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KUMEC Evaluation Report

2014-15

Executive Summary

KUMEC | The Community Campus

Website: www.kcl.ac.uk/kumec

Twitter: @KUMEC4KCL

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Introduction

The KUMEC Team, as the King’s College London School of Medicine Community Campus provides

supports and promotes medical education in community contexts. This is implemented through

fostering learning opportunities with and for patients, students and community teachers. We are all

working towards the preparation of caring and well trained doctors. The KUMEC central team is part

of the King’s College London Department of Primary Care and Public Health Sciences; is housed on

the Guy’s Campus; and consists of administrative (5.6 FTE) and academic (6.4 FTE) staff. Many of the

academic staff also have NHS clinical commitments. The central team leads on the development and

delivery of undergraduate medical education in primary care to our 2,000+ King’s medical students.

The KUMEC community teaching network that delivers the teaching is made up of approximately

600 teachers, 310 teaching practices (general practices) and 30 community-based student

learning centres where seminars take place. Teaching practices are mostly situated in south-east

London but a significant proportion, mainly those who teach students on the final year eight-week

placement, can be found in south-east England and other parts of the UK. One-to-one and small

group teaching allows good supervision, support and honest and insightful feedback, mirroring the

doctor-patient relationship. The KUMEC team and network teaches 195,000 student hours each year

and we teach in each year of the curriculum. In Years 1 and 2 we focus on why patients attend the

GP, the consultation, health and illness, and chronic illness and the health care team; in Phase 3 the

clinical examination and patient-centred care; in Phase 4 the longitudinal pregnancy study and

health promotion; and in Phase 5 an eight-week apprenticeship in general practice and the

community. We also run a number of 12-day student selected components that cover all kinds of

community-based health related topics ranging from the impact of sickle cell on families, to early

literacy, health care in Cuba, smoking cessation, prison health care, community care of older people

and ‘the good doctor’. Teacher development is key to our success and a full programme of support,

briefing and training events is organised through KUMEC. In addition all teachers, particularly those

that are just starting out, are encouraged to complete the two day ‘Introduction to Teaching in

Primary Care’ course run jointly by the London Deanery and the London Medical Schools. The

KUMEC programme is robustly evaluated by students and teachers and, based on that information,

continually updated. We also have a system of practice visits for quality assurance and we take great

pride in delivering a strongly student- and patient-centred programme of community focussed

teaching and learning. The past year has gone well and we have continued to place our students in

the community in all years of the curriculum and provide supporting sessions centrally as part of

their primary care programme. We have brought in a number of new teachers, some of whom now

teach on-campus, as well as provide ongoing teacher briefing and training events and a number of

visits to existing teaching practices. A new King’s undergraduate medical curriculum is being

developed to start, for Year 1, in 2016. This is in response to the changing needs of patients and the

public with more people living with multiple long-term conditions; the advance of technology

transforming clinical relationships; advances in genomics and personalised care; and the drive for an

integrated approach delivering whole-person care closer to home. We also want to focus on medical

students and in developing their resilience and professionalism as well as improving population

health. The new curriculum will be divided into three stages: Foundations of Medicine (Year 1);

Principals of Clinical Practice (Years 2 and 3); and Integrated Clinical practice (Years 4 and 5). There

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will be a focus in the early years on scenario-based teaching and integrating clinical and biomedical

sciences. Assessment will be stream-lined with some years having formative assessment only and

other years having summative assessments and the final year assessment will be brought forward to

allow the students time to focus on the transition to becoming an F1 doctor. We will deliver a

longitudinal placement one day a week in general practice in Year 2 (Stage 2) starting in September

