Simulated Patients

Associated Clinical Educators & Simulated Patients In Medical Education

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Physician Associate students being taught by academic on a medical scenario using an associate clinical educator in the role of a patient
Physician Associate students were guided through an end-of-life scenario at Chester University

I want to answer a question I am regularly asked by academics, clinicians, students and other medical roleplayers: “How does an ACE differ from a medical roleplayer, a simulated patient and a volunteer patient?”

The following information draws on our 25 years of collective experience as medical roleplayers and ACEs. We have years of interaction with simulated patients, volunteers and medical roleplayers.

Let us start with volunteers.

In our experience, a volunteer is someone who offers their services to give something back to the NHS for free. They have little or no training and often have to use crib sheets to help them act like a patient for students. Whilst volunteers are of some value to the student, they are not trained or qualified to give constructive feedback on the techniques the student needs to learn.

A simulated patient is someone who acts as if they have a pathology, or uses their actual pathology, with a short backstory they must learn. They have not been trained to give specific feedback to the student about the techniques the students are employing. Simulated patients may be asked for feedback by the teaching team on how the student made them feel during the session. However, this information is fed back to the student by the training team, not by the simulated patient. During the session, the teaching staff will monitor student/patient interaction.

The Medical Role player on the other hand is someone who is usually a trained actor and has undergone some training with regard to communication skills. They are expected to give high-quality objective feedback from a third-person perspective to the student. They can, and often come out of their role to give instruction about how the student can improve their performance and increase empathy with the patient. They work on everything from a simple consultation (history taking) to playing difficult patients, challenging behaviours, suicide and mental health scenarios, as well as working with colleagues from other health professions. They will also play the role of consultants, doctors, nurses and paramedics when needed.

The Associate Clinical Educator (ACE) is a type of medical roleplayer who is exemplified by their in-depth knowledge of the various body systems and pathologies. The ACE is responsible for developing and delivering educational programs that utilize simulated patients and medical role-players. The ACE takes a comprehensive approach to develop these programs, ensuring that each program is designed to meet the specific needs of the learners.

The Associate Clinical Educator (ACE) takes the models of the simulated patient and medical role-player to a different level. Exemplified by in-depth knowledge of the various body systems and their pathologies. A medical roleplayer is an individual who is trained to simulate different medical scenarios in order to help students learn how to interact with patients. These scenarios can include breaking bad news, dealing with difficult patients, and end-of-life scenarios. The role-player is expected to provide objective feedback to the student on how they interacted with the patient, from the patient’s point of view. In order to do this, the role-player must have a basic understanding of communication training and be able to help the student improve their communication skills.

ACEs are highly trained professionals themselves, but also have in-depth knowledge of the various body systems and their pathologies. This makes them uniquely suited to running simulations that are as realistic as possible. This helps medical staff to be as prepared as possible for when they need to use these procedures in real-life situations.

Evidence of a mix of styles, from volunteers, experienced role players and ACEs, was exemplified by the work we did for Chester University at a recent training session with the first and second-year Physician Associate Students.  These students worked alongside nursing staff and social workers in an immersive exercise designed to allow the students the opportunity to work under the pressure of a simulated patient journey. The simulation suites were designed to replicate two busy hospital wards. In the simulation, there were patients presenting with dementia, alcohol dependency, gastrointestinal and cardiac problems, as well as the challenge of working with other health professionals.

The students were supervised by experienced members of the academic staff and the at the end of the simulation the students were given feedback by both the clinicians and the associate clinical educators.

If you are a clinician who would like your current group of Physician Associates to benefit from our expertise in medical simulation, get in touch with us now. Please contact: bobspour@meducateacademy.com.

Diversity & Confidence Building In Medical Simulation

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Demonstration of MSK skills at The University of Wolverhampton

The past month has been frantic! Both of our partners (Wolverhampton and Chester University) have kept us busy with both their 1st and 2nd year cohorts. We have sent teams of ACEs out, providing hi-fidelity teaching and simulation covering a number of body systems. The teaching included reviews of both their communication and history taking skills. So far the topics we have covered are Cranial Nerves, Cardio-vascular, Gastro-intestinal, Respiratory and scenario based training.

