GP Block Student and Tutor e-Guide for Stage 3, Integrated Clinical Practice 2 2019-2020 - School of Medical Education - King's College London
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School of Medical Education GP Block Student and Tutor e-Guide for Stage 3, Integrated Clinical Practice 2 2019-2020
Welcome to GP Block
Dear Future Doctor,
Welcome to your GP block in final year! By now some of you will already have decided you quite fancy
being a GP, some of you will be sure you don’t want to work in Primary Care in the future. Either way
this block will provide you access to the most diverse mix of patients and presenting complaints you
could possibly hope for as a medical student. As such this block will be an amazing learning
opportunity regardless of your future career hopes.
You will get out of the block what you put in and if you work well with your GP tutor to address your
learning goals and the curriculum you will have fun, learn about lots of medical conditions and
develop your confidence in managing patients. For some of you this will be the first time you begin
to make decisions about patient care (all be it with appropriate support and supervision), this
responsibility is something you will need to take seriously and will help you learn and enjoy this block.
This block generally receives amazing feedback and we hope you get as good as an experience as is
encapsulated by this comment from one of your predecessors:
“A fantastic block where I genuinely looked forward to coming into work each day and actively wanted
more sessions! I have learned a lot of medicine and clinical skills, and most importantly I feel that my
confidence has improved significantly. The GP placement is excellent chance to take responsibility and
get really involved in patient management. Thanks for a fantastic placement, I would wholeheartedly
recommend the GP block.”
Final Year King’s Student
Your GP tutor will be your mentor and teacher, and we are here to support you and ensure you are
having a useful learning experience. If you have any problems or questions that your GP tutor can’t
answer, then that’s why we are here so get in touch.
We hope you enjoy your time in GP and that it helps you consider this as a future career. At the end
of the day 50% of you will get to be GPs! It will offer you an amazing life with flexibility and a good
work/life balance. You will have the opportunity to work as part of an extraordinary multidisciplinary
team and meet a stimulating (and at times challenging) variety of patients who you will have the
privilege of helping throughout their lives.
Best Wishes,
Dr Russell Hearn Dr Marion Hill Monica Martin
Stage 3 GP Block Lead Deputy Stage 3 Block Stage 3 GP Block Administrator
Pete Tayler-Hunt
Stage 3 Educationalist
1|PageContents
Welcome to GP Block .................................................................................................................. 1
Contents ..................................................................................................................................... 2
Key Dates and Contacts for ICP2 ..................................................................................................3
Stage 3 GP Block dates 2019 .............................................................................................................. 3
Stage 3 GP Campus block dates 2019 ................................................................................................ 3
Stage 3 GP Midterm Seminar dates 2019 .......................................................................................... 3
Key Contacts for Stage 3 GP Block ..................................................................................................... 3
General Practice Block Requirements Overview: .......................................................................... 4
Learning Outcomes for the Block .................................................................................................5
Stage 3 GP Block Practice Induction ............................................................................................. 6
Learning in General Practice and Primary Care ............................................................................. 6
The first week (or two) ................................................................................................................ 7
Initial Clinical Sessions ................................................................................................................. 8
Feedback..................................................................................................................................... 8
Tutorials...................................................................................................................................... 8
Troubleshooting .......................................................................................................................... 9
Portfolio Work While On GP Placement ..................................................................................... 10
Case Based Discussion (CBDs) .......................................................................................................... 10
RCGP prize ........................................................................................................................................ 11
Interprofessional Relationship / LEADER piece ............................................................................... 11
Reflective Learning Diary ................................................................................................................. 12
Weekly Seminars ....................................................................................................................... 13
Midterm Seminars..................................................................................................................... 14
Assessment ............................................................................................................................... 14
Signed up activity during the placement..................................................................................... 15
Hospice ............................................................................................................................................. 15
Administration at the end of the placement ............................................................................... 16
The GP tutor submits ....................................................................................................................... 16
The student submits......................................................................................................................... 16
Appendix 1 – Sample timetables ................................................................................................ 17
Appendix 2 – Initial questions to ask students ............................................................................ 18
Appendix 3 – Supplements to the community cases ................................................................... 19
Appendix 4 – Virtual Learning Platform ...................................................................................... 20
Appendix 5 – Personal Safety ..................................................................................................... 21
Appendix 6 – Student Travel Policy ............................................................................................ 23
Appendix 7 – Suggested LEADER activities ................................................................................. 24
2|PageKey Dates and Contacts for ICP2
Stage 3 GP Block dates 2019
10 June – 2 August 2019 Block 5
19 August – 11 October 2019 Block 6
14 October – 6 December 2019 Block 7
Stage 3 GP Campus block dates 2019
Attendance at the campus days is compulsory, and students will need to collect signatures in their
portfolios to confirm their attendance.
