Phase 3 KUMEC Community Teaching Handbook 2017 … · KUMEC Teaching Handbook 2017-2018 ... At the...
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Phase 3 KUMEC Community Teaching Handbook 2017-18 School of Medical Education
Transcript of Phase 3 KUMEC Community Teaching Handbook 2017 … · KUMEC Teaching Handbook 2017-2018 ... At the...
Phase 3
KUMEC Community
Teaching Handbook 2017-18
School of Medical Education
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Phase 3 KUMEC Teaching Handbook 2017-2018
Key Dates
Term 1 Dates 25/09/2017 - 15/12/2017
Term 2 Dates 8/01/2018 - 23/03/2018
Term 3 Dates 26/03/2018 - 13/07/2018
RCGP Term 1 Days 13/10/2017 & 20/10/2017
RCGP Term 2 Days 12/01/2018 & 19/01/2018
RCGP Term 3 Days 06/04/2018 & 13/04/2018
SSC Days Thursdays
Useful Contacts
Dr Russell Hearn
Phase 3 Community Lead [email protected] Tel: 0207 848 8694
Dr Niki Jakeways
Phase 3 Community Lead Assistant [email protected] Tel: 0207 848 8694
KUMEC Fax: 020 7848 8706 Postal Address: KUMEC, Division of Health & Social Care Research
King’s College London Addison House, Guy’s Campus London, SE1 1UL KUMEC website: www.kcl.ac.uk/kumec KUMEC Twitter: https://twitter.com/kumec4kcl
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Contents Welcome ............................................................................................................................................................... 5
Summary of Phase 3 Community Sessions ........................................................................................................... 6
Phase 3 Community Programme in Context ........................................................................................................ 7
Before Phase 3 .................................................................................................................................................. 7
Phase 3 Structure & Content ................................................................................................................................ 7
Hospital Learning .............................................................................................................................................. 7
Student Selected Components ......................................................................................................................... 8
KUMEC Community Programme ...................................................................................................................... 8
Phase 3 Assessment ............................................................................................................................................. 8
After Phase 3 ........................................................................................................................................................ 9
Phase Three Community Placements ................................................................................................................... 9
Learning Objectives .......................................................................................................................................... 9
Organisation ................................................................................................................................................... 10
Content ........................................................................................................................................................... 10
Patient-centredness ....................................................................................................................................... 10
Session details ................................................................................................................................................ 11
Suggested Session Plans ..................................................................................................................................... 12
Session 1 – can be conducted for two pairs of students together ................................................................. 12
Session 2 (one pair of students at a time) ...................................................................................................... 12
Session 3 (one pair of students at a time) ...................................................................................................... 13
Session 4 (one pair of students at a time) ...................................................................................................... 13
Mini-CEX ......................................................................................................................................................... 13
Being a Phase 3 Teacher: Roles & Responsibilities............................................................................................. 14
Working with Students ................................................................................................................................... 14
Organisation ................................................................................................................................................... 14
Pastoral Care................................................................................................................................................... 15
Working with Patients .................................................................................................................................... 15
Working with KUMEC ..................................................................................................................................... 15
Payment for Teaching ..................................................................................................................................... 16
Conducting Tutorials........................................................................................................................................... 17
The Curriculum Content for Community Tutorials ......................................................................................... 17
Arranging Tutorials ......................................................................................................................................... 18
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Choosing Appropriate Patients for Tutorials .................................................................................................. 18
Preparation for a Tutorial ............................................................................................................................... 19
Giving Constructive Feedback to Students ..................................................................................................... 19
Signing Logbooks and marking students ........................................................................................................ 20
Student feedback for Tutors ........................................................................................................................... 20
Appendix A – Student feedback guidance .......................................................................................................... 21
Appendix B – Patient Information Booklet ......................................................................................................... 22
Appendix C – Student in-course Assessment ..................................................................................................... 25
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Welcome
Dear GP Tutor,
Welcome to the new academic year. Thanks to your continued hard work, last year’s student evaluation
confirmed both the high quality of teaching students receive in General Practice and how much they enjoy
their GP placements. As a Medical School we really appreciate your valuable contribution.
