CBME Newsletter Issue 11 by Queen Mary University of London

Community-Based Medical Education (CBME) Newsletter for General Practice www.ihse.qmul.ac.uk/cbme

October 2011 • Issue 11

Welcome to the autumn newsletter and thank you to all who have contributed to it. This issue includes new Case-based Discussions in Year 3, a report on our Annual Tutors Day and The OCSE Experience. Inside this issue Farewell to Dr Rhiannon England of Statham Grove Surgery

Introducing Elora Baishnab

Introducing Mbang Ana

GP Tutors Day

Introducing Emma Ovink

Introducing Peter Washer

Baby Boom

New for 2011-12

SAPC Conference July 2011

The Salaried GP Tutor Scheme

Annual GP Tutors’ Day, 1st July

Student satisfaction at Queen Mary rises to highest ever level

Aunty Aggie’s Problem Page

The OSCE Experience – Through the Examiner’s Eyes

New Yvonne Carter building

Puzzle Corner

www.qmul.ac.uk

October 2011 Issue 11

Farewell to Dr Rhiannon England of Statham Grove Surgery I am leaving my practice in Statham Grove, Stoke Newington after 22 happy years as a partner and teacher. Over the years I have taught most modules, from Medicine in Society to final year attachments and have definitely learnt an enormous amount from the students. Teaching can feel a chore at times- especially when work is busy, a partner is off on holiday, reception are complaining about time keeping and the students are yawning. But then there is a spark- a patient whose story is so moving that the students are profoundly affected, a patient who makes them laugh, or a difficult encounter that provokes a really interesting debate on the ills of society. Teaching keeps me passionate about General Practice. It confirms for me the importance of the doctor/patient relationship and the importance of retaining the generalist approach. However it has also been hard work, occasionally very challenging and more and more difficult to fit into an increasingly demanding work environment. The rewards of meeting talented and interested students greatly outweigh the difficulties though, and teaching certainly has encouraged me to maintain reflective and informed practice in order to stay one step ahead! Thank you to CBME for all your support and to all the students that I have taught over the years. If I continue to work locally in the future I will certainly be offering to teach again if possible! Best wishes Dr Rhiannon England, Statham Grove Surgery

Introducing Elora Baishnab I am pleased to say I have recently joined the CBME team to cover Liz Nuttall’s maternity leave. I will be taking over the supervision of Year 3 Integrated Clinical Studies in Primary Care. I am GP working in and around North East London. I have recently completed an Academic GP ST4 post at St Georges University of London where I have submitted two Cochrane reviews for publication. I am due to complete a Postgraduate Certificate in Healthcare and Biomedical Education in the coming months. I have a strong interest in undergraduate education which I have furthered through teaching, examining and designing assessments at both Barts and The London and St George’s Medical Schools. I am excited about returning to East London as I love the area and I very much look forward to being part of the team here. If you need to contact me, my email address is e.baishnab@qmul.ac.uk. Dr Elora Baishnab, CBME

Introducing Mbang Ana I am Mbang Ana, a part-time GP in Arlesey, Bedfordshire. I joined CBME in January 2011 as a Clinical Teaching Fellow with two main roles within the department. Firstly, I am Unit Convenor for Student Selected Components (SSCs); working alongside Emma Ovink. This is a very enjoyable job because it allows Emma and I to help interested GP tutors deliver teaching to their areas of strengths, often in very innovative ways. Secondly I work alongside Sian Stanley on the Year 4 community teaching units; Brain and Behaviour, Human Development and our new teaching unit Community Locomotor. Working on the Year 4 community units is challenging, rewarding and always interesting. I encourage those of you who are interested in teaching Year 4 medical students to consider signing up for the Community Locomotor teaching. If you have any questions regarding any of the Year 4 teaching units or SSCs please feel free to email me (m.ana@qmul.ac.uk). Dr Mbang Ana, CBME

Teaching with Small Groups At the Tutors Day, Dr Peter Washer ran a session on teaching with small groups. This was exceptionally well attended, which points to a desire from our tutors for similar training opportunities. For those who missed the session, the take home messages were: • Plan, plan, plan your session (in terms of setting and timings) • Identify your intended learning domains (knowledge / skills / attitudes) • Determine your learning objectives • Decide on what would be the most appropriate teaching methods to meet those learning objectives • Identify a method by which you could assess that the students have met the learning outcomes? • Reflectively review and revisit your lesson plan. The session was a précis of a half day workshop that Peter runs at QMUL’s Learning Institute. He will be running this workshop on Monday 7 November, and on Friday 27th January 2012, both from 2-5pm. These sessions are free to our GP tutors, and can be booked via the Learning Institute website at www.learninginstitute.qmul.ac.uk/booking In addition to this, Peter is happy to run further similar training for GP tutors if there is a demand for it (either at QM or in practices). Please contact Peter to discuss by email p.j.washer@qmul.ac.uk or tel: 020 7882 2505

