Associate Clinical Educators

Working With New Associate Clinical Educators At Chester University

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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

Agenda For Meducate Academy Online ACE Conference 2021

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Meducate Academy First Annual Online Conference on Simulation

 

September 4th between 12-2pm on Zoom

 

Are you involved in Medical Education?

Do you use simulation as part of your teaching?

Do you use Role Players and simulated patients during your Clinical Skills teaching sessions?

Would you like to know more about the benefits of simulation?

If you have answered yes to any of the above, why not find out more about the work of the Associate Clinical Educator (ACE).

Hi Fidelity simulation with focussed feedback from an expert patient can play an important role in improving the learning outcomes of your clinical sessions, and utilising the skills of an ACE can help you improve the performance and standard of your clinical teaching modules.

Meducate Academy are therefore pleased to announce the launch of their Free First Annual Online Conference on Simulation on Sept 4th between 12-2pm on Zoom.

You will have the chance to listen to 6 Highly experienced clinicians talk about their experience of simulation in teaching practice and how the ACE has helped their students develop important skills whilst also developing their ability to communicate more effectively with a patient.

There will be a Q & A session in the last hour, giving you the opportunity to address the speakers directly.

ACE National Conference Day

The big day is almost upon us!

Our Guest Speakers & Agenda

 

Meducate Academy’s ACE National Conference is for anyone interested in simulation and its use specifically in teaching medical professionals.

We have some great speakers lined up.

Speakers with expertise in teaching medicine using Role-players and Associate Clinical Educators, all of whom have had a personal experience of working with ACEs in a clinical teaching environment.

The agenda for the conference is as follows:

12 noon: Opening Introduction from Mark Reynolds, your host for the event.

Each speaker will talk for approximately 10-15 minutes about their chosen subject outlined briefly below.

 

 

Professor Jim Parle - Keynote Speaker

Professor Jim Parle will talk about his role in creating the Associate Clinical Educator. People based simulation has been a key theme of his academic career and he utilised ACEs widely to both teach and examine PA students during his tenure at the University of Birmingham.

This will be a short history lesson from a highly experienced clinician and clinical educator who is a former chair of the UK and Ireland Universities for PA education.

Jim believes strongly that if we are to make best and most moral ‘use’ of patients in clinical education, we have to do as much as we possibly can in simulation and that real people are the best hi fidelity simulators.

 

James Ennis

James is currently Clinical Director at the University of Chester and will discuss his work on the use of ACEs alongside other methods of simulation. His work is based on his experience of working with ACEs at various Universities around the country on the Physician Associate Programme that he has been heavily involved in.

Uzo Ehiogu

Currently, Uzo is a consultant in Rehabilitation and Physical preparation. He is also a Clinical Teaching Fellow at the Royal Orthopedic Hospital in Birmingham. He will talk about the work he has been doing with ACEs from a Musculo-skeletal perspective with 4th Year Medical Students and how that has informed his teaching style.

Kate Straughton

Kate is a Senior Lecturer with The Physician Associate Programme at The University of Birmingham. She is also currently the President of the Faculty of Physician Associates and will talk about how working with ACEs has assisted her in the education of Physician Associates.

Peter Gorman

Pete is a Clinical Lead at the University of Wolverhampton on the Physician Associate Programme and will talk about his experiences working online with ACEs during the Pandemic, and how this has affected the students he has taught during this difficult period.

Sarah Baig

Sarah is a Pharmacist and is currently Programme Director for Independent Prescribing at the University of Birmingham. Sarah has worked in several sectors during her career, including hospital and community pharmacy, but more recently has headed up a team of pharmacists in the Local Primary Care Network. She only recently started working with ACEs and is going to talk about her personal experiences in this area.

Bob Spour

Bob Spour

Founder

Matt Chapman

Matt Chapman

Managing Director

Meducate Academy’s First National Online ACE Conference

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Meducate Academy’s First National Online ACE Conference

Meducate Academy are pleased to announce their First National Online Conference on The role of the Associate Clinical Educator in Medical Education.

As I have said repeatedly, Simulation with an ACE plays a very important role in helping Medical Students, Physician Associates, Pharmacists and other health professionals in the application of their skills. This coupled with the use of other tools such as the Sim Man, anatomical models and volunteer patients integrate the teaching so that the students practical development is maximised. It prepares them to work with real life patients.

