GP Teaching

by Dr Agalya Ramanathan and Dr Sian Powell

It is known that medical students may experience discrimination in clinical placements and the BMA and GMC have called for universities to provide training for clinical teachers to create more inclusive learning environments. In a recent survey, we asked our community GP Teachers for their perspectives on what training would help them to best support our students if they experience discrimination. Many of our GP Teachers reported feeling unsure how to advise students to report discrimination or access further support. To address this, we developed contextualised training materials in partnership with a community GP tutor and students with lived experience. 

We have created a short video for GP tutors which includes tips on creating an inclusive learning environment and supporting students experiencing discrimination, and information about the faculty’s reporting and support systems. If you have not already seen the video, you can access it here. We are grateful to Dr Saad, a GP tutor, and to medical student Thivyaa Gangatharan for contributing their insights in the video.  

We have also held two interactive workshops. The first was in person at our Annual Teachers’ Conference in June and was well received. Our online ASTIC (Advanced Skills for Teachers at Imperial College) workshop in October offered space and time for authentic facilitated case-based discussions in a safe environment where participants could reflect on ways to support students experiencing different forms of discrimination and where to signpost them to for additional support. 

We will run this workshop again in 2024 and welcome as many of you to attend as possible so that we can continue discussions on how best to create inclusive clinical learning environments for our students. We know all of you will have different perspectives that we can all learn from, and we look forward to seeing you at future workshops.  

Read Supporting students experiencing discrimination during GP placements in full

Dr Georgina Neve has taken over from Dr Renee Ewe as Year 3 Medicine In the Community Apprenticeship (MICA) placement lead whilst Renee is on maternity leave.  Georgina was an Academic Clinical Fellow in the department between 2018 and 2020 and completed her GP training locally on the Riverside Vocational Training Scheme.  Now post CCT, Georgina is very pleased to be returning to the team at the Department of Primary Care and to be taking on this role.  Georgina has previous experience as a tutor group lead on the MICA course and is excited by recent developments and innovations in the course, including the strengthened focus on community collaboration and the new central teaching opportunities.  

 Georgina is passionate about medical education and has a Masters in Medical Education as well as a breadth of experience teaching across the MBBS course, both within the primary care teaching faculty andin her clinical role.  Georgina has a special interest in Digital Health and has published on this topic, as well as a wider interest in Medical Leadership having completed the National Medical Directors Clinical Fellow Scheme at NHS England.  Georgina is looking forward to this new challenge and to supporting students to realise their potential in pursuing a career in primary care.  She is committed to empowering students to make a difference to both patients and their local communities.

Georgina is looking forward to getting to know all the MICA GP tutors and working with them over the coming year.   Georgina will be in touch with the tutors before the beginning of next term with updates and key course dates.  In the meantime, she can be reached via email on georgina.neve14@ic.ac.uk if you need to get in touch.

Read Year 3 Medicine In the Community Apprenticeship (MICA) placement lead in full

by Dr Sian Powell

Students on their Year 6 General Practice Senior Assistantship (GPSA) placements are required to complete a quality improvement project (QIP) during their 4-week placement. By conducting a QIP we hope that the student will engage with the local patient community to make a sustainable difference.  

Here is a recent example of a QIP that one of our Year 6 students, Alexandra Cardosa-Pinto, completed whilst on placement at The James O’Riordan Medical Centre with Dr Baskaran. 

Here, Dr Baskaran first tells us about their experience of supervising the setting up of a new clinic at the practice as part of Alex’s QIP. Alex then shares her reflections on this experience and what she gained.  

Dr Lavan Baskaran, GP Senior Partner, James O’Riordan Medical Centre, Sutton and Addington Medical Practice, Croydon

The James O’Riordan Medical Centre, was started in 1938. We’ve had a long tradition of teaching students and had the opportunity to support students from all five medical schools in London. Over the last few years, when it came to student projects, we’ve tried to avoid the usual audit on vitamin D or ECGs for those on Citalopram. This has shown both little impact for us as a practice, but also for the student.  

