Community-Based MedicalEducation (CBME) Newsletter for General Practice October 2011 • Issue 11 www.ihse.qmul.ac.uk/cbme

Welcome to the autumn newsletterand thank you to all who havecontributed to it. This issue includesnew Case-based Discussions in Year3, a report on our Annual Tutors Dayand The OCSE Experience.

www.qmul.ac.uk

Inside this issueFarewell to Dr Rhiannon Englandof Statham Grove Surgery 02

Introducing Elora Baishnab 02

Introducing Mbang Ana 02

GP Tutors Day 02

Introducing Emma Ovink 03

Introducing Peter Washer 03

Baby Boom 03

New for 2011-12 04

SAPC Conference July 2011 05

The Salaried GP Tutor Scheme 06

Annual GP Tutors’ Day, 1st July 08

Student satisfaction at Queen Mary risesto highest ever level 09

Aunty Aggie’s Problem Page 10

The OSCE Experience – Throughthe Examiner’s Eyes 11

New Yvonne Carter building 12

Puzzle Corner 12

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October 2011 Issue 11

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

Introducing Elora BaishnabI am pleased to say I have recently joined the CBMEteam to cover Liz Nuttall’s maternity leave. I will betaking over the supervision of Year 3 IntegratedClinical Studies in Primary Care.

I am GP working in and around North East London. Ihave recently completed an Academic GP ST4 post

at St Georges University of London where I have submitted twoCochrane reviews for publication. I am due to complete aPostgraduate Certificate in Healthcare and Biomedical Education inthe coming months. I have a strong interest in undergraduateeducation which I have furthered through teaching, examining anddesigning assessments at both Barts and The London and StGeorge’s Medical Schools. I am excited about returning to EastLondon as I love the area and I very much look forward to beingpart of the team here. If you need to contact me, my email addressis e.baishnab@qmul.ac.uk.

Dr Elora Baishnab, CBME

Introducing Mbang AnaI am Mbang Ana, a part-time GP in Arlesey,Bedfordshire. I joined CBME in January 2011 as aClinical Teaching Fellow with two main roles withinthe department. Firstly, I am Unit Convenor forStudent Selected Components (SSCs); workingalongside Emma Ovink. This is a very enjoyable jobbecause it allows Emma and I to help interested GP

tutors deliver teaching to their areas of strengths, often in veryinnovative ways. Secondly I work alongside Sian Stanley on the Year4 community teaching units; Brain and Behaviour, HumanDevelopment and our new teaching unit Community Locomotor.

Working on the Year 4 community units is challenging, rewardingand always interesting. I encourage those of you who are interestedin teaching Year 4 medical students to consider signing up for theCommunity Locomotor teaching.

If you have any questions regarding any of the Year 4 teaching unitsor SSCs please feel free to email me (m.ana@qmul.ac.uk).

Dr Mbang Ana, CBME

Farewell to Dr RhiannonEngland of Statham GroveSurgeryI am leaving my practice in Statham Grove, Stoke Newington after22 happy years as a partner and teacher.

Over the years I have taught most modules, from Medicine inSociety to final year attachments and have definitely learnt anenormous amount from the students. Teaching can feel a choreat times- especially when work is busy, a partner is off on holiday,reception are complaining about time keeping and the studentsare yawning. But then there is a spark- a patient whose story isso moving that the students are profoundly affected, a patientwho makes them laugh, or a difficult encounter that provokes areally interesting debate on the ills of society.

Teaching keeps me passionate about General Practice. Itconfirms for me the importance of the doctor/patient relationshipand the importance of retaining the generalist approach.However it has also been hard work, occasionally verychallenging and more and more difficult to fit into an increasinglydemanding work environment. The rewards of meeting talentedand interested students greatly outweigh the difficulties though,and teaching certainly has encouraged me to maintain reflectiveand informed practice in order to stay one step ahead!

Thank you to CBME for all your support and to all the studentsthat I have taught over the years. If I continue to work locally inthe future I will certainly be offering to teach again if possible!

Best wishesDr Rhiannon England, Statham Grove Surgery

Teaching with SmallGroupsAt the Tutors Day, Dr Peter Washer ran a session on teachingwith small groups. This was exceptionally well attended,which points to a desire from our tutors for similar trainingopportunities.

For those who missed the session, the take home messageswere:

• Plan, plan, plan your session (in terms of setting andtimings)

• Identify your intended learning domains (knowledge / skills/ attitudes)

• Determine your learning objectives

• Decide on what would be the most appropriate teachingmethods to meet those learning objectives

• Identify a method by which you could assess that thestudents have met the learning outcomes?

• Reflectively review and revisit your lesson plan.

