Community-Based Medical Education Newsletter

Community-Based MedicalEducation (CBME) Newsletter for General Practice December 2010 • Issue 9 www.ihse.qmul.ac.uk/chs/education/cbme

Welcome to our Christmas Newsletter and thank you to those who contributed. As always, it is greatly appreciated!

This edition includes a review of the Hub andSpoke Model, an article from the New Surgeryin Brentwood about their experience with the new 5th Year Community Care Unit andDr Chris Derrett’s sabbatical experience inWestern Australia.

If you have something you would like tocontribute to the next edition of the CBMENewsletter, please send it to us by email. (please see back page for email addresses)

www.qmul.ac.uk

Inside this issueFarwell to Amy Flint 02

Welcome to Holly Riches 02

5th Year Community Care Unit 02

Welcome to Will Spiring 03

The New Surgery Article 03

Salaried GP Pilot 04

Medical Communications Skills and Law 04

Arising from the business meeting 05

An Educational Sabbatical 06

NHS Changes to Sift Payment 07

Puzzle Corner 08

Interested in teaching Medical students 08

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December 2010 Issue 9

I began working for CBME at the beginningof July. I was taking over from AngelaSilvester, a much loved member of the teamwho had spent 17 years at the university. Ihad some big shoes to fill! I settled in wellthanks to a friendly team and started totackle my varied role.

I look after the Medicine in Societyallocations for Yr 1 and Yr 2 students and also the GP allocations for the 5th year students .A lot of work goes into

finding the tutors for these allocations so it is important to maintain a good relationship with them.

Once all the administration is completed before a student begins their placement, contacts details, start dates, tutor and student guidessent out, there is always more to do. Collecting all the grades andassessment sheets, keeping the Academic lead involved, ensuringfeedback surveys are completed and then the process begins again! I also help to organise the Plenary days at the beginning and end of astudent’s allocation. Another part of my role is to order equipment forthe practices that need it. Without this they cannot provide the highlevel of teaching they do.

I have been on some practice visits too, checking that a new Tutor has enough space and time for their preferred module. I really enjoyliaising with both the students and the practices and sorting out any niggles that they may have. After previous roles within teachingrecruitment and with a language school this brings the two sides ofacademics and students together. I am really enjoying it, the cakeshelp, but really it’s the people.

Holly Riches

Welcome to Holly RichesFarewell and thank you to Amy Flint Amy Flint has been covering maternity leave for Janet Johnstonefrom January 2010 to the end of September. Amy has since starteda course studying MSc Forensic Archaeological Sciences. BeforeAmy left we had a chance to catch up with her.

Are you sad to leave?Absolutely! It's always sad to leave somewhere you have enjoyedworking. CBME is a fantastic department – the people there do anamazing job. I'm very much looking forward to starting my MScand being a student again, as archaeology is where my heart is,but I've had a fabulous nine months experiencing the other side of university life.

If you had one word to describe your experience in the CBME office,what would that be?Insightful

They say that it is a hard working office. Is this true?Without a shadow of doubt - so much goes on behind the scenes,which the students and GPs never see. The running of CBME isfundamentally about co-ordination, similar to spinning plates, if theteam wasn't on the ball all the time there would be a lot of brokencrockery.

Have there been any memorable times? Any times when you knew that you had made a difference to Teaching and Learning at Barts and The London?I'm not sure I've made a difference per se, but I think I've managedto caretake the role while Janet's on maternity leave. There havebeen many memorable moments, usually at around 3pm!

So what are you going to do now?MSc in Forensic Archaeological Sciences at the Institute of Archaeology, UCL.

Well good luck. We will all miss you.

Katheryn Livingston, CBME

Barts and The London School of Medicine and Dentistry, Academic Unit for Community-Based Medical Education, Garrod Building, Turner Street, Whitechapel , E1 2AD.

