GP Teaching

by Dr Flik Lalloo and Dr Nicky Hawkins

OOPE

[pronounced ooo-pee]

noun.

‘You’re on an OOPE? What’s that?’ Frequently asked this question over the past 12 months by colleagues, students, family and friends, occasionally it has been all too easy for us to fall back on the automated response – ‘we’re taking a year out of GP training to work in medical education’, and leave it at that. In reality, the insights gained and lessons learned over this past year have formed a significant part of our postgraduate training in themselves. Here we expand and reflect on our Out Of Programme Experience (OOPE); a year-long full-time post as Medical Education Fellows within the Undergraduate Primary Care Education Team at Imperial College London.

Generally granted for a period of up to 12 months, an OOPE does not count towards the Certificate of Completion of Training (CCT) but provides a valuable opportunity for postgraduate trainees to gain experience in areas outside the curriculum of their chosen specialty.  In 2019, as GP-trainees fast approaching CCT, we were keen to build on previous extra-curricular teaching and learning experience and further develop skills that could be applied to our future careers; with primary care a prime environment from which to facilitate authentic undergraduate learning experiences, there is a demand for community clinicians that are willing and able to actively engage in medical education. Despite this, little (if any) formal training exists within the postgraduate GP curriculum. We therefore sought to temporarily pause our GP training and apply for this post, enabling us to pursue these interests further.

Fully immersed within the Primary Care department, we have been involved in a wide range of educational activities (Figure 1). Alongside the regular delivery of departmental teaching sessions across all years of the MBBS, we have engaged in assessment and feedback practice, course evaluation, curriculum development and medical education research, simultaneously undertaking postgraduate qualifications in teaching and learning ourselves.

We feel lucky to have been supported by a dynamic team that is passionate about general practice, continually striving to deliver meaningful undergraduate learning experiences. Beyond developing practical skills in teaching and learning, we have gained insight into the value of true collaborative working – between students, faculty and the community and across different courses and institutions both nationally and internationally. Building on this, it has been exciting to be part of innovative departmental projects that are underpinned by socially accountable values and evidence-based practice; amongst others, specific examples include two pilot Longitudinal Integrated Clerkships (Year 5 Longitudinal Community Clerkship and Year 6 F-Zero), the Widening Access to Careers in Community Healthcare scheme, and the Year 3 Community Action Project response to COVID-19.

Taking a step back from the demands of clinical work and focussing on medical education in this way, we have gained valuable perspective on the symbiotic relationship that exists between the two areas of practice – core knowledge and skills acquired from each one enhancing everyday practice in the other. As we prepare to return to our final year of GP training, we feel empowered to actively seek and maintain a balance between the two fields in our future careers. The OOPE year has been invaluable in our development as general practitioners, looking to guide and inspire the next generation of tomorrow’s doctors. To all of you that have guided and inspired us over the past 12 months – thank you.

Read Out Of Programme Experience (OOPE) Reflections in full

by Murray MacKay and Bethany Golding

Third-year medical students partnered with community, voluntary, health & social care leaders to respond to local needs in the era of COVID-19

Twenty-five third-year medical students volunteered to take part in the normally compulsory part of their degree. All have worked with their partner organisations remotely via video-conferencing. Faculty connected early on with healthcare commissioners and community leaders to identify needs and assets, meaning that our students were well-placed to get involved and bring innovative ideas to important initiatives.

Dr Nina Dutta said: “Medical students across the world have been able to come together and work with community leaders to address pressing local needs.”

The seven different projects were ongoing over a period of ten weeks, and range from partners as varied as Queens Park Rangers (QPR) in the Community Trust to local community groups and voluntary organisations such as the Community Champions, Sobus, Healthy W12, the BME Health Forum and Healthwatch CWL.

Students taking part in the project also had the opportunity to discuss their plans with international thought leaders, and West London Health Partnership has funded some of the promising projects.

Nafsika Thalassis, the Director of the BME Health Forum, reflected: “The best thing about it was how you found out what was important to the community leaders. As a result, we were doing a project that we thought genuinely mattered.”

