Community-Based Medical Education Newsletter

Community-Based Medical Education (CBME) Newsletter for General Practice www.ihse.qmul.ac.uk/cbme

May 2011 • Issue 10

Welcome to our summer newsletter and thank you very much to all those who contributed, it is very much appreciated. This edition includes an article on the changing face of medical education, tips on helping students through OCSEs and our new Aunty Aggie problem page. (please see back page for email addresses)

Inside this issue Farewell to Tilly Gosai

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Return to Work Janet Johnstone

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Charity Camps

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New Year 4 Locomotor Module

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How to help students through their OSCEs

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Year 3 Changes

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Student Selected Components (SSCs)

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The Changing Face of Undergraduate Medical Education

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Aunty Aggies Problem Page – a problem shared

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Tutors’ Day 2011

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Maynard Court Surgery and The Knares

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Alfie’s Puzzle Corner

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www.qmul.ac.uk

May 2011 Issue 10

Farewell to Tilly Gosai Are you sad to leave CBME? Definitely! CBME is a wonderful office to work in. It is always sad to leave an enjoyable work place. However, I am now ready to move on and get some experience in my chosen career.

If you had one word to describe your experience in the CBME office, what would that be?

Eventful.

They say that it is a hard working office. Is this true?

CBME do a fantastic job to ensure that the needs of both GP tutors and students are met.

Have there been any memorable times? Any times when you knew that you had made a difference to teaching and learning at Barts and The London?

There have been many memorable times, usually at 3pm when it is tea time and it is recommended you eat a banana to feel the vibe. I am not sure that I have made a difference to CBME. Nevertheless, it was a good experience to see what goes on behind the scenes.

What are you going to do next?

I am doing an Internship at Ketchum Pleon.

Charity Camps Return to work – Janet Johnstone

We have been arranging charity camps in 3rd World/ underdeveloped countries, for the last 17 years, under the auspices of Third World Medical Charity a UK based registered charity (UK Registration No. 1099886). We treat and manage cleft lip and palate deformities and other plastic surgery problems. These camps are arranged for two weeks in March and November every year.

I have now returned to CBME after a year away on maternity leave. I am now proud mum to my baby boy Thomas and we have had a very eventful year together.

Although I am missing my days with Tom it’s lovely to be back in CBME. I am busy getting back in to work mode and look forward to working with you all again.

Any medical student individually or groups of four students who would like to visit, at the moment in Pakistan, may contact me for further information. Any surgical trainee or anaesthetist who wants to get involved in childrens services would be very welcomed. It is a good surgical and anaesthesia training.

Janet Johnstone, CBME

Dr Aman U K Raja, GP Tutor Park Lane Medical and Surgical Services Tel: 0208 340 6898 / 07956320287

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Barts and The London School of Medicine and Dentistry, Academic Unit for Community-Based Medical Education, Garrod Building, Turner Street, Whitechapel , E1 2AD.

www.ihse.qmul.ac.uk/cbme

New Year 4 Locomotor Unit General Overview The primary care component in Year 4 continues to expand! This year CBME have been asked to design a new 2 week Community Locomotor Unit. This comprises of Rheumatology, Orthopaedics, Health Care of the Elderly and Dermatology. The students will be introduced to this new unit with a week of centralised teaching at Whitechapel, Mile End or Barts. During this introductory week a program of interactive lectures and tutorials spanning all the composite modules will be delivered.

In week two, brimming with their newly acquired knowledge, the students will spend three days in practice. The aim is that the students will learn how to apply their knowledge; understand the presentation of Rheumatological, Orthopaedic, Health Care of the Elderly and Dermatological cases in the community; understand the prevalence of such disease in the community; learn about the community approach to management in particular the role of the primary care team and finally gain an understanding of the impact of living with such conditions on patients.

Week two has been designed to be delivered as a half day of dedicated teaching, followed by a half day of active sitting in over 3 days. The days are divided into Orthopaedics and Rheumatology (Mondays), Dermatology (Tuesdays) and Health Care of the Elderly (Thursdays). GP Tutors can either opt to provide teaching on all three days or they can choose to deliver two days of teaching in Rheumatology and Orthopaedics and Health Care of the Elderly (in view of their clinical overlap these topics have been paired) or just one day of teaching in Dermatology. The benefit of this system is that GP Tutors are able to teach to their strengths and students do not have to travel to too many different practices over the course of the week.

