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Hear what professionals have to say about what shapes medical education.
Hello, everyone, and welcome to the latest podcast from the faculty development team at the University of Aberdeen. As usual, it's me, Kim hosting the podcast and I'm delighted to say I've got two new guests. This week we're going to talk about The Educator's Handbook or to give it its full title, Teaching University of Aberdeen Medical Students colon an educator's guide. I have to say, this title caused quite a lot of stirring amongst various people as to what should or shouldn't be included. However, it has now been finalised, but it's probably just easier just to talk about at the Educator's Handbook. So two people who were instrumental in making sure that it came to fruition this year are with me today, so I'll get them to introduce themselves. So first of all, cheer. Hi. Um, I'm Chiyo, I'm a clinical teaching fellow here, University of Aberdeen. For the last year I have surgical background. So previously SD ENT and been teaching this last year which has been fantastic. And Liz. Hi I'm Liz. I'm another one of the clinical teaching fellows. So it's really good to have both of you here today to talk about the handbook, which I have to say has had a very long gestation. It was probably first thought of, ooh, probably a few years ago. So I think I worked out I had the same gestation life as an elephant, but hopefully it's much better than it's not an elephant in the room publication. So anyway, it's had various iterations. It's had various lengths, um, but has finally got published, um, in twenty twenty five. So Chiyo and Liz, do you want to give me a bit of background about how did you get involved in it and what were your thoughts as you were helping to create it? It sounded like a good project. Um, obviously we got involved with it through you, Kim, and it's maybe not the best thing to say, but I think, you know, when you have an experience in the hospital, it leads to you trying to make things better. And I think Liz will agree with this. Uh, the idea of having a handbook that's going to be helpful for clinical educators was pretty instrumental, I think. Um, both or definitely me, um, have had situations, say in a hospital during your core training where the people in charge of you might not exactly know what's happening or might want some, um, instruction. There is no one place to find that. And so the idea of having a handbook that goes over everything, or as much as possible with giving some instruction is quite a good idea, building on what you said and what you mentioned about it having quite a long gestation. Kim, when we took over this project, there was a draft version, which was quite long, and I think you and I came out of that with a surgical mindset. Um, Which hopefully means that it's now in a state that it's very digestible so that people know where to go if they have certain questions, if they're not initially answered. So rather than overwhelm a busy, a busy clinician on the ward with too much information, we thought better to have one single place that they could go to try and answer any immediate questions, or at least point them in the direction of where those answers might be, particularly when thinking about looking after the University of Aberdeen students, not only in Aberdeen, but also across all of the kind of the remote and rural placements as well. Um, which is obviously something that's relatively unique and defining as part of the University of Aberdeen Medical School. So picking up the point about cutting because um, yeah, it was cut down quite a lot. Did you have any theories? Was it just gut feeling? Was it your clinical background or what was it that pointed you to the areas that you felt should be reduced? Or was it the other way around where actually you thought more about these are the important points and we'll cover those. And anything else that's in there will take out be useful to know about how you thought about developing that. Yeah, I think it was more we kept the important things, the things that we felt you actually needed to know. There was a lot in it initially about the actual university itself, the way the teaching runs, which is incredible. It is, but isn't exactly what we needed the clinical educators to know. And that's where we started. I think we come at it from quite a unique position because we have been working full time as as doctors in the system, and then also still day week clinical work. So I think maybe you are a little bit more, um, in touch with exactly the type of questions that may come up as a medical educator from that perspective, being a clinician on the ward, having medical students around that maybe you weren't aware were going to be there or weren't aware what skills they have or what would be beneficial for their learning. So I think add a perspective which allowed us to write it from the point of view of the people who hopefully will be reading it. I studied at the University of Aberdeen, so I've been through here as a student. I've had my placements in Inverness, I've had my placements in the Army and the Royal Children's Hospital, and have had experiences where I meet people that aren't expecting. You don't know what to expect. So having that experience from learners side and an educator side, it was I felt that we knew what was needed. Because, Liz, you didn't study here, did you? No, I studied down in London, so I think that probably makes quite a good partnership. Does it? We have somebody who's used to the system and somebody who's coming from elsewhere that's probably had a different system. So it's probably, you know, almost like the yin and yang good pairing to to get the handbook. This is very much for University of Aberdeen medical students. Um, and interestingly enough, when this was first thought of, Twelve. It was going to be a locum handbook. Handbook for locums, because there's quite a few places where there's a lot of locums. But as time developed, um, people felt actually it was perhaps for new consultants or new educational supervisors. And then as time progressed even more, we decided it could be for everybody. So it would be useful to get your thoughts about how you concentrated on the important points, given that it's you've got quite a wide readership. Um, I think for me, it's trying to equip some someone on the ward with what they need to know for students in front of them. So