Medical Role Play

The Patient Journey in Medical Education & The Use of Associate Clinical Educators (ACEs)

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University of Chester Physician Associate students participating in the patient journey before their community placements

In medical education, the term “patient journey” refers to the comprehensive pathway a patient experiences from the onset of symptoms to the resolution of their health issue. This concept includes all interactions and processes a patient undergoes within the healthcare system. Here’s a detailed breakdown of the key aspects and how an Associate Clinical Educator (a highly trained Simulated Patient) can improve outcomes through high-fidelity simulation and feedback.

1. Initial Encounter

The initial encounter marks the beginning of the patient’s journey and includes the patient’s first recognition of symptoms and their initial steps to seek medical help. This phase can vary greatly depending on the individual’s health literacy, access to care, and socio-economic background. Patients may initially attempt self-care based on their understanding and available resources, seek advice from family or friends, or visit a primary care provider. This phase is crucial as it sets the tone for the subsequent healthcare experiences. In medical education, understanding this initial phase helps future healthcare professionals recognize the diverse entry points into the healthcare system and the barriers patients may face in accessing care.

Health Literacy and Socio-economic Factors

Health literacy plays a significant role in how patients recognize symptoms and decide on their initial steps. Those with higher health literacy are more likely to identify symptoms accurately and seek appropriate care promptly. Socio-economic factors, such as income, education, and access to healthcare services, also influence this initial encounter. For example, individuals from lower socio-economic backgrounds may delay seeking medical help due to financial constraints or lack of nearby healthcare facilities.

Barriers to Access

Recognizing and understanding the barriers patients face in accessing care is essential for medical professionals. These barriers can include geographic limitations, financial issues, cultural beliefs, and previous negative experiences with the healthcare system. Addressing these barriers is crucial for improving patient outcomes and ensuring equitable access to healthcare.

Role of the Associate Clinical Educators

ACEs play a crucial role in medical education, particularly in training students to handle initial patient encounters effectively. They are highly trained lay educators & in most cases trained roleplayers who portray patients with specific medical conditions and backgrounds, allowing students to practice and refine their communication and clinical skills in a controlled, realistic setting.

– Enhanced Communication Skills: ACEs provide students with the opportunity to practice eliciting patient histories, understanding patient concerns, and explaining medical concepts in a way that is understandable to individuals with varying levels of health literacy.

– Cultural Competence: ACEs can be used to represent diverse socio-economic and cultural backgrounds, helping students develop cultural competence and learn how to address potential biases and barriers to care.

– Immediate Feedback: ACEs can give immediate, structured feedback from the patient’s perspective, helping students improve their bedside manner, empathy, and ability to make patients feel heard and respected.

– Scenario Variety: Through ACE encounters, students are exposed to a wide range of initial presentation scenarios, from common physical & psychological symptoms to rare conditions, helping them build a broad base of experience and confidence.

– Safe Learning Environment: Using ACEs allows students to make mistakes and learn from them without causing harm to real patients, fostering a safer learning environment and encouraging a growth mindset.

2. Diagnosis

The diagnostic process is a critical step where healthcare professionals gather the patient’s medical history, perform physical examinations, and order diagnostic tests to identify the underlying cause of the symptoms. This phase involves clinical reasoning and decision-making skills, which are fundamental components of medical training. The accuracy and efficiency of the diagnostic process directly impact the patient’s subsequent treatment and outcomes. Medical students and trainees learn the importance of taking a thorough history, conducting a detailed physical exam, and selecting appropriate diagnostic tests. Additionally, they are taught to consider differential diagnoses and to communicate findings effectively with patients and the healthcare team.

Role of Associate Clinical Educator

ACEs can significantly enhance the training during the diagnostic process:

– Clinical Reasoning: Students practice diagnostic reasoning with ACEs, learning to synthesise patient information and develop differential diagnoses.

– Examination Skills: ACEs help students refine their physical examination techniques and adapt their approach based on patient feedback.

– Diagnostic Tests Interpretation: Through ACE scenarios, students learn to select and interpret appropriate diagnostic tests, understanding the implications of their choices.

