The RCGP has published a detailed curriculum that needs to be covered over the specialist training scheme, whether that be through job rotations, teaching sessions or private study and eportfolio entries. These are the areas that will be tested in the AKT and CSA.
A full curriculum and the accompanying documents can be found at: http://www.rcgp.org.uk/training-exams/gp-curriculum-overview.aspx, but we have listed the curriculum headings below, with an adaption of some of the Key Messages detailed on the RCGP website.
The core curriculum statement
1: Being a General Practitioner
This first area introduces the use of competencies and the curriculum, and how to apply these to the rest of the GP training.
The contextual statements
2.01: The GP Consultation in Practice
This statement talks about patient-centred medicine. Ensure you have a non-judgemental attitude, use a normality-centred approach (as opposed to disease-centred) to negotiate a management plan. You should also learn how to manage complexity, uncertainty and continuity of care within time constraints.
2.02: Patient Safety and Quality of Care
It is important to take a role in improving health outcomes. This can be done through influencing your own practice and practice of others, working in a partnership with patients, reducing health inequalities and sharing learning experiences.
2.03: The GP in the Wider Professional Environment
This includes; co-ordinating and working with a multi-professional team in a clinical leadership role; leading and managing improvement in healthcare systems; considering your wider social responsibility as a GP by using resources economically and sustainably.
2.04: Enhancing Professional Knowledge
Trainees need to be able to develop skills to learn; critically appraise and teach; apply guidelines and evidence in the context of the patient; complete audits; stay up to date; be willing to receive constructive feedback.
The clinical examples
3.01: Healthy People: Promoting Health and Preventing Disease
As a GP you have a crucial role to play in promoting health, preventing disease and delivering brief advice and intervention where appropriate. It is also important to recognise factors the predispose ill health, and be aware of national and local screening programmes.
3.02: Genetics in Primary Care
The main themes of genetics in primary care are; identifying patients with, or at risk of, a genetic condition; clinical management of genetic conditions; communicating genetic information. Trainees should also be able to discuss antenatal and newborn screening programme results, and talk about the genetic susceptibility in common conditions
3.03: Care of Acutely Ill People
You must be able to recognise signs of illnesses that require urgent intervention, be able to prioritise problems, consider the patient’s wishes when choosing interventions. It is important to be able to make mental state assessments, and assess safety, keep your resuscitation skills up to date and keep calm during an emergency.
3.04: Care of Children and Young People
A GP has an important role in the care of children and young people, and there is an opportunity to promote health, particularly in vulnerable to socially excluded groups. You need to be competent at dealing with safeguarding matters, and be able to recognise children in need of support.
3.05: Care of Older Adults
With an increasingly ageing population, it is important to recognise how to deal with co-morbidities, problems with communication, issues surrounding polypharmacy and the team approach that is needed.
3.06: Women’s Health
Women’s health matters including contraception, pregnancy, menopause and disorders of the reproductive organs are an important aspect of general practice. It is also important to remember about the different ways women can present with non-gender related issues such as; Domestic Violence, Depression and Alcoholism.
3.07: Men’s Health
As well as conditions involving the reproductive organs and urinary tract, there is also an important issue of there being an approximately 14 year difference in life expectancy between men and women. Men are more likely to die prematurely (42% of men over 75 years old compared to 26% of women), but also present less frequently to their GP. Men present in different ways with mental and emotional health problems.
3.08: Sexual Health
Trainees need to be aware of the increasing rates of sexually transmitted infections, and how to manage these in a holistic manner, and approaching them in a sensitive and non-judgemental manner.
3.09: End of Life Care
An essential role of being a GP is helping patients die with dignity and with minimal distress, in a team approach. GPs should be able to identify patients in their last year of life, and help them make plans for their future care needs.
3.10: Care of People with Mental Health Problems
You should consider the mental health of a patient in every consultation, but be cautious not to medicalise all the time. It is important to have good communication, particularly listening, skills, and be aware of alternative approaches to manage these conditions.
3.11: Care of People with Intellectual Disabilities
A GP needs to recognise those patients who have difficulty with communicating, social relationships and managing their own affairs, and identify how you can support them. These patients can present atypically, and so additional diagnostic skills may be needed.
3.12: Cardiovascular Health
Managing risk factors is essential for cardiovascular health in primary care, but you should also be able to make accurate diagnoses of symptoms and manage cardiovascular emergencies
3.13: Digestive Health
These are common in general practice, and GPs have a central role in their diagnosis and management.
3.14: Care of People who Misuse Drugs and Alcohol
This is an often stigmatised group by society and professionals. These problems need to be treated with compassion, and treating the physical and mental health as well as their substance misuse is important.
3.15: Care of People with ENT, Oral and Facial Problems
A large proportion of consultations involve patients presenting with conditions involving the upper respiratory tract, head or neck, but there is variable training in this area at an undergraduate level. There are multiple guidelines for appropriate management, but these are often forgotten.
3.16: Care of People with Eye Problems
GPs have a key role in co-ordinating access to community and secondary care services, and using that role as part of opportunistic health screening.
3.17: Care of People with Metabolic Problems
Tackling the health issues surrounding patients who are overweight or obese is key in this statement. Trainees should have an understanding about common endocrine disorders such as diabetes mellitus, thyroid or reproductive conditions, as well as being aware of some of the rarer, but important, conditions such as Addisons disease.
3.18: Care of People with Neurological Problems
Many neurological conditions can be managed in primary care, and so an awareness of the common conditions and when to refer is integral.
3.19: Respiratory Health
This statement addresses some of the most long-term and common conditions to affect patients. Identification, assessment, diagnosis and treatment are generally a primary care issue, and these conditions have a large impact on the patient and their families.
3.20: Care of People with Musculoskeletal Problems
Simple positive approaches can have the best effect in these patients, and so GPs should encourage appropriate self-care. An effective history and focused examination is essential, and likely more important that imaging.
3.21: Care of People with Skin Problems
This is one of the most common complaints to General Practice, so trainees should review their current knowledge and skills.