We have been fortunate to have had very keen, inspiring students, who have taken on projects like Transgender clinics in Primary Care, ADHD stable follow up clinics (resulting in a prize at UCL) and more recently, a Chronic Kidney Disease-Diabetes Holistic clinic, designed and set up by Alexandra Cardosa-Pinto, a student from Imperial College. Initially, the assumption was this would be a very “medical” clinic, tackling proteinuria, hypertension and use of ACE-inhibitors and SGLT-2 inhibitors. However, a more rounded approach was taken, through Alexandra’s skill in health coaching, as well as genuine care and empathy and a desire to make a long term difference and leave a legacy effect. 

It was a success! Patients were extremely grateful, telling us that her approach had given them the impetus to change their lifestyle, and others saying the traditional DESMOND diabetes teaching had not been inspiring, but that Alexandra, in one session, had been able to have them think differently. She had adapted her consultation to focus on their mental health, appreciating that this was barrier that did not allow for change, and addressing and supporting this would see the difference these patients needed. It was heartwarming to jointly consult the last patient, in her clinic, who offered her a hug for all the care and time she had given, and indicated she was very special for giving her time and effort for this. 

Learning on aspects of both diabetes and chronic kidney disease were gained, as well as an appreciation for general practice, and the part it plays in chronic disease management in the community. Moving from what is good to eat and drink in kidney disease, to whether a lack of employment may be contributing to stress and therefore health was all included in the assessment. 

As a practice, we have certainly learnt that chronic disease clinics, with a holistic angle can not only help our practices gain great feedback from patients, add a tick for CQC, but actually lead to a great project experience for medical students. The pride and energy that develops from allowing the student to develop the clinic on their own, with our oversight and then seeing the final creation with results, is fulfilling for patient, student and ourselves as teachers. It allows for other members of the practice to be included, such as social prescribers, mental health counsellors, paramedics and physician associates of the practice, and thereby leads to the imprinting of a clinic, that can be continued by the next student or adapted to support another chronic disease.

I have been teaching for a decade, and although students have always been a joy to teach, there was some lack of fulfilment from students walking away without a proud project. One of the very few rays of light to come from the pandemic was to allow some time to reflect on the student experience with us at the practice and being inspired to change project work to include a genuine interesting topic for the student whilst mobilising a new clinic in a short space of time. 

Alexandra Cardoso Pinto, Year 6 Imperial College Medical Student:

I had an amazing time during GPSA; I genuinely felt part of a team (that was so welcoming to me) and felt like I was able to make a (even if only small) difference to patients.   

 Throughout the 4-weeks I was given the opportunity to consult patients independently and later set up my own clinic for patients with multiple comorbidities, where I not only performed physical health and medication reviews, but also had the chance to practice coaching skills to support lifestyle changes. I remember feeling incredibly out of depth in my very first consultation, but by the end, I found myself surprised at how natural those conversations became. These patients and our consultations were tremendously impactful in helping me see myself not just as a final year medical student, but as a (hopefully) soon-to-been junior doctor.   

 My time in GPSA also emphasised the value of working within a welcoming, diverse, multidisciplinary team. Alongside developing my clinical skills, I practiced communicating with different team members and gained better understanding of how different professionals have a unique (but each vital) role to play in a patient’s healthcare journey. From a more personal perspective, I also found that working within a friendly, supportive team makes a world of difference to overall happiness and motivation!   

 Finally, GPSA also highlighted the importance of having supervisors who I can ask for advice from and share my concerns with, who are ready to support my management plans – or constructively challenge them – and who enable me to practice holistic patient care.    

 I am grateful to everyone at the James O’Riordan Medical Centre for welcoming into their team and providing me with learning opportunities that I will carry forward throughout my career.  

Read Quality Improvement Projects in GPSA – a GP Tutor and Year 6 student share their experience in full

by Stephanie Powell

This academic year we have expanded our community connections and made progress in weaving their valuable insight through everything we do. We also collaborate directly with community organisations and have highlighted examples below. We would like to extend a huge thank you to all community organisations, GP supervisors and practice team members that support this work, and we hope that it has continued to create new opportunities and insights for you.  

Community organisations presented to second year students undertaking their Community Collaboration Projects, about how their organisations positively impact health and the opportunities that collaborations with medical students and GP practices offer. Speakers were from Dalgarno Trust, a community centre whose countless initiatives support the health and wellbeing of residents in North Kensington, and QPR in the Community Trust whose programmes are supporting residents to flourish in White City.  