In the next few weeks we will also be teaching upper and lower limb neurological exams, as well as intimate examinations on males and females. We have access to specially trained ACEs for this type of examination. Obviously when students perform these types of examinations there is often a degree of embarrassment on the part of the student. Our ACEs are highly experienced in allaying any fears the student may have, and this creates a safer and confident approach when examining a real patient. Most medical institutions don’t offer this type of experience to their students and often rely on using mannequins to practice their skills on.

Our connections to other institutions continue to expand and we are currently in talks with a couple of universities who have expressed an interest in what we are doing. We have recently been involved in MMIs for the recruitment of medical students at The University of Chester.

It still amazes me at how adept our ACE™ team can be. They are able to switch systems examinations at a moments notice, improvise around a theme and yet still provide high quality feedback to the academics and clinicians who are teaching on that module. It is experiences like these that have prompted me to write this month’s post. Without wanting to sound repetitive and simply repeating the last post, I think institutions and individuals are starting to realise the difference between an ACE™ and a simulated patient.

In a few weeks you will have the opportunity to listen to Mark and myself talk about the ACE™ role with James Catton from the PA Podcast. He was somewhat surprised at the level of our knowledge of body systems and was under the illusion that we were simply simulated patients and role players. He was so impressed with our expertise that he is in the process of organizing workshops with the University of East Anglia and Anglia Ruskin University Cambridge Campus.

So, coming back to our team of ACEs and their diverse range of skills, let’s look at a typical month of Meducate Academy’s workload.

Cranial Nerves Examination with Clinician Jack and ACE Howard (Seated) at The University of ChesterIn the last month we have worked with students to improve both their clinical and history taking skills. This was done in the context of both OSCE practice and when they are out on placement where they are expected to use a hybrid approach. We also worked with an experienced Physician Associate in a GP Practice, helping them with their time management and trouble shooting skills. This demonstrates how diverse our ACEs can be when required.

Our skills were also required in order to help pharmacists with their clinical examinations. This was for an assessment to help them gain their Independent Prescribing Course qualification. The pharmacists were given the opportunity to practice their examination skills in a safe environment with ACEs who gave feedback on their techniques. Techniques such as percussion, palpation and auscultation. We helped them work through the seven main body systems whilst the clinicians present talked about the common pathologies they would encounter.

Skills such as these can be practiced with a volunteer or even a sim-man, however what the students don’t get is high quality feedback. This is the main strength of our approach to teaching and the key to our success. Knowing the moves is not enough. The clinician must be able to perform these skills correctly and with our help, through educated feedback, become excellent, safe clinicians.

The body systems covered in the past month have included G.I, respiratory, cardio-vascular, cranial nerves as well as a whole range of neurological exams. We also covered history taking scenarios and the practical aspects of examining a diabetes patient, and how to examine the thyroid.

With the 2nd year Physician Associates we were able to guide them with multiple systems reviews working in a hybrid way. Just like the real world of medicine.

Happy team of Associate Clinical Educators Greg Hobbs, Ellie Darville, Howard Karloff & Meducate director BobOn top of all this of course is the ongoing conversations we have with the students about their fears and worries about the intensity of their course. The students always feel that they can talk to us more openly about their fears rather than going to the academic tutor. This takes some of the pressure off the academics who already have a full timetable. In the 12 years I have been an Associate Clinical Educator I have spent many hours helping students build their confidence and motivation through a variety of strategies.

Knowing that students will confide in you and seeing them graduate is the most rewarding part of the job and the reason I do this work. It’s a role I would recommend to anyone who enjoys working with the medical profession. It’s our way of giving back to the NHS in a small way.

Also, we have finally organised the accreditation process for the ACE™ role and will be running a pilot of this at the University of Wolverhampton in May 2022 with Professor Jim Parle.

On top of all that, a few weeks ago I was called into Trinity Court GP surgery in Stratford-Upon – Avon to run a workshop to 25 staff about how to deal with conflict in the workplace!

Now that’s diversity.

If you are a Clinical Educator and would like to take advantage of using ACEs as part of your clinical teaching, book now for a free consultation. Contact us via the form below or give us a call on 07870611850. Thanks again for reading this post.

