Teaching about chronic illness – a practical approach Melissa Gardner Clinical teaching fellow, UCL Medical School

Year 1 - Fundamentals of clinical science 1 Year 2 - Fundamentals of clinical science 2 Year 3 - Integrated BSc Year 4 - Integrated clinical care Year 5 - Life cycle Year 6 - Preparation for practice Foundation Programme UCL MBBS programme 2012

Teaching day Year 4 medical undergraduates Within Module A “Preparation for practice” week students 9 times over the year

Preparing for practice

Case study throughout the day

Multidisciplinary teaching Physiotherapists Junior doctors GPs Patients

Signposting assessment

Outline of the day 1.Referral to hospital 2.Discharge home 3.Respiratory physiotherapy 4.Patient experience 5.Managing chronic illness

Outline of the day 1.Referral to hospital 2.Discharge home 3.Respiratory physiotherapy 4.Patient experience 5.Managing chronic illness

Outline of the day 1.Referral to hospital 2.Discharge home 3.Respiratory physiotherapy 4.Patient experience 5.Managing chronic illness

Outline of the day 1.Referral to hospital 2.Discharge home 3.Respiratory physiotherapy 4.Patient experience 5.Managing chronic illness

Outline of the day 1.Referral to hospital 2.Discharge home 3.Respiratory physiotherapy 4.Patient experience 5.Managing chronic illness Think about a patient you have met with severe COPD. Write down questions you have about their experience and day-to day life.

Outline of the day 1.Referral to hospital 2.Discharge home 3.Respiratory physiotherapy 4.Patient experience 5.Managing chronic illness

Utility of sessions – snap shot

Utility of sessions – over time

Teaching delivery

Students liked… Interactive, practical tasks Teaching style – friendly, relaxed Case study throughout the day Trying the BiPAP machines Listening to a patient’s story Relevant Focus on preparation for practice Covered areas not usually covered on wards

Referrals and discharge summaries Think harder about how to present and refer patients to colleagues rapidly yet in a logical & detailed way Pay more attention to structured style of various discharge summaries/ referral letters & develop my own! Pay attention to junior doctors doing admin and try and understand why they're doing it I will volunteer to fill out discharge summaries

Smoking I am going to try approach how I bring up smoking cessation with my sister to help her quit Be less "preachy" when asking patients to stop smoking! Put more effort into talking to people about smoking cessation

End-of-life care Don't shy away from asking important questions about end-of-life plans Don't be afraid of talking about death with patient - as medical student you have the time to do this Confidence in discussing end-of-life topics Talk about death in an open constructive way

Holistic care Try to be more personal with patients, learn one interesting fact about each person, make sure I know who the patient is as a person. Try to view illness in the patient's home setting rather than just considering what I see in hospital Remember the patient is more than a condition I will remember that the patient's disease journey does not end the moment they get discharged from hospital. There is much more to be done after that. Remember to treat patient as humans and not just physical symptoms and signs

Students recommendations for change More practical tasks More patients More chronic conditions Attending a physiotherapy session Shorter sessions Less focus on simpler topics Smaller groups

Moving forward Similar sessions focussing on different diseases, bringing in different professionals, eg. –Heart failure –Asthma –Diabetes More tasks, eg –Ordering tests –Practical prescribing –Organising ward rounds and prioritisation

Summary Effective, worthwhile teaching day Teaching preparedness for practice earlier : –Provides varied learning points for students –Highlights areas for self-directed learning –Enthuses students