Year 3 SSC Project 2013-14 - Tutor Proposed Projects

0 | P a g e

Contents Page – Projects by Institution/Area

Area Page no Cardiff & Vale 2 Royal Gwent 62 Bridgend 65 Neville Hall 66 Prince Charles 67 Swansea 69 Ebbw Vale 71 North Wales 73

1 | P a g e

------An Audit of the management of Bacterial Vaginosis in the Cardiff Department of Integrated Sexual Health and the University Hospital Wales Pregnancy Advisory Service ------Institution: Cardiff Royal Infirmary Department: Department of Integrated Sexual Health Tutor: Dr Laura Cunningham

------Project Code: CRI01 ------Brief Project Aims: 1. Audit local practice at the Cardiff Royal Infirmary against the British Association of Sexual Health and HIV Guideline 2. Audit and compare practice within the UHW Pregnancy Advisory Service. 3. Produce recommendations for improved practice. 4. Disseminate findings at local and regional clinical governance meetings/Welsh BASHH Audit meeting. 5. Produce a written report.

Educational Objectives: 1. Acquire knowledge and understanding around the routine management of pregnant and non-pregnant symptomatic and asymptomatic women in the sexual health clinic and pregnancy advisory service. 2. Acquire knowledge around the pathophysiology, epidemiology, presentation, diagnosis and management of bacterial vaginosis. 3. To become competent at sexual history taking. 4. To develop a non-judgemental approach to individuals presenting to sexual health services. 5. To gain an understanding of the audit process/cycle. 6. To become competent at designing and completing audit proformas. 7. To gain competence at data anaylsis using Excel if appropriate. 8. To gain skills and experience at presenting and ocmmunicating data and its interpretation to a multidiscliplinary audience. 9. To develop skills in report writing

Outline of SSC Activities: 1. Sitting in sexual health and pregnancy advisory service clinics with the opportunity to take histories from patients and observe the existing patient pathway. 2. Dedicated tutorials from consultant staff with signposting to relevant resources. 3. Attendance at departmental training and clinical governance meetings. 4. Sitting in with sexual health advisors seeing patients within the sexual health clinic – most of these will have been diagnosed with a sexually transmitted infection or will have other risk/vulnerability factors. 5. Completion of an audit proposal and proforma under consultant supervision. 6. Data collection using casenotes and analysis in line with the project aims.

2 | P a g e

7. 30 minute presentation at the departmental Clinical Governance meeting to present findings. 8. Option to present at the Wales BASHH Clinical Audit meeting (biannual). 9. Complete a written report under consultant supervision. 10. Opportunity to submit the project findings as a poster/oral abstract at the BASHH Spring Conference 2015.

Is this project Research, Audit or Service Evaluation or other: Audit

Nature of Project: Clinical

Number of students who can undertake this project: 1

Opportunities to Present at Conferences:

3 | P a g e

------An audit and service evaluation of antiretroviral therapy prescribing for patients with HIV infection seen within the Department of Integrated Sexual Health at the Cardiff Royal Infirmary. ------Institution: Cardiff Royal Infirmary Department: Department of Integrated Sexual Health Tutor: Dr Laura Cunningham

------Project Code: CRI02 ------Brief Project Aims: 1. To audit the prescribing of antiretroviral therapy against the British HIV Association UK Guideline 2012. 2. To conduct a service evaluation of the provision of antiretroviral therapy, including through the home delivery service.

Educational Objectives: 1. Acquire knowledge and understanding around the care pathway for patients with established HIV infection within the Cardiff Royal Infirmary. 2. Acquire knowledge around the pathophysiology, epidemiology, presentation, diagnosis and management of HIV, in particular the use of antiretroviral therapy. 3. To become competent at sexual history taking. 4. To develop a non-judgemental approach to individuals presenting to sexual health services. 5. To develop a non-judgemental and sensitive approach to those diagnosed with HIV. 6. To gain an understanding of the audit process/cycle and of the service evaluation process. 7. To become competent at designing and completing audit proformas and data collection forms. 8. To gain competence at data analysis using Excel if appropriate. 9. To gain skills and experience at presenting and communicating data and its interpretation to a multidisciplinary audience. 10. To develop skills in report writing.

Outline of SSC Activities: 1. Sitting in sexual health and HIV clinics with the opportunity to take histories from patients and observe the existing patient pathway. 2. Dedicated tutorials from consultant staff with signposting to relevant resources. 3. Attendance at departmental training and clinical governance meetings. 4. Sitting in with sexual health advisors seeing patients within the sexual health clinic – most of these will have been diagnosed with a sexually transmitted infection or will have other risk/vulnerability factors. 5. Completion of an audit proposal and proforma under consultant supervision. 6. Data collection using casenotes and analysis in line with the project aims. 7. 30 minute presentation at the departmental Clinical Governance meeting to present findings.

4 | P a g e

8. Option to present at the Wales BASHH Clinical Audit meeting (biannual). 9. Complete a written report under consultant supervision. 10. Opportunity to submit the project findings as a poster/oral abstract at the BHIVA Spring Conference 2015.

Is this project Research, Audit or Service Evaluation or other: Audit

Nature of Project: Clinical

Number of students who can undertake this project: 1

Opportunities to Present at Conferences:

5 | P a g e

------An audit of HIV testing in the Cardiff Department of Integrated Sexual Health ------Institution: Cardiff Royal Infirmary Department: Cardiff Department of Integrated Sexual Health Tutor: Dr Laura Cunningham

------Project Code: CRI03 ------Brief Project Aims: 1. To audit HIV testing in the Department of Integrated Sexual Health against guidance from the British HIV Association (BHIVA) and British Association of Sexual Health and HIV (BASHH) 2. To produce recommendations for improved practice for dissemination.

Educational Objectives: 1. Acquire knowledge and understanding around the care pathway for patients presenting to the sexual health clinic at the Cardiff Royal Infirmary 2. Acquire knowledge around the pathophysiology, epidemiology, presentation, diagnosis and management of HIV and other sexually transmitted infections. 3. To become competent at sexual history taking. 4. To develop a non-judgemental approach to individuals presenting to sexual health services. 5. To develop a non-judgemental and sensitive approach to those diagnosed with HIV. 6. To gain an understanding of the audit process/cycle. 7. To become competent at designing and completing audit proformas and data collection forms. 8. To gain competence at data analysis using Excel if appropriate. 9. To gain skills and experience at presenting and communicating data and its interpretation to a multidisciplinary audience. 10. To develop skills in report writing.

Outline of SSC Activities: 1. Sitting in sexual health clinics with the opportunity to take histories from patients and observe the existing patient pathway. 2. Dedicated tutorials from consultant staff with signposting to relevant resources. 3. Attendance at departmental training and clinical governance meetings. 4. Sitting in with sexual health advisors seeing patients within the sexual health clinic – most of these will have been diagnosed with a sexually transmitted infection or will have other risk/vulnerability factors. 5. Completion of an audit proposal and proforma under consultant supervision. 6. Data collection using casenotes and analysis in line with the project aims. 7. 30 minute presentation at the departmental Clinical Governance meeting to present findings. 8. Option to present at the Wales BASHH Clinical Audit meeting (biannual). 9. Complete a written report under consultant supervision. 10. Opportunity to submit the project findings as a poster/oral abstract at the BHIVA or BASHH Spring Conference 2015.

6 | P a g e

Is this project Research, Audit or Service Evaluation or other: Audit

Nature of Project: Clinical

Number of students who can undertake this project: 1

Opportunities to Present at Conferences:

7 | P a g e

------An audit of the management of genital warts in the Cardiff Department of Integrated Sexual Health ------Institution: Cardiff Royal Infirmary Department: Cardiff Department of Integrated Sexual Health Tutor: Dr Laura Cunningham

------Project Code: CRI04 ------Brief Project Aims: 1. To audit the management of genital warts against British Association of Sexual Health and HIV (BASHH) UK Guidance and against new local protocols. 2. To produce recommendations for improved practice for dissemination.

Educational Objectives: 1. Acquire knowledge and understanding around the care pathway for patients presenting to the sexual health clinic at the Cardiff Royal Infirmary 2. Acquire knowledge around the pathophysiology, epidemiology, presentation, diagnosis and management of genital warts and other sexually transmitted infections. 3. To become competent at sexual history taking. 4. To develop a non-judgemental approach to individuals presenting to sexual health services. 5. To develop a non-judgemental and sensitive approach to those diagnosed with genital warts. 6. To gain an understanding of the audit process/cycle. 7. To become competent at designing and completing audit proformas and data collection forms. 8. To gain competence at data analysis using Excel if appropriate. 9. To gain skills and experience at presenting and communicating data and its interpretation to a multidisciplinary audience. 10. To develop skills in report writing.

8 | P a g e

9. Complete a written report under consultant supervision. 10. Opportunity to submit the project findings as a poster/oral abstract at the BHIVA or BASHH Spring Conference 2015.

Is this project Research, Audit or Service Evaluation or other: Audit

Nature of Project: Clinical

Number of students who can undertake this project: 1

Opportunities to Present at Conferences:

9 | P a g e

------An audit of the management of syphilis within the Cardiff Department of Integrated Sexual Health Service ------Institution: Cardiff Royal Infirmary Department: Cardiff Department of Integrated Sexual Health Tutor: Dr Laura Cunningham

------Project Code: CRI05 ------Brief Project Aims: 1. To audit the management of syphili against British Association of Sexual Health and HIV (BASHH) UK Guidance and against local protocols. 2. To produce recommendations for improved practice for dissemination.

Educational Objectives: 1. Acquire knowledge and understanding around the care pathway for patients presenting to the sexual health clinic at the Cardiff Royal Infirmary 2. Acquire knowledge around the pathophysiology, epidemiology, presentation, diagnosis and management of syphilis and other sexually transmitted infections. 3. To become competent at sexual history taking. 4. To develop a non-judgemental approach to individuals presenting to sexual health services. 5. To develop a non-judgemental and sensitive approach to those diagnosed with syphilis. 6. To gain an understanding of the audit process/cycle. 7. To become competent at designing and completing audit proformas and data collection forms. 8. To gain competence at data analysis using Excel if appropriate. 9. To gain skills and experience at presenting and communicating data and its interpretation to a multidisciplinary audience. 10. To develop skills in report writing.

10 | P a g e

10. Opportunity to submit the project findings as a poster/oral abstract at the BHIVA or BASHH Spring Conference 2015.

Is this project Research, Audit or Service Evaluation or other: Audit

Nature of Project: Clinical

Number of students who can undertake this project: 1

Opportunities to Present at Conferences:

11 | P a g e

------'Methods in molecular virology' ------Institution: Cardiff University Department: Cardiff Institute for Infection and Immunity Tutor: Dr Joachim J. Bugert

------Project Code: CU01 ------Brief Project Aims: In the 2014 Y3 SSC the assigned student(s) will help establish a new PCR protocol to detect and quantitate measles virus for an antivirals project running in the supervisors lab. Measles virus proteins F and H will be cloned from cDNA for positive controls. The lab uses recombinant paramyxoviruses expressing green fluorescent protein (IC323, CDV-gfp; antiviral connected program of work) to investigate the antiviral activity of novel L - ddBCNAs. The work is notified to HSE for L2, the supervisor is biosaftey officer for MedMicro-Main building. The students will have to show proof of vaccination for measles virus , and fulfill lab criteria to be permitted to work in L2 labs 1TB_115 and 6FT_182.

Educational Objectives: Basic skills: The student will be instructed to i. work in a professional environment using the scientific method, ii. develop problem solving skills iii. work in a team effectively, iv. communicate effectively using scientific terminology, v. present work in talk and poster format, vi. critically read published work of others, vii. write up own work in a report/ poster. Advanced skills: The student, working under close supervision at all times will be encouraged to take iresponsibility for the lab and the project as a trusted member of the research team.

Outline of SSC Activities: Background reading- powerpoint presentation. Laboratory training PCR detection of viruses (ID) Laboratory training PCR quantitation of viruses (load) Presentation of results to a expert audience. Report writing in the form of a short dissertation.

