The Generalist Clinical Mentor (GCM)
One of the innovative aspects of ScotGEM – and I think many of the cohort would argue, the best – is the creation of the ‘Generalist Clinical Mentor’ or ‘GCM’ as it is often referred to. The GCM is an experienced GP who works part-time local to the university when they are not working with ScotGEM. While in Years 1 and 2, we spend one full day per week with them at their practice consulting with acute and expert patients, learning from other GPs, nurses and other staff in the practice and also consolidating the current course material for that week with the rest of our small GCM group. As an aside, you will soon realise if you have not already, that abbreviations are part and parcel of ScotGEM as much as they are medicine as a whole and they continue to accumulate unmercifully as you progress through the course.
Collaborative learning
We also spend half a day per week with the same GCM and group in the Clinical Interactions Course, also known as ‘CLIC’ – see what I mean about abbreviations? These sessions are used to build up our repertoire of fancy doctor skills in a practical and supportive environment. The GCM would often take us through the skills being learned that week, let us practice on each other and then apply it to some simulated patients. The medical school at St Andrews has a bank of approximately 90 people who can be called upon to give up their time and play the role of a patient in order for us to practice our skills on them. This starts off with something as simple as learning how to take a structured history in the first weeks of Year 1, all the way up to breaking news that a patient has a terminal illness during Year 2. A lot of our simulated patients help out regularly and do it for a variety of reasons; some have worked in healthcare before, they may want to give back to their community in some way, others have children or grandchildren that are (or are training to be) doctors, and some are professional actors that enjoy the challenge of the roles given to them. They are undeniably a fantastic resource to learn from and allow us to fine-tune our skills in an environment where we can make mistakes and learn the best ways in which to interact with real patients in the future.
You can quickly become really close with each of your GCM groups. You learn everyone’s strengths and weaknesses, how to work and learn with each other, and it results in a nice collaborative unit trying to make the large volume of information we need to learn as fun and as tolerable as possible. For example, one of the students in my first group presented the permeability of cell membranes in a lecture on migration in the European Union (which won ‘Best Presentation’ at our group’s prestigious end of block Oscars), while another would have photoshopped each of our faces onto stupid memes interspersed throughout their slides on serious clinical presentations. We changed GCM groups in the 2nd semester which was either a traumatic and emotional separation from our new small medical families, or a welcome new change, depending on how it has all gone (it has always been the former for me each time). This format continued into Year 2 but with more frequent switching as we rotated through Dumfries & Galloway, the Highlands and Fife and I am currently on GCM number 5 overall.
Elie
The first GP practice I was based in was in Elie on the east coast of Fife for the first 12 weeks of the course. Each group had 7 or 8 students per GCM spread out across Fife. One of the things I really enjoyed about Elie was that the practice was so small. There were only a couple of GPs and a practice nurse at any one time and sometimes we had the place to ourselves so we could bring in lots of patients and see a wide variety of presentations each week. It also had a partner practice in the nearby village of Pittenweem so we also got to head over there on occasion too which only added to the rural feeling of the place. My GCM, Dr Niamh Day, was one of the few GCMs that hadn’t relocated to take up this new role and had worked at the practice for over 10 years, so she had a vast knowledge of patients that could be called upon that were relevant to each week, or who had particularly interesting conditions or symptoms to share with us. Elie itself was also such an idyllic little town that had a real rural vibe to it and the people were really welcoming.
Community
One of the aspects of medicine the course promotes is the importance of the role of a clinician within the community they serve. We were able to visit a local aerobics class for elderly citizens in the Pittenweem town hall nearby. It was great to see people from their 60’s almost up to 100 years old coming together to keep active in such a nice community way. They were all so happy that we had come to join in and do some exercise, although the amount of homemade food they tried to ply us with would definitely have undone our calorie-burning efforts. As lovely as the people were, and as hilarious as the session was to be a part of, I could really have done without being outclassed and outworked by numerous 80+ year olds.
Clinical encounters
While the aerobics class was great fun, Elie was also my first foray into the clinical side of medicine, and all the uncertainty, complexity and emotion that comes with working as a doctor. On my first day in my GCM practice I was able to actually examine an unwell patient with an infection. We admitted them to hospital and they were diagnosed with an underlying cancer and sadly passed away a short while later. I found this so unexpected and shocking and it was a bit of a wake-up call to the reality of medicine and being a doctor.
I met patients with diagnoses that have hindered rather than helped them. Some conditions have no treatment available and although the efforts of doctors had been with the best intentions, the result of investigations had left some with a diagnosis that only brought them distress and anxiety, and left them unable to plan their lives. There were countless lessons like this that made me realise that no matter how much I learn and try to improve the lives of patients, there will always be cases where things do not work out, where trying to do something good ends up with a negative outcome for a patient. I think if someone had asked me before starting the course whether doctors have to deal with a lot of uncertainty I would have probably said ‘yes’, but when you start to experience clinical practice it makes you realise the extent of how uncertain medicine can be. This is one of the great things about ScotGEM, it embeds you in this reality from the start and you get to see how GCMs and other GPs deal with it from their experience and it makes it a really rich experience.
I also took blood from patients for the first time, which was pretty stressful, but completely rewarding when you get the hang of it. The tactic of asking the patient how their day had been – to keep them, and myself, at ease – while I was finding a vein immediately backfired as they told me, “not great, I have been waiting 45 minutes to have my bloods done” which had the opposite effect I had hoped for on my already shaky hands. Thankfully the phrase ‘third time’s the charm’ graciously applied to this patient’s veins and they were able to go about their day without the need for a repeat appointment. Taking bloods for the first time felt like a big milestone for me, just purely because it’s invasive and you’re worried about things like hurting or distressing the patient, not getting any blood on the first attempt, or possibly even having to get someone else to do it for you. Fortunately, once you do it, it is something that becomes a lot easier with practice.
When I reflect on my first 12 weeks back in 1st year, there was no one thing that made it so great, but a combination of lots of positive factors that resulted in feeling like I had learned an immense amount while having a lot of fun doing it. I loved learning in a place like Elie with the sea at your doorstep, to consult with and meet so many local people who were so keen to have us a part of their little rural world, to be in a group of students where we wanted to see each other improve and have fun doing it, and to have an experienced GP supporting, guiding and teaching us while making sure we enjoyed ourselves – and ensuring there was a constant supply of teacakes in the practice – culminated in a great first 12 weeks on ScotGEM.
Beyond Elie
Since my time in Elie, I have been based in GP practices in Auchtermuchty (Fife), Annan (Dumfries & Galloway), Inverness (Highlands) and I am currently in Newburgh (Fife). In Year 2, our GP experiences are supplemented with clinical placements in local hospitals and you can learn more about that here and I have also written a short piece about my experiences in Dumfries. I found all of these experiences so positive and valuable, and the variety of things I have seen is so much more than I would have imagined being exposed to when I was applying to the course.
