The Oncology Project Year 3 Dr Alison Brewster Consultant Clinical Oncologist, Velindre Hospital
Introduction to the Oncology Project Why is it important? Learning objectives Process Tutorials Patient contact Portfolio Patient feedback Marking scheme Student feedback Where to get information about project
Broad Aims of the oncology project Help you learn to understand what it might be like to have a diagnosis of a life threatening disease Inform your practice when working as a doctor Help you deal with your own issues which can arise when dealing with cancer patients
Why is the oncology project important? 40% of people will be diagnosed with cancer at some time in their life
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External factors Media TV soaps Magazines Internet Cancer Backup Text Family and friends
Why is the oncology project important? Whatever discipline of medicine you will be managing patients with cancer Paediatrics Radiology Public Health GP etc 7 10
What do you need to know as a junior doctor? ACUTE ONCOLOGY recognise neutropaenic sepsis recognise spinal cord compression diagnose pulmonary embolus manage GI complications of cancer treatment 8 11
What you need to know as a junior doctor Why some people get cancer and how it can be prevented What cancers can we screen for What are the key presentations of the common cancers What are the initial investigations that need to be done How is a management plan put together 13
What you need to know as a junior doctor How do we assess risks and benefits of treatment What are the principles of surgery, radiotherapy, chemotherapy and biological treatments What are the common side effects and how are they managed How do we communicate with and support patients and their family/carers What are the principles of surveillance and follow up 14
How does the oncology project help you with these objectives? Can t teach you everything you need to know Use the learning opportunities to build on previous teaching to treatment 15
Learning objectives Improved understanding of Natural history of cancer Screening Therapeutic strategies Impact on the patient and family/carer Decision making process MDT Risk and benefits of treatment 16
Learning objectives Demonstrate empathetic and professional approach Improve communication skills Reflect on what you have seen and learnt All in the SSC handbook 17
Process Allocated tutor Work within groups of 6-7 students One to one relationship with a patient Tutor will run tutorials - about one per month You will get to know the patient and their family Attend outpatients, treatment, surgery etc Try and do a home visit 18
Oncology Visit Attendance Slip The nature of the project has not allowed us to identified designated slots within the curriculum But, for important oncology project events you ARE encouraged to request release from your timetabled curriculum events Ideally you should Ask permission from the tutor of the timetabled event that you are asking leave from If necessary ask your oncology project tutor to sign a Visit Attendance Slip This should avoid conflict that has occurred previously DO NOT just miss a timetabled event for the oncology project
Process Start project in late September Complete write up by March counts towards final year mark - 25% of SSC mark 20
TUTORIALS Every month to six weeks meet for tutorials Review and reflect on your contact and progress with the patient Widen experience by hearing others stories Some tutors arrange expert sessions with colleagues, e.g. surgeons, to widen the discussions within the group
TUTORIALS Direct your learning and wider reading Identify areas of knowledge gaps Identify areas of particular interest Some tutors ask for students to prepare a short presentation to the group on a particular subject of interest Provide help with structuring the portfolio
How does it work in practice? Talk to your patient as a person: the patient is your teacher! Go with them to clinics, investigations, treatment Ask about medical history, all aspects Visit them at home at least once Get to know them over time Communicate by phone as well This is a unique opportunity throughout your training and future medical career
The patient s journey triggers active learning Treatment options Diagnostic process Symptom control Breaking bad news Emotional impact Bereavement
The Reflective Cycle Gibbs et al
Description What happened? Action plan If it arose again what would you do? Feelings What were you thinking and feeling? Conclusion What else could you have done? Analysis What sense can you make of the experience? Evaluation What was good and bad about the experience?
Action plan Find out about symptoms of depression What treatment is available? Description PHONED TO SPEAK TO PATIENT BUT THEY REFUSED Feelings Have I said something wrong? Should I phone again? Conclusion Help them discuss issues Find out who can help Analysis May not have been my fault Is he depressed? Evaluation Having visited patient on the ward wife explains he has become very withdrawn and how difficult this is for her
THE MARKED OUTPUT The portfolio a summary of the patient's history and its evolution over the six months a diary of the student s interactions with the patient focus points on active learning notes from the tutorials cross-references to other sources reflection on those interactions
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Feedback from tutor to student What did the student do well? What could have been improved? Any additional points?