Is this project Research, Audit or Service Evaluation or other: Research

Nature of Project: Laboratory

Number of students who can undertake this project: 2

Opportunities to Present at Conferences: Dear Andy, we would aim to present results from this work at a Society of General Microbiology meeting in the UK, or at the American Society for Virology meeting in the US. Regards, J

12 | P a g e

------Drama and Public Health ------Institution: Cardiff University Department: Cochrane Institute for Primary Care and Public Health Tutor: Dr Simon Braybrook

------Project Code: CU02 ------Brief Project Aims: To build upon knowledge and skills acquired in the year 2 SSC (Drama and Public Health) in order to further understand how public health messages can be communicated to school children both through theatre presentations and classroom based drama. To deepen understand of public health, particularly in terms about how education systems and social contexts interact to affect children's health and health behaviours.

Educational Objectives: Knowledge: • Understand health in context of the community • Consider strategies to propagate public health messages Skills: • Improve communication • Improve team working skills • Improve writing skills • Experiment & enjoy using humanities in field of medicine Attitudes: • Use a holistic approach to medicine • Understand health in context of the community • Learn by reflection

Outline of SSC Activities: Students will attend seminars and discussion groups on public health principles. They will cover some educational theory to help construct a health message. They will undertake drama workshops to help develop drama and script-writing skills. They will design a 20-30 minute theatre piece, and a 90 minute drama in education lesson plan for delivery in schools They will consider how best to evaluate their lesson and assess a change in their students knowledge and/or behaviour. They will deliver the theatre piece and lesson in at four separate schools. They will be assessed on their participation in the programme and on an essay on the topic of communicating health messages through drama

Is this project Research, Audit or Service Evaluation or other: Education

Nature of Project: Community

Number of students who can undertake this project: 10

13 | P a g e

Opportunities to Present at Conferences: Happy to present at conferences.

14 | P a g e

------Neurofeedback in neuropsychiatric disorders ------Institution: Cardiff University Department: Cardiff University Brain Research Imaging Centre Tutor: Prof David Linden

------Project Code: CU03 ------Brief Project Aims: We have developed a new procedure to train patients in the self-regulation of their local brain activity through real-time feedback of functional magnetic resonance imaging signals. We are exploring the clinical utility of this technique for depression, Parkinson's disease and addiction. Students will have an opportunity to participate in patient assessments, patient scanning and data analysis.

Educational Objectives: Understanding of the biological mechanisms of the investigated disorder (depression, Parkinson's disease or addiction). Understanding of basics of magnetic resonance imaging and its application to the study of brain function. Skills in acquisition and analysis of MRI data and patient assessments. Presentation skills.

Outline of SSC Activities: Participate in psychometric and clinical assessments of patients pre- and post-intervention. Participate in MRI training activities and be present at scanning sessions. Conduct sub-project on data analysis with guidance from supervisor and research team. Participate in seminars/ teaching events at neuroimaging research centre (CUBRIC) and department (MRC Centre for Neuropsychiatric Genetics and Genomics).

Is this project Research, Audit or Service Evaluation or other: Research

Nature of Project: Clinical

Number of students who can undertake this project: 2

Opportunities to Present at Conferences: Yes, students can present this at regional conferences such as Welsh Psychiatric Society (might require funding for conference fee) or Mental Health Research Network-Cymru (no conference fee).

15 | P a g e

------History of Medicine ------Institution: Cardiff University Department: PCPH Tutor: Dr Harry Ahmed

------Project Code: CU04 ------Brief Project Aims: • To develop an interest and enthusiasm in the History of Medicine • To be able to put the present in the context of the past • To enjoy learning about medicine through a different perspective

Educational Objectives: Knowledge: • Understand the development of philosophy, culture and delivery of healthcare in the past and present • Describe the history of one area of medicine in detail Skills: • Research skills, reading, writing and presentation skills. • Analyse literature from historical papers • Carry out presentations to a high standard Attitudes: • Use a holistic and historically informed approach to medicine • Gain a greater understanding of medicine as we practice now by studying the changes in medical theories and why these changes may have taken place

Outline of SSC Activities: • Course material is broad and interesting. We have focused on studying a variety of different medical subjects that have changed over time including: Contraception and Sexual health Psychiatry Anatomy/surgery/aneasethesia Epidemiology/Public Health Medical Proffesionalism • Two field trips are included within this SSC. The first is to St Fagan’s – National Museum of Wales to view medical instruments preserved in Wales from over the last centuries. The second field trip is to Whitchurch Hospital to gain a greater insight into the history of Pyschiatry. • Students will be required to present to the group on a weekly basis. We will provide teaching sessions on the use of powerpoint/prezzi and other media in presentations. We will give feedback on your presentation skills during informal presentations during the nine week period. • At the end of the nine week block you will be given the opportunity to present and share your work to our team and your colleagues. The best three presentations will be given the opportunity to present to the “History of Medicine Society of Wales” at their Autumn meeting. This is an ideal opportunity to gain experience of presenting work to a friendly and enthusiastic large group. It would also look fantastic on your CV. 16 | P a g e

• Assessment will be in line with the SSC requirments; a brief paper similar in style to papers submitted to journals. It must not exceed 1,500 words and should include a 150 word Abstract/Summary.

Is this project Research, Audit or Service Evaluation or other: Literature Review

Nature of Project: medical humanities

Number of students who can undertake this project: 8

Opportunities to Present at Conferences:

17 | P a g e

------Measuring complement in the mouse ------Institution: Cardiff University Department: Infection & Immunity Tutor: Professor Paul Morgan

------Project Code: CU05 ------Brief Project Aims: > To characterise antibodies against mouse complement proteins already developed in the laboratory for specificity and sensitivity of detection; > To develop ELISA for measuring levels of mouse complement proteins using the characterised antibodies; > To establish normal ranges of selected complement proteins in common lab strains of mouse.

Educational Objectives: > A broad understanding of research method; > An in-depth knowledge of the complemnt system; > An understanding of the methods for making and characterising monoclonal antibodies.

Outline of SSC Activities: > Journal article critical reading; > Presentation of research data at lab meetings; > Proactical skills in ELISA, western blotting, protein purification etc.

Is this project Research, Audit or Service Evaluation or other: Research

Nature of Project: Laboratory

Number of students who can undertake this project: 2

Opportunities to Present at Conferences: Could potentially present at conferences

18 | P a g e

------CD38 in Chronic Lymphocytic Leukaemia (CLL) cell homing to the lymph node microenvironment ------Institution: Cardiff University Department: Institute of Cancer and Genetics Tutor: Dr Elisabeth Walsby

------Project Code: CU06 ------Brief Project Aims: CD38 is involved in cell adhesion and signaling. The only known ligand of CD38 is CD31, which is found on endothelial cells. High expression of CD38 is an adverse prognostic marker in CLL and this may be due to its interaction with CD31 on endothelial cells as part of lymphocyte transmigration out of the circulation into lymph nodes. We have developed novel systems to model the different microenvironments in vitro and will use these systems to: Determine effect of an anti-CD38 antibody on CLL cells in in vitro culture. Show whether CD38 expression level on CLL cells in vitro correlates with their ability to move between different microenvironments in culture. Determine whether inhibition of CD38 using an anti-CD38 antibody inhibits migration of CLL cells between different microenvironments modeled in vitro.

Educational Objectives: To examine the role of the lymph node microenvironment in CLL To understand the role of CD38 in lymphocyte homing to the lymph node microenvironment To develop an understanding of modeling different experimental microenvironments and systems to allow cell migration between them in vitro To develop the student’s practical skills in the laboratory

Outline of SSC Activities: Tissue culture of primary CLL cells in vitro to determine the effects of an anti CD38 antibody in different culture conditions that modeling different microenvironmental conditions which are important in CLL. Measuring the level of CD38 that is expressed on the CLL cells to determine whether some patients are more responsive to the anti-CD38 antibody than others. Using the concentration of anti-CD38 antibody calculated as optimal in the previous experiment to determine whether this has an effect on the ability of the CLL cells to move between different in vitro microenvironments through transwell culture systems incorporating endothelial layers and cytokine gradients compared to CLL cells from the same patient but without the anti-CD38 antibody.

Is this project Research, Audit or Service Evaluation or other: Research

Nature of Project: Laboratory

Number of students who can undertake this project: 1

19 | P a g e

Opportunities to Present at Conferences: In answer to the query, there are no definite plans for presentation of the findings at a conference but it is foreseen that the results would be incorporated into a manuscript for publication as part of a larger body of work and credit would be given to

20 | P a g e

------Literature, Culture and Medicine ------Institution: Cardiff University Department: Institute of Primary Care and Public Health Tutor: Doctor Lionel Jacobson

------Project Code: CU07 ------Brief Project Aims: To enhance students' understanding of illness and disease through literature and other cultural means.

Educational Objectives: • An understanding of lay perceptions of illness/disease;

• An exploration of the integration of illness/disease into a social context;

• An examination of representations of doctors in literature and general culture;

• An understanding of ethical issues in a wider cultural context;

• An examination of representations of the metaphor of illness as social comment;

• A process to help students reflect on how they may be perceived in their life-long professional role;

• A process to help students develop a patient centred understanding of illness.

Outline of SSC Activities: The SSC is broadly split into three consecutive phases. Initially, there are a series of seminars, lasting approximately three hours each loosely based around a core theme; examples include addiction, mental health, ethics, doctors as characters, medicine as an instrument of the state. The seminars will involve discussion of poetry, excerpts of novels, short stories, plays, music, patient accounts of illness in literature, and films. There are also two trips, one to the National Museum of Wales in Cardiff, and later a trip to Hay on Wye for the Literature festival. In phase two, students will be asked to propose a specific subject for study ('specialist subject') which will be discussed and approved by the tutor group. Students will be assigned an individual tutor to facilitate their self-directed learning for the rest of the course. Individual tutorials of approximately one-hour duration will take place weekly between student and tutor to discuss problems arising, and to assist in the development of this particular area of study, which may involve some reading or review of cultural media by the tutor to allow shared discussion to take place. Students will be working towards a presentation. In phase three, students will lead their own seminaron their 'specialist subject' to a group comprising the other students, possibly another tutor from the tutor group who is asked to be largely non-participant and usually Dr Jacobson who can act as ‘commentator’. These seminars will usually last about one hour, and will be informally assessed by at least one

21 | P a g e tutor according to criteria of presentation of the subject matter, and facilitation of discussion.

After the seminar students prepare their 1500 word essay on their ‘specialist subject’. These essays will all be marked by Dr Jacobson, and one other tutor according to the centrally used University marking schedule for SSCs. Further, as per University requirements students may be asked to produce a poster.

Is this project Research, Audit or Service Evaluation or other: It does have aspects of Research needed to be carried out by students

Nature of Project: Seminar based discussion on wider aspects of medicine

Number of students who can undertake this project: 8

Opportunities to Present at Conferences:

22 | P a g e

------Utility of ultrasound simulators for quality assurance of ultrasound technical skills among clinical practitioners ------Institution: Cardiff University/UHW Department: Institute TIME, School of Medicine Tutor: Prof Nazar Amso

------Project Code: CU08 ------Brief Project Aims: 1. Introduce medical students to the basic principles of ultrasound as an integral skill in clinical practice 2. Utilise the availability of ultrasound simulators to develop key examination skills that are rapidly becoming indispensable and integral component of clinical practice 3. Raise awareness among medical students of the importance of quality assurance measures in clinical practice

Educational Objectives: 1. Students will develop an understanding of the principles of ultrasound image formation and arefacts and the broad applications of ultrasound in clinical practice 2. Students will learn how to undertake ultrasound scans for a number of organs using virtual reality simulators developed at Cardiff by a University spin-out company 3. Students will appreciate the importance of team working in a multidisciplinary environment 4. Students will appreciate the value of quality assurance measures in ultrasound practice

Outline of SSC Activities: 1. Students will have access to online reading material developed specifically for ultrasound education 2. Students will use a virtual reality ultrasound simulator to develop ultrasound examination skills of a number of organs/structures through a self-directed approach embedded in the simulator 3. Students will use skills learned in 2 above to evaluate the reproducibility of examination skills and measurements of key organs/structures undertaken by established independent practitioner in ultrasonograhy

Is this project Research, Audit or Service Evaluation or other: Service Evaluation

Nature of Project: Skills

Number of students who can undertake this project: 4

Opportunities to Present at Conferences:

23 | P a g e

Presentation at scientific meeting or even publication

24 | P a g e

------Evaluating e-Learning resources in clinical biochemistry: how do we tell what is good? ------Institution: Cardiff University / UHW Department: Medical Biochemistry Tutor: Dr Duncan Cole

------Project Code: CU09 ------Brief Project Aims: Learning how to use and interact with the clinical laboratory, and how to interpret the results produced by the laboratory, remain important components of medical education. With learning focussed on patients in the clinical years of the course and less time in the classroom, there is a need for learning in areas such as clinical biochemistry to be supported with good quality e-Learning. We currently use a number of different e-Learning approaches within the department, including in-house e-tutorials, workbooks in pdf format, and online web-based curation. The aims of this SSC are to: • Develop indicators / guidelines on e-Learning resource quality • Evaluate the quality of the current e-Learning resources in clinical biochemistry

Educational Objectives: At the end of the SSC you will be able to: • Determine student and staff perceptions of features of good quality e-Learning resources using a Delphi exercise • Produce guidelines on assessing the quality of e-Learning resources • Evaluate existing e-Learning resource quality against the guidelines

Outline of SSC Activities: This SSC will involve attachment to the Department of Medical Biochemistry and Immunology. You will take part in regular department activities, including attendance at outpatient clinics run by consultants in the department. Features of a good quality e-Learning resource will be determined using a Delphi process – a technique used to gain consensus through a series of rounds of questionnaires sent to a group. The results of this, in conjunction with a literature review, will allow you to produce a set of guidelines to assess e-Learning resource quality. You will then have the opportunity to evaluate the current clinical biochemistry e-Learning resources against these criteria, to test the utility of the criteria.

