King's Undergraduate Medical Education in the Community

King’s Undergraduate Medical Education in the Community Evaluation Report – Executive Summary

KUMEC – The Community Campus 2013-14

INTRODUCTION

The KUMEC Team, as the King’s College London School of Medicine Community Campus provides supports and promotes medical education in community contexts. This is implemented through fostering learning opportunities with and for patients, students and community teachers. We are all working towards the preparation of caring and well trained doctors.

The KUMEC central team is part of the King’s College London Department of Primary Care and Public Health Sciences; is housed on the Guy’s Campus; and consists of administrative (5.6 FTE) and academic (6.4 FTE) staff. Many of the academic staff also have NHS clinical commitments. The central team leads on the development and delivery of undergraduate medical education in primary care to our 2,000+ King’s medical students. The KUMEC community teaching network that delivers the teaching is made up of approximately 600 teachers, 310 teaching practices (general practices) and 30 community-based student learning centres where seminars take place. Teaching practices are mostly situated in south-east London but a significant proportion, mainly those who teach students on the final year eight-week placement, can be found in south-east England and other parts of the UK. One-to-one and small group teaching allows good supervision, support and honest and insightful feedback, mirroring the doctor-patient relationship. The KUMEC team and network teaches 195,000 student hours each year and we teach in each year of the curriculum. In Years 1 and 2 we focus on why patients attend the GP, the consultation, health and illness, and chronic illness and the health care team; in Phase 3 the clinical examination and patient-centred care; in Phase 4 the longitudinal pregnancy study and health promotion; and in Phase 5 an eight-week apprenticeship in general practice and the community. We also run a number of 12-day student selected components that cover all kinds of community-based health related topics ranging from the impact of sickle cell on families, to early literacy, health care in Cuba, smoking cessation, prison health care, community care of older people and ‘the good doctor’.

Teacher development is key to our success and a full programme of support, briefing and training events is organised through KUMEC. In addition all teachers, particularly those that are just starting out, are encouraged to complete the two day ‘Introduction to Teaching in Primary Care’ course run jointly by the London Deanery and the London Medical Schools. The KUMEC programme is robustly evaluated by students and teachers and, based on that information, continually updated. We also have a system of practice visits for quality assurance and we take great pride in delivering a strongly student- and patient-centred programme of community- focused teaching and learning. The past year has gone well and we have continued to place our students in the community in all years of the curriculum and provide supporting sessions centrally as part of their primary care programme. We have brought in a number of new teachers, some of whom now teach on-campus, as well as provide ongoing teacher briefing and training events and a number of visits to existing teaching practices.

A new King’s undergraduate medical curriculum is being developed to start, for Year 1, in 2016. This is in response to the changing needs of patients and the public with more people living with multiple long-term conditions; the advance of technology transforming clinical relationships; advances in genomics and personalised care; and the drive for an integrated approach delivering whole-person care closer to home. We are also wanting to focus on medical students and in developing their resilience and professionalism as well as improving population health. The new curriculum will be divided into three stages: Foundations of Medicine (Year 1); Principals of Clinical Practice (Years 2 and 3); and Integrated Clinical practice (Years 4 and 5). There will be a focus in the early years on scenario-based teaching and integrating clinical and biomedical sciences. Assessment will be stream-lined with some years having formative assessment only and other years having summative assessments, and the final year assessment will be brought forward to allow the students time to focus on the transition to becoming an F1 doctor. Planning the details is in in the early stages.

In the last year we have continued to respond to repeated challenges reported in the National Students’ Survey, with our focus on providing excellent administrative support and improving the feedback that we give our students by engaging with our teachers to help students feel that they belong; signposting feedback to our students; encouraging students to ask for feedback; and reminding students them that our primary care teaching practices are part of King’s College London. Each year, in introductory sessions we also let students know what we have done to address the evaluations they have made of our programme.

