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Welcome to Clinical Teacher Induction Training YEARS 3 - 5 2012/2013.

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Presentation on theme: "Welcome to Clinical Teacher Induction Training YEARS 3 - 5 2012/2013."— Presentation transcript:

1 Welcome to Clinical Teacher Induction Training YEARS 3 - 5 2012/2013

2 Outcomes of the Session UNDERSTANDING THE CURRICULUM To have achieved an understanding of how to: assess students’ clinical reasoning skills facilitate CLINICAL FEEDBACK sessions facilitate PATIENT BASED PRESENTATIONS assess students’ IN-VIVO CLINICAL SKILLS assess students’ PATIENT ORIENTATED INTEGRATED STRUCTURED EXAMINATIONS assess students’ PROFESSIONALISM


4 Years 1 and 2 Plymouth Exeter Years 3 and 4 Plymouth Exeter Truro Year 5 Plymouth Torbay Exeter Barnstaple Clinical Learning Clinical Care Clinical Practice Overall Curriculum Design F1 programme (PRHO) Year 6

5 Student Numbers 2012/13 YEAREXETERPLYMOUTHTRUROTOTAL 1102113X215 2115103X218 3767765218 4748166221 554 49 Plymouth 54 Torbay 47204 TOTAL 4214771781076

6 F1 Doctor Life CyclePathwaysClinical Blocks Clinical LearningClinical CareClinical Practice Curriculum Overview Year 1: Human Life Cycle Normality Life Sciences Clinical Skills Public Health Human Sciences PPD

7 F1 Doctor Life CyclePathwaysClinical Blocks Clinical LearningClinical CareClinical Practice Curriculum Overview Year 2: Human Life Cycle Pathology Life Sciences Clinical Skills Public Health Human Sciences PPD

8 F1 Doctor Life CyclePathwaysClinical Blocks Clinical LearningClinical CareClinical Practice Curriculum Overview Year 3: Pathways Acute Care 1 Ward Care Integrated Ambulatory Care Life Sciences Clinical Skills Public Health Human Sciences PPD

9 F1 Doctor Life CyclePathwaysClinical Blocks Clinical LearningClinical CareClinical Practice Curriculum Overview Year 4: Pathways Acute Care 2 Continuing Care Oncology & Palliative Care Life Sciences Clinical Skills Public Health Human Sciences PPD

10 F1 Doctor Life CyclePathwaysClinical Blocks Clinical LearningClinical CareClinical Practice Curriculum Overview Year 5: Clinical Blocks Immediate Care Medicine Surgery Community Specialty Life Sciences Clinical Skills Public Health Human Sciences PPD

11 Placements 2 hours x 10 per year in pairs Placements help students to take a wide view of society, people with health problems and healthcare delivery in the community Problem Based Learning Small Group Learning Special Study Units YEAR 1

12 6 x one day placements in pairs Same GP Practice 2 x Professionalism Judgements 4 x clinical competencies: Observed History Gastrointestinal Examination Respiratory System Examination Cardiovascular System Examination YEAR 2

13 YEARS 3 & 4 Developing clinical skills with underpinning science Learning in clinical environments Clinical sciences, pathology and therapeutics are key syllabus areas Academic Day (Year 3 – Monday, Year 4 – Friday)

14 Structure of Years 3&4 Acute Care 1 9 weeks Acute Care 2 9 weeks Ward Care 9 weeks Oncology / Palliative Care 9 weeks Continuing Care 9 weeks Integrated Ambulatory Care 9 weeks Year 3 Year 4 Pathways of Care SSU

