Blog posts

WATCCH 2019 (Widening Access to Careers in Community Healthcare)

This summer the Undergraduate Primary Care Education Team are delighted to welcome students to the third year of our innovative widening access programme, WATCCH (widening access to careers in community healthcare). WATCCH supports young people from diverse and deprived backgrounds who are keen to pursue a career in healthcare. Our WATCCH students are enjoying learning about a diverse range of healthcare careers via campus-based education days and work experience in the primary care setting. This year, we have partnered with the student society Vision who are offering mentoring for our WATCCH students, following bespoke coaching and mentoring training from our in-house coaching lead. We will be running a series of student-led mentoring workshops throughout the year on topics including admissions tips, finances and personal skill development.

This popular programme supported by HEE NWL, has hosted one hundred students over the last three years and has sparked interest in universities nationally.  Our evaluation to date shows that WATCCH increased students’ awareness of the range of healthcare careers available and has generated new thinking about career options. The programme also increased participants’ self- confidence in their ability to pursue their career choice, and importantly has given students access to relatable healthcare professional role models increasing their drive and motivation to join the healthcare workforce.

We look forward to expanding WATCCH further in upcoming years and would like to thank all the schools, teachers, Imperial College students, and our WATCCH students for the enthusiasm and dedication they bring to the scheme.

WATCCH sits within the Diversity and Inclusion theme of the newly-established Medical Education and Research Innovation Centre (MEdIC) based within Undergraduate Primary care Education Team in the School of Public Health. MEdIC aims to translate the medical education evidence-base into robust educational innovations and research which strengthen our medical workforce and have a sustainable, equitable and transformational impact on society.

For further information on WATCCH, please contact n.dutta@imperial.ac.uk

WONCA Asia Pacific Region (APR) Conference 2019

by Dr Neha Ahuja and Dr Bhakti Visani

As two GP trainees currently taking an OOPE to do a medical education fellowship, we were both extremely lucky to go to Kyoto, Japan for the WONCA Asia Pacific Region (APR) Conference 2019 in May this year to present our experiences and learning in this post.

Why were we there? South East Asia’s primary care systems are currently in their infancy, but there is a strong drive to improve its standing and recognition because, as has been consistently shown across the world, high-quality primary care is the bedrock of a high performing health system and has the ability to reduce all-cause mortality, increase life expectancy, lower health inequalities and reduce costs amongst many other benefits.

This was one of the biggest lessons that was reinforced for us. Do we truly appreciate what we have until its gone? Often forgotten in the UK, this shows why we should invest our time and energy into high quality primary care and create a passion for it in our students too.

Amongst talks about the benefits of Primary Care, we also learnt from a myriad of streams including mentorship, education, quality improvement and surviving in the profession as a young doctor.

Dr. Felicity Goodyear-Smith gave us examples of a patient and clinician engagement programme (PACE) with doctor-patient dyads co-creating research. This was a great insight into forward movement in social accountability where the key stakeholders have ownership of the studies, use the findings and assist in dissemination. This of course raises questions about the implications on the professional boundaries in the doctor-patient relationship, and this short BJGP article explores their thoughts. If you are interested in the project, you might find this paper on PaCE gives a good insight.

Nothing we do in medicine is risk-free. It’s all a balance.

Another stark idea that was floated was about doing too much medicine. Dr. Iona Heath gave a powerful talk on the harms of overdiagnosis as well as our misconceptions on the benefits of multiple interventions. We already know that the burden of adverse drug reaction in the UK is high, with a report in 2006 showing that they result in 250, 000 UK admissions a year!

“So benumbed are we nowadays by electric lights that we have become utterly insensitive to the evils of excessive illumination.”

If you are as interested in this as us, you may find these links useful: Preventing Overdiagnosis and Choosing Wisely UK.

We also had the pleasure of learning about the cultural considerations in teaching and learning in a truly cross-cultural workshop run by none other than our wonderful colleague Dr. Maham Stanyon!
Kyoto itself was beautiful to explore; full of Shrines, Pagodas and Zen gardens that seemed to be taken straight from a dream!

As an added bonus, we had an extra few days before the conference to try some local delicacies like Japanese curry, Ramen, Mochi and Melon-Pan! We dressed up in traditional kimonos and even came across geisha down an unsuspecting alley.