3. Treatment Planning

Once a diagnosis is made, developing a treatment plan is the next step in the patient journey. This plan may include medications, surgical interventions, lifestyle changes, or other therapeutic measures. Involving the patient and their family in this process is essential for ensuring that the treatment plan is realistic, acceptable, and adheres to the patient’s preferences and values. In medical education, emphasis is placed on shared decision-making and patient-centred care. Trainees learn to discuss the risks, benefits, and alternatives of treatment options with patients, considering their unique circumstances and goals. This phase highlights the importance of clear communication and the need for healthcare providers to be compassionate and empathetic.

Role of Associate Clinical Educator

ACEs enhance the development of treatment planning skills:

– Shared Decision-Making: ACEs allow students to practice engaging patients in treatment planning, considering their preferences and values.

– Communication of Risks and Benefits: Students learn to clearly explain treatment options, potential outcomes, and risks to patients.

– Patient-Centered Approach: Training with ACEs emphasizes the importance of empathy and respect in developing a collaborative treatment plan.

4. Treatment and Management

The treatment and management phase involves implementing the treatment plan. Patients may need to visit various healthcare providers, undergo procedures, or adhere to specific medication regimens. This phase often requires coordination among multiple healthcare professionals, including specialists, nurses, and allied health staff. Medical education programs stress the importance of interdisciplinary teamwork and the role of each team member in providing comprehensive care. Students are trained in care coordination, time management, and the use of healthcare technologies that facilitate communication and collaboration. This phase also includes managing potential complications and adjusting the treatment plan as necessary based on the patient’s response.

Role of Associate Clinical Educator

ACEs contribute to improving treatment and management skills:

– Interdisciplinary Collaboration: ACE scenarios often involve multiple healthcare providers, teaching students how to work effectively in teams.

– Care Coordination: Students practice coordinating care among different providers and settings, ensuring comprehensive management of the patient’s condition.

– Adaptability: ACEs help students learn to adjust treatment plans based on patient responses and emerging complications.

5. Follow-up and Monitoring

After the initial treatment, ongoing follow-up is necessary to monitor the patient’s progress, manage any side effects, and make adjustments to the treatment plan as needed. Regular follow-up appointments, lab tests, and imaging studies may be part of this phase. It ensures that the patient is recovering well and that any complications are promptly addressed. In medical education, this phase emphasizes the importance of continuity of care and the role of primary care providers in maintaining long-term patient relationships. Trainees learn to develop follow-up plans, recognize early signs of complications, and provide ongoing support to patients as they navigate their health journey.

Role of Associate Clinical Educator

ACEs play a vital role in training for follow-up and monitoring:

– Long-Term Relationships: Students practice maintaining ongoing relationships with ACEs, simulating real-world follow-up scenarios.

– Monitoring and Adjusting Care: ACEs help students learn to monitor patient progress and make necessary adjustments to the treatment plan.

– Recognition of Complications: Through ACE interactions, students develop the skills to identify and address potential complications early.

6. Outcome and Long-term Care

The patient journey also encompasses long-term outcomes and any necessary chronic care management. This could involve rehabilitation, ongoing medication, lifestyle adjustments, or palliative care in some cases. Long-term care aims to maintain or improve the patient’s quality of life and manage any chronic conditions effectively. Medical education programs highlight the importance of chronic disease management, rehabilitation medicine, and palliative care. Students are taught to develop long-term care plans, coordinate with other healthcare providers, and support patients and their families in managing ongoing health issues. This phase underscores the need for a holistic approach to patient care that addresses physical, emotional, and social aspects of health.

Role of Associate Clinical Educator

ACEs improve training in long-term care and outcomes:

– Chronic Disease Management: ACEs simulate patients with chronic conditions, allowing students to practice developing and managing long-term care plans.

– Rehabilitation and Palliative Care: Students engage with ACEs to understand the complexities of rehabilitation and end-of-life care.

– Holistic Care: ACEs help students appreciate the importance of addressing physical, emotional, and social needs in long-term care.