Teaching Opportunities Centralised Teaching - GP Tutors, Salaried and Locum GPs with an interest in developing their teaching skills further are welcome to volunteer to teach during the first week of centralised teaching. This week will be dynamic, enjoyable and challenging and a brilliant way to meet the students you may well go on to teach during the second week of the unit.

Practice Based Teaching - GP Tutors or Salaried GPs with an interest in providing in house teaching are invited to register their interest. This provides a great opportunity to demonstrate to students the ‘staple’ of general practice - chronic disease management with a holistic approach.

If you would like to provide teaching during week one and/or week two please register your interest by email to Barbara Sommers (b.e.sommers@qmul.ac.uk) Dr Mbang Ana, CBME

Issue 10, May 2011

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May 2011 Issue 10

How to help students through their OSCEs

I write this article as the head of the Year 4 OSCE (Objective Structured Clinical Examinations). My official title is SIE or Senior Internal Examiner, a rather grandiose title but sadly comes with no chains of office or official car. As the Year 4 SIE I blueprint, proof read the questions, mark sheets and serve as the academic lead on the day.

The exams are divided into five or ten minute stations the number of these stations vtaries depending on which year is being examined. At each station the students are asked to take a history, explain a diagnosis or drug, perform a clinical examination or demonstrate a skill such as canulation. The mark sheets are a detailed breakdown of each of these processes, the student is given a mark for each part completed and an overall pass/borderline/fail grade. In the early years OSCEs we simulated patients (mainly actors, ‘bodies’ or mannequins); in Year 5 patients are used.

OSCEs are sat by the students in all the five years, they are not the only way the students are examined but they constitute a large part over their overall score. The OSCE exams in the first FOUR years contribute to their ranking; the Year 5 exam is a pass or fail exercise. The ranking element means that these exams have become much more high stakes than they were when many of us qualified. In the current climate the students have more to gain from these exams so it is therefore not surprising that they become exam focus towards the end of the year and often ask for our help as tutors.

When I lecture the students at the beginning of the fourth year I ask them to consider how many occasions they see doctors examining patients in five or ten minutes. The only time the students can think of

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is in General Practice where (for good or for ill) we see patients in rapid succession taking focused histories and quick thorough clinical examinations. The students may like being taught neurology by a neurologist but they will rarely see them clerk and examine their patients at such a pace and without the benefits of their MRI scan results. I have long been of the opinion that GPs are very well placed to help students hone the skills that they need to do well in the exam.

It has become an odd misconception that the students can do well in the exam by merely communicating well and knowing the process.

I have been an examiner many times and I can assure you that the major reason students fail is due to lack of knowledge. Whilst communication skills are important and carry marks from both the examiner and the simulated patient, their knowledge has to be deep and it often isn’t.

I suspect many people looking into General Practice may think what we are doing looks easy but the flexibility of mind required to be a good GP can be underestimated by both colleagues in secondary care and by students. The OSCE is not dissimilar to a GP surgery with the students encountering different presenting complaints in seeming never ending and random order

So what can you do?

The students are often asked to sit in and observe you taking histories etc. It might be worth asking them to look at how you take the initial open questions into a tighter framework in an efficient and kind manner thus ensuring you get all the salient facts. It is also important

Barts and The London School of Medicine and Dentistry, Academic Unit for Community-Based Medical Education, Garrod Building, Turner Street, Whitechapel , E1 2AD.

www.ihse.qmul.ac.uk/cbme

that the students learn to LISTEN. We are often teaching them about the right questions to ask but sometimes it is their listening skills that are really letting them down. It is all too common to see a student in the exam ask a question and then not actually listening to the answer, this is because they are too busy thinking of the next question. The problem with this is that they often miss vital cues and steer the patient (either real or simulated) in the direction that they think will get them marks rather than responding to the situation presented. All the simulated patients in the exam are asked to reveal facts to the students in a sequential and responsive way, if the students miss cues they may be missing huge parts of the history and thus losing half the marks available to them. It can be quite strange when the simulated patient reveals a distressing fact i.e.” my cat has just died” and the student responds with “ok, right………. have you noticed any blood in your stool?”