Barts and The London School of Medicine and Dentistry, Academic Unit for Community-Based Medical Education, Garrod Building, Turner Street, Whitechapel , E1 2AD.

www.ihse.qmul.ac.uk/cbme

Introducing Emma Ovink I joined the CBME team as an Attached Salaried GP in November 2010, which is when I began a 2 year post with the Tower Hamlets Salaried GP Scheme. Under this scheme I am employed by Tower Hamlets PCT; two thirds of my week is spent working at Jubilee Street Practice as a Salaried GP, and the remaining third is dedicated to professional development. I wanted to develop my skills in teaching and to become more involved in medical education, and so a role in CBME seemed perfect. I am not a local graduate myself, having studied at Nottingham University, but I moved to London upon completing my house officer training, and undertook my GP training on the local Tower Hamlets Vocational Training Scheme. I then worked abroad as a private GP in Dubai for two years while my husband was seconded there by his firm but we were very happy to return home last June, and I have been living and working in Tower Hamlets ever since. I am currently working with Dr Mbang Ana as joint Selected Study Component Unit Convenors, which means I am responsible for the primary care SSC programme. SSCs offer students the opportunity to study an area of the curriculum in greater depth, or to study an area not covered by the curriculum. They can choose from a range of excellent ‘standard’ primary care SSCs, and since I joined the team I have been able to assist two GP tutors to develop brand new SSCs that have been offered (and chosen) by students this coming academic year. I am also working with other tutors to develop more new SSCs, and am always happy to be contacted about new ideas. Students can also choose to ‘self-organise’ their SSC, and part of my role here has been in improving our process for approving these, and ensuring that the SSC is robust, worthwhile, and a valuable learning experience for the student. Since starting work here I have had the opportunity to improve my abilities as a teacher, firstly by attending the ITTPC course, and also by attending training in becoming a PBL (problem based learning) facilitator. I am involved in teaching students in my own practice, and I am also going to be involved in delivering centralised teaching to students at the Medical School this year, as well as facilitating a PBL course, and, with Dr Anne Pauleau, delivering an SSC in Communications Skills. I have also been learning huge amounts about medical education and the work of CBME as a whole, and have been able to get involved in continuing to improve the department’s links with our GP tutors, through workshops at the tutor training days, as well as working on the content for our new website, and of course through writing articles for our newsletter! I am thoroughly enjoying my attachment here so far – it is hard work but very satisfying, and it makes all the difference to work as part of such a friendly, fun and dedicated team. Dr Emma Ovink, CBME

Introducing Peter Washer I joined CBME as a Lecturer in Medical Education in April, covering Maria Hayfron-Benjamin’s maternity leave. I’m now four months into my ten month contract, and feel as though I’ve established myself in a very friendly team, primarily by carving out a role for myself as the office tea boy. I’ve had a long and circuitous career. I trained as a Registered Nurse as a school leaver, and then worked as a haemodialysis staff nurse in this country and in Saudi Arabia for a little while. But then I got the bug to study at university and gave that up to do a degree in philosophy in Wales, and then a Masters in medical law and ethics at Kings. After finishing the Masters, I worked for a few years in the mid1990s in a residential project / hospice in Hammersmith for people with HIV related dementia. In 1997 I got my first job as a lecturer, and since then I’ve moved around quite a few different London universities teaching different health care professionals and doing staff development, including a few years teaching clinical communication to medical students at UCL and Imperial College. At the risk of being accused of being a perpetual student, since becoming a lecturer, I’ve also done a second Masters in education at Greenwich and a PhD in history and philosophy of science at UCL. In terms of my research, I’m interested in the more social aspects of medicine, particularly how the public makes sense of the risk of contemporary infectious diseases, such as SARS and MRSA. For the past few years I’ve been freelancing and doing contract research while writing two books: the first was a textbook Clinical Communication Skills for Oxford University Press, which I’m delighted to say won first prize in the Basis of Medicine category at the BMA book awards last year. Since then I’ve published a cultural history of infectious diseases, Emerging Infectious Diseases and Society, which has been shortlisted for this year’s British Sociological Association’s Sociology of Health and Illness book prize. Wish me luck! – The decision will be announced at the BSA conference in September. Here at CBME I am Unit Convenor for Medicine in Society for the graduate entry students and in Years 1 and 2, and for Extending Patient Contact. I’m also caretaking the Salaried GP Tutor Scheme. I’ve spent the past few months getting to know the place and the people, revising the tutor and student guides, and generally doing the type of housekeeping that academics do during exam times and before the students return in September. I met quite a few of the GP tutors at the Tutor’s Day, and look forward to working with you all over the next six months. Dr Peter Washer, CBME

Baby Boom We are very pleased to announce the arrival of two new CBME babies. Dr Liz Nuttall has a baby boy named Ben, and Maria Hayfron-Benjamin has a girl, Lucy. We would like to send our best wishes to all.

Issue 11, October 2011

October 2011 Issue 11

New for 2011-12: Case-based discussions for Year 3 Community-Based Teaching Placements

history of one of your patients this will enrich the discussion and make it more ‘real’ for the students. We do not want it to replace the small group teaching, with patients, that is already done brilliantly.

