King’s Undergraduate Medical Education in the Community (KUMEC)

1. Medical students – potential contributors to smoking cessation provision: the added benefits of the online NCSCT training Dr Ann Wylie Senior Teaching Fellow KUMEC King’s undergraduate medical education in the community Ann.wylie@kcl.ac.uk NCSCT London Friday 13th June 2014 King’s Undergraduate Medical Education in the Community (KUMEC) Department of Primary Care and Public Health Sciences

2. AIMS KUMEC - King's Undergraduate Medical Education in the Community To describe the background to our cessation teaching and challenges The opportunity NCSCT offered The benefits and limitations Future of cessation teaching in one medical school

3. Smoking cessation in medical curriculum

4. Doctors’ responsibilities for lifestyle modification – a norm! KUMEC - King's Undergraduate Medical Education in the Community

5. Background Behaviour change skills essential for medical education (GMC) Specifically smoking cessation Students need some theory and evidence base as well as technique Been in KCL core curriculum for a decade, with assessment but various challenges

6. Challenges Only recently seen as essential for clinical therapeutics Limited number medical teachers with smoking cessation skills Students getting “mixed messages”, not necessarily evidence based Core teaching time only 90 mins in 3rd year!

7. The Stages of Change: students identify where the patient is on this journey KUMEC - King's Undergraduate Medical Education in the Community

8. Current teaching • With scenarios and facilitators • Focused on applied techniques • stages of change • 5 As • motivational interviewing • brief intervention • the normality and response to relapse • enabling students to see this as a treatment and management

9. Small groups Currently groups of 20 clinical students From 2014 moving to start of first clinical year to enable students to link this to their clinical placements and repeated learning opportunities Smaller groups if possible - suitable facilitators and room availability can be problematic

10. NCSCT – a new opportunity Since 2011-12 senior medical students completing online Stage 1 and /or 2 received a certificate Students advised of the potential benefit of this training however this was not compulsory Suggested they did it around their core teaching and respiratory training Constant promotion was needed!

11. Complementary learning During the Behaviour Change teaching sessions students with Stage 1 and or 2 displayed confidence, knowledge and skills Prompted other students to do NCSCT Some students with Stage 1 and or 2 did GP practice based cessation projects – helpful to GP practices Some students did hospital based cessation project to prepare for NICE secondary care implementation

12. Current data • Students from 3-5th year with Stage 1 • N = 140 (12%) • Students from 3-5th year with Stage 2 • N = 46 (3%) • Graduating final year students with one or more certificate • N = 116 (30%)

13. Disseminating Students have used their skills to design posters and presentations • for GP practices (46 students based at 13 practices) • for GP conferences (3) • for presentations to policy makers (3) • for research (2) • for further academic work • for encouraging other students

14. Medical students – significant contributors About 6000 medical students graduate each year in UK – becoming FY1 doctors in Aug At KCL about 400 graduates and currently about 120 have an NCSCT certificate In their final 3 years medical students have substantive patient contact and opportunities to talk to patients

15. Potential problems Early evaluation qualitative research findings suggested: Students had limited opportunities to “apply & practice” skills in clinical arena – danger of “atrophy” The online process (now improved) was onerous Needed to repeat the course for exam revision Limited exposure to good clinical role modelling

16. 2014 Graduating cohort KUMEC - King's Undergraduate Medical Education in the Community Will be junior doctors in Aug Assessing new patient admissions for smoking status Providing appropriate therapy including NRT 30% of KCL graduates have Stage 1 5% have Stage 2

17. Future Online learning/e-learning now the norm Need to ensure students are given time to do this, at appropriate junctures in curriculum at linked to clinical contact/patient context Integrate into wider curriculum and assessment Other medical schools adopting NCSCT option GP practices and NHS training hospitals can expect students to have competences and be contributors to cessation provision/policy

18. Smoking cessation in medical curriculum

19. Students as learners and contributors It was beneficial to be able to put what we learn into context. We learnt about GP community practice and we learnt about smoking cessation It also enables us to critically assess the functioning of the GP practice …in terms of what smoking cessation services they provided and how efficient they were.” KUMEC - King's Undergraduate Medical Education in the Community