5th Year Community Care Unit

Barts and the London School of Medicine and Dentistry havelaunched a new module in Community Care as part of the final year MBBS rotations. Students spend 5 weeks placed in generalpractice to learn and improve clinical skills in a semi-supervisedindependent setting. This replaces the two fortnight placementswhich were split over the final year. This new module affords theopportunity for students to immerse themselves in one practice and experience more fully the role of the primary care team andthe members of it. Most students are placed in pairs. There is alsoan opportunity for students to select an own choice placement forapproval.

Also included for the first time are placements in out of hours care centres, walk-in centres and a palliative care half day based at St. Josephs Hospice, Hackney.

In the surgery, students are expected to see and assess patientsindependently before discussing the management and prescribingneeds of their patient with the GP tutor. These student clinicsprovide a valuable preparation for independent practice atfoundation school level.

Students are assessed by their tutor through workplace-basedassessments, which parallel the foundation level portfolio, andalso undertake a team poster project.

It is hoped to undertake a formal evaluation of the module andwe would hope you will feel able to be involved. More details tocome!

For more information and for opportunities to feedback on this new module contact Holly Riches on 020 7882 2522 or [email protected]

Dr Will SpiringYear 5 Clinical Teaching Fellow, CBME

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www.ihse.qmul.ac.uk/chs/education/cbme

Issue 9, December 2010

Welcome to Dr Will SpiringDr Will Spiring started with CBME in September 2010 working as a Year 5 Clinical Teaching Fellow for three sessions a week.

You’ve been here 2 months, Will. How have you found working forthree sessions a week with CBME?The time is easily filled. It’s fun and friendly so far at least! I findcontact with the students and tutors the most satisfying part. Althoughmy job often brings me into contact with challenging students orplacements where there are problems it’s been fantastic to see thehuge volume of positive student feedback about our tutors.

So what else is in your life?I am a partner at the Mission Practice in Bethnal Green where I still teach students in General Practice.

Why did you decide to join CBME?For me it was equally about the opportunity to teach and developsome of core undergraduate curriculum and to develop myself as an educator.

So what have you done so far?Well relearning the structure and immunology of the HIV virus to facilitate FUNMED PBL has to be a highlight…

What does the future at CBME hold for you?I am going to be working on the 5th year documentation, the centralintroduction and final day teaching programmes and attending anASME conference next month. Expect to see me at the Tutors dayevents with my 5th year hat on.

Do you find that your CBME sessions benefit your work as a GP?It’s never a good thing to be isolated as a GP physically or mentally.Our jobs are about Life in all its fullness. Yes I find benefit for everyday practice in even the most abstract aspects of academicandragogy.

Thank you, Will. It’s good to get such positive feedback on the CBMEexperience.

Dr Bruna CarnevaleYear 4 Clinical teaching Fellow, CBME

The New Surgery – 5th Year Community Care Placement

At The New Surgery we have accepted Year 5 QMUL students over the past two years, four at a time in each firm throughout theacademic year. Ten days in the practice for Preparing for Finalsand two weeks for Preparing for Independent Practice provided uswith an opportunity for our GP’s to brush up on their teaching skillsand having the student doctors around the place was invigoratingand somewhat refreshing for all.

Our positive outlook looked like being called into questionhowever when at the Business Meeting our very dear KathrynLivingston advised of the intended 5 week placements for Year5’s commencing September 2010. I had to think long and hardabout how much in the way of refreshment the practice couldcope with in one period without becoming saturated to its core!

With a definite increase in our careful planning undertaken inthe main by my superb assistant, Jayne Farmer we were able to convince the partners that we could take it on board. Thoughwe have aged slightly and have a little less hair – the good newsis we are managing in the main!! In fact we have seen one ortwo benefits such as fewer induction sessions!!

Our first firm of students in September were quite simplyoutstanding, managing to get themselves exactly where theyneeded to be and always arriving on time. (Thank you Susie,Charlotte and Samantha for the lovely picture above). Theprogramme does take a lot of planning and tweaking throughoutthe module but it is I hope interesting and varied. It really isn’tas bad as I thought it would be – in fact it has been a pleasure

Debbie ElamPractice Manager – The New Surgery Brentwood

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SGPT Pilot Scheme:As the proportion of the MBBS curriculum in Primary Care increases,so Community Based Medical Education (CBME) needs morepractices and more teachers. This teaching is carried out by allocatedGPs in practices from Year 1 through to Year 5 with increasing timespent seeing patients in theme-based sessions.