More often than not students only get to practice these skills on volunteer patients and mannequins. Neither of these can replace the type of feedback given by a human being in real time.

A few years ago this problem was addressed by Prof Jim Parle at The University of Birmingham on the Physician associate Course. He realised the importance of high quality feedback and created the role of the Associate Clinical Educator (ACE). The ACE, as we have previously said, is a highly experienced medical roleplayer who has been trained by clinicians to understand “how” the Systems examinations should be carried out. The ACE will then guide the student, allowing them to develop their skills in a safe and controlled environment.

It is also important to realise that as well as aiding the student in passing their OSCEs, the ACE role is there to help the student develop safe practice. This is a topic that is often not mentioned and this too will be discussed during the conference.

At the present moment ACEs are only being used by three institutions in the UK.

Birmingham University (In house through the ISU)
Chester University (Meducate Academy)
Wolverhampton University (Meducate Academy)

We are inviting clinical leads as well as those involved in simulation in the health professions to attend free of charge.

You will have a chance to listen to 5 key speakers who currently use ACEs alongside traditional methods of simulation and also get to see a brief example of how an ACE works with a student. This will be followed by a Q & A session with the speakers themselves.

The Line Up:
Professor Jim ParleProfessor Jim Parle

Professor Jim Parle will be speaking about the history of the role of associate clinical educator and his part in its development and what the future holds for simulation.

Jim Parle was Professor of Primary Care and was Course director for the Physician Assistant PGDip programme at The University of Birmingham. Although retired he continues to work tirelessly on a variety of projects.

Jim entered General Practice in 1982 and was Senior Partner from 1983 to 2000, continuing part-time General Practice alongside academia since then.  Jim’s main activity in his 20 years as an academic has been in education, leading on the introduction of a major community based teaching strand within the MBChB course; championing the place of non bio-sciences such as ethics and law and behavioral science in the medical curriculum; establishing the PA PGDip; and leading innovative educational approaches such as using lay women to teach medical students how to perform female pelvic examinations. His research interests have been predominantly in thyroid epidemiology and in education. He has received grants from, among others, the RCGP, PPP (now the Health Foundation) and the NIHR.

Jim had also led the development of community based experience for medical students, initiated (with Dr Sheila Greenfield), the innovative and successful intercalated degree in non-bioscience subjects; led the development of various types of simulation as enjoyable and effective learning methodologies for clinical skills and set up one of the first, and by most measures the most successful, postgraduate diploma in Physician Assistant studies in the UK. He was also chair of the UK and Ireland Board for PA Studies. He has been on the Steering Committee for the Biennial International Clinical Skills Conference series held in Tuscany, and chaired the Scientific Committee for that conference.

He is well known in the fields of thyroid epidemiology and, in education, particularly in the development of innovative approaches to learning clinical skills. He has spoken at numerous conferences on these issues (e.g. quinquennial thyroid conference, Buenos Aires, Ottawa conference on assessment, Toronto).

He recently stepped down as Chief Senior Examiner of the RCP Faculty of Physician Associate National Exam board.

James Ennis Course Director University of ChesterJames Ennis

James has worked in a number of clinical fields across the UK including general surgery, trauma and orthopaedics, acute medicine and general practice. He has worked in educational institutes across England and is currently research active. His research interest is in the PA role in the UK and the use of simulation in medical education. Recent publications include:

Effectiveness of technology-enhanced simulation in teaching digital rectal examination: a systematic review narrative synthesis.

Physician associates: the challenge facing general practice.

Physician associates working in secondary care teams in England: interprofessional implications from a national survey.

James is currently the Course Director of the MSc Physician Associate studies at the University of Chester.

Kate Straughton President FPAKate Straughton

President of the Faculty of Physician Associates and Senior Lecturer at The University of Birmingham Physician Associate Programme.

Kate is a qualified PA, graduating from the University of Birmingham in 2009 and completing her MsC in 2017 from the University of Worcester. She has over ten years experience including working in acute medicine and neurosurgery. She has been working in PA education since 2014, with a focus on work-based learning and clinical placements. Kate is currently the placement lead for the University of Birmingham PA course, and also oversees the MsC ‘top up’ for PAs who wish to carry out some further research.

