ACEs

Professionalism in Undergraduate Medicine: Key Insights and Challenges

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Clinical Lead James Ennis and Senior ACE Greg Hobbs collaborating to ensure the best possible student experience

In the ever-evolving field of medical education, professionalism is paramount in shaping future health professionals. Our comprehensive guide, “Professionalism in Undergraduate Medicine: Key Insights and Challenges,” delves into the essential aspects of ethical practice, patient-centered care, and lifelong learning. We explore the integration of professionalism into medical curriculums, the importance of role models, and effective assessment methods. Addressing challenges such as cultural sensitivity, resistance to change, and student burnout, we emphasize the need for continuous improvement and effective communication. By fostering a culture of excellence and integrity, we aim to prepare the next generation of healthcare professionals to provide high-quality, compassionate patient care.

When I am training new Associate Clinical Educators (ACEs) to work for Meducate Academy, I’m focused on more than just their ability to discuss communication issues or demonstrate basic knowledge of body systems and examination techniques. My expectations go beyond these foundational skills; I also require them to assist students in understanding questions about professional conduct and ensuring safe practices.

The content of this month’s post is relevant not only to the ACEs but also to a wide range of other professions. I invested considerable thought into this article, as the topic of professionalism frequently arises in my discussions. Reflecting on what it truly means to be professional, I realize I could share numerous alarming anecdotes about individuals and organizations lacking many of the attributes I’m about to explore.

In our training sessions, we delve deeply into the nuances of professional behaviour. This includes adhering to ethical standards, maintaining a commitment to continuous learning, and embodying a respectful and empathetic approach towards patients and colleagues. It is crucial that ACES must understand their role in fostering a safe learning environment, where students feel supported not only in their technical skills but also in their development as compassionate and ethical practitioners.

Moreover, professionalism includes effective communication, accountability, and the ability to manage and reflect on feedback constructively. These qualities are crucial for ACEs, who must exemplify them for the students they mentor. By emphasizing these aspects, our goal is to nurture a culture of excellence and integrity within Meducate Academy.

Through these comprehensive training programs, our goal is to prepare ACEs to not only excel in their instructional roles but also to instil in their students the values that define true professionalism. This, in turn, ensures that the next generation of healthcare professionals is equipped with the knowledge, skills, and ethical framework necessary to provide high-quality, safe patient care.

Vision

Professionalism in undergraduate medical education is fundamental to shaping future health professionals who not only excel in clinical knowledge and skills but also uphold the highest ethical standards and interpersonal competencies. The vision encompasses:

Ethical Practice

Ensuring that future clinicians adhere to the highest moral principles involves instilling values such as honesty, integrity, accountability, and respect for patient autonomy. This ethical foundation guides decision-making and fosters trust in the doctor-patient relationship.

Patient-Centered Care

Prioritizing the needs and values of patients requires that medical students learn to listen actively, show empathy, and involve patients in their own care. This approach enhances patient satisfaction and health outcomes.

Lifelong Learning

Promoting a commitment to continuous improvement and adaptation to advancements in medicine is crucial. This involves teaching students the importance of staying current with medical research, technologies, and best practices throughout their careers.

Interpersonal Skills

Fostering respectful and effective communication with patients, families, and colleagues is essential. This includes teaching students to work well within healthcare teams, manage conflicts, and convey complex information clearly and compassionately.

Considerations

Several key considerations must be addressed to integrate professionalism into undergraduate medical education successfully:

Curriculum Design

Integrating professionalism into the curriculum requires a combination of theoretical instruction and practical experiences. This might include dedicated courses on medical ethics, communication skills, and reflective practice, as well as embedding these themes throughout clinical training.

Role Models

Experienced healthcare professionals who embody professionalism play a crucial role in teaching by example. Mentorship programs and shadowing opportunities can expose students to exemplary professional behaviour in real-world settings.

Assessment Methods

Developing reliable and valid methods to assess professionalism is challenging but essential. Tools such as 360-degree feedback, reflective writing assignments, objective structured clinical examinations (OSCEs), and patient feedback can be used to evaluate students’ professional behaviour.

Cultural Sensitivity

Medical education must address the diverse cultural backgrounds of students and patients. This includes teaching cultural competence and humility, which helps future doctors provide respectful and effective care to patients from various backgrounds.

Feedback Mechanisms

Implementing constructive feedback systems is vital for promoting self-improvement. Regular, formative feedback helps students recognize their strengths and areas for growth in professionalism.

Opportunities

The integration of professionalism in undergraduate medical education offers numerous opportunities:

Enhanced Patient Trust

Building trust between future physicians and their patients through professionalism leads to better patient engagement and adherence to treatment plans.

Improved Healthcare Outcomes

Professional behaviour, characterized by empathy, clear communication, and ethical practice, directly contributes to better patient outcomes and satisfaction.

Interdisciplinary Collaboration

Encouraging teamwork and collaboration across various healthcare disciplines fosters a holistic approach to patient care, improving the quality and efficiency of healthcare delivery.

Career Advancement

Professionalism is often a key determinant in career progression and leadership roles. Students who demonstrate high levels of professionalism are more likely to be selected for prestigious residencies and leadership positions.

Research and Innovation

A professional and ethical approach to medical research ensures the integrity and credibility of scientific findings, fostering an environment where innovation can thrive while maintaining public trust.

