R Spour | Associate Clinical Educators

Associated Clinical Educators & Simulated Patients In Medical Education

December 19, 2022October 31, 2022 by R Spour

Physician Associate students being taught by academic on a medical scenario using an associate clinical educator in the role of a patient — Physician Associate students were guided through an end-of-life scenario at Chester University

I want to answer a question I am regularly asked by academics, clinicians, students and other medical roleplayers: “How does an ACE differ from a medical roleplayer, a simulated patient and a volunteer patient?”

The following information draws on our 25 years of collective experience as medical roleplayers and ACEs. We have years of interaction with simulated patients, volunteers and medical roleplayers.

Let us start with volunteers.

In our experience, a volunteer is someone who offers their services to give something back to the NHS for free. They have little or no training and often have to use crib sheets to help them act like a patient for students. Whilst volunteers are of some value to the student, they are not trained or qualified to give constructive feedback on the techniques the student needs to learn.

A simulated patient is someone who acts as if they have a pathology, or uses their actual pathology, with a short backstory they must learn. They have not been trained to give specific feedback to the student about the techniques the students are employing. Simulated patients may be asked for feedback by the teaching team on how the student made them feel during the session. However, this information is fed back to the student by the training team, not by the simulated patient. During the session, the teaching staff will monitor student/patient interaction.

The Medical Role player on the other hand is someone who is usually a trained actor and has undergone some training with regard to communication skills. They are expected to give high-quality objective feedback from a third-person perspective to the student. They can, and often come out of their role to give instruction about how the student can improve their performance and increase empathy with the patient. They work on everything from a simple consultation (history taking) to playing difficult patients, challenging behaviours, suicide and mental health scenarios, as well as working with colleagues from other health professions. They will also play the role of consultants, doctors, nurses and paramedics when needed.

The Associate Clinical Educator (ACE) is a type of medical roleplayer who is exemplified by their in-depth knowledge of the various body systems and pathologies. The ACE is responsible for developing and delivering educational programs that utilize simulated patients and medical role-players. The ACE takes a comprehensive approach to develop these programs, ensuring that each program is designed to meet the specific needs of the learners.

The Associate Clinical Educator (ACE) takes the models of the simulated patient and medical role-player to a different level. Exemplified by in-depth knowledge of the various body systems and their pathologies. A medical roleplayer is an individual who is trained to simulate different medical scenarios in order to help students learn how to interact with patients. These scenarios can include breaking bad news, dealing with difficult patients, and end-of-life scenarios. The role-player is expected to provide objective feedback to the student on how they interacted with the patient, from the patient’s point of view. In order to do this, the role-player must have a basic understanding of communication training and be able to help the student improve their communication skills.

ACEs are highly trained professionals themselves, but also have in-depth knowledge of the various body systems and their pathologies. This makes them uniquely suited to running simulations that are as realistic as possible. This helps medical staff to be as prepared as possible for when they need to use these procedures in real-life situations.

Evidence of a mix of styles, from volunteers, experienced role players and ACEs, was exemplified by the work we did for Chester University at a recent training session with the first and second-year Physician Associate Students. These students worked alongside nursing staff and social workers in an immersive exercise designed to allow the students the opportunity to work under the pressure of a simulated patient journey. The simulation suites were designed to replicate two busy hospital wards. In the simulation, there were patients presenting with dementia, alcohol dependency, gastrointestinal and cardiac problems, as well as the challenge of working with other health professionals.

The students were supervised by experienced members of the academic staff and the at the end of the simulation the students were given feedback by both the clinicians and the associate clinical educators.

If you are a clinician who would like your current group of Physician Associates to benefit from our expertise in medical simulation, get in touch with us now. Please contact: bobspour@meducateacademy.com.

A Week In The Life Of An Associate Clinical Educator

October 31, 2022September 30, 2022 by R Spour

Clinical-Lead-James-Ennis-teaches-the-finer-points-of-systems-examination — Mark and Helen of Meducate Academy listen in as Clinical Lead James Ennis teaches the finer points of systems examination.

It’s always busy at Meducate Academy and some weeks are busier than others, but what is it an ACE does? What’s a typical week in the life of an ACE? It’s a question I often get asked by students and role-players and friends alike.

To answer that question I thought I’d keep a diary of a typical week and hopefully answer those questions. It might also help those medical role-players gain some insight as to whether they want to take the next step and start training to become an ACE and take their abilities to the next level.

So let’s take a look at a typical week.

The week started as it usually does with checking emails and messages that might be left on social media. LinkedIn seems to be the best one for keeping in touch with colleagues at institutions around the country and abroad.

Once that’s out of the way, I will usually look at some scenarios and teaching sessions that may be on the timetable that week. It always pays to prepare for some of the more technical sessions we are involved in. Cranial nerves examinations, for some reason, seem to scare ACEs as much as it does the students, but because I’ve been working as an ACE for over 12 years, I don’t find this as daunting.

The week we are looking at was varied and included respiratory, cardio and a brief session on Gastro Intestinal examinations.

As the students were first-year Physician Associates, it was important that I also understood what was required of me by the clinicians. Every clinician has their way of carrying out these types of examinations, and it’s important that we, as ACEs, ensure that we are all singing from the same hymn sheet.

Experienced clinicians often take shortcuts in clinical practice when examining a patient. This is because they have many years of experience working in medicine. Students are often confused by this approach particularly because the methodology used in training is far more detailed.

My experience working as an ACE, has made me realise that students frequently get confused about this approach and what is required of them in terms of how they should examine a patient effectively, efficiently and safely.

ACE-Greg-Hobbs-answering-questions-from-1st-Year-Physician-Associates — ACE Greg Hobbs answering questions from 1st Year Physician Associates

I always use the driving test as an analogy. When we learn to drive, we have to be meticulous about every detail, and every nuance and develop the technique of driving until we have unconscious competence. Only then, once we have passed the test and thrown away the L plates do we learn to drive efficiently. Some things we needed to do to pass the driving test are no longer useful to us, so they’re discarded. It’s almost the same process as learning physical examinations. Once we have explained this to the students it becomes obvious why they have to learn a systems exam in such detail. When they have finally qualified this methodology shows its potential.

