Community-Based MedicalEducation (CBME) Newsletter for General Practice May 2011 • Issue 10 www.ihse.qmul.ac.uk/cbme

Welcome to our summer newsletter and thankyou very much to all those who contributed, it is very much appreciated. This editionincludes an article on the changing face ofmedical education, tips on helping studentsthrough OCSEs and our new Aunty Aggieproblem page. (please see back page for email addresses)

www.qmul.ac.uk

Inside this issueFarewell to Tilly Gosai 02

Return to Work Janet Johnstone 02

Charity Camps 02

New Year 4 Locomotor Module 03

How to help students through their OSCEs 04

Year 3 Changes 05

Student Selected Components (SSCs) 06

The Changing Face of Undergraduate Medical Education 08

Aunty Aggies Problem Page – a problem shared 10

Tutors’ Day 2011 11

Maynard Court Surgery and The Knares 11

Alfie’s Puzzle Corner 12

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May 2011 Issue 10

Barts and The London School of Medicine and Dentistry, Academic Unit for Community-Based Medical Education, Garrod Building, Turner Street, Whitechapel , E1 2AD.

Are you sad to leave CBME?

Definitely! CBME is a wonderful office towork in. It is always sad to leave anenjoyable work place. However, I am nowready to move on and get someexperience in my chosen career.

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

Eventful.

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

CBME do a fantastic job to ensure that the needs of both GPtutors and students are met.

Have there been any memorable times? Any times when you knewthat you had made a difference to teaching and learning at Bartsand The London?

There have been many memorable times, usually at 3pmwhen it is tea time and it is recommended you eat a banana tofeel the vibe. I am not sure that I have made a difference toCBME. Nevertheless, it was a good experience to see whatgoes on behind the scenes.

What are you going to do next?

I am doing an Internship at Ketchum Pleon.

Farewell to Tilly Gosai

Charity CampsWe have been arranging charity camps in 3rd World/underdeveloped countries, for the last 17 years, under theauspices of Third World Medical Charity a UK basedregistered charity (UK Registration No. 1099886). Wetreat and manage cleft lip and palate deformities andother plastic surgery problems. These camps are arrangedfor two weeks in March and November every year.

Any medical student individually or groups of fourstudents who would like to visit, at the moment inPakistan, may contact me for further information. Anysurgical trainee or anaesthetist who wants to get involvedin childrens services would be very welcomed. It is a goodsurgical and anaesthesia training.

Dr Aman U K Raja, GP Tutor

Park Lane Medical and Surgical ServicesTel: 0208 340 6898 / 07956320287

Return to work – Janet JohnstoneI have now returned to CBME after a yearaway on maternity leave. I am now proudmum to my baby boy Thomas and wehave had a very eventful year together.Although I am missing my days with Tomit’s lovely to be back in CBME. I am busygetting back in to work mode and look forwardto working with you all again.

Janet Johnstone, CBME

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New Year 4 Locomotor UnitGeneral OverviewThe primary care component in Year 4 continues toexpand! This year CBME have been asked to design anew 2 week Community Locomotor Unit. Thiscomprises of Rheumatology, Orthopaedics, HealthCare of the Elderly and Dermatology. The students willbe introduced to this new unit with a week ofcentralised teaching at Whitechapel, Mile End orBarts. During this introductory week a program ofinteractive lectures and tutorials spanning all thecomposite modules will be delivered.

In week two, brimming with their newly acquiredknowledge, the students will spend three days inpractice. The aim is that the students will learn howto apply their knowledge; understand thepresentation of Rheumatological, Orthopaedic,Health Care of the Elderly and Dermatological casesin the community; understand the prevalence ofsuch disease in the community; learn about thecommunity approach to management in particularthe role of the primary care team and finally gain anunderstanding of the impact of living with suchconditions on patients.

Week two has been designed to be delivered as ahalf day of dedicated teaching, followed by a halfday of active sitting in over 3 days. The days aredivided into Orthopaedics and Rheumatology(Mondays), Dermatology (Tuesdays) and HealthCare of the Elderly (Thursdays). GP Tutors caneither opt to provide teaching on all three days orthey can choose to deliver two days of teaching inRheumatology and Orthopaedics and Health Careof the Elderly (in view of their clinical overlapthese topics have been paired) or just one day ofteaching in Dermatology. The benefit of thissystem is that GP Tutors are able to teach to theirstrengths and students do not have to travel totoo many different practices over the course ofthe week.