7. Patient Experience

Throughout the patient journey, the patient’s experience is a crucial component. This includes their interactions with healthcare providers, the clarity of information provided, emotional support, and overall satisfaction with the care received. Patient experience directly impacts health outcomes and adherence to treatment plans. In medical education, understanding the patient experience is essential for training healthcare professionals to provide compassionate and empathetic care. Trainees learn to listen actively to patients, address their concerns, and ensure they feel valued and respected throughout their healthcare journey. Programs often incorporate patient feedback and case studies to highlight the importance of patient-centred care and continuous quality improvement.

Role of Associate Clinical Educator

ACEs significantly enhance the understanding and improvement of patient experience:

– Empathy and Compassion: ACEs provide feedback on students’ communication and interpersonal skills, fostering empathy and compassion.

– Active Listening: Students practice active listening with ACEs, learning to address patient concerns effectively.

– Patient Satisfaction: Training with ACEs helps students understand the factors that contribute to patient satisfaction and overall experience.

Understanding the patient journey in medical education is essential for training healthcare professionals to provide holistic and patient-centered care. It helps students and practitioners appreciate the importance of each step in the process and the need for effective communication, empathy and coordination among healthcare providers to ensure the best outcomes for patients. By comprehensively understanding the patient journey and incorporating ACEs into training, future healthcare professionals can enhance the quality of care and improve the overall patient experience.

Transform Your Healthcare Training with Meducate Academy

  • Are you an institution or training organization providing healthcare education for Medical Students, Physician Associates, Nurses, Pharmacists, or Physiotherapists?
  • Do you incorporate simulation as part of your teaching methodology?
  • Do you aspire for your students to excel in medical knowledge, communication skills, and safe practice?

If you answered yes to any of these questions, Meducate Academy will elevate your training programs. With over 25 years of experience, our Associate Clinical Educators specialize in advanced simulation techniques to enhance your curriculum.

We have successfully delivered training courses for Physician Associates, Medical Students, Pharmacists, and Nurses. Recently, we have been honoured to collaborate with The Royal Orthopaedic Hospital in Birmingham, assisting in the teaching of musculoskeletal examinations to 3rd and 4th-year medical students from the University of Birmingham and Aston University.

Our impressive clientele includes the University of Birmingham (Pharmacy), the University of Newcastle, the University of Chester (Physician Associate students), and the University of Wolverhampton (Pharmacists). Additionally, we are proud educational partners of The Pharmacy Show, held annually at the NEC, collaborating with our partners at Cliniskills.

We are excited to introduce our latest educational package, “The Patient Journey – A Hands-On Approach”. We invite organizations to join us in this innovative training experience and help shape the future of healthcare education.

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

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.

James Ennis On The Use of ACEs & Roleplayers In Clinical Education

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James Ennis Clinical Lead at The University of Chester Physician Associate Programme

James Ennis is currently Clinical Lead at The University of Chester Physician Associate Programme. He has worked with ACEs both as student Physician Associate, and also used ACEs when he was teaching at The University of Birmingham and latterly at Chester University. Here we have an overview of his contribution to the Meducate Academy ACE Online Conference 2021 in an abridged form. If this sparks your interest please watch the attached video and share the link with colleagues and friends.

“Today on the conference, I’m just going to quickly give you an overview of how we use Associate Clinical Educators at Chester University. This was quite a new concept to Chester and as I’ve recently moved from Birmingham up to the area, I decided to bring the Associate Clinical Educator role up with me. We consider the ACEs to be an integral part of the teaching team, and so I’m now going to talk about how we use them and where we use them. I’m going to give you some quotes from our students about their experience in working with ACEs on the course and more importantly a little about simulation and the ACEs themselves.

“I’d like to give you a balanced opinion on the role because there are some perceived threats, in my opinion about the use of ACEs and roleplayers. I want to talk about the future development too at some point. The main point that should come across is that the ACE can give accurate Hi-Fidelity feedback to both the teacher about the student and more importantly to the student themselves.

“Typically a roleplayer is used as a live patient often able to give feedback to the student in terms of their communication skills. The ACE does this and more. They can give  feedback on the physical examination skills themselves, both from the point of view of safety and technique. We’ve kind of gone away from the compartmentalisation of history taking and then  physical examination skills and we have looked at it more as a kind of an integrated model which is how clinicians truly consult. As well as that, we use the ACEs in specialist roles for example intimate examinations.