As an ACE, I always explain that my job is to guide them through the processes involved that will allow them to demonstrate in an OSCE just how competent they are examining one system at a time.

Once they move into the second year, the distinction blurs. Patients often have more than one pathology, so if a patient turns up with shortness of breath, there might be several causes. This is when the student thinks of the patient holistically and not as just one body system.

During this particular week, I had been asked to take 2nd years through a very brief, but focused, cardio and respiratory examination. This meant they had to start thinking logically and clinically about how to examine the patient, both from a respiratory and a cardiovascular perspective. Blending two systems examinations effectively is difficult. Teaching in this way is very rewarding, not just for the student but for the ACE. We also have to think about how best to teach these skills to the student.

The first-year students we taught this week were practising the Cardio examination and having to do it to the clock. As OSCEs are always timed, the students also have to deal with time pressure. A typical OSCE is 2 minutes of reading time and 8 minutes in the room with a patient and an examiner. In that 8 minutes, they only have 7 minutes to examine and 1 minute to give a management plan. The ACE needs to be aware of the acronym SBAR (Situation, Background, Assessment and Recommendations).

Working like this can be stressful for the student, and part of our role is to keep the student motivated and confident: teaching and therapy all in one.

Prof Jim Parle looks on as Meducate Aacademy ACEs demonstrate their knowledge of the hand examination — We take accreditation seriously. Prof Jim Parle looks on as ACEs demonstrate their knowledge of the hand examination

The sessions above took place over two days with Physician Associate students. Later in the week, I worked alongside GPs in collaboration with Orthopathways. A medical training company developing new software to aid GPs in diagnosing and the treatment of MSK pathologies. I was playing the role of a patient with different pathologies and then giving feedback to the GP. I worked with twenty GPs during that month, and I look forward to continuing working with them again.

The week concluded with teaching history taking and communication skills to 1st-year students. An essential skill for any health professional and particularly important for Medical Students and Physician Associates. All ACEs have to have had some training in Medical Roleplay before they can become an ACE.

The above is an example of a busy week. Sometimes it is quieter due to holidays and students going out on placement. These are the times I employ to ensure that my skill set is still high by taking advantage of reading books on the subject and looking at online resources.

I have learned to be cautious of making assumptions about what is expected of the ACE. We need to be flexible about the programmes institutions run, as their teaching methodologies can vary. Each institution has its approach to the teaching of medicine, and the ACE must be aware of these differences. ACEs must keep up to date with the latest teaching methodologies that medical schools currently employ. It pays to get hold of the teaching materials the staff use at these institutions. These will assist you when working with the students.

For those of you who might wish to embark upon this career as an ACE, get in touch with us now. Please contact: bobspour@meducateacademy.com.

Meducate Academy: Building New Initiatives For The Physician Associate In GP Practice

October 2, 2022August 31, 2022 by R Spour

Meducate Academy has recently been involved with building a new initiative in collaboration with a GP Practice and health authority in the South of England. There has been much talk of building PA Academies around the UK and Meducate Academy have now put a package together from the ground up to help any organisation interested in doing this.

At this point, I can’t give too many details but suffice to say it was an extensive project, and we had to gather all of our resources to make it possible.

From administration to clinical teaching, from simulation to accreditation, and from recruitment to installation, we have finally put together what we think is the complete package for newly qualified Physician Associates who have got their first job.

It’s often been the case that once a PA has finished their studies and got themselves a job that things will go well. However, the feedback we have been getting is that this is not normally the case and that new PAs feel like they’re a little unprepared for moving into the workplace. It’s true to say that the employer often doesn’t have the time or resources to help and that’s where the PA Academy can fit in.

This involves some help from the employer (GP Surgery for example ) where they will release the PA one day a week for an initial period and then learn skills at the academy that will help them function at a higher level once in the workplace.

We include an example of what we have been working on below:

The Proposal

Meducate Academy will:

Format the proposed timetable for over 36 weeks.

Each session will last 3 hours and will involve the use of 2 Associate Clinical Educators (ACEs) and will cover the most common conditions encountered by Physician Associates in the first 3-6 months of working in a GP setting.

Produce an overall timetable outlining the basic schedule followed by a more in-depth breakdown of what we will teach to the PA in each session, including the learning outcomes for each session.

We will cover the following common conditions encountered by PAs in this type of setting which will include:

Chronic conditions

MSK

Diabetes

Contraception

HRT

ENT

Headaches and Dizziness

Co-Morbid Conditions

Triage

Telephone consultations

Note-taking/Referrals

We would also expect to discuss topics that might be in the public eye, such as changes in NICE Guidelines and Prescribing.

We will prepare this timetable in collaboration with Mr. James Ennis, Clinical Lead of the PA Programme at Chester University, who has over 10 years of experience working as a PA and as an academic teaching PAs.

Objectives

To create an Academy which will provide quality, continued professional development to PA Graduates in their first year of practice.

Achieve consistent 5-star ratings from GPs Practices and Graduates. These will be collated through several review platforms relating to the services offered through the Foundation Academy.

Aims

Create a syllabus of education that supports the PA in their first year in practice.

Develop a mentor/buddy system for each PA.

Create a feedback system that takes information from both GPs and PAs. This will allow for continuous development and improvements within the academy.

Seven Reasons for using Meducate Academy

1. References available from Senior Clinical Professionals.

2. Fully insured.

3. Supported by Prof Jim Parle and James Ennis Clinical Lead at Chester University Medical School.

4. Meducate Academy established in 2018

5. Created an Internal Accreditation and training programme for all the Associate Clinical Educators (ACE).

6. Create links with FPA and RCP regarding accrediting elements of the material for PA accessing CPD points.

7. Currently working alongside Orthopathways, assisting them in the development of software to help GP referral for MSK pathologies.

8. Intended affiliation with MSK groups such as Arthritis, UK.

Programme Outline

2 days in GP practice (or other)–Support offered–GP Educator

2 days at Foundation Academy–Support offered by GP Educators & ACEs (Associate Clinical Educators). This is based on 8 PAs in attendance. A typical day comprises 2 X 3 hr sessions.