Is this project Research, Audit or Service Evaluation or other: Research

Nature of Project: Clinical and education

Number of students who can undertake this project: 1

Opportunities to Present at Conferences:

25 | P a g e

Thanks for your email. I can confirm that there will be opportunities to present work from the project - locally at the Annual Curriculum conference, and nationally/internationally at ASME, and possibly AMEE as well. I would also anticipate a publicatio

26 | P a g e

------Designing e-Learning Resources in Clinical Biochemistry ------Institution: Cardiff University/ UHW Department: Medical Biochemistry Tutor: Dr Duncan Cole

------Project Code: CU10 ------Brief Project Aims: Clinical biochemistry tests are frequently requested on patients in both primary and secondary care and doctors may review many results every day. Learning how to use and interact with the clinical laboratory, and how to interpret the results produced by the laboratory, remain important components of medical education. With learning focussed on patients in the clinical years of the course and less time in the classroom, there is a need for learning in areas such as clinical biochemistry to be supported with good quality e-Learning resources. The aims of this SSC are to: • Assess the Learning Needs of medical students in clinical biochemistry • Design and develop an e-Learning resource on a clinical biochemistry topic based on sound educational principles

Educational Objectives: At the end of the SSC you will be able to: • Evaluate student learning needs • Plan an educational strategy using the Analyse, Design, Develop, Implement, Evaluate (ADDIE) model • Design and develop an e-Learning resource using evidence-based educational principles

Outline of SSC Activities: This SSC will involve an attachment to the Department of Medical Biochemistry and Immunology in UHW. You will take part in regular department activities, including attendance at outpatient clinics run by consultants in the department. Learning needs will be surveyed through an electronic questionnaire, which you will analyse, and through a brief literature review in this area. A review of currently available educational resources will also be required. You will carry out a literature review of evidence-based educational design principles and using this information will design and develop an e-Learning resource. Please note this will NOT require any specific knowledge of eLearning software packages as the design may be completely paper-based.

Is this project Research, Audit or Service Evaluation or other: Education evaluation and design

Nature of Project: Lab, clinical and education

27 | P a g e

Number of students who can undertake this project: 1

Opportunities to Present at Conferences: there will be opportunities to present work from this project. Again this may be local - at the Annual Curriculum conference, and also nationally/internationally at ASME and possibly AMEE. There will also be opportunities to present at FOCUS, the annual

28 | P a g e

------A human right's based approach to Women's Health ------Institution: Cardiff University/UHW Department: Obstetrics and Gynaecology, UHW Tutor: Prof Alison Fiander

------Project Code: CU11 ------Brief Project Aims: To review human rights as they relate to women's health and consider the implications for teaching in Women's Health and provision of Women's services.

Educational Objectives: -undertake literature review on a rights based approach to women's health -discuss issue with Prof L Regan, Imperial College - FIGO human rights lead -review any educational interventions teaching a human rights based approach to women's care -design a workshop or teaching session on a human rights based approach to reproductive health.

Outline of SSC Activities: -undertake literature review on a rights based approach to women's health -discuss issue with Prof L Regan, Imperial College - FIGO human rights lead -review any educational interventions teaching a human rights based approach to women's care -design a workshop or teaching session on a human rights based approach to reproductive health.

Is this project Research, Audit or Service Evaluation or other: Literature Review

Nature of Project: Community

Number of students who can undertake this project: 2

Opportunities to Present at Conferences:

29 | P a g e

------Supporting multimedia learning resources for Obs and Gynae teaching ------Institution: Cardiff University/UHW Department: Obstetrics and Gynaecology, UHW Tutor: Prof Alison Fiander

------Project Code: CU12 ------Brief Project Aims: -to investigate multimedia resources to support undergraduate learning in Women's Health -to identify suitable resources and upload to learning central -to develop accompanying background, learning points or questions based around the resource eg learning points for video of breech delivery -to identify gaps in supporting resource and make recommendations for further development.

Educational Objectives: -to investigate the literature regarding need, potential and evaluation of multimedia learning resources particularly related to women's health -to review learning objectives for women's health module in 4th year and identify multimedia teaching resources to support the module eg GLOWM (Global Library of Women's medicine) -to identify gaps in learning support and recommend development of learning resources

Outline of SSC Activities: -literature review -review of GLOWM and other multimedia resources eg you-tube -match resources to learning outcomes in women's health -identify gaps

Is this project Research, Audit or Service Evaluation or other: Literature Review

Nature of Project: multimedia learning support

Number of students who can undertake this project: 2

Opportunities to Present at Conferences:

30 | P a g e

------Community Wound Care ------Institution: Cardiff University/UHW Department: Wound Healing Research Unit Tutor: Mrs Samantha Holloway

------Project Code: CU13 ------Brief Project Aims: The Wound Healing Research Unit investigates the many facets of wound healing (including physiological, biomechanical, biological, health outcomes and health service delivery) so leading to the development of novel therapies and wound diagnostic technologies. Emphasis will be placed on the importance of collaboration with Primary Health Care staff in planning and co-ordinating care for patients with wound problems. Opportunity will be given to see many treatment regimes and diagnostic methods such as biopsies, Doppler and duplex ultrasound and advanced wound management techniques. The placement offers activities that that are clinic and community based. Students are able to study a particular topic or topics and pursue their interests in some depth under the guidance of a tutor with specialist knowledge of the field. Potential project topics are discussed and negotiated during the first week of the SSC.

Educational Objectives: Identify a variety wound aetiologies Examine the assessment process used to aid diagnosis Identify a range of wound management products (dressings) available to treat patients Identify the effects of having a wound on the patients’ quality of life Identify the role of research & wound management interventions in facilitating wound healing Identify the potential difficulties of performing trials on patients with wounds Discuss the limitations of performing trials in the community environment Explore the patients perspective of being part of a clinical trial

Outline of SSC Activities: Attendance at out-patient, community and research clinics on a weekly basis Opportunity to undertake in-patient ward rounds with the Clinical Nurse Specialists for Wound Healing Dedicated study time to complete SSC project

Is this project Research, Audit or Service Evaluation or other: We offer the full range of options listed

Nature of Project: Combined

Number of students who can undertake this project: 2

Opportunities to Present at Conferences:

31 | P a g e

Where appropriate we do submit an abstract of the 3rd year SSC projects to one of the National wound care conferences held annually (WoundsUK, Harrogate). This year our three, 3rd year students from May-July have had their poster abstracts accepted. The o

32 | P a g e

------Saving the Planet - contribution of improving Women's Health to saving the planet ------Institution: UHW Department: Obstetrics and Gynaecology, UHW Tutor: Prof Alison Fiander

------Project Code: UHW01 ------Brief Project Aims: Reviewing the evidence from paper: "Can a collapse of global civilization be avoided?" Paul R. Ehrlich and Anne H. Ehrlich Published 9 January 2013 doi: 10.1098/rspb.2012.2845 Proc. R. Soc. B 7 March 2013 vol. 280 no. 1754 Abstract Environmental problems have contributed to numerous collapses of civilizations in the past. Now, for the first time, a global collapse appears likely. Overpopulation, overconsumption by the rich and poor choices of technologies are major drivers; dramatic cultural change provides the main hope of averting calamity. Look at contribution of improving women's health to preventing planet collapse

Educational Objectives: -understand place of public health in maintaining global civilisation and sustainability. - be able to identify the role of women's health improvement to maintaining global civilisation and sustainability. - identify and discuss specific aspects of women's health involved - discuss a relevant aspect of women's health in detail. - write a review for an appropriate journal - make a presentation on the topic to the academic dept

Outline of SSC Activities: - Review of paper and comments made on paper. - Identify aspects of paper related to women's health. - Write review on women's health contribution for saving the planet

Is this project Research, Audit or Service Evaluation or other: Literature Review

Nature of Project: Community

Number of students who can undertake this project: 2

Opportunities to Present at Conferences:

33 | P a g e

------Understanding and attitudes of emergency unit medical and nursing staff to deceased organ donation from the emergency unit. ------Institution: UHW Department: Emergency Unit Tutor: Dr Katja Empson

------Project Code: UHW02 ------Brief Project Aims: To understand the ethical and legal principles behind organ donation including the Human Transplantation Act Wales 2013 To develop an understanding of the barriers to organ donation from the emergency unit Explore the understanding and attitudes of emergency medicine clinicians and nursing staff to the process of organ donation

Educational Objectives: After completing this project the student will have nowledge and understanding of the process of organ donation; including the clinical situations leading to potential organ donation, management of the potential organ donor Understand the importance of team work and communication within the emergency unit and how it is applied to work with families of potential organ donors Gain experience in the interface between emergency medicine and critical care and the process of transferring critically ill patients

Outline of SSC Activities: The students will be expected to spend time in the emergency unit basing themselves in the resuscitation room. They will have the opportunity to work with the emergency medicine team caring for critically ill and injured patients. They might have the opportunity to observe and gain experience in decision making with respect to the withdrawal of treatment and consideration of organ donation. They will observe the process of referral to intensive care and the transfer of patients to the intensive care unit. In addition they will conduct a survey of emergency medicine clinicians and nursing staff to gain experience in the practice of research and support understanding of attitudes to organ donation. To support their project work the student will be expected to read guidelines and protocols pertaining to organ donation.

Is this project Research, Audit or Service Evaluation or other: Research

Nature of Project: Combined

Number of students who can undertake this project: 2

34 | P a g e

Opportunities to Present at Conferences: I'm happy to confirm that we will aim to submit the results of this study to a national conference for presentation. This is likely to be either a College of Emergency Medicine conference of a NHS Blood and Transplant symposium

35 | P a g e

------Reaudit of Domestic Abuse enquiry for antenatal patients ------Institution: UHW Department: Obstetrics and Gynaecology Tutor: Mrs Anne Morgans

------Project Code: UHW03 ------Brief Project Aims: This re-audit aims to complete the audit cycle by assessing the uptake of Domestic Abuse (DA) screening since the actioning of recommendations made by primary audits in 2010 and 2012. The study seeks to identify current attitudes toward and barriers against DA enquiry and to identify how these attitudes have changed since the primary audit. The questionnaire hopes to gain information on the training midwives have received relating to DA screening.

Educational Objectives: - learning how to undertake an audit - learning about domestic abuse and how to screen for this in antenatal clinics - consider interventions to improve screening for domestic abuse - design intervention to improve domestic abuse enquiry/screening.

Outline of SSC Activities: Design For continuity, the design follows that of the primary audits to include a retrospective review of antenatal notes belonging to women who deliver in the obstetric led unit of University Hospital of Wales (UHW) and the redistribution of a questionnaire amongst midwives currently employed within the trust. Field notes will be collected whilst in the department.

