GP Teaching

by Hollie Meyers and Alexandra Cardoso Pinto

The connection between climate change and health is undeniable, with environmental changes exacerbating conditions such as respiratory illnesses, heat-related diseases, and the spread of infectious diseases (1). Despite the increasing recognition of these links, including recent updates to GMC outcomes underscoring the importance of sustainability in the medical curriculum, we couldn’t help but notice how sustainable healthcare practices remained underemphasised in our medical education (2).

Driven by our desire to make a meaningful difference in helping medical students and medical educators understand sustainable healthcare, we applied for StudentShaper roles in the Undergraduate Primary Care Education Unit. In collaboration with Faculty, our job was to review and further integrate sustainability into the Primary Care curriculum at Imperial. We hope that this project helps to equip future doctors with the skills and understanding needed to practice sustainably – whilst supporting GP tutors in being a part of this journey too.

The Project: What We Did

Our efforts began with a review of the existing curriculum, focusing on online learning modules and project assessments. Through this process, we learned that there is a paucity of innovative and engaging learning resources to support students learning about sustainable healthcare practices. We conducted an extensive literature review and gathered student feedback to inform our approach in updating this material. We also reviewed assessment briefs for projects conducted in Primary Care, to ensure these not only emphasise sustainability as a core principle, but also provide sufficient guidance for students to achieve this.

We discovered that while there is interest in the topic, there is also lack of confidence amongst educators on how to best support students in incorporating sustainability in healthcare. In response, we filmed a video incorporating insights from Dr Tamsin Ellis, a GP tutor, who emphasised that primary care is a prime setting for integrating sustainable healthcare education. Dr Ellis highlighted the importance of explaining the relevance of sustainability through stories and practical examples to make the learning meaningful. You can watch the video below.

The Role of GP Tutors in supporting students

This project also highlighted how GP tutors have a pivotal role in shaping the next generation of healthcare professionals. Here are three ways that GP tutors can support the integration of sustainable healthcare into medical education:

1. Support Sustainability QIPs and other placement projects: Encourage students to undertake Quality Improvement Projects (QIPs) with a sustainability focus. We have provided guidance on the core pillars of sustainability and how to use these in practice – encourage students to review this material and apply it in their work.
2. Emphasise Existing Content: Many aspects of current GP teaching, such as health coaching, health promotion and preventative medicine are inherently linked to sustainability. Highlight these connections to show students how sustainability is already part of their learning.
3. Foster Interest and Engagement: Enthusiastic tutors inspire enthusiastic students. Stay informed about sustainability issues and current recommendations, use real patient stories to help illustrate these concepts to keep learning engaging and relevant.

Some resources we have found helpful in our learning journey include:

• This article by Stancliffe et al (2022) describing the impact and key terminology related to climate change and what we can do as clinicians (3).
• The Centre for Sustainable Healthcare website, with courses, a blog and key resources to stay up-to-date on how to practice sustainably (4).
• The RCGP Green Impact Toolkit, to help understand what sustainable healthcare practice may look like in the Primary Care setting (5).

Final StudentShaper Reflections

Having now completed this project, we feel a mixture of realisation and responsibility.

This work is far from done – but we leave with a better sense of the extent of our own knowledge and equipped to apply this in our clinical practice.

Integrating sustainability into healthcare education is essential for preparing us, future doctors, to address the health impacts of climate change. By leveraging existing resources and focusing on practical applications of our knowledge, we can make sustainable healthcare a core component of medical education. The role of GP tutors is vital in this transformation, and together, we can cultivate a generation of healthcare professionals dedicated to sustainable practices. 

References

(1) World Health Organization. Climate Change. 2023. Available from: https://www.who.int/news-room/fact-sheets/detail/climate-change-and-health

(2) General Medical Council. Sustainability Q&A. n.d.. Available from: https://www.gmc-uk.org/professional-standards/learning-materials/sustainability-questions-and-answers

(3) Stancliffe R, et al. Towards net zero healthcare. BMJ. 2022 Oct 11;379:e066699. doi: 10.1136/bmj-2021-066699. PMID: 36220183.