Uzo Ehiogu Uzo Ehiogu

Uzo is a Clinical Specialist Physiotherapist who led the Spinal Therapy Unit at London Bridge Hospital in London, England. In that role he was responsible for the specialist spinal rehabilitation of post surgical patients referred by orthopaedic, upper limb and neuro surgeons. He also acted a source of clinical expertise for lower quadrant related dysfunction within the department. He now heads up the training of 4th year Medical students in Musculo Skeletal Examinations at the Royal Orthopedic Hospital in Birmingham as well as working in a busy clinical role.

Uzo is a retired British Army Physiotherapy Officer of the Royal Army Medical Corps. He spent several years in the Royal Marines Commandos and qualified as a Parachutist before being selected for a Commission in the Army as an Officer. During his service in the Army he has worked in secondary care, primary care and occupational health environments.

One his most recent appointment was as the Rehabilitation Officer at the Royal Military Academy Sandhurst providing clinical and administrative leadership for a high performance musculoskeletal service. He was the clinical lead responsible for the delivery of a high class service in a premier military training establishment for injured soldiers. He led the  accelerated return to military training and work of patients with career threatening injuries requiring ongoing care and extended rehabilitation for periods of 4-8 months.

Uzo deployed to Afghanistan twice during his Army service years in support of British Special Forces personnel. He conducted specialist musculoskeletal clinics. This role required independent decision making regarding the clinical diagnosis and future management of high value personnel.  He has also worked as a Specialist Physiotherapist at Defence Medical  Rehabilitation Centre Headley Court.

Uzo has worked in the National Health Service as a Senior Physiotherapist where he developed a Pilates and Spinal Stability retraining service in East London England. He has worked for several football teams in Northeast London, England, most notably at West Ham Professional Football Club as the Youth Team Physiotherapist.

Uzo is a Bachelor of Applied Sports Science, and an accredited Strength and Conditioning Specialist with the National Strength and Conditioning Association USA. He is also a Bachelor of Physiotherapy and is in his final year of a Clinical Masters of Science Degree in Manipulative and Manual Physiotherapy. He is a keen researcher and reader and is currently involved in a year long prospective research project investigating lower limb injury risk profiling in British Army Officer Cadets.

Mark Reynolds Mark Reynolds (Host) Mark has been working as an ACE since 2008 having trained as a medical role player two years previously. Aside from teaching cardiovascular, respiratory and gastrointestinal examinations, his special interests in the ACE role include clinical communication, orthopaedic examinations and Mark is a leading educator in the male intimate examinations. Outside of the ACE role Mark is currently involved with various narration projects for the BBC Doctor Who franchise.

We look forward to you joining us on the 4th September 2021 at 12 noon and engage with our experienced clinicians who will talk about their experience of simulation in teaching practice and how the ACE has helped their students develop important clinical and communication skills.

Click here to register for Meducate Academy’s First National Online ACE Conference

Training A New Generation Of Associate Clinical Educators

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Group image of ACEs at Meducate Academy's first training day
All of the ACEs at Meducate Academy’s training day in Birmingham on 19th June 2021

Meducate Academy have been working tirelessly with a view to creating more high quality ACEs, to help with the growing interest in the role we play. There seems to be a shortage of high quality ACEs and as our workload seems to be increasing, we conducted our first training programme on the weekend of the 19th June in Birmingham.

We have recently been busy over the past three weeks with the buildup to the OSCEs and of course the ongoing work with Chester and Wolverhampton Universities. It has been a successful time  for all involved and our ACEs have had their work cut out for them.

Working alongside clinicians, we have been assisting in the teaching of physician associates in:

  • MSK
  • Cranial Nerves
  • Gastro Intestinal
  • Respiratory
  • Cardio Vascular
  • Blood Pressure Measurement,
  • Peripheral Pulses and Nerves

We have also roleplayed a variety of exceptionally challenging scenarios, assisting the physician associate with a methodology of history taking, which enables them to become empathetic and safe clinicians.

We support and have continued to work closely with Matrix Education on their programme of weekend training courses.

Meducate Academy recently conducted our first training programme on the weekend of the 19th June in Birmingham.

The session was led by ACEs with the curriculum for the day previously scrutinised by two senior clinicians. Once they were satisfied with the content we gathered the delegates together in central Birmingham for the big day. There were 13 potential ACEs who had committed themselves to the training, who all turned up on time, ready for a very intense but enjoyable day.

