GP Block Student and Tutor e-Guide for Stage 3, Integrated Clinical Practice 2 2019-2020

School of Medical Education

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Welcome to GP Block

Dear Future Doctor, Welcome to your GP block in final year! By now some of you will already have decided you quite fancy being a GP, some of you will be sure you don’t want to work in Primary Care in the future. Either way this block will provide you access to the most diverse mix of patients and presenting complaints you could possibly hope for as a medical student. As such this block will be an amazing learning opportunity regardless of your future career hopes. You will get out of the block what you put in and if you work well with your GP tutor to address your learning goals and the curriculum you will have fun, learn about lots of medical conditions and develop your confidence in managing patients. For some of you this will be the first time you begin to make decisions about patient care (all be it with appropriate support and supervision), this responsibility is something you will need to take seriously and will help you learn and enjoy this block. This block generally receives amazing feedback and we hope you get as good as an experience as is encapsulated by this comment from one of your predecessors: “A fantastic block where I genuinely looked forward to coming into work each day and actively wanted more sessions! I have learned a lot of medicine and clinical skills, and most importantly I feel that my confidence has improved significantly. The GP placement is excellent chance to take responsibility and get really involved in patient management. Thanks for a fantastic placement, I would wholeheartedly recommend the GP block.”

Final Year King’s Student Your GP tutor will be your mentor and teacher, and we are here to support you and ensure you are having a useful learning experience. If you have any problems or questions that your GP tutor can’t answer, then that’s why we are here so get in touch. We hope you enjoy your time in GP and that it helps you consider this as a future career. At the end of the day 50% of you will get to be GPs! It will offer you an amazing life with flexibility and a good work/life balance. You will have the opportunity to work as part of an extraordinary multidisciplinary team and meet a stimulating (and at times challenging) variety of patients who you will have the privilege of helping throughout their lives. Best Wishes, Dr Russell Hearn Dr Marion Hill Monica Martin Stage 3 GP Block Lead Deputy Stage 3 Block Stage 3 GP Block Administrator

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Contents

Welcome to GP Block .................................................................................................................. 1 Contents ..................................................................................................................................... 2 Key Dates and Contacts for ICP2 .................................................................................................. 3

Stage 3 GP Block dates 2019 ............................................................................................................. 3 Stage 3 GP Campus block dates 2019 ............................................................................................... 3 Stage 3 GP Midterm Seminar dates 2019 ......................................................................................... 3 Key Contacts for Stage 3 GP Block .................................................................................................... 3

General Practice Block Requirements Overview: .......................................................................... 4 Learning Outcomes for the Block ................................................................................................. 5 Stage 3 GP Block Practice Induction ............................................................................................. 6 Learning in General Practice and Primary Care ............................................................................. 6 The first week (or two) ................................................................................................................ 7 Initial Clinical Sessions ................................................................................................................. 8 Feedback ..................................................................................................................................... 8 Tutorials ...................................................................................................................................... 8 Troubleshooting .......................................................................................................................... 9 Portfolio Work While On GP Placement ..................................................................................... 10

Case Based Discussion (CBDs) ......................................................................................................... 10 RCGP prize ....................................................................................................................................... 11 Interprofessional Relationship / LEADER piece ............................................................................... 11 Reflective Learning Diary ................................................................................................................. 12

Weekly Seminars ....................................................................................................................... 13 Midterm Seminars ..................................................................................................................... 14 Assessment ............................................................................................................................... 14 Administration at the end of the placement ............................................................................. 155

The GP tutor submits..................................................................................................................... 155 The student submits ...................................................................................................................... 155

Appendix 1 – Sample timetables .............................................................................................. 166 Appendix 2 – Initial questions to ask students .......................................................................... 177 Appendix 3 – Supplements to the community cases ................................................................. 188 Appendix 4 – Virtual Learning Platform .................................................................................... 199 Appendix 5 – Personal Safety ................................................................................................... 200 Appendix 6 – Student Travel Policy .......................................................................................... 222 Appendix 7 – Suggested LEADER activities ............................................................................... 233

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Key Dates and Contacts for ICP2

Stage 3 GP Block dates 2019

8 June – 31 July 2020 Block 5

24 August – 16 October 2020 Block 6

19 October – 11 December 2020 Block 7

Stage 3 GP Campus block dates 2019

Attendance at the campus days is compulsory, and students will need to collect signatures in their portfolios to confirm their attendance.

