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.
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!
Last week saw us working online with our partners at Wolverhampton and Chester University. Although the role of the ACE is to work predominantly with helping the student to develop their physical skills with systems examinations, we also spent a lot of the time teaching them how to take an effective history.
Alfred Korzybski the developer of General Semantics once said:
“The meaning of communication is the response you get”.
When you are a medical professional sitting with an actual patient, you won’t be in the fortunate position of receiving feedback from them. They just won’t tell you.
They don’t really know what you are doing and you wouldn’t expect them too!
Working with an ACE or simulated patient changes all of that.
When ACEs work with students, their key role in the interaction is to provide quality feedback to the student clinician on their communication and the systems exam that they are performing.
Everyone employed by Meducate Academy are experienced actors and can therefore present powerful examples of a patient with a variety of problems and pathologies. Whether it be a mental health scenario, a difficult or challenging patient, an angry patient, those presenting with physical problems or working with colleagues and relatives of a patient. We have done them all!
This is all very useful as it creates a ‘reality’ for the student to work with, but it is not the complete story.
Role-play and simulation without high-quality feedback is just acting, and that’s not our aim here at Meducate Academy.
An ACE is an important and vital resource for the student, and our ability to recreate a scenario as a simulated patient providing feedback is of critical importance to the student and their assessors.
The feedback we offer allows the student time to reflect on their performance without the worry of making a ‘mistake’. That the environment is safe and that they can stop the scenario at any time in order to make any adjustments to their communication style.
You can’t do this with an actual patient!
Providing feedback in a nonjudgmental way gives the student an opportunity to improve without the pressure of having to get it right every time.
Feedback when given is always specific and detailed where necessary. We never say:
“Oh. That was Good!”
Without qualifying the statement to the student with detail as to why it was good and how it made the patient feel at the time they said it. Feedback should be evident and observable.
For example, the ACE would explain how the patient felt when the student failed to make eye contact when delivering bad news. There should be no ambiguity in your feedback, and clarity is vital:
“When you auscultated my chest and asked me to take deep breaths, you lifted the stethoscope off my chest before I completed a full breath cycle.”
This is much better than: “Keep the stethoscope on a little longer.”
The timing of the feedback is also important. We always wait until the end of the history and/or examination before giving feedback. This is normal unless the assessor/staff member asks for it earlier.
In some cases (mainly physical examinations) the ACE may stop the interaction if a procedure is performed roughly, or if the ACE is in danger of getting injured.
When we give feedback to more than one participant in a simulation, we keep it as succinct as possible and we never judge. An ACE will never compare one students’ performance against another. We take each person on their own merits.
When giving feedback, we do it in the third person as the patient. Explaining how the patient felt from their perspective is vital, and when we give feedback, we always ensure that we only make two or three points. We never overwhelm the student with a wealth of information, only enough to develop their skill set.
An ACE never gives feedback on the medical content of the simulation unless they have been specifically trained by a clinician. We always remind ourselves that we are lay educators and not clinicians.
If a student becomes defensive about feedback, we do not engage in arguing the point. Speak calmly and logically. A good structure therefore is vital. We are never too negative in our feedback and if the support of the facilitator is required, the ACE will get them involved.
If a student seems confused by the feedback, we take a few moments to reflect on what has been said and then recalibrate our communication style to suit the student. Everyone is different, and an ACE always endeavours to be a master communicator.
If a member of staff contradicts the ACE, we always wait till the session is over to discuss that difference in perspective. We would never discuss issues in front of the students. This may be an opportunity to learn something new and improve our skillsets.
It is often the case in our multicultural society that an ACE may not understand the student because of an accent, dialect or even the volume. We are always respectful, and will explain to the student that they sometimes have to work on this aspect of their communication in order to ensure they are understood and that their interaction has a high degree of clarity. Lack of clarity is always pointed out sensitively.
Sometimes the ACE may notice that the accepted dress code is not being adhered too. It is important that we highlight this in our feedback to the staff. Personal matters such as bad breath, body odour and unkempt appearance should be addressed. We don’t mention this directly to the student, but through the facilitator.
We always expect our ACEs and simulated patients to also develop their communication skills. We regularly assess them in this ability. Being an actor does not mean that you can be a role-player. The ability to deliver feedback effectively to the student is what is expected.
Let’s ensure that the standards of the ACE are as high as that of the clinicians.
We are currently producing a workbook for the ACEs and this will serve as a useful aide-mémoire for those who take on this very demanding but rewarding role.
Matt Chapman is Managing Director of Meducate and is a founding member of the company. In this post, Matt talks about his vision for the company and how Meducate differs from other companies he has worked for over the years.