“We also use the all singing all dancing SIM Man. This is what we would typically think of with regard to high fidelity simulation. Of course we do use the Sim Men as well, particularly for emergency scenarios, but we also use the ACEs as part of a role play that would fit into the scenario and so the communication isn’t lost during the interaction.

“During the pandemic we also had to change the way we worked with ACEs and a lot of the work was carried out online. This also fitted in with the growth of online consultations that are now part of a clinicians responsibility. Of course this is useful for maybe online medication reviews but not for someone presenting with acute abdominal pain.

“To maintain balance of opinion I’ve captured a few of our most recent students/staff liaison minutes from meetings and these  are from our year two students. These are kind of common themes so I’ve just picked a few just to quickly touch on.  Looking at the completely comprehensively positive feedback from from students on the ACEs role and what they give to the student.

“Many students said that they find working with the ACE far less threatening, particularly when making the inevitable mistakes while performing physical examinations, and they were able to refine their technique with the ACE. However, I would like to  mention that it does say that mannequins and other types of simulation may be just as helpful.

“Now, what I would say is, I don’t see the ACE role completely dominating simulation in medical education. It’s very much used as an adjunct and that’s how we now utilise our ACEs. Also  the students obviously get quite twitchy around OSCE season assessment periods. Again, we found the ACE  to be  incredibly helpful, not just for improving students technique and examination skills but also in building their confidence.

“Again, as Professor Jim Parle mentioned previously, the students really responded positively to the ACE role in working on things that they find specifically difficult. One of the things I’d like to highlight is the MSK examinations. It’s one thing that our ACEs really cover in depth with our students. All of our ACEs are heavily trained in MSK examination technique as I’m sure Uzo will talk about in far greater depth in his talk.

“The student feedback has always been positive and more time with ACEs is constantly being requested. This is why we really are so keen on simulation with ACEs.

“I’m sure most of you haven’t used ACEs or simulated patients in any great detail, but you will find that they have had some push back from institutes, mainly because of  the financial burden and restricted budgets. The way we’ve worked around this, is I would far prefer to have the human factor in  simulation than simply by props and Sim Men, sometimes costing up to £80,000. Sim Men have their place, but I would prefer to spend our money towards the use of ACEs. I have  certainly not had any problems from my institute with  getting the financial backing, especially when we keep  getting such excellent feedback.

“We haven’t yet got a great amount of evidence on the  student and patient outcome from such interventions and that’s something I’ll come onto later.

“Another thing, although the ACE is highly trained they are of course not a substitute for a skilled clinician. They are always available to discuss and answer questions of a clinical nature and each supports the other. The ACE and the clinician work as a team.

“So, that’s just a quick overview of where I’m going with my research and I would invite anybody to contact me if they are interested in this subject. I’m constantly monitoring the impact the ACEs have on student performance, and therefore patient outcomes after training. Take a look at the slides I have provided and I am as always interested in any questions you might have.”

Click arrows to view PowerPoint slides of this talk by James Ennis

Meducate Academy ACE Recruitment & Training Programme

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Meducate Academy ACE recruitment and training programme online

Meducate Academy recently embarked upon a continuing ACE recruitment and training programme with candidates who had expressed an interest in our ACE training schedules. We emphasised that the role we play is vital in ensuring a clinician is safe to practice with an actual patient and how much commitment is required to fulfill the role of an ACE.

Saturday 15th May 2021 was a very busy day at ‘Meducate Towers’ as we embarked upon our continuing ACE recruitment and training programme. After an initial online webinar a few weeks ago we set Saturday as the date to bring in those candidates who had expressed an interest in our ACE training schedules.

After an initial conversation, in which Mark and I outlined our background and history, we then went on to explain the role of the ACE in medical training. We went onto describe the body systems and how the student clinician would examine a patient. What then followed was a typical ACE hands-on session, with Mark playing the Physician Associate Student, and I as the ACE/simulated patient giving feedback.