Mon 10 June & Tues 11 June 2019 Block 5
Mon 19 August & Tues 20 August 2019 Block 6
Mon 14 October & Tues 15 October 2019 Block 7
Stage 3 GP Midterm Seminar dates 2019
(Midterm seminars for students placed outside the M25 or by arrangement)
Thur 4 July & Fri 5 July 2019 Block 5
Thur 12 September & Fri 13 September 2019 Block 6
Thur 7 November & Fri 8 November 2019 Block 7
Key Contacts for Stage 3 GP Block
Monica Martin GP Block & Community Teaching 020 7848 8692 monica.martin@kcl.ac.uk
Administrator
Dr Russell Hearn GP Block Lead & Deputy Director 020 7848 8694 russell.hearn@kcl.ac.uk
of Community Education 07941 590 214
Dr Marion Hill Deputy Block Lead 020 7848 8690 marion.hill@kcl.ac.uk
Pete Tayler-Hunt Educationalist 020 7848 8695 peter.tayler-hunt@kcl.ac.uk
Guidance and contact details can be found on the KUMEC website: http://www.kcl.ac.uk/kumec
Twitter: @KUMEC4KCL
3|PageGeneral Practice Block Requirements
Overview:
Medical School curriculua must give medical students experience in a range of specialiaties, in
different settings, with the diversity of patient groups that they would see when working as a doctor.
An eight week placement at a GP practice (full time). To achieve the learning outcomes it is essential
that the student has:
Space – a room in which to consult alone
Computer access – to record consultations and for Internet access to check College e-mails and the
Virtual Campus (R1.19) and to take part in the webinars for Global Health.
Time per week for:
• Four sessions in direct patient contact consulting on their own, seeing 3-6 patients per
session (a total of 12-24 patients per week). From Week 2, students should be given the
opportunity to start to consult independently.
• One session on community cases which may be an obesity study
• One protected one-to-one tutorial of two hours.
• One seminar (face-to-face or time to engage in virtual learning space)
• One session for e-learning
• One self directed study session
• One free session
Seminars – Students will need to be released for weekly seminars. If the student has a placement in
a practice that, for reasons of geography, means they cannot attend weekly seminars, they must
attend their midterm seminar.
4|PageLearning Outcomes for the Block
Please see the full learning outcomes for the block by accessing the following URL:
https://keats.kcl.ac.uk/mod/book/view.php?id=1777398. GP tutors who do not have a KEATS
accounts can access these documents on the KUMEC Stage 3 Website. These have been carefully
constructed to meet the GMC learning outcomes for UK medical schools, are relevant and achievable
within general practice, and fit with other activities in the undergraduate medical curriculum. Some
themes related to these outcomes are represented in the figure below:
Here are a few of the Administer a drug via a
activities you can take part nebuliser/ IM
in whilst on your GP injection/inhaler
Placement…but there are
more! Complete a GP
Prescription or Medication
Review
Take a swab or blood test, fill in
the appropriate form, interpret
Write a referral letter the results and act on them
Explain a procedure to a
Measure and calculate a BMI and
patient/relative
offer nutritional advice
Communicate effectively
with another professional…. Change a dressing/wound care…
Please refer to the GMC’s guide Promoting Excellence – standards for medical education and
training for further information.
5|PageStage 3 GP Block Practice Induction
There are two compulsory induction days at the start of each GP block, on campus which introduce
the students to:
• what to expect on their placements;
• the general practice consultation;
• managing uncertainty;
• the essentials of note keeping including the use of the electronic health records;
• the management of chronic disease and minor and serious illnessess;
• examples of health promotion, multidisciplinary communication and shared care between
primary and secondary care;
• common presentations and diagnoses in general practice;
• global health in primary care.
• how to approach the Supervised Learning Events on this placement.
A variety of large group lecture teaching and small group sessions are used, including simulated
general practice consultations with trained actors as patients and experienced primary care clinicians
as facilitators.
Stage 3 students should be encouraged to develop an adult learning style i.e. they are self-directed
and intrinsically motivated. That said, attendance at the campus days is not optional as these form
an essential foundation for the GP block placement.
Learning in General Practice and
Primary Care
• The named GP tutor, the clinical supervisor for this block, is the main person who co-
ordinates the student’s learning and will provide the majority of their tutorials and feedback.
• Daily activities should centre on the patients of the practice. The experience of community
services will arise through following these patients and researching for the community case
studies.
• The placement should provide the student the opportunity to experience a wide range of
medical, surgical, obstetric, gynaecological, paediatric and psychiatric problems, among
others, including an understanding of when referrals are required as part of the management
plan. Managing these patients will help students gain useful practice in therapeutics and risk
management.
• The student will be expected to take significant clinical responsibility under close supervision
for the patients they see and sometimes follow up. They will have opportunities to learn and
practise clinical skills under the supervision of named primary care health professionals.
6|PageThe first week (or two)
The GP tutor and the practice manager, should orientate the student to the facilities and locale of the
practice, as well as draw up a timetable for the placement (see Appendix 1).