Teaching OpportunitiesCentralised Teaching - GP Tutors, Salaried and Locum GPs with aninterest in developing their teaching skills further are welcome tovolunteer to teach during the first week of centralised teaching. Thisweek will be dynamic, enjoyable and challenging and a brilliant wayto meet the students you may well go on to teach during the secondweek of the unit.

Practice Based Teaching - GP Tutors or Salaried GPs with aninterest in providing in house teaching are invited to register theirinterest. This provides a great opportunity to demonstrate tostudents the ‘staple’ of general practice - chronic diseasemanagement with a holistic approach.

If you would like to provide teaching during week one and/or weektwo please register your interest by email to Barbara Sommers(b.e.sommers@qmul.ac.uk)

Dr Mbang Ana, CBME

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Barts and The London School of Medicine and Dentistry, Academic Unit for Community-Based Medical Education, Garrod Building, Turner Street, Whitechapel , E1 2AD.

I write this article as the head of the Year 4 OSCE (Objective StructuredClinical Examinations). My official title is SIE or Senior InternalExaminer, a rather grandiose title but sadly comes with no chains ofoffice or official car. As the Year 4 SIE I blueprint, proof read thequestions, mark sheets and serve as the academic lead on the day.

The exams are divided into five or ten minute stations the number ofthese stations vtaries depending on which year is being examined. Ateach station the students are asked to take a history, explain adiagnosis or drug, perform a clinical examination or demonstrate a skillsuch as canulation. The mark sheets are a detailed breakdown of eachof these processes, the student is given a mark for each partcompleted and an overall pass/borderline/fail grade. In the early yearsOSCEs we simulated patients (mainly actors, ‘bodies’ or mannequins);in Year 5 patients are used.

OSCEs are sat by the students in all the five years, they are not the onlyway the students are examined but they constitute a large part overtheir overall score. The OSCE exams in the first FOUR years contributeto their ranking; the Year 5 exam is a pass or fail exercise. The rankingelement means that these exams have become much more highstakes than they were when many of us qualified. In the currentclimate the students have more to gain from these exams so it istherefore not surprising that they become exam focus towards the endof the year and often ask for our help as tutors.

When I lecture the students at the beginning of the fourth year I askthem to consider how many occasions they see doctors examiningpatients in five or ten minutes. The only time the students can think of

is in General Practice where (for good or for ill) we see patients in rapidsuccession taking focused histories and quick thorough clinicalexaminations. The students may like being taught neurology by aneurologist but they will rarely see them clerk and examine theirpatients at such a pace and without the benefits of their MRI scanresults. I have long been of the opinion that GPs are very well placed tohelp students hone the skills that they need to do well in the exam.

It has become an odd misconception that the students can do well inthe exam by merely communicating well and knowing the process. I have been an examiner many times and I can assure you that themajor reason students fail is due to lack of knowledge. Whilstcommunication skills are important and carry marks from both the - examiner and the simulated patient, their knowledge has to be deepand it often isn’t.

I suspect many people looking into General Practice may think whatwe are doing looks easy but the flexibility of mind required to be a goodGP can be underestimated by both colleagues in secondary care andby students. The OSCE is not dissimilar to a GP surgery with thestudents encountering different presenting complaints in seemingnever ending and random order

So what can you do? The students are often asked to sit in and observe you taking historiesetc. It might be worth asking them to look at how you take the initialopen questions into a tighter framework in an efficient and kindmanner thus ensuring you get all the salient facts. It is also important

How to help students through their OSCEs

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that the students learn to LISTEN. We are often teaching them aboutthe right questions to ask but sometimes it is their listening skills thatare really letting them down. It is all too common to see a student inthe exam ask a question and then not actually listening to the answer,this is because they are too busy thinking of the next question. Theproblem with this is that they often miss vital cues and steer the patient(either real or simulated) in the direction that they think will get themmarks rather than responding to the situation presented. All thesimulated patients in the exam are asked to reveal facts to the studentsin a sequential and responsive way, if the students miss cues they maybe missing huge parts of the history and thus losing half the marksavailable to them. It can be quite strange when the simulated patientreveals a distressing fact i.e.” my cat has just died” and the studentresponds with “ok, right………. have you noticed any blood in your stool?”