The BME Health Forum, whose work provides space for marginalised groups to voice their healthcare priorities and feed this back to healthcare providers, co-created curricular materials to support third year students to consider effective collaboration and co-creation during their Community Action Project in MICA. 

Third year students who undertook an optional short course in Promoting Health Equity visited local groups to understand how their activity impacts health equity. They toured almshouses and had coffee with residents at Hammersmith United Charities, joined an adult English language class to discuss what matters to the health of attendees at Urban Partnership Group and spoke to volunteers and attendees of the food bank at Dalgarno Trust. 

There have also been countless examples of community collaboration during student projects during their GP practice placements. During the Annual Teachers Conference, GP tutors and community organisations shared the opportunities that community-engaged student projects provide. Attendees mentioned they are an opportunity to: forge new connections with community organisations, to understand and address local health priorities that might not be visible from the practice alone, and enhance local trust towards the practice. 

If you have any feedback, suggestions or questions please contact Community Collaboration Lead Steph: stephanie.powell@imperial.ac.uk  

Read Community spotlight  in full

by Dr Sian Powell, Dr Faye Maxwell-Carr, Dr Amina Mirza and Dr Aaliya Mohammad

Widening access to healthcare professions is a key priority of the Department of Primary Care and Public Health. The recent publication of Health Education England’s ‘Training the Future GP’ report (2023) places a new emphasis on growing health inequalities and the need to train socially accountable GPs who are better equipped to understand and address the needs of their local communities. By increasing diversity, we incorporate a broader range of perspectives, experiences and cultural insights that can enhance the quality of patient care by promoting cultural competence, empathy and understanding.  

Therefore, when a local school invited us to support their science week, we jumped at the opportunity. The school is located in the borough of Hammersmith and Fulham, a diverse community facing challenges of income and health deprivation (5/10 on the Index of Multiple Deprivation). We saw an opportunity to not only support the school’s STEMM curriculum, but also for pupils to interact with doctors to understand our role and the significance of primary care, and we aimed to inspire the pupils to consider a future career in community healthcare.

Working in partnership with the local primary school teachers and with Steph Powell (Community Collaboration Lead for the Undergraduate Primary Care Education Unit), Sukhi Ubhi (Coordinator for the Medical Education Innovation and Research Centre) and Sian Powell (Faculty Development Lead), we co-designed and delivered a half-day workshop for 26 school pupils aged 10 to 11 on the subject of ‘Healthy Hearts’.  

We designed a series of short, interactive and engaging stations for the pupils on topics such as the anatomy and physiology of the circulatory system where pupils explored 3D heart models, completed drawings and worksheets. Pupils took part in an interactive whole-class demonstration on how blood flows through the human body’s circulatory system. We completed the session with small group exercises exploring how blockages in the circulatory system develop and the impact this has on the body.  

 Pupils measured each other’s heart rate, oxygen saturations and blood pressure with bedside equipment used by GPs such as peripheral pulse oximeters and blood pressure monitors. They were able to explore the impact of exercise after doing a series of star-jumps. Finally, pupils participated in a simulated role-play of a patient attending their local GP practice with symptoms and signs of a heart attack. They assisted the GP in their assessment of the patient in this role-play and arranged safe transfer to hospital by calling an ambulance, gaining an understanding of the role of a GP in an acute emergency.

When the simulated patient returned to their GP practice three weeks later, pupils helped the GP advise the patient on health promotion, which helped them to understand the role of a GP in holistic care and disease prevention. Finally, pupils created posters to display in GP practice waiting rooms to communicate key messages to the local community on healthy food choices. Each group presented their poster and explained the reasoning behind their choices and how these could improve the health outcomes of the wider community.  

Given the multicultural local populace of Hammersmith and Fulham, we tailored the workshop content so that it was engaging and inclusive for the children. We ensured that inclusive language was used across the spectrum of language abilities and learning differences, and we provided nutritional information on various cultural diets that they could use for their patient posters.  

