Medicine in Society Guide Malta 2021/22

Preparatory work

In preparation, students should have:

• Read the General Medical Council’s (GMC) good medical practice and the British Medical Association’s (BMA) ethics toolkit for medical students; this contains lots of useful and accessible information for students.  The GMC have also produced specific guidance on Doctor's use of social media). 
• Read this student perspective on the doctor-patient relationship.
• Looked at their practice's website and reviewed the practice summary on Public Health England's (PHE) National General Practice Profiles website to get an idea of the practice's locality and patient population.
• Established which Clinical Commissioning Group (CCG) and/or health authority their placement is in and read from the relevant Local Authority Health Profile to get a feel for what some of the major causes of morbidity and mortality are in the area. Whether or not their first placement is in Tower Hamlets students might like to read this Profile of Tower Hamlets to get a feel for the area local to the Medical School, this may be similar or very different to the area where their GP practice is located.  
• Found a definition and the main principles of health promotion.

Aims

• To introduce students to the professional and ethical framework of the health professional-patient relationship in clinical consultation.
• To consider how COVID-19, specifically the increased use of remote consultation, has impacted on the doctor patient relationship.
• To orientate students to the practice area.
• To introduce health promotion and illness prevention activities in primary care.

Learning Outcomes

By the end of the day, students should be able to:

• Explain the ethical and practical guidelines for interviewing patients, including how to obtain consent from a patient for history-taking
• Describe some reasons why patients present in general practice
• Identify some of the skills healthcare professionals use in their relationships with patients
• Start to build a community profile of the local area and reflect upon what their observations tell them about the area and the community
• Describe some health promotion interventions that occur in primary care, such as a new patient check
• Be aware of some of the main areas of impact of COVID-19 in primary care

 

Example timetable

9.30 – 10.30	Tutorial - What is professionalism?
10.30 – 10.45	Tea break
10.45 – 11.30	Community area profile- group discussion of pre-reading, provide map and instructions for virtual walkabout and signpost students to other resources
11.30 – 12.15	Virtual walkabout in small groups
12.15 – 13.00	Small group presentations and group debrief on walkabout findings
13.00 – 14.00	Lunch break
14.00 – 15.00	Health promotion Group discussion: What is health promotion? Definitions and examples. Materials in consulting rooms/in reception area – maybe virtual tour, or look on practice/CCG/PCN/PHE website Other influences – personal, socioeconomic factors; link wink community area profile   Activity: Impact of COVID-19 on health promotion within primary care e.g. cancer screening, immunisation uptake, antibiotic prescribing/resistance more widely e.g. social isolation, employment, food poverty, domestic violence, air pollution lots of media resources, use mix of medical and public media Breakout task – give small groups a topic e.g. immunisation uptake, students conduct online research, review and discuss resources and then present key points back to group.
15.00 – 15.15	Tea break
15.15 – 16.00	Small groups present on their topic (as above) Debrief from day Plans/set homework for next session

 

Suggested Activities

• Tutorial - What is professionalism? Could include ethics, consent, social media/confidentiality, professional relationships; how students are expected to conduct themselves – attendance, group conduct, dress code. Consider specifics for virtual platforms; ethics and COVID-19; so many ‘hot topics’ e.g. PPE, remote consultations, practitioner wellbeing. Lots COVID-19 specific guidance and FAQs on BMA site
• to include ethical issues and obtaining consent for interviewing and physical examination.
• Breakout task - ethical cases given to students to discuss in small groups e.g.  consent, confidentiality, unprofessional colleague, inappropriate use social media. Regroup and debrief after small group discussions.
• Remote consultation RCGP resources
• Community area profile – group discussion of pre-reading, PHE’s profiles for the borough and the practice. What did students notice for London/specific borough/practice compared to national data? e.g. see age profile graph showing younger age of London/Newham’s population - how might this affect health and socioeconomic issues in area?
• Virtual walkabout – students are assigned a patch/road in practice catchment area. Could use Google maps, other local area maps e.g. Newham LocalView Maps, where you can enter practice address and then search for nearby facilities, and local services websites e.g.  Active Newham map and information. Signpost where else students could find local information to help them build a community profile, such as local press and social media or searching for other online resources e.g. YouTube video (watch from 6.30-9.30) walking through the Stratford centre. Each group notes down their key observations to present to the group. After this, students should attempt to generate hypotheses about possible health and social problems (and opportunities) for the practice population; there is further guidance for students in appendix 7.3.
• Health promotion; note generally what health promotion information the practice displays on its website and within the waiting and clinical areas e.g. posters/screen displays.
• Impact of COVID-19 on primary care e.g.  increased use of remote consultation and telemedicine, possible group discussion of benefits and disadvantages of this.
• Observe a member of the primary care team carry out a health promotion intervention e.g. new patient check, dietary advice, routine health check.

 

Questions for students to consider

• What reasons do patients present in general practice? Do you think patients communicate differently with non-clinical and with clinical staff. 
• Why should you ensure patient’s consent to any examination and treatment has been obtained?
• How has the COVID-19 pandemic changed the day-to-day workings of primary care and the patient’s experience of “seeing” their GP?
• Why is health promotion important in primary care?  What do you think the GPs role is in health promotion?  Which other healthcare professionals have health promotion roles?
• Having completed your community profile, what did you think of the area?  Were you taken aback by anything?  Did you think the facilities in the area would help people to live a healthy lifestyle?  What would you like to change about the area and why?