nm0445: just for those who perhaps were the far side of the room when i was er introducing myself in the sort of round robin there er i'll just say A who i am and quite why i'm standing up here talking to you and perhaps quite what i may be able to tell you er my name's namex i'm a senior lecturer in medical education and i spend half of my time at namex Medical School running the clinical element of phase two of the four year accelerated graduate entry course and pretty much the focus of what i'll be talking about in the next half hour or so but the other half of my time i'm a paediatrician at University Hospitals namex and namex N-H-S Trust er doing general paediatrics with a special interest in food allergy so that's kind of who i am and what i do what i've really been asked to do is to try and give you an overview of the phase two of our course perhaps for those of you who are particularly new to this enterprise it might be worth just very briefly mentioning phase one of the course and how they fit together would that be useful for people nf0446: yes nm0445: yeah as hopefully you're aware this is a four year accelerated graduate entry medical school and we are the only pure graduate entry medical school at the moment er although there are a number of graduate entry streams that operate either fairly well integrated to school leaver streams or relatively as separate entities just within the same school in other places and compared to other graduate entry streams and they're slowly coming online round the country er we are probably the narrowest in terms of the sorts of graduates we take in that we accept biomedical science graduates there is a separate stream that's just started off at namex this summer which is obviously following a fairly similar course and certainly with the same assessments which is taking healthcare science graduates but we here are only currently taking biomedical science graduates we can discuss over coffee afterwards if that's a good thing or a bad thing or or whatever but that's who we currently get in er so for instance you could get into ours with biochemistry genetics physiology those kind of things as first degrees but we wouldn't let you in with a physiotherapy degree or with a pure chemistry degree or a pure physics degree so we're taking a relatively narrow tranche of students we're giving them a four year course as opposed to the five year course er that runs for the school leavers at Easter and all the time we've chopped off the course is chopped off the early part of the course the school leavers who go to namex do five years they do two-and-a-half years of phase one two-and-a-half years of phase two broadly speaking phase one is university based and broadly preclinical and phase two is pretty much hospital based and broadly clinical having said that as i'm sure you're aware everybody integrated their courses years ago so we're not actually allowed to use those labels but in terms of understanding where the students are and what they're doing that's broadly the case although clearly there was clinical exposure from the beginning within phase one phase one is modular mainly systems based modules but also a number of er social science based modules and health policy and other such such modules and the students that come here broadly miss the basic science modules because the presumption is that we've collected a stream of people who have either that to a great depth or the ability to get up to that level relatively rapidly as an interesting aside irrespective of your first degree you do the same course so we don't run all modules and we chop and change depending on where people's strengths and weaknesses are they all do the same stuff they all miss out the same modules from phase one as a sort of reaction to that or perhaps a way of of dealing with that a lot of phase one is based around group learning and the groups are deliberately structured to have a range of students with a range of first degrees so hopefully as they go through phase one if they operate nicely within their groups the strengths of those individuals will help the group and the balance between the groups should help hopefully ensure that er perhaps that works well perhaps in some groups that doesn't there's a lot of dynamic industry going on there after they've done that eighteen months of phase one shortened from two-and-a-half years they come into phase two which is in effect the full-time clinical placements that's pretty much all i planned to say about phase one because that's not the main topic of what i'm talking about here but can i just pause for a second just in case there is anything that people want clarification bearing in mind i'm not the phase one coordinator and it's not my prime role but if there is anything that that people will al-, be always be desperate to know or that doesn't make sense of what i've just said okay thank you very much so i'll i'll carry on with with perhaps the sort of main meat of what i was going to say what i'm hoping to do is tell you why the clinical course at namex Medical School is arranged in the way it is because as will become fairly clear fairly quickly unless you're a recent namex graduate it will be fundamentally different from the majority of medical courses running in the U-K at present it is an unusual model some would say it's quite a brave and dynamic model some would say that causes some problems but we'll go through that in a bit more detail but it is different and i think that's important having started on that i'll then hopefully give you enough information so at least you know the structure and how it's put together and then o-, we'll lead on to a period of discussion which hopefully will bring out some of the issues that namex was mentioning at the beginning about learning styles and about self-directed learning and the sorts of students who find our course a good way of doing things and the sorts of students that