The SGPT Pilot Scheme has been developed to provide opportunity tocombine SGPs and established Barts and the London TeachingPractices, and to create exciting new teaching possibilities for ourmedical undergraduates.

Why:Salaried GPs are increasing in number, highly motivated, enthusiasticand often unable to get involved in undergraduate medical education,through lack of opportunity or exposure to teaching possibilities.

Equally, there may be already established teaching practices whohave recently lost teaching GPs, or would like to expand their teachingteam, or have the space without the teachers who would all be idealas host teaching practices for a SGP Tutor (not a salaried GP).

Who would be Involved:A SGPT:• a Salaried GP working as a GP Tutor and not as a GP, who

has completed the London Deanery “Introduction to Teaching in Primary Care Course” (ITTPC) or equivalent course.

A SGPT Host Practice:• a practice that is willing to involve an SGPT in the development

of their Undergraduate Teaching across the academic year.

A SGPT Host Practice Mentor:• a GP tutor in the practice that would supervise the SGPT. This

would involve meeting with the SGPT on 3 occasions, at thebeginning, middle and end of the academic year.

Provision by Host Teaching Practice:• SGPT Mentor.

• 1 room for tutorials or for student clerking and examining ofpatients.

• List of patients with appropriate conditions that SGPT can contact for teaching.

Barts and the London, CBME Process:1) Matching of SGPT to a Host practice.

2) Initial meeting with SGPT, SGPT Mentor and CBME academicclinical teaching fellow prior to teaching.

Finances:SGPT Host Practice: • Barts and the London sessional teaching payment

• Facilities funding as appropriate

• Additional sessional funding for mentoring activities (to a maximum of 5 per academic year)

SGPT:• The host practice would negotiate teaching payment to the SGPT.

• It would be expected that the SGPT rate would be based upon the Bart and the London sessional teaching payment.

Appropriate Teaching:Year 2: Extending Patient Contact (EPC)This year two module links the disease processes being studied inproblem-based learning sessions with relevant patient contact.Students build on their early clinical experiences with a growing focuson professional development. They attend GP in groups of 4, for 12alternate Tuesday mornings.

Year 3: Clinical Placement Programme Clinical and communication skills development, linked to the 3 majorbody systems, is the key aim of this third year placement. Students, ingroups of 4 or 6, attend for one day alternate weeks (timing flexible)over 8 weeks for each system.

Dr Bruna Carnevale, Year 4 Clinical Teching Fellow, CBME

Salaried GP Tutor (SGPT) Pilot Scheme

Barts and The London School of Medicine and Dentistry, AcademicUnit for Community-Based Medical Education, Garrod Building, Turner Street, Whitechapel , E1 2AD.

Medical CommunicationSkills and Law - A patientcentred approach made easyKwong et al.

Published Churchill Livingstone 2009 ISBN 978-0-7020-3083

Available from amazon.co.uk £14.99

This is a small pocket sized book aimed at medical students butis suitable for anyone who needs a quick summary of points tocover when communicating in various clinical situations. It isbroad rather than deep and is unashamedly pragmatic anddidactic in its approach. There is section by section guidanceon what to cover when explaining common procedures, drugsand tests as well as a useful section on explaining commondevices. The guidance is based on direct patient feedback andshould provide a useful reference for those preparing for and infoundation jobs, both hospital and primary care based.

One of its strengths is up to date and relevant comments on thelegal aspects of note keeping. These tips are spread throughout the sections on history taking, obtaining consent and patientcompetence. It covers the Mental Capacity Act 2005 and itsrelevance to practicing doctors and the updated Mental HealthAct 2007 giving case examples that should provide groundingfor both undergraduate OSCEs and practicing foundation yeardoctors. It even covers the peculiarities of Scottish Law for thoseBarts and The London students who get matched to schemesin the far north.