Meducate Academy will create the syllabus. This will be signed off by the relevant clinicians. The syllabus will be based on information supplied by experienced Clinical Leads PAs and the attendees themselves.

We are currently conducting research based on the experiences of PAs who have been working in their chosen speciality for over 5 years. Results from which will help us determine the direction of the proposed course.

We will also collate feedback from the PA students who wish to attend the Academy. This approach will allow us to create a tailor-made programme comprising Student Directed Learning Modules (SDLM) ^TM.

Creation of a feedback loop for continuous improvement and development.

Regular Assessment of students every 3 months over the period of a 12-month timetable.

So, as you can see we have put a lot of effort into developing this model. Naturally, it will be subject to evaluation and ultimately evolution. If you are a clinician who thinks that this might help you with your current group of Physician Associates let us know. Please contact: bobspour@meducateacademy.com. We would love to have a chat and get some of your expert guidance.

Building Rapport and Maintaining Empathy In Challenging Scenarios

August 8, 2022July 27, 2022 by R Spour

Demonstrating the role of the ACE to a group of 1st and 2nd year Physician Associates

Meducate Academy were recently invited down to The Drummond Education Centre West Suffolk Hospital to demonstrate the role of the ACE to a group of 1st and 2nd year Physician Associates. The vast majority of the day was spent taking the students through systems examination techniques. Many of the students requested that we discuss techniques dealing with challenging patients, building rapport and maintaining empathy under stressful conditions.

During my time as an ACE, I inevitably get asked these types of questions from both students and novice ACEs. Questions usually focus on:

How do I deal with an angry patient?
How do I deal with contentious issues?
How do I deal with upset patients?
How do I break bad news empathetically?

Although each situation may present with its own problems, there are a few rules you can abide by which will help achieve the desired outcome.

When we talk about communication, the phrase that always crops up is:

“How do I build rapport and create empathy in a challenging scenario?”

Sometimes, when you are under pressure to deal with (for example) an aggressive, angry patient, it’s not so easy. Stress will cloud your judgement, you will doubt your ability to communicate effectively. You may panic, or at worst display anger of your own!

The first thing you should do is acknowledge the person’s situation. Acknowledge how they are feeling. Begin by asking them for more information about the source of their anger and then listen! If they use words like angry, frustration, annoyed, upset, use their words when replying to them, for example:

“I can see that you are angry.”

“I can see that you are frustrated… How can I help?”

Do not interrupt the patient. Wait for a natural space that they will create. Recognise how they feel without judgement. You must then explore the situation that has caused the anger, the frustration. Get them to define and clarify what they mean when they say they are frustrated.

Listen – Listen – Listen.

Whilst you are listening, use minimal encouragers. These are little verbal or non-verbal cues to show the patient that you are listening. For example:

Nodding of the head.

Saying, “Mmmm.”

Saying, “Go on, or yes.”

When I say listen, you must actively listen and not wait for the patient to stop talking, so that you can throw in a question that has no relevance to the patient’s current situation.

New students have a list of things they must ask the patient. SOCRATES is one of them and of course there is ICE (Ideas, Concerns, Expectations). Whilst these are important to complete a consultation, use them in the context of the situation. This is a conversation, not a battle or a debate. Become a partner in the interaction.

Once you have found out what the source of the problem is, it is time to restate what the patient has said. You could even say: “Is that everything?” Restate what they have said and get acknowledgement. You are now both talking on the same page and you can now help them come to some sort of closure. You are thereby maintaining rapport.

During any heated conversation, you must think about your body language. Do not be too defensive in the way you are sitting or standing. To a certain degree, you need to mirror some of their nonverbal language. If they are in an open posture, keep yours as open as possible. If their arms are crossed, cross your hands or maybe your legs. This is called micro-mirroring and is less obvious to the patient.

You may also notice that some patients use words that sound visual, auditory or kinesthetic. It’s important to listen for these types of words. Below are some examples of sensory language or phrases that are commonly used.

The patient might use words or phrases that describe their experience visually:

“It’s clear to me.”
“I see where we are going.”
“The future is bright.”
“Look at it this way.”

They might however talk about:

“Getting to grips with the situation.”
“Trying to get a handle on things.”

These are kinesthetic statements and again you must learn to listen for them and use similar types of language in your reply.

Finally, we have the auditory pattern:

“I hear what you’re saying.”
“You are not listening to me.”
“Does that click for you?”

Often, people will use one or more of these sensory based patterns when speaking. Mirror some of these patterns and you are on the way to creating trust and rapport. Using the patient’s verbal and nonverbal language is a powerful way to build trust and hence come to an agreement.

Finally, never jump in mid-sentence when your partner is speaking. Keep listening and if the patient pauses, wait a little longer as they may be reflecting on what they have said. I often tell a student to bite their tongue and count to five before speaking. Give the patient time.

It is your responsibility to find out what the patient is trying to say. If you don’t understand what the patient means, ask them, for example:

“Would you explain what you meant by that?”

“I’m sorry, that’s unclear. I’m not sure what you said. Can you help me understand?”

If you are a student PA reading this, use these ideas to generate powerful, meaningful conversations with your patients. If you are an ACE, these techniques are the tools of your trade, so it’s your responsibility to be aware of them. You need to help a PA student to recognise them too.

If you are a Clinical Educator and would like to take advantage of using ACEs as part of your clinical teaching, book now for a free consultation. Contact us via the form below or give us a call on 07870611850. Thanks again for reading this post.

Meducate Academy On The Physician Associate Podcast

June 30, 2022June 24, 2022 by R Spour

The Meducate Team and their Assessors at The University of Wolverhampton

Those that follow us on social media will also know that we were interviewed by James Catton of The Physician Associate Podcast. We had a great time answering his many questions, and it also gave us the opportunity to let a wider audience hear just what an ACE is and does. There are many misconceptions about our role and it’s important that we are not seen as just a body to practice on, but a highly trained expert patient, able to give accurate feedback to students whilst performing a physical systems examination. We chatted at length about the origins of the role, where we are today with the role, and what the future has in store. The future, of course, will see us producing a robust assessment process for the role of Associate Clinical Educator. This is something Bob has had a personal interest in for years. More of this later on in this post!