struggle and hopefully that'll come u-, up in discussion a bit i'll also try and underline some of the challenges that this particular way of doing things gives us which may or may not be a little bit different from other medical courses going right back to the beginning there is a stated philosophy for our curriculum which broadly is the sort of thing that's come out of the G- M-C anyway and broadly is the sort of the thing that the majority of medical schools will sta-, state that they're trying to do but i think as will become clear er perhaps the curriculum we are running here has really bitten the bullet and actually tried to develop on the basis of these principles being that doctors must be lifelong learners the sort of thing that gets thrown out on many many occasions but perhaps it does mean something perhaps there's something we can do about that in the course and it's stated that our curriculum is designed to help students take charge of their own learning and that phase one which is broadly group work with a variety of levels of support is a preparation for the self-directed learning that they will have to do if they're going to s-, be successful in phase two of the course in the clinical environments the majority of us who are medically qualified in this room will have gone to a variety of medical schools if you graduated from the U-K in the last ten to fifteen years you will have done an integrated course of some sort probably although there were examples of of people holding on to even older models er but you will probably have had a course which attempted to teach you a lot of different things that was loaded with content to er up to a point and tried to gain experience for the students over a number of specialties certainly i remember as a student having my fortnight in E-N-T and i remember learning not very much there certainly as a year we were shuffled through in phases of our clinical course a lot of brief clinical experiences in relatively large groups where the teachers didn't particularly know us because we were coming on so quickly and it very much felt we were being given a sort of cycle of teaching on a rapid basis and in a fortnight it's actually relatively easy to just miss the point and not get anything out of it and with the increasing subspecialization of hospital medicine this was a trend that was continuing and continuing it was no longer good enough to spend send students to general medicine you had to spend send them to chest medicine and cardiology and gastroenterology and as divisions and more and more subdivisions appeared the tendency was to cut courses into smaller more smaller segments trying to gain the breadth of experience for the students by rushing them round all the specialties one of the upshots of this was that something that's always said about U-K medical education is it runs on an apprenticeship model and that almost certainly broadly is not true er and certainly the model of rushing everybody round in groups of six or eight briefly through a n-, l-, a large number of short clinical experiences gave little chance for the students to get to know the teachers the teachers to get to know the students and the students to model themselves on the teachers in any meaningful way which would be the elements if apprenticeship was going to actually work as a concept there was also little opportunity for self-directed learning on your timetable you were shuffled off to E-N-T got to learn a bit of E-N-T a few seminars packing some information in not a lot of opportunity for students to work out where they are what they're doing where their strengths are where their weaknesses are where they need to be working on the basis of this the new namex curriculum which has subsequently become the namex curriculum which is the curriculum we follow was made up of what perhaps are a series of relatively old ideas rather unusually for a medical course it was made very very explicit exactly what the learning outcomes for the whole clinical course were so there was a book it's there i should have brought a copy with me to wave at you actually but if you haven't otherwise seen it it's The Objectives of Phase Two Curriculum and if you want a copy if you can get in touch with us we can send you it er and it shows everything in a list that we expect of the students and it's based on the competencies required of a new P-R- H-O which is what the G-M-C tell us we should be doing but we are completely explicit on paper there it is this is what they've got to learn they've got two-and-a-half years to learn it and it's listed and the assessments are based on that document and therefore if they know what's in there they should pass in theory there was also a move from away a very strong move away from lots and lots of short attachments and this is perhaps the boldest part of the phase two curriculum that we operate here in that instead of taking the students in groups round lots of short attachments we attach them currently in pairs although that may need to go up to threes at some point with expanding numbers of students to two consultants in hospital for the hospital attachments and therefore we attach them at a ratio of one to one two students two consultants and we give them eight weeks to get on and do something useful so we're using long attachments where a small number of students are attached to an equal number of consultants the argument being that that gives time for the students to know learners the sorry learners to know the teachers teachers to know the learners for them to actually plan what learning's going to take be undertaken during that eight weeks for them to implement that for some degree of apprenticeship or wardling or that kind of thing to go on and also for at the end of the process hopefully the teacher to be able to say something sensible about the student having known them for a period of time and not just had them rush around with the group for