MEDEV

School of Medical Sciences Education Development

Introduction

In dentistry they're called Outreach. In veterinary medicine they're called Extra Mural Studies and in medicine they're simply called Clinical Placements. Whatever their name, LTSN-01 recognised external clinical placements as a key issue facing its constituency. And so the conference Twenty Twenty Vision was born to provide a forum for an exchange of ideas about supporting innovation and sharing good practice in the management and support of external clinical placements.

Twenty Twenty Vision started life as a small, invitation only event but grew to be something much larger. Prompted by interest from the whole LTSN-01 constituency the event was opened up to all and also widened to encourage those working in the health sciences and practice arena to attend. The venue was the Atlantic Suite at Manchester Airport and it took place on 6th May 2004.

External clinical placements

The day was chaired by Professor Reg Jordan, the Director of LTSN-01, and the initial keynote address was given by Professor Amanda Howe from the University of East Anglia School of Medicine, Health Policy and Practice, on the topic of External clinical placements: Why do we do it?

Attendees were asked imagine what the curriculum would be like without placements. She then went on to contrast the typical current approach which tends to be based on the apprenticeship model and emphasises an opportunistic and somewhat unstructured approach with a more systematic, structured, externally controlled form which has the potential to be more effective and productive.

But, given the practical difficulties arising from organising placements, why do we do it? There are all kinds of benefits available from placements but key ones include the opportunity to integrate theory with practice and to set learning in the context of the patient.

Placements enable the student to develop clinical skills, to see the full development of disease processes in a real setting and to learn at first hand about the doctor/patient relationship. They can also experience how services are delivered in multi-disciplinary teams and crucially can undergo attitude changes as they encounter powerful learning experiences.

However there are real problems associated with clinical attachments. It is very difficult to ensure a consistent learning experience across differing sites and there is an ever increasing mismatch between demand and supply as the service pressures are increased.

The variations in quality create a strong case for developing standards for clinical placements, whilst the pressures on supply lead to hard choices as to what we will prioritise within the available time and resources. They also lead us to consider how else we can achieve the purposes of attachments within the faculty.

There are a variety of possibilities but none can be a complete substitute for a high quality learning experience grounded in the real world of clinical care.

Breakout sessions

During the day, delegates were the opportunity to discuss particular issues in breakout groups. Issues addressed were:

• Portfolios - How can portfolios support learning on external clinical placements? Led by Janet Strivens, Lecturer in Education, University of Liverpool.
• eLearning - How can e-learning support learning on external clinical placements. Led by Pat Reynolds, Deputy Director of Education for Distance Learning, Kings College London
• Student support - What is an ideal support framework for students on placements? Led by Professor Stephen May, Vice Principal for Teaching, Royal Veterinary College

Conclusions

To close the day Professor Richard Halliwell, President of the Royal College of Veterinary Surgeons summed up the key messages he had gathered during the day. He set the context and then listed some of the key benefits while also mentioning the supplementary strategies that are available.

A key question was whether it is reasonable to expect busy practitioners to give time to teaching students and the unequivocal answer is that they have a professional duty do so.

Portfolios are potentially a very useful tool to support placements but barriers to their use still exist and elearning has great potential but again needs careful thought and planning if it is to be of real use.

Prof Halliwell acknowledged that making effective use of clinical placements has never been easy and is probably harder than ever in the current intensely service focused situation but he concluded on an upbeat note by saying: We don't have problems, we have challenges!

What you said...

"I found the e-learning session very good. I valued most hearing about the common challenges and solutions; I particularly valued the mixed participants from the LTSN constituency."

"I really liked the attitude and approach of the speakers, and valued Megan and Reg's friendly but authoritative handling of the day. Thanks for organising it and giving me the chance of attending."

Find out more....

A full report and downloads of the presentations and breakout group feedback are available from http://www.medev.ac.uk/resources/meetings/twentytwenty_vision.