The workshop concluded with a Q&A session where it became clear that the pupils, despite their young age, were aware of and engaged with contemporary media coverage of the NHS. They asked us what we thought of the junior doctors’ strikes, and enquired as to how much doctors are currently paid. We were also encouraged to share the reasons why we had chosen to become doctors, allowing us to communicate our enthusiasm and passion for the profession, despite the systematic difficulties it is currently facing. We were therefore able to challenge some of the media misrepresentation of doctors, providing a more positive perspective on the value of being a doctor in today’s NHS. 

Our primary aim had been to educate primary-school children about the role of GPs in maintaining the health and well-being of the community, and this achievement was reflected in feedback from the pupils; 68% of whom felt that the session had changed their understanding of what a GP does. Several pupils also expressed an interest in a career in medicine following the workshop. The teacher’s feedback was also overwhelmingly positive, telling us that we had inspired the pupils to expand their ideas of what careers could be possible for them, and that the pupils were still “happily recounting the activities from the day” a week on from the workshop. 

Personally, we felt proud to deliver a session that was aimed at introducing pupils, at a young age, to careers they may not have considered previously. Witnessing the pupils’ excitement and engagement with the session not only renewed our awareness of the ways we can contribute to the communities we serve as healthcare professionals, in and out of clinical settings, but also gave us hope that, despite all the present challenges, the future of medicine is in safe hands. 

Names and roles of authors 

Sian Powell (Faculty Development Lead, Undergraduate Primary Care Education Unit, Imperial College London) 

Faye Maxwell-Carr (GPST1, Imperial VTS) 

Amina Mirza (GPST1, Central Middlesex VTS) 

Aaliya Mohammad (GPST1, Imperial VTS) 

Read Widening access: inspiring the next generation of doctors   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: Kinan Wihba
Kinan effectively explored the wider determinants of health in relation to his patient, stressing the importance of trauma-informed care in the treatment of asylum seekers and refugees in the UK. Through investigating his patient’s support systems in this country and abroad, he involved the multidisciplinary team from the practice and also initiated a referral to social prescribers himself. Kinan made a meaningful impact to his individual patient’s experience and included excellent personal reflection on the doctor-patient dynamic.

Runner-up: Alexandra Cardoso Pinto
Alexandra’s patient project was an impactful case centring on a missed case of metastatic cervical cancer involving complex ethical dimensions. Alexandra provided multiple practical recommendations for her host GP surgery – including utilising a health coaching approach to fully explore her patient’s concerns and community organisations to help support the patient in the future.

Runner-up: Aleksandra Dunin-Borkowska
Aleksandra highlighted a holistic view of her patient’s chronic illness, incorporating the WHO Chronic Care Model in her analysis. Aleksandra made a real effort to navigate her patient’s priorities and challenges and emphasised the importance of joined-up clinical care and the importance of listening to a patient to build trust.

Year 3 Community Action Project
Dr Renee Ewe

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

Read Annual Teachers Conference 2023: Student prizes in full

Congratulations to all the winners of tutors prizes at the 2023 Annual Teachers Conference. Below you can read feedback from students placed with each of the winners:

Teaching Excellence Award: Dr Fatin Karam, Fairfield Medical Centre, Liverpool

Dr Fatin Karam has been the most wonderful GP Tutor throughout my GP placement and is an excellent educator.  She was encouraging in giving me responsibility to run my own clinics, take histories and document, perform examinations, develop a management plan and eventually debrief with her about each and every case. She would take a lot of time and effort to ensure that my learning was of utmost importance, I definitely noticed an improvement in my skills.

Overall, Fairfield Medical Centre is an incredible GP surgery and students who are placed here will have a fantastic learning experience in a highly supportive, friendly environment. I could not recommend it more highly.

Supporting the Student Experience Practice Award: Cardiff Bay Surgery

I was lucky to have had great teaching and the opportunity to consult independently. The teaching provided during the placement wasn’t as a formal session, but more opportunistic, thorough discussion of the cases after I had seen patients with a certain presentation. The GPs supervising me made sure to provide a wide range of presentations to expose me to. The practice has a more relaxed family feel to it, and they made sure to make me feel part of it.. All in all, this placement has confirmed that I do really like GP as a career and further motivated me to pursue this in future. I would love to work in a practice like this one. All the other practice staff were very nice and friendly, special mentions to Abeeda, the practice manager and the pharmacist.

