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Interview With James Ennis, Clinical Director (PA Program) At Chester University

Image of Bob ACE working with a group of physician associate students at a recent training course
Bob working as an ACE with a group of PA students at a recent training course giving feedback to students is a vital part of the ACEs role.

One of the greatest innovations the computer age has brought us is the opportunity for anyone to set up a podcast. Podcasts are great to watch or listen to when you are on the move and allow you to get information quickly from a variety of sources. We at Meducate have embraced that technology and are now producing a series of podcasts on Medical Roleplay and Associate Clinical Education (ACE). We will be talking to clinicians and simulated patients and, in some cases students, about their experience of working with us.

Image of Clinical Director (PA Program) at Chester University
James Ennis Course Director University Of Chester

Last week I interviewed James Ennis, Clinical Director of the Physician Associate Program at Chester University, who I have had a working relationship with for over 10 years.

You can listen to the podcast here, but I thought it would be good to give a very abbreviated version as a blog post for those who don’t have the time to listen.

BOB: Welcome to the Podcast, James.  First of all, thanks for coming on and agreeing to do this. I know you are very busy dealing with a multitude of challenges at the moment, but I’d like to get your view on what it’s like to work with medical role players and ACEs in this ever changing environment.

JAMES:  Thanks, Bob. It’s a pleasure to talk to you about this subject and get it out to a wider audience. As you know I’ve been working with Associate Clinical Educators and role players for the best part of 10 years and we’ve always had them within our curriculum both at Birmingham University and now at Chester. I think it’s an important aspect to medical education, and the feedback we receive from students about the experience is always exceptional. I’ve never once had negative feedback from a student regarding clinical educators or role players because of their ability to help the students relax and also give them constructive feedback about both their physical examination skills and their communication skills. It’s often the case that students can feel more anxiety when working with an academic clinician than with an external educator such as an ACE.

BOB: Yes, I’ve noticed how much more relaxed the students are with us and I guess it’s because we come in at their level in many ways and with our knowledge of systems examinations we can help them practice their techniques quickly and effectively without recourse to in-depth academic analysis. It’s hands on without too much theory, which a lot of students crave.

They really enjoy the hands-on skills we help them with, and even simple techniques like palpation and percussion are keenly rehearsed with us over and over. Sometimes it’s the simplest things that can cause the most confusion and we are there to hold their hands, as it were.

I was obviously trained by Clinicians like yourself, but the students often comment on how knowledgeable we are in terms of our understanding of the examination process. We are also able to tell whether the student is gaining rapport with the patient and handling the patient in a respectful way. That and of course our extensive understanding on what is expected in OSCE’s.

As an ACE and role player, I and my colleagues must have been through 1000s of OSCE stations in our time. We have a good idea what an examiner is looking for, and this gives us a lot of credibility when students ask about OSCEs. It’s one of their big concerns, and having this knowledge helps us build trust with the students.

JAMES: Yes, I’ve noticed that when we work with you guys, you have this knack of reading the whole situation and responding appropriately. The fact that you have background knowledge of history taking and Systems Examinations, as well as a clear understanding as to what’s required in the OSCEs, has been tremendous in improving the students ability to, not just pass exams but turn out as very good, very safe clinicians. The feedback you guys give about excessive use of jargon is also important and can sometimes be missed by volunteer patients, for example.

Consulting with simulated patients when it might be called upon for them to perform intimate examinations, are made so much easier when working with an experienced ACE. That ability to help the student keep their sense of humour and deal effectively in a relaxed manner in what could be a very embarrassing situation.

Like I said you guys are an  invaluable resource. I don’t know how you how you found it over the years, but I think it’s grown into something far more meaningful than we ever thought it would be.

BOB: Obviously you have embraced the idea of using ACEs as part of your teaching methodology and you find them of great value in consolidating the students learning. Yet, there are only a few institutions that utilise our skills. Chester, Wolverhampton and Birmingham are the three I know of. Why do you think ACEs have not been used elsewhere, bearing in mind the high value you place on them?