two weeks those of you who are good at quick maths will realize that if we've got two-and-a-half years and they're being attached in blocks of eight weeks you don't actually get that many eight week blocks and indeed in total in addition to the medical elective which is still within the curriculum they have twelve eight week blocks now there were certain elements that were felt to be tangibly different that had to be taught as a specialty block and those are psychiatry clinical methods obs and gynae and child health and they are taught as eight week blocks everything else is taught in the remaining now we're just down to eight eight week blocks and once i get into the sort of the descriptions of how those are actually worked out we can talk a bit more about those in detail these what actually goes on in these eight week blocks has varied to a degree over time from the inception to curriculum to where we are now the original notion was that if you gave a good student to teacher ratio and you gave them eight long attachment blocks almost on a random basis and you told them what they needed to learn then lots of good learning would go on and that didn't work very well because the students could really have a very very different sequence of attachments and could for instance spend an awful lot of time with dermatologists and no time at all with certain other important areas so after a while efforts were made to take them through some sort of sequence where where there were surgically labelled eight week blocks and medically labelled eight week blocks some of which were more specialist than others and this culminated in there actually then being an extra specialist block invented which was kind of a rehab block which goes under the unedifying title of Geri-ortho because it's er elderly care physician and an orthopaedic surgeon so having gone from this very out of the grey superrandomness great things will happen an increasing amount of structure was put in and this is before we got started at this end this is very much at the namex end and as the numbers have become more pressured the elements of structure that are in there have actually started to creak a little bit at the edges and look a little bit er suspect so this is what it looks like er that is the timeline from left to right of the phase two curriculum with the various elements they start off with a junior period they have an exam and they go into a senior period and within the junior and senior periods there are big blocks of general clinical education within the junior they have four eight week blocks and within the senior they have a further four the specialties are also there Clinical Method and Psychiatry coming in for the most junior students Child Health and Obs and Gynae coming in for the more senior going back to the general clinical education blocks because i think these are the most interesting i've already said that at the beginning there was very little structure as to how these were organized we are at the moment looking at that quite active plan because there still isn't that much structure to it because at the moment there is actually the last block they get block twelve they get a bit of choice as to what they do which is a nice thing but that means our four and four eight blocks are now down to seven one of those is the so-called Geri-ortho which gets us down to six and of the remainder i've lost some in my maths somewhere i've remembered clini-, nf0447: yes nm0445: er just that you see er there is also one of those senior blocks is tau- , is taken up with the some generic teaching and a little bit of choice which is something called the clinical special study module so that gets us down to five blocks now at the moment the general clinical education that isn't geri- ortho is arranged to either be specialist medicine sorry general medicine or spe-, or general surgery or specialist medicine which is divided into specialist medicine one and specialist medicine two or specialist surgery one and specialist surgery two so three medical three surgical types of blocks available five slots in which to do it basically means that not all students do all types of blocks which and in addition to that they can do any of those blocks in either junior or senior which actually means that one particular group of teachers could have one group of students who were brand new to the clinical course for one w-, eight weeks and the next eight weeks they might have some that have just finished which may keep their life interesting but it also means that we can't put together teaching partnerships with consultants that are particularly suitable for students at the beginning of the course or particularly suitable for students at the end of the course because at the moment they could undertake them at any point in the course the other thing to say about this is i've already said that one of the problems was the number of specialties students had to rush through now clearly on this m-, model they are only going to get exposed to five plus an optional six different things they're not all going to get E-N-T although there are E-N-T surgeons in both the partnerships as some will know they're not all going to get opthalmology they are going to get some general medicine but they're not all going to get cardiology respiratory medicine gastroenterology and this is one of the fundamental things to understand about this way of delivering our curriculum that we are not aiming to fulfil their learning needs by rushing them round a bunch of specialists who happen to have specialist knowledge in particular areas we are looking to address their learning needs by giving them a list of what they need to learn and putting them in a series of clinical situations where there are opportunities but if they just sit back and wait for it to wash over them they are not going to meet everything by a long shot they not only are encouraged to take control of their