MEDEV

School of Medical Sciences Education Development

Introduction

University Departments and NHS Trusts within the West Midlands, under the auspices of the Birmingham and Black Country Strategic Health Authority Centre for Innovation and Training in Elective Care (CITEC*) and the West Midlands South Strategic Health Authority Inter-professional Learning Group, have established a project to develop treatment centrebased inter-professional clinical attachments for undergraduate students of medicine and the allied health professions.

In a climate in which increasing student numbers and changing patterns of inpatient care are making traditional ward-based teaching more difficult, and in which understanding of the approach to patient care adopted by treatment centres will be important for the health professionals of the future, it is essential to exploit to the full the educational opportunities offered by such centres.

Within the NHS, less seriously ill patients are increasingly cared for in treatment centres and other managed care environments, rather than in traditional, in-patient settings. Such changes offer both opportunities and challenges for the education of future health professionals. Here in the West Midlands, Universities and NHS Trusts have embarked on a project to develop treatment centrebased clinical attachments for undergraduate students in medicine and the allied health professions. The project will explore the potential for inter-professional learning in such environments, will identify the good practice needed to make such attachments successful, and will assess the contribution to be made by on-line virtual patient type simulations.

The project builds on work undertaken for undergraduate medical students at Good Hope Hospital NHS Trust. Medical students at Good Hope undertake a one week attachment to the Treatment Centre during which they undertake a series of activities to help them understand the clinical process from initial recognition of symptoms by the patient, through to discharge. This includes a preparatory on-line simulation, clinical experience in the treatment centre, and associated follow up work. The on-line simulation follows a patient pathway model in which the student follows a virtual patient through each stage of referral, diagnosis and treatment (Figure 1). Two care pathways are currently available, haematuria and transient ischaemic attack (TIA). In each, the use of video clips of consultations and associated activities encourage the students to view the journey as an integrated whole, rather than as a series of discrete steps.

Activities simulate, as far as possible, the tasks the student will undertake when qualified, for example, preparation of a GP referral letter using information from video sequences of a GP consultation and interpretation of investigation results.

Formative MCQ and open answer questions, with feedback, are included, as are questions that encourage the students to empathise with and reflect on the patient’s experience (Figure 2). Initial student evaluation of the usefulness of the simulation is very encouraging.

The potential of the model for inter-professional learning was recognised at an early stage of the development and, over the last few months, project groups to consider how this might be done have been established at each of the NHS Trusts within the West Midlands that have Treatment  Centres (Figure 3). At Good Hope, project groups are developing two patient pathway-based clinical attachments, one for pre-operative assessment, and one for falls and fractures. At Kidderminster, a project group is adapting the existing haematuria pathway into an inter-professional attachment for medical, nursing and radiography students and are in the first stages of preparing an attachment relating to the breast cancer pathway.

Sandwell and West Birmingham (City Treatment Centre) will, over the next few months, develop pathway attachments for chest pain, arthritis, and, possibly, back pain. We hope to have a number of pilot attachments running in the 06-07 academic year. For more information about the project, please contact Sharon Buckley at s.g.buckley@bham.ac.uk

Key features of the patient pathway-based on-line simulations for haematuria and transient ischaemic attack

• Patient perspective focus

• Video clips of a virtual patient at each stage of the patient journey

• Interactive activities thatsimulate as far as possible actual clinical tasks

• Formative MCQ and opentext questions with feedback on answers 

Acknowledgements

The project groups gratefully acknowledge the time, enthusiasm, commitment and expertise of clinicians

at Good Hope Hospital Trust, particularly Mr Hemant Ojha, Consultant Urologist

Dr Rafiq Henry, Consultant in Elderly Care Medicine

Mr Richie Malloy, Senior Cardiac Nurse

Mr Peter Appleton, Development Manager, Electronic Bookings