The Danish DYNAMOs: GP trainees engaged in the educational development and delivery of GP training

Article (PDF Available)inEducation for Primary Care 25(3) · April 2014with 155 Reads
Abstract
Innovations and developments Our contribution this time describes what is certainly an innovation. But it is not new. It has quietly been happening in Denmark for many years. EPC readers now have the chance to hear about it – and we hope that such an excellent scheme can be introduced into other countries.
Education for Primary Care (2014) 25: 171–5 © 2014 Radcliffe Publishing Limited
Innovations and developments
Our contribution this time describes what is certainly
an innovation. But it is not new. It has quietly been
happening in Denmark for many years. EPC readers
now have the chance to hear about it – and we hope
that such an excellent scheme can be introduced
into other countries.
* * * *
The Danish DYNAMOs: GP
trainees engaged in the
educational development and
delivery of GP training
Charlotte Tulinius MD PhD
Associate Professor of Postgraduate Education,
Research Unit for General Practice, University
of Copenhagen, Denmark
Eva Bonde Jacobsen MD
General Practitioner and Professional
Development Advisor and Educator for GPs,
Sjælland, Denmark
Per Kallestrup MD PhD
General Practitioner, Aarhus, Denmark and
Associate Professor and Co-Director of Centre
for Global Health, Aarhus University
Keywords: empowerment, general practice
training, peer-assisted learning, recruitment
INTRODUCTION
From studies of peer-assisted learning we know
that there are good experiences with several models
of peers teaching within different disciplines.1
Apart from its higher acceptability, peer-assisted
learning also displays the concept of reciprocity
of educational exchange.2 The majority of studies
have mainly explored peer-assisted learning at an
undergraduate level.3,4
From continuing professional development
(CPD) studies we also know that peers play an
important role5,6 as they do in the training of general
practice (GP) trainers.7 Peers teaching throughout
postgraduate medical specialty training has,
however, been less reported in the literature and in
recent work8 the motivation among trainees to teach
during their own training is reported as low priority
and with several barriers.
As in many other European countries, young
Danish doctors have been represented politically at
boards and committees of health organisations, such
as the National Medical Association, the medical
colleges and the regional medical quality and
development initiatives. Since 1999 Denmark has
also had young GP trainees ‘DYNAMUs’ engaged
in the education of their peers in GP specialty
training. ‘DYNAMU’ is the Danish mnemonic of ‘The
younger GP educational coordinator’, a GP trainee,
employed as a young educationalist and educational
coordinator, taking part in the planning and delivery
of GP specialty training. Also, in Danish this sounds
very much like ‘dynamo’ as in generator of energy
and, as it is a very good description for these young
educationalists, we have chosen to label them
‘DYNAMOs’ throughout this paper.
In Denmark, as in other European countries, the
GP training curriculum is built on the assumption
that GP trainees are self-directed adult learners.9 The
responsibility of becoming a GP is more a matter of
the trainee ‘taking’ the education than ‘being given’
the specialist training. Relying on the concept of the
adult learner we have introduced self-monitoring of
learning, facilitated but with an expectation of self-
directed and continuous definition of learning needs,
self-assessment, and responsibility to become
competent. The transition from medical school to
clinical training may, however, not be so easy for
the trainees.
The DYNAMOs were introduced at the time when
the GP training scheme in Denmark changed to
include 30 months of hospital training, with only
a few ‘return-days’ in a GP surgery. The DYNAMO
was necessary to sustain contact with general
practice as a medical specialty. The vision was that
the DYNAMO would remind the GP trainees of the
professional identity of their future specialty.
From a single area of Denmark it started as a
bottom-up project. It spread quickly throughout
the entire country. Despite financial and structural
challenges, it is now a well-established function
supporting most of Denmark’s GP training
communities.
Below we describe the work of the DYNAMOs and
the educational benefits they have brought about.
172 Innovations and developements
METHODS AND SOURCES OF
INFORMATION USED TO MAKE
THIS DESCRIPTION
PK was one of the initiators of the first DYNAMO
project in 1999. Both EJ and PK have worked as
DYNAMOs themselves, and CT has worked as part
of the project managing system for GP training in
the Eastern part of Denmark. Together we have been
able to locate much of the written documentation
about the DYNAMOs. We have combined personal
experiences of the DYNAMO function with different
perspectives, from the different levels in GP training
and the structural changes we have had in Denmark
over the last decade.