15 Chest pain Palpitations Shortness of breath 1 Abdominal pain 1 Abdominal pain 2 The confused drinker Thirst Right-sided weakness Perioperative collapse on the ward Elective major surgery Fever in the postoperative patient Broken leg Collapse, falls & funny turns Confusion Deafness HIV/AIDS/STD Psychoses Depression Substance misuse & self-harm Pregnancy & labour 1 Pregnancy & labour 2 Day surgery New baby The worrying child Lumps and bumps Haemoptysis & weight loss Dysphagia Haemorrhagic tendency Breast cancer & wobbly legs Abdominal swelling Agitation, fear & aggression The last few weeks Adult with chronic disability Child with special needs Joint pain Non-specific symptoms Visual disturbance Raised blood pressure Rash Chronic SOB The sick child The collapsed infant The sick adult Stridor Abdominal pain 3 Multiple injuries Shortness of breath 2 Acute severe headache Year 4 Acute Care 1Ward Care Integrated Ambulatory Care Year 3 Oncology / Palliative Care Continuing CareAcute Care 2

16 Exemplar Clinical Week Year 3

17 Assessments AMK Clinical skills: –In-Vivo Competencies –In-Vitro Competencies –ISCE –Clinical Reasoning Professionalism - PAs +PPD Judgements


19 Summative & Formative Assessment Understanding the need and the difference Summative means a ‘marked assessment’ – pass or fail Formative assessment is a learning opportunity after delivering a judgement on the quality of the behaviour All summative assessments should contain an element of formative / learning in the clinical setting Summative assessments go towards the student’s final score

20 Applied Medical Knowledge (AMK) – The Progress Test (from PCMD assessment unit)

21 Clinical Skills In vivo Clinical Competencies x 12 per year – formative in year 3 and summative in year 4 Summative ISCE at end of year 4 Clinical Reasoning – “Feedback”

22 In Vivo Competencies Years 3 & 4 SEE PINK FORMS IN PACK

23 In vivo Competencies 12 competency assessments per year in yrs 3&4 ALL 12 must be completed Observed process 15 minutes per student –8-10 for intro & examination –5-7 for explanation of findings & differential Ideally timetabled during a defined pathway week ST4 doctors & above to assess (exception: O&G midwife)

24 In vivo Competencies Paperwork is student’s responsibility Written feedback on the form is essential From 2010/11 Form includes Professional Judgement (year 4) “Global judgement of the observed professional behaviour demonstrated by student.” First attempt, remediation then second attempt must be undertaken by relevant PCMD staff (Benchmarking later today)

25 The Systems CVS GI Respiratory Musculoskeletal Neuro – cranials Neuro - periph General / skin Swelling / mass Assessment of child Pregnant woman Mental State Exam Observed History See handouts for which departments assess in each year

26 Year 3 Formative Feedback only Learning experience Year 4 Summative Have 2 attempts only

27 Problems Student misses the week Extenuating Circumstance (EC) does NOT cancel the competency out. Student must complete this. Assessor away Undertaken by other trained assessors within department Rearrange Clinical Skills Co-ordinator (last resort) Student loses paperwork Their problem!

28 Why? Progression Formative-Year 3 Summative-Year 4 POISE-Year 5 Mini CEX-F1 / F2 MRCP etc …

29 In Vivo Clinical Competency Benchmarking

30 Clinical Placements and Feedback Clinical placements / seeing patients Case presentation and feedback 2 hours


32 ‘Sitting and watching… a lot less useful than ‘doing’ and receiving feedback on performance’ Bligh 2002

33 The Clinical Feedback Session A two hour session at the end of each week Protected time with 2 or 3 students Develop clinical reasoning skills via –Case presentations –Feedback and assessment Identify learning needs for students SEE BLUE FORMS IN PACK

34 Failing to attend/prepare for the session is a professionalism issue Please report non-attendance (without EC) or failure to prepare for the session to the Undergraduate Office Preparation / Attendance

35 What are your experiences of Students’ Presentations?

36 Clinical Reasoning ‘Encourage students to think about the data they collect during history taking and relate it to understanding the patient’s problem’ Nendaz. M.R., & Bordage, G., (2002) Medical Education, 36, 760-766

37 Promoting Diagnosis Reasoning Commit to working diagnosis early Co-select: gather data with working diagnosis in mind Focus on the discriminating features Summarize the big picture: build an abstracted problem representation Encourage students to express uncertainties: disclosure without blame