The delegates were provided with a comprehensive manual/Aide-mémoire outlining the Gastro intestinal, Cardiovascular and Respiratory systems examinations.

It was important that we paid particular attention to the expectations of the role of the ACE, as none of the delegates had ever worked in this way before.

Medical mannequin
Whilst medical mannequins are useful, they can’t give structured feedback

It was explained that the ACE is not simply a body to practice on, but a high-quality expert patient capable of giving quality feedback about the process of the examination to the Physician Associate Student. We stressed this throughout the day because if the ACE can’t deliver this type of information correctly the student may well as have a mannequin to practice on!

The ACE is essentially an ‘expert’ patient who knows how a student should perform several of the primary systems examinations. It is our role as an ACE to guide the student from start to finish, creating a safe and effective clinician in a supportive and friendly learning environment.

The ACE does not get involved in diagnosis, or the theory behind the examination. We leave that to the clinician, who is usually present throughout the lessons. 

We are there to teach the physician associate student HOW an examination is carried out, and not WHY…

The delegates had traveled from all over the UK and the course was provided free to all those attending. It was satisfying to see how motivated and engaged they all were as we took them through basic jargon and vocabulary, peripheral pulses, blood pressure measurement and of course the main body systems.

Obviously, a day is not enough to encapsulate everything that is required of an ACE, so it was made clear that this was the first step on the road to becoming an Associate Clinical Educator.

Regarding attendance on future Meducate Academy courses (which will also be monitored by experienced clinicians and ACEs) we explained to the group that they will also be expected to shadow the more experienced ACEs before moving onto working autonomously. The new ACEs would also have an informal evaluation conducted by a clinician before being allowed to work as an ACE with Meducate Academy.

Clinical Lead Pete Gorman and Dr Banu Deniziri with newly qualified Physician Asscoiates Zaki and Asim
Clinical Lead Pete Gorman and Dr Banu Deniziri (Wolverhampton University) with newly qualified Physician Asscoiates Zaki and Asim

We want to ensure that our clients get the very best from Meducate Academy. I feel training programmes like ours go someway to developing a model that will provide the client with consistently high quality ACEs.

As has been mentioned on previous posts we are still endeavouring to get some sort of accreditation for the role of the ACE. This may take some time, but we are working on validation of the role with a couple of our university partners.

On another note, I have just had news that one of our partners, The University of Wolverhampton, has just repeated last years success at the National Exams and their last cohort achieved 100% in the written and 88% pass rate in the OSCEs.

It’s nice to know that our ACEs played a small part in that success and I would like to thank them for the hard work and dedication over the past 12 months.

Following up on this, Clinical Lead Peter Gorman has offered to take part in a podcast for Meducate Academy to talk about his innovative approach to preparing Physician Associates for their National Exams. Bookmark this blog and look out for the podcast video which will be posted in the near future.

Meducate Academy ACE Recruitment & Training Programme

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Meducate Academy ACE recruitment and training programme online

Meducate Academy recently embarked upon a continuing ACE recruitment and training programme with candidates who had expressed an interest in our ACE training schedules. We emphasised that the role we play is vital in ensuring a clinician is safe to practice with an actual patient and how much commitment is required to fulfill the role of an ACE.

Saturday 15th May 2021 was a very busy day at ‘Meducate Towers’ as we embarked upon our continuing ACE recruitment and training programme. After an initial online webinar a few weeks ago we set Saturday as the date to bring in those candidates who had expressed an interest in our ACE training schedules.

After an initial conversation, in which Mark and I outlined our background and history, we then went on to explain the role of the ACE in medical training. We went onto describe the body systems and how the student clinician would examine a patient. What then followed was a typical ACE hands-on session, with Mark playing the Physician Associate Student, and I as the ACE/simulated patient giving feedback.

This was a great opportunity for the candidates to see how much knowledge is required in order for them to fulfill their role with Meducate Academy. I think it surprised those watching just how much skill and knowledge is necessary to perform the task. Though we did explain that we have been in the role for twelve years, emphasising that this was not our expectation of them at the moment. ACE Training is an ongoing process and even Mark and I are still learning and developing our roles as ACEs.

