How can primary care contribute to the medical undergraduate curriculum? Lessons from the UK David Pearson MA(Cantab) MBChB (Edin) EdD FHEA FRCGP Deputy Dean (Education) Hull York Medical School
Overview Primary & Community Care in the UK Community Based Medical Education in the UK Community Based Medical Education at the Hull York Medical School [HYMS]
Introduction: David Pearson David Pearson Deputy Dean (Education) HYMS MA (Cantab) MBChB (Edin) MMedSc EdD FRCGP Family Doctor Deputy Dean (Education) HYMS In charge of all educational programmes at the medical school Head of Centre for Education Development (Medical Education) Research interests in Primary Care, Quality and Education, Learning Environment & Sustainability
Hull York Medical School Region HYMS Locations
Activity and Achievements MBBS unique community focus Undergraduate biomedical science programme (2014) Postgraduate taught programmes Growing research profile Academic centres in: Anatomy, Cancer, Cardiovascular & metabolic diseases, Education, Infection & immunology, Health Sciences [Primary care/public health], Neurosciences
Why is primary care imporant?
UK primary care - overview National Health Service, funded from taxation 90% of patient contact in the NHS happens in primary care. Mainly GP led. Strong team working. High quality, well organised, well funded. Increasingly integrated with secondary care.
Expansion of primary care nursing & pharmacy roles Non-medical prescribing Integrated, comprehensive computer records Extensive management infrastructure Quality management and incentive payments UK Primary care recent changes
Primary care nursing Increasingly professionalised Increasingly high status Integrated team approaches Role diversification Increased autonomy
UK general practice- recent changes
Future challenges for medical education.. Changing demographics Rapidly developing knowledge and technology Increased chronic disease, comorbidity and complexity of care Changing patterns of health care delivery Increased costs of health care
Community based generalist clinicians Worse scenario: chronically ill patients consult multiple specialists whose inputs are poorly coordinated, contributing to poorer outcomes, increased costs Best scenario: Having a community based generalists coordinating and rationalising care World Health Organisation (WHO) 2008 Primary Health Care: Now more than ever
Community based medical education
Julian Tudor-Hart The world turned upside down: proposals for community-based undergraduate medical education. Julian Tudor-Hart 1984, George Swift Lecture
John Spencer Turning the world upside down... revisited John Spencer 2006, George Swift Lecture
Increased importance for community based medical education Percentage of the UK curriculum delivered by General Practice
Why teach in community and primary care settings? Clinical education should reflect the changing patterns of health care and must provide experience in a variety of environments including hospitals, general practices and community medical services TD 106 Why tomorrow s doctors need primary care today.2010 David J Pearson & Robert K McKinley J R Soc Med 103: (1) 9-13
What to teach in community and primary care settings? Making an educational case for a national primary care curriculum for medical students: lessons from one UK medical school (2012) Nicholls, Gail; Blythe, Andrew & Pearson, David Education for Primary Care 23 (5) 313-3
What to teach in community and primary care settings? In chronological terms across the curriculum: Communication & clinical skills; clinical method; clinical information systems Social and psychological integration with physical problems an holistic approach ; and a patient centred perspective; Common illness presentation, key features, epidemiology, public health aspects of medicine How to recognise, and treat, common acute illnesses An appreciation of longitudinal nature of illnesses /health problems How to manage chronic illness (including appreciation of team roles) Co-morbidity and treatment challenges presented by multi-morbidity Professionalism, ethics, team work, leadership Appreciation of general practice as a career.
Community based medical education at the Hull York Medical School
HYMS a spiral curriculum
Community based curriculum at the Hull York Medical School Teaching of clinical medicine across all health sectors Approximately 33% of clinical placements in general practice Year 1: 1/2 day alternate weeks in a general practice (50%) Year 2: 1 day alternate weeks in a general practice (50%) Years 3 & 4: 4 days/week on placements ; integrated but with students attached throughout to GP teaching practice (c25%) Year 5: 8 week rotation in general practice (c33%) Plus: Student selected components, elective study & elements of speciality teaching within primary care and community
Community based curriculum at the Hull York Medical School Recruitment, retention and support Aim to recruit: Existing postgraduate teaching practices Larger practices, group practices or research practices Looking for: Whole practice commitment Strong administrative support Committed tutors, with clear leadership We offer: Good financial package via NHS Teaching budget, to practice Strong support; for tutors, practice and as quality assurance
Community based curriculum at the Hull York Medical School Quality assurance and student experience How do you shift teaching into a wide range of small independent providers and retain student satisfaction and an excellent learning environment? Careful recruitment Clear curriculum Clear expectations of providers Excellent support, practices and tutors Highly organised quality assurance processes
What has community based medical education offered HYMS students?
Career choices of HYMS graduates Career preferences 1 year after graduation: Graduates who specified general practice as their choice of future career Hull York First choice 43.8 % (49) Any choice 65.2 % (89) UK-wide First choice 30.2 % (4552) Any choice 48.6 % (7323)
Summary
Contact details Dr David Pearson Deputy Dean (Education) Hull York Medical School Universities of Hull and York, in partnership with the NHS Email: david.pearson@hyms.ac.uk Tel: +441904 321750 Website: http://www.hyms.ac.uk/