Despite the flaws in our UK primary care system, this opportunity reaffirmed our choice to be GPs and to be proponents for investing in a system that has the potential to truly have large scale health impacts when done in the right way.

My last act at Imperial: Medical Education Elective

by Dr Gautham Benoy

So, I’ve just finished medical school, got my results and passed exams. Now what? I’m a doctor supposedly? These are my last few weeks in Imperial now! I start my FY1 in Sheffield so it’s not just bye bye Imperial, It’s bye bye London! But before I leave, I had one last act to finish; my elective. Ever since participating in the ICA (the Integrated Clinical Apprenticeship) at Imperial College, I’ve started to develop a fond interest in medical education and Primary Care. Partly to blame for this are 2 of my most inspiring role models, Dr Ravi Parekh and Dr Andy McKeown who ran the ICA course which had been the best learning experience I’ve had at Imperial College. Since I’d become quite acquainted with the Department of Primary Care through my participation in the ICA and I had really enjoyed my specialty choice placement in medical education, I decided to do 3 weeks of my elective with the department. I’m also starting my foundation job as an Academic Foundation Doctor in medical education and hope to incorporate medical education into my career; I thought a short glimpse into the future might be useful for me.

The Imperial College medical education elective dream team
(L-R) Seraphina Rong, Gautham Benoy, Ann Sebastian

Week 1

So, I’m in the middle of packing all my things and moving out of my London accommodation. My contract expires in a week and I’ve also got an AirBnB booked for 2 weeks to complete my elective. Things are quite hectic with packing and tenancy related paperwork e.t.c. But I look forward to starting my elective. I’m getting to work with my favorite department and I’ve still got 2 of my fellow Imperial students and good friends Ann and Seraphina who are still around doing their medical education elective with me.

In our first week, we got to meet Ravi in day 1 who gave us a rundown of what we might expect for the next few weeks. He shows us a big excel spreadsheet with all the activities we would be doing, from teaching, mock-PACES, working on e-modules, the F-Zero Course and other projects going on in the department. We’ve got a lot to do and so little time! So we rush off, sending emails to our supervisors for the projects we’re working on arranging meetings, reminders and decorating my calendar with dates, locations and times. We take the first few days relaxed, just getting to know everyone and doing some of the background reading for our projects and planning, lots and lots of planning and timetabling. While also taking time to register where one can acquire free tea and biscuits.

Worst of all, there was a slight miscalculation, next week was Easter! Meaning I’d have to get some initial work done ASAP and get all the information I need to make sure I know what I’m doing next week. Thankfully, I managed to plan my next few weeks with just enough time to spare.

Most of my work involved designing content for e-learning modules with Dr Ali Dhankot, Dr Sian Powell regarding clinical reasoning and also for the lifestyle and prevention module with Dr Ed Maine. I also got to work with the F-Zero team including Ravi, Andy and Neha to help design in-course assessments. I would also be working with the other students to design a mock PACES and clinical communications stations for the current ICA cohort.

Week 2

This is where all the work gets crammed in. Lots of tea and coffee was drunk, lots of hours typing and lots of jumping up and down on the exercise ball in the office to get the blood pumping.

Even though it was Easter, I still had the company of Ann, Seraphina and also Dr Bhakti Visani and Dr Neha Ahuja who we

re so helpful during the elective. They had their own work to do but both took on the responsibility of baby-sitting us, providing us with much needed guidance whenever we got stuck.

We’re all hard at work while making sure we’re well fed with tea and snacks
(L-R) Ann Sebastian, Gautham Benoy, Seraphina Rong

I managed to do more reading into the literature around the content I was creating for the e-modules and the F-Zero assessments. I also made a start on the cases for the ICA students by interviewing some of the current Year 5 Specialty Choice Placement students on what cases they thought would be helpful for their year group. After going through all my specialties knowledge and thinking hard about the cases, I managed to come up with some cases designed to challenge the 5th years and hopefully improve their preparation for specialties. We also spent a lot of time planning and arranging the mock, considering things like rooms, timings and how it’ll be supervised. This was a really good independent project for us since we were arranging an event ourselves.

