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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

 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 

Agenda For Meducate Academy Online ACE Conference 2021

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

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

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

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.

The Physician Associates Program And The Role Of The ACE

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.

 

Meducate Academy: Building Lasting Partnerships

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

What a great week we have had this week.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

2021 could be our best year yet.

Why not join us!

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

Meducate Academy Is Moving

Clinical training room at Wolverhampton University

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Thanks to everyone who has helped us make this journey.