KUMEC staff are heavily involved in Medical School initiatives. This includes Anne Stephenson who is sub-Dean for Student Support, leads on professionalism for the School and is a senior clinical adviser; Ann Wylie who is part of the School global health initiative and leads on Phase 4 SSCs within the School; Ruth Sugden who deputises for the School Phase 5 Lead and leads on the Phase 5 programme for re-sit and struggling students; and Russell Hearn who is now Deputy Lead for Phase 3. Kerry Boardman and others in the team have leadership roles in the development of the new curriculum. Maria Elliott has developed professionalism symposia for Year 1 and Phases 3 and 5. Kay Leedham-Green is doing research into the literacy and reflective capabilities of our Year 1 students.

Tina Challacombe who for many years has been part of our team as Teacher Support Lead, has retired this year and we are very grateful for her wise counsel and hard work.

Tasnim Patel is now a permanent member of our team as Research & Teacher Development Administrator

I would once again like to thank the KUMEC team, especially the administrators, who work tirelessly and with considerable expertise and enthusiasm both for primary care teaching, for the Medical School, and for medical education nationally and internationally.

Dr Anne Stephenson, Director of Community Education, December 2014

Members of the Central KUMEC Team for the Academic Year 2013-2014

Anne Stephenson Senior Clinical Lecturer, Director of Community Education,

Deputy Dean for Student Support, Senior Clinical Advisor and Professionalism Lead for the School

Ann Wylie Deputy Director and Senior Teaching Fellow: KUMEC Phase 4 Lead, SSC and Health Promotion Lead and SSC Phase 4 Deputy Lead for the School

Kay Leedham-Green Teaching Fellow: Year 1 and 2 KUMEC Lead

Russell Hearn Teaching Fellow: Phases 3 KUMEC Lead and Phase 3 Deputy-Lead for the School

Ruth Sugden Senior Teaching Fellow; Phase 5 KUMEC Lead and Phase 5 Deputy-Lead for the School

Kerry Boardman Senior Teaching Fellow; Teacher Development Lead

Rini Paul Senior GP Tutor; Phase 5 KUMEC Assistant

Sandra Roscoe Senior GP Tutor: Phase 3 and 4 KUMEC Assistant (until 31 July 2014)

Maria Elliott Senior Teaching Fellow; Professionalism and Teacher Training Roles within the KUMEC team

Tina Challacombe Honorary Senior Teaching Fellow; Community Teacher Support Lead for KUMEC (until 30 September 2014)

Simon Power KUMEC Manager, Phases 3 and 4 KUMEC Administrator

Anna Quinn Years 1 and 2 KUMEC Administrator

Monica Martin Phase 5 KUMEC Administrator

Lorraine Thompson Finance Administrator for KUMEC

Aysegul Cakir Database Developer for KUMEC

Tasnim Patel Research & Teacher Development Administrator

YEAR 1: EXPLORING MEDICINE IN THE COMMUNITY

Executive Summary

This year KUMEC placed 364 students for four visits at 41 practices. Students interviewed patients, observed consultations, and went on two home visits. They attended four seminars, a lecture on general practice, and a symposium on long-term conditions, giving an assessed presentation at their final seminar.

The course continues to be highly valued by students, with a majority of students providing strongly positive feedback:

“Both Dr S and Dr B were encouraging, knowledgeable, and helpful in providing feedback. My most valuable experience of the year.” MBBS1 student

Word cloud of all feedback:

However satisfaction relating to placements is lower in some areas than last year which we attribute to a higher proportion of students being placed in trios rather than pairs. The number of teaching practices continues to fall putting greater pressure on existing practices to take more students than they might comfortably accommodate.

Equivocal feedback tended to relate to travelling time and to GP teachers that did not adhere to the suggested session content.

Poor feedback tended to relate to cancelled sessions, too many students at one practice, unprepared teachers, or insufficient patients for students to talk to.

