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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


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 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

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