The session was a précis of a half day workshop that Peterruns at QMUL’s Learning Institute. He will be running thisworkshop on Monday 7 November, and on Friday 27thJanuary 2012, both from 2-5pm. These sessions are free toour GP tutors, and can be booked via the Learning Institutewebsite at www.learninginstitute.qmul.ac.uk/booking

In addition to this, Peter is happy to run further similartraining for GP tutors if there is a demand for it (either at QMor in practices). Please contact Peter to discuss by emailp.j.washer@qmul.ac.uk or tel: 020 7882 2505

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Introducing Emma OvinkI joined the CBME team as an Attached SalariedGP in November 2010, which is when I began a2 year post with the Tower Hamlets Salaried GPScheme. Under this scheme I am employed byTower Hamlets PCT; two thirds of my week isspent working at Jubilee Street Practice as aSalaried GP, and the remaining third is dedicated

to professional development. I wanted to develop my skills inteaching 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 NottinghamUniversity, but I moved to London upon completing my houseofficer training, and undertook my GP training on the local TowerHamlets Vocational Training Scheme. I then worked abroad as aprivate GP in Dubai for two years while my husband wasseconded there by his firm but we were very happy to returnhome last June, and I have been living and working in TowerHamlets ever since.

I am currently working with Dr Mbang Ana as joint SelectedStudy Component Unit Convenors, which means I amresponsible for the primary care SSC programme. SSCs offerstudents the opportunity to study an area of the curriculum ingreater depth, or to study an area not covered by the curriculum.They can choose from a range of excellent ‘standard’ primarycare SSCs, and since I joined the team I have been able to assisttwo GP tutors to develop brand new SSCs that have been offered(and chosen) by students this coming academic year. I am alsoworking with other tutors to develop more new SSCs, and amalways happy to be contacted about new ideas.

Students can also choose to ‘self-organise’ their SSC, and part ofmy role here has been in improving our process for approvingthese, and ensuring that the SSC is robust, worthwhile, and avaluable learning experience for the student.

Since starting work here I have had the opportunity to improvemy abilities as a teacher, firstly by attending the ITTPC course,and also by attending training in becoming a PBL (problembased learning) facilitator. I am involved in teaching students inmy own practice, and I am also going to be involved in deliveringcentralised 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 educationand the work of CBME as a whole, and have been able to getinvolved in continuing to improve the department’s links with ourGP tutors, through workshops at the tutor training days, as wellas working on the content for our new website, and of coursethrough writing articles for our newsletter!

I am thoroughly enjoying my attachment here so far – it is hardwork but very satisfying, and it makes all the difference to workas part of such a friendly, fun and dedicated team.

Dr Emma Ovink, CBME

Introducing Peter WasherI joined CBME as a Lecturer in Medical Education inApril, covering Maria Hayfron-Benjamin’s maternityleave. I’m now four months into my ten monthcontract, and feel as though I’ve established myself ina very friendly team, primarily by carving out a role formyself as the office tea boy.

I’ve had a long and circuitous career. I trained as a Registered Nurseas a school leaver, and then worked as a haemodialysis staff nurse inthis country and in Saudi Arabia for a little while. But then I got thebug to study at university and gave that up to do a degree inphilosophy in Wales, and then a Masters in medical law and ethics atKings. After finishing the Masters, I worked for a few years in the mid-1990s in a residential project / hospice in Hammersmith for peoplewith HIV related dementia.

In 1997 I got my first job as a lecturer, and since then I’ve movedaround quite a few different London universities teaching differenthealth care professionals and doing staff development, including a fewyears teaching clinical communication to medical students at UCL andImperial College. At the risk of being accused of being a perpetualstudent, since becoming a lecturer, I’ve also done a second Masters ineducation at Greenwich and a PhD in history and philosophy ofscience at UCL.

In terms of my research, I’m interested in the more social aspects ofmedicine, particularly how the public makes sense of the risk ofcontemporary infectious diseases, such as SARS and MRSA. For thepast few years I’ve been freelancing and doing contract research whilewriting two books: the first was a textbook Clinical CommunicationSkills for Oxford University Press, which I’m delighted to say won firstprize in the Basis of Medicine category at the BMA book awards lastyear. Since then I’ve published a cultural history of infectious diseases,Emerging Infectious Diseases and Society, which has been shortlistedfor this year’s British Sociological Association’s Sociology of Health andIllness book prize. Wish me luck! – The decision will be announced atthe BSA conference in September.

