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Clinical Communication and History Taking – An Associate Clinical Educators Perspective

It’s always important for an ACE to understand the protocols health professionals must follow to help them take a good history from a patient. Once we understand this we are able to give hi-fidelity feedback to the Clinician and thus help them improve their ability to build rapport and gather information simultaneously.

Last week I had the pleasure of working with our partners at The University of Chester and The University of Wolverhampton Physician Associate Programmes.

At Chester University  we worked with 1st Year physician associates and at Wolverhampton we were working with 2nd year students. In both cases we were looking at how students communicate effectively with patients. What was apparent is the importance of quality feedback to the student.

For the students at Chester this was their first time looking at role-play, it was difficult convincing shy students to step up to the plate and hear their thoughts. It turns out that the ACE also has to be something of a motivator encouraging the students to take part. To get to grips with the scenario and to see that “roleplay” can be fun and educational, rather than scary and intimidating. It is this element of teaching that I particularly enjoy.

Wolverhampton however was very different, but still had its challenges. Although the students were more experienced with role-play and history taking, we still had a lot of work to do as the scenarios were far more challenging.

This week however, they had a reprieve from taking part in role-play.

I had been asked by the clinical lead Pete Gorman to deliver a session on communication theory and to talk about the practical challenges students face when talking to a difficult patient.

Whenever we communicate we interact both verbally and non-verbally, and understanding how we can make this work would take more than this short article. Here is a brief synopsis of what we discussed.

There are four legs to effective communication and these are:

  • Rapport
  • Behavioural Flexibility
  • Sensory Acuity
  • Knowing your Outcome

Rapport is key to successful communication. Indeed without rapport it is very difficult to influence anyone, whether that be to make behavioral change or to take a simple history. We have all had that experience with another person when we feel we just connect. We sometimes find ourselves engaged in a conversation with a stranger and feel that they are just like us. That is rapport. People deeply in love have rapport to the extent that they mirror each others’ posture, language and even breathing patterns. That is rapport.

Interacting With A Patient Whilst Performing A Systems Exam Is Crucial To Building And Maintaining Rapport
Interacting With A Patient Whilst Performing A Systems Exam Is Crucial To Building And Maintaining Rapport

In order to be effective in our communications with patients we must also be aware of the continuous process of feedback. It is important to know whether we are getting what we want from our communication. To do this effectively we must have sensory acuity. We notice  changes in physiology, breathing, eye accessing and language patterns. Armed with this information we can build rapport more authentically and deepen the relationship with the patient.

Once we have noticed these seemingly imperceptible cues, we can help the patient make better decisions and connect fully with the health professional. Using these tools will allow the clinician to help the patient to have a greater awareness of the choices available to them in the present, rather than have these choices restricted by past experiences and out-dated responses. This is what we sometimes call motivational interviewing.

Finally, everything you achieve is an outcome. If you are successful in your endeavours; that is an outcome. If you don’t succeed, that is still an outcome. Whatever we do results in an outcome. In order to achieve desirable outcomes we need to effectively model what works and then go out and do it! Rehearsal through role-play is the key to achieving positive outcomes when taking a history. You will always get what you ask for! Ask in the correct way and you will achieve your goal.

Whilst all of the above should be noted there are other important considerations that a clinician should be aware of in history taking.

I asked the students to remember the following when taking a history.

  • Presenting complaints – This is a list of the main symptoms or problems.
  • History of presenting complaint – This is an in-depth description the the presenting compliant.
  • Previous medical history – This is a comprehensive list of the all the illnesses, conditions and operation the patient has had in the past.
  • Drug history – A list of all of the patients medications and any allergies they may have.
  • Family history – Ask about conditions that run in the family.
  • Social history – This includes information about home, occupation, hobbies and habits. This would include smoking, drinking and illicit drug use.
  • Systems review – This a checklist of closed questions for every organ system in the body.

Using open and closed questions is an important skill. Closed questions at the start of a consultations encourage short yes and no type answers. Not good for building rapport in the opening stages of a meeting. Open questions encourage the patient to talk and that can be useful. Save the closed questions for gathering a quick response.

Engaging The Patient Both Verbally And Non Verbally Is Crucial For Building And Maintaining Rapport
Engaging The Patient Both Verbally And Non Verbally Is Crucial For Building And Maintaining Rapport

A common question I get from students is what factors hinder good communication? The list is extensive and I’ve seen and heard them all, but here are a few.

A badly worded introduction where you don’t clearly say your name. Not remembering the patients name, embarrassment, lack of curiosity, not asking the right types of questions, not making the right amount of eye contact, misreading body language, making assumptions, not listening actively, missing cues, not knowing how to deal with an answer, an over talkative patient, misunderstandings, making assumptions about the patient, stacking questions, judgemental behaviours. There are so many!

