Community-Based Medical Education Newsletter

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

December 2010 • Issue 9 Welcome to our Christmas Newsletter and thank you to those who contributed.

As always, it is greatly appreciated!

This edition includes a review of the Hub and Spoke Model, an article from the New Surgery in Brentwood about their experience with the new 5th Year Community Care Unit and Dr Chris Derrett’s sabbatical experience in Western Australia.

If you have something you would like to contribute to the next edition of the CBME Newsletter, please send it to us by email. (please see back page for email addresses)

Inside this issue Farwell to Amy Flint

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Welcome to Holly Riches

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5th Year Community Care Unit

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Welcome to Will Spiring

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The New Surgery Article

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Salaried GP Pilot

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Medical Communications Skills and Law

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Arising from the business meeting

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An Educational Sabbatical

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NHS Changes to Sift Payment

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Puzzle Corner

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Interested in teaching Medical students

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www.qmul.ac.uk

December 2010 Issue 9

Farewell and thank you to Amy Flint

Welcome to Holly Riches

Amy Flint has been covering maternity leave for Janet Johnstone from January 2010 to the end of September. Amy has since started a course studying MSc Forensic Archaeological Sciences. Before Amy left we had a chance to catch up with her.

Are you sad to leave?

Absolutely! It's always sad to leave somewhere you have enjoyed working. CBME is a fantastic department – the people there do an amazing job. I'm very much looking forward to starting my MSc and being a student again, as archaeology is where my heart is, but I've had a fabulous nine months experiencing the other side of university life.

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

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

Without a shadow of doubt - so much goes on behind the scenes, which the students and GPs never see. The running of CBME is fundamentally about co-ordination, similar to spinning plates, if the team wasn't on the ball all the time there would be a lot of broken crockery.

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?

I'm not sure I've made a difference per se, but I think I've managed to caretake the role while Janet's on maternity leave. There have been many memorable moments, usually at around 3pm!

So what are you going to do now?

MSc in Forensic Archaeological Sciences at the Institute of Archaeology, UCL. Well good luck. We will all miss you.

Katheryn Livingston, CBME

I began working for CBME at the beginning of July. I was taking over from Angela Silvester, a much loved member of the team who had spent 17 years at the university. I had some big shoes to fill! I settled in well thanks to a friendly team and started to tackle my varied role.

I look after the Medicine in Society allocations for Yr 1 and Yr 2 students and also the GP allocations for the 5th year students .A lot of work goes into finding the tutors for these allocations so it is important to maintain a good relationship with them.

Once all the administration is completed before a student begins their placement, contacts details, start dates, tutor and student guides sent out, there is always more to do. Collecting all the grades and assessment sheets, keeping the Academic lead involved, ensuring feedback surveys are completed and then the process begins again!

I also help to organise the Plenary days at the beginning and end of a student’s allocation. Another part of my role is to order equipment for the practices that need it. Without this they cannot provide the high level of teaching they do.

I have been on some practice visits too, checking that a new Tutor has enough space and time for their preferred module. I really enjoy liaising with both the students and the practices and sorting out any niggles that they may have. After previous roles within teaching recruitment and with a language school this brings the two sides of academics and students together. I am really enjoying it, the cakes help, but really it’s the people.

Holly Riches

5th Year Community Care Unit Barts and the London School of Medicine and Dentistry have launched a new module in Community Care as part of the final year MBBS rotations. Students spend 5 weeks placed in general practice to learn and improve clinical skills in a semi-supervised independent setting. This replaces the two fortnight placements which were split over the final year. This new module affords the opportunity for students to immerse themselves in one practice and experience more fully the role of the primary care team and the members of it. Most students are placed in pairs. There is also an opportunity for students to select an own choice placement for approval.

Also included for the first time are placements in out of hours care centres, walk-in centres and a palliative care half day based at St. Josephs Hospice, Hackney.

Students are assessed by their tutor through workplace-based assessments, which parallel the foundation level portfolio, and also undertake a team poster project.

It is hoped to undertake a formal evaluation of the module and we would hope you will feel able to be involved. More details to come!

For more information and for opportunities to feedback on this new module contact Holly Riches on 020 7882 2522 or h.a.riches@qmul.ac.uk Dr Will Spiring Year 5 Clinical Teaching Fellow, CBME

In the surgery, students are expected to see and assess patients independently before discussing the management and prescribing needs of their patient with the GP tutor. These student clinics provide a valuable preparation for independent practice at foundation school level.

