1. YEAR 2 COMMUNITY TRAINING Dr Colan Robinson

2. SUMMARY Curriculum overview Curriculum overview Year 2 curriculum in general Year 2 curriculum in general Year 2 community Year 2 community Indicative timetable for attachment Indicative timetable for attachment Student Assessments Student Assessments Competencies (DVD) Competencies (DVD) Professionalism judgements Professionalism judgements Evaluation and feedback Evaluation and feedback

3. CURRICULUM OVERVIEW Life cycle Pathways “Clinical Learning”“Clinical Care” “Clinical Practice” SSU Clinical skills Community SSU Clinical skills Community Electives Clinical skills Clinical Blocks Shadowing F1 Yr 5 Yr 3 and 4Yr 1 and 2 Life sciences Clinical Skills Public Health Human Sciences PPD Yr 1&2 Yr 3&4Yr 5

4. 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

5. 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

6. 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

7. 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

8. 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

9. Years 1+2 Community Clinical skills Maturity 1 Fetal life Infancy Childhood Adolescents Young adults Maturity 2 Old age 1 Old age 2 SSU Conception

10. Problem Based Learning – Fortnightly Triggers Clinical Skills Life Science Resource Centres Community Placements Plenaries SSU’s Jigsaw = Reflective feedback

11. Small Group Learning All students All students Every year Every year Facilitated groups of 8-9 students Facilitated groups of 8-9 students Explore students development and professional growth Explore students development and professional growth Specific topics – e.g. ethics, public health Specific topics – e.g. ethics, public health

12. Body Person Context Human structure Physiology Pathology Microbiology etc Examining a patient Identity Experience of illness Health beliefs Cultural beliefs Feelings Knowledge and skills Views & opinions Taking a history etc. Population health Inequalities in health The environment Family Social support Culture Poverty Employment,school etc.

13. SESSION FOUR: Adult 2, Adult 3 As a result of the session (and follow up work) students can: Motivating for change describe Prochaska and Diclementes stages of change model and give examples of its application in practice, including an example from their own experience give examples of strategies and tools for motivating people to change and how they might use these in practice give examples of questions to establish how ready a patient is to change give examples of different situations in which doctors need to manage change

14. Suggested group and follow up activities: Feedback on significant experiences from placements Listen to the presentation on the change cycle. In what ways, as a doctor, do you need to think about and manage “change”? Ensure each group member has made a connection to their own personal life “Have you ever tried to get someone else to make changes?” “How effective was this? Why?” “How was this for you Presentation feedback Ask for volunteers to do presentations for next time on 1) Carers 2) Self- help groups – local and national- why are they there? What do they offer? Preparation for next time What questions could you use to find out what life is like for a carer? Ask your placement provider if you can talk to a carer. What would they most like to help them? What have they been offered? Do you know anyone who is a carer? Ask them these questions If you look on the local council website- is there any information for carers?

15. GP Placements GP Placements Monthly attachments x 6 Monthly attachments x 6 Followed the same week by feedback/jigsaw sessions Followed the same week by feedback/jigsaw sessions Attachments to include protected assessment of clinical competency x 4 in addition to supervised experience with feedback Attachments to include protected assessment of clinical competency x 4 in addition to supervised experience with feedback

16. GP Placements A pair of students for whole day A pair of students for whole day Possibly best viewed as two half-days, one for experience and one for competency Possibly best viewed as two half-days, one for experience and one for competency 2 – 4 patients/hour (instead of 6) 2 – 4 patients/hour (instead of 6) Do rather than observe (Hx and practice competency) Do rather than observe (Hx and practice competency) Opportunistic v invited patients Opportunistic v invited patients One patient with a chronic illness One patient with a chronic illness