There are stations which I call ‘describing’ stations where there is verylittle interaction with the simulated patient but the students areexpected to describe how a drug works, how to use particularequipment or explain a diagnosis. There is a sense of them having totalk AT the patient to get their marks, but I suspect we all have to dothis from time to time. I often wonder how my well worked speech onhow to take the contraceptive pill is received by my patients- it can feellike a one woman monologue (and I often bore myself) but there aretimes when it is my job to tell people how to use certain drugs or toexplain a complex diagnosis. It is vital that the students see how youdo this in an appropriate way; you might like to get them to practise onyou or each other. The explaining stations are often done badly as theyrequire huge amounts of knowledge and very specific communicationskills- mark my words 99% of them could use the practise. I suspectyou would be surprised at the level of detail they need to know to getthe marks on these stations.

There are what I call the ‘Hercule Poirot’ stations, where the studenttakes a history and believes that the aim of the game is to get to thediagnosis as quickly as possible. Sometimes they have their ‘Voila!’moment then sit back in a self -satisfied manner and look as if theyhave just split the atom. There was one occasion where I was thesimulated patient (not an Oscar winning performance but not bad eventhough I say so myself) and I can honestly say it was a most bizarreexperience where the students tended to disregard any feelings I mighthave and leap to rapid and often wrong conclusions. The point thatthey missed was it is the process that matters as well as the diagnosis-unless they take an appropriate history or perform the correctexamination they cannot score highly. I must point out that this is aglobal student trait; I have seen this behaviour reproduced at all themedical schools I have examined at.

I do have some sympathy for the students that complain about thedifficulty they face talking to a plastic penis about the merits of safe sexor those that complain that the time constraints don’t allow them todemonstrate real empathy - but this is the system we have for now andit is a very discriminating exam. I would encourage any of you who mayhave avoided talking about the OSCE with students to practis e somescenarios with them. If any of you would like to examine you would bemost welcome we find GPs are good examiners as we are so versatile-please let Barbara Sommers b.e.sommers@qmul.ac.uk know if you areinterested. I do run some training and we have a lot of fun looking athow to and not to examine.

Dr Sian Stanley, CBME

Year 3 ChangesFirstly, a big thank you for everybody who has been teachingYear 3. We have had some excellent feedback, so keep up thegreat work!

Some of you may know that over this last year we have beenpiloting a new scheme. We took forty Year 3 students eachterm and got some GP Tutors to kindly cover some case baseddiscussion with them. We have had some excellent feedback,so from September 2011 we are rolling it out to all the thirdyear students while on their GP attachments. During eachthird year attachment we would like GP Tutors to cover fourcase based discussions with their group of students. Thesecases will be in your tutor handbook, and will include learningobjectives and tutor notes.

Case based discussions allow the tutors to examine clinicaldecision making and the application or use of medicalknowledge. It also forms discussion of the ethical and legalframework of practice, and it allows students to discuss whythey thought what they did.

As part of assessment we will not ask you to grade the studenton each case based discussion but more to show that theyhave taken part in four during their time in General Practice.

If you have any questions please don’t hesitate to get in touch.

Dr Liz Nuttall, CBME

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Student Selected Components (SSCs)In accordance with GMC guidance, in addition to the core medicalcurriculum, students at Barts and The London have the opportunityto choose Student Selected Components (SSCs) which give themthe opportunity to study a topic not currently covered in the coremedical curriculum, or to study an area of the core curriculum ingreater depth.

Students have the option to either choose from a bank of ‘Standard’SSCs, or to organise their own ‘Self-Organised’ SSC, and canchoose to undertake these SSCs in either primary or secondarycare. Primary care SSCs are available in Year 1 (2 x 2 weekplacements), Year 2 (2 x 2 week placements), and Year 5 (3 x 4/5week placements, one of which is their elective), as well as in Year4 (a single SSC with time spread throughout the year in order toprepare and submit a 6000-8000 word dissertation).

At present the majority of SSC modules available are in secondarycare. There are only 8 standard SSCs available in primary care (3 inYears 1 and 2, and 5 in Year 5). We at the CBME are very keen toencourage more students to choose primary care based SSCs; thiswill require better promotion of the existing primary care basedSSCs, as well as expanding the bank of primary care SSCs on offer.And this means we need you!