Challenges

Despite the benefits, promoting professionalism among undergraduate medical students presents several challenges:

Subjectivity

Professionalism can be subjective and difficult to measure consistently. Different educators and evaluators might have varying standards and interpretations of professional behaviour.

Resistance to Change

Some students and faculty may resist new approaches to teaching professionalism, especially if they perceive these methods as subjective or intrusive.

Time Constraints

The already demanding medical curriculum may leave little room for additional focus on professionalism. Balancing the teaching of medical knowledge and skills with the development of professional behaviours can be challenging.

Cultural Differences

Diverse cultural norms and values can complicate the standardization of professionalism. What is considered professional in one culture may not be seen the same way in another, necessitating a flexible and inclusive approach.

Burnout

High stress and burnout among medical students can negatively impact their professional behaviour. Addressing student well-being and promoting resilience is essential to maintaining professionalism under pressure.

Conclusion

Professionalism is a critical component of undergraduate medical education, essential for developing competent, ethical, and empathetic clinicians. While there are significant opportunities to enhance medical training through the integration of professionalism, it is crucial to address the inherent challenges thoughtfully and strategically. By doing so, we can ensure that the next generation of clinicians is well-equipped to meet the evolving demands of the healthcare landscape, ultimately leading to better patient care and improved health outcomes.

Contact Meducate Academy today to take your training programs to the next level.

For an informal chat please get in touch with me: bobspour@meducateacademy.com or on 07870 611850

Adapt, Improvise, Excel: How ACEs Deliver Effective Educational Content

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University of Newcastle Physician Associate 2nd year cohort
We were invited to teach MSK skills to University of Newcastle Physician Associate 2nd year cohort in preparation for their upcoming OSCEs.

Being an Associate Clinical Educator (ACE) is a rewarding and dynamic role that contributes to the education and growth of future healthcare professionals. The ACEs receive immense fulfilment from positive student feedback and witnessing their progress. The job brings excitement and unpredictability, requiring adaptability and improvisation to deliver effective educational content. ACEs gain valuable experience from working with diverse clinicians, undergo regular training and evaluation to stay updated, and ensure the quality of education. Recently, at Newcastle University Medical School, a four-person ACE team provided comprehensive MSK examination training and extended support in other areas of healthcare education. The students appreciated learning from experienced ACEs and requested guidance on various exams. Despite time constraints, consultation skills were briefly covered, and a group Q&A session concluded the day. Gratitude was expressed to the university staff for their collaboration in creating a valuable learning environment.

Experienced Associate Clinical Educator (ACE), Mark Reynolds, collaborates with experienced clinicians from the FRCS (Fellowship of the Royal College of Surgeons) at the prestigious Royal Orthopaedic Hospital
Experienced Associate Clinical Educator (ACE), Mark Reynolds, collaborates with experienced clinicians from the FRCS at the prestigious Royal Orthopaedic Hospital

Working as an Associate Clinical Educator (ACE) is an incredibly fulfilling and stimulating role. ACEs play a vital role in the education and development of future healthcare professionals, and the rewards of this position are often experienced on a personal and professional level. The positive feedback received from students after a job well done is a source of immense fulfilment. Knowing that your efforts have contributed to their growth and progress is a testament to the significance of the ACE role.

One aspect that makes this role exciting is the unpredictability it brings. The subject matter can change at a moment’s notice, from cranial nerves to a cardio examination with a roleplay element added spontaneously. These unexpected twists and turns add an element of excitement and keep the role fresh and invigorating. As ACEs, it is crucial to be adaptable and ready to improvise, as this flexibility ensures the effective delivery of educational content.

The ability to adapt and improvise stems from the wealth of experience ACEs gain from working with clinicians from diverse backgrounds. This experience equips them with the necessary skills and knowledge to handle various teaching scenarios. To ensure the continuous professional development of ACEs, regular training sessions and a rigorous evaluation process are implemented. These measures not only guarantee that ACEs are up to date with the latest advancements but also uphold the quality of education they provide.

Recently, at Newcastle University Medical School, we had the privilege of teaching MSK examinations to 2nd Year Physician Associate students. Musculoskeletal (MSK) is one of our specialties, and our expertise in this field is derived from training with renowned clinicians and collaborating with members of the FRCS. Our knowledge is cutting-edge, ensuring that students receive the most up-to-date information.

Experienced MSK ACE Howard takes the student through the details of a Spine examination at The University of Newcastle
At The University of Newcastle, experienced MSK Associate Clinical Educator (ACE), Howard, expertly guides students through the intricacies of a spine examination

The positive feedback we received from our previous visit to Newcastle prompted the university to invite us back for further training. While the students initially exhibited some reticence, having only practiced on each other, our four-person ACE team quickly alleviated their fears. The advantage of having a small student-to-ACE ratio allowed us to delve into details and answer their questions promptly and effectively. We covered a range of MSK examinations, including the hip, knee, shoulder, and spine. Additionally, we fulfilled requests for hand and ankle exams, ensuring a comprehensive learning experience. Our instruction included all the special tests for MSK, providing continuous feedback to aid their learning. The students greatly appreciated the opportunity to learn from experienced ACEs rather than relying solely on practicing with their peers. One student even humorously remarked that it was a case of the blind leading the blind!

