As the COVID-19 pandemic unfolded in early March it became clear that our medical students could form a key role in providing support to local communities via volunteering their services to GP Practices across North West London. The Undergraduate Primary Care Education Team set up an innovative new medical student volunteering scheme which has to date allocated 70 individual students to 45 GP Practices who expressed the need for volunteers to help during the COVID-19 pandemic.
Students from across the MBBS years came forward to be part of the scheme, many of whom were still carrying out their studies and preparing for their end of year exams, but were keen to find the time to devote some hours each week to support GP Practices across North West London.
The medical students undertook a variety of activities whilst in the practices, ranging from manning the practice telephones in reception, processing repeat prescriptions and delivering medications, telephone triage of patients, calling vulnerable and isolated patients plus working with practice based link workers in the community.
The scheme is still running for medical students in years 1-3 who can continue to volunteer until nearer to the start of the new academic year, and we are still finding that new recruits are coming forward to help.
Medical students have commented on how much they have learnt from the experience, how they have felt able to contribute towards the national emergency efforts and importantly how much of an impact they were able to make to the lives of vulnerable and isolated patients during the COVID-19 pandemic.
‘You’re on an OOPE? What’s that?’ Frequently asked this question over the past 12 months by colleagues, students, family and friends, occasionally it has been all too easy for us to fall back on the automated response – ‘we’re taking a year out of GP training to work in medical education’, and leave it at that. In reality, the insights gained and lessons learned over this past year have formed a significant part of our postgraduate training in themselves. Here we expand and reflect on our Out Of Programme Experience (OOPE); a year-long full-time post as Medical Education Fellows within the Undergraduate Primary Care Education Team at Imperial College London.
Generally granted for a period of up to 12 months, an OOPE does not count towards the Certificate of Completion of Training (CCT) but provides a valuable opportunity for postgraduate trainees to gain experience in areas outside the curriculum of their chosen specialty. In 2019, as GP-trainees fast approaching CCT, we were keen to build on previous extra-curricular teaching and learning experience and further develop skills that could be applied to our future careers; with primary care a prime environment from which to facilitate authentic undergraduate learning experiences, there is a demand for community clinicians that are willing and able to actively engage in medical education. Despite this, little (if any) formal training exists within the postgraduate GP curriculum. We therefore sought to temporarily pause our GP training and apply for this post, enabling us to pursue these interests further.
Fully immersed within the Primary Care department, we have been involved in a wide range of educational activities (Figure 1). Alongside the regular delivery of departmental teaching sessions across all years of the MBBS, we have engaged in assessment and feedback practice, course evaluation, curriculum development and medical education research, simultaneously undertaking postgraduate qualifications in teaching and learning ourselves.
We feel lucky to have been supported by a dynamic team that is passionate about general practice, continually striving to deliver meaningful undergraduate learning experiences. Beyond developing practical skills in teaching and learning, we have gained insight into the value of true collaborative working – between students, faculty and the community and across different courses and institutions both nationally and internationally. Building on this, it has been exciting to be part of innovative departmental projects that are underpinned by socially accountable values and evidence-based practice; amongst others, specific examples include two pilot Longitudinal Integrated Clerkships (Year 5 Longitudinal Community Clerkship and Year 6 F-Zero), the Widening Access to Careers in Community Healthcare scheme, and the Year 3 Community Action Project response to COVID-19.
Taking a step back from the demands of clinical work and focussing on medical education in this way, we have gained valuable perspective on the symbiotic relationship that exists between the two areas of practice – core knowledge and skills acquired from each one enhancing everyday practice in the other. As we prepare to return to our final year of GP training, we feel empowered to actively seek and maintain a balance between the two fields in our future careers. The OOPE year has been invaluable in our development as general practitioners, looking to guide and inspire the next generation of tomorrow’s doctors. To all of you that have guided and inspired us over the past 12 months – thank you.
Third-year medical students partnered with community, voluntary, health & social care leaders to respond to local needs in the era of COVID-19
Twenty-five third-year medical students volunteered to take part in the normally compulsory part of their degree. All have worked with their partner organisations remotely via video-conferencing. Faculty connected early on with healthcare commissioners and community leaders to identify needs and assets, meaning that our students were well-placed to get involved and bring innovative ideas to important initiatives.
