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C21: Modernising Medical Education in Cardiff Annual Curriculum Away Day Friday 16 th September 2011, All Nations’ Centre Community Based Learning.

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Presentation on theme: "C21: Modernising Medical Education in Cardiff Annual Curriculum Away Day Friday 16 th September 2011, All Nations’ Centre Community Based Learning."— Presentation transcript:

1 C21: Modernising Medical Education in Cardiff Annual Curriculum Away Day Friday 16 th September 2011, All Nations’ Centre Community Based Learning

2 ‘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

3 C21 strap line: To produce excellent clinicians who understand their patients and the world in which we all live and work

4 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

5 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

6 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

7 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

8 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:

9 Systematic Review findings: 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, multi- disciplinary 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

10 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’

11 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

12 C21: Phase 1 Clinical Case Led Chronological Life Cycle – 20 weeks in year 1 and 26 weeks in year 2 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 Introduction to Medicine in Cardiff The Mature Family Old Age 1 The Young Family Adolescence Young Adult 2 Conception Foetal Life 2 Infancy Childhood 2 Maturity 2 Old Age 2 Research Block 2

13 Introduction to Medicine in Cardiff The Mature Family Old Age 1 Adolescence, young adulthood and the young family OncologyHospital Front DoorChronic Disease Women, Children and Family Neuroscience and Mental Health Complex Needs and Rehabilitation Science in Practice Adolescence Young Adult 2 Conception Foetal Life 2 Infancy Childhood 2 Maturity 2 Old Age 2 Research Block 2 ElectiveSenior Student Assistantship Primary Care Attachment Junior Student Assistantship Put yourself in their shoes...

14 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

15 C21: Phase 1 Typical Week Day 1Day 2Day 3Day 4Day 5Day 1 AMAM Lecture 1 & 2 Physiology Practical Clinical Skills Lab Physiology Practical Closing Small Group Session Self Directed Learning PMPM Introductory Small Group Session Human Anatomy Practical Free Community Placement Clinical Demonstration Lecture 3 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

16 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

17 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

18 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

19 OncologyHospital Front DoorChronic Disease Women, Children and Family Neuroscience and Mental Health Complex Needs and Rehabilitation Science in Practice ElectiveSenior Student Assistantship Primary Care Attachment Junior Student Assistantship C21 Phase 2 + Phase 3 (still fluid…) Phase 2: Patient pathways - Following patients out to their homes and communities Longitudinal case studies in each block – similar in style to the current Oncology project ? Assessed by case based discussion with a panel of tutors Reflective diaries, eportfolio logs Phase 3: Primary Care attachment – 8 weeks, 6.5 attached to GP. Development of learning curriculum to deliver agreed Primary Care and other community learning outcomes

20 Community Based Learning: Next Steps 1.Finalise Learning Outcomes from the submitted discipline groups 2.Develop a series of cases which reflect basic science learning linking to Community Based and other clinical learning outcomes 3.Establish community based placements – capacity and funding 4.Recruit and train small group facilitators 5.Draft handbooks for students and facilitators 6.Pilot case based learning and some community placements 7.Design the assessment and feedback programme 8.Develop academic and administrative structures to support and maintain teaching and learning 9.Ensure continuity of learning into Phases 2 and 3, keeping the core curriculum focussed


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