There are stations which I call ‘describing’ stations where there is very little interaction with the simulated patient but the students are expected to describe how a drug works, how to use particular equipment or explain a diagnosis. There is a sense of them having to talk AT the patient to get their marks, but I suspect we all have to do this from time to time. I often wonder how my well worked speech on how to take the contraceptive pill is received by my patients- it can feel like a one woman monologue (and I often bore myself) but there are times when it is my job to tell people how to use certain drugs or to explain a complex diagnosis. It is vital that the students see how you do this in an appropriate way; you might like to get them to practise on you or each other. The explaining stations are often done badly as they require huge amounts of knowledge and very specific communication skills- mark my words 99% of them could use the practise. I suspect you would be surprised at the level of detail they need to know to get the marks on these stations.

There are what I call the ‘Hercule Poirot’ stations, where the student takes a history and believes that the aim of the game is to get to the diagnosis as quickly as possible. Sometimes they have their ‘Voila!’ moment then sit back in a self -satisfied manner and look as if they have just split the atom. There was one occasion where I was the simulated patient (not an Oscar winning performance but not bad even though I say so myself) and I can honestly say it was a most bizarre experience where the students tended to disregard any feelings I might have and leap to rapid and often wrong conclusions. The point that they missed was it is the process that matters as well as the diagnosisunless they take an appropriate history or perform the correct examination they cannot score highly. I must point out that this is a global student trait; I have seen this behaviour reproduced at all the medical schools I have examined at.

I do have some sympathy for the students that complain about the difficulty they face talking to a plastic penis about the merits of safe sex or those that complain that the time constraints don’t allow them to demonstrate real empathy - but this is the system we have for now and it is a very discriminating exam. I would encourage any of you who may have avoided talking about the OSCE with students to practise some scenarios with them. If any of you would like to examine you would be most welcome we find GPs are good examiners as we are so versatileplease let Barbara Sommers b.e.sommers@qmul.ac.uk know if you are interested. I do run some training and we have a lot of fun looking at how to and not to examine.

Year 3 Changes Firstly, a big thank you for everybody who has been teaching Year 3. We have had some excellent feedback, so keep up the great work!

Some of you may know that over this last year we have been piloting a new scheme. We took forty Year 3 students each term and got some GP Tutors to kindly cover some case based discussion with them. We have had some excellent feedback, so from September 2011 we are rolling it out to all the third year students while on their GP attachments. During each third year attachment we would like GP Tutors to cover four case based discussions with their group of students. These cases will be in your tutor handbook, and will include learning objectives and tutor notes.

Case based discussions allow the tutors to examine clinical decision making and the application or use of medical knowledge. It also forms discussion of the ethical and legal framework of practice, and it allows students to discuss why they thought what they did.

As part of assessment we will not ask you to grade the student on each case based discussion but more to show that they have taken part in four during their time in General Practice.

If you have any questions please don’t hesitate to get in touch.

Dr Liz Nuttall, CBME

Dr Sian Stanley, CBME

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May 2011 Issue 10

Student Selected Components (SSCs) In accordance with GMC guidance, in addition to the core medical curriculum, students at Barts and The London have the opportunity to choose Student Selected Components (SSCs) which give them the opportunity to study a topic not currently covered in the core medical curriculum, or to study an area of the core curriculum in greater depth.

Students have the option to either choose from a bank of ‘Standard’ SSCs, or to organise their own ‘Self-Organised’ SSC, and can choose to undertake these SSCs in either primary or secondary care. Primary care SSCs are available in Year 1 (2 x 2 week placements), Year 2 (2 x 2 week placements), and Year 5 (3 x 4/5 week placements, one of which is their elective), as well as in Year 4 (a single SSC with time spread throughout the year in order to prepare and submit a 6000-8000 word dissertation).

At present the majority of SSC modules available are in secondary care. There are only 8 standard SSCs available in primary care (3 in Years 1 and 2, and 5 in Year 5). We at the CBME are very keen to encourage more students to choose primary care based SSCs; this will require better promotion of the existing primary care based SSCs, as well as expanding the bank of primary care SSCs on offer.

And this means we need you!

