Education and Teaching Skills

Expanding the horizons of practice based small-group learning: what are we learning?

Since the development of the practice-based small-group learning programme (PBSGL) some 25 years ago, the appeal of this dynamic approach to distributed continuing learning has led to applications in a variety of different educational settings – as two articles (refs) in this edition of EPC describe.

May 2013

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Integration in medical education: what do we mean?

The term ‘integration’ is commonly used in medical education to describe a variety of practices that span a broad range of educational practices. It is often used to describe a curriculum, assessment practices, an approach to teaching and learning across levels of learning or professions, or simply a bringing together of ideas. As an experienced educator I sometimes still find the use of the terms puzzling, because there are probably no agreed definitions and no code of practice that guides when the term should be used.

May 2013

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Consultation skills teaching in primary care

We start this time with the last of Paul Silverston’s articles about undergraduate teaching in primary care. This article aims to bring everything together and describe a programme of teaching for students’ attachment to general practice – though the details will obviously vary between different medical schools. We hope you will find Paul’s practical approach helpful. For our second contribution we move to nurse education and a short piece from the USA about a type of problem-based learning. We then continue with a fascinating account of a visit to the Wellcome Gallery by a group of foundation doctors. Their reflections on what they saw in the gallery showed just how much art can inform clinical practice. Finally we have an article aimed particularly at GP trainers, though it may well have resonances for other educators. How many trainers despair at their trainee’s minimalistic approach to the e-portfolio? Mike Tomson and Ramesh Mehay suggest that this is a ‘symptom’ and it needs to be ‘investigated’ and then ‘treated’. Their description of how the investigation might be carried out makes interesting reading and no doubt applies to may similar situations.
May 2013

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A national primary care curriculum for medical students: Is this another quest for the Holy Grail?

The creation of a primary care curriculum for medical students is argued to have important parallels with the Holy Grail myth.
May 2013

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Quality of report writing falls off during GPST training

In the Severn Deanery we looked at the quality of educational supervisor reports for all GP trainees going through the ARCP panels in June and July 2012. We assessed each report against the criteria currently being used by the RCGP external advisors for quality assurance.
May 2013

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E-resources for learning about Alzheimer’s disease

In the last TEL paper, the authors described their development of a practical checklist for the evaluation of e-learning resources. In this article, they describe how they evaluated a variety of e-learning resources on dementia diagnosis and management, especially their congruence with the learning needs of primary care professionals in the United Kingdom.
May 2013

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Trainee Engagement Grid: a new tool to assess the engagement of GP specialty trainees

Jennifer and George Gavriel explain their Trainee Engagement Grid. This attempts to measure the involvement of trainees that is so crucial to their learning and development. Having measured that involvement, trainee and trainer can work together to increase it. We hope you will be motivated to use the grid and we welcome any feedback.
May 2013

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How to ... Identify learning needs

Identifying learning needs is not a straightforward task, and involves incorporating both traineegenerated perceived needs and more objective true learning needs as opined by external sources such as the RCGP curriculum and the trainee’s own educational supervisor.
May 2013

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Medical student perspectives of what makes a high-quality teaching practice

What is already known in this area: GP tutors have a central role in delivering quality primary care placements; There is potential for variation in the quality of placements delivered by practices due to the large number involved. What this work adds: Students feel that patient involvement in teaching is beneficial for both themselves and patients; Students want to be actively involved during their placements and recognise that this would not be possible without patient participation in teaching; How well patients are involved in teaching may have potential to be used as a measure of quality at teaching practices. Suggestions for future research: An initial step could be to involve existing patient groups within teaching practices to find out how they want to be involved in teaching.
May 2013

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Teaching Exchange

We start this time with the second of Paul Silverston’s papers on teaching the GP consultation to medical students. This paper introduces us to a model that helps students to understand the differences between consultations in a hospital setting and in general practice. Next we have a paper from Leeds about a paediatric attachment in general practice. This is for undergraduates, it’s just for one day and it’s logistically challenging to arrange. But the students really appreciate it and it surely helps them relate what they have learnt in hospital to the ‘real world’ outside. We apologise to the authors for the delay in publishing this paper. It was intended for an earlier issue but somehow disappeared down a black hole. Continuing with the theme of undergraduate education, our third paper is a report of some action research. Janet McGee describes how she used the students’ attachment to her practice as a piece of action research, looking at how she and her practice team delivered the teaching. The work is described in a very engaging and individual way. Finally we have a paper describing a half-day release session for GP trainees using ‘expert’ patients. It surely reminds us, if a reminder were needed, that we learn most from our patients – if we are listening to them.
May 2013

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GP tutor opinions on quality criteria generated for undergraduate education in primary care: a practice-based educational evaluation