Student Shaper Ray Wang added: “What I think makes this type of work more meaningful for the local people and the people involved, is to have a problem and then have some sort of open-ended discussion around how do you go about solving that problem in a way that works for you rather than an idea that works for people that might be sitting in the office suite.”

Communities and medical students tackle health inequalities together

Dr Nina Dutta, course lead in the School of the Public Health, said: “Our students have admirably risen to the challenge of identifying and addressing the needs of the College’s local community. Although this term, currently a voluntary part of their programme, we’ve had a great response to the project. The undergraduate medicine MBBS course has had to shift to delivering education online response to the pandemic. This has posed challenges due to the inherent hands-on nature of healthcare, however the digital community action project has been a successful example of this transition. Here medical students across the world have been able to come together and work with community leader to address pressing local needs. We’re looking forward to learning lessons from this experience, and hopefully being able to see all our students and community partners in person again soon.”

Presenting their projects remotely to their peers on 6 May, one student group’s ‘Community Action Project’ (CAP) has built on past work by the Community Champions Programme and QPR in the Community Trust. The need for the project was identified by the Champions and the Trust early on, with their respective profiles, community and social media reach being key to the project’s sustainability.

The Addison Community Champions and representatives from QPR in the Community Trust are now preparing to create and deliver resource packs for one hundred vulnerable families living in the London borough of Hammersmith and Fulham. The packs will provide items to support children and young people’s creativity and emotional well-being during the COVID-19 pandemic, including recipe books and exercise ideas, mental health support, mood journals, arts and crafts materials, and signposting flyers designed by Imperial students.

Barbara Shelton, Project Manager at Addison Community Champions, said: “This is my third year of being involved with Imperial community projects. The students were wonderful. Many have never set foot in a community centre before and don’t necessarily recognise what they’re there for, so that learning experience is always useful. Especially in times like these the medical profession needs to recognise that community leaders are an asset. If students can have those interactions at this early stage of their career, it will change the way they view their communities forever. For our part as community partners, one of the biggest lessons we learn from the students is how to better showcase the work we do, and how we can tackle social inequalities together.”

Another student group, working with the BME Health Forum Director and West London CCG, created accessible, captioned videos in multiple languages (English, Farsi, Sylheti, Kurdish, Somali, and Arabic) to reassure communities in North West London that NHS services continue to be safe to use during the pandemic. Targeted especially to meet the needs of BAME communities, the videos will be shared via community leaders and social media platforms, particularly on WhatsApp and Facebook.

Student Abi Mahendran said: “With A&E attendance 30% lower than in normal times, and with 4% of Londoners not speaking English well, we knew this might be a useful project. We originally had a shortlist of languages we wanted our videos to be translated into, but we’ve found the communities we’re working with are even more diverse and require additional translations. Hopefully we’ll have the opportunity to put plans in place to publish even more videos.”

Educational empowerment

All seven projects were taken forward owing to the College’s commitment to continue delivering on its educational mission during the social distancing measures introduced in a number of other countries across the world.

Bethany Golding, Community Collaborations Lead in the School of Public Health, said: “It has been really impressive to see how students and community leaders have come together under challenging circumstances to work on targeted projects that could make a real difference. It was great to work with West London Health Partnership in bringing down funding for these projects where needed, and I am grateful to our inspiring community partners who worked so hard to connect our students with the voices of communities, and are now taking the projects forward. As a Faculty we should be very proud of our students’ engagement with community needs at a very challenging time.”

Third-year medical students Nadia Zaman and Kim Alipio undertook a CAP exploring how global examples of asset-based community development (ABCD) could help to proliferate community-led COVID-19 related initiatives in Hammersmith and Fulham, Hounslow and Ealing. Nadia said:

“Undertaking the Community Action Project opened my eyes to the challenges faced by different groups in society. Having grown up in London my whole life, doing this research made me more aware of how social determinants of health can impact on residents’ quality of life in different boroughs. I learnt the importance of community collaboration and how great work can be done when communities and organisations come together with the common goal of changing lives for the better.”

