Continuing medical education in mental illness: a paradox for general practitioners.

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BACKGROUND: In 1992, the Royal College of General Practitioners instituted its fellowship in mental health education, which aimed to provide general practitioner tutors with the skills they need to help general practitioners manage mental illness in general practice. However, the emphasis of the fellowship on pedagogic education may discourage educators wishing to introduce andragogic teaching, a paradox which general practitioners must resolve if the aims are to be realized. AIM: This study set out to follow the difficulties encountered by the regional fellows in managing the fellowship and to understand how the scheme has evolved. METHOD: Data collected for interim evaluation of the fellowship was studied and interviews undertaken with the senior fellow and the regional fellows participating in the scheme. RESULTS: From its beginnings, the project encountered difficulties involving acceptance among general practitioner tutors. In response to the objections raised, the project metamorphosed through three stages, from a (perceived) pedagogic approach to a much more overtly learner-centered one. CONCLUSION: Learner-centred education requires trust and belief in the ability of general practitioners to teach general practitioners; over-protection of the audience from 'non-expert' educators merely perpetuates the status quo. If education in mental health care is to become truly learner-centred, general practitioners must address this paradox.

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