An ACE™ Is Not a Simulated Patient, But A Simulated Patient On Steroids!

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1st Year Physician Associate Students and Associate Clinical Educators at Wolverhampton University

Recently my attention was drawn to an article, ‘It’s Not An Acting Job … Don’t Underestimate What A Simulated Patient Does”: A Qualitative Study Exploring the Perspectives of Simulated Patients in Health Professions Education”, which was submitted to the journal of the Society for Simulation in Healthcare about Simulated Patients (SP).

The article, whilst interesting and enlightening, discusses the work of the ‘normal’ SP, and shows how valuable their contribution is to medical education. However the title sums up the fact that an SP is more than just an actor who learns their lines and portrays a character. Any role player will be quick to alert you to the fact that, unlike actors, the SP has to give feedback on the communications skills of the student clinician. This is beyond what we expect an actor to be capable of doing.

A good SP can improvise around a common theme, for example breaking bad news. However each student will approach this in a variety of different ways and this is based on their communication style. Some may be hesitant to break the bad news, whilst others may be more exp-licit with their communication. It is the job of the SP to respond to the different approaches that students have effectively, and then give feedback on what the student did well and how they can improve their communication for the benefit of the ‘patient’.

Some students will build rapport readily and easily whilst others need feedback on how to do this more effectively. Non-verbal language also plays its part in communication as we have discussed in a previous post. However, if the SP is presenting with a specific physical condition i.e. central chest pains, the student will respond by performing an examination, for example ‘cardio-vascular’. An SP is unable to give feedback on this part of the process. This is where to Associate Clinical Educator (ACE™) excels.

What the article previously mentioned didn’t cover (and I wouldn’t expect it to) was how an ACE™ can take the interaction to the next level.

An ACE™ is not a Simulated Patient, he’s a simulated patient on steroids! On many occasions I have spoken to clinicians who mistake what we do for medical roleplay and/or that we are simply simulated patients. This is simply not the case.

An ACE™, whilst giving feedback on the communication, will also be able to quickly inform the student whether of not the examination itself is being performed correctly. For example, below is a typical respiratory examination as expected to be performed by a first year physician associate student:

    • Introduction using full name and role
    • Confirms patient’s full name and DOB
    • Explains examination and takes informed consent for examination.
    • Asks if they want a chaperone
    • Washes/disinfects hands
    • Exposes patient appropriately and maintains dignity
    • Inspects the patient’s chest (looking for scars, asymmetry, both axillary area)
    • Positions patient on the couch at 45 degree angle and asks if they have any pain anywhere
    • Inspects the patient’s hands looking for peripheral cyanosis, clubbing, tar staining, CO2 flap
    • Checks patient’s pulse (radial/brachial) checks for rate (90 bpm), rhythm and character
    • Counts respiratory rate (offers to do for one minute: 18/min)
    • Checks patients face for pursed lip breathing, central cyanosis, pale conjunctiva etc.
    • Palpates patient’s chest checking for chest expansion and apex beat
    • Percusses the chest (top middle bottom, axillar, compares left and right)
    • Auscultates the chest (top middle and bottom and both axillar)
    • Checks tactile vocal fremitus or vocal resonance
    • Checks for sacral oedema, feet and legs (for swelling and tenderness)
    • Checks for lymphadenopathy (supraclavicular, cervical, submandibular, etc) from behind
    • Concludes examination, offers to help patient dress
    • Summarises findings in a logical systematic manner (including important negatives)
    • Gives differential diagnosis

Senior Associate Clinical Educator teaching session at Wolverhampton universityThe role of the ACE™ therefore is to give feedback on all of the above. This will ensure that the student performs the examination correctly,to the standard of the current OSCE curriculum and demonstrates safe practice. As you can see the function of the ACE™ far exceeds that of a simulated patient or role player.

This level of expertise requires training and a high degree of commitment from the ACE™ and with that in mind, Meducate Academy continues to train and support new and experienced ACEs whilst they work with us. Alongside that, the various institutions and academics we work with will continue guide and assist us in producing the best outcomes for their students. Vitally important when you consider the role OSCEs play in the students development and assessment.