“I’ve been involved with Meducate from it’s inception over 2 years ago and the big thing that stood out for me was how engaged the students were with the ACEs and the methods we use. Feedback was always phenomenal something I hadn’t experienced in any other business before. There’s always a grumpy customer that you have to deal with in any business, but with Meducate it was always positive feedback.
“Every time we engage with an institution and their students, they give us 5 stars across the board.
“When we first met and you talked about the concept of Meducate you were already doing corporate training with me and when you told me about the potential of the ACE role in medical training, I suspended my judgement on how good you said the work was. I remember coming on the first session with one of our earliest customers at Wolverhampton and it was all true. Not only were you and the other ACE enjoying the day but so were the students. Id never seen that level of engagement with anyone in business before. 100% of the class were involved and craved more! That is when I knew we could make this work. In business we always want a win-win situation, and this seemed to be the right type of service to offer. That and the fact that we are almost the only people to be offering this service.
“The fact that this had never been picked up on before and was an open market surprised me. I know there are lots of role play companies out there offering medical role players, but the role of the ACE is unknown. My only concern was, would we have enough ACEs to cover the 40 + institutions that may need our services. Our answer came with the pandemic. This gave us time to regroup and begin training role players in the skills required for them to perform as an ACE. We did this with the help of some senior academic tutors and experienced clinicians who work in the health care sector. Again, this was another of Meducate’s strengths. Our ability to contact the right people is paramount and we are even in discussions to validate the role of the ACE with two Universities keen to promote what we do.
“I was asked recently what drives me in business and I remember we were talking about values and how you see the work we do at Meducate. One of the core values I have always had was with having the ability to measure and monitor every aspect of the customer experience. That would be at all levels. So how well do we handle incoming calls and meetings with potential clients? Feedback from students is something I have already talked about, but what do the clinicians think? How do they feel about utilising ACEs in the educational process and how valuable are they? The answers coming back so far have been outstanding. I really believe in giving the customer what they want and will always work with them to achieve their goals.
“I have always believed in being transparent with the people who work for us and the customer. Keeping everyone in the loop on a regular basis makes for a happy and fruitful relationship.
“What has been difficult, but I have now adapted too, is the sudden changes a client might make at the last minute about the type of training they want delivered? I was surprised by how flexible our ACEs were. They were able to shift gear quickly and improvise, effectively delivering exactly what the customer wanted. This I believe is one of Meducate’s great strengths and is due to the intensity, passion and abilities of the people we have working with us.
“With regard to the abilities of the ACEs I would like to mention that we update the ACEs skill sets every 6 months and will run regular training days to help the ACE with any areas in which they might feel weak. We want everyone to feel like they’re part of a family and if we all look after each other, we will all prosper. It’s a continuing process that we can’t let slip. As times change, we must change, as we have all recently experienced, and we were quickly working online in March of this year. I don’t believe any other organisation reacted that quickly. We were already prepared to provide online trainings anyway, so it was simply a matter of contacting our customers and setting it up.
“In closing, I would just like to say that I feel we are a very under-used resource, but we have professional credibility with several universities using us and several ACEs with over 12 years’ experience. If you want to test us out, why not call us or email or call us for a 5 minute conversation?”
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.
Once 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.
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.”
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.
One of the greatest innovations the computer age has brought us is the opportunity for anyone to set up a podcast. Podcasts are great to watch or listen to when you are on the move and allow you to get information quickly from a variety of sources. We at Meducate have embraced that technology and are now producing a series of podcasts on Medical Roleplay and Associate Clinical Education (ACE). We will be talking to clinicians and simulated patients and, in some cases students, about their experience of working with us.
Last week I interviewed James Ennis, Clinical Director of the Physician Associate Program at Chester University, who I have had a working relationship with for over 10 years.
You can listen to the podcast here, but I thought it would be good to give a very abbreviated version as a blog post for those who don’t have the time to listen.
BOB: Welcome to the Podcast, James. First of all, thanks for coming on and agreeing to do this. I know you are very busy dealing with a multitude of challenges at the moment, but I’d like to get your view on what it’s like to work with medical role players and ACEs in this ever changing environment.
JAMES: Thanks, Bob. It’s a pleasure to talk to you about this subject and get it out to a wider audience. As you know I’ve been working with Associate Clinical Educators and role players for the best part of 10 years and we’ve always had them within our curriculum both at Birmingham University and now at Chester. I think it’s an important aspect to medical education, and the feedback we receive from students about the experience is always exceptional. I’ve never once had negative feedback from a student regarding clinical educators or role players because of their ability to help the students relax and also give them constructive feedback about both their physical examination skills and their communication skills. It’s often the case that students can feel more anxiety when working with an academic clinician than with an external educator such as an ACE.
BOB: Yes, I’ve noticed how much more relaxed the students are with us and I guess it’s because we come in at their level in many ways and with our knowledge of systems examinations we can help them practice their techniques quickly and effectively without recourse to in-depth academic analysis. It’s hands on without too much theory, which a lot of students crave.
