Welco lcome me GP4 Workshop 4 Getting ready for your students - - PowerPoint PPT Presentation

Welco lcome me

GP4 Workshop 4

Getting ready for your students

• Dr. Barbara Laue
• Dr. Kimberly Bruce

Thank you

For teaching GP4 in these difficult times

Barbara and Kimberly

Overview

• GP4 – In and OUT models
• Learning remote consulting
• Linking students to virtual consultations
• AccuRx and conference calls
• Tutorials
• Authentic tasks - Giving Flu jabs
• Engaging OUT students
• GP4-PCC clinical diary and student reviews

Quick recap - GP4-PCC clerkship

Two GP placements = One GP4-PCC clerkship

The learning outcomes for GP4 need to be achieved by the end of the academic year

• Two GP placements, one in each academy make up the GP4 – PCC clerkship
• 18 Wednesdays in each placement, 36 Wednesdays in total
• Students can catch up in the second GP placement on what they missed in the

first one

• GP4-PCC = GP4 Primary Care and Community

Recap - GP4 Building Blocks for GP4

Morning Lunch Afternoon

Check in Check out

9.00 17.00

Surgery Consulting Self directed learning Authentic tasks Community Allied Health

Tutorial/cons. skills 1 hour every 2/52

Wednesday structure - 3 contact points

Check in

• Hello and welcome
• Icebreaker
• Skill of the week

Check out

• How did it go today?
• Concerns?
• What learned, what

sticks out?

• Drug of the week
• Planning for the next

week

Tutorial or consultation skills

Covid/Influenza Gaining consent for flu immunisation

47 practices teaching year 4

• 3 F2F x 2
• 4 F2F x 24
• 4 PIN&POUT x 5
• 6 F2F x 13
• 6 IN&OUT x 1
• Online only x1

GP4-PCC placement models

How many students in your group? Please type the number in the chat box

What your students are bringing to GP4-PCC

• Knowledge
• Experience in CBL-case based learning, finding things out
• Missed some year 3 skills (Covid)
• Signed primary care confidentiality agreement
• (sample in GP guide)
• Signed DBS statement (had full DBS check in year 1)
• Mandatory training in eLfH – 12 modules

Mandatory Training – e-lfh by HEE

Complete before starting year 4, completion is monitored.

• 1. Health, Safety and Welfare - Level 1
• 2. Data security awareness level 1 – confidentiality, data protection, GPDR, Caldicott principles
• 3. Infection Prevention and Control level 1 - PPE
• 4. Infection Prevention and Control level 2 – covid-19 Resuscitation UK Guidance
• 5. Resuscitation adults - level 2 - covid-19
• 6. Resuscitation paediatric - level 2
• 7. Fire safety - level 1
• 8. Moving and Handling - level 1
• 9. Safeguarding children – level 2
• 10. Mental Capacity Act and Adult Safeguarding
• 11. Chaperones and Consent – authentic task
• 12. Equality and Diversity and Human Rights - level1

Data Protection – CAPC teaching

DPIA

• accuRx ,Blackboard Collaborate and telephone consulting
• Data protection officers – UoB and Avon LMC
• Viewed on request

Is it safe to invite students on to accuRx calls? accuRx approved by NHS digital as a secure tool for video consultations. How should I consent patients for student consultations? verbal consent as you would for medical student teaching pre-Covid. Is Blackboard Collaborate safe to discuss patient identifiable data (PID)? We have made as much effort as possible to ensure that Blackboard Collaborate is a secure platform for discussion of patients Only use PID in the discussions if essential for clarity Sessions should not be recorded

In most security breaches, humans are the weak link and we are providing training to students and GP teachers to ensure they know how to use the software.

Preparation

Practice

• Room, some equipment
• Information for the whole team
• Student names and ? Photos

prominently displayed

• Timetable in place for first 2-4

weeks

Students

• We will send them an email with

details of their group and practice

• Sign the primary care

confidentiality statement

• Answer a list of questions about

your practice

Learning about remote consultations

• Practical – lighting, picture quality, processing effects, examination
• Medico-legal – 3-point ID check, consent, documentation
• Para-verbal signals
• Lose non-verbal cues - Cognitive overload and decision fatigue, lose

congruency between visual/auditory, summarise and clarify

• Physical barrier – difficult conversations, aggression

Student online tutorial – remote consulting

GP teacher guide COGConnect remote consulting top tips

Handbook - responding to domestic abuse during telephone and video consultations

Using accuRx in remote consulting

• Secure NHS digital approved software - reviewed by CAPC Teaching, data

protection team at the University of Bristol

• Invite 2 people into the consultation in addition to the patient and clinician.
• Students have undertaken data protection training and signed a confidentiality

agreement that specifically addresses video consulting.