Building on the success of last year’s curriculum we will be following the same programme for this academic
year. This will comprise seven sessions in general practice over the course of the year. Three of these will be
sessions at the RCGP, where students will take part in simulated surgeries, and the remaining four spent in
General Practice. We feel that this combination provides students with an opportunity to meet many of their
phase 3 learning objectives
Thank you for agreeing to take 2 pairs of students over the year. We ask that you see each pair once per
term and have a joint tutorial for both pairs (most likely the first session) at some point during the academic
year. The total number of sessions you will be asked to teach students for in the community will be seven.
As always, we would appreciate your feedback on the course and we would like to encourage you to get in
touch if any problems occur.
We hope you have an enjoyable teaching year,
Dr Russell Hearn
Dr Russell Hearn
The Phase 3 Team
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Summary of Phase 3 Community Sessions
Students spend seven, three hour sessions spread over the course of the academic year in considering
community medicine and general practice. As last year, the sessions will be split into two experiences:
• Three sessions at the RCGP simulated surgery.
• Four sessions in General Practice.
During these sessions students gain exposure to the primary care perspective related to each of their three
broader Phase 3 rotations.
Learning Themes in General Practice:
• Developing students’ history taking and examination skills.
• The patient perspective and individualised approaches to care.
• The differences in patient presentation between Primary and Secondary Care.
• Primary Care diagnosis and management strategies, including monitoring over time and safety-
netting.
• Investigations used in Primary Care.
• Chronic disease management in the community.
• The interface between Primary and Secondary Care, including referral and discharge communication.
• Primary Care communication with other health care providers in the community.
RCGP Surgery
General Practice placement
Rotation 1 Rotation 2 Rotation 3
Phase 3
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Phase 3 Community Programme in Context
Before Phase 3
Phase 1 & 2 incorporates a 12 week introduction to medicine course; providing a grounding in the skills
necessary for subsequent years of the programme. This is followed by focused teaching, using clinical
scenarios, for learning relevant biomedical, epidemiological and behavioural science.
Students also meet patients in Primary and Secondary Care at intervals during Years 1 and 2 to learn about:
• The impact of illness on the patient and family. (This theme is built upon further in Phase 3)
• Issues of access to health care, for example how marginalised patient groups such as patients with
mental health issues may find themselves disadvantaged.
Phase 3 Structure & Content
For hospital placements Phase 3 students are divided into three groups that complete three rotations through the year.
• Rotation A - Abdomen
o General Medicine, Surgery, Urology
• Rotation B – Brain
o Neurology, Ophthalmology & Psychiatry
• Rotation C – Chest
o Cardiology, Respiratory Medicine, ENT
Hospital Learning
At the start of Phase 3, students have a 2 week Introductory Course. This course aims to revise clinical
communication skills developed in the first two years, and introduce basic clinical examination and
procedural skills.
Students are subdivided into Firms of six to eight students, based in London at Guy’s, King’s College, St.
Thomas’, or Lewisham Hospitals; or at the “peripheral sites” of Queen Elizabeth the Queen Mother
(Margate), Kent and Canterbury (Canterbury), Medway Maritime (Medway), St. Richards (Chichester), and
William Harvey (Ashford) Hospitals. Each firm is led by a consultant “Firm Head”. Firms will have differing
strengths depending on the specialist expertise of the hospital teachers. Students will often ask their
community teachers to focus on areas of the curriculum that are less well covered in the hospital teaching.
Students learn theory by working individually through ‘web-based scenarios’, which are consolidated during
a group seminar.
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At the weekly ‘grand rounds’ 12-16 students present patients they have clerked during the rotation. The
students’ presentations are assessed as part of the in-course assessment. Cases seen in GP may be ideal for
students to use in their Grand Ground.
Student Selected Components
During the first two terms, Thursdays are reserved for students to undertake a Student Selected
Components (SSC). The SSC portfolio offered by KCL is extensive and includes many topics both inside and
outside of medicine.
KUMEC Community Programme
The aim of the Community Teaching in Phase 3 is to contribute to the students’ basic clinical skills learning as
detailed in the General Medical Council’s Tomorrow’s Doctors1 and the KCL Core Curriculum.
Feedback from student evaluations shows that KUMEC general practice placements are very highly rated.
Students particularly value:
• Individual teaching in a non-threatening environment
• The opportunity to direct the content of the tutorials
• The chance to practice clinical skills such as history taking and examination (whilst being observed)
• Constructive feedback
It is important that we offer medical students a community perspective and exposure to conditions that are
more commonly seen and managed in Primary Care, which they may not see in Secondary Care. This helps
students develop a more accurate sense of the prevalence and burden of disease and where most chronic
disease management takes place.