As you can see from the heavily edited video above, Mark was playing a poorly prepared student. This was an extreme example which gave us the opportunity to show how the ACE needs to be alert when working in a situation with a below standard student.

We explained that the student does not expect us to give feedback on the students’ medical knowledge, or on their diagnosis, but on their technique when performing the examination. Of course, we would also comment on the students’ communication skills if we had any concerns.

Our role is to ensure that the student is safe to practice with a real patient and make a valuable contribution to their profession.

After the demonstration was over, we then went into an Q & A session, which included questions on the duration of training and how their assessment will be carried out. We explained that although the initial training is quite short, we will expect them to shadow an experienced ACE until we feel they are ready to take on the role. We emphasised that the part we play is vital in ensuring a clinician is safe to practice with an actual patient, and so stress was placed on the role and how much commitment is required to fulfill the role of an ACE.

Our customers are highly skilled professional educators and we expect the same high standard from our ACEs.

We are currently working on educational materials for the ACEs, and this is being done in conjunction with senior clinicians who are overseeing the development of this information. These instructional materials include training videos, handbooks and regular telephone or internet support along the way.

Meducate Academy has also been working recently with PAs at Wolverhampton and Chester Universities, and we received welcome news that many of our students had passed their National exams. Good news indeed.

Last weekend Mark and I worked with Matrix Education, again helping student Physician Associates get ready for their upcoming exams. It was great to touch base with students from every part of the UK and a pleasure to work with the team at Matrix, as always. I recently did a podcast with founder of Matrix Education Sofia Hiramatsu and we will be posting a video of the podcast next week on this blog.

I have also spent some time with Wolverhampton University developing their Golden 2 sessions on a weekday evening. If you have ever taken part in OSCEs, you’ll know that one of the vital parts of an OSCE station is the 2 minutes that the students have to read the question.

Sometimes, students find this really difficult and often miss the obvious. With this in mind, Peter Gorman of the Wolverhampton PA Program has put together sessions based purely on “how to read the question”. His approach has been really successful. Helping the student get to grips with being able to answer the question effectively, and I can’t believe someone has not attempted this before. Maybe they have!

It has been an honour to be involved in these sessions and I have seen this approach help struggling students turn a corner in their development. I intend to write something with Pete about this in the next few weeks.

The month ahead looks busy, so I would like to thank all those who attended the Webinar on Saturday. We are currently putting dates together for the initial 2 day training course.

If you are a role player who wishes to take your medical roleplay to the next level, we are always on the lookout for new people, so get in touch.

From Comedy to Clinical Education: My Journey As An Associate Clinical Educator

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Clinical Director James Ennis demonstrates an Elbow exam with ACE Mark Reynolds
Clinical Director James Ennis going through an Elbow exam with ACE Mark Reynolds

My journey as An Associate Clinical Educator started way back in 1984 when I enrolled on the Drama and Theatre Arts Degree course at The University of Birmingham. It was a massive departure from my previous life back in the North of England. I was a mature student and at least ten years older than my fellow students, and the real challenge was also having two small children in tow! The course was the best thing I could have done and has changed my life immeasurably.

I would never have imagined that many years later I would work as an associate clinical educator at the same university but this time in the Medical School and not the Drama department.

After qualification I was working as an actor in TV, Film, Theatre and Motion Capture. I served a fifteen year apprenticeship as a comedian on the alternative comedy circuit through the late 80s to the early noughties as part of a double act.

It was during my time as a comedian that I was able to develop skills as an performer and spent this time persuading the audience that we were funny. Working as a live comedian is the best place to learn to deal with an audience. If you don’t get your message across, you are told to “Get Off”. Not usually as politely as that!

In the background to this I was also building my skills as a corporate educator, motivational speaker, and a Trainer of NLP (Neuro Linguistic Programming). NLP is something I continue to be involved with to the present day.

Associate Clinical Educators Bob Spour, Greg Hobbes, Mark Reynolds at The University of Chester
Working with Clinical Director James Ennis, and ACEs Greg Hobbes and Mark Reynolds at The University of Chester

In 2009 I changed direction and applied to be a Medical Role Player with The Interactive Skills Unit (ISU) at The University of Birmingham. This required a different set of skills and as well as acting I was also expected to give feedback to the medical students after having role played various scenarios with them. A different way of working for me, and I enjoyed it immensely.