Case-based discussions (CBDs) were initially designed to support the provision of problem-based learning (PBL) content of Year 3; they were piloted last year with a cohort based at The Royal London Hospital and the student feedback was excellent. CBDs differ, however, from PBL cases in that they are shorter and more structured. Whilst they will still utilise an element of self directed learning, they are better adapted to the general practice setting by allowing a structured discussion around a case based on set learning objectives.

4. Why are the case-based discussions being introduced? We ran a successful pilot last year involving 40 students each term. We had excellent feedback from the students. It enabled students to discuss the MDT nature of general practice and ethics of treatment and was an activity the students could do at lunchtime which is often a quieter time in GP for students.

1. What are case-based discussions? It is a discussion centred on a patient case. It allows the tutor to examine clinical decision-making and the application or use of medical knowledge. It also allows for discussion of the ethical and legal framework of practice.

- Student log book sign-off after each case-based discussion in the Problem Based Learning sections of their log book.

5. How are the case-based discussions assessed? Several ways-

- Students to write one case up in more detail, including each learning objective covered and their answers. The students are very used to writing up cases from their first and second years. The written-up case and the fact that all the case-based discussions have been covered are noted in the final assessment sheet. The student should keep a copy of the write up in their portfolios.

2. How many case-based discussions do I need to do with the students? Each term while students are based at your practice we would like you to cover four case-based discussions, except if you are taking Met3a students based at The London, when you only need to do the first two cases. Each case has a GP focus and is linked to the 6. What do I do if I have problems? topics the students are seeing in their hospital placements and the Please do get in touch. Elora Baishnab e.baishnab@qmul.ac.uk lectures they have received. The cases are prepared for you in the (covering for Liz Nuttall’s maternity leave) will be happy to help. new tutor guides with suggested learning outcomes. And finally... Four cases need to be completed and signed off in students’ log 3. How do I incorporate the case-based discussions in my books. One case needs to be written up by student and marked by teaching? GP Tutor, showing learning objectives and answers to learning You can use these cases in your teaching however you think best, but all four must be covered. When you email the students before objectives. the attachment starts you need task them to prepare case one. You could then briefly discuss the case with them in the morning and produce learning objectives. At lunch the students could research these objectives. In the afternoon you could go over the learning objectives with them. The whole teaching should not take longer than 1 hour. If you can illustrate the case with the clinical

DO NOT GIVE COPIES OF THE ANSWERS TO THE STUDENTS: THESE ARE FOR YOUR REFERENCE ONLY. Dr Ann O’Brien, CBME

Barts and The London School of Medicine and Dentistry, Academic Unit for Community-Based Medical Education, Garrod Building, Turner Street, Whitechapel , E1 2AD.

www.ihse.qmul.ac.uk/cbme

SAPC (Society for Academic Primary Care) Conference July 2011 The SAPC conference which was run in Bristol this year was very well attended by primary care researchers. This year more focus was also given to educational research alongside clinical research. There were two education parallel sessions, an educational workshop and one of the two Masterclasses was focussed on education. The workshop titled, Inspiration through creation! Using creative approaches to extend perception and reflection in the undergraduate medical curriculum, was led by myself and two colleagues from the University of Bristol. We offered medical educators space to discuss the use of the arts in medical education, as well as time to engage in the creative-reflective process themselves. One of the lines of discussion, based on this first year student creative piece produced after a home visit, was how the arts can help us think about the difference between looking at a patient on the surface with their presenting complaint etc and actually seeing them more holistically, considering their lived experience with illness.

people say they do) offers different perspectives to enlighten the research question.

by Richard Purcell (2010) (for more examples with reflections, produced by University of Bristol students as well as a few academics, patients and artists see www.outofourheads.net )

The educational masterclass, Horses for courses: choosing and adapting appropriate study designs for educational research, was convened by myself and chaired by Anne Stephenson, director of community education at King's College London. Paul Dieppe and Gene Feder, both health services researchers, brought their expertise to help us as medical education researchers to consider alternative approaches to medical education research. A number of top tips were shared including the following: • Involve naive users in the form of user groups (e.g. medical students) when trying to work out the research question to ask – ask them what is important in the area you are considering from their perspective. • Don’t eschew observational studies, confounding is a bit problem with them, but they can still be of value. • Take a long time to close the variable list of factors measured. NB pilot studies are particularly useful when considering what are the outcomes of interest.

• Break down the barriers between research in different fields. At the end of the day we are all interested in questions that impact health care (whether through clinical interventions, drug treatment or education and development of the deliverers of treatments). • There needs to be variation to do an observational study e.g. if all GP practices are involved in teaching, it is difficult to tell what difference being involved in teaching makes. • One of the biggest challenges is formulating a clean question – one that is answerable, interesting and important. To help with this process one might o Work things through with trusted colleagues o Have a safe space to ask daft questions • When researching we are usually one step removed from what is actually happening in practice. For example we might be measuring what is happening within the individual student and changes in their behaviour, but good patient care is the result of a whole system in operation rather than at the level of the individual. • Financial costs of the delivery of undergraduate medical education is an important area to consider across the medical schools e.g. different ways in teaching anatomy and the concurrent costs.