Here at CBME I am Unit Convenor for Medicine in Society for thegraduate entry students and in Years 1 and 2, and for ExtendingPatient Contact. I’m also caretaking the Salaried GP Tutor Scheme.I’ve spent the past few months getting to know the place and thepeople, revising the tutor and student guides, and generally doing thetype of housekeeping that academics do during exam times andbefore the students return in September. I met quite a few of the GPtutors at the Tutor’s Day, and look forward to working with you all overthe next six months.

Dr Peter Washer, CBME

We are very pleased toannounce the arrival of two newCBME babies. Dr Liz Nuttall hasa baby boy named Ben, andMaria Hayfron-Benjamin has agirl, Lucy. We would like to sendour best wishes to all.

Baby Boom

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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.

Case-based discussions for Year 3Community-Based TeachingPlacementsCase-based discussions (CBDs) were initially designed to supportthe provision of problem-based learning (PBL) content of Year 3;they were piloted last year with a cohort based at The RoyalLondon Hospital and the student feedback was excellent. CBDsdiffer, however, from PBL cases in that they are shorter and morestructured. Whilst they will still utilise an element of self directedlearning, they are better adapted to the general practice setting byallowing a structured discussion around a case based on setlearning objectives.

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

2. How many case-based discussions do I need to do with thestudents?Each term while students are based at your practice we would likeyou to cover four case-based discussions, except if you are takingMet3a students based at The London, when you only need to dothe first two cases. Each case has a GP focus and is linked to thetopics the students are seeing in their hospital placements and thelectures they have received. The cases are prepared for you in thenew tutor guides with suggested learning outcomes.

3. How do I incorporate the case-based discussions in myteaching?You can use these cases in your teaching however you think best,but all four must be covered. When you email the students beforethe attachment starts you need task them to prepare case one.You could then briefly discuss the case with them in the morningand produce learning objectives. At lunch the students couldresearch these objectives. In the afternoon you could go over thelearning objectives with them. The whole teaching should not takelonger than 1 hour. If you can illustrate the case with the clinical

history of one of your patients this will enrich the discussion andmake it more ‘real’ for the students. We do not want it to replacethe small group teaching, with patients, that is already donebrilliantly.

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

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

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

- Students to write one case up in more detail, including eachlearning objective covered and their answers. The students arevery used to writing up cases from their first and second years.The written-up case and the fact that all the case-baseddiscussions have been covered are noted in the finalassessment sheet. The student should keep a copy of the writeup in their portfolios.

6. What do I do if I have problems? Please do get in touch. Elora Baishnab e.baishnab@qmul.ac.uk(covering for Liz Nuttall’s maternity leave) will be happy to help.

And finally...Four cases need to be completed and signed off in students’ logbooks. One case needs to be written up by student and marked byGP Tutor, showing learning objectives and answers to learningobjectives.

DO NOT GIVE COPIES OF THE ANSWERS TO THE STUDENTS:THESE ARE FOR YOUR REFERENCE ONLY.

Dr Ann O’Brien, CBME

New for 2011-12:

The SAPC conference which was run in Bristol this year was very wellattended by primary care researchers. This year more focus was alsogiven to educational research alongside clinical research. There were twoeducation parallel sessions, an educational workshop and one of the twoMasterclasses was focussed on education.

The workshop titled, Inspiration through creation! Using creativeapproaches to extend perception and reflection in the undergraduatemedical curriculum, was led by myself and two colleagues from theUniversity of Bristol. We offered medical educators space to discuss theuse of the arts in medical education, as well as time to engage in thecreative-reflective process themselves.

One of the lines of discussion, based on this first year student creativepiece produced after a home visit, was how the arts can help us thinkabout the difference between looking at a patient on the surface withtheir presenting complaint etc and actually seeing them more holistically,considering their lived experience with illness.

The educational masterclass, Horses for courses: choosing and adaptingappropriate study designs for educational research, was convened bymyself and chaired by Anne Stephenson, director of communityeducation at King's College London. Paul Dieppe and Gene Feder, bothhealth services researchers, brought their expertise to help us as medicaleducation researchers to consider alternative approaches to medicaleducation research. A number of top tips were shared including thefollowing:

• 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 whatis important in the area you are considering from their perspective.

• Don’t eschew observational studies, confounding is a bit problem withthem, but they can still be of value.

• Take a long time to close the variable list of factors measured. NB pilotstudies are particularly useful when considering what are theoutcomes of interest.

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

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

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

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

• Break down the barriers between research in different fields. At theend of the day we are all interested in questions that impact healthcare (whether through clinical interventions, drug treatment oreducation and development of the deliverers of treatments).

• There needs to be variation to do an observational study e.g. if all GPpractices are involved in teaching, it is difficult to tell what differencebeing involved in teaching makes.