Kim noted how the CAP had affected him on both a professional and personal level: “Participating in the CAP has shown to me the affirmative and inclusive aspects of engaging with the community, where anyone and everyone can thrive by working together to achieve common aspirations. Everything I have learnt throughout this project, I will take away and keep close to my heart not only as a medical student, but as a person as well.”

The CAP module is just one of a number of learning experiences created by Imperial’s Undergraduate Primary Care Team in the School of Public Health that are intended to encourage students to collaborate, engage with the communities in which they’re living and working, studying and working in, and gain an authentic understanding of what it means to be a medic in the modern world.

Read Medical students and community leaders work together to make a difference in full

Dr Pearson is one of our longstanding tutors and has been teaching students for us for over 15 years. She teaches on a number of courses and over the years she has consistently received fantastic feedback from students. This year she won an award for her Outstanding Contribution to Teaching at our Annual Teachers Conference.

How long have you been teaching and what inspired you start teaching originally? I started teaching soon after joining The Fulham Medical Centre in 2004 and have increased my teaching commitment over the years. I spent hours at medical school hanging around being ignored and the one attachment where I felt included was my GP attachment. My GP in year 5 inspired me so much as he had a positive attitude to his job, his patients loved him and he was making a real difference. I wanted to do the same and make the students see general practice as an amazing and privileged job, which is so much more interesting than hospital work as we are almost the last generalists in the NHS.

Tell us about the practice you work in and your role in the practice. I am a partner in my practice and it really helps having a supportive team. I am the most enthusiastic but they all help and any staff joining our team know it’s a vital part of our work, so will be part of the their day to day practice too.

Since you have been teaching for us you have maintained a consistently high standard of feedback – what tips do you have for teaching? My biggest tip for anyone considering teaching is to think of the benefits for yourself, for surgery, your patients and your students. Everyone benefits from Undergraduate teaching. Imperial students are very intelligent and ask really probing questions, so keep me on my toes. When asked a question I don’t know the answer to I ask them to research the answer and let me know! I have a catch-up during my surgery so can run a little slower which the patients appreciate. They love having their problems discussed between us all so they understand the plan we come up with. You must have the support of your front desk to warn patients that you have students, so it saves you time explaining who is with you and why.

How do you balance teaching on top of clinical pressures faced in primary care? The catch-up slot I have helps, but I pre-book my clinic with long term patients for the first half and then quicker ‘on the day appointments’ for the latter part. This means I am running on time for the pre-booked patients and the emergencies are generally happier to wait if I am running late and give often quite simple problems with focused histories. A good balance, I feel. The students are so clever and enthusiastic; keen to help with audits, chronic disease management etc. that it helps the practice too.

Tell us about a moment that particularly stands out as a highlight from your time teaching Imperial Undergraduate Medical Students.
The two most memorable moments of teaching students are very different situations. The first was doing a home visit with a year 5 student, arriving at an elderly ladies flat to find her having a cardiac arrest. It’s a rare occurrence (thankfully!) for us GPs, so I felt very stressed and worried having to quickly flick into emergency mode. My year 5 student had never experienced anything like it, but was great at dialling 999, speaking to the operator and asking for the ambulance, then assisting me with CPR. I was so thankful to have her with me. It made me realise how important our CPR training was and how grateful I was to have someone so competent with me. The second case involved one of my war veteran patients. The practice is in the Sir Oswald Stoll Foundation and we care for lots on veterans. One of our 90+ year old gentlemen had been on the beaches in northern France during the D-Day landings and so had the student’s great grandfather. Sadly his great grandfather had died in France and the student sat and chatted to the patient for a long time about his experience. He then described how enormously privileged he felt having met a man who lived through what his great grandfather had been through and it helped him realise what a sacrifice he had given.  It was a very emotional experience for both patient and student, and for me too. The student still emails me now about his progress up through the ranks to be a consultant and mentions how this meeting has been such an important experience in his life.