I also had the chance to run my own mini-PACES while being assessed by Dr Georgina Neve. When I arrived at the room I was teaching in, it was printed “Dr Gautham Benoy”, now that definitely hit me. I have responsibilities now! I started to worry if the students would actually trust me to be a tutor despite being a student a few weeks ago. I wanted to make sure my students would benefit from the session, so I reflected on teaching I’d already done through the student union and how GP tutors ran mini-PACES sessions. I incorporated all the knowledge and teaching I’ve had on medical education to deliver mini-PACES session which was really immersive for me as a tutor. I felt like I had been given that responsibility as an educator and I really managed to reflect and learn from this experience where I was given full control over the tutorial.

Week 3

Everyone’s back from Easter! Now I’ve got to show my supervisors all the work I’d done. But I still had a lot to do before my meetings spread throughout the week. I crammed a lot of work in, writing content for the e-modules and finishing the assessment forms for F-Zero while simultaneously having multiple meetings and catching up with everyone. I got a feel for what it really is like working in the department and chasing deadlines. It was hard work, but it was definitely enjoyable and useful to experience.

Bhakti takes the opportunity to help me out with some of my project work
(L-R) Dr Bhakti Visani and Gautham Benoy

I’d managed it all in the end and with all my tasks complete I had my final debriefs with everyone. It turned out a lot better than I expected. Having rushed some tasks and always questioning whether what I produced was good enough, all my supervisors found my work really helpful and I felt like I had genuinely contributed to the improvement of the medical school. I was happy with what I had done and the whole experience, I felt fulfilled by the end of the week and also went on a lunch social with the department in my last week which was really good fun.

With my elective over, I’m really going to miss Imperial College. I’d learnt so much over the elective and I’m so glad to have been involved. It had driven me even more to pursue my career in General Practice and medical education. I met some amazing, inspirational people and the department was really friendly. I’d definitely hope to take all I’ve learnt forward in my career, but I’d also love to keep in touch with the department even into the distant future since this is where my career began.

Gizmos and Gremlins: when things don’t go as planned

by Dr Ben Stone

“Look mister, there are some rules that you’ve got to follow”

“Yeah, what kind of rules?”

“First of all, keep him out of the light, he hates bright light…Second, don’t give him any water, not even to drink…But the most important rule…never feed him after midnight.”

You’re probably wondering one of two things at this stage, depending on your knowledge of 1980s pop-culture:

  1. What on earth is this blog about?
  2. Why is this blog referencing Joe Dante’s 1984 comedy-horror cult film: Gremlins?

Prior to a recent teaching session, I was discussing with a colleague about how we felt the session may go: “I suppose you have always got to be prepared for the gremlins” I said, and we chuckled. We repeated the same phrase a few days later, realising that our wireless clicker had inexplicably reversed left and right. I can’t count the various mishaps that occurred in sessions I have witnessed: computers failing, tutors disappearing, printers misprinting, and the list goes on. Our instinctual cognitive reaction to all these events probably protects us from curling up into sobbing balls of human anxiety:

“That will never happen to me!”

I recently wrote another blog “From taught to teacher: the dark side of the moon” in which I introduced myself as a Foundation Year 2 trainee, preparing a teaching session on Prescribing Safety. Like we should with all sessions, see this blog as the debrief; an epilogue to the prologue. As you may have anticipated already, it did not all go to plan.

As Edward Jenner and Randall Peltzer, of smallpox and Gremlins fame respectively, both teach us: prevention is key. On the day of my session delivery I had prepped my facilitators, adjusted my clinical hours and organised my printing materials into one electronic folder. However, I had not prepared for the actions of those photophobic, hydrophilic and nocturnal hyperphagic beings. No, not the students.

The first mishap occurred 25 minutes before the start of the session; a facilitator emailed in unwell. A vital component to my session was to have facilitators for each group to answer questions and, well, facilitate. I am fortunate to have colleagues willing to step in at the last minute, but this meant the countdown to showtime was spent trying to condense two hours of material into a 20-minute rundown. The Gremlin of others.

The second occurred 25 minutes into the start of the session. “Is this everybody for today?” A familiar question for regular teachers. The need to appropriately introduce students to a session vs having enough time to deliver your material. The devilish realisation that you wasted the 20 minutes you spent prepping the extra facilitator that is no longer needed. The Gremlin of time.

The third occurred shortly after that. A face at the door.

