Planning Practice-based Tutorials · everything is well organised and runs smoothly. KUMEC - King's...

KUMEC Teacher Development

KUMEC - King’s Undergraduate Medical Education in the Community 2014-15

Planning Practice-based Tutorials Dr Kerry Boardman

Introduction

This is a mandatory introductory training module for KUMEC community tutors.

It should take most people about 45 minutes to complete, including time to reflect on implications for teaching in your practice.

We would recommend that you write down your answers to the exercises in this module and use these as prompts to develop your own teaching task list to ensure everything is well organised and runs smoothly.

KUMEC - King's Undergraduate Medical Education in the Community

There is a certificate of completion on the final slide that can

be printed or copied. Please return one copy to KUMEC and

retain another for your appraisal portfolio. Copies are

retained by KUMEC for GMC review of tutor training.

Acknowledgements


Special thanks must go to Maria Elliot, Ron Bailey and Russell

Hearn for helping to develop this module.

Aims of the Module


1. To introduce elements of

successful community-

based tutorials

2. To review common issues

that arise in or about

tutorial sessions

3. To provide tips for effective

student learning in tutorials

4. To prompt reflection on

your own teaching

Module Outline


Summary

Reflection on your learning from this module Certificate of completion (keep a copy and return a copy to

[email protected])

Common Tutor Concerns

Preparing for students

Recruiting patients

Knowing enough Pitching teaching at the right level

Structuring sessions

Challenging students

How am I doing?

Activating prior learning

Reflection on learning experiences you have had and skills you might use in teaching

Introduction

The KUMEC Network The KUMEC Curriculum

The KUMEC Network


You are joining our network of

over 600 KUMEC General

Practice Tutors (GPTs), teaching

in practice and/or on campus.

KUMEC allocates a very diverse

group of around 2200

undergraduate medical students

to about 300 practices each year.

The map show the locations of

our practices, mostly in and

around Southeast London, but

with some independent Phase 5

teaching practices as far away as

Highland Scotland.

The KUMEC Curriculum


Students spend time in a

General Practice setting in

every year of their

undergraduate training, each

year having a specific emphasis

Groups are kept small – trios, pairs

or single students, allowing for

close observation and detailed

feedback from their tutor

The KUMEC Curriculum


Practice-based tutorials and seminars are intended to help students:

• develop their skills in clinical

communication and examination

• learn patient-centred care

• develop skills in health promotion

• learn about the management of patients

with long-term conditions in the community

• contrast the differences between patients

requiring primary and secondary/tertiary

care and recognise the importance of good

communication during transitions

• develop an understanding of the work of

general practice and the community

healthcare teams


1. Think of a good learning

experience you have had in the

past:

What did the teacher do to make it

a good experience?

2. Think of a poor learning

experience you have had in the

past:

What did the teacher do to make it

a poor experience?

3. What skills might you use to help

your learners have a good

experience?

Exercise 1 Reflecting on your experiences as a learner

Common Tutor Concerns


How do I prepare for students coming to my practice?

How will I find enough time to teach?

Which patients should I choose for teaching?

How will I recruit and consent patients?

Will I know enough?

Will I pitch the teaching at the right level?

How should I structure sessions?

How will I deal with challenging students?

How will I know how I am doing?


Five things to consider

when preparing for

students

Who?

When?

Where? What?

How?

Exercise 2 Are you prepared for students?

Write down answers to

the following questions

for your forthcoming

teaching. You may

want to use it to

develop a task list to

refer to when preparing

teaching…

How many students will you have (at a time)?

What stage of training are they at?

Have you met them before?

Who else in the practice needs to know when the students are

coming?

How will you ensure they do?

Who will greet the students on arrival?

Who? When? Where? What? How?

Who?


When? When is the teaching – date, time?

When is the teaching in relation to the students’ rotation/year?

Does this clash with other busy periods/popular leave time for

the practice?

Do you need to re-arrange clinics or other commitments?



Where? Will you be teaching in your room?

Do you need to book the room(s)?

Does the setup of the room(s) work for the planned teaching?

Will students be seeing patients at home?

How will they get there?

Will they be supervised?



What? What learning are you facilitating?

What are the learning objectives?

How can these be best achieved?



How? Will you see students in pairs, one to one or in seminars groups?

Will they be sitting in with you? Someone else?

Will they be seeing specially recruited patients?

Have you set aside time for a tutorial/discussion afterwards?



Preparing for Students


Setting aside protected time is a key element to practice-based teaching, which both KUMEC and the GMC monitor carefully

Students value dedicated time with their tutor and commonly remark on this in their practice evaluation

Each year group’s information will specify the expected length of protected time for a student session.

Protected time means:

no booked patients

no enquiries

no phone calls

no paperwork/other jobs

during teaching time.

