Imperial College GP Tutor, Dr Christine Scott, won a 2017 Lifetime Teaching Award for her contribution to teaching medical students from Imperial College London. Here, she reflects on her experiences of teaching medical students.
Were you aware you were students’ inspiration and role model?
I think we often underestimate our impact on students. Now, as I read my feedback I recognise once again how extremely influential we are. What a great privilege, and what a great responsibility!
How long have you been teaching Imperial Medical Students for?
A lot of my embarrassment in receiving a lifetime teaching award is that I’ve only really been teaching at Imperial for about eight years. In a former era, I taught undergraduates from my alma mater, Newcastle University.
Why so long?
It hasn’t really been a very long time but I have been privileged to teach a number of different courses from first-year communication skills and First Clinical Attachment (FCA), doing some lecturing and teaching both in my practice and in the Department for Year 5 students on GP placement.
I really became involved in Imperial when I came along with a colleague to an introductory teaching session. It was a pragmatic decision, sessions were available and it’s my local medical school.
What kind of qualifications / CPD did you build up when teaching and how did this help you in this role?
Early on in my time teaching, I attended the Deanery Introduction to Teaching in Primary Care course (ITPCC). This really inspired me to be creative about the way I taught and gave me confidence to experiment, I really got a taste for it. Over the years, the annual GP teachers’ day and foundations of clinical practice (FoCP) conferences have been wonderful opportunities to learn. I always come not only with CPD credits but with my mind buzzing with new ideas of ways to teach and a whole new PDP for myself.
In what ways has teaching changed you and the way you practice medicine?
I think teaching has helped me to be more reflective and self-critical but also more confident. There is nothing like teaching something to ensure that you understand it well yourself and this is particularly true teaching within the clinical setting. My students have inspired me and challenged me to look at my practice through their young eyes. The skills of facilitation and feedback that I have learnt have had wider applicability working within the practice team. Lots of the teaching provided to us GP tutors at Imperial has also been extremely helpful. I look back gratefully on a number of memorable sessions, particularly those led by Giskin Day. Her teaching on medicine in the humanities has rekindled my love of reading and given me the courage to become creative!
Do you think hosting students has benefitted your GP practice, or the community you serve, in anyway?
The patients love talking to students and the perspective they bring, both on individual patients and on the service in general have been really useful. I think it also gives the whole practice a sense that they are contributing to the development of future doctors. In these days when we often feel tired and under pressure, it’s great to have the refreshing medical student perspective.
With the current NHS admin and recruitment pressures what would you be telling a family member if they were a GP and considering teaching?
Do it! The students you meet and the support and training you gain will be part of keeping you enthusiastic. When it works well, and it mostly does, the tutor-student partnership is formative for both parties, we change students but they change us. It is also clear from students that GPs are the people that really recognise them as individuals, adapt teaching to suit their learning needs and care about them – and that really counts. Finally, when I am old and unwell I want well taught and caring doctors to look after me!
Is there a memorable funny story from teaching you can imagine still recounting in the future?
I can’t really think of any funny stories, but certainly touching ones. The student who after his patient project was given a small silver teaspoon to remind him of parts of her story. My first year students performing a ballad to tell their patients story. Most recently two students explaining their patient’s illness using a wonderful model of a computer they had made as an allegory for his life.
We’ve heard about a beautiful house in France – tell us more about ‘life after being an Imperial teacher’
The beautiful house is on the edge of Paris and is part of my husband’s job. The main thing that will happen in my life after Imperial is being able to spend much more time in Paris with him making the most of all Paris offers. I’m also hoping to do some work developing appraisal with doctors working abroad and take some of my counselling skills to support our local church community. There will be plenty of time for coffee and museum visits and my Imperial friends will be warmly welcomed so keep in touch!
The NHS prescription charge in England is currently £8.60 per item. At this level, many commonly prescribed drugs will cost less than the prescription charge and so some NHS patients may occasionally ask if they can have a private prescription rather than an NHS prescription.
In the past, some GPs have been advised that they could issue both an NHS FP10 and a private prescription, and let the patient decide which to use. But the British Medical Association’s General Practice Committee has obtained legal advice that said under the current primary care contract, GPs in England may not issue a private prescription alongside or as an alternative to an NHS FP10 prescription. In any consultation where a GP needs to issue an FP10, the concurrent issue of a private prescription would be a breach of NHS regulations.