Mon 8 June & Tues 9 June 2020 Block 5

Mon 24 August & Tues 25 August 2020 Block 6

Mon 19 October & Tues 20 October 2020 Block 7

Stage 3 GP Midterm Seminar dates 2019

(Compulsory midterm seminars for students placed outside the M25 or by arrangement)

Thur 2 July & Fri 3 July 2020 Block 5

Thur 17 September & Fri 18 September 2020 Block 6

Thur 12 November & Fri 13 November 2020 Block 7

Key Contacts for Stage 3 GP Block

Monica Martin GP Block & Community Teaching

Administrator

020 7848 8692 monica.martin@kcl.ac.uk

Dr Russell Hearn

GP Block Lead & Deputy Director

of Community Education

020 7848 8694

07941 590 214

russell.hearn@kcl.ac.uk

Dr Marion Hill Deputy Block Lead 020 7848 8690 marion.hill@kcl.ac.uk

Pete Tayler-Hunt Educationalist 020 7848 8695 peter.tayler-hunt@kcl.ac.uk

Guidance and contact details can be found on the KUMEC website: http://www.kcl.ac.uk/kumec

Twitter: @KUMEC4KCL

mailto:monica.martin@kcl.ac.ukmailto:russell.hearn@kcl.ac.ukmailto:marion.hill@kcl.ac.ukmailto:peter.tayler-hunt@kcl.ac.ukhttp://www.kcl.ac.uk/kumec

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General Practice Block Requirements Overview:

Medical School curriculua must give medical students experience in a range of specialiaties, in

different settings, with the diversity of patient groups that they would see when working as a doctor.

An eight week placement at a GP practice (full time). To achieve the learning outcomes it is essential

that the student has:

Space – a room in which to consult alone

Computer access – to record consultations and for Internet access to check College e-mails and the

Virtual Campus (R1.19) and to take part in the webinars for Global Health.

Time per week for:

• Four sessions in direct patient contact consulting on their own, seeing 3-6 patients per

session (a total of 12-24 patients per week). From Week 2, students should be given the

opportunity to start to consult independently.

• One session on community cases which may be an obesity study

• One protected one-to-one tutorial of two hours.

• One seminar (face-to-face or time to engage in virtual learning space)

• One session for e-learning

• One self directed study session

• One free session

Seminars – Students will need to be released for weekly seminars. If the student has a placement in

a practice that, for reasons of geography, means they cannot attend weekly seminars, they must

attend their midterm seminar.

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Learning Outcomes for the Block

Please see the full learning outcomes for the block by accessing the following URL:

https://keats.kcl.ac.uk/mod/book/view.php?id=1777398. GP tutors who do not have a KEATS

accounts can access these documents on the KUMEC Stage 3 Website. These have been carefully

constructed to meet the GMC learning outcomes for UK medical schools, are relevant and achievable

within general practice, and fit with other activities in the undergraduate medical curriculum. Some

themes related to these outcomes are represented in the figure below:

Please refer to the GMC’s guide Promoting Excellence – standards for medical education and

training for further information.

Administer a drug via a nebuliser/ IM injection/inhaler Complete a GP Prescription or Medication Review

Write a referral letter

Explain a procedure to a patient/relative

Communicate effectively with another professional….

Take a swab or blood test, fill in the appropriate form, interpret the results and act on them Measure and calculate a BMI and offer nutritional advice Change a dressing/wound care…

Here are a few of the activities you can take part in whilst on your GP Placement…but there are more!

https://keats.kcl.ac.uk/mod/book/view.php?id=1777398http://www.kcl.ac.uk/kumec

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Stage 3 GP Block Practice Induction

There are two compulsory induction days at the start of each GP block, on campus which introduce

the students to:

• what to expect on their placements;

• the general practice consultation;

• managing uncertainty;

• the essentials of note keeping including the use of the electronic health records;

• the management of chronic disease and minor and serious illnessess;

• examples of health promotion, multidisciplinary communication and shared care between

primary and secondary care;

• common presentations and diagnoses in general practice;

• global health in primary care.

• how to approach the Supervised Learning Events on this placement.

A variety of large group lecture teaching and small group sessions are used, including simulated

general practice consultations with trained actors as patients and experienced primary care clinicians

as facilitators.

Stage 3 students should be encouraged to develop an adult learning style i.e. they are self-directed

and intrinsically motivated. That said, attendance at the campus days is not optional as these form

an essential foundation for the GP block placement.

Learning in General Practice and Primary Care

• The named GP tutor, the clinical supervisor for this block, is the main person who co-

ordinates the student’s learning and will provide the majority of their tutorials and feedback.

• Daily activities should centre on the patients of the practice. The experience of community

services will arise through following these patients and researching for the community case

studies.

• The placement should provide the student the opportunity to experience a wide range of

medical, surgical, obstetric, gynaecological, paediatric and psychiatric problems, among

others, including an understanding of when referrals are required as part of the management

plan. Managing these patients will help students gain useful practice in therapeutics and risk

management.

• The student will be expected to take significant clinical responsibility under close supervision

for the patients they see and sometimes follow up. They will have opportunities to learn and

practise clinical skills under the supervision of named primary care health professionals.