Dr Nina Dutta said: “Medical students across the world have been able to come together and work with community leaders to address pressing local needs.”
The seven different projects were ongoing over a period of ten weeks, and range from partners as varied as Queens Park Rangers (QPR) in the Community Trust to local community groups and voluntary organisations such as the Community Champions, Sobus, Healthy W12, the BME Health Forum and Healthwatch CWL.
Students taking part in the project also had the opportunity to discuss their plans with international thought leaders, and West London Health Partnership has funded some of the promising projects.
Nafsika Thalassis, the Director of the BME Health Forum, reflected: “The best thing about it was how you found out what was important to the community leaders. As a result, we were doing a project that we thought genuinely mattered.”
Student Shaper Ray Wang added: “What I think makes this type of work more meaningful for the local people and the people involved, is to have a problem and then have some sort of open-ended discussion around how do you go about solving that problem in a way that works for you rather than an idea that works for people that might be sitting in the office suite.”
Communities and medical students tackle health inequalities together
Dr Nina Dutta, course lead in the School of the Public Health, said: “Our students have admirably risen to the challenge of identifying and addressing the needs of the College’s local community. Although this term, currently a voluntary part of their programme, we’ve had a great response to the project. The undergraduate medicine MBBS course has had to shift to delivering education online response to the pandemic. This has posed challenges due to the inherent hands-on nature of healthcare, however the digital community action project has been a successful example of this transition. Here medical students across the world have been able to come together and work with community leader to address pressing local needs. We’re looking forward to learning lessons from this experience, and hopefully being able to see all our students and community partners in person again soon.”
Presenting their projects remotely to their peers on 6 May, one student group’s ‘Community Action Project’ (CAP) has built on past work by the Community Champions Programme and QPR in the Community Trust. The need for the project was identified by the Champions and the Trust early on, with their respective profiles, community and social media reach being key to the project’s sustainability.
The Addison Community Champions and representatives from QPR in the Community Trust are now preparing to create and deliver resource packs for one hundred vulnerable families living in the London borough of Hammersmith and Fulham. The packs will provide items to support children and young people’s creativity and emotional well-being during the COVID-19 pandemic, including recipe books and exercise ideas, mental health support, mood journals, arts and crafts materials, and signposting flyers designed by Imperial students.
Barbara Shelton, Project Manager at Addison Community Champions, said: “This is my third year of being involved with Imperial community projects. The students were wonderful. Many have never set foot in a community centre before and don’t necessarily recognise what they’re there for, so that learning experience is always useful. Especially in times like these the medical profession needs to recognise that community leaders are an asset. If students can have those interactions at this early stage of their career, it will change the way they view their communities forever. For our part as community partners, one of the biggest lessons we learn from the students is how to better showcase the work we do, and how we can tackle social inequalities together.”
Another student group, working with the BME Health Forum Director and West London CCG, created accessible, captioned videos in multiple languages (English, Farsi, Sylheti, Kurdish, Somali, and Arabic) to reassure communities in North West London that NHS services continue to be safe to use during the pandemic. Targeted especially to meet the needs of BAME communities, the videos will be shared via community leaders and social media platforms, particularly on WhatsApp and Facebook.
Student Abi Mahendran said: “With A&E attendance 30% lower than in normal times, and with 4% of Londoners not speaking English well, we knew this might be a useful project. We originally had a shortlist of languages we wanted our videos to be translated into, but we’ve found the communities we’re working with are even more diverse and require additional translations. Hopefully we’ll have the opportunity to put plans in place to publish even more videos.”
All seven projects were taken forward owing to the College’s commitment to continue delivering on its educational mission during the social distancing measures introduced in a number of other countries across the world.
Bethany Golding, Community Collaborations Lead in the School of Public Health, said: “It has been really impressive to see how students and community leaders have come together under challenging circumstances to work on targeted projects that could make a real difference. It was great to work with West London Health Partnership in bringing down funding for these projects where needed, and I am grateful to our inspiring community partners who worked so hard to connect our students with the voices of communities, and are now taking the projects forward. As a Faculty we should be very proud of our students’ engagement with community needs at a very challenging time.”
