HEA-01 Workshop Supporting students who are struggling academically: one medical school’s approach

1. HEA-01 WorkshopSupporting students who are struggling academically:one medical school’s approach Jo Brown & Dason Evans 12 The Clinical Communication and Learning Skills Unit

2. Plan for the day The Clinical Communication and Learning Skills Unit

3. Defining the problem The Clinical Communication and Learning Skills Unit

4. Examples Student 1: an excellent student academically, fails her first Clinical Skills OSCE. She has a deep learning style for theoretical knowledge but an inappropriate learning style for clinical skills. We provided her with sessions on “how to learn clinical skills”. The Clinical Communication and Learning Skills Unit

5. Examples Student 2: fails his third year theory exams with a very poor score. He had excellent A-levels, good year one exams and reasonable year two exams. He turns out to have an excellent short term memory and a superficial learning style. The volume of work is finally too much to cram and he fails. We provided him with sessions encouraging a regular habit of self directed learning. The Clinical Communication and Learning Skills Unit

6. Examples Student 3: a previously excellent student fails her third year clinical skills OSCE. She has no insight into the fact that she is clinically depressed. Her attendance has been poor, but she is academically strong as she starts bookwork when she wakes at 3am every morning. We arranged an urgent GP and psychiatry appointment. The Clinical Communication and Learning Skills Unit

7. Examples Student 4: an international student fails her clinical skills exam, saying she didn’t know what to expect More to come! The Clinical Communication and Learning Skills Unit

8. Examples Student 5: Fails his clinical skills exam scoring poorly on communication skills stations He finds talking to patients difficult, as he isn’t sure exactly what information he needs to gather and how he might go about this in a time-limited fashion. We went with him to the wards on two occasions and using video tape review helped him gain structure and confidence in talking to patients. The Clinical Communication and Learning Skills Unit

9. Your examples The Clinical Communication and Learning Skills Unit

10. Common problems at Barts and the London The Clinical Communication and Learning Skills Unit

11. Why Bother? The Clinical Communication and Learning Skills Unit

12. Ethical and moral duty to students. Socio-political culture of accepting and responding to individual differences. Obligation and responsibility to future patients. (philosophy of ASP – Not a revision course) GMC Producing “Life Long Learners.” Belief that students who have been supported through difficulty may end up better doctors. Coping mechanisms empathy School philosophy to: meet the needs of students produce graduates… who are fit for the nation's present and future health, research and health care needs . Financial benefits (widening access) penalties (attrition rates) Why do we bother? The Clinical Communication and Learning Skills Unit

13. Group Work 1 The Clinical Communication and Learning Skills Unit

14. Group work 1 The Clinical Communication and Learning Skills Unit

15. Lunch The Clinical Communication and Learning Skills Unit

16. 12Support for Students with Academic Difficulties The Clinical Communication and Learning Skills Unit

17. Overview of Presentation • Background to the school • Background to the A.S.P. • Model Macro Micro • Specific Case History • Validation of programme • Looking to the future Macro The Clinical Communication and Learning Skills Unit

18. Background to Barts and the London • An ancient and amalgamated medical school • A spiral curriculum • Curriculum revised in 1999: • Problem Based Learning running throughout the curriculum • Early clinical experience in the community • Explicit teaching of Communication and Clinical Skills The Clinical Communication and Learning Skills Unit

19. Assessment Continuous assessment Year 1 Written Assessment Year 2 Data interpretation Year 3 Clinical skills OSCE Year 4 Year 5 The Clinical Communication and Learning Skills Unit

20. Background and History To ASP • Began in 1999 when committed teachers began to give detailed feedback to students about their exam results and offer clinical skills workshops. • Previously informal and variable support from senior tutors, concerned and interested faculty • Formalised and funded in 2002, the ASP has grown to provide student centred support for learning. • Now represented on all major educational committees and produces an annual report. The Clinical Communication and Learning Skills Unit

21. Formalised & embedded in curriculum Dean for Student Affairs and senior tutor system Teaching CCLSU Dean for Education ASP Assess Medical School Education Directorate The Clinical Communication and Learning Skills Unit

22. Short Courses: Learning style • Aimed at encouraging a change in learning style, • how to learn clinical skills • Reflective communication skills • exam (eg MCQ) technique • anxiety management • others The system Referral Assessment Intervention Poor Performance in Summative Assessment Principally JOSCE & 3rd year EMQ No action E.g. precipitating problem resolved or obtaining academic support elsewhere • Educational Assessment interview • Free discussion • Semi-structured interview • Fine-tooth analysis of assessment results • Problem List • Action Plan • Learning Contract Specific Suggestions To Students, Senior tutors, tutors or firms Direct Poor performance in continuous assessment Ongoing Individual Tuition Aimed at supporting self-directed Learning either in clinical skills or theoretical background to medicine. Always student led. Indirect Senior Tutor Referral • Referral Elsewhere • Medical referral • Educational psychologist • Learning support unit Student request Other The Clinical Communication and Learning Skills Unit

