Download CONSOLIDATION AND REVIEW SESSIONS (2014-15)

CONSOLIDATION AND REVIEW SESSIONS (2014-15)
KCL MBBS PHASE 4 COMMUNITY TEACHING
Please note there have been significant changes made to the C&R sessions for this academic year.
There will be two C&R sessions - one session in Primary care and one on Campus.
2014-15 academic year review session dates:
Stream A on 10/04/15 and Stream B on 24/04/15
based at the General Practice.
A choice of: 13/05/15, 15/05/15, 20/05/15 or 22/05/15
based on Guys Campus.
The above dates for the Primary Care session can be renegotiated to suit the needs of the students
and the practice but the Department must be informed of any revised dates. These should have be
discussed at the Day 3 tutorial when the topics for the C&R session are selected (20th March Stream
A and 27th March Stream B).
WHY FOCUS ON CONSOLIDATION AND REVIEW OF PREVIOUS LEARNING IN PRIMARY CARE?
As students plan for their final year long mentorship in Phase 5 they often express concerns about
common areas of clinical practice about which they are unsure. Perhaps they have missed out on
practicing some key skill or procedure in their general practice or hospital rotations. These might be
participating in a baby or travel immunization clinic, working with a translator to take a history,
giving birth control advice, or examining a child’s ear. We want to offer students a flexible choice of
opportunities to learn or practice these basic clinical skills as they come to the end of their Phase 4
allocation in general practice. This will NOT necessarily be new learning, but will enable a student
over 4 sessions to see patients with certain conditions or have broader age-related patient contact,
and to hone their skills in examining, history taking, assessing and/or checking their knowledge. We
believe the General Practice surgery is a good and logical place for supporting this learning with
patients. Some students may also want to review their learning using a mini-CEX assessment. The
assessment form used for running a Mini-CEX is on the Phase 4 KUMEC website.
WHAT ARE THE LEARNING OBJECTIVES FOR STUDENTS?
Based on discussion with students after a 2011 pilot study of C&R, the aims for these sessions are to:
(1) Increase students’ abilities in identifying their own learning needs and being self-directed
learners.
(2) Provide opportunities to practice clinical skills specifically identified by the student, based on
previous teaching, and
(3) Enable students to become more familiar with the primary care context for health care in
preparing for Phase 5 and their F1 year.
WHAT IS THE STRUCTURE OF THE SESSIONS?
These review sessions are designed to be somewhat tutor-light in the sense that they allow each
student in their Phase 4 pair to see a recruited patient(s), observe consultations or attend a GPbased clinic to practice a skill. Essentially students will identify two or three topics they would like to
explore or review. Some examples are shown below. These will probably relate to Phase 4 rotation
activities in September – December. The session will be pre-arranged by the GP teacher and
practice team and prior verbal consent will be gained for any patient contact.
The selected topics should be agreed during Day 3 at the practice. This plan will confirm that the
tutor and student have agreed on at least two topics to cover on Day 4.
WHAT SORT OF THINGS COULD BE COVERED IN A TUTORIAL DISCUSSION?
We suggest that tutorial begins by discussing why the students chose their topic or skills for review,
and trying to find out what he/she knows already. If the tutor has previously had a chance to
observe the students carrying out their chosen skill there could be a discussion about the
performance of the skill and other ways of doing it (that have a good evidence base). A discussion
about the context in which the skill was used may also be appropriate e.g. checking inhaler
technique/peak flow followed by a discussion of the impact of chronic respiratory illness on a
patient.
PRACTICING A FORMATIVE ASSESMENT USING THE MINI-CEX
This is a short assessment tool often used in final year, the foundation programme and specialty
training with a tutor observing a student’s performance. We would use it here as a formative tool for
discussion, with marks not submitted. Students may come with questions about “what to review”
with an eye toward the OSCE stations; this is a good chance to practice what is important to them
without specifically teaching to the test. The Mini- CEX form, slightly adapted, is posted on the Phase
4 KUMEC website and on the Virtual Campus for students.
TROUBLESHOOTING
Students have helped us identify a selection of topics which could be covered in the C&R session.
These are shown below. Members of the pair do not always have to select the same aspect of the
patient or clinic they review. And, as the OTHER option indicates, students may ask you about
another worrisome review topic.
Please let us know if there are problems; we do see this day as flexible and adaptable. We will
evaluate the changes made to the Phase 4 programme in the summer of 2015.