Exciting times continue for Meducate Academy with the development of some innovative and fresh approaches to medical simulation, including a top secret Meducate partnership in the pipeline. Sadly, we cannot talk about this until the research phase is complete. However, we can say it has something to do with our high level of skill in delivering MSK teaching modules.

Bob and the team have continued to build relationships with Chester University Medical School, which includes working as a visiting lecturer interviewing potential candidates for the medical degree that starts there in September of this year. This started a couple of months ago when Bob was invited to observe the process and then being asked to act as facilitator at the communications station, working with one of the medical role players.

One other development with The University of Chester was working as an ACE teaching alongside James Ennis and Dr Gareth Nye (Lead BmedSci course Chester), with medical scientists on history taking in the morning. The afternoon saw them demonstrating the physical skills required when performing a cardio-vascular examination, with the students taking an active part. It became apparent to the students how important taking a history was to finding a diagnosis. The students, who had no experience of this methodology found it fascinating and were highly engaged throughout the day.

The students also had the opportunity to get ‘hands on’ with Bob and learn more about taking a blood pressure, palpating pulses and running through a basic cardio exam. A few asked about taking this further as post graduates and possibly joining the Physician Associate programme at Chester. It sort of turned into a recruiting drive! Later on in the month, we ran the same course at Chester University Shrewsbury Campus. Again, the students showed a real flare for hands on medicine rather simply working in the laboratory.

Meducate Academy also specialises in GTA and MTA teaching (Gynaecological Training Associate and Male Teaching Associate). For the uninitiated, these are ACEs who are trained in intimate exams such as gynaecological, breast, testicular and prostate examinations. The ACEs who teach in this field are highly specialised and work alongside experienced clinicians. Student feedback is always excellent once they get over the initial embarrassment and nervousness around this subject. It’s a valuable session for students and is the next step up from working with mannequins.

Members of the Meducate Academy Team in their official polo shirts

The keen eyed amongst you may also notice that we now have a uniform (of sorts). The new dress code includes a polo shirt with embroidered company logo and name tag. This helps the students identify the ACE they are working with so they can provide feedback and also gives a clear impression that they are working with a team of professionals.

Meducate Academy have also started training volunteers at the Royal Orthopedic Hospital in Birmingham, who give up their time to help 4th and 3rd year medical students from the University of Birmingham and Aston learn the correct approach to MSK examinations. This was a great opportunity to show our skills and knowledge to the clinicians assisting us.

As mentioned previously, we have been involved in creating a robust system of assessment for our ACEs. On Saturday 28th May 2022 we brought together eleven of our team and with the help of Professor Jim Parle, ran a pilot of the assessment process. This gave us an opportunity to test run the marking scheme that Jim and Bob had previously created. The ACEs were expected to demonstrate a high degree of skill in teaching and demonstrating their knowledge of the various body systems. This could never have happened if it wasn’t for the help of Clinical Lead Teresa Dowsing and the use of the University of Wolverhampton’s clinical skills suite. We ran the assessment very much like an OSCE with the ACEs core skills being put under scrutiny and the marking being overseen by Professor Parle. Many lessons were learned during the session and we are currently reviewing feedback from the ACEs.

ACE Accreditation is something Bob has been passionate about for almost ten years and he has been working tirelessly behind the scenes to get organised.

“Having Jim Parle on board is vital, as he has years of experience assessing both medical students and Physician Associates. He spent some years as the National Examiner for the PA course and, of course, was one of the creators of the PA programme in the UK.”

Next month will see Meducate Academy taking their show on the road. We will be doing workshops for The University of Newcastle on 15th July 2022. We will also be running a workshop at The Education Centre, West Suffolk Hospital, Hardwick Lane, Bury St Edmunds with ARU and UEA in attendance on 26th July 2022. These workshops are open to all PA students who attend the universities mentioned.

Keep your eyes open for the next post which will be looking at:

How students can use effective questioning techniques to elicit information from difficult patients,
Why students fail to ask the questions they should to help with a diagnosis.
How to get patients to answer your questions even if they are resistant.
7 techniques for creating questions that get to the core of the problem.

If you want to hear more about the type of work that Meducate Academy is involved in please listen to our interview on the Physician Associate Podcast.

Physician Associate Podcast with Meducate Academy

How To Pass The OSCE On Purpose

June 10, 2022May 18, 2022 by R Spour

Associate Clinical Educator Bob of Meducate Academy and a cohort of PA Students — Associate Clinical Educator Bob working with a cohort of PA Students at Chester University

For many years I’ve worked with thousands of students in medical schools and institutions teaching specifically on the physician associate programme at Wolverhampton and Chester University. It’s been a highly satisfying job and allows me to do what I love more than anything and that is to teach students! One of the major concerns students have are about passing their OSCEs. From the day their course starts to the day of their exams the conversation inevitably centres around one topic: The dreaded OSCEs.

OSCE is an acronym that has become linked to insecurity and fear, most of which is unfounded. These fears and insecurities are prevalent with most PA students wherever I am teaching. The common questions I get asked are:

“What’s going to happen in the OSCE?”

“What happens if I fail the OSCE?”

“Are they going to try and catch me out in the OSCE?”

“I get really nervous before any exam and never do well.”

It’s all students think and talk about to colleagues and friends. It seems to be the main topic of conversation whenever I talk to students. I often tell the students, why not focus this emotional energy and time on the coursework itself. These negative types of conversations can only produce one outcome; that all involved in this unproductive dialogue will scare each other to death. Instead, I get them to imagine using that intensity of focus on doing what they need to do to pass the exams, rather than fretting, worrying and talking to other students who also feel the same way.

These negative thoughts and ideas about the OSCEs are after all just assumptions based on ignorance. Ignorance inevitably leads to the imagination running riot and before you know it you have prepared yourself to fail the exam. Talk of OSCE fears inevitably start in week one of the first term, two years before the actual national exams. What a waste of time and energy.

When I talk to these students (usually in their 1^st year) I ask them,“What made them choose the PA Programme. What made them want to be a Physician Associate? What is it about the PA Programme that excites them? Does it excite them?” In other words, I ask them if they know their purpose in becoming a PA?

“Why are you doing this course?”

“What will you get out of becoming a physician associate?”

