GP Teaching

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

by Murray MacKay

The Collaborative Award for Teaching Excellence (CATE) recognises and rewards collaborative work that has had an impact on teaching and learning. Introduced in 2016, the Award, established by the Higher Education Academy, which is itself part of Universities UK, is open to all providers of higher education across the four nations of the UK.

Since 2016, 30 teams have been recognised, with 12 of them being awarded funding to continue their collaborative projects and further their impact.

Dr Kumar said: “The Undergraduate Primary Care Team’s story begins with a vision for medical education to become truly inclusive, making a transformational and sustainable difference to the health and wellbeing of patients, their families and communities.

“It is this that has directed our attention, energy and drive as the team has grown beyond expectations over the past five y

ears. Maximising the energy and talents of the full team, we all work to embrace our guiding principles of creativity, community, collaboration and evidence-based education in new exciting unpredictable ways.

“The team has created a multitude of courses and projects that are transformational to medical students and accountabl

e to society, with education creating a powerful space in which an exciting symbiosis is starting to emerge with students learning their curriculum meaningfully, acting as agents of change within our local community.

“Winning the CATE is a momentous occasion for all of us in the team, receiving such an accolade and national acknowledgement for our work will serve as a potent catalyst for us to now evolve even further, sharing our vision and way of working with others.”

Working with students

One of the highlights of the teaching team’s efforts has been the development of ‘Community Action Projects’ (CAP) alongside a student steering group.

3rd Year Medicine students are now encouraged to complete an authentic, peer-assessed experiential project during their 10-week community medicine attachment. In this CAP, students identify a real-world problem within their local community and they engage with community stakeholders, patient and charity groups to design an intervention to address the challenge identified.

Examples of CAP projects include a pair of students who recognised the ethnic diversity of their local population, which meant that local patients were unable to understand any health-related literature which was being provided by the doctors due to their limited English language skills. After engaging the local clinical commissioning group and patient groups, they developed an online website where patient condition leaflets were translated into variety of languages.

The initiative has been so successful, neighbouring areas are interested in the students working with their communities. In another example, one pair of students identified a lack of uptake of the cervical smear screening program in their local GP practice population. After discussing this with patients, they identified a lack of awareness amongst the patients as a key driver. They approached a local women’s cancer charity, and a Gynaecology Consultant from the local hospital to deliver an educational evening where local patients were invited to attend and learn about gynaecological malignancies and how they can be prevented.

Anonymous student feedback showed the value of this kind of active teaching:

• “Personally, I was happy I was able to do something that really helped patients. It was heartening to hear patients’ positive feedback for our project…I learnt that patients have a lot of healthcare needs and this is an eye-opener for me”
• “[I am] more aware of the needs of local populations and the need to think critically about how to influence people positively and in a sustainable way”
• “For the first time I felt I was able to do something as a student and not feel like I was at university just waiting to become a doctor”

The Director of Imperial’s Centre for Higher Education Scholarship and Research (CHERS), Professor Martyn Kingsbury, said: “The remarkable aspect of the Undergraduate Primary Care Education Team’s work is how they have embraced established educational expertise, whilst also developing their own innovations. They have used this to great effect in a variety of authentic and truly transformative learning experiences.

“Their practice and enthusiasm is exemplary. Their work is increasingly influential and they are a key part of our mission to transform teaching and learning at Imperial.”

Read Undergraduate Primary Care Team takes home coveted CATE Award in full

by Dr Andy McKeown and Dr Ravi Parekh

This year’s Association for the Study of Medical Education (ASME) took place in Newcastle upon Tyne from 11 -13 July. As part of a wider team of Undergraduate GP Teachers presenting a myriad of innovative work from the department, Andy McKeown and Ravi Parekh delivered a presentation to ASME delegates on the Integrated Clinical Apprenticeship (ICA). This innovative Longitudinal Integrated Clerkship, delivered by the GP team in year 5 of the MBBS, gives 24 students the opportunity to have a meaningful role in the healthcare of patients with multiple conditions in primary care over a full year. The ICA students have the chance to follow these patients into secondary care, providing a unique opportunity to advocate for their patients where appropriate. By spacing and integrating authentic teaching and learning, this innovative project is novel to the UK and is beginning to shape the path of undergraduate medical education, especially with our undergraduate curriculum review in full swing at present!

