GP2 is a community-based placement for all Year 2 students at Barts and The London School of Medicine and Dentistry. The emphasis is on DEVELOPING CLINICAL METHODS THROUGH PATIENT CONTACT.  

There are two focus areas for student learning:  

1. Novice-to-expert transition –  

• helping students grow in confidence and ability as clinicians (coping with things getting more complicated) [see Appendix 6] 

2. Integrated patient centred clinical method  

• Attending to both the PATIENT’S AGENDA & DOCTOR’S AGENDA 

• Ensuring the consultation is a conversation not an interrogation [see Appendix 7] 

GP2 Structure  

(2) interact with each other (formally and informally)  

(3) receive support, feedback, and inspiration for GP tutors and their teams.  

Getting started – it is crucial that there is time set aside on the first practice-based day for the GP tutor/s and the students to get to know one another, agree the group ground rules and complete an induction to the practice including the following: 

1. Welcome – Resettling and Risk Reduction [See Appendix 5] 

2. Placement Checklists [See Appendix 2]  

3. Student Learning Agreement [See Appendix 4] 

The online Central days will include role-play, reflective exercises and video analysis supported by discussions and feedback in Tutorials led by a GP facilitator. These days are opportunities to further hone skills and deepen understanding of how to respond to patients’ needs while gathering clinical information that help will them. 

Year 2 students have limited experience of talking to patients – they are novices, beginning their transition to becoming clinicians. They may be anxious and unsure how to structure a conversation without taking control or getting lost. You might remember – listening to the patient while thinking about what to ask next – without interrupting or interrogating - takes a lot of practice! [See Appendix 7] 

MODULE AIMS: 

OVERALL AIMS of the GP2 placement are to support students to: 

• Develop and practise patient-centered clinical method (integrating communication & examination skills)  

• Link their knowledge of biological, medical, and social sciences with clinical experiences  

• Develop their clinical reasoning when seeing patients in primary care 

• Maintain their compassion, curiosity, and humanity – listen to the patient narrative while thinking clinically 

• Learn from patients and their carers/families (see everyone as a potential teacher)  

LEARNING OUTCOMES: 

By the end of this module, students can expect to be able to: 

• Show confidence in initiating conversations with peers, professionals, patients, and their families, 

• Seek consent from patients and their companions - and explain who they are (including how much experience they have)  

• Apply relevant knowledge of biological, medical, and social science to clinical situations as appropriate  

• Use a framework for a clinical conversations with patients that incorporate the patient’s agenda and basic history-taking / information gathering  

• Conduct a simple, focused examination of a patient under adequate supervision (such as the respiratory, cardiovascular, or abdominal system – but not limited to these) 

• Demonstrate ability to reflect on their own strengths and learning needs, and provide constructive feedback to their peers   

GP PRACTICE BASED LEARNING ACTIVITIES: 

GP Tutors are asked to ensure students have: 

• Observed their students initiating conversations with patients and undertaking focused examinations  

• Plenty of opportunities to practise talking to patients,  

• Ensure students are observed and receive feedback from their GP tutor and their peers 

• At least one opportunity to undertake a focused clinical examination, ideally the cardiovascular, respiratory, or abdominal system but not limited to these– depending on patients). This should include pulse and blood pressure measurement in a variety of patients 

• Completed their own learning needs assessment and reviewed their professional development, including using reflective practice  

• Experience of giving and receiving of feedback 

DATES 

Patient encounters: 

• Observing GPs and other healthcare professionals with guided observations  

• Observe and participate in different modes of consultation – telemedicine as well as F2F  

• Student-led patient interviews and clinical examinations - including opportunity for observation and GP tutor/patient feedback; patients do not need to have symptoms/signs, practicing taking consent for examinations and conducting “normal” examinations is very valuable 

• Student-led or supported clinics e.g., students take lead for new patient checks or LTC checks, do initial assessment including height/weight/BMI, urine dip, BP check and checking patient’s agenda/understanding of conditions. (Some practices have set up student-led BP checks alongside their flu clinics or in the quieter lunchtime period) 

• Home visits – in pairs or accompanied by GPs and other healthcare professionals e.g., visiting housebound patients for flu jabs/long term condition/palliative reviews 

• Expert patients - students interview patients in pairs/small groups, promote opportunity for patient to teach as well 

Other activities: 

• Tutorials for group debriefing and discussions 

• Student research and presentations - perhaps around specific knowledge gaps identified 

• Reviewing recent journal articles and media publications, especially to discuss current 'hot topics' 

• Any near-peer teaching opportunities if other medical students/junior doctors on site 

• Role-plays – assign roles and consider specific observation tasks for feedback and discussion 

• Case-based presentations & discussions - could include navigating electronic patient records 

• Interviewing members of primary care team 

• OSCE-style clinical skills practice – students can practice with each other as well as patients 

• Joining practice team, or wider MDT, meetings 

• Community-based activities –encourage students to walk around local area to build their understanding of the local community, attend local community group meeting, any opportunities to go out with allied health professionals e.g., local district nursing team or other MDT members 

PLACEMENT ASSESSMENT 

The practice-based days will be assessed by: 

1. REFLECTIVE TASK: This will be marked by the practice-based GP tutors. See details below. 

2. END OF PLACEMENT ONLINE FORM:  ATTENDANCE & PROFESSIONALISM ASSESSMENT GP Tutors must complete an online form for each student [see Appendix 6]. GP Tutors are asked to give students formative feedback on their progress and professionalism during the placement, so that students have opportunities to modify their behaviour before they are formally assessed at the end of the year. 