(4) Centre for Sustainable Healthcare. n.d.. Available from https://sustainablehealthcare.org.uk/

(5) RCGP. RCGP’s Green Impact for Health Tool Kit. 2024. Available from https://toolkit.sos-uk.org/greenimpact/giforhealth/login

Read Integrating Sustainable Healthcare in Medical Education: A Guide for GP Tutors in full

The MEdIC team, who run the WATCCH (Widening Access to Careers in Community Healthcare) programme, delivered workshops at both Imperial’s Festival of Learning and Teaching (FoLaT) on 29^th April and the NIHR ARC NWL Collaborative Learning Event on 9th May.

Through small group work, these interactive workshops encouraged attendees to engage critically with barriers to accessing healthcare education and careers, as well as identify what can be done to support young people interested in pursuing them. Our WATCCH student lead, who was previously a participant in the programme, gave a unique longitudinal student perspective. Small group discussions revealed insights around valuing individuals’ experiences and working towards an inclusive educational and workforce experience within healthcare and attendees’ own contexts.

The session at the FoLaT focussed on barriers to accessing and participating in healthcare education and was well attended by colleagues from across the College, including teaching fellows, researchers interested in EDI and outreach officers. Small groups explored practical ways to overcome barriers; ideas discussed included greater financial support, extended student mentor programmes, and critically reviewing implicit expectations and requirements of students within courses to identify points of hidden exclusivity. The NIHR ARC NWL Collaborative Learning Event workshop considered the conference theme of ‘Building Capacity for Integration: Engaging Local Workforces’. Attendees included academics, research participants and students. Brainstorming of solutions for implementation led to discussions about role models, raising awareness and engagement of key stakeholders.

As well as providing insightful learning for the WATCCH team, both workshops ignited thoughts about how the principles of widening participation can be applied in various contexts. We thank all participants for their contributions.

If you are interested in learning more about WATCCH or supporting the programme, please email r.bhudia@imperial.ac.uk

Read Conference Workshops: WATCCH in full

Year 6 General Practice Senior Assistantship
Dr Sian Powell

The GPPHC Patient Project aims to increase students’ understanding of person-centred care in the context of complex health needs and/or social factors. Students are able to understand and enhance the care of patients by exploring wider issues surrounding care pathways and the interaction between primary/secondary and social care.

Winner: Christie Tsang
Nitrous Oxide Toxicity

Winner: Anežka Macey-Dare

Year 3 Community Action Project
Dr Georgina Neve

Years 1 and 2 Patients, Communities and Healthcare
Dr Viral Thakerar

Read Annual Teachers Conference 2024: Student prizes in full

Congratulations to all the winners of tutors prizes at the 2024 Annual Teachers Conference. Below you can read feedback from students placed with each of the winners:

Teaching Excellence Award: Dr Yulia Peysakhova,  Cavendish Health Centre

“My supervisor Dr Peysakhova is so awesome. She actually wants us to learn and gives us opportunity to do this.”

“Dr Peysakhova doesn’t waste time. She makes sure everything is a learning opportunity and she’s so well versed in teaching younger years. Very lucky to be put on this placement. Thank you!”

“She’s so awesome. Would definitely recommend her to be put forward to teach more students.”

“She lets us take calls to practice history taking. Her advice is actually targeted and useful. I’ve learnt so much from her.”

Teaching Excellence Award: Dr Sabri Trepca, Barlby Surgery

“Dr Trepca is very encouraging and teaches useful and relevant lessons during his clinic.”

“Dr Sabri Trepca was an excellent teacher who discussed all the cases that presented with us – he was kind and understanding and gave good advice – contributing to our clinical knowledge and general life knowledge. Dr Sabri created a relaxed environment for us – where we felt comfortable to speak up and ask questions. He was non-judgmental and did not use harsh language. He showed us how to deal with difficult patients, how to perform and interpret findings from otoscopy/ophthalmoscopy/blood pressure measurements/urine dipsticks/blood results, what to notice in a patient when they walk in – signs that show a child is ill – what to do when in clinical doubt. He covered a vast scope of topics with us including multiple myeloma, nutrient deficiencies, ear infections, tonsillitis, vitamin deficiencies, 8 week checks, smear tests etc It was a pleasure to be on placement with him – he worked hard and made it as enjoyable and as engaging as he could.”

