Monday, 6 June 2011


As a trainee in the hospital the best role models i saw had a proactive approach of following up the cases they were involved with. I believe in part this made them the high quality clinicians they had become.

Knowing the final outcome in cases you were directly involved, is the basis of one of the Work Place Based Assessment tools(WPBA) the Case based Discussion (CBD). For me reflecting on an interesting case and discussing this with a senior has been an enriching way of learning. It has changed my clinical practice for the better.

Politically, the NHS Outcomes Framework has shifted the focus to end results rather than processes. How these newer quality measures are incorporated into medical education and training, needs to be considered. I remember in medical school having to be signed off for doing X no. of procedures. There was no follow up about how long the venflon lasted for or how the patient felt subsequently days later e.g bruising, pain, infection. It is only when things go really wrong that we ever get things fed back to us.

The 'inbetween' stuff which is useful but not significant we dont seem to capture and feedback to fine tune our expertise. Outside the realms of WPBAs my experience is that proactive outcome based follow up isn't culturally the norm for most clinicians.

I have heard paramedics really curious about pts they treated for a CVA, A+E doctors curious but time poor of knowing what happened to their referrals and GPs like myself wanting to know the outcomes from my actions after referring a pt to hospital in or out of hours. We all want to know but the system makes it very difficult to find out.

There is a strong case for a system where these unreported facts about pt outcomes are fed back to those that have been responsible for their care. This makes sense educationally and training wise building on the WBPA on CBDs to raise the quality.

The concept of refection is already disseminated across the spectrum of medical education and the ability to use this skill with the final patient outcome is a strong combination to produce high quality training in a subject which ultimately is a vocation.

An ideal world for me in General Practice would be to have the facility to 'follow' interesting cases i have been involved with and receive a 'twitter style feed' of the pts journey via results of investigations, clinical encounters or written correspondence from the hospital which directly fed back to me until i stopped 'following'.This would enhance my learning in a time effective way rather than chasing the info.Furthermore it would provide a good solution for forthcoming revalidation to demonstrate clinical competence based on results and reflections from where outcomes haven't been satisfactory.

Unfortunately technical issues with IT that has haunted the NHS for years, info governance and diverse vested interests has made it difficult to create a joined up network of communication across all healthcare providers to facilitate this sort of feedback.

I think there is a strong case for this style of learning to begin if it hasn't done so already. What i would like to know is what research/evidence (if any) has been conducted to look into this aspect of education in a clinical setting.