At the end of the session I gave students strategies to go away and practice. We always have opportunities every day to practice our communication skills. Unless you’re a hermit of course!

Check out the interactions between Mark and Bob on the video and if you are an actor interested in becoming a medical role-player and want to take it to the next level get in touch and join our growing ACE team. We will be posting dates for the next ACE training soon.

Meducate Academy: Building Lasting Partnerships

Bache Hall, University of Chester
Bache Hall was the venue for this years Summative OSCEs for the 2nd year physician associates

What a great week we have had this week.

We started the week with a mixture of Summative OSCEs for The University of Chester and ended the week with a long day of filming MSK examination procedures for The University of Wolverhampton.

The University of Chester Physician Associate Programme, under the guidance of Course Director James Ennis, were running a series of online and in person Summative OSCEs for their 2nd year students.

We had seven ACEs working on a variety of stations. I was personally responsible for being in Chester taking two days out to work alongside senior clinicians working on Suicide Assessment and Breaking Bad news scenarios.

Preparing for a days filming with Wolverhampton University
Setting up the scene and preparing for filming at the Meducate Offices

The team of ACEs from Meducate Academy gave a great account of themselves and all received glowing testimonials from the Clinicians they were working with. We had no problems with the technology and Chester University has mastered the art of working on Microsoft Teams to great effect. Even the students commented on how well organised the two days went.

Running OSCEs is always a challenge for both Meducate Academy and the universities involved. Our extensive experience working in this fields for over ten years ensures that we always deliver the best service.

Our close working relationship with Chester University means no matter what happens we all work together as a team to ensure the students have the best possible educational experience. I always know that things are going well when individual students remember the names of our ACEs and ask for them by name. It’s also important to build relationships with the students.

Friday morning saw Meducate Academy back in our offices in Birmingham, filming a whole range of Musculoskeletal Examinations for The University of Wolverhampton in preparation for their 2021 teaching modules and the start of their new cohort in February.

Course Lead Pete Gorman and myself filmed Hip, Knee, Shoulder, Spine, Wrist and Foot exams in great detail with explanations of how they can be adapted when demonstrating them on an OSCE station. Safe practice was always the main focus of the sessions, and we made mention of the importance of accurate communication with the patient.

Clinical lead Pete Gorman prepares to preform a hip examination
Clinical lead Pete Gorman prepares to preform a hip examination on the ACE at Meducate Academy

Although the day was long it was made easier by the shared sense of humour of both Professor Kenny Langlands (Course Director), Pete Gorman (Course Clinical Lead) and the team from Meducate Academy.

We also managed to film a short interview with Kenny and Pete as to how they see their close relationship with us and how important the ACE role is with regard to the development of the student Physician Associate.

The films are now in the film edit process and I shall work on this all week.

I’d like to take this opportunity to thank all of our friends and colleagues at both The University of Wolverhampton and the University of Chester for making 2020 a significant year for us, despite the restrictions placed on us by a series of Lockdowns.

2021 could be our best year yet.

Why not join us!

If you are a roleplayer, actor or clinician and wish to be part of the Meducate Team contact us by sending your name and email in the box below.

My Top 10 Tips For Failing The OSCEs

Image of long haired and unshaven medical student
Here are my top ten tips that will assure you fail the OSCEs

The idea for this post developed over the past ten years of my involvement in the training of Physician Associates, Medics, Pharmacists, Dentists and other health professionals. Ten years of working as an ACE and role-player observing those same students pass and fail their OSCEs every year.

I have also spent ten years mentoring and coaching students from all walks of life, at various levels of their education in order to help them become a success.

I have consequently developed strategies and models to help students become safe and competent health professionals. I have seen how successful many of them have become, time and time again.

Over that time, I have also made a careful study of underachievement. The students who fail. I have therefore reached a shocking conclusion that many of the students who fail, share the same strategies on a daily basis that leads to a state of total and absolute failure.

It takes an awful lot of work to fail this well. Often a lot more work than it takes to succeed.

Successful people always reveal that they never feel that they are working for a living.

They’re invariably optimists.

Failures are invariably pessimists.

They usually hate their work.

I have learned a lot from failures.

Failure is a choice… It takes conscious effort!

As I have said, I have studied success too and I know those strategies well. I guess if you know specific strategies for success and do the exact opposite, you’re well on your way to being a spectacular failure.

So, here are my top tips, my step-by-step approach to help you fail the OSCEs majestically.

Of course you could also do the exact opposite… But that would be crazy!!

So here we go:

STEP ONE

If you want to ensure that you fail the OSCE then you must definitely never ever think about what success could mean for you. Avoid, at all costs, positive role models and avoid successful people.