“Knock-knock”

“Who’s there?”

“Sorry, I’ve actually booked this room”

“’Sorry, I’ve actually booked this room,’ who?”

Like a punchline delivered by an overexuberant parent at a teenage house party, it had me in tears. The room, seemingly booked on an eternal rolling reservation, had been available on the booking system and utilised for other means. Whilst we could fortunately share the room space, I no longer had use of the computer. The Gremlin of technology, the Gremlin of misfortune and the Gremlin of “…” all at once.

Gizmo is the name of the original mogwai gifted to the protagonist in ‘Gremlins’, whom, despite the actions of his kin, never becomes mischievous or ultimately murderous. It would have been very easy for this string of mishaps to derail the session completely, like the mogwai upon Kingston Falls, but that never happened. It was at this stage I appreciated the journey here, to the dark side of the moon. It wasn’t perfect, but the materials and content I had prepared could be utilised by the students. It was adaptable. I learnt that even when it looks like everything is going wrong, there will still be something right: not every Gizmo becomes a Gremlin.

In the final moments of Dante’s film, Randall gives the following advice:

“If your air conditioner goes on the fritz, or your washing machine blows up, or your video recorder conks out, before you call the repairman, turn on all the lights, check all the closets and cupboards, look under all the beds, ‘cause you can never tell. There just might be a gremlin in your house”

It is many months since I first made that prescribing error. I have learnt about educational theory. I have learnt about human error. I have learnt that teaching is not just about turning up on the day, with your colleague’s slides and hoping to “wing it”. I have even learnt about fictional villains from 80s cult films. But most importantly, I have learnt that there is always more to learn in the educational sphere. So, in true reflective fashion, what are my three things to take away from this day?

Be prepared. Be adaptable. But most importantly:

Don’t let Gizmos become Gremlins.

An introduction to the new F-Zero course

Medical Education Fellow Dr Neha Ahuja speaks to Co-course Lead Dr Ravi Parekh about the new F-Zero course

Calling all GP Practices referring to Northwick Park Hospital…

Are you an energised, enthusiastic practice referring patients to Northwick Park Hospital?

Do you want to become involved teaching final year medical students from Imperial?

If you are, you may be a perfect GP Practice to host our F-Zero students!

What is your commitment?

  • You will host pairs (up to 3 pairs) of final year medical students
  • The students will act as true apprentices, running independent clinics for 1 day a week over 30 weeks, able to see all patients and take an active part in the GP Practice activities.
  • You will provide a half a day tutorial weekly (which includes pastoral supervision for the students)

What is the benefit for you?

  • Generously financially reimbursed for your time (details being finalised)
  • The students are also working in Northwick Park Hospital and will have additional medical and surgical consultant supervisors. This allows for a true opportunity for bridges between primary and secondary care.
  • Final year students who are highly skilled and able to aid with service delivery.
  • Develop a true mentoring relationship with these students.
  • Professional development for you as a tutor to develop educational skills

Each pair of student allocated 3 supervisors across Year 6:

  • General Practitioner:  Clinical & Educational supervision
  • 2 x Hospital Consultant:  Clinical supervision

Proposed individual student timetable (each student’s timetable will vary)

  Monday Tuesday Wednesday Thursday Friday
AM GP Medicine Central Tutorial Surgery GP Tutorial
PM GP Medicine Sports Surgery SCM

Curriculum Review news

As you may already be aware, the MBBS curriculum is currently undergoing a review which involves all years and, excitingly, has an increased focus on teaching in General Practice. The new curriculum will start to roll out from MBBS year 1 in September 2019 (phasing in over the next 6 years) but there are also few changes which are happening in the later clinical years ahead of the process, giving us more opportunity to demonstrate to our students why General Practice is such an amazing teaching environment and such a rich and varied career. Below are some of the opportunities for the community, beginning this coming academic year.