39 What would YOU want to hear first when a patient is presented ?

40 Clinical Method ‘The student should practice the art of presenting the leading features in a few sentences’ Hunter, D. & Bomford, R.R., (1968), Hutchinsons Clinical Methods, p1., London, Bailliere Tindall & Cassell

41 Clinical Reasoning Assessment Summarising statements Differential diagnosis History & Examination Demonstration of relevant clinical skills Understanding of investigations Areas of uncertainty Patient centred issues Behaviour consistent with Good Medical Practice Management Plan and treatments Links to prior learning Identification of Learning Needs Attendance & engagement with clinical learning process

42 Clinical Reasoning Assessment As from September 2011 will be formative for both years 3 & 4 Formative nature of the session Detailed written feedback on the form –Areas of good practice –Areas for improvement/development –Agreed action plan No grades given

43 Ideas from QA visits of Clinical Reasoning sessions: Linking presentation to basic sciences Highlighting patient centred/social/ethical issues Appropriate learning environment Reviewing patients when possible Year 3 & 4 Good Practice

44 Why have Professionalism Judgements? Conforms to GMC Good Medical Practice Encourages students to develop appropriate professional behaviour Monitors actual behaviour in the clinical environment Identifies students who need additional help and remediation Provides a structure for constructive feedback

45 Professionalism in Years 3 & 4 By GP supervisors x 3 per year SSU supervisors x 4 per year Small Groups x 2 per year Clinical Skills x 2 per year One from each Pathway x 3 per year (not GP) Portfolio analysis x 2 per year Elective Advisor after elective proposal SEE CREAM FORMS IN PACK

46 Summary of Year 3 & 4 Professionalism Judgements Year of StudyNo. of Summative Judgements Assessed by: 312 4 x SSU Providers 2 x Small Group Providers 3 x GP Week Provider 3 x Clinical Week Providers 430 4 x SSU Providers 2 x Small Group Providers 3 x GP Week Provider 3 x Clinical Week Providers 12 x In vivo Competency Assessors 6 x ISCE Station Assessors

47 Professionalism Judgements Provide feedback about student behaviour –At regular intervals –In a variety of settings –By multiple observers However –Students may perform for the assessment –We hear of other examples of poor or very good behaviour –We need to document these in order to provide feedback or take action where necessary

48 On-the-Spot Feedback An opportunity to identify exceptional behaviour and provide feedback to students and the School

49 The aim of on-the-spot feedback To encourage good professional behaviour and modify poor professional behaviour To record exceptional behaviours Provide timely feedback about this to students Develop a process for dealing with this, where necessary, as a School

50 Process for this Forms to be available in locality offices When exceptional student behaviour is identified feedback will ideally be given directly to student Form to be completed and returned to locality office Associate Dean to decide appropriate action

51 In order to capture this information each student will now be allocated an extra Professionalism Judgement based on this feedback and awarded by an expert Panel of the Associate Deans and Lead for Professionalism. If no On-the-Spot feedback has been awarded a student will automatically be awarded a “satisfactory” but in the light of the On-the-Spot feedback the Panel may award “excellent”, “borderline” or “unsatisfactory”. The same rules of progression will apply to the module. On-the-Spot Feedback

52 Student Selected Component (SSC) 30% of the course (GMC Tomorrow’s Doctor) Consists of regular Special Study Units (SSU) Elective in year 5

53 Special Study Units (SSUs) Special Environment – 3 of them during years 3 & 4 (3 weeks each) Doctors as Service Planners and Managers Year 3 (2 weeks) Working together for patients Year 3 (2 weeks)

54 Longitudinal SSUs Year 4 – 3 of them run across the year Doctors as Teachers Medicine an Art? – “humanities” Research in Action Total of 6 weeks One day conferences for Doctors as Teachers and Medicine an Art? - April

55 Year 5 SSC – The Elective At the beginning of year 5 8 weeks duration Planned during year 4 – with assessment to ensure appropriate and safe Mostly taken abroad Elective write up by student, report from “host” organisation assessed