Teaching Excellence Award: Dr Stephanie Hughes, The Friarsgate Practice

“Dr Hughes was absolutely amazing, such a well organised and useful placement This was genuinely one of my favourite placements of medical school. I was going to GP not expecting to enjoy it much as I had not enjoyed it in previous years due to insufficient opportunity to get involved with the team. However I had the opportunity to get involved with multiple members of the MDT, run numerous clinics and decide patient plans. I also think this placement prepared me for being a doctor – I got practice writing patient prescriptions, writing referral letters, requesting investigations and I was well supported by all the doctors who supervised me. I would really strongly recommend this placement. All the doctors were instrumental in my education especially Dr Stephanie Hughes who is an excellent GP tutor.”

Supporting the Student Experience Practice Award: KS Medical Centre, Southall

“KS Medical Centre welcomed us so well and made us feel a part of the team. Dr Kamini was an amazing mentor and teacher, who always went above and beyond to give us useful teaching and experience. She was very passionate about us getting more confident throughout the 8 weeks and she ensured that we became more confident with our own skills and knowledge. Both Dr Kamini and Dr Ross taught us really well and also understood the importance of getting our sign offs done so we felt really comfortable and did not have to worry about not getting things done.”

“Overall, they were incredible and definitely should be praised for giving both me and my partner such an enjoyable time during MICA. Dr Kamini Gautam+ Dr Ross Mcjannette were incredibly accomodating. They went above and beyond in support, teaching and general care. I have never enjoyed and learnt so much from a placement before.”

Supporting the Student Experience Practice Award: Millbank Medical Centre, Westminster

“This was the best medical placement I have had up to date in my medical education. The structure and organisation from the get go with regards to teaching and the forms we needed, the additional opportunities provided by Dr McLaughlin; the hospice, the district nurses and the coroners court. She went above and beyond what is required for our medical teaching and provided experiences that I will not forget throughout my professional career. All the GPs, in particular Dr Dee and Dr Patel, made sure to have us as included as possible within the team and would actively involve us in any learning experiences available. The teaching was centred on what we wanted to get out of the placement and made us feel involved with the practice team as well as being able to take control of our learning was something I haven’t experienced at any other placement. I have no improvements to recommend. This experience was incredible. If there are any accolades awarded I would like to nominate both the practice and Dr Niamh McLaughlin as it is well deserved for the effort and care they put in their teaching. Truly exceptional. Again just to emphasise any medical student should feel privileged to have the opportunity to learn at Millbank! Absolutely fantastic GP tutor and team at the practice, really welcoming, keen to learn and to teach and open to answering any questions. Niamh McLaughlin is a great mentor, who is keen to facilitate our learning and catered our timetable to what we wanted to achieve. Couldn’t have been better.”

Supporting the Student Experience Award: The Croft Medical Centre, Leicester

“The entire team at the croft medical center was so lovely! I had the best time, all of the reception staff, all nurses and of course all of the lovely GP’s I got to spend time with were all kind beyond end. A HUGE thank you to Dr Makda for being such a great student mentor, his team gave me a perfect amount of authority during the time I was there; I was allowed my own clinics but was guided in terms of management and quieres along the way. He was an outstanding GP and even more so teacher; very understanding, very enthusiastic and extremely kind. I can only recommend this practice highly. Generally as a GP service, this practice was by far one of the most organised and thought through practices I have ever seen. From splitting the workload to timetabling students, whether these were from London universities or Leicester university, all of it was done seamlessly with absolutely no problems; no IT problems, no reasons to be shy, no problems accessing the GP center. It was top tier.”

Outstanding contribution to teaching: Fulham Medical Centre

Jan 2024: “The entire team at the Fulham Medical Centre was exceptional. In particular, Dr Libby Pearson and Dr George Hawche went above and beyond in their teaching and support, making this one of the most enjoyable and useful placement I have had to date.”

Oct 2023: “All of the members of the team at this GP were extremely friendly and welcoming and made us feel at home in the practice. In particular Dr Tim and Dr Libby gave us excellent teaching and feedback. They always picked out specific patients for us to see which would be most useful to our learning, which I found very beneficial.”