common things that would be within that first thing I would say is what is expected of the student and what is expected of me. So that's included. In addition to that, I think it's very important to be able to signpost them to student support. If, for instance, you are concerned about a student or not turning up. What do you do? Who do you go to? And then other other key contacts or further resources if they want to get involved further or they want to contact someone specifically. I don't know if you've got anything to add here. No, I agree with those three points. Create a more practical version of the first point. What's expected of a student. I think a common question you get as a student is have you done this yet? Have you done the Krebs cycle as an example, the infamous Krebs cycle? Uh, so before they ask a question, they always try and justify it in this way. It's just a really simple guide to let clinicians know what systems have been done so far. If they're a fourth year, they should have already done some of their specialist blocks. If they're only in second year, they might not have done haematology, for example. So it shows as expected of the student or what they should be able to answer at this stage. I once got the question, do you go to Aberdeen Med School? And I think it was just in second year. It was a question actually about my specialty and, you know, head and neck. And I just didn't know I hadn't done it yet. So this is is helpful in that regard, I think. Yeah. Because I think one of the key things in it for me as a, as a, you know, responsible for faculty development is for supervisors to know and for educators to know what level the student is. So I think there's something about that question. What level are you? Because I don't think they always know what level of student. You know, student turns up on a ward. Do they know whether they're first, second, third, fourth or fifth? Um, I do think they should have marks on their uniform, but that's another story. Um, but, you know, and what a first year is allowed to do or permitted to do or should I say, would know is going to be very different from a fourth year. And the amount of time they spend in that unit is also or that ward is also going to be very, very different. What do you think are the main Differences because we quite often talk about year one to three and year four to five. Do you think there are significant differences between those two groups, or is there much difference between year one and year three? I think there is, from my personal experience of what I've seen on the ward. When you get to about year four, year five, that's when I start to consider more almost an adult learner. They're not doing this for exams. They're not doing it for simply tests. They are now collating all of their knowledge, trying to become a good clinician. That's when you also start to spend a lot more time on the wards in longer blocks as well as that. So you're getting to practice and to practice these skills that you've been learning, the knowledge that you've been gaining. So I think there is a there is quite a difference in what they want to achieve. Yeah, I would agree, especially the year fives who are past their finals, their shift and focus is very much towards how do I become a day one F1 and be independent in that job and confident and prepared. And so you'll see a lot of them being used on placement. Um, you know, they might go and clerk a patient and then present it back to the consultant. Um, and they find that experience very valuable. But at that point in time, they're also becoming an asset to the team as well. I think, um, whereas you know, obviously when you have earlier stage learners, it's more about them understanding the environment, understanding what's expected of them, probably a bit more to do with kind of hidden curriculum and picking up on how things are done. Um, so it's, it's a continuum, obviously, and within every year, there's the students that are completely stellar and the ones that struggle a little bit more. Um, but, you know, medical education is quite unique in that learning on clinical placement is obviously such a valuable resource. The more we can do to, um, standardize that and also, um, as kind of beneficial experience as possible better, Um, you mentioned student support. Um, and I suppose I would, um, because obviously if there are, there are, there are issues, then it's useful to know about that. Um, the other key thing I noticed there's a section on is um, monitoring attendance, which seems to be an ever increasing dialogue at various meetings that I'm going to at the moment about, um, monitoring attendance. And I appreciate that may be difficult when the students coming and going, but I'm glad you've left it in. How important do you think that bit is? I think that is quite important. Um, again, it's the differences of the year groups and how long they're going to be spending on board. Um, you know, some fourth years and fifth years have either a few days or a few weeks on the board, whereas some of the early learners are going to only be there for a small sections or even parts of days. Um, you know, I think something that we remove because we Thought it's now more obvious is in the wards you will have flyers. What students should be there and how long they should be there. And we thought because that's already publicly available, we don't need to have it in the handbook, but we do have a small section on how long you're going to expect a certain group to be on the. Yeah, I guess again, it's just about communicating what's expected of the students. So a clinician, a medical educator on board, knowing that someone's supposed to attend if they don't attend, that needs reporting. Obviously, the nurse educators do a lot of that side of things and a lot of that work. So, um, credit for them for the attendance in Aberdeen, I think has looked at it compared to other universities. I wouldn't be surprised if it wasn't really pretty high. Um, and I think as a result you get very good practicing clinicians as day one F1's as a result of that hard work. Um, but again, I think the main point of the handbook is that people know what's expected so they know when something is out with the norm, and then they know what to do about it if it is out with them. I think that's a really important point. You know, what are the expectations? Because if you don't have a baseline, then how can you measure, measure, measure