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How To Pass The OSCE On Purpose

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 1st 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

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

Demonstration of MSK skills at The University of Wolverhampton

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.

Cranial Nerves Examination with Clinician Jack and ACE Howard (Seated) at The University of ChesterIn 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 BobOn 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!

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 universityThe 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.

Pharmacist Sarah Baig On Working With Associate Clinical Educators

Pharmacist Sarah Baig on Pharmacist's Experiences With ACE's Teaching

Programme director, Independent Prescribing Course – NHS Lead PCN Pharmacist Sarah Baig is involved in teaching on the Independent Prescribing Course, a multi-disciplinary course working with Health Professionals from a whole range of disciplines. On our recent Associate Clinical Educators online conference she discussed her first experience of working with ACEs. Prior to that she had only worked with medical role players and simulated patients. She found that the experience of working with ACEs far exceeded her expectations. Here, is what she had to say:

“Today, I’m going to talk about the pharmacists’ experience of working with ACEs, teaching on a multi-professional course. Involved were nurses, pharmacists, physiotherapists, paramedics, optometrists who were studying on the Independent Prescribing Course at the University of Birmingham Medical School.

“This was my first experience of working with ACEs and I was surprised as to how much they knew. I was new to the course, so this was my first experience working with ACEs. I was surprised at how much they contributed to the physical examination, which is taught as part of the Independent Prescribing Course.

“The course itself was attended by a whole range of Clinicians. We very often have nurses who are very experienced in clinical examinations, as well as physios are great at MSK examinations. Then we have pharmacists who have never done physical examinations before, and so there is a big variation in the level of knowledge the students have.

“One thing that really helped was having ACEs assist us to integrate the different skill sets. The ACEs helped utilise the experience of other students to support the weaker ones. We had lots of positive feedback about how intensive the ACEs understanding of clinical skills was. Feedback on the teaching was also very positive and having that level of skill from the ACEs was vital.

“I was really impressed by the ACEs, especially their consistency in the teaching process, and also surprised at there versatility. The ACEs (it turns out) are multi skilled and able to teach lots of different systems examinations, which in itself really helpful. I really liked the way they built rapport with the students and the teaching staff. Their other contribution was the ability to put the students at ease, which helps in the learning process. The ACEs are not clinicians and therefore the students don’t feel that they are being judged in any way, which of course opens them up to learning the techniques that much quicker.

“I think what is also important to mention, is that the ACEs know their limitations and I really liked that. They will never try and overstep the mark, so when they found that they didn’t know a clinical reason for certain parts of the examination they would enlist the clinician at hand to take over. I think it’s really important as a professional to demonstrate that mutual trust, and that the ACEs are working as part of the team. The students really valued the feedback that the ACEs were able to give about techniques like palpation and percussion, for example.

“I wasn’t in such high demand from students on the days I worked with the ACEs. At one session we had three ACEs assisting us teach and the ratio was 26 students to 3 aces. We also noticed there was a big difference between the way the role players and the ACEs were working, and that’s what really cemented my passion for working with ACEs. The ACEs, it turns out are also Roleplayers, and can therefore provide feedback on the students communication skills as well as their practical skills.

“The ACEs were used also for the OSCEs which was really helpful. We had some very honest and appropriate feedback from the ACEs which was included in our global assessment tool. The feedback from the students and the clinicians attending has been absolutely amazing, and they’ve actually said that they’d like to have ACEs in other aspects of their core system of training. All of our students are advanced clinical practitioners and they asked if it was possible to have ACEs on the ACP course. For me that was really positive. It says a lot about the way the ACEs work. I think there’s lots of scope for development of clinical skills within the ACP and the utilisation of ACEs. I for one will be working with the ACEs whenever I can.”

 

If you are a Clinical Educator like Sarah 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. Please also leave a comment and share.

Kate Straughton On Working With ACEs & Training Student Physician Associates

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.

