YEAR 2 COMMUNITY TRAINING

Guy Bradley-Smith

20th Oct 2010

Introductions

• Previous experience?

• Any particular requirements from session?

• Please sign attendance sheet

• Locum fees

• Record of training

Summary of session

• PCMD News• Tomorrow’s Doctors 2009• Quality Assurance• Training Requirements & assessments• Curriculum overview• Year 2 curriculum in general• Year 2 community placements• Indicative timetable for attachment• Student Assessments

• Competencies• Professionalism judgements

• IT and EMILY• Evaluation and feedback

PCMD news

• Professor Steve Thornton is the new Dean. 

Joins us 1 September 2010 from the University of Warwick Medical School. 

Obs & Gynae Researcher. • Vice Dean, Prof. John Bligh has moved to Cardiff• Decreasing SIFT• Training Requirements

Tomorrow’s Doctors 2009

TEACHERS

• Quality assurance of teaching and assessments - Visits• Training of providers and assessors – records & update• Equality and Diversity – all teachers need to have completed

training The South West Peninsula Deanery offers an equality and diversity e-learning

module that takes 1 ½ hours and includes a printable certificate. Valid for 3 years.

www.peninsuladeanery.nhs.co.uk

Modules on Equality and Diversity are also available on e-GP (supported by the RCGP)

www.e-lfh.org.uk

Training Requirements

Staff Training mandatory to carry out assessments.

Must be updated every two years.

Quality Assurance Visits

• Observe assessments• Year 3 & 4 Clinical Reasoning• In vivo competencies• Year 5 Patient Based Presentations• Year 5 POISE

Curriculum overview

Life cycle Pathways

“Clinical Learning” “Clinical Care” “Clinical Practice”

SSU

Clinical skills

Community

SSU

Clinical skills

Community

Electives

Clinical skills

Clinical Blocks

Shadowing F1

Yr 5Yr 3 and 4Yr 1 and 2

Life sciences Clinical Skills Public Health Human Sciences PPD

Year 1 Normal functionYear 2 Abnormal function

Yr 3&4 Yr 5

Years 1+2 Community Clinical skills

Maturity 1

Fetal life

Infancy

Childhood

Adolescents

Young adults

Maturity 2

Old age 1

Old age 2

SSU

SSU

SSU

SSU

Conception

Year 2 structure

• monthly GP attachments

• followed the same week by feedback/jigsaw sessions

• attachments include clinical skills assessment

• case following

GP placements

• 1 Pair of students for a whole day

• Attendance is mandatory

• once a month

• 6 placements in total

• £2124 per pair of students pa

• Locum payment for training

GP placements

• seeing patients with the GP• interviewing patients• practical procedures eg, BP, venepuncture• using patients to learn - Logbook• mini case presentations – for jigsaw• longer presentations – Longitudinal• clinical skills• time allowed for Self directed learning (SDL)• internet access helpful• Involvement with other parts of practice life:

Admin/management/PAMs/GP registrar/Practice meetings• will bring their own stethoscopes• discuss dress code if necessary

Indicative Timetable for Year 2 Community Attachment

Time

GP Activity

Student Activity

9.00

Greet students – Agree aims and outcomes for day

Greet GP – Agree aims and outcomes for day

9.15

Start Clinic

Student 1: Observing and logging questions Student 2: Interviewing patient Pattern can alternate through surgery

11.00

Extras / Paperwork

Student SDL: Researching questions arising from morning surgery / Preparation of presentations

12.00-14.00

Meetings / Lunch /

Visits

Student 1: Observing and logging questions Student 2: Interviewing patient in surgery or at home

14.00

Clinical teaching (protected time)

Student 1: Examines patient then feedback from GP and student 2 Student 2: Examines patient then feedback from GP and student 1

15.00

Continue afternoon

surgery

Student 1: Observing and logging questions Student 2: Interviewing patients Pattern can alternate through surgery

16.00-16.30

Continue afternoon

surgery

Student presentations to each other on cases seen that day and issues to raise at jigsaw

16.45

Meet with students

Students present to GP / Review what has been learned and agree on areas for further work

17.00

Students depart

Students depart

Top tips

1. Ask students what case unit they are studying, what clinical skills they have been taught and what competencies need assessing

2. Ask what the next Jigsaw (see next slide) is about and what they are researching for it

3. Make links, where possible, to 1 and 24. Offer as much exposure to patients as possible5. Give them a chance to play an active role in a consultation either

by asking questions from the side or offering them your chair at the start of a consultation

6. Explain to the students about what you are asking/examining and quiz them about it

7. At the end of the day spend 15 minutes, ask what they have learned, what questions they may have and give them something to research before your next meeting (and make a note of it!)

