1. Teaching about chronic illness – a practical approach Melissa Gardner Clinical teaching fellow, UCL Medical School

3. Year 1 - Fundamentals of clinical science 1 Year 2 - Fundamentals of clinical science 2 Year 3 - Integrated BSc Year 4 - Integrated clinical care Year 5 - Life cycle Year 6 - Preparation for practice Foundation Programme UCL MBBS programme 2012

4. Teaching day Year 4 medical undergraduates Within Module A “Preparation for practice” week 30-40 students 9 times over the year

5. Preparing for practice

6. Case study throughout the day

7. Multidisciplinary teaching Physiotherapists Junior doctors GPs Patients

8. Signposting assessment

10. Outline of the day 1.Referral to hospital 2.Discharge home 3.Respiratory physiotherapy 4.Patient experience 5.Managing chronic illness

11. Outline of the day 1.Referral to hospital 2.Discharge home 3.Respiratory physiotherapy 4.Patient experience 5.Managing chronic illness

12. Outline of the day 1.Referral to hospital 2.Discharge home 3.Respiratory physiotherapy 4.Patient experience 5.Managing chronic illness

13. Outline of the day 1.Referral to hospital 2.Discharge home 3.Respiratory physiotherapy 4.Patient experience 5.Managing chronic illness

14. Outline of the day 1.Referral to hospital 2.Discharge home 3.Respiratory physiotherapy 4.Patient experience 5.Managing chronic illness Think about a patient you have met with severe COPD. Write down questions you have about their experience and day-to day life.

15. Outline of the day 1.Referral to hospital 2.Discharge home 3.Respiratory physiotherapy 4.Patient experience 5.Managing chronic illness

16. Utility of sessions – snap shot

17. Utility of sessions – over time

18. Teaching delivery

19. Students liked… Interactive, practical tasks Teaching style – friendly, relaxed Case study throughout the day Trying the BiPAP machines Listening to a patient’s story Relevant Focus on preparation for practice Covered areas not usually covered on wards

20. Referrals and discharge summaries Think harder about how to present and refer patients to colleagues rapidly yet in a logical & detailed way Pay more attention to structured style of various discharge summaries/ referral letters & develop my own! Pay attention to junior doctors doing admin and try and understand why they're doing it I will volunteer to fill out discharge summaries

21. Smoking I am going to try approach how I bring up smoking cessation with my sister to help her quit Be less "preachy" when asking patients to stop smoking! Put more effort into talking to people about smoking cessation

22. End-of-life care Don't shy away from asking important questions about end-of-life plans Don't be afraid of talking about death with patient - as medical student you have the time to do this Confidence in discussing end-of-life topics Talk about death in an open constructive way

23. Holistic care Try to be more personal with patients, learn one interesting fact about each person, make sure I know who the patient is as a person. Try to view illness in the patient's home setting rather than just considering what I see in hospital Remember the patient is more than a condition I will remember that the patient's disease journey does not end the moment they get discharged from hospital. There is much more to be done after that. Remember to treat patient as humans and not just physical symptoms and signs

24. Students recommendations for change More practical tasks More patients More chronic conditions Attending a physiotherapy session Shorter sessions Less focus on simpler topics Smaller groups

25. Moving forward Similar sessions focussing on different diseases, bringing in different professionals, eg. –Heart failure –Asthma –Diabetes More tasks, eg –Ordering tests –Practical prescribing –Organising ward rounds and prioritisation

26. Summary Effective, worthwhile teaching day Teaching preparedness for practice earlier : –Provides varied learning points for students –Highlights areas for self-directed learning –Enthuses students