Is this project Research, Audit or Service Evaluation or other: Audit

Nature of Project: Clinical

Number of students who can undertake this project: 2

Opportunities to Present at Conferences:

36 | P a g e

------audit of acute non-invasive ventilation in cardiff and vale ------Institution: UHW Department: Respiratory Medicine Tutor: Dr Simon Barry

------Project Code: UHW04 ------Brief Project Aims: NIV has been found in nationwide audits to be poor. In wales, we have developed guidelines to improve this process. the aim of this audit is to retrospectively review the casenotes of patients admitted with acute respiratory failure and review their care according to the NIV guidelines. It is suggested that this is preformed in both UHW and Llandough respiratory wards. In addition, NIV provision on ITU/HDU will also be audited

Educational Objectives: 1. the student will learn about the management of patients with acute ventilatory failure 2. the student will understand the value and process of audit 3. the student will develop an understanding of the complexities of delivering high quality care and in particular the core aspects of team work and education

Outline of SSC Activities: 1. development of a standard audit form 2. identification of patients in ventilatory failure by clinical coding 3. collation of data through note review on audit form 4. writing up of project 5. reflection and suggestions for improvment

Is this project Research, Audit or Service Evaluation or other: Audit

Nature of Project: Clinical

Number of students who can undertake this project: 1

Opportunities to Present at Conferences:

37 | P a g e

------A review of 15 years of ECV practice ------Institution: UHW Department: Women's Health Tutor: Mr Richard Penketh

------Project Code: UHW05 ------Brief Project Aims: - To establish the success rate over time of External Cephalic Version in reducing the rate of Cesarean Section for breech presentation at term - To determine personal success rates for individual operators - To determine perinatal outcomes for babies undergoing attempted ECV

Educational Objectives: - Knowledge and understanding of the options available for Breech presentation at term - database management and statistics - conduct of a large scale audit - opportunity to contribute to the writing of a paper with a high chance of publication

Outline of SSC Activities: - constructing databases from already completed audit forms and obtaining data from various types of register and notes - searching for and assessing current evidence and publications regarding breech presentation at term, ECV, perinatal outcomes etc

Is this project Research, Audit or Service Evaluation or other: Audit

Nature of Project: Data management, audit, writing for publication

Number of students who can undertake this project: 2

Opportunities to Present at Conferences: However, abortion in particular is discussed on FIAPAC, in October 2014, unfortunately not in the UK but Ljubljana

38 | P a g e

------Managment of fetal tissue disposal following medical abortion ------Institution: UHW and UHL Department: Gynaecology Tutor: Dr Caroline Scherf

------Project Code: UHW10 ------Brief Project Aims: Therapeutic abortion is the most common gynaecology procedure in the UK with about 200000 treatments per annum. Disposal of fetal tissue after abortion has been an issue fraught with problems and uncertainties. The current possible disposal routes for tissue include four options 1) Respectful Disposal by the treatment centre 2) Tissue cremation with council crematorium 3) Patient making own arrangements either privately or with an undertaker 4) Donating fetal tissue to bioscience research projects Particularly stem cell research has generated much interest with encouraging results especially in the area of treating neurondegenerative diseases. This stem cell research increasingly relies on fetal tissue provision and a more open and formalised process of donating such tissue is required. Several questions need to be addressed at this point: 1) what are the current regulations for organ donation? Both cadaver and live doners can be considered. Can existing organ donation rules easily be applied to fetal tissue donation or would it perhaps be more appropriate to write a new set of rules for this situation? 2) Clearly fetal tissue is special, particularly with the sensitivities around therapeutic abortion. What are the ethical issues of fetal tissue donation that have to be considered - or recognised and refuted? Could these ethical and / or political views have created unnecessary barriers? 3) What exactly do women undergoing a medical abortion think about fetal tissue disposal? What assumptions have been made on their view and how much could they have been influenced by the challenging ethics around this subject?

Educational Objectives: 1) Knowledge and understanding of legal position in the UK around abortion and tissue donation and how this impacts medical and research practice. 2) knowledge and understanding of ethical and political issues on abortion and tissue donation. An appreciation how much ethical challenges are part of daily medical work. 3) skill and competence of questionnaire design, logistics of administering this, evaluation of results

Outline of SSC Activities: A maximum of three students can share/divide the following work areas: 1) websearch and literature search 2) critical reading of important papers 3) summarise findings of relevant papers / websites / books

39 | P a g e

4) design a patient questionnaire with mostly binary questions 5) ensure correct administration of questionnaire and collection 6) evaluate process of questionnaire administration and collection 7) analyse first batch of samples

Is this project Research, Audit or Service Evaluation or other: Service Evaluation

Nature of Project: Combined

Number of students who can undertake this project: 3

Opportunities to Present at Conferences: Most conferences are in the first half of 2014

40 | P a g e

------The incidence of atypical viral infections (CMV and BKV) in transplant patients over a 5-year period ------Institution: UHW Department: Transplant Surgery Tutor: Mr Rafael Chavez

------Project Code: UHW06 ------Brief Project Aims: To evaluate the incidence of atypical infections in transplant patients To assess whether this incidence is influenced by type of induction used for immunosuppression To assess whether this incidence is influenced by type of donation of graft

Educational Objectives: The student will gain first hand knowledge of clinical research including data collection, analysis and presentation The student will conduct this research project which has the potential to lead to publication and presentation at a national conference (BTS) The student will also gain a broad understanding of pertinent issues related to transplant patients (by attending clinics and ward rounds)

Outline of SSC Activities: Data collection Organising the study Statistical analysis Presentation

Is this project Research, Audit or Service Evaluation or other: Research

Nature of Project: Combined

Number of students who can undertake this project: 1

Opportunities to Present at Conferences: held in November 2014, date and exact venue not published yet, as this years' event is still awaited.

41 | P a g e

------Frailty in the Older Person in the Acute General Surgical Setting ------Institution: UHW Department: Surgery Tutor: Dr Jonathan Hewitt

------Project Code: UHW07 ------Brief Project Aims: To assess the association between frailty in elderly patients undergoing surgery and post- operative outcomes including complications, 28 day mortality and length of stay.

Educational Objectives: Data collection, handling and processing Basic epidemiology, statistics and the use of SPSS software Produce a formal scientific report Completion and presentation of abstracts at national meetings (the 2013 SSC was presented at the Welsh Geriatric Society meeting and won the Phyllis Amelia Peach prize for the best SSC relating to Geriatric Medicine)

Outline of SSC Activities: Data collection at UHW. Data and statistical work using XL and SPSS software Report writing Further info: Students will collect data, this will be well defined and closely supervised. It will be routing data from patient notes as part of a service evaluation. They will perform basic SpSS analysis of their data

Is this project Research, Audit or Service Evaluation or other: Service Evaluation

Nature of Project: Clinical

Number of students who can undertake this project: 3

Opportunities to Present at Conferences:

42 | P a g e

------Vascular Access Surgery for Haemodialysis ------Institution: UHW Department: Transplant Tutor: Mr Michael Stephens

------Project Code: UHW08 ------Brief Project Aims: The aim of this project is to collect and analyse data in relation to vascular access (fistula) surgery, to conduct audit(s) and to submit the findings to scientific meetings.

Educational Objectives: Develop clinical data collection and analysis skills Understand the audit cycle (including how to present audit outcomes Learn to assess renal failure patients for fistula formation Learn to construct and submit abstracts to scientific meetings

Outline of SSC Activities: The student will work alongside the vascular access surgical team in Cardiff (3 consultant surgeons and two specialist nurses) learning to assess patients with renal failure who require fistula formation for haemodialysis. The project involves attending outpatient clinics and collecting data on patients prior to and after fistula formation. The data generated will be used to assess/audit outcomes following vascular access surgery with the aim of presenting at least one audit to the Nephrology and Transplant Clinical Governance meeting and submitting at least one abstract to be considered for presentation at a national meeting. There will also be the opportunity to attend surgical sessions to observe vascular access surgery. The student will be taught how to assess patients suitability for fistula formation, how to assess fistulas and learn about the physiology of arteriovenous circuits. They will have the opportunity to learn about clinical data collection and analysis, the audit process (including presentation), and also constructing and submitting abstracts to scientific meetings.

Is this project Research, Audit or Service Evaluation or other: Service Evaluation

Nature of Project: Clinical

Number of students who can undertake this project: 1

Opportunities to Present at Conferences: b) RCSEd (Wales) Med Student Surgical Research Symposium

43 | P a g e

------Patient Care in the Pre-hospital and Emergency Settings ------Institution: UHW Department: Emergency Unit, UHW Tutor: Dr Huw Williams

------Project Code: UHW09 ------Brief Project Aims: 1. To become skilled/competent in pre-hospital life support. 2. To gain an understanding of the experiences of the acutely unwell patient.

3. To gain an understanding of the pathway of the acutely unwell patient into urgent/unscheduled NHS care.

4. To gain an understanding of intra-disciplinary communication in urgent/unscheduled care.

Educational Objectives: 1. To become skilled/competent in pre-hospital life-support to a standard to be able to act as representatives of the Welsh Ambulance Service and to act as a member of the Cardiff Medics’ First Responders group. (‘Competency’ assessed by the Welsh Ambulance Service) 2. To gain an understanding of the experiences of the acutely unwell patient by attending category A 999 calls with ambulance crews and as part of Cardiff Medics’ First Responders group. (‘Understanding’ assessed by Emergency Medicine Registrar/Consultant – marking of pre-hospital clerking) 3. To gain an understanding of the pathway of the acutely unwell patient into urgent/unscheduled NHS care by completion of 1 of 4 audits (A) Events Medicine Audit (with placement in the Millennium Stadium), (B) Pre-hospital Stroke Audit, (C) Ambulance usage/handover Audit, (D) Pre-hospital STEMI audit (‘Knowledge and Understanding’ assessed by Emergency Medicine Consultant and second ‘buddy’ marker – marking of audit) 4. Gaining an understanding of, and become involved with, handover and intra-disciplinary communication (‘Attitudes & Behaviours’ assessed by Emergency Medicine Registrar/Consultant – form assessment)

Outline of SSC Activities: Day 1 – (A) Completion of forms (CRB / WAST Ride-out Application / First Responder Application) (B) Orientation - UHW Emergency Unit & Blackweir Ambulance Station Day 2 – (A) Tutorial - Code of Conduct / (B) Tutorial - Inoculation Injuries (C) Tutorials (multiple) - Pre-hospital Life Support Theory Day 3-to-5 – Practical training in Pre-hospital Life Support Day 5 – Welsh Ambulance Service’s assessment by the South Wales First Responder Co- ordinator Day 6-to-49 – Responding to category A 999 calls with ambulance crews and Medics’ First Responders. ‘Pre-hospital clerking’ and ‘attitudes/behaviours’ assessed by Emergency Medicine Registrars/Consultants. Audits undertaken. Day 50-56 – Audit completion and write-up

44 | P a g e

Day 57-62 – Audit marking by consultant and ‘buddy’ marker / collation of marks Day 63 – Marking completed and score handed to SSC co-ordinator / End of SSC

Is this project Research, Audit or Service Evaluation or other: Audit

Nature of Project: Clinical/skills

Number of students who can undertake this project: 6

Opportunities to Present at Conferences: In relation to the feedback could you please inform Dr Hibbitts that we have encouraged the students to present their findings as a poster presentation at the AWSEM (All Wales School of Emergency Medicine) Annual Conference. Over the past 4 years, 3 s

45 | P a g e

------Review of Pulmonary Rehabilitation service ------Institution: University Hospital Llandough Department: Respiratory Medicine Tutor: Dr Ramsey Sabit

------Project Code: UHL01 ------Brief Project Aims: - assess 1 year of pulmoanry rehabilitation outocme data - compare our service with BTS pulmoanry rehabilitation guidlines

Educational Objectives: - learn and about what pulmonarr rehabilitation involves and what it can achieve - appreciate importance of assessing outcomes in pulmoanry rehabilitation - improve wirting and analyitical skills

Outline of SSC Activities: - attend pulmonary rehabilitation sessions - review literature on pulmonary rehabilitation, including BTS guidelines - review data on pulmoanry reahbilitation outcomes for a 12 month period - compare our service to what is recommended in BTS guidelines

Is this project Research, Audit or Service Evaluation or other: Service Evaluation

Nature of Project: Clinical

Number of students who can undertake this project: 2

Opportunities to Present at Conferences: Yes, the finding can be presented at our monthly cardiff chest federation meeting

46 | P a g e

------Cystic Fibrosis Related Liver Disease (CFRLD) ------Institution: University Hospital Llandough Department: Cystic Fibrosis Tutor: Dr Jamie Duckers

------Project Code: UHL02 ------Brief Project Aims: CF related liver disease is the second commonest cause of death in patients with CF. Aims:- 1. Audit of the number of our patients meeting the diagnostic criteria for CF related liver disease 2. Audit of treatment given for CF related liver disease