In a recent survey, the students told us that they would be morelikely to choose SSCs in primary care if there was a greater varietyof topics on offer. The topics they are particularly keen to seeoffered include Mental Health (for example psychotherapy, CBT,

addiction services), Women’s and Children’s Health (for exampleCommunity Midwifery, Community Paediatrics, GUM/FamilyPlanning services), Elderly and Palliative Care, and Forensicservices (for example Prison/Police doctors).

Encouragingly at the recent GP Tutor Training Day, many of you toldus that you would be interested in offering SSCs. The topics yousuggested were very similar to those requested by the students,including Mental Health (with a focus on psychotherapy), Women’sHealth (with a focus on cervical screening or contraception,Community Paediatrics, Pharmacology (perhaps with a focus onprescribing for the elderly), Dementia (diagnosis and managementin primary care), and Dermatology (perhaps offered by ADermatology GPwSI).

The Student PerspectiveSara Sheikh, a 2nd year student, chose to self-organise an SSC inDiabetes in Primary Care at Wallington Family Practice in February2011. She kindly agreed to share a student’s perspective oncommunity based SSCs.

Why did you choose to undertake an SSC based in the community?I chose to do a self-organised SSC in General Practice as I am veryinterested in this particular field. Although we have GP placementsin our first and second years, I wanted to gain further insight intochronic disease management in primary care and how the varioushealthcare professionals work together to optimise patient care.

What do you feel was special about a community based SSC?I became very familiar with the management of Diabetes Mellituswithin primary care, and hopefully will be able to retain thisknowledge for my later clinical years at university! It was interestingto see how patients had different health beliefs and how theirmotivations altered. However, I realised how complex the conditionactually is and how important good glucose control is needed inorder to prevent the complications of DM. Despite this, I fullyempathised with patients as losing weight and general lifestylemodification can be really difficult. Truthfully, I didn’t appreciate thisissue until I spoke to patients and understood their difficulties. Itwas really good to see chronic disease management from a clinicalperspective, as learning about it from a textbook is completelydifferent altogether.

Do you think SSC’s are an important part of the curriculum?SSCs are an incredible opportunity to gain insight into the variousspecialities, as Medicine is such a diverse profession. However, if astudent has a particular interest, this must be explored further andSSCs are the perfect excuse to do so! I feel it is very important tofamiliarise ourselves with the specialities so we can make moreinformed career choices as it is very daunting to make such a life-changing decision after our foundation jobs.

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Did you enjoy the SSC and would you recommend it to others?The placement was fantastic, as I engaged with patients and tookmedical histories. Furthermore, I was able to shadow practice andspecialist nurses, GP’s, the community matron and the optician aswell as having the opportunity to practice some clinical skills that wehad learned at university.

I have always had a keen interest in general practice and thisplacement has only made me more determined to pursue this as a career in the future!

The Tutors Perspective Standard SSC’s (Tutor organised)Developing a new SSC teaching module from scratch provides anexciting and unique opportunity for GP Tutors to be creative and toteach to their area of interest. Dr Jim Lawrie is a GP Tutor based atRoyal Docks Medical Practice in Newham. He currently offers 2SSCs, one on Chronic Disease Management and Audit, and one onPatient Pathways for OOH care. He kindly agreed to be interviewedand provide a tutor’s perspective on the merits of developing anddelivering an SSC in primary care.

How did you come to offer SSCs and why did you choose these topics to offer?The initial development for the SSC came from an encouragementby the excellent staff at QMUL to put down in writing an educationalbrief about areas of my work that I felt passionate about. In essenceit was a couple of pages of A4 with learning objectives and teachingmethods for each of the topics. I chose the subjects because I amthe Chairman of the GP out of hours co-operative in Newham andthe PCT clinical lead for out of hours and unscheduled care, sospend a fair bit of time thinking about out of hours and unscheduled

care pathways. I am interested in audit as a way to reflect on andimprove the work that we do both in the practice and in the GP co-operative.

What do you think the students get out of your SSCs?The SSC continues to develop with each group that attends as thereis some freedom for the students to set their own agendas withinthe broad remit of the SSC. I hope that this flexibility allows thestudents to have ownership of their project. I hope that the SSCgives the students some direct exposure to patients and allowsthem to see something of the work done in General Practice. I hopethat each student has a useful project to take away and to add totheir educational portfolio.