This was a great opportunity for the candidates to see how much knowledge is required in order for them to fulfill their role with Meducate Academy. I think it surprised those watching just how much skill and knowledge is necessary to perform the task. Though we did explain that we have been in the role for twelve years, emphasising that this was not our expectation of them at the moment. ACE Training is an ongoing process and even Mark and I are still learning and developing our roles as ACEs.

As you can see from the heavily edited video above, Mark was playing a poorly prepared student. This was an extreme example which gave us the opportunity to show how the ACE needs to be alert when working in a situation with a below standard student.

We explained that the student does not expect us to give feedback on the students’ medical knowledge, or on their diagnosis, but on their technique when performing the examination. Of course, we would also comment on the students’ communication skills if we had any concerns.

Our role is to ensure that the student is safe to practice with a real patient and make a valuable contribution to their profession.

After the demonstration was over, we then went into an Q & A session, which included questions on the duration of training and how their assessment will be carried out. We explained that although the initial training is quite short, we will expect them to shadow an experienced ACE until we feel they are ready to take on the role. We emphasised that the part we play is vital in ensuring a clinician is safe to practice with an actual patient, and so stress was placed on the role and how much commitment is required to fulfill the role of an ACE.

Our customers are highly skilled professional educators and we expect the same high standard from our ACEs.

We are currently working on educational materials for the ACEs, and this is being done in conjunction with senior clinicians who are overseeing the development of this information. These instructional materials include training videos, handbooks and regular telephone or internet support along the way.

Meducate Academy has also been working recently with PAs at Wolverhampton and Chester Universities, and we received welcome news that many of our students had passed their National exams. Good news indeed.

Last weekend Mark and I worked with Matrix Education, again helping student Physician Associates get ready for their upcoming exams. It was great to touch base with students from every part of the UK and a pleasure to work with the team at Matrix, as always. I recently did a podcast with founder of Matrix Education Sofia Hiramatsu and we will be posting a video of the podcast next week on this blog.

I have also spent some time with Wolverhampton University developing their Golden 2 sessions on a weekday evening. If you have ever taken part in OSCEs, you’ll know that one of the vital parts of an OSCE station is the 2 minutes that the students have to read the question.

Sometimes, students find this really difficult and often miss the obvious. With this in mind, Peter Gorman of the Wolverhampton PA Program has put together sessions based purely on “how to read the question”. His approach has been really successful. Helping the student get to grips with being able to answer the question effectively, and I can’t believe someone has not attempted this before. Maybe they have!

It has been an honour to be involved in these sessions and I have seen this approach help struggling students turn a corner in their development. I intend to write something with Pete about this in the next few weeks.

The month ahead looks busy, so I would like to thank all those who attended the Webinar on Saturday. We are currently putting dates together for the initial 2 day training course.

If you are a role player who wishes to take your medical roleplay to the next level, we are always on the lookout for new people, so get in touch.

Clinical Communication and History Taking – An Associate Clinical Educators Perspective

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It’s always important for an ACE to understand the protocols health professionals must follow to help them take a good history from a patient. Once we understand this we are able to give hi-fidelity feedback to the Clinician and thus help them improve their ability to build rapport and gather information simultaneously.

Last week I had the pleasure of working with our partners at The University of Chester and The University of Wolverhampton Physician Associate Programmes.

At Chester University  we worked with 1st Year physician associates and at Wolverhampton we were working with 2nd year students. In both cases we were looking at how students communicate effectively with patients. What was apparent is the importance of quality feedback to the student.

For the students at Chester this was their first time looking at role-play, it was difficult convincing shy students to step up to the plate and hear their thoughts. It turns out that the ACE also has to be something of a motivator encouraging the students to take part. To get to grips with the scenario and to see that “roleplay” can be fun and educational, rather than scary and intimidating. It is this element of teaching that I particularly enjoy.

Wolverhampton however was very different, but still had its challenges. Although the students were more experienced with role-play and history taking, we still had a lot of work to do as the scenarios were far more challenging.

This week however, they had a reprieve from taking part in role-play.

I had been asked by the clinical lead Pete Gorman to deliver a session on communication theory and to talk about the practical challenges students face when talking to a difficult patient.

