Colchester Specialty Training Programme for GP

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 26/05/2010

Timetable for this session

9.00 Aggressive patients

10.30 Coffee

11.00 Trainee session- Anne-Marie, Ayisha

12.30 Lunch

1.30 Safeguarding children and vulnerable adults .

Preparatory work

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Aggressive patients Trainee session- Anne-Marie, Ayisha Safeguarding children and vulnerable adults  
How useful? Has it changed your thinking? Something you've learned? How useful? Has it changed your thinking? Something you've learned? How useful? Has it changed your thinking? Something you've learned? Can you suggest any other improvements?
3 2 no right way to deal with such cases when caught out but remaining calm is important 2 2 Update myself on the BASH guidelines soon 3 4 very pertinent to our practice. Need to be on top of guidelines and possible new legislation coming in Child protection and Adults should have been separate talks -- a bit lengthy
4 4 Very useful lecture - learn't what strategies i can adapt to deal with aggressive patients 4 4 learn about stages of CKD and how to manage in primary care 4 4 very very useful topic and very relevant to GP Can we have a talk on " health promotion "topic Also could we have genetic sessions and equality and diversity please
4 3 how to diffuse confonting situation 4 4 antenatal care and checking abt the Blood screening etc 4 4 referal pathway
3 3 keep calm,helps diffuse situations 4 4 Antenatal pts- follow up 4 4 referral procedure
3 3 approach to managing an aggressive pt 3 2 importance of safety netting 4 5 referral pathways for abused children and adults. Warning signs of abuse
4 4 To think about how the experience within the surgery eg conditions in the waiting room can influence someones behaviour not just consultation style. 3 4 Useful case discussion around pregant women and not assuming care will be done by antnatal services but following up on bloods etc. 2 2 Useful to hear about vulnerable adults services. Have a prepared CSA scenario for us to practice for violent patients. The safeguarding session was too long and far too in depth on the legalities/structure of the system and not focused on the practical situations we encounter. We dont need to know about tiers of management in child protection or dates of legal acts but practically how to deal with situations and maybe have group discussion of how to proceed in different situations etc.
4 3 these are usually difficult situations and its good to stay calm and assertive 4 4 Thought provoking Significant event analysis case and useful guidelines on managemnet of HIV in pregnancy and labour. Watch for drug toxicity of zidovudine To give aspirin and statin prophylaxis in CVD risk >20%in CKD patients 4 3 overall good presentation and useful information covering various aspects of safegaurding children and adults As we discussed regular eportfolio work and OOH update during vts days can be quite helpful
4 4 Importance of letting a patients anger diffuse. Would have been good to have smaller groups led by one PD so that we could practice being agressive and dealing with angry patients. It is abit intimidating to do it in front of the entire group 2 2 Alot of repeated information and fact learning in a long session which didnt hold my attendtion well enough, especially post prandial! Too much info about the actual structure of the service rather than practical information. Not interactive enough. Also very distracting when a trainee is being rude to the presenter. Perhaps structure the days into Themes - rather than having randeom subjects covered
4 2 Useful talk, could have been more interactive. 4 3 Thorough guide to CKD. Interesting case of HIV in pregnancy and SEA. Raised a lot of discussion. 4 3 Important topic. Coukd have talk from paediatrician about what they do when receive such patients.
5 5 Techniques of dealing with an aggressive patient - remaining calm allowing the patient to vent 4 5 Interesting about referral for CKD. New information about HIV and pregnancy. If low viral load C-section not necessary. 4 4 Informative and engaging. n/a
4 3 Financial, institutional and discriminatory are extra categories of abuse for adults. More group work/interaction.
5 5 Techniques of dealing with an aggressive patient - remaining calm allowing the patient to vent 4 5 Interesting about referral for CKD. New information about HIV and pregnancy. If low viral load C-section not necessary. 4 4 Informative and engaging. n/a
5 4 How to change environmental settings to calm patients such as waiting room. 4 2 Always check antenatal bloods 3 2 Useful to know local procedure
3 2 Surprising number of elderly subject to abuse (although source of statistics not clear) Perhaps some case based scenarios in child and adult protection would be helpful
