Jim Parle

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

 

Diversity & Confidence Building In Medical Simulation

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Demonstration of MSK skills at The University of Wolverhampton

The past month has been frantic! Both of our partners (Wolverhampton and Chester University) have kept us busy with both their 1st and 2nd year cohorts. We have sent teams of ACEs out, providing hi-fidelity teaching and simulation covering a number of body systems. The teaching included reviews of both their communication and history taking skills. So far the topics we have covered are Cranial Nerves, Cardio-vascular, Gastro-intestinal, Respiratory and scenario based training.

In the next few weeks we will also be teaching upper and lower limb neurological exams, as well as intimate examinations on males and females. We have access to specially trained ACEs for this type of examination. Obviously when students perform these types of examinations there is often a degree of embarrassment on the part of the student. Our ACEs are highly experienced in allaying any fears the student may have, and this creates a safer and confident approach when examining a real patient. Most medical institutions don’t offer this type of experience to their students and often rely on using mannequins to practice their skills on.

Our connections to other institutions continue to expand and we are currently in talks with a couple of universities who have expressed an interest in what we are doing. We have recently been involved in MMIs for the recruitment of medical students at The University of Chester.

It still amazes me at how adept our ACE™ team can be. They are able to switch systems examinations at a moments notice, improvise around a theme and yet still provide high quality feedback to the academics and clinicians who are teaching on that module. It is experiences like these that have prompted me to write this month’s post. Without wanting to sound repetitive and simply repeating the last post, I think institutions and individuals are starting to realise the difference between an ACE™ and a simulated patient.

In a few weeks you will have the opportunity to listen to Mark and myself talk about the ACE™ role with James Catton from the PA Podcast. He was somewhat surprised at the level of our knowledge of body systems and was under the illusion that we were simply simulated patients and role players. He was so impressed with our expertise that he is in the process of organizing workshops with the University of East Anglia and Anglia Ruskin University Cambridge Campus.

So, coming back to our team of ACEs and their diverse range of skills, let’s look at a typical month of Meducate Academy’s workload.

Cranial Nerves Examination with Clinician Jack and ACE Howard (Seated) at The University of ChesterIn the last month we have worked with students to improve both their clinical and history taking skills. This was done in the context of both OSCE practice and when they are out on placement where they are expected to use a hybrid approach. We also worked with an experienced Physician Associate in a GP Practice, helping them with their time management and trouble shooting skills. This demonstrates how diverse our ACEs can be when required.

Our skills were also required in order to help pharmacists with their clinical examinations. This was for an assessment to help them gain their Independent Prescribing Course qualification. The pharmacists were given the opportunity to practice their examination skills in a safe environment with ACEs who gave feedback on their techniques. Techniques such as percussion, palpation and auscultation. We helped them work through the seven main body systems whilst the clinicians present talked about the common pathologies they would encounter.

Skills such as these can be practiced with a volunteer or even a sim-man, however what the students don’t get is high quality feedback. This is the main strength of our approach to teaching and the key to our success. Knowing the moves is not enough. The clinician must be able to perform these skills correctly and with our help, through educated feedback, become excellent, safe clinicians.

The body systems covered in the past month have included G.I, respiratory, cardio-vascular, cranial nerves as well as a whole range of neurological exams. We also covered history taking scenarios and the practical aspects of examining a diabetes patient, and how to examine the thyroid.

With the 2nd year Physician Associates we were able to guide them with multiple systems reviews working in a hybrid way. Just like the real world of medicine.

Happy team of Associate Clinical Educators Greg Hobbs, Ellie Darville, Howard Karloff & Meducate director BobOn top of all this of course is the ongoing conversations we have with the students about their fears and worries about the intensity of their course. The students always feel that they can talk to us more openly about their fears rather than going to the academic tutor. This takes some of the pressure off the academics who already have a full timetable. In the 12 years I have been an Associate Clinical Educator I have spent many hours helping students build their confidence and motivation through a variety of strategies.

Knowing that students will confide in you and seeing them graduate is the most rewarding part of the job and the reason I do this work. It’s a role I would recommend to anyone who enjoys working with the medical profession. It’s our way of giving back to the NHS in a small way.

Also, we have finally organised the accreditation process for the ACE™ role and will be running a pilot of this at the University of Wolverhampton in May 2022 with Professor Jim Parle.

On top of all that, a few weeks ago I was called into Trinity Court GP surgery in Stratford-Upon – Avon to run a workshop to 25 staff about how to deal with conflict in the workplace!

Now that’s diversity.