When you’re not teaching students or working in the practice, how do you like to spend your free time?
I work full time so I don’t have a lot of spare time, but I love travelling. I have three kids (12, 10 and 7 years old) and we go to South Africa at least once a year on safari, or to go on a new adventure to Zimbabwe, to see Victoria Falls, or Mozambique to relax on their glorious beaches. It’s always such an exciting trip and so different from our lives in London which is why we all enjoy it so much.

Read Interview with Dr Libby Pearson in full

by Dr Gautham Benoy

So, I’ve just finished medical school, got my results and passed exams. Now what? I’m a doctor supposedly? These are my last few weeks in Imperial now! I start my FY1 in Sheffield so it’s not just bye bye Imperial, It’s bye bye London! But before I leave, I had one last act to finish; my elective. Ever since participating in the ICA (the Integrated Clinical Apprenticeship) at Imperial College, I’ve started to develop a fond interest in medical education and Primary Care. Partly to blame for this are 2 of my most inspiring role models, Dr Ravi Parekh and Dr Andy McKeown who ran the ICA course which had been the best learning experience I’ve had at Imperial College. Since I’d become quite acquainted with the Department of Primary Care through my participation in the ICA and I had really enjoyed my specialty choice placement in medical education, I decided to do 3 weeks of my elective with the department. I’m also starting my foundation job as an Academic Foundation Doctor in medical education and hope to incorporate medical education into my career; I thought a short glimpse into the future might be useful for me.

Week 1

So, I’m in the middle of packing all my things and moving out of my London accommodation. My contract expires in a week and I’ve also got an AirBnB booked for 2 weeks to complete my elective. Things are quite hectic with packing and tenancy related paperwork e.t.c. But I look forward to starting my elective. I’m getting to work with my favorite department and I’ve still got 2 of my fellow Imperial students and good friends Ann and Seraphina who are still around doing their medical education elective with me.

In our first week, we got to meet Ravi in day 1 who gave us a rundown of what we might expect for the next few weeks. He shows us a big excel spreadsheet with all the activities we would be doing, from teaching, mock-PACES, working on e-modules, the F-Zero Course and other projects going on in the department. We’ve got a lot to do and so little time! So we rush off, sending emails to our supervisors for the projects we’re working on arranging meetings, reminders and decorating my calendar with dates, locations and times. We take the first few days relaxed, just getting to know everyone and doing some of the background reading for our projects and planning, lots and lots of planning and timetabling. While also taking time to register where one can acquire free tea and biscuits.

Worst of all, there was a slight miscalculation, next week was Easter! Meaning I’d have to get some initial work done ASAP and get all the information I need to make sure I know what I’m doing next week. Thankfully, I managed to plan my next few weeks with just enough time to spare.

Most of my work involved designing content for e-learning modules with Dr Ali Dhankot, Dr Sian Powell regarding clinical reasoning and also for the lifestyle and prevention module with Dr Ed Maine. I also got to work with the F-Zero team including Ravi, Andy and Neha to help design in-course assessments. I would also be working with the other students to design a mock PACES and clinical communications stations for the current ICA cohort.

Week 2

This is where all the work gets crammed in. Lots of tea and coffee was drunk, lots of hours typing and lots of jumping up and down on the exercise ball in the office to get the blood pumping.

Even though it was Easter, I still had the company of Ann, Seraphina and also Dr Bhakti Visani and Dr Neha Ahuja who we

re so helpful during the elective. They had their own work to do but both took on the responsibility of baby-sitting us, providing us with much needed guidance whenever we got stuck.

I managed to do more reading into the literature around the content I was creating for the e-modules and the F-Zero assessments. I also made a start on the cases for the ICA students by interviewing some of the current Year 5 Specialty Choice Placement students on what cases they thought would be helpful for their year group. After going through all my specialties knowledge and thinking hard about the cases, I managed to come up with some cases designed to challenge the 5^th years and hopefully improve their preparation for specialties. We also spent a lot of time planning and arranging the mock, considering things like rooms, timings and how it’ll be supervised. This was a really good independent project for us since we were arranging an event ourselves.