What is already known in this area: The importance of community-based medical education for undergraduate and postgraduate provision is embedded within curricular design; Practices supporting a range of learners from different stages and teaching programmes face different sets of quality criteria; Core criteria for practice-based teaching have been previously devised; however, a lack of research from the perspective of practitioner views of such criteria is evident. What this work adds: This educational evaluation explores GP perspectives of the appropriateness and practicality of quality criteria generated for practice-based education and prioritises them within a locality-based practice context. Suggestions for future research: This small-scale study has significant implications for further research in terms of practitioner perspectives of core criteria for undergraduate practice education and their utility for teaching, learning and its quality assurance; Another exploratory area identified was the role of out-of-hours teaching within undergraduate medical education.
May 2013

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Supporting educational supervisor development at the interface: evaluation of a pilot of PBSGL for faculty development

What is already known in this area: PBSGL is a popular approach to CPD for GPs that has grown rapidly in Scotland in recent years; PBSGL has been developed in Canada to include educational modules for faculty development; Evaluation of PBSGL as a faculty development tool in Canada that involved community-based teachers reported commitment to change practice after addressing a single educational module that was sustained after three months. What this work adds: PBSGL as an approach to faculty development is acceptable also for UK educational faculty; As a tool to facilitate educational supervisors from across the primary care/secondary care interface to learn together, the PBSGL format seemed to be particularly useful; Both commitment to change educational practice and reported actual change in practice were reported. Suggestions for future research: A bigger and longer study would be required to evaluate whether sustained change in educational practice occurs and whether this impacts on learners.
May 2013

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Practice-based small group learning (PBSGL) for CPD: a pilot with general practice trainees to support the transition to independent practice

What is already known in this area: Newly qualified GPs can struggle in making the transition from trainee to independent practitioner; The literature shows that on completion of training a range of learning needs can remain; Supporting newly qualified GPs is currently an area of considerable activity in order to facilitate a smooth transition and to continue the ‘habit of learning’. What this work adds: The study presented here is a small-scale evaluation of a pilot scheme to trial the introduction of practicebased small group learning for newly qualified GPs; Two sessions ran prior to the end of the training year, and two after. The main findings showed that the sessions helped participants to: Consolidate their learning from their third year of GP training and improve their ability to identify and use evidence in practice; shift the focus of their learning needs away from their postgraduate exams and towards ‘real world’ practice and establish a peer group to provide support for the early years in practice. Suggestions for future research: The findings from the present study would benefit from further evidence arising from wider testing and reporting of PBSGL for newly qualified GPs; Our data were limited as they were derived from one of the two groups participating in the pilot; The findings do, however, mirror those of MacVicar et al (2006).
May 2013

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‘Thinking on my feet’: an improvisation course to enhance students’ confidence and responsiveness in the medical interview

WHAT IS ALREADY KNOWN IN THIS AREA: Communicating effectively with patients is essential if GPs are to deliver high-quality care to their patients; Many different techniques and methods have been tried to help in the advancement of medical trainees’ skills in communicating with patients. WHAT THIS WORK ADDS: Medical students were attracted to an elective to learn improvisational skills because they thought it would be fun, and they did enjoy themselves; Students believe that the content and skills emphasised in the ‘Improv’ curriculum will improve their communications with patients; Objectives, methods and select exercises from a successful improvisational skills curriculum for medical students are presented so that training programmes and schools can adapt the materials to teach their own trainees. SUGGESTIONS FOR FUTURE WORK AND PRACTICE: Future studies could assess the impact of improvisational training on learners’ (both trainees’ and GPs’) ability to more effectively engage in meaningful communications with patients, and the extent to which this translates into improved patient satisfaction and compliance with therapeutic plans.
May 2013

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Module evaluation: a comparison of standard evaluation with nominal group technique

WHAT IS ALREADY KNOWN IN THIS AREA: Module evaluation plays a key role in institutional quality assurance, enhancement and reflective practice; Student feedback, often using standard questionnaires, plays an essential role in the process; An alternative evaluation approach is the use of ‘nominal group technique’ (NGT). WHAT THIS WORK ADDS: This study directly compares standard questionnaire-based evaluation with NGT; NGT provided added value by allowing students not only to identify the strengths and weaknesses of a module, but also crucially to discuss ways to enhance learning, negotiate, and propose shared solutions to any conflicting views; Routine use of NGT may be unfeasible due to the time required for data collection and analysis; NGT may be particularly useful in the development of new modules, or to assess underlying reasons when poor feedback has been obtained using conventional evaluation questionnaires. SUGGESTIONS FOR FUTURE RESEARCH: Evaluation of NGT methodology in different settings and with diverse student groups is needed.
May 2013

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