The issuing of a private prescription in such circumstances could also be seen as an attempt to deprive the NHS of the funds it would receive from the prescription charge. Furthermore, for private prescriptions, the pharmacist is free to add a dispensing fee to the cost of the drug and so the patient might end up paying the same or even more than the NHS prescription charge for their private prescription. Finally, trying to explain NHS guidance on prescribing and its implications to the patient makes the issuing of a private prescription impractical in the time available.
Hence, I would advise GPs not to issue a private prescription to NHS patients in place of an NHS FP10 prescription in these circumstances. This advice should be communicated to the other prescribers in the practice so that they all follow the same policy.
Of course, the Department of Health could update its guidance and make it easier for NHS GPs in England to issue private prescriptions but there is no currently sign of this happening.
This article was originally published in the medical journal, Pulse.
The Master of Public Health (MPH) programme at Imperial College London is a one-year course that provides a comprehensive introduction to public health for students intending to practise in public health or related fields. This video gives an overview of the course’s content and outlines the prospects for MPH graduates.
We aim to provide a comprehensive introduction to public health for students who intend to pursue careers in public health practice, management and/or research at local, national or international level. The course offers cutting-edge knowledge and skills base in the principles and methods of public health and a creative and supportive learning environment. The programme has special focus on the development of quantitative analytical skills for public health, epidemiology and health services research.
Former Master of Public Health (MPH) student Natasha Kassami wrtes about her MPH research project.
“According to the World Health Organisation (WHO), Non-Communicable Diseases (NCDs) currently constitute the largest share of deaths worldwide (38 million deaths each year) with nearly three quarters of these deaths occurring in low- and middle-income countries (LMICs). Among these, cancers constitute the second largest proportion of NCD deaths and it has been suggested that a disproportionate amount of this burden falls on women in these regions who face the challenge of gender inequality in addition to the lack of access to cancer care, which results from their geographical predisposition.
It is fair to say that for a long time, I was relatively ignorant of the threat NCDs like cancer posed to low-resource populations. My attention was always drawn to infectious diseases like malaria, HIV/AIDS, TB, which have been the focus of public health campaigns in Uganda for many years. Needless to say I had suffered from Malaria countless times as a child in Uganda. My final year MPH dissertation came around the same time the threat of cancer became real to me. It was towards the end of the second semester of my Master’s program that I found out my hero, mentor and the head of my family, my father was being treated for colorectal cancer. His illness was an apt reminder of the significance of the research I was doing for my final year dissertation. That and the constant support and encouragement I received from my supervisors, Dr. Lesong Conteh (Senior Lecturer in Health Economics, Imperial College London) and Dr. Ophira Ginsburg (Medical Officer, World Health Organization, Geneva, Switzerland) and Dr. John Tayu (Assistant Professor, National University of Singapore), prompted me to work tirelessly on the summer project, which was a Systematic review on the ‘Economic Burden of breast and cervical cancers in LMICs’.
The review generated a landscape analysis, of sorts, for the current state of economic literature on the burden of these cancers in LMICs. We focused on these two cancers as they are the predominant causes of cancer morbidity and mortality in women around the world. Through our review, we identified several gaps in the research in low resource settings in comparison to High Income Countries (HICs). For example, while there is a growing evidence base on the cost effectiveness of specific interventions to address breast and cervical cancer in low-income countries (LICs), there is a paucity of studies evaluating the wider economic burden of breast cancer at both the household and the national level. Which suggests that the full economic cost of women’s cancer has not yet been realised. Furthermore, there is little research on the cost of advocacy, primary and secondary prevention of breast cancer in LMICs and the economic implications of a diagnosis in the younger, more productive years of a woman’s life are vast and rarely estimated in the literature.
Through the persistence of my amazing supervisors this study was able to have a greater impact than I could have ever achieved on my own, with its findings contributing to a paper on “The global burden of women’s cancers: a grand challenge in global health” which in turn was part of “The Lancet Series on ‘Health, Equity and Women’s Cancers’. The series, which was spearheaded by Dr. Ginsburg featured contributions of many formidable names in Cancer policy and research. Our paper in the series described the burden of breast and cervical cancer in relation to mortality, incidence survival and their implications on socioeconomically disadvantaged women (a subject Dr. Conteh and I contributed towards). I’m forever indebted to my supervisors for ensuring our work that summer was not shelved away and for pursuing it even after I graduated from the School of Public Health. We are currently working on publishing the original Systematic Review.”
US Senator Bernie Sanders shared a recent paper from Imperial College London on his Facebook page. The paper highlighted the importance of expanding universal health coverage to reduce ‘avoidable’ deaths among Brazil’s black and mixed-race populations. The paper was published in the journal PLoS Medicine.