What do you and your practice get out of offering the SSCs?I enjoy the enthusiasm of the students and the original ideas thatthey bring to the projects that they undertake. Some of the projectsare brilliant in their concept and execution. One group of 1st yearstudents decided to look at the mix of patients who attend the A/Edepartment. They had attended an ‘urgent care liaison board’meeting with me. At this meeting the A/E consultant hadcomplained of the difficulties for her staff of patients with minorhealth problems still needing to be seen within 4 hours and theburden that this put on her staff to cope with the range of healthproblems that attended.

The students decided to interview every patient who attended thedepartment over a 24 hour period and to ask the patient at the endof their treatment pathway if they thought that any health careservice other than A/E could have provided their care. 50% of thepatients volunteered that one of a range of alternatives healthservices, including, GP, physio, GUM clinic, dental care, primarycare nurse or counsellor could have provided their care. As a resultof this survey the PCT set up a pathway directing 30 patients a dayfrom the A/E department to the walk in centre, helping to reducethe burden on our A/E colleagues. The next group of students readthis project and decided to develop an information leaflet forpatients giving information about alternatives to attending A/E. ThePCT were so impressed with the leaflet that (after re-badging it withPCT and NHS logos) several thousands were printed for distributionthrough local libraries and GP surgeries. It is 5 years since thisproject and I recently found a number of leaflets in the generaloffice at our local hospital.

And finally, would you suggest other GP Tutors got involved with SSCs?I recommend that other GPs consider developing an SSC in an areathat interests them and be amazed at the enthusiasm and ingenuityof the students who attend.

We hope that many more of you will be inspired by Jim Lawrie’sexample and take the opportunity to be amazed by our students!We recognise that developing and offering teaching modules istime-consuming, and we are happy to assist you in the process ofturning an idea into a complete SS C. Please feel free to contact usat e.ovink@qmul.ac.uk or m.ana@qmul.ac.uk to discuss anyqueries you have.

Drs Emma Ovink and Mbang Ana, CBME

Barts and The London School of Medicine and Dentistry, Academic Unit for Community-Based Medical Education, Garrod Building, Turner Street, Whitechapel , E1 2AD. 08

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I recently joined the CBME department as part of the Tower HamletsPCT-run Salaried GP Scheme. Through my role here I aim to developa deeper understanding of medical education and teaching, and tothat end I jumped at the opportunity to write a piece on the recenthistory of undergraduate medical education in the UK. Dr TusharGhosh and Dr Ranajit Ukil at Gables Surgery in Essex have beenteaching for QMUL for 14 years, and they kindly agreed to share withme their thoughts on how teaching has changed over the years.

The way that undergraduate medical education is delivered haschanged significantly over the last 50 years. From the late 19thcentury to the mid 20th century medical teaching was relatively static,with the early (pre-clinical) years concentrating on basic sciences withlittle clinical context. The later (clinical) years were spent almostentirely in hospital attachments, and there was little or nocommunication or consultation skills teaching. This system producedjunior doctors who had an awful lot of factual knowledge that they maynever need to use, but were lacking in important skills that they wouldrequire daily.1

Tomorrow’s Doctors first incarnation in 1993 signalled an importantchange in emphasis from recommending the simple accumulation offactual knowledge, to a learning process that also involved developingskills to interact with patients and colleagues as well as the ability toevaluate data.2 This resulted in medical schools redeveloping theirundergraduate curricula using ‘horizontal’ integration (blurring theboundaries between the basic sciences) and ‘vertical’ integration(increasing clinical exposure in the early years and incorporating basicsciences into the clinical years). Most medical schools now includesome clinical attachments from Year 1, and many use PBL (problembased learning) in some form. This uses clinical scenarios and providesa framework for assimilating teaching and learning across differentscientific and clinical disciplines, and also allows students to take asignificant amount of responsibility for their own learning.1

The setting in which clinical teaching is delivered has also changed. At Barts and The London increasing amounts of teaching has beenmoved into primary care in recent years, and the idea of theseplacements is for students to experience individualised and small-group teaching that is student-centred and relevant to their learningneeds. Community-based learning is perceived by students asparticularly appropriate for learning about psychosocial issues inmedicine, for increasing their awareness of patient autonomy and forimproving communication skills. Students tend to perceive advantagesof hospital-based learning as including learning about specialties andthe management of acute conditions, and gaining experience ofprocedures and investigations.3

Dr Ukil, now a GP Prinicipal at Gables Surgery, and previously a StaffGrade Cardiologist, observes that hospital-based teaching is bynecessity more didactic, whereas in community placements studentshave more time to spend with patients and tutors, allowing tutors

greater flexibility to tailor their teaching to the learning needs ofindividual students.