In a recent survey, the students told us that they would be more likely to choose SSCs in primary care if there was a greater variety of topics on offer. The topics they are particularly keen to see offered include Mental Health (for example psychotherapy, CBT,

addiction services), Women’s and Children’s Health (for example Community Midwifery, Community Paediatrics, GUM/Family Planning services), Elderly and Palliative Care, and Forensic services (for example Prison/Police doctors).

Encouragingly at the recent GP Tutor Training Day, many of you told us that you would be interested in offering SSCs. The topics you suggested were very similar to those requested by the students, including Mental Health (with a focus on psychotherapy), Women’s Health (with a focus on cervical screening or contraception, Community Paediatrics, Pharmacology (perhaps with a focus on prescribing for the elderly), Dementia (diagnosis and management in primary care), and Dermatology (perhaps offered by A Dermatology GPwSI).

The Student Perspective Sara Sheikh, a 2nd year student, chose to self-organise an SSC in Diabetes in Primary Care at Wallington Family Practice in February 2011. She kindly agreed to share a student’s perspective on community based SSCs. Why did you choose to undertake an SSC based in the community?

I chose to do a self-organised SSC in General Practice as I am very interested in this particular field. Although we have GP placements in our first and second years, I wanted to gain further insight into chronic disease management in primary care and how the various healthcare professionals work together to optimise patient care.

What do you feel was special about a community based SSC? I became very familiar with the management of Diabetes Mellitus within primary care, and hopefully will be able to retain this knowledge for my later clinical years at university! It was interesting to see how patients had different health beliefs and how their motivations altered. However, I realised how complex the condition actually is and how important good glucose control is needed in order to prevent the complications of DM. Despite this, I fully empathised with patients as losing weight and general lifestyle modification can be really difficult. Truthfully, I didn’t appreciate this issue until I spoke to patients and understood their difficulties. It was really good to see chronic disease management from a clinical perspective, as learning about it from a textbook is completely different altogether.

Do you think SSC’s are an important part of the curriculum?

SSCs are an incredible opportunity to gain insight into the various specialities, as Medicine is such a diverse profession. However, if a student has a particular interest, this must be explored further and SSCs are the perfect excuse to do so! I feel it is very important to familiarise ourselves with the specialities so we can make more informed career choices as it is very daunting to make such a lifechanging decision after our foundation jobs.

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Barts and The London School of Medicine and Dentistry, Academic Unit for Community-Based Medical Education, Garrod Building, Turner Street, Whitechapel , E1 2AD.

www.ihse.qmul.ac.uk/cbme

care pathways. I am interested in audit as a way to reflect on and improve the work that we do both in the practice and in the GP co-operative.

What do you think the students get out of your SSCs? The SSC continues to develop with each group that attends as there is some freedom for the students to set their own agendas within the broad remit of the SSC. I hope that this flexibility allows the students to have ownership of their project. I hope that the SSC gives the students some direct exposure to patients and allows them to see something of the work done in General Practice. I hope that each student has a useful project to take away and to add to their educational portfolio.

What do you and your practice get out of offering the SSCs? I enjoy the enthusiasm of the students and the original ideas that they bring to the projects that they undertake. Some of the projects are brilliant in their concept and execution. One group of 1st year students decided to look at the mix of patients who attend the A/E department. They had attended an ‘urgent care liaison board’ meeting with me. At this meeting the A/E consultant had complained of the difficulties for her staff of patients with minor health problems still needing to be seen within 4 hours and the burden that this put on her staff to cope with the range of health problems that attended.

Did you enjoy the SSC and would you recommend it to others?

The placement was fantastic, as I engaged with patients and took medical histories. Furthermore, I was able to shadow practice and specialist nurses, GP’s, the community matron and the optician as well as having the opportunity to practice some clinical skills that we had learned at university.

I have always had a keen interest in general practice and this placement has only made me more determined to pursue this as a career in the future!

The Tutors Perspective Standard SSC’s (Tutor organised) Developing a new SSC teaching module from scratch provides an exciting and unique opportunity for GP Tutors to be creative and to teach to their area of interest. Dr Jim Lawrie is a GP Tutor based at Royal Docks Medical Practice in Newham. He currently offers 2 SSCs, one on Chronic Disease Management and Audit, and one on Patient Pathways for OOH care. He kindly agreed to be interviewed and provide a tutor’s perspective on the merits of developing and delivering an SSC in primary care.

