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Meducate Academy On The Physician Associate Podcast

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!

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

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.

Working With New Associate Clinical Educators At Chester University

Associate Clinical Educators Vikki, Bob, Howard and Gregg at Chester University
Associate Clinical Educators Vikki, Bob, Howard and Gregg at Chester University

Working on the Physician Associate Programmes as an Associate Clinical Educator is always a pleasure. It’s an even better experience when you give a new ACE an opportunity to spread their wings and fly solo for a day. They are the lifeblood of the organisation, after all.

This week we gave one of our new ACEs the opportunity to work with us at the University of Chester on the PA programme. We also gave a potential ACE the opportunity to shadow another experienced ACE before being let loose on the students.

We were tasked with assisting in the teaching of Musculoskeletal Examinations: Hands, Feet, Shoulders, Knee and Hip, with the help of clinical Lecturers Jack and Alice, who had prepared the students with an earlier lecture.

I particularly enjoy the MSK sessions and as I have some significant pathologies myself. This gave the students the opportunity to work with someone with real musculoskeletal problems, and also able to give feedback to the students on their examination technique.

Teaching in the skills suite next door was Greg Hobbs, a trusted and highly experienced Associate Clinical Educators. He was being shadowed by Vikki one of our newly trained ACEs.

I was in the main skills suite with Howard, one of our new ACEs, who was now being given an opportunity to show me and the clinicians what he could do. He never let me down and his understanding of motivational interviewing techniques also allowed him to help the PA students sharpen their communication skills.

All of our Associate Clinical Educators are highly experienced communicators before they embark upon our ACE training programme. This is one of the main criteria for the role.

Clinical skills are important, but so are communication skills, and we pride ourselves on being able to give structured feedback to students about both elements of their interaction with an “expert patient”.

We always give the groups a small demonstration of the examination being taught, then we let the students get hands on with the ACEs as soon as possible, making sure everyone engages with the lesson for the day.

Happy group of Physician Associates at Chester University
Working with this happy group of Physician Associates at Chester University is always rewarding

Keeping the students engaged is another skill we are very good at. All of our ACEs have performance based training backgrounds and are trained actors, and know how to keep an audience focussed on the performance. This is an important but often missed aspect of clinical teaching and is not something that is taught to clinical educators normally.

We believe that it is important for the students to have a light hearted approach to the training. Learning should be enjoyable and not be a chore.

Next week is revision week at Chester University, so three of our experienced ACEs are up there again to help the students prepare for their Mock OSCEs, another aspect of the important role we play.

If you have enjoyed this post and want to learn more about how we can add hi-fidelity simulation with structured feedback to your students and institution, why not come online on the 4th September 2021 at 12 noon and listen to 6 clinical leads talk about their experience of working with ACEs and Meducate Academy. It’s free and you even receive a free hardback, soft touch notebook in the post!

Sign up here to join The ACE Online Conference 2021