The Oncology Project

1. The Oncology Project Dr Robert Jones Reader and Consultant in Medical Oncology Cardiff University and Velindre Cancer Centre

2. Oncology Project 2018-2019 • Why is it important • Learning outcomes • Process • Tutorials • Patient contact • Written portfolio • Patient feedback • Marking scheme • Student feedback • Where to get information about the project

4. Oncology Project 2018-2019 • Patient as teacher

5. Broad Aims of the project • Help students learn to understand what it might be like to have a diagnosis of a life threatening disease • Inform their practise when working as a doctor • Develop their communication skills • Help them deal with their own issues which can arise when dealing with cancer patients

6. Why is the oncology project important ‘40% of people will be diagnosed with cancer at some time in their life’

7. Factors influencing patients • Media • TV soaps • Magazines • Charity fundraising • Internet • Cancer Back-up • Family and Friends

9. Why is the oncology project important? Whatever discipline of medicine you are in you will be responsible for managing patients with cancer Paediatrics Radiology Surgery Care of the Elderly GP

10. What do they need to know as a junior doctor? • Acute Oncology emergencies • Recognise Neutropaenic sepsis

11. What do they need to know as a junior doctor? • Acute Oncology emergencies • Recognise Neutropaenic sepsis • Recognise Spinal Cord Compression

12. What do they need to know as a junior doctor? • Acute Oncology emergencies • Recognise Neutropaenic sepsis • Recognise Spinal Cord Compression • Diagnose Pulmonary Embolus • Manage GI complications of cancer treatment

13. Student Guide On Learning Central Applied Clinical Sciences Patient Pathways Oncology Training Wales Website: https://oncologytrainingwales.wordpress.com/undergraduate-medical-students/ • Learning Objectives • Assessment • Guidance for background reading

14. Learning Objectives Improved Understanding of: • Natural History of Malignant Disease • Epidemiology/screening/pathology • Treatment including Palliative care • Impact of Malignant Disease and its treatment on patient/family/carer • Physical/emotional/spiritual • Decision Making in Cancer • MDT • Communication of risks and benefits of treatments

15. Process • Tutor allocated September • Will run from September to April: hand in date mid April (TBC) • 4 months to follow patient but extended deadline as some placements are in North Wales • Cannot timetable alongside oncology placement • 1 of 2 longitudinal patient reports • Must achieve >50% • Top 20% receive a certificate of merit (with HFD project) • All students > 90% letter of commendation from Oncology Exec Board • Velindre Hospital award Prizes for top 3 students

16. Introduction/consolidation teaching for modules Year 3 Clinical Module Hospital Front Door Chronic Disease Oncology 8 weeks SSC – 6 weeks 12 MARCH Applied Clinical Sciences 4 Sep 25 Sep-20 Nov 8 Jan – 5 March 14 May-9 July Oncology Project September - April

17. Deadlines dates

18. Process • Tutor facilitates learning and offers support throughout project • Work within groups of about 7 students • Tutor will recruit suitable patients • One to one relationship with a patient • Follow a patient for about 4 months • Tutor will run tutorials –about one a month • Tutor will talk through what should be in the portfolio • Tutor with mark your project and provide some written feedback

19. How does it work in practice? • Talk to your patient as a person: the patient is your teacher • Go with them to clinics, investigations, treatment • Ask about medical history, symptoms, medication, family circumstances • Visit them at home once if at all possible • Get to know them and their family over time • Communicate by phone /email whatever the patient is happy with

20. During the project • Keep a good record of their interactions with the patient and family • Document their reflections and thoughts as they go • Keep notes/copies of tutorials/presentations • Understand the treatment the patient is receiving • Describe toxicities and their management • To attend an MDT meeting and reflect on what happened and what they learnt • Observe patients having treatment such as radiotherapy, chemotherapy or surgery • Sit with the patient when they attend clinics for review/results • Work out the role the different professionals play and how they communicate with each other and with the patient/family • Be critical- could anything have been handled better/how would I have dealt with the situation

21. Oncology Project Pack • Oncology Project Summary (Learning Objectives) • Velindre Map/Leaflet • Activity Log for Oncology Project • University want to know what you are doing • Need to get permission to miss timetabled teaching • Must submit the form by email to your tutor and TURNITIN when submit the project • Letter for patient about patient feedback (English /Welsh) • Patient feedback form • You will give this to the patient during the project and it will be returned to the tutor directly • Can also be completed online if the patient is happy to do so

22. FAQ • Problem travelling to tutorials/clinic visits/patient home • Discuss with tutor at the beginning if no access to transport • Delay in allocation of patient • Need to allocate appropriate patients • Is the home visit essential? • Helpful but may not always be feasible or appropriate • Intruding at a sensitive time? • Written information leaflet • Fully discussed by health professional responsible for their care

23. Patients are keen to get involved • 82% thought the project helped student to understand what it is like to be a patient with a serious illness • 85% felt students valued the patient’s contribution • 81% felt oncology project worthwhile experience for students • 62% patients felt is was worthwhile for them

24. Patient’s comments “(My Student) helped myself and my family through the most difficult time of our lives. We will always be grateful to her.” “(My Student) talked to me and treated me as a person when everyone else was just treating me like an illness. He reminded me that I still have a life outside cancer.”

25. Patient’s comments “This project must continue for years to come. It gives the students the medical insight and experience they need, but also allows them to see things from our point of view.” “It is clear to see that (My Student) is 100% cut out for this job. The way she handled the passing of my husband was professional yet compassionate – Thank you.”