The DYNAMO is now an established part of GP
training in Denmark but it has not been systematically
evaluated. To try to understand more about
perceptions of the functionality of the DYNAMOs,
we sent out a short open-ended questionnaire to
all GP educational coordinators and DYNAMOs in
Denmark. We cascaded the questionnaire down
through the virtual network of GP educators of
Denmark, and the educators were asked to forward
the questionnaire to previously employed DYNAMOs
who were no longer part of the network. From an
assumed establishment we received less than 25%
of possible replies, so we have only used examples
to illustrate our major points of experience. Three
of the current DYNAMOs have provided us with
numbers and descriptions of the current DYNAMO
arrangements in Denmark. Hence this paper mainly
presents our experiences with the DYNAMO function
in Denmark supported by an analysis of:
• Danish descriptive articles from the start of the
initiative to the present, published in non-peer-
reviewed local or national journals10,11
• documents used in the revision of the DYNAMOs’
function and tasks during structural and political
changes of GP training; current DYNAMO job
descriptions; numbers supplied by three of the
current DYNAMOs
• responses from the few returned questionnaires.
DESCRIPTION OF THE DYNAMOS
After almost 15 years of action the mnemonic is still
a good description of the function – a DYNAMO.
Local GP trainees
For the most part the DYNAMOs are formally
appointed or employed, and paid for their work. It
is always GP trainees from the local geographical
area, who will work in cooperation with the local
GP educational coordinator to plan and deliver
educational initiatives as part of the GP training in
the area where their own training takes place.
Varied and multiple functions
The DYNAMOs engage in GP education at all levels.
To get an overview, we describe their work in relation
to three main elements of GP training:
1 General planning of the training, and recruitment
for training.
2 Teaching during training.
3 Social and professional networking for trainees.
Further details on the examples of the functions are
shown in Table 1.
General planning of the training and
recruitment for training
The DYNAMOs are represented in the planning of GP
training at all levels, from the local educational office
to the national GP educational and scientific board.
They have been involved in creating and delivering
all educational reforms for GPs since 1999 and they
are part of the adjustments of the overall planning.
From a GP educational coordinator point of view,
the DYNAMOs are valuable partners in educational
planning and implementation of GP specialty
training. They contribute with the perspective of the
trainees but their own ongoing training also gives
them an insight into educational areas and topics
with a potential for development. An example is the
training taking place in hospital departments. Here
they have easy and informal access to their trainee
colleagues as well as the hospital wards. They are
therefore important key persons in the contact and
communication with the hospital wards, with whom
the GP educational coordinators do not have the
same (daily) contact. The DYNAMOs cannot solve
problems arising from this part of specialty training
but they can help to flag up where the next initiative
might be beneficial, and suggest solutions from their
own and their peers’ training experiences.
The DYNAMOs hereby provide advocacy for the
GP trainees.
Teaching during training
The DYNAMOs are an important part of the teaching
in their geographical area. They assist the GP
educational coordinator not just in the planning of
the teaching, but they also undertake teaching on
their own.
The presence of a DYNAMO is perceived as
legitimising the need for, and importance of,
teaching and training. Seeing a peer being paid to
be part of the training coordination team underlines
the importance of teaching and learning in hospital
departments as well as in general practice surgeries.
At all levels of training the DYNAMO secures the
adequacy and relevance of the content of training.
This facilitates enthusiasm and engagement among
the GP trainees.
Innovations and developements 173
The social and professional network for
trainees
GP trainees are scattered over a large geographical
area for a substantial time of their training, not just
because there are only one or two trainees in each
GP surgery, but also because a large part of their
training is located at different hospital departments.
The local DYNAMO helps to sustain the trainees’
feeling of being part of a GP training community,
socially as well as professionally. The DYNAMOs
contribute to the creation and maintenance of a
‘GP identity’.
The DYNAMOs undertake the tasks of teaching
and informing peers in their local network of GP
trainees. Any new information is posted on websites
or through email, and they make sure that ‘their’
group of trainees is kept informed on changes and
developments.
When a group of trainees are getting to the
final stage of training the DYNAMOs have also
cooperated with the trainers in arranging a ‘doctor-
dating service’. These are meetings with established
GPs who are interested in taking a new partner in
their surgery. Because of GP recruitment problems,
this has been a very valued initiative for both
established GPs and for GP trainees exploring their
future possibilities.
Organisationally the development of the function
of the DYNAMO has proved to be a platform
for recruitment of future leaders for the further
development of general practice in Denmark.
Through their involvement in the professional
development of their peers, they gain experience
and courage to continue to play a role in the
organisational structures that exist in teaching and
training, research and quality development of Danish
general practice.
How much does a DYNAMO cost?