I also had the chance to run my own mini-PACES while being assessed by Dr Georgina Neve. When I arrived at the room I was teaching in, it was printed “Dr Gautham Benoy”, now that definitely hit me. I have responsibilities now! I started to worry if the students would actually trust me to be a tutor despite being a student a few weeks ago. I wanted to make sure my students would benefit from the session, so I reflected on teaching I’d already done through the student union and how GP tutors ran mini-PACES sessions. I incorporated all the knowledge and teaching I’ve had on medical education to deliver mini-PACES session which was really immersive for me as a tutor. I felt like I had been given that responsibility as an educator and I really managed to reflect and learn from this experience where I was given full control over the tutorial.

Week 3

Everyone’s back from Easter! Now I’ve got to show my supervisors all the work I’d done. But I still had a lot to do before my meetings spread throughout the week. I crammed a lot of work in, writing content for the e-modules and finishing the assessment forms for F-Zero while simultaneously having multiple meetings and catching up with everyone. I got a feel for what it really is like working in the department and chasing deadlines. It was hard work, but it was definitely enjoyable and useful to experience.

I’d managed it all in the end and with all my tasks complete I had my final debriefs with everyone. It turned out a lot better than I expected. Having rushed some tasks and always questioning whether what I produced was good enough, all my supervisors found my work really helpful and I felt like I had genuinely contributed to the improvement of the medical school. I was happy with what I had done and the whole experience, I felt fulfilled by the end of the week and also went on a lunch social with the department in my last week which was really good fun.

With my elective over, I’m really going to miss Imperial College. I’d learnt so much over the elective and I’m so glad to have been involved. It had driven me even more to pursue my career in General Practice and medical education. I met some amazing, inspirational people and the department was really friendly. I’d definitely hope to take all I’ve learnt forward in my career, but I’d also love to keep in touch with the department even into the distant future since this is where my career began.

Read My last act at Imperial: Medical Education Elective in full

by Dr Ben Stone

“Look mister, there are some rules that you’ve got to follow”

“Yeah, what kind of rules?”

“First of all, keep him out of the light, he hates bright light…Second, don’t give him any water, not even to drink…But the most important rule…never feed him after midnight.”

You’re probably wondering one of two things at this stage, depending on your knowledge of 1980s pop-culture:

1. What on earth is this blog about?
2. Why is this blog referencing Joe Dante’s 1984 comedy-horror cult film: Gremlins?

Prior to a recent teaching session, I was discussing with a colleague about how we felt the session may go: “I suppose you have always got to be prepared for the gremlins” I said, and we chuckled. We repeated the same phrase a few days later, realising that our wireless clicker had inexplicably reversed left and right. I can’t count the various mishaps that occurred in sessions I have witnessed: computers failing, tutors disappearing, printers misprinting, and the list goes on. Our instinctual cognitive reaction to all these events probably protects us from curling up into sobbing balls of human anxiety:

“That will never happen to me!”

I recently wrote another blog “From taught to teacher: the dark side of the moon” in which I introduced myself as a Foundation Year 2 trainee, preparing a teaching session on Prescribing Safety. Like we should with all sessions, see this blog as the debrief; an epilogue to the prologue. As you may have anticipated already, it did not all go to plan.

As Edward Jenner and Randall Peltzer, of smallpox and Gremlins fame respectively, both teach us: prevention is key. On the day of my session delivery I had prepped my facilitators, adjusted my clinical hours and organised my printing materials into one electronic folder. However, I had not prepared for the actions of those photophobic, hydrophilic and nocturnal hyperphagic beings. No, not the students.

The first mishap occurred 25 minutes before the start of the session; a facilitator emailed in unwell. A vital component to my session was to have facilitators for each group to answer questions and, well, facilitate. I am fortunate to have colleagues willing to step in at the last minute, but this meant the countdown to showtime was spent trying to condense two hours of material into a 20-minute rundown. The Gremlin of others.