Sept 2023: “The entire team were very kind and inviting. They all welcomed us and would ensure that any queries we had were dealt with efficiently. Moreover, the doctors were very kind. Particularly, the leads (Libby Pearson and Tim McNicholas) always ensured we were seeing interesting patients and were fulfilling any goals or objects we had set out. Dr Pearson is a very wonderful mentor and I understand why she has won so many teaching awards! She had a very kind and reassuring demeanour. If any issues had arisen, I would have felt more than happy to discuss with her.”

August 2023: “Dr Libby Pearson, Dr Tim Mcnicolas and Dr George Hawche were excellent in providing opportunities for me to clerk patients independently, while feeling involved in the team”

“This GP practice is a shining beacon of what a GP team can achieve. Dr Pearson, Dr Hawche and Dr Tim (forgetting his last name) were all thorough and patient teachers despite having busy schedules. All staff members at the practice were warm and welcoming and provided any support needed.”

Oct 2022: “Dr Pearson was incredibly supportive throughout the placement. Along with support from Dr MacNicholas, the practice was very welcoming and granted me a high level of autonomy and independence which was very helpful for my professional development.”

 July/Aug 2022: “The team at Fulham Medical Centre were amazing! I felt so welcomed by all the doctors and staff there. Dr Pearson was so lovely and eager to teach, and gave us our own clinic from week 1 so we could practice independent interactions with patients. Dr George was also particularly enthusiastic about teaching us regarding various topics and cases presented.”

“This was such a great placement, my anxieties of continuing clinical years after finishing my BSc were mostly gone after this placement! My confidence greatly increased due to the guidance provided by the team here.”

Read Annual Teachers Conference 2024: Tutor prizes in full

On Thursday 6 June 2024, the Undergraduate Primary Care Education Unit hosted its Annual Teachers Conference. This year we welcomed colleagues from the GP community to the new School of Public Health Building at White City Campus. Themed “Innovative Partnerships: Learning and Working Together in Medical Education,”

Dr Chaand Nagpaul CBE delivered the morning keynote address on inspiring and equipping our future generation of doctors. The afternoon keynote was by Maisie Irvine, a 3^rd year student from Norwich Medical School. She captivated the audience, sharing her experiences as an autistic medical student. She centred this around a creative enquiry piece, a poem she had written to reflect on her experience on her GP placement. She encouraged Tutors to take a proactive approach with neurodivergent students considering environmental and learning adaptations.

The conference featured a dynamic mix of student presentations showcasing their prize-winning projects that they complete during their GP placements in each year of the course. They engaged with patients and community organisations to address various community priorities including flu vaccine access, healthcare access for refugees, a quality improvement project focused on a holistic, coaching approach to diabetes care.

Members of the department and community GP tutors facilitated interactive workshops including sessions on coaching for collaborative conversations, creating inclusive GP placements for neurodivergent students, supporting students with community-engaged projects and the impact of Artificial Intelligence (AI) in primary care. Workshops also explored the integration of arts in medical education, sustainable healthcare practices, and strategies for supporting interprofessional, multidisciplinary learning.

GP tutors were recognised for their contributions to medical education, with our awards ceremony celebrating their achievements and dedication. Dr Libby Pearson accepted the Outstanding Contribution to Teaching Award on behalf of her practice Fulham Medical Centre. You can see a full list of winners here.

The 2024 Annual Teachers Conference underscored the vital role of innovative partnerships in shaping the future of medical education, leaving attendees inspired and equipped with new strategies to enhance their teaching practices and student support. A big thank you to all our students, community tutors and faculty who helped make the day such a success.

Read Annual Teachers Conference 2024 Innovative Partnerships: Learning and Working Together in Medical Education in full

by Kynthia Ravikumar

It is without a doubt that being a General Practitioner comes with engaging in Public Health initiatives. With their new and improved name, ‘Imperial General Practice and Public Health Society’, the student committee has reaffirmed its dedication to strengthening this crucial relationship. By rebranding, Imperial GPPH Society hopes to foster further collaborations, promote public health awareness, and inspire students and staff to broaden their careers.

Fortified by this new sense of direction, Imperial GPPH Society successfully hosted its inaugural in-person conference, marking a significant milestone after several years. Held on April 21st 2024, the event brought together a variety of speakers, delving into a spectrum of topics under the overarching theme of ‘Unity in Health’. Discussions encompassed navigating the training pathway, combining Public Health with General Practice, insights into private practice, and strategies for achieving special interest opportunities.