2017 and continue to provide an eight-week placement in general practice in Year 5 (Stage 3). We

are working with the Health Education South London organization and associated CEPNs in

delivering this part of the curriculum. We have continued to respond to repeated challenges

reported in the National Students’ Survey (albeit with an improvement in ratings in this past year),

with our focus on providing excellent administrative support and improving the feedback that we

give our students by engaging with our teachers to help students feel that they belong; signposting

feedback to our students; encouraging students to ask for feedback; and reminding students them

that our primary care teaching practices are part of King’s College London. Each year, in introductory

sessions we also let students know what we have done to address the evaluations they have made

of our programme. KUMEC staff are heavily involved in Medical School initiatives. This includes Anne

Stephenson who is Sub-Dean for Student Support, leads on professionalism for the School and is a

senior clinical adviser; Ann Wylie who is part of the School global health initiative and leads on Phase

4 SSCs within the School; Ruth Sugden who deputises for the School Phase 5 Lead and leads on the

Phase 5 Academic Support Programme for re-sit and struggling students ; Russell Hearn who

is Deputy Lead for Phase 3 and leads on the academic support programme for Phase 3

students; Kerry Boardman who is involved in teacher training across the whole School; and

Kay Leedham-Green who is Head of the Practice of Medicine component for Years 1 and 2. We are

also involved as personal tutors and clinical advisers, OSCE examiners and in the selection of medical

students. I would once again like to thank the KUMEC team who work tirelessly and with

considerable expertise and enthusiasm both for primary care teaching, for the Medical School, and

for medical education nationally and internationally. Our excellent evaluation results reflect the

time and effort that the team puts into community-based education.

Dr Anne Stephenson, Director of Community Education, November 2015

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Year 1 Evaluation Report 2014/15 Exploring Medicine in the Community

Executive Summary

This has been an educationally successful year, particularly for year 1 seminars, which have had

substantial changes and significant increases in student satisfaction. Learning objectives and content

of GP placements have remained static, as efforts have been concentrated on recruitment and

retention. Apart from one practice, where there were difficulties due to a teacher on maternity

leave, satisfaction with GP placements has remained stable.

Word cloud of all qualitative feedback relating to GP placements

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Year 2 Evaluation Report 2014/15 Eliciting a Medical History and Access to Healthcare

Executive Summary

Year 2 has also been successful and all significant changes in student feedback have been positive.

As with year 1, there has been very little change in the content of GP teaching, as attention has been

paid to recruitment and retention, and running alternative sessions for students without

placements. Significant changes to year 2 seminars have included critical reasoning exercises in the

access to healthcare seminar, new role-pay scenarios, explicit scaffolding of consultation skills,

facilitation of self-directed learning through video-assisted reflective feedback and peer-observation

sheets, and a variety of feedback methods to encourage group participation in learning. Our year 2

seminars are now the highest rated in all years.

A word cloud of all qualitative feedback relating to year 2 seminars:

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Phase 3 Evaluation Report 2014/15 Developing Patient-Centred Clinicians

Executive Summary

I always really looked forward to our sessions. I got loads of really useful feedback

and was able to ask questions and get an insight into life as a GP. I’m just sad

that we didn’t get to spend more time there as I feel I would have learned even

more!!- student evaluation 2014/15

The quote above demonstrates the positive attitude students have towards the Community

Teaching they received, and is just one of many similar comments made by students.

This academic year saw significant changes made to the Phase 3 curriculum. Following on from the

success of the innovative simulated GP placement at the Royal College of General Practitioners

(RCGP), in which a quarter of the students participated last year, this was incorporated into the

curriculum for all Phase 3 students. Last year students either had seven sessions in general practice

or seven session based at the RCGP, with the same GP tutor. This year students experienced a

combination of both placements, with four sessions in their allocated practice (again with the same

tutor) and three sessions at the RCGP. Where possible they had the same tutor for both parts of the

placement. This allowed the students to build a relationship with their tutor and the practice.

Students gained exposure to the Primary Care perspective related to each of their three broader

Phase 3 rotations. The RCGP teaching consisted of three simulated surgeries spread over the

academic year, also correlating with their broader Phase 3 rotations. Students were taught in small

groups of three to four by GP tutors and saw recruited patients, expert patients or simulated

patients. Student satisfaction scores for both courses were high.

