Table 7 Details of structure and content of main trial GP training sessions
| Timing | Topic | Detail | Methods & Resources |
|---|---|---|---|
| Intervention Practice – 2 h in a single session | |||
| 10 Min | Introductions |
▪ Personal introductions, roles, etc. ▪ Brief outline of the practice and its population ▪ Special interests of GPs |
Pre-trial background sheet completed by practice ▪ Informal chat to get people warmed up |
| 15 Min | Brief outline of study, stratified care approach and pilot study results |
▪ Background to study ▪ Explain prognostic risk ▪ Clinical conditions and sites involved ▪ Summary of pilot results ▪ Proportion in each risk group |
Few slides – scant detail ▪ Interactive ▪ Emphasise “Risk” is of chronicity/complexity not pathology ▪ Explain complementarity with diagnostic process presentation and brief Q/A |
| 30 Min | The STarT MSK tool in practice |
▪ Overview of questionnaire and matched treatments ▪ GP actions we hope to foster ▪ Providing the tool score to onward treating clinicians ▪ Trying out the tool – paper exercise: ➢ GPs work in pairs, each with a vignette ➢ One asks questions and completes paper tool, other responds from vignette ➢ Swap roles for second vignette ➢ Compare scores and experience of using tool ▪ Use of the tool in consultations - video |
▪ Discussion around slides: Pyramid slide for overview Questionnaire and matched treatments ▪ Giving patients score and recommended options Communicating score in referrals Paper copies of vignettes and risk tool Live EMIS system with template ▪ Demo of template use ▪ All GPs trying out template, using vignettes, with no attempt at consultation elements Video of mock TAPS consultation |
| 30 Min | Simulated “consultations” using vignettes |
▪ Facilitator gives outline from a TAPS vignette, as a patient might present ▪ GP uses template to get score and treatment options ▪ GP explains and negotiates options ▪ Facilitator might try asking/challenging for other options |
▪ Skills session ▪ Emphasise simulation and not role play ▪ Use selection of low/medium/high risk vignettes as basis Set up clinical computer in a consulting room if possible ▪ GP or facilitator gives outline story ▪ Group works together on suggestions – problem-solving approach Prompt sheet for consultations |
| 10 Min | GP management of low risk patients |
▪ Effective reassurance ▪ GPs’ confidence in managing low risk ▪ Resources available for low risk management ▪ Other primary care team members involved in low risk? |
▪ Discussion about how GPs will manage low risk ▪ How to provide effective reassurance ▪ Look at advice materials Printout of PILS + Leaflets |
| 20 Min | Management of medium and high risk patients |
▪ Addition of layers to complement low risk management ▪ Directed at specific pathology and wider issues e.g. co-morbidity, psycho-social, employment, etc ▪ Physio hubs and provision we have negotiated ▪ Detail of physio referral process – how would GPs like us to set it up? ▪ Liaison with physio in high risk patients if needed – Email arrangements |
▪ Discussion around recommended treatment options ▪ Emphasise MSK rehab for high risk ▪ Hub physios to attend if possible to build personal relationship and clarify arrangements Paper copies of matched treatments to illustrate |
| 5 Min | Action plan and lead GP actions |
▪ Lead GP role: ➢ Keep a training record ➢ Cascade training to locums, etc ➢ Respond to monthly feedback email ➢ Liaise with team over any issues or problems ➢ Dealing with queries ▪ Additional support if needed ▪ Who to contact etc |
Training record for practice Sample monthly feedback report Prompt sheet for GPs |
| Training session for control practices – 1 h or less | |||
| 10 Min | Introductions |
▪ Personal introductions, roles, etc. ▪ Brief outline of the practice and its population ▪ Special interests of GPs |
Pre-trial background sheet completed by practice ▪ Informal chat to get people warmed up |
| 10 Min | Brief outline of study its background and scope |
▪ Clinical conditions and sites involved ▪ What we are investigating, in general terms ▪ Questionnaires to patients ▪ Medical record review |
Few slides – scant detail ▪ Interactive presentation and brief Q/A |
| 10 Min | What we ask of GPs |
▪ Patient verbal consent for study and record of this ▪ Pain score and pain site recorded in >50% ▪ Usual care of patients | One slide |
| 15 Min | EMIS template | ▪ Demonstration of real template and practice with it | |
| 5 Min | Additional support | ▪ Coping with GPs absent from training or joining later Briefing session by Practice Manager | Laminated prompt sheets for all GPs |