Educational Objectives: -develop knowledge and understanding of CF and the comorbidities patients with CF have -knowledge of the roles of the multidisciplinary team caring for patients with CF -literature search and awareness of gold standard -presentation skills

Outline of SSC Activities: Attend CF clinic and Unit to develop knowledge and understanding of CF and the comorbidities patients with CF have -Meet members of the multidisciplinary team caring for patients with CF -data collection and database management -use of SPSS package -abstract writing for publication

Is this project Research, Audit or Service Evaluation or other: Audit

Nature of Project: Clinical

Number of students who can undertake this project: 1

Opportunities to Present at Conferences: Thank you- yes we would hope to present results at departmental clinical governance meeting and at All Wales CF Club meeting along with submitting for a poster presentation at European CF Society

47 | P a g e

------Adult Bronchiectasis Service Evaluation ------Institution: University Hospital Llandough Department: Respiratory Medicine Tutor: Dr Jamie Duckers

------Project Code: UHL03 ------Brief Project Aims: The University Hospital Llandough bronchiectactic service is a rapidly expanding service. Aims:- 1. Characterise the aetiology of the bronchiectasis in patients attending the service. 2. Characterise the radiology and microbiology of patients attending the service 3. Characterise the treatment of the patients attending the service 4. Helping to develop individualised patient management plans

Educational Objectives: -gain knowledge and understanding of the diagnosis and management of patients with bronchiectasis -experience of literature search -experince of database management and data collection -writing abstracts for publication -Presentation skills

Outline of SSC Activities: -Attend clinic to gain knowledge and understanding of the diagnosis and management of patients with bronchiectasis -literature search on standards of care -using SPSS and access database and review of clinic results -writing abstract for publication and presentation of results

Is this project Research, Audit or Service Evaluation or other: Audit

Nature of Project: Clinical

Number of students who can undertake this project: 1

Opportunities to Present at Conferences: Thank you- yes we would hope to present results at departmental clinical governance meeting and at Welsh Thoracic Meeting along with submitting for a poster presentation at British Thoracic Society

48 | P a g e

------An integrated analysis of rectal cancer care and outcomes in Cardiff and Vale LHB and Velindre Cancer Centre ------Institution: UHW and Velindre Cancer Centre Department: Oncology/surgery/pathology/radiology Tutor: Dr Richard Adams

------Project Code: UHW11 ------Brief Project Aims: *The four students will work independently on their clinical specialist data sets, being mentored by individual members of the MDT as indicated below. *Patients will be selected from a 12 month period who have rectal cancer and have been presented at the C&V MDT (which all mentors attend) * student 1 pathology, will review histology reports as an audit of proforma reporting completion and quality of surgery, they will understand the processes involved in pathologic assessment of a rectal cancer ( ie plane of surgery, LN yield, emvi, CRM etc.) student 2. radiology will assess proforma'd pelvic MRI radiology reporting and MDT radiology review using data collected in 2008 and then in 2013, this data will be assessed as a part of a service review. a specific interest will be taken in patints who have local relapse and correlations with site of relapse student 3 surgery, will collate data on surgical type and outcomes including local and distant relapse and survival student 4 will assess radiotherapy and chemotherapy utilised in the neoadjuvant, adjuvant and palliative setting a s aservice review looking at patients in 2008 and 2013. the student will understand the role for each of these therapies and why each was chosen The integrated data set will be developed for a national presentation

Educational Objectives: *All students will, understand the management of rectal cancer as a multidisciplinary phenomenon * Individuals will gain specific insight in to aspects relating to pathology (student 1, mentored by Dr. Mel Morgan consultant pathologist), radiology (student 2, mentored by Dr Robert Bleehan, consultant radiologist), surgery (student 3, mentored by Mr. Chris Morris consulant surgeon) * students will develop skills in database development and data integration and basic analysis *students will present their data to the Multidisicplianry team gaining skills in presentation

Outline of SSC Activities: *literature review (with a focus on the pathology, radiology, surgery, oncology of rectal cancer) *intergroup discussion *clinical observation and MDT attendance allied to the individual members of the team * data base creation

49 | P a g e

*data analysis *scientific report writing *scientific oral presentation

Is this project Research, Audit or Service Evaluation or other: Service Evaluation

Nature of Project: Clinical

Number of students who can undertake this project: 4

Opportunities to Present at Conferences:

50 | P a g e

------Urinary symptoms after pelvic radiotherapy ------Institution: Velindre Cancer Centre Department: Clinical Oncology Tutor: Dr Louise Hanna

------Project Code: VEL01 ------Brief Project Aims: With increasing numbers of patients surviving cancer, there is a growing need to identify and treat patients who develop side effects of their cancer treatment. Pelvic radiotherapy frequently forms part of the radical (curative) treatment of patients with pelvic malignancies. But in addition to its anti-cancer effect, pelvic radiotherapy is an important cause of long term side effects including urinary problems. Symptoms can arise from reduced bladder capacity which causes urinary frequency, urgency and incontinence, or from strictures of the urethra or ureter which cause problems with obstruction of urine. A recent project showed that over half of all patients who had undergone pelvic radiotherapy for gynaecological cancer experienced urinary symptoms. Treatments for urological symptoms include lifestyle measures and pharmacological or surgical treatments. There is a need to ensure that patients who experience these symptoms are identified, investigated and treated in order to improve their quality of life. The aims of this project are: • To study the incidence of urinary problems in patients who have been treated with radiotherapy for gynaecological cancers at the Velindre Cancer Centre. • To establish a baseline level to determine the incidence of urinary symptoms prior to starting treatment. • To investigate and describe how Clinical Oncologists identify and investigate patients with urinary symptoms following pelvic radiotherapy, including what observations are carried out in the Cancer Centre and at what point they refer to other health care professionals such as Urological Surgeons.

Educational Objectives: Educational objectives • Demonstrate the ability to exercise initiative, analytical and critical thought • Demonstrate basic skills in literature search/review, data collection, data analysis • Prepare a written report in the form of a scientific paper • Understand the concept of survivorship following treatment for cancer • Understand the impact that pelvic radiotherapy can have on urological function • Evaluate the incidence of urinary symptoms in patients before and after pelvic radiotherapy for gynaecological cancer in Velindre Cancer Centre • Investigate what evaluations or investigations are performed on patients with urinary symptoms following pelvic radiotherapy prior to referral to other health care professionals

Outline of SSC Activities: Outline of SSC activities • To analyse questionnaire responses for patients who have received pelvic radiotherapy for gynaecological cancer in Velindre Cancer Centre, identifying what proportion of patients have urological symptoms before and after radiotherapy.

51 | P a g e

• To make a comparison with the incidence of urological symptoms in this population and the incidence reported in the literature. • To undertake a survey of health care professionals who follow up patients who have received pelvic radiotherapy for cancer in order to identify what investigations and treatment they undertake for patients with urological problems following pelvic radiotherapy and at what point they refer to other health care professionals. • To collate responses from this survey to identify variations among health care professionals and to identify areas of best practice.

Is this project Research, Audit or Service Evaluation or other: Service Evaluation

Nature of Project: Combined

Number of students who can undertake this project: 1

Opportunities to Present at Conferences: there will be the opportunity to present at forthcoming conferences. There are numerous opportunities some of which are national conferences.

52 | P a g e

------Psychosexual symptoms after pelvic radiotherapy ------Institution: Velindre Cancer Centre Department: Clinical Oncology Tutor: Dr Louise Hanna

------Project Code: VEL02 ------Brief Project Aims: With increasing numbers of patients surviving cancer, there is a growing need to identify and treat patients who develop side effects of their cancer treatment. Pelvic radiotherapy frequently forms part of the radical (curative) treatment of patients with pelvic malignancies. But in addition to its anti-cancer effect, pelvic radiotherapy is an important cause of long term side effects including psychosexual problems. Psychosexual problems may be complex including physical, body image, and other psychological issues, and patients may be reluctant to talk about such issues because of a variety of factors including embarrassment or a reluctance to bother their doctor. Specific interventions such as psychosexual counselling can help to ameliorate some of the difficulties but it is not known to what extent these are available across Wales. The aims of this project are • To identify and describe the services available for patients with psychosexual symptoms following pelvic radiotherapy throughout Wales. • To study the incidence of psychosexual problems in one group of patients, those with gynaecological cancers treated in the Velindre Cancer Centre. • To examine the proportion of patients utilising a newly established psychosexual clinic.

Educational Objectives: • Demonstrate the ability to exercise initiative, analytical and critical thought • Demonstrate basic skills in literature search/review, data collection, data analysis • Prepare a written report in the form of a scientific paper • Understand the concept of survivorship following treatment for cancer • Understand the impact that pelvic radiotherapy can have on psychosexual function • Describe the services available in Wales for patients with psychosexual symptoms following pelvic radiotherapy • Evaluate the incidence of psychosexual symptoms in patients who have received pelvic radiotherapy for gynaecological cancer in Velindre Cancer Centre

Outline of SSC Activities: • To undertake a survey of health care professionals around Wales who follow up patients who have received pelvic radiotherapy for cancer in order to identify what services are available to assess and treat patients with psychosexual problems following pelvic radiotherapy. Such services might include pharmacological treatments, access to a clinical nurse specialist, access to dedicated psychosexual clinics, use of standardised models of assessment and treatment and access to specialist psychological assessment and treatment. • To interpret the data to make an overall judgement whether assessment and treatment for psychosexual problems are readily available for patients in Wales.

53 | P a g e

• To analyse questionnaire responses for patients who have received pelvic radiotherapy for gynaecological cancer in Velindre Cancer Centre, identifying what proportion of patients have psychosexual problems and what their main symptoms are. • To make a comparison with the incidence in this population and the incidence of psychosexual problems reported in the literature. • To estimate the proportion of patients with psychosexual symptoms who are referred on for specialist advice by comparing the incidence of symptoms with the numbers seen in a newly-established local psychosexual clinic.

Is this project Research, Audit or Service Evaluation or other: Service Evaluation

Nature of Project: Combined

Number of students who can undertake this project: 1

Opportunities to Present at Conferences: there are numerous opportunities to present at local regional and national conferences so I'm sure it would be possible to find a suitable one.

54 | P a g e

------Short Geriatric assessment of cancer patients in the out-patient setting ------Institution: Velindre Cancer Centre Department: Oncology Tutor: Dr Satish Kumar

------Project Code: VEL03 ------Brief Project Aims: AIMS: 1. To assess the feasability of conducting a short geriatric assessment of cancer patients starting systemic therapy in the out patient setting 2.Develop a cohort of patients with breast, colorectal and urological cancers who have undergone geriatric evaluation. 3. To enhance a holistic approach to elderly cancer patients so as to improve their overall health.

Educational Objectives: OBJECTIVES: 1. To gain knowledge and understanding of the interface between ageing and cancer (geriatric oncology). Specifically, a knowledge of the domains that need testing such as physical functioning, psycho-social, mental and nutritional. 2. Skills and competencies will be expected in administartion of validated questionnaires assessing these domains prior to treatment and assessing side effects/quality of life during treatment. 3. Attitudes and behaviours: To promote a multi-dimensional appraoch to elderly patients in general and cancer patients in particular.

Outline of SSC Activities: STUDENT ACTIVITIES DURING PROJECT: 1. SCP activities will include 1. Literature review of the value of geriatric assessment and the commonly employed validated questionnaires employed. 2. Pre treatment administration of questionnaires, history taking particularly focussed on the domains of interest in elderly patient such as physical functioning and psychosocial domains. 3. Writing up of a short report and adding to the existing database of patient who have undergone geriatric screening/assessment.

Is this project Research, Audit or Service Evaluation or other: Research

Nature of Project: Clinical

Number of students who can undertake this project: 2

Opportunities to Present at Conferences:

55 | P a g e

The choice is pretty masive. Local welsh meetings, cancer ncri conference and a geriatric conference would all be possibilities.