• One of the biggest challenges is formulating a clean question – onethat is answerable, interesting and important. To help with this processone mighto Work things through with trusted colleagueso Have a safe space to ask daft questions

• When researching we are usually one step removed from what isactually happening in practice. For example we might be measuringwhat is happening within the individual student and changes in theirbehaviour, but good patient care is the result of a whole system inoperation rather than at the level of the individual.

• Financial costs of the delivery of undergraduate medical education isan important area to consider across the medical schools e.g. differentways in teaching anatomy and the concurrent costs.

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

Next year the SAPC conference is held jointly with the 60th Royal Collegeof General Practitioners annual conference. The theme is ‘Celebratingdifference’ and it will take place in Octoaber in Glasgow. Maybe see youthere.

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

SAPC (Society for Academic Primary Care) Conference July 2011

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

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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. 06

October 2011 Issue 11

The Salaried GP Tutor Scheme Teaching delivered in primary care has always been a feature ofmedical education, but in recent years this aspect of future doctor’straining has increased, as medicine is increasingly practised outsideof the hospital and in the community. Reflecting and driving thistrend, the GMC in Tomorrow’s Doctors recommended that allmedical school curricula should place a greater emphasis onteaching in community settings. In line with this recommendation,Barts and The London Medical School has increased the proportionof teaching in the MBBS curricula delivered in primary caresettings. As a result, the medical school needs more and more GPpractices and GP tutors to cope with this extra demand. However,the demands on individual GPs time often prevents even those GPswho really enjoy teaching from committing themselves to extrateaching sessions.

Another trend in the way medicine is practised in recent years hasbeen a change from the traditional model of general practice, runand managed by GP partners, to a model where salaried GP posts

are increasingly popular. Salaried GPs can be employed by apractice, a primary care organisation, or by alternative providers ofmedical services. A salaried GP can be an assistant, an associate, aGP who undertakes special interest work, a GP employed to workout of hours, a GP retainer, a flexible career scheme GP, or areturner scheme GP. For those employing salaried GPs, these postscan bring financial benefits in terms of enabling servicedevelopment by freeing up partners’ time to allow them to engagein practice development. For the salaried GPs themselves, theseposts can offer positive incentives for them in terms of job stability,reduced hours of work, and freedom from administrativeresponsibility. For some newly qualified GPs, they can provide astepping stone to a partnership. Many of these salaried GPs arenew to teaching and would welcome the opportunity to gain moreteaching experience.

Following a pilot project set up in 2010-11 by CBME ClinicalTeaching Fellows Dr(s) Bruna Carnevale and Liz Nuttall, Barts andThe London now have an established and innovative Salaried GPTutor (SGPT) Scheme. The idea behind the scheme is to matchsalaried GPs who want more opportunities to teach with ‘host’teaching practices. The medical school then benefits by being ableto cover all the necessary teaching sessions that need to bedelivered in primary care; the salaried GPs benefit from beingoffered the opportunity to teach; and the host practices benefit fromextra resources made available to them to support this teaching.And last but by no means least, our students benefit from beingexposed to highly motivated, student-centered and enthusiasticteachers.

The ProcessThe Community-Based Medical Education team has an ongoingrecruitment drive to find more practices that may be willing andable to host teaching, and to find salaried GPs with time to devoteto working as a GP tutor outside of their clinical contract.

Potential host practices should contact CBME (see below) and willinitially need to complete an application form. They would also needto identify a GP tutor in the practice who could act as a GP mentorto supervise the salaried GP tutor. This would involve meeting withthe SGPT on three occasions, at the beginning, middle and end ofthe academic year. Host practices also need to have adequatefacilities such as a room for tutorials or for student clerking andexamining of patients.

Potential salaried GP tutors should also contact CBME andcomplete a form outlining their experience and other commitments.A salaried GP should have completed or be about to complete theLondon 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 hostpractice by the CBME team, who will also organise an initialmeeting with SGPT, SGPT mentor and a CBME academic prior toteaching.

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Issue 11, October 2011

The TeachingSGPTs in host practices carry out teaching from across thecurriculum, with increasing time spent seeing patients in theme-based sessions. Typical teaching sessions may include:

Year 2: Extending Patient Contact (EPC) – This unit links diseaseprocesses being studied in university-based problem-based learningsessions with relevant patient contact. Students build on their earlyclinical experiences with a growing focus on professionaldevelopment. They attend the GP practice in groups of four fortwelve alternate Tuesday mornings.

Year 3: Integrated Clinical Studies in Primary Care – This developsthe students’ clinical and communication skills, and is linked to thethree major body systems Surgery, GI and Cancer; Renal andEndocrine; Cardiology, Respiratory and Haematology. Studentsattend in groups of four. Each student attends a four day GPplacement for each body system and the GP tutors can select whichday they teach.