Supporting the Student Experience Practice Award: The Village Practice, Islington

The team at The Village Practice were absolutely wonderful to learn under, and it was a huge privilege to have undertaken a placement in this practice. They paid particular attention to both the academic and wellbeing needs of us students, and worked hand-in-hand to ensure that we were obtaining our sign-offs but also encountering patients who would give us the best opportunity to learn to make us great future clinicians.

They provided us with amazing teaching opportunities, particularly by Dr.  Ardavan Algooneh. His clinical teaching sessions were thorough and he used great techniques to reinforce our learning.

Special mention also to Sammie Hubbard, Dr. Richard Ma and Dr. Robbie Howell  – they were essential in making this the wonderful clinical placement that it was. I envy students who get the chance to have their MICA placements there in the future

Supporting the Student Experience Award: Dr Jack Roberts, Richford Gate Medical Practice

Dr Jack Roberts is an amazing GP tutor. He is the best teacher I have had on placement in medical school. The highlight of this placement for me was the Tuesday afternoon tutorials where we covered history-taking and physical examination on a specific topic. Dr. Roberts kept the sessions interesting by acting as a patient himself for the history-taking part. Not only was his acting convincing, but the feedback and tutorial that followed were extremely helpful in developing our history-taking skills and clinical knowledge. My placement partner and I both agree that this has been the most fulfilling and enriching placement we have been on.

Supporting the Student Experience Practice Award: Wood Lane Medical Centre

The GPs did an amazing job integrating us into the practice and teaching us whilst we went through consultations. Dr Khawaja, Dr Merali and Dr Bhadye invested so much time and energy into us to make our placement as enjoyable and useful as possible. Any medical student in the future would greatly benefit from a placement at Wood Lane Medical Centre, it was truly exceptional!

All our GP tutors, namely Dr Khawaja, Dr Bhadye and Dr Merali were amazing and made huge efforts to support us in our learning. We were encouraged to attend home visits, run our own clinics and take the lead on examinations, all of which has exponentially improved my knowledge,  this is down to these three doctors creating an incredible learning environment for us.

Outstanding contribution to teaching nominations: Dr Shuman Hussein, Stanhope Mews West Surgery

Dr Shuman Hussein has been a GP tutor and PACES examiner for many years He has also assisted in taking on remedial placements/ and supporting students with additional needs particularly during the pandemic.  Dr Neepa Thacker

I am extremely grateful to have been placed in this GP surgery, it was one of the very best placements I have had so far in medical school.

I gained lots of practice in independent consulting, confidence in my clinical knowledge/history taking/examinations skills, greater awareness of what happens in primary care (not just during consultations, but between them, including administrative tasks)

I truly felt like I was part of the team. Even though I was the only medical student at the practice, I never felt alone – I was extremely supported and always invited to partake in any events

In particular, I want to thank Dr Hussein, my GP tutor/supervisor….and Dr Victoria Taylor.

The team was very caring and kind. They all were keen to help us learn and teach us about the cases that were quite different.

It was a lovely experience with great learning opportunities and practice for clinical medicine and felt supported.

Read Annual Teachers Conference 2023: Tutor prizes in full

by Dr Agalya Ramanathan

Whilst clinical placements in general practice continue to be rated highly by medical students, unfortunately, some students report experiencing or witnessing discrimination whilst on placement, which may lead to them feeling excluded, disengaged and experiencing poor wellbeing and mental health issues.  

Students affected have reported being unsure about who to go to for support and concern about what will happen if they do seek support. The BMA has created a racial harassment charter for medical schools which Imperial, along with many other universities, has signed up to. Two key aspects include supporting individuals to speak out, as evidence suggests students rarely do, and addressing racial harassment in placements.  

We have developed resources and training for our GP tutors on supporting students experiencing discrimination during their clinical placements. These include a video for GP tutors which includes student and tutor perspectives on how best to support students and further resources for tutors to access and share with students. The video can be viewed here:

Supporting students experiencing discrimination during GP placements.