Changes since last year include:

• A clarified, simplified KUMEC handbook • A new slide set for seminars • An observed written task was piloted

YEAR 2: ACCESS TO HEALTHCARE AND THE MEDICAL HISTORY

Executive Summary This year KUMEC placed 405 students for two visits in 38 practices. Students attended two symposia, one on eliciting a medical history, one on access to healthcare, and four seminars centred on practising eliciting a medical history through role play, and access to healthcare. Students developed the skill of eliciting a medical history and critically analysed the care of vulnerable patient groups and their access to healthcare issues.

The course continues to be highly value by students, with the majority of students providing strongly positive feedback:

“Wonderful practice, helpful staff and overall feel it has been a real benefit to my education” MBBS2 student

Word cloud of all feedback:

Equivocal feedback tended to relate to travelling time, lack of opportunity to speak to appropriately chosen patients, or GPs that did not adhere to the learning objectives.

Poor feedback tended to relate to GP teachers that were either not expecting them, absent, or unprepared.

Despite struggling with a three hour Friday afternoon slot, Year 2 seminars continue to be the highest rated in all years, however student feedback indicates that smaller seminar groups would be beneficial.

Changes since last year include:

• A clarified simplified handbook • Quick reference guides for GPs and seminar leaders • New role play scenarios • Peer-to-peer role-play opportunities • Critical reasoning skills development in the access to healthcare seminar • New lesson plans on the shared ‘google group’ for seminar leaders

PHASE 3: DEVELOPING PATIENT-CENTRED CLINICIANS

Executive Summary

“Brilliant teaching, supportive learning environment, ample time to practice histories and presenting them, able to see patients with signs on examination, able to understand more about healthcare in the community” ~ student evaluation 2013/14

The quote above demonstrates the positive attitude students have towards the Community Teaching they received and is just one of many similar comments made by students.

This academic year saw changes made to the Phase 3 curriculum. Rather than the course being divided into two modules, students spent seven sessions spread over the course of the academic year with the same GP Tutor. This allowed the students to build a relationship with their tutor and the practice. Students gained exposure to the Primary Care perspective related to each of their three broader Phase 3 rotations. In addition, approximately one quarter of the Phase 3 student cohort was allocated randomly to an innovative simulated GP placement at the Royal College of General Practitioners. This teaching consisted of six simulated surgeries spread over the academic year. Students were taught in small groups of 3-4 by GP tutors and saw recruited patients or simulated patients. Student satisfaction scores for both courses were high.

Current successes

Students enjoy their community teaching and find the quality of teaching very high. Numerous community tutors are highly commended in individual comments.

Both Phase 3 programmes offered students direct observation and constructive feedback. Students greatly valued the learning and feedback opportunities provided by both of these programmes.

The Simulated placements produced student satisfaction scores that are the highest across all KUMEC programmes with students finding the feeling of safe learning with useful feedback being key features of this programme’s success.

Areas for improvement

The majority of negative comments continue to refer to time of travelling in the traditional course, yet simultaneously many students recognise the cost benefit of the travel for GP teaching. Our goal should be to both reduce the amount of travelling for students wherever possible and also to re-align student expectations and emphasise the benefits offered by rural and suburban practices so that they are less disgruntled by travel and value these diverse learning opportunities.

As before, Phase 3 students are asking for more teaching to take place in a General Practice setting. Achieving this would require structural change to the overall Phase 3 programme. Finally there are clear benefits to incorporate the simulated programme for all students into the Phase 3 KUMEC curriculum.

Changes being implemented in 2014/15

Students who took part in the Simulated Practice rated it highly and felt that all students should have access to this innovative learning opportunity. To achieve this, in the 2014/15 academic year, we will be offering each student four sessions in General Practice plus three Simulation sessions at the RCGP.