Contacts for C&R sessions
Scheduling questions to Simon Power: [email protected]
Session content questions to Dr Sandra Roscoe [email protected]
POSSIBLE CONSOLIDATION AND REVIEW TOPICs FOR PHASE 4 STUDENTS (SPRING 2015)
This list aims to spark ideas and discussion as to how students and tutors can work together to get
the best possible learning experience. Not all practices will be able to offer all options and some will
have suggestions based on the clinics and services they offer. Each practice is individual and will
provide services and clinics based on local availability. Keep in mind some specialist clinics happen
at times that may require you to be flexible about when you visit.
LONG HISTORY
This is a chance to see one or more patients with chronic or complex problems. Practice your history
taking skills and discuss your findings with a tutor. Examples could include a child and parent with
autism, a patient with heart failure, patients with multiple problems or a patient with poorly
managed asthma. This could happen in various settings e.g. in the surgery or on a home visit. Your
tutor can help you identify suitable patients.
MINI MENTAL STATE EXAMINATION
Get to grips with the MMSE and how it is used in practice. Your Practice may suggest patients you
can go through this tool with. Your tutor may be able to suggest local services you could engage
with such as a day centre for people with dementia, or a local memory clinic they have links with.
The practice may have its own MMSE form, or there is one in the main Phase 4 handbook.
STROKE PATIENT AND CARER
Discuss with both the patient and carer the impact of stroke on their lives and families. You may
want to explore how their experience with health and support services has been, or how they have
learned to manage their lives in the wake of a stroke. You can feed back your discussion to your
tutor and gain insight into their perception of the patient, and your history taking.
MUSCULOSKELETAL
Practice history taking, examination, diagnosis and explanation of common musculoskeletal
problems. Some practices have in-house physiotherapy, joint injections or even acupuncture clinics
you could sit in or take a role in. See the differing approaches to acute and chronic conditions and
potentially between different healthcare providers. Your tutor may be able to suggest interesting
patients to meet or clinics to attend. You could look at exercise referrals schemes as part of the care
and management.
MOBILITY
How do patients manage short or long term loss of mobility? You could organise visiting or seeing a
patient with mobility problems. Mobility can be affected in many ways from acute trauma to long
term disability. With your tutor’s help you may be able to contact the local occupational health
team and see how they help patients with mobility issues manage day-to-day tasks.
LIFESTYLE INTERVENTIONS
How does the practice help women who smoke and have become pregnant or those who cannot
attend the surgery? Is there a local weight loss service doctors and nurses can signpost patients to?
Can your tutor suggest a success story patient who you can talk to about what worked for them?
Discuss with your tutor how you can learn more about lifestyle interventions.
BABY CHECKS
All babies are offered a routine check at 6-8 weeks old; this is a comprehensive screen to find
problems early. In your placement area this could be done by GPs, nurses or health visitors. Discuss
with your tutor how it is offered in their area and how you can get involved seeing them being done,
explaining findings to parents and learning what to look, listen and feel for.
CONCERNS WITH CHILD DEVELOPMENT
What happens when there are concerns about a child’s development? Who raises concerns and how
are they assessed. Your tutor may have suggestions of patients and parents you could interview, or
local clinics you could approach to attend.
ACUTE ILLNESS IN CHILDREN
Primary care is the first point of call for unwell children, from simple viral infections to meningitis.
See how you can maximise exposure, maybe sitting in on a duty or on-call surgery with a tutor in the
practise. Learn how to examine unwell children and understand parental concerns. You could ask to
see some patients before the doctor/nurse and present your findings.
SKIN CONDITIONS
Review how to take a history and manage common skin conditions such as eczema. Dermatology is
common in general practice so you may want to sit in a routine clinic or your practice may have a GP
with an interest in dermatology or even a special clinic. Perhaps your practice offers cryotherapy for
common skin problems.
CONTRACEPTION AND SEXUAL HEALTH
Perhaps attend a smear clinic and refresh your skills of examination. Some practices offer sexual
health clinics or family planning clinics where you can learn more. See a coil fitted or learn when a
practice offers pregnancy test, and how do they deal with what could be “difficult news”. Discuss
with your tutor the range of services available to patients be it via a referral or in-house
MINI CEX ASSESSMENT AFTER SEEING A PATIENT TOGETHER
Your tutor will help you identify a suitable patient for you to see whilst being observed. This is an
opportunity to get feedback on your skills, and learn how to develop them. It will serve as a
formative introduction to the mini Clinical Evaluation eXercise (mini-CEX) which is used throughout
medicine for both undergraduate and postgraduate assessments.
OTHER POSSIBLE TOPICS FOR REVIEW
Your tutor may have suggestions based on their local services and clinics; you can talk about what
could be offered and what you would be interested in doing. Examples could include: minor surgery
in general practice; instructing patients about inhaler technique; Drug and Alcohol services; Local
cultural services or counselling.