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 give us a call on 07870611850. Thanks again for reading this post.

The Importance Of Simulation In Medical Education

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Professor Jim Parle discusses the use of Associate Clinical Educators at the online conference

Professor Parle was our keynote speaker at the conference and it was an honour to have him join us. What follows is an abridged version of the talk. If you want to view the complete talk it is available in the video above.

“I’ve been involved with the ACE process for something like 15-18 years or so. I am now a retired professor at the University of Birmingham and I’ve been using ACEs and similar kinds of approaches to education for a long time. What I’m going to do today is to go straight into talking about what ACEs are and why we introduced them into the Physician Associate Course and what sparked my interest in education generally.

“We used ACEs on the PA programme for probably at least 15 years if not longer, so for today’s conference I would like to spend more time talking about simulation generally. Also, would like to talk about why we need simulation and why I think we need more simulation and why I think we need high fidelity simulation by which I mean using real human beings, not computers or robots!

“Obviously there’s an ethical issue about performing intimate or any kind of physical examination on actual patients. When I was a student, which is quite a long time ago, we used to examine patients without consent. The patient wasn’t really given an opportunity to say no.

“Obviously you should never do this kind of thing and fortunately, times have changed. I remember my first female patient examination, in which I was embarrassed. She was embarrassed, and I was probably incompetent. I don’t think I hurt the patient, but I didn’t know what I was doing. Looking back now, it was a ridiculous way to learn to carry out examinations. That is one reason we need to think about simulation.

“There’s also the point that medical students need repeated practise and repeated, focused and relevant feedback. You don’t really get that from a patient and when you examine a patient, they rarely know whether you’re doing a good job. We don’t really give them a voice, so we need to have or recruit a patient or patient substitute who is skilled in that area.

“There’s also the issue that students arrive with different levels of skill. You therefore need somebody who can work at the level the student is at. We can’t expect a real patient to do that, as they’ve got their own problems and their own things to focus on when in a consultation. An ACE, however, can do that and more, because we have trained them to be able to show certain kinds of pathology or abnormalities.

“I’ll give you an example: A patient comes off his or her bike and injures their chest. Maybe a couple of fractured ribs and difficulty breathing. If you were to examine an actual patient, they will be in a great deal of pain. They will have tenderness around the area and having restricted breathing. It would be unethical to subject an actual patient to multiple examinations by new students. With an ACE, that problem won’t occur. Some of our ACEs can even demonstrate asymmetric breathing and can obviously be examined throughout the day by many students with no ill effects.

“We can therefore reproduce an extremely convincing simulation with an actual person who the student has to interact with just like an actual patient, but they’re not putting a patient through all that kind of discomfort.

“I just want to add the importance of recognising what is also normal and an ACE can present both sides of this situation. Consider the previous example of asymmetric breathing. The ACE can easily demonstrate what is normal, then quickly change to abnormal. I can only assert that it’s much easier to learn something that’s abnormal when you have something normal to compare it with and, obviously, vice versa. The ACE  can do this. Is able to switch asymmetric breathing too symmetrical breathing and back again so the student can see the difference and we as human beings are good at spotting differences but not so good at spotting absolute values. On a similar but not quite the same theme, I am concerned that if we learn something incorrectly, then it becomes difficult to unlearn it.

“I think it’s really important when students are learning physical examination skills that they compare normal with abnormal there and then. This means that they get immediate feedback, and which they don’t necessarily get with mannequins.

“Because of austerity and the current COVID crisis, students are not able to wander as freely around the wards interacting with patients as they did during my time as a student. So pressure on clinical learning environments and the clinicians who might teach us has become more and more restricted. It’s becoming increasingly difficult for students, whether medical, physician associates or pharmacists, and I’m sure it’s true of other clinical professions that an ACE could fulfill that role.

“An ACE is somebody who’s been trained to use their body and their psyche in educating clinicians by responding appropriately when asked to do something by a student. An ACE, as well as being a responsive patient, can also play a naïve patient, so if simple instructions are not given, the ACE will respond appropriately. If the student wants to take a blood pressure, for example, then the ACE knows exactly how this should be done. An ACE can replicate being a patient who has never had it done and do a variety of things that will affect the blood pressure reading. The ACE can then teach the student how to do it correctly. The student can see the blood pressure go up and down when a patient moves their arm or flexes their muscles. They will see the blood pressure go up and down. The student then gets the reason for doing it correctly and shows that they can do it correctly. This is immediate feedback and students love feedback. They’re always asking for more feedback! If it applies to the individual students’ strengths and weaknesses, they then improve straight away.

