Focus on shared learning

How our medical training programme began 
When Auckland GP Tana Fishman started an open door consultation style in Manurewa in the early 2000s, she might not have realised what a long-term positive impact that would have.
Initially, Dr Fishman called in other doctors in the practice to share an interesting case or give a second or even third opinion. The other GPs duly asked her to do the same with their patients. The GPs benefited from this shared learning and patients grew accustomed to it and appreciated the added expertise.

The GPs then decided to extend the learning by taking on medical students for elective placements. This was very successful and the doctors realised the benefits were much bigger than they had first imagined: they were all – doctors and students – learning from the placements, improving safety and building their experience base.

Changed behaviour in the other doctors in the practice was quite an eye-opener too; with an extra pair of student eyes and hands at their sides, the GPs’ confidence and accountability grew, they took more pride in their work and some even improved their standard of dress!

Two of Dr Fishman’s colleagues at the time were well-known and respected Auckland GPs
Bruce Arroll and Tane Taylor.

Shared learning for doctors and students extended to ETHC
Dr Taylor was impressed with the shared learning environment and took the idea with him when he began work as a consultant for ETHC in 2007. His main brief was to provide support to ETHC especially in helping with workforce morale and he knew that shared learning and teaching lay at the very heart of improving that.

Very few ETHC staff had experience within a learning environment or with shared learning, but Dr Taylor knew from the Manurewa experience that taking on students would be a very effective way to get a shift in morale.

ETHC’s first intake of medical undergraduates was at the Airport Oaks clinic. There was one doctor there who had a background in teaching medical students in his own country and was keen to relive it in New Zealand. Dr Taylor, in leading the change, had free rein with structuring the student programme as long as it didn’t upset or hinder the clinical service delivery process.

Student programme swept from one ETHC clinic to all 17
This “incubator” stage was a great success, making medical practice safer and more efficient and enjoyable, so the undergraduate programme was slowly rolled out across all ETHC clinics. Lunchtime meetings to review cases with students provided opportunities for doctors from other clinics to meet on a regular basis. Students became experts in the particular topics that they researched as part of the programme. They evaluated how they identified problems, did their research and presented their findings – and everyone benefited from that.

Over time, ETHC saw the culture change from one focused on fee for service to one that gave back to the students. Most notable was a renewed sense of pride in the organisation as a whole. Not only were GPs and nurses valuing their work more but so too were others including the receptionists. Being involved in the students daily work improved their self worth and made them more willing to change and learn.

As a result of this extremely valuable student programme, throughout the entire ETHC family there is an acknowledgement that a person is never too old to learn and update their skills and that flexibility is paramount.