Third-year medical students Nadia Zaman and Kim Alipio undertook a CAP exploring how global examples of asset-based community development (ABCD) could help to proliferate community-led COVID-19 related initiatives in Hammersmith and Fulham, Hounslow and Ealing. Nadia said:
“Undertaking the Community Action Project opened my eyes to the challenges faced by different groups in society. Having grown up in London my whole life, doing this research made me more aware of how social determinants of health can impact on residents’ quality of life in different boroughs. I learnt the importance of community collaboration and how great work can be done when communities and organisations come together with the common goal of changing lives for the better.”
Kim noted how the CAP had affected him on both a professional and personal level: “Participating in the CAP has shown to me the affirmative and inclusive aspects of engaging with the community, where anyone and everyone can thrive by working together to achieve common aspirations. Everything I have learnt throughout this project, I will take away and keep close to my heart not only as a medical student, but as a person as well.”
The CAP module is just one of a number of learning experiences created by Imperial’s Undergraduate Primary Care Team in the School of Public Health that are intended to encourage students to collaborate, engage with the communities in which they’re living and working, studying and working in, and gain an authentic understanding of what it means to be a medic in the modern world.
Congratulations to several members of the Undergraduate Primary Care Education team who were nominated by students for the 2020 Imperial College Union Student Choice Awards.
Dr Arti Maini, Deputy Director of the Undergraduate Primary Care Education Team, received the Award for Outstanding Student Partnership. This award is given to an individual with a student-centred mindset who embraces all aspects of student-staff collaboration from co-creation to co-evaluation. The students who nominated Arti commented that she demonstrates ‘a true understanding of the student perspective and goes above and beyond to create space for them to express their opinions. She is able to create a symbiosis between staff and students.’ Arti is an inspiration for all who she works with and this award is appropriate recognition of her hard work and dedication to students and faculty.
Dr Camille Gajria, Teaching Fellow within the Undergraduate Primary Care Education Team, was shortlisted for the Award for ‘Outstanding Professional Support Staff’. The panel were impressed with how Camille was able to apply her knowledge as a GP to help her students. She was recognised particularly for her engagement and student-centred approach with the Imperial GP Society.
Dr Nichola Hawkins and Dr Nina Dutta were nominated for Student Choice Awards for Outstanding Teaching. Nichola is an out of programme GP trainee in the department and Dr Nina Dutta leads the Year 3 MICA course.
Bethany Golding, community collaborations lead, was nominated for an award for Outstanding Student Partnership. This is particularly impressive as Beth joined the department in January. In the few months she has been here, she has been able to forge important collaborative relationships with students and community to develop our undergraduate courses such that they are better able to target the assets and needs of our local community.
Thank you to all of our students for their nominations and we look forward to continuing these hugely valuable collaborative relationships.
Since 2017, the Widening Access to Community Careers in Healthcare (WATCCH) programme has hosted over 100 individuals from diverse and disadvantaged backgrounds who are interested in a career in healthcare. The programme aims to support young people in making informed career choices, raise their aspirations and facilitate access to healthcare careers. Previous participants having gone on to take up offers on a wide range of healthcare-related degrees; amongst others, these include Dentistry, Nursing, Audiology, Biomedical Sciences, Pharmacy, Psychology, Radiography, Neuroscience and Medicine.
The 2019/20 WATCH programme has supported 40 students with primary care work experience and educational workshops, including multi-professional healthcare panel question and answer sessions and admissions workshops including personal statements and mock Multiple Mini Interview (MMI) circuits. This year’s programme has also included a mentoring scheme, whereby WATCCH participants are linked to current Imperial College School of Medicine (ICSM) student volunteers that have received training in coaching and mentoring. As the 2019/20 WATCCH programme comes to an end, our online closing event will focus on preparing students for the transition to life in higher education via a practical introduction to coaching, led by Dr Arti Maini, and talks spanning mentors’ ‘top tips’ on finances, accommodation, study skills and student welfare.