“So in conclusion I think I would say that what ACEs bring to the interaction is that they can role play, they can show abnormalities including assessments, they can understand what errors students make or errors patients make and then feedback to the students.

“The most important thing I want you to remember from what I’ve said is it’s sometimes good to take the clinician out of the room when the ACE is working. You do not want a clinician in there. If you have a clinician in with the ACE there, they’ll inevitably get into discussions about various pathologies and what a particular system does in terms of it’s function.

“The ACE is there to work as a tool to aid in the learning of the systems exams. We can do the theory at another session. Making full use of the ACE is vital and students’ feedback always shows they learn the examination processes quicker when the academic leaves the room!”

Click here to watch Professor Jim Parle talking about the value of using ACEs as simulated patients on the ACE National Conference 

Agenda For Meducate Academy Online ACE Conference 2021

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Meducate Academy First Annual Online Conference on Simulation

 

September 4th between 12-2pm on Zoom

 

Are you involved in Medical Education?

Do you use simulation as part of your teaching?

Do you use Role Players and simulated patients during your Clinical Skills teaching sessions?

Would you like to know more about the benefits of simulation?

If you have answered yes to any of the above, why not find out more about the work of the Associate Clinical Educator (ACE).

Hi Fidelity simulation with focussed feedback from an expert patient can play an important role in improving the learning outcomes of your clinical sessions, and utilising the skills of an ACE can help you improve the performance and standard of your clinical teaching modules.

Meducate Academy are therefore pleased to announce the launch of their Free First Annual Online Conference on Simulation on Sept 4th between 12-2pm on Zoom.

You will have the chance to listen to 6 Highly experienced clinicians talk about their experience of simulation in teaching practice and how the ACE has helped their students develop important skills whilst also developing their ability to communicate more effectively with a patient.

There will be a Q & A session in the last hour, giving you the opportunity to address the speakers directly.

ACE National Conference Day

The big day is almost upon us!

Our Guest Speakers & Agenda

 

Meducate Academy’s ACE National Conference is for anyone interested in simulation and its use specifically in teaching medical professionals.

We have some great speakers lined up.

Speakers with expertise in teaching medicine using Role-players and Associate Clinical Educators, all of whom have had a personal experience of working with ACEs in a clinical teaching environment.

The agenda for the conference is as follows:

12 noon: Opening Introduction from Mark Reynolds, your host for the event.

Each speaker will talk for approximately 10-15 minutes about their chosen subject outlined briefly below.

 

 

Professor Jim Parle - Keynote Speaker

Professor Jim Parle will talk about his role in creating the Associate Clinical Educator. People based simulation has been a key theme of his academic career and he utilised ACEs widely to both teach and examine PA students during his tenure at the University of Birmingham.

This will be a short history lesson from a highly experienced clinician and clinical educator who is a former chair of the UK and Ireland Universities for PA education.

Jim believes strongly that if we are to make best and most moral ‘use’ of patients in clinical education, we have to do as much as we possibly can in simulation and that real people are the best hi fidelity simulators.

 

James Ennis

James is currently Clinical Director at the University of Chester and will discuss his work on the use of ACEs alongside other methods of simulation. His work is based on his experience of working with ACEs at various Universities around the country on the Physician Associate Programme that he has been heavily involved in.

Uzo Ehiogu

Currently, Uzo is a consultant in Rehabilitation and Physical preparation. He is also a Clinical Teaching Fellow at the Royal Orthopedic Hospital in Birmingham. He will talk about the work he has been doing with ACEs from a Musculo-skeletal perspective with 4th Year Medical Students and how that has informed his teaching style.

Kate Straughton

Kate is a Senior Lecturer with The Physician Associate Programme at The University of Birmingham. She is also currently the President of the Faculty of Physician Associates and will talk about how working with ACEs has assisted her in the education of Physician Associates.

Peter Gorman

Pete is a Clinical Lead at the University of Wolverhampton on the Physician Associate Programme and will talk about his experiences working online with ACEs during the Pandemic, and how this has affected the students he has taught during this difficult period.

Sarah Baig

Sarah is a Pharmacist and is currently Programme Director for Independent Prescribing at the University of Birmingham. Sarah has worked in several sectors during her career, including hospital and community pharmacy, but more recently has headed up a team of pharmacists in the Local Primary Care Network. She only recently started working with ACEs and is going to talk about her personal experiences in this area.

Bob Spour

Bob Spour

Founder

Matt Chapman

Matt Chapman

Managing Director