Never define your goals or find your purpose.

STEP TWO

DO NOT turn up early or even on time for lectures. In fact make sure you miss as many as possible. Forget to set your alarm and enjoy those extra minutes in your lovely warm bed. You deserve it after all. It’s been a tough week!

STEP THREE

If you insist on revising, remember to never revise in a structured way. Never plan you day around your study time.There are more important things to do. Tidying up your room, washing the dishes, the laundry or catching up on the a Netflix series that you missed first time around.

STEP FOUR

As the OSCE dates get closer never try to be optimistic about this approaching nightmare. Do anything but think about those exams.

Reaffirm on an hourly basis, that it’s going to be difficult. Maybe even impossible. OSCEs are difficult and scary.

STEP FIVE

Repeat Step Four the night before the OSCE and stay up late. Never get an early night and always panic. Lots of panicking!

“DO NOT REMAIN CALM.”

STEP SIX

You have somehow made it to the OSCEs and you are at your first station. Whatever you do… DO NOT READ THE QUESTION PROPERLY! Tell yourself that those two minutes are going to fly by, so only give it a quick scan.

STEP SEVEN

Never tidy up your appearance. Do not iron your clothes and always wear something inappropriate. You washed your hands earlier in the day, so do not use the hand gel when you enter the room.

STEP EIGHT

When you enter the room, lack confidence. This shouldn’t be difficult if you have followed the previous seven steps. If you look scared, you may win a sympathy vote. Mumble your name incomprehensibly and as fast as you can to save time.

STEP NINE

Forget to take notes. If you have been stupid enough to have wasted time making some outside the station… NEVER refer to them again. Remember to leave your stethoscope and watch at home. You can borrow them from the examiner, anyway!

STEP TEN

Have no structure when performing a systems exam. You’re a free spirit and want to show your improvisational skills to the examiner. When taking a history, DO NOT make eye contact. DO NOT listen for cues and always use jargon. Keep saying: “OK. OK. OK.”

Finally. Thanks for coming this far with the article. You have succeeded at something! Best that you forget everything I have said and now delete all the above from your memory. That would just take up valuable space.

This is by no means a complete guide for failing the OSCEs. That would take a book and you probably wouldn’t be bothered to read it, anyway. Avoid books, research papers and journals related to medicine. Hello magazine has more pictures in it, is more interesting and wastes a bit of time.

Meducate Academy Is Moving

Clinical training room at Wolverhampton University

Meducate Academy is moving, in many senses of the word…

Almost three years in the business and despite the impact that Covid-19 has created, Meducate Academy seem to be leading the way in the education of health-care professionals by Lay Clinical Educators and Simulated Patients.

The past week has seen us providing our services to one of our partners, The University of Wolverhampton. Under the direction of Pete Gorman Clinical Lead we supplied Associate Clinical Educators on their Physician Associate Programme. Working with three experienced ACEs we covered scenarios including the management of Mental Health issues, dealing with an anxious patient presenting with STEMI and a session on how to examine a patient with thyroid problems

These scenarios were designed to challenge the students both in their ability to take a focused history and a perform a focused cardiovascular and thyroid examination, including testing them on their ability to read an ECG correctly.

We ran the sessions as a mock OSCE over ten minutes, but unlike an OSCE we were able to give feedback to the students for twenty minutes each. The days were long but productive and very rewarding, plus the feedback given by the students was also excellent.

The students had worked with us previously, so they were not surprised by the level of challenge and the way we approach the delivery of Clinical Examinations. They were all PA students in their second year, so the pressure was put on them to perform at the highest level. Most of them didn’t let us down, and they thanked us for the work we had done last year.

Unlike volunteers and real patients, an ACE working alongside an experienced clinician can make a significant difference to the development of a PA student.

It is sessions like this that allow the students to make their mistakes in a safe and supportive environment. The ACE always gives feedback in a structured way, including information on the students ability to build rapport with the patient.

We will be following these sessions up next week with Mock OSCEs under actual exam conditions using seven of our most experienced ACEs. It should be an enjoyable week!

Next month we will also work with The University of Chester on their PA programme, but this time we will work online using Microsoft Teams. This is a different type of teaching and requires good camera skills. More of that in another post.

Working online presents us all with a variety of communication challenges. Lousy cameras, dodgy Wi-Fi and misunderstandings about how to use the system. The Internet can seem to have a life of its own at times. We have contingency plans for events like this.

We have even run online sessions to help students and our ACEs use the technology more effectively. Most of the online work we do focuses more on History Taking as it’s virtually impossible to do physical exams online.

Working online presents its challenges, but we have been working online since the start of the first lockdown back in March earlier this year. We more or less have it sorted!