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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/chs/education/cbme

Welcome to Dr Will Spiring Dr Will Spiring started with CBME in September 2010 working as a Year 5 Clinical Teaching Fellow for three sessions a week.

You’ve been here 2 months, Will. How have you found working for three sessions a week with CBME? The time is easily filled. It’s fun and friendly so far at least! I find contact with the students and tutors the most satisfying part. Although my job often brings me into contact with challenging students or placements where there are problems it’s been fantastic to see the huge volume of positive student feedback about our tutors.

Do you find that your CBME sessions benefit your work as a GP? It’s never a good thing to be isolated as a GP physically or mentally.

Our jobs are about Life in all its fullness. Yes I find benefit for every day practice in even the most abstract aspects of academic andragogy.

Thank you, Will. It’s good to get such positive feedback on the CBME experience.

Dr Bruna Carnevale Year 4 Clinical teaching Fellow, CBME

So what else is in your life?

I am a partner at the Mission Practice in Bethnal Green where I still teach students in General Practice.

Why did you decide to join CBME? For me it was equally about the opportunity to teach and develop some of core undergraduate curriculum and to develop myself as an educator.

So what have you done so far?

Well relearning the structure and immunology of the HIV virus to facilitate FUNMED PBL has to be a highlight…

What does the future at CBME hold for you?

I am going to be working on the 5th year documentation, the central introduction and final day teaching programmes and attending an ASME conference next month. Expect to see me at the Tutors day events with my 5th year hat on.

The New Surgery – 5th Year Community Care Placement Our positive outlook looked like being called into question however when at the Business Meeting our very dear Kathryn Livingston advised of the intended 5 week placements for Year 5’s commencing September 2010. I had to think long and hard about how much in the way of refreshment the practice could cope with in one period without becoming saturated to its core!

With a definite increase in our careful planning undertaken in the main by my superb assistant, Jayne Farmer we were able to convince the partners that we could take it on board. Though we have aged slightly and have a little less hair – the good news is we are managing in the main!! In fact we have seen one or two benefits such as fewer induction sessions!!

At The New Surgery we have accepted Year 5 QMUL students over the past two years, four at a time in each firm throughout the academic year. Ten days in the practice for Preparing for Finals and two weeks for Preparing for Independent Practice provided us with an opportunity for our GP’s to brush up on their teaching skills and having the student doctors around the place was invigorating and somewhat refreshing for all.

Our first firm of students in September were quite simply outstanding, managing to get themselves exactly where they needed to be and always arriving on time. (Thank you Susie, Charlotte and Samantha for the lovely picture above). The programme does take a lot of planning and tweaking throughout the module but it is I hope interesting and varied. It really isn’t as bad as I thought it would be – in fact it has been a pleasure Debbie Elam Practice Manager – The New Surgery Brentwood

Issue 9, December 2010

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December 2010 Issue 9

Salaried GP Tutor (SGPT) Pilot Scheme SGPT Pilot Scheme: As the proportion of the MBBS curriculum in Primary Care increases, so Community Based Medical Education (CBME) needs more practices and more teachers. This teaching is carried out by allocated GPs in practices from Year 1 through to Year 5 with increasing time spent seeing patients in theme-based sessions.

The SGPT Pilot Scheme has been developed to provide opportunity to combine SGPs and established Barts and the London Teaching Practices, and to create exciting new teaching possibilities for our medical undergraduates.

Why: Salaried GPs are increasing in number, highly motivated, enthusiastic and often unable to get involved in undergraduate medical education, through lack of opportunity or exposure to teaching possibilities.

Equally, there may be already established teaching practices who have recently lost teaching GPs, or would like to expand their teaching team, or have the space without the teachers who would all be ideal as host teaching practices for a SGP Tutor (not a salaried GP).

Who would be Involved:

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Additional sessional funding for mentoring activities (to a maximum of 5 per academic year)

SGPT: • The host practice would negotiate teaching payment to the SGPT. •

It would be expected that the SGPT rate would be based upon the Bart and the London sessional teaching payment.

Appropriate Teaching: Year 2: Extending Patient Contact (EPC) This year two module links the disease processes being studied in problem-based learning sessions with relevant patient contact.

Students build on their early clinical experiences with a growing focus on professional development. They attend GP in groups of 4, for 12 alternate Tuesday mornings.

Year 3: Clinical Placement Programme Clinical and communication skills development, linked to the 3 major body systems, is the key aim of this third year placement. Students, in groups of 4 or 6, attend for one day alternate weeks (timing flexible) over 8 weeks for each system.