It was during a GPVTS roleplay session that the Manager of the ISU, Karen Reynolds, approached me and asked if I would be interested in working as an ACE. This was a role developed by Professor Jim Parle of The Physician Associate Programme at Birmingham. I jumped at the chance and embraced this new venture. It would shape the course of my future career working with health professionals.

With the help of Jim Parle I embarked upon my new career as an ACE. It meant I could combine my skills as a communicator alongside my new growing knowledge of body systems examinations. Giving feedback on the students technique as well as their communication skills. I could now help the student on two levels. Having been a trained engineer in the 70s I took to the role easily, as body systems are not dissimilar to mechanical systems. I also took this approach whilst studying anatomy and physiology.

Over the next six months I bought books on body system examinations and practiced the techniques with Mark, one of the other ACEs. Together we made a formidable team and worked with The Physician Associates and their Clinical staff. The clinicians were always supportive of our efforts and always made us feel part of the team. They gave us insight into the methodology of examining the CV, respiratory, GI, cranial nerves, upper and lower limb neurology. We also helped the students’ approach to sitting the OSCEs (Objective Structured Clinical Exams). We were learning on the job and I spent many hours pouring over medical textbooks to enhance my knowledge in my own time.

In 2011 I was offered a chance to learn examinations of the musculo-skeletal systems, working for The Royal Orthopaedic Hospital (ROH). Training was carried out by Consultant Surgeon Mr Edward Davis and Consultant Physiotherapist Andy Emms. These sessions were well structured, theoretical and practical, and they guided us through the hip, knee, shoulder, spine, hand and ankle examinations in great detail along with supporting materials. This would be another string to my bow.

University of Chester. Riverside Campus
University of Chester, Riverside Campus

As time went on, I was fortunate to work with some great clinicians who were always happy to help and answer my questions. Some have even become friends as well as colleagues.

I now have the pleasure of extending my knowledge to other universities and institutions and find myself able to offer employment and training to other role players and actors wishing to embark on this amazing career.

I am also in the process of creating a course with a view to ACEs gaining accreditation for the role through one of our partners. I believe this is vitally important in maintaining high standards of teaching to the medical students. Many of the clinicians I have worked with over the years have offered their help in teaching new ACEs to the very highest level.

Who would have thought it would have come this far? It’s thanks to the people who gave me the opportunity to reach out to students and help them on their journey to becoming great clinicians.

The recent pandemic saw a downturn with employment in the field for many role players, but I was able to take up this challenge and run with it. Working in conjunction with Peter Gorman at The University of Wolverhampton and James Ennis at Chester University, we were able to teach online and take OSCEs from March 2020 right up to the present date. Thus ensuring the students had as little disruption as possible to their studies. Sadly, some universities did not embrace this way of working until much later. We were therefore ahead of the curve in adapting to the changing working environment and I was able to offer employment to some of my friends and colleagues.

It is during tough times like this that I fully realise the significance of one of my lifelong maxims:

There is no Failure. Only Feedback.

If 2020-21 was anything to go by, 2022 promises to be an exceptional year for Meducate Academy. This is how I see the future.

If you, like me, fancy a real challenge, come work with Meducate Academy and join us on the journey.

The Physician Associates Program And The Role Of The ACE

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Bob Spour working with Clinical Lead Pete Gorman at The University of Wolverhampton
Working alongside Clinical Lead Pete Gorman at The University of Wolverhampton

Congratulations are in order to all of those Physician Associates who were successful in passing their recent National Exams.

The Physician Associates Program is a very intensive 2 year Post-Graduate course and requires great dedication, focus, resilience and determination to complete. It takes many hours of reading, studying and practicing hands on skills training to produce a competent and safe PA.

Image of the University of Wolverhampton from the PA Skills suite
The University of Wolverhampton from the PA Skills suite

Working in close partnership with The University of Chester and The University of Wolverhampton has shown me how demanding the course can be. I see it as my duty as an ACE to ensure that the PA student gets the support and the skills they need to progress in the profession

As an ACE it is also important to keep up to date with any changes that might be happening in the curriculum. Whilst this sometimes is a challenge, I am always grateful to the tutors for their continued support.

Just as the students work and study hard, I am conscious that Meducate Academy’s ACEs put in the same effort. We will therefore continue to work closely with Chester University and Wolverhampton University to produce high quality training programmes for both communication skills and systems examinations this year.

