Year 4 GP Placement Feedback

1. Year 4 GP Placement Feedback Alastair Wright 4th year MBBS

2. Comments taken from Year 4 feedback for terms 1 and 2 of 2012-13 academic year. Feedback source

3. A number that allows a good teaching/learning environment (only commented on when a problem) “There were too many students for a practice with only 1 GP” “Other medical schools' students had clinics reserved, so it was very difficult to sit in with some doctors, as it was over-crowded.” “As there were 4 students, only 2 students could sit in with the GP and see patients at a time, and the other 2 would sit and wait.” How many students?

4. Gaps in the middle of the day may be a problem – perhaps fill with some teaching? No need to keep students there all day – we always have other work to do, SSC’s etc. “Leaving the surgery at 2:30 or 3pm is not such a terrible thing if we have been working consistently since 9 or 9:30am, especially as we need time to digest all the information and go through it ourselves.” “Would like to be able to leave earlier in the evenings! Days were 9-6” Timetabling /Admin

5. Students appreciated good organisation and a clear timetable of what they will do, and what’s expected of them e.g. presentations. “We liked that we had timetables but that we were able to swap clinics if necessary” “The placement was well organised with a set timetable with time specifically dedicated to us” “We were all given timetables on the first day, outlining our morning and afternoon activities. This was really helpful” Admin - timetabling

6. Students often know what they don’t know, and appreciate having the choice of what they learn: “we get to choose what we want to do” “the [GP] was very flexible, teaching us what we felt we needed” “The teaching was logical and we were able to choose the main topics we would like to cover” What to teach?

7. Find a balance between clinical experience / community medicine e.g. home visits, and separate teaching sessions. Generally students like patient contact, but also find separate teaching useful. “I enjoyed the fact that we had a balance of GP consultation, teaching and then home visits. Each day was different and the variation kept me interested throughout!” - Again, ask students what’s the right balance for them. How to teach it

8. Varied responses – find the right balance “More patient contact, please! Less teaching (felt like a repeat of our lecture week that we had just completed).” “Very high level of commitment to teaching - each morning given over entirely to tutorial and afternoon patients specifically chosen to match studied areas” “Separate teaching sessions that were module appropriate were organised which I found very useful.” Dedicated teaching sessions

9. Rare to get small group teaching at medical school. “I liked the tutorials feeling more like a discussion than a lecture.” “Separate teaching sessions that were module appropriate were organised which I found very useful.” “Small group. Opportunity to all lots of questions” Teaching sessions

10. As they’re small they can be interactive – make them so! “Excellent interactive teaching from GPSI in derm” “The teaching was not engaging. Instead of asking us questions and waiting to answer, he answered the questions immediately after asking. It made concentrating for 2-2½ hours of slides in a row very difficult.” “Interactive, friendly atmosphere, felt able to ask questions” Teaching sessions

11. Highly valued by students: “Lots of patient contact- I learnt more in my paediatric week at the GP practise than I did in a month at a hospital which had no teaching for students.” “Fantastic. Great amount of patient contact” “Less classroom-style teaching. It almost felt like we were doing nothing else but being taught. Only a few goldfish bowl consultations and apart from that no patient contact, which was a bit of a shame. Patient contact

12. In clinic – Relevant patients Students very much appreciate being able to see patients relevant to the module they’re studying. Some GP’s plan ahead and bring in relevant patients for students to see. “He invited in relevant patients who gave good histories and knew exactly why they were there” “Saw neurological and psychiatric conditions relevant to the module.” “Having module specific patients booked in was brilliant.”

13. A great (and rare) opportunity to be observed taking a history. “Got to sit in on a clinic and was allowed to ask patient questions which I never had before (it was really good)” “let us lead the occasional consultation, which was helpful.” “Dr had a session where she observed us taking histories, which was a very good learning experience.” “Dr was really good at allowing us to try to take a history during her appointments with patients. She then added points which also helped us as we found out what we missed.” In clinic – History taking

14. Also can be an opportunity to let students speak with patients before they see the GP (may depend on space available) “Although daunting at first, we were left with patients to take their histories and start the examination (e.g. for 6-8 week postnatal checks). It was a fantastic way to learn and Dr was always nearby if we needed assistance.” “The 'Student Clinics' were both challenging (since cases could involve any organ system, not just the ones we have studied recently) and engaging, an idea more GP placements should pick up.” In clinic – History taking

15. In clinic – Clinical skills Again, a relatively rare opportunity to have clinical skills observed. “Very interactive clinic sessions. It was very helpful being able to participate in the clinics, such as taking a history, examining a patient. Other GP placements should take note as they often lack this” “Gave me a chance to run a surgery and practice my clinical skills.” “observing students history taking and examination skills is useful and rarely happens in hospital placements”

16. Some students find it helpful to give small presentations to their groups. “He encouraged us to learn in different ways: His teaching, group discussions, seeing patients, private study, presenting your own work, watching others' presentations. Because he treated us like adults we could ask questions and lead discussions” “The presentations and extra homework, although daunting at first, were very helpful for our learning” Time available may depend on time of year – perhaps not in the week before exams… Homework?

17. Mentioned by a significant number of students as a positive. Perhaps reflects a contrast to the way we are sometimes treated in hospitals and by the medical school. “G.P. treated us as (near) equals.” “This was an exceptional placement. Without doubt the best I have been on. The GP treated us like adults.” “Treating us with respect and as the adults that we are, rather than patronising us, treating us like children, and not listening to us (as I have experienced in numerous GP surgeries before now!)” Being treated as adults

18. Exams are never far away, and students never get that much OSCE practice. They liked: “Tutorials and OSCE practice on bimanual examination and speculum” “A formal mock-type OSCE session might be useful at the end of the placement, to ensure we've learnt the necessary skills.” “Being taken through OSCE examples with the correct practice explained.” Exam / OSCE Practice

19. “Dr was extremely inviting making a point to get to know each of the four students, asking and giving advice about our future careers” “Dr was friendly and approachable, felt like he was genuinely interested in our learning” “Very friendly practice staff and doctors. Excellent teaching facilities with dedicated room, wide screen for viewing images etc. Organisation of the teaching was impressive.” “Dr is an amazing teacher, and very devoted to the students” “Useful for the more than just exams, good career advice also.” Other good points about GP

20. If you give students responsibility they will respond to it and act in a responsible manner. • Students appreciate connecting with GP’s who generally seem genuinely interested in them. • Interactivity and engagement are key. • Imagine the best student and create a programme for them rather than imagining the worst student and trying to create a programme that remediates them. • Final thought – feedback overwhelmingly positive – we love GP! Best practice: