One of the major changes to modern medical school curricula is the amount of teaching that now takes place in general practice and community settings. Medical students must understand that patients receive most of their health care in or close to their own homes from their general practitioners and community services. This is reflected in students spending more time learning in general practices and with community services than in the past.
Throughout your time as a medical student at Keele you will be encouraged to think of community and social dimensions of illness and health. You will have placements with community services and general practices in Years 1 and 2 and over 20% of teaching in Years 3, 4, and 5 takes place in general practices. Examples of other community services we use are schools, the workplace, residential homes, and drop-in centres to name but a few; all places which contribute to the health and care of people.
In the revised curriculum we are changing how we use general practices and community services to support your learning.
You will be learning in general practice and/or the community in each year of study at Keele.
As a medical student you are working towards becoming a doctor. Recognising this fact, modern medical curricula seek to enrich your study of medicine by organising early clinical experience placements throughout your first year of medical school.
The activities aim to stimulate, inform, and enhance your learning at the medical school about, for example, the complex interactions between psychological, social and physical aspects of health and illness.
The activities also help you to develop the skills, attitudes and professionalism required of you as students now, and doctors serving society in the future.
You will spend twelve half-days in a variety of placement settings including primary care, secondary care, and third sector organisations. During these placements you will be observing clinical colleagues, interviewing patients, and practising newly acquired skills. Some of this time will be in the Lifestyle unit. General practice is an excellent opportunity to learn about health promotion, by understanding the many aspects that can influence the health of individuals and populations. The Lifestyle unit will see you assigned to a general practice for three consecutive Thursday afternoons where, as a group, you will focus on a variety of topics including Obesity, Smoking, and Alcohol problems.
You will spend an average of ten half-days in a placement setting observing clinical colleagues, interviewing patients and practising newly acquired skills, some of which will be in community settings.
The focus of these placements will relate to the specific unit you are being taught. You will have a variety of Unit Specific and Non-Unit Specific Placements taking place in a variety of settings.
The Student Selected Component web page contains further information on this element of the year.
You will be allocated to a general practice for four weeks towards the end of the academic year. Some students will be placed in the Shropshire/Ludlow area. If that is the case, accommodation will be provided to you, free of charge.
This placement provides an excellent opportunity for you to practice the clinical skills you have learned earlier in the year, particularly consultation skills; hence the block is referred to as ‘Consolidation of Clinical Skills’ (CCS)
During the block you will have multiple opportunities to consult with patients (~15 per week). Many of your consultations will be observed by your GP tutor who will give you feedback to help you improve. You will also have opportunities to consult on your own with appropriate supervision. You will present the patients that you have seen to your GP tutor. You will make recordings of some of your consultations which you will be able to review on your own, with your tutor, or with your cluster group.
You will also work with other members of the practice team. You will learn how the different members of the practice team work together to provide high quality care to the local community.
Finally, once a week you will meet with a small group of your peers (placed in other GP practices) and a GP tutor. These ‘cluster’ sessions provide the opportunity for you to discuss and learn from the experiences that you have had over the previous week.
All assessments during the CCS block will be formative. You will receive formal feedback on your consultation skills on three occasions during the placement and informal feedback on multiple occasions. The feedback will help you to identify what you are good at, what you need to improve, and how you might achieve this.
By the end of Year 3, you will be able to obtain a basic patient-centred medical history and to perform a physical examination using core clinical skills.
In the Developing Consultation Skills (DCS) or Clinical Reasoning course you will learn how to make good clinical decisions, confidently use information in the consultation, and negotiate management plans which patients are likely to follow and benefit from. These skills will enable you to consult more effectively and you will use them throughout your professional life irrespective of the specialty you choose to enter. The DCS/CR course is tightly integrated with the four week general practice placements in Year 4.
The subject matter will cover:
- Making good decisions
- Managing information
- Effective clinical management
- Sharing decision-making with patients
- Health Literacy
You will spend Monday in the ‘classroom’ in small group tutorials developing your understanding of key theoretical concepts of clinical reasoning and practicing their application in clinical situations.
For the rest of the week you will be in a general practice where you will be able to practise and refine these skills. As a result of the combination of DCS/CR, your hospital placements, and your increasing experience in a variety of clinical settings, you should see substantial improvements in your consultation skills during Year 4. You will have the opportunity to undertake observed consultations and receive formative feedback to help with your development.
DCS/CR is an innovative aspect of our course, which has won a national educational prize. We believe that its greatest strength is the combination of the classroom sessions and the opportunity to practice your learning in a real clinical setting with the support of your GP tutor. You will receive individual tailored feedback and guidance on how to develop your consultation skills at the most appropriate time; once you have mastered the basic skills and with plenty of time to build on and refine these higher skills before graduation.
Year 5 in the Keele curriculum is called Preparation for Professional Practice. The major part of the year consists of three longer ‘assistantships’, or clinical attachments, where you will work as part of a health care team. You will spend 20 weeks in hospital working in medicine, surgery, emergency medicine and critical care and 10 weeks in general practice.
The GP assistantship provides many opportunities for you, as Year 5 students, to consolidate and develop your consultation and procedural skills, to assimilate your learning across all five curricular themes (including Scientific Basis of Medicine) and to enhance and develop your decision making, professionalism, team working, and leadership skills.
You will be consulting directly with approximately 250 patients under the close supervision of your GP tutors and will be performing a range of clinical procedures carried out in general practice. You will have regular formal and informal workplace assessment of your consultation skills, resulting in tailored feedback to help you focus the development of your skills. You will be encouraged to assimilate your learning by following a small number of patients through their health care journeys to emphasise all that is needed to fully understand patients’ problems and their management. This requires the integration of all that you have learned over the past five years from the basic sciences, clinical sciences, clinical knowledge and skills.
Student Selected Components
You will have additional opportunities to work in general practice and the community as part of your Student Selected Components throughout the course. These will primarily take place during Years 3 and 4.