Training is ongoing and we are still in negotiation with academic institutions to ratify our position in the industry through a strict accreditation process. This will ensure that the quality of our ACEs is of the highest standard and meets the requirements of any academic institution.

 

If you are a Clinical Educator and would like to take advantage of using ACEs as part of your clinical teaching, book now for a free consultation. Contact us via the form below or even give us a call on 07870611850. Thanks again for reading this post.

The Importance Of Simulation In Medical Education

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Professor Jim Parle discusses the use of Associate Clinical Educators at the online conference

Professor Parle was our keynote speaker at the conference and it was an honour to have him join us. What follows is an abridged version of the talk. If you want to view the complete talk it is available in the video above.

“I’ve been involved with the ACE process for something like 15-18 years or so. I am now a retired professor at the University of Birmingham and I’ve been using ACEs and similar kinds of approaches to education for a long time. What I’m going to do today is to go straight into talking about what ACEs are and why we introduced them into the Physician Associate Course and what sparked my interest in education generally.

“We used ACEs on the PA programme for probably at least 15 years if not longer, so for today’s conference I would like to spend more time talking about simulation generally. Also, would like to talk about why we need simulation and why I think we need more simulation and why I think we need high fidelity simulation by which I mean using real human beings, not computers or robots!

“Obviously there’s an ethical issue about performing intimate or any kind of physical examination on actual patients. When I was a student, which is quite a long time ago, we used to examine patients without consent. The patient wasn’t really given an opportunity to say no.

“Obviously you should never do this kind of thing and fortunately, times have changed. I remember my first female patient examination, in which I was embarrassed. She was embarrassed, and I was probably incompetent. I don’t think I hurt the patient, but I didn’t know what I was doing. Looking back now, it was a ridiculous way to learn to carry out examinations. That is one reason we need to think about simulation.

“There’s also the point that medical students need repeated practise and repeated, focused and relevant feedback. You don’t really get that from a patient and when you examine a patient, they rarely know whether you’re doing a good job. We don’t really give them a voice, so we need to have or recruit a patient or patient substitute who is skilled in that area.

“There’s also the issue that students arrive with different levels of skill. You therefore need somebody who can work at the level the student is at. We can’t expect a real patient to do that, as they’ve got their own problems and their own things to focus on when in a consultation. An ACE, however, can do that and more, because we have trained them to be able to show certain kinds of pathology or abnormalities.

“I’ll give you an example: A patient comes off his or her bike and injures their chest. Maybe a couple of fractured ribs and difficulty breathing. If you were to examine an actual patient, they will be in a great deal of pain. They will have tenderness around the area and having restricted breathing. It would be unethical to subject an actual patient to multiple examinations by new students. With an ACE, that problem won’t occur. Some of our ACEs can even demonstrate asymmetric breathing and can obviously be examined throughout the day by many students with no ill effects.

“We can therefore reproduce an extremely convincing simulation with an actual person who the student has to interact with just like an actual patient, but they’re not putting a patient through all that kind of discomfort.

“I just want to add the importance of recognising what is also normal and an ACE can present both sides of this situation. Consider the previous example of asymmetric breathing. The ACE can easily demonstrate what is normal, then quickly change to abnormal. I can only assert that it’s much easier to learn something that’s abnormal when you have something normal to compare it with and, obviously, vice versa. The ACE  can do this. Is able to switch asymmetric breathing too symmetrical breathing and back again so the student can see the difference and we as human beings are good at spotting differences but not so good at spotting absolute values. On a similar but not quite the same theme, I am concerned that if we learn something incorrectly, then it becomes difficult to unlearn it.

“I think it’s really important when students are learning physical examination skills that they compare normal with abnormal there and then. This means that they get immediate feedback, and which they don’t necessarily get with mannequins.

“Because of austerity and the current COVID crisis, students are not able to wander as freely around the wards interacting with patients as they did during my time as a student. So pressure on clinical learning environments and the clinicians who might teach us has become more and more restricted. It’s becoming increasingly difficult for students, whether medical, physician associates or pharmacists, and I’m sure it’s true of other clinical professions that an ACE could fulfill that role.