Looking ahead to 2020/21, we are committed to delivering a valuable WP programme despite the challenges posed by the COVID-19 pandemic. Applications are now open (until 27/06/2020) to eligible students as we begin to plan an innovative series of interactive online workshops accompanied by remote student mentoring. Using technology to our advantage we hope to expand the online programme to accommodate a higher number of students across the UK and also collaborate with a wider range of healthcare professionals. Evaluation of the programme also continues via the Higher Education Access Tracker (HEAT) and the Medical Education and Research Innovation Centre (MEdIC) based within Undergraduate Primary Care Education Team in the School of Public Health. As well as evaluating the programme from the perspective of student participants, we are also interested in the impact of near-peer WATCCH mentoring on the personal and professional development of mentors themselves.
Once again, we would like to thank all of the student participants, schools, teachers, and our Imperial WATCCH mentors for the enthusiasm and dedication that they bring to the programme.
Quote from student in the current WATCCH 2019/20 cohort:
“The WATCCH programme was fantastic in helping me secure medical school offers by firstly providing a week of general practice work experience. This was a valuable opportunity to shadow healthcare staff that could be included in my personal statement and discussed in the interview. There was a focus on reflective learning following the GP placement and then there was helpful support in the personal statement as well as practice MMI mock interviews. These sessions overall strengthened my medical school application by improving my confidence at every stage of the UCAS application process.”
by Dr Nicky Hawkins, Dr Nina Dutta, Dr Neepa Thacker and Dr Arti Maini
The Undergraduate Primary Care Education Team leads on the delivery of a wide range of courses across the six years of the Imperial MBBS programme. On March 14th 2020, the medical school announced the suspension of all face-to-face undergraduate clinical placements in light of the COVID-19 pandemic. With major implications for two of our key primary care courses – Year 3 Medicine In the Community Apprenticeship (MICA) and Year 5 General Practice and Primary Healthcare (GPPHC) – we were tasked with the rapid conversion of these face-to-face clinical attachments into courses that could be developed and delivered entirely remotely.
Traditionally, both MICA and GPPHC are centred around medical students observing and assisting doctors in an authentic clinical environment, regularly engaging in meaningful interactions with patients themselves. The team therefore sought to capture the complexities of this learning environment, ensuring that we were adequately addressing the educational needs of our students. Here we describe and reflect on selected key components of the digital MICA and GPPHC courses, sharing some of the lessons learned from our students along the way.
Large group live webinars. Alongside other webinars, both MICA and GPPHC digital courses incorporated weekly live ‘Case Rounds’; webinars centred around clinical cases and questions, circulated to students in advance. Attended by up to 140 students, interactivity was integral to these webinars and maintained by actively encouraging students to submit questions and answers via the ‘chat’ and utilising real-time voting applications such as Mentimeter. Student feedback on live webinars in general was overwhelmingly positive. It was interesting to hear them repeatedly describe feeling liberated to interact more freely, due to the anonymity of the online format; it appeared to create a more inclusive environment for students whilst retaining engagement and learning value.
“I like this format because I feel more comfortable to engage and interact compared to face to face. Makes it feel safe knowing that we can contribute without other students knowing it’s me giving that answer…I felt more engaged and switched off less. I think it’s a good idea which should be incorporated more for future years.” Year 3 MICA student
Small-group history taking sessions. Recognising the need for peer-peer interaction, and a platform to actively promote development of students’ consultation skills, both MICA and GPPHC held history taking sessions using Zoom’s breakout room function to facilitate interactive small-group work. This enabled role-play of a range of primary care scenarios. Students rated the session highly, commenting on the value of real-time personalised feedback from both tutors and their peers.
“It was a good opportunity to socially connect with colleagues remotely and undertake some peer-to-peer learning.” Year 5 GPPHC student
Self-study e-learning resources. Alongside timetables of live sessions, an online package of learning materials mapped to core curriculum content was made available to both MICA and GPPHC cohorts, combining internally created resources and external resources that had been quality assured by the team. Well received by students, this was available to access remotely in their own time, at their own pace, promoting asynchronous online learning.
As a team, we have rapidly upskilled in our digital capabilities to deliver innovative online learning across a range of formats. It is exciting to pause and reflect on what has been achieved in such a short space of time. We have also had the opportunity to collaborate with colleagues in Melbourne University who have been leading a similar radical change to digital delivery of medical education. This collaboration has led to shared learning and innovation, which has led to a acceptance of a joint publication in The Clinical Teacher.
