Learning Medicine In The Community
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Learning Medicine In The Community

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Opportunities for Manchester University undergraduate medical students to learn in the community setting

Opportunities for Manchester University undergraduate medical students to learn in the community setting

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  • NHS care has changed and is changing: around 90% of clinical care takes place in the community around 90% of the population see their GP each year. Patients spend less and less time in hospital: home antenatal care Home deliveries day case surgery, Hospital stays tend to involve an intervention or complex investigation and then home again. When patients are in hospital they tend to be ill and may not want to spend time talking to students. Remember they’re the same people when they’re at home. Disease patterns have changed from infectious disease to chronic disease with increasing affluence, much of NHS care is focused on maintaining health rather than curing disease – much of this happening in the community. So, there are less and less hospital beds and more and more students, and teaching and learning needs to follow the delivery of care in to the community more and more. Direction of GMC (The doctor as a scholar, scientist, practitioner and professional) From the start, students must have opportunities to interact with people from a range of social, cultural, and ethnic backgrounds and with a range of disabilities, illnesses or conditions. Such contact with patients encourages students to gain confidence in communicating with a wide range ofpeople, and can help develop their ability to take patients’ histories and examine patients. Placements should reflect the changing patterns of healthcare and must provide experience in a variety of environments including hospitals, general practices and community medical services.
  • 20% of your clinical teaching will take place in the community. Range of patients seen and undifferentiated illness One to One and one to two teaching Health education zones- look at provision of teaching and learning in the community around each of the base hospitals. The NHS is constantly changing , it isn’t just GPs and Hospitals, there is a wide range of other services such as intermediate care, tier 2 clinics, Intermediate Care and Treatment Service (ICATS) and the private sector An initiative to redesign outpatients and diagnostics fundamentally with a view to preventing unnecessary hospital attendances and meeting the 18-week target. 􀂾 The independent sector (IS) is being asked to take over outpatient assessment and associated diagnostics of up to 90% of GP referrals in a range of specialties including ENT, urology, general surgery and orthopaedics. Fewer visits for patients Less unnecessary hospitalisation Lack of coordinated care Breaking down of relationship between GPs and consultants Deskilling of staff and loss of training opportunities
  • What do you think?
  • It’s NOT all coughs and colds, patients with serious long term illness may not come and see their doctor every day but they are out there and accessible in the community!
  • AND chronic illness, things like people living after a stroke, breast cancer, mi etc for many years. Likewise copd, asthma and diabetes, LOTS of patients!
  • Remind students of overall aims of the course There is not a hospital curriculum and a community curriculum but one curriculum using the resources of both community and hospital to allow students to achieve the broad aims laid out here.
  • Patients as well as seeing them as individuals, part of family or other network. The community in which they live Time as an aid – a diagnosis unfolding. Life events…Continuity – getting to know the patient. ?Empowered or enablement Complexity Interaction – people often/usually have multiple diagnoses. Drug interactions. Patient choice – may choose not to take advice , not take treatment, smoke etc, etc Uncertainty e.g. Undifferentiated presentations – e.g. is it a symptomatic seizure e.g. syncope? could it be epilepsy? Individual management Variety Dermatology / ENT/ Eyes Populations How common is it? What is feasible in prevention / treatment
  • TURN UP: Preparation / appropriate dress / email contacts
  • PATIENTS: THINK AHEAD: Practice may have known patients: BUT CAN you find them? Practices can show you how to ‘search’ - learn from case notes – variety e.g. headache
  • CHECK + CAUTION: Don’t assume consent to look at records / RELEVANT parts NOT all of a case record / What about fellow students?
  • USE THE TEAM – Who are key players? When are they free? E.g. midwife / CPN - What can you offer them?
  • BE FLEXIBLE: - step outside your ‘box’ - Think beyond your module. Look at any thing new. Revise and remind and broaden your understanding of what you have met before. Pattern recognition e.g. rashes!
  • Find out how your practice learns: much learning contextual: use their systems: Web mentor, Internet links, email
  • Write things down – what you see/ what’s missing? use your notes: reflect (remind re confidentiality)
  • Get involved, Watch then DO It is ok to be wrong. We ALL learn from our mistakes v myth of perfection!
  • Feedback is very important. We all need feedback- it is part of how we form our insight in to how we are doing- areas where we can demonstrate proficiency to others, areas where we have weaknesses, or demonstrate weakness. When doing things it is a good idea to prompt your tutor to give you some informal feedback. My tip would be- do something and ask how your seniors or peers thought things went… Most tutors, particularly in community will be happy to outline things that they thought went well, things that they think you should do differently or improve upon. But the two most important questions are: WHY and HOW. You have told me that you thought X went well- WHY do you think it went well? You have told me that you thought Y would be best done differently- HOW should I make this change?