James Ennis On The Use of ACEs & Roleplayers In Clinical Education


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 James Ennis Clinical Lead at The University of Chester Physician Associate Programme

James Ennis is currently Clinical Lead at The University of Chester Physician Associate Programme. He has worked with ACEs both as student Physician Associate, and also used ACEs when he was teaching at The University of Birmingham and latterly at Chester University. Here we have an overview of his contribution to the Meducate Academy ACE Online Conference 2021 in an abridged form. If this sparks your interest please watch the attached video and share the link with colleagues and friends.

“Today on the conference, I’m just going to quickly give you an overview of how we use Associate Clinical Educators at Chester University. This was quite a new concept to Chester and as I’ve recently moved from Birmingham up to the area, I decided to bring the Associate Clinical Educator role up with me. We consider the ACEs to be an integral part of the teaching team, and so I’m now going to talk about how we use them and where we use them. I’m going to give you some quotes from our students about their experience in working with ACEs on the course and more importantly a little about simulation and the ACEs themselves.

“I’d like to give you a balanced opinion on the role because there are some perceived threats, in my opinion about the use of ACEs and roleplayers. I want to talk about the future development too at some point. The main point that should come across is that the ACE can give accurate Hi-Fidelity feedback to both the teacher about the student and more importantly to the student themselves.

“Typically a roleplayer is used as a live patient often able to give feedback to the student in terms of their communication skills. The ACE does this and more. They can give  feedback on the physical examination skills themselves, both from the point of view of safety and technique. We’ve kind of gone away from the compartmentalisation of history taking and then  physical examination skills and we have looked at it more as a kind of an integrated model which is how clinicians truly consult. As well as that, we use the ACEs in specialist roles for example intimate examinations.

“We also use the all singing all dancing SIM Man. This is what we would typically think of with regard to high fidelity simulation. Of course we do use the Sim Men as well, particularly for emergency scenarios, but we also use the ACEs as part of a role play that would fit into the scenario and so the communication isn’t lost during the interaction.

“During the pandemic we also had to change the way we worked with ACEs and a lot of the work was carried out online. This also fitted in with the growth of online consultations that are now part of a clinicians responsibility. Of course this is useful for maybe online medication reviews but not for someone presenting with acute abdominal pain.

“To maintain balance of opinion I’ve captured a few of our most recent students/staff liaison minutes from meetings and these  are from our year two students. These are kind of common themes so I’ve just picked a few just to quickly touch on.  Looking at the completely comprehensively positive feedback from from students on the ACEs role and what they give to the student.

“Many students said that they find working with the ACE far less threatening, particularly when making the inevitable mistakes while performing physical examinations, and they were able to refine their technique with the ACE. However, I would like to  mention that it does say that mannequins and other types of simulation may be just as helpful.

“Now, what I would say is, I don’t see the ACE role completely dominating simulation in medical education. It’s very much used as an adjunct and that’s how we now utilise our ACEs. Also  the students obviously get quite twitchy around OSCE season assessment periods. Again, we found the ACE  to be  incredibly helpful, not just for improving students technique and examination skills but also in building their confidence.

“Again, as Professor Jim Parle mentioned previously, the students really responded positively to the ACE role in working on things that they find specifically difficult. One of the things I’d like to highlight is the MSK examinations. It’s one thing that our ACEs really cover in depth with our students. All of our ACEs are heavily trained in MSK examination technique as I’m sure Uzo will talk about in far greater depth in his talk.

“The student feedback has always been positive and more time with ACEs is constantly being requested. This is why we really are so keen on simulation with ACEs.

“I’m sure most of you haven’t used ACEs or simulated patients in any great detail, but you will find that they have had some push back from institutes, mainly because of  the financial burden and restricted budgets. The way we’ve worked around this, is I would far prefer to have the human factor in  simulation than simply by props and Sim Men, sometimes costing up to £80,000. Sim Men have their place, but I would prefer to spend our money towards the use of ACEs. I have  certainly not had any problems from my institute with  getting the financial backing, especially when we keep  getting such excellent feedback.