Current successes

Students enjoy both their community and RCGP teaching and find the quality of teaching very high.

Numerous tutors are highly commended in individual comments.

Both aspects of the Phase 3 programmes offered students direct observation and constructive

feedback. Students greatly valued the learning and feedback opportunities provided by both of

these programmes.

Areas for improvement

The majority of negative comments continue to refer to time of travelling in the traditional course,

yet simultaneously many students recognise the cost benefit of the travel for GP teaching. Our goal

should be to both reduce the amount of travelling for students wherever possible and also to

re-align student expectations and emphasise the benefits offered by rural and suburban practices so

that they are less disgruntled by travel and value these diverse learning opportunities.

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Other negative comments related to not gaining sufficient exposure to patients and opportunities to

take a history from and examination of patients in the GP placements. These comments represented

the minority of placements.

As before, Phase 3 students are asking for more teaching to take place in a General Practice setting.

We anticipate that there to be a greater proportion of GP teaching for students once the new 2020

curriculum is fully implemented.

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Phase 4 Evaluation Report 2014/15 Community Study and Health Promotion

Executive Summary

The Phase 4 programme during 2014/15 consisted of three components:

Community Study (CS), whereby students in pairs/trios followed a pregnant woman during her third

trimester and the first few months of her baby’s life. The students made two visits to her during this

time. They were supported with GP tutorials and seminars.

A Health Promotion (HP) intervention/review local to the students’ GP practice.

Consolidation & Review (C&R) sessions were introduced in the academic year 2012/13 and have

continued. They consisted of four sessions in which students were asked to identify areas they would

like to do further work on. They discussed these with their GP tutor and together designed a

programme for the sessions.

The 2014/15 student cohort was divided into two streams, Stream A and Stream B, with Stream A

starting in September and finishing in April, and Stream B starting in December and finishing in April.

These were followed by a campus-based consolidation and review session in May. This enabled a

good spread of the workload and facilitated easier recruitment of patients and HP interventions.

Such arrangements were integrated with the Rotation 1 Student Selected Component schedules.

Two significant changes were made from the previous academic year’s course. Firstly, there were

two rather than three visits during the longitudinal study. Secondly, one of the consolidation and

review sessions was held on campus. These changes were implemented to ease the situation

regarding logistics and travel.

The Phase 4 evaluation was executed by means of an online questionnaire, using Likert scales with

the opportunity for free text comments. The response rate was 75%, a decrease from 89% the

previous year.

Travel and logistics of contacting patients continued to be particular problem for students and in

some cases these problems seem to sap the positive learning from the experience. Other issues

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highlighted were lack of clarity in what is expected from the Health promotion review and whether

this is really needed in the programme, feedback which is unchanged from last year. However, there

were also students who found doing the review helpful and interesting. This probably reflects

variation in the support different practices give for this aspect of the course, as well as individual

student’s interest. Where the logistics did not cause significant difficulties, students felt the

longitudinal study was a valuable aspect of the course. They appreciated seeing a pregnant woman

in the community setting and felt that seeing her several times added to their understanding of the

impact of having a baby. However, many students found it hard to make a distinction between this

experience and that on the RSH block and questioned the value of this perceived repetition. The

evaluation of the consolidation and review sessions was excellent and has improved since last year.

There were far fewer comments about exams and positive comments usually related to experiencing

patient contact and feeling supported by their tutors.

1The best bits of Phase 4 GP were...

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Phase 5 Evaluation Report 2014/15 The Apprenticeship

Executive Summary

Students, GPs and staff value this aspect of the MBBS course and many students continue to be

encouraged to make general practice a career choice following the placement. Organisationally and

educationally the programme has delivered exceptional results across the year and the team

continues to work on areas that the students and staff find less than satisfactory; place large

numbers of students in high quality practices; work on making the community placements more

relevant to students, patients and colleagues; support large numbers of GP tutors all over the UK;

and to be a part of producing professional doctors.