learning but if they don't they're not going to do very well do people see what i'm saying about that that it is quite a radical and different way of looking at things and it's a w-, way that some of the students get and some of them don't a lot of them say oh well we were never taught such and such they might be coming to you today you know we we we've not done E-N-T so i don't know it so i'm not prepared to think about it is that something that people have come across in their practice oh we we didn't we didn't do that we didn't do head and neck yeah we just don't do it it's not important can't matter i think in discussion we can talk a little bit more about how different stu-, types of students cope with this but that is the theory of what we do and how it's actually practically arranged the specialist blocks are much more like your traditional blocks you know eight weeks of obs and gynae eight weeks of psychiatry er although interestingly these are our most pressured blocks in terms of finding new new placements for increasing student numbers up to a point we are protected in the general clinical education block end because as far as our curriculum's concerned we could send them to nearly anybody although actually there's probably some sort of moral compulsion on us to actually send them to reasonably good people in reasonably good combinations in a reasonably good order but there's no compulsion for us to find X number of opthalmologists or X number of E-N-T surgeons the elective still exists and it comes just after phase one and they've done Intermediate Clinical Examination just as an aside er medical student electives are a very interesting beast they've been around since the seventies we are er in effect although we're not officially a new medical school because we're set up with namex but we're certainly a university that is new to having medical students around and quite sensibly are asking lots of sensible questions about safety security supervision er consistency of marking er institutional responsibility all that kind of thing about the medical student elective which are all the sorts of questions that actually all the other medical schools should probably be asking themselves anyway so who knows what's going to happen with that but watch this space we are currently in the process of getting a legal opinion as to quite where we stand and all that but anyway there are two summative assessments the intermediate clinical exam and the final professional exam which come between junior and senior and then after senior and if people are particularly interested in those we can chat afterwards about quite how they're structured but broadly the intermediate clinical exam is a version of the s-, assessments you are doing within clinical methods of the observed consultation type assessments and final professional exam is the same again only at a slightly higher level plus a written paper we've got a number of challenges at the moment in the system i've already said that capacity is a challenge er it's a challenge up and down the country i think er we're trying to run a medical school on a population of about eight-hundred-thousand which is not a desperately large population to try and run a relatively large medical school but capacity although it is a particular local problem is also a national issue as there are new medical schools popping up all over the place er pu-, taking up those pools of population that the other medical schools use to feed students who on an in creeping basis and keep their courses running but there are also the specific challenges of areas like child health for instance er which are problematic not because of availability of teachers particularly but the availability of young children because there aren't enough children or there aren't as many children as there used to be out there and they're in better health so we need to think perhaps more radically about how addressing some of those issues or perhaps we should just cancel the immunization programme and then we'll get er [laughter] much iller and er we could teach our students much better [laughter] there is a challege here though that's much more inherent to the structure of our course about the quality of experience they get clearly they get a hopefully deeper more personal experience within their eight week attachments but they don't get the breadth of the specialty experience that other medical students get up and down the country and that is a direct trade-off but we have to look about whether there are particular things that they struggle to get whether there are particular skills particularly like ophthalmoscopy or E-N-T examination i keep using those as examples er that we have to put in structurally in another way to bridge certain gaps but up to a point that's a direct trade-off if we're going to give them long attachments at a low ratio they are never ever ever going to get round everything but then the majority of medical schools are doing the same thing in a much softer way we've just taken the big bold step perhaps there is an issue of equity in that if you've only got five allocated general clinical education attachments if you get two bad ones that's a pretty big proportion of your course and also if you get two that are pretty similar although all patients have abdomens chests ears eyes mostly er and therefore there is always stuff to examine and always er people to take histories from and all that kind of thing certainly students feel if they spend too much time with a particular type of doctor that they've had an unequal experience and there are also particular quality issues around attaching students in very small numbers to a huge pool of teachers at a very small ratio clearly in the perfect world that's a very high quality experience the stude-, the learner and the teacher get to sit together think plan be very individual be very observant give direct feedback et cetera et cetera