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The first week (or two)

The GP tutor and the practice manager, should orientate the student to the facilities and locale of the

practice, as well as draw up a timetable for the placement (see Appendix 1).

An initial one-to-one tutorial and induction session to talk with the student about where they are in

their training and how well they are progressing is invaluable. It should also include time to discuss

expectations - what the GP tutor (clinical supervisor) expects from the student and vice versa, how

they might resolve differences in these expectations in a constructive and supportive way and to

discuss the student’s self assessment to look at areas for development. This will help the student

complete their Personal Development Plan which is in their hardcopy portfolio and which needs to

be completed and reviewed with their Educational Supervisor at the start of their GP Block. The

Educational Supervisor role is separate to that of the GP tutor as clinical supervisor and will be a

hospital clinician for Stage 3. The GP tutor and student should look at the portfolio together to gain

an overview of the student’s expectations. See Appendix 2 for more details. The induction session is

also a good platform for the student and GP tutor to identify how the student portfolio work may be

completed. See page 11 and Appendix 7.

The student will also need to spend some time in reception to gain a fuller understanding of reception

roles and to meet with all members of the team. Training in the use of electronic patient records

should be provided. The student will need to know how to log on, keep notes etc., and will need a

‘Medical Student’ log-in for audit purposes. Learning to record accurate, concise and

contemporaneous notes is an integral part of the student’s learning and therefore it is essential that

students record these contemporaneously into the electronic notes.

Tutors and Practice Managers should address the following issues during the student’s induction:

• Confidentiality and consent

• Personal safety (see Appendix 5)

• Timetable for the placement, practice activities (a copy of which – including sick leave,

absences and lateness must be retained and sent to KUMEC)

• When and from whom the student can seek help

• Who to contact if the student is unable to attend a session due to unforeseen circumstances

• Practice policies for chaperones and home visits

• Clinical governance

• Emergency procedures and panic alarm

• Named supervisor and their deputy if the GP tutor is away

• Where to lock/leave personal items

• How to make refreshments and where the rest rooms are etc.

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Initial Clinical Sessions

• Student sits in with the GP tutor for a couple of sessions to get to know them and so that the GP tutor

can begin to assess the student’s level of confidence and competence.

• Student can sit in with other GPs as well to see a range of consultation styles.

• Student gradually gets involved and then begins to take part in the consultation.

• Student does consultations with GP tutor in the room.

• By Week 2 the student should be consulting independently and in a room on their own, they need to

be able to get the tutor’s attention quickly at all times.

If independent consultations are not happening by the end of Week 2, the student or tutor should

contact KUMEC for advice and help.

Once every couple of weeks you should aim to do a shared surgery, where both tutor and student

take turns observing each other consulting. The tutor can see how the student is progressing and is

able to offer constructive feedback, the student can see with greater insight the broad range of

consultation techniques used by a more experienced doctor and has the opportunity to practice and

provide feedback.

Feedback

Giving and receiving constructive feedback is a vital part of learning. Feedback is most useful if it is

immediate or soon after the consultation whilst still fresh in both the student and the tutor’s minds.

Students can learn not only from established GPs but also from F2 doctors and GP registrars. They

can share some of their consulting lists, seeing alternate patients and have shared debriefing with the

GP tutor about the cases seen. This is a useful teaching opportunity for the F2/GP Trainee to practise

giving and receiving feedback.

Tutorials

One-to-one tutorials are an essential and valuable part of the course, consolidating learning, filling

gaps and monitoring progress.

An early assessment of the student’s learning needs is vital in ensuring that the attachment fulfils

their educational needs. GP tutors need to set aside two hours of protected time for one-to-one

tutorials with the student each week, these can be split into smaller sessions but please signpost

this for the student.

Tutorials should be student-led and could include:

• an in-depth analysis of a patient seen that day;

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• a teaching session on a topic identified by the student or tutor;

• a review of current policies or guidelines etc.

Tutorials can be led by other appropriate members of the team and occasionally shared with other

learners at the practice.

Troubleshooting

Sometimes students and practice staff raise issues with the KUMEC about the placement and/or

learning. Mostly they simply have a question that needs answering or a query they want clarifying.

Most queries from students are about a lack of one-to-one tutorials, an inability to consult

independently or a perceived lack of organisation in the timetable.

We are always happy to help if a problem arises which cannot be solved in-practice. Our contact

details are here. If you have any concerns please contact us sooner rather than later.

Members of the KUMEC team are always available to visit the practice if necessary and will want to

meet with student and GP tutor in an attempt to help resolve any problems.

Where it is clear that relations have broken down irreparably, the student will be placed elsewhere if

at all possible, but this is never our initial response.