  • It is ok to be wrong. We ALL learn from our mistakes v myth of perfection!
  • Don’t be afraid to ask for help. Ask early. Explain what problems (if any) you are having and ask your GP to help you. Help your GP by for example doing searches for the patients you will need to see in the following week. If it’s not working tell someone Don’t just stop going Don’t just tell us about it at the end The best way to learn is actively, take part, become part of the team, ask to sit in the hot seat, see patients on your own, get feedback on your history taking and examination skills,
  • Background; students may complain disappointed expectation of Excellent ….towards prized Honours point! Need to BOTH Plan on attachments AND agree with supervisor on learning targets EARLY
  • Enhance your CV!
  • Contact Mark Perry
  • These placements ensure that all students get a broad experience in the community and give you an insight into specialist areas and a chance to gain specific skills. We need them because as previously mentioned, 90% of care takes place in the community and this is another way to broaden your knowledge and experience of community medicine Areas currently covered include Podiatry, dermatology, pharmacy, palliative care and hospice (child and adult), diabetic clinics, obesity clinics, ophthalmology, out-of-hours services, cancer support services. Students sign up in the same way they do for the hospital sign-up’s through Medlea. They will have (or are due to) have training on this. There are also guidance sheets on Medlea to inform you of the sorts of things you may cover when you reach your placement. You need to attend from 9am-5pm unless otherwise stated. If you have any problems contact Philip Burns or Mandy Brownhill (administrator) and they will answer any questions or issues you may have. This is a compulsory part of the course. You must attend at least 80% of the community placements and you will be monitored. This will be done through Medlea. IMPORTANT. You can only sign up if you are doing the NME module, these are only related to that, you will attend 6 days with a GP and 6 days with community sign-ups. If you are on HLB do not sign up, everyone will get the opportunity but if HLB students sign up, there will not be enough sign-ups for the NME students. Everyone is issued with a portfolio card. This is for you to keep, make sure you get the tutor to sign it to confirm that you have attended. This will cover you if the tutor forgets to mark your attendance on Medlea. It is also a record for you showing which placements you have attended and how many times. Dress code is smart in all places (no jeans, smart clothes please). If there is any variation, it will be written on Medlea on the description on the sign-up page. Some placements will require you to take your lab coat, please observe and respect these requirements. Dress smartly Try to vary the placements you go on, don’t attend more than 2 of the same placement type if you can help it. Remember that there are placements at the weekend and out-of-hours which will free you up on the day you should be doing community Please complete the feedback when we ask as this will be used to assess our tutors and for guidance for next year We would love to hear any ideas or comments you have in the year, just email Philip or Mandy. Always read the description of the placements and make a note of the contact number in case you are ill and need to cancel. PLEASE ring the tutor to cancel as they will be expecting you. Ask questions! Prepare yourself before you attend, think of any questions you might have, these are specialists in their field so pick their brains!!
  • One day placements in the community, In addition to GP placements. In 14 week block, half will be spent in GP and half in CSU’s or vice versa depending on which rotation you are on, your base will inform you of your rotation. Reflects movements of healthcare into the community. as previously mentioned, 90% of care takes place in the community and this is another way to broaden your knowledge and experience of community medicine with NHS and Non-NHS teams The main aims are that students get to interact with patients, take histories, examine patients and perform procedures with observation, supervision and feedback
  • There are numerous placements available within the Greater Manchester area, the majority are specific to the NME module, also OOH in addition there are some placements that will prepare you for year 4. Podiatry, dermatology, pharmacy, palliative care and hospice (child and adult), diabetic clinics, obesity clinics, ophthalmology, out-of-hours services, cancer support services.
  • MedLea, you are assigned to 2 small group teaching sessions that are compulsory, Natasha will put these into your calendar, in addition to these you must sign up to and attend 4 other placements on your community day. You can view placements 4weeks in advance on MedLea and sign up to them, only sign up when you now you can commit to the day. Try to vary the placements you go on, don’t attend more than 2 of the same placement type if you can help it. IMPORTANT. You can only sign up if you are doing the NME module, these are only related to that, you will attend 6 days with a GP and 6 days with community sign-ups. If you are on HLB do not sign up, everyone will get the opportunity but if HLB students sign up, there will not be enough sign-ups for the NME students. Attendance is monitored and absences will be reported to your base hospital. Full day placements unless otherwise stated on MedLea, there are placements available during evenings and weekends, this will free a day up in the week. First come first served, competitive.