Patient Feedback 1. How did your student make contact with you throughout the project? Clinic Telephone Home visit Letter/email 2. Overall, how would you rate the communication between you and your student? poor excellent 1 2 3 4 5 Please feel free to add additional comments below:
Patient Feedback 3. Do you feel your student behaved in an appropriate manner throughout the project with regards to the following headings: 1) Polite and courteous 2) Appropriately dressed 3) Punctual, reliable and conscientious 4) Demonstrated sensitivity and respect to you and your family/carers Poor excellent 1 2 3 4 5 4. We would welcome any feedback you may have about your experience of the project, whether positive or negative
Patient Feedback 5. If asked, would you consider taking part in a project like this again. 6. Thinking back do you feel that you had enough information about the project before you agreed to take part not enough plenty 1 2 3 4 5
Student Feedback Encourage you to complete the on line feedback Annual tutor meeting Tutors individual feedback FAQ s New tutor guidance Pilot this year for you to give tutors more specific feedback 36
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FAQ s Intruding at a sensitive time? How much information do patients receive before consenting? Delay in allocation of patient. Is the home visit essential?
The Patients view 82% helped student to understand what it is like to be a patient with a serious illness 85% felt students valued the patient s contribution 81% felt oncology project was a worthwhile experience for students 62% patients felt it was worthwhile for them
Patient s views We feel the project is an excellent way of giving future doctors an insight into the effect cancer has on patients and their family. I shared my innermost thoughts on my illness with my student, so I think she knew how I felt about my illness. I also think it will help her when talking to patients in the future.
Patient s Feedback The project is worthwhile because it does help the student to understand the stress of serious illness and the detrimental effect it can have on the rest of the family Until I had spoken to my student I had not explained my illness to my stepson. I felt I was protecting him, my student helped me to realise I should discuss things more openly with my stepson
Student s Feedback 91% learnt about cancer as a disease 85% will enhance my care of patients with other diseases 88% more confident in talking to patient with life threatening illness 75% more confident in dealing with distress and symptoms
Student comments enjoyed the experience of meeting a patient with cancer on my own, rather than in a pair as it allowed me to face my fear of cancer my patient was the best bit.this project as a whole played a vital role for my enjoyment this year as it was very rewarding
5:Overall 06/07 07/08 08/09 09/10 10/11 My confidence has increased n/a n/a 94.1% 91.4% 96.3% Communication skills have improved n/a n/a 96.7% 94.4% 98.8% Learning objectives achieved n/a n/a n/a 86% 95%
Cancer Care is Multidisciplinary MDT team surgeons, physicians, radiologists, oncologists, specialist nurses, clinical trial nurses, palliative care, junior doctors, data collectors Hospital teams therapeutic radiographers, pharmacists, dieticians, chemotherapy nurses etc Community teams palliative care nurses, district nurses, GP, social workers Family and carers 45 23
Confidentiality Do REMEMBER patients must know that what they tell in private remains private Do NOT use patient name, initials, DOB in the portfolio Doctor/nurse should NOT be identified in the portfolio write-up the markers know their colleagues and it is not appropriate. Do not photocopy the notes Do not put identifiable material onto memory sticks or CD s Do not discuss patients in public areas such as corridors
Safety Use common sense when considering home visits with a patient. Especially for female students. Do not agree to a home visit until you have met the patient, and if in doubt contact your tutor.
IT and library services There is an excellent IT service, particularly at Velindre. There is also a dedicated oncology and palliative care library with a fulltime librarian who is a font of information and help Bernadette Coles: bernadette.coles@wales.nhs.uk
Plagiarism UNFAIR PRACTICE PROCEDURE 2.1.1 Plagiarism: this is using the words or ideas of others without acknowledging them as such and submitting them for assessment as though they were one s own work TURNITIN UK is an online service hosted at www.submit.ac.uk that enables institutions and staff to carry out electronic comparison of students' work against electronic sources including other students' work
Student support This is a frightening situation for many Personal issues friends and family with cancer Not the usual doctor-patient relationship May be difficult to move on at end of project
Student support 80% students felt adequately supported; 7% did not. - fairly stable Use your tutors! do not be afraid to ask for support as an individual, if not within the group Any issues, especially feeling inadequately supported: contact SSC admin in the medical school or Dr Staffurth or Dr Brewster
STUDENT SUPPORT CENTRE studentsupportcentre@cardiff.ac.uk Heath Park 029 2074 2070 Cathays Park 029 2087 4966
Conclusions Unique opportunity to get to know a patient and understand the complex issues surrounding ill health in general Patients value having a student with them Please let us know if you are having problems if delay being allocated your patient
There is a prize available for the top project
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Contacts Oncology Project Organiser Dr John Staffurth, Senior Clinical Lecturer, Velindre Hospital john.staffurth@wales.nhs.uk T: 029 2031 6964 Education Department Velindre Angela Voyle-Smith, Education and Development officer. angela.voyle-smith@wales.nhs.uk T: 029 2031 6230 Velindre Hospital Organiser Dr Alison Brewster, Consultant Oncologist, Velindre Hospital, alison.brewster@wales.nhs.uk T: 029 2031 6220 Medical School Office Andrew Edwards T:029 2074 2310 edwardsa17@cardiff.ac.uk