“What is your purpose?”

Their usual response when asked these questions is to get confused and talk about setting goals and passing the exams. A few will say it’s what they have always wanted to do. A minority will say that their purpose is to care for people and see themselves as a compassionate person. This is what drives them each day. Now that sounds like someone who understands their purpose in life.

I knew one PA many years ago who shared his thoughts with me after a session and he had just this mindset. He said when he was a student and thought about the OSCEs it got him excited, not afraid. He looked forward to the OSCEs because this meant he was getting nearer to his goal of fulfilling his purpose which was to help others. Incidentally, he passed all 14 stations in the National Exams later that year. He knew what his purpose was and kept that in mind every day. Yes, he was nervous before the exams, but he had developed a strategy for dealing with those emotions. More of that later.

Once you have defined your purpose, you now need to review it every day and get yourself excited about achieving the goal of becoming a PA. If you stay on purpose you will achieve your goals both short and long term. But remember a goal without purpose will be short-lived.

This is a strategy I have always used and it helps keep me focused. I know why I am doing what I am doing and I know I will reap the rewards. I have never been goal oriented only purpose driven and yet I seem to achieve my goals.

Another technique I encourage students to practice is to add a sensory component to their thoughts when they think about their approach to the PA course. For example:

“How will it look when you are working as a PA?” (Visual component)

“How will it feel when you are doing the job you were born too do?” (Kinesthetic component)

“Imagine how it will sound when you proudly tell people you are a Physician Associate”, (Auditory component)

Employing your imagination and thinking like this changes your mindset so that you stay focused on your purpose. You have already been doing this when you have spoken negatively about the OSCEs. You know how to do this, but have been using your imagination to work against you and not for you. Use your brain for a positive change, not a negative one!

When fellow students say things like:

“What happens if I fail the OSCEs?” I always re-frame it and say: “What happens if you pass the OSCEs? What would that look like and feel like in your minds eye?”

By staying focused on that feeling your energy will begin to change. You will approach each task with the knowledge that you are getting closer to living out your purpose.

Sometimes, it is true to say that you will encounter setbacks, when things don’t quite work out the way you wanted them. I call these badly formed outcomes. I don’t see them as a failure. These situations are often outside of your control and have been dictated by others. That’s OK. See these episodes as just feedback. That’s all. This approach allows you to stay focused on what’s important and not worry about being a failure. This just wastes emotional energy. Energy you can use in a more positive way.

A great way to re-programme your brain, so that you do more of the above, is to sit for 10-15 minutes a day in a quiet place. Focus on your purpose, imagining how you will feel when you finish the final station of the OSCEs and become a Physician Associate. You should timetable this in to your activity every day. It’s an OSCE meditation, if you like. It will be time well spent and as mindfulness is a big thing at the moment why not get in with the trend?

I’ve taught and used meditation long before it was fashionable, as well as taking part in physical exercise, both of which have helped me stay balanced and integrated and lead a pretty stress free life. So why not add those two beneficial activities to your diary every week to improve your mental and physical health. These activities will not only help you with work, but in all areas of you life.

I suggest you give both a try and 10-15 minutes of meditation every day will show you what state your mind is in. It will teach you how to ensure that you won’t be ambushed by the inevitable negative thoughts, internal dialogue and subsequent emotions when the acronym OSCE is mentioned!

When you sit in meditation for the first time, many thoughts will come into your awareness. Being a PA student you may encounter many negative reactions including thoughts about the OSCEs. Focus on those thoughts and then do the following:

Observe the emotion, the reaction and see it for what it is. Just a creation of your mind. Just a sensation in the body.
Then Let It Go. That’s right,just release it and watch it vanish. A student once said to me what happens when this train of thought arises? I said, “Do not get on the train”. “Let it Go. Let it leave the station”. She said she waved it off, smiled and felt relief.
Once you have Let Go of the thought, any inevitable knee jerk reaction you would normally experience will stop. Allowing you time to …
Be in the moment and come back to focusing on your purpose. These techniques will help you to become more mindful of your mental states, and you can practice this awareness which will carry over into your daily life.

It is a great technique for improving your overall mental health too. It helps you remain balanced and integrated in the other aspects of your life. Do it for a week and see how you feel!

This doesn’t mean you wont be influenced by those around you though. They will still attempt to discuss their failings with you but this time stay focused and listen politely with out getting dragged into the conversation. I have a technique to deal with that to and I’ll share it now.

When the negativity starts to flow from others around me and they don’t want to listen for an alternative, I have a delete button. Yes a delete button in my head. I use it quite a lot actually. Mainly if I listen to the news. But seriously, it can be a powerful tool and a great strategy that will help you stay on track. Just use it for a week and see what happens.

It turns out that this is what successful people seem to do most of the time. Some of the most successful people have not listened to the naysayers and the critics. They stay on purpose until they achieve what it is they are looking for. If you become one of them you become an optimist. Optimists always seem to get things done. They don’t always succeed on the first attempt, but optimism keeps them going. There is always a silver lining to every cloud and a light at the end of the tunnel for an optimist.

By putting yourself in this mindset you are as the saying goes, “living in the moment”, but with an optimistic eye on the future. The only alternative is of course to do what you are probably doing already:

Thinking about how tough the OSCE will be and how badly you are going to do.

Filling your head with self-doubt and negative internal chatter.

Deciding ahead of time how you are more than likely going to fail a station or two.

If you’re doing that, use the delete button or turn the volume down! Drown out the internal dialogue by reminding yourself of your purpose, and asking yourself every day as to just why you want the job of a Physician Associate.

If you want to learn more about some of these strategies and techniques Bob will be running an online seminar on 23rd July 2022 at 12pm until 2pm explaining in detail how to put these techniques into daily practice. Once you’ve signed up for the course you will receive a downloadable handbook on how to improve your mental health.

When you enroll on the course please send your questions to Bob in confidence and he will address those issues during the online seminar. The cost, including the manual, is only £9.99 paid via PayPal.

He is also available to do 121 coaching for any students who feel they need a little bit of personal help. Contact him on 07870 611850 to arrange private Zoom meeting.