18. Sample Day in Surgery 08:45 – 09:00 Discuss plan for day and expectations 08:45 – 09:00 Discuss plan for day and expectations 09:00 – 10:00 One case each for competency 09:00 – 10:00 One case each for competency 10:00 – 10:30 Coffee 10:00 – 10:30 Coffee 10:30 – 12:30 Half hour appointments, observe one student taking history whilst other can take history on a patient and swop, feedback. 10:30 – 12:30 Half hour appointments, observe one student taking history whilst other can take history on a patient and swop, feedback. 12:30 – 13:00 One visit or with nurse 12:30 – 13:00 One visit or with nurse 13:00 – 14:00 Lunch 13:00 – 14:00 Lunch 14:00 – 16:00 4 x Half hour appts, each student taking turns to take history 14:00 – 16:00 4 x Half hour appts, each student taking turns to take history 16:00 – 16:30 Feedback on session, plan for next one. 16:00 – 16:30 Feedback on session, plan for next one.

19. Assessment at PMS K S A K S A Continuous assessment Continuous assessment Knowledge: AMK: Applied knowledge test Knowledge: AMK: Applied knowledge test Skills: Skills: –Clinical skills labs, ISCES (In vitro) –Competencies in practices (In vivo) Attitudes: Attitudes: –Portfolio analyses to Academic Tutors (Theory) –Judgements: Small group tutors and Placement providers (2 per year)

20. AMK - Applied Medical Knowledge AMK - Applied Medical Knowledge 125 questions in 2 hrs, negatively marked - ¼ mark off for wrong answer 125 questions in 2 hrs, negatively marked - ¼ mark off for wrong answer Clinical vignettes with 5 possible answer stems Clinical vignettes with 5 possible answer stems Same exam all years Same exam all years Students should follow ‘growth curve’ Students should follow ‘growth curve’ Aggregate scores important Aggregate scores important There is a recommended technique: There is a recommended technique: –First run through of easy questions –Then questions less sure about –Whittle down to 3 worth a guess?

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

22. CLINICAL SKILLS Clinical compentencies summative assessment Clinical compentencies summative assessment 4 Main systems exams: Observed History, CVS, RS, GI 4 Main systems exams: Observed History, CVS, RS, GI Marking criteria supplied Marking criteria supplied Expect faltering performance but main elements of inspection, palpation, auscultation etc should be present. Expect faltering performance but main elements of inspection, palpation, auscultation etc should be present. Remediation in clinical skills in event of non satisfactory performance. Remediation in clinical skills in event of non satisfactory performance. Keep copies of the assessment grades (and other community – based assessments) Keep copies of the assessment grades (and other community – based assessments)

24. Professionalism (PPD) judgements 2 per year 2 per year Paperwork sent by locality office (Feb and June) Paperwork sent by locality office (Feb and June) Attendance and Dress Code Attendance and Dress Code Don’t be afraid to use borderline Don’t be afraid to use borderline Remediation with Academic Tutors Remediation with Academic Tutors

28. ASSESSMENTS IN PRACTICE - SUMMARY Summative assessment of 4 clinical competencies (Yr end ISCE in June) Summative assessment of 4 clinical competencies (Yr end ISCE in June) 2 x Professionalism judgement (Feb and May/June)) 2 x Professionalism judgement (Feb and May/June)) Concerns made to academic tutor or jigsaw facilitator: Think before giving students benefit of doubt. Concerns made to academic tutor or jigsaw facilitator: Think before giving students benefit of doubt. Lateness / DNA: susan.osborne@pms.ac.uk Lateness / DNA: susan.osborne@pms.ac.uk

29. Other roles Academic Tutor Academic Tutor SSU provider SSU provider Small Group Facilitator Small Group Facilitator Year 5 students Year 5 students

30. EVALUATION AND FEEDBACK Feedback forms collected from students at end of the year. Feedback forms collected from students at end of the year. Comments from these forms will be fed back to placement providers. Comments from these forms will be fed back to placement providers. Addittional feedback from jigsaw facilitators. Addittional feedback from jigsaw facilitators.

31. THANK YOU Colan.robinson@pms.ac.uk