• accuRx text to the patient before the consultation (e.g. template with max 400

characters) Thank you for agreeing to have x medical students present in your video consult

• today. Your GP will send you a link to join the consult. They will check that you

are still OK to take part. Students will then join the call. You will be able to see the students and GP on screen. The call is not recorded. One of the students may consult, the GP observes and helps out as needed. Please let reception know if you do not wish to have students present.

Using accuRx in remote consulting

• OUT (virtual) students - email addresses of both students
• IN (in Practice) students – if in separate consulting room - logged onto

EMIS/System One – working videocam and microphone

• EMIS users – screen messaging
• System One users – instant messaging

1. Invite the patient to the consultation as you normally would 2. Obtain verbal consent from the patient for the students to be present, as you would do for normal student teaching in practice. 3.

• 3. Click on the grey icon on the top left of the video screen:

4.

• 4. Select Copy link and paste this into an email to OUT students. Paste into an

instant message (System One) or screen message (EMIS) for IN students 5.

• 5. The students click the link to join the consultation. They should enter their

names as “First name (Student)” and ensure that their camera is turned on.

Click on the grey icon on the top left of the video screen:

Select “Copy link” and paste into an email to OUT students. Paste into an instant message (System One) or screen message (EMIS) for IN students

FAQ document – AccuRx text to patients What will the students want to know? These are students in the fourth year of their course to train to be a doctor. They are learning about different illnesses and health conditions. They will ask you questions but it is okay if you are not sure

• f the answer, and your GP will also be there to help out.

Your GP will be able to give you more information when they invite you to the teaching session. Where are the students? Similarly to you, the students may be dialling in remotely from home due to the current covid-19 pandemic. Is what I say confidential? Video sessions will not be recorded. Students are bound by a code of confidentiality much like your doctors are. Students will discuss their general learning on clinical placement with their colleagues and teachers on their course. They cannot share any information where you could be identified with anyone outside your healthcare team without your permission. Your safety is paramount, and confidentiality can be broken if, when speaking to you, a student or doctor becomes concerned about your safety or that of others.

Using teleconferencing in remote consulting

• accuRx text to the patient before the consultation (e.g. template with max

400 characters) Thank you for agreeing to have X med students present in your telephone call today. Your GP will send you a link to join the consult. They will confirm that you are still OK to take part. The students will then join the call. One of the students may consult whilst the GP observes and helps the student out as needed. Please let reception know if you do not wish to have students present.

• Telephone the patient as usual
• Verbal consent from the patient for the students to be present, as you

would normally do when students are present in a consultation

• Conference call in the medical students

Tutorials - 1 hour protected time

• 14 tutorials in total
• 7 in each GP placement
• About fortnightly
• 1 hour protected time
• Alternating with consultation skills/skills practice/other activities
• No tutorials on academy afternoon and student review days

Tutorials – 1 hour protected time

• 14 tutorials in total
• 7 in each GP placement
• About fortnightly
• Alternating with consultation skills/skills practice/other activities
• No tutorials on academy afternoon and student review days
• All learning resources including model answers are provided for GP teachers

CBL Case based learning approach for tutorials

• Students are given questions, research the answers, discuss and share what they

have learned in the tutorial, GP facilitating, correcting, filling in missing information

• We are not giving answers to students in their resources
• Associated communication skills practice

Tutorials – 1 hour protected time

9th September 20th January 27th January - 9th June GP placement 1 GP placement 2 First 3 tutorials At the start of year 4 7 tutorials Order to be agreed between GP and students GP4 Remote consulting CH1 Newborn, breast feeding GP4 Lifestyle medicine CH3 Minor illness CMOP1 URTI, Influenza, Covid MH 1 Anorexia, mental health checks Remaining 4 tutorials Order to be agreed between GP and students MH3 MUS RHCN1 Contraception RHCN3 HRT, Menopause RHCN 2 PN check, PN depression CMOP2 Cancer CH2 Fever, UTI, OM, D&V CMOP3 Dementia MH2 Depression, Anxiety, sleep

CH1 includes child protection, CMOP3 includes adult safeguarding

We have assigned specific tutorials to each half of the year. We would like students to have the two GP4 and CMOP1 tutorials at the start of the year to get up to speed with Covid and key GP skills.

