Cover
Title Page
Contributors
Introduction
1. Reference
Acknowledgements
Chapter 1: What to learn in community settings
1. Introduction
2. Early years
3. What to learn during early patient contact
4. Professionalism and personal growth
5. Patient perspectives on health and healthcare
6. Social and psychological aspects of health
7. Learning clinical method (history taking and examination)
8. Clinical and procedural skills
9. Middle clinical years
10. Later clinical years
11. Learning in the community ‘out of hours’
12. Further opportunities
13. Summary
14. References
15. Further resources
Chapter 2: Learning the public health aspects of medicine
1. Public health perspectives
2. Health promotion
3. Primary and secondary disease prevention
4. Behaviour change: health promotion and prevention for individuals
5. Public health and health education
6. Summary
7. References
Chapter 3: Preparing for and learning on primary care and community placements
1. Introduction
2. Preparing for your community placements
3. When you arrive on placements
4. Your responsibilities at the end of your placement
5. Summary
6. References
Chapter 4: Active learning in the consultation
1. Introduction
2. Learning objectives, learning plans
3. Learning consultation skills
4. Understanding the consultation
5. The art of consultation
6. Engaging with patients, introductions, information, consent
7. Working with patients
8. Active learning in the consultation
9. Student-led consultations
10. Problems, pitfalls and suggested solutions
11. Complex consultations for the later clinical years
12. Summary
13. References
Chapter 5: What to learn from the primary healthcare team
1. Introduction
2. Professional behaviour in a team
3. What the PHCT does
4. Learning with and from the primary healthcare team
5. Learning from the practice nurses
6. Learning from the pharmacy team
7. Primary health team meetings
8. Learning from mistakes
9. Patients and public involvement in your education
10. Summary
11. References
12. Further resources
Chapter 6: Learning medicine in community settings
1. Learning from community visits
2. Learning from doctor’s home visits
3. Visiting residential care and nursing homes
4. Learning from community mental health teams
5. Long-term mental healthcare in the community
6. Community mental health for the elderly
7. Community maternity and child health services
8. Community sexual health services
9. Palliative and end of life care
10. Summary
11. References
12. Further resources
Chapter 7: Clinical information systems, opportunities to learn
1. What are clinical information systems?
2. Why learn about clinical information systems?
3. Clinical information systems in community practice
4. Making the most of the CIS in learning and teaching
5. What do clinical information systems offer in the diagnosis and management of acute illnesses? How do they support your learning of these conditions?
6. How do clinical information systems support the management of long-term conditions? How can they support your learning about this vital area of medicine?
7. Learning from clinical guidelines
8. How can clinical information systems support the learning of prescribing (and patient safety)?
9. Family medicine, using clinical information systems to learn public health aspects – what do you need to know?
10. Clinical information systems: supporting learning about communication with patients, and colleagues
11. Using clinical information systems in supporting assessment
12. Clinical information systems: problems and pitfalls
13. Clinical information systems: projects, audit and research
14. Summary
15. References
Chapter 8: Supporting learning in primary care using social media and other technologies
1. Social media in your primary care placements
2. When media becomes social media
3. Social media landscape
4. Your online profile and digital professionalism
5. Your digital footprint
6. Doctors and patients online
7. Digital literacy and information literacy
8. Social media sites: Facebook, Twitter, Blogs, Wikis, YouTube, Slideshare/Prezi, Scoop.it/Pinterest
9. Summary
10. References
11. Further resources
Chapter 9: Assessment, feedback and quality assurance
1. Assessment in your primary care placement
2. Assessments in medical courses, what should you expect?
3. What types of assessment should you expect on your primary care placements?
4. How can you best use your time on primary care placements to survive (or even excel) in your medical school assessments?
5. Some potential strengths of assessment in primary care
6. Opportunities for self-assessment in primary care settings
7. Some final thoughts: why authenticity in assessment matters
8. Feedback within your primary care placement
9. Types of feedback in primary care placements
10. Giving and receiving feedback
11. Giving something back – your responsibility to offer feedback
12. Summary
13. References
Chapter 10: Conclusions
1. Reference
Index
End User License Agreement

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Library of Congress Cataloging-in-Publication Data

Pearson, David (David J.), author.
How to succeed on primary care and community placements / David Pearson, Sandra Nicholson.
p. ; cm.
Includes bibliographical references and index.

ISBN 978-1-118-34344-9 (pbk.)
I. Nicholson, Sandra, author. II. Title.
[DNLM: 1. Primary Health Care–Great Britain. 2. Clinical Clerkship–Great Britain.3. Community Health Services–Great Britain. 4. Education, Medical, Undergraduate–Great Britain. W 84.6]
RA427
362.120941–dc23

2015026509

A catalogue record for this book is available from the British Library.

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Cover image: Meaden Creative

Introduction

International healthcare systems, including a modernised NHS within the United Kingdom, increasingly need clinicians in the future who have the appropriate knowledge and skills to work in community settings. Community-based clinical care is changing rapidly, with the increasing movement of patient care from hospital to community settings, there is an increased reliance on clinical information systems, clinical guidelines and protocols and more emphasis on highly organised team-based care for patients with long-term conditions. For example, in the United Kingdom the Department of Health expects 50% of the future NHS workforce to practise in the community (DoH, 2013 ). Future doctors, such as you, need to have education tailored to address the changing needs of the future clinical environment and how clinical care will be provided for patients. Medical education is seeking new ways of workplace-based learning, revisiting apprenticeship models and exploring new assessment models. Our book acknowledges and addresses these new realities and is equally relevant to you and your tutors.