but it also means it's much harder for us to u-, us to survey quality in a way we could in a much more organized teaching programme such that we could be observing the session specialty X is providing or reviewing a specialty at a given time in a d-, given way whereas we've got our students scattered over a huge number of lo-, of teachers and those teachers are going to vary and there's a big question of how we m-, feed back to them in a meaningful way in a way that the students are happy with that doesn't bring their confidentiality that allows them to be er honest and also er issues about how we give support to such a big diverse group because they are teaching in such small groups scattered all over the place the new directions really er was just to say that we are currently looking at doing a number of things wi-, with the way we organize phase two which have some relevance to certainly a lot of relevance to what the students might be saying to you but probably won't affect clinical methods that much we are aiming to rearrange the general clinical attachments such that some are specified to being done in the junior phase and some are specified to be done in the senior phase this allows us to put together more challenging partnerships for more experienced students and it allows us to put together attachments that are more introductory for more junior students we are also looking to iron out some of the anomalies in the system that we've inherited from namex in that to give an example there is currently a general surgery attachment on the general surgical list which is paediatric surgery and maxillofacial surgery which is a combination i think sounds pretty specialized [laughter] i don't know about you er we are also looking at rearranging what the orthopaedic surgeons are up to and drawing in er more anaesthetists which is partly an un-, underutilized area but i don't think that's of too much er er importance to yourselves er what our aim throughout is to get the students to do basically these things take history examine the patient problem solve explain and manage and behave professionally throughout and you can actually learn to do that in a whole number of different settings and they should do that in the context of common clinical presentations and uncommon but serious situations which is one of the ways we justify not rushing around all these specialty experiences do people want to talk about any depth of clinical assessments or shall we just break for a moment and have a chat more about learning styles and things like that 'cause i think that's possibly more useful yeah can i take some guidance from the chair nm0448: yeah let's t-, talk about the the the what what the ethos of namex Medical School is in relation to er is it a problem based learning school nm0445: sure nm0448: or is it ethos is it self-directed learning nm0445: okay i think i'll kind of lead on to that if that's all right by sort of just outlining what seems to happen when we put students through this kind of system i've already said that it's very reliant on or it's it's very much based on self-directed learning and therefore for them to get the most out of these long eight week attachments they actually have to have at least some insight as to what they've already done what they've never done at all what they're good at and what they're bad at and they also have to have the ability to have a sensible discussion with their c-, clinical teacher about those areas broadly the top tranche of students thrive on this but then good students thrive no matter what you do to them basically they'll always pick out the best learning opportunity and get on with it i think the next kind of quartile probably to probably the er second and third quartile take a while to get their head round all of this but when they do i think they do quite well and i think they probably do better than if we were very structured with them i think the lower quartile flounder and they do so much much more than in much struc-, more structured courses or at least they are seen to flounder much much more it's more obvious and i can't actually tell you whether actually putting them through structure that actually just hides the fact they're floundering or whether it actually gives them enough structure to help them get on with things but i think one of the challenges we have to look at is how we deal with students who are struggling with the insight and the self you know who haven't cottoned on to the self-directed nature i think one of the things which is quite important in in understanding how things operate is the way the course was cut down to four years was to a large degree based on the presumption that these guys are graduates which is true it's not a presumption it's a it's a truth but the presumption that graduates come to us as accomplished adult learners and i don't know if that's entirely true or it certainly doesn't seem to be the whole story we undoubtedly have a lot of people coming to us who are mature efficient effective adult learners who have learned that in their first degree or in the work they've done since or whatever and we undoubtedly have some very very effective learners on our course far more so than you'd expect with a school leavers' group but i think our spectrum is much wider and my personal opinion i don't have any data to back this up at all but it seems to ring true whenever i talk to other teachers is we have also a group of people who've gone straight from school straight to first degree have had a very spoon fed first degree as many science degrees appear to be nowadays who actually are more dependent learners than the majority of school leavers so the presumption that we can let our wonderful adult learners loose on the learning material and let them get on with it is perhaps a bit naive for some groups and i think we do have this h-, er i think s-, school leaver populations are more homogenous i think we've