If you’re an Associate Clinical Educator (ACE), you may have wondered what sets you apart from a simulated patient or medical role player. In this article, we will be exploring this question and providing a useful questionnaire that will help you become a better ACE, teacher, and communicator. Our goal is to improve the quality of ACEs by answering important questions and providing helpful training resources.
How well do you really know your role as an Associate Clinical Educator? I have been thinking for a while now about creating a quiz for ACEs. I wanted to find out what makes an ACE more than just a simulated patient or medical role player. I believe the following questionnaire will help us become better Associate Clinical Educators, as well as better teachers and communicators.
Over the past couple of years, Meducate Academy has been putting together training courses to help existing ACEs and simulated patients improve their existing skills and introduce new people to the role of the ACE. We are always striving to improve the quality of our ACEs, and in order to do that, we always listen to what they have to say.
When I was starting out, many of these questions were never answered satisfactorily, and after much discussion with our existing ACEs, they all seemed to ask the same questions.
On the 13th of this month (May 2023), we will be running another one-day training course aimed at potential ACE. These are normally people who have been medical role players or have some experience as simulated patients and wish to take it to the next level.
If you are one of those people, you might find it helpful to ask yourself these questions below. If you are an experienced ACE, you could revisit this questionnaire or add more questions to the list. So, get a sheet of paper and answer these questions now.
1. When did you first start working as a medical role player and why?
2. When did you start working as an ACE, and how easy was the transition?
3. How often do you work as a medical role player or ACE?
4. What types of students have you worked with, and did their needs differ?
5. Have you been involved in OSCEs or any other type of examination?
6. Was the training we gave you adequate, or do you feel it was confusing?
7. What type of training would you find most useful?
8. Which aspect of your previous training (prior to medical roleplay/simulated patient/ACE) has helped you engage with your current role?
9. Where do you find resources that help with your current role?
10. What new resources would you find useful to help you improve the quality of teaching?
11. How much do you think your personality affects the learning outcome, and do you think you should spend more time on that aspect of your training?
12. Do you know how to teach a student how to develop rapport with a difficult patient?
13. What do you get, at a personal level, from teaching as an ACE?
14. How do you structure feedback to the student?
15. Do you always achieve your desired outcome when teaching, and if not, do you reflect on what you could do better next time?
We came up with these initial 15 questions, but we welcome any suggestions. As we ask these types of questions to our new ACEs, it’s essential to understand that none of us are experts or masters of our craft. Acknowledging that there is always room to learn something new helps us stay vigilant. Our honesty fosters implicit trust from our students, and they feel that we are with them on their journey.
The type of people we are looking for are those who say, “C’mon chaps, let’s get stuck in,” not “Go on, chaps, off you go.” Lead from the front. We are there to work with the students, not talk at them. Build rapport with the students, have the flexibility to change your behaviour when you need to, be aware, and you and the students will achieve their desired outcomes.
Have an open mind and question everything! At the end of the day, that is what education should be about. That is how we grow and become better humans.
Those that follow us on social media will also know that we were interviewed by James Catton of The Physician Associate Podcast. We had a great time answering his many questions, and it also gave us the opportunity to let a wider audience hear just what an ACE is and does. There are many misconceptions about our role and it’s important that we are not seen as just a body to practice on, but a highly trained expert patient, able to give accurate feedback to students whilst performing a physical systems examination. We chatted at length about the origins of the role, where we are today with the role, and what the future has in store. The future, of course, will see us producing a robust assessment process for the role of Associate Clinical Educator. This is something Bob has had a personal interest in for years. More of this later on in this post!
Exciting times continue for Meducate Academy with the development of some innovative and fresh approaches to medical simulation, including a top secret Meducate partnership in the pipeline. Sadly, we cannot talk about this until the research phase is complete. However, we can say it has something to do with our high level of skill in delivering MSK teaching modules.
Bob and the team have continued to build relationships with Chester University Medical School, which includes working as a visiting lecturer interviewing potential candidates for the medical degree that starts there in September of this year. This started a couple of months ago when Bob was invited to observe the process and then being asked to act as facilitator at the communications station, working with one of the medical role players.
One other development with The University of Chester was working as an ACE teaching alongside James Ennis and Dr Gareth Nye (Lead BmedSci course Chester), with medical scientists on history taking in the morning. The afternoon saw them demonstrating the physical skills required when performing a cardio-vascular examination, with the students taking an active part. It became apparent to the students how important taking a history was to finding a diagnosis. The students, who had no experience of this methodology found it fascinating and were highly engaged throughout the day.