The rest of the practice team also need to be made aware that a tutor is teaching and therefore unavailable.

Recruiting Patients for Teaching


Teaching often involves finding a patient

with a long-term condition, with stable

clinical signs, to come to the practice for a

dedicated teaching session or see

students on a home visit.

Tutors or Practice Managers may find it

useful to keep a list of current patients

who would be suitable and willing to see

students.

Tutors asking their own patients or asking

colleagues for recommendations and

approaching the patients themselves

usually works better than one of the

administrative or reception staff doing so.

Recruiting Patients for Teaching


In Phases 3 and 5, students will sometimes sit in with a GP for a routine surgery session, with unselected patients. These patients should be notified of the presence of students in surgery when they arrive.

Patients should be asked for informed consent before they see students and always given the opportunity to say “no”, knowing it will not affect their care in any way.

Documentation of consent should be made in the patient’s notes, along with a note to say they have seen students. Most year groups do not have a requirement for written consent, but for Phase 4 teaching, mothers in the longitudinal pregnancy study must sign a consent form for the three visits, to be held on record by the practice.

Exercise 3 How will you recruit patients?


Who will select appropriate patients in your practice?

Who will contact those patients?

How will information be provided to patients?

Will someone call to remind patients on the day of teaching?

Who will that be?

What will you do if a patient doesn’t turn up or is too unwell on

the day? Have you got a back-up?

Timeline – Student & Patient Logistics


When students are

allocated

The week before

teaching

The morning of teaching

Email students: Introduce yourself

Clarify dates

Surgery Logistics: Confirm dates

Block session(s)

Arrange cover, if needed

Start contacting suitable

patients

Email students: Reminder of dates &

times

Travel directions

Plan for teaching

Background reading

Surgery Logistics: Confirm protected

session time and cover

Surgery Logistics: Call patients to confirm

arrangements

Reminder to Reception

staff that students are

coming

Check who will greet

students on arrival

Check room set-up

Knowing Enough


Tomorrow’s Doctors 2009 sets out the

requirements of all undergraduate medical

curricula. The KUMEC curriculum aligns with

the rest of the MBBS course in order to ensure

these are met.

The KUMEC Teaching Handbook and Quick

Reference Guides (colour-coded for each

year) should provide you with all the

information regarding structure and content of

your tutorials. Please refer to these before you

start teaching, and again to relevant sections

prior to each tutorial. They can be found at

www.kcl.ac.uk/kumec

While there are set Learning Objectives for

community teaching in each year, which we

expect tutors to cover, we would also

encourage discussion of interesting issues

arising opportunistically from patient

encounters.

http://www.gmc-uk.org/TomorrowsDoctors_2009.pdf_39260971.pdf

http://www.kcl.ac.uk/kumec

Knowing Enough


Our tutors are experts in General Practice,

so you will have ample knowledge. We are

not expecting you to answer detailed

questions about biochemical pathways or

specialised hospital management.

Content of the tutorials should be linked to

patients the students have seen, linking

theory and practice and developing their

repertoire of “illness scripts”.

Tutors can also set a great example to

students by being confident to admit when

you don’t know something, and discussing

with students how you might find out

together!

Tutorials are not intended to be

opportunities for didactic teaching on a

given subject.

Pitching Teaching at the Right Level


“The First Conversation” is a term you will hear us use a lot in KUMEC.

It refers to the first moments of the first tutorial with students.

This is where you can discover what the student already knows and what they want to learn during the placement, based both on their handbook learning outcomes and their perceived knowledge gaps.

It is also a chance to get to know a bit more about the student – what are their hopes for the coming year? Fears? Challenges? What do they enjoy? How do they best learn? All these things will help you to tailor your teaching appropriately, in a learner-centred way.

Structuring Sessions


So, what can you do to help

students get the most from your

sessions?

The Evidence Based Teachers

Network (EBTN) have a list of the

top ten evidence-based teaching

strategies. Have a look at their

website for more details:

http://www.ebtn.org.uk/top-ten-

methods and think about how you

might incorporate these into your

teaching sessions.

EBTN Top 10 Teaching Strategies

1.Using similes and analogies

2. Note-making and summaries

3. Reinforcing effect (acknowledge

effort)

4. Repetition

5. Visual methods

6. Co-operative learning

7. Goals and feedback

8. Hypothesis testing

9. Activating prior knowledge

10. Advance organisers

http://www.ebtn.org.uk/top-ten-methods







In addition, many of the year handbooks will have suggested session plans that you can follow

Useful material for your tutorial discussions might include:

Feedback on skills you have observed

Questions students have after seeing a patient

Linking patients seen to theoretical knowledge of “typical” cases of a condition, clinical pharmacology (e.g. What is the patient taking? Why? How do they work?)