Embracing the new technology meant we had to invest in state-of-the-art cameras, lighting and sound equipment to ensure that our customers get the very best experience.

It also means we can film training material and create Podcasts for use by our clients for future use when the Covid-19 pandemic is all over.

Those of you with a keen eye will see that our address has also changed.

We have now moved our offices from Shenstone in Staffordshire to a Birmingham city center location, situated at Grosvenor House in the Jewellery Quarter in St Paul’s Square. Having a central location makes it easier to train upcoming ACEs and meet potential clients. We are near to Central Station and on the major route into Birmingham from the M6.

All this and more to come. Including a proposed webinar where we invite senior Clinicians and Associate Clinical Educators together with students to talk about how to approach OSCEs. We are also currently filming and building a library of systems exams so students can have access to the latest examination methods being used in the OSCEs.

Thanks to everyone who has helped us make this journey.

Answer the Question: Common Errors When Sitting The OSCEs

Image of man writing on exam paper

As a roleplayer and ACE for more than ten years one of the most common errors I see students make when taking part in their OSCEs is failure to read the questions correctly.

It is more common than you may imagine and not enough time is spent on this aspect of their education. Pete Gorman, course lead of Wolverhampton University, spends one evening of the week working online with his PA students looking at what he calls the “Golden 2 Minutes”. Meducate Academy are currently working as partners with him on this aspect of their training.

That’s how important it is.

At the start of OSCEs we have stations and on each one of them there is a question. The students have two minutes to read this question before they enter the station.

A nail biting two minutes for unprepared students!

What students do in that two minutes is crucial to their success when they sit down with the “patient’ they are about to see.

It is often the case that a student, who feels they have performed badly on a previous station, carry this negative state onto the next question. When they arrive at the next station this inevitably clouds their judgement and therefore their ability to read the question correctly is compromised. Their heads are filled full of ideas about how they might have done better on that last station and this attitude has a definite influence on their state of mind when they sit down and look at the new question. This is the time to let that last experience go, to draw a line under it and clear their mind.

I often tell students to have a delete button in their head so that no matter what they did on the last station, positive or negative, is erased.

Deleted. They don’t need it.

They need clarity of mind to enable them to read the next question now placed in front of them, to take a couple of deep breaths and relax. Then read the question.

So the first thing they need to do is to read the question carefully. Ask themselves what type of question it is. Quickly skim through it to pick out it’s main features.

Is it a procedure, an examination or a history? How much detail do they have?

Quickly make a few relevant notes. Look at the patient information of which there may not be much, but if they concentrate and read the question there may be clues.

Age of patient, gender, ethnicity, marital status and their occupation?

Is there any information about previous medical history, or the medications they are currently on?

I know all of this may seem obvious, but when the red mist of fear comes down and clouds judgement it’s easy to lose sight of the basics.

Think about your strategy for diagnosing the likely outcome. What are the red flags and if this is a mental health problem remember to do a suicide assessment.

All of these things are basic to good structure and in the heat of the moment it’s so easy to skim through the question and think you have it right. Read the question carefully. It is that simple.

I remember one student who hadn’t read the question carefully after a perfect introduction and performed a respiratory exam on me when she was supposed to be performing a cardio vascular exam! Ooooops! Needless to say she failed that station.

Check out some of our videos on our YouTube channel to give more guidance. I will be posting more later in the month.

In Conversation With Senior Associate Clinical Educator Mark Reynolds

Interview with Associate Clinical Educator Mark Reynolds
Associate Clinical Educator Mark Reynolds giving feedback to a PA student on a recent course

A few subscribers have asked me to expand further on the role of the ACE, and this is a transcript of an interview I did with fellow ACE Mark Reynolds a few years ago. It still has relevance today and should answer any questions I have received over the past few months.

Meducate: What can you tell me about the difference between a Role Player and an ACE (Associate Clinical Educator)?

Mark: A role player is involved in clinical communication, in that they play opposite a medical student as a patient or colleague in order to to improve their learning in terms of their technique of clinical communication.  The associate clinical educator is also trained as a role player but is also trained in the body system examination so they are a hand on resource for the student to work on. The ACE then feeds back how well the student carries out that examination.

Meducate: You mentioned the term “body systems” what do you mean by that?

Mark: The basic body systems, from the point of view of the  medical world, would be  the cardiovascular, respiratory, gastrointestinal, neurological and musculoskeletal systems. We are trained to give feedback on their examination technique. Techniques such as percussion, auscultation and palpation.  We  never teach pathology, that’s up to an academic tutor who normally works alongside us.

Meducate: So the academic tutor teaches the pathologies and the theory, and you are the resource? A bit like a living mannequin?