Dr Will Spiring, Year 5 Clinical Teaching Fellow, CBME


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“Arising from the Business Meeting”


Changes to the SLA structure.At the last Business Meeting, in April 2010, I introduced a proposal tostreamline our contractual arrangements so that our documentationbecame more timely and relevant. The challenge is that we arefunded over a Financial Year and operating over an Academic Year.Thus we can only issue funding contracts when the teachingcommitments have been agreed. As this can be as late as June/July ,teaching practices can be signing contracts in July/August whichrelate to activities starting in the previous April.

The proposal is to provide a contract for you to sign and return beforeApril which highlights your intention to teach with us for the rest of thecurrent Academic Year and in the next Academic Year under theBarts and The London ways of teaching, professional developmentand quality assurance set out in the (revised) contract. This is,effectively a commitment to teach contract. We will then continue withour normal practice recruitment processes (preference forms) andthen send you a codicil to the contract which confirms your actualteaching in the coming academic year and the payment that you willreceive for that funding. We will provide you with two sets of figures:the payments you will receive from April to March (NHS financialyear) and the payments you will receive from September to August (academic year).

The proposal met with agreement at the Business Meeting and I amworking to a timescale that will see a draft ready for consultation inJanuary 2011. If you would like to be part of the consultation processand provide me with feedback on the new documents, please contactme on [email protected].

Reviewing the Hub and Spoke model The prospect of a review of the hub and spoke model was raised at the 2010 Business Meeting. The position is summarised in thePowerPoint presentation from that meeting (stored on the Web under “events” ) and the report of that meeting sent to all practiceselectronically in October. This article forms the first part of the CBME consultation process.

When we move to the new single funding tariff described earlier, thedistinction between “hub” practices and “spoke” practices in terms ofthe financial model will disappear. However, as I am working with thenew SLA structure (see earlier) I can see that there are distinct rolesthat were linked to Hub practices, and more recently to SuperHubpractices that we would not wish to lose, and may wish to revive andgive more support to.

BackgroundInitially, the Hub and Spoke model recognised the responsibility thatlarger teaching practices had for supporting smaller teachingpractices:

“Hub Practices (are) accredited teaching practices undertaking teachingactivities and lead responsibilities for a group of associated teaching practices”Hub contract 1998-9

It was refined by the introduction of the Super Hub practice whichhad an identified GP training component of time alongside a sizableundergraduate teaching load.

“Super Hub practices will be required to take a lead role in the development ofcommunity-based teaching activities and tutor training and as such will need tooperate at the highest standards, be committed to the development of evidencebased medicine and be proactive in the development of teaching in thecommunity. Specifically, they will be required to work in conjunction with theCentre to provide training for community-based tutors (to share their ownexpertise and to support the development of the highest teaching standards in other practices) and to pilot new teaching and help devise and implementchanges to the community-based curriculum.” SuperHub contract 2005-6

It is now more than 10 years since the initial Hub and Spoke modelwas developed. The implication that a teaching practice with fewteaching sessions is necessarily more able to support the teaching oflocal neighbours than a practice teaching many sessions is no longera valid model.

Organisationally, the Community of Barts and The London TeachingPractices is expanding. In 2009-10 we had 153 local (to Whitechapel)teaching practices. This size of organisation requires a rethink interms of ensuring quality teaching, efficient transmission of messagesabout curriculum change and standard approaches to matters likeattendance and professionalism. We have a greater proportion ofpractices new to Barts and The London and we need to look again atsupport for new practices. We also have a healthy flow of Salaried GPTutors developing within our area and we need to look at supportmechanisms for them.

The model that we will be looking at developing is one that does notdifferentiate practices by the amount of teaching they do, but looks atthe concept of Lead Practice in areas such as:• curriculum support/ specialist clinical teaching• mentoring new GP tutors/practices, • hosting salaried GP Tutors, • supporting Peer review.