  • There are guidance sheets on MedLea for the placements. Be pro-active, have objectives in mind before the placement, do not make presumptions on what you will be doing during the day, look on MedLea and read the placement description in advance. Identify objectives and discuss these with placement tutor at the beginning of the placement, discuss any problems with the tutor during the day. Placements can be tailored to your needs if the tutors is aware of what you want – they cannot read minds! Get involved during the day as much as you can, we don’t want you to sit and observe, ask questions of the team, make the most of the opportunity of being with patients, interact with them, take histories, examine them and perform procedures under supervision, and enjoy! Portfolio cards will be issued to you in advance, get them signed by someone at the placement, this is for your own records but will also cover you if there are any discrepancies with your attendance. Dress code on most of the placements is smart unless otherwise stated on MedLea, respect the requests of the provider Feedback, we require feedback from you for the development of the placements, please take the time to feedback constructively about the placements.
  • This is a notice from the Community Based Medical Education team (or CBME for short). We have a complaints/concerns/compliments procedure which can be found on MedLea if you have any issues (or compliments) with your community placements in community. You’ll also find a document on MedLea which tells you how we addressed some of the issues from last year. Your alternative form of feedback is to use the MedLea feedback form at the end of each semester. A pop-up reminder to take the evaluation questionnaire should appear when you log into MedLea. This will appear 1 week before the end of your community placement. The evaluation questionnaire focuses on ALL aspects of your third and fourth year in medicine, including: your Hospital and Community placements, portfolio, support (such as IT services and tutor support) and learning (such as learning environments and future career choices). In the 2007/08 only 63% of all active practices were given some form of feedback with these reports This was due to a student response rate of 69%. 657 students provided viable feedback on MedLea out of a possible 956 In 2008/09 the response rate has dropped dramatically to only 23%. 220 students provided viable feedback on MedLea out of a possible 941. Unfortunately some student feedback is lost because participants do not include the name of their practice and GP tutor. Therefore we cannot match up their comments to any practice and feed it back to the GPs. It’s really important that as many students as possible provide us with feedback on their placements so that we know what is going on, what the level of the quality is and can work to provide students with the best placements possible. If you don’t tell us, we don’t know. You’ve benefited from the previous years feedback as we have given practices reports and discussed with them how they can improve their placements. Please do the same for your colleagues.

Learning Medicine In The Community Learning Medicine In The Community Presentation Transcript

  • Learning Medicine in the Community in Third Year Getting the most from Community Clinical Placements Dr. Philip Burns Philippa Lindsay Dr. Mark Perry Dr. Sarah Smithson Professor Val Wass Dr. Kurt Wilson www.manchester.ac.uk /CBME
  • Why Learn in the Community?
    • 90% of care takes place in the community
    • Less patient time in hospital
    • Inpatients are more ill
    • Chronic disease
    • Fewer hospitals
    • Tomorrows Drs – GMC
  • Why Learn in the Community?
    • Approx 20% of Manchester clinical curriculum
    • Boundaries between primary and secondary care are becoming blurred – hence health education zones (HEZ)
    • Intermediate care, changing professional boundaries
    • 50% of you will become GP’s
  • Do GPs see much serious illness?
    • Yes or No
  •  
  • Do GPs see serious illness?
    • In a typical year
    • 10 myocardial infarctions
    • 5 strokes
    • 2 new lung cancers
    • 1 new breast cancer
    • 1 new prostate cancer
    • 20 deaths (1 suicide every 4 years)
  • What are you here for?
    • Not just to pass exams!
    • To become a competent F1 doctor
    • To become equipped for lifelong learning
    • To become (or remain) a competent communicator
    • Vocational course
    • One curriculum
  • Why is the community different?
    • Patients…as individuals
    • … families
    • … communities
    • Time. Continuity
    • Complexity
    • Uncertainty
    • Variety
    • Populations
  • Opportunities? Top Ten Tips
  • Opportunities? Top Ten Tips
    • Turn up!
  • Opportunities? Top Ten Tips
    • Turn up!
    • Patients: ‘pick-your-own’, do searches
  • Opportunities? Top Ten Tips
    • Turn up!
    • Patients: ‘pick-u-own’ - searches
    • Check consent /confidentiality
  • Opportunities? Top Ten Tips
    • Turn up!