23. Free discussion about reasons for poor performance How he/she learns Knowledge Skills Self directed learning Collaborative learning Fine tooth-comb analysis of assessment results Screening questions Motivation Scale of 1-10 What sort of doctor? Enjoy the course? Attribution Have you received enough teaching? Was the exam a fair exam? Is mark representative of performance? Pastoral Medics in the family? Received enough support? Working with patients Problems attending Educational Assessment Interview The Clinical Communication and Learning Skills Unit

24. Short Courses: Learning style • Aimed at encouraging a change in learning style, • how to learn clinical skills • Reflective communication skills • exam (eg MCQ) technique • anxiety management • others The system Referral Assessment Intervention Poor Performance in Summative Assessment Principally JOSCE & 3rd year EMQ No action E.g. precipitating problem resolved or obtaining academic support elsewhere • Educational Assessment interview • Free discussion • Semi-structured interview • Fine-tooth analysis of assessment results • Problem List • Action Plan • Learning Contract Specific Suggestions To Students, Senior tutors, tutors or firms Direct Poor performance in continuous assessment Ongoing Individual Tuition Aimed at supporting self-directed Learning either in clinical skills or theoretical background to medicine. Always student led. Indirect Senior Tutor Referral • Referral Elsewhere • Medical referral • Educational psychologist • Learning support unit Student request Other The Clinical Communication and Learning Skills Unit

25. The Clinical Communication and Learning Skills Unit

26. Questions on process The Clinical Communication and Learning Skills Unit

27. Case study Referral The Clinical Communication and Learning Skills Unit

28. Case Study: Referral I An international student fails her clinical skills exam, saying she didn’t know what to expect. • Came in the lowest 5% of cohort • Failed 12 out of 19 stations • Previously received A and B grades for her written exams The Clinical Communication and Learning Skills Unit

29. Score The Clinical Communication and Learning Skills Unit

30. Number of stations passed The Clinical Communication and Learning Skills Unit

31. Case study Educational Assessment Interview The Clinical Communication and Learning Skills Unit

32. Case Study: Diagnostic I • Fine tooth analysis The Clinical Communication and Learning Skills Unit

33. The Clinical Communication and Learning Skills Unit

34. The Clinical Communication and Learning Skills Unit

35. Semi-structured interview • General questions • Lives in international halls • Rarely mixes with students of other nationalities • Rarely uses conversational English • Home sick, isolated and unsure if she really wants to study medicine in the UK The Clinical Communication and Learning Skills Unit

36. Semi-structured interview • Learning Methods – declarative knowledge • Works 3-4 hours a week SDL • Relies on memory of reading from text books • Reads with TV or radio on • Learning Methods - skills • Has used clinical skills lab (alone) • Uses one skills book and handouts • Clerks 2 patients a week “if I am pushed” • Found third year unstructured The Clinical Communication and Learning Skills Unit

37. Semi-structured interview • Specific questions • Is motivated to be a Dr • No medics in the family, much pressure to succeed from her government • Doesn’t feel there has been enough teaching • “sometimes” finds difficulty approaching patients The Clinical Communication and Learning Skills Unit

38. Case study Problem List The Clinical Communication and Learning Skills Unit

39. Problem List • Not fully committed to course, not working • Social isolation • Language • Collaborative learning • Loneliness • Study skills • Limited for theory to simply reading • Poor model for learning clinical skills • Never seeks feedback • Limited amounts of practice The Clinical Communication and Learning Skills Unit

40. Common problems at Barts and the London The Clinical Communication and Learning Skills Unit

41. Case study Negotiated learning contract The Clinical Communication and Learning Skills Unit

42. Learning Contract • Consider if she wants to be a doctor • Consider if she wants to continue training in the UK • If she wishes to remain • Clerk a minimum of 5 patients a week • Study a minimum of 2 hours a night • Commit to work collaboratively with retake group • Move into college halls • Integrate with other students from the medical school The Clinical Communication and Learning Skills Unit

43. Case study Intervention The Clinical Communication and Learning Skills Unit

44. Case Study: Interventions • Clinical Skills • Extra clinical skills tuition • Clinical skills study skills • Supportive ward placement • Communication Skills • Collaborative learning • Pastoral The Clinical Communication and Learning Skills Unit

45. Case study Outcomes The Clinical Communication and Learning Skills Unit

46. Case Study: Outcomes I • Exam Success/Competency • Ongoing success • Pastoral • Smiling! The Clinical Communication and Learning Skills Unit

47. Score The Clinical Communication and Learning Skills Unit

48. Number of stations passed The Clinical Communication and Learning Skills Unit

49. 64% 60% 64% 62% Case Study: Outcomes III Knowledge test Data Interpretation test Continuous assessment Skills test The Clinical Communication and Learning Skills Unit

50. 65% Finals 2005 The Clinical Communication and Learning Skills Unit