We also need to look again at the possibilities of managing at least 2of our 4 annual training sessions on a regional basis, thus reducingthe pressure on your time caused by travelling to Whitechapel or MileEnd or Barts. This calls for the development of the SuperSpoke modelwhere training can be more localised. The SuperSpoke would be aregional venue and resource centre for training knowledge andpossibly physical resources while the actual organisation of thetraining would still be managed by CBME staff.

Each of these possibilities come with implications for either GP time orPractice Manager/Administrator time. The funding for this needs to befactored in to any model that is developed.

These changes need much more discussion before a model is put outto consultation. There is a tear-off slip with the covering letter to thisnewsletter. Please answer the questions on that slip and send or faxthem to me (addresses on the slip) or e-mail me with your thoughts [email protected]. I will be looking for some willing colleaguesto join me to work towards the new structure for our Teachingpractices. My plan is to take two afternoons in January to develop thenew model ready for consultation in February and presentation at thebusiness meeting in April. Please let me know if you would like to joinme.

Kathryn Livingston, CBME

Barts and The London School of Medicine and Dentistry, Academic Unit for Community-Based Medical Education, Garrod Building, Turner Street, Whitechapel , E1 2AD. 06


An Educational Sabbaticalin Western AustraliaIntroductionI have been a GP principal and medical educator in East Londonfor 24 years. This year I decided that I needed a sabbatical torecharge my batteries and reflect on my professional roles as aclinician and teacher. I chose to visit “the outback” of WesternAustralia to study a unique system of medical education.

Western AustraliaWestern Australia (WA) represents one third of the Australian landmass; with an area of nearly one million square miles, it is morethan 10 times larger than the UK. Most of the 2 million residents

live in Perth or the surrounding metropolitan area, but the sparselydistributed rural population has considerable political influencebecause the country areas of WA are the source of much of thestate’s productive wealth in the form of agriculture and minerals.There is a chronic shortage of country GPs in WA and this hasbecome a political “hot potato”.

The Rural Clinical School of Western AustraliaThe Rural Clinical School of Western Australia (RCSWA) is acollaboration of both of WAs medical schools : the Universities of

WA and Notre Dame. The school was set up to addressthe shortage of “home grown” rural doctors in the stateand to provide specialist rural medical training. Studentswho are accepted on the RCSWA programme spend thewhole of the penultimate year of their undergraduatetraining in a “country” town. Currently there are 77students working with the RCSWA in 13 rural placementsites throughout the state. During my sabbatical I visited6 of these sites (Broome, Derby, Kalgoorlie, Esperance,Albany and Bunbury) over a 3 month period.

The RCSWA teaching sites vary in their size, cultural andethnic makeup and economic base. The medical andeducational facilities and student accommodation alsovary, but all conform to certain basic standards. Each sitehas a small library and excellent IT facilities and severallocations can be linked for video conferencing. There is aprogramme of local and remotely-presented lectures andtutorials. Students are given free accommodation andother financial incentives whilst they are on the ruralprogramme.

The school has 43 part time medical coordinators (GPsand hospital consultants) who supervise and assess thestudents with the support of at least one localadministrative assistant,

A “vertical” education curriculum is employed withstudents working in a range of health facilities whichgenerally include a local district hospital with inpatientsand an emergency department, one or more generalpractices and remote clinics and aboriginal medicalservices. The teaching programme is opportunistic and isbased around appropriate clinical cases as they present.

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The RCSWA one year programme includes internal medicine, surgery,paediatrics, obstetrics and gynaecology, cancer and ophthalmologyand these are all taught in both primary and secondary care settings.

The educational programmes at the various sites are all different;MCs are free to plan the detailed timetable and to exploit thestrengths of their colleagues and locations. They do this withoutlosing sight of the overall academic framework.

The RCSWA provides a unique opportunity to develop medicalprofessionalism. The students are “highly visible” to colleagues andteachers who can identify and address inadequate performanceand/or unprofessional behaviour that has been previously hidden.

The Medical Coordinators (MCs) are a committed and enthusiasticgroup of experienced clinicians and medical teachers and the ruralundergraduate programme attracts the more able, mature andadventurous medical students. The overall academic standardcompares favourably with that in the UK.

