Meducate Opportunity Banner 1

The Importance Of Feedback From The Physician Associate Student

Meducate Academy - Teaching physician associates the importance of having a systematic approach to physical exams

In my last post The Associated Clinical Educators Role In Providing Feedback To Student Clinicians, I talked about the importance of feedback to the Physician Associate student and how an ACE structures their feedback to ensure that they achieve the best learning outcomes.

Feedback is important to the student and is also of importance for us to receive feedback on our performance. This is a vital part of the communication interaction and helps us improve our facilitation skills.

At Meducate Academy we always want to hear what the student thinks of the session and we often ask them to appraise our performance and give us feedback, and it’s always nice when that feedback comes in the form of a testimonial that you just didn’t expect.

Last week we were lucky enough to work with the 2nd year Physician Associate cohort at The University of Chester. A very highly motivated group of students who show real promise. We were assisting clinicians in teaching MSK and general systems examinations, and the day went well.

There were six ACEs teaching all day and each group broke off into their separate rooms, observing the current Covid-19 restrictions. The students were able to take histories and then perform a physical examination. We then asked them to report their findings (if any) and give a summary and management plan.

Meducate Academy review on Instagram

I was happy that everyone performed well (including the ACEs) and we left Chester in high spirits.

Our return journey to Birmingham gave us a chance to reflect on our performance and that of the groups we were working with, and we all felt that the day had gone well. Self-reflection is an important part of the process for all Meducate Academy employees and allows us to develop our skills to the highest standard.

Within 24 hours some students had put a post up on Instagram and I felt I had to share it here on the blog.

We are currently working on writing a manual that will help students pass their OSCEs. This is in partnership with a senior clinician from The Royal Orthopedic Hospital. It’s aim is to give two different perspectives on the OSCE process. The first is from the point of view of the ACE/simulated patient and the other from the examiners perspective. We believe this is the first time anything like this has been published. As ACEs and simulated patients we have been involved in thousands of hours of OSCEs which in-turn gives us an insight into how students can improve their performance. Keep your eyes peeled for this in the near future.

Primary care for physician associates by matrix educationOn a similar note Matrix Education has produced Primary Care For Physician Associates, an excellent reference source for the training of physicians associates which is available now. One of the authors, Sofia Hiramatsu, was an old student of mine at the University of Birmingham medical school. She is now a successful PA working in London and founder of Matrix Education. I am particularly proud of her achievements in the field of medical education. At over 600 pages, this book will be a useful aid to not only help you pass your exams but also serve as as useful aide memoir when you are qualified as a Physician Associate.

Meducate Academy Is Moving

Clinical training room at Wolverhampton University

Meducate Academy is moving, in many senses of the word…

Almost three years in the business and despite the impact that Covid-19 has created, Meducate Academy seem to be leading the way in the education of health-care professionals by Lay Clinical Educators and Simulated Patients.

The past week has seen us providing our services to one of our partners, The University of Wolverhampton. Under the direction of Pete Gorman Clinical Lead we supplied Associate Clinical Educators on their Physician Associate Programme. Working with three experienced ACEs we covered scenarios including the management of Mental Health issues, dealing with an anxious patient presenting with STEMI and a session on how to examine a patient with thyroid problems

These scenarios were designed to challenge the students both in their ability to take a focused history and a perform a focused cardiovascular and thyroid examination, including testing them on their ability to read an ECG correctly.

We ran the sessions as a mock OSCE over ten minutes, but unlike an OSCE we were able to give feedback to the students for twenty minutes each. The days were long but productive and very rewarding, plus the feedback given by the students was also excellent.

The students had worked with us previously, so they were not surprised by the level of challenge and the way we approach the delivery of Clinical Examinations. They were all PA students in their second year, so the pressure was put on them to perform at the highest level. Most of them didn’t let us down, and they thanked us for the work we had done last year.

Unlike volunteers and real patients, an ACE working alongside an experienced clinician can make a significant difference to the development of a PA student.

It is sessions like this that allow the students to make their mistakes in a safe and supportive environment. The ACE always gives feedback in a structured way, including information on the students ability to build rapport with the patient.

We will be following these sessions up next week with Mock OSCEs under actual exam conditions using seven of our most experienced ACEs. It should be an enjoyable week!

Next month we will also work with The University of Chester on their PA programme, but this time we will work online using Microsoft Teams. This is a different type of teaching and requires good camera skills. More of that in another post.

Working online presents us all with a variety of communication challenges. Lousy cameras, dodgy Wi-Fi and misunderstandings about how to use the system. The Internet can seem to have a life of its own at times. We have contingency plans for events like this.

We have even run online sessions to help students and our ACEs use the technology more effectively. Most of the online work we do focuses more on History Taking as it’s virtually impossible to do physical exams online.

Working online presents its challenges, but we have been working online since the start of the first lockdown back in March earlier this year. We more or less have it sorted!

Embracing the new technology meant we had to invest in state-of-the-art cameras, lighting and sound equipment to ensure that our customers get the very best experience.

It also means we can film training material and create Podcasts for use by our clients for future use when the Covid-19 pandemic is all over.

Those of you with a keen eye will see that our address has also changed.