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Portfolio Work While On GP Placement

The GP Block has two Supervised Learning Events (SLEs) associated with it: the Case Based Discussion

(CBD); and the Interprofessional Relationship / LEADER piece. There is also a Reflective Learning Diary.

For these supervised learning events the student may complete up to three CBDs and three LEADER activities but only needs to submit one CBD and one LEADER refection. If more than one of each type of SLE is completed, the student must indicate in the portfolio which of these they are submitting for assessment by placing an “X” in the check box above the item in the portfolio. If students find the space provided in the portfolio for the SLEs insufficient, they can enclose printed copies in the plastic wallets at the back of the portfolio.

Case Based Discussion (CBDs)

During their Stage 3 GP placement the student is expected to learn how to manage patients with

chronic and complex conditions in the community. These patients will usually have input from several

members of the multidisciplinary team. As part of their progression to the next stage of their training

the student will need to demonstrate that they have learnt about the management of patients with

chronic and complex conditions and understood the patients’ perspectives. The student may identify

appropriate patients whilst consulting independently or they may need to ask the GP tutor to help

identify suitable patients. For additional ideas see Appendix 3.

Students have one session per week to prepare their CBDs. These sessions give them time to meet

with patients and/or carers and relatives and discuss their experiences and management; to go on

visits with relevant members of the multidisciplinary team to learn about their role (e.g. the

community matron, district nurse, community pharmacist, occupational therapist) and to see how

they help patients manage their conditions and support informal carers; and to research and to write

up the CBDs. The student describes the patient seen in their portfolio - approximately half is a

summary of the patient’s situation from a bio-psycho-social perspective, including who is involved in

the patient’s care, and half is a reflection on how well the patient’s needs are being met and thoughts

on how the patient’s care could be improved. Below are some questions that students may address

when writing up each case:

Who?

•How, why, to and by whom has the patient been referred?

•Who else is involved in the care of this patient?

What?

•What is the community practicioner(s) role and what can they provide?

•How do the various practicioners communicate with each other?

Patient

•What is the context for this patient?

•Are this patient's needs being met?

Next

•What else can I do to manage this patient? A medication review? Another referral? Feedback at a multidisciplinary meeting?

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Analysis of these case studies by KUMEC has shown that students who are actively involved in these

processes learn more. So rather than passively observing, students can help do the dressings for

example, a medication review or complete a referral form. Students should present cases to the GP

tutor (and at MDT meetings if appropriate) and perhaps to peers and facilitators in seminars, to

compare and share experiences and deepen their learning from managing these patients. The student

chooses one case to be assessed by the school.

Portfolio Entry:

1. The student discusses the case(s) with their GP tutor.

2. The student will be required to write-up a summary of the case.

• After discussion of the case, the GP tutor will grade the student’s case summary using

the scale in the portfolio and the anchoring statements below and provide written

feedback in the portfolio on what was done well and areas for improvement.

• Following this, the student will write a reflective piece in the portfolio about what things

they did well, things they need to improve and the next steps they need to take in order

to improve.

• One CBD, which may be based on a chronic complex case should be submitted.

• If more than one CBD is completed, the student must indicate in the portfolio which of

these they wish to submit for assessment by placing an “X” in the check box above the

item in the portfolio.

Anchor statements:

• Clinical assessment: A thoughtful and balanced assessment of the patient’s situation from a

bio-psycho-social perspective

• Investigations and management plan: A clear summary of the patient’s investigation and

management history from a multi-disciplinary perspective

• Clinical judgement: A reflective account of how the patient’s needs are being met and how

their care could be improved

• Professionalism: The student demonstrates respect, compassion and empathy; sensitivity to

the patient’s opinions, opinions and concerns; with insight into their own and the

professionals’ / professions’ limitations.

GP tutor and student need to negotiate the timing of these portfolio assessment pieces.

They will be submitted, with the completed portfolio at the end of the academic year.

RCGP prize

The RCGP has awarded a monetary prize for the best community case study each year. GP tutors are

invited to submit nominations for exceptional work in a CBD to russell.hearn@kcl.ac.uk.

Interprofessional Relationship / LEADER piece

This portfolio piece asks the student to take part and reflect on a leadership activity within the Primary Health Care Team. The GMC in their ’Outcomes for Graduates’ document (http://www.gmc-uk.org/education/undergraduate/undergrad_outcomes.asp) expect students to ‘demonstrate [an]

mailto:russell.hearn@kcl.ac.ukhttp://www.gmc-uk.org/education/undergraduate/undergrad_outcomes.asphttp://www.gmc-uk.org/education/undergraduate/undergrad_outcomes.asp