Surprisingly, some students were amazed at our level of knowledge of other body systems. They requested that we check their cardio, GI, and respiratory exams ahead of their upcoming OSCEs (Objective Structured Clinical Examinations). As ACEs, our expertise extends beyond our specialization, allowing us to provide guidance and support in various areas of healthcare education.

Although time constraints prevented us from fully exploring consultation skills, we provided the students with a brief overview of the basics. We reassured them that their history-taking skills were up to par for their current stage of training.

As the day came to an end, we conducted a group Q&A session to address any remaining questions. We expressed our gratitude to the students for their active participation and made the journey back to Birmingham, reflecting on the meaningful interactions and knowledge shared.

We would like to extend our heartfelt thanks to Alice Fitzpatrick, Year 2 & EDI Lead for MSc Physician Associate Studies, and Emma McAllister, Degree Program Director, MSc Physician Associate Studies, for granting us the opportunity to teach at Newcastle University. Their support and collaboration have been instrumental in fostering a rich learning environment for the students.

In Other News…

Exciting times are ahead for Meducate Academy as we prepare to launch our latest offering: Pharma Pathways. This is a programme of training designed to support clinical pharmacists. In collaboration with experienced Clinical Lecturers in Clinical Pharmacy, we aim to assist pharmacists in meeting the new government directive regarding consultation and clinical skills training. Through our dedicated ACEs and Medical Roleplayers, who possess decades of experience working with healthcare professionals such as Physician Associates and Nurses, we are committed to delivering comprehensive support.

Currently, Meducate Academy supplies ACEs and Medical Roleplayers to pharmacy programs at both the University of Wolverhampton and Birmingham, further expanding our reach and impact in the field of healthcare education. Pharma Pathways has been created to offer educators access to ACEs and Medical Roleplayers.

In conclusion, the role of an Associate Clinical Educator is undeniably fulfilling, interesting, and exciting. It provides opportunities for personal growth and professional development while positively influencing the education and future careers of aspiring healthcare professionals.

 

If you’re a Pharmacy Clinical Lead and wish to discuss working with Meducate Academy Ltd., we would love to give you a demonstration and a workshop at your institution.

Please contact: bobspour@meducateacademy.com or on 07870 611850

15 Questions to Test Your Skills as an Associate Clinical Educator

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Meduucate Academy ACEs with Medical students at the University of Chester
If you’re an Associate Clinical Educator (ACE), you may have wondered what sets you apart from a simulated patient or medical role player. In this article, we will be exploring this question and providing a useful questionnaire that will help you become a better ACE, teacher, and communicator. Our goal is to improve the quality of ACEs by answering important questions and providing helpful training resources.

How well do you really know your role as an Associate Clinical Educator? I have been thinking for a while now about creating a quiz for ACEs. I wanted to find out what makes an ACE more than just a simulated patient or medical role player. I believe the following questionnaire will help us become better Associate Clinical Educators, as well as better teachers and communicators.

Over the past couple of years, Meducate Academy has been putting together training courses to help existing ACEs and simulated patients improve their existing skills and introduce new people to the role of the ACE. We are always striving to improve the quality of our ACEs, and in order to do that, we always listen to what they have to say.

When I was starting out, many of these questions were never answered satisfactorily, and after much discussion with our existing ACEs, they all seemed to ask the same questions.

On the 13th of this month (May 2023), we will be running another one-day training course aimed at potential ACE. These are normally people who have been medical role players or have some experience as simulated patients and wish to take it to the next level.

If you are one of those people, you might find it helpful to ask yourself these questions below. If you are an experienced ACE, you could revisit this questionnaire or add more questions to the list.  So, get a sheet of paper and answer these questions now.

1. When did you first start working as a medical role player and why?
2. When did you start working as an ACE, and how easy was the transition?
3. How often do you work as a medical role player or ACE?
4. What types of students have you worked with, and did their needs differ?
5. Have you been involved in OSCEs or any other type of examination?
6. Was the training we gave you adequate, or do you feel it was confusing?
7. What type of training would you find most useful?
8. Which aspect of your previous training (prior to medical roleplay/simulated patient/ACE) has helped you engage with your current role?
9. Where do you find resources that help with your current role?
10. What new resources would you find useful to help you improve the quality of teaching?
11. How much do you think your personality affects the learning outcome, and do you think you should spend more time on that aspect of your training?
12. Do you know how to teach a student how to develop rapport with a difficult patient?
13. What do you get, at a personal level, from teaching as an ACE?
14. How do you structure feedback to the student?
15. Do you always achieve your desired outcome when teaching, and if not, do you reflect on what you could do better next time?

We came up with these initial 15 questions, but we welcome any suggestions. As we ask these types of questions to our new ACEs, it’s essential to understand that none of us are experts or masters of our craft.  Acknowledging that there is always room to learn something new helps us stay vigilant. Our honesty fosters implicit trust from our students, and they feel that we are with them on their journey.

The type of people we are looking for are those who say, “C’mon chaps, let’s get stuck in,” not “Go on, chaps, off you go.” Lead from the front. We are there to work with the students, not talk at them. Build rapport with the students, have the flexibility to change your behaviour when you need to, be aware, and you and the students will achieve their desired outcomes.