The conference also featured three exciting workshops. A networking carousel gave students the invaluable chance to ask their burning questions and establish connections with professionals. An ethical cases discussion prompted thoughtful reflections on commonly faced dilemmas, in a safe non-judgemental space. Additionally a virtual reality programme (complete with immersive headsets) offered a unique platform for attendees to hone their clinical skills and engage in simulated healthcare scenarios.

Overall, the conference hosted by the Imperial GPPH Society was a resounding success, cultivating an atmosphere of collaboration, learning, and personal development. It attracted attendees from various universities and received exemplary feedback. Heartfelt thanks go to the speakers and workshop facilitators for delivering insightful talks and engaging workshops. Additionally, appreciation is extended to Jenna Mollaney, Tom Rozier-Hope, Dr. Arti Maini, and Dr. Nina Dutta for their incredible involvement as faculty members. Special recognition is also given to Kynthia Ravikumar, Kavyesh Vivek, and Charlotte Fenner for their outstanding efforts in organising this spectacular event.

Looking forward, Imperial GPPH Society hopes to continue its mission of promoting interdisciplinary collaboration and showcasing the field. Your involvement and support is vital to the students; if you are interested in inspiring future GPs and Public Health ambassadors, please do reach out to Imperial GPPH Society via email: gp.careers@imperial.ac.uk, or Instagram @imperialgpsoc

Read Imperial General Practice and Public Health Society in full

by Dr Viral Thakerar

A student reflection

PCH2 is the first clinical placement where our students take histories. This year, it occurred at a critical time in the NHS’s journey when technologies that promote personalised care may ironically lead to the loss of the personal touch. One of our students shared their reflections on this.

I admit that on my first encounter with a treatment algorithm, a faint feeling of dread came over me. Fears I thought I had put to bed when applying for medicine were renewed; was medicine just a form of glorified factory work? Would an algorithm not be better adhered to by a computer?

My last primary care placement went some way to assuage these fears and led me to consider the importance of human connection for patients. Despite current staffing pressures, clinicians on my placement knew patients well and patients seemed to really appreciate this. This is in the context of evidence suggesting patients who receive a greater continuity of care have improved health outcomes. Beyond recommending treatments or making diagnoses, I came to appreciate the role healthcare professionals could have in helping patients navigate difficult times in their lives. Often, it seemed that just lending an ear while patients talked through their concerns could have its own therapeutic value. Thank you!

A tutor reflection

One of our longest standing PCH tutors shares his experience of the community projects and how they give them insight into what matters to their population.

PCH1 was a particular eye opener for us as they looked at satisfaction amongst our patients and the appointment system. There was a lot of free text for them to also write comments and suggestions. The feedback was more positive than I thought. One interesting thing we learnt is trying to give better access to people with hearing impairments. This group of patients will often send in for request via email etc, but when there is something urgent it is a lot more challenging for them to book an appointment personally via calling up. As GPs we only think of the things we can improve or the negative things, but both PCH1 and PCH2 gave us some much-needed positive feedback which I have been able to share with colleagues.

PCH2 was particularly useful with regards to looking at Mental Health in young people. One of the projects also looked at homelessness. We looked at many of the issues. I was able to also explain the challenges from Primary Care- by thinking out loud that not all changes could be implemented- but that there were still changes which would be helpful. For example, young people with mental health problems often want to feel listened to and that their experience is believed, and that some people in this group prefer to talk to older doctors as they may feel judged by younger doctors.

Read Patients, Communities and Healthcare (PCH 1 & 2) reflections from a student and a tutor in full

by Dr Stephanie Bull

As part of its commitment to promoting conversations between students studying healthcare across the globe, MEdIC have created a Global Creative Competition. Initially established in 2020, the competition invited students to understand and reflect on the global COVID-19 pandemic. Further iterations of the competition have focussed on the themes of: Global Unity (2022) and the United Nations Sustainability goals (2024) reflecting international priorities. In 2024 the competition was also opened to all healthcare profession students from across the globe to reflect the multidisciplinary nature of healthcare delivery globally.

Students were asked to produce creative work and to submit a reflection about what their work meant to them personally and professionally.