PHASE 4: COMMUNITY STUDY AND HEALTH PROMOTION

Executive Summary

The Phase 4 programme during 2013/14 consisted of three components:

• Community Study (CS), whereby students in pairs/trios followed a pregnant woman during her third trimester and the first few months of her baby’s life. The students made three visits to her during this time. They were supported with GP tutorials and seminars.

• A Health Promotion (HP) intervention/review local to the students’ GP practice

• Consolidation & Review (C&R) sessions were introduced in the academic year 2012/13 and continued this year. They consisted of four sessions in which students were asked to identify areas they would like to do further work on. They discussed these with their GP tutor and together designed a programme for the sessions.

The 2013/14 cohort was divided into two streams, Stream A and Stream B, with Stream A starting in September and finishing in March, and Stream B starting in December and finishing in April. This enabled a better spread of the workload and facilitated easier recruitment of patients and HP interventions. Such arrangements were integrated with the Rotation 1 Student Selected Component schedules.

The Phase 4 evaluation was by means of an online questionnaire, using Likert scales with the opportunity for free text comments. The response rate was 89%, an increase of 27% compared to the previous year. Overall, the evaluation was much more positive compared to the 2012/13. However, there was variability in the comments from great praise to calls to remove the programme entirely from the curriculum.

Travel and logistics of contacting patients continued to be particular problem for students and in some cases these problems seem to sap the positive learning from the experience. Other issues highlighted were lack of clarity in what is expected from the Health Promotion review and whether this is really needed in the programme. However, there were also students who found doing the review helpful and interesting. This probably reflects variation in the support different practices give for this aspect of the course. Where the logistics did not cause significant difficulties students felt the longitudinal study was a valuable aspect of the course. They appreciated seeing a pregnant woman in the community setting and felt that seeing her several

times added to their understanding of the impact of having a baby. The evaluation of the consolidation and review sessions continued to improve although free text comments again highlighted the variability in the students’ experiences of these sessions. Positive comments were usually related to sessions involving work which was helpful for exams.

Two significant changes have been made to next academic year’s course. Firstly, there will be two rather than three visits during the longitudinal study. Secondly, one of the consolidation and review sessions will be held on campus. Hopefully, these changes will ease the situation regarding logistics and travel.

PHASE 5: GP APPRENTICESHIP

Executive Summary

‘There’s a lot of good things I could say about the placement – but in short, it was probably the most productive placement in terms of personal improvement and I’ve really enjoyed my time in General Practice’ Phase 5 student

‘I wanted to extend my thanks to yourself and the rest of the MBBS 5 GP team for making this a wonderfully well organised and rewarding placement. I have had an excellent learning experience’ Phase 5 student

‘Very well organised. Ran very smoothly’ GP tutor

Students and GPs value the course and many students change their views, wanting to take up General Practice as a career choice having done the placement. Organisationally and educationally the Phase 5 component of the general [practice and primary care programme has delivered exceptional results overall. The team continues to: work on areas that the students and staff find less than satisfactory: place large numbers of students in high quality practices; work on making the community placements more relevant to students, patients and colleagues; support large numbers of GP tutors all over the country; and to be a part of producing professional doctors. The move to Moodle as a more ‘user friendly’ platform to run the virtual seminars has been well received by students geographically far from Kings. We take the students’ evaluations seriously and hear the continued suggestions from them that more GP & PC placements earlier on in their teaching would be invaluable to training tomorrow’s doctors. Our main achievements for this year are:

• A response rate of 75% from our students in the end of Phase evaluation • 91% saying they would recommend this component of the course • Over 90% saying that the Department and Practice were well organised and prepared for them • Submission of all assessments online • Introduction of Occupational Health lecture in the campus blocks • Continuity of facilitators of Mid-Term Seminars • Development of multi-professional facilitators for faculty. • Collection and distribution of student self-assessment survey • Introduction of electronic tutor evaluation of course. • In-course assessment marked and collated electronically • Updating of student evaluation and successful integration into the database. • Taking into account students’ comments about the community sessions and so developing community case studies instead

KARABINER GROUP

Executive Summary This was the first year of the Karabiner Group. The group comprises all students entering Phase 5 at a disadvantage. Student profiles which have in the past have caused them problems. Fourty-four students were identified as being at risk and invited to join. Feedback has been listened to and successes built on.