56 | P a g e

------Is Home Start Cardiff East an effective community based project for struggling families? ------Institution: St Davids Hospital, Cardiff Department: Community Child Health Tutor: Dr Alison Mott

------Project Code: STD01 ------Brief Project Aims: • To evaluate the effectiveness of Home Start, a charity based community programme for struggling families in East Cardiff

Educational Objectives: • To gain an understanding of the difficulties families living in socioeconomically deprived communities face bringing up children in the 21st century • To develop an understanding of community based interventions for families • To measure the effectiveness of community based projects through the analysis and interpretation of data provided by the organisation Proposal: HomeStart Cardiff East is an independently registered charity that supports struggling families, with at least 1 child under 5, living in the communities of St Mellons, Trowbridge, Rumney and Llanrumney. It is an example of a community based intervention rooted in the communities they serve. The team recruit and train volunteers who are usually parents themselves (or have extensive childcare experience), and carefully matches them with local families who need support. Currently 125 families are supported through home-visiting volunteers, and at group support sessions: this includes 271 children, 161 of whom are under 5, 11 children who are registered as disabled and 20% of the children are on the Child Protection Register. There is little objective evidence that is available in the literature about the effectiveness of HomeStart interventions. However, a recent 2013 study yielded very encouraging results. Although interventions by HomeStart schemes are based on national principles and guidance, each scheme has its unique way of working and the delivery of the service might differ. Thus assessment and evaluation of each scheme's effectiveness is worthwhile. There are many such community based interventions competing for limited funding: to achieve funding it is important to demonstrate their own effectiveness. This project has detailed information about their work and it is proposed that this SSC reviews, analyses and interprets this data. The project should give an insight into the tremendous and diverse amount of work that is done in the Community in order to help families in need of guidance and support. The work is relevant to anyone who is pursuing a career in Medicine especially in General Practice, Child Health, Mental Health and other disciplines. Reference: (Long-term changes in parenting and child behaviour after the Home-Start family support program. Jo M.A. Hermanns, Jessica J. Asscher, Bonne J.H. Zijlstra, Peter J. Hoffenaar, Maja Dekovič. J.M.A. Hermanns et al. / Children and Youth Services Review 35 (2013) 678–684 )

57 | P a g e

Outline of SSC Activities: Service evaluation of Home Start Cardiff East During the initial visit of the HomeStart worker, the needs of the families are identified under four headings; Parental Skills, Parental Well-being, Children Well-being and Family management. These scores, the coping levels, are done in discussion with the family and are repeated at intervals after the intervention is started. The medical student would accompany the HomeStart workers as well as the scheme manager when they attend to assess families and when interventions are required. The families will be informed in advance of the visit and their approval of the presence of the student would be sought. Students would also attend the group sessions that are held at the Community Education Centre in St Mellons and the John Reynold's Community Centre in Llanrumney, each held once weekly, thus gaining further insight into the work of the Scheme. A study can be conducted comparing the score at the initial visit and subsequent visits. This will be based on records of families that have already had an intervention. Other factors will be considered which would influence the results, for example, use of services and other interventions as well as changes within the family such as the birth of a baby, illness and others, the latter are collectively recorded under the heading of Recent Life Events. HomeStart workers also score, at intervals, the Hardiker Level of Need, thus taking into consideration such life events as well as interventions. We can incorporate the Level of Need, 1-4, into the analysis. This should help to guide us in observing the trend of improvement, or worsening, of the progress of the individual families. The Hardiker Level of Need would be based on several factors that are of a diverse nature, but it is measurable and can guide the overall analysis. In addition, this analysis will be accompanied by appropriate explanation of such events. Statistical analysis: The SSC will be analysed both quantitatively and qualitatively. The students will compare the scores that represent the needs (the coping levels) of each family over a period of time. The Null hypothesis would be that the interventions that are applied by HomeStart had no significant effect (i.e. are not associated with any evidence of improvement). The influence of any life events as well as the interventions that are applied are scored through the Hardiker level of need and would be analysed using the same tool. There will be opportunities to work alongside community health workers for example health visitors, and other community multiagency workers in the area. STUDENTS MUST HAVE OWN TRANSPORT

Is this project Research, Audit or Service Evaluation or other: Service Evaluation

Nature of Project: Clinical

Number of students who can undertake this project: 3

Opportunities to Present at Conferences:

58 | P a g e

------"Living with a Chronic Disease"" ------Institution: General Practices in CAV Department: General Practice Tutor: Dr Uroosa Kabeer

------Project Code: GPC01 ------Brief Project Aims: Aim of SSC:

To become aware of the presentation and management of chronic disease in primary care and the problems encountered from a population, community and especially an individual perspective.

Educational Objectives: At the end of the SSC the student will have: Gained an in depth and holistic understanding of a chronic condition. Gained an understanding of what its like to live with a chronic disease. Studied the factors that influence a patients utilisation of services available to them as well as those factors influencing compliance. Studied the interface between primary, secondary and social care. Enhance the ability to undertake an in depth self directed learning experience. Consider integration of knowledge from other areas of the medical curriculum.

Outline of SSC Activities: Patients with chronic disorders face a host of challenges in their daily lives. Students based in general practice will explore a common chronic disease in depth. The clinical impact of the disorder, its impact on the individual patients and the population will be examined. Also the interplay between the patient and their environment, professional care that they receive will be a part of the study. Students will be based in a General Practice and will have daily access to resources, tutor time and the support needed to conduct their SSC. Access to libraries and IT will be facilitated and support will be available for problem solving. There will be weekly organised theory sessions which may involve small group work as well as protected meeting with their tutors in practice. Further Info: A Student choosing this SSC will be expected to gather data relating to patients with Chronic Disease of their choice. The data could be qualitative or quantitative and they would need to adhere to the guidance given in the support session we plan for them during the 9 week SSC. These session are called " Designing your data gathering and Interpreting your findings" On the last but one day of their SSC, we hold a poster presentation. This has been historically very successful for some 15 years. Students spend 30 minutes presenting a few key slides on a power point. They are given the opportunity to speak about their projects, take questions from peers and other tutors. This we feel adds further colour to their written submissions and is a valuable part of their assessment.

59 | P a g e

Is this project Research, Audit or Service Evaluation or other: Service Evaluation

Nature of Project: Community

Number of students who can undertake this project: 7

Opportunities to Present at Conferences: Our SSC students often use their SSC work as a spring board to further their individual interest in a Chronic Disease or a specialty of medicine. They present not only to their peers but also to all the SSC tutors. In addition, the other attendees at this

60 | P a g e

------Audit of exacerbation frequency, inhaler prescribing and adherance to guidelines for COPD patients in Primary Care Cardiff and Vale ------Institution: GP practices in CAV Department: Respiratory Medicine Tutor: Dr Simon Barry

------Project Code: GPC02 ------Brief Project Aims: AIMS: 1. look at spiromtetric diagnoses of COPD 2. examine inhaler prescribing 3. record admission rates and exacerbation frequencies in primary care

Educational Objectives: OBJECTIVES: 1. Learn about audit and data collection in a primary care setting 2. Understand COPD pathways and local guidelines 3. Appreciate the cost implications of prescribing in common conditions such as COPD 4. gain experience in data analysis

Outline of SSC Activities: This is an ongoing audit of patients across 8 practices in CAV. Students will liaise with the lead respiratory GP, Dr Guy Marshall and be allocated to practices in the Vale or Cardiff. Data as per previous audits will be analysed on the same cohort of patients extracting information about spirometry, prescribing and exacerbation. Data will then be analysed and compared with the previous years

Is this project Research, Audit or Service Evaluation or other: Audit

Nature of Project: Clinical

Number of students who can undertake this project: 2

Opportunities to Present at Conferences:

61 | P a g e

------Outcome of a clinic-based monitoring programme for patients with solitary pulmonary nodule (SPN) ------Institution: royal gwent hospital Department: Tutor: dr Andreea-Alina Ionescu

------Project Code: RGW01 ------Brief Project Aims: To investigate the number of lung cancer vs. benign disease diagnosed in patients who had incidental findings of solitary pulmonary nodules (i.e. subcentimetre lung nodules) on thoracic CT and who have been monitored according to the radiological Fleischner international protocol. This is an audit of our practice against the Fleischner recommendations (internationally accepted)

Educational Objectives: - to understand the diagnostic process of lung cancer (according to the radiological appearance of lung nodules and the time dynamics of size and structure of the nodules) To investigate the number of lung cancer vs. benign disease diagnosed in patients who had incidental findings of solitary pulmonary nodules (i.e. subcentimetre lung nodules) on thoracic CT and who have been monitored according to the radiological Fleischner international protocol. This is an audit of our practice against the Fleischner recommendations (internationally accepted)- to understand the role of co-morbidities and the assesment of 'patient as a whole' when decissions on how to best monitor incidental radological findings are made - to gain insight into the role of smoking and occupational exposures when incidental lung nodules are diagnosed and monitored

Outline of SSC Activities: - assessment of the paper-based database kept by lung cacner service in the Gwent and investigate outcome over and 2 years - the student will put together a new electronic database of cases monitored for 2 years and of cases who are still actively monitored at present (up to 2 years) - if a lung cancer was diagnosed the outcome of treatment will be assessed from the local HB database (clinical work station) - the risk factors for each individual case will be studied and documented in the electronic database

Is this project Research, Audit or Service Evaluation or other: Audit

Nature of Project: Clinical

Number of students who can undertake this project: 1

Opportunities to Present at Conferences:

62 | P a g e

------Monitoring and management of multi-organ failure ------Institution: Cwm Taf UHB Department: ACT Directorate Tutor: Dr Tamas Szakmany

------Project Code: CWM01 ------Brief Project Aims: Multi-organ failure carries a high morbidity and mortality. Much improvement has been achieved in the last decade, however the real impact of new treatment strategies evaluated in randomised clinical trials is poorly understood. This project aim to evaluate the effect of numerous monitoring and management strategies recently embedded in critical care. In particular, the aims are: 1. Discover the real burden and outcome of multi-organ failure in an average district general hospital 2. Evaluate the effects of newly adopted treatment strategies, i.e. early intervention in sepsis, lung protective ventilation, use of corticosteroids, intensive insulin therapy, renal replacement therapy, choice of fluids etc outside the randomised clinical trial environment 3. Evaluate the different monitoring options in haemodynamic support, ventilatory, neurological and renal failure 4. Investigate the incidence and available treatment options for ICU induced delirium.

Educational Objectives: 1. To have an understanding of the pathophysiology of multi-organ failure 2. To be able to gather information from wide variety of resources including clinical information systems and various journals. 3. Summarise available evidence and put it into the context of real-life ICU setting. 4. Write an abstract for a local, national or international meeting 5. Experience the ICU environment and observe procedures 6. To interact with patients from a wide variety of backgrounds and different members of the ICU team

Outline of SSC Activities: 1. Literature review of the currently available evidence 2. Meta-analysis of the published trials if applicable 3. Retrospective service evaluation of the clinical practice, utilising the integrated clinical information system on the ICU 4. Participate in the educational lectures on pathophysiology and management of multi- organ failure 5. Write up the project with the view of presenting the findings on a local/national or international ICU meeting.

Is this project Research, Audit or Service Evaluation or other: Service Evaluation

Nature of Project:

63 | P a g e

Clinical

Number of students who can undertake this project: 2

Opportunities to Present at Conferences: So, essentially the answer to the question is yes, but there are a few proviso's as outlined above.

64 | P a g e

------Pathways of care taken in acute / critical care medicine ------Institution: Princess of Wales Bridgend Department: Anaesthetics Tutor: Dr Jonathan Williams

------Project Code: POW01 ------Brief Project Aims: Introduce students to patient safety / crew resource management concepts. Focus on patient care being a team concept.

Educational Objectives: Knowledge / Understanding : to show how best practice guidelines / care bundles are applied to patient care. Evaluate if health care professionals are adequately trained.

Outline of SSC Activities: The SSC is hospital based but will involve spending time with South Wales Fire Rescue Service and the Hazardous Area Response Team of the Welsh Ambulance Service Trust. Time will also be spent with myself as a Pre Hospital Care Doctor.

Is this project Research, Audit or Service Evaluation or other: Service Evaluation

Nature of Project: Combined

Number of students who can undertake this project: 2

Opportunities to Present at Conferences: within the UK there is the Current Choices Meeting of the FSRH

65 | P a g e

------Thrombolysis in acute stroke- using severity scales to determine decision making ------Institution: Nevill Hall Hospital Department: STROKE/COTE Tutor: Dr Richard Bella

------Project Code: NEV01 ------Brief Project Aims: currently protocols suggest not offering thrombolysis to very mild and very severe strokes. What is the evidence for this practice? And what are the outcomes for these patients who were excluded from thrombolysis.

Educational Objectives: The student will develop knowledge in hyperacute and acute stroke. Will also be familiar with stroke thrombolysis pathways, stroke severity scoring and stroke scales i.e FAST and ROSSIER scales. Neurological knowledge and neurology examination skills will improve. Knowledge regarding stroke mimics and how to identify stroke from non-stroke symptoms.