got an enormous breadth of maturity and learning ability far far wider than the school leavers' group but i think that also actually goes much lower in terms of ability to learn than the school leaver group er and i think that's quite a challenge is that something that rings true in the students that you've been seeing nf0449: can i ask you do they have er a sort of individual mentor a personal sort of er tutor or somebody tha-, who can actually help them appraise where they are you know er during this stage or do they have to keep doing it with their at the beginning of their new each block with er whoever's sort of you know sort of nm0445: they do not have a consistent block a block mentor nf0449: right nm0445: they who carries them through the core course this as an idea has been muted er there are a number of practical considerations but there's also quite who that person would be and whether we genuinely have two-hun well if they didn't have more than one student at a time four-hundred-plus useful active quality mentors out there but no it's very much they they have a formative feedback process which informs them at the end of each block and we collate that and for those in trouble we can act as that kind of person collating their information er but we do not have an individual who's taking an individual eye on that individual's progress no nf0450: i-, if a student er decided that they weren't learning very much in their attachment nm0445: yes nf0450: let's say the consultant was not a particularly good teacher say if it's the en-, chest clinic nm0445: yeah nf0450: are they allowed to to to discuss with the consultant that they could go to the say the eye clinic are they allowed nm0445: sure nf0450: to move around a little bit nm0445: yeah i mean they are not limited to the learning opportunities that are strictly within that partnership i think it's important that they have a a discussion and that we should be encouraging them to do about what other opportunities are around clearly the o-, there is a limitation in that as the numbers go up there will be s-, perhaps students already sitting in the thing that they want to go to which is a limitation but as long as they are with their clinical tutors enough that that clinical tutor can make a reasonable assessment of them and as long as they've negotiated their learning needs enough that that clinical tutor knows that they're actually off being useful and off by addressing their learning needs rather than have just vanished home for the night nf0450: mm nm0445: or whatever then that's absolutely fine but we get on slightly to the population issue in that you know effectively we're working off one big trust into medium to small trusts and perhaps a little bit in one further trust and there are partnerships in lots of specialties and i'm quite happy for them to go off and sit in the eye clinic i think that would be great but they may well find that there's somebody already there nf0450: mm nm0445: er and i think as numbers of students nationally increase i think a lot of learning historically went on in these opportunistic fashions because there were lots of little learning opportunities sitting all round the place underutilized think what we're doing now is utilizing more and more and more of them so there's less and less scope for that kind of thing to go on unfortunately but we would encourage it and we'd be quite happy with it nf0450: okay nm0451: how is it looked at with the specialist blocks as to you know who are the good teachers and what qualifies somebody 'cause it's just the example that's been given there if if there's poor teaching occurring nm0445: sure nm0451: in an area through becoming a general practitioner or consultant in whatever doesn't mean that you're good nm0445: sure nm0451: teacher how does how does would that be sorted out and the other a kind of another part of that is a kind of convergence in it or or ethos in relation to teaching i i notice that with students who at a mentors' interview you know a differing ethos which seems you know varies from block to block nm0445: to sort of look at your f-, first point if i'm entirely honest with you the biggest problem with quality we've got here is actually capacity because we are struggling to find enough teachers which means er the bottom line of a poor attachment is we shouldn't be using it but our current situation if i'm quite honest with you is you'd have to be pretty bad actually for us not to use [laughter] an attachment because we are so short across the board nm0451: right nm0445: er and i would like to think that that is a temporary capacity building phase that we will get in-, get beyond that will allow us that flexibility and obviously at lesser levels there is supporting those individual teachers and things like that and i think we've been relatively slow about getting the central course's structure support going at this end and i think that's something we ought to be or i ought to be thinking of er we do have we're in the middle of revamping the process by which we get get feedback to them because that's going to become all electronic and we are in discussions with the trust about how to best feed back that back to them because again one of the things that's slightly unusual about this is there is no head of medicine who is particularly interested in the medicine feedback these are individual teachers and it's trying to give meaningful feedback to them in a way that's useful and helpful rather than trying to give feedback to a whole department who can then reallocate the resources or change how we do the teaching er which does make it quite challenging your second point has gone from my mind entirely [laughter] what was it nm0451: it w-, it was the different er i suppose the ethos seems different in in between varying blocks so you know one example springs to mind in the way that the histories are taken er it it it seems that you know part of well