The central days will be assessed by: 

3. ATTENDANCE, ENAGAEMENTS & PARTICIPATION: There will be NO formally submitted task or grade. GP Facilitators will confirm attendance and active participation in online activities on all 3 central days. 

Important: Students need to have completed and passed the 3 assessment components to be eligible to sit the end of year exams. If a student has not completed the placement and remediation cannot be completed in time the student will forfeit the first sit of the Year 2 exams and will sit in August as a second sit. 

TUTORS/FACILITATORS: Please complete a register for each GP2 placement day. Poor attendance is often an early warning for students who are experiencing academic difficulties.  

Please inform as soon as possible QMUL CBME staff (via f.langridge@qmul.ac.uk ) : 

• At the time of any non-attendance (whether the student informed you or it was unexplained). 

• If you have any concerns about a student’s attendance, behaviour, health etc.  

• Module leads are keen to discuss issues as early as possible  

Reflection is a key skill for all healthcare professionals and learning how to develop reflective practice is an essential part of medical education. Creative enquiry has been found to extend reflection and understanding and engage the student voice and perspective [See Appendix 1]. 

Task: A reflective piece triggered by a ‘A significant encounter’ 

Options:  

1. 750-1000 word written reflective piece   

2. 500 words supported by a creative enquiry piece e.g., a photograph, drawing, poem, piece of music that helps to convey your message. 

Submission: Students need to submit their Reflective Task on or before the deadline for their group as above: 

• on QM+ and  

• via email to their GP tutor  

• Late submissions will incur penalties  

• Non submission / inadequate remediation task work may mean the student will forfeit the first sit of the Year 2 exams and will sit in August as a second sit 

Assessment of the reflective piece 

• The reflective piece should be assessed and graded by the practice-based GP tutor 

• GP tutors will be asked to submit these marks to the QMUL CBME team and provide both the marks and feedback, written and/or verbal, directly to the students as well  

• Students should receive their mark by the next placement day after the submission date. 

MARKING SCHEME – REFLECTIVE TASK  

Guidance for grading the reflective pieces  

Feedback to students could include:  

• Points of excellence  

• Points for improvement - could include questions/prompts to encourage continued reflection 

• General comments 

1. Know where you are going and plan your journey 

2. Ask for help and instructions from your tutor if unsure  

3. Ensure your practice knows where you are going and when you are expected back 

4. Be clear about the purpose of your visit and how to conduct yourself 

5. Always carry your identification card, adequate finances to get you home, your mobile phone and have access to a map 

6. Terminate and excuse yourself from the visit if for any reason you feel unsafe  

Students are asked to discuss with their tutors any planned visits they feel uncomfortable with, in which case the tutor will accompany you if possible or cancel the visit. You can access details of your practice if you have lost the information, provided you know the rough location and name from: 

http://www.nhs.uk/england/ 

In London you can plan a route using the Transport for London or Citymapper websites or apps.  

Resettling and Risk Reduction Checklist 

1. WELCOME & WELLBEING - Start by adapting GPs placement to your student(s) 

The last 18 months – in particular the pandemic and events triggering the Black Lives Matter movement - have had a complex, and unique, impacts on us all. For our students this meant a sudden switch to online learning, a reduction in direct patient contact and tutor and peer support. Some have cared for or lost loved ones to COVID-19, others have been ill themselves – all have become more aware of health disparities. These factors coupled with lockdowns have affected their learning experience and wellbeing and, in some cases, has led to demotivation and poorer exam results. Students are so looking forward to restarting GP placements but will need help with hybrid and virtual learning or patient contact. Attendance is expected to be 100% (face to face or online as appropriate), less than 90% will require remediation. 

• Please set aside early time to talk to each student about their experiences, expectations and needs. 

• Please also use the opportunity to share your experiences over the past year – to build rapport ad compassion 

• Support students to SPEAK UP if they experience or observe situations that worry them (please see e-Learning for Health online module for supervisors: LISTEN UP  

2. RISK REDUCTION – local arrangements 

We have all learned much about reducing COVID 19 transmission and risk of serious illness over the last year. The Medical School has assessed students’ individual risk and introduced a daily rapid Lateral Flow Test before coming to campus. We know each GP practice has developed a local approach based on specific context. 