4 3 Taking a non confrontational approach, ensuring environment is safe and that there is help/exit readily available. 4 3 Checking HIV status and bloods have been discussed in pregnancy. Increased prevalence in london. 3 3 Procedures for safeguarding in this trust. Types of abuse and recognition of this. I think the e portfolio check was a good idea that I think will help us all improve our entries in quality and quantity.
3 3 Send letters to patient warning re behaviour 3 3 Ensuring you check antenatal bloods 3 3 Look out for adult abuse Cases for safeguarding children lecture.
3 3 Ways to calm an aggressive patient such as using conversational tone, asking patient to sit down, try to position desk close to door. 4 4 This talk has made me more aware to check that booking bloods have been done for all pregnant women. Antiretroviral treatment should not be started in first trimester of pregnancy and is normally started between 28-32 weeks. 3 4 refer suspected child abuse cases to social care direct. More aware of the different services available to get advise such as the safegaurding team.
4 3 Keep calm, firm and assertive can help get control of the situition. 4 4 A good refresher for CKD and its management according to NICE guidelines. 3 3 Good and very important topic, wish it would have been made more focused, simple and practical for us. May be few CSA practice cases could be arranged to practice handling such situitions
4 4 How to manage an aggressive pt 3 3 ann maries presentation was good -reflective 3 3 Was long
3 3 Follow up of antenatal patients re bloods 2 2 Keeping children DNAs under close follow up / review with letter to parents etc. Found combination of adult and child abuse in same session difficult to follow. Much too much on the administrative background. Waving guidelines about without explaining what is in them is unhelpful. More on practical things, how to identify possible abuse and what to do about it.
3 4 4 4 2 1 To proof read slides before giving a presentation. am sessions good. pm session poor. Important topic let down by poor slides with questionable statistics. Could be improved by halving in duration and improving more information useful for GP. E.g how many are on Child Protection Register in local area? Discuss some recent cases. Presenters seem to have a very superficial knowledge of their subject.
4 4 calm approach 4 4 Anne-Marie's case presentation was particularly useful and opened up an interesting discussion. 1 1 To check I understand the information I am presenting as fact. AM sessions good. PM session poor. An very important subject let down by incorrect and questionable statistics. Established child training techniques mis-labelled as inappropriate and abusive. Could be improved by local stats on numbers of kids on child protection register and recent local SCR. Less handwringing about social ills and more information of use to practising GPs. I do not think the advice that we must physically prevent a patient being forced into an arranged marriage from going home was particularly helpful or practical.
4 5 Can write to the patient warning letter. 5 4 Very good short informative presentation about CKD, learn when to refer. 5 5 Local/service and contact details. Good lunch-to keep up.
4 3 It suprised me to learn that simple things can make a difference to a patient's level of aggression, for example the environment of the waiting room and the presence of a TV! 4 4 Really good talks. CKD was highly relevant and an area that is not taught that often. Good to know about the need to prescribe aspirin. HIV talk succinct and interesting. 4 3 Useful talk and relevant to GP. Have learned who to contact if concerns. Was a bit long and might have been better as a morning session? Maybe we could have a session on general Gynae?
4 3 It suprised me to learn that simple things can make a difference to a patient's level of aggression, for example the environment of the waiting room and the presence of a TV! 4 4 Really good talks. CKD was highly relevant and an area that is not taught that often. Good to know about the need to prescribe aspirin. HIV talk succinct and interesting. 4 3 Useful talk and relevant to GP. Have learned who to contact if concerns. Was a bit long and might have been better as a morning session? Maybe we could have a session on general Gynae?
4 4 Techniques for managing aggressive patients and importance of staying calm, trying to reach a compromise rather than just giving in. 4 4 Learnt referral criteria for patients with CKD and learnt about prevention of vertical transmission of HIV I think it would be helpful to spend time on our learning logs/updating our PDPs during the VTS sessions. If trainee presentations were kept concise and to the point like the ones today, then I think we would have enough time for ePortfolio.
5 4 no right or wrong way to deal with it. but be calm, 4 3 CKD guidelines 5 4 Whom to refer if any concerns
5 5 when dealing with an aggressive patient listen to them find out what has happened. 4 4 when an antenatal patient is seen dont assume all investigations have been done unless there is objective evidence 5 5 whom to refer if suspected