 

Patients, Communities and Healthcare (Year 1) November 2019

PCH is a new, community-based early years course to the Imperial MBBS (replacing FCA).Students will spend 8 Thursdays in a GP Practice over the course of year 1 with a further 8 days in the second year.  Mornings will be spent with students visiting patients in their homes or sitting in GP clinics, with the afternoon back at the Practice for a patient de-brief, followed by a tutorial. There is an opportunity now to sign up to year 1 of the course by contacting n.engineer@imperial.ac.uk

 

F-Zero (Year 6) July 2019

F-Zero is an innovative new course based on the international model of “longitudinal learning” and leads on from our highly successful ICA placement in year 5. F-Zero students will be based in GP, Medicine & Surgery with allocated supervisors in each through the academic year (July to February), taking a meaningful and authentic role in the care of patients across their primary and secondary teams. This coming July 2019, 30 students have self-selected to take part in the course, replacing their traditional Year 6. They will be based at Northwick Park Hospital and a surrounding GP practice that refers into Northwick. There is an opportunity now to sign up to this F-zero course by contacting n.engineer@imperial.ac.uk

 

GPSA (Year 6) July 2019

From July 2019 the ever popular out of London GPSA course will be extended to 4 weeks, recognising the importance of General Practice teaching and learning prior to finals. There is an opportunity now to sign up to this by contacting n.engineer@imperial.ac.uk

 

ENT & Ophthalmology (Year 6)

From July 2019, ENT and Ophthalmology teaching will be delivered in a more integrated way. Rather than discrete blocks, both disciplines will be taught through other relevant specialities. Students, especially those in Year 6, may need additional signposting to practise their ENT and Ophthalmology skills so please be mindful of any learning opportunities that arise in your practice.

 

Other Changes July 2019 (Years 5/6)

Other broader changes outside of General Practice include musculoskeletal medicine moving from year 5 to year 6 and, in exchange, the Specialty Choice Placement will move from year 6 to year 5 and will be increased to 4 weeks. Renal medicine will now be delivered within the 4 week Senior Medicine placement in Year 6 and lastly Emergency Medicine will be extended to 4 weeks in Year 6.

 

There is no doubt that General Practice being front and centre in the above changes to the curriculum is down to your hard work teaching our students to such a high level. For this, we continue to be grateful and look forward to taking these exciting opportunities together. We will stay in touch as other changes roll out in the forthcoming years and if you have any questions on the above on how this may affect your teaching in the practice or getting involved in any of the new courses, please do contact n.engineer@imperial.ac.uk our Faculty Development Manager.

UKLIC

The 2nd UK Longitudinal Integrated Clerkship Think Tank was held at Imperial on Thursday 7 February. Representatives of 15 different medical schools from across the United Kingdom attended the day to share knowledge, experience and advice in running longitudinal attachments for their students.

We saw showcases from institutions across the UK including Cardiff University, King’s College London, Hull York Medical School, Sheffield University and Dundee University, with representatives presenting their LIC models alongside their students.

A student discussion panel followed before the group broke out into small group discussions on topics such as The role of social accountability in LICs, The dark side of service learning and Continuity and belonging.

The next meeting of the think tank is due to take place at Cardiff University in 2020.

Society of Academic Primary Care: South East Regional Meeting

By Dr Georgina Neve

A large number of the Primary Care department attended the SAPC South East Regional Meeting, held once again at the wonderful setting of Madingley Hall, Cambridge.  The theme of this year’s conference, hosted by King’s College, was ‘Digital Features in Primary Care?’  Note the question mark.

We heard from Professor Chris Salisbury, past chair of the RCGP, who raised some concerns about digital health looking at some of the hype and the cons as well as a few pros.  Dr Shubs Upadhyay spoke to us about his experience with developing a podcast and designing healthcare apps.  Dr Zoe Williams educated us on the world of health and wellbeing apps, encouraging us to both use these ourselves and promote them to our patients. Professor Martin Marshall addressed the conference on the topic of re-thinking medicine, discussing the role of social prescribing and the community.

Imperial had many abstracts accepted for presentation this year – it was hard to keep track!  Neepa Thacker, clinical teaching fellow, and Joanne Winning, Director for Medical Humanities at Birkbeck Centre, presented their work on humanities and medical education which stimulated a lot of exciting discussion. One of our medical students, Saniya Mediratta, presented alongside two UCL students on the collaborative work they have been doing on ‘The Hidden Curriculum’, an ethnographic study describing the student perspective on a career in General Practice.