Please start your tutorials by having a conversation with the students to assess their learning needs, and plan
subsequent tutorials accordingly.
We are aware that students are often motivated by assessment, and will ask you “How should I do this in an
OSCE?” However, as you know there are often several ways of doing something and we do not encourage
them to rote-learn a series of specific actions in order to perform them in the OSCE. We would encourage
that you discuss underlying science (anatomy and physiology) with the students in relation to the steps of an
examination, and emphasise the importance of clinical reasoning, i.e. why are they doing this part of the
examination, what does it tell them, and how can it add to their working diagnosis, based on the information
they already have.
1 General Medical Council (2009). Tomorrow's Doctors. London.
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After Phase 3
Students will transfer to the new ‘Stage-based Curriculum 2020’, and will enter Stage 3 which runs for the 4th
and 5th year of their medical school studies. The focus then will be on ‘Integrated Clinical Practice’: helping
students to integrate and consolidate their clinical capabilities and begin to contribute, under direct
supervision, to the care of patients with acute and long-term conditions.
During Integrated Clinical Practice (ICP 1) they will rotate through Blocks in:
• Child Health
• Women’s Health
• Emergency Medicine and Critical Care
• Long Term Conditions
During ICP 2 they will rotate through 8-week Blocks in:
• General Practice
• Acute Care
• Surgery
Phase Three Community Placements
In their Phase 3 community placements students practice their clinical skills – both communication and
practical, with guidance and feedback from their Community Tutor. Students are encouraged to approach
consultations in a patient centred and holistic way.
Learning Objectives
• To develop clinical skills (communication, examination and practical) through observed practice,
constructive feedback and guidance
• To demonstrate proficiency in core clinical logbook skills relevant to General Practice
• To build on the patient-centred interview skills in order to explore the patient perspective and
experience of ill health and disease
• To explore the difference between presentation and management of conditions in primary and
secondary care
• To discuss the importance of handover and information transfer during patient transition between
primary and secondary care
• To learn about chronic disease management in the community.
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Organisation
• In General Practice:
o Four sessions of 3 hours spread over academic year
o Tutors will need protected time for these – i.e. no surgery, on-call or paperwork
commitments that will disrupt the session. Surgery staff should be asked not to put calls
through to the GP or interrupt during tutorials.
o Some sessions may include students sitting in a normal clinic to get experience of primary
care – for these sessions the GP may have patients booked but may perhaps have 15 min
rather than 10 min appointments to allow time for discussion
o Patients for sessions will need to be recruited in advance. It is useful to have a list of patients
with stable chronic signs and good stories, but it can also be useful to recruit some patients
with acute histories and signs nearer the time. Please see KUMEC guidance on recruiting
patients, available at:
http://www.kcl.ac.uk/lsm/research/divisions/hscr/study/undergradops/kumec/Teachers/Ph
ase-3.aspx
Content
• Where possible, the patients chosen to be seen in general practice seen should ideally match up with
the student’s current hospital rotations (Abdo, Chest or Brain).
• Specific content is dependent both upon the patients you have, and an initial learning needs
assessment with the students, where they may suggest topic areas they feel weaker in.
• Patients should ideally cover a mix of chronic and acute conditions – for example, you may have
patients with chronic conditions such as COPD or artificial heart valves, who have good clinical signs
for examination; or you may have seen a patient with recent onset chest symptoms who is willing to
talk to the students about their acute presentation.
• Each student should present patients during the course of the year and should be encouraged to
consider the patient’s agenda and how their care can be delivered in patient-centred way.
Patient-centredness
We want students to be interested and inquisitive about the interaction between the patient’s illness and
life and think about how general medical principles are applicable to the individual, in order to optimise their
care. Being patient-centred does not mean simply having a chat with the patient about their life, nor does it
mean asking formulaic questions about “ideas, concerns and expectations”.
Students should have an idea of structure for a patient interview, but it should take the form of a dialogue
with the patient. Information might be elicited in a non-linear fashion. We would like students to let
patients tell their story in their own words and then clarify details of the problem with more specific
questions rather than to ask a series of closed questions at the start. One of the skills of communication is
learning to translate this patient narrative into a structured presentation – whether this is an oral
presentation to a fellow student or health professional, written clinic notes, or a formal referral letter.