Have an open mind and question everything! At the end of the day, that is what education should be about. That is how we grow and become better humans.

If you are interested in joining us or want to have a chat about our one-day training course aimed at potential ACEs on 13th May 2023 get in touch. Please contact: bobspour@meducateacademy.com or on 07870 611850

 

Become an ACE in Medical Education: Free Training Course Available Now!

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Do You Want To Be Part Of Our Team?

Are you an Actor, Role-player or retired Clinician who would like to get involved in our ACE training programmes?

We are looking for people with the following attributes

Skills?

Do you have a desire to develop new skills yourself and really make a difference?

Communication?

Do you enjoy the act of communication?

Passion?

Do you have a passion to help students develop their skills?

Are you a medical role-player looking for new opportunities to expand your skills and knowledge? Meducate Academy has the perfect solution – a free Associate Clinical Educator (ACE) training course on the 13th of May 2023. 

The course will be held at The University of Wolverhampton and will provide attendees with a comprehensive introduction to basic body systems examinations and feedback techniques with the help of experienced clinicians. In addition, drinks, lunch, and a manual to further your knowledge and understanding will be provided on the day.

And this is just the beginning! As an ACE, you will have ongoing training to continue building your practical examination skills and responsibilities to students and clinicians. It’s a challenging and rewarding role that involves working with the same team of clinicians and students over a period of two years or more.

At Meducate Academy, we have been busy developing relationships with institutions across the UK and are keen to find medical role-players who want to expand their portfolio of skills. The ACE training course is just one of the many opportunities available to those looking to advance their careers in medical education.

But what does it mean to be an Associate Clinical Educator? It means being part of a team that is dedicated to providing high-quality education and training to the next generation of healthcare professionals. It means using your knowledge and experience to help students develop the skills they need to succeed in their future careers.

If you’re the kind of person who enjoys working with students, learning new skills, and collaborating with professionals, then the ACE role may be right for you. Check out the videos below to learn more about what it means to be an ACE and the impact you can have on medical education.

Don’t miss out on this fantastic opportunity to take your career to the next level. Sign up for the ACE training course today and start your journey towards becoming an Associate Clinical Educator. Time is running out – act now!

If you are a Medical Roleplayer and would like to take your skill set to the next level, sign up for our training courses in 2023. Our next one is on May 13th 2023 and it’s free! Give Bob a call on 07870 611850 if you would like more details or want to ask anything about our courses. Or sign up in the below form for more information about the course.

 

The Associate Clinical Educator (ACE) successfully combines the role of the simulated patient and lay teacher involved in the training of health professionals of all kinds. From medical students to physician associates, from dental students to nurses and many, many more.

The ACE is a hands on resource for the student. They provide the student a chance to get quite literally hands on with an experienced simulated patient. It gives the student the opportunity to put into practice the theory they learn in the classroom from tutors and medical textbooks. The opportunity for them to work with a ‘real person’ who can present as a healthy patient or one who has a variety of pathologies.

ACEs are not clinicians, and their backgrounds are varied. Some may have a background in performance and others in teaching. Some are already medical role players, but this is not a requirement. The desire to teach and assist students in order to help them become better and safer clinicians is our chief priority. An ACE should therefore be able to give structured feedback to the student in a way that helps them learn and improve their skill sets.

An ACE of course has their own skill sets to learn too, and with that in mind we are putting a campaign together to recruit new role players and ACEs to the organisation. So, whatever your background, there may be a place in Meducate Academy for you.

We have training programmes that are designed to get you up to speed in no time at all. You will then work alongside our more experienced people to consolidate those skills.

All of our ACEs and roleplayers are self-employed and payment is made by invoice. We pay industry standards and some of our ACEs work most weeks of the year.

We are also on the lookout for experienced clinicians to work alongside our ACEs. Contact us about this very important role.

Good rates, good conditions and a successful and helpful team are waiting for you to join them.

Meet The Team

Meducate Academy group photo of team of associate clinical educators

Based in the West Midlands, Meducate boasts a great mix of Academics and Entrepreneurial people including Clinicians, Lay Educators and others who have been involved in almost 50 years of corporate and business development training.

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

Bob Spour

Bob Spour

Training Director

Matt Chapman

Matt Chapman

Finance Director

Bootcamp For Physician Associate Students At Chester University

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The Meducate Team and some 2nd year PA students on their Bootcamp at The University of Chester

The Bootcamp for Physician Associate students at Chester University is an intensive training program designed to help students prepare for National Exams. It involves practising skills, receiving feedback from experienced trainers, and honing communication and consultation skills. The Bootcamp is structured over three days and covers a variety of conditions and scenarios, including multi-systems examinations. The program is designed to help students deal with stress and pressure in a simulated exam setting, and to conform to the standards required by OSCE assessors. The Bootcamp ends with the students having the opportunity to practice under exam conditions and receive feedback.

Who Dares Trains!

Putting the Physician Associate student through their paces.

I think it is essential to define what I mean by Bootcamp. The definition of a boot camp is an intensive way to obtain knowledge about a specialisation. In the case of the Physician Associate program, these are related to medicine.

A common practice is to take the students (usually 2nd years) through a whole range of skills working with ACEs, mannequins and clinicians to help them hone their skills and then receive focused feedback at the end of the process.

