Associate Clinical Educators

The Physician Associates Program And The Role Of The ACE

April 22, 2021April 18, 2021 by R Spour

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

March 22, 2021 by R Spour

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.

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.

On 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

March 9, 2021 by R Spour

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

February 8, 2021 by R Spour

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 1^st Year physician associates and at Wolverhampton we were working with 2^nd 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

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

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.

Meducate Academy: Building Lasting Partnerships

March 6, 2021December 16, 2020 by R Spour

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 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.

My Top 10 Tips For Failing The OSCEs

November 22, 2020November 22, 2020 by R Spour

Image of long haired and unshaven medical student — Here are my top ten tips that will assure you fail the OSCEs

The idea for this post developed over the past ten years of my involvement in the training of Physician Associates, Medics, Pharmacists, Dentists and other health professionals. Ten years of working as an ACE and role-player observing those same students pass and fail their OSCEs every year.

I have also spent ten years mentoring and coaching students from all walks of life, at various levels of their education in order to help them become a success.

I have consequently developed strategies and models to help students become safe and competent health professionals. I have seen how successful many of them have become, time and time again.

Over that time, I have also made a careful study of underachievement. The students who fail. I have therefore reached a shocking conclusion that many of the students who fail, share the same strategies on a daily basis that leads to a state of total and absolute failure.

It takes an awful lot of work to fail this well. Often a lot more work than it takes to succeed.

Successful people always reveal that they never feel that they are working for a living.

They’re invariably optimists.

Failures are invariably pessimists.

They usually hate their work.

I have learned a lot from failures.

Failure is a choice… It takes conscious effort!

As I have said, I have studied success too and I know those strategies well. I guess if you know specific strategies for success and do the exact opposite, you’re well on your way to being a spectacular failure.

So, here are my top tips, my step-by-step approach to help you fail the OSCEs majestically.

Of course you could also do the exact opposite… But that would be crazy!!

So here we go:

STEP ONE

If you want to ensure that you fail the OSCE then you must definitely never ever think about what success could mean for you. Avoid, at all costs, positive role models and avoid successful people.

Never define your goals or find your purpose.

STEP TWO

DO NOT turn up early or even on time for lectures. In fact make sure you miss as many as possible. Forget to set your alarm and enjoy those extra minutes in your lovely warm bed. You deserve it after all. It’s been a tough week!

STEP THREE

If you insist on revising, remember to never revise in a structured way. Never plan you day around your study time.There are more important things to do. Tidying up your room, washing the dishes, the laundry or catching up on the a Netflix series that you missed first time around.

STEP FOUR

As the OSCE dates get closer never try to be optimistic about this approaching nightmare. Do anything but think about those exams.

Reaffirm on an hourly basis, that it’s going to be difficult. Maybe even impossible. OSCEs are difficult and scary.

STEP FIVE

Repeat Step Four the night before the OSCE and stay up late. Never get an early night and always panic. Lots of panicking!

“DO NOT REMAIN CALM.”

STEP SIX

You have somehow made it to the OSCEs and you are at your first station. Whatever you do… DO NOT READ THE QUESTION PROPERLY! Tell yourself that those two minutes are going to fly by, so only give it a quick scan.

STEP SEVEN

Never tidy up your appearance. Do not iron your clothes and always wear something inappropriate. You washed your hands earlier in the day, so do not use the hand gel when you enter the room.

STEP EIGHT

When you enter the room, lack confidence. This shouldn’t be difficult if you have followed the previous seven steps. If you look scared, you may win a sympathy vote. Mumble your name incomprehensibly and as fast as you can to save time.

STEP NINE

Forget to take notes. If you have been stupid enough to have wasted time making some outside the station… NEVER refer to them again. Remember to leave your stethoscope and watch at home. You can borrow them from the examiner, anyway!

STEP TEN

Have no structure when performing a systems exam. You’re a free spirit and want to show your improvisational skills to the examiner. When taking a history, DO NOT make eye contact. DO NOT listen for cues and always use jargon. Keep saying: “OK. OK. OK.”

Finally. Thanks for coming this far with the article. You have succeeded at something! Best that you forget everything I have said and now delete all the above from your memory. That would just take up valuable space.

This is by no means a complete guide for failing the OSCEs. That would take a book and you probably wouldn’t be bothered to read it, anyway. Avoid books, research papers and journals related to medicine. Hello magazine has more pictures in it, is more interesting and wastes a bit of time.

Meducate Academy Is Moving

November 22, 2020November 14, 2020 by R Spour

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.

Answer the Question: Common Errors When Sitting The OSCEs

November 22, 2020November 9, 2020 by R Spour

Image of man writing on exam paper

As a roleplayer and ACE for more than ten years one of the most common errors I see students make when taking part in their OSCEs is failure to read the questions correctly.