    • Patients: ‘pick-u-own’ - searches
    • Check consent /confidentiality
    • Use the whole team
  • Opportunities? Top Ten Tips
    • Turn up!
    • Patients: ‘pick-u-own’ - searches
    • Check consent /confidentiality
    • Use the whole team
    • Be flexible: step outside the lines
  • Opportunities? Top Ten Tips
    • Turn up!
    • Patients: ‘pick-u-own’ - searches
    • Check consent /confidentiality
    • Use the whole team
    • Be flexible: step outside the lines
    • Ask questions – challenge!
  • Opportunities? Top Ten Tips
    • Turn up!
    • Patients: ‘pick-u-own’ - searches
    • Check consent /confidentiality
    • Use the whole team
    • Be flexible: step outside the lines
    • Ask questions – challenge!
    • Find out how the practice learns
  • Opportunities? Top Ten Tips
    • Turn up!
    • Patients: ‘pick-u-own’ - searches
    • Check consent /confidentiality
    • Use the whole team
    • Be flexible: step outside the lines
    • Ask questions – challenge!
    • Find out how the practice learns
    • Write things down – use your notes
  • Opportunities? Top Ten Tips
    • Do stuff !
  • Opportunities? Top Ten Tips
    • Do stuff !
    • Do one
  • Opportunities? Top Ten Tips
    • Do stuff !
    • Do one
    • Do another…Ask for feedback
  • Opportunities? Top Ten Tips
    • Do stuff !
    • Do one
    • Do another…Ask for feedback
    • Do another
  • Opportunities? Top Ten Tips
    • Do stuff !
    • Do one
    • Do another…Ask for feedback
    • Do another
    • Do another…GET IT WRONG
  • Opportunities? Top Ten Tips
    • Do stuff !
    • Do one
    • Do another…Ask for feedback
    • Do another
    • Do another…GET IT WRONG
    • LEARN FROM IT
  • Opportunities? Top Ten Tips
    • Do stuff !
    • Do one
    • Do another…Ask for feedback
    • Do another…GET IT WRONG
    • LEARN FROM IT
    • Tell your GP what you need – learning objectives from PBL! – what sort of patient will you need next week?
    • Any Problems: ask for help early!
    • GP tutor / hospital dean
  • Finally… assessment headaches!
    • Does your tutor know YOU want honours?
    • Demonstrating excellence:
    • initiative, organisation + feedback
  • Community SSCs Explore new horizons … but plan early!
  • Send in a proposal! Sports elite exercise Rx schools campaigns Everything else! Occupational Health Law, Charity Business Culture drama,voice,writing,media galleries,music,dance,film . Disabilities rights, groups, university, deaf/visual impairment, learning dis. OT/mental health
  • Some other opportunities! Charity... hospices, Age Concern, Rape Crisis Cancer Research, Occupational Health... benefits agency, fitness for work Law... prison health, forensics, probation, rehab, victim support
  • Community Sign-ups
    • Over to Jac
  • Community Sign-ups
    • What are they?
    • Why do we need them?
    • What areas do they cover?
      • Podiatry
      • Dermatology
      • Pharmacy
      • Palliative Care
      • Diabetic clinics
      • Ophthalmology
      • Out of hours services
      • Homeless Team
      • Intermediate Care
      • Cancer support services
      • Chronic kidney disease teams
      • Nutritional Therapy
      • Active living
      • Audit Training
      • Suturing
      • Breast Unit
      • Nursing and Residential Homes
      • Musculoskeletal Team
      • Epilepsy and neurological service
    • How do we sign-up?
    • Only open to NME students
    • Attend 6 placements
    • Attend 100% - compulsory
    • What do we do when we get there?
    • Portfolio cards
    • Dress code
    • Feedback
    • Over to Kurt
  • Compliments, comments and concerns
    • We want to hear your compliments and comments regarding community experience
    • Please let the base hospital community administrator teams know
    • We want to help you address concerns
    • First speak to the team at your practice
    • Stuck? Speak to your base administration team and where necessary, the GPEF
  • We want to hear your thoughts!!
    • CBME Complaints/Concerns/Compliments procedure
    • MedLea Evaluation
      • Pop-up reminder
      • Focuses on all elements of the year
    • Only 63% of active practices were given an evaluation report in 2007/08
    • Student response rate
      • 2007/08 was 69% (657 responded out of a possible 956)
      • 2008/09 was 23% (220 responded out of a possible 941)
    • Remember: put your practice and GP tutor name on the community part.
  • Contact us
    • www.manchester.ac.uk /CBME