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Students may worry that a “patient-centred approach” will be different from the case presentation structure
they have previously learned, or that clinicians use. This is not the case. We suggest emphasizing the
importance of incorporating both relevant clinical information and equally relevant contextual information.
In these Phase 3 consultations, students should be able to come up with an assessment of patient problems
and start to try to formulate some suggestions for future management, i.e. they are moving from being
reporters of information to being interpreters of information.
As they move into Years 4 and 5, they should be able to use this patient-centred approach to consider ways
in which management can be best tailored to suit that patient. Patient-centred management certainly does
not mean ignoring evidence or guidelines, rather integrating that knowledge with one’s understanding of the
patient as an individual and working with patients to find common ground and the most appropriate
management for each person.
Session details
• Students will be expected to take a history from and/or examine patients
• Tutors are expected to observe and provide constructive feedback to the students
• The numbers of patients recruited depends upon the complexity of their case, the ability of the
students and the learning tasks for the session: you may wish to start with a couple of patients and
ask one student to take a full history, then ask the other student to examine the patient. As the
sessions progress, you may feel the students are able to take more concise histories and examine
more patients. In this case, you may wish to invite more patients. Regardless of number, it is
important for students to present their findings and receive useful and specific feedback.
• Students should be encouraged to consider patients from a Community perspective, including
thinking about how the patient’s condition is impacting upon their life; what can be done in Primary
Care; and when referral to Secondary Care is appropriate. Although we are not teaching students
“General Practice” as a specialty, it is still useful for them to get an understanding of what is available
in a General Practice setting for the patients they see and how this may differ from Secondary Care.
• The School of Medicine has defined ‘core clinical skills’ to be learned in Phase 3 (Copies of the
student logbooks can be found on the KUMEC Phase 3 teachers’ pages at:
http://www.kcl.ac.uk/lsm/research/divisions/hscr/study/undergradops/kumec/Teachers/Phase-
3.aspx. Students must demonstrate their proficiency to teachers, who sign the appropriate part of
the student’s logbook. We encourage you to examine students’ proficiency of the skills you have
taught in the community.
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Suggested Session Plans
Session 1 – can be conducted for two pairs of students together
AIMS
• Introduction to General Practice
• Setting learning goals for the year
SUGGESTED STRUCTURE (This can be adapted to suit you and the students. It is a general guide)
• Introduction - 30 minutes
o Introduction to the practice.
o First conversation with students, setting learning goals for the year
o Clarify order of rotations with the students (to help planning – invited patients for
subsequent sessions should have conditions relevant to the rotation the students are
undertaking at the time).
• Practise Consultation Skills – 90 minutes
o Suggest one patient per pair of students, selected in advance by GP, ideally conditions to
match the rotation the students are currently undertaking.
o Observed history and examination of patients.
o Feedback from tutor.
• Tutorial – 30 minutes
o Discussion topics might include: the difference between primary and secondary care
presentations (undifferentiated problems, multiple problems, management of chronic
conditions, minor ailments), communication skills used by GPs.
Session 2 (one pair of students at a time)
AIMS
• To gain a better understanding of the consultation and how patients present in primary care
SUGGESTED STRUCTURE
• Introduction – 20-30 minutes
o Follow-up review of interesting patients seen in session 1 (GP and students look at notes
together, see what has happened since, review letters from referrals etc) .
• Joint surgery – 90 minutes
o GP & students to see patients together
o Patients are not specially selected, so students see “normal” consultations.
o Time blocked out between patients (or longer appointments – 15 min min) to allow
discussion or give time students to ask the patient questions or examine if the GP feels this is
appropriate (Suggest GP keeps a list of patients seen, so outcomes can be reviewed with the
students in Session 3).
• Tutorial - 30 minutes
o Further discussion around the topics raised by the patients seen.
o Setting action plan for practice/areas to focus on next session.
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Session 3 (one pair of students at a time)
AIMS
• Practise clinical communication and examination skills, with feedback
SUGGESTED STRUCTURE
• Introduction - 15 minutes
o Review of action points from Session 2
• Practise Consultation Skills - 1 hour 45 mins.
o Suggest a minimum of two patients, but by this time in the academic year most students’
groups will need a minimum of four patients to see (Students value home visits, so please
consider taking them to see patients in their home if possible/appropriate).
o Observed history and examination with feedback.