Year 4: Locomotor – The Locomotor days are divided into thefollowing – Orthapaedics and Rheumatology (Mondays) Healthcareof the Elderly (Thursdays) and Dermatology (Tuesdays).Orthapaedics and Rhematology has been paired with Healthcare ofthe Elderly as it is good for students to attend the same practice foreach. Students attend in groups of 4 and practices can take morethan one group through the year.

The FinancesThe host practice receives the teaching payment, as well as extrafacilities funding as appropriate. All teaching undertaken by theSGPT 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 thefinancial rewards worthwhile. In addition, the practice receivessessional funding for mentoring activities (to a maximum of 5sessions per academic year).

The host practice then pays the SGPT on a sessional rate. Althoughthis is negotiable between the practice and the SGPT, it is expectedthat the SGPT rate would be based upon the Barts and The Londonsessional teaching payment, which is £165 per session.

This SGPT scheme has its origins as a pilot with Tower HamletsPCT, and arose from discussions with Barts and The LondonTeaching Practices at training and business meetings. Following atrial pilot project, the initiative has become established. Anyoneinterested in joining the scheme, or wishing to know more about thescheme works should contact us at:

Dr Peter Washer, CBMECommunity-Based Medical Education Tel: 020 7882 2505Email: p.j.washer@qmul.ac.uk

Also see Carnevale, B (2011) Salaried GP tutor pilot scheme BMJ Careers http://careers.bmj.com/careers/advice/view-article.html?id=20001782

Barts and The London School of Medicine and Dentistry, Academic Unit for Community-Based Medical Education, Garrod Building, Turner Street, Whitechapel , E1 2AD. 08

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About 70 GP tutors gathered to shareknowledge at our annual GP tutor’s day thisyear at sunny Mile End by the river. Weoffered a mixture of plenary sessions andbreakout workshops, both year specific andrelated to generic educational topics such as

digital literacy, smallgroup work or givingfeedback. There wasalso opportunity forinformal networkingin the long lunchqueue and at theend of the day overrefreshments.Photo Barbara –caption – thank youBarbara for yourlunch queueinterventionFeedback from theday suggested thattutors valued thisopportunity fordialogue and toconsider delivery ofmedical studenteducation in moredetail.

Of the plenary sessions, it seemed thestudent feedback from Lisa Elam, a secondyear student and Corinna Lea, a fifth yearstudent was particularly appreciated. Many ofthe workshops were also highly evaluated butwould have benefited from being longersessions. We will take this forward into futureplanning.

Our congratulations went to Dr Faiez Al-Shawk (1st Place) Dr Martha Leigh (2nd

Place) and DrFarzana Hussain(3rd Place) as wepresented theannual tutor awards.A number of othernominations werealso received.Students wrote

about how they valued the kindness, level ofsupport and approachability of theirnominated teachers, also how theywelcomed being treated like adults andbeing listened to. Facilitating learning, beinga good role-model with patients andenthusiasm were also noted.

“Getting nominated for a tutor of the yearaward by the students, I feel is the mostpositive feedback one can get as a teacher.I am sure that as a tutor I do not do thingsdifferently from my colleagues. Reflecting onmy own practice, what I have been doingconsistently and what may have helped mewith the nomination include the usual. Thisincludes preparation in advance, respectingthe students as adult learners, negotiating howthey may achieve their objectives, beingapproachable and sensitive to theireducational and personal needs, going theextra mile when identifying a major deficiencyand a balance between a challengingeducational experience with a sense ofhumour and fun. As GPs we care for ourstudents as we may care for our patients.Therefore the ultimate reward is to see thecandidates’ progress in their educational andprofessional development.” Dr Faiez Al-Shawk

Top tips and learning from the individualworkshops will be placed on the new websitewhich we are still developing (coming soon!).

Thank you for all your comments regardingfuture tutor training (from the GP tutordevelopment questionnaire in April, 2011and feedback from this tutor’s day). Theseare being considered as we put together nextyear’s program realising though, as has beenfamously said:

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

We will do our best though.

Dr Louise Younie, CBME

Annual GP Tutors’ Day, 1st JulyYear 2 StudentFeedback (EPC,Extending PatientContact)This year there was a great deal ofpositive feedback from students...

Key aspects included having wellorganised placements, enthusiastictutors, teaching alongside currentPBL scenarios/modules and theopportunity to have patient contactand practise clinical skills.

Areas that could be improvedcentred around a lack of clinicalskills and basic examinationpractise, which stressed the fact thatstudents regard their EPC module asthe perfect opportunity to developthese skills in time for exams.

Other aspects of the module thatreceived less positive feedbackincluded assessment methods and alack of organisation at someplacements.