In 2024 we had hundreds of applications which were shortlisted by a panel of judges and experts to our finalists. An awards ceremony provided an opportunity for healthcare students from both low- and high-income countries to celebrate our finalists and engage in knowledge conversations on topics that are important to the transformational change of global health systems. The finalists from 2024 will be taking part in a panel discussion in March 2024 and we are working to develop a digital exhibition of their work to further showcase their achievements.

Read MEdIC update: Global Creative Competition 2023 in full

by Dr Sian Powell

This year’s annual conference of academic primary care for the South East and London was hosted once again at Madingely Hall, Cambridge and a number of the team were in attendance to present various aspects of our work. The theme for the conference was ‘Challenging Inequality and Promoting Inclusiveness’ and we were treated to fantastic key note speeches from Drs Sally Hull, Margaret Ikpoh and Ban Haider which got us all thinking and on our feet as we heard about their inspiring work and initiatives in this field.

Our team also had an opportunity to showcase some of our recent work and departmental priorities. Drs Ismail Ismail and Aamena Bharmal presented our faculty development work on recruiting GP practices from lower IMD deciles to teach medical students and Dr Agalya Ramanathan described our recent faculty workshop and video for community GP teachers to support students experiencing discrimination in primary care placements. Agalya also described the development of a Student Selected Choice (SSC) for medical students on critical appraisal that incorporated a decolonising lens, and Dr Felicity Lalloo and Steph Powell presented their work on identifying interprofessional multidisciplinary learning opportunities within the undergraduate primary care curriculum.

However, what we probably all enjoyed most was hearing medical students from South East England presenting in the creative enquiry category which included paintings, photography, prose, poetry and film, all accompanied by the student’s reflection on their piece. The standard was exceptional and it was inspiring to see how talented, thoughtful and reflective the students were and to experience their perspectives on complex aspects of life as a doctor.

Of particular note was a poem by Maisie Irvine, an autistic medical student who powerfully described stereotypes and challenges she has experienced as a medical student on placement. We’re privileged and honoured that Maisie will be able to join us for our Annual Teachers’ Conference in June to share her poem with our community GP teachers.

Read Society of Academic Primary Care conference 2024 in full

by Stephanie Powell

As part of the primary care curriculum, our medical students learn about the wider determinants of health and health inequalities, and how these impact on healthcare access, experiences and outcomes. Our students also need to learn skills in holding more person-centred, inclusive conversations with patients, including those with complex health needs and those experiencing social exclusion.  As part of this, we are keen to develop curriculum materials that reflect diverse lived experiences of patients and communities.

We have worked with Expert Focus, who are a team with lived experience of homelessness, to explore their perspectives about health, healthcare and what they would most like our students to know. Their insights highlight the reality of experiencing homelessness and the diversity within this experience.

Some examples include:

• The stigma associated with experiencing homelessness and the impact on experiences of and access to healthcare
• The challenges of accessing primary care, whether by phone or through an online booking system, when a person might not have enough credit on their device.
• The importance of building trust and the life-changing impact of engaging with a healthcare professional that listens and believes you.
• The impact of using clear and simple vocabulary when explaining a diagnosis or procedure, particularly if a patient speaks English as an additional language.
• The constant worry associated with a low income.

We are weaving these insights throughout our curriculum materials. For example, in a case-based session on inclusion health, our Phase 1c (year 3) students listen to audio clips of people discussing their lived experiences of homelessness, and these prompt exploration about how to take a person- centred, trauma-informed approach. Similarly, in our Promoting Health Equity module, Phase 1c students reflect on lived experience excerpts to develop a better appreciation of the impact of wider determinants of health, and on what could make the most difference, including the role of advocacy. Student feedback has been overwhelmingly positive, with many students citing how impactful it has been for them to hear from people with lived experience, including their insights and advice, and that the audio clips made the topic feel more real. We would like to extend a huge thank you to the Expert Focus team for their involvement.

We know that our students hugely value the opportunities they receive on their primary care placements to build on this learning, through meeting and consulting with diverse patients and working with community organisations as part of their project work. Thank you so much to all our GP tutors and practices for facilitating this vital and impactful experiential learning.

If you have any questions about the collaboration or curriculum materials, please contact Steph Powell, Community Collaboration Lead: stephanie.powell@imperial.ac.uk

Read Lived experience insights in the primary care curriculum in full