• Size matters – collaborate across medical schools. o Although collaboration is really important, there often needs to be a clear leader who is driving the research forward also.

Conferences are a great way to network, share ideas and consider latest developments in the field.

• Measure what matters (are we measuring what we can measure or what is important to measure) – again pilot studies are crucial here (but often difficult to fund).

Next year the SAPC conference is held jointly with the 60th Royal College of General Practitioners annual conference. The theme is ‘Celebrating difference’ and it will take place in Octoaber in Glasgow. Maybe see you there.

• In interviews people tend to say what you want to hear e.g. if asking clinicians or educators. Conducting observational studies in practice (to see what people actually do) alongside interviews (asking what

Dr Louise Younie CBME (new Clinical Senior Lecturer, joined CBME in January 2011)

Issue 11, October 2011

October 2011 Issue 11

The Salaried GP Tutor Scheme Teaching delivered in primary care has always been a feature of medical education, but in recent years this aspect of future doctor’s training has increased, as medicine is increasingly practised outside of the hospital and in the community. Reflecting and driving this trend, the GMC in Tomorrow’s Doctors recommended that all medical school curricula should place a greater emphasis on teaching in community settings. In line with this recommendation, Barts and The London Medical School has increased the proportion of teaching in the MBBS curricula delivered in primary care settings. As a result, the medical school needs more and more GP practices and GP tutors to cope with this extra demand. However, the demands on individual GPs time often prevents even those GPs who really enjoy teaching from committing themselves to extra teaching sessions. Another trend in the way medicine is practised in recent years has been a change from the traditional model of general practice, run and managed by GP partners, to a model where salaried GP posts

are increasingly popular. Salaried GPs can be employed by a practice, a primary care organisation, or by alternative providers of medical services. A salaried GP can be an assistant, an associate, a GP who undertakes special interest work, a GP employed to work out of hours, a GP retainer, a flexible career scheme GP, or a returner scheme GP. For those employing salaried GPs, these posts can bring financial benefits in terms of enabling service development by freeing up partners’ time to allow them to engage in practice development. For the salaried GPs themselves, these posts can offer positive incentives for them in terms of job stability, reduced hours of work, and freedom from administrative responsibility. For some newly qualified GPs, they can provide a stepping stone to a partnership. Many of these salaried GPs are new to teaching and would welcome the opportunity to gain more teaching experience. Following a pilot project set up in 2010-11 by CBME Clinical Teaching Fellows Dr(s) Bruna Carnevale and Liz Nuttall, Barts and The London now have an established and innovative Salaried GP Tutor (SGPT) Scheme. The idea behind the scheme is to match salaried GPs who want more opportunities to teach with ‘host’ teaching practices. The medical school then benefits by being able to cover all the necessary teaching sessions that need to be delivered in primary care; the salaried GPs benefit from being offered the opportunity to teach; and the host practices benefit from extra resources made available to them to support this teaching. And last but by no means least, our students benefit from being exposed to highly motivated, student-centered and enthusiastic teachers.

The Process The Community-Based Medical Education team has an ongoing recruitment drive to find more practices that may be willing and able to host teaching, and to find salaried GPs with time to devote to working as a GP tutor outside of their clinical contract. Potential host practices should contact CBME (see below) and will initially need to complete an application form. They would also need to identify a GP tutor in the practice who could act as a GP mentor to supervise the salaried GP tutor. This would involve meeting with the SGPT on three occasions, at the beginning, middle and end of the academic year. Host practices also need to have adequate facilities such as a room for tutorials or for student clerking and examining of patients. Potential salaried GP tutors should also contact CBME and complete a form outlining their experience and other commitments. A salaried GP should have completed or be about to complete the London Deanery’s ‘Introduction to Teaching in Primary Care Course’ (ITTPC) or other equivalent teaching course. With their agreement, the salaried GP tutor is then allocated to a conveniently located host practice by the CBME team, who will also organise an initial meeting with SGPT, SGPT mentor and a CBME academic prior to teaching.

Barts and The London School of Medicine and Dentistry, Academic Unit for Community-Based Medical Education, Garrod Building, Turner Street, Whitechapel , E1 2AD.

www.ihse.qmul.ac.uk/cbme

The Teaching

The Finances

SGPTs in host practices carry out teaching from across the curriculum, with increasing time spent seeing patients in themebased sessions. Typical teaching sessions may include:

The host practice receives the teaching payment, as well as extra facilities funding as appropriate. All teaching undertaken by the SGPT will count towards the total teaching of the host practice, which can mean that for hosting an extra few sessions with a SGPT, the practice may move up to a higher payment band, making the financial rewards worthwhile. In addition, the practice receives sessional funding for mentoring activities (to a maximum of 5 sessions per academic year).

