Thursday 5 December 2013

Online mutual mentorship for GPs - the why

As a regular user of social media, I have been surprised by the degree of support I have derived from it. Public or large fora are a great place to learn and to interact with opinion leaders. Less expectedly, perhaps, one can form very real friendships.

However, there is a limit to how much one is willing to share in such fora. In particular, it is rare for someone willingly to expose a vulnerability in public, especially if it could damage their professional reputation. However, it is by reflecting on these very vulnerabilities that must be of highest importance for any professional in maintaining and improving their competence.

GPs face emotional and professional challenges every day. Most helping professions have well established systems for supporting each other. GPs now have a system of appraisal to support their professional development and applications for revalidation: these meetings occur only once a year and rarely provide much emotional support.

There have been many attempts at meeting this need in general practice. Local discussion groups of various kinds exist. Often, these comprise a factual educational component, sometimes with a guest speaker, in which case the group tends to be larger and more formal. One to one coaching or mentoring also takes place on a small scale.

Balint groups have been promoted as an explicit way of addressing the need of GPs for emotional support by encouraging in groups the exploration psychological aspects of consultations. Although there has recently been renewed interest in Balint groups, they never have achieved widespread adoption. John Launer suggests this may in part be due to the exclusive focus on psychological aspects. I suspect logistical obstacles such as spare time and local availability of like-minded trusted colleagues are also important.

Launer champions the concept of narrative-based clinical supervision (which he also calls "conversations inviting change"). Such conversations can take place informally in any setting, such as over the kettle when colleagues have just a few minutes to spare between patients. He opines: "the time has arrived for experimentation and pluralism in clinical supervision for GPs".

I would suggest that online social media could be a very useful setting for clinical supervision. Geographical separation may assist confidentiality and therefore openness. Even face to face and verbal communication is possible using video and telephone conferencing technology respectively. However, these benefits need to be set against the benefits of asynchronous text communication, which will allow participants to communicate whenever is individually convenient for them, in the now established manner of social media.

Launer J. Moving on from Balint: embracing clinical supervision. BJGP 2007; 57(536): 182–183.

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