An initial one-to-one tutorial and induction session to talk with the student about where they are in
their training and how well they are progressing is invaluable. It should also include time to discuss
expectations - what the GP tutor (clinical supervisor) expects from the student and vice versa, how
they might resolve differences in these expectations in a constructive and supportive way and to
discuss the student’s self assessment to look at areas for development. This will help the student
complete their Personal Development Plan which is in their hardcopy portfolio and which needs to
be completed and reviewed with their Educational Supervisor at the start of their GP Block. The
Educational Supervisor role is separate to that of the GP tutor as clinical supervisor and will be a
hospital clinician for Stage 3. The GP tutor and student should look at the portfolio together to gain
an overview of the student’s expectations. See Appendix 2 for more details. The induction session is
also a good platform for the student and GP tutor to identify how the student portfolio work may be
completed. See page 11 and Appendix 7.
The student will also need to spend some time in reception to gain a fuller understanding of reception
roles and to meet with all members of the team. Training in the use of electronic patient records
should be provided. The student will need to know how to log on, keep notes etc., and will need a
‘Medical Student’ log-in for audit purposes. Learning to record accurate, concise and
contemporaneous notes is an integral part of the student’s learning and therefore it is essential that
students record these contemporaneously into the electronic notes.
Tutors and Practice Managers should address the following issues during the student’s induction:
• Confidentiality and consent
• Personal safety (see Appendix 5)
• Timetable for the placement, practice activities (a copy of which – including sick leave,
absences and lateness must be retained and sent to KUMEC)
• When and from whom the student can seek help
• Who to contact if the student is unable to attend a session due to unforeseen circumstances
• Practice policies for chaperones and home visits
• Clinical governance
• Emergency procedures and panic alarm
• Named supervisor and their deputy if the GP tutor is away
• Where to lock/leave personal items
• How to make refreshments and where the rest rooms are etc.
7|PageInitial Clinical Sessions
• Student sits in with the GP tutor for a couple of sessions to get to know them and so that the GP tutor
can begin to assess the student’s level of confidence and competence.
• Student can sit in with other GPs as well to see a range of consultation styles.
• Student gradually gets involved and then begins to take part in the consultation.
• Student does consultations with GP tutor in the room.
• By Week 2 the student should be consulting independently and in a room on their own, they need to
be able to get the tutor’s attention quickly at all times.
If independent consultations are not happening by the end of Week 2, the student or tutor should
contact KUMEC for advice and help.
Once every couple of weeks you should aim to do a shared surgery, where both tutor and student
take turns observing each other consulting. The tutor can see how the student is progressing and is
able to offer constructive feedback, the student can see with greater insight the broad range of
consultation techniques used by a more experienced doctor and has the opportunity to practice and
provide feedback.
Feedback
Giving and receiving constructive feedback is a vital part of learning. Feedback is most useful if it is
immediate or soon after the consultation whilst still fresh in both the student and the tutor’s minds.
Students can learn not only from established GPs but also from F2 doctors and GP registrars. They
can share some of their consulting lists, seeing alternate patients and have shared debriefing with the
GP tutor about the cases seen. This is a useful teaching opportunity for the F2/GP Trainee to practise
giving and receiving feedback.
Tutorials
One-to-one tutorials are an essential and valuable part of the course, consolidating learning, filling
gaps and monitoring progress.
An early assessment of the student’s learning needs is vital in ensuring that the attachment fulfils
their educational needs. GP tutors need to set aside two hours of protected time for one-to-one
tutorials with the student each week, these can be split into smaller sessions but please signpost
this for the student.
Tutorials should be student-led and could include:
• an in-depth analysis of a patient seen that day;
8|Page• a teaching session on a topic identified by the student or tutor;
• a review of current policies or guidelines etc.
Tutorials can be led by other appropriate members of the team and occasionally shared with other
learners at the practice.
Troubleshooting
Sometimes students and practice staff raise issues with the KUMEC about the placement and/or
learning. Mostly they simply have a question that needs answering or a query they want clarifying.
Most queries from students are about a lack of one-to-one tutorials, an inability to consult
independently or a perceived lack of organisation in the timetable.
We are always happy to help if a problem arises which cannot be solved in-practice. Our contact
details are here. If you have any concerns please contact us sooner rather than later.
Members of the KUMEC team are always available to visit the practice if necessary and will want to
meet with student and GP tutor in an attempt to help resolve any problems.
Where it is clear that relations have broken down irreparably, the student will be placed elsewhere if
at all possible, but this is never our initial response.
9|PagePortfolio Work While On GP Placement
The GP Block has two Supervised Learning Events (SLEs) associated with it: the Case Based Discussion
(CBD); and the Interprofessional Relationship / LEADER piece. There is also a Reflective Learning Diary.
For these supervised learning events the student may complete up to three CBDs and three LEADER
activities but only needs to submit one CBD and one LEADER refection. If more than one of each type
of SLE is completed, the student must indicate in the portfolio which of these they are submitting
for assessment by placing an “X” in the check box above the item in the portfolio.