Meducate Academy – Five Years Of Providing Student Centered Medical Simulation

June 26, 2022April 29, 2022 by R Spour

Meducate Academy has been providing student centered educational services now for five years. Five exciting years of ups and downs but mostly ups!

When we established the Academy in 2017 the world was a very different place, pre-Covid, when every thing looked brighter. We had established ourselves with two growing University departments. Wolverhampton had only just recommenced their Physician Associate Programme under the leadership of Gill Conde and Pete Gorman. It was going from strength to strength.

Meducate Academy ACES at The University of Chester Medical School — Meducate Academy hard at work at The University of Chester Medical School

Chester University was also using our Associate Clinical Educators across their programme under the guidance of their new Clinical Lead James Ennis. Things were going well and growing rapidly. Who could have guessed what would happen next.

The Pandemic came as something of a surprise to everyone and things started slowing down for most educational institutions. Some closed their doors and didn’t start up again until twelve months had passed and things for us looked bleak.

Simulation means being in front of students. Face to face interaction and hands on physical examinations which were the norm had all but ended for everyone.

Undaunted, we took the bull by the horns and started working online with history taking skills, and even had an attempt to run a pilot of online OSCEs. It was a creative time for us and our partners, and we learned a lot during that period. We adapted and improvised and came up with innovative new ways of teaching online and used a variety of different technologies to further our cause.

Once restrictions began to lift we were back to work but this time in full PPE, taking the students through the preparatory work on systems examinations in preparation for their OSCEs; and it worked. Students were keen to get back into the sessions and Chester and Wolverhampton Universities led the way. Whilst other Institutions were using mannequins, we were back at it. Cardio, respiratory, G.I. Cranial nerves, Neurological, and of course MSK examinations were being practiced almost as normal.

Teaching and support for the students was second to none and we were able to carry on almost as normal. It was for us a good time and now that the situations is getting back to normality we are being approached by a number of institutions to supply Associate Clinical Educators on their Programmes.

In the above video we listen to Bob (Founder and Director of Meducate Academy) and Senior ACE™ Mark Reynolds about what’s been happening and how Meducate Academy is shaping up for the next 5 years.

If you are a Clinical Educator and would like to take advantage of using ACEs as part of your clinical teaching, book now for a free consultation. Contact us via the form below or give us a call on 07870611850. Thanks again for reading this post.

Diversity & Confidence Building In Medical Simulation

May 12, 2022March 31, 2022 by R Spour

The past month has been frantic! Both of our partners (Wolverhampton and Chester University) have kept us busy with both their 1st and 2nd year cohorts. We have sent teams of ACEs out, providing hi-fidelity teaching and simulation covering a number of body systems. The teaching included reviews of both their communication and history taking skills. So far the topics we have covered are Cranial Nerves, Cardio-vascular, Gastro-intestinal, Respiratory and scenario based training.

In the next few weeks we will also be teaching upper and lower limb neurological exams, as well as intimate examinations on males and females. We have access to specially trained ACEs for this type of examination. Obviously when students perform these types of examinations there is often a degree of embarrassment on the part of the student. Our ACEs are highly experienced in allaying any fears the student may have, and this creates a safer and confident approach when examining a real patient. Most medical institutions don’t offer this type of experience to their students and often rely on using mannequins to practice their skills on.

Our connections to other institutions continue to expand and we are currently in talks with a couple of universities who have expressed an interest in what we are doing. We have recently been involved in MMIs for the recruitment of medical students at The University of Chester.

It still amazes me at how adept our ACE™ team can be. They are able to switch systems examinations at a moments notice, improvise around a theme and yet still provide high quality feedback to the academics and clinicians who are teaching on that module. It is experiences like these that have prompted me to write this month’s post. Without wanting to sound repetitive and simply repeating the last post, I think institutions and individuals are starting to realise the difference between an ACE™ and a simulated patient.

In a few weeks you will have the opportunity to listen to Mark and myself talk about the ACE™ role with James Catton from the PA Podcast. He was somewhat surprised at the level of our knowledge of body systems and was under the illusion that we were simply simulated patients and role players. He was so impressed with our expertise that he is in the process of organizing workshops with the University of East Anglia and Anglia Ruskin University Cambridge Campus.

So, coming back to our team of ACEs and their diverse range of skills, let’s look at a typical month of Meducate Academy’s workload.

In the last month we have worked with students to improve both their clinical and history taking skills. This was done in the context of both OSCE practice and when they are out on placement where they are expected to use a hybrid approach. We also worked with an experienced Physician Associate in a GP Practice, helping them with their time management and trouble shooting skills. This demonstrates how diverse our ACEs can be when required.

Our skills were also required in order to help pharmacists with their clinical examinations. This was for an assessment to help them gain their Independent Prescribing Course qualification. The pharmacists were given the opportunity to practice their examination skills in a safe environment with ACEs who gave feedback on their techniques. Techniques such as percussion, palpation and auscultation. We helped them work through the seven main body systems whilst the clinicians present talked about the common pathologies they would encounter.

Skills such as these can be practiced with a volunteer or even a sim-man, however what the students don’t get is high quality feedback. This is the main strength of our approach to teaching and the key to our success. Knowing the moves is not enough. The clinician must be able to perform these skills correctly and with our help, through educated feedback, become excellent, safe clinicians.

The body systems covered in the past month have included G.I, respiratory, cardio-vascular, cranial nerves as well as a whole range of neurological exams. We also covered history taking scenarios and the practical aspects of examining a diabetes patient, and how to examine the thyroid.

With the 2nd year Physician Associates we were able to guide them with multiple systems reviews working in a hybrid way. Just like the real world of medicine.

Happy team of Associate Clinical Educators Greg Hobbs, Ellie Darville, Howard Karloff & Meducate director Bob On top of all this of course is the ongoing conversations we have with the students about their fears and worries about the intensity of their course. The students always feel that they can talk to us more openly about their fears rather than going to the academic tutor. This takes some of the pressure off the academics who already have a full timetable. In the 12 years I have been an Associate Clinical Educator I have spent many hours helping students build their confidence and motivation through a variety of strategies.

Knowing that students will confide in you and seeing them graduate is the most rewarding part of the job and the reason I do this work. It’s a role I would recommend to anyone who enjoys working with the medical profession. It’s our way of giving back to the NHS in a small way.

