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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

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