PBSGL: an opportunity to make CPD more engaging and improve patient care

Dr David Cunningham and Dr Leon Zlotos

 

AFTER seeing the acronym PBSGL on Twitter, and not having a clue what it meant, I visited NHS Education for Scotland (NES) in Glasgow to meet with Dr David Cunningham — Assistant Director of GP Education (Professional Development) and a GP in Irvine, and Dr Leon Zlotos — Principal Lead (Professional Development) for NES Pharmacy and Pharmacy Advisor for CPD Connect, to get some answers.

You may not have heard of it either, but practice-based small group learning (PBSGL) is a method of continued professional development (CPD) which promises to deliver learning in a different way, with the aim of improving patient care.

While it’s been around for over 25 years (first in Canada and then in Scotland since 2004) it continues to grow in popularity. In Scotland one third of GPs use the resource and now around 260 pharmacy professionals are involved — not just amongst themselves, but also within interprofessional teams.

What is it?
PBSGL is an effective learning programme delivered in a specific format by CPD Connect — the GP CPD network, which is a part of NES. Essentially you get a group of around 7–12 (size is important) healthcare professionals, supported by a trained facilitator – an essential component.

Groups meet when they like, on a regular basis, between 4 and 10 times a year (or more) and where they like (for example their practice, a local health board building, or a member’s home). They discuss real patient problems and the evidence to solve them using specially prepared modules. Meetings usually last for about 2 hours and generally they follow the same process.

The modules are provided to guide the discussion, and these cover a broad range of conditions, with 12-14 new modules produced each year, by primary health care clinicians in Scotland. Module topics are decided upon by members, then go through a rigorous editorial process to ensure they are of a high quality, and are then tested.

Module management
Modules are designed in a specific format:

  • Cases — the basis for the discussion.
  • Information section — evidence based information to ensure evidence based practice is discussed.
  • Case commentaries — these are not the answers to the cases but the perspective of another healthcare profession/specialist. These are used during the discussion to check if the group could have considered a different approach.
  • Appendices — additional information which often includes useful documents: for example, information or flowcharts that can be used in practice.

Facilitator function
While the facilitator’s role is a peer-facilitator, they are also a member of the group and they can contribute their views and experiences too. However, they are not there to teach the group.

Experience has shown that in the early stages of groups they may look to the facilitator for the answers. “But that is not their role, they should facilitate the discovery of potential solutions/answers through the group discussion. They need to ensure that the group work together, that members are able to contribute appropriately and that the discussion is aligned to the group’s learning needs,” explains Dr Leon Zlotos.

They also need to manage the progress of the discussion through the process of a PBSGL meeting. All facilitators attend a compulsory one-day PBSGL facilitator training course, during which they are taken through the process and they practise facilitating.

Meeting management
The trained facilitator starts the meeting and encourages one group member to read the module introduction — they then progress onto the case, and the first question is discussed, with a focus on real-life examples from group members.

The facilitator then progresses the discussion taking the lead from the group, and refers to the modules’ information section throughout the discussion to keep in touch with the evidence base and to draw attention to the relevant facts.

Either at the end of each case or at the end of the meeting, the facilitator may ask the group to consider the case commentaries to check if there is anything else that they missed, or if there were any alternative approaches that they could consider.

At the end of the meeting the group fills out a log sheet to provide feedback on the module, focus on commitments to change their practice, and identify homework (source some material they agreed to bring to the next meeting, or find the answer to a query they couldn’t answer at the meeting. These commitments to change and homework are reviewed at the next meeting.

No wrong answer
The aim of the discussion isn’t necessarily to come to a finite answer for each module, but instead to reflect on practice, learn from colleagues and to take this learning into practice. “We are not looking for answers to cases, we are using the cases to try to stimulate discussion about real life cases,” says Dr Zlotos.

One of the other key points is to explain at the next meeting what changes you have you implemented in practice as a result of the previous meeting. Once the module has been completed an evaluation of the module is part of a continuous quality improvement process.

Fringe benefits
Not only is PBSGL a collaborative and social way of enjoying CPD, but it also fits in nicely with the General Pharmaceutical Council (GPhC) revalidation proposals which includes requirements for a peer discussion and a reflective account.

Moreover, it can help reduce professional isolation, and is an opportunity to discuss other real life problems that occur in practice.

While pharmacy professionals can form groups themselves, and perhaps stay within their comfort zones, research has shown that pharmacists, pharmacy technicians, practice nurses and GPs can work well with each other during PBSGL meetings, and that learning extends beyond the meetings into primary healthcare, and relationships improved within the interprofessional team.

Moreover, participants value the PBSGL method even more if that group is made up of different professions involved, and anecdotally, GPs find it useful to have a pharmacist in their groups1,2.

Get involved
PBSGL is sponsored by NES Pharmacy for pharmacy professionals in Scotland, which means that funding is available for pharmacists to take part. If you are a pharmacist or pharmacy technician and you are interested in getting involved with PBSGL, e-mail Leon Zlotos at NES or contact [email protected].

 

Further information
www.cpdconnect.nhs.scot/pbsgl/

References
1. Judy Wakeling, Julie Ferguson, David E. Cunningham, Leon Zlotos, Ailsa Power (2016). Inter-professional small group learning: A case study of two pharmacist-facilitated groups in Scotland. Pharmacy Education, 2016; 16 (1) 210 – 217.

2. David E. Cunningham, Julie Ferguson, Judy Wakeling, Leon Zlotos & Ailsa Power (2016) GP and pharmacist inter-professional learning – a grounded theory study, Education for Primary Care, 27:3, 188-195, DOI: 10.1080/14739879.2016.1163645.

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