Education Posters 514 – 520
514 Challenges in end of life care
Aim The objective of the project was to understand the training needs of GPs in end of life care, to facilitate development of an education programme to improve anticipatory care planning by GPs for palliative patients.
Content A survey showed 71% of GPs had never received formal postgraduate training in discussing resuscitation wishes. It also revealed that the top priorities for training were: prognostication,prescribing,
Relevance Although 2/3 of people with incurable disease wish to die at home, fewer than 1/3 achieve this goal. Developing primary care is therefore essential for realising the expectations of dying people.
Outcomes Between December 2014 and March 2016, 28 training sessions were delivered to 548 attendees which, due to unprecedented demand, included 135 other professionals: nurses, healthcare assistants, psychiatrists, pharmacists, and paramedics. Multi-professional learning has enhanced collaboration and increased understanding of each other’s roles. Feedback from training sessions has been overwhelmingly positive with qualitative analysis suggesting training has positively impacted patient care. Education has informed service transformation and improvement cycles have then been created by disseminating changes into future training.
Discussion This project has demonstrated that collaborative working between GPs and specialists, to co-create and co-facilitate education for a multi-professional audience, enhances the learning experience, develops services and ultimately improves patient care.
515 Type 2 diabetes mellitus: lifestyle changes to prevent amputation
Type 2 diabetes mellitus: lifestyle changes to prevent amputation Worldwide over 400 million people who have type 2 diabetes mellitus, (T2DM), are at risk of microangiopathic and macroangiopathic complications, including lower extremity amputation. Compared to the general population, diabetics are 30 times more likely to have an amputation. T2DM is preventable and in the early stages may be reversed by lifestyle modification.
Though diabetics are targeted with education on lifestyle modifications, there is a lack of patient awareness of the increased risk of a lower limb amputation and its resultant morbidity and impact on the quality of life. There is evidence for the use of shock tactics in other public health campaigns such as lung cancer, which was effective in encouraging smoking cessation.
The aim was to produce a graphic poster to illustrate the devastating impact of a lower limb amputation, in order to promote lifestyle changes. An A3 size, prototype, educational poster was produced to inform patients of lifestyle modifications that can prevent or reverse T2DM, to be displayed in the waiting room and reception area of a GP surgery.
The impact of the poster on T2DM control and potential reversal will be evaluated quantitatively through measures such as BMI and HbA1C levels, during annual diabetic checks and the number of lower extremity amputations in the surgery before and after display of the poster. If an impact is demonstrated there is scope to disseminate this to the wider public through general display in the community.
516 Addressing the end-of-life-care knowledge deficit
Aims/Objectives To overcome the knowledge deficit amongst primary care clinicians in end of life care (EoLC).
Content of Presentation: A systematic literature review and qualitative primary analysis identified a knowledge deficit amongst primary care clinicians regarding EoLC. Staff lacked the ability, confidence and training in approaching EoLC, limiting patient’s ability to achieve home death. Health Education England are currently attempting to address this deficit in NHS staff, however curriculum evaluation at a UK medical school suggested a deficit still existed in medical education training. A survey of medical students was conducted to assess perceived EoLC competence, with approval from the relevant ethics committee.
Relevance/Impact EoLC conversations are inevitable in primary care and the acknowledgement of a knowledge gap is crucial, in developing better EoLC experience for patients. Targeting clinicians in their medical infancy will encourage them to discuss EoLC preferences more comfortably.
Outcomes Only 7% of medical students at a large UK medical school stated they felt comfortable approaching the topic of EoLC, while 85% felt that there should be more EoLC teaching and experience.
Discussion Our recommendations involve the introduction of a spiral curriculum for end-of-life care. This survey and curriculum evaluation was conducted exclusively at one (large) medical school and it follows that further research is required to identify how a spiral curriculum can be introduced at other institutions. Moreover, this is one means of tackling this multi-dimensional problem, studies must also explore the prospect of incorporating EoLC in other disciplines of community care.