• Tutorial - 30 minutes
o Further discussion around the topics raised by the patients seen
o Setting action plan for practice/areas to focus on next session
Session 4 (one pair of students at a time)
AIMS
• Practise clinical communication and examination skills, with feedback using mini-CEX form (see
below).
• Consolidation of learning from the year.
SUGGESTED STRUCTURE
• Introduction - 15 minutes
o Review of action points from Session 3.
• Consultation Skills Practice - 1 hour 45 mins
o Minimum of two patients.
o Feedback from tutor, using mini-CEX for one of the cases for each student.
o Observed history and examination with feedback.
• Tutorial - 30 minutes
o Discussion of the patients seen and conclusions from the year’s placements.
Mini-CEX
The mini-CEX form is used widely in postgraduate education as a means of focusing observation and
feedback to help clinicians develop. The form is available here:
http://www.kcl.ac.uk/lsm/research/divisions/hscr/study/undergradops/kumec/Teachers/Phase-3.aspx
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Being a Phase 3 Teacher: Roles & Responsibilities
Working with Students
Phase 3 is normally a student’s third year of undergraduate study. However, Medical students enter Phase 3
from differing backgrounds:
• The majority of students are taking the traditional five year undergraduate programme.
• A small number of students will be on the Extended Medical Degree Programme (EMDP) and so will
be in their fourth or fifth year of study.
• The Postgraduate Entry Programme (GPEP) students with be in their second of a four year course.
• Around 50 students transfer into Phase 3 from Oxford or Cambridge universities.
• In addition, many students take a year out to pursue a BSc degree before they enter Phase 3.
The difference in previous student experience is most significant at the beginning of Phase 3. Reassuringly,
research at this school has shown that there is no significant difference in student performance between the
different groups by the time they reach the finals.
Some students face a culture shock when they enter Phase 3. Some will have to cope with a new city and
university. The culture in the medical course changes dramatically when students advance to the more
clinical part of the course. Some students find it difficult to adapt to the clinical environment and to the
different study skills needed for learning clinical medicine compared to basic sciences.
With any students, it is important to assess their individual learning needs prior to starting your tutorials.
Initially you will need to find out about their background and experience. As the year progresses please check
in with them about how they are getting on with their current placement and what they would like to focus
on in the session. You will most likely see an evolution in their skills and abilities over the year.
Organisation
We ask you to organise your sessions with students at the beginning of each term, once they have their
timetable then please identify times that are mutually convenient for both parties. If you are having
problems organising suitable times for placements with students then please contact KUMEC early in the
year. Some students and hospital firm heads may not understand the way GP sessions are arranged.
• The curriculum has seven sessions in primary care allocated to general practice.
• Students should aim to negotiate sessions at a time which is mutually beneficial for their GP tutor,
themselves and also minimises the impact of being away from their firm. If at all possible students
should not miss the same crucial firm activity more than once – for example if their firm head’s ward
round or grand round is on Friday morning each week then only one session should be arranged
during this period.
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• When at an impasse it has been made clear by the Phase 3 curriculum committee that the GP
teaching takes priority over firm activities.
Pastoral Care
Effective teachers are advocates for students’ learning. One aspect of this may mean seeking help from a
member of the Phase 3 Team if you have concerns about students. Attendance, punctuality, attitudes,
progress in learning, health or well being may give you cause to contact us to discuss a student. The Phase 3
team can liaise with hospital teachers and a student’s clinical advisor (who has a pastoral role). We ask you to
suggest a student sees their own GP if you or they have concerns about their health.
When identified early in the course it is easy to help students who are having difficulties establishing
appropriate professional behaviours. For this to work in such a diverse learning environment it is important
that all tutors share information. It may be that you have a minor concern about a student, if so please do let
us know as this may add to a portfolio of minor concerns resulting in a threshold to offer further support.
Our professionalism and pastoral care approach is not intended to be castigatory but to offer support and
guidance where needed.
Working with Patients
As one of our Community Teachers we ask you to:
• Discuss confidentiality of patient information with students
• Invite suitable patients to take part in teaching, giving adequate briefing and gaining consent. o More details and information leaflets for patients are available below and online.
• Involve the patient in discussion about health issues, management and effects on living.
• Give the patient the opportunity to feedback to students and you regarding the teaching experience. It is very likely that patients will actively enjoy taking part in tutorials. There is even evidence to show that it may well be therapeutic2.