If students find the space provided in the portfolio for the SLEs insufficient, they can enclose printed
copies in the plastic wallets at the back of the portfolio.
Case Based Discussion (CBDs)
During their Stage 3 GP placement the student is expected to learn how to manage patients with
chronic and complex conditions in the community. These patients will usually have input from several
members of the multidisciplinary team. As part of their progression to the next stage of their training
the student will need to demonstrate that they have learnt about the management of patients with
chronic and complex conditions and understood the patients’ perspectives. The student may identify
appropriate patients whilst consulting independently or they may need to ask the GP tutor to help
identify suitable patients. For additional ideas see Appendix 3.
Students have one session per week to prepare their CBDs. These sessions give them time to meet
with patients and/or carers and relatives and discuss their experiences and management; to go on
visits with relevant members of the multidisciplinary team to learn about their role (e.g. the
community matron, district nurse, community pharmacist, occupational therapist) and to see how
they help patients manage their conditions and support informal carers; and to research and to write
up the CBDs. The student describes the patient seen in their portfolio - approximately half is a
summary of the patient’s situation from a bio-psycho-social perspective, including who is involved in
the patient’s care, and half is a reflection on how well the patient’s needs are being met and thoughts
on how the patient’s care could be improved. Below are some questions that students may address
when writing up each case:
•How, why, to and by whom has the patient been referred?
Who? •Who else is involved in the care of this patient?
•What is the community practicioner(s) role and what can they provide?
What? •How do the various practicioners communicate with each other?
•What is the context for this patient?
Patient •Are this patient's needs being met?
•What else can I do to manage this patient? A medication review? Another referral?
Next Feedback at a multidisciplinary meeting?
10 | P a g eAnalysis of these case studies by KUMEC has shown that students who are actively involved in these
processes learn more. So rather than passively observing, students can help do the dressings for
example, a medication review or complete a referral form. Students should present cases to the GP
tutor (and at MDT meetings if appropriate) and perhaps to peers and facilitators in seminars, to
compare and share experiences and deepen their learning from managing these patients. The student
chooses one case to be assessed by the school.
Portfolio Entry:
1. The student discusses the case(s) with their GP tutor.
2. The student will be required to write-up a summary of the case.
• After discussion of the case, the GP tutor will grade the student’s case summary using
the scale in the portfolio and the anchoring statements below and provide written
feedback in the portfolio on what was done well and areas for improvement.
• Following this, the student will write a reflective piece in the portfolio about what things
they did well, things they need to improve and the next steps they need to take in order
to improve.
• One CBD, which may be based on a chronic complex case should be submitted.
• If more than one CBD is completed, the student must indicate in the portfolio which of
these they wish to submit for assessment by placing an “X” in the check box above the
item in the portfolio.
Anchor statements:
• Clinical assessment: A thoughtful and balanced assessment of the patient’s situation from a
bio-psycho-social perspective
• Investigations and management plan: A clear summary of the patient’s investigation and
management history from a multi-disciplinary perspective
• Clinical judgement: A reflective account of how the patient’s needs are being met and how
their care could be improved
• Professionalism: The student demonstrates respect, compassion and empathy; sensitivity to
the patient’s opinions, opinions and concerns; with insight into their own and the
professionals’ / professions’ limitations.
GP tutor and student need to negotiate the timing of these portfolio assessment pieces.
They will be submitted, with the completed portfolio at the end of the academic year.
RCGP prize
The RCGP has awarded a monetary prize for the best community case study each year. GP tutors are
invited to submit nominations for exceptional work in a CBD to russell.hearn@kcl.ac.uk.
Interprofessional Relationship / LEADER piece
This portfolio piece asks the student to take part and reflect on a leadership activity within the
Primary Health Care Team. The GMC in their ’Outcomes for Graduates’ document (http://www.gmc-
uk.org/education/undergraduate/undergrad_outcomes.asp) expect students to ‘demonstrate [an]
11 | P a g eability to build team capacity and positive working relationships and undertake various team roles
including leadership and the ability to accept leadership by others’ (Learning outcome 22d).
One of the GMC’s learning outcomes for this GP Block is to ‘understand the importance of clinical
leadership within the evolving NHS, using opportunities and examples within the community setting
to demonstrate personal development of skills relevant to organisational leadership’ (Learning
Outcome 8). The MBBS 2020 vision is to produce graduates who are leaders. Leadership from
clinicians is also an important a component of the ‘Five year forward view’ and a sustainable NHS.
Details of this activity are in the student portfolio. In discussion with their GP tutor the student is
asked to choose an activity in which they can demonstrate leadership in a team or acting as part of a
team. Details of the leadership example are to be completed by the student in their portfolio and the
student is expected to discuss this with their GP tutor. The LEADER domains in the portfolio present
areas for discussion and development.