Nadine Engineer, faculty development manager, presented her work around online learning tools for GP undergraduate tutors.  Sonia Kumar spoke passionately about social accountability and rethinking how we educate medical students on this topic.  Georgina Neve, academic clinical fellow, presented and demonstrated an artificial intelligence chatbot designed to support medical students. Edward Maile, academic clinical fellow, delivered a presentation on the impact of mergers describing ten lessons learned from a merger at Oxford University.   Viral Thakerar, course lead, and Tom Durley, primary care executive officer, delivered a workshop on creating a digital learning resource from scratch – ‘Doodles to Digital’ – which was well attended and well received.

Overall the conference was an excellent two days with fascinating presentations from a range of institutions. We look forward to applying all that we learnt to our own student teaching and education research.

 

 

From taught to teacher: the dark side of the moon

by Dr Ben Stone

When was the last time you planned a journey? I visited a friend recently; with just an address I found the quickest route, adjusted for traffic and was acquainted with their garden gnomes before I heard a single beat of my “Driving tunes” playlist. Now imagine planning a journey; you can visualise how the destination will look, but you’ll only know for sure once you arrive. The dark side of the moon.

Everyone has heard the outdated adage of medical education: “see one, do one, teach one”. The gap between see and do is noticeably palpable, principally as you walk away from your first cannulation with a blood-stained shoe and still-shaking hand. Can the second gap be so large? It can’t require as much shoe polish.

I joined the Department of Primary Care and Public Health at Imperial College London in early December 2018, the second rotation of my Foundation Year 2. Days before, on a busy medical post-take round, I made a prescribing error. I reflected: what could I do to prevent this in future? Following a slightly protracted e-portfolio entry: Eureka! In my new role, I will have the time, audience and resources to develop a prescribing safety session for medical undergraduates. Inception, albeit with less DiCaprio. The destination is set, but why there?

Performing a literature search is familiar: big studies, national guidelines and a few slightly blurry pdf versions of old books. Maybe I spent some time updating the “Study tunes” playlist. There was a lot of value in discussing my early findings with colleagues, especially as they are too kind to tell me they have work of their own. Soon, I constructed a glimmering evidence-based educational proposal, presenting it proudly to my supervisor. Of course, I’m sure I wouldn’t have overlooked the small matter of educational theory.

It can be tempting to skim a stone across the literary ocean of medical education, but without full immersion my session lacked structure and substance. Has your topic been taught before? How has your topic been taught? Why is your selected teaching style appropriate? Asking these questions is one of the hardest steps, but there are many excellent Imperial College courses designed to hold your hand as you dip your toes (see links at the bottom of the article). With their help, my stage was set, my proposal complete. It was time to plan.

The, hopefully not copyrighted, mnemonic of AILMENTS is the ABCDE of lesson planning:

  • Aim: the overarching goal of the session – what will I achieve?
  • Intended Learning Outcomes: often an afterthought, but the lifeblood of a session from aim to evaluation. My greatest appreciation of verbs since Year 3 literacy.
  • Learning needs analysis: fine tuning the contextual pitch, somewhere between astrophysics and sucking eggs. I performed a quick online survey ahead of time, much to the delight of my future audience.
  • Methods: the fruit of your literature search. What will I do? What will I use? You do realise you will have to write all those complex clinical cases now?
  • Evaluation: “how likely were you to give a 5 if the presenter was nice and you didn’t fall asleep?” I found that evaluation was integrated throughout a session, not just a feedback form at the end.
  • Next steps: this can range from 200 page guideline to a curriculum required e-learning module, but I found it interesting, hopefully they may do too.
  • Tests/assessments: Nothing demonstrates enlightenment like a pop quiz! I had to write these questions too.
  • Summary: what was that all about again?

With some flesh on the bones, my lesson was coming to life. But like a fleshy skeleton or cake without icing, the final epidermal layer of planning pulls everything together.

It does not take long to realise the logistics involved. Do you have a room? Do you have a speaker? Did you want to show a presentation? Have you got the link ready for that video? I’m sure that video worked the last time I used it? Are there enough chairs? Have you made enough print-outs? Have you made your print-outs? Do you have access to a printer? And so on. Whilst I was fortunate to have the help of experienced colleagues and willing volunteers, classic OSCE/PACES practice with a trusty squadron of stuffed animals could iron out a few creases. My materials were ready. I felt prepared.

The dark side of the moon.