Dr Ghosh, also a GP Principal at Gables Surgery, says he has noticedthat the Barts and The London undergraduate syllabus has becomeclearer, and therefore more useful for teaching, in recent years. Heand Dr Ukil believe that what is almost more important to convey tostudents during their primary care attachments, is the importance ofdeveloping adult learning skills in identifying one’s own learningneeds and how to meet these.

At Gables Surgery teaching methods have evolved, and no longerconsist mainly of students sitting in on surgery, now encompassingjoint consultations, mini surgeries run by the students, small groupteaching and OSCEs, among other formats. Teaching has alsochanged from being delivered almost entirely by GPs to now includeGP Registrars, Practice Nurses, Practice Manager, as well as AlliedHealth Professionals. Dr Ukil notes that ready access to IT and web-based resources also mean it is possible to much more quickly matchteaching to topics seen opportunistically in practice.

Teaching can be hugely rewarding for GP Tutors. Dr Ukil saysteaching keeps him on his toes clinically, and that he derivesstimulation in particular from the variety of teaching he provides –from teaching basic clinical skills to medical students, to teaching aGP Registrar to become an independent practitioner. Dr Ghosh alsofinds teaching is a good way to keep his knowledge up to date, andbelieves that if he can infuse the concept of high quality patient-centred care to his students, then whatever their future career paths,the community as a whole will benefit. Both doctors say they lovehosting students and wish to continue to teaching, but it is notwithout its costs, chiefly in terms of pressures on their time. They arethe only GPs in their practice and as well as providing care to their3600 patients, they teach medical students in Years 2, 3, 4 and 5,are GP trainers, and have been elected to their local GP Consortium.This pressure is likely to become more of an issue in the future asGPs take on more of a role in commissioning, and as more teachingis moved into the community.

Community based teaching has an important role in helping studentsmake decisions on future career choices. Research has shown thatmany students start medical school with negative images of primarycare that can be reinforced by tutors in secondary care4, and thatconversely, positive experiences of teaching in primary care can makea student more likely to choose a career in General Practice.Individual GP’s have even been shown to influence career choice5. Dr Ghosh and Dr Ukil have noticed that over the years from Year 1 toYear 5 the students they teach become more enthusiastic aboutGeneral Practice, and the negative perception they often start withslowly but surely improves, with absenteeism definitely reducing overthe years.

The Changing Face of Undergraduate Medical Education

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It has been shown that students feel the most important influence ontheir future is the experiences they take out of their clinicalattachments, and those curricula that are more community orientatedcan alter students’ perceptions of primary care6. I hope, through myattachment with CBME, to contribute to the further development ofteaching modules based in primary care, and to help raise the profileof high quality primary care amongst medical students. The changingface of medical education is certainly a challenge, but it is one to beembraced, bringing with it opportunities to make use of ever-advancing technology such as e-learning when developing teachingmodules, something we at CBME are keen to work more closely withGP Tutors on in the future. It also offers up far more possibilities for allof us in primary care to take a greater role in shaping tomorrow’sdoctors, whatever path their future career may take. As the landscapeof General Practice changes and there are ever-increasing demandson GPs, it is therefore essential that we continue to value our GPTutors and to support them in their important role.

Dr Emma Ovink, CBME

1. Gillespie and Cookson 2006. Training tomorrow’s doctors.CareerScope

2. Tomorrow’s Doctors (1993); GMC3. O’Sullivan et al 2001. Students’ perceptions of the relative

advantages and disadvantages of community-based and hospital-based teaching: a qualitative study. Medical Education December2001

4. Firth and Wass 2007. Medical students’ perceptions of primarycare: the influence of tutors, peers and the curriculum. Educationfor Primary Care, 18 pp364-72.

5. Edgcumbe et al 2008. A qualitative study of medical students’attitudes to careers in general practice. Education for Primary Care,19 pp65-73

6. Pearson and Lucas 2005. Learning medicine in primary care: what isthe added value? 2005. Education for Primary Care. 16 pp424-31.