Students’ evaluations and comments are taken seriously and the course continues to develop.

The main achievements for this year are:

Continuity of a hard working team

Many practice visits to GP tutors including all those supporting Phoenix Students.

A response rate of over 90% from students in the end of Phase evaluation

Ninety-five percent of students saying they would recommend this component of the course

Over 90% of students saying that the Department and Practice were well organised and prepared for

them

Continuity of facilitators of Mid-Term Seminars

Updating of student evaluation and successful integration into the database.

Taking into account students’ comments about the community case studies and the introduction of

an RCGP prize (see later)

Continued support of the Phoenix Group students (those resitting the year)

Support for students entering P5 at a disadvantage

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Community Based Student Selected Components (SSCS)

Executive Summary

This was again a busy year with additional library project titles being offered to Phase 2 students at

short notice. We supervised 149 students and a team of 20 marked 420 global health essays as part

of the Phase 4 rotation 2 SSCs. A new Peer assisted teaching SSC Phase 5 SSC with 22 students taking

this option was introduced.

A student presented her work at the annual SAPC conference in Oxford, and she contributed to

other related presentations and an e-learning module for KHP and three students presented

lightning talks at our annual Tutor conference.

The RCGP and Apothecaries Prize event was moved to 2nd October 2014, and part of a larger

celebration of the KCL SSC programme and elective prize winners.

The 2013-14 RCGP prize winner was Huma Alam and Apothecaries prize winner was Kerry- Lee

Rosenberg.

The 2014-15 prize winners will be announced 7th October 2015.

This year we continued with the Phase 4 Global health essay arrangements and marking was done

by a team of 20 as part of the rotation 2 SSC, with responsibility for marking 420 essays. Some

outstanding work was evident and will be reflected in the elective prizes to be announced at the in

October.

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Teacher Development and Support

Executive Summary

2014-15 saw a continuation of the successful Teacher Development programme, with a new

workshop, “Behavioural Change – approaches to teaching”, added to the AoME-accredited

“Mastering Teaching Skills” (MTS) series. The first reflective essay submissions from tutors working

towards their AoME Membership were also received.

A total of 363 attendees took part in teacher development activities, including online introductory

training, new teacher sessions, core training workshops, mastering teaching skills workshops, and

the annual KUMEC teachers’ conference. We supported 22 new tutors in their applications to

attend the two-day Introduction to Teaching in Primary Care (ITTPC) courses run collaboratively by

the London Multiprofessional Faculty Development Team and London Medical Schools.

Ongoing teacher development and quality assurance were also supported through online student

evaluation of tutors; a teacher commendation system; regular emails to teaching practices; termly

newsletters; telephone support and practice visits.

Focused practice visiting by KUMEC staff continues to be a major element of teacher development:

recruiting new practices; meeting new tutors within established teaching practices; and monitoring

individual teacher or practice performance after student evaluation. Between July 2014 and July

2015 a total of 42 recorded practice visits were completed out of a total of 176 “network” teaching

practices. We had an additional 134 “Independent” practices spread across the country, where

Phase 5 students elect to arrange their own placement. These practices receive telephone calls

from the Phase 5 Senior Tutor instead of a visit. Many of the KUMEC team were involved in the

visits and the process and outcomes of the visits were discussed and reviewed in the quarterly

meetings of the Evaluation Committee, with follow-up where needed.

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Contributors

Dr Anne Stephenson, Director of Community Education

Dr Kay Leedham-Green, Year 1 & 2 Community Lead

Dr Russell Hearn, Phase 3 Community Lead

Dr Liza Kirtchuk, Phase 3 & 4 Assistant Community Lead

Dr Ann Wylie, Phase 4 Community and SSC Lead

Ms Ruth Sugden, Phase 5 Community Lead

Dr Rini Paul, Phase 5 Assistant Community Lead

Dr Kerry Boardman, Teacher Development Lead