Working with KUMEC
As one of our Community Teachers we ask you to:
• Negotiate tutorial dates and times at the beginning of each term with your students.
• Keep brief written records on the content and process of your teaching, especially keep note of ‘core clinical skills’ you sign up in the student logbook. Your notes may help you to reflect, and understand the student feedback which is provided at the end of a rotation. Notes may also help you to complete the teaching and training section of your own appraisal. You may find that a simple and useful way of doing this is to email a summary of the session to students after each session.
• You will be asked to mark your students for attendance and performance in your sessions. Your mark is a standalone mark. This mark contributes 2.5% to the student’s grade for the year (the mark from the RCGP sessions also contributes 2.5%). The combined mark i.e. 5% is equivalent to the firm head mark for each rotation.
2 Walters K et al. (2003). Teaching as Therapy. British Medical Journal 326; 740.
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• Please, inform the Phase 3 Community Administrator if your students have failed to attend your arranged sessions. Unexcused non-attendance is unprofessional behaviour and the Phase 3 team will address this where needed.
• Take part in the teacher development programme and Peer Support of teaching. It is an expectation that as a tutor you will attend one KUMEC training session per year or our annual teachers’ conference. Details of available training session can be found on the KUMEC website.
Payment for Teaching
Payment for tutorials will happen automatically and you do not need to invoice us for core teaching. Payment for teaching outside of core activities such as OSCE examining need to be invoiced to the Finance Administrator who will organise your payments. All payments are processed once the placement has been completed and this process can take up to six weeks. The current rates for Phase 3 teaching are:
• £1,200 for seven sessions over the year. This is for four students taught (paid at the end of the year).
• £300 per additional student, if teaching in trios. RCGP Tutor
• £360 per day
OSCE examiner
• Half day: £ 200.00
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Conducting Tutorials
The Curriculum Content for Community Tutorials
The community curriculum is intended to mesh with and support the larger Phase 3 curriculum. As such, we do not add any specific content of our own. We do however encourage several themes which are easily found and emphasised in the community setting:
• Clinical skills • Communication skills • Patient-centredness • The Primary Care perspective and transitions between Primary and Secondary Care
Some conditions are more commonly seen in the community than in secondary care. As such we ask you to expose students to common medical problems as seen in the community. We ask you to introduce students to patients with typical histories for beginners, increasing in complexity as they progress through the year. GPs provide continuity of care and often focus on health promotion issues. Community tutorials offer
students a unique opportunity to integrate different teaching, spanning all specialities of the Chest,
Abdomen and Brain rotations. For example, a stroke case might bring up issues around Diabetes Mellitus
(Abdomen), hypertension (Chest) and hyperlipidaemia (Chest) together with neurological findings (Brain).
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Arranging Tutorials
We would strongly encourage a consistent approach between tutors in organising tutorials as follows:
1. At the beginning of the academic year the Phase 3 Administrator will send you the names and email addresses of the students no less than one week before the beginning of the rotation.
2. The Phase 3 Administrator then sends the students the contact details of your GP practice one week before the beginning of the rotation.
3. Tutors will email their students within the first week of the first term to introduce themselves and explain the programme for the year.
4. Students should be able to identify flexible sessions in their timetable for teaching to occur and reply to you.
5. Please contact the Phase 3 Administrator if students have not replied to your initial email within 7 days.
6. Please agree the dates and times for the first terms sessions (2 or 3) with students.
7. For subsequent terms your students will be known to you and it would be reasonable to ask them to contact you at the beginning of the term once they have their timetable to suggest suitable sessions. If you have not heard from your students please email them, and again if you do not get a reply please email the Phase 3 Administrator.
Choosing Appropriate Patients for Tutorials
What type of patient?
• Patients able to give a clear story
• Patients with physical findings on examination
• Patients who can give disease typical histories
• Patients with a complex story
• Patients of varying age groups
• Patients followed up in Primary Care rather than Secondary Care
How to recruit patients
• Watch out for suitable patients in your normal surgeries
• Search your practice disease database
• Ask colleagues, GPs, practice nurses and your receptionists
• Think about housebound patients
• Ask patients informally during consultations
• Keep a list of patients
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Preparation for a Tutorial
Preparation Checklist:
• Has the date and time of the tutorial been agreed with the Teaching Site administrator and students?
• Do your students know how to find your surgery?
• Is your time protected – booked out?
• Have you reviewed the last tutorial (if relevant) and noted follow up points?