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ability to build team capacity and positive working relationships and undertake various team roles including leadership and the ability to accept leadership by others’ (Learning outcome 22d). One of the GMC’s learning outcomes for this GP Block is to ‘understand the importance of clinical leadership within the evolving NHS, using opportunities and examples within the community setting to demonstrate personal development of skills relevant to organisational leadership’ (Learning Outcome 8). The MBBS 2020 vision is to produce graduates who are leaders. Leadership from clinicians is also an important a component of the ‘Five year forward view’ and a sustainable NHS. Details of this activity are in the student portfolio. In discussion with their GP tutor the student is asked to choose an activity in which they can demonstrate leadership in a team or acting as part of a team. Details of the leadership example are to be completed by the student in their portfolio and the student is expected to discuss this with their GP tutor. The LEADER domains in the portfolio present areas for discussion and development. 1. Look at the Interprofessional Relationship / LEADER piece in the portfolio. In discussion with

the GP tutor, the student identifies an activity where they can demonstrate leadership of a

team or as part of a team. They are asked to write details of the leadership example in their

portfolio focusing on one of these domains.

2. After this activity has taken place, the student discusses their role with their GP tutor. What

leadership issues emerged from the discussion? What went well in terms of clinical

leadership? What have they learnt from this?

3. The GP tutor then summarises details of the discussion points and themes in the portfolio

against the relevant LEADER domain. Furthermore the GP tutor marks in the portfolio

whether or not this supervised learning event was satisfactory (see Anchor Statements below

for guidance about what is satisfactory). Was there anything especially good in terms of

medical leadership, and what leadership-related developmental goals has the student

identified?

4. Finally the student summarises in the portfolio things they did well, things they need to

improve and the next steps they need to take in order to improve. This exercise and examples

may be discussed in seminars.

Anchor statements:

• Engaged with the process and with colleagues

• Demonstrated an awareness of their role and responsibilities within the team and those of

others involved

• Demonstrated insights into group dynamics

• Demonstrated an appreciation of how teams work and their own contribution to this activity

• Shows that they have learnt / reflected on leadership skills that they can use in the future.

GP tutor and student need to negotiate the timing of these assessment pieces, so they are

completed and submitted by the end of the block.

Please see Appendix 7 for some suggestions.

Reflective Learning Diary

The GP tutor can help the student with this exercise through discussion but is not involved in the final assessment process. The reflective learning diary entries comprise:

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1. The student’s PDP which is the first page of the Reflection area of the portfolio, should inform

how the reflective entries will be used to demonstrate learning. Guidance on the Reflective

Learning Diary is in the Portfolio Introduction. This is a deliberate piece of work and is meant

to provide the student with the opportunity to think about how they will go about effectively

and efficiently recording their professional opinions in medical notes in the future.

2. Two sets of reflective entries are required. One must be a response to a patient interaction.

The student is encouraged to think about the interpersonal aspect of their work with a patient.

To reflect, in a safe environment, on the effect that a patient’s presentation, condition,

treatment, outcome or behaviour has had on the student. This encourages focus on their own

responses and those of the person that they are dealing with. Meaningful and critical reflection

enables us to learn from our own experiences, and to identify potentially unexpected

behavioural drivers, obtain support and improve therapeutic relationships.

3. The student should discuss the interaction with their GP tutor, conveying how they

experienced the interaction in order to make more sense of what was going on for the patient

and to explore the student’s reaction to the patient. The whole activity should take about 10-

15 minutes.

4. The student may choose to present the patient’s situation and their response at a seminar,

sharing what they and the GP tutor talked about and discussing it with their seminar group.

5. For their portfolio entry, the student will be required to write a summary of the patient

interaction they have chosen and reflected upon.

The other reflective entry is chosen by the student, discussed with their GP tutor, during seminars if

wished and written up as directed in the portfolio instructions. Both reflective entries will be assessed

by the student’s Educational Supervisor, not by the GP tutor.

Weekly Seminars

It has long been known that students who work with their peers fair better in exams1. The seminar

group work supplements learning by providing opportunities for the student to compare notes with

their peers at different practices, potentially with very different experiences. It is also a safe place to

discuss sensitive or contentious issues. Students are expected to bring experiences and cases from

which they learned, were challenged by or with which they would like help.

Students attached to GP tutors who are also seminar leaders will be allocated to a different seminar

group. Attendance at seminars is compulsory as they are part of the course and ongoing professional

development.

1 Blumenfeld, P. C., Marx, R. W., Soloway, E., and Krajcik, J. S. (1996). Learning with peers: From small

group cooperation to collaborative communities. Educ. Res. 25(8): 37-40.

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Seminar groups allow the student to:

• Present interesting and challenging cases to a peer group

• Work collaboratively on particular topics

• Share individual experiences during the placement

• Provide support for each other

• Debate difficult or sensitive issues in a protected environment

• Practise peer review and receiving constructive criticism

• Practise decision-making (including reasoning, bargaining, confronting and avoiding collusion)

through role-plays and group discussion

• Discuss career choices and options

• With their seminar leader students can select from some structured learning provided by the

Stage 3 GP team.