The second occurred 25 minutes into the start of the session. “Is this everybody for today?” A familiar question for regular teachers. The need to appropriately introduce students to a session vs having enough time to deliver your material. The devilish realisation that you wasted the 20 minutes you spent prepping the extra facilitator that is no longer needed. The Gremlin of time.

The third occurred shortly after that. A face at the door.

“Knock-knock”

“Who’s there?”

“Sorry, I’ve actually booked this room”

“’Sorry, I’ve actually booked this room,’ who?”

Like a punchline delivered by an overexuberant parent at a teenage house party, it had me in tears. The room, seemingly booked on an eternal rolling reservation, had been available on the booking system and utilised for other means. Whilst we could fortunately share the room space, I no longer had use of the computer. The Gremlin of technology, the Gremlin of misfortune and the Gremlin of “…” all at once.

Gizmo is the name of the original mogwai gifted to the protagonist in ‘Gremlins’, whom, despite the actions of his kin, never becomes mischievous or ultimately murderous. It would have been very easy for this string of mishaps to derail the session completely, like the mogwai upon Kingston Falls, but that never happened. It was at this stage I appreciated the journey here, to the dark side of the moon. It wasn’t perfect, but the materials and content I had prepared could be utilised by the students. It was adaptable. I learnt that even when it looks like everything is going wrong, there will still be something right: not every Gizmo becomes a Gremlin.

In the final moments of Dante’s film, Randall gives the following advice:

“If your air conditioner goes on the fritz, or your washing machine blows up, or your video recorder conks out, before you call the repairman, turn on all the lights, check all the closets and cupboards, look under all the beds, ‘cause you can never tell. There just might be a gremlin in your house”

It is many months since I first made that prescribing error. I have learnt about educational theory. I have learnt about human error. I have learnt that teaching is not just about turning up on the day, with your colleague’s slides and hoping to “wing it”. I have even learnt about fictional villains from 80s cult films. But most importantly, I have learnt that there is always more to learn in the educational sphere. So, in true reflective fashion, what are my three things to take away from this day?

Be prepared. Be adaptable. But most importantly:

Don’t let Gizmos become Gremlins.

Read Gizmos and Gremlins: when things don’t go as planned in full

The 2nd UK Longitudinal Integrated Clerkship Think Tank was held at Imperial on Thursday 7 February. Representatives of 15 different medical schools from across the United Kingdom attended the day to share knowledge, experience and advice in running longitudinal attachments for their students.

We saw showcases from institutions across the UK including Cardiff University, King’s College London, Hull York Medical School, Sheffield University and Dundee University, with representatives presenting their LIC models alongside their students.

A student discussion panel followed before the group broke out into small group discussions on topics such as The role of social accountability in LICs, The dark side of service learning and Continuity and belonging.

The next meeting of the think tank is due to take place at Cardiff University in 2020.

Read UKLIC in full

By Dr Georgina Neve

A large number of the Primary Care department attended the SAPC South East Regional Meeting, held once again at the wonderful setting of Madingley Hall, Cambridge.  The theme of this year’s conference, hosted by King’s College, was ‘Digital Features in Primary Care?’  Note the question mark.

We heard from Professor Chris Salisbury, past chair of the RCGP, who raised some concerns about digital health looking at some of the hype and the cons as well as a few pros.  Dr Shubs Upadhyay spoke to us about his experience with developing a podcast and designing healthcare apps.  Dr Zoe Williams educated us on the world of health and wellbeing apps, encouraging us to both use these ourselves and promote them to our patients. Professor Martin Marshall addressed the conference on the topic of re-thinking medicine, discussing the role of social prescribing and the community.

Imperial had many abstracts accepted for presentation this year – it was hard to keep track!  Neepa Thacker, clinical teaching fellow, and Joanne Winning, Director for Medical Humanities at Birkbeck Centre, presented their work on humanities and medical education which stimulated a lot of exciting discussion. One of our medical students, Saniya Mediratta, presented alongside two UCL students on the collaborative work they have been doing on ‘The Hidden Curriculum’, an ethnographic study describing the student perspective on a career in General Practice.