The idea of the Bootcamp comes from the military where soldiers are put under intense pressure and made to perform the skills they have learnt in their area of expertise. Unlike the military, we do not shout at students but guide them with structured feedback. They do feel pressured to perform which helps them deal with the stress of their upcoming OSCEs. This is also a valuable skill for a PA as they will inevitably find themselves outside of their comfort zone when out in the workplace. In particular Emergency Medicine and Breaking Bad news.

Bob works with students on the intensive bootcamp held at the University of ChesterThe ACE plays a very important part in this process, and because of their high level of knowledge and skill can replicate the patient journey in fine detail. This is what distinguishes us from volunteers or role-players, who give high-fidelity feedback on more than just communication skills. An Ace is trained to give feedback on the way a student handled the patient, and the efficacy of the techniques they are using. For example, the way the student auscultates and percusses the patient or the way the student used palpation.

Did the student perform the examination using the accepted methodology? Did they conform to the standards required by the OSCE assessors?

Each institution has its way of running the boot camps, but generally, the structure is something like this:

Day One: Introduction to the methodology and approach expected from the student. Consultation skills: History taking on a variety of conditions to be determined by the academic staff.

Challenging scenarios related to the workplace. It is not just patients that can be a challenge, but colleagues too, so it is important to learn how to have difficult conversations.

Day one usually ends with a group discussion about what they would like to cover over the remaining 2 days. At Chester University, the students worked with 4 experienced ACEs and we covered Cardio, Respiratory and GI. We practised them as stand-alone examinations and blended them, where a patient would present with a pathology that required a multi-systems approach. The students always find this a challenge but usually do well at this level of their training.

We also worked through MSK and Neurological examinations.

For a Physician Associate to prepare for National Exams it is always great for the team at Meducate Academy to get the feedback they deserve. We work hard to ensure the students get the best tuition and feedback.

The two years working with this cohort have flown by, as they say, and it has been a journey filled with surprises and detours. Plain sailing and a few rough patches, but when all is said and done we got there in the end!

PA Students sent a thank you letter to Meducate Academy teamBoot camps are a great way to help the students tie up any loose ends they may feel they have in their understanding, and I am pleased to say we and the academics were there to support them.

I got the sense that the students were more than ready for the nationals and we wish them all the luck for their future as Physician Associates.

As an aside, it was also great to get a ‘thank you’ card from the students, which was totally unexpected but very welcome. I look forward to being at their graduation.

So, it is onwards and upwards for the coming year and 2023 promises to be a good one with us working closely with our partners and also with Pharmacists at Wolverhampton University.

If you’re a Clinical Lead or Senior Lecturer and want to have a chat with us about how we can add value to what you already get in touch. We would love to give you a demonstration and a workshop at your institution. Please contact: bobspour@meducateacademy.com or on 07870 611850

 

Associated Clinical Educators & Simulated Patients In Medical Education

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Physician Associate students being taught by academic on a medical scenario using an associate clinical educator in the role of a patient
Physician Associate students were guided through an end-of-life scenario at Chester University

I want to answer a question I am regularly asked by academics, clinicians, students and other medical roleplayers: “How does an ACE differ from a medical roleplayer, a simulated patient and a volunteer patient?”

The following information draws on our 25 years of collective experience as medical roleplayers and ACEs. We have years of interaction with simulated patients, volunteers and medical roleplayers.

Let us start with volunteers.

In our experience, a volunteer is someone who offers their services to give something back to the NHS for free. They have little or no training and often have to use crib sheets to help them act like a patient for students. Whilst volunteers are of some value to the student, they are not trained or qualified to give constructive feedback on the techniques the student needs to learn.

A simulated patient is someone who acts as if they have a pathology, or uses their actual pathology, with a short backstory they must learn. They have not been trained to give specific feedback to the student about the techniques the students are employing. Simulated patients may be asked for feedback by the teaching team on how the student made them feel during the session. However, this information is fed back to the student by the training team, not by the simulated patient. During the session, the teaching staff will monitor student/patient interaction.

The Medical Role player on the other hand is someone who is usually a trained actor and has undergone some training with regard to communication skills. They are expected to give high-quality objective feedback from a third-person perspective to the student. They can, and often come out of their role to give instruction about how the student can improve their performance and increase empathy with the patient. They work on everything from a simple consultation (history taking) to playing difficult patients, challenging behaviours, suicide and mental health scenarios, as well as working with colleagues from other health professions. They will also play the role of consultants, doctors, nurses and paramedics when needed.

The Associate Clinical Educator (ACE) is a type of medical roleplayer who is exemplified by their in-depth knowledge of the various body systems and pathologies. The ACE is responsible for developing and delivering educational programs that utilize simulated patients and medical role-players. The ACE takes a comprehensive approach to develop these programs, ensuring that each program is designed to meet the specific needs of the learners.

The Associate Clinical Educator (ACE) takes the models of the simulated patient and medical role-player to a different level. Exemplified by in-depth knowledge of the various body systems and their pathologies. A medical roleplayer is an individual who is trained to simulate different medical scenarios in order to help students learn how to interact with patients. These scenarios can include breaking bad news, dealing with difficult patients, and end-of-life scenarios. The role-player is expected to provide objective feedback to the student on how they interacted with the patient, from the patient’s point of view. In order to do this, the role-player must have a basic understanding of communication training and be able to help the student improve their communication skills.