Midterm Seminars

For the students on placements too distant to return to London for seminars, they are enrolled on

the Virtual Learning Platform (hosted via KEATS – see Appendix 4) and will attend two days of face-

to-face campus-based teaching in the middle of the Block. The student travel policy in Appendix 6

provides guidance on the reimbursement of travel costs. These placements are normally independent

placements and students should factor the time and costs of travelling back for these into account

when planning their placements.

The midterm sessions contain the same learning opportunities as the weekly seminars and all

students should read the weekly seminar information above. Students attending midterm seminars

should prepare for the seminar by identifying topics that they would like to cover during this time. All

students are expected to bring at least one case of interest to the seminars.

Assessment

The students must successfully complete their portfolio entries as outlined in the previous section.

Additional feedback will be sought from the GP tutor on the domains of student performance. These

include:

Attendance and Punctuality

Reliability and dependability are attributes of a good doctor, which we measure, in part, by

attendance and punctuality. Undue absences may be considered to have a bearing on a student’s

fitness to practise.

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Tutors and patients will have made special arrangements for the student, organising their time and

surgery rotas for teaching. Absence will also seriously affect the student’s learning. If a student knows

they will be unavoidably absent or late, they need to inform whoever is leading the session.

Punctuality is essential: lateness is a discourtesy to patients, tutors and colleagues and it disrupts the

process of any group work, which is unacceptable.

Students should aim to attend 100% of the time, but a minimum of 90% of the sessions. Attendance

of 75 - 90% should be addressed by the tutor and the student warned that they risk damaging their

learning and having an unsatisfactory sign-up.

If a student fails to attend for less than 75% of the time KUMEC must be notified and evidence of

attendance provided by means of the daily engagement log. Students who attend less than 75% of

the time can only progress to their final examinations if the Head of Stage 3 is satisfied that there is

a plan in place to compensate for this.

GP tutors may wish to discuss individual cases with KUMEC staff. We welcome this and our contact

details are above. Experience has shown that students whose attendance is poor are at greater risk

of failing finals, so it is of paramount importance that poor attendance is picked up and dealt with at

the earliest opportunity to avoid this.

Requests for conference attendance or absence

Students should understand that their first priority should be to attend their clinical placement and

whilst presentation at conference and other activities are important they cannot impact upon

learning. Requests to attend conferences that conflict with manditory session such as mid-term

seminars or induction days will normally be declined.

If you wish to miss any of your clinical placment then this will need to be formally approved and will

need to be discussed by emailing Dr Hearn (russell.hearn@kcl.ac.uk) and the Head of Stage 3 Dr Sam

Thanabadu (sam.thenabadu@kcl.ac.uk).

Administration at the end of the placement

The GP tutor submits

• Online evaluation of the placement/student - a link will be sent to GP Tutors towards

the end of the placement to complete.

The student submits

• Online evaluation of the placement/practice - a link will be sent to students towards

the end of the placement to complete.

mailto:russell.hearn@kcl.ac.ukmailto:sam.thenabadu@kcl.ac.uk

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Appendix 1 – Sample timetables

Student

GP tutor

9.00

Patient 1

9.00

Patient 2

9.10

9.10

Patient 3

9.20

9.20

“Empty” slot for debriefing student on Pt 1

9.30

Patient 4

9.30

Patient 5

9.40

9.40

Patient 6

9.50

9.50

“Empty” slot for debriefing student on Pt 4

The student must accept that to fit in with surgeries, there may be gaps during the day. These are excellent revision times. At the same time, the tutors should do their best to ensure these gaps do not occur every day particularly if there are no library facilities available.

Example Student Time Table for GP Placement

Time

Monday Tuesday Wednesday Thursday Friday

09:00 Consult in tandem with GP tutor (GP tutor available nearby)

Community cases/case-based discussion/reflective practice

Online activity including Global Health Webinars and preparation for Elective.

Consult in tandem with GP tutor

Tutorial (half session)

10:30 Coffee Break

Coffee Break

10:50 Consult in tandem with Tutor

Consult in tandem with GP tutor

Consult in tandem with GP tutor (half session)

12.00 Lunch

Lunch and travel to seminar

Lunch Lunch

13:00 Home visits with Tutor

Home visits with Tutor

Tutorial (2 hours – may be split if required)

Private study time

14:00 Consult in tandem with Tutor

Seminar or engaging with virtual learning platform on KEATS.