Drawing on the valuable lessons learned, we are looking to develop these digital course components further as we approach the start of the new academic year. Although students will be returning to clinical placements, it is clear there will remain an important role for digital learning strategies alongside more traditional placement teaching.
We are delighted that Dr Nina Dutta is the recipient of this year’s Imperial President’s Award for Excellence in Teaching.
Nina’s commitment to promoting excellence, diversity and inclusion has driven her outstanding work in education. She has taken core values of education and social justice into the very heart of how she provides leadership, promoting an inclusive culture for students, faculty, patients and wider community.
Nina is the Lead for the Year 3 undergraduate Medicine in the Community (MICA) course, Diversity and Inclusion lead for MEdIC (Medical Education Innovation and Research Centre), Deputy Lead for Faculty Development, and Lead for the team’s Widening Access to Community Careers in Healthcare (WATCCH) programme which is open to all year-12 secondary school students from diverse and challenging backgrounds who are interested in healthcare. She also continues to work clinically as a GP in London and applies this experience to all her educational roles.
Nina’s leadership of MICA has transformed the experience for Imperial students, faculty and our wider local community, and the course receives outstanding student feedback every year. She has developed teaching materials to support community GPs with innovative tutorials and support students to learn about patients’ holistic health needs. She has also led on developing on-campus and community tutorials for her year 3 students. Nina has developed a unique suite of trans-disciplinary specialty choice options within MICA, so students can experience cutting-edge aspects of medicine including Medicine in the Media, Digital Health Futures, Health Coaching, Yoga and Mindfulness, preparing our future doctors to navigate the evolving and broad healthcare landscape.
Her students clearly value her work, and as one student comments:
“I think Dr Dutta has delivered to us some of the best teaching we’ve received at Imperial. She’s an incredibly engaging teacher and always gives us highly relevant teaching sessions. She also makes a lot of effort to build relationships with all her students, which we all notice.”
It is of no surprise that she has also been nominated by her students for this year’s Imperial College Student Union ‘Student Choice’ awards.
Nina has led development of the Community Action Project that all year 3 students undertake to identify and address a community need. Examples have included projects to increase access to healthcare for people who are homeless as well as people from Black and Minority Ethnic communities and to co-create video-based resources with members of the Arab community aimed at raising awareness within this community of mental health conditions and reducing the stigma associated with these. Through Nina’s exemplary mentorship, students have presented at conferences and published in peer-reviewed publications, winning numerous awards offered by the RJGP, The King’s Fund and Royal Society of Medicine.
As Faculty Development Deputy Lead, Nina directly influences the teaching practices of hundreds of GP tutors. She and her team have developed robust quality assurance methods to provide support and mentorship for tutors. She also applies her ability to develop robust and inclusive education by delivering regular teacher training RCGP accredited courses (TACTIC and ASTIC), contributing to our student’s positive student experience whilst they are on community placements.
Nina’s President’s Award is richly deserved and we are grateful for all her work in supporting and inspiring students, tutors and colleagues, developing innovative curricula and promoting a diverse, inclusive workforce.
A few weeks ago the Medical school took the difficult decision along with the rest of the country, to suspend all clinical placements and on campus teaching for the rest of this academic year. Over the past few weeks the UG Primary Care team have worked at pace to convert all primary care tutorial teaching and clinical experience in local practices to a digital online format.
Dr Nina Dutta and Dr Neepa Thacker have tirelessly worked on this mammoth task and led two teams to create literally in days, full timetables of online learning for the students to work from. The teams have held student webinars from their living rooms and even managed to hold small group zoom tutorials, checking in with the students with their on-going learning and also importantly to check how the students are doing themselves.
The Medical School has also made the difficult decision to suspend all clinical examinations. Of note they held the first of its kind remote open book exit exam for the final year students. This similar format will be rolled out in the next few months for the year 3 and 5 clinical exams. As many of you may have also read, many of our final year students have taken up the opportunity to graduate early, to help serve on the NHS frontline in the next few weeks.