Outline of SSC Activities: 1. familiarise with stroke guidelines and standard stroke practise 2. be based on a stroke ward and learn to assess stroke thrombolysis patients with the specialist nurse and registrar. 3. learn about the thrombolysis indications and contra-indications 4. review retrospectively patients notes to see if the severity of stroke determined the decision to thrombolyse or not. 5. determine the outcome of such patients using case notes and/or GP records. 6. write up their findings backed by evidence and determine our compliance with current national guidelines and local pathways.

Is this project Research, Audit or Service Evaluation or other: Audit

Nature of Project: Clinical

Number of students who can undertake this project: 1

Opportunities to Present at Conferences:

66 | P a g e

------Palliative care: experience specialist palliative care and design an educational workbook for peers on a chosen palliative care topic ------Institution: Prince Charles Hospital, Ysbyty Cwm Cynon, Hospice of the Valleys Department: Palliative Care Tutor: Dr Dylan Harris

------Project Code: PCH01 ------Brief Project Aims: This SSC will allow the student to: > Experience specialist palliative care in a variety of settings (hospital, community, hospice and both NHS and charitable sector) and > Study a specific palliative care topic in detail to allow the student to design a short educational workbook for undergraduate medical students on that topic.

Educational Objectives: By the end of the SSC the student will: (a) Have the opportunity to develop knowledge and understanding of symptom management in palliative care and observe its application in clinical practice (e.g. management of cancer pain, management of nausea and vomiting, management of malignant spinal cord compression) through clinical exposure to specialist palliative care in a variety of settings (hospital, hospice, community) and for patients with a variety of life limiting diagnosis (e.g. cancer, motor neurone disease). (b) Have chosen a specific topic within palliative care to explore in detail and used the knowledge and understanding assimilated from their literature review to produce their SSC assignment and a short interactive educational workbook for undergraduate medical students on the chosen topic area. Examples of potential topics include: management of cancer pain; management of nausea and vomiting; management of palliative care emergencies (e.g. malignant spinal cord compression); treatment of anxiety and depression in patients with life limiting illness; management of the patient in the last days of life.

Outline of SSC Activities: The SSC will be structured with a timetable that provides a selection of clinical placements sessions in a variety of palliative care settings over the duration of the SSC, the other 50% of the timetable with be allocated to self directed learning time to allow the student to conduct their literature review and design their educational workbook. Examples of activities/sessions incorporated into the clinical component of the timetable: -Consultant palliative medicine/pain clinics in Ysbyty Cwm Cynon (Mountain Ash) or Prince Charles Hospital -Specialist palliative care multidisciplinary team meetings (in Ysbyty Cwm Cynon (Mountain Ash) with the NHS palliative care team and at Tredegar with the Hospice of the Valleys non- NHS palliative care team) -Consultant ward round in a specialist palliative care inpatient unit (Ysbyty Cwm Cynon, Mountain Ash)

67 | P a g e

-Home visits with a consultant or clinical nurse specialist in palliative care -Hospital visits with a consultant or clinical nurse specialist in palliative care (Prince Charles Hospital) -Home visits to observe a complimentary therapist -Palliative care register review meetings in general practice.

Is this project Research, Audit or Service Evaluation or other: Literature Review

Nature of Project: Combined

Number of students who can undertake this project: 1

Opportunities to Present at Conferences: c) Possibly British or european paediatric urology conference

68 | P a g e

------Audit of the new emergency laparotomy pathway in Morriston hospital ------Institution: Morriston hospital Department: Anaesthetics Tutor: Dr Rhidian Jones

------Project Code: MOR01 ------Brief Project Aims: Emergency laparotomy patients have a high mortality Recent mortality rates in Morriston revealed there could be some room for improvement in the peri-operative care of these patients A new perioperative pathway for these patients has been introduced Ongoing audit will reveal if this pathway is having beneficial effects of patient care

Educational Objectives: Knowledge and understanding: - clinical understanding of the treatment of sick laparotomy patient - an understanding of the importance of audit - an understanding of how to implement a quality improvement project Skills and competencies: - clinical time spent in theatre gaining anaesthetic skills - data collection and interpretation - opportunity of developing presenting skills Attitudes and behaviour: - a chance to develop a determine attitude towards quality improvement - develop a mature attitude to working in a clinical environment - the opportunity to develop team working skills

Outline of SSC Activities: Opportunity to attend routine and emergency surgical lists Attendance at monthly governance meetings Opportunities to analyse and collect data Presentation locally and nationally of results from the project

Is this project Research, Audit or Service Evaluation or other: Audit

Nature of Project: Clinical

Number of students who can undertake this project: 2

Opportunities to Present at Conferences: will be scope to present the project regionally and nationally hopefully

69 | P a g e

------Evaluation of complication rates of hypospadias surgery ------Institution: Morriston hospital Department: Welsh Centre for Burns and Plastic Surgery, Tutor: Mr Nicholas Wilson Jones

------Project Code: MOR02 ------Brief Project Aims: Evaluation of a common paediatric surgical procedure Compare to worldwide standards

Educational Objectives: Gain an understanding of paediatric plastic surgical practice in a major centre Gain an understanding of the evaluation of service delivery in a surgical practice Analysis and evaluation of a single procedure and the formation and management of a medical database Preparation and presentation of work at local and national meeting

Outline of SSC Activities: The student will be part of a multidisciplinary team with exposure to the whole remit of paediatric plastic surgical practice Evaluation of a procedure against national standards via retrospective note review Creation of database Presentation of work at local and national meeting

Is this project Research, Audit or Service Evaluation or other: Service Evaluation

Nature of Project: Clinical

Number of students who can undertake this project: 1

Opportunities to Present at Conferences: a) South West UK regional plastic surgery audit meeting

70 | P a g e

------Obesity in Adults ------Institution: Ysbyty Aneurin Bevan Department: Tutor: Dr Nadim Haboubi

------Project Code: YAB01 ------Brief Project Aims: Auditing morbidly obese patients with various comorbidities in a multi-disciplinary setting

Educational Objectives: To acquire in-depth knowledge on the conservative management of obesity. This would include sessions with the doctor, dietician, nurses, counselor, and physiotherapist.

Outline of SSC Activities: Regular attendance of a weekly clinic, which is multidisciplinary. The student will acquire comprehensive knowledge of motivational interviewing and lifestyle modifications. Auditing weight loss maintenance in subjects attending the clinics over 18onths Further Info: The 3rd year medical students would attend the Specialist Multi Disciplinary Weight Management Clinic, which is Level 3 of the Wales Government's Obesity Pathway. The service is based on a 1:1 interviewing. Therefore the students would have to join all members of the team which comprises, the specialist nurse, the specialist dietician, specialist doctor and specialist psychologist. Which project the students will be allocated to is optional and he or she will be given the chance to choose whether to do patient surveys or audits or literature review etc. The students will be expected to attend this once-weekly clinic all day on a Thursday. The clinic is located in Ysbyty Aneurin Bevan Hospital, Ebbw Vale. It is desirable but not mandatory that the student get in touch with the tutor to discuss and choose a project suitable to progress their interests. This has been useful in the past because of the time limit available for the students to finalise their projects. We have had excellent feedback from students in the past. .

Is this project Research, Audit or Service Evaluation or other: Audit

Nature of Project: Clinical

Number of students who can undertake this project: 1

71 | P a g e

Opportunities to Present at Conferences:

72 | P a g e

------Law and Medical Ethics ------Institution: Bangor University - School of Medical Sciences Department: North Wales Clinical School Tutor: Dr Rossela Roberts

------Project Code: BU04 ------Brief Project Aims: The advancements in knowledge and medical practice derived from the implementation of research findings are not without their share of controversy. They often require a grasp of medical ethics and the law, forming part of good clinical practice, and supporting sound decision-making, communication and effectiveness. The aim of this module is to present the most common ethical and legal issues relating to medical treatment, the fundamentals of human rights and medical practice, issue of consent, capacity, refusal and withdrawal of treatment, negligence, futility and duty, confidentiality.

Educational Objectives: To familiarise students with the legal and ethical implications of the doctor-patient interaction. Introductory module • To survey international ‘codes’, and a range of legal and ethical approaches to a list of core concepts in medical practice, including ‘duty’ and ‘utility’; • Explore the definitions and limits of concepts of autonomy and personhood as central, guiding, and often determinative principles; Consent module • To provide an understanding of the meaning and importance of ‘competence’ and ‘consent’ as concepts in law and clinical practice, including the role that consent plays in medical negligence cases; • Appreciate the circumstances in which consent issues typically arise, how they differ depending on the type of patient, and the factors that limit ‘lawful’ medical intervention in the absence of consent; and • Explore the consequences of providing non-consensual treatment in the face of objection, how the presumption of capacity operates, and the potential for uncertainty in determining whether to override a patient's expressed wishes. Refusal & withdrawal of consent • Explore the fundamental principle of the 'right' to refuse medical treatment, and is followed (like in the previous consent module) by what is entailed in judging the competence to refuse (or in law, the 'legal capacity') of adult patients and minors. You will also come to discover that the nature of the subject of refusing medical treatment (especially in relation to incompetent patients, and due to its potentially fatal consequences) means that the standards, tests and principles are often much more complex than the ones we explored in the 'positive consent' and 73 | P a g e

'standard' case. • Investigate the position of the unborn child and the terminally ill patient as examples of situations where law, ethical systems, and human rights questions arise in a practical setting. Negligence module • To survey the basic legal elements in negligence actions in the context of medical mishaps, including the meaning of the duty of care, and the duty to disclose; • Discuss the different standards of care expected, and the separate standards for information disclosure, which establish whether a breach of duty has occurred; and • Consider the possible defences that are available to a 'civil law' claim, and look at the related area of criminal negligence. Confidentiality module • To consider the nature of the concept of confidentiality, the reasons which support its maintenance, and the sources and content of the duty in legal and ethical terms; • Examine the role of the law in imposing sometimes conflicting obligations on medical professionals, as part of the legal process (doctors as witnesses), and in relation to the disclosure and protection of patient information more generally; and • Assess how conflicting obligations and duties regarding the protection of patient privacy, and the facilitation of public access to information, might be resolved. Mental capacity and mental health •To explore the ethical and legal approaches to when and why compulsory measures may be used for people with mental disorders; •Examine ways in which the law attempts to preserve both patient autonomy and ‘best interests’ in situations of temporary or permanent incapacity; and •Consider ways in which the law balances the rights of the individual suffering from a mental disorder, with the interests of the public.

Outline of SSC Activities: investigate legal and ethical issues in clinical practice (develop an understanding on how the theoretical issues described above apply in clinical practice) Further info: students will be attending weekly teaching sessions and a number of seminars and problem solving based learning activities; these are complemented by clinical experience work on a hospital ward where they can see how the legal aspects surrounding patient care underpin medical care (e.g. stroke ward to understand how the decision to withdraw/withhold medical care, nutrition and hydration is made and how are the legal considerations approached)

Is this project Research, Audit or Service Evaluation or other: lit review with practical application

Nature of Project: Skills

Number of students who can undertake this project: 8

74 | P a g e

Opportunities to Present at Conferences: There are no barriers to presentations and the student is supported in preparing the material if required. (but we do not have an upcoming local conference where this can be presented)

75 | P a g e

------Clinical - Radiological correlations in neurological disorders ------Institution: Bangor University Department: School of Psychology Tutor: Dr Giovanni d'Avossa

------Project Code: BU01 ------Brief Project Aims: The main methodology to localize, along the neural axis, the sites of parenchymal injuries associated with specific clinical syndromes, has been the correlation between clinical observations, obtained at the bedside, and post mortem examinations, since the inception of modern Neurology. The availability of high resolution, non invasive imaging techniques has allowed the precise localization of parenchymal injuries in vivo, obviating the need, at least for some pathologies, to obtain autopsies. The tutor has been collecting detailed assessment of cognitive, motor and sensory functions as well as high resolution, magnetic resonance imaging scans in cohorts of patients with cerebrovascular disease and traumatic brain injury. The goal is to localize brain areas where lesions lead to specific neurological impairments. The rotators are expected to help with the analysis of the clinical, behavioural and imaging data.