They really enjoy the hands-on skills we help them with, and even simple techniques like palpation and percussion are keenly rehearsed with us over and over. Sometimes it’s the simplest things that can cause the most confusion and we are there to hold their hands, as it were.
I was obviously trained by Clinicians like yourself, but the students often comment on how knowledgeable we are in terms of our understanding of the examination process. We are also able to tell whether the student is gaining rapport with the patient and handling the patient in a respectful way. That and of course our extensive understanding on what is expected in OSCE’s.
As an ACE and role player, I and my colleagues must have been through 1000s of OSCE stations in our time. We have a good idea what an examiner is looking for, and this gives us a lot of credibility when students ask about OSCEs. It’s one of their big concerns, and having this knowledge helps us build trust with the students.
JAMES: Yes, I’ve noticed that when we work with you guys, you have this knack of reading the whole situation and responding appropriately. The fact that you have background knowledge of history taking and Systems Examinations, as well as a clear understanding as to what’s required in the OSCEs, has been tremendous in improving the students ability to, not just pass exams but turn out as very good, very safe clinicians. The feedback you guys give about excessive use of jargon is also important and can sometimes be missed by volunteer patients, for example.
Consulting with simulated patients when it might be called upon for them to perform intimate examinations, are made so much easier when working with an experienced ACE. That ability to help the student keep their sense of humour and deal effectively in a relaxed manner in what could be a very embarrassing situation.
Like I said you guys are an invaluable resource. I don’t know how you how you found it over the years, but I think it’s grown into something far more meaningful than we ever thought it would be.
BOB: Obviously you have embraced the idea of using ACEs as part of your teaching methodology and you find them of great value in consolidating the students learning. Yet, there are only a few institutions that utilise our skills. Chester, Wolverhampton and Birmingham are the three I know of. Why do you think ACEs have not been used elsewhere, bearing in mind the high value you place on them?
JAMES: Ultimately if we’re going to be completely honest, I think a lot of it comes down to money and resources and availability, which is a real shame, because as we know working with ACEs really embellish and enrich the student experience, and we have both alluded to the fact that ultimately students retain information and learn faster when examining real people. People who can give extensive feedback in a structured way and link that to the real world. We were even talking about getting the ACE role validated, which I know you have been a keen advocate of. That would be icing on the cake as it were.
BOB: Yes, I for one would be very keen to have the role validated. I think academics would take us more seriously and once they had experienced working with an ACE, would then realise the value and they would then add is to their program.
JAMES: Absolutely. We’ve spoken about this in the past and I think it needs to be a requirement and there is an important need to have some accreditation process or some monitoring, because it is actually a very robust system.
Academics who have not experienced working with an ACE might not be aware of the amount of training that goes into being an effective ACE, and I have seen the type of preparation ACEs go through, both as individuals and as part of the team. That’s the other aspect that needs to be mentioned. When you work with us at Chester, you really are seen as part of the team and are treated as such.
BOB: Yes, that’s true. We feel valued as much as other external educators, and we do appreciate it. It makes for a smooth working relationship and I think the students notice this too.
The recent Pandemic must have posed challenges for you as an educator and I know it has affected the amount of work we have had. Some Institutions were up and running, but most seemed to struggle with embracing the new idea of working online. What was your experience like?
JAMES: Yeah, that’s a good question, actually. Obviously, we have had to change our approach to clinical practise and there have been significant changes in general practise in the community. We have had to work with video conferencing, telephone triage and consultations and we have found new ways to use these technologies with you guys at Meducate.
In fact, you were up and running as soon as the lockdown happened. This was great news for us, as we could use your services almost immediately and the skill and depth of understanding you brought to this new way of working was refreshing. Everything ran like clockwork. I can only say thanks and say that for those reading this Meducate can provide you with an excellent and very professional service.
I would like to thank James for giving permission to abbreviate our podcast and in future posts will include more interviews with clinicians as well as ACEs and students.
It’s true to say that during the Covid – 19 crises our services have not been required as much as normal. Whilst many institutions seem to be struggling to embrace online teaching some have risen to the challenge and hit the ground running. We have been fortunate however, working with both Wolverhampton and Chester Universities on their PA Programs. This is great news as it helps keep our skillsets sharp and allows us the opportunity to embrace this new way of working.
Teaching online does have its challenges but I find it as easy as if we were working face to face with students in a classroom. The feedback we have received from students has been excellent and this gives us confidence that what we are doing is hitting the mark.
Working with students directly, and in particular with Physical examinations, has not yet been possible due to social distancing. This will change soon with September seeing us back in the driving seat working as ACEs.