The students also had the opportunity to get ‘hands on’ with Bob and learn more about taking a blood pressure, palpating pulses and running through a basic cardio exam. A few asked about taking this further as post graduates and possibly joining the Physician Associate programme at Chester. It sort of turned into a recruiting drive! Later on in the month, we ran the same course at Chester University Shrewsbury Campus. Again, the students showed a real flare for hands on medicine rather simply working in the laboratory.
Meducate Academy also specialises in GTA and MTA teaching (Gynaecological Training Associate and Male Teaching Associate). For the uninitiated, these are ACEs who are trained in intimate exams such as gynaecological, breast, testicular and prostate examinations. The ACEs who teach in this field are highly specialised and work alongside experienced clinicians. Student feedback is always excellent once they get over the initial embarrassment and nervousness around this subject. It’s a valuable session for students and is the next step up from working with mannequins.
The keen eyed amongst you may also notice that we now have a uniform (of sorts). The new dress code includes a polo shirt with embroidered company logo and name tag. This helps the students identify the ACE they are working with so they can provide feedback and also gives a clear impression that they are working with a team of professionals.
Meducate Academy have also started training volunteers at the Royal Orthopedic Hospital in Birmingham, who give up their time to help 4th and 3rd year medical students from the University of Birmingham and Aston learn the correct approach to MSK examinations. This was a great opportunity to show our skills and knowledge to the clinicians assisting us.
As mentioned previously, we have been involved in creating a robust system of assessment for our ACEs. On Saturday 28th May 2022 we brought together eleven of our team and with the help of Professor Jim Parle, ran a pilot of the assessment process. This gave us an opportunity to test run the marking scheme that Jim and Bob had previously created. The ACEs were expected to demonstrate a high degree of skill in teaching and demonstrating their knowledge of the various body systems. This could never have happened if it wasn’t for the help of Clinical Lead Teresa Dowsing and the use of the University of Wolverhampton’s clinical skills suite. We ran the assessment very much like an OSCE with the ACEs core skills being put under scrutiny and the marking being overseen by Professor Parle. Many lessons were learned during the session and we are currently reviewing feedback from the ACEs.
ACE Accreditation is something Bob has been passionate about for almost ten years and he has been working tirelessly behind the scenes to get organised.
“Having Jim Parle on board is vital, as he has years of experience assessing both medical students and Physician Associates. He spent some years as the National Examiner for the PA course and, of course, was one of the creators of the PA programme in the UK.”
Next month will see Meducate Academy taking their show on the road. We will be doing workshops for The University of Newcastle on 15th July 2022. We will also be running a workshop at The Education Centre, West Suffolk Hospital, Hardwick Lane, Bury St Edmunds with ARU and UEA in attendance on 26th July 2022. These workshops are open to all PA students who attend the universities mentioned.
Keep your eyes open for the next post which will be looking at:
How students can use effective questioning techniques to elicit information from difficult patients,
Why students fail to ask the questions they should to help with a diagnosis.
How to get patients to answer your questions even if they are resistant.
7 techniques for creating questions that get to the core of the problem.
For many years I’ve worked with thousands of students in medical schools and institutions teaching specifically on the physician associate programme at Wolverhampton and Chester University. It’s been a highly satisfying job and allows me to do what I love more than anything and that is to teach students! One of the major concerns students have are about passing their OSCEs. From the day their course starts to the day of their exams the conversation inevitably centres around one topic: The dreaded OSCEs.
OSCE is an acronym that has become linked to insecurity and fear, most of which is unfounded. These fears and insecurities are prevalent with most PA students wherever I am teaching. The common questions I get asked are:
“What’s going to happen in the OSCE?”
“What happens if I fail the OSCE?”
“Are they going to try and catch me out in the OSCE?”
“I get really nervous before any exam and never do well.”
It’s all students think and talk about to colleagues and friends. It seems to be the main topic of conversation whenever I talk to students. I often tell the students, why not focus this emotional energy and time on the coursework itself. These negative types of conversations can only produce one outcome; that all involved in this unproductive dialogue will scare each other to death. Instead, I get them to imagine using that intensity of focus on doing what they need to do to pass the exams, rather than fretting, worrying and talking to other students who also feel the same way.