Year 2: Extending Patient Contact (EPC) – This unit links disease processes being studied in university-based problem-based learning sessions with relevant patient contact. Students build on their early clinical experiences with a growing focus on professional development. They attend the GP practice in groups of four for twelve alternate Tuesday mornings. Year 3: Integrated Clinical Studies in Primary Care – This develops the students’ clinical and communication skills, and is linked to the three major body systems Surgery, GI and Cancer; Renal and Endocrine; Cardiology, Respiratory and Haematology. Students attend in groups of four. Each student attends a four day GP placement for each body system and the GP tutors can select which day they teach. Year 4: Locomotor – The Locomotor days are divided into the following – Orthapaedics and Rheumatology (Mondays) Healthcare of the Elderly (Thursdays) and Dermatology (Tuesdays). Orthapaedics and Rhematology has been paired with Healthcare of the Elderly as it is good for students to attend the same practice for each. Students attend in groups of 4 and practices can take more than one group through the year.

The host practice then pays the SGPT on a sessional rate. Although this is negotiable between the practice and the SGPT, it is expected that the SGPT rate would be based upon the Barts and The London sessional teaching payment, which is £165 per session. This SGPT scheme has its origins as a pilot with Tower Hamlets PCT, and arose from discussions with Barts and The London Teaching Practices at training and business meetings. Following a trial pilot project, the initiative has become established. Anyone interested in joining the scheme, or wishing to know more about the scheme works should contact us at: Dr Peter Washer, CBME Community-Based Medical Education Tel: 020 7882 2505 Email: p.j.washer@qmul.ac.uk Also see Carnevale, B (2011) Salaried GP tutor pilot scheme BMJ Careers http://careers.bmj.com/careers/advice/viewarticle.html?id=20001782

Issue 11, October 2011

October 2011 Issue 11

Annual GP Tutors’ Day, 1st July About 70 GP tutors gathered to share knowledge at our annual GP tutor’s day this year at sunny Mile End by the river. We offered a mixture of plenary sessions and breakout workshops, both year specific and related to generic educational topics such as digital literacy, small group work or giving feedback. There was also opportunity for informal networking in the long lunch queue and at the end of the day over refreshments. Photo Barbara – caption – thank you Barbara for your lunch queue intervention Feedback from the day suggested that tutors valued this opportunity for dialogue and to consider delivery of Thank you Barbara for your lunch queue medical student intervention education in more detail. Of the plenary sessions, it seemed the student feedback from Lisa Elam, a second year student and Corinna Lea, a fifth year student was particularly appreciated. Many of the workshops were also highly evaluated but would have benefited from being longer sessions. We will take this forward into future planning. Our congratulations went to Dr Faiez AlShawk (1st Place) Dr Martha Leigh (2nd Place) and Dr Farzana Hussain (3rd Place) as we presented the annual tutor awards. A number of other nominations were Dr Sandra Nicholson also received. and Dr Faiez Al-Shawk Students wrote about how they valued the kindness, level of support and approachability of their nominated teachers, also how they welcomed being treated like adults and being listened to. Facilitating learning, being a good role-model with patients and enthusiasm were also noted.

“Getting nominated for a tutor of the year award by the students, I feel is the most positive feedback one can get as a teacher. I am sure that as a tutor I do not do things differently from my colleagues. Reflecting on my own practice, what I have been doing consistently and what may have helped me with the nomination include the usual. This includes preparation in advance, respecting the students as adult learners, negotiating how they may achieve their objectives, being approachable and sensitive to their educational and personal needs, going the extra mile when identifying a major deficiency and a balance between a challenging educational experience with a sense of humour and fun. As GPs we care for our students as we may care for our patients. Therefore the ultimate reward is to see the candidates’ progress in their educational and professional development.” Dr Faiez Al-Shawk Top tips and learning from the individual workshops will be placed on the new website which we are still developing (coming soon!). Thank you for all your comments regarding future tutor training (from the GP tutor development questionnaire in April, 2011 and feedback from this tutor’s day). These are being considered as we put together next year’s program realising though, as has been famously said:

Year 2 Student Feedback (EPC, Extending Patient Contact) This year there was a great deal of positive feedback from students... Key aspects included having well organised placements, enthusiastic tutors, teaching alongside current PBL scenarios/modules and the opportunity to have patient contact and practise clinical skills. Areas that could be improved centred around a lack of clinical skills and basic examination practise, which stressed the fact that students regard their EPC module as the perfect opportunity to develop these skills in time for exams. Other aspects of the module that received less positive feedback included assessment methods and a lack of organisation at some placements.

We will do our best though.

Many students suggested the use of a planned timetable each week (which could be given either at the very beginning of the course or on a weekly basis). Overall students recognise the value of EPC as an integrated module and are keen to make the most of this potentially hands-on learning opportunity.

Dr Louise Younie, CBME

Lisa Elam

You can please some of the people all of the time and all of the people some of the time, but you can't please all of the people all of the time.