Dr Bruna Carnevale, Year 4 Clinical Teching Fellow, CBME

A SGPT: • a Salaried GP working as a GP Tutor and not as a GP, who has completed the London Deanery “Introduction to Teaching in Primary Care Course” (ITTPC) or equivalent course.

Medical Communication Skills and Law - A patient centred approach made easy

A SGPT Host Practice: • a practice that is willing to involve an SGPT in the development of their Undergraduate Teaching across the academic year.

Kwong et al.

A SGPT Host Practice Mentor: • a GP tutor in the practice that would supervise the SGPT. This would involve meeting with the SGPT on 3 occasions, at the beginning, middle and end of the academic year.

Provision by Host Teaching Practice: •

SGPT Mentor.

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1 room for tutorials or for student clerking and examining of patients.

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List of patients with appropriate conditions that SGPT can contact for teaching.

Barts and the London, CBME Process: 1) Matching of SGPT to a Host practice.

2) Initial meeting with SGPT, SGPT Mentor and CBME academic clinical teaching fellow prior to teaching.

Finances: SGPT Host Practice: • Barts and the London sessional teaching payment •

Facilities funding as appropriate

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Published Churchill Livingstone 2009 ISBN 978-0-7020-3083 Available from amazon.co.uk £14.99 This is a small pocket sized book aimed at medical students but is suitable for anyone who needs a quick summary of points to cover when communicating in various clinical situations. It is broad rather than deep and is unashamedly pragmatic and didactic in its approach. There is section by section guidance on what to cover when explaining common procedures, drugs and tests as well as a useful section on explaining common devices. The guidance is based on direct patient feedback and should provide a useful reference for those preparing for and in foundation jobs, both hospital and primary care based.

One of its strengths is up to date and relevant comments on the legal aspects of note keeping. These tips are spread throughout the sections on history taking, obtaining consent and patient competence. It covers the Mental Capacity Act 2005 and its relevance to practicing doctors and the updated Mental Health Act 2007 giving case examples that should provide grounding for both undergraduate OSCEs and practicing foundation year doctors. It even covers the peculiarities of Scottish Law for those Barts and The London students who get matched to schemes in the far north.

Dr Will Spiring, Year 5 Clinical Teaching Fellow, CBME

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/chs/education/cbme

“Arising from the Business Meeting” Changes to the SLA structure.

At the last Business Meeting, in April 2010, I introduced a proposal to streamline our contractual arrangements so that our documentation became more timely and relevant. The challenge is that we are funded over a Financial Year and operating over an Academic Year.

Thus we can only issue funding contracts when the teaching commitments have been agreed. As this can be as late as June/July , teaching practices can be signing contracts in July/August which relate to activities starting in the previous April.

The proposal is to provide a contract for you to sign and return before April which highlights your intention to teach with us for the rest of the current Academic Year and in the next Academic Year under the Barts and The London ways of teaching, professional development and quality assurance set out in the (revised) contract. This is, effectively a commitment to teach contract. We will then continue with our normal practice recruitment processes (preference forms) and then send you a codicil to the contract which confirms your actual teaching in the coming academic year and the payment that you will receive for that funding. We will provide you with two sets of figures: the payments you will receive from April to March (NHS financial year) and the payments you will receive from September to August (academic year).

The proposal met with agreement at the Business Meeting and I am working to a timescale that will see a draft ready for consultation in January 2011. If you would like to be part of the consultation process and provide me with feedback on the new documents, please contact me on k.livingston@qmul.ac.uk.

Reviewing the Hub and Spoke model The prospect of a review of the hub and spoke model was raised at the 2010 Business Meeting. The position is summarised in the PowerPoint presentation from that meeting (stored on the Web under “events” ) and the report of that meeting sent to all practices electronically in October. This article forms the first part of the CBME consultation process.

When we move to the new single funding tariff described earlier, the distinction between “hub” practices and “spoke” practices in terms of the financial model will disappear. However, as I am working with the new SLA structure (see earlier) I can see that there are distinct roles that were linked to Hub practices, and more recently to SuperHub practices that we would not wish to lose, and may wish to revive and give more support to.

Background Initially, the Hub and Spoke model recognised the responsibility that larger teaching practices had for supporting smaller teaching practices: “Hub Practices (are) accredited teaching practices undertaking teaching activities and lead responsibilities for a group of associated teaching practices” Hub contract 1998-9 It was refined by the introduction of the Super Hub practice which had an identified GP training component of time alongside a sizable undergraduate teaching load.