ACEs are highly trained professionals themselves, but also have in-depth knowledge of the various body systems and their pathologies. This makes them uniquely suited to running simulations that are as realistic as possible. This helps medical staff to be as prepared as possible for when they need to use these procedures in real-life situations.

Evidence of a mix of styles, from volunteers, experienced role players and ACEs, was exemplified by the work we did for Chester University at a recent training session with the first and second-year Physician Associate Students.  These students worked alongside nursing staff and social workers in an immersive exercise designed to allow the students the opportunity to work under the pressure of a simulated patient journey. The simulation suites were designed to replicate two busy hospital wards. In the simulation, there were patients presenting with dementia, alcohol dependency, gastrointestinal and cardiac problems, as well as the challenge of working with other health professionals.

The students were supervised by experienced members of the academic staff and the at the end of the simulation the students were given feedback by both the clinicians and the associate clinical educators.

If you are a clinician who would like your current group of Physician Associates to benefit from our expertise in medical simulation, get in touch with us now. Please contact: bobspour@meducateacademy.com.

A Week In The Life Of An Associate Clinical Educator

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Clinical-Lead-James-Ennis-teaches-the-finer-points-of-systems-examination
Mark and Helen of Meducate Academy listen in as Clinical Lead James Ennis teaches the finer points of systems examination.

It’s always busy at Meducate Academy and some weeks are busier than others, but what is it an ACE does? What’s a typical week in the life of an ACE? It’s a question I often get asked by students and role-players and friends alike.

To answer that question I thought I’d keep a diary of a typical week and hopefully answer those questions. It might also help those medical role-players gain some insight as to whether they want to take the next step and start training to become an ACE and take their abilities to the next level.

So let’s take a look at a typical week.

The week started as it usually does with checking emails and messages that might be left on social media. LinkedIn seems to be the best one for keeping in touch with colleagues at institutions around the country and abroad.

Once that’s out of the way, I will usually look at some scenarios and teaching sessions that may be on the timetable that week. It always pays to prepare for some of the more technical sessions we are involved in. Cranial nerves examinations, for some reason, seem to scare ACEs as much as it does the students, but because I’ve been working as an ACE for over 12 years, I don’t find this as daunting.

The week we are looking at was varied and included respiratory, cardio and a brief session on Gastro Intestinal examinations.

As the students were first-year Physician Associates, it was important that I also understood what was required of me by the clinicians. Every clinician has their way of carrying out these types of examinations, and it’s important that we, as ACEs, ensure that we are all singing from the same hymn sheet.

Experienced clinicians often take shortcuts in clinical practice when examining a patient. This is because they have many years of experience working in medicine. Students are often confused by this approach particularly because the methodology used in training is far more detailed.

My experience working as an ACE, has made me realise that students frequently get confused about this approach and what is required of them in terms of how they should examine a patient effectively, efficiently and safely.

ACE-Greg-Hobbs-answering-questions-from-1st-Year-Physician-Associates
ACE Greg Hobbs answering questions from 1st Year Physician Associates

I always use the driving test as an analogy. When we learn to drive, we have to be meticulous about every detail, and every nuance and develop the technique of driving until we have unconscious competence. Only then, once we have passed the test and thrown away the L plates do we learn to drive efficiently. Some things we needed to do to pass the driving test are no longer useful to us, so they’re discarded. It’s almost the same process as learning physical examinations. Once we have explained this to the students it becomes obvious why they have to learn a systems exam in such detail. When they have finally qualified this methodology shows its potential.

As an ACE, I always explain that my job is to guide them through the processes involved that will allow them to demonstrate in an OSCE just how competent they are examining one system at a time.

Once they move into the second year, the distinction blurs. Patients often have more than one pathology, so if a patient turns up with shortness of breath, there might be several causes. This is when the student thinks of the patient holistically and not as just one body system.

During this particular week, I had been asked to take 2nd years through a very brief, but focused, cardio and respiratory examination. This meant they had to start thinking logically and clinically about how to examine the patient, both from a respiratory and a cardiovascular perspective. Blending two systems examinations effectively is difficult. Teaching in this way is very rewarding, not just for the student but for the ACE. We also have to think about how best to teach these skills to the student.

The first-year students we taught this week were practising the Cardio examination and having to do it to the clock. As OSCEs are always timed, the students also have to deal with time pressure. A typical OSCE is 2 minutes of reading time and 8 minutes in the room with a patient and an examiner. In that 8 minutes, they only have 7 minutes to examine and 1 minute to give a management plan. The ACE needs to be aware of the acronym SBAR (Situation, Background, Assessment and Recommendations).

Working like this can be stressful for the student, and part of our role is to keep the student motivated and confident: teaching and therapy all in one.

Prof Jim Parle looks on as Meducate Aacademy ACEs demonstrate their knowledge of the hand examination
We take accreditation seriously. Prof Jim Parle looks on as ACEs demonstrate their knowledge of the hand examination

The sessions above took place over two days with Physician Associate students. Later in the week, I worked alongside GPs in collaboration with Orthopathways. A medical training company developing new software to aid GPs in diagnosing and the treatment of MSK pathologies. I was playing the role of a patient with different pathologies and then giving feedback to the GP. I worked with twenty GPs during that month, and I look forward to continuing working with them again.