Mark: Yes, we are a living resource able to give feedback on the technique as well as our extensive knowledge of the OSCEs and what is required in those academic exams. At first Techniques like Percussion and Palpation are often a problem for new students, and we can guide them in the correct technique as well as ensuring they’re in the correct position on the body.

Meducate: And because you’re also a communications expert, you can give feedback on their ability to communicate effectively and build rapport with the patient.

Mark: Absolutely yes. Communication is a vital part of the examination process and it would be remiss of me to allow a student to carry on if they couldn’t build rapport with the patient.

Meducate: So can you describe a typical session with an ACE?

Mark: So normally a body system is picked for the day and the ACE will be working with four to six students. Sometimes the clinician may do a live demonstration using the ACE as the model, and then the students will be taken through the various pathologies they may come across on a typical patient. The students would then be left to work with the ACE, and they would then give feedback about how well they are doing. Having a “Talk the Walk” approach works very well, as we can direct the student toward the correct method right from the start. Sometimes we may run a scenario alongside the physical examination and thereby making it more realistic. With the help of the clinician present, we will also include a management plan and how to explain that to the patient in layman’s terms. We can also present various pathologies to the student such as asymmetrical breathing, antalgic gait, Shortness of breath and many more. We even have a member of the team who can create ulcers, bruising, and other physical signs using moulage.

Meducate: I have heard students say that they feel more relaxed when working with an ACE can you expand on that?

Mark: Yes, when a student has a clinician in the room they feel that they are being judged. Which of course is true. We are there as a resource, a tool, if you will to help them develop without judgement. It is true that we assess them, but not professionally. We are not qualified Medics!

 Meducate: ACEs are often used in OSCEs to great effect. How does that work?

Mark: During an OSCE it is not possible for the examiner to feel what is going on such as palpation, and that’s where we can give our feedback about how well the palpation went. Whether it was painful or too light. Because of our intensive hands on training, we know what a good technique is. This ensures that the PA is safe to practice once qualified. It should be remembered too that we have probably been involved in thousands of OSCEs, so we have an extensive experience, often much more than the examiners themselves. Examiners often remark on how extensive our knowledge is!

Meducate: Better than a real patient?

Mark: Yes, very different. A patient will not be qualified to give feedback. Of course, working with real patients is also valuable to the learning process.

Meducate: Thanks for taking time out to chat with us, Mark.

An Interview With Matt Chapman Managing Director of Meducate

Image of Matt Chapman Managing Director of Meducate Academy
Matt Chapman Managing Director of Meducate Academy

Matt Chapman is Managing Director of Meducate and is a founding member of the company. In this post, Matt talks about his vision for the company and how Meducate differs from other companies he has worked for over the years.

“I’ve been involved with Meducate from it’s inception over 2 years ago and the big thing that stood out for me was how engaged the students were with the ACEs and the methods we use. Feedback was always phenomenal  something I hadn’t experienced in any other business before. There’s always a grumpy customer that you have to deal with in any business, but with Meducate it was always positive feedback.

“Every time we engage with an institution and their students, they give us 5 stars across the board.

“When we first met and you talked about the concept of Meducate  you were already doing corporate training with me and when you told me about the potential of the ACE role in medical training, I suspended my judgement on how good you said the work was. I remember coming on the first session with one of our earliest customers at Wolverhampton and it was all true. Not only were you and the other ACE enjoying the day but so were the students. Id never seen that level of engagement with anyone in business before. 100% of the class were involved and craved more! That is when I knew we could make this work. In business we always want a win-win situation, and this seemed to be the right type of service to offer. That and the fact that we are almost the only people to be offering this service.

“The fact that this had never been picked up on before and was an open market surprised me. I know there are lots of role play companies out there offering medical role players, but the role of the ACE is unknown. My only concern was, would we have enough ACEs to cover the 40 + institutions that may need our services. Our answer came with the pandemic. This gave us time to regroup and begin training role players in the skills required for them to perform as an ACE. We did this with the help of some senior academic tutors and experienced clinicians who work in the health care sector. Again, this was another of Meducate’s strengths. Our ability to contact the right people is paramount and we are even in discussions to validate the role of the ACE with two Universities keen to promote what we do.

“I was asked recently what drives me in business and I remember we were talking about values and how you see the work we do at Meducate. One of the core values I have always had was with having the ability to measure and monitor every aspect of the customer experience. That would be at all levels. So how well do we handle incoming calls and meetings with potential clients? Feedback from students is something I have already talked about, but what do the clinicians think? How do they feel about utilising ACEs in the educational process and how valuable are they? The answers coming back so far have been outstanding.  I really believe in giving the customer what they want and will always work with them to achieve their goals.

