Best in Staffordshire Award 2016 15.3.2016 Developing teaching of neurological examination with Patient Involvement and Feedback Patients as Educators Team, Keele University School of Medicine

Thank you!

Plan of talk Introductions Use of patients in teaching clinical skills Review of Year 2 students’ neurological examination teaching 2014 -> new format 5.2015 Evaluations of this Plans for 5.2016

Introductions Dr Alison Irvine Madeley Practice Keele University General Practitioner 1990-2006 Keen teacher & trainer Keele University Sessional tutor, 2005-08 Teaching Fellow, 2008-> 5th year as Patient Volunteer Coordinator & patient!

The Team Gemma Proctor, Claire Ryan, Patient Volunteers Administrator Clinical Skills Administrative & Technical Support Coordinator Claire Ryan, Patient Volunteers Administrator Emma Foxhall, Clinical Skills Technician/Administrator

Aim: “graduating excellent clinicians” “fully competent and caring” School of Medicine 9.2002 Aim: “graduating excellent clinicians” “fully competent and caring”

What it feels like to be a doctor Learning from and with patients Taking a history Patient insights Learning to examine, and interpret clinical signs What it feels like to be a doctor

Patients are important “(f) Patients can contribute unique and invaluable expertise to teaching, feedback and assessment of medical students, which should be encouraged and facilitated”. General Medical Council ‘Tomorrow’s Doctors Supplementary Guidance’ “Patient and public involvement in undergraduate medical education” May 2011, Page 2

Placements in Community 3 main teaching hospitals 100 + GP Practices Community groups, Voluntary, Charity, Mutual Societies & Private Sector, Statutory Agencies H Crewe Stoke-on-Trent H Staffordshire H Telford & Wrekin H Birmingham Shropshire Kidderminster http://medicine2.keele.ac.uk/cbr/placements_map.html

Some teaching centres Clinical Education Centre David Weatherall Building, Keele Shropshire

2013 Year 2 Neurological Examination 2nd session - challenging for students and tutors Students struggled to understand what the abnormal looked and felt like and to make sense of examination routines 2, 3 hour sessions normal examination and explaining pathology. videos then peer physical examination in small groups 1st: cranial nerves and eye examination 2nd: sensory and motor examination arms and legs Placements not giving students sufficient opportunity to see and examine patients with neurological conditions

Could we do better? May 2014: John Morgan agreed to sit in on & observe Session 2 -> Discussions with Patient Volunteers Team re involving patients in 2015 Built on a successful similar format for cardiovascular examination in Feb/March 2014

Changes to Session 2, 2015 3 hours Plenary: overview and 4 short videos showing how to examine 5-6 students in a group rotate between 3 patients with neurological conditions (40 minutes per patient). A clinical tutor talks to and examines their paired patient and stays with them throughout. Parkinson’s Disease Stroke Neuropathy/Multiple Sclerosis Student may take a relevant history Patients may give feedback

Evaluations 5,2015 3 sessions 118 students 16 patients 12 different tutors

Students’ views re value of plenary and tutors 93% felt tutors ‘very good’ or ‘good’ 89% felt overview of examination ‘very good’ or ‘good’ 75% felt videos ‘very good’ or ‘good’

How students rated the educational value of the patient component

Student views Me examining: 13 comments “Great experience” “Very helpful” “Very interesting” “Chance to see real signs” Others examining: 3 comments:- “Observe common mistakes” “Good to see again and again”

Contd. Hearing patient’s history: 8 comments:- “Motivating” “Enjoyed” “How they were diagnosed” “Developed understanding” “Nice to take history from patients before examination” “Helps put things in context”

Students - the value of patients giving feedback within the small groups?

How did you feel about real patients giving feedback directly to students? 113 students, 96 open text responses “very useful” “thought provoking”; “Very good for learning in professionalism” “Good because it’s sincere and truthful” “Very enjoyable” “Real feedback from patients is excellent and helps my manner”; “Valuable- good for tips on communication”, “what is too hard too soft etc” “Makes me have a feel of what 3rd year will be like”

Continued “Good – important to hear their experience of us examining them”; “Is really beneficial as it gives us an insight for future practice” “It was very useful, moreso than a SP as they have real experience of the medical profession”; “they’re who we’ll be treating in the future” “apprehensive”; “It is daunting but essential”-> “Very reassuring… it was in a very supportive environment”

Students: are there any problems with patients giving feedback?

Students: problems with patient feedback 113 responses; 40 open comments “Not enough time”; ”Not much feedback” “Helpful- although they only said nice things”; “If it’s a bad experience, it could knock the student’s confidence”; Some “Patients weren’t sure what sort of thing to say- training/briefing would help” “Feedback is more targeted to personal skills as opposed to technical skills” “If students can’t accept criticism from real patients they should think again -> Helps us improve”

Students: Do you think real patients need further help or training before giving feedback? “We have SPs for trained feedback. Real pts should be free to give us honest feedback”. Tutors: feedback =“sincere and truthful”; “DON’T TRAIN THEM! IT KEEPS IT MORE REAL”

Tutors’ feedback “Excellent, fun”. “real patients bring examination to life”, “focuses students more” Students engaged well, but a minority initially struggled after seeing the 4 videos. Students enjoyed being asked to work out the diagnosis from history, then deciding what to examine, finding abnormalities and trying to interpret findings.

Patients’ experiences Found session interesting and enjoyed helping students learn ¾ found giving feedback easy, only 1 felt any training might be needed

Suggested improvements “more time” for history “it would be better to practise skills on peers first then more confident with patients also gives chance to see what normal is” Tutors to invite more patient feedback So, 2016: splitting videos, peer practice first then 2 patients. Ethical approval for use of patient data

In conclusion “Excellent session” “Having real patients is the best way to learn” “The patients were all very kind and willing to talk about their conditions” “Thank you to the patients! ”