The roles of other members of the primary healthcare team in caring for this patient

Excerpt from the Phase 3 Handbook



Developing a student’s lifelong orientation towards patient-centred practice is an important aspect of General Practice teaching. You may wish to talk with students about:

Respecting patient views and autonomy

Learning responses appropriate to a patient’s emotional state

Applying ethical considerations in daily decisions

Understanding that views may legitimately differ

Treating all team members with respect

Giving Feedback


Giving feedback on students’ communication and examination skills will form a large part of teaching in General Practice. Students often complain that they do not get much feedback, so make sure you signpost that you are giving feedback!

Feedback should be:

Constructive, not destructive

Descriptive, Clear and specific

Balanced – positives and areas for improvements (not “negatives”)

About things that can be changed

Suggestions rather than prescriptive

(If you have time) practice a particular bit again

Discuss suggestions for improvement

Tutor gives their feedback

Learner feeds back first

Do the activity

Learner to identify areas/skills that they want the assessor to focus on

Agenda Led Outcome Based Analysis (ALOBA) feedback model

Kurtz SM, Silverman JD, Draper J (2005) Teaching and Learning

Communication Skills in Medicine (Second Edition). Radcliffe

Publishing (Oxford and San Francisco)

Common Challenges


Problem Potential Solution

Late or absent students •Ensure all students have a direct contact number for

you, or the practice bypass number, to facilitate

contact in case of transport issues/illness

•Find out if previous teaching is overrunning (may

need to liaise with the hospital Firm Head, either

directly, or via the KUMEC team)

Students wanting to leave early •Find out the reason

•Remind students of attendance requirements

•Do they need to get back for hospital teaching? You

may need to liaise with Firm Head

Quiet students •Address questions to the student

•Offer an alternative active role e.g. taking notes

•Consider speaking with them separately to find out if

there are problems?

Dominant students •Set group rules about taking turns

•Address questions to individual students

•Compliment supportive listening skills

•Consider speaking with them separately – are they

aware of their behaviour?

If in doubt, contact the KUMEC team for advice!

Unprofessional Behaviour


If a student behaves

unprofessionally, please

contact the KUMEC staff as

soon as possible. Even if it

is something you think you

can deal with, we prefer to

know, as small incidents may

form part of a larger forming

pattern of behaviour.

Exercise 4 How will you deal with challenges?


Are there any kinds of feedback you think that you may find

difficult to raise with particular students?

Which kinds of students might require you to adapt your usual

teaching style to meet their individual need or motivational level?

Are there any aspects of tutorials that you still think will be a

challenge for you or your practice? What would be helpful to

address these?

How Am I Doing?


It is always useful to ask for feedback at the end of each tutorial. Many tutors also ask students for their “take home points”. One useful way to think about learning and ongoing action points is to use the “What?” model of reflection.

Students also submit end of placement evaluation for their tutors. Likert scores and free text comments are made available (anonymised) for each tutor to access via their KUMEC portal log in.

WHAT?

• What did you do?

SO WHAT?

• What has it taught you?

NOW WHAT?

• What will you do differently as a result?

Driscoll, J. (2007). Practising Clinical Supervision: a reflective

approach for healthcare professionals. London, Elsevier Ltd.

How Am I Doing?


Tutor workshops and training are

also ways of developing,

improving your skills and meeting

other tutors, where you can

“compare notes” on your

teaching. We ask tutors to attend

at least one session a year

From time to time, KUMEC staff

will arrange a routine visit to you

to see how teaching is going.

Occasionally we will also contact

you if a concern or problem has

been identified by a student, to

see how we can help.

Your Impact as a Tutor


Students learn from

positive role-models and

General Practice Tutors

are often identified as

such in student

evaluation.

Summary

Consider the “Who?, When?,

Where?, How? & What?”

Planning and getting the

logistics right improves

student experience and the

teacher’s comfort, satisfaction

and feedback

Help students to feel

welcome and wanted

And…


If in doubt, ask the KUMEC team!


Russell

Hearn

Anne

Stephenson

Kay Leedham-

Green

Ann Wylie

Kerry

Boardman

Ruth Sugden

Tina

Challacombe

Lorraine

Thompson Anna Quinn

Monica Martin

Maria Elliott

Rini Paul

Simon Power

Tasnim Patel

Anne

Stephenson

Certificate of Completion Planning Practice-based Tutorials


First name:

Surname:

Practice:

Email address:

Date of module completion:

What did you learn from the module?

How will you put this into action for future tutorials?

Thank you for completing this module. Please fill in the following certificate, keep one copy for your appraisal and email a copy to [email protected]

Planning Practice-based Tutorials · everything is well organised and runs smoothly. KUMEC - King's...

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