Authentic tasks - covered in tutorials (protected time)

First 3 weeks:

• Remote consulting
• Motivational interviewing
• Lifestyle advice – smoking cessation, alcohol, weight, diet
• Chaperone training (mandatory training)
• Flu vaccination - storage, indication, administration, contra-

indications, side-effects, counselling

Authentic tasks

Authentic tasks - covered in tutorials (protected time)

• Asthma PAAP – inhalers, 3RCP questions
• Cancer care review
• 6 week baby check
• Postnatal check
• Screening for depression
• Mental health annual review
• Screening for cognitive impairment
• Annual dementia review
• COCP/HRT annual review - verbal advice about long acting contraception
• Child health and safety advice e.g. vitamin D, SIDS prevention, safety

equipment

Authentic tasks

Authentic tasks – Early on

• Phlebotomy
• Flu jabs
• Health checks
• chaperone

Authentic tasks

How to get your students up to speed Invest time early in the placement Record that you have observed them and feel they are competent to carry out these tasks with indirect supervision This record needs to be passed on to the second GP teacher

Getting students ready to give flu jabs

• CMOP Tutorial (protected time) – storage, indication, administration, contra-indications, side-effects,

counselling

• Students need to learn how to give injections. Flu jabs are a good opportunity to teach them.
• Go through flu immunisation protocol with the student
• Demonstrate how to give a flu jab
• Observe the student going through the protocol with a patient
• When you feel that the student is ready
• Sign them off as competent with direct supervision
• Sign them off as competent with indirect supervision (you are happy for them to give flu jabs with you nearby, but not

necessarily in the same room)

Authentic tasks

Protocol for flu immunisation

• Confirm patient ID, check for contra-indications, gain verbal consent for procedure
• Ensure adrenaline injection in room in case of anaphylaxis
• Sit patient with exposed upper arm fully exposed and relaxed e.g. let arm hang by side
• Sanitise hands with alcohol gel and wear gloves, skin cleaning of patient is not necessary in socially clean

patients

• Hold skin firmly with free hand, introduce needle at 90 degree angle (aspiration may be performed to ensure

a blood vessel has not been penetrated) into deltoid muscle

• Do not get rid of the air bubble. To try to expel it risks accidently expelling some of the vaccine and therefore

not giving the patient the full dose. The air bubble is also there for a reason – the air injected into the muscle forms an airlock preventing the medication seeping out along the needle tract into subcutaneous tissue and

• nto the skin. The small bolus of air injected following administration of medication clears the needle and

prevents a localised reaction from the vaccination

• Following administration of the vaccine, remove the needle slowly and dispose immediately into yellow

sharps bin

• Gentle pressure may be applied with a cotton wool for a few seconds if bleeding occurs
• Advise protection lasts for about one year, antibody levels may take 10-14 days to reach a protective level.

Immunocompromised may not mount an antibody response to the vaccine. (Children who have had the live attenuated vaccine should avoid contact with severely immunocompromised individuals for 2 weeks after vaccination)

• Record batch number, brand of vaccine, expiration date and site of vaccine in patient’s notes

Authentic tasks

Learning Disability Health Checks

• Lifestyle tutorial and

communication skills practice (protected time)

• alcohol, smoking, weight loss,

diet

• Handbook - communication

tips for consulting with patients with disabilities

Authentic tasks

Engaging your OUT students

Technologically: BBC- Blackboard Collaborate

• Blackboard is the VLE used by Bristol University
• Collaborate is a function, similar to zoom but more secure
• Virtual meeting space in BBC is called a ‘room’
• We are creating a BBC room for every practice teaching Bristol students
• One ‘room’ per practice
• Same link every week for the whole academic year
• This BBC ‘room’ is open all the time