Also, we have finally organised the accreditation process for the ACE™ role and will be running a pilot of this at the University of Wolverhampton in May 2022 with Professor Jim Parle.

On top of all that, a few weeks ago I was called into Trinity Court GP surgery in Stratford-Upon – Avon to run a workshop to 25 staff about how to deal with conflict in the workplace!

Now that’s diversity.

If you are a Clinical Educator and would like to take advantage of using ACEs as part of your clinical teaching, book now for a free consultation. Contact us via the form below or give us a call on 07870611850. Thanks again for reading this post.

An ACE™ Is Not a Simulated Patient, But A Simulated Patient On Steroids!

June 11, 2022February 15, 2022 by R Spour

1st Year Physician Associate Students and Associate Clinical Educators at Wolverhampton University

Recently my attention was drawn to an article, ‘It’s Not An Acting Job … Don’t Underestimate What A Simulated Patient Does”: A Qualitative Study Exploring the Perspectives of Simulated Patients in Health Professions Education”, which was submitted to the journal of the Society for Simulation in Healthcare about Simulated Patients (SP).

The article, whilst interesting and enlightening, discusses the work of the ‘normal’ SP, and shows how valuable their contribution is to medical education. However the title sums up the fact that an SP is more than just an actor who learns their lines and portrays a character. Any role player will be quick to alert you to the fact that, unlike actors, the SP has to give feedback on the communications skills of the student clinician. This is beyond what we expect an actor to be capable of doing.

A good SP can improvise around a common theme, for example breaking bad news. However each student will approach this in a variety of different ways and this is based on their communication style. Some may be hesitant to break the bad news, whilst others may be more exp-licit with their communication. It is the job of the SP to respond to the different approaches that students have effectively, and then give feedback on what the student did well and how they can improve their communication for the benefit of the ‘patient’.

Some students will build rapport readily and easily whilst others need feedback on how to do this more effectively. Non-verbal language also plays its part in communication as we have discussed in a previous post. However, if the SP is presenting with a specific physical condition i.e. central chest pains, the student will respond by performing an examination, for example ‘cardio-vascular’. An SP is unable to give feedback on this part of the process. This is where to Associate Clinical Educator (ACE™) excels.

What the article previously mentioned didn’t cover (and I wouldn’t expect it to) was how an ACE™ can take the interaction to the next level.

An ACE™ is not a Simulated Patient, he’s a simulated patient on steroids! On many occasions I have spoken to clinicians who mistake what we do for medical roleplay and/or that we are simply simulated patients. This is simply not the case.

An ACE™, whilst giving feedback on the communication, will also be able to quickly inform the student whether of not the examination itself is being performed correctly. For example, below is a typical respiratory examination as expected to be performed by a first year physician associate student:

- Introduction using full name and role
- Confirms patient’s full name and DOB
- Explains examination and takes informed consent for examination.
- Asks if they want a chaperone
- Washes/disinfects hands
- Exposes patient appropriately and maintains dignity
- Inspects the patient’s chest (looking for scars, asymmetry, both axillary area)
- Positions patient on the couch at 45 degree angle and asks if they have any pain anywhere
- Inspects the patient’s hands looking for peripheral cyanosis, clubbing, tar staining, CO2 flap
- Checks patient’s pulse (radial/brachial) checks for rate (90 bpm), rhythm and character
- Counts respiratory rate (offers to do for one minute: 18/min)
- Checks patients face for pursed lip breathing, central cyanosis, pale conjunctiva etc.
- Palpates patient’s chest checking for chest expansion and apex beat
- Percusses the chest (top middle bottom, axillar, compares left and right)
- Auscultates the chest (top middle and bottom and both axillar)
- Checks tactile vocal fremitus or vocal resonance
- Checks for sacral oedema, feet and legs (for swelling and tenderness)
- Checks for lymphadenopathy (supraclavicular, cervical, submandibular, etc) from behind
- Concludes examination, offers to help patient dress
- Summarises findings in a logical systematic manner (including important negatives)
- Gives differential diagnosis

Senior Associate Clinical Educator teaching session at Wolverhampton university The role of the ACE™ therefore is to give feedback on all of the above. This will ensure that the student performs the examination correctly,to the standard of the current OSCE curriculum and demonstrates safe practice. As you can see the function of the ACE™ far exceeds that of a simulated patient or role player.

This level of expertise requires training and a high degree of commitment from the ACE™ and with that in mind, Meducate Academy continues to train and support new and experienced ACEs whilst they work with us. Alongside that, the various institutions and academics we work with will continue guide and assist us in producing the best outcomes for their students. Vitally important when you consider the role OSCEs play in the students development and assessment.

Training is ongoing and we are still in negotiation with academic institutions to ratify our position in the industry through a strict accreditation process. This will ensure that the quality of our ACEs is of the highest standard and meets the requirements of any academic institution.

If you are a Clinical Educator and would like to take advantage of using ACEs as part of your clinical teaching, book now for a free consultation. Contact us via the form below or even give us a call on 07870611850. Thanks again for reading this post.

Kate Straughton On Working With ACEs & Training Student Physician Associates

November 26, 2021November 22, 2021 by R Spour

Kate Straughton discusses the vaulue of working with ACEs & training student physician associates

Kate Straughton is one of the senior lecturers with the Physician Associate Programme at the University of Birmingham and is also currently the President of the Faculty of Physician Associates (FPA). Kate wanted to talk about how working with ACEs has helped in her educational role in training student Physician Associates.

“Thank you very much for inviting me to the conference. I’m a Physician Associate and have been qualified for several years now, working in a few different settings and in education itself for around seven years. I have also worked in a university that did not use role players, simulated patients or ACEs and instead relied on volunteers. Now, I find myself working on a different programme where we rely heavily on ACEs, simulated patients and role players. So, I just want to talk a little bit about my experiences from having been a student but also from working on the other side of the fence as an educator.