1. Look at the Interprofessional Relationship / LEADER piece in the portfolio. In discussion with
the GP tutor, the student identifies an activity where they can demonstrate leadership of a
team or as part of a team. They are asked to write details of the leadership example in their
portfolio focusing on one of these domains.
2. After this activity has taken place, the student discusses their role with their GP tutor. What
leadership issues emerged from the discussion? What went well in terms of clinical
leadership? What have they learnt from this?
3. The GP tutor then summarises details of the discussion points and themes in the portfolio
against the relevant LEADER domain. Furthermore the GP tutor marks in the portfolio
whether or not this supervised learning event was satisfactory (see Anchor Statements below
for guidance about what is satisfactory). Was there anything especially good in terms of
medical leadership, and what leadership-related developmental goals has the student
identified?
4. Finally the student summarises in the portfolio things they did well, things they need to
improve and the next steps they need to take in order to improve. This exercise and examples
may be discussed in seminars.
Anchor statements:
• Engaged with the process and with colleagues
• Demonstrated an awareness of their role and responsibilities within the team and those of
others involved
• Demonstrated insights into group dynamics
• Demonstrated an appreciation of how teams work and their own contribution to this activity
• Shows that they have learnt / reflected on leadership skills that they can use in the future.
GP tutor and student need to negotiate the timing of these assessment pieces, so they are
completed and submitted by the end of the block.
Please see Appendix 7 for some suggestions.
Reflective Learning Diary
The GP tutor can help the student with this exercise through discussion but is not involved in the final
assessment process. The reflective learning diary entries comprise:
12 | P a g e1. The student’s PDP which is the first page of the Reflection area of the portfolio, should inform
how the reflective entries will be used to demonstrate learning. Guidance on the Reflective
Learning Diary is in the Portfolio Introduction. This is a deliberate piece of work and is meant
to provide the student with the opportunity to think about how they will go about effectively
and efficiently recording their professional opinions in medical notes in the future.
2. Two sets of reflective entries are required. One must be a response to a patient interaction.
The student is encouraged to think about the interpersonal aspect of their work with a patient.
To reflect, in a safe environment, on the effect that a patient’s presentation, condition,
treatment, outcome or behaviour has had on the student. This encourages focus on their own
responses and those of the person that they are dealing with. Meaningful and critical reflection
enables us to learn from our own experiences, and to identify potentially unexpected
behavioural drivers, obtain support and improve therapeutic relationships.
3. The student should discuss the interaction with their GP tutor, conveying how they
experienced the interaction in order to make more sense of what was going on for the patient
and to explore the student’s reaction to the patient. The whole activity should take about 10-
15 minutes.
4. The student may choose to present the patient’s situation and their response at a seminar,
sharing what they and the GP tutor talked about and discussing it with their seminar group.
5. For their portfolio entry, the student will be required to write a summary of the patient
interaction they have chosen and reflected upon.
The other reflective entry is chosen by the student, discussed with their GP tutor, during seminars if
wished and written up as directed in the portfolio instructions. Both reflective entries will be assessed
by the student’s Educational Supervisor, not by the GP tutor.
Weekly Seminars
It has long been known that students who work with their peers fair better in exams 1. The seminar
group work supplements learning by providing opportunities for the student to compare notes with
their peers at different practices, potentially with very different experiences. It is also a safe place to
discuss sensitive or contentious issues. Students are expected to bring experiences and cases from
which they learned, were challenged by or with which they would like help.
Students attached to GP tutors who are also seminar leaders will be allocated to a different seminar
group. Attendance at seminars is compulsory as they are part of the course and ongoing professional
development.
1Blumenfeld, P. C., Marx, R. W., Soloway, E., and Krajcik, J. S. (1996). Learning with peers: From small
group cooperation to collaborative communities. Educ. Res. 25(8): 37-40.
13 | P a g eSeminar groups allow the student to:
• Present interesting and challenging cases to a peer group
• Work collaboratively on particular topics
• Share individual experiences during the placement
• Provide support for each other
• Debate difficult or sensitive issues in a protected environment
• Practise peer review and receiving constructive criticism
• Practise decision-making (including reasoning, bargaining, confronting and avoiding collusion)
through role-plays and group discussion
• Discuss career choices and options
• With their seminar leader students can select from some structured learning provided by the
Stage 3 GP team.
Midterm Seminars
For the students on placements too distant to return to London for seminars, they are enrolled on
the Virtual Learning Platform (hosted via KEATS – see Appendix 4) and will attend two days of face-
to-face campus-based teaching in the middle of the Block. The student travel policy in Appendix 6
provides guidance on the reimbursement of travel costs. These placements are normally independent
placements and students should factor the time and costs of travelling back for these into account
when planning their placements.
The midterm sessions contain the same learning opportunities as the weekly seminars and all
students should read the weekly seminar information above. Students attending midterm seminars
should prepare for the seminar by identifying topics that they would like to cover during this time. All
students are expected to bring at least one case of interest to the seminars.