Whenever we communicate we interact both verbally and non-verbally, and understanding how we can make this work would take more than this short article. Here is a brief synopsis of what we discussed.

There are four legs to effective communication and these are:

  • Rapport
  • Behavioural Flexibility
  • Sensory Acuity
  • Knowing your Outcome

Rapport is key to successful communication. Indeed without rapport it is very difficult to influence anyone, whether that be to make behavioral change or to take a simple history. We have all had that experience with another person when we feel we just connect. We sometimes find ourselves engaged in a conversation with a stranger and feel that they are just like us. That is rapport. People deeply in love have rapport to the extent that they mirror each others’ posture, language and even breathing patterns. That is rapport.

Interacting With A Patient Whilst Performing A Systems Exam Is Crucial To Building And Maintaining Rapport
Interacting With A Patient Whilst Performing A Systems Exam Is Crucial To Building And Maintaining Rapport

In order to be effective in our communications with patients we must also be aware of the continuous process of feedback. It is important to know whether we are getting what we want from our communication. To do this effectively we must have sensory acuity. We notice  changes in physiology, breathing, eye accessing and language patterns. Armed with this information we can build rapport more authentically and deepen the relationship with the patient.

Once we have noticed these seemingly imperceptible cues, we can help the patient make better decisions and connect fully with the health professional. Using these tools will allow the clinician to help the patient to have a greater awareness of the choices available to them in the present, rather than have these choices restricted by past experiences and out-dated responses. This is what we sometimes call motivational interviewing.

Finally, everything you achieve is an outcome. If you are successful in your endeavours; that is an outcome. If you don’t succeed, that is still an outcome. Whatever we do results in an outcome. In order to achieve desirable outcomes we need to effectively model what works and then go out and do it! Rehearsal through role-play is the key to achieving positive outcomes when taking a history. You will always get what you ask for! Ask in the correct way and you will achieve your goal.

Whilst all of the above should be noted there are other important considerations that a clinician should be aware of in history taking.

I asked the students to remember the following when taking a history.

  • Presenting complaints – This is a list of the main symptoms or problems.
  • History of presenting complaint – This is an in-depth description the the presenting compliant.
  • Previous medical history – This is a comprehensive list of the all the illnesses, conditions and operation the patient has had in the past.
  • Drug history – A list of all of the patients medications and any allergies they may have.
  • Family history – Ask about conditions that run in the family.
  • Social history – This includes information about home, occupation, hobbies and habits. This would include smoking, drinking and illicit drug use.
  • Systems review – This a checklist of closed questions for every organ system in the body.

Using open and closed questions is an important skill. Closed questions at the start of a consultations encourage short yes and no type answers. Not good for building rapport in the opening stages of a meeting. Open questions encourage the patient to talk and that can be useful. Save the closed questions for gathering a quick response.

Engaging The Patient Both Verbally And Non Verbally Is Crucial For Building And Maintaining Rapport
Engaging The Patient Both Verbally And Non Verbally Is Crucial For Building And Maintaining Rapport

A common question I get from students is what factors hinder good communication? The list is extensive and I’ve seen and heard them all, but here are a few.

A badly worded introduction where you don’t clearly say your name. Not remembering the patients name, embarrassment, lack of curiosity, not asking the right types of questions, not making the right amount of eye contact, misreading body language, making assumptions, not listening actively, missing cues, not knowing how to deal with an answer, an over talkative patient, misunderstandings, making assumptions about the patient, stacking questions, judgemental behaviours. There are so many!

At the end of the session I gave students strategies to go away and practice. We always have opportunities every day to practice our communication skills. Unless you’re a hermit of course!

Check out the interactions between Mark and Bob on the video and if you are an actor interested in becoming a medical role-player and want to take it to the next level get in touch and join our growing ACE team. We will be posting dates for the next ACE training soon.

My Top 10 Tips For Failing The OSCEs

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

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

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

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

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

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

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

They’re invariably optimists.

Failures are invariably pessimists.

They usually hate their work.

I have learned a lot from failures.

Failure is a choice… It takes conscious effort!

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

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

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

So here we go:

STEP ONE

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

Never define your goals or find your purpose.

