'The patient will never care how much you know, until they know how much you care.'
[Terry Canale in his American Academy of