This book provides the information you as medical students need to know to get the most out of your community-based placements. Most UK-based medical students will begin to attend community placements from their first year of studies and it is important that you know what to expect and how to maximise your learning opportunities. You may otherwise miss out on essential clinical learning that balances and brings alive both your medical school theoretical teaching and learning from placements in other clinical settings.

‘Community-based placements’ is a loose generalised term to describe any of your clinical placements that occur outside of a university or hospital setting. The first port of call for most patients worldwide seeking help with their health concerns will be services based in the community. Frequently, medical school placements will be organised within primary care settings using members of the primary healthcare team as your tutors. Within a UK context primary care services focussing on general practice and the immediate practice-based team are common placements. The detail will vary across other healthcare systems. Wider community placements with voluntary organisations, specialist tertiary centres and outreach clinics may also be available.

This book has been written by experienced general practitioners and educators, closely involved with delivering community-based education, and aims to be a practical guide for undergraduate medical community placements. It has primarily been written for you as students, although you may find it helpful to share some of it with your tutors and we hope they will also find much in here of direct interest. It isn’t written only for students wishing to be GPs. On the contrary, we strongly believe all future doctors can learn much of their medical knowledge in community settings and for those set on a career in hospital medicine or surgery, this book and community experiences provide a vital insight into the care provided to your future patients across most of their lives. The book aims to inspire you about community medicine, provides an insight into learning about clinical medicine including teamwork and also medical specialty teaching relevant to a community setting. As such, unique elements of community-based teaching ranging from clinical information systems to home visits are included.

Each chapter is written with considerable student and tutor input; ensuring chapters are fresh, relevant and up to date. Where possible you are encouraged to read and learn actively and each chapter describes its learning outcomes at the start with reference to tasks for you to reinforce what you may learn on placement. Community-based medical education isn’t just about a change in location. Many students find that they have opportunities to engage in very personal learning with individual tutor attention and focussed feedback across a range of clinical and non-clinical community settings. We have tried to ensure this is a practical guide that will allow you to best work with your tutors to make your time in community settings informative and inspiring.

Many medical schools now use community-based medical education to cover a significant component of their undergraduate curriculum, reflecting the changing nature of healthcare worldwide, the increasing importance of recognising the social determinants of health, and the challenge of meeting the costs associated with healthcare. Rapidly changing patient demographics, an ageing global population, advances in medical treatment and a consequent expansion in multi-morbidity and complexity of care worldwide have highlighted the importance of community care.

What can you expect as you read the book?

Chapter 1 explains what you can learn within your community placements in early years, including the psycho-social determinants of health, and how clinical placements within primary care emphasise the holistic longitudinal nature of patients’ conditions, which highlight a multi-professional team-based approach. We explore clinical placements from early years teaching that introduces patients and related clinical material alongside your theoretical medical science teaching, middle year placements that focus on learning clinical method, communication and clinical skills, to later placements specifically designed to learn aspects of clinical and specialty medicine common to the community, such as the management of long-term medical conditions. These later placements also give opportunities to prepare for the transition to more independent practice, so we focus on aspects of professionalism and continuing professional development. Chapter 2 gives an introduction to the opportunities available to learn about public health aspects of medicine, and the chance to learn about health prevention and promotion at individual, community and regional levels. Chapter 3 explores how best to learn within community settings. It includes some very practical advice that you need to consider before embarking upon these placements, including what necessary preparations you should make that will both ensure that you are safe and that you get the most out of your time. Chapter 4 explores the centrality of the doctor–patient interaction and what you can learn from the process of a GP consultation.

Chapter 5 widens your learning opportunities. It introduces the primary healthcare team, what you can learn from individual members, how such a team works to deliver and improve patient care. We explore how medicines are prescribed and managed within community settings (something that offers many opportunities for you to learn about not only pharmacology but also the underlying medical conditions and the issues that many patients raise regarding co-morbidity and multiple drug use). The chapter includes what we can learn from patients themselves and how you can best involve patients directly in your learning. Chapter 6 looks at how our patient care is delivered within wider community settings and teams, including the learning opportunities from visits to patients’ homes and residential care homes and also learning from the professionals, who make up the wider community-based health teams. It explores various aspects of preventive and public health, including women and children’s services, mental health and palliative and end of life care. The chapter also includes examples and ideas for learning outside of health settings with voluntary and community support groups.

Chapters 7 and 8 are a little more specialised. Detailed clinical information systems, information technology, patient records are included in Chapter 7, and it also describes advice on planning your audit, quality improvement and research projects. Chapter 8 describes in some detail what opportunities and challenges new advances in technology and social media provide to enhance learning; especially with regards to e-learning and social media. Chapter 9 explains how you may be assessed during the placement and the importance of two-way feedback, that is, from your tutors to you and from you back to your placements. We also offer tips on how to get the most out of your placement and learn from these assessments.

Finally, Chapter 10 reflects on the journey we have taken and you are just beginning to describe some of the future and currently developing aspects of community-based learning.

We hope you enjoy and find this book helpful in preparing for and getting the most out of your community placements. Most of all we hope that you learn what it is that you need to know in becoming an excellent, engaged and empathic doctor and make the most out of the opportunities for learning from your community placements.

Reference

Department of Health (2013) Delivering high quality, effective, compassionate care: Developing the right people with the right skills and the right values. A mandate from the Government to Health Education England: April 2013 to March 2015. http://hee.nhs.uk/wp-content/uploads/sites/321/2013/11/HEE-Mandate.pdf. Accessed July 11, 2015.