These negative thoughts and ideas about the OSCEs are after all just assumptions based on ignorance. Ignorance inevitably leads to the imagination running riot and before you know it you have prepared yourself to fail the exam. Talk of OSCE fears inevitably start in week one of the first term, two years before the actual national exams. What a waste of time and energy.
When I talk to these students (usually in their 1st year) I ask them,“What made them choose the PA Programme. What made them want to be a Physician Associate? What is it about the PA Programme that excites them? Does it excite them?” In other words, I ask them if they know their purpose in becoming a PA?
“Why are you doing this course?”
“What will you get out of becoming a physician associate?”
“What is your purpose?”
Their usual response when asked these questions is to get confused and talk about setting goals and passing the exams. A few will say it’s what they have always wanted to do. A minority will say that their purpose is to care for people and see themselves as a compassionate person. This is what drives them each day. Now that sounds like someone who understands their purpose in life.
I knew one PA many years ago who shared his thoughts with me after a session and he had just this mindset. He said when he was a student and thought about the OSCEs it got him excited, not afraid. He looked forward to the OSCEs because this meant he was getting nearer to his goal of fulfilling his purpose which was to help others. Incidentally, he passed all 14 stations in the National Exams later that year. He knew what his purpose was and kept that in mind every day. Yes, he was nervous before the exams, but he had developed a strategy for dealing with those emotions. More of that later.
Once you have defined your purpose, you now need to review it every day and get yourself excited about achieving the goal of becoming a PA. If you stay on purpose you will achieve your goals both short and long term. But remember a goal without purpose will be short-lived.
This is a strategy I have always used and it helps keep me focused. I know why I am doing what I am doing and I know I will reap the rewards. I have never been goal oriented only purpose driven and yet I seem to achieve my goals.
Another technique I encourage students to practice is to add a sensory component to their thoughts when they think about their approach to the PA course. For example:
“How will it look when you are working as a PA?” (Visual component)
“How will it feel when you are doing the job you were born too do?” (Kinesthetic component)
“Imagine how it will sound when you proudly tell people you are a Physician Associate”, (Auditory component)
Employing your imagination and thinking like this changes your mindset so that you stay focused on your purpose. You have already been doing this when you have spoken negatively about the OSCEs. You know how to do this, but have been using your imagination to work against you and not for you. Use your brain for a positive change, not a negative one!
When fellow students say things like:
“What happens if I fail the OSCEs?” I always re-frame it and say: “What happens if you pass the OSCEs? What would that look like and feel like in your minds eye?”
By staying focused on that feeling your energy will begin to change. You will approach each task with the knowledge that you are getting closer to living out your purpose.
Sometimes, it is true to say that you will encounter setbacks, when things don’t quite work out the way you wanted them. I call these badly formed outcomes. I don’t see them as a failure. These situations are often outside of your control and have been dictated by others. That’s OK. See these episodes as just feedback. That’s all. This approach allows you to stay focused on what’s important and not worry about being a failure. This just wastes emotional energy. Energy you can use in a more positive way.
A great way to re-programme your brain, so that you do more of the above, is to sit for 10-15 minutes a day in a quiet place. Focus on your purpose, imagining how you will feel when you finish the final station of the OSCEs and become a Physician Associate. You should timetable this in to your activity every day. It’s an OSCE meditation, if you like. It will be time well spent and as mindfulness is a big thing at the moment why not get in with the trend?
I’ve taught and used meditation long before it was fashionable, as well as taking part in physical exercise, both of which have helped me stay balanced and integrated and lead a pretty stress free life. So why not add those two beneficial activities to your diary every week to improve your mental and physical health. These activities will not only help you with work, but in all areas of you life.
I suggest you give both a try and 10-15 minutes of meditation every day will show you what state your mind is in. It will teach you how to ensure that you won’t be ambushed by the inevitable negative thoughts, internal dialogue and subsequent emotions when the acronym OSCE is mentioned!
When you sit in meditation for the first time, many thoughts will come into your awareness. Being a PA student you may encounter many negative reactions including thoughts about the OSCEs. Focus on those thoughts and then do the following:
Observe the emotion, the reaction and see it for what it is. Just a creation of your mind. Just a sensation in the body.
Then Let It Go. That’s right,just release it and watch it vanish. A student once said to me what happens when this train of thought arises? I said, “Do not get on the train”. “Let it Go. Let it leave the station”. She said she waved it off, smiled and felt relief.