“I have always believed in being transparent with the people who work for us and the customer. Keeping everyone in the loop on a regular basis makes for a happy and fruitful relationship.

“What has been difficult, but I have now adapted too, is the sudden changes a client might make at the last minute about the type of training they want delivered? I was surprised by how flexible our ACEs were. They were able to shift gear quickly and improvise, effectively delivering exactly what the customer wanted. This I believe is one of Meducate’s great strengths and is due to the intensity, passion and abilities of the people we have working with us.

“With regard to the abilities of the ACEs I would like to mention that we update the ACEs skill sets every 6 months and will run regular training days to help the ACE with any areas in which they might feel weak. We want everyone to feel like they’re part of a family and if we all look after each other, we will all prosper. It’s a continuing process that we can’t let slip. As times change, we must change, as we have all recently experienced, and we were quickly working online in March of this year. I don’t believe any other organisation reacted that quickly. We were already prepared to provide online trainings anyway, so it was simply a matter of contacting our customers and setting it up.

“In closing, I would just like to say that I feel we are a very under-used resource, but we have professional credibility with several universities using us and several ACEs with over 12 years’ experience. If you want to test us out, why not call us or email or call us for a 5 minute conversation?”

Click here to view the full video podcast of the Matt Chapman interview on the Meducate Academy Channel at YouTube 

Meducate Academy Educating The Next Generation Of PAs

ACE Mark Reynolds roleplaying with a 1st Year PA student at The University of Chester
Meducate ACE Mark Reynolds roleplaying with a 1st Year PA student at The University of Chester 1st Year OSCE

Meducate Academy has had a busy two weeks working alongside the University of Chester, University of Wolverhampton and Matrix Education on several exciting projects.

As always, Matrix Education delivered an excellent two day course, this time in a beautiful hotel deep in the heart of London’s West End. We were there in our capacity as Role Players and Associate Clinical Educators providing our role play and lay clinical education services to the PA students about to take their National Exams. Students from Bournemouth, Reading, Sheffield, Birmingham and other parts of the UK were in attendance.

We encouraged the students to stay engaged with both history taking in the morning session and physical examinations in the afternoon. We also coached them in techniques that would allow them to get through the exams with confidence and advice on how to lower their stress levels prior to the OSCE.

Associated Clinical Educator Mark ReynoldsOnce the weekend was over we were booked to work with 2nd year PAs at the Riverside Campus at the University of Chester. They tasked us with delivering a whole range of skills. We went through all the systems exams from Musculo-skeletal, through Cardiovascular examinations and some challenging scenarios thrown in. One of our team also ran a breast examination station, giving the students an opportunity to practice important but often neglected skills, including feedback on their technique from the associate clinical educator.

After two days of teaching in Chester we were back on the road the next day day to Wolverhampton University, working on an OSCE with my old colleague and the developer of the ACE role, Professor Jim Parle and the PA Course Clinical Lead Pete Gorman.  Despite the obvious restrictions placed on us due to Covid-19, we were still able to perform at a high level.

Meducate were represented by two roleplayers on the day and the feedback was excellent.

This week has seen us travelling back up to Chester for a mock OSCE with 1st year PAs. We were tasked with providing two ACEs and also with the filming of one of the history stations. This presented us with its own challenges. We are fortunate in having some new cameras, lights and sound equipment, which proved their worth on the day. The quality of the video was excellent and Chester are thinking of using this set up as a regular feature of their training programme. It is a great way for students to check on their own progress and has the added bonus of being available for them to access during their revision.

It is great to get back to working with students once more, and for many the Covid-19 crisis has been problematic.

At Meducate Academy we used this time to create opportunities and we are glad to say that we have been having our most successful year yet.

I also spent some time chatting to one of our most senior ACEs and role players Mark Reynolds, and he offered to pen a few words about how much he enjoys his role working with Meducate Academy.

Mark has been involved in Medical Role Play and ACE work for over twelve years and he is also a great facilitator.

“I have been pleased to be part of the Meducate team since day one and hope that my input in those early days helped the company to shape the way forward.

Meducate is really up and running now and we are currently enjoying working for the Universities of Chester and Wolverhampton on their Physician Associate Programmes, as well as working on pre-national PA OSCE courses for Matrix Education.

ACE Mark Reynolds
Mark Reynolds

The role of the Associate Clinical Educator is something I have been identified with since 2008. My background in performance helped me to become an effective educator and I enjoy so much teaching clinical communication skills and body system examinations. I believe that it is very important in life to seek a role that makes a difference. I can see when my colleagues and I are working with PA students that we are making a difference to their learning; helping them to improve their communication and examination skills and most importantly, helping them to reach that point where they pass their formative and summative OSCEs.