How did you come to offer SSCs and why did you choose these topics to offer?

The initial development for the SSC came from an encouragement by the excellent staff at QMUL to put down in writing an educational brief about areas of my work that I felt passionate about. In essence it was a couple of pages of A4 with learning objectives and teaching methods for each of the topics. I chose the subjects because I am the Chairman of the GP out of hours co-operative in Newham and the PCT clinical lead for out of hours and unscheduled care, so spend a fair bit of time thinking about out of hours and unscheduled

The students decided to interview every patient who attended the department over a 24 hour period and to ask the patient at the end of their treatment pathway if they thought that any health care service other than A/E could have provided their care. 50% of the patients volunteered that one of a range of alternatives health services, including, GP, physio, GUM clinic, dental care, primary care nurse or counsellor could have provided their care. As a result of this survey the PCT set up a pathway directing 30 patients a day from the A/E department to the walk in centre, helping to reduce the burden on our A/E colleagues. The next group of students read this project and decided to develop an information leaflet for patients giving information about alternatives to attending A/E. The PCT were so impressed with the leaflet that (after re-badging it with PCT and NHS logos) several thousands were printed for distribution through local libraries and GP surgeries. It is 5 years since this project and I recently found a number of leaflets in the general office at our local hospital.

And finally, would you suggest other GP Tutors got involved with SSCs? I recommend that other GPs consider developing an SSC in an area that interests them and be amazed at the enthusiasm and ingenuity of the students who attend.

We hope that many more of you will be inspired by Jim Lawrie’s example and take the opportunity to be amazed by our students!

We recognise that developing and offering teaching modules is time-consuming, and we are happy to assist you in the process of turning an idea into a complete SSC. Please feel free to contact us at e.ovink@qmul.ac.uk or m.ana@qmul.ac.uk to discuss any queries you have.

Drs Emma Ovink and Mbang Ana, CBME

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May 2011 Issue 10

The Changing Face of Undergraduate Medical Education I recently joined the CBME department as part of the Tower Hamlets PCT-run Salaried GP Scheme. Through my role here I aim to develop a deeper understanding of medical education and teaching, and to that end I jumped at the opportunity to write a piece on the recent history of undergraduate medical education in the UK. Dr Tushar Ghosh and Dr Ranajit Ukil at Gables Surgery in Essex have been teaching for QMUL for 14 years, and they kindly agreed to share with me their thoughts on how teaching has changed over the years.

The way that undergraduate medical education is delivered has changed significantly over the last 50 years. From the late 19th century to the mid 20th century medical teaching was relatively static, with the early (pre-clinical) years concentrating on basic sciences with little clinical context. The later (clinical) years were spent almost entirely in hospital attachments, and there was little or no communication or consultation skills teaching. This system produced junior doctors who had an awful lot of factual knowledge that they may never need to use, but were lacking in important skills that they would require daily.1 Tomorrow’s Doctors first incarnation in 1993 signalled an important change in emphasis from recommending the simple accumulation of factual knowledge, to a learning process that also involved developing skills to interact with patients and colleagues as well as the ability to evaluate data.2 This resulted in medical schools redeveloping their undergraduate curricula using ‘horizontal’ integration (blurring the boundaries between the basic sciences) and ‘vertical’ integration (increasing clinical exposure in the early years and incorporating basic sciences into the clinical years). Most medical schools now include some clinical attachments from Year 1, and many use PBL (problem based learning) in some form. This uses clinical scenarios and provides a framework for assimilating teaching and learning across different scientific and clinical disciplines, and also allows students to take a significant amount of responsibility for their own learning.1 The setting in which clinical teaching is delivered has also changed.

At Barts and The London increasing amounts of teaching has been moved into primary care in recent years, and the idea of these placements is for students to experience individualised and smallgroup teaching that is student-centred and relevant to their learning needs. Community-based learning is perceived by students as particularly appropriate for learning about psychosocial issues in medicine, for increasing their awareness of patient autonomy and for improving communication skills. Students tend to perceive advantages of hospital-based learning as including learning about specialties and the management of acute conditions, and gaining experience of procedures and investigations.3 Dr Ukil, now a GP Prinicipal at Gables Surgery, and previously a Staff Grade Cardiologist, observes that hospital-based teaching is by necessity more didactic, whereas in community placements students have more time to spend with patients and tutors, allowing tutors

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greater flexibility to tailor their teaching to the learning needs of individual students.

