Transcript 1st Annual Curriculum Conference All Wales Teaching

Community Based Learning
C21: Modernising Medical Education in Cardiff
Annual Curriculum Away Day
Friday 16th September 2011, All Nations’ Centre
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‘To study the phenomenon of disease without books
is to sail an uncharted sea, while to study books
without patients is not to go to sea at all’.
Sir William Osler
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C21 strap line:
To produce excellent clinicians who understand their
patients and the world in which we all live and work
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GMC requirements
Prof Jim McKillop, Chair of Undergraduate Board,
Education and Training Committee, GMC (AMEE
conference, Glasgow 2010):
•Early clinical contact
•Professionalism stream throughout the course
•Clinical and practical skills from early stage
•Integration of scientific and clinical material
•Room for innovation and individuality – both for
students and the course
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Rationale for Clinical Learning in the early
years
Integrate clinical, basic, behavioural and social sciences
Explore patients’ experiences of illness
Gain competence in history taking
Become proficient in conducting physical examinations
Develop a patient-centred approach to clinical practice
Develop professional attitudes
Learn clinical reasoning and decision making skills
Experience a wide range of specialties
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Rationale for Community Based Learning in
early years
Experience of a more personal relationship with patients in their own
settings
Experience patient contact and continuity of care over a length of time
and in appropriate settings – especially for long term conditions
More opportunities to sample and contribute to community projects and
get involved
Contextualises learning - effect of social environment on health and
healthcare, effects of diversity and disadvantage of different types
Patients are willing to participate
Students may be more likely to come back to work in these settings
Students will learn transferable skills and informed professional attitudes
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Rationale for Community Based Learning in
early years
Issues in ‘traditional’ training:
NHS greater emphasis on primary care and community services
Shorter inpatient stays reducing learning opportunities
Pressure to meet waiting list targets
Changes in junior Dr hours
Fragmentation of firms within hospitals
Competition with postgraduate training
Increased numbers of students
Increasing specialisation reduces the numbers of patients suitable for
undergraduate training
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So - what’s the evidence?
• Systematic review 2006:
• How can experience in clinical and community settings
contribute to early medical education?
• 6 electronic databases + 6 journals hand searched (1992 –
2001)
• 73 studies – 25% comparative, 75% descriptive
• 277 educational outcomes:
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Systematic Review findings:
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Fosters self-awareness and empathetic attitudes towards sick people
Boosts students’ confidence, motivates and satisfies
Helps develop professional identity, roles and responsibilities
Better understanding of underserved communities and their needs
Learn the context of medicine delivery better: communication, multidisciplinary working, health care systems, population health needs
Gives relevance to medical biosciences and makes them easier to learn
Motivates teachers and patients
Increased recruitment to areas and specialties under-doctored, if clinical
experience in those areas.
Entering FY1 less stressful – better interpersonal skills
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Students’ comments from published
literature:
‘…we start our clinical placements early. We tend to get to grips with
communication skills, patient rapport quite quickly. I think this is a really
good part of the curriculum because we have really early patient contact
– which is why many of us want to be doctors in the first place! It certainly
reinforces learning outcomes and revision, as we see in reality what we
see in books’.
‘teaches us things that cannot be learned from books’
‘value being able to explore social and psychological determinants of
health and illness through contact with real patients’
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How do we apply this to the Cardiff
curriculum?
Develop learning outcomes for community based learning
• Primary Care
• Aspects of
• Public Health
• Social sciences medicine
• Psychology
Develop structures for community based learning
• Phase 1
• Phase 2
• Phase 3
•Identify placement capacity issues and funding capacity issues
•Engage and involve stakeholders, incorporate ideas
•Develop new learning sessions and link to curriculum and assessment
programme via learning outcomes
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C21: Phase 1
Introduction
to Medicine in
Cardiff
Conception
Foetal Life
2
Infancy
Childhood
2
The Young
Family
Adolescence
Young
Adult
2
The Mature
Family
Maturity
2
Old Age 1
Old Age
2
Research
Block
2
Clinical Case Led Chronological Life Cycle – 20 weeks in year 1 and 26 weeks in year 2
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Small Group Facilitated Sessions
Community based clinical placements – up to 20 half days Year 1 and 26 half days Year 2
Programme of lectures, seminars, practicals and clinical skills
Year 1:
• Basic Science applied to medicine and basic clinical consulting
• Normal Structure and Function
• Year 2:
• Consolidate knowledge and skills with application to more complex clinical presentations
• Abnormal Structure and Function
Put yourself in their shoes...