Engaging your OUT students

Technologically: BBC- Blackboard Collaborate

• 3 virtual contact points
• OUT students join ‘check in’, tutorial/consultation skills practice and ‘check out’

virtually

• Using BBC
• Use the ‘chat box’ facility in BBC to write what they are hoping to learn
• Ask them to use the emoticons to say how they are feeling
• Ask a question and ask them to vote in BBC
• Try and connect OUT students with remote consultations via accuRx

Engaging your OUT students

Emotionally

• Create a sense of belonging
• Ensure all are known to all practice staff - F2F intros
• Ask students for photos - photos of the students in prominent place
• Noticeboard with info re students, who they are, what they do
• Info about the students on practice intranet
• Help them to get to know you
• Make short video of yourself and your practice and email it to your students
• Send students a welcome email with some info about yourself, why you are teaching, and

a positive message about what you are looking forward to with year 4

• Check how they are by asking them to use emojis in BBC
• Make it relevant – give them a role (flu jabs), real world examples

Engaging your OUT students

Intellectually

• Give OUT students an active part at the 3 contact points
• Follow up for tasks given to OUT students
• OUT students to start the conversation about ‘drug of the week’, tutorial etc.
• OUT students to instruct IN students how to do a skill, i.e. take a pulse

(good practice for remote consultations with patients)

• Out students to instruct IN students how to use the otoscope/ophthalmosc.
• Go to your OUT students first for answers
• Actively engage OUT students in role play
• One IN and one OUT student to role play together
• Both OUT students to role play while IN students observe
• Mix it up

Engaging your OUT students

• Spend time in the first session and beyond to get to know them well
• Students need to get to know each other, too
• Set expectations – attendance, engagement, active contributions
• Active part for OUT students and FU of tasks
• Icebreakers

Engaging your OUT students

Icebreakers

• What has made you happy this week?
• What has frustrated you?
• What is your favourite James Bond movie?
• What is your favourite food?
• Favourite sport?
• What music cheers you up?
• Favourite piece of clothing?
• A book/film/piece of music you would recommend to everybody?
• Funniest film you have ever seen?
• Favourite TV?
• Do you play music when you are studying?
• Your students might think of an icebreaker…

Student cli linical dia iaries in in CH, , CMOP, GP4-PCC, MH, , RHCN

Students will have a clinical diary with tasks to complete in each clerkships Purpose

• For student and tutor/GP to track student activity
• Measure of student attendance, engagement and achievement
• Will be reviewed and signed off with their clerkship tutor/GP tutor

Content

• Activities for satisfactory completion of the clerkship
• WBAs (MiniCex, CBD)

GP4-PCC clinical diary ry

• Minimum tasks to be signed off (we are asking them to engage with more activities)
• 4 review points in GP4-PCC
• Needs to be signed off at the last GP4 review point

Academy 1 Academy 2 GP placement 1 GP placement 2 Review 1 Review 2 Review 3 Review 4 and sign

• ff for GP4-PCC

clerkship

GP4-PCC clinical diary ry

• Patient log x ≥28 consultations
• Wednesday learning activity log x28
• Patient feedback x2
• Governance micro project x1
• Safeguarding discussion (adults and children) with practice safeguarding lead and at least one

case review

• X2 Brief written reflections on assigned patients (one in each GP placement)
• Observation
• 6-week baby check x1 (or online resource)
• Baby/Childhood immunisations x1
• Vaginal examination
• Consultations
• students to conduct the following types of consultations
• (During the pandemic students may not be able to conduct these consultations themselves, but

should be able to observe them)

• 1x RHCN (contraception, Menopause)
• 1x Child <5 years old
• 1x Older person with cognitive impairment, polypharmacy, multimorbidity or frailty

GP4-PCC clinical diary ry - Attendance

• Will be monitored by GP4 admin team
• We will send you an email every Wednesday to tell us whether your

students were present

• Email will include information for the following week as needed
• Optional feedback and comment boxex

In progress

• Student clinical diary
• Handover form/information between 1st and 2nd GP placement
• Evaluation of GP4

GP4-PCC – the essence

As much patient contact as possible Learning from ‘doing’ Continuity of tutor, patients and practice

Students are our future colleagues

Thank you for supporting student learning in these difficult times

Barbara and Kimberly