26. Activity Log for Oncology Project • No designated time within the curriculum • Please request release from your timetabled curriculum event • Use your judgement about what is OK to miss either in curriculum or in oncology project • Ideally you • Ask permission from the tutor of the timetabled event • Ask patient/nurse/doctor to sign the attendance slip Please do not just miss a timetabled event without clearing it first

29. The Portfolio and Marking • Summary of patient history and developments over time • Refer to the marking scheme • Cross reference all learning sources • Previous teaching • Literature • Websites • Patient information • Treatment protocols and guidelines such as NICE • Reflections • 4000 (+/- 10%) word count

31. Demonstrate an understanding of the medical decision making process and the MDT – 3% points • ‘I was unable to attend my patient’s MDT as this happened before I was introduced to the patient but I have attended other cancer related MDT’s and they provide an opportunity for health professionals to discuss individual cases and decide on a treatment plan’ Score 1/3 • ‘I was unable to attend my patient’s MDT as this happened before I was introduced to the patient but I have attended other cancer related MDT’s. A wide range of professionals were present including a respiratory physician, radiologist, surgeon, oncologist, clinical trials nurse, clinical nurse specialist and MDT co-ordinator. During the discussion all possible treatment options were considered and the nurses ensured that the patients views are represented’ Score 2/3 • add your own observation about how well/badly the meeting went – • was everyone’s opinion considered equally, • were the views of the patient considered, • was the discussion constructive • Any criticism? – time consuming, time taken to prepare for the meeting so very costly Score 3/3

32. Side effects and management ‘My patient lost all her hair after the second cycle of chemotherapy and she found this very distressing as she was reluctant to go out of the house’ • Which drug was responsible? • Do all chemotherapy drugs cause hair loss • What can be done to reduce hair loss • Was cold cap considered. What are its limitations • What psychological support can be offered if patient experiences loss of confidence or worries about body image

33. Confidentiality patients must know that what they tell in private remains private • Do NOT use patient name, initials, DOB in the portfolio • Doctor/nurse should NOT be identified in the portfolio write-up – the markers know their colleagues and it is not appropriate. • Do not photograph/copy the notes • Do not put identifiable material onto memory sticks or CD’s • Do not discuss patients in public areas such as corridors • Do not keep patient name/address alongside their medical details

34. Student safety • Use common sense when considering home visits with a patient. • Do not agree to a home visit until you have met the patient, and if in doubt contact your tutor.

35. Student support • This is a challenging project for many • Personal issues – friends and family with cancer • May get distressed if patient becomes unwell • Not the usual ‘doctor-patient’ relationship • more like a friend - but only for a few months • May be difficult to move on at end of project

36. Student Support • 94% of students felt supported • Students shouldn’t be afraid to ask for support from tutors as an individual, if not within the group • Steffanie is also available to guide you to the correct support services • Any issues, especially feeling inadequately supported: contact us

37. STUDENT SUPPORT CENTRE studentsupportcentre@cardiff.ac.uk 029 2087 4844

38. Contacts Medical School Office • Hannah Lister T:029 2068 8102 ListerH@cardiff.ac.uk Education Department Velindre • Steffanie Pothecary – Medical Education and Development Co-Ordinator T: 029 2061 5888 Steffanie.Pothecary@wales.nhs.uk Ext 4646 Velindre Hospital Medical Organisers • Dr Rob Jones, Consultant Oncologist Robert.hugh.jones@wales.nhs.uk • Dr Jo Ocen, Oncology Registrar Joanita.ocen2@wales.nhs.uk

39. Student feedback • Encouraged to complete the online feedback • Presented at the annual tutor meeting • Tutors are given individual feedback • Helps us to improve if needed • Written FAQ’s • ‘New tutor’ guidance

40. Student comments ‘enjoyed the experience of meeting a patient with cancer on my own, rather than in a pair as it allowed me to face my fear of cancer’ ‘my patient was the best bit….this project as a whole played a vital role for my enjoymentthis year as it was very rewarding

41. Student feedback 2017-2018 Tutor feedback • 96% thought tutors were accessible • 96% felt they had opportunities to discuss their perceptions of their patients’ issues • The majority of tutors carried out 3-4 tutorials (57%) • 78.4% didn’t experience any difficulties in attending tutorials and patient-related Oncology Project sessions

42. Student feedback 2017-2018 Learning • 95% found that learning opportunities were ample (35%)/adequate • 95% found opportunities to increase knowledge of patients with cancer were ample (41.5%)/adequate • 87% found opportunities to increase understanding of the role of the MDT and support services available ample (37%)/adequate

43. Student feedback 2017-2018 Patient care • 80% feel more confident in approaching patients with a life-threatening illness • 75% feel more confident in dealing with patients’ symptoms and distress Feedback • 81% received written feedback from their tutors • 78% found the feedback useful

44. Student feedback 2017-2018 Overall • 74% felt adequately supported during the difficult stages of my patient's illness (22% N/a) • 97% felt their communication skills continued to improve • 87% felt the learning outcomes were completely/largely achieved

45. SHO tutor feedback comments ‘Very accessible, was easy to ask questions and got good responses. They knew information on our patients so could give us more information’ ‘Tutor was very approachable and tried to find a time to suit the whole group’ ‘Excellent organisation, very accessible and useful when I encountered difficulties with my Patient’ ‘Engaged well with the group -Allowed us to highlight any concerns about our patient’ ‘Very easy to get hold of and willing to discuss any problems with the project. Well structured tutorials too!’

46. Deadline dates

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