The five-year Danish GP training takes place in
general practice surgeries and in relevant hospital
departments. In general practice it is the GP
trainers and in the hospital departments it is the
Table 1 Examples of functions undertaken by the DYNAMOs
1. General planning
of training and
recruitment for
training
• Represented in the planning of GP training at all levels
• Rolling out new educational initiatives and development and adjustments of the overall planning
of training
• Initiating and maintaining of peer supervision groups for GP trainees leading to CPD groups after
certication
• Initiating new projects (local quality assurance projects, minor research projects)
• The idea and the set-up of the now national website for GP trainees
• Local coordination and evaluation of educational initiatives
• Contact and communication with hospital wards, agging up needs and problems in learning
environments
• Advocacy for the GP trainees
• In most interview panels recruiting GP trainees, DYNAMOs are represented as equal interviewers
for the GP training posts
2. Teaching during
training
• Assist the GP educational coordinator in the planning of the teaching, and suggest courses or
other initiatives that the DYNAMO see as needed in the area
• Undertake teaching on their own, e.g. in the use of the e-portfolio and other learning resources
• Assist in the monthly education days for all trainees in the area themed around learning
resources, clinical or other professional topics, e.g. as a preparation for the leader and
management role as future GPs
• Caring for the newly appointed GP trainees to introduce them to all the elements of GP specialty
training
• Teaching trainees how to seek help, information and other kinds of support during training
• Arrange peer visits to make it possible for GP trainees to visit other GP surgeries
3. Social and
professional
network for
trainees
• Supporting trainees’ identity as a GP
• Teaching and informing peers in their local network of GP trainees
• Peer support for the trainee in difculty
• Professionally and socially providing a connection between older and newly appointed GP
trainees
• Invite to and undertake introduction meetings for their peers
• Can be contacted formally or informally by anyone in the training community.
• ‘Doctor dating service’: arranging meetings with established GPs who are interested in taking in
a new partner in their surgery
• Participate in educational research meetings, AMEE congresses, etc.
174 Innovations and developements
clinical supervisors who support the GP trainees.
Overall coordination and educational development
is delivered by postgraduate associate professors
but the day-to-day practical coordination, problem-
solving, recruitment of new trainees and trainers and
arrangement of local GP trainer and trainee courses
are all delivered by GP educational coordinators.
Denmark is divided into five geographical areas
of GP training, each employing between three and
nine GP educational coordinators and three or four
DYNAMOs. The DYNAMO’s employment hours relate
to the number of GP trainees employed in the area,
but also to the number of tasks and the educational-
political support for the DYNAMO function. In an
area with a cohort of approximately 300 GP trainees
(at different educational levels) the three DYNAMOs
in total use approximately 35 hours per month. It
means that the cost of a DYNAMO is in the region
of seven minutes per trainee per month, but for the
GP educational coordinator they make a remarkable
difference.
Apart from the basic hours, DYNAMOs have
functioned as an important part of the stakeholders
at regional and national educational meetings. They
have also been representatives at educational boards
and committees. Even if this is not covered by the
basic hours of employment, they receive a refund of
expenses. Where possible a senior GP trainee and a
newly appointed GP trainee are employed together
as DYNAMOs, in order to maintain the continuity and
sharing of knowledge between them.
It creates a vacuum when
DYNAMOs disappear
The value of DYNAMOs became obvious when
national structural changes of the administrative
system left parts of Denmark without DYNAMOs for
a period. The amount of work and coordination not
done in the training patches without a DYNAMO was
overwhelming, and gave a supplementary picture of
the DYNAMOs’ importance for GP training. Essential
parts of the communication between trainees and
the regional offices were lost. Thus trainees did
not know about important meetings and teaching
sessions. The educational coordinators reported a
lack of understanding of the curriculum among the
new trainees, a lack of knowledge in where to find,
and how to use, other learning resources, especially
lack of competence in how to use the e-portfolio;
they reported that the trainees were nervous that
they did not have access to their planned training,
the trainee website was not updated and, as they
had no DYNAMO, no peers were representing
them at regional and national levels of educational
organisation. All this, and the lack of peer support
in difficult situations, were reported by the trainees
as extremely damaging to the training in that area.
Since 2005 DYNAMOs have formed a network to
learn from each other, harmonise their functions and
to support each other during difficult times. There
have been problems. In some areas the political
support for the DYNAMOs has left much to wish
for. In other areas a few GP training practices did
not share the engagement in training and would not
support the DYNAMO. A few hospital departments
neglected the need for flexibility in rota planning for
the DYNAMO. Also, some political budget decisions
persistently did not take the benefits of the DYNAMO
into account. However, the fact that the function of
the DYNAMO is implemented in the entire country
and has survived and developed for almost 15 years
tells the secret that all Danish GP educationalists
know; that DYNAMOs are very important in GP
training in Denmark both in their daily work with
trainees and others, and for their future development
following their practical, organisational, structural
and educational experiences of being DYNAMOs.