I’m proud to be an ACE, indeed I’m one of the longest serving ones in the UK, and it’s a lot of fun working with these students and my colleagues too. When you’re having fun and being paid, life doesn’t get any better than that.”

Mark Reynolds

RECRUITMENT OPPORTUNITIES

If you are an Actor / Roleplayer who wishes to train as an Associate Clinical educator please get in touch with Matthew Chapman at Meducate Academy. We will be offering Free Training Courses in the coming months, to help you realise this ambition.

Interview With James Ennis, Clinical Director (PA Program) At Chester University

Image of Bob ACE working with a group of physician associate students at a recent training course
Bob working as an ACE with a group of PA students at a recent training course giving feedback to students is a vital part of the ACEs role.

One of the greatest innovations the computer age has brought us is the opportunity for anyone to set up a podcast. Podcasts are great to watch or listen to when you are on the move and allow you to get information quickly from a variety of sources. We at Meducate have embraced that technology and are now producing a series of podcasts on Medical Roleplay and Associate Clinical Education (ACE). We will be talking to clinicians and simulated patients and, in some cases students, about their experience of working with us.

Image of Clinical Director (PA Program) at Chester University
James Ennis Course Director University Of Chester

Last week I interviewed James Ennis, Clinical Director of the Physician Associate Program at Chester University, who I have had a working relationship with for over 10 years.

You can listen to the podcast here, but I thought it would be good to give a very abbreviated version as a blog post for those who don’t have the time to listen.

BOB: Welcome to the Podcast, James.  First of all, thanks for coming on and agreeing to do this. I know you are very busy dealing with a multitude of challenges at the moment, but I’d like to get your view on what it’s like to work with medical role players and ACEs in this ever changing environment.

JAMES:  Thanks, Bob. It’s a pleasure to talk to you about this subject and get it out to a wider audience. As you know I’ve been working with Associate Clinical Educators and role players for the best part of 10 years and we’ve always had them within our curriculum both at Birmingham University and now at Chester. I think it’s an important aspect to medical education, and the feedback we receive from students about the experience is always exceptional. I’ve never once had negative feedback from a student regarding clinical educators or role players because of their ability to help the students relax and also give them constructive feedback about both their physical examination skills and their communication skills. It’s often the case that students can feel more anxiety when working with an academic clinician than with an external educator such as an ACE.

BOB: Yes, I’ve noticed how much more relaxed the students are with us and I guess it’s because we come in at their level in many ways and with our knowledge of systems examinations we can help them practice their techniques quickly and effectively without recourse to in-depth academic analysis. It’s hands on without too much theory, which a lot of students crave.

They really enjoy the hands-on skills we help them with, and even simple techniques like palpation and percussion are keenly rehearsed with us over and over. Sometimes it’s the simplest things that can cause the most confusion and we are there to hold their hands, as it were.

I was obviously trained by Clinicians like yourself, but the students often comment on how knowledgeable we are in terms of our understanding of the examination process. We are also able to tell whether the student is gaining rapport with the patient and handling the patient in a respectful way. That and of course our extensive understanding on what is expected in OSCE’s.

As an ACE and role player, I and my colleagues must have been through 1000s of OSCE stations in our time. We have a good idea what an examiner is looking for, and this gives us a lot of credibility when students ask about OSCEs. It’s one of their big concerns, and having this knowledge helps us build trust with the students.

JAMES: Yes, I’ve noticed that when we work with you guys, you have this knack of reading the whole situation and responding appropriately. The fact that you have background knowledge of history taking and Systems Examinations, as well as a clear understanding as to what’s required in the OSCEs, has been tremendous in improving the students ability to, not just pass exams but turn out as very good, very safe clinicians. The feedback you guys give about excessive use of jargon is also important and can sometimes be missed by volunteer patients, for example.

Consulting with simulated patients when it might be called upon for them to perform intimate examinations, are made so much easier when working with an experienced ACE. That ability to help the student keep their sense of humour and deal effectively in a relaxed manner in what could be a very embarrassing situation.

Like I said you guys are an  invaluable resource. I don’t know how you how you found it over the years, but I think it’s grown into something far more meaningful than we ever thought it would be.

BOB: Obviously you have embraced the idea of using ACEs as part of your teaching methodology and you find them of great value in consolidating the students learning. Yet, there are only a few institutions that utilise our skills. Chester, Wolverhampton and Birmingham are the three I know of. Why do you think ACEs have not been used elsewhere, bearing in mind the high value you place on them?