The value of a sabbaticalIt has been a privilege to take a sabbatical at this stage in myprofessional career. Travel overseas is generally mind expanding, but this is particularly the case when one is able to be more than atourist. Whilst staying in Broome and Kalgoorlie, I had time to reflecton the lifestyle of colleagues and on the varied health care systems.Working with enthusiastic teachers and students of the RCSWA has convinced me that when adequately resourced, a “vertical”curriculum with longer term attachments can offer a richer learningexperience than is generally available with the traditional medicalschool programme based on shorter specialist“firms”

The RCSWA is demonstrating that undergraduate experiences can influence the career choices of doctors. Teachers and medical workforce planners, please note!


AcknowledgementsMany people helped make my sabbatical exciting, educational andthought provoking. I would like to thank my colleagues at BartonHouse Group Practice for allowing me to step off the “tread mill” and take time out. The London Deanery and NHS City and Hackneygranted me Prolonged Study Leave , Sandra Nicholson offeredencouragement from Bart’s and the London Medical School andProfessor Geoff Riley and colleagues kindly extended an invitation to work with the Rural Clinical School of Western Australia.

Dr Christopher DerrettBarton House Group Practice

My route in Western Australia

RCSWA Students in Broome Student (and visitor) accommodation Broome

NHS London changes to SIFTpaymentsChanges to SIFT funding have been forecast since well before Ijoined CBME in July 2008. The change is clear: we are requiredto move to a single linear tariff for funding. This means that ourtwo phase approach to funding which takes account of:

• the actual teaching undertaken (placements payment), and

• the resource implications of supporting and managing theorganisation of teaching (facilities payments)

will need to be merged into a single payment for teachingfunding stream.

Currently, the timing is not clear: we thought we would berequired to implement this change in April 2011, but we mayhave a few years to put a new system in place. I will bepresenting the new model for funding at the Business meeting in April 2011 and will be able to indicate our timetable forimplementation. As we phase the new model in, we will belooking to ensure that, in the first years of the changes, that no practice receives less in funding under the new model than they would have received under the old model.

Kathryn Livingston, CBME

Barts and The London School of Medicine and Dentistry, Academic Unit for Community-Based Medical Education, Garrod Building, Turner Street, Whitechapel , E1 2AD. 08


Contact the Editorial TeamThis is your newsletter. If you have anysuggestions for future content, usefulteaching tips, teaching resources orexperiences you would like to shareplease send us your contribution.

Lynne Magorrian [email protected]

Tilly Gosai [email protected]

Pub7171

Down1. Measured amounts of medication (5)2. Offense (7)3. An expression of esteem (7)4. Swelling under the skin (5)5. Sugared (9)6. Ancient Greek or Roman warship (7)7. Intention (7)8. A disorderly outburst (9)13. Thought transference (9)17. Bother (7)18. A pike fitted with an ax head (7)20. Dirigible (7)21. A hormone lacking in diabetics (7)23. Spanish for "(girl) friend" (5)24. Harps (5)

Across

1. Fearless (9)6. Something to talk about (5)9. Lessen (7)10. A witty saying (7)11. A food turner (7)12. Vocal vibrato (7)13. Immediately after that (9)15. Lacquer ingredient (5)16. Lock (5)19. The product of nuclear decay (9)22. Difficulty (7)23. Spray can (7)25. Scene (7)26. Asthmatic's device (7)27. Cede (5)28. Accessories (9)

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Alfie’s Puzzle Corner

Interested in Teaching MedicalStudents at the University?

We are looking for enthusiastic GP’s (Partners or salaried) who would be willingto supervise small groups of Year 3 Students doing Problem-Based Learning atthe University.

• You can do as little or as many sessions as you like.

• Everything needed for the teaching session will be arranged for you. Justarrive and supervise the session.

• Personal training regarding Problem Based Teaching will be givenbeforehand.

If interested please get in touch. Email [email protected].

Dr Liz NuttallYear 3 Clinical Teaching Fellow, CBME

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