Wholepractice training

Mental health training has mainly been concerned with training for single professions, despite much overlap in content. (93) In the United Kingdom, the Chief Medical Officer, on reviewing continuing professional development in general practice, recommended that the profession should 'integrate and improve the educational process through the Practice Professional Development Plan, developing the concept of the "whole practice" as a human resource for health care, resembling the health promotion plan in general practice'. This plan would be based on the service development plans of the practice, local and national objectives (e.g. inequalities), and identified educational need. The plan should be practice based, use novel forms of learning, and indicate how it will be achieved and evaluated. This system will run in parallel with the existing system of funding education.(94)

This direction fits with the main activity of the Royal College of General Practitioners' Unit for Mental Health Education in Primary Care at the Institute of Psychiatry. (95) The aim of the unit is to improve the recognition and management of mental illness by primary health care teams by providing 'whole-practice' mental health skills training tailored to educational need through a new network of multiprofessional tutors (including GPs, nurses and psychologists). These tutors are trained and supported on a modular 1-year Teach the Teachers course(96) Tutors work in pairs geographically and are helped to elicit whole-practice learning need and in skills training provision. A new national network of multiprofessional tutors is developing, and health authorities and primary care groups are seeing the potential benefit. The main outcomes so far are good tutor satisfaction, change in tutor teaching activity to whole-practice training, and some change in practice service delivery.

A flexible learner-centred approach to continuing professional development has been advocated, (9 ^^dOM01. and 102) although many GPs remain unconvinced.(l°3) Approaches need to include systematic reading, reflection, and audit, with formal education being complementary and relevant. (1°1) A modular approach to continuing medical education has been advocated whereby learners build up portfolios with the help of an educational mentor; approaches include diaries, commentaries on read material, and performance review.(!02) No formal tradition of mentorship currently exists.(1°4)

Primary health care teams increasingly need greater clinical and interpersonal skills and skills in population needs assessment, practice management, and quality assurance.(l°5) Practice-based training is the best venue for continuing medical education, ^i07,!08 and 109) as it focuses training on everyday problems such as issues around teamwork, communication, and practice management. Primary health care teams can undertake multiprofessional audits, the development of practice guidelines and protocols and their implementation, the use of screening instruments, and the use of paper-based or computer-aided prompts. (97) Practice teams often require facilitation and mentorship with these approaches, which is why the Royal College of General Practitioners' Unit for Mental Health Education has focused on training pairs of mentors/tutors to be sensitive to the training needs of whole teams. Pairs of mentors are taught to 'model' interprofessional collaboration.

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