Assessment
The students must successfully complete their portfolio entries as outlined in the previous section.
Additional feedback will be sought from the GP tutor on the domains of student performance. These
include:
Attendance and Punctuality
Reliability and dependability are attributes of a good doctor, which we measure, in part, by
attendance and punctuality. Undue absences may be considered to have a bearing on a student’s
fitness to practise.
14 | P a g eTutors and patients will have made special arrangements for the student, organising their time and
surgery rotas for teaching. Absence will also seriously affect the student’s learning. If a student knows
they will be unavoidably absent or late, they need to inform whoever is leading the session.
Punctuality is essential: lateness is a discourtesy to patients, tutors and colleagues and it disrupts the
process of any group work, which is unacceptable.
Students should aim to attend 100% of the time, but a minimum of 90% of the sessions. Attendance
of 75 - 90% should be addressed by the tutor and the student warned that they risk damaging their
learning and having an unsatisfactory sign-up.
If a student fails to attend for less than 75% of the time KUMEC must be notified and evidence of
attendance provided by means of the daily engagement log. Students who attend less than 75% of
the time can only progress to their final examinations if the Head of Stage 3 is satisfied that there is
a plan in place to compensate for this.
GP tutors may wish to discuss individual cases with KUMEC staff. We welcome this and our contact
details are above. Experience has shown that students whose attendance is poor are at greater risk
of failing finals, so it is of paramount importance that poor attendance is picked up and dealt with at
the earliest opportunity to avoid this.
Requests for conference attendance or absence
Students should understand that their first priority should be to attend their clinical placement and
whilst presentation at conference and other activities are important they cannot impact upon
learning. Requests to attend conferences that conflict with manditory session such as mid-terms
seminars or induction days will normally be declined.
If you wish to miss any of your clinical placment then this will need to be formally approved and will
need to be discussed by emailing Dr Hearn (russell.hearn@kcl.ac.uk) and the Head of Stage 3 Dr Sam
Thanabadu (sam.thenabadu@kcl.ac.uk).
Signed up activity during the
placement
Hospice
During your GP Block you will have the opportunity to attend an arranged visit to a local hospice. The
sessions are arranged with three Hospices and the times, venues and sign up arrangements will be
provided to the students via KEATS. Students in practices outside London are encouraged to arrange
a hospice visit local to their GP practice. It might be possible for your GP tutor to facilitate this.
15 | P a g eIn London, just over half of all expected deaths of people receiving palliative care take place under
care of the general practitioner2. Although this research was undertaken in 2005, many people still
wish to die in their own home. There remains variable access to palliative care services across the UK,
and the 'Ways forward' (page 12 of King's Fund Research summary) are yet to be fully implemented.
Working with palliative care organisations and patients, the RCGP has developed an end of life tool
kit3. The RCGP also promotes engagement with general practitioners, patients, and by its
involvement with the National Council for Palliative Care through the Dying Matters initiative4.
During your GP Block, aim to work out how the palliative care you learn about and witness during
your GP placement fits in with what you learn on your hospice visit.
Please inform your GP tutor as soon as you know the date of the session you have booked to attend.
Administration at the end of the
placement
The GP tutor submits
• Online evaluation of the placement/student - a link will be sent to GP Tutors towards
the end of the placement to complete.
The student submits
• Online evaluation of the placement/practice - a link will be sent to students towards
the end of the placement to complete.
2 https://www.kingsfund.org.uk/sites/default/files/field/field_publication_file/palliative-care-perspectives-dying-people-
jenni-burt-cathy-shipman-julia-addington-hall-patrick-white-kings-fund-1-march-2005.pdf
3 http://www.rcgp.org.uk/clinical-and-research/resources/toolkits/palliative-and-end-of-life-care-toolkit.aspx
4 https://www.dyingmatters.org/gp
16 | P a g eAppendix 1 – Sample timetables
Student GP tutor
9.00 Patient 1 9.00 Patient 2
9.10 9.10 Patient 3
9.20 9.20 “Empty” slot for debriefing student on Pt 1
9.30 Patient 4 9.30 Patient 5
9.40 9.40 Patient 6
9.50 9.50 “Empty” slot for debriefing student on Pt 4
Example Student Time Table for GP Placement
Time Monday Tuesday Wednesday Thursday Friday
09:00 Consult in Community Online activity Consult in Tutorial (half
tandem with GP cases/case-based including Global tandem with session)
tutor (GP tutor discussion/reflective Health Webinars GP tutor
available practice and preparation
nearby) for Elective.
10:30 Coffee Break Coffee Break
10:50 Consult in Consult in Consult in
tandem with tandem with tandem with
Tutor GP tutor GP tutor (half
session)
12.00 Lunch Lunch and travel to Lunch Lunch
seminar
13:00 Home visits with Home visits with Tutorial (2 Private study
Tutor Tutor hours – may be time
14:00 Consult in Seminar or engaging Free afternoon split if
tandem with with virtual learning required)
Tutor platform on KEATS.