CONCLUSION
Almost 15 years of experience with DYNAMOs in
Denmark suggests that engaging peers to function
as young educationalists can introduce and support
the GP trainees to a relevant use of their training
time and possible learning resources.
It takes courage to acknowledge the importance
of ownership to education by handing over some of
the responsibility to the trainees. Acknowledging the
DYNAMOs’ insight into the training situation from
a trainee perspective supports the planning and
delivery of GP education within the context of the
GP trainee, rather than of the trainer.
It also supports the sustainability in faculty
development among GPs. Many DYNAMOs have
continued their engagement in GP education after
their training, providing insightful and, for most
of them, apprenticeship-trained, educators of the
future.
From our experience we can recommend the
introduction of this concept into the GP training
curriculum of other countries – the Danish DYNAMOs
provide invaluable contributions to future generations
of GPs.
Acknowledgements
We are very grateful to the three GP trainees and
DYNAMOs Pernille Smalbro Hylleberg, Christina
Svanholm and Jonas Halfdan Ry Hessler for
providing us with the information on the current
DYNAMO arrangements in Denmark.
References
1 Topping KJ (1996) The effectiveness of peer tutoring in
further and higher education: a typology and review of
the literature. Higher Education 32: 321–45.
2 Glynn LG, MacFarlane A, Kelly M, Cantillon P and Murphy
AW (2006) Helping each other to learn – a process
evaluation of peer assisted learning. BMC Medical
Education 6: 18. doi:10.1186/1472-6920-6-18
Innovations and developements 175
3 Rashid MS, Sobowale O and Gore D (2011) A near-peer
teaching program designed, developed and delivered
exclusively by recent medical graduates for nal year
medical students sitting the nal objective structured
clinical examination (OSCE). BMC Medical Education 11:
11.
4 Dickson JM,Harrington R andCarter MJ (2011) Teaching
clinical examination using peer-assisted learning amongst
graduate-entry students. Clinical Teacher8: 8–12.
5 Finlay K and McLaren S (2009) Does appraisal enhance
learning, improve practice and encourage continuing
professional development? A survey of general
practitioners’ experiences of appraisal. Quality in Primary
Care 17: 387–95.
6 McKay J, Shepherd A, Bowie P and Lough M (2008)
Acceptability and educational impact of a peer feedback
model for signicant event analysis. Medical Education
42: 1210 –17. doi: 10.1111/j.1365-2923.2008.03235.x.
7 Shepherd A,McKay J and Bowie P (2010) Training the
trainer in general practice: the perceived value of
independent peer feedback for learning activities.
Education for Primary Care 21: 368–75.
8 Thampy H,Agius S and Allery LA (2013) The motivation
to teach as a registrar in general practice. Education for
Primary Care 24: 244–50.
9 Royal College of General Practitioners (2012) The RCGP
Curriculum Introduction and User Guide. www.rcgp.org.
uk/gp-training-and-exams/~/media/Files/GP-training-and-
exams/Curriculum-2012/RCGP-Curriculum-Introduction-
and-User-Guide-2012.ashx (accessed 25/11/13).
10 Kallestrup P and Maagaard R (1999) AMU DYNAMU – et
team for specialeuddannelsen [AMU (GP educational
coordinator) – DYNAMY (Young educationalist GP trainee)
– a team for the specialty training]. Practicus 130: 175–6.
11 Maagaard R and Kallestrup P (1999) Uddannelsen i almen
medicin – Århus Amt vil gerne være i front [Specialty
training for general practice – Aarhus County wants to be
in the frontline]. Medicus 29: 29–31.
Correspondence to: Dr Charlotte Tulinius, Research
Unit for General Practice and Department of General
Practice, Department of Public Health, Faculty of
Health Sciences, University of Copenhagen, Øster
Farimagsgade 5, Postboks 2099, 1041 KBH K,
Denmark. Tel: +45 35 32 71 71; email: tulinius@
sund.ku.dk
This research hasn't been cited in any other publications.
  • AMU DYNAMU – et team for specialeuddannelsen [AMU (GP educational coordinator) – DYNAMY (Young educationalist GP trainee) – a team for the specialty training]
    • P Kallestrup
    • R Maagaard
    10 Kallestrup P and Maagaard R (1999) AMU DYNAMU – et team for specialeuddannelsen [AMU (GP educational coordinator) – DYNAMY (Young educationalist GP trainee) – a team for the specialty training]. Practicus 130: 175–6.
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