It is more common than you may imagine and not enough time is spent on this aspect of their education. Pete Gorman, course lead of Wolverhampton University, spends one evening of the week working online with his PA students looking at what he calls the “Golden 2 Minutes”. Meducate Academy are currently working as partners with him on this aspect of their training.

That’s how important it is.

At the start of OSCEs we have stations and on each one of them there is a question. The students have two minutes to read this question before they enter the station.

A nail biting two minutes for unprepared students!

What students do in that two minutes is crucial to their success when they sit down with the “patient’ they are about to see.

It is often the case that a student, who feels they have performed badly on a previous station, carry this negative state onto the next question. When they arrive at the next station this inevitably clouds their judgement and therefore their ability to read the question correctly is compromised. Their heads are filled full of ideas about how they might have done better on that last station and this attitude has a definite influence on their state of mind when they sit down and look at the new question. This is the time to let that last experience go, to draw a line under it and clear their mind.

I often tell students to have a delete button in their head so that no matter what they did on the last station, positive or negative, is erased.

Deleted. They don’t need it.

They need clarity of mind to enable them to read the next question now placed in front of them, to take a couple of deep breaths and relax. Then read the question.

So the first thing they need to do is to read the question carefully. Ask themselves what type of question it is. Quickly skim through it to pick out it’s main features.

Is it a procedure, an examination or a history? How much detail do they have?

Quickly make a few relevant notes. Look at the patient information of which there may not be much, but if they concentrate and read the question there may be clues.

Age of patient, gender, ethnicity, marital status and their occupation?

Is there any information about previous medical history, or the medications they are currently on?

I know all of this may seem obvious, but when the red mist of fear comes down and clouds judgement it’s easy to lose sight of the basics.

Think about your strategy for diagnosing the likely outcome. What are the red flags and if this is a mental health problem remember to do a suicide assessment.

All of these things are basic to good structure and in the heat of the moment it’s so easy to skim through the question and think you have it right. Read the question carefully. It is that simple.

I remember one student who hadn’t read the question carefully after a perfect introduction and performed a respiratory exam on me when she was supposed to be performing a cardio vascular exam! Ooooops! Needless to say she failed that station.

Check out some of our videos on our YouTube channel to give more guidance. I will be posting more later in the month.

In Conversation With Senior Associate Clinical Educator Mark Reynolds

October 12, 2020 by R Spour

Interview with Associate Clinical Educator Mark Reynolds — Associate Clinical Educator Mark Reynolds giving feedback to a PA student on a recent course

A few subscribers have asked me to expand further on the role of the ACE, and this is a transcript of an interview I did with fellow ACE Mark Reynolds a few years ago. It still has relevance today and should answer any questions I have received over the past few months.

Meducate: What can you tell me about the difference between a Role Player and an ACE (Associate Clinical Educator)?

Mark: A role player is involved in clinical communication, in that they play opposite a medical student as a patient or colleague in order to to improve their learning in terms of their technique of clinical communication. The associate clinical educator is also trained as a role player but is also trained in the body system examination so they are a hand on resource for the student to work on. The ACE then feeds back how well the student carries out that examination.

Meducate: You mentioned the term “body systems” what do you mean by that?

Mark: The basic body systems, from the point of view of the medical world, would be the cardiovascular, respiratory, gastrointestinal, neurological and musculoskeletal systems. We are trained to give feedback on their examination technique. Techniques such as percussion, auscultation and palpation. We never teach pathology, that’s up to an academic tutor who normally works alongside us.

Meducate: So the academic tutor teaches the pathologies and the theory, and you are the resource? A bit like a living mannequin?

Mark: Yes, we are a living resource able to give feedback on the technique as well as our extensive knowledge of the OSCEs and what is required in those academic exams. At first Techniques like Percussion and Palpation are often a problem for new students, and we can guide them in the correct technique as well as ensuring they’re in the correct position on the body.

Meducate: And because you’re also a communications expert, you can give feedback on their ability to communicate effectively and build rapport with the patient.

Mark: Absolutely yes. Communication is a vital part of the examination process and it would be remiss of me to allow a student to carry on if they couldn’t build rapport with the patient.

Meducate: So can you describe a typical session with an ACE?

Mark: So normally a body system is picked for the day and the ACE will be working with four to six students. Sometimes the clinician may do a live demonstration using the ACE as the model, and then the students will be taken through the various pathologies they may come across on a typical patient. The students would then be left to work with the ACE, and they would then give feedback about how well they are doing. Having a “Talk the Walk” approach works very well, as we can direct the student toward the correct method right from the start. Sometimes we may run a scenario alongside the physical examination and thereby making it more realistic. With the help of the clinician present, we will also include a management plan and how to explain that to the patient in layman’s terms. We can also present various pathologies to the student such as asymmetrical breathing, antalgic gait, Shortness of breath and many more. We even have a member of the team who can create ulcers, bruising, and other physical signs using moulage.