JAMES: Ultimately if we’re going to be completely honest, I think a lot of it comes down to money and resources and availability, which is a real shame, because as we know working with ACEs really embellish and enrich the student experience, and we have both alluded to the fact that ultimately students retain information and learn faster when examining real people. People who can give extensive feedback in a structured way and link that to the real world. We were even talking about getting the ACE role validated, which I know you have been a keen advocate of. That would be icing on the cake as it were.

BOB: Yes, I for one would be very keen to have the role validated. I think academics would take us more seriously and once they had experienced working with an ACE, would then realise the value and they would then add is to their program.

JAMES:  Absolutely. We’ve spoken about this in the past and I think it needs to be a requirement and there is an important need to have some accreditation process or some monitoring, because it is actually a very robust system.

Academics who have not experienced working with an ACE might not be aware of the amount of training that goes into being an effective ACE, and I have seen the type of preparation ACEs go through, both as individuals and as part of the team. That’s the other aspect that needs to be mentioned. When you work with us at Chester, you really are seen as part of the team and are treated as such.

BOB: Yes, that’s true. We feel valued as much as other external educators, and we do appreciate it. It makes for a smooth working relationship and I think the students notice this too.

The recent Pandemic must have posed challenges for you as an educator and I know it has affected the amount of work we have had. Some Institutions were up and running, but most seemed to struggle with embracing the new idea of working online. What was your experience like?

JAMES:  Yeah, that’s a good question, actually. Obviously, we have had to change our approach to clinical practise and there have been significant changes in general practise in the community. We have had to work with video conferencing, telephone triage and consultations and we have found new ways to use these technologies with you guys at Meducate.

In fact, you were up and running as soon as the lockdown happened. This was great news for us, as we could use your services almost immediately and the skill and depth of understanding you brought to this new way of working was refreshing. Everything ran like clockwork. I can only say thanks and say that for those reading this Meducate can provide you with an excellent and very professional service.

***

I would like to thank James for giving permission to abbreviate our podcast and in future posts will include more interviews with clinicians as well as ACEs and students.

Associate Clinical Educators On Film At Chester University

Course Director James Ennis performing a knee examination on ACE Bob
ACE Bob works closely with Course Director James Ennis whilst performing a knee examination for a training video at Chester University

It’s true to say that during the Covid – 19 crises our services have not been required as much as normal. Whilst many institutions seem to be struggling to embrace online teaching some have risen to the challenge and hit the ground running. We have been fortunate however, working with both Wolverhampton and Chester Universities on their PA Programs. This is great news as it helps keep our skillsets sharp and allows us the opportunity to embrace this new way of working.

Teaching online does have its challenges but I find it as easy as if we were working face to face with students in a classroom. The feedback we have received from students has been excellent and this gives us confidence that what we are doing is hitting the mark.

Working with students directly, and in particular with Physical examinations, has not yet been possible due to social distancing. This will change soon with September seeing us back in the driving seat working as ACEs.

James Ennis and Mark (ACE) preparing for a Lower Limb Neurology Examination that is being recorded for training purposes
Experienced ACE Mark assists James Ennis (Course Director Chester University) in performing a Lower Limb Neurology Examination

Many ACEs and role players are also trained actors which obviously ensures that scenarios are realistic and believable. We often get feedback from students saying how “real” they felt the interaction was, and because of our varied skillsets we often get asked to make training videos. These, more often than not, see us in consultations with us acting as patients, who might have challenging behaviours, as well as physical conditions and a comprehensive history.

Last week, we had a opportunity work with the Chester University PA Program when we were asked to take part in a filming session for James Ennis the Clinical Director at Chester University. We were tasked with developing a training video demonstrating a variety of typical Musculo-Skeletal Examinations (MSK).

We have been trained in clinical MSK examinations over 10 years ago by Professor Edward Davies (Consultant Surgeon) and Andy Emms (Consultant Physiotherapist) of the Royal Orthopaedic Hospital in Birmingham. This means that our level of skill and knowledge of how to prepare the students to perform these examinations is text book.

We often help prepare PA students and 4th Year Medical Students when working for The University of Birmingham Medical School in MSK examinations and this has sharpened our skills. This experience has been invaluable to our education as an ACE, as well as us being able to take advantage of online resources that are readily available if you know where to look.

The requirement was for us to go through complete Hip, Knee, Shoulder and Lumber Spine examinations, which also included Upper and Lower Limb Neurological exams.