PHOENIX GROUP (RESITTERS)

Executive Summary Another successful year.

Of the 33 students in the Phoenix Group – none failed. 32 passed finals. One student was unwell during the OSCE and unable to recover in time for the replacement. That candidate will take the exams at the next opportunity. One student passed all 18 OSCE stations and obtained the highest OSCE mark of the whole Phase 5 cohort. Feedback has been listened to and successes built on.

COMMUNITY BASED STUDENT SELECTED COMPONENTS (SSCS)

Executive Summary

This was a busy year, with new Student Selected Components (SSCs) introduced, some research related, and a total of 116 SSC students, supervised by faculty and or colleagues associated with the Department.

Students presented their work at conferences, contributed to curricular change, and six students displayed posters at our annual Tutor Conference.

One final year student developed and ran, with supervision, an Advocacy SSC for Phase 3 students. This will now be a regular SSC.

The RCGP and Apothecaries Prize event was moved to October, as part of a larger celebration of the KCL SSC programme and elective prize winners.

Amelia Cook presented her work at the annual SAPC conference in Edinburgh with regard to needs of unaccompanied asylum seekers aged 16-18 and to the regional SAPC conference in Cambridge. Two students, Cat Scott and Bryan Ceronie, presented their work at the annual Forensic Psychiatry conference, one student, Huma Alum, was the presenting author (Naeem Mitha and Ed Cantelo were unable to attend) at the annual Smoking cessation conference and currently we are exploring some publication options.

This year we changed the Phase 4 Global health essay arrangements and marking was done by a team of 18, as part of the rotation 2 SSC, with responsibility for marking 420 essays. Some outstanding work was evident and will be reflected in the elective prizes announced at the Oct 2014 event.

From SSC to core curriculum was the experience of a final year student who previous developed an SSC on exercise prescribing.

TEACHER DEVELOPMENT AND SUPPORT

Executive Summary

2013-14 saw a continuation of our successful Teacher Development programme, with the addition of accreditation from the Academy of Medical Educators (AoME) for our newly renamed “Mastering Teaching Skills” (MTS) series (formerly Masterclass sessions). This means that tutors attending three of the MTS workshops and completing a reflective essay for each, will be eligible for membership of AoME. We are particularly proud of this achievement, as this accreditation is usually reserved for courses at Postgraduate Certificate of Education level.

A total of 215 teachers took part in teacher development activities, including online introductory training, new teacher sessions, core training workshops, mastering teaching skills workshops, the KUMEC network meeting and our main teacher development event – the annual KUMEC teachers’ conference. We also supported 11 new tutors to attend the two-day Introduction to Teaching in Primary Care (ITTPC) courses run collaboratively by the London Deanery and London Medical Schools, including KUMEC.

As well as our teacher development workshop programme, ongoing teacher development and quality assurance were supported through online student evaluation of tutors; a teacher commendation system; regular emails to teaching practices; termly newsletters; telephone support and practice visits.

Focused practice visiting by KUMEC staff continues to be a major element of our teacher development for recruiting new practices, meeting new tutors within established teaching practices, and monitoring individual teacher or practice performance after student evaluation. This year we also relaunched our quality assurance visits, attending student teaching sessions at practices to see how teaching is happening “on the ground”. Between July 2013 and July 2014 a total of 53 recorded practice visits were completed out of a total of 233 teaching practices (excluding 79 Independent practices spread across the country, who teach Phase 5 students.) Most of the KUMEC team were involved in the visits and the process and outcomes of the visits were discussed and reviewed in the quarterly meetings of the Evaluation Sub Group which now incorporates the Practice Visit Group.