How to Succeed on Primary Care and Community Placements
Description
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Other editions
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Persons
David Pearson is a?General Practitioner and?Director, Academy of Primary Care, Hull York Medical School, York.
Sandra Nicholson is Lead, Academic Unit for Community-Based Medical Education, Barts and The London School of Medicine and Dentistry, London.
Content
Contributors x
Introduction xi
Acknowledgements xv
Chapter 1: What to learn in community settings 1
With Ann O'Brien
Introduction 1
Early years 3
What to learn during early patient contact 4
Professionalism and personal growth 5
Patient perspectives on health and healthcare 8
Social and psychological aspects of health 9
Learning clinical method (history taking and examination) 11
Clinical and procedural skills 13
Middle clinical years 14
Later clinical years 22
Learning in the community 'out of hours' 25
Further opportunities 26
Summary 29
References 29
Further resources 30
Chapter 2: Learning the public health aspects of medicine 32
With Ann O'Brien
Public health perspectives 32
Health promotion 35
Primary and secondary disease prevention 36
Behaviour change: health promotion and prevention for individuals 38
Public health and health education 39
Summary 41
References 41
Chapter 3: Preparing for and learning on primary care and community placements 42
With Maria Hayfron-Benjamin
Introduction 42
Preparing for your community placements 45
When you arrive on placements 47
Your responsibilities at the end of your placement 59
Summary 60
References 61
Chapter 4: Active learning in the consultation 62
With Catie Nagel
Introduction 62
Learning objectives learning plans 63
Learning consultation skills 64
Understanding the consultation 65
The art of consultation 66
Engaging with patients introductions information consent 67
Working with patients 68
Active learning in the consultation 71
Student-led consultations 76
Problems pitfalls and suggested solutions 77
Complex consultations for the later clinical years 79
Summary 82
References 83
Chapter 5: What to learn from the primary healthcare team 85
With Will Spiring and Ann O'Brien
Introduction 86
Professional behaviour in a team 87
What the PHCT does 90
Learning with and from the primary healthcare team 95
Learning from the practice nurses 98
Learning from the pharmacy team 100
Primary health team meetings 105
Learning from mistakes 106
Patients and public involvement in your education 107
Summary 109
References 109
Further resources 110
Chapter 6: Learning medicine in community settings 111
With Ann O'Brien and Will Spiring
Learning from community visits 112
Learning from doctor's home visits 113
Visiting residential care and nursing homes 115
Learning from community mental health teams 116
Long-term mental healthcare in the community 119
Community mental health for the elderly 120
Community maternity and child health services 121
Community sexual health services 122
Palliative and end of life care 123
Summary 126
References 126
Further resources 127
Contents vii
Chapter 7: Clinical information systems opportunities to learn 128
With Jane Kirby
What are clinical information systems? 128
Why learn about clinical information systems? 129
Clinical information systems in community practice 130
Making the most of the CIS in learning and teaching 130
What do clinical information systems offer in the diagnosis and management of acute illnesses? How do they support your learning of these conditions? 132
How do clinical information systems support the management of long-term conditions? How can they support your learning about this vital area of medicine? 134
Learning from clinical guidelines 138
How can clinical information systems support the learning of prescribing (and patient safety)? 139
Family medicine using clinical information systems to learn public health aspects - what do you need to know? 141
Clinical information systems: supporting learning about communication with patients and colleagues 143
Using clinical information systems in supporting assessment 144
Clinical information systems: problems and pitfalls 145
Clinical information systems: projects audit and research 148
Summary 149
References 150
Chapter 8: Supporting learning in primary care using social media and other technologies 151
With Jonathon Tomlinson
Social media in your primary care placements 152
When media becomes social media 153
Social media landscape 154
Your online profile and digital professionalism 155
Your digital footprint 155
Doctors and patients online 156
Digital literacy and information literacy 157
Social media sites: Facebook Twitter Blogs Wikis YouTube Slideshare/Prezi Scoop.it/Pinterest 159
Summary 164
References 165
Further resources 166
Chapter 9: Assessment feedback and quality assurance 167
With Mark Williamson
Assessment in your primary care placement 168
Assessments in medical courses what should you expect? 169
What types of assessment should you expect on your primary care placements? 171
Contents ix
How can you best use your time on primary care placements to survive (or even excel) in your medical school assessments? 174
Some potential strengths of assessment in primary care 177
Opportunities for self-assessment in primary care settings 181
Some final thoughts: why authenticity in assessment matters 181
Feedback within your primary care placement 182
Types of feedback in primary care placements 184
Giving and receiving feedback 187
Giving something back - your responsibility to offer feedback 188
Summary 191
References 192
Chapter 10: Conclusions: Looking to the future 194
Reference 197
Index 198
Chapter 1
What to learn in community settings
With Ann O'Brien
Introduction
Medicine is best learned from patients, and patients overwhelmingly engage with healthcare in their own community settings. Increasingly modern healthcare is structured to occur in community settings, and it necessarily follows that much of medicine can, and we believe should, be learned in these settings. This chapter highlights aspects of the undergraduate syllabus common to many medical schools that you will have the chance to learn in primary care and the community as you progress through your undergraduate curriculum. In Chapter 2 we focus particularly on public health and health promotion aspects of medicine, and in later chapters we explore the practicalities.
Helping you appreciate all that you can learn while on a community placement will motivate you to make the most of your time. This is important because some topics will only be covered during your time in the community and hence it's useful for you to know how these learning opportunities may present. There are additionally many opportunities for you to see how community-based medical education complements and puts into perspective the science and theoretical learning you do at university and also your hospital-based experiences.
