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#TeamGP – why we need to learn together

Ahmed Rashid - 16 Jan, 2020

Learning is all about making some sort of change. As GPs, it can be easy for us to think of our learning simply as a process we go through to tick a box in our appraisals. But maybe we should be thinking more deeply about the types of learning that truly cause us to change for the better.

Some learning leads to really obvious and direct change in our practice, like offering a new type of treatment. But often it’s more subtle than that. For example, learning can represent a change in how we feel towards a certain individual or group, or a change in the way we think about a new (or old) disease.

If you think of all the ways in which you learn, the chances are, you can divide them into experiences which are either individual or communal. Individual learning might include reading journal articles and books, completing online modules, watching videos, or listening to podcasts. Communal learning, on the other hand, might include clinical meetings, conferences, study days, or even interacting with colleagues online, such as on social media, or on a secure discussion forum such as GP Horizon.

In recent decades, though, the raft of individual learning opportunities has meant that we may question whether we need communal learning at all. If you can read, listen to, and watch all the right content in your pyjamas on the sofa, or on your commute to work, or whilst completing your run or bike ride, why should you bother to make the effort to learn with others?

The answer to that, I would suggest, is that communal learning helps us to change in ways that aren’t necessary possible when we learn individually. Being a GP is often a lonely and isolating job, and as the job gets busier and more intense, it can be even more difficult to find time to share anecdotes or advice in coffee breaks or other informal environments within the workplace. This makes it even more important that we use our valuable learning time to recalibrate, benchmark, and make sense of all the latest evidence and developments with our professional colleagues.

The transition to online, though, is difficult to resist. So communal learning doesn’t necessarily mean that we need to be in the same room (although this can be helpful for many of us for all sorts of reasons). Technological advances have meant that we can interact with each other in so many different ways, and Twitter journal clubs and Facebook groups are as popular with GPs as they are with other specialties within medicine, and other professional groups both inside and outside of healthcare.

Those attending NB Medical Education courses regularly tell us how helpful they find the Q&A sections of our courses, both to hear more informal insights from lecturers, as well as to gauge what others in the room are thinking about how to interpret and contextualise new information. We also often hear how valuable the conversations that take place in the breaks are, and we really appreciate the exchanges that we take part in too. As the courses have moved to additional online offerings through webinars, it’s been encouraging (and perhaps unsurprising) that those taking part have continued to value the interactivity that is offered through live questions and comments.

So as you plan your learning for 2020, I would encourage you to think about what kind of change you are hoping for, and how learning with others from within the #TeamGP community might help you to achieve some of those in ways that may not be possible alone. 

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Wuhan Novel Coronavirus – what we need to know in general practice

Dr Neal Tucker - 30 Jan, 2020

The start of 2020 has seen the emergence of a new disease - the Wuhan novel coronavirus. Everywhere in the news at the moment, but how worried should we be and what do we need to know in general practice?

What is it?

Coronavirus itself is actually a large group of viruses, ranging from the human coronavirus, one of many viruses which cause the common cold, to more serious infections such as SARS and MERS. This outbreak is specifically the Wuhan novel coronavirus (WN-CoV).

It’s not yet clear how this developed – many viruses mutate from animal-based versions (SARS is a close relative and came from bats) and it was thought the WN-CoV may have originated from seafood linked to a local Wuhan fish market.

How is it spread?

Still to be fully confirmed, but there seems little doubt that transmission is now human-to-human. The mode has not been clarified, but it's likely respiratory droplet spread and direct contact. The virus has been isolated from basically every orifice so wash those hands and flush with the lid down… It has also been demonstrated that, just like with many infections, it is transmissible prior to symptoms developing.

Any figures in the blog will be out of date by the time you read it, but currently the virus has been isolated in almost 8 thousand people throughout China, is linked to >200 deaths and now present in 15 countries, but not yet the UK. The death rate is relatively high although bear in mind the lab-confirmed numbers are likely to grossly under-represent the actual level of disease burden in China, so may not be as bad as it appears.

What are the clinical features?

Most people have mild illness and simple URTI symptoms of fever, cough, chest tightness and/or dyspnoea. We need to be vigilante for symptoms suggesting more severe disease as clearly some patients will be very unwell.

How should we manage suspected cases?

Don’t let them in the practice! No really, that’s the recommendation from public health.

Hopefully patients will already be aware of their personal risk and they will contact by phone. If they have symptoms of acute respiratory illness and have lived in or travelled to Wuhan in the past 14 days, or had contact with a person with confirmed WH-CoA then advise them to stay at home, seek specialist advice from the local infectious diseases team and notify your local Health Protection Team.

Hopefully patients will simply call 111 for advice – there is a national system in place to manage patients recently returned from Wuhan.

If during the course of a face to face consultation it becomes apparent that the patient may have WN-CoV the advice is: “withdraw from the room, close the door and wash your hands thoroughly with soap and water… the patient should remain in the room with the door closed … seek further specialist advice from a local microbiologist, virologist or infectious diseases physician.”

Seriously ill patients may need ambulance transfer in which case we should ensure they are aware of the potential for WN-CoA. If transfer is not urgent, we should call the hospital and discuss with them first. Don’t ask them to take a bus or taxi… After the patient has gone the advice is to close the room and await advice from the local HPT. My friends in public health have been waiting for years to get the flame throwers out…

There is a very clear algorithm from PHE on management of suspected cases – click here. It also encourages us to keep an open mind. It could be Avian flu instead…

Clearly, the authorities are taking it VERY seriously until we know more about the nature of the infection and we need to as well.

Useful Resources

These have developed rapidly and may change, but right now:

PHE Interim Guidance for Primary Care

Government Advice for the Public including: travel

Investigation and initial clinical management guidance

NHS advice to patients about coronavirus including calling 111

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