Placement Activities

(timings are flexible - but should cover a minimum of 6 hours)

Morning activities

9-9.30 Welcome, preparation for the day

9.30-11.30: Meet patients - face-to-face or remote (opportunity for CEX, DOPS, Continuity Exercise) - We suggest Supervised student clinics with minimum of 3-4 acute presentation or F/U each week (30 min appointments)

11.30-12.30: Debrief, feedback & filling knowledge gaps

Afternoon activities

13.30-14.30 Tutorial  - opportunity to explore student requested themes, or consider one of year 3 clinical themes or vertical threads. 

Other activities

• Data interpretation session (NB students have a data interpretation exam - blood test results etc)

• Time for working on Group Based Assessment

• Nurse or other healthcare professional clinic (supervised learning including opportunity for clinical skills e.g. BP, ECG, spirometry, or to assist chronic disease monitoring clinic e.g. diabetes: take histories, review meds, check BP, dip urine, complete template)

• Practice meetings (e.g. palliative care, MDT, clinical meetings)

• Expert patient (virtual) encounter

• Virtual/face-to-face home visit (with member of MDT, or as part of learning e.g. coping with chronic illness)

• Role play - patient consultation

• Peer-led teaching

15.30 Debrief and Feedback

Dear Students 

My name is Dr ….and I will be your GP Tutor at …Practice Name for your upcoming GP3 placement.

SURGERY INFORMATION

·       Address of Practice

·       How to get there

·       Details of Educational Co-ordinator

·   If there is more than one site – clarify where they have to go

SESSIONS

- The Sessions will be from (add timings)

- Please arrive for (add time) at the surgery for your first session

- Information about lunch – should they bring their own or are there places nearby

- If there is any reason why you cannot attend, especially on the first day please inform me by email as soon as possible.

- We have moved to a “total triage” system in general practice with a “telephone-first” approach, it may be useful for you to familiarise yourself with these concepts. 

I look forward to meeting you all in ............ and we want to make sure you get as much patient exposure as possible.

Please could you CONFIRM RECEIPT OF THIS EMAIL (with thoughts on key learning needs and what you hope to get out of the placement).

Best wishes

Dr

Human dimension

This section is a reminder of the huge importance of the human dimension on placement - i.e. the relationships between students and students, between students and their GP tutor, between students and patients. 

1. For student engagement and learning on placement, having a sense of belonging matters 

• Posited as the key variable in whether students persist with their studies and are successful in the Higher Education Academy’s “What works?” student retention and success programme, sense of belonging is strongly associated with academic and social engagement while at university. https://wonkhe.com/blogs/belonging-inclusion-and-mental-health-are-all-connected/ 

2. Mattering matters - students need to feel that they matter, and are not just in the way - enhances learning, reduces burnout

• “Some of this suffering can’t be avoided,” she acknowledged. “You’ll have a first patient who dies. There will be unexpected bad outcomes. It’s unavoidable. But even in those moments, a student can be of value to the patient or their team and there are ways we can let them know they are valued. We can enhance the experiences of our students by letting them know, ‘We want you to be here, you cancontribute, you’re in nursing and medicine because you have qualities that will make you a great nurse or doctor.’ https://www.nursing.virginia.edu/news/mattering/ 

3. Getting to know you as GP tutor and your lived experience of practice is central to student learning

• Here are some suggestions from our GP tutors on how to build relationship at the start of placement https://sites.google.com/view/educator-development/educator-development-opportunities/nuggets-workshop-7th-september-2022 

4. Building relationships across students as course mates enables learning and engagement

• When asked what would help students feel a greater sense of belonging, developing closer or more friendships was the most popular choice for all respondents (46 per cent) across all demographic categories....“Getting to know people on my course better” was a close second at 42 per cent

• ... it’s key to create opportunities for peer learning and collaboration from day 1, ... through group activities and assessment – when students interact extensively through their learning, it ‘naturally’ forges stronger links with each other and they create a real ‘community’... it works better to forge those stronger connections and friendships through the natural process of learning, rather than (only) through social interactions outside of the course. https://wonkhe.com/blogs/belonging-inclusion-and-mental-health-are-all-connected/

• email you prior to placement to let you know where to come etc. 

• introduce you to themselves, the practice, the team, the processes and how things work in general practice

• do a learning needs assessment when you first attend the practice

• offer you debrief opportunities after seeing patients

• offer you a mid-term review

• offer you feedback on your clinical, consulting, professionalism

You should meet patients both remotely over phone or video as well as face to face, different skills may be brought out in either of these. Your GP tutor should gradually allow you to engage more with patients as you gain in confidence and ability. 

• require good history taking skills

• offer less opportunity for examination (but for example of remote examinations see here)

• invite development of patient management (e.g. by stopping the consultation, discussing management plan with the GP and returning to the consultation to practice management conversation. 

• invite development of the ability to triage which patients need to come in for review 

Your role in the third year is to learn with, from and for patients. The key things to remember are that patients need to know who you are and need willingly to give informed consent to help in your learning. The information that they need to enable them to give informed consent includes what will be involved, a true estimate of how long it will take and the fact that it is for your education and whether they say 'yes' or 'no' will not affect their care. 

You need to explain that you have the same duty of confidentiality as other professionals, namely that you will not discuss the patient outside of the clinical team or your learning group. Most patients will be happy to help you learn. If the patient prefers that you don’t examine them, thank them very politely and then move on to the next

patient, they might well feel up to it next time you speak to them.

Student: ‘Hello, my name is ***, I’m a third-year medical student attached to Dr  ***. I’m currently learning how to take a medical history and I was wondering if you might allow me to talk with you before you see the GP. It will take about 10 minutes It’s just for my learning, so no problem if you say no.’

Obviously, never pressure a patient to allow you to examine them – consent is a gift from the patient and should be given freely. Also, never allow the patient to misunderstand who you are – if they say ‘Yes, of course doctor’, for example, correct them ‘Oh no, I’m not a doctor yet, I’m a student doctor and I’m just here to learn.’ Not only is this the right and ethical thing to do, but it also stops you from getting into trouble if a patient assumes that you are qualified.