• Have suitable patients been arranged?
• Have you informed relevant practice staff that students are coming (receptionists, practice manager,
other doctors)? It’s really nice for students to turn up and be expected as opposed to a surprise!
Giving Constructive Feedback to Students
Educational research supports the use of challenging and personally supportive feedback in stimulating
learning. This sort of effective feedback from a Teacher will serve as a model for interactions with patients.
Thus, medical students will learn to maintain professional relationships with patients wherein difficult issues
can be discussed.
Giving effective, challenging and supportive feedback is an active process that requires some effort. Here are
some guidelines:
• Make notes whilst you observe.
• Be specific when giving feedback, give examples and reasoning.
• Be supportive (otherwise the student may be defensive and unreceptive) whilst being challenging enough to spur them on.
• Begin by identifying strengths, these may be: o Existing knowledge (e.g. basic principles) o Attitudes and suspicions (interpersonal and indices of suspicion) o Skills (clinical, technical and interpersonal)
• Suggest/discuss alternatives in terms of approaches, questions asked, conclusions drawn etc.
• Discuss lessons learned for the future and action points students can take to improve.
Examples
“Your history of the patient’s chest pain was great!”
This may seem supportive, but it is non-specific and not at all challenging and so may be experienced as patronising or simply unconstructive. “That was OK”
This is unsupportive, non-specific and unchallenging, and may be experienced as indifferent. “Your history of the patient’s breathlessness was extremely muddled.”
This is certainly challenging, but unsupportive, non-specific, and unless you have already established a solid positive working relationship, it may be experienced as humiliating and demoralising. The student may switch off and be unlikely to take further learning onboard.
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“You asked lots of detailed questions about the patient’s physical condition which allowed me to hear about some important features such as breathlessness, cough and sputum production, all of which helped with the diagnosis. To improve, you could have asked about the impact that the shortness of breath has had on the patient’s life to give some idea of severity and of how the patient could be helped.” This is great feedback: it is supportive (specific strengths were identified with examples given) and challenging (suggests were made without putting the student down). This feedback should be experienced positively by the student. It reinforces their strengths and gives them some guidance for next time.
Signing Logbooks and marking students
Competence in key logbook skills can be assessed by Community Tutors. If you are satisfied with a student’s performance in these skills, please sign their Logbook accordingly. We ask you to fill in your GMC number and use your practice stamp to verify your signature. Please, help your students by making your entries verifiable. Copies of the logbook are available on the KUMEC Phase 3 teachers’ pages at: http://www.kcl.ac.uk/lsm/research/divisions/hscr/study/undergradops/kumec/Teachers/Phase-3.aspx NB: We would expect that students get around 4 to 8 skills signed-up during their community placements. Near the end of the year you will be asked to submit marks and feedback for each student.
Student feedback for Tutors
Students are also asked to provide feedback for you (very useful for the teaching part of your appraisal). You can access your feedback using the same login details that you use to complete the student assessments.
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Appendix A – Student feedback guidance
From the phase 3 student logbook:
Receiving feedback from your course tutors and other teachers
Throughout the medical course, you will receive feedback on your work and clinical performance. Feedback
is useful and if used constructively helps improve your standards. The GMC’s guidance in Good Medical
Practice states that “you must reflect regularly on your standards of medical practice and respond
constructively to the outcome of appraisals and performance reviews”. <www.gmc-org.uk>.
Why is feedback important?
Feedback and self-critical appraisal on your performance helps gauge your progress. Knowing what you
do well and where you could improve helps to build self-confidence. Feedback on your performance in
assessments will help identify strengths and weaknesses and allow changes to be made. Receiving and
accepting feedback constructively is a process that will be important throughout medical school and in
your professional life.
How can I ask for feedback in the clinical environment?
There are several sources of potential feedback on your performance.
Decide what you would like feedback on. Be specific on the points you feel need improving, and then ask for
feedback from an observer. Patients and your peers are a useful source of feedback as well as your clinical
tutor. Use the skills performance criteria in the logbooks to assess your own performance.
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Useful questions:
• How do you think I did with my history taking/ examination/ specified skill?
• Am I up to standard in this skill or procedure?
• How can I improve in this skill?
• How should I react to receiving feedback?
Ways of giving feedback are variable. Indeed giving constructive feedback is a difficult skill. Receiving
feedback well requires a professional attitude that you need to develop as a student in readiness for your
medical career. It is essential for progression. So…
Listen carefully. Be sure you have understood the feedback. If not, clarify.