“Super Hub practices will be required to take a lead role in the development of community-based teaching activities and tutor training and as such will need to operate at the highest standards, be committed to the development of evidence based medicine and be proactive in the development of teaching in the community. Specifically, they will be required to work in conjunction with the Centre to provide training for community-based tutors (to share their own expertise and to support the development of the highest teaching standards in other practices) and to pilot new teaching and help devise and implement changes to the community-based curriculum.” SuperHub contract 2005-6 It is now more than 10 years since the initial Hub and Spoke model was developed. The implication that a teaching practice with few teaching sessions is necessarily more able to support the teaching of local neighbours than a practice teaching many sessions is no longer a valid model.

Organisationally, the Community of Barts and The London Teaching Practices is expanding. In 2009-10 we had 153 local (to Whitechapel) teaching practices. This size of organisation requires a rethink in terms of ensuring quality teaching, efficient transmission of messages about curriculum change and standard approaches to matters like attendance and professionalism. We have a greater proportion of practices new to Barts and The London and we need to look again at support for new practices. We also have a healthy flow of Salaried GP Tutors developing within our area and we need to look at support mechanisms for them.

The model that we will be looking at developing is one that does not differentiate practices by the amount of teaching they do, but looks at the concept of Lead Practice in areas such as: • curriculum support/ specialist clinical teaching • mentoring new GP tutors/practices, • hosting salaried GP Tutors, • supporting Peer review.

We also need to look again at the possibilities of managing at least 2 of our 4 annual training sessions on a regional basis, thus reducing the pressure on your time caused by travelling to Whitechapel or Mile End or Barts. This calls for the development of the SuperSpoke model where training can be more localised. The SuperSpoke would be a regional venue and resource centre for training knowledge and possibly physical resources while the actual organisation of the training would still be managed by CBME staff.

Each of these possibilities come with implications for either GP time or Practice Manager/Administrator time. The funding for this needs to be factored in to any model that is developed.

These changes need much more discussion before a model is put out to consultation. There is a tear-off slip with the covering letter to this newsletter. Please answer the questions on that slip and send or fax them to me (addresses on the slip) or e-mail me with your thoughts at k.livingston@qmul.ac.uk. I will be looking for some willing colleagues to join me to work towards the new structure for our Teaching practices. My plan is to take two afternoons in January to develop the new model ready for consultation in February and presentation at the business meeting in April. Please let me know if you would like to join me.

Kathryn Livingston, CBME

Issue 9, December 2010

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December 2010 Issue 9

An Educational Sabbatical in Western Australia Introduction I have been a GP principal and medical educator in East London for 24 years. This year I decided that I needed a sabbatical to recharge my batteries and reflect on my professional roles as a clinician and teacher. I chose to visit “the outback” of Western Australia to study a unique system of medical education.

Western Australia Western Australia (WA) represents one third of the Australian land mass; with an area of nearly one million square miles, it is more than 10 times larger than the UK. Most of the 2 million residents

live in Perth or the surrounding metropolitan area, but the sparsely distributed rural population has considerable political influence because the country areas of WA are the source of much of the state’s productive wealth in the form of agriculture and minerals.

There is a chronic shortage of country GPs in WA and this has become a political “hot potato”.

The Rural Clinical School of Western Australia The Rural Clinical School of Western Australia (RCSWA) is a collaboration of both of WAs medical schools : the Universities of WA and Notre Dame. The school was set up to address the shortage of “home grown” rural doctors in the state and to provide specialist rural medical training. Students who are accepted on the RCSWA programme spend the whole of the penultimate year of their undergraduate training in a “country” town. Currently there are 77 students working with the RCSWA in 13 rural placement sites throughout the state. During my sabbatical I visited 6 of these sites (Broome, Derby, Kalgoorlie, Esperance, Albany and Bunbury) over a 3 month period.

The RCSWA teaching sites vary in their size, cultural and ethnic makeup and economic base. The medical and educational facilities and student accommodation also vary, but all conform to certain basic standards. Each site has a small library and excellent IT facilities and several locations can be linked for video conferencing. There is a programme of local and remotely-presented lectures and tutorials. Students are given free accommodation and other financial incentives whilst they are on the rural programme.

The school has 43 part time medical coordinators (GPs and hospital consultants) who supervise and assess the students with the support of at least one local administrative assistant, A “vertical” education curriculum is employed with students working in a range of health facilities which generally include a local district hospital with inpatients and an emergency department, one or more general practices and remote clinics and aboriginal medical services. The teaching programme is opportunistic and is based around appropriate clinical cases as they present.

