The highs and lows of general practice – Using highly abnormal clinical findings and investigation results in general practice training

Dear Sir

Discussion of clinical cases is a core educational activity of general practice training. Cases may be directed by specific trainee learning needs; trainer interest and experience; random case analysis; or required curriculum objectives. Cases should be interesting, relevant, instructive and challenging in order for learning to be effective.

Highly abnormal clinical findings and investigation results have previously been used in the education of physician trainees (Rosenblum 2010). As a regional general practice training provider, we have developed a workshop-based, trainee-led teaching activity using clinical case studies centred on highly abnormal clinical findings or investigation results from the general practice setting. Trainees are invited to identify any patients with extreme findings, e.g. high blood pressure, or test results, e.g. low haemoglobin, over the course of each six month training term, and document them on a whiteboard at each monthly workshop. Only patients seen in the ambulatory care setting are included. At the end of each term, two trainees are selected to prepare a 15-min presentation on their cases, including discussion of the clinical presentation and outcome. Even though the trigger is an extremely abnormal finding/result, the focus of the presentation is the use and interpretation of the finding/result in routine clinical practice.

This teaching activity has been very highly evaluated as the cases are invariably fascinating and an excellent learning experience. Furthermore, the activity meets a number of our curriculum objectives. These include the critical use of investigations; evidence based practice and the use of clinical guidelines; and the opportunity for trainees to develop skills in large group teaching and presentation development.

We acknowledge the contribution of the trainees and medical educators in delivering this activity.

Declaration of interest: The author reports no conflicts of interest.