Dr Thomas Hone, Professor Christopher Millett, Professor Azeem Majeed from the Department of Primary Care and Public Health, and the School of Public Health, at Imperial College London and their colleagues from Fiocruz in Brazil analysed mortality data from 2000-2013 to determine the effect of Brazil’s Family Health Strategy (FHS) on avoidable deaths in black and mixed-race Brazilians compared to white Brazilians.
We found that rates of avoidable deaths were between 17% and 23% higher in black and mixed-race populations than in the white population during 2000-2013.
Volunteer doctors and lawyers providing support to survivors of the Grenfell Tower disaster have spoken of residents who escaped from the fire but remain, they believe, too frightened to seek medical and legal help for fear of being reported to the Home Office because of their irregular immigration status.
Dr Paquita de Zulueta, a London GP and Honorary Clinical Senior Lecturer in Primary Care in the School of Public Health at Imperial College London who has been volunteering to help survivors in the Westway, said she and colleagues were aware of at least three patients who were reluctant to go to hospital because of concerns about their immigration status.
The full story can be read on the Guardian Website.
Professor Christopher Millett and Dr Anthony Laverty from the Public Health Policy Unit at Imperial College London contributed to a ground-breaking WHO report which provides an analysis of the current health, social and economic costs and impacts of tobacco use and policies in China. The report highlights the impact of tobacco use on development, with special emphasis on poverty and inequality and the tremendous burden tobacco represents for the poorest and most vulnerable.
China is the epicentre of this epidemic, and thus lies at the heart of global efforts to stop it. China is the world’s largest producer and consumer of tobacco. A staggering 44% of the world’s cigarettes are smoked in China. One million people die of tobacco-related diseases in China every year, many of them in the prime of their productive years.
The report can be viewed on the WHO Website.
As part of a research project on the effectiveness of the NCMP (National Child Measurement Programme), a workshop was held in the School of Public Health to evaluate the current use of National Child Measurement Programme feedback by GPs. The aim was to investigate how GPs feel they could add further value to NCMP feedback in the future and any challenges they face incorporating National Child Measurement Programme feedback into their routine clinical work.
The workshop was facilitated by Dr Sonia Saxena & Prof Russell Viner, with participation from Dr Zoe Williams and Dr Rachel Pryke.
In the interactive 2-hour workshop, the audience discussed and came up with different ideas and solutions to overcome barriers faced in monitoring childhood obesity in Primary Care as well as the National Child Measurement Programme feedback. They specifically highlighted the importance of allocating more time for growth and weight checks, improving awareness of appropriate local weight management services and developing an integrated system with BMI centiles entered before consultations.
They also suggested introducing obesity/overweight topics into the CSA examination for GP trainees. Furthermore, attendees underlined the importance of educating GPs on a healthy lifestyle, weight management and specific approaches on how to address these sensitive topics in consultations with families effectively.
Workshop discussions provided a base to develop a short survey on how the National Child Measurement Programme link can better with primary care.
Complex and time-consuming memory clinic referral criteria may be contributing to delays in the diagnosis of dementia, according to a paper published today by the Journal of the Royal Society of Medicine. Around 850,000 people are living with dementia in the UK but the number thought to have dementia substantially exceeds those with a formal diagnosis. Early diagnosis is a priority for the government and the NHS.
Currently GPs are responsible for referring patients for assessment and diagnosis by specialists, usually in dedicated memory clinics which set referral criteria. There is considerable variation in referral criteria, with requirements set by some memory clinics that exceed national guidelines. Requirements can include different combinations of cognitive tests, laboratory blood tests, urine tests and physical examination that vary between clinics.
Lead author Dr Benedict Hayhoe, of the School of Public Health at Imperial College London, says: “GPs have difficulty assessing patients with memory problems in strict accordance with guidance within a 10-minute consultation; in our experience a significant proportion of available consultation time can be taken up by carrying out just one of the brief cognitive tests.” He went on to suggest that, with current workload pressures on primary care, complex criteria involving multiple investigations are likely to provide a significant disincentive for referral.
The authors set out alternative approaches to speed up diagnosis. Dr Hayhoe said: “A primary care led process, perhaps staffed by practice nurses carrying out assessments according to protocols, may speed up diagnosis while reducing pressure on GPs and specialists.” He added that it may also be appropriate to allow some people with memory concerns direct access to memory clinics.
Dr Hayhoe concludes: “A system that discourages or delays referral for dementia is highly counterproductive; an urgent review of this area is necessary to establish a system that effectively supports patients and clinicians in early diagnosis, treatment and prevention“.