16:00 Consult in Consult in
17:00 tandem with GP tandem with
tutor GP tutor (half
session)
The student must accept that to fit in with surgeries, there may be gaps during the day. These are excellent
revision times. At the same time, the tutors should do their best to ensure these gaps do not occur every day
particularly if there are no library facilities available.
17 | P a g eAppendix 2 – Initial questions to ask
students
Before the General Practice Block students are asked to complete an Initial Self-Assessment form sent to them
by email. Students are asked to rate themselves, on a 1-5 scale, on how confident they feel in consultation skills,
therapeutics, knowledge of PHCT, professional values, etc. This tool may help you begin a stronger mentoring
dialogue with the student about their needs and interests, and about any specific skill areas where they need
more experience which could be provided in general practice. It also serves as a reminder of key clinical
management skills to have mastered by the end of the stage. Once completed the Self-Assessment Form will
be emailed to tutors automatically. Be sure to use the Initial Self-Assessment form emailed to you with this
discussion. If you have not received this, ask if the student has completed it.
Here are some helpful questions you might like to ask students once they have settled down and started trusting
you.
How many years have you been studying medicine?
This question will help you to identify students’ previous experiences. Are they on the 4, 5 or 6-year course?
Have they transferred from another university? Have they taken a year out to pursue a BSc? Did they have to
repeat a year? Or have they taken a ‘gap’ year?
In which quartile or decile does your ranking fall?
Some students in the lower rankings struggle with their learning. This might be due to physical or mental illness,
personal problems or financial difficulties and therefore these students will need a more careful educational
assessment at the beginning of the attachment and additional help in some areas. If during the attachment you
uncover substantial problems, please contact Dr Marion Hill or Pete Tayler-Hunt. The sooner issues are brought
to our attention, the faster we can resolve them. Please don’t take on the role of the student’s GP or counsellor;
instead alert KUMEC so that we can monitor and assist the student.
Can you tell me how do you usually learn?
How do you learn a new clinical skill?
Medicine is learnt through clinical encounters with patients. The analysis of OSCE results of the last few years
shows that students do well on clinical examination and technical skills but in comparison, do less well on history
taking communication stations and management. One explanation is that clinical and technical skills are well
described in the logbooks and they can ‘cram learn’ in the skills centre before the exam. History taking is related
to knowledge of disease and application of communication skills in the patient interview. Mastery needs
practice, meaning history taking skills cannot be crammed.
How do you feel about approaching patients (or colleagues)?
Some students may feel they don’t want to impose on patients, and that they are in the way of nurses and
doctors. The modelling of positive professional relationships with patients and colleagues will help the students
in their approach.
18 | P a g eAppendix 3 – Supplements to the
community cases
Learning from the community cases may be enhanced through the inclusion of some of the activities
listed below
• Home visits with the DN, HV, paediatric community nurse, CPN or Community Matron
• Home visits with community physio, OT, specialist HV, community midwife or Clinical Nurse
Specialists
• Pharmacist – in shop/clinic/surgery settings
• Visits to residential homes/intermediate care centres
• Observing voluntary organisations attached to practice
• Domiciliary and podiatry clinics
• Speech and language therapists
• Domiciliary dentists and opticians
• Reproductive and Sexual Health clinics
• Leg ulcer/vascular clinic
• Continence clinic
• Shadowing a patient on an OPD appt
• Visit to an undertaker/funeral parlour
• Learning the role of Social Services in the community
• Liaising with all other members of the PHCT
• Child health clinics
• School nurses
• Community support/auxiliary nurses
• Macmillan/palliative care nurses
• Asylum-seeker groups
• DUAL and addiction therapists
• Home loans of hospital equipment
• Weekend/emergency community visits.
19 | P a g eAppendix 4 – Virtual Learning Platform
The Virtual Learning Platform (VLP) is available to students who are attending mid-term seminars for
reasons of geography.
The VLP provides students with access to a learning envrionment where they can engage in
moderated discussions with peers. It also provides access to learning activities and a FAQ area.
Students will have one timetabled session per week to enagage with the VLP. Previous students have
found the VLP to be a useful forum which allows them to share learning, new insights and to discuss
challenging cases. It creates a sense of cohesion in the group and is helpful in reducing the isolation
of being outside London. Engagement with the VLP should supplement the midterm seminar (face-
to-face) teaching students also receive.
The VLP can be found on KEATS: https://keats.kcl.ac.uk/. A King’s log-in is needed to access the
group.
An experienced facilitator facilitates and moderates the group and may respond to posts with ideas
to prompt further/deeper thinking.
If you have any questions, queries or suggestions about the virtual learning platfom please contact
Marion Hill - marion.hill@kcl.ac.uk
20 | P a g eAppendix 5 – Personal Safety
Safety
Students should do everything they reasonably can to ensure their own safety and that of others at
all times. Taking care after dark, being sure to get good directions and preferably being accompanied
are all sensible precautions.
