Transforming postgraduate GP teaching through collaborative course design and peer-facilitated small-group, reflective learning.

Shropshire Vocational Training Scheme's (VTS) traditional structure of peer-delivered teaching had received poor feedback from trainees. There is good evidence in the literature for stakeholder engagement in training design and participation in small group learning and case discussion as a bedrock of GP learning in the VTS. We introduced three new initiatives to improve half-day release (HDR): 1. collaborative course design; 2. reflective, case-based learning with flipped learning resources; and 3. peer-facilitated, small groups. The aim was to marry trainees' desire for clinical context with the need to comprehensively cover the professional knowledge, skills and attitudes of the 'Being a GP' Royal College of General Practitioner's curriculum.The new collaborative model has improved feedback, facilitated high-level small group reflection and resulted in a smooth transition to virtual HDR during Covid-19. We now have a cohort of highly motivated facilitators, with the opportunity to develop leadership skills, and a bank of complex clinical cases developed to facilitate useful, trainee-led, case-based discussion.Our model is deliverable in other VTS areas and could enhance trainee experience of HDR. Future challenges will be maintaining facilitator training, quality control for cases and discussion and how to ensure our near-peer facilitators successfully become future leaders in primary care.

Partial Response to Small Molecule Inhibition in a Case of Anaplastic Large Cell Lymphoma.

In the era of personalized medicine, small-molecule inhibitors have become key to targeting many malignancies. Multiple hematologic malignancies are driven by small-molecule pathways that are seemingly ripe for such targeting. In this case report, we present a patient who was treated with a mitogen-activated extracellular signal-regulated kinase (MEK) inhibitor for what was originally diagnosed as a histiocytic sarcoma. Re-biopsy ultimately revealed an anaplastic lymphoma kinase (ALK)-negative anaplastic large cell lymphoma (ALCL), but his disease initially showed a remarkable response to MEK inhibition. This case illustrates both the importance of obtaining high-quality biopsy specimens for diagnostic and molecular analysis as well as the need for further research into the molecular drivers of T-cell lymphomas that may be amenable to targeted therapies.