Free afternoon

16:00 Consult in tandem with GP tutor

Consult in tandem with GP tutor (half session)

17:00

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Appendix 2 – Initial questions to ask students

Before the General Practice Block students are asked to complete an Initial Self-Assessment form sent to them by email. Students are asked to rate themselves, on a 1-5 scale, on how confident they feel in consultation skills, therapeutics, knowledge of PHCT, professional values, etc. This tool may help you begin a stronger mentoring dialogue with the student about their needs and interests, and about any specific skill areas where they need more experience which could be provided in general practice. It also serves as a reminder of key clinical management skills to have mastered by the end of the stage. Once completed the Self-Assessment Form will be emailed to tutors automatically. Be sure to use the Initial Self-Assessment form emailed to you with this discussion. If you have not received this, ask if the student has completed it. Here are some helpful questions you might like to ask students once they have settled down and started trusting you. How many years have you been studying medicine? This question will help you to identify students’ previous experiences. Are they on the 4, 5 or 6-year course? Have they transferred from another university? Have they taken a year out to pursue a BSc? Did they have to repeat a year? Or have they taken a ‘gap’ year? In which quartile or decile does your ranking fall? Some students in the lower rankings struggle with their learning. This might be due to physical or mental illness, personal problems or financial difficulties and therefore these students will need a more careful educational assessment at the beginning of the attachment and additional help in some areas. If during the attachment you uncover substantial problems, please contact Dr Marion Hill or Pete Tayler-Hunt. The sooner issues are brought to our attention, the faster we can resolve them. Please don’t take on the role of the student’s GP or counsellor; instead alert KUMEC so that we can monitor and assist the student. Can you tell me how do you usually learn?

How do you learn a new clinical skill? Medicine is learnt through clinical encounters with patients. The analysis of OSCE results of the last few years shows that students do well on clinical examination and technical skills but in comparison, do less well on history taking communication stations and management. One explanation is that clinical and technical skills are well described in the logbooks and they can ‘cram learn’ in the skills centre before the exam. History taking is related to knowledge of disease and application of communication skills in the patient interview. Mastery needs practice, meaning history taking skills cannot be crammed. How do you feel about approaching patients (or colleagues)? Some students may feel they don’t want to impose on patients, and that they are in the way of nurses and doctors. The modelling of positive professional relationships with patients and colleagues will help the students in their approach.

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Appendix 3 – Supplements to the community cases

Learning from the community cases may be enhanced through the inclusion of some of the activities

listed below

• Home visits with the DN, HV, paediatric community nurse, CPN or Community Matron

• Home visits with community physio, OT, specialist HV, community midwife or Clinical Nurse

Specialists

• Pharmacist – in shop/clinic/surgery settings

• Visits to residential homes/intermediate care centres

• Observing voluntary organisations attached to practice

• Domiciliary and podiatry clinics

• Speech and language therapists

• Domiciliary dentists and opticians

• Reproductive and Sexual Health clinics

• Leg ulcer/vascular clinic

• Continence clinic

• Shadowing a patient on an OPD appt

• Visit to an undertaker/funeral parlour

• Learning the role of Social Services in the community

• Liaising with all other members of the PHCT

• Child health clinics

• School nurses

• Community support/auxiliary nurses

• Macmillan/palliative care nurses

• Asylum-seeker groups

• DUAL and addiction therapists

• Home loans of hospital equipment

• Weekend/emergency community visits.

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Appendix 4 – Virtual Learning Platform

The Virtual Learning Platform (VLP) is available to students who are attending mid-term seminars for

reasons of geography.

The VLP provides students with access to a learning envrionment where they can engage in

moderated discussions with peers. It also provides access to learning activities and a FAQ area.

Students will have one timetabled session per week to enagage with the VLP. Previous students have

found the VLP to be a useful forum which allows them to share learning, new insights and to discuss

challenging cases. It creates a sense of cohesion in the group and is helpful in reducing the isolation

of being outside London. Engagement with the VLP should supplement the midterm seminar (face-

to-face) teaching students also receive.

The VLP can be found on KEATS: https://keats.kcl.ac.uk/. A King’s log-in is needed to access the group.

An experienced facilitator facilitates and moderates the group and may respond to posts with ideas

to prompt further/deeper thinking.

If you have any questions, queries or suggestions about the virtual learning platfom please contact

Marion Hill - marion.hill@kcl.ac.uk

https://emea01.safelinks.protection.outlook.com/?url=https%3A%2F%2Fkeats.kcl.ac.uk%2F&data=01%7C01%7Cmonica.martin%40kcl.ac.uk%7C8307b8ea7c044a58450d08d69d8ce791%7C8370cf1416f34c16b83c724071654356%7C0&sdata=zqMPCYdkwtP65GTwOydutUrs1lblK9Pq9DUfIw5HdRU%3D&reserved=0mailto:marion.hill@kcl.ac.uk

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Appendix 5 – Personal Safety

Safety Students should do everything they reasonably can to ensure their own safety and that of others at

all times. Taking care after dark, being sure to get good directions and preferably being accompanied

are all sensible precautions.