Once you have Let Go of the thought, any inevitable knee jerk reaction you would normally experience will stop. Allowing you time to …
Be in the moment and come back to focusing on your purpose. These techniques will help you to become more mindful of your mental states, and you can practice this awareness which will carry over into your daily life.
It is a great technique for improving your overall mental health too. It helps you remain balanced and integrated in the other aspects of your life. Do it for a week and see how you feel!
This doesn’t mean you wont be influenced by those around you though. They will still attempt to discuss their failings with you but this time stay focused and listen politely with out getting dragged into the conversation. I have a technique to deal with that to and I’ll share it now.
When the negativity starts to flow from others around me and they don’t want to listen for an alternative, I have a delete button. Yes a delete button in my head. I use it quite a lot actually. Mainly if I listen to the news. But seriously, it can be a powerful tool and a great strategy that will help you stay on track. Just use it for a week and see what happens.
It turns out that this is what successful people seem to do most of the time. Some of the most successful people have not listened to the naysayers and the critics. They stay on purpose until they achieve what it is they are looking for. If you become one of them you become an optimist. Optimists always seem to get things done. They don’t always succeed on the first attempt, but optimism keeps them going. There is always a silver lining to every cloud and a light at the end of the tunnel for an optimist.
By putting yourself in this mindset you are as the saying goes, “living in the moment”, but with an optimistic eye on the future. The only alternative is of course to do what you are probably doing already:
Thinking about how tough the OSCE will be and how badly you are going to do.
Filling your head with self-doubt and negative internal chatter.
Deciding ahead of time how you are more than likely going to fail a station or two.
If you’re doing that, use the delete button or turn the volume down! Drown out the internal dialogue by reminding yourself of your purpose, and asking yourself every day as to just why you want the job of a Physician Associate.
If you want to learn more about some of these strategies and techniques Bob will be running an online seminar on 23rd July 2022 at 12pm until 2pm explaining in detail how to put these techniques into daily practice. Once you’ve signed up for the course you will receive a downloadable handbook on how to improve your mental health.
When you enroll on the course please send your questions to Bob in confidence and he will address those issues during the online seminar. The cost, including the manual, is only £9.99 paid via PayPal.
He is also available to do 121 coaching for any students who feel they need a little bit of personal help. Contact him on 07870 611850 to arrange private Zoom meeting.
Congratulations are in order to all of those Physician Associates who were successful in passing their recent National Exams.
The Physician Associates Program is a very intensive 2 year Post-Graduate course and requires great dedication, focus, resilience and determination to complete. It takes many hours of reading, studying and practicing hands on skills training to produce a competent and safe PA.
Working in close partnership with The University of Chester and The University of Wolverhampton has shown me how demanding the course can be. I see it as my duty as an ACE to ensure that the PA student gets the support and the skills they need to progress in the profession
As an ACE it is also important to keep up to date with any changes that might be happening in the curriculum. Whilst this sometimes is a challenge, I am always grateful to the tutors for their continued support.
Just as the students work and study hard, I am conscious that Meducate Academy’s ACEs put in the same effort. We will therefore continue to work closely with Chester University and Wolverhampton University to produce high quality training programmes for both communication skills and systems examinations this year.
We are about to start producing video and online resources materials for our ACE training programme over the summer months. In less than a month our ACE Aide Memoire will be available to all of our staff here at Meducate Academy.
Academy continue to invest in our ACEs and we are still working on gaining some type of accreditation for the role. Although we are seen as lay educators our ability to provide high fidelity simulations and clinical skills is well documented by the institutions we work with. It is about time this was rewarded with some type of recognised qualification. It also means that our partners know that they are getting the highest quality ACEs working alongside their clinical staff.
We have always been passionate about continued professional ACE training and we want the quality of that work to be second to none.
We will be rolling out a regular annual training camp for the ACEs. This means we have control over the quality of the people we provide to our customers. This of course will be dependent on social distancing rules being relaxed in the coming months.
If you want to work as an ACE and be part of the team at Meducate Academy enter your details in the landing page here and we will get in touch.
Incidentally we will also be hosting an Annual Conference in July 2021. The panel will consist of five speakers all senior clinicians in their own right who have an impressive track record on the UK PA programme. The topic will be the role of simulation in medical training, specifically focusing on the role of the associate clinical educator.