If a student feels uncomfortable about going somewhere, they need to inform the tutor. Students
must always pay attention to their personal belongings.
Whilst this is rare, if someone is threatening or abusive, or if the student feels that their safety is in
doubt, they should terminate the consultation, alert the tutor immediately, and record and report
the incident.
We recommend that before starting consultations students should have a discussion with the GP
tutor or practice manager, at the end of which they should know:
• What the practice health and safety protocol is
• Where the panic buttons are or what to do to raise the alarm
• What the practice alarm sounds like
• What response you should expect if you press the panic button
• What you should do if you hear an alarm set off by someone else.
Guidance on Home Visits
Students will have limited experience of home visits and the associated potential health and safety
issues. It is therefore important that the GP tutor and the practice staff undertake a general risk
assessment of student safety.
Students are allowed to do home visits for those patients deemed ‘low risk’.
Examples where there maybe an increased risk of violence to health professionals on home visits are:
• Visiting in the dark
• Tower blocks
• Female doctors visiting lone male patients
• Patients with known alcohol misuse or drug misuse history
• Patients with previous violent behaviour to NHS workers
• Patients with acute psychiatric problems.
Third, fourth and fifth year students are allowed to do a home visit unaccompanied provided a risk
assessment as outlined above has been conducted by their GP tutor. Students must have a functional
phone with them at all times and their contact details available at the practice. Students are required
to sign out of the practice and inform the GP tutor and practice staff of their expected time of return.
They should not go directly home from a home visit without making contact with their tutor. If they
21 | P a g edo not return within an agreed period of time, the student should be contacted. If the student does
not respond then please escalate as appropriate.
Indemnity
Students should ensure they have read the school policy on indemnity. They should be aware that
the School requires that all students have membership of a medical defence society.
Informed Consent
The patient’s consent for any involvement in teaching is always carefully sought and it is made clear
they have the opportunity to decline without prejudice to their care; the principle of informed
consent means that the exact nature and extent of the student’s involvement should be made clear
to them at the outset. If at any time a patient decides to withdraw, students must treat this
courteously and not take offence, reflecting the patient-centred approach to healthcare.
Students should ensure the practice adequately informs patients of their presence, and that patients
consent to being seen by the student.
Permission
Students should not visit or arrange to visit patients without the express permission of the GP tutor.
Confidentiality
The trust that is put in a confidential conversation allows truth, fear and uncertainty to be expressed;
breaching confidentiality destroys that trust. It is imperative that students respect confidentiality at
all times, whether as part of consulting with patients or learning with colleagues.
Students will become aware of the, sometimes, difficult aspects of maintaining confidentiality when
working with more than one member of a family.
Students should never discuss what they have heard, even anonymously, in a flippant or disparaging
manner.
22 | P a g eAppendix 6 – Student Travel Policy
Student Travel Reimbursement to GP placements:
• Please see the Accommodation and Transport Policy on the MBBS Home\ Your Programme\
Clinical Placements\ Section 4.
• Stage 3 students have been given a choice about the type and location of the general practice
to which they will be attached, and only reasonable travel is permitted. Students are
expected to use student oyster cards and/or purchase season tickets and travel in an
economical manner.
• As of January 2019, and based on the present curriculum, students allocated to their GP
practices by KUMEC, will need to budget for a maximum of £366.80 for the eight-week
placement. If you anticipate that your travel expenses will be substantially more than
£366.80 and you intend to claim this back, please discuss this with the Stage 3 GP
administrator, before the block begins. Only claims approved by the Stage 3 Block Lead, in
advance of the placement commencing will be granted.
• If you arrange an independent placement, you are advised to be aware of the full travel costs
associated with travel to and from the practice. If you anticipate that your travel expenses
will be substantially more than £366.80 and you intend to claim this back, please discuss
this with the Stage 3 GP administrator before the block begins. Only claims approved by
the Stage 3 Block Lead, in advance of the placement commencing will be granted.
• Students attending midterm seminars may claim for travel costs over £70. If you anticipate
that your travel expenses will be substantially more than £70 and you intend to claim this
back, please discuss this with the Stage 3 GP administrator, before the block begins. Only
claims approved by the Stage 3 Block Lead, in advance of the placement commencing will
be granted.
• Reimbursement rates are reviewed annually.
• Each case is considered on an individual basis.
23 | P a g eAppendix 7 – Suggested LEADER
activities
1) Offer to help with an area of QOF which needs improving. This may be suggested by the
student’s interest. E.g. neurology – epilepsy; psychiatry – mental health, LD.
2) Take the initiative and create a health-promotion resource for patients and/or staff.
3) Activities based on RCGP toolkits (your GP tutor should be able to help you access these if
you do not hold RCGP student membership).
4) Leading on meeting an educational need within your practice.
5) Implement a small-scale Quality Improvement project, either patient or staff-centred.
24 | P a g eYou can also read