Many students suggested the use ofa planned timetable each week(which could be given either at thevery beginning of the course or on aweekly basis). Overall studentsrecognise the value of EPC as anintegrated module and are keen tomake the most of this potentiallyhands-on learning opportunity.

Lisa Elam

Dr Sandra Nicholsonand Dr Faiez Al-Shawk

Thank you Barbarafor your lunch queueintervention

Student satisfaction at Queen Mary ishigher than the national average

Student satisfaction at Queen Mary, University of London, is fivepercentage points above the national average, and best amongst thelarge London universities, according to a nationwide survey of finalyear students.

The 2011 National Student Survey (NSS) questioned UKundergraduates on various aspects of their student experience andmeasured overall student satisfaction.

For students at Queen Mary this score has risen from 86 per cent in2010 to 88 per cent in 2011 with the national average at 83 percent. The University is now ranked 29th out of 184 higher educationinstitutions for overall satisfaction, up 11 places from 2010.

Amongst the major multi-faculty universities in London, Queen Maryranked joint first with UCL, ahead of King’s College London, ImperialCollege London and LSE. Student satisfaction at Queen Mary ishigher than the average score of the Russell Group universities.

Medicine at Queen Mary ranked eighth in the UK out of 32 medicalschools, second in London to UCL, and ahead of Imperial, King’s, StGeorge’s and Cambridge University.

“This year’s NSS results are Queen Mary’s best yet, withimprovements not just in overall satisfaction, but also teaching,assessment and feedback, organisation and management, learningresources and personal development,” said Professor Susan Dilly,Vice-Principal for Teaching and Learning.

Queen Mary also achieved exceptionally high satisfaction results inmany subject areas, including: Aerospace Engineering (96 percent), Law (96 per cent), French studies (96 per cent), Chemistry(95 per cent), Medicine (94 per cent) and Comparative LiteraryStudies (94 per cent).

French studies has shown the greatest improvement and is nowranked second nationally, rising 25 places since last year.

Biology has risen 17 places, whilst Economics and Medicine haveboth risen 15 places and are now ranked fifth nationally and eighthnationally respectively. Chemistry is up 14 places, now ranking tenthin the country.

The School of Engineering and Materials Science has seenparticular improvement. Materials is ranked top in its sector, withoverall satisfaction at 93 per cent - 20 percentage points above thenational average.

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Issue 11, October 2011

Studentsatisfaction atQueen Maryrises to highestever level

Aerospace Engineering is placed second in its field and MechanicalEngineering equal fifth.

Professor Dilly added:

About Queen Mary’s resultsFrench Studies scored 96 per cent in overall student satisfactionand is ranked equal 2/30 in its sector, up 25 places from 2010.

Economics is rated 93 per cent for student satisfaction and hasrisen 15 places to equal 5/57.

Medicine is rated 94 per cent for student satisfaction and has risen15 places to equal 8/32.

Chemistry is rated 95 per cent for student satisfaction and has risen14 places to equal 10/37.

Aerospace Engineering is rated 96 per cent for student satisfactionand has risen ten places to 2/19.

About NSSOver 260,000 final-year students took part in this year’s NationalStudent Survey, which has been published annually since 2005 bythe Higher Education Funding Council for England (HEFCE).

Final year undergraduates from all publicly funded Higher EducationInstitutions (HEIs) in England, Wales, Northern Ireland, andparticipating HEIs in Scotland, are invited to take part.

For media information, contact:

Sally WebsterHead of CommunicationsQueen Mary, University of Londonemail: s.webster@qmul.ac.uk

While we congratulate all those who haveworked towards these achievements wealso recognise that there is always room

for improvement as we continue to provide QueenMary’s students with an excellent experience in allareas and in all subjects.”

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

October 2011 Issue 11

Dear Jim

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

based urine spray by mail order. GMC guidance does not precludea ‘modest’ thank you gift to participants in teaching or research solong as it does not constitute market rate payment.

Will SpiringMission Practice

Dear Jim

Thank you for your letter. The sober issue you raise here is aroundpatients informed consent to participate in teaching withoutcoercion. It is interesting to consider the benefits to the patient ofparticipating in teaching. Beyond the obvious general interest ofsociety to have a well trained medical workforce patientsparticipating in medical education have reported a number ofperceived benefits including improving their own knowledge andsatisfaction with and enjoyment from the encounter (young maleor otherwise!)