If a student feels uncomfortable about going somewhere, they need to inform the tutor. Students

must always pay attention to their personal belongings.

Whilst this is rare, if someone is threatening or abusive, or if the student feels that their safety is in

doubt, they should terminate the consultation, alert the tutor immediately, and record and report

the incident.

We recommend that before starting consultations students should have a discussion with the GP

tutor or practice manager, at the end of which they should know:

• What the practice health and safety protocol is

• Where the panic buttons are or what to do to raise the alarm

• What the practice alarm sounds like

• What response you should expect if you press the panic button

• What you should do if you hear an alarm set off by someone else.

Guidance on Home Visits Students will have limited experience of home visits and the associated potential health and safety

issues. It is therefore important that the GP tutor and the practice staff undertake a general risk

assessment of student safety.

Students are allowed to do home visits for those patients deemed ‘low risk’.

Examples where there maybe an increased risk of violence to health professionals on home visits are:

• Visiting in the dark

• Tower blocks

• Female doctors visiting lone male patients

• Patients with known alcohol misuse or drug misuse history

• Patients with previous violent behaviour to NHS workers

• Patients with acute psychiatric problems.

Third, fourth and fifth year students are allowed to do a home visit unaccompanied provided a risk

assessment as outlined above has been conducted by their GP tutor. Students must have a functional

phone with them at all times and their contact details available at the practice. Students are required

to sign out of the practice and inform the GP tutor and practice staff of their expected time of return.

They should not go directly home from a home visit without making contact with their tutor. If they

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do not return within an agreed period of time, the student should be contacted. If the student does

not respond then please escalate as appropriate.

Indemnity Students should ensure they have read the school policy on indemnity. They should be aware that

the School requires that all students have membership of a medical defence society.

Informed Consent The patient’s consent for any involvement in teaching is always carefully sought and it is made clear

they have the opportunity to decline without prejudice to their care; the principle of informed

consent means that the exact nature and extent of the student’s involvement should be made clear

to them at the outset. If at any time a patient decides to withdraw, students must treat this

courteously and not take offence, reflecting the patient-centred approach to healthcare.

Students should ensure the practice adequately informs patients of their presence, and that patients

consent to being seen by the student.

Permission Students should not visit or arrange to visit patients without the express permission of the GP tutor.

Confidentiality The trust that is put in a confidential conversation allows truth, fear and uncertainty to be expressed;

breaching confidentiality destroys that trust. It is imperative that students respect confidentiality at

all times, whether as part of consulting with patients or learning with colleagues.

Students will become aware of the, sometimes, difficult aspects of maintaining confidentiality when

working with more than one member of a family.

Students should never discuss what they have heard, even anonymously, in a flippant or disparaging

manner.

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Appendix 6 – Student Travel Policy

Student Travel Reimbursement to GP placements:

• Please see the Accommodation and Transport Policy on the MBBS Home\ Your Programme\

Clinical Placements\ Section 4.

• Stage 3 students have been given a choice about the type and location of the general practice

to which they will be attached, and only reasonable travel is permitted. Students are

expected to use student oyster cards and/or purchase season tickets and travel in an

economical manner.

• As of January 2019, and based on the present curriculum, students allocated to their GP

practices by KUMEC, will need to budget for a maximum of £366.80 for the eight-week

placement. If you anticipate that your travel expenses will be substantially more than

£366.80 and you intend to claim this back, please discuss this with the Stage 3 GP

administrator, before the block begins. Only claims approved by the Stage 3 Block Lead, in

advance of the placement commencing will be granted.

• If you arrange an independent placement, you are advised to be aware of the full travel costs

associated with travel to and from the practice. If you anticipate that your travel expenses

will be substantially more than £366.80 and you intend to claim this back, please discuss

this with the Stage 3 GP administrator before the block begins. Only claims approved by

the Stage 3 Block Lead, in advance of the placement commencing will be granted.

• Students attending midterm seminars may claim for travel costs over £70. If you anticipate

that your travel expenses will be substantially more than £70 and you intend to claim this

back, please discuss this with the Stage 3 GP administrator, before the block begins. Only

claims approved by the Stage 3 Block Lead, in advance of the placement commencing will

be granted.

• Reimbursement rates are reviewed annually.

• Each case is considered on an individual basis.

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Appendix 7 – Suggested LEADER activities

1) Offer to help with an area of QOF which needs improving. This may be suggested by the

student’s interest. E.g. neurology – epilepsy; psychiatry – mental health, LD. 2) Take the initiative and create a health-promotion resource for patients and/or staff. 3) Activities based on RCGP toolkits (your GP tutor should be able to help you access these if

you do not hold RCGP student membership). 4) Leading on meeting an educational need within your practice. 5) Implement a small-scale Quality Improvement project, either patient or staff-centred.