56 YEAR 5

57 Year 5 5 clinical blocks of 6 weeks –Immediate Care –Community –Specialties –Medicine –Surgery

58 Clinical Component Year 5

59 Peninsula Medical School – Year 5 Medicine Surgery Immediate Care Community Specialties Intensive clinical experience

60 Clinical Impact Funding covers 30% reduction in patients seen Time required for POISE, PBP and microteaching

61 Working with Clinical Team Ward Round Admissions Outpatients Ward/GP Work Theatres Multi Disciplinary Team Meetings

62 Teaching Clinical Placement “Same concept/impact” as years 3 & 4 Ward Round Outpatients Specific GP Surgery

63 Peninsula Medical School – Year 5 Medicine Surgery Immediate Care Community Specialties Culminating in a week “Professional Practice”

64 Student Assistantship/ Professional Practice Week Follows on from the 5 weeks of the Clinical Block i.e. a sixth week “Acting up” under supervision An explicit change of role for the student – PMS version of “shadowing” Practice “doing the job” Demonstrate Good Medical Practice (professionalism)

65 Students should particularly use this week to document clinical skills performed and list the activities they have performed as a member of the team (this will be communicated to students) Evaluation of this week is ongoing Student Assistantship/ Professional Practice Week

66 Peninsula Medical School – Year 5 Medicine Surgery Immediate Care Community Specialties Small GroupTherapeuticsPublic Health Pathology/RadiologyDiscipline Overview Clinical Skills Supporting Academic Programme

67 Wednesday am during Clinical Blocks An integrated programme “Master-classes” in pathology, radiology, public health, therapeutics, medicine/ surgery etc overview, clinical skills Block specific i.e. medical topics whilst in the medicine block

68 Small Group Learning All students Every year Facilitated groups of 8-11 students Explore students development and professional growth Specific topics – e.g. ethics, public health

69 Supporting Academic Programme for the Medicine Block

70 Peninsula Medical School – Year 5 Medicine Surgery Immediate Care Community Specialties 2 x Patient based In vivo practical skills competencies BLS and ALS competencies 2 x Patient based Small GroupTherapeuticsPublic Health Pathology/RadiologyDiscipline Overview Clinical Skills With rigorous, authentic assessment of clinical capability 2 x Patient based 2 x POISE 2 x POISE 2 x POISE 2 x POISE 2 x POISE

71 Assessment Overview – Year 5 4 Progress Tests (Applied Medical Knowledge) 8 summative Patient Based Presentations– like a Foundation Programme “Case Based Discussion (CbD)” 8 POISE assessments (summative) – like a “Mini CEX” Practical Skills Log – evidence of competencies required in Tomorrow’s Doctors 5 Professionalism Judgments (with multi-professional feedback) 5 “progress reviews” by the Academic Tutor (AT) with a summative portfolio analysis at the end of block 4 Assessment of the student’s elective report Maintain a Clinical Log of all significant patient encounters – monitored by AT via ATLAS No finals! – award board after block 4

72 Patient Based Presentations (PBPs) One session per week Multi-source feedback – peers, clinical teacher In week one of the first clinical block only practice assessment occurs Then 2 summative assessments per student during the remainder of the block SEE BLUE FORM IN PACK

73 Patient Based Presentation (Structured Clinical Session) Patient Based Presentation (Structured Clinical Session) How it Works in the Medical Block Week 1Cardiology Week 2Respiratory Week 3Endocrinology Week 4Gastroenterology Week 5Renal

74 Exemplar Cardiology Patient Based Presentation Clinical TeacherCardiology Consultant Cardiology StudentHe/She is the “Organising student” and finds patients, collates feedback, organises sessions – runs the show! Does not present. Respiratory StudentClerks Mr A who has cardiac failure Endocrinology StudentClerks Miss B who has had an MI Gastroenterology StudentClerks Mr C who has an arrythmia Renal StudentClerks Mrs D who has aortic stenosis

75 Patient Presentations Clinical Teacher selects which patients to visit Visit at least 3 patients Student presentations Demonstrate clinical reasoning, clinical skills and “behaviour consistent with Good Medical Practice” Patient based discussion – at the bedside if appropriate Student provides assessment forms and hands in.