The Undergraduate Primary Care team has been working hard to also set up ICSM-C led by Dr Ravi Parekh and Ms Nadine Engineer, the community arm of the medical school-volunteering programme. We plan to induct and link together a small army of medical students with local GP practices, where the students will be able to support vulnerable patients at home by remotely calling them, delivering medications and following up on their chronic disease management as many if the primary care staff are being diverted to COVID-19 duties. We plan to evaluate the impact of this unique scheme, by looking at the impact on the students, patients and GP practices.
This is an uncertain and stressful time for us all, and as a department we have been keen that we try to continue to maintain some normality with working from home, holding meetings remotely and team wellbeing sessions where possible. The UG Primary care team have been a great source of support to each other and also to myself, as we have very abruptly moved to a very new way of working and teaching our students in the midst of a national crisis.
Thank you to everyone in Undergraduate Primary Care, we are lucky to have each and every one of you.
A meridian line is an imaginary circle that passes through the earth’s surface to connect the poles. The prime meridian line runs to within two miles of Madingley, Cambridge. Many of you will be familiar with the beautiful Madingley Hall, where the annual SAPC SE meeting is held in January. Once again, members of the Primary Care Undergraduate Teaching team attended.
This year’s theme was “Academic Primary Care: Optimising Impact”. Our team shared the following impactful projects from the department:
F-zero – a longitudinal integrated clerkship for final year medical students – Dr Neha Ahuja (OOPE 2018-2019) and Dr Nicky Hawkins (OOPE 2019-2020)
A primary school based service learning programme – Dr Rachel Pilling (GPST2 Feb-Aug 2019)
How mindfulness training can build community teachers’ skill – Dr Camille Gajria
The conference was a succinct way to broaden one’s thinking on topical medical education issues. One of the keynotes was an entertaining and sobering talk by Prof Robbie Foy, a world leader in implementation research, and a GP. 85% of health research is wasted1, for multiple reasons including being not contextual enough. For example, when validated tools for depression screening are used in real life, ethnographic studies showed they can become a tick-box exercise and reduce the quality of the consultation for all. He called for more collaborative research implementation that takes account of what happens in real life rather than under study conditions. As general practice educators, I think this pragmatic view of impact is what we try to move our students towards.
The hosting Cambridge team expertly organised it to be an egalitarian, enabling event. Attending SAPC SE was like standing on a meridian, connecting educational research to our teaching practice, and catching up with colleagues while being inspired by new connections.
1 Chalmers I, Glasziou P. Avoidable waste in the production and reporting of research evidence. Lancet. 2009 Jul 4;374(9683):86-9.
Our ageing and diverse population requires doctors to understand the broad sociocultural context of health, and to work collaboratively with local communities to address health needs and reduce our health inequities. During year 3, as part of their 10-week Medicine in the Community Apprenticeship (MICA), students complete a Community Action Project (CAP). This provides an excellent opportunity for our medical students to learn important skills in health improvement and making a real difference on the ground with communities while on clinical placements.
Working in pairs to assess local community needs and deliver and evaluate a sustainable healthcare intervention using quality improvement principles, students are encouraged to engage with members of the community (including patients, community groups, third sector organisations and health professionals). The projects are peer-assessed at a CAP presentation morning at the end of the placement where students present a poster in their pair detailing their project to their peers and then mark each other’s work.
Examples of CAP projects include a pair of students who recognised the ethnic diversity of their local population, which meant that local patients were unable to understand any health-related literature which was being provided by the doctors due to their limited English language. After engaging the local clinical commissioning group (CCG) and patient groups, they developed an online website where patient condition leaflets were translated into variety of languages. The initiative has been so successful, neighbouring areas are interested in the students working with their communities.
In another example, one pair of students identified a lack of uptake of the cervical smear screening program in their local GP practice population. After discussing this with patients, they identified a lack of awareness amongst the patients as a key driver. They engaged a local women’s cancer charity, and a Gynaecology Consultant from the local hospital to deliver an educational evening where local patients were invited to attend and learn about gynaecological malignancies and how they can be prevented.
The Community Action Project has allowed our students to engage in meaningful community engagement and make real impact on the health and welfare of the communities in which they are working. The Undergraduate Education Primary Care team are now carrying out research addressing the impact of the projects on both the student learning experience and impact on local communities.