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.
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
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.
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.
Meducate Academy has recently been involved with building a new initiative in collaboration with a GP Practice and health authority in the South of England. There has been much talk of building PA Academies around the UK and Meducate Academy have now put a package together from the ground up to help any organisation interested in doing this.
At this point, I can’t give too many details but suffice to say it was an extensive project, and we had to gather all of our resources to make it possible.
From administration to clinical teaching, from simulation to accreditation, and from recruitment to installation, we have finally put together what we think is the complete package for newly qualified Physician Associates who have got their first job.
It’s often been the case that once a PA has finished their studies and got themselves a job that things will go well. However, the feedback we have been getting is that this is not normally the case and that new PAs feel like they’re a little unprepared for moving into the workplace. It’s true to say that the employer often doesn’t have the time or resources to help and that’s where the PA Academy can fit in.
This involves some help from the employer (GP Surgery for example ) where they will release the PA one day a week for an initial period and then learn skills at the academy that will help them function at a higher level once in the workplace.
We include an example of what we have been working on below:
The Proposal
Meducate Academy will:
Format the proposed timetable for over 36 weeks.
Each session will last 3 hours and will involve the use of 2 Associate Clinical Educators (ACEs) and will cover the most common conditions encountered by Physician Associates in the first 3-6 months of working in a GP setting.
Produce an overall timetable outlining the basic schedule followed by a more in-depth breakdown of what we will teach to the PA in each session, including the learning outcomes for each session.
We will cover the following common conditions encountered by PAs in this type of setting which will include:
Chronic conditions
MSK
Diabetes
Contraception
HRT
ENT
Headaches and Dizziness
Co-Morbid Conditions
Triage
Telephone consultations
Note-taking/Referrals
We would also expect to discuss topics that might be in the public eye, such as changes in NICE Guidelines and Prescribing.
We will prepare this timetable in collaboration with Mr. James Ennis, Clinical Lead of the PA Programme at Chester University, who has over 10 years of experience working as a PA and as an academic teaching PAs.
Objectives
To create an Academy which will provide quality, continued professional development to PA Graduates in their first year of practice.
Achieve consistent 5-star ratings from GPs Practices and Graduates. These will be collated through several review platforms relating to the services offered through the Foundation Academy.
Aims
Create a syllabus of education that supports the PA in their first year in practice.
Develop a mentor/buddy system for each PA.
Create a feedback system that takes information from both GPs and PAs. This will allow for continuous development and improvements within the academy.
Seven Reasons for using Meducate Academy
1. References available from Senior Clinical Professionals.
2. Fully insured.
3. Supported by Prof Jim Parle and James Ennis Clinical Lead at Chester University Medical School.
4. Meducate Academy established in 2018
5. Created an Internal Accreditation and training programme for all the Associate Clinical Educators (ACE).
6. Create links with FPA and RCP regarding accrediting elements of the material for PA accessing CPD points.
7. Currently working alongside Orthopathways, assisting them in the development of software to help GP referral for MSK pathologies.
8. Intended affiliation with MSK groups such as Arthritis, UK.
Programme Outline
2 days in GP practice (or other)–Support offered–GP Educator
2 days at Foundation Academy–Support offered by GP Educators & ACEs (Associate Clinical Educators). This is based on 8 PAs in attendance. A typical day comprises 2 X 3 hr sessions.
Meducate Academy will create the syllabus. This will be signed off by the relevant clinicians. The syllabus will be based on information supplied by experienced Clinical Leads PAs and the attendees themselves.
We are currently conducting research based on the experiences of PAs who have been working in their chosen speciality for over 5 years. Results from which will help us determine the direction of the proposed course.
We will also collate feedback from the PA students who wish to attend the Academy. This approach will allow us to create a tailor-made programme comprising Student Directed Learning Modules (SDLM) TM.
Creation of a feedback loop for continuous improvement and development.
Regular Assessment of students every 3 months over the period of a 12-month timetable.
So, as you can see we have put a lot of effort into developing this model. Naturally, it will be subject to evaluation and ultimately evolution. If you are a clinician who thinks that this might help you with your current group of Physician Associates let us know. Please contact: bobspour@meducateacademy.com. We would love to have a chat and get some of your expert guidance.
Associate Clinical Educator Bob working with a cohort of PA Students at Chester University
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.
The Meducate Academy online AEC conference was a great success and attracted some great speakers
We began September with our first ACE National Online Conference held online using Zoom as the platform, and it went well.
We had six speakers talk about their personal experience of working with ACEs as part of their programmes of teaching. Coming from a variety of backgrounds, they talked at length about the real value of the ACE as a hi-fidelity simulated patient. As well as discussing the pros and cons of using ACEs and also about the students experience of working an ACE.
Professor Jim Parle started the proceedings with a brief chat about the development of the ACE role. Indeed, it was Jim who created the role of the ACE at the University of Birmingham many years ago alongside the ISU. Although retired, he still likes to play an active role in medical education, and it was an honour for us to have him as our keynote speaker.
Other speakers included James Ennis, the Clinical Lead at the University of Chester who also utilises ACEs in all of his teaching modules and is currently doing a PhD which takes a focussed look at the role of simulation in clinical teaching.
Founder and Director of Meducate Academy Bob behind the scenes with Mark Reynolds
Uzo Ehiogu, a teaching fellow and senior physiotherapist at the Royal Orthopedic Hospital in Birmingham, speaks about his experiences using volunteer patients and the ACE, and talks about the relative values of both when he is working with 4th year medical students from the University of Birmingham.
The current President of the Faculty of Physician Associates, Kate Straughton, shared her experiences of working alongside ACEs at The University of Birmingham on the PA Course there. She talked a little about her time as a student Physician Associate and how the ACEs helped her when she studied at Birmingham, where she is now a senior lecturer.
Peter Gorman was next up and he went into great detail about how he used ACEs to transform the way his University (Wolverhampton) coped with the demands that the Pandemic placed on the staff and the students. He also talked about the initiatives he came up with to keep the students engaged during this difficult time.
Finally, we heard from Sarah Baig, a Clinical Pharmacologist who used ACEs for the very first time at The University of Birmingham on the Independent Prescribing Course. New to the whole concept of the ACE, Sarah expressed how valuable the ACE can be compared to the run-of-the-mill role player when it comes to clinical examinations.
ACE Online Conference Host and Chairman Mark Reynolds
We want to say thanks to all the speakers and also to the delegates who attended. Some as far away as the USA! We know that some delegates would have liked to have attended but couldn’t, which is why we recorded the conference so that you may listen to the speakers at your leisure.
We are planning our next conference which is being held online again in March 2022, so look out for information on that soon.
We are also going to run an online conference in November aimed specifically at Physician Associates and how to approach physical examinations and how to prepare for the OSCEs. All Physician Associates students are invited and the conference will be free and will feature several speakers, including some of the speakers in this video. You will also have the opportunity to put your questions directly to each speaker. It will be a bit like Question Time but a lot more fun.
We will post specific dates for these events on social media and on this blog.
At this point, I can’t give too many details but suffice to say it was an extensive project, and we had to gather all of our resources to make it possible.