“An ACE is somebody who’s been trained to use their body and their psyche in educating clinicians by responding appropriately when asked to do something by a student. An ACE, as well as being a responsive patient, can also play a naïve patient, so if simple instructions are not given, the ACE will respond appropriately. If the student wants to take a blood pressure, for example, then the ACE knows exactly how this should be done. An ACE can replicate being a patient who has never had it done and do a variety of things that will affect the blood pressure reading. The ACE can then teach the student how to do it correctly. The student can see the blood pressure go up and down when a patient moves their arm or flexes their muscles. They will see the blood pressure go up and down. The student then gets the reason for doing it correctly and shows that they can do it correctly. This is immediate feedback and students love feedback. They’re always asking for more feedback! If it applies to the individual students’ strengths and weaknesses, they then improve straight away.

“So in conclusion I think I would say that what ACEs bring to the interaction is that they can role play, they can show abnormalities including assessments, they can understand what errors students make or errors patients make and then feedback to the students.

“The most important thing I want you to remember from what I’ve said is it’s sometimes good to take the clinician out of the room when the ACE is working. You do not want a clinician in there. If you have a clinician in with the ACE there, they’ll inevitably get into discussions about various pathologies and what a particular system does in terms of it’s function.

“The ACE is there to work as a tool to aid in the learning of the systems exams. We can do the theory at another session. Making full use of the ACE is vital and students’ feedback always shows they learn the examination processes quicker when the academic leaves the room!”

Click here to watch Professor Jim Parle talking about the value of using ACEs as simulated patients on the ACE National Conference 

Agenda For Meducate Academy Online ACE Conference 2021

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Meducate Academy First Annual Online Conference on Simulation

 

September 4th between 12-2pm on Zoom

 

Are you involved in Medical Education?

Do you use simulation as part of your teaching?

Do you use Role Players and simulated patients during your Clinical Skills teaching sessions?

Would you like to know more about the benefits of simulation?

If you have answered yes to any of the above, why not find out more about the work of the Associate Clinical Educator (ACE).

Hi Fidelity simulation with focussed feedback from an expert patient can play an important role in improving the learning outcomes of your clinical sessions, and utilising the skills of an ACE can help you improve the performance and standard of your clinical teaching modules.

Meducate Academy are therefore pleased to announce the launch of their Free First Annual Online Conference on Simulation on Sept 4th between 12-2pm on Zoom.

You will have the chance to listen to 6 Highly experienced clinicians talk about their experience of simulation in teaching practice and how the ACE has helped their students develop important skills whilst also developing their ability to communicate more effectively with a patient.

There will be a Q & A session in the last hour, giving you the opportunity to address the speakers directly.

ACE National Conference Day

The big day is almost upon us!

Our Guest Speakers & Agenda

 

Meducate Academy’s ACE National Conference is for anyone interested in simulation and its use specifically in teaching medical professionals.

We have some great speakers lined up.

Speakers with expertise in teaching medicine using Role-players and Associate Clinical Educators, all of whom have had a personal experience of working with ACEs in a clinical teaching environment.

The agenda for the conference is as follows:

12 noon: Opening Introduction from Mark Reynolds, your host for the event.

Each speaker will talk for approximately 10-15 minutes about their chosen subject outlined briefly below.

 

 

Professor Jim Parle - Keynote Speaker

Professor Jim Parle will talk about his role in creating the Associate Clinical Educator. People based simulation has been a key theme of his academic career and he utilised ACEs widely to both teach and examine PA students during his tenure at the University of Birmingham.

This will be a short history lesson from a highly experienced clinician and clinical educator who is a former chair of the UK and Ireland Universities for PA education.

Jim believes strongly that if we are to make best and most moral ‘use’ of patients in clinical education, we have to do as much as we possibly can in simulation and that real people are the best hi fidelity simulators.

 

James Ennis

James is currently Clinical Director at the University of Chester and will discuss his work on the use of ACEs alongside other methods of simulation. His work is based on his experience of working with ACEs at various Universities around the country on the Physician Associate Programme that he has been heavily involved in.

Uzo Ehiogu

Currently, Uzo is a consultant in Rehabilitation and Physical preparation. He is also a Clinical Teaching Fellow at the Royal Orthopedic Hospital in Birmingham. He will talk about the work he has been doing with ACEs from a Musculo-skeletal perspective with 4th Year Medical Students and how that has informed his teaching style.