“We haven’t yet got a great amount of evidence on the  student and patient outcome from such interventions and that’s something I’ll come onto later.

“Another thing, although the ACE is highly trained they are of course not a substitute for a skilled clinician. They are always available to discuss and answer questions of a clinical nature and each supports the other. The ACE and the clinician work as a team.

“So, that’s just a quick overview of where I’m going with my research and I would invite anybody to contact me if they are interested in this subject. I’m constantly monitoring the impact the ACEs have on student performance, and therefore patient outcomes after training. Take a look at the slides I have provided and I am as always interested in any questions you might have.”


Click arrows to view PowerPoint slides of this talk by James Ennis

The Importance Of Simulation In Medical Education

Professor Jim Parle discusses the use of Associate Clinical Educators at the online conference

Professor Parle was our keynote speaker at the conference and it was an honour to have him join us. What follows is an abridged version of the talk. If you want to view the complete talk it is available in the video above.

“I’ve been involved with the ACE process for something like 15-18 years or so. I am now a retired professor at the University of Birmingham and I’ve been using ACEs and similar kinds of approaches to education for a long time. What I’m going to do today is to go straight into talking about what ACEs are and why we introduced them into the Physician Associate Course and what sparked my interest in education generally.

“We used ACEs on the PA programme for probably at least 15 years if not longer, so for today’s conference I would like to spend more time talking about simulation generally. Also, would like to talk about why we need simulation and why I think we need more simulation and why I think we need high fidelity simulation by which I mean using real human beings, not computers or robots!

“Obviously there’s an ethical issue about performing intimate or any kind of physical examination on actual patients. When I was a student, which is quite a long time ago, we used to examine patients without consent. The patient wasn’t really given an opportunity to say no.

“Obviously you should never do this kind of thing and fortunately, times have changed. I remember my first female patient examination, in which I was embarrassed. She was embarrassed, and I was probably incompetent. I don’t think I hurt the patient, but I didn’t know what I was doing. Looking back now, it was a ridiculous way to learn to carry out examinations. That is one reason we need to think about simulation.

“There’s also the point that medical students need repeated practise and repeated, focused and relevant feedback. You don’t really get that from a patient and when you examine a patient, they rarely know whether you’re doing a good job. We don’t really give them a voice, so we need to have or recruit a patient or patient substitute who is skilled in that area.

“There’s also the issue that students arrive with different levels of skill. You therefore need somebody who can work at the level the student is at. We can’t expect a real patient to do that, as they’ve got their own problems and their own things to focus on when in a consultation. An ACE, however, can do that and more, because we have trained them to be able to show certain kinds of pathology or abnormalities.

“I’ll give you an example: A patient comes off his or her bike and injures their chest. Maybe a couple of fractured ribs and difficulty breathing. If you were to examine an actual patient, they will be in a great deal of pain. They will have tenderness around the area and having restricted breathing. It would be unethical to subject an actual patient to multiple examinations by new students. With an ACE, that problem won’t occur. Some of our ACEs can even demonstrate asymmetric breathing and can obviously be examined throughout the day by many students with no ill effects.

“We can therefore reproduce an extremely convincing simulation with an actual person who the student has to interact with just like an actual patient, but they’re not putting a patient through all that kind of discomfort.

“I just want to add the importance of recognising what is also normal and an ACE can present both sides of this situation. Consider the previous example of asymmetric breathing. The ACE can easily demonstrate what is normal, then quickly change to abnormal. I can only assert that it’s much easier to learn something that’s abnormal when you have something normal to compare it with and, obviously, vice versa. The ACE  can do this. Is able to switch asymmetric breathing too symmetrical breathing and back again so the student can see the difference and we as human beings are good at spotting differences but not so good at spotting absolute values. On a similar but not quite the same theme, I am concerned that if we learn something incorrectly, then it becomes difficult to unlearn it.

