External Clinical Teaching (ECT) visits, where a GP observes your consults, are a vital part of your GP training and an excellent way to develop your GP skills. ECT visits are part of RACGP’s requirement, while for our ACRRM registrars, Mini Clinical Evaluation Exercises (MiniCEX)/Case Based Discussions (CBD) are incorporated into these visits.
Medical educator Dr Rebecca Lock shares why these visits are so important and how you can best prepare for them.
1. ECT visits are an excellent learning opportunity
Each ECT visit involves an external GP supervisor or medical educator directly observing your patient consultations for a morning or an afternoon, usually taking about three hours. Most of that time will be spent observing. The visiting doctor will also speak to your supervisor and practice manager, and then prepare a report to be shared with your supervisor, GPTQ and you.
2. This is a rare opportunity in your career to have another GP in your consultation
Rebecca says: “In general practice, there are many ways to do the same thing or arrive at the same outcome. ECT visits allow you to expand your circle of knowledge by getting a second take on your consults for that day. It’s a real luxury to have someone observing and looking at the structural component of the consultation and offering advice. That’s really the main aim of the visit.”
3. The requirements for RACGP and ACRRM are different
To achieve Fellowship, RACGP registrars must participate in at least five ECT visits. Each one involves a morning or afternoon session of observed consults. ACRRM registrars must complete nine MiniCEX formative assessments but these are all based on individual patient consults.
Rebecca explains: “With the ACRRM fellowship, ECT visits aren’t a compulsory part of training. However, at GPTQ, we feel it makes sense to merge the two – so your ECT visitor might sit in on six or ten consultations during your ECT session and you can then choose a few of those consults to write up as MiniCEX visits. The whole thing is also written up as an ECT visit.”
Another difference for ACRRM registrars has to do with the consult itself. While the ECT visit for RACGP registrars focuses on communication during the consult process, MiniCEXs have an additional component.
“The visitor will also fill out a proforma detailing the type of consult it was – ie what system the presenting complaint was about. It also asks for information about how you take the patient’s history plus for some specifics about your examination and management approach,” Rebecca says.
4. The observations focus on your consult process, not your clinical knowledge
ECT/MiniCEX visits are not about what you do and don’t know content-wise. Rather, they help you structure and refine your consultation process. They’re meant to be ‘low stakes’ and you shouldn’t worry about feeling judged.
Rebecca says: “Of course there is an assessment component to the ECT visit because you can’t give feedback without first assessing what’s going on. But it’s feedback for learning – not assessment that stops you progressing your training.”
5. Every GP who visits you is unique
Rebecca says GPTQ tries to ensure you are seen by five different ECT visitors over the course of your training, so you’re exposed to a diversity of expertise. She also says the actual observation process varies.
“Some doctors prefer to be the true ‘fly on the wall’ and will tell you ‘If you normally call your supervisor during a consultation, do that as I want to observe your interaction’, whereas others say ‘If you’d like some clinical advice while I’m here, I’m happy to do some teaching about the people you see,” she says.
7. Occasionally, ECT visitors are new Fellows
Most of the ECT visitors you’ll see are experienced medical educators or GP supervisors, many of who you may have encountered before on the GPTQ circuit. But from time to time, you may get a visit from a newly Fellowed GP too.
“Having somebody come and sit with you who’s just finished their Fellowship, and has the recent exam experience, has some great perks. They’re up to date with clinical information and have lots of resources to share,” Rebecca says.
“Often, it’s only when you’ve just Fellowed that you have the hindsight to reflect back on what you could have done better during your ECT visits. It’s really nice to pass this advice on and I encourage recent Fellows to consider becoming ECT visitors for this very reason.”
6. You can use these visits to glean advice and put it directly into practice
Every six months you will create a learning plan with your GP supervisor. Rebecca believes this is a great time to talk about some of the different communication strategies you’re learning about, and highlight areas you’d like to work on.
She says: “It’s good to try and put one of these into practice during an ECT visit and then work on it over the next few months. You can then try something else the next time you have an ECT visit. You’ll also find your ECT visit report valuable here in giving you further ideas on where you can make improvements.”
When the ECT visitor arrives at your practice, they will usually meet with you before your consults. At this time, they’ll ask if there’s anything, in particular, you want them to observe and provide advice about. Rebecca says it’s ‘very rare’ for a registrar to say there is and that’s often a missed opportunity.
“Registrars usually say ‘oh just look at everything’ but I highly recommend highlighting a few specific areas you’d like to refine. This allows you to work on them while you’ve got somebody sitting in with you.”
Some suggestions from Rebecca include addressing the structure of your consultation, the fluidity of your physical exam, or even your approach in breaking bad news.
8. Your visiting doctor often learns something too
As an ECT visitor herself, Rebecca says she gets a lot of personal insights from her visits.
“Sometimes I’ll pick up the way a registrar phrases something and think ‘oh that’s really nice. I’m going to use that.’ You gain a lot from seeing different people practice,” she says. “General practice can be a little bit isolating and it’s such a rare opportunity to watch somebody else practice what you do every day. A lot of personal growth results from an ECT visit for both the registrar and myself.”
Want to learn more about some of the ECT/MiniCEX visitors you might encounter during your training? Then visit our educator page.