Nadine Engineer, faculty development manager, presented her work around online learning tools for GP undergraduate tutors.  Sonia Kumar spoke passionately about social accountability and rethinking how we educate medical students on this topic.  Georgina Neve, academic clinical fellow, presented and demonstrated an artificial intelligence chatbot designed to support medical students. Edward Maile, academic clinical fellow, delivered a presentation on the impact of mergers describing ten lessons learned from a merger at Oxford University.   Viral Thakerar, course lead, and Tom Durley, primary care executive officer, delivered a workshop on creating a digital learning resource from scratch – ‘Doodles to Digital’ – which was well attended and well received.

Overall the conference was an excellent two days with fascinating presentations from a range of institutions. We look forward to applying all that we learnt to our own student teaching and education research.

Read Society of Academic Primary Care: South East Regional Meeting in full

by Dr Ben Stone

When was the last time you planned a journey? I visited a friend recently; with just an address I found the quickest route, adjusted for traffic and was acquainted with their garden gnomes before I heard a single beat of my “Driving tunes” playlist. Now imagine planning a journey; you can visualise how the destination will look, but you’ll only know for sure once you arrive. The dark side of the moon.

Everyone has heard the outdated adage of medical education: “see one, do one, teach one”. The gap between see and do is noticeably palpable, principally as you walk away from your first cannulation with a blood-stained shoe and still-shaking hand. Can the second gap be so large? It can’t require as much shoe polish.

I joined the Department of Primary Care and Public Health at Imperial College London in early December 2018, the second rotation of my Foundation Year 2. Days before, on a busy medical post-take round, I made a prescribing error. I reflected: what could I do to prevent this in future? Following a slightly protracted e-portfolio entry: Eureka! In my new role, I will have the time, audience and resources to develop a prescribing safety session for medical undergraduates. Inception, albeit with less DiCaprio. The destination is set, but why there?

Performing a literature search is familiar: big studies, national guidelines and a few slightly blurry pdf versions of old books. Maybe I spent some time updating the “Study tunes” playlist. There was a lot of value in discussing my early findings with colleagues, especially as they are too kind to tell me they have work of their own. Soon, I constructed a glimmering evidence-based educational proposal, presenting it proudly to my supervisor. Of course, I’m sure I wouldn’t have overlooked the small matter of educational theory.

It can be tempting to skim a stone across the literary ocean of medical education, but without full immersion my session lacked structure and substance. Has your topic been taught before? How has your topic been taught? Why is your selected teaching style appropriate? Asking these questions is one of the hardest steps, but there are many excellent Imperial College courses designed to hold your hand as you dip your toes (see links at the bottom of the article). With their help, my stage was set, my proposal complete. It was time to plan.

The, hopefully not copyrighted, mnemonic of AILMENTS is the ABCDE of lesson planning:

• Aim: the overarching goal of the session – what will I achieve?
• Intended Learning Outcomes: often an afterthought, but the lifeblood of a session from aim to evaluation. My greatest appreciation of verbs since Year 3 literacy.
• Learning needs analysis: fine tuning the contextual pitch, somewhere between astrophysics and sucking eggs. I performed a quick online survey ahead of time, much to the delight of my future audience.
• Methods: the fruit of your literature search. What will I do? What will I use? You do realise you will have to write all those complex clinical cases now?
• Evaluation: “how likely were you to give a 5 if the presenter was nice and you didn’t fall asleep?” I found that evaluation was integrated throughout a session, not just a feedback form at the end.
• Next steps: this can range from 200 page guideline to a curriculum required e-learning module, but I found it interesting, hopefully they may do too.
• Tests/assessments: Nothing demonstrates enlightenment like a pop quiz! I had to write these questions too.
• Summary: what was that all about again?