The week concluded with teaching history taking and communication skills to 1st-year students. An essential skill for any health professional and particularly important for Medical Students and Physician Associates. All ACEs have to have had some training in Medical Roleplay before they can become an ACE.

The above is an example of a busy week. Sometimes it is quieter due to holidays and students going out on placement. These are the times I employ to ensure that my skill set is still high by taking advantage of reading books on the subject and looking at online resources.

I have learned to be cautious of making assumptions about what is expected of the ACE. We need to be flexible about the programmes institutions run, as their teaching methodologies can vary. Each institution has its approach to the teaching of medicine, and the ACE must be aware of these differences. ACEs must keep up to date with the latest teaching methodologies that medical schools currently employ. It pays to get hold of the teaching materials the staff use at these institutions. These will assist you when working with the students.

For those of you who might wish to embark upon this career as an ACE, get in touch with us now. Please contact: bobspour@meducateacademy.com.

Meducate Academy On The Physician Associate Podcast

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The Meducate Team and their Assessors at The University of Wolverhampton

Those that follow us on social media will also know that we were interviewed by James Catton of The Physician Associate Podcast. We had a great time answering his many questions, and it also gave us the opportunity to let a wider audience hear just what an ACE is and does. There are many misconceptions about our role and it’s important that we are not seen as just a body to practice on, but a highly trained expert patient, able to give accurate feedback to students whilst performing a physical systems examination. We chatted at length about the origins of the role, where we are today with the role, and what the future has in store. The future, of course, will see us producing a robust assessment process for the role of Associate Clinical Educator. This is something Bob has had a personal interest in for years. More of this later on in this post!

Exciting times continue for Meducate Academy with the development of some innovative and fresh approaches to medical simulation, including a top secret Meducate partnership in the pipeline. Sadly, we cannot talk about this until the research phase is complete. However, we can say it has something to do with our high level of skill in delivering MSK teaching modules.

Bob and the team have continued to build relationships with Chester University Medical School, which includes working as a visiting lecturer interviewing potential candidates for the medical degree that starts there in September of this year. This started a couple of months ago when Bob was invited to observe the process and then being asked to act as facilitator at the communications station, working with one of the medical role players.

One other development with The University of Chester was working as an ACE teaching alongside James Ennis and Dr Gareth Nye (Lead BmedSci course Chester), with medical scientists on history taking in the morning. The afternoon saw them demonstrating the physical skills required when performing a cardio-vascular examination, with the students taking an active part. It became apparent to the students how important taking a history was to finding a diagnosis. The students, who had no experience of this methodology found it fascinating and were highly engaged throughout the day.

The students also had the opportunity to get ‘hands on’ with Bob and learn more about taking a blood pressure, palpating pulses and running through a basic cardio exam. A few asked about taking this further as post graduates and possibly joining the Physician Associate programme at Chester. It sort of turned into a recruiting drive! Later on in the month, we ran the same course at Chester University Shrewsbury Campus. Again, the students showed a real flare for hands on medicine rather simply working in the laboratory.

Meducate Academy also specialises in GTA and MTA teaching (Gynaecological Training Associate and Male Teaching Associate). For the uninitiated, these are ACEs who are trained in intimate exams such as gynaecological, breast, testicular and prostate examinations. The ACEs who teach in this field are highly specialised and work alongside experienced clinicians. Student feedback is always excellent once they get over the initial embarrassment and nervousness around this subject. It’s a valuable session for students and is the next step up from working with mannequins.

Members of the Meducate Academy Team in their official polo shirts
Members of the Meducate Academy Team in their official polo shirts

The keen eyed amongst you may also notice that we now have a uniform (of sorts). The new dress code includes a polo shirt with embroidered company logo and name tag. This helps the students identify the ACE they are working with so they can provide feedback and also gives a clear impression that they are working with a team of professionals.

Meducate Academy have also started training volunteers at the Royal Orthopedic Hospital in Birmingham, who give up their time to help 4th and 3rd year medical students from the University of Birmingham and Aston learn the correct approach to MSK examinations. This was a great opportunity to show our skills and knowledge to the clinicians assisting us.

As mentioned previously, we have been involved in creating a robust system of assessment for our ACEs. On Saturday 28th May 2022 we brought together eleven of our team and with the help of Professor Jim Parle, ran a pilot of the assessment process. This gave us an opportunity to test run the marking scheme that Jim and Bob had previously created. The ACEs were expected to demonstrate a high degree of skill in teaching and demonstrating their knowledge of the various body systems. This could never have happened if it wasn’t for the help of Clinical Lead Teresa Dowsing and the use of the University of Wolverhampton’s clinical skills suite. We ran the assessment very much like an OSCE with the ACEs core skills being put under scrutiny and the marking being overseen by Professor Parle. Many lessons were learned during the session and we are currently reviewing feedback from the ACEs.

ACE Accreditation is something Bob has been passionate about for almost ten years and he has been working tirelessly behind the scenes to get organised.

“Having Jim Parle on board is vital, as he has years of experience assessing both medical students and Physician Associates. He spent some years as the National Examiner for the PA course and, of course, was one of the creators of the PA programme in the UK.”