Many ACEs and role players are also trained actors which obviously ensures that scenarios are realistic and believable. We often get feedback from students saying how “real” they felt the interaction was, and because of our varied skillsets we often get asked to make training videos. These, more often than not, see us in consultations with us acting as patients, who might have challenging behaviours, as well as physical conditions and a comprehensive history.
Last week, we had a opportunity work with the Chester University PA Program when we were asked to take part in a filming session for James Ennis the Clinical Director at Chester University. We were tasked with developing a training video demonstrating a variety of typical Musculo-Skeletal Examinations (MSK).
We have been trained in clinical MSK examinations over 10 years ago by Professor Edward Davies (Consultant Surgeon) and Andy Emms (Consultant Physiotherapist) of the Royal Orthopaedic Hospital in Birmingham. This means that our level of skill and knowledge of how to prepare the students to perform these examinations is text book.
We often help prepare PA students and 4th Year Medical Students when working for The University of Birmingham Medical School in MSK examinations and this has sharpened our skills. This experience has been invaluable to our education as an ACE, as well as us being able to take advantage of online resources that are readily available if you know where to look.
The requirement was for us to go through complete Hip, Knee, Shoulder and Lumber Spine examinations, which also included Upper and Lower Limb Neurological exams.
With the help of Scott Howard from simulation, we managed to film all of the sequences and we look forward to seeing them being used by all those on the PA program in the near future. What made it even more useful was that we were able to review our knowledge base, and have an opportunity to practice skills we have not used for 4 months. It was a win-win situation!
I was assisted as always by my travelling companion Mark, who made the journey up to Chester pass by in the wink of an eye.
If you want to find out more about the role of the ACE and how we can help your students improve their technique, contact is at Meducate Academy.
Now that we have been in lockdown for almost five months, working online has been a challenge. We have had to explore new ways of working and teaching using technologies we have never used before. We embraced the challenge fully and have managed to work online with PA students at Wolverhampton and Chester Universities. In fact, we were even asked to do a summative OSCE at Wolverhampton University last month, which went very well.
In terms of teaching communication skills for history taking, there was very little difference from working face to face in a classroom. Students have also stepped up to the plate and invested time and energy in adapting to the new technologies and methodology.
At Meducate Academy we embraced this new approach to teaching online in the very first week of lockdown in March 2020.
Webinar for Matrix Education
This month, I had the honour of talking about the role of the Associate Clinical Educator and Medical Roleplayer on a webinar hosted by ‘Matrix Education’. We had over 50 delegates and talked for well over an hour, fielding questions from students attending Physician Associates Post Graduate courses at Universities around the UK.
Most of the questions were based on the students concerns and worries about their up- coming OSCEs later this year.
I was assisted by colleague and co-worker Mark and between us we provided entertainment as well as giving useful advice on:
How to conduct yourself in an OSCE station.
How does a student build rapport.
How to control nerves and anxiety.
What is the best way to prepare for a systems exam?
And much, much more.
Collectively, my colleague and I have had over 25 years experience working in the field of Medical Education, and have taken part in hundreds of OSCEs over this period, including working with other Health Professionals such as GPs, Dentists, Medical Students, Nurses and Physiotherapists.
If you would like to know more about how we can help your students realise their potential please contact us at Meducate Academy.
Welcome to this the first of many posts related to Meducate Academy and the work we do to provide Universities and Colleges with High Quality Associate Clinical Educators and Role Players.
Meducate was created in response to the growing demand for highly skilled Physician Associates (PAs), Medical Students, Independent Prescribing Pharmacists, Nurses, Dentists and others working in the Health Care Professions.
Our aim is to provide Colleges and Universities who run these educational programmes with teams of highly trained and experienced Clinicians, Clinical Leaders, Associate Clinical Educators (ACE) and Professional Medical Role Players.
We have already worked in partnership with Wolverhampton University and Chester University providing both Associate Clinical Educators and Role Players for their Physician Associate Programmes and we have taken our training to these establishments via Teams and Zoom. In fact, working online has saved the customer valuable time and kept the costs down considerably.
In this post we explore the role of the ACE and how they work alongside experienced clinicians to offer the best learning outcomes. We also find out how they differ from medical role players and just what it is they offer the student, The term Associate Clinical Educator was first pioneered by Professor Jim Parle at The University of Birmingham Medical School 10 years ago.
In the following video we interview a highly experienced Role Player and Associate Clinical Educator and find out just what it is they do and how it will fit in with your programme of teaching.
In upcoming post we will be talking to Pete Gorman, Clinical Lead from The University of Wolverhampton Physician Associate Course.
The University of Wolverhampton has worked closely with Meducate over the past 12 months both online as well as in the classroom and Pete Gorman explains how he has utilised the services of Associate Clinical Educators to great effect during his tenure there.
For more information and a free consultation as to how we can help you check in at our website Meducate Academy.