Meducate: I have heard students say that they feel more relaxed when working with an ACE can you expand on that?

Mark: Yes, when a student has a clinician in the room they feel that they are being judged. Which of course is true. We are there as a resource, a tool, if you will to help them develop without judgement. It is true that we assess them, but not professionally. We are not qualified Medics!

Meducate: ACEs are often used in OSCEs to great effect. How does that work?

Mark: During an OSCE it is not possible for the examiner to feel what is going on such as palpation, and that’s where we can give our feedback about how well the palpation went. Whether it was painful or too light. Because of our intensive hands on training, we know what a good technique is. This ensures that the PA is safe to practice once qualified. It should be remembered too that we have probably been involved in thousands of OSCEs, so we have an extensive experience, often much more than the examiners themselves. Examiners often remark on how extensive our knowledge is!

Meducate: Better than a real patient?

Mark: Yes, very different. A patient will not be qualified to give feedback. Of course, working with real patients is also valuable to the learning process.

Meducate: Thanks for taking time out to chat with us, Mark.

An Interview With Matt Chapman Managing Director of Meducate

September 30, 2020 by R Spour

Image of Matt Chapman Managing Director of Meducate Academy — Matt Chapman Managing Director of Meducate Academy

Matt Chapman is Managing Director of Meducate and is a founding member of the company. In this post, Matt talks about his vision for the company and how Meducate differs from other companies he has worked for over the years.

“I’ve been involved with Meducate from it’s inception over 2 years ago and the big thing that stood out for me was how engaged the students were with the ACEs and the methods we use. Feedback was always phenomenal something I hadn’t experienced in any other business before. There’s always a grumpy customer that you have to deal with in any business, but with Meducate it was always positive feedback.

“Every time we engage with an institution and their students, they give us 5 stars across the board.

“When we first met and you talked about the concept of Meducate you were already doing corporate training with me and when you told me about the potential of the ACE role in medical training, I suspended my judgement on how good you said the work was. I remember coming on the first session with one of our earliest customers at Wolverhampton and it was all true. Not only were you and the other ACE enjoying the day but so were the students. Id never seen that level of engagement with anyone in business before. 100% of the class were involved and craved more! That is when I knew we could make this work. In business we always want a win-win situation, and this seemed to be the right type of service to offer. That and the fact that we are almost the only people to be offering this service.

“The fact that this had never been picked up on before and was an open market surprised me. I know there are lots of role play companies out there offering medical role players, but the role of the ACE is unknown. My only concern was, would we have enough ACEs to cover the 40 + institutions that may need our services. Our answer came with the pandemic. This gave us time to regroup and begin training role players in the skills required for them to perform as an ACE. We did this with the help of some senior academic tutors and experienced clinicians who work in the health care sector. Again, this was another of Meducate’s strengths. Our ability to contact the right people is paramount and we are even in discussions to validate the role of the ACE with two Universities keen to promote what we do.

“I was asked recently what drives me in business and I remember we were talking about values and how you see the work we do at Meducate. One of the core values I have always had was with having the ability to measure and monitor every aspect of the customer experience. That would be at all levels. So how well do we handle incoming calls and meetings with potential clients? Feedback from students is something I have already talked about, but what do the clinicians think? How do they feel about utilising ACEs in the educational process and how valuable are they? The answers coming back so far have been outstanding. I really believe in giving the customer what they want and will always work with them to achieve their goals.

“I have always believed in being transparent with the people who work for us and the customer. Keeping everyone in the loop on a regular basis makes for a happy and fruitful relationship.

“What has been difficult, but I have now adapted too, is the sudden changes a client might make at the last minute about the type of training they want delivered? I was surprised by how flexible our ACEs were. They were able to shift gear quickly and improvise, effectively delivering exactly what the customer wanted. This I believe is one of Meducate’s great strengths and is due to the intensity, passion and abilities of the people we have working with us.

“With regard to the abilities of the ACEs I would like to mention that we update the ACEs skill sets every 6 months and will run regular training days to help the ACE with any areas in which they might feel weak. We want everyone to feel like they’re part of a family and if we all look after each other, we will all prosper. It’s a continuing process that we can’t let slip. As times change, we must change, as we have all recently experienced, and we were quickly working online in March of this year. I don’t believe any other organisation reacted that quickly. We were already prepared to provide online trainings anyway, so it was simply a matter of contacting our customers and setting it up.

“In closing, I would just like to say that I feel we are a very under-used resource, but we have professional credibility with several universities using us and several ACEs with over 12 years’ experience. If you want to test us out, why not call us or email or call us for a 5 minute conversation?”