Patient consent

• Patients booking for appointments should be alerted to the possible presence of medical students

• Verbal consent must be obtained before the start of any consultation involving a student

• a wish not to be involved must be respected• Posters, and flyers about PMS student teaching

for the waiting area are available from Wonford PMS

Home visits

• is a valuable learning experience and a large part of General Practice

• Patient consent must be obtained, and recorded, prior to any visits including a student

• Students should always be accompanied by a healthcare professional or a fellow student

• after discussion, further visits may be made by the student on their own but must not include any examination of the patient

• GP remains responsible for any arrangements

Feedback/Jigsaw

• 3-4 Hrs – 1-2 days after GP attachment

• Groups of 8-10 students

• Briefing and debriefing, feedback, exploration, reflection

• Medically qualified facilitators

• Topic guide available at http://emily.pms.ac.uk

Jigsaw themes

• Chronic disease management

• Health beliefs and coping strategies

• Change cycle

• Communicating risk

• Mental health

• Capacity/consent

• Carers

Assessment at PMS

• Continuous KSA• Knowledge: Applied knowledge test (AMK)• Skills:

Clinical skills labs, ISCEs (In vitro)Competencies in practices (In vivo)

• Attitudes:Portfolio analyses (Theory)Judgements: Small group tutors and Placement providers (2 per year)

Assessment at PMS

• Continuous KSA• Knowledge: Applied knowledge test (AMK)• Skills:

Clinical skills labs, ISCEs (In vitro)Competencies in practices (In vivo)

• Attitudes:Portfolio analyses (Theory)Judgements: Small group tutors and Placement providers (2 per year)

AMK - Applied Medical Knowledge

• 125 questions in 2 hrs, negatively marked - ¼ mark off for wrong answer

• clinical vignettes with 5 possible answer stems• same exam all years• students should follow ‘growth curve’• aggregate scores important• try it yourself!!

Applied Medical Knowledge – Progress Test

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Progress Test

02/03 Cohort

Year5

Year4

Year3

Year2

Year1

Clinical Skills

• CSRC @ Heavitree Hospital – Open evenings • Week 1 of Year 1• Nurses and sessional doctors• Examination skills• Communication skills• Course notes• Students use each other to practice on where possible• Regular in-house competency testing

Clinical Skills• Clinical competencies: Summative assessment• 4 competencies: Examination of CVS, RS and GI systems and

Observed History• Mark forms supplied• Expect faltering performance, slower than a GP would do it but

more extensive with main elements (inspection, palpation, percussion, auscultation: IPPA) present.

• only 1 attempt in community• Remediation in clinical skills in event of non satisfactory

performance (student self refers)• Keep copies of the assessment grades for this and other

community based assessments (Yellow part of triplicate form)• Must be attempted before mid-April 2011

Clinical Skills – in vivo

Remember• They are only at the start of Year 2• This is about the process not the detection of physical

signs• students know when they are to be tested• there is a need to strike a balance between what we, as

experienced GPs, do and what they have been taught• 1 Formative assessment allowed• Rest are Summative• 1 doctor watching is hard, several doctors watching is

intimidating ++

CRSC manuals

Today, intend looking at the examination of theRespiratory system

• CRSC manuals• Mark sheets

Clinical Skills

Respiratory:

CSRC Year 1 Young Adult 6

Assessment FormClinical competency – Summative in-practice assessment

Student name

Student number

Date

Assessor

Competency/system (please circle)

Feedback

Un

satis

fact

ory

Bo

rde

rlin

e

Sa

tisfa

cto

ry

Exc

elle

nt

OVERALL JUDGEMENT OF INTEGRATED PERFORMANCE

Not required

Unsatisfactory Borderline Satisfactory Excellent

CVS RS GIT

Communication

Health and safety & Hygiene

Inspection

Palpation

Percussion

Auscultation

Candidate/patient position

Assessor signature

Assessment attempt 1 2 3

Assessment discussion

Clinical Skills competencies

Week 1 Settle inWeek 2 CVS Week 3 Respiratory / 1st PPDWeek 4 AbdominalWeek 5 Observed historyWeek 6 Final PPD

Clinical Skills competency assessments

Please:1. If you have 2 students, only examine 1 at a time2. Fill in the mark sheets and return to Kelly Lewis at the

PMS St Lukes site in May 20113. Remember that an unsatisfactory mark does NOT mean

they will fail the year, but is a clear pointer to a need to improve and they will be assessed again in the CSRC

Professionalism (PPD) judgements

• 2 per year• Paperwork sent by locality office (Feb and

June)• Don’t be afraid to use borderline• Remediation with Academic Tutors• Contact PMS administration if a student is

absent without your prior knowledge – this carries an automatic ‘unsatisfactory’ at the end of year PPD judgement

Assessments in Community module

• Professionalism judgement at end of attachment (summative)

• Professionalism judgement at end of jigsaw sessions (summative)

• Summative assessment of clinical skills• Concerns made to academic tutor or jigsaw

facilitator: Think before giving students benefit of doubt.

• Lateness / DNA: olive.thomas@pms.ac.uk

IT

• Electronic web based resources EMILY http://emily.pms.ac.uk

• Honorary contracts (Free BMJ Learning!!)

Evaluation and Feedback

• Feedback forms collected from students at end of the year

• Comments from these forms will be fed back to placement providers

• Additional feedback from jigsaw facilitators

Questions??

and thank you for coming