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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/chs/education/cbme

My route in Western Australia Acknowledgements Many people helped make my sabbatical exciting, educational and thought provoking. I would like to thank my colleagues at Barton House Group Practice for allowing me to step off the “tread mill” and take time out. The London Deanery and NHS City and Hackney granted me Prolonged Study Leave , Sandra Nicholson offered encouragement from Bart’s and the London Medical School and Professor Geoff Riley and colleagues kindly extended an invitation to work with the Rural Clinical School of Western Australia.

Dr Christopher Derrett Barton House Group Practice RCSWA Students in Broome

Student (and visitor) accommodation Broome

The RCSWA one year programme includes internal medicine, surgery, paediatrics, obstetrics and gynaecology, cancer and ophthalmology and these are all taught in both primary and secondary care settings.

The educational programmes at the various sites are all different; MCs are free to plan the detailed timetable and to exploit the strengths of their colleagues and locations. They do this without losing sight of the overall academic framework.

The RCSWA provides a unique opportunity to develop medical professionalism. The students are “highly visible” to colleagues and teachers who can identify and address inadequate performance and/or unprofessional behaviour that has been previously hidden.

The Medical Coordinators (MCs) are a committed and enthusiastic group of experienced clinicians and medical teachers and the rural undergraduate programme attracts the more able, mature and adventurous medical students. The overall academic standard compares favourably with that in the UK.

The value of a sabbatical It has been a privilege to take a sabbatical at this stage in my professional career. Travel overseas is generally mind expanding, but this is particularly the case when one is able to be more than a tourist. Whilst staying in Broome and Kalgoorlie, I had time to reflect on the lifestyle of colleagues and on the varied health care systems.

Working with enthusiastic teachers and students of the RCSWA has convinced me that when adequately resourced, a “vertical” curriculum with longer term attachments can offer a richer learning experience than is generally available with the traditional medical school programme based on shorter specialist“firms” The RCSWA is demonstrating that undergraduate experiences can influence the career choices of doctors. Teachers and medical workforce planners, please note!

NHS London changes to SIFT payments Changes to SIFT funding have been forecast since well before I joined CBME in July 2008. The change is clear: we are required to move to a single linear tariff for funding. This means that our two phase approach to funding which takes account of: • the actual teaching undertaken (placements payment), and • the resource implications of supporting and managing the organisation of teaching (facilities payments) will need to be merged into a single payment for teaching funding stream.

Currently, the timing is not clear: we thought we would be required to implement this change in April 2011, but we may have a few years to put a new system in place. I will be presenting the new model for funding at the Business meeting in April 2011 and will be able to indicate our timetable for implementation. As we phase the new model in, we will be looking to ensure that, in the first years of the changes, that no practice receives less in funding under the new model than they would have received under the old model.

Kathryn Livingston, CBME

Issue 9, December 2010

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December 2010 Issue 9

Alfie’s Puzzle Corner 2

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Interested in Teaching Medical Students at the University?

We are looking for enthusiastic GP’s (Partners or salaried) who would be willing to supervise small groups of Year 3 Students doing Problem-Based Learning at the University.

• You can do as little or as many sessions as you like.

• Everything needed for the teaching session will be arranged for you. Just arrive and supervise the session.

• Personal training regarding Problem Based Teaching will be given beforehand.

Across

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Fearless (9) Something to talk about (5) Lessen (7) A witty saying (7) A food turner (7) Vocal vibrato (7) Immediately after that (9) Lacquer ingredient (5) Lock (5) The product of nuclear decay (9) Difficulty (7) Spray can (7) Scene (7) Asthmatic's device (7) Cede (5) Accessories (9)

Down 1. Measured amounts of medication (5) 2. Offense (7) 3. An expression of esteem (7) 4. Swelling under the skin (5) 5. Sugared (9) 6. Ancient Greek or Roman warship (7) 7. Intention (7) 8. A disorderly outburst (9) 13. Thought transference (9) 17. Bother (7) 18. A pike fitted with an ax head (7) 20. Dirigible (7) 21. A hormone lacking in diabetics (7) 23. Spanish for "(girl) friend" (5) 24. Harps (5)

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.

Lynne Magorrian l.c.magorrian@qmul.ac.uk Tilly Gosai j.r.johnstone@qmul.ac.uk

If interested please get in touch. Email e.nuttall@qmul.ac.uk.

Dr Liz Nuttall Year 3 Clinical Teaching Fellow, CBME

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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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