i don't know whether anyone else has noticed it but part of the one we we're approaching things in one way which is directly opposite to i think it's the old by rote way of taking the history i-, in another block they're occurring at the same time nm0445: so by blocks you mean the other teaching blocks that med nm0451: yes nm0445: students have come through nm0451: yes nm0445: before er they meet you or whatever nm0451: yes before before nm0445: er i think that's the reality of clinical medicine teaching up to a point and we when we talk to the clinical teachers in all the specialties and when we train examiners in all of that kind of thing we are training on the er basically the namex assessment package in terms of nm0451: right nm0445: the examinations for ICE and the final professional exam er when we meet with teachers which we've not done as much as we need to yet we're talking through the same issues nm0451: right nm0445: here but i think we've a large number to get through to and probably a large number who we'll struggle to get the message across to nm0451: that's not clear to me 'cause i thought they'd all done it so that that's more clear if they haven't nm0445: all done nm0451: the LAP assessment thing nm0445: er nm0451: all gone through the package nm0445: not all the teachers no no nm0451: yes that makes sense nm0445: only of those who are not doing clinical methods nm0451: yeah nm0445: the only ones who have been through it are the trained examiners nm0451: right nm0445: yes yeah nf0452: can i just ask just thinking about this it's obviously a very very new idea and to for most of us who are trained in a traditional way it's so different i wondered whether there are any plans to as these cohorts of doctors come out to follow them up long term and see what happens and to see nm0445: sure nf0452: because it might be five years down the line there are obviously these group of doctors are much much better at some things but much much worse at others and it'd be very interesting to see what happens throughout their careers and see if tinkering with the course is for the good or the bad nm0445: i er there's a whole number of of issues there nf0452: mm nm0445: up to a point that job is probably best done with with namex who invented the thing and who have got the school leavers who are up to a point the more comparable group nf0452: mm nm0445: we of course have got an extra level of complexity in that we've got a new type of entrant and you can argue it as many ways as you like you know perhaps they're more positive and committed because they've already done something else or financially it's a bigger in-, you know investment they could have gone off and you know but they've they've gone back into education so perhaps they're more committed nf0452: although ac-, nm0445: equally you could argue that nf0452: i think my year at medical school about five per cent of the course were postgraduates nm0445: yeah nf0452: actually taken in so nm0445: yeah nf0452: you you sort of got some some there nm0445: yeah er but i think there are lots of reasons why our bunch could be better or worse er because of that aspect as well nf0452: mm nm0445: er but i think that's the point you make is a good one i think that's one thing to do i think as well in terms of different intake streams we actually are mol-, are almost running a natural experiment nf0452: mm nm0445: in that we've got ICE and s-, final professional exams are identical summative assessments and fairly shortly going through them we'll have school leavers biomedical science graduates and healthcare science graduates nf0452: mm nm0445: going through the same key points who will then go out into careers probably the majority within a relatively local geographical area and i think it would be an absolute crime if we didn't at least you know have a reasonable look at at what's happening and how the numbers shape up nf0452: mm nm0445: perhaps just to move on to to just cover one more thing which was er to make sense of this session a little bit for those er who weren't in the session i i gave for the er the local G-P senior lecturers and lecturers we talked through similar issues and then went on to a discussion and one of the things we discussed up to a point was the problem based learning er which is something that came up in discussion then er because a lot of people are throwing the phrase problem based learning around and you'll have heard about problem based medical courses yes have you heard anybody say that this is a problem based course no good 'cause it isn't [laugh] i want to say a few well i've been asked to say a few words i'm quite delighted to say a few words [laughter] i'll get the phras-, phraseology right about problem based learning because if you're not aware of it there is a er movement within medical education called the problem based learning movement or whatever it's quite old now it started in the late sixties er in Canada it's also up and running in the Netherlands in Maastricht and an increasing number of medical schools in the last five years or so have taken up this as their er mantra in the U-K and to various degrees of popularity er i don't want to talk about it too much because it's not what we do but i think i-, er it's worth making a point of clarification because a lot of our teaching in phase one is a group teaching a lot of the group teaching is based around clinical problems and because of that a lot of people think that we're a problem based curriculum but we're not and perhaps if i try and explain the difference er it'll at least clarify things in if you're having that conversation with somebody later teaching around clinical problems there's absolutely nothing new about it people have sat and discussed on ward rounds and after ward rounds clinical problems and used it as teaching material and effectively what we are doing is an extension of that we're simply trying to make stuff clinically