“I think it’s really important when students are learning physical examination skills that they compare normal with abnormal there and then. This means that they get immediate feedback, and which they don’t necessarily get with mannequins.

“Because of austerity and the current COVID crisis, students are not able to wander as freely around the wards interacting with patients as they did during my time as a student. So pressure on clinical learning environments and the clinicians who might teach us has become more and more restricted. It’s becoming increasingly difficult for students, whether medical, physician associates or pharmacists, and I’m sure it’s true of other clinical professions that an ACE could fulfill that role.

“An ACE is somebody who’s been trained to use their body and their psyche in educating clinicians by responding appropriately when asked to do something by a student. An ACE, as well as being a responsive patient, can also play a naïve patient, so if simple instructions are not given, the ACE will respond appropriately. If the student wants to take a blood pressure, for example, then the ACE knows exactly how this should be done. An ACE can replicate being a patient who has never had it done and do a variety of things that will affect the blood pressure reading. The ACE can then teach the student how to do it correctly. The student can see the blood pressure go up and down when a patient moves their arm or flexes their muscles. They will see the blood pressure go up and down. The student then gets the reason for doing it correctly and shows that they can do it correctly. This is immediate feedback and students love feedback. They’re always asking for more feedback! If it applies to the individual students’ strengths and weaknesses, they then improve straight away.

“So in conclusion I think I would say that what ACEs bring to the interaction is that they can role play, they can show abnormalities including assessments, they can understand what errors students make or errors patients make and then feedback to the students.

“The most important thing I want you to remember from what I’ve said is it’s sometimes good to take the clinician out of the room when the ACE is working. You do not want a clinician in there. If you have a clinician in with the ACE there, they’ll inevitably get into discussions about various pathologies and what a particular system does in terms of it’s function.

“The ACE is there to work as a tool to aid in the learning of the systems exams. We can do the theory at another session. Making full use of the ACE is vital and students’ feedback always shows they learn the examination processes quicker when the academic leaves the room!”

Click here to watch Professor Jim Parle talking about the value of using ACEs as simulated patients on the ACE National Conference 

Report & Video Of Ace National Online Conference 2021

The Meducate ACE National Conference attracted some great speakers
The Meducate Academy online AEC conference was a great success and attracted some great speakers

We began September with our first ACE National Online Conference held online using Zoom as the platform, and it went well.

We had six speakers talk about their personal experience of working with ACEs as part of their programmes of teaching. Coming from a variety of backgrounds, they talked at length about the real value of the ACE as a hi-fidelity simulated patient. As well as discussing the pros and cons of using ACEs and also about the students experience of working an ACE.

Professor Jim Parle started the proceedings with a brief chat about the development of the ACE role. Indeed, it was Jim who created the role of the ACE at the University of Birmingham many years ago alongside the ISU. Although retired, he still likes to play an active role in medical education, and it was an honour for us to have him as our keynote speaker.

Other speakers included James Ennis, the Clinical Lead at the University of Chester who also utilises ACEs in all of his teaching modules and is currently doing a PhD which takes a focussed look at the role of simulation in clinical teaching.

Director of Meducate Academy with Mark Reynolds
Founder and Director of Meducate Academy Bob behind the scenes with Mark Reynolds

Uzo Ehiogu, a teaching fellow and senior physiotherapist at the Royal Orthopedic Hospital in Birmingham, speaks about his experiences using volunteer patients and the ACE, and talks about the relative values of both when he is working with 4th year medical students from the University of Birmingham.

The current President of the Faculty of Physician Associates, Kate Straughton, shared her experiences of working alongside ACEs at The University of Birmingham on the PA Course there. She talked a little about her time as a student Physician Associate and how the ACEs helped her when she studied at Birmingham, where she is now a senior lecturer.

Peter Gorman was next up and he went into great detail about how he used ACEs to transform the way his University (Wolverhampton) coped with the demands that the Pandemic placed on the staff and the students. He also talked about the initiatives he came up with to keep the students engaged during this difficult time.