Dr Ghosh, also a GP Principal at Gables Surgery, says he has noticed that the Barts and The London undergraduate syllabus has become clearer, and therefore more useful for teaching, in recent years. He and Dr Ukil believe that what is almost more important to convey to students during their primary care attachments, is the importance of developing adult learning skills in identifying one’s own learning needs and how to meet these.

At Gables Surgery teaching methods have evolved, and no longer consist mainly of students sitting in on surgery, now encompassing joint consultations, mini surgeries run by the students, small group teaching and OSCEs, among other formats. Teaching has also changed from being delivered almost entirely by GPs to now include GP Registrars, Practice Nurses, Practice Manager, as well as Allied Health Professionals. Dr Ukil notes that ready access to IT and webbased resources also mean it is possible to much more quickly match teaching to topics seen opportunistically in practice.

Teaching can be hugely rewarding for GP Tutors. Dr Ukil says teaching keeps him on his toes clinically, and that he derives stimulation in particular from the variety of teaching he provides – from teaching basic clinical skills to medical students, to teaching a GP Registrar to become an independent practitioner. Dr Ghosh also finds teaching is a good way to keep his knowledge up to date, and believes that if he can infuse the concept of high quality patientcentred care to his students, then whatever their future career paths, the community as a whole will benefit. Both doctors say they love hosting students and wish to continue to teaching, but it is not without its costs, chiefly in terms of pressures on their time. They are the only GPs in their practice and as well as providing care to their 3600 patients, they teach medical students in Years 2, 3, 4 and 5, are GP trainers, and have been elected to their local GP Consortium.

This pressure is likely to become more of an issue in the future as GPs take on more of a role in commissioning, and as more teaching is moved into the community.

Community based teaching has an important role in helping students make decisions on future career choices. Research has shown that many students start medical school with negative images of primary care that can be reinforced by tutors in secondary care4, and that conversely, positive experiences of teaching in primary care can make a student more likely to choose a career in General Practice.

Individual GP’s have even been shown to influence career choice5.

Dr Ghosh and Dr Ukil have noticed that over the years from Year 1 to Year 5 the students they teach become more enthusiastic about General Practice, and the negative perception they often start with slowly but surely improves, with absenteeism definitely reducing over the years.

Barts and The London School of Medicine and Dentistry, Academic Unit for Community-Based Medical Education, Garrod Building, Turner Street, Whitechapel , E1 2AD.

www.ihse.qmul.ac.uk/cbme

It has been shown that students feel the most important influence on their future is the experiences they take out of their clinical attachments, and those curricula that are more community orientated can alter students’ perceptions of primary care6. I hope, through my attachment with CBME, to contribute to the further development of teaching modules based in primary care, and to help raise the profile of high quality primary care amongst medical students. The changing face of medical education is certainly a challenge, but it is one to be embraced, bringing with it opportunities to make use of everadvancing technology such as e-learning when developing teaching modules, something we at CBME are keen to work more closely with GP Tutors on in the future. It also offers up far more possibilities for all of us in primary care to take a greater role in shaping tomorrow’s doctors, whatever path their future career may take. As the landscape of General Practice changes and there are ever-increasing demands on GPs, it is therefore essential that we continue to value our GP Tutors and to support them in their important role.

1. Gillespie and Cookson 2006. Training tomorrow’s doctors.

CareerScope 2. Tomorrow’s Doctors (1993); GMC 3. O’Sullivan et al 2001. Students’ perceptions of the relative advantages and disadvantages of community-based and hospitalbased teaching: a qualitative study. Medical Education December 2001 4. Firth and Wass 2007. Medical students’ perceptions of primary care: the influence of tutors, peers and the curriculum. Education for Primary Care, 18 pp364-72.

5. Edgcumbe et al 2008. A qualitative study of medical students’ attitudes to careers in general practice. Education for Primary Care, 19 pp65-73 6. Pearson and Lucas 2005. Learning medicine in primary care: what is the added value? 2005. Education for Primary Care. 16 pp424-31.