against it? If you know what I mean? And I suppose the other thing picking up about what is expected is, you know, in terms of practical procedures, you know, can somebody who's just started go away and take blood, you know, for example, and I think that for me is also quite a as a looking at it from maybe from the patient side, you know, if a student turns up, it's important that they, they know their boundaries, but sometimes some of them are very keen and want to do more. So I do think it's important that educators know the boundaries and what can and can't be covered without going into too much detail, but having an understanding of the level because I've noticed, because also we've put in the handbook is QR codes leading to further resources. Um, how did that come about? I guess it was, you know, as I mentioned at the start here, and I wanted to keep this very digestible and not an overwhelming amount of information that someone wouldn't even pick it up and look at it. Um, but equally acknowledging that there is quite a lot of resource and information out there that someone might need to know. So we thought the use of QR codes and prompts not only allows us to keep the handbooks succinct. It also allows someone to be able to easily access information outside of that handbook. But also it allows us to keep information more up to date because obviously anything that's hosted for a QR code can be more easily updated than necessarily a physical handbook kept on board. So a lot of benefits that I think both of us saw from trying to streamline it as much as possible. And then for anyone that's got specific interests or worries or needs in a further resource is easily accessible. From that, and as an initial resource to use for the practical handbook itself. The physical version of handbook. And we did leave an appendix section that does actually have a procedural guidelines and what year groups should be able to undertake those. And collating that was essentially just going through each year group, looking at their key procedures or sign up procedures for that year group. And some have been added in by the GMC and just creating a little table at the back. It's not front and centre of the handbook, but it's there if you need it. So either the QR code or the physical version, it's there for you to see. So there was a lot of debate, certainly at its inception about should we have a hard copy? Because in terms of sustainability, everything's supposed to be online now. But there is for me, as personally, there's something quite satisfying about having a piece of paper that that you can, you can turn over and look at the pages. So the way it's been set up is so that it can be downloaded as a, as a, it can either be downloaded as a PDF, or it can be downloaded like a sort of proper handbook with staples in the middle. Um, and it was interesting when we were launching it, how many people asked me for the hard copy? Because I think we only printed out a few copies and everybody was saying, oh, I've got a hard copy, like a hard copy. So, um, how do you think, what do you think is the best way? I mean, thinking about how you might use it, would you have a hard copy? Would you just constantly have it online? Would you save it onto a desktop? I think the best version would probably be to have it as a PDF copy. Um, you know, it's not going to be something you use constantly. Um, so there is a chance that, you know, it gets lost in a drawer somewhere. So to have a PDF copy online, but also not to need a password to find it, because that's also going to be something that's a lot of clinicians, you know, previously complained about, you know, they can't access patient, um, student documents or skis because there is multiple passwords to remember. There's different applications to open. So to have a PDF version online that is yours, you can access at any time, you can control f and find your one procedures practical. Um, easy peasy. We are trying to make it as simple as possible. Then even a surgeon can use it. I think to add to that, and I completely agree, not only do you want it easily accessible, once you have the QR code in front of you, you want the QR code to be in a place that is easily accessible and applicable to when you might need it. So for instance, you could have it on the poster with the students who are on the ward to introduce themselves, you know, linked to the handbook. Have any questions, for instance? So I think there are ways of bypassing. Necessarily having to have a physical copy, but you need it to be in a place which is quite prompt in terms of being able to access it quite easily. Um, now that it's been produced and is available, um, um, on north dot org where you can also download it as a PDF quick advert there. One of the areas we're now moving into is dissemination. So just thinking about your clinical experience, um, one of the suggestions has been, for example, that it goes on to the local boards, um, global email, which I know lots of people automatically delete. So um, any thoughts from yourself as a clinician or if you were just, you know, thinking about if you were starting work in August as a, as a consultant or an educator or whatever, how do you think we can? Have you got any ideas and thoughts about the best way to disseminate advertise. So I think multiple ways is probably the best way to do it. I very much agree with Liz. Having a QR code on the flyer where it shows you where your students are or who your students are. It's easily accessible. Sending it to the new clinicians that are starting fantastic as well. But the last thing is also possibly to just have a QR code on guidebook that students have or the students, when they go to award in Aberdeen, have some sort of communications guidebook or some sort of PDF book that they have. Having a QR code on that. As an educator, you can say, can I just have a look at what you're expected to know? And they can provide that. Have a look at it. It's very simple. Yeah, I agree. I think I don't know if this is an idea we've moved away from, but we were also talking about having a little pocket size guide. So I think that's another kind of touch point that you might be able to use to distribute to people that point them to the fuller resource as well, because I think it's one of those things where we have to constantly reinforce the message this is available, and hopefully a few, you know, a year down the line, everybody will