76 Patient Orientated Integrated Structured Exam (POISE) Builds on years 3 & 4 “in vivo” competencies and links to F1 assessments – the mini CEX CVS, Resp, GI and Neuro are core with 8 others available of which 4 must be assessed Assessors must have attended this or similar training session (see forms in pack) 2 POISEs (1 st attempt) per block and 2 by any single assessor during the year Students to perform 8 POISEs by the end of the fourth block SEE PINK FORM IN PACK

77 Key Issues in PBP & POISE See BMBS Assessment Summary Booklet (in pack) POISE only by PMS trained assessors (ST4 + above) PBP’s only by PMS trained Consultants Satisfactory grade = Competence of new F1 2 x Unsatisfactory/Borderline = Fail 2 nd attempts must be in same system (POISE) / department (PBP) and undertaken at least 1 week later, following remediation

78 Practical Skills Competencies An ongoing assessment of “in vivo” competencies – building on years 3 & 4 Assessed by any competent practitioner Competencies include cannulae, PEFR, ABGs, drug dose calculation, catheterisation Checked during “Progress Review” with Academic Tutor New for 2010/11 – 18 skills all assessed once. FORM IN PACK

79 Year 5 Professionalism Judgements 1 per block i.e. 5 Summative judgement by clinician at end of professional practice week Supported by 360 degree formative feedback from the clinical team - end of week 3 “Do they have the professionalism to be an F1?” - yes/no/maybe SEE CREAM FORMS IN PACK

80 These are of a different quality to other judgements and will now carry more weight than a normal Judgement. A “maybe” and “no” will lead to 2nd level remediation by the Associate Dean or representative and will carry the same consequences as an “unsatisfactory” judgement in the module. If a student is given a “maybe” or a “no” in 2 of the 5 blocks this will result in failure of the module and may prevent the successful completion of the year. Year 5 Professionalism Judgements

81 Summary of Year 5 Professionalism Judgements No. of Summative JudgementsAssessed by: 17 5 x Block Leads 8 x POISE 2 x Small Group Providers 2 x Clinical Skills Staff POISE (added to the form for 2010/11): “Global judgement of the observed professional behaviour demonstrated by student” Unsatisfactory / Borderline / Satisfactory / Excellent

82 Year 5 Exemplar Week – Secondary Care

83 Year 5 Exemplar Week – Primary Care

84 Parallel Surgery Time DoctorStudent Time DoctorStudent 0900Patient APatient B0930Patient DPatient E 0910Patient C0940Patient F 0920Discuss Patient B Together0950Discuss Patient E Together

85 Learning Outcomes for the Community Block Working with the team, seeing patients Follow patient pathways through episodes of hospital care Assessment of clinical skills and professionalism Participate in chronic disease management Video consultation (FLIP)

86 ALL YEARS Clinical Log Significant Cases

87 Indicative Presentations 185 presentations Single page, unified format Points students towards “ideal” presentations Forms the backbone of the Year 5 learning materials Gives “alternatives” to Year 3 and 4 trigger presentations Electronic links to prior learning

88 Educational Support Academic Tutors One Academic Tutor per student who changes each year They oversee academic progress Assess portfolios and in year 5 the elective report Refer students to the “learning support team” if a student is struggling/failing

89 Some Key Points on Remediation Patient safety concerns: contact Clinical Sub-Dean 1 x Unsatisfactory or Borderline grade - student to discuss with Academic tutor 2 x U/B - either Director Clinical Skills or Locality Clinical Skills Coordinator Remediation team

90 Pastoral Support Pastoral tutors – a team at each locality with “informal” access by students “Signposting” of students with more complex issues to support agencies Counsellor available in all localities who is a university appointee and accessed by appointment

91 Electronic Resources Managed learning environment (EMILY) Electronic support for the trigger presentations and clinical learning –Images (clinical, radiological, pathological, etc) –CD ROMs, DVDs –Powerpoint presentations –Downloadable handouts –Interactive sites –Useful weblinks –Structured feedback If you would like access/training please contact Hannah Poole

92 Discussion/Questions

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