The most significant findings of the mixed-methods research within the first year of the course were that students were significantly more likely to be more empathetic, more able to manage uncertainty and retained work empowerment at the end of the year compared to their counterparts who did not do the ICA. Students great gained insight into the patient pathway and described acting as a ‘bridge’ between patients and clinicians and between primary and secondary care. They described feeling empowered by having an authentic role in patient care. This lead the research team to question whether students should have more clearly defined paraprofessional roles as they transition from medical student to student doctor.

The presentation was well attended, with the Heads of Teaching of Newcastle and Bristol especially interested in the findings (as they are planning similar courses in the coming years). ASME’s day-two  visiting speaker, Professor Susan Van Schalkwyk, even mentioned the ICA’s findings within her own Keynote address to conference. This vote of confidence certainly has spurred Andy and Ravi on to ensure that our next innovative course, a fully integrated course in both primary and secondary care within one single North West London community, is as much of a success! Look out for more information on the Year 6 F-Zero course, coming in 2019!

Read ASME Report in full

This summer the Department of Primary Care and Public Health ran the second year of the Widening Access to Community Careers in Healthcare (WATCCH) programme. This is a programme for 16-17 year olds from diverse and deprived backgrounds who have an interest in careers in community healthcare.  The programme gives pupils an opportunity to get vital work experience in healthcare and provides support with the application process. This is needed, now more than ever, when OFFA data shows that in 2016 entry rate to “higher tariff universities” for 18 year olds from the most disadvantaged backgrounds was just 3.6%. The WATCCH programme doubled in numbers this year to accommodate 40 pupils and was once again oversubscribed with high calibre applicants.

The programme starts with a Welcome Day at Imperial College London’s Charing Cross campus. Here, the school pupils heard from a multiprofessional healthcare panel including GPs, a pharmacist, physiotherapist, midwife, nurse and occupational therapist.  The panel shared their career journeys and then took part in a Q&A session with an honest discussion on the pros and cons of a career in healthcare. The pupils then got the opportunity to get some hands-on experience practicing blood taking and blood pressure taking. The day ended with a creative session where the pupils created mindmaps, reflecting on their future aspirations and the steps they could take to achieve their goals (see picture).

Following the welcome day, the pupils took part in a 3 day work experience attachment in a local GP practice, where they had the opportunity to shadow a range of healthcare professionals. The pupils then came back together for a Closing Day where they reflected on their work experience and also received teaching on how to maximise their chance of successful application to their chosen career.

Our WATCCH pupils told us about the struggles they had had getting any work experience, and how valuable it had been to gain insight into what a healthcare career might involve. They also learnt about new potential healthcare career options, such as physician associates, which most had not previously encountered. In an era where the NHS workforce is facing a recruitment crisis, this scheme supports applicants from underrepresented backgrounds in their journey to careers in healthcare. Supporting these students is vital in order to create a diverse workforce which better reflects the patients we care for.

Read WATCCH – Widening Access to Community Careers in Healthcare in full

by Dr Christine Douglass

The Global Consensus for Social Accountability of Medical Schools (GCSA) has articulated a requirement for medical schools to “respond to current and future health needs and challenges in society, re-orientate their education, research and service priorities accordingly, strengthen governance and partnerships with other stakeholders, and use evaluation and accreditation to assess their performance and impact”. At a time of undergraduate curriculum review at Imperial, the Department of Undergraduate Primary Care Education and Public Health, is prioritising Social Accountability (SA) in its curriculum development, teaching and research.

In conjunction with The Training for Health Equity Network (THEnet) the Department held a Think Tank to explore the relevance of social accountability (SA) for medical education in the UK. Executive director and co-founder of THEnet, Björg Pálsdóttir, and CEO, Professor André-Jacques Neusy provided an international perspective based on their extensive work in this field. Case studies were also presented from the UK, including our ongoing Departmental SA work. Attended by delegates from across the UK, the Think Tank work groups provided an excellent opportunity to actively debate the challenges of healthcare and medical education in the UK in the 21^stcentury with a focus reducing health inequity across communities. Discussions included how to build equitable partnerships & meaningful collaborations across multiple stakeholders that simultaneously meet community priorities and professional standards.

The Department is continuing active collaboration with THEnet Schools and planning an international conference on Social Accountability. Dr Christine Douglass has recently been appointed as Senior Social Accountability Teaching Fellow.

Read Social Accountability in Medical Education in full