Next month will see Meducate Academy taking their show on the road.  We will be doing workshops for The University of Newcastle on 15th July 2022. We will also be running a workshop at The Education Centre, West Suffolk Hospital, Hardwick Lane, Bury St Edmunds with ARU and UEA in attendance on 26th July 2022. These workshops are open to all PA students who attend the universities mentioned.

Keep your eyes open for the next post which will be looking at:

  • How students can use effective questioning techniques to elicit information from difficult patients,
  • Why students fail to ask the questions they should to help with a diagnosis.
  • How to get patients to answer your questions even if they are resistant.
  •  7 techniques for creating questions that get to the core of the problem.

If you want to hear more about the type of work that Meducate Academy is involved in please listen to our interview on the Physician Associate Podcast.

Physician Associate Podcast with Meducate Academy

 

An ACE™ Is Not a Simulated Patient, But A Simulated Patient On Steroids!

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1st Year Physician Associate Students and Associate Clinical Educators at Wolverhampton University

Recently my attention was drawn to an article, ‘It’s Not An Acting Job … Don’t Underestimate What A Simulated Patient Does”: A Qualitative Study Exploring the Perspectives of Simulated Patients in Health Professions Education”, which was submitted to the journal of the Society for Simulation in Healthcare about Simulated Patients (SP).

The article, whilst interesting and enlightening, discusses the work of the ‘normal’ SP, and shows how valuable their contribution is to medical education. However the title sums up the fact that an SP is more than just an actor who learns their lines and portrays a character. Any role player will be quick to alert you to the fact that, unlike actors, the SP has to give feedback on the communications skills of the student clinician. This is beyond what we expect an actor to be capable of doing.

A good SP can improvise around a common theme, for example breaking bad news. However each student will approach this in a variety of different ways and this is based on their communication style. Some may be hesitant to break the bad news, whilst others may be more exp-licit with their communication. It is the job of the SP to respond to the different approaches that students have effectively, and then give feedback on what the student did well and how they can improve their communication for the benefit of the ‘patient’.

Some students will build rapport readily and easily whilst others need feedback on how to do this more effectively. Non-verbal language also plays its part in communication as we have discussed in a previous post. However, if the SP is presenting with a specific physical condition i.e. central chest pains, the student will respond by performing an examination, for example ‘cardio-vascular’. An SP is unable to give feedback on this part of the process. This is where to Associate Clinical Educator (ACE™) excels.

What the article previously mentioned didn’t cover (and I wouldn’t expect it to) was how an ACE™ can take the interaction to the next level.

An ACE™ is not a Simulated Patient, he’s a simulated patient on steroids! On many occasions I have spoken to clinicians who mistake what we do for medical roleplay and/or that we are simply simulated patients. This is simply not the case.

An ACE™, whilst giving feedback on the communication, will also be able to quickly inform the student whether of not the examination itself is being performed correctly. For example, below is a typical respiratory examination as expected to be performed by a first year physician associate student:

    • Introduction using full name and role
    • Confirms patient’s full name and DOB
    • Explains examination and takes informed consent for examination.
    • Asks if they want a chaperone
    • Washes/disinfects hands
    • Exposes patient appropriately and maintains dignity
    • Inspects the patient’s chest (looking for scars, asymmetry, both axillary area)
    • Positions patient on the couch at 45 degree angle and asks if they have any pain anywhere
    • Inspects the patient’s hands looking for peripheral cyanosis, clubbing, tar staining, CO2 flap
    • Checks patient’s pulse (radial/brachial) checks for rate (90 bpm), rhythm and character
    • Counts respiratory rate (offers to do for one minute: 18/min)
    • Checks patients face for pursed lip breathing, central cyanosis, pale conjunctiva etc.
    • Palpates patient’s chest checking for chest expansion and apex beat
    • Percusses the chest (top middle bottom, axillar, compares left and right)
    • Auscultates the chest (top middle and bottom and both axillar)
    • Checks tactile vocal fremitus or vocal resonance
    • Checks for sacral oedema, feet and legs (for swelling and tenderness)
    • Checks for lymphadenopathy (supraclavicular, cervical, submandibular, etc) from behind
    • Concludes examination, offers to help patient dress
    • Summarises findings in a logical systematic manner (including important negatives)
    • Gives differential diagnosis

Senior Associate Clinical Educator teaching session at Wolverhampton universityThe role of the ACE™ therefore is to give feedback on all of the above. This will ensure that the student performs the examination correctly,to the standard of the current OSCE curriculum and demonstrates safe practice. As you can see the function of the ACE™ far exceeds that of a simulated patient or role player.

This level of expertise requires training and a high degree of commitment from the ACE™ and with that in mind, Meducate Academy continues to train and support new and experienced ACEs whilst they work with us. Alongside that, the various institutions and academics we work with will continue guide and assist us in producing the best outcomes for their students. Vitally important when you consider the role OSCEs play in the students development and assessment.

Training is ongoing and we are still in negotiation with academic institutions to ratify our position in the industry through a strict accreditation process. This will ensure that the quality of our ACEs is of the highest standard and meets the requirements of any academic institution.

 

If you are a Clinical Educator and would like to take advantage of using ACEs as part of your clinical teaching, book now for a free consultation. Contact us via the form below or even give us a call on 07870611850. Thanks again for reading this post.

Kate Straughton On Working With ACEs & Training Student Physician Associates

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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.