Tutors of course need to be mindful of assuming too much. It isgood practice to display notices in the waiting room when studentsare in practice and to ask the patients permission for studentinvolvement in consultations in a way that they can decline withoutembarrassment. Tutors will all have their unique way of doing thisbut must satisfy themselves the patients autonomy has beenrespected

Aunty Aggie

1 BMA Medical Education Subcommittee(2008) “Role of thePatient in Medical Education”, BMA available atwww.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 forpractices to teach this new module which is a single day placementin each subject for 4 students. Contact l.c.magorrian@qmul.ac.uk .

Dr Sian Stanley (Year 4 lead)

Aunty Aggie’s Problem Page – a problem shared...

Dear Aunty Aggie

I find that persuading patients to see medical studentssometimes requires a certain amount of negotiation and I wasrecently presented with an ethical dilemma which I am keen toshare with you and other tutors.

One of my patients with rheumatoid arthritis has classical signsof this disabling disease. In the past she has been a lively andengaging person for the medical students to visit at home. Shefinds it hard to get out of the house to visit the surgery.

When I asked her if she would agree to see another group ofmedical students and she replied that she would on twoconditions:

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 areason. She explained that she is plagued by foxes that dig upher plants. She had been informed that male urine (especiallyfrom 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 ofthe 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 needfor guidance and supervision.’’

Mindful of Section 8 of the guidance, I am seeking guidancefrom other tutors. Any advice or suggestions would be gratefullyreceived, and I would also be interested to hear if other GPTutors have had similar experiences.

Jim Lawrie, GP Tutor

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

Dear Aunty Aggie

My Year 1 and Year 2 students are struggling with the ideaof writing reflectively. Do you have any suggestions as tohow I can support them with this activity?

Yours in hope

Maria, MedSoc Tutor

11

www.ihse.qmul.ac.uk/cbme

Issue 11, October 2011

The OSCE Experience – Throughthe Examiner’s EyesSummer 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 yearexams! Your role as a tutor usually ends once the final students leave your practice, but it is also possible to get involved in this veryimportant part of the education process, by becoming an OSCEexaminer.

Our students sit Objective Structured Clinical Examinations (OSCE’s) as well as written exams at the end of each year of study. OSCE’s arestation-based clinical examinations which allow us to assessknowledge in a different manner to other assessment formats, bycontextualising theoretical knowledge around clinical skills. Studentsmake their way around the OSCE “circuit”, a sequence of 5 or 10minute stations, and have no idea what they will be asked to do untilthey enter the station. They may be asked to examine a normal elbowjoint, identify the pathology in an abnormal abdominal examination,demonstrate the use of a metered-dose inhaler, counsel a patient oncontraceptive options, or perhaps take a history from a depressedpatient. The ‘Simulated Patient’ is played by either an actor or apatient volunteer, and the role of the examiner is to observe and toscore the performance of the student using the prepared markingsheet.

I recently took part in this process as an examiner in the Year 1 andYear 4 OSCE’s. This was a very interesting as well as challengingexperience, and I found it very rewarding to be involved in a differentaspect of the students’ educational experience. It is of course hardwork and tiring to maintain active listening and remain engaged for awhole day of examining, but the organisers are well aware of thisproblem and there was plenty of tea, coffee and snacks at registrationand in the mid-session and lunch breaks. The clinical scenarios andcharacters portrayed by the simulated patients were often complexand fascinating, and each student tackled the scenario in a differentway, 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 areliable and valid assessment because of the potential for variationbetween examiners and simulated patients. In order to enhance thereliability of our OSCE’s, the interaction between student and examineris restricted, the marking schedule is highly structured, and newexaminers undergo training. Having never been an OSCE examinerbefore I was very nervous before my first session, but the training,preparatory reading, and structured marking forms made the processin fact very straightforward.

As well as completing the marking forms for each student, examinersare also asked to complete a form giving feedback on the station itself.It is important that these are completed as it allows the organisers tomake changes to stations where appropriate. There is also a form to be completed if you have any serious concerns about a student’sprofessional conduct. I was fortunate not to need to complete one ofthese, and found the students on the whole to be of an extremely highstandard. This reflects very highly on the quality of teaching beingprovided 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 KarinHogan (k.hogan@qmul.ac.uk) for more details.

Dr Emma Ovink, CBME

Dear Maria

The concept of reflective practice is based on the work of DonaldSchon, and has become the model for many professions such asnursing, teaching and, increasingly, medicine. Yet many medicalstudents struggle with the idea of writing reflectively. One reason forthis is that anyone with a scientific educational background, such asmost medical students have, will be used to writing about the world‘out there’ as if they weren’t in it. They may be unfamiliar anduncertain about writing about themselves, their thoughts andfeelings, as well as the effect that they have had on the world.Medical education has been criticised in the past for being toocentred on learning vast amounts of facts by rote learning and thenrewarding ‘surface learning’ with assessments that requiredregurgitation of these facts. The sheer volume and complexity ofmedical knowledge will inevitably expand and evolve over the courseof our students’ careers. The purpose of getting medical students towrite reflectively is to equip them for careers as lifelong learnerswhere they will need to determine their own learning needs andgoals, and continually reflect on their own learning and professionaldevelopment.