With the help of Scott Howard from simulation, we managed to film all of the sequences and we look forward to seeing them being used by all those on the PA program in the near future. What made it even more useful was that we were able to review our knowledge base, and have an opportunity to practice skills we have not used for 4 months. It was a win-win situation!

I was assisted as always by my travelling companion Mark, who made the journey up to Chester pass by in the wink of an eye.

If you want to find out more about the role of the ACE and how we can help your students improve their technique, contact is at Meducate Academy.

Working Online With Meducate

ACE and role player Mark plays a suicidal patient in a scenario
Dealing with suicidal patients is very challenging and Meducates Associate Clinical Educators have years of experience to help guide the student through these difficult scenarios (Image Matrix Education)

Now that we have been in lockdown for almost five months, working online has been a challenge. We have had to explore new ways of working and teaching using technologies we have never used before. We embraced the challenge fully and have managed to work online with PA students at Wolverhampton and Chester Universities. In fact, we were even asked to do a summative OSCE at Wolverhampton University last month, which went very well.

In terms of teaching communication skills for history taking, there was very little difference from working face to face in a classroom. Students have also stepped up to the plate and invested time and energy in adapting to the new technologies and methodology.

At Meducate Academy we embraced this new approach to teaching online in the very first week of lockdown in March 2020.

Webinar for Matrix Education

This month, I had the honour of talking about the role of the Associate Clinical Educator and Medical Roleplayer on a webinar hosted by ‘Matrix Education’. We had over 50 delegates and talked for well over an hour, fielding questions from students attending Physician Associates Post Graduate courses at Universities around the UK.

Most of the questions were based on the students concerns and worries about their up- coming OSCEs later this year.

I was assisted by colleague and co-worker Mark and between us we provided entertainment as well as giving useful advice on:

  • How to conduct yourself in an OSCE station.
  • How does a student build rapport.
  • How to control nerves and anxiety.
  • What is the best way to prepare for a systems exam?

And much, much more.

PA student performing a CV exam with ACE Bob
Correct placement of the stethoscope is vital when performing a CV exam. Our Associate Clinical Educators know exactly how the examination should be performed and give guidance throughout (Image Matrix Education).

Collectively, my colleague and I have had over 25 years experience working in the field of Medical Education, and have taken part in hundreds of OSCEs over this period, including working with other Health Professionals such as GPs, Dentists, Medical Students, Nurses and Physiotherapists.

If you would like to know more about how we can help your students realise their potential please contact us at Meducate Academy.

Associate Clinical Educators

Welcome to this the first of many posts related to Meducate Academy and the work we do to provide Universities and Colleges with High Quality Associate Clinical Educators and Role Players.

Meducate was created in response to the growing demand for highly skilled Physician Associates (PAs), Medical Students, Independent Prescribing Pharmacists, Nurses, Dentists and others working in the Health Care Professions.

Our aim is to provide Colleges and Universities who run these educational programmes with teams of highly trained and experienced Clinicians, Clinical Leaders, Associate Clinical Educators (ACE) and Professional Medical Role Players.

We have already worked in partnership with Wolverhampton University and Chester University providing both Associate Clinical Educators and Role Players for their Physician Associate Programmes and we have taken our training to these establishments via Teams and Zoom. In fact, working online has saved the customer valuable time and kept the costs down considerably.

In this post we explore the role of the ACE and how they work alongside experienced clinicians to offer the best learning outcomes. We also find out how they differ from medical role players and just what it is they offer the student, The term Associate Clinical Educator was first pioneered by Professor Jim Parle at The University of Birmingham Medical School 10 years ago.

In the following video we interview a highly experienced Role Player and Associate Clinical Educator and find out just what it is they do and how it will fit in with your programme of teaching.

In upcoming post we will be talking to Pete Gorman, Clinical Lead from The University of Wolverhampton Physician Associate Course.

The University of Wolverhampton has worked closely with Meducate over the past 12 months both online as well as in the classroom and Pete Gorman explains how he has utilised the services of Associate Clinical Educators to great effect during his tenure there.

For more information and a free consultation as to how we can help you check in at our website Meducate Academy.