Barts and The London School of Medicine and Dentistry, Academic Unit for Community-Based Medical Education, Garrod Building, Turner Street, Whitechapel , E1 2AD.

www.ihse.qmul.ac.uk/cbme

Student satisfaction at Queen Mary rises to highest ever level Student satisfaction at Queen Mary is higher than the national average Student satisfaction at Queen Mary, University of London, is five percentage points above the national average, and best amongst the large London universities, according to a nationwide survey of final year students. The 2011 National Student Survey (NSS) questioned UK undergraduates on various aspects of their student experience and measured overall student satisfaction. For students at Queen Mary this score has risen from 86 per cent in 2010 to 88 per cent in 2011 with the national average at 83 per cent. The University is now ranked 29th out of 184 higher education institutions for overall satisfaction, up 11 places from 2010. Amongst the major multi-faculty universities in London, Queen Mary ranked joint first with UCL, ahead of King’s College London, Imperial College London and LSE. Student satisfaction at Queen Mary is higher than the average score of the Russell Group universities. Medicine at Queen Mary ranked eighth in the UK out of 32 medical schools, second in London to UCL, and ahead of Imperial, King’s, St George’s and Cambridge University. “This year’s NSS results are Queen Mary’s best yet, with improvements not just in overall satisfaction, but also teaching, assessment and feedback, organisation and management, learning resources and personal development,” said Professor Susan Dilly, Vice-Principal for Teaching and Learning. Queen Mary also achieved exceptionally high satisfaction results in many subject areas, including: Aerospace Engineering (96 per cent), Law (96 per cent), French studies (96 per cent), Chemistry (95 per cent), Medicine (94 per cent) and Comparative Literary Studies (94 per cent). French studies has shown the greatest improvement and is now ranked second nationally, rising 25 places since last year.

Aerospace Engineering is placed second in its field and Mechanical Engineering equal fifth. Professor Dilly added:

While we congratulate all those who have worked towards these achievements we also recognise that there is always room for improvement as we continue to provide Queen Mary’s students with an excellent experience in all areas and in all subjects.”

About Queen Mary’s results French Studies scored 96 per cent in overall student satisfaction and is ranked equal 2/30 in its sector, up 25 places from 2010. Economics is rated 93 per cent for student satisfaction and has risen 15 places to equal 5/57. Medicine is rated 94 per cent for student satisfaction and has risen 15 places to equal 8/32. Chemistry is rated 95 per cent for student satisfaction and has risen 14 places to equal 10/37. Aerospace Engineering is rated 96 per cent for student satisfaction and has risen ten places to 2/19.

About NSS Over 260,000 final-year students took part in this year’s National Student Survey, which has been published annually since 2005 by the Higher Education Funding Council for England (HEFCE). Final year undergraduates from all publicly funded Higher Education Institutions (HEIs) in England, Wales, Northern Ireland, and participating HEIs in Scotland, are invited to take part.

Biology has risen 17 places, whilst Economics and Medicine have both risen 15 places and are now ranked fifth nationally and eighth nationally respectively. Chemistry is up 14 places, now ranking tenth in the country.

For media information, contact:

The School of Engineering and Materials Science has seen particular improvement. Materials is ranked top in its sector, with overall satisfaction at 93 per cent - 20 percentage points above the national average.

Sally Webster Head of Communications Queen Mary, University of London email: s.webster@qmul.ac.uk

Issue 11, October 2011

October 2011 Issue 11 Please send your responses to Aunty Aggie using the contact details on the back of the newsletter.

Aunty Aggie’s Problem Page – a problem shared... Dear Aunty Aggie I find that persuading patients to see medical students sometimes requires a certain amount of negotiation and I was recently presented with an ethical dilemma which I am keen to share with you and other tutors. One of my patients with rheumatoid arthritis has classical signs of this disabling disease. In the past she has been a lively and engaging person for the medical students to visit at home. She finds it hard to get out of the house to visit the surgery. When I asked her if she would agree to see another group of medical students and she replied that she would on two conditions: 1. That at least one young man was included in the group 2. That the young man would urinate in her garden Trying to control my shock at this unusual request, I asked for a reason. She explained that she is plagued by foxes that dig up her plants. She had been informed that male urine (especially from young men) would keep the foxes out of her garden. The guidance on professional attitude and conduct states: Section 6: Compassion and Empathy: ‘’responds humanely to patient’s concerns’’ Section 9: Determination to protect the patient’s best interests: ‘’Displays a genuine advocacy for the well-being and needs of the patient’’ Section 8: Self awareness and knowledge of limits: ‘’Personal beliefs do not prejudice approach to patients’’ But also………. ‘’Aware of appropriate professional boundaries, recognises need for guidance and supervision.’’ Mindful of Section 8 of the guidance, I am seeking guidance from other tutors. Any advice or suggestions would be gratefully received, and I would also be interested to hear if other GP Tutors have had similar experiences.

based urine spray by mail order. GMC guidance does not preclude a ‘modest’ thank you gift to participants in teaching or research so long as it does not constitute market rate payment. Will Spiring Mission Practice