Please a make your practice’s local risk reduction policy is clear to students before they start their placement detailing: 

• LFT Testing requirements 

• PPE & mask wearing 

• Ventilation and flow arrangements  

• Adjustments for the very few students with specifics risks 

3. VACCINATIONS  

COVID-19 vaccinations remain voluntary in the UK. The medical school, in line with other institutions, is not compelling students to be vaccinated – but we know the vast majority have had two doses. A very small number may have personal or clinical reasons for not being fully vaccinated. We ask you to accommodate these learners. All students must undertake an online Vaccine Confidence module focusing on individual narratives, and fact verification skills rather than assumed informational deficit. 

• You can ask students about their vaccination status (we cannot inform you of this)   

• Accommodate learners who have not completed their vaccination as you would a member of staff – this may mean reducing patient contact 

• Discuss anxieties and hesitancy without taking a coercive approach  

• Tell students it is part of their role to support vaccination (regardless of their own status or views)  

• Please Offer Flu Vaccine - Students are designated essential workers should be treated as staff 

• Any concerns or questions - Please contact the CBME Module Lead or Administrator. 

 EACH ONE IS MARKED USING ONCE OF 4 OPTIONS:  

• Satisfactory /Cause for Concern/Unsatisfactory/Unable to observe 

1. Honesty and Integrity SATISFACTORY CRITERIA: Always honest with patients, peers, staff and in professional work (presentations, documentation, communication) * 

2. Reliability and Responsibility SATISFACTORY CRITERIA: Reliable and conscientious. Punctual. Completes assigned tasks. Accepts responsibility for errors. * 

3. Respect for Patients SATISFACTORY CRITERIA: Consistently demonstrates respect for patients’ autonomy and dignity. Maintains confidentiality at all times. Always appropriately dressed for clinical setting. * 

4. Respect for Others SATISFACTORY CRITERIA: Shows respect for patients' relatives, other healthcare team professionals and members of staff. * 

5. Attendance and Approach to Learning SATISFACTORY CRITERIA: Full attendance, participation at seminars and other learning opportunities. * 

6. Compassion and Empathy SATISFACTORY CRITERIA: Listens attentively and responds humanely to patients' and relatives' concerns. * 

7. Communication and Collaboration SATISFACTORY CRITERIA: Works cooperatively and communicates effectively with patients and healthcare team members. * 

8. Self-Awareness and Knowledge of Limits SATISFACTORY CRITERIA: Recognises need for guidance and supervision, aware of appropriate professional boundaries. Personal beliefs do not prejudice approach to patients. * 

9. Altruism and Advocacy SATISFACTORY CRITERIA: Adheres to the best interests of patients. * 

10. Health SATISFACTORY CRITERIA: Does not allow his/her health or condition to put patients and others at risk. * 

11. Overall Professional Assessment *             

•  Satisfactory         

•  Unsatisfactory  

12. Please indicate if this assessment has been discussed with the student *          This field is required. 

•  Yes   / No  

13. GP TUTOR COMMENTS This field is required. 

• Comments...(free text) Please give FULL reasons for any "Cause for Concern" or "Unsatisfactory" assessments here, you may also make other comments. Please inform the Head of Year and/or Administrative Lead if there are concerns regarding professionalism. 

14. STUDENT COMMENTS 

Comments... (free text) 

15. To be signed and dated by both student and tutor

Gathering information  

• Learning to ‘take a history’ is a daunting task for some students  

• Novices tend to be over controlling - they can lose sight of the patient as the managing a lot of information and are eager ‘tick all the boxes’ (especially in the systems review)  

• Maybe they have seen the history more as an interrogation  

• They can lose their focus on the patient agenda very quickly as they navigate history taking (the doctor's agenda) and think about the examinations they may need to do  

• At the same time the conversation has to be purposeful – the questions they ask have to related to the patient’s problems – so they need to BEGIN TO THINK CLINICALLY  

Diagnostic hypotheses  

Everyone develops a diagnostic hypothesis in 30 secs – (even the old man on the top of the bus) Students should be encouraged to develop hypotheses. They will see their accuracy of their hypothesis increases with expertise 

Attending to the patient's agenda 

• Not just a nice thing to do! 

• The key to being trusted and appropriate 

• Being trusted is key to being effective and safe – that is making shared management plan  

The generalist contribution is to consider: 

1. Patient may have complex narratives/contexts  

2. There may not be any ‘pathology’ or label possible or needed – there may be ‘illness without disease’  

3. Physical symptoms may be explained by psychological processes (and occasionally the other way round e.g., anxiety in thyrotoxicosis)   

4. Over-diagnosis and over-investigations can lead to HARMS  

5. Things can present very early and in an ‘undifferentiated’ manner – uncertainty is common – but plans can still be made  

6. There may be reasons for the consultation that are not always obvious (to the doctor or the patient)