517 Integrating telephone consultation skills into the curriculum: evaluating a telephone consultation seminar for fourth year students at a UK medical school
Aims/Objectives Our aim was to evaluate a single seminar-based teaching session using teaching materials from a local GP out-of-hours service provider. This presented the theoretical aspects of telephone consultation and allowed students to practise and develop skills using role-play scenarios. These seminars, for 32 groups of 11- 12 fourth year medical students, took place in the 2015/2016 academic year. It was evaluated by questionnaires completed by both students and facilitators.
Content The method and results of the analysed questionnaires are outlined on the poster and included quantitative and free text questions. The responses were analysed for any recurring themes and trends.
Relevance/Impact Telephone consultations are now commonplace in general practice and increasingly being used in secondary care. They made up 10-20% of GP practice consultations in 2014 and over 40% in out-of-hours GP services 1. To date there has been no formal teaching of telephone consultation to medical students within the university leaving many junior doctors feeling underprepared post qualification.
Outcomes There was a positive response from students with a significant increase of their self-reported confidence in consulting by telephone. Students’ concerns centred around missing cues and ‘red flags.’ Facilitators felt that their own skills improved as a result of the session.
Discussion Although the session did highlight some areas for improvement it was rated highly by both students and facilitators. There are plans to develop this seminar as well as introducing further advanced communication skills into other parts of the curriculum.
Reference: 1.National Audit Office, http://www.nao.org.uk/report/
519 Pear shaped – responding to adversity
Background As part of a Postgraduate Certificate in Medical Education I was asked to give a ten minute presentation to my fellow students on any aspect of training. I chose a very difficult situation in which my ST3 had to work through the consequences of a patient suicide. I used the presentation to analyse the way we both responded, how we had to alter our training schedule and what we learned about resilience and personal growth along the way.
Summary of Work My reflections on the process were presented in the form of an extended poem in which I considered our emotional responses to the event and proposed some tools to enable a good response to difficult, unexpected situations, both for trainers and trainees. Choosing to express my reflection in the form of poetry helped work through the aftermath and focused our training into positive ways to move forward. The poster represents the text of the poem along with some of the visual ideas that were incorporated into the presentation.
Conclusions The proposed tools for dealing with adversity that are expressed in the poem are transferable to different situations for trainers, and represent a message of hope that is accessible and practical. Poetry is a powerful tool for communicating ideas and the presentation has resonated with many who have heard it. I would be happy to perform it again.
520 Perinatal mental health: innovative approaches to education
National and local agendas identify the imperative to improve perinatal mental healthcare. Reports suggest poor education provision for GPs. Our GP scheme piloted an innovative programme involving multi-professional and patients in co-production.
Humanities resources were intertwined with factual teaching. Sessions were designed to enable learning discussions between patients and professionals, increase knowledge, experience and empathy, to achieve better navigation of existing services and explore opportunities for improving care. The programme comprised of three half-day sessions: An innovative humanities workshops using live dramatisation, video, art installations, literature, film and popular culture.
Artists and academics who were service users taught on the patient experience and the impact of illness on family networks and society. A multi-disciplinary approach in detection and treatment, taught by a mental heath midwife, psychiatrist, social worker, GPs and patients. Inspirational approaches for quality improvement were co-created by trainees, multi-professionals, patients and local community members working with parents of young children.
Initial evaluation has revealed that service-users and NHS workers enjoy learning together, sharing stories and co-designing new approaches in care. 100% of participants would recommend this programme to others.90% of trainees could directly apply this learning to their GP and secondary care patients. 80% of trainees felt prepared to embark on QIP in this area. 100% participants reported improved knowledge of perinatal mental symptoms, pharmacological treatments, specialist mental health services and social prescribing to third sector organisations eg. PANDA, postnatal groups.
Addressing this topic sensitively may increase GP trainee resilience: A few trainees with unidentified personal perinatal health needs were empowered to seek support. We hope to further evaluate the impact of this education by following up GP trainee QIP activities.