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May 2011 Issue 10

Dear Sian

Thank you for your letter. You are right to view students as adultlearners which means that once the ground rules are clearlycommunicated it is not unreasonable to expect them to behave. Youcould use a ‘formal’ learning contract to help communicate yourexpectations clearly.

The problem may be unrelated to anything you are doing, andcommunicating with the unit administrator about your concernsearly on in the placement allows the School to identify students thatneed academic or pastoral support sooner rather than later. TheSchool would like tutors to make more use of the professionalismassessment forms when completing student assessments. Theseforms are taken very seriously by everyone.

I have included some advice from others below. As you can seenobody likes it when students don’t turn up - least of all their peers.

Yours, Aunty Aggie

Dear Sian

On the first morning of a placement I make it clear to a new groupof students that they are expected to attend full time and be ontime for every session. If they know that they can't make a session Iinsist on them informing me in advance.

I clearly remember one student who just could not get it together.He had other issues, not just with attendance and punctuality. I hadno option but to fail him and I understand that he did subsequentlyget the help he needed.

Dr Spitzer, GP Tutor

Dear Sian

I think there are three main reasons why students don’t attend:

1) They don’t feel they are learning and so it is not a good use of time

2) They are worried about upcoming exams

3) They can’t be bothered.

GP tutors should timetable students to have good interactivesessions where they can examine or be involved in patient historytaking or management which is all very helpful preparation for finalMBBS exams.

You could entice the students to come with teaching sessions,exam them OSCE style, or give them a written EMQ paper; all goodfor exam preparation! Or, perhaps you could give them some SDLsessons.

I think students should fail if they don’t attend their placements. Itis unprofessional and as we are going to be doctors in a fewmonths, we need to learn about the importance of attending everyday. Students need to learn the consequences of their actions.

A. Student, Year 5

Aunty Aggie’s Problem Page – a problem shared...

Dear Aunty Aggie

I have been having a lot of trouble with my students arrivinglate or not at all. I have been getting increasingly frustratedwith this as there are times I have asked patients to attendspecially. I have tried to talk to the students in question butthey seem to be resentful of my asking them to arrive on timeand I am worried about how best to enforce their attendance. Iam conflicted as I do view them as adult learners but thereality is their time keeping is hugely disruptive to both me andthe practice.

When I have failed the students they seem quite incredulousby my actions and I think this has been reflected in thefeedback they have given to me and my colleagues in thepractice. I sometimes think the students think I am beingunreasonable and they behave as if their non attendance is infact my fault.

I do not like being in conflict with the students but I cannottolerate this behavior any longer – HELP!

Sian, GP Tutor

Please send your responses to Aunty Aggie using the contact details on the back of the newsletter.

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Tutors’ Day, 2011Our annual Tutors Day will be held at Whitechapel on 1st July 2011.It will be a full day event and will include a variety of trainingactivities and workshops. We will be sending all GP tutors furtherinformation in due course, so please put this date in your diary andwe will look forward to seeing you there!

Maynard Court SurgeryI am the Practice Manager at Maynard Court Surgery in WalthamAbbey, Essex.

We are a semi-rural practice which has a large population of elderlypeople both in the community and care homes which are managed byour three GP’s. We are a close team which consists of our three GP’s,two nurse/nurse practitioners, four part-time receptionists, our secretaryand myself. We provide a range of services which include a counsellingservice, minor surgery/joint injections, cryosurgery, monthly diabeticclinics and undertake most chronic disease management.

We are now in our second year of tutoring students from Barts and TheLondon. All the GP’s and staff are keen to provide learning for themedical students. We have also recently become involved in researchwith primary care medical research, and have participated in the NorthLondon Cancer Audit.

Although we are a small practice with very limited accommodation wehope that we provide a good quality service to our practice population.

Jackie Whillock, Practice Manager

The Knares Medical PracticeWe are now in the brand new building and our books are open to everyone.Please look on the NHS Choices website and read about us and the widerange of services we offer www.nhs.uk. We even have our own phlebotomistso there is no need to go to the hospital to have blood taken.

Teresa Euston, Secretary/Acting Practice Manager

Maynard Court Surgery and The Knares

Can you help? How would youanswer these tutors...