STEP TWO

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

STEP THREE

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

STEP FOUR

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

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

STEP FIVE

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

“DO NOT REMAIN CALM.”

STEP SIX

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

STEP SEVEN

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

STEP EIGHT

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

STEP NINE

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

STEP TEN

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

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

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

Meducate Academy Educating The Next Generation Of PAs

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ACE Mark Reynolds roleplaying with a 1st Year PA student at The University of Chester
Meducate ACE Mark Reynolds roleplaying with a 1st Year PA student at The University of Chester 1st Year OSCE

Meducate Academy has had a busy two weeks working alongside the University of Chester, University of Wolverhampton and Matrix Education on several exciting projects.

As always, Matrix Education delivered an excellent two day course, this time in a beautiful hotel deep in the heart of London’s West End. We were there in our capacity as Role Players and Associate Clinical Educators providing our role play and lay clinical education services to the PA students about to take their National Exams. Students from Bournemouth, Reading, Sheffield, Birmingham and other parts of the UK were in attendance.

We encouraged the students to stay engaged with both history taking in the morning session and physical examinations in the afternoon. We also coached them in techniques that would allow them to get through the exams with confidence and advice on how to lower their stress levels prior to the OSCE.

Associated Clinical Educator Mark ReynoldsOnce the weekend was over we were booked to work with 2nd year PAs at the Riverside Campus at the University of Chester. They tasked us with delivering a whole range of skills. We went through all the systems exams from Musculo-skeletal, through Cardiovascular examinations and some challenging scenarios thrown in. One of our team also ran a breast examination station, giving the students an opportunity to practice important but often neglected skills, including feedback on their technique from the associate clinical educator.

After two days of teaching in Chester we were back on the road the next day day to Wolverhampton University, working on an OSCE with my old colleague and the developer of the ACE role, Professor Jim Parle and the PA Course Clinical Lead Pete Gorman.  Despite the obvious restrictions placed on us due to Covid-19, we were still able to perform at a high level.

Meducate were represented by two roleplayers on the day and the feedback was excellent.

This week has seen us travelling back up to Chester for a mock OSCE with 1st year PAs. We were tasked with providing two ACEs and also with the filming of one of the history stations. This presented us with its own challenges. We are fortunate in having some new cameras, lights and sound equipment, which proved their worth on the day. The quality of the video was excellent and Chester are thinking of using this set up as a regular feature of their training programme. It is a great way for students to check on their own progress and has the added bonus of being available for them to access during their revision.

It is great to get back to working with students once more, and for many the Covid-19 crisis has been problematic.

At Meducate Academy we used this time to create opportunities and we are glad to say that we have been having our most successful year yet.

I also spent some time chatting to one of our most senior ACEs and role players Mark Reynolds, and he offered to pen a few words about how much he enjoys his role working with Meducate Academy.

Mark has been involved in Medical Role Play and ACE work for over twelve years and he is also a great facilitator.

“I have been pleased to be part of the Meducate team since day one and hope that my input in those early days helped the company to shape the way forward.

Meducate is really up and running now and we are currently enjoying working for the Universities of Chester and Wolverhampton on their Physician Associate Programmes, as well as working on pre-national PA OSCE courses for Matrix Education.

ACE Mark Reynolds
Mark Reynolds

The role of the Associate Clinical Educator is something I have been identified with since 2008. My background in performance helped me to become an effective educator and I enjoy so much teaching clinical communication skills and body system examinations. I believe that it is very important in life to seek a role that makes a difference. I can see when my colleagues and I are working with PA students that we are making a difference to their learning; helping them to improve their communication and examination skills and most importantly, helping them to reach that point where they pass their formative and summative OSCEs.

I’m proud to be an ACE, indeed I’m one of the longest serving ones in the UK, and it’s a lot of fun working with these students and my colleagues too. When you’re having fun and being paid, life doesn’t get any better than that.”

Mark Reynolds

RECRUITMENT OPPORTUNITIES

If you are an Actor / Roleplayer who wishes to train as an Associate Clinical educator please get in touch with Matthew Chapman at Meducate Academy. We will be offering Free Training Courses in the coming months, to help you realise this ambition.