“A word that has come up on the conference today is consistency, which I have found personally when working with ACEs. When you have a scenario to work with, you know that that’s what the ACE is going to deliver. As an educator, you can then concentrate and talk to the student about the learning outcome. You don’t have to worry about whether the ACE is delivering the scenario in the correct way, consistently and accurately. That’s the beauty of having such highly trained people with that type of experience over several years; and who also have the ability to improvise when needed quickly, yet still work within the parameter you have set as a teacher. This means we can go down different routes depending on how the student interacts with the ACE.

“For me, the really useful thing is whilst teaching the students we are able to stop the scenario and if necessary, rewind and play it again. We give students time to reflect on the experience, they can then have a chat with their colleagues, re-calibrate and try it again to see how the response changes.

“It’s about identifying errors and being able to iron those out. I’ll give an example: I recently taught a Breaking Bad News session and here we had a scenario which we had used several times before. We knew that it worked very well: ‘One student said what if we adapt the scenario so the ACE and the scenario is one where the patient wasn’t expecting any bad news, so it was a complete surprise for her.’ The ACE we were working with was highly experienced and so I had a very quick chat with her and then she came back in and ran it in a completely different style. The student was then able to compare and re-calibrate some of the earlier statements they had made. A stupid statement made previously was changed and the learning outcome was remarkable.

“The students really appreciated being able to see those changes and, as we went through another example, their style of communication was demonstrably better. The other real strength, and what makes the ACE unique, is their ability to give feedback on examination technique.

“We’ve had students, fairly new first-year students, who had gone out on their first hospital placements. They returned to university and said that they were nervous about examining real patients. This is quite a common experience. So we explored why and the comment came back that they were afraid to examine patients in pain. They felt that although they had a good grasp of the examination routine, they were worried that they might hurt a patient. As a result they were stepping back and weren’t getting too involved with real patients. They didn’t want to cause any discomfort and consequently they were nervous.

“We were therefore able to incorporate that into our teaching and the ACE and I ran a session about examining a patient in severe pain. We had the student perform a GI examination on the ACE who presented with severe abdominal pain. What we found was that aside from being nervous they just weren’t palpating deeply enough because they were really worried about hurting the patient, and that’s obviously knowing that this is a simulated patient! Once two or three students had received the feedback from the ACE that they needed to palpate appropriately with good communication skills, they were able to allay any fears they had. Incidentally one student was was too forceful and would have hurt a real patient. We then had the ACE turn the pain on and off until the students got the message. You can’t do this with a volunteer or a real patient!

“Having the ability to turn the symptoms on and off is really useful and all the students walked away saying that was one of the best sessions they had had. They felt much more competent and confident in their abilities.

“The other thing I think that I wanted to raise at this conference is that what I like to do when I’m working with ACEs is to let them get on with it without me interfering. I’m still involved, but at a distance, so there is no undue pressure on the student from the academic. I’m there if they need to talk to me. They tend to share their worries with the ACEs more openly too, which is extremely useful. To be honest, the ACEs know the answers to a lot of the questions, especially when it comes to their experiences of being involved in OSCEs. The student tend talk to the academic about their academic performances, whereas they will admit things to the ACE about their lack of confidence or worries.

“I’m really confident and I do feel this quite strongly, that the little bit of time away from the academics really helps. With an experienced ACE, we know that the student is in safe hands. They are able to get more out of their experiences, which ultimately will help them in the long term too.

“I think simulation using mannequins also plays an important role. The more I talk to my fellow professionals about simulation in my role as FPA president, the more we discuss how you have to get the mix of skills just right. ACEs are not the answer to everything to be honest and the right answer is probably going to be that we should think in terms of a hybrid approach to simulation in teaching.

“However, the training that goes into producing ACEs and the confidence they engender in the student definitely improves the students skill sets quickly and effectively. They bring the human side to simulation and also provide standardisation. I’m just finally, quickly going to touch on that topic now as I feel this is important.

“With an ACE, you will get an expert patient who can repeat again and again a task, whether that be roleplay or physical examinations or a mixture of the two. In the past, I have used volunteer patients and the main problem was their lack of consistency and their inability to react in the same way every time, which is very important in an OSCE or training for the OSCEs. They would also get tired and sometimes give the student too much information too readily or even forget important details. In some cases, they would also add details that were not relevant. This can take a student off course quite dramatically.

“We’ve seen OSCEs where we’ve had students having wildly different experiences over the course of a day, and if it’s for something like an assessment, particularly high-stakes assessments, you need to be able to rely on consistency and standardisation. This sort of improvised information can be included of course, but needs to be done in a way that maintains consistency across the day.

“We have ACEs and role players who can improvise within a fixed scenario without losing track of what the key points are and what the desired outcome is. They will also make sure that this done within a specified timeframe. For me the important point is that I’ve had extensive experience from both sides, both as a student where I was really nervous and didn’t have any clinical background, then as a Practice Manager before I trained as a Physician Associate.

“When I was a student Physician Associate, having an ACE there was so reassuring. My colleagues, some of whom who are on this conference, who were responsible for training me were also incredibly intimidating. They knew so much about medicine and had so much experience, and actually just having someone who you could just have a chat to such as the ACE, was invaluable to me. It made real life much less scary! I also felt much more prepared to be able go into a hospital and have a chat with a real person because of my experiences with the ACEs. It also meant that I got stuck into the course as a PA student and it prepared me to be able to take an accurate history, to examine a real human being, and to be more practical rather than just observing clinicians on placement. That experience to me was the key to my success as a PA and educator.”

If you have enjoyed reading these posts and you are a student Physician Associate who wants to learn more about the work of the Associate Clinical Educator and how they can help you gain more insight into the OSCEs; why not join us on our workshop on January 8th 2022 at 12 noon on Zoom.

We will have two highly experienced Associate Clinical Educators along with President of the Faculty of Physician Associates Kate Straughton to answer any questions you might have about passing your OSCEs in 2022/23.

Our ACEs have over 12 years experience of being involved, not just in the teaching of Physician Associates but actually taking part in the exams, both as role players and ACEs. They have interesting things to say about:

Confidence building
Motivation
The Golden 2 minutes that happen outside of the station
Taking a history
Building Rapport and knowing when you have it
The cues the role player will give you
How to structure for success

Of course we will be directed by your questions and will make sure we can answer most of them.

Why not join us on January 8th 2022 at 12 noon online on Zoom.