Introduction
to Medicine in
Cardiff
Conception
Foetal Life
2
Adolescence, young
adulthood and the
young family
Infancy
Childhood
2
Oncology
Women,
Children and
Family
Junior Student
Assistantship
Adolescence
Young
Adult
2
The Mature
Family
Maturity
2
Old Age 1
Old Age
2
Hospital Front Door
Neuroscience
and Mental
Health
Primary Care
Attachment
Research
Block
2
Chronic Disease
Complex Needs
and
Rehabilitation
Elective
Science
in
Practice
Senior Student
Assistantship
Mr Pritchard a salesman with
palpitations
•40 year old IT salesman from Newport
• Attending an international conference in Paris
• Several episodes of palpitations each lasting a few minutes
• Lifestyle Information and Family History
• Although he and his wife are worried, he hasn’t been to
see a doctor yet
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C21: Phase 1 Typical Week
Day 1
A
M
Day 2
Lecture 1 & 2
Day 3
Physiology
Practical
Day 4
Clinical Skills
Lab
Day 5
Physiology
Practical
Free
Community
Placement
Clinical
Demonstration
Self Directed
Learning
P
M
Introductory Small
Group Session
Human Anatomy
Practical
Self Directed
Learning
Taught Hours:
Lectures - 3 hours
Practicals – 6 hours
Clinical Skills (incl demo) – 4 hours
Small Group Learning – 4.5 hours
Community based Learning – 3.5 hours
Self Directed Learning – 10.5 hours
Total – 31.5hours
Lecture 3
Day 1
Closing Small
Group
Session
Clinical Learning
Clinical Skills Lab:
• Measuring and assessing the pulse
• Communication skills
• Developing active listening skills
• Meaning of patient centred consulting and background to the concept
• How professional understanding of ‘palpitations’ might differ from lay perspectives
• Focussed history taking for patients presenting like Mr Pritchard
Community Based Learning:
• Visit facilitated by GP Tutor
•Home visit in pairs to patient with history of palpitations
• Experiential Learning: how patients present and psychosocial and lifestyle factors affecting
that presentation
• How patients would be assessed in a general practice setting, incorporating principles learnt
from Clinical Skills Lab
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Threats
Funding
Capacity
Organisation
‘Students don’t get the same experience – eg if based in Biosciences Cathays Park versus
Merthyr Health Park’
•Rotate groups every few blocks
•Aim for equivalence in content
•Some of the block community learning will be about the community site
Merthyr – mining tradition/ closure of mines - effect on community/
unemployment and health/ how we bring about change and work with communities
Cardiff – comparisons between Butetown/ Grangetown and Vale of
Glamorgan/ Barry. Effect of a port city/ minority groups/ why people settle here
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Opportunities for the School, the University
and local communities
Working with partners in the NHS:
Cwm Taf LHB and Merthyr Health Park
Bridgend Hospital teaching and learning facilities
Barry Community Hospital
Gwent hospitals
Opportunities for active patient involvement
Involving the Patients Association in planning
Expert patients as teachers
Involvement in curriculum development, lay representation – the patient
perspective on chronic illness management, diversity and equality, ethical dilemmas or
dr/Patient communication
Training in patient centredness, shared decision making
Developing a sense of ‘service’ to communities and social accountability
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C21 Phase 2 + Phase 3
(still fluid…)
Phase 2:
Patient pathways - Following
patients out to their homes and
communities
Oncology
Hospital Front Door
Longitudinal case studies in each
block – similar in style to the
current Oncology project
Chronic Disease
? Assessed by case based
discussion with a panel of tutors
Women,
Children and
Family
Neuroscience
and Mental
Health
Complex Needs
and
Rehabilitation
Science
in
Practice
Reflective diaries, eportfolio logs
Phase 3:
Junior Student
Assistantship
Primary Care
Attachment
Elective
Senior Student
Assistantship
Primary Care attachment – 8
weeks, 6.5 attached to GP.
Development of learning
curriculum to deliver agreed
Primary Care and other
community learning outcomes
Community Based Learning:
Next Steps
1.
2.
3.
4.
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6.
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8.
9.
Finalise Learning Outcomes from the submitted discipline groups
Develop a series of cases which reflect basic science learning linking to
Community Based and other clinical learning outcomes
Establish community based placements – capacity and funding
Recruit and train small group facilitators
Draft handbooks for students and facilitators
Pilot case based learning and some community placements
Design the assessment and feedback programme
Develop academic and administrative structures to support and
maintain teaching and learning
Ensure continuity of learning into Phases 2 and 3, keeping the core
curriculum focussed
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