gerry Sullivan (Clonmel, Co. Tipperary) & Dr. Bernardine Rochford (Clonmel, Co. Tipperary)

Dr. Mark Rowe (Waterford) & Dr. Ita Creavin (Waterford)

Dr. Tony Lee (Waterford) & Dr. Aine Hennigan (Waterford)

Dr. Claire Cusack (Kilkenny) & Dr. Gobnait Kearney (Kilkenny)

Dr. Derek Forde (Enniscorthy, Co. Wexford & Dr. Linda Forde (Enniscorthy, Co. Wexford)

Dr. Pascal O'Dea (Bagenalstown, Co. Carlow) & Dr. Aoife Cody (Bagenalstown, Co. Carlow)

 

DAY RELEASE PROGRAMME

A half day release course is organised throughout the four year scheme. For 2nd and 3rd years in practice this is expanded to full day release. This takes place on Wednesday afternoon, from 2.30pm to 5.30pm, at the General Practice Teaching Unit, University Hospital, Waterford during the academic term. (Note: day release teaching was delivered via Zoom during the Covid pandemic). Moodle was introduced on 1st February 2008 and provides an interactive learning platform for day release. Members use discussion forum facilities to prepare and follow up on day release teaching sessions.

The focus of the day release sessions is on the skills, attitudes and knowledge base of General Practice. Trainees are encouraged to participate actively in selecting topics, choosing the resource people and presenting as many topics as possible themselves. Preparatory work is under the supervision of one of the scheme directing team members.

The format of small group work encourages Trainees to identify their own learning needs as well as gaining the skills necessary to meet them.

 

PERSONAL STUDY

Trainees are encouraged to develop the life long professional responsibility of continuing medical education. This may be achieved through critical reading of the literature, audit and peer review in practice and basic research.

Development of information technology skills both for research and presentation is encouraged and facilitated.

Trainees will be expected to undertake a research project relevant to General Practice during their fourth year. Presentation of such research takes place at an annual study day.

There is an excellent library facility at Waterford University Hospital . The necessary skills of literature searching and critical review form part of the curriculum. A wide range of literature relevant to GP's is available to Trainees.

Trainees will be encouraged to attain further professional qualifications through examination. During the course of the Programme Trainees may sit relevant diploma examinations if they so wish. 

On satisfactory completion of the Programme, Trainees may seek membership of the Irish College by examination (MICGP) to obtain entry to the Specialist Register for general practice.

EVALUATION

There is a commitment to the ongoing evaluation of all elements of the Training Scheme. This includes regular assessment of the work of Trainees, Trainers, Hospital Teachers and Programme Directors. It also includes evaluation of the various elements of training to ensure that they are meeting the objectives of the Training Scheme. The Training Scheme undergoes an accreditation visit by the ICGP on a two yearly basis.

SELECTION OF TRAINEES

Trainees are selected by a system of open competition which includes a short-listing and interview process. Successful applicants are required to give a commitment to the four years of training.