Medical Student Perspectives of a community training experience

Problem

Medical students spend most undergraduate curricula time in hospitals rather than community settings. This collaboration aimed to provide insights into how community, inter-professional healthcare is delivered. The traditional undergraduate GP placement explores some of this territory but contact with pharmacists, community nurses and other professional groups is often ad hoc and quite limited. Newly forming Primary Care Training Hubs (formerly ‘community educational provider networks’) co-ordinate some community-based multi-disciplinary teaching. We, therefore collaborated, to provide undergraduate medical students with a one-day teaching session in this setting.

Approach

Barnet Primary Care Training Hub has collaborated with UCL to deliver a community-based multidisciplinary day to 1st year clinical students (Year 4), complimenting an existing longitudinal general practice peel-out programme. The sessions are facilitated with a mixture of disciplines exploring how care is delivered to those in the community with acute and long-term conditions. The format is a day-long course with 40 students rotating round OSCE style interactive simulated scenarios with input from practice-based pharmacists, expert patients, GPs and practice nurses. This was a mixed methods evaluation utilising content analysis of course documents, direct observation, & facilitator & students’ feedback.

Findings

The course is delivered for groups of 40 students (total 340 across the year). Patient educators report enjoying the experience and are pleased to have their voice and expertise heard. The student feedback is largely positive. Students report gaining insights into the patients’ perspective, and the clinicians’ ability to manage patients with many illnesses in the community. For example, noticing the different resources available between primary and secondary care, the challenge of making sense of patient’s symptoms the first time they are presented and the challenge of identifying potentially serious illness within this context. Students wanted the scenarios to link to their “hospital firms” and struggled when they hadn’t acquired a working knowledge of all the systems e.g “not having done cardiology yet”. Travel gripes were only mentioned once. Not having cash for refreshments in a community clinic hints at students having a very technological, metropolitan perspective that such educational settings might challenge. PCT hub staff found resourcing the design, review and delivery of teaching challenging, within the available GP tariff.

Consequences

Medical students need to develop a wide view of what it is to be ill and how community health care services respond to that need. Community education hubs can contribute to some gaps in students’ knowledge and experience. Authentic experiences of delivering actual clinical care in the community (patient’s home, pharmacists etc) away from the familiar doctors’ clinical territory, while logistically complex, could be the next steps.