Dear Jim Thank you for your letter. The sober issue you raise here is around patients informed consent to participate in teaching without coercion. It is interesting to consider the benefits to the patient of participating in teaching. Beyond the obvious general interest of society to have a well trained medical workforce patients participating in medical education have reported a number of perceived benefits including improving their own knowledge and satisfaction with and enjoyment from the encounter (young male or otherwise!) Tutors of course need to be mindful of assuming too much. It is good practice to display notices in the waiting room when students are in practice and to ask the patients permission for student involvement in consultations in a way that they can decline without embarrassment. Tutors will all have their unique way of doing this but must satisfy themselves the patients autonomy has been respected Aunty Aggie 1 BMA Medical Education Subcommittee(2008) “Role of the Patient in Medical Education”, BMA available at www.bma.org.uk/careers/becoming_doctor/roleofthepatient.jsp

Dear Jim It sounds to me like a perfect opportunity to teach on the new Year 4 Rheumatology community day as part of the Rheumatology, Care of the Elderly and Dermatology rotation. We are still looking for practices to teach this new module which is a single day placement in each subject for 4 students. Contact l.c.magorrian@qmul.ac.uk . Dr Sian Stanley (Year 4 lead)

Jim Lawrie, GP Tutor Dear Aunty Aggie Dear Jim It sounds like your dilemma requires some careful negotiation. Fortunately as with many ethical issues I feel there may be a third way. Access to the internet has been a positive step forward for many disabled and elderly patients allowing independence in tasks on which previously they would rely on individuals such as your ‘young man’. The US based site www.predatorpee.com sells wild wolf

My Year 1 and Year 2 students are struggling with the idea of writing reflectively. Do you have any suggestions as to how I can support them with this activity? Yours in hope Maria, MedSoc Tutor

Barts and The London School of Medicine and Dentistry, Academic Unit for Community-Based Medical Education, Garrod Building, Turner Street, Whitechapel , E1 2AD.

www.ihse.qmul.ac.uk/cbme Dear Maria The concept of reflective practice is based on the work of Donald Schon, and has become the model for many professions such as nursing, teaching and, increasingly, medicine. Yet many medical students struggle with the idea of writing reflectively. One reason for this is that anyone with a scientific educational background, such as most medical students have, will be used to writing about the world ‘out there’ as if they weren’t in it. They may be unfamiliar and uncertain about writing about themselves, their thoughts and feelings, as well as the effect that they have had on the world. Medical education has been criticised in the past for being too centred on learning vast amounts of facts by rote learning and then rewarding ‘surface learning’ with assessments that required regurgitation of these facts. The sheer volume and complexity of medical knowledge will inevitably expand and evolve over the course of our students’ careers. The purpose of getting medical students to write reflectively is to equip them for careers as lifelong learners where they will need to determine their own learning needs and goals, and continually reflect on their own learning and professional development. What does this mean in practice? Reflective writing is more personal writing than perhaps the students are used to, but at the same time it is more rigorous than a ‘Dear diary’ entry. Reflective writing means to foster reflective thinking. This is usually done retrospectively, by looking back at an event (or an idea) and analysing it or thinking it through from a number of different perspectives, or with perhaps a theory or model or evidence in mind. An important part of this process is thinking through the implications of the event and the way they felt about it, or dealt with it, and what consequences this will have for their future practice. The type of events that trigger this reflective thinking need not be anything terribly dramatic. For example, this year we have changed the EPC assessment slightly, so that: “Students must write a 500 word reflective essay on an occasion where they interacted with a patient that resonated with them for some reason, for example it made them think of a patient / medical condition in a new light, or it raised some ethical issues, for example where they were required to gain consent from a patient for a task that they were about to perform.” One way to structure this assignment, and indeed any piece of reflective writing, could be: • A description of the event, including what made it noteworthy • How this event impacted on the writer – how did they feel about it, did they think differently about things before or after it happened? • Is there some theory or empirical evidence that could help explain or elucidate what went on? • What was the outcome, including how they might approach similar situations differently in future as a result of this reflection Good reflective writing should be honest and authentic, in other words, the negative thoughts and feelings should be there, as well as things were successful and positive. The important thing is that the students have learned from the experience in a way that will move them towards being better doctors. There is more information on writing reflectively in the appendices of the MedSoc and EPC student and tutor guides, as well as loads of useful guidance on the internet – for example http://www.qmu.ac.uk/futurefocus/SSAAwriting.htm Dr Peter Washer, CBME