Dear Aunty Aggie

My Year 1 and Year 2 students are struggling with the idea ofwriting reflectively. Do you have any suggestions as to how Ican support them with this activity?

Yours in hope, Maria, MedSoc Tutor

Dear Aunty Aggie

I find that persuading patients to see medical studentssometimes requires a certain amount of negotiation and I wasrecently presented with an ethical dilemma which I am keen toshare with you and other tutors.

One of my patients with rheumatoid arthritis has classical signsof this disabling disease. In the past she has been a lively andengaging person for the medical students to visit at home. Shefinds it hard to get out of the house to visit the surgery.

When I asked her if she would agree to see another group of medical students and she replied that she would on two conditions:

1. That at least one young man was included in the group2. That the young man would urinate in her garden

Trying to control my shock at this unusual request, I asked for areason. She explained that she is plagued by foxes that dig up herplants. She had been informed that male urine (especially fromyoung men) would keep the foxes out of her garden.

The guidance on professional attitude and c onduct states:

Section 6: Compassion and Empathy: ‘’responds humanely to patient’s concerns’’

Section 9: Determination to protect the patient’s best interests:‘’Displays a genuine advocacy for the well-being and needs ofthe patient’’

Section 8: Self awareness and knowledge of limits‘’Personal beliefs do not prejudice approach to patients’’ But also...‘’Aware of appropriate professional boundaries,recognises need for guidance and supervision.’’

Mindful of Section 8 of the guidance, I am seekin g guidancefrom other tutors. Any advice or suggestions would be gratefullyreceived, and I would also be interested to hear if other GPTutors have had similar experiences.

Jim Lawrie, GP Tutor

12

May 2011 Issue 10

Contact the Editorial TeamThis is your newsletter. If you have anysuggestions for future content, usefulteaching tips, teaching resources orexperiences you would like to shareplease send us your contribution.

Lynne Magorrian l.c.magorrian@qmul.ac.uk

Janet Johnstone j.r.johnstone@qmul.ac.uk

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Alfie’s Puzzle CornerAlfie George says, it’s great to exercise your brain!

Postgraduate Certificate in Non-invasive AestheticTechniques 2011This intensive programme is designed specifically to provide a core curriculum for established general practitioners, dentists anddermatologists who wish to practice in the field of aesthetic surgery.

The programme consists of a mixture of structured distance learning,online multimedia/ live clinical teaching, and four essays. We cover theentire spectrum of non-invasive aesthetic surgery with an emphasis onfundamental principles and instruction in a wide range of techniques.Two clinical training days will be provided to demonstrate the practicalapplications of the theory studied in the course material.

Completion of the course leads to a postgraduate certificate in NonInvasive Aesthetic Techniques awarded by the University of London.

For further information please visit our website atwww.londonplastics.org

The next course for both UK and Overseas students starts on 10October 2011. Closing date for applications will be Wednesday31 August 2011.

Diploma in Clinical Dermatology 2011-2012The Diploma in Clinical Dermatology is a one-year part time course which providestraining at Postgraduate level in dermatology, with emphasis on diagnostic and practicalaspects. Full details of the course may be viewed at: www.londondermatology.org

There are two closely linked programmes: The UK programme provides training via a blended learning package incorporating 6Clinical Days based in and around London with small group consultant-led teaching. Itis aimed principally at Primary Care physicians.

The International Programme is a pure distance-learning programme designed specificallyfor physicians outside the UK wishing to gain further experience in dermatology.

Teaching for both programmes is via a structured web-based distance learning packagecomprising 29 weekly modules. Written material and clinical slide library aresupplemented by extensive audio and visual content. Whilst the UK programme holdsregular Clinical Days, the International Programme features individual and group case-based tutorials and discussions online. Both programmes concentrate on the practicaland clinical aspects of Dermatology. Participants are required to complete weeklyassessments, a dissertation and a written final examination.

Successful completion of the programme leads to the award of Postgraduate Diploma in Clinical Dermatology, from the University of London. Places are limited.

For further information please visit our website atwww.londonplastics.org

The next programme starts on 26 September 2011Closing date for applications is 29 July 2011

Barts and The London School of Medicine and Dentistry, Academic Unit for Community-Based Medical Education, Garrod Building, Turner Street, Whitechapel , E1 2AD. Pub7802