automatically know what it what it is and where it is and how and hopefully how useful, how useful it is. I think one of your challenges is that there's a lot of, um, difference between how different departments are run within the hospital. So there's no standard way that one set of consultants or educators who are on the ward might be communicated or not located with. Um, so if I think about my experience in plastic surgery, probably the regular email that actually gets read is the weekly rota update. So for me, if I wanted to communicate with that department along those sort of lines, that would be a good place to put it. Um, but that will vary between different departments. Um, so that kind of lack of heterogeneity makes it a little bit harder to have a one size fits all solution. Yeah, there's well there's that. So when you think about Forest Hills site and all the different specialties and all the different ways they communicate, and then we have to think about our other sites, in some respects it's slightly easier because they're smaller and you might be able to get hold of everybody. But equally, sometimes it's a bit harder because you have to try and make that connection and make sure that people, that people know about it, which is one of the reasons why we're doing this podcast. And particularly, I think one of our struggles will be thinking about its inception was in terms of if we have a lot of locums, particularly in some of the islands, there's a regular turnover of staff. How do we ensure that people get to get to read it? You can incorporate it into induction. Yeah, yeah. It's interesting when you start talking about consultant induction. It's true. But that's another, another another whole whole story. So thinking about the handbook, I mean. Obviously you did it as part of your project, and clearly I suggested that you might want to do it or propose that you did it. Um, just in terms of your CTF role, have there been any advantages in being involved in it? How do you think it's helped you? Have you developed any further skills? Because there's one thing about producing a product, but there's also something about an individual and what development or what they got out of the process as well. I mean, I know I talked about it lasting as long as an elephant, but did you find it useful? Did you like doing the project? Let's have some feedback from your own perceptions of being involved in the project. Yeah, I think it was very useful. Um, obviously working on the, the handbook means we had to become familiar with it ourselves, which means that the people that were signposting these clinicians to are people that met or know. And it's helpful to know who to reach out to in case we're having any issues as new educators ourselves in this clinical teaching fellow role. So it is a shame that it happened a bit after we started, but it means that we I did get quite a lot familiar with, um, what students need, um, who I should be speaking to if I've got any slight concerns about it. Um, instead of handing it off to the next person who's then going to actually go where it needs to go. Um, that was my experience. I quite liked it. Yeah, I agree, I think one of the benefits of this role is it allows you to have a little bit more time to take a different perspective on how education is delivered, particularly in a clinical environment. Um, and that's, that's a good thing to reflect on and learn a bit more about, I guess. Um, she and I are also starting to work on the medical educators product, um, project, which is around, um, helping clinical educators on the ward better educate in that environment and resources to use around that. And I guess that feels like quite a natural extension from this project and will be the type of things that people might be signposted out towards. Um, so it all feeds into our kind of growing practice as clinical educators. Um, I know she has already done a graduate certificate in medical education, but I'm doing that this year. So it kind of feeds into thinking about the more theoretical aspects and underpinnings as to why you might make certain decisions in terms of curriculum planning or assessments, um, and things like that. So yeah. And helpful. And also it means that you have got something to show for that you have got an outcome or something tangible. You say, this is, this is us. And I think to be, you know, I would like to commend both of you because it's very different. I wouldn't say it is quite significantly different from what you started off with. And, um, the advantage for us was having some clinicians working on it, because up until now we hadn't had that same clinical input. So from that perspective, it was it was it was really, it was really, really helpful. And it's been received really, really well. So thinking again about the handbook, which, um, and hopefully you can remember what's in it, what would be your, but thinking maybe perhaps a bit more broadly, what would be your take home message to an educator in terms of this handbook? For me, I think it's the first port of call. So that's a good first place to go to try and answer any questions you might have about educating students. Yeah, I think very similar. It's a handbook that lets you know who's in front of you, where your students came from. A bit of background about the Aberdeen medical students, what they're required to know, what they should be getting out of this placement and what your role is as an educator and making sure that they leave this ward with. As I say, it's it's been well received by everybody who's looked at it so far. We just need to distribute it a bit more widely. Widely. So I'd just like to thank you both for, for coming not only for you to do this podcast, but also for all your work around the handbook. And hopefully you were pleased to see the reception it received when we launched it at the senior years away day. So this is just to remind everybody who's listening that if you want to, or should I say, you must get a copy of the handbook. It is available on the website norgine dot org. Um, and it comes up at the top. You can look at it online. You can download it as a PDF. And the important point is with the QR codes, as we've said, they will be constantly if there's new information, you'll still be able to use this QR code. So once again, thanks very much for listening. Thank you to you and Liz for coming. Thanks very much for the opportunity. It's been great. Thanks, Kim.