By the end of this chapter you should be able to:
- be aware of what areas of your curriculum can be covered within the community
- understand how early attachments lay the foundations for later clinical placements
- appreciate how this book will help support you to make the most of such learning opportunities
Making the most of your community time whether you eventually become a general practitioner (GP), hospital physician or surgeon is time well spent as what you learn in this setting will make you better clinicians.
It is important that medical students receive clinical experience in a range of healthcare settings. The healthcare system in the UK is varied, increasingly decentralised and subject to change. A varied medical education and clinical experience can help students adapt to these differences and changes when they graduate. Clinical placements should start early in the undergraduate curriculum.
Furthermore:
Placements should reflect the changing patterns of healthcare and must provide experience in a variety of environments including hospitals, general practices and community medical services.
(GMC Tomorrow's Doctors, 2009)
This chapter is divided into four sections: early years, middle years, later years and further opportunities which reflect the range of community attachments occurring within an undergraduate medical curriculum. Each section outlines what you and your tutors might expect such a placement, at that time of the curriculum, to deliver. You will have different opportunities depending on how your medical school delivers its curriculum, but there is often a common core syllabus with similar aims and learning objectives. Although much of this book focuses on a UK perspective, the principles and many examples are of relevance if you are a student studying outside of the United Kingdom. Community placements are designed to provide increasing clinical exposure and responsibility across the years as you become more knowledgeable. Equally the concept of longitudinal integrated clerkships (LICs) is gathering momentum in medical education; primary and community care will tend to have a disproportionate role in delivering these longitudinal experiences and the advantages they are thought to bring. Ultimately all these placements aim to help you to prepare for independent clinical practice.
Take a look at what some of the world's leading medical educationalists have to say about what competencies a doctor should have (CanMEDS Framework; http://www.royalcollege.ca/portal/page/portal/rc/canmeds/framework) or what the UK's General Medical Council has to say (http://www.gmc-uk.org/education/undergraduate/tomorrows_doctors.asp):
The curriculum will include practical experience of working with patients throughout all years, increasing in duration and responsibility so that graduates are prepared for their responsibilities as provisionally registered doctors. It will provide enough structured clinical placements to enable students to demonstrate the 'outcomes for graduates' across a range of clinical specialties, including at least one student assistantship period.
GMC (2009) Tomorrow's Doctors; Para 84
Early years
Meeting patients, learning how and why some people become ill, and how to help them were some of the reasons why you wanted to become doctors. The social and psychological aspects of health and illness are well covered during community attachments. You will therefore be able to learn about how patients' lives and work affect their health and experience of disease.
This is one of the important learning outcomes stated by GMC:
Explain sociological factors that contribute to illness, the course of the disease and the success of treatment including issues relating to health inequalities, the links between occupation and health and the effects of poverty and affluence.
GMC (2009) Tomorrow's Doctors: Outcomes 1 The doctor as scholar and a scientist
TASK
Why not take another look at the GMC's document 'Tomorrow's Doctors, 2009' or its equivalent alternatives such as the Scottish Doctor or the CanMEDS (for links, see reference section) and see what you need to know and what can be covered during your community placements.
Meeting your first patient as a medical student can seem daunting, and you may also feel that your patient may have unrealistic expectations of what you know and can do. Early patient contact often occurs within primary care and the community and sets a student's mind at ease, increases your confidence and begins to make you feel like you are learning to be a real doctor, ensuring your theoretical knowledge is grounded in a patient-centred holistic framework.
Early on, it is easy to fixate on skills you think you lack, or believe that you must have answers for the patient, or be able to diagnose illness. In reality, this is an opportunity to develop innate skills that underpin this diagnostic ability. Learning how to talk to patients, empathise with their problems and appreciate the impact of illness on their life without a diagnostic or history taking agenda may be the most valuable thing you develop in your entire medical career.
(Final year medical student)
What to learn during early patient contact
Community placements are an opportunity for you to meet patients early on. Often referred to as early patient contact (EPC), these placements focus on authentic patient interactions, encourage you to appreciate the psycho-social aspects of medicine and contribute to your growing understanding of the varying roles of different health professionals involved in multi-professional team working (Dornan and Bundy, 2004). Opportunities will be available for you to actively engage with patients in a safe clinical environment, helping you to reflect on developing your communication skills and attitudes towards patients and illness. This is an important task which should complement your growing scientific knowledge. Becoming a doctor requires you to learn from a structured curriculum that balances learning to know with learning to care.
Benefits of early patient contact:
- Brings alive your scientific learning
- Encourages confidence in students
- Sets the scene for later clinical learning
- Develops a patient-centred approach
TASK
Introduce yourself to a patient by explaining who you are and that you would like to find out how their health affects them. Consider how you should best approach this interaction with a patient and whether there are any ethical issues involved such as confidentiality.
Community-based EPC provides you with a learning environment which integrates scientific and clinical education. With a more holistic view of medicine you will be able to better appreciate the clinical context of the underlying biomedical principles you are learning about elsewhere (Dahle et al., 2002). Your early clinical exposure contextualises the science you need to learn in order to fully understand the clinical scenarios, which you will engage with later on in your training (Dornan and Bundy, 2004). If you have been enthusiastic and engaged with earlier clinical opportunities that highlight the centrality of patients, you will feel better prepared and more confident when you start your clinical placements later. Primary care often reflects opportunities to meet with patients, who in their own environments, feel empowered to talk with you, and share their experiences with you, more so than when they are hospitalised.
TASK
Speak to your community tutor. Explain what you have recently covered at medical school. Your tutors should understand the content of your curriculum but their experiences at medical school may be very different compared to yours. Then discuss how the medical science that you are learning can be applied to the clinical situations you see each day.