The OSCE Experience – Through the Examiner’s Eyes Summer for our GP tutors usually means the end of teaching and a break before the new academic year begins. For our students, however, there is one hurdle they must clear first – the end of year exams! Your role as a tutor usually ends once the final students leave your practice, but it is also possible to get involved in this very important part of the education process, by becoming an OSCE examiner. Our students sit Objective Structured Clinical Examinations (OSCE’s) as well as written exams at the end of each year of study. OSCE’s are station-based clinical examinations which allow us to assess knowledge in a different manner to other assessment formats, by contextualising theoretical knowledge around clinical skills. Students make their way around the OSCE “circuit”, a sequence of 5 or 10 minute stations, and have no idea what they will be asked to do until they enter the station. They may be asked to examine a normal elbow joint, identify the pathology in an abnormal abdominal examination, demonstrate the use of a metered-dose inhaler, counsel a patient on contraceptive options, or perhaps take a history from a depressed patient. The ‘Simulated Patient’ is played by either an actor or a patient volunteer, and the role of the examiner is to observe and to score the performance of the student using the prepared marking sheet. I recently took part in this process as an examiner in the Year 1 and Year 4 OSCE’s. This was a very interesting as well as challenging experience, and I found it very rewarding to be involved in a different aspect of the students’ educational experience. It is of course hard work and tiring to maintain active listening and remain engaged for a whole day of examining, but the organisers are well aware of this problem and there was plenty of tea, coffee and snacks at registration and in the mid-session and lunch breaks. The clinical scenarios and characters portrayed by the simulated patients were often complex and fascinating, and each student tackled the scenario in a different way, which also made it easier to maintain my focus and interest. One criticism of OSCE’s is that it is difficult to ensure they are a reliable and valid assessment because of the potential for variation between examiners and simulated patients. In order to enhance the reliability of our OSCE’s, the interaction between student and examiner is restricted, the marking schedule is highly structured, and new examiners undergo training. Having never been an OSCE examiner before I was very nervous before my first session, but the training, preparatory reading, and structured marking forms made the process in fact very straightforward. As well as completing the marking forms for each student, examiners are also asked to complete a form giving feedback on the station itself. It is important that these are completed as it allows the organisers to make changes to stations where appropriate. There is also a form to be completed if you have any serious concerns about a student’s professional conduct. I was fortunate not to need to complete one of these, and found the students on the whole to be of an extremely high standard. This reflects very highly on the quality of teaching being provided by our tutors throughout the year, so thank you once again! If you would like to become involved in OSCE examining for next year, please contact Anne Musker (a.g.musker@qmul.ac.uk) or Karin Hogan (k.hogan@qmul.ac.uk) for more details. Dr Emma Ovink, CBME Issue 11, October 2011

October 2011 Issue 11

New Yvonne Carter building The opening of the new Yvonne Carter building on the QMUL Whitechapel Campus been teaching with us continually for over 12 years. We actually sent out 40 invitations. More than 100 people came to the Perrin Lecture Theatre at Whitechapel to hear speeches from Professor Sir Denis Pereira Gray and Professor Gene Feder and Dr Michael Bannon, Yvonne’s husband. The over-riding impression I took away from their words was that Yvonne Carter had been an energetic campaigner for the place of Primary Care in Education and Research and a tireless champion of colleagues – whether or not they believed in themselves. There was a genuine warmth and respect for Yvonne from all speakers which was echoed by the nods of remembering visible around the lecture theatre.

As many of you will remember, the origins of CBME, the Academic Unit for Community-Based Medical Education, owe a great deal to the work of Professor Yvonne Carter who joined the School of Medicine and Dentistry in 1996 as Head of General Practice and Primary Care. Yvonne died early in 2009, aged 50, from breast cancer, and is still sadly missed. Colleagues in the Centre for Health Sciences, which included CBME up until February 2011, took the opportunity to honour her memory as they moved into a brand new teaching and research location. They are now known as the Centre for Primary Care and Public Health and are part of the newly formed Blizard Institute. We are still close to our colleagues in Primary Care, both in promoting good learning practice in Primary Care and in geography - they are also located in Turner Street not far from The Garrod Building where CBME is based.

After the formal speeches, we all followed Dr Bannon over the road to the new building where he ceremonially cut the ribbon and we were able to see for ourselves the light, airy and well appointed buildings that house the new Centre for Primary Care and Public Health. Refreshments and chat continued and it was also possible to tour the three floors of the building with its vibrant use of space and clever use of glass inside the building to maintain the feeling of openness. I felt it was a fitting testimony to the pioneering work of Yvonne Carter during her life and a remarkable start to the work of the new Centre, with whom we hope to work in partnership in the future.

Invitations to the Opening Ceremony on 25th May 2011 had been sent to colleagues who had known Yvonne and CBME invited GP Tutors from Barts and The London Teaching practices who have

Kathryn Livingston, CBME

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Here’s something to keep those little grey cells active - enjoy!

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Contact the Editorial Team This is your newsletter. If you have any suggestions for future content, useful teaching tips, teaching resources or experiences you would like to share please send us your contribution. Lynne Magorrian l.c.magorrian@qmul.ac.uk

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Puzzle Corner

Janet Johnstone j.r.johnstone@qmul.ac.uk

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Barts and The London School of Medicine and Dentistry, Academic Unit for Community-Based Medical Education, Garrod Building, Turner Street, Whitechapel , E1 2AD.

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