We are about to start producing video and online resources materials for our ACE training programme over the summer months. In less than a month our ACE Aide Memoire will be available to all of our staff here at Meducate Academy.

It's always fun working with ACEs at The University of Chester
Bob & Mark enjoy working at The University of Chester

Academy continue to invest in our ACEs and we are still working on gaining some type of accreditation for the role. Although we are seen as lay educators our ability to provide high fidelity simulations and clinical skills is well documented by the institutions we work with. It is about time this was rewarded with some type of recognised qualification. It also means that our partners know that they are getting the highest quality ACEs working alongside their clinical staff.

We have always been passionate about continued professional ACE training and we want the quality of that work to be second to none.

We will be rolling out a regular annual training camp for the ACEs. This means we have control over the quality of the people we provide to our customers. This of course will be dependent on social distancing rules being relaxed in the coming months.

If you want to work as an ACE and be part of the team at Meducate Academy enter your details in the landing page here and we will get in touch.

Incidentally we will also be hosting an Annual Conference in July 2021. The panel will consist of five speakers all senior clinicians in their own right who have an impressive track record on the UK PA programme. The topic will be the role of simulation in medical training, specifically focusing on the role of the associate clinical educator.

 

The Importance Of Feedback From The Physician Associate Student

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Meducate Academy - Teaching physician associates the importance of having a systematic approach to physical exams

In my last post The Associated Clinical Educators Role In Providing Feedback To Student Clinicians, I talked about the importance of feedback to the Physician Associate student and how an ACE structures their feedback to ensure that they achieve the best learning outcomes.

Feedback is important to the student and is also of importance for us to receive feedback on our performance. This is a vital part of the communication interaction and helps us improve our facilitation skills.

At Meducate Academy we always want to hear what the student thinks of the session and we often ask them to appraise our performance and give us feedback, and it’s always nice when that feedback comes in the form of a testimonial that you just didn’t expect.

Last week we were lucky enough to work with the 2nd year Physician Associate cohort at The University of Chester. A very highly motivated group of students who show real promise. We were assisting clinicians in teaching MSK and general systems examinations, and the day went well.

There were six ACEs teaching all day and each group broke off into their separate rooms, observing the current Covid-19 restrictions. The students were able to take histories and then perform a physical examination. We then asked them to report their findings (if any) and give a summary and management plan.

Meducate Academy review on Instagram

I was happy that everyone performed well (including the ACEs) and we left Chester in high spirits.

Our return journey to Birmingham gave us a chance to reflect on our performance and that of the groups we were working with, and we all felt that the day had gone well. Self-reflection is an important part of the process for all Meducate Academy employees and allows us to develop our skills to the highest standard.

Within 24 hours some students had put a post up on Instagram and I felt I had to share it here on the blog.

We are currently working on writing a manual that will help students pass their OSCEs. This is in partnership with a senior clinician from The Royal Orthopedic Hospital. It’s aim is to give two different perspectives on the OSCE process. The first is from the point of view of the ACE/simulated patient and the other from the examiners perspective. We believe this is the first time anything like this has been published. As ACEs and simulated patients we have been involved in thousands of hours of OSCEs which in-turn gives us an insight into how students can improve their performance. Keep your eyes peeled for this in the near future.

Primary care for physician associates by matrix educationOn a similar note Matrix Education has produced Primary Care For Physician Associates, an excellent reference source for the training of physicians associates which is available now. One of the authors, Sofia Hiramatsu, was an old student of mine at the University of Birmingham medical school. She is now a successful PA working in London and founder of Matrix Education. I am particularly proud of her achievements in the field of medical education. At over 600 pages, this book will be a useful aid to not only help you pass your exams but also serve as as useful aide memoir when you are qualified as a Physician Associate.

The Associated Clinical Educators Role In Providing Feedback To Student Clinicians

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Associated Clinical Educators Providing Feedback To Student Clinicians

Last week saw us working online with our partners at Wolverhampton and Chester University. Although the role of the ACE is to work predominantly with helping the student to develop their physical skills with systems examinations, we also spent a lot of the time teaching them how to take an effective history.

Alfred Korzybski the developer of General Semantics once said:

“The meaning of communication is the response you get”.