We have now moved our offices from Shenstone in Staffordshire to a Birmingham city center location, situated at Grosvenor House in the Jewellery Quarter in St Paul’s Square. Having a central location makes it easier to train upcoming ACEs and meet potential clients. We are near to Central Station and on the major route into Birmingham from the M6.

All this and more to come. Including a proposed webinar where we invite senior Clinicians and Associate Clinical Educators together with students to talk about how to approach OSCEs. We are also currently filming and building a library of systems exams so students can have access to the latest examination methods being used in the OSCEs.

Thanks to everyone who has helped us make this journey.

In Conversation With Senior Associate Clinical Educator Mark Reynolds

Interview with Associate Clinical Educator Mark Reynolds
Associate Clinical Educator Mark Reynolds giving feedback to a PA student on a recent course

A few subscribers have asked me to expand further on the role of the ACE, and this is a transcript of an interview I did with fellow ACE Mark Reynolds a few years ago. It still has relevance today and should answer any questions I have received over the past few months.

Meducate: What can you tell me about the difference between a Role Player and an ACE (Associate Clinical Educator)?

Mark: A role player is involved in clinical communication, in that they play opposite a medical student as a patient or colleague in order to to improve their learning in terms of their technique of clinical communication.  The associate clinical educator is also trained as a role player but is also trained in the body system examination so they are a hand on resource for the student to work on. The ACE then feeds back how well the student carries out that examination.

Meducate: You mentioned the term “body systems” what do you mean by that?

Mark: The basic body systems, from the point of view of the  medical world, would be  the cardiovascular, respiratory, gastrointestinal, neurological and musculoskeletal systems. We are trained to give feedback on their examination technique. Techniques such as percussion, auscultation and palpation.  We  never teach pathology, that’s up to an academic tutor who normally works alongside us.

Meducate: So the academic tutor teaches the pathologies and the theory, and you are the resource? A bit like a living mannequin?

Mark: Yes, we are a living resource able to give feedback on the technique as well as our extensive knowledge of the OSCEs and what is required in those academic exams. At first Techniques like Percussion and Palpation are often a problem for new students, and we can guide them in the correct technique as well as ensuring they’re in the correct position on the body.

Meducate: And because you’re also a communications expert, you can give feedback on their ability to communicate effectively and build rapport with the patient.

Mark: Absolutely yes. Communication is a vital part of the examination process and it would be remiss of me to allow a student to carry on if they couldn’t build rapport with the patient.

Meducate: So can you describe a typical session with an ACE?

Mark: So normally a body system is picked for the day and the ACE will be working with four to six students. Sometimes the clinician may do a live demonstration using the ACE as the model, and then the students will be taken through the various pathologies they may come across on a typical patient. The students would then be left to work with the ACE, and they would then give feedback about how well they are doing. Having a “Talk the Walk” approach works very well, as we can direct the student toward the correct method right from the start. Sometimes we may run a scenario alongside the physical examination and thereby making it more realistic. With the help of the clinician present, we will also include a management plan and how to explain that to the patient in layman’s terms. We can also present various pathologies to the student such as asymmetrical breathing, antalgic gait, Shortness of breath and many more. We even have a member of the team who can create ulcers, bruising, and other physical signs using moulage.

Meducate: I have heard students say that they feel more relaxed when working with an ACE can you expand on that?

Mark: Yes, when a student has a clinician in the room they feel that they are being judged. Which of course is true. We are there as a resource, a tool, if you will to help them develop without judgement. It is true that we assess them, but not professionally. We are not qualified Medics!

 Meducate: ACEs are often used in OSCEs to great effect. How does that work?

Mark: During an OSCE it is not possible for the examiner to feel what is going on such as palpation, and that’s where we can give our feedback about how well the palpation went. Whether it was painful or too light. Because of our intensive hands on training, we know what a good technique is. This ensures that the PA is safe to practice once qualified. It should be remembered too that we have probably been involved in thousands of OSCEs, so we have an extensive experience, often much more than the examiners themselves. Examiners often remark on how extensive our knowledge is!

Meducate: Better than a real patient?

Mark: Yes, very different. A patient will not be qualified to give feedback. Of course, working with real patients is also valuable to the learning process.

Meducate: Thanks for taking time out to chat with us, Mark.

Meducate Academy Educating The Next Generation Of PAs

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.

Interview With James Ennis, Clinical Director (PA Program) At Chester University

Image of Bob ACE working with a group of physician associate students at a recent training course
Bob working as an ACE with a group of PA students at a recent training course giving feedback to students is a vital part of the ACEs role.

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.

Image of Clinical Director (PA Program) at Chester University
James Ennis Course Director University Of Chester

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.

Working Online With Meducate

ACE and role player Mark plays a suicidal patient in a scenario
Dealing with suicidal patients is very challenging and Meducates Associate Clinical Educators have years of experience to help guide the student through these difficult scenarios (Image Matrix Education)

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.

PA student performing a CV exam with ACE Bob
Correct placement of the stethoscope is vital when performing a CV exam. Our Associate Clinical Educators know exactly how the examination should be performed and give guidance throughout (Image Matrix Education).

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.

Associate Clinical Educators

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.