Dr Emma Ovink, CBME

Issue 10, May 2011

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May 2011 Issue 10

Aunty Aggie’s Problem Page – a problem shared...

Please send your responses to Aunty Aggie using the contact details on the back of the newsletter.

Dear Aunty Aggie

Dear Sian

I have been having a lot of trouble with my students arriving late or not at all. I have been getting increasingly frustrated with this as there are times I have asked patients to attend specially. I have tried to talk to the students in question but they seem to be resentful of my asking them to arrive on time and I am worried about how best to enforce their attendance. I am conflicted as I do view them as adult learners but the reality is their time keeping is hugely disruptive to both me and the practice.

On the first morning of a placement I make it clear to a new group of students that they are expected to attend full time and be on time for every session. If they know that they can't make a session I insist on them informing me in advance.

I clearly remember one student who just could not get it together.

He had other issues, not just with attendance and punctuality. I had no option but to fail him and I understand that he did subsequently get the help he needed.

When I have failed the students they seem quite incredulous by my actions and I think this has been reflected in the feedback they have given to me and my colleagues in the practice. I sometimes think the students think I am being unreasonable and they behave as if their non attendance is in fact my fault.

Dr Spitzer, GP Tutor

I do not like being in conflict with the students but I cannot tolerate this behavior any longer – HELP!

1) They don’t feel they are learning and so it is not a good use of time

Sian, GP Tutor

2) They are worried about upcoming exams

Dear Sian I think there are three main reasons why students don’t attend:

3) They can’t be bothered.

Dear Sian Thank you for your letter. You are right to view students as adult learners which means that once the ground rules are clearly communicated it is not unreasonable to expect them to behave. You could use a ‘formal’ learning contract to help communicate your expectations clearly.

The problem may be unrelated to anything you are doing, and communicating with the unit administrator about your concerns early on in the placement allows the School to identify students that need academic or pastoral support sooner rather than later. The School would like tutors to make more use of the professionalism assessment forms when completing student assessments. These forms are taken very seriously by everyone.

GP tutors should timetable students to have good interactive sessions where they can examine or be involved in patient history taking or management which is all very helpful preparation for final MBBS exams.

You could entice the students to come with teaching sessions, exam them OSCE style, or give them a written EMQ paper; all good for exam preparation! Or, perhaps you could give them some SDL sessons.

I think students should fail if they don’t attend their placements. It is unprofessional and as we are going to be doctors in a few months, we need to learn about the importance of attending every day. Students need to learn the consequences of their actions.

A. Student, Year 5

I have included some advice from others below. As you can see nobody likes it when students don’t turn up - least of all their peers.

Yours, Aunty Aggie

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Barts and The London School of Medicine and Dentistry, Academic Unit for Community-Based Medical Education, Garrod Building, Turner Street, Whitechapel , E1 2AD.

www.ihse.qmul.ac.uk/cbme

Can you help? How would you answer these tutors...

Dear Aunty Aggie My Year 1 and Year 2 students are struggling with the idea of writing reflectively. Do you have any suggestions as to how I can support them with this activity?

Yours in hope, Maria, MedSoc Tutor

Dear Aunty Aggie I find that persuading patients to see medical students sometimes requires a certain amount of negotiation and I was recently presented with an ethical dilemma which I am keen to share with you and other tutors.

One of my patients with rheumatoid arthritis has classical signs of this disabling disease. In the past she has been a lively and engaging person for the medical students to visit at home. She finds it hard to get out of the house to visit the surgery.

When I asked her if she would agree to see another group of medical students and she replied that she would on two conditions: 1. That at least one young man was included in the group 2. That the young man would urinate in her garden Trying to control my shock at this unusual request, I asked for a reason. She explained that she is plagued by foxes that dig up her plants. She had been informed that male urine (especially from young men) would keep the foxes out of her garden.

The guidance on professional attitude and conduct states: Section 6: Compassion and Empathy: ‘’responds humanely to patient’s concerns’’ Section 9: Determination to protect the patient’s best interests: ‘’Displays a genuine advocacy for the well-being and needs of the patient’’ Section 8: Self awareness and knowledge of limits ‘’Personal beliefs do not prejudice approach to patients’’ But also...‘’Aware of appropriate professional boundaries, recognises need for guidance and supervision.’’