Finally, we heard from Sarah Baig, a Clinical Pharmacologist who used ACEs for the very first time at The University of Birmingham on the Independent Prescribing Course. New to the whole concept of the ACE, Sarah expressed how valuable the ACE can be compared to the run-of-the-mill role player when it comes to clinical examinations.

Host and Chairman Mark Reynolds
ACE Online Conference Host and Chairman Mark Reynolds

We want to say thanks to all the speakers and also to the delegates who attended. Some as far away as the USA! We know that some delegates would have liked to have attended but couldn’t, which is why we recorded the conference so that you may listen to the speakers at your leisure.

We are planning our next conference which is being held online again in March 2022, so look out for information on that soon.

We are also going to run an online conference in November aimed specifically at Physician Associates and how to approach physical examinations and how to prepare for the OSCEs. All Physician Associates students are invited and the conference will be free and will feature several speakers, including some of the speakers in this video. You will also have the opportunity to put your questions directly to each speaker. It will be a bit like Question Time but a lot more fun.

We will post specific dates for these events on social media and on this blog.

Watch the full video of the Ace National Online Conference

 

Working With New Associate Clinical Educators At Chester University

Associate Clinical Educators Vikki, Bob, Howard and Gregg at Chester University
Associate Clinical Educators Vikki, Bob, Howard and Gregg at Chester University

Working on the Physician Associate Programmes as an Associate Clinical Educator is always a pleasure. It’s an even better experience when you give a new ACE an opportunity to spread their wings and fly solo for a day. They are the lifeblood of the organisation, after all.

This week we gave one of our new ACEs the opportunity to work with us at the University of Chester on the PA programme. We also gave a potential ACE the opportunity to shadow another experienced ACE before being let loose on the students.

We were tasked with assisting in the teaching of Musculoskeletal Examinations: Hands, Feet, Shoulders, Knee and Hip, with the help of clinical Lecturers Jack and Alice, who had prepared the students with an earlier lecture.

I particularly enjoy the MSK sessions and as I have some significant pathologies myself. This gave the students the opportunity to work with someone with real musculoskeletal problems, and also able to give feedback to the students on their examination technique.

Teaching in the skills suite next door was Greg Hobbs, a trusted and highly experienced Associate Clinical Educators. He was being shadowed by Vikki one of our newly trained ACEs.

I was in the main skills suite with Howard, one of our new ACEs, who was now being given an opportunity to show me and the clinicians what he could do. He never let me down and his understanding of motivational interviewing techniques also allowed him to help the PA students sharpen their communication skills.

All of our Associate Clinical Educators are highly experienced communicators before they embark upon our ACE training programme. This is one of the main criteria for the role.

Clinical skills are important, but so are communication skills, and we pride ourselves on being able to give structured feedback to students about both elements of their interaction with an “expert patient”.

We always give the groups a small demonstration of the examination being taught, then we let the students get hands on with the ACEs as soon as possible, making sure everyone engages with the lesson for the day.

Happy group of Physician Associates at Chester University
Working with this happy group of Physician Associates at Chester University is always rewarding

Keeping the students engaged is another skill we are very good at. All of our ACEs have performance based training backgrounds and are trained actors, and know how to keep an audience focussed on the performance. This is an important but often missed aspect of clinical teaching and is not something that is taught to clinical educators normally.

We believe that it is important for the students to have a light hearted approach to the training. Learning should be enjoyable and not be a chore.

Next week is revision week at Chester University, so three of our experienced ACEs are up there again to help the students prepare for their Mock OSCEs, another aspect of the important role we play.

If you have enjoyed this post and want to learn more about how we can add hi-fidelity simulation with structured feedback to your students and institution, why not come online on the 4th September 2021 at 12 noon and listen to 6 clinical leads talk about their experience of working with ACEs and Meducate Academy. It’s free and you even receive a free hardback, soft touch notebook in the post!

Sign up here to join The ACE Online Conference 2021