Educational Objectives: OBJECTIVES: 1) Become familiar with the assessment of cognitive function in neurological patients. 2) Be proficient in the use of brief, common instruments for the assessment of cognitive function. 3) Gain familiarity with brain anatomy. 4) Be able to recognize major cerebral landmarks on standard neuroradiological scans 5) Be able to differentiate parenchymal injury from healthy tissue in standard neuroradiological scans and recognize some common pathologies

Outline of SSC Activities: STUDENT ACTIVITIES DURING PROJECT: 1) Attend weekly neuroradiology reviews conducted by the tutor. During these meetings the tutor reviews all the brain scans performed at Bangor Hospital over the previous week 2) Attend and help with bedside assessment of prospective research participants in the Stroke Unit 3) Attend and help with research assessment of patients and controls, carried out in the School of Psychology 4) Review clinical neuroimaging scans autonomously 5) Review and analyse research neuroimaging scans 6) Perform data analysis using common statistical procedures

Is this project Research, Audit or Service Evaluation or other: Research

76 | P a g e

Nature of Project: Combined

Number of students who can undertake this project: 2

Opportunities to Present at Conferences:

77 | P a g e

------Time to Spare? Time & Motion study in Acute Medicine ------Institution: Bangor University Department: Medicine Tutor: Dr Chris Subbe

------Project Code: BU02 ------Brief Project Aims: Acute Medicine is the specialty dealing with the majority of emergencyadmissions to hospital: establishing a diagnosis, starting treatment,stabilizing and discharging. For a specialty that relies so much on slickrunning of operations there is an astonishing dearth of literature on howto organize services in a time efficient way. As the likely consequence1000s of hours of time are wasted. More importantly essential treatment isoften delayed. The purpose of the project is to observe teams in real time, trackmovements, timing and suggest a better lay-out of processes as a result.

Educational Objectives: 1. To understand the time sensitive nature of acute illness 2. To describe the working of teams on the Acute Medical Unit 3. To apply industrial time & motion tools to Acute Medicine 4. To engineer time efficient processes

Outline of SSC Activities: The student will be based for the project on the Acute Medical Unit of theYsbyty Gwynedd. The AMU admits over 800 patients per months with a broadrange of conditions from pneumonia, to myocardial infarction, to diabeticketoacidosis, stroke, sepsis, etc etc.The student will take part in the Acute Medical Take to become familiarwith processes; the student will then perform a time & motion analysis ofthe timing and movements of staff on the unit. This will be followed byanalysis of time and movement that is "wasted" due to inefficientorganization and lay-out of the ward.The final part of the project is a proposal for changes in the set-upincluding a review of patient documentation, office space, task allocationetc. If successful the results from the project will be presented at theInternational meeting of the Society for Acute Medicine.

Is this project Research, Audit or Service Evaluation or other: Service Evaluation

Nature of Project: Clinical

Number of students who can undertake this project: 2

Opportunities to Present at Conferences:

78 | P a g e

------A Critical Age - How to decide whether an elderly patient is "fit" forIntensive Care ------Institution: Bangor University Department: Medicine Tutor: Dr Christian Subbe

------Project Code: BU03 ------Brief Project Aims: Acute illness strikes particularly hard in elderly people. But can theyrecover? Critical illness is something that affects every organ system and drainspatients of strength and energy. Many take months to get back to theirnormal self and some do never return to full active life. This makes thedecision to admit somebody to Intensive Care more complex in those withlimited strength at the start of this journey. Additionally in the UK critical care capacity is seriously limited. Thisputs additional responsibility on those clinicians referring and admittingpatients to ICU to select patients that are likely to benefit. While age is often used as a surrogate for life expectancy and likelyquality of life after critical illness, other factors might affect patientsprospects to a much stronger degree: mobility, mood, the fact that theyhave friends, a hobby, a partner... The SSC project aims to explore how the literature on prognostication ofelderly patients can be applied to the local patient population. Theproject is likely to form the foundation for an epidemiological researchprogram with colleagues of the Welsh Society for Intensive Care Medicine toimprove clinical decision processes and base triage of patients on more objective criteria.

Educational Objectives: 1. To understand the impact of serious illness on patients quality of life. 2. To describe the rationale and principles of organ support in criticalcare. 3. To appreciate and assess the different impact of age in differentpatients. 4. To assess patients frailty using a number of published tools. 5. To be able to explain the pros and cons of intensive care admission indifferent patient scenarios. 6. To explore the ethical dimension of applying critical care medicine.

Outline of SSC Activities: The project will involve a 4 week clinical placement on the Intensive CareUnit of the Ysbyty Gwynedd and work with faculty from Bangor University. Bangor University is home to one of the UKs leading faculties forPsychology and Sport Sciences. The student will establish contacts withmembers of the faculties to explore themes of recovery from illness. The student will undertake a literature review of factors influencing recovery from critical illness and empirical tools measuring the capacity to recover. The student will apply these tools from the literature in a number of casestudies and explore feasibility of pathway design in the Intensive Care Environment and pre-Intensive Care Environment on General Wards. If successful the SSC will lead to a poster at national Intensive Caremeeting (this has been the case for the last two years). Further info re timeline: 1 week of introduction and review of literature

79 | P a g e

6 weeks in clinical environment 2 weeks for writing of final report The tutor meets the Students every Monday (lunchtime) and Thursday (pm) and on other days as needed.

Is this project Research, Audit or Service Evaluation or other: Service Evaluation

Nature of Project: Clinical

Number of students who can undertake this project: 2

Opportunities to Present at Conferences:

80 | P a g e

------Airway management - principles & practice ------Institution: Ysbyty Gwynedd Department: Anaesthetics Tutor: Dr Declan Maloney

------Project Code: YGH01 ------Brief Project Aims: Spend time in theatre learning basic and advanced airway techniques Complete airway related project

Educational Objectives: The med student by end of the project will 1 be able to manage a basic airway - bag mask ventilation 2 insert successfully an LMA 3 intubate 4 get acquainted with more advanced techniques such as videolaryngoscopy 5 produce a project related to airway management

Outline of SSC Activities: Rostered time in theatre fully supervised Videoscopes allow remote supervision by the consultant so the medical student will be able to practice these advanced techniques Time allowed to practice with manikins with option of simulation

Is this project Research, Audit or Service Evaluation or other: Service Evaluation

Nature of Project: Clinical

Number of students who can undertake this project: 1

Opportunities to Present at Conferences: some of the medical students that have come to us have been successful at getting poster presentations at national anaesthetic meetings and been published

81 | P a g e

------Medical Simulation and Resuscitation Training ------Institution: Ysbyty Gwynedd Department: Anaesthesia and Resuscitation Training Tutor: Dr Suman Mitra

------Project Code: YGH02 ------Brief Project Aims: 1) To learn principles of medical simulation training. Write a scenario for use with Simman and help run training sessions. 1) Assist in teaching / training sessions as member of resuscitation training department. 2) Shadow 1st on-call anaesthetist to gain experience in resuscitation, airway skills and care of the acutely unwell patient.

Educational Objectives: 1) Allows student to develop an interest in teaching, training and medical education. 2) Introduces student to simulation training which is becoming an increasingly important part of undergraduate and post-graduate education. Student will learn how to use the simulator (Simman), write a new scenario and use it to help train fellow students and F1 doctors. 3) To appreciate the importance of “human factors” in medical training. 4) Student can develop their own teaching skills by joining the resuscitation department and assisting in teaching and training sessions. 5) Student will gain experience of resuscitation and care of the acutely unwell patient by shadowing the first on-call anaesthetist.

Score SSC in relation to following objectives: 0 – does not meet objective 1 – partly meets objective 2 – fully meets objective The SSC goes beyond core teaching 2 The SSC allows students to study in depth 2 The SSC allows students to study areas of particular interest to them 2 The SSC provides students with insights into scientific methods 1 The SSC engenders an approach to medicine that is questioning and self-critical 2 The SSC provides students with a wide range of choice 1

Outline of SSC Activities: SIMMULATION TRAINING YOU WILL BE ATTACHED TO THE ANAESTHETIC DEPARTMENT, WILL BE INTRODUCED TO THE SIMMULATOR AND WILL ASSIST IN SESSIONS RUN FOR STUDENT DOCTORS, FOUNDATION YEAR DOCTORS AND TRAINEE ANAESTHETISTS. YOU WILL COMPILE A SCENARIO OF AN ACUTELY UNWELL PATIENT TO BE RUN ON THE SIMMULATOR, COMPLETE WITH A SET OF CASE NOTES AND ALL NECESSARY CHARTS. THIS IS A GOOD EXERCISE IN LEARNING ABOUT RECOGNITION AND TREATMENT OF ACUTELY UNWELL PATIENTS. YOUR SCENARIO WILL BE ADDED TO OUR BANK OF SCENARIOS FOR TRAINING.

82 | P a g e

WE ARE PARTICULARLY KEEN THAT YOU LEARN THE IMPORTANCE OF TRAINING IN “HUMAN FACTORS”. BY HUMAN FACTORS WE MEAN FOR EXAMPLE, COMMUNICATION, CO- OPERATION, TEAM BUILDING, LEADERSHIP, SITUATIONAL AWARENESS AND DECISION MAKING. THE SIMMULATOR IS VERY USEFUL IN TEACHING THESE VITAL SKILLS. RESUSCITATION TRAINING YOU WILL ALSO BE ATTACHED TO THE RESUSCITATION DEPARTMENT WHERE YOU CAN DEVELOP YOUR TEACHING SKILLS BY ASSISTING IN TEACHING AND TRAINING SESSIONS IN BLS AND ILS (INTERMEDIATE LIFE SUPPORT). THERE MAY ALSO BE A CHANCE TO ASSIST WITH OTHER COURSES SUCH AS ALS, APLS AND ATLS. SHADOWING FIRST ON-CALL ANAESTHETIST THIS WILL ALLOW YOU TO GAIN EXPERIENCE IN RESUSCITATION AND RECOGNITION AND TREATMENT OF THE ACUTELY UNWELL PATIENT. YOU WILL BE ENCOURAGED TO DO THIS AS OFTEN AS YOUR TEACHING COMMITMENTS ALLOW.

Is this project Research, Audit or Service Evaluation or other: Research

Nature of Project: Clinical

Number of students who can undertake this project: 1

Opportunities to Present at Conferences:

83 | P a g e

------The Use of Modern Non Invasive Imaging in the diagnosis and Management of Heart Disease ------Institution: Ysbyty Gwynedd/Ysbyty Glan Clwyd Department: Computing and Engineering Tutor: Prof Michael Rees

------Project Code: YBH03 ------Brief Project Aims: To introduce medical students to a range of modern cardiac imaging modalities including nuclear medicine, magnetic resonance imaging, computed tomography and echocardiography. To demonstrate the relevance of thee imaging techniques in the management of patients with cardiac disease To give students an insight into t how patients who undergo invasive treatment for coronary disease benefit from targeting therapy to individual patients by the use of non invasive imaging. Students will also have some exposure to invasive cardiology at the Ysbyty Glan Clwyd catheter laboratory.

Educational Objectives: Students will be introduced to principles and practice of modern non invasive cardiology and invasive cardiology. They will gain knowledge of the objective use of imaging information in the workup of patients and how this information helps decision making in patient treatment. Students will have exposure to a range of patients with cardiac conditions in a ward and outpatient setting and how patients presenting with acute cardiac conditions are investigated and treated. Students will be able to develop competencies in patient history taking and examination for cardiac disease. The project will also involve critical examination of the literature in cardiac imaging topics and evaluation of NICE guidance.

Outline of SSC Activities: Students will spend time in the radiology department at Ysbyty Gwynedd where they will observe and discuss imaging of the heart by MRI, nuclear medicine and CT. there will be an opportunity to observe cardiac echo . Students will be able to spend time either or both in the X Ray department and the cardiology department in Ysbyty Gwynedd. There will be some seminars involving critical evaluation of literature and scientific writing at Bangor University and the opportunity to meet imaging scientists in the department of computing at Bangor University There will be the option to spend time observing invasive procedures in the cardiac catheter laboratory at Ysbyty Glan Clwyd and to interview patients undergoing these procedures. There will be support to write up the project by a senior member of academic staff

84 | P a g e

Is this project Research, Audit or Service Evaluation or other: Service Evaluation

Nature of Project: Clinical

Number of students who can undertake this project: 5

Opportunities to Present at Conferences: With regard to this project there will be opportunities to present the findings at meetings. These may be local or national meetings such as the All Wales audit meeting for cardiovascular disease, the north Wales cardiac meetings, or other UK meetings such

85 | P a g e