Kate Straughton

Kate is a Senior Lecturer with The Physician Associate Programme at The University of Birmingham. She is also currently the President of the Faculty of Physician Associates and will talk about how working with ACEs has assisted her in the education of Physician Associates.

Peter Gorman

Pete is a Clinical Lead at the University of Wolverhampton on the Physician Associate Programme and will talk about his experiences working online with ACEs during the Pandemic, and how this has affected the students he has taught during this difficult period.

Sarah Baig

Sarah is a Pharmacist and is currently Programme Director for Independent Prescribing at the University of Birmingham. Sarah has worked in several sectors during her career, including hospital and community pharmacy, but more recently has headed up a team of pharmacists in the Local Primary Care Network. She only recently started working with ACEs and is going to talk about her personal experiences in this area.

Bob Spour

Bob Spour

Founder

Matt Chapman

Matt Chapman

Managing Director

Meducate Academy ACE Recruitment & Training Programme

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Meducate Academy ACE recruitment and training programme online

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

The Importance Of Feedback From The Physician Associate Student

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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.

The Associated Clinical Educators Role In Providing Feedback To Student Clinicians

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Associated Clinical Educators Providing Feedback To Student Clinicians

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 can’t.

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.

Meducate Academy: Building Lasting Partnerships

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Bache Hall, University of Chester
Bache Hall was the venue for this years Summative OSCEs for the 2nd year physician associates

What a great week we have had this week.

We started the week with a mixture of Summative OSCEs for The University of Chester and ended the week with a long day of filming MSK examination procedures for The University of Wolverhampton.

The University of Chester Physician Associate Programme, under the guidance of Course Director James Ennis, were running a series of online and in person Summative OSCEs for their 2nd year students.

We had seven ACEs working on a variety of stations. I was personally responsible for being in Chester taking two days out to work alongside senior clinicians working on Suicide Assessment and Breaking Bad news scenarios.

Preparing for a days filming with Wolverhampton University
Setting up the scene and preparing for filming at the Meducate Offices

The team of ACEs from Meducate Academy gave a great account of themselves and all received glowing testimonials from the Clinicians they were working with. We had no problems with the technology and Chester University has mastered the art of working on Microsoft Teams to great effect. Even the students commented on how well organised the two days went.

Running OSCEs is always a challenge for both Meducate Academy and the universities involved. Our extensive experience working in this fields for over ten years ensures that we always deliver the best service.

Our close working relationship with Chester University means no matter what happens we all work together as a team to ensure the students have the best possible educational experience. I always know that things are going well when individual students remember the names of our ACEs and ask for them by name. It’s also important to build relationships with the students.

Friday morning saw Meducate Academy back in our offices in Birmingham, filming a whole range of Musculoskeletal Examinations for The University of Wolverhampton in preparation for their 2021 teaching modules and the start of their new cohort in February.

Course Lead Pete Gorman and myself filmed Hip, Knee, Shoulder, Spine, Wrist and Foot exams in great detail with explanations of how they can be adapted when demonstrating them on an OSCE station. Safe practice was always the main focus of the sessions, and we made mention of the importance of accurate communication with the patient.

Clinical lead Pete Gorman prepares to preform a hip examination
Clinical lead Pete Gorman prepares to preform a hip examination on the ACE at Meducate Academy

Although the day was long it was made easier by the shared sense of humour of both Professor Kenny Langlands (Course Director), Pete Gorman (Course Clinical Lead) and the team from Meducate Academy.

We also managed to film a short interview with Kenny and Pete as to how they see their close relationship with us and how important the ACE role is with regard to the development of the student Physician Associate.

The films are now in the film edit process and I shall work on this all week.

I’d like to take this opportunity to thank all of our friends and colleagues at both The University of Wolverhampton and the University of Chester for making 2020 a significant year for us, despite the restrictions placed on us by a series of Lockdowns.

2021 could be our best year yet.

Why not join us!

If you are a roleplayer, actor or clinician and wish to be part of the Meducate Team contact us by sending your name and email in the box below.

In Conversation With Senior Associate Clinical Educator Mark Reynolds

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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.