JAMES: Ultimately if we’re going to be completely honest, I think a lot of it comes down to money and resources and availability, which is a real shame, because as we know working with ACEs really embellish and enrich the student experience, and we have both alluded to the fact that ultimately students retain information and learn faster when examining real people. People who can give extensive feedback in a structured way and link that to the real world. We were even talking about getting the ACE role validated, which I know you have been a keen advocate of. That would be icing on the cake as it were.

BOB: Yes, I for one would be very keen to have the role validated. I think academics would take us more seriously and once they had experienced working with an ACE, would then realise the value and they would then add is to their program.

JAMES:  Absolutely. We’ve spoken about this in the past and I think it needs to be a requirement and there is an important need to have some accreditation process or some monitoring, because it is actually a very robust system.

Academics who have not experienced working with an ACE might not be aware of the amount of training that goes into being an effective ACE, and I have seen the type of preparation ACEs go through, both as individuals and as part of the team. That’s the other aspect that needs to be mentioned. When you work with us at Chester, you really are seen as part of the team and are treated as such.

BOB: Yes, that’s true. We feel valued as much as other external educators, and we do appreciate it. It makes for a smooth working relationship and I think the students notice this too.

The recent Pandemic must have posed challenges for you as an educator and I know it has affected the amount of work we have had. Some Institutions were up and running, but most seemed to struggle with embracing the new idea of working online. What was your experience like?

JAMES:  Yeah, that’s a good question, actually. Obviously, we have had to change our approach to clinical practise and there have been significant changes in general practise in the community. We have had to work with video conferencing, telephone triage and consultations and we have found new ways to use these technologies with you guys at Meducate.

In fact, you were up and running as soon as the lockdown happened. This was great news for us, as we could use your services almost immediately and the skill and depth of understanding you brought to this new way of working was refreshing. Everything ran like clockwork. I can only say thanks and say that for those reading this Meducate can provide you with an excellent and very professional service.

***

I would like to thank James for giving permission to abbreviate our podcast and in future posts will include more interviews with clinicians as well as ACEs and students.

Associate Clinical Educators On Film At Chester University

Course Director James Ennis performing a knee examination on ACE Bob
ACE Bob works closely with Course Director James Ennis whilst performing a knee examination for a training video at Chester University

It’s true to say that during the Covid – 19 crises our services have not been required as much as normal. Whilst many institutions seem to be struggling to embrace online teaching some have risen to the challenge and hit the ground running. We have been fortunate however, working with both Wolverhampton and Chester Universities on their PA Programs. This is great news as it helps keep our skillsets sharp and allows us the opportunity to embrace this new way of working.

Teaching online does have its challenges but I find it as easy as if we were working face to face with students in a classroom. The feedback we have received from students has been excellent and this gives us confidence that what we are doing is hitting the mark.

Working with students directly, and in particular with Physical examinations, has not yet been possible due to social distancing. This will change soon with September seeing us back in the driving seat working as ACEs.

James Ennis and Mark (ACE) preparing for a Lower Limb Neurology Examination that is being recorded for training purposes
Experienced ACE Mark assists James Ennis (Course Director Chester University) in performing a Lower Limb Neurology Examination

Many ACEs and role players are also trained actors which obviously ensures that scenarios are realistic and believable. We often get feedback from students saying how “real” they felt the interaction was, and because of our varied skillsets we often get asked to make training videos. These, more often than not, see us in consultations with us acting as patients, who might have challenging behaviours, as well as physical conditions and a comprehensive history.

Last week, we had a opportunity work with the Chester University PA Program when we were asked to take part in a filming session for James Ennis the Clinical Director at Chester University. We were tasked with developing a training video demonstrating a variety of typical Musculo-Skeletal Examinations (MSK).

We have been trained in clinical MSK examinations over 10 years ago by Professor Edward Davies (Consultant Surgeon) and Andy Emms (Consultant Physiotherapist) of the Royal Orthopaedic Hospital in Birmingham. This means that our level of skill and knowledge of how to prepare the students to perform these examinations is text book.

We often help prepare PA students and 4th Year Medical Students when working for The University of Birmingham Medical School in MSK examinations and this has sharpened our skills. This experience has been invaluable to our education as an ACE, as well as us being able to take advantage of online resources that are readily available if you know where to look.

The requirement was for us to go through complete Hip, Knee, Shoulder and Lumber Spine examinations, which also included Upper and Lower Limb Neurological exams.

With the help of Scott Howard from simulation, we managed to film all of the sequences and we look forward to seeing them being used by all those on the PA program in the near future. What made it even more useful was that we were able to review our knowledge base, and have an opportunity to practice skills we have not used for 4 months. It was a win-win situation!

I was assisted as always by my travelling companion Mark, who made the journey up to Chester pass by in the wink of an eye.

If you want to find out more about the role of the ACE and how we can help your students improve their technique, contact is at Meducate Academy.