1. Group Report C is for CLASS

2. Overall plan – teaching module on Community Orientation 1 to 1 teaching process in practice Both student and trainee teaching Preparatory work 1 hour teaching session based on scenarios Follow-up assessment session based on a real consultation (trainee only)

3. Learning outcomes Method –Timetable – content –Pre-course work – introduction to what work is needed – outline of plan for formal session – 15 minutes –Description – scenario based; real case follow up session for the assessment of trainee Learning resources Bibliography Assessment of learner Evaluation Teaching Plan

4. Detailed Description of Module This teaching module is for practice based teaching of students and/or trainees. There will be a short introductory meeting to explain the process and to describe the preparatory work needed. The preparatory work will be active with learners aeeking data and interviewing appropriate key workers; these must be briefed as to their role. There will then be a one-hour teaching session based on the two scenarios described, exploring the areas and issues outlined in the learning outcomes and using the structured aide memoire. Trainees only will undergo a second session during which they will be assessed on their performance in consulting with a practice patient (whom they have not previously met). This will be observed by their trainer who will then undertake a structured assessment interview, and complete the scoring grid. The trainer will feedback the score and discuss any areas in which the trainee achieves a low score.

5. At the end of the tutorial the learner will be able to (1): 1.Understand the epidemiology of important diseases in the local community and the practice 2.Be able to assign patients to the appropriate category of problems in the community using the above data. 3.Use simple statistical tools (incidence/prevalence; age/sex; socio-economic status( if available); chronic diseases) 4.Identify the resources available in the HCS, SSS, and community 5.Refer the patient to the most appropriate cost efficient service within available resources 6.Identify unmet needs of the patient and of the community.

6. At the end of the tutorial the learner will be able to (2): 1.Understand the role of the GP in the care of complex problems in the community. 2.Understand the roles of other members of the primary health care team 3.Manage the patients with problems with a community focus accessing appropriate resources within the practice, and other elements of the community. 4.Manage these problems within the constraints of usual general practice. 5.Understanding how the doctor’s own attitudes and beliefs may influence the care of such patients, and use appropriate coping strategies.

7. Method – preparatory work Examine practice data – relevant to the case to be discussed – trainer to have available; trainee/student to discover: morbidity data – MS, childhood disability and development delay teenage pregnancy rates single parent statistics practice policies on contraception social security information community facilities special equipment provision Interview key workers – eg social worker, district nurse, specialist nurse, MS Society

8. Method – practice teaching session Scenario based tutorial – 60 minutes Aide memoire for teacher What have you done? Who did you meet? What did you discover in your meeting with key worker? Are there any outstanding issues? Scenario discussion – how would you manage this? Present the scenario in detail – what are your issues in relation to community orientation? Money; housing; equipment; bereavement process; human social support; professionals. What are you going to do about this? Referral to professional etc Apply for special equipment Provide counselling support Information – specific disease support group Relate all of these to the real patient view What are your continuing learning needs? How will we address these?

9. Method - Scenarios 1.50 year old man with multiple sclerosis which has become rapidly progressive. Off work but has to complete a work based examination. If he fails he will lose his job. Also worried by recent erection problems. 2.19 year old woman who had a pregnancy aged 17, child now 2 and has serious global development delay. Lives with mother who is also a single parent; there are no partners contributing to the family.

10. Method – Assessment session Real patient consultation, selected by GP trainer. Observed consultation followed by structured interview. Judgement of performance by tutor – performance in relation to aims of the teaching session For specialty trainees but not BME students Consultation length determined by trainee. Whole session = 1 hour

11. Assessment Case Content Case for consultation should: 1.Be from your practice. 2.Have given informed consent. 3.Require the use of the extended PHC team and community facilities in patient management. 4.Not too exotic! 5.Will be the first consultation for this doctor.

12. Structured interview aide-memoire – use this as the basis for your interview to complete the assessment form In what way does this patient demonstrate community orientation? What are the available social resources in your community for this patient? Are there any unmet needs in your community? How do you discover these? What is the method for referring to those resources? Which health needs have you identified for this patient? Are there any unmet needs? How cost effective was your management plan for this patient? How do you prioritise the use of resources in your community?* What is your plan for this patient (immediate/follow-up)? How long did the consultation last? How did you prioritise your interventions in the consultation? What are the limitations to your available resources? What are the other barriers to you in managing this patient? What are your feelings and how will you cope with them? How may they impact on your relationship with the patient?

13. Assessment Grid 1. Refers the patient to the most appropriate cost efficient services within available resources. 012345 Poorly Very well 2. Identifies unmet needs* of the patient and of the community. 012345 Poorly Very well 3. Manages the patient accessing appropriate resources within the practice, and other elements of the community. 012345 Poorly Very well 4. Manage these problems within the constraints of usual general practice. 012345 Poorly Very well 5. Understands how his/her own attitudes and beliefs may influence the care of such patients, and uses appropriate coping strategies. 012345 Poorly Very well

14. Learning resources Age/sex, chronic disease, morbidity/mortality registers Access to appropriate key workers in the field Access to library, internet Facilities for observed consultation

15. Bibliography To be decided in the national context

16. Evaluation Evaluation form –Was it fun? –Will it be useful to my work? –Did it meet its aims? –Will you come back? –Free text comments Trainee performance in assessment External audit