What does this mean in practice? Reflective writing is more personalwriting than perhaps the students are used to, but at the same timeit is more rigorous than a ‘Dear diary’ entry. Reflective writing meansto foster reflective thinking. This is usually done retrospectively, bylooking back at an event (or an idea) and analysing it or thinking itthrough from a number of different perspectives, or with perhaps atheory or model or evidence in mind. An important part of thisprocess is thinking through the implications of the event and theway they felt about it, or dealt with it, and what consequences thiswill have for their future practice. The type of events that trigger thisreflective thinking need not be anything terribly dramatic. Forexample, this year we have changed the EPC assessment slightly, sothat: “Students must write a 500 word reflective essay on anoccasion where they interacted with a patient that resonated withthem for some reason, for example it made them think of a patient /medical condition in a new light, or it raised some ethical issues, forexample where they were required to gain consent from a patient fora task that they were about to perform.”

One way to structure this assignment, and indeed any piece ofreflective writing, could be:

• A description of the event, including what made it noteworthy

• How this event impacted on the writer – how did they feel aboutit, did they think differently about things before or after ithappened?

• Is there some theory or empirical evidence that could help explainor elucidate what went on?

• What was the outcome, including how they might approachsimilar situations differently in future as a result of this reflection

Good reflective writing should be honest and authentic, in otherwords, the negative thoughts and feelings should be there, as wellas things were successful and positive. The important thing is thatthe students have learned from the experience in a way that willmove them towards being better doctors.

There is more information on writing reflectively in the appendices ofthe MedSoc and EPC student and tutor guides, as well as loads ofuseful guidance on the internet – for examplehttp://www.qmu.ac.uk/futurefocus/SSAAwriting.htm

Dr Peter Washer, CBME

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October 2011 Issue 11

Contact the Editorial TeamThis is your newsletter. If you have anysuggestions for future content, usefulteaching tips, teaching resources orexperiences you would like to share pleasesend us your contribution.

Lynne Magorrian l.c.magorrian@qmul.ac.uk

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

Barts and The London School of Medicine and Dentistry, Academic Unit for Community-Based Medical Education, Garrod Building, Turner Street, Whitechapel , E1 2AD. Pub8397

8 5 1

2 9

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As many of you will remember, theorigins of CBME, the AcademicUnit for Community-BasedMedical Education, owe a greatdeal to the work of ProfessorYvonne Carter who joined theSchool of Medicine and Dentistryin 1996 as Head of GeneralPractice and Primary Care.Yvonne died early in 2009, aged50, from breast cancer, and is stillsadly missed. Colleagues in theCentre for Health Sciences, whichincluded CBME up until February2011, took the opportunity to

honour her memory as they moved into a brand new teaching andresearch location. They are now known as the Centre for PrimaryCare and Public Health and are part of the newly formed BlizardInstitute. We are still close to our colleagues in Primary Care, bothin promoting good learning practice in Primary Care and ingeography - they are also located in Turner Street not far from TheGarrod Building where CBME is based.

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

been teaching with us continually for over 12 years. We actuallysent out 40 invitations. More than 100 people came to the PerrinLecture Theatre at Whitechapel to hear speeches from Professor SirDenis Pereira Gray and Professor Gene Feder and Dr MichaelBannon, Yvonne’s husband. The over-riding impression I took awayfrom their words was that Yvonne Carter had been an energeticcampaigner for the place of Primary Care in Education andResearch and a tireless champion of colleagues – whether or notthey believed in themselves. There was a genuine warmth andrespect for Yvonne from all speakers which was echoed by the nodsof remembering visible around the lecture theatre.

After the formal speeches, we all followed Dr Bannon over the roadto the new building where he ceremonially cut the ribbon and wewere able to see for ourselves the light, airy and well appointedbuildings that house the new Centre for Primary Care and PublicHealth. Refreshments and chat continued and it was also possibleto tour the three floors of the building with its vibrant use of spaceand clever use of glass inside the building to maintain the feeling ofopenness.

I felt it was a fitting testimony to the pioneering work of YvonneCarter during her life and a remarkable start to the work of the newCentre, with whom we hope to work in partnership in the future.

Kathryn Livingston, CBME

New Yvonne Carter buildingThe opening of the new Yvonne Carter building on the QMUL Whitechapel Campus

Puzzle CornerHere’s something to keep those little greycells active - enjoy!