relevant and using patient type problems to try and bring out the clinical relevance and also try and bring out some of the family dynamics psychosocial and all of those aspects separate to that in a problem based learning curriculum it's one of the few things within educational within medical education which requires a completely different way of thinking about learning and it's done in a completely different way they're put in groups and they've got a mentor and they are given clinical problems and up till now that sounds pretty similar but they are for instance given one clinical problem every month or two which is a complicated problem and as a group they have to decide on their strategy for solving that problem and they are given problems right from the beginning of their course so in week two once they've done the icebreaking exercises and everything like that they will be given their first clinical problem and as a group they have to say well to solve this clinical problem we're going to need to know this bit of anatomy we're going to need to know a bit of how this heart works and we're going to need to know a little bit about blood and we're going to need to know a bit about this and a bit about that and they go away and they set an agenda and members of the group bring back that knowledge and use that knowledge to structure how they're going to answer that problem so they are not given a module of cardiovascular in which clinical problems are used to illustrate things they're given a series of clinical problems which are supposedly de-, designed to cover the whole curriculum but it's entirely up to the group to manage the process of finding all the information for everything the whole course in effect to bring it back to their group to assimilate it to make sense of it and to learn the material and the role of facilitator is not to provide any of that information it's to facilitate the process by which they decide and they set their agendas and they send people off and gather their knowledge and are supposed to stop them going off on a complete red herring and i think the difference is important 'cause that is radically different from what we do and it's actually quite a well researched teaching technique and there are some good things about it and some bad things about it but one of the things that tends to happen is that people find the research in problem based learning and say it supports another style of learning where actually it's something completely different does that make sense and is that enough on that is that what you were intending nm0448: that's very helpful thank you very much are there any questions at all for namex at all on problem based er learning nf0450: well i guess question now is there not formal t-, anatomy teaching in phase one nm0445: now in our phase one yes nf0450: right nm0445: then for problem based learning different discussion other people nf0450: yes nm0445: in ours okay we there is formal anatomy teaching as part of their systems based modules so they have time in the dissection room nf0450: yeah nm0445: when they're doing musculoskeletal when they're doing cardiovascular when they're doing respiratory they don't have much time and it's much more illustrative than it is learning the skill of cutting up a body but they do have all of those elements formally taught within our curriculum nm0453: namex can you explain a little bit further the partnerships for the general sort of clinical education rotation er for the junior rotation and the senior you called them introductory partnerships and those more challenging partnerships and just what the difference in kind of nm0445: at the moment there is no difference at all nm0453: right nm0445: because they're not differentiated at all at the moment any student could meet any partnership at any phase nm0453: right nm0445: yep so at the moment it's a bit nebulous now that offers us a couple of challenges it offers us a logistic challenge because actually we've got increasing numbers i-, and they increase in big steps nm0453: right nm0445: and therefore if you've got a group of partnerships that a stream would go to at one time and it could be a junior or a senior stream it takes us very makes it very difficult to plan for us because there there might be a hundred- and-thirty juniors and a hundred-and-ninety a hundred-and-thirty seniors and a hundred-and-ninety juniors and then you know you end up juggling up all the time so there's a administrative logic to separating them but i think there's also an educational logic to separate them and make some partnerships used in the junior phase and some in the senior phase because there are certain teachers and certain combinations which might be quite difficult and challenging but if they've already done a year of clinical medicine could be very valuable so you wouldn't dare put a student who's straight you know who's only done phase one straight into this partnership but you might want to use it because there's so much to learn there and that you can make that partnership with the only medicine senior on the converse you could for instance decide that actually they ought to tr-, they all ought to meet a general surgeon in the junior therefore we will have junior partnerships that all you know one stream that all includes general surgeons or something like that but that's a development on what currently happens because at the moment there is no differentiation at all nm0453: thank you nm0448: right maybe at that point give namex a rest and say thank you very much for er really making phase two of the course a lot clearer because i think sometimes we can be a bit tunnel vision and just see the Clinical Methods course and forget about what else happens in phase two and that's really helpful insight thank you very much er we're going to break for coffee and can i suggest we reassemble at about twenty-five to four if that's okay it's in about fifteen minutes' time