Mindful of Section 8 of the guidance, I am seeking guidance from other tutors. Any advice or suggestions would be gratefully received, and I would also be interested to hear if other GP Tutors have had similar experiences.

Jim Lawrie, GP Tutor

Tutors’ Day, 2011 Our annual Tutors Day will be held at Whitechapel on 1st July 2011.

It will be a full day event and will include a variety of training activities and workshops. We will be sending all GP tutors further information in due course, so please put this date in your diary and we will look forward to seeing you there!

Maynard Court Surgery and The Knares Maynard Court Surgery I am the Practice Manager at Maynard Court Surgery in Waltham Abbey, Essex.

We are a semi-rural practice which has a large population of elderly people both in the community and care homes which are managed by our three GP’s. We are a close team which consists of our three GP’s, two nurse/nurse practitioners, four part-time receptionists, our secretary and myself. We provide a range of services which include a counselling service, minor surgery/joint injections, cryosurgery, monthly diabetic clinics and undertake most chronic disease management.

We are now in our second year of tutoring students from Barts and The London. All the GP’s and staff are keen to provide learning for the medical students. We have also recently become involved in research with primary care medical research, and have participated in the North London Cancer Audit.

Although we are a small practice with very limited accommodation we hope that we provide a good quality service to our practice population.

Jackie Whillock, Practice Manager

The Knares Medical Practice We are now in the brand new building and our books are open to everyone.

Please look on the NHS Choices website and read about us and the wide range of services we offer www.nhs.uk. We even have our own phlebotomist so there is no need to go to the hospital to have blood taken.

Teresa Euston, Secretary/Acting Practice Manager

Issue 10, May 2011

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May 2011 Issue 10

Postgraduate Certificate in Non-invasive Aesthetic Techniques 2011

Diploma in Clinical Dermatology 2011-2012 The Diploma in Clinical Dermatology is a one-year part time course which provides training at Postgraduate level in dermatology, with emphasis on diagnostic and practical aspects. Full details of the course may be viewed at: www.londondermatology.org

This intensive programme is designed specifically to provide a core curriculum for established general practitioners, dentists and dermatologists who wish to practice in the field of aesthetic surgery.

There are two closely linked programmes: The UK programme provides training via a blended learning package incorporating 6 Clinical Days based in and around London with small group consultant-led teaching. It is aimed principally at Primary Care physicians.

The programme consists of a mixture of structured distance learning, online multimedia/ live clinical teaching, and four essays. We cover the entire spectrum of non-invasive aesthetic surgery with an emphasis on fundamental principles and instruction in a wide range of techniques.

Two clinical training days will be provided to demonstrate the practical applications of the theory studied in the course material.

The International Programme is a pure distance-learning programme designed specifically for physicians outside the UK wishing to gain further experience in dermatology.

Teaching for both programmes is via a structured web-based distance learning package comprising 29 weekly modules. Written material and clinical slide library are supplemented by extensive audio and visual content. Whilst the UK programme holds regular Clinical Days, the International Programme features individual and group casebased tutorials and discussions online. Both programmes concentrate on the practical and clinical aspects of Dermatology. Participants are required to complete weekly assessments, a dissertation and a written final examination.

Completion of the course leads to a postgraduate certificate in Non Invasive Aesthetic Techniques awarded by the University of London.

Successful completion of the programme leads to the award of Postgraduate Diploma in Clinical Dermatology, from the University of London. Places are limited.

The next course for both UK and Overseas students starts on 10 October 2011. Closing date for applications will be Wednesday 31 August 2011.

The next programme starts on 26 September 2011 Closing date for applications is 29 July 2011

For further information please visit our website at www.londonplastics.org

For further information please visit our website at www.londonplastics.org

Alfie’s Puzzle Corner Alfie George says, it’s great to exercise your brain!

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Contact the Editorial Team This is your newsletter. If you have any suggestions for future content, useful teaching tips, teaching resources or experiences you would like to share please send us your contribution.

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Lynne Magorrian l.c.magorrian@qmul.ac.uk

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Janet Johnstone j.r.johnstone@qmul.ac.uk

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Barts and The London School of Medicine and Dentistry, Academic Unit for Community-Based Medical Education, Garrod Building, Turner Street, Whitechapel , E1 2AD.

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