When you are a medical professional sitting with an actual patient, you won’t be in the fortunate position of receiving feedback from them. They just won’t tell you.

They can’t.

They don’t really know what you are doing and you wouldn’t expect them too!

Working with an ACE or simulated patient changes all of that.

When ACEs work with students, their key role in the interaction is to provide quality feedback to the student clinician on their communication and the systems exam that they are performing.

Everyone employed by Meducate Academy are experienced actors and can therefore present powerful examples of a patient with a variety of problems and pathologies. Whether it be a mental health scenario, a difficult or challenging patient, an angry patient, those presenting with physical problems or working with colleagues and relatives of a patient. We have done them all!

This is all very useful as it creates a ‘reality’ for the student to work with, but it is not the complete story.

Role-play and simulation without high-quality feedback is just acting, and that’s not our aim here at Meducate Academy.

An ACE is an important and vital resource for the student, and our ability to recreate a scenario as a simulated patient providing feedback is of critical importance to the student and their assessors.

The feedback we offer allows the student time to reflect on their performance without the worry of making a ‘mistake’. That the environment is safe and that they can stop the scenario at any time in order to make any adjustments to their communication style.

You can’t do this with an actual patient!

Providing feedback in a nonjudgmental way gives the student an opportunity to improve without the pressure of having to get it right every time.

Feedback when given is always specific and detailed where necessary. We never say:

“Oh. That was Good!”

Without qualifying the statement to the student with detail as to why it was good and how it made the patient feel at the time they said it. Feedback should be evident and observable.

For example, the ACE would explain how the patient felt when the student failed to make eye contact when delivering bad news. There should be no ambiguity in your feedback, and clarity is vital:

“When you auscultated my chest and asked me to take deep breaths, you lifted the stethoscope off my chest before I completed a full breath cycle.”

This is much better than: “Keep the stethoscope on a little longer.”

The timing of the feedback is also important. We always wait until the end of the history and/or examination before giving feedback. This is normal unless the assessor/staff member asks for it earlier.

In some cases (mainly physical examinations) the ACE may stop the interaction if a procedure is performed roughly, or if the ACE is in danger of getting injured.

When we give feedback to more than one participant in a simulation, we keep it as succinct as possible and we never judge. An ACE will never compare one students’ performance against another. We take each person on their own merits.

When giving feedback, we do it in the third person as the patient. Explaining how the patient felt from their perspective is vital, and when we give feedback, we always ensure that we only make two or three points. We never overwhelm the student with a wealth of information, only enough to develop their skill set.

An ACE never gives feedback on the medical content of the simulation unless they have been specifically trained by a clinician. We always remind ourselves that we are lay educators and not clinicians.

If a student becomes defensive about feedback, we do not engage in arguing the point. Speak calmly and logically. A good structure therefore is vital. We are never too negative in our feedback and if the support of the facilitator is required, the ACE will get them involved.

If a student seems confused by the feedback, we take a few moments to reflect on what has been said and then recalibrate our communication style to suit the student. Everyone is different, and an ACE always endeavours to be a master communicator.

If a member of staff contradicts the ACE, we always wait till the session is over to discuss that difference in perspective. We would never discuss issues in front of the students. This may be an opportunity to learn something new and improve our skillsets.

It is often the case in our multicultural society that an ACE may not understand the student because of an accent, dialect or even the volume. We are always respectful, and will explain to the student that they sometimes have to work on this aspect of their communication in order to ensure they are understood and that their interaction has a high degree of clarity. Lack of clarity is always pointed out sensitively.

Sometimes the ACE may notice that the accepted dress code is not being adhered too. It is important that we highlight this in our feedback to the staff. Personal matters such as bad breath, body odour and unkempt appearance should be addressed. We don’t mention this directly to the student, but through the facilitator.

We always expect our ACEs and simulated patients to also develop their communication skills. We regularly assess them in this ability. Being an actor does not mean that you can be a role-player. The ability to deliver feedback effectively to the student is what is expected.

Let’s ensure that the standards of the ACE are as high as that of the clinicians.

We are currently producing a workbook for the ACEs and this will serve as a useful aide-mémoire for those who take on this very demanding but rewarding role.

Clinical Communication and History Taking – An Associate Clinical Educators Perspective

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

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

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

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

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

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

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

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

There are four legs to effective communication and these are:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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