With some flesh on the bones, my lesson was coming to life. But like a fleshy skeleton or cake without icing, the final epidermal layer of planning pulls everything together.

It does not take long to realise the logistics involved. Do you have a room? Do you have a speaker? Did you want to show a presentation? Have you got the link ready for that video? I’m sure that video worked the last time I used it? Are there enough chairs? Have you made enough print-outs? Have you made your print-outs? Do you have access to a printer? And so on. Whilst I was fortunate to have the help of experienced colleagues and willing volunteers, classic OSCE/PACES practice with a trusty squadron of stuffed animals could iron out a few creases. My materials were ready. I felt prepared.

The dark side of the moon.

Read From taught to teacher: the dark side of the moon in full

Dr Ishani Barai spent 4 months in the department as an Academic Foundation Trainee from August-December 2018. She produced this mind map to summarise her experiences and involvement over this time.

by Dr Ishani Barai

Read My experience in the Department of Primary Care in full

by Dr Jo Harris

I would like to update our community GPs on the new School of Medicine reporting form. This form known as the ‘concerns and compliments’ form was introduced as an optional addition to the end of year sign-off form, completed after every placement, in the academic year 2017/18. The launch has been successful and it is particularly good to see that our GPs have engaged well with this form.

Overall, we received 68 compliments and 14 concerns across all our sites for the whole School in 17/18. The forms are not meant to be completed for every student, but for those who either impress or who cause concern especially in terms of their professional behaviour.

The range of roles of those who have submitted forms so far is shown in the table below: –

Table 1: Concerns and compliments 2017/18 by role of submitter

Students told us the sign-off form provided little feedback on their achievements or professionalism, especially when they had done something in excess of Imperial expectations. We wanted to ensure that excellence was being recognised and that the students knew there was oversight of their performance even on placements further afield.

Teachers are sometimes unwilling to write negative comments or fail to sign-off students as there is a worry this would affect their progression on the course. This means that low–level concerns – such as attendance issues or timekeeping – can often go unreported, and students could have similar issues in more than one attachment. We are keen to know about these low-level concerns since there is often an underlying welfare issue that can be addressed to support the student before this becomes a major issue. The GMC have also highlighted that Schools should identify cases where student behaviour may flag a need for extra support in the new GMC professionalism guidance, Professional behaviours and fitness to practice (GMC, 2016).

Students who are complimented receive a letter detailing the teacher’s comments, together with congratulations from Mr Martin Lupton, Head of Undergraduate Medicine. A copy is saved on the student’s file. The form does not affect progression or ranking and cannot be used as part of the FPAS application. Although students are encouraged to keep forms of this nature as part of their portfolio, you should only complete a compliment form if you feel the student has excelled in some way, and not because the student has suggested it will assist their progress.

The response to the submission of a concern form varies dependent on the issue. Forms go to the Head of Year, year administrator and Deputy Head of Undergraduate Medicine for consideration.

We are always very happy for unprofessional behaviour to be addressed at practices by the teacher (or GP) in question, but it is useful for the School to know about the extent of unprofessional behaviour. It may be that issues such as attendance are recurrent in a student and they require more support from the School, so we encourage you to let us know any issues even if you consider them dealt with.

This is particularly important in the GPPHC course in Year 5, where we are piloting clinical encounter forms in the place of sign-off forms. Although students will get more feedback about their knowledge and skills with the clinical encounter forms, without an end-of-firm sign-off we need you to tell us if anything has been particularly good, or particularly concerning about that student, which can be submitted through the concerns and compliments form system.

GPs who are signing off students will get a link in the confirmatory email they receive from the FEO. The form can always be found here:

https://imperial.eu.qualtrics.com/jfe/form/SV_8CijnFiEtk8UNq5

We also hope to make it available on the College website for easier access in future. Any staff who receive the termly ‘Teaching Bulletin’ will also have access to the standard link.

Thank you again for helping our students and your involvement with this new form.

Dr Joanne Harris

Deputy Head of Undergraduate Medicine

Read Concerns and Compliments Form in full