In the video, Thivya Gangatharan, a medical student, shares her view that “If a student were to come to a GP tutor, and talk about their experiences of discrimination…one thing that would really really help would be just to have that space, just to provide space to talk about what it is they are reflecting on. Because… that’s really the first step to tackling discrimination. Having spaces where we can acknowledge that it happens and from then on, thinking about raising it further” 

At our Annual Teachers Conference on 9th June, we will be facilitating a workshop titled “What can we do to support students who experience discrimination in primary care teaching settings? All our GP tutors are invited to attend. We are also planning a half-day training course on this topic for GP tutors. We hope these resources will be helpful for our tutors in ensuring our students feel supported.   

Please see our website https://www.imperial.ac.uk/school-public-health/primary-care-and-public-health/teaching/undergrad/atc/2023/ to book onto the Annual Teachers’ Conference. 

Read Supporting students experiencing discrimination during GP placements  in full

by Stephanie Powell

The Promoting Health Equity Student Selected Component (SSC) provides space for third year medical students to consider how social factors and lived experience impact health, access to healthcare and health outcomes, and how they can apply this understanding in their career. After a session exploring health equity, students spend two sessions with local community organisations to encourage their understanding of the health priorities of different groups.  

Hammersmith United Charities provide small grants for community initiatives and run almshouses. Here, students toured the almshouses and met with residents at their weekly coffee morning, discussing what about their health matters most to them. Urban Partnership Group runs a variety of community services. Students visited their Edward Woods community centre to hear more about their work and joined an Adult Education English class, discussing health priorities and inclusive access to healthcare for all patients regardless of their level of English. Mosaic LGBT+ Young Persons’ Trust supports young people in London who are part of the LGBT+ community through a variety of initiatives, events and support. Here, a panel of community members discussed their experience of LGBTQ+ health and answered questions from students.  

The organisations involved are keen to engage the next generation of medical professionals, highlighting what really matters to the communities they work with. Each session is co-created with them to ensure that they are mutually beneficial. 

“We are keen to engage medical students to shine a light on Almshouses and activities occurring in our community that have a positive impact on health. We hope it is helpful to understand potential ways that medical professionals can collaborate with community organisations for the benefit of their patients. Our residents are always happy to speak to students about their experiences and answer any questions they may have.” Victoria Hill – Chief Executive Hammersmith United Charities. 

Creating space for students to visit community organisations has proven useful for them to develop an understanding of community priorities. Reflecting on their experiences, students identified areas they had not previously considered, for example how people may be concerned about calling for an appointment because of fears that their English is not “good enough.” Others reflected on how older adults might be just as agile and engaged at 90 as they were at 60 and that having a community around them can help them avoid becoming isolated or lonely. Some students also suggested that clarifying pronouns could transform a consultation, ensuring they were not making assumptions which may affect patient care. 

In their own words “The community organisation visits were great! Learnt so much.”   

This SSC runs every term for third year medical students. If you would like to know more or have any thoughts, reach out to Community Collaboration Lead Stephanie Powell: stephanie.powell@imperial.ac.uk 

Read Health Equity: Community Perspectives in full

by Dr Megan Brown and Dr Stephanie Bull

A team at the Medical Education Innovation & Research Centre (MEdIC) have been working on bringing creative enquiry into the MBBS curriculum. Dr Megan Brown, Dr Stephanie Bull, and Dr Reem Moussa have co-created a Student Selected Component for medical students entitled “Exploring experiences in medicine through the creation of the arts” which will run this academic year 2022/23.

This SSC builds on research more broadly within MEdIC which focuses on the impact of the creation of arts, and on a workshop recently presented by Megan at the Association of Medical Education (AMEE) international conference, on the topic of creative enquiry and flourishing within medical education.

The SSC will engage medical students actively in making art, by offering them opportunities to reflect on their lived experience of medical education using the art of others and create art of their own across diverse media (e.g., painting, drawing, sculpture, poetry, music, dance etc.).

Students will be prompted to consider how the experience of creating art might inform their development or practice as a clinician. The team have shared images of the art they’ve created (across digital, written, and illustrated formats) as a way of beginning a conversation surrounding the joy and possible role of creating art within medical education.

Read Communicating experiences in medicine through art in full