• Thank your teacher or observer for their feedback.
• Avoid being defensive. Ask for an explanation if you feel the comments are too critical.
• Ask yourself if you reacted appropriately? It is unprofessional to argue with the tutor giving feedback
and to reject their comments.
• Use the feedback to improve your performance.
Appendix B – Patient Information Booklet
A printable booklet for patients agreeing to take part in student teaching is included on the next two pages.
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Patient Information Booklet
Phase 3 Developing patient centred clinicians
INTRODUCTION
Thank you for your interest in helping to teach medical students. This will help medical students in their third
year of study to learn how to interview and examine patients.
It is important that, as future doctors, these students learn to listen to and understand patient’s thoughts
and feelings. They also need to know how health impacts on people’s daily lives. With your help, we can
ensure students have the opportunity to learn about these important areas. Learning to examine patients is
crucially important for our future doctors to diagnose and treat patients to the highest level.
We know students gain a great deal from these sessions. The students are keen and enthusiastic. We are
confident that you will enjoy meeting them and that you will teach them a great deal. You are helping them
to become better future doctors.
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WHAT HAPPENS NEXT?
Your GP has identified you as a patient who would be really helpful for our students to see. Your GP will
contact you to discuss any questions you have and to check whether you are still happy to take part. They
will confirm with you the time and date of session.
HOW LONG WILL IT TAKE?
You should expect the session to take approximately 1 hour.
WHAT WILL HAPPEN DURING THE SESSION?
The students are in their third year, which means they are just starting the clinical-based part of their studies.
They have had some experience of talking to and examining patients before, but are not yet at the stage
where they can advise you about your treatment or medical condition. If you do have any questions or
concerns however, they will be pleased to feedback these to your GP if you wish.
The students will be learning how to ask patients question and examine them. The students will ask you
about your health and how it is treated. They will be keen to hear your thoughts regarding the care you
receive and the impact that your health has on you and those close to you.
The students are also learning to examine patients, with your consent and the supervision of their tutor they
will examine you looking for signs of your medical conditions and practicing their skills. Your feedback will be
encouraged to help them understand how they can take into account patients’ feelings regarding being
examined.
WHAT HAPPENS TO THE INFORMATION WE DISCUSS?
The students may ask your permission to take a few notes while they talk with you. They will be expected to
discuss this with your GP to demonstrate what they have learned from their conversation with you, but as
with all of your usual medical care, your information is confidential within your healthcare team.
A few students may be asked to give a patient case presentation to a group of colleagues at the hospital, but
your name would not be used and any identifying information would be removed before they do this.
Students will check with you at the start of the interview that you are happy to proceed, and will be happy to
answer any questions you might have about the interview process. You have the right to withdraw from the
interviews at any point if you wish. The students and your GP will respect your decision, and it will not affect
your usual GP care in any way.
WHAT DO I DO IF I HAVE ANY QUESTIONS OR CONCERNS?
If any difficulties arise, or if you have any queries, please get in touch with your GP (or the practice manager
if your GP is not available) and they will advise you further.
THANK YOU
Both students and doctors are immensely grateful for patients help in education. Students can only learn the
art and skills of medicine with the opportunity to meet and practice with real people. If you volunteer to help
by giving your time you will be helping train the future doctors.
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Appendix C–Student in-course Assessment
Participation and performance in GP placements
Mark should take account of attendance and performance in all GP sessions
Marking scheme Performance Descriptors
Exceptional All-round excellent performance, especially with respect to knowledge
and application of clinical issues for a Phase 3 student. Evidence of
contribution to organisation of teaching, excellent attendance record,
demonstrated initiative, enthusiasm and developing professionalism.
Good Full attendance, good level of clinical knowledge and skills in all areas
with no deficiencies. Evidence of continual improvement and progress
overall.
Pass Adequate attendance, clinical knowledge and skills. Evidence of progress
and improvement, with no significant deficiencies in any area.
Borderline Attendance and performance that is adequate overall, but showed
significant deficiencies in at least one area of skill or knowledge.
Fail Inadequate attendance, knowledge below acceptable level and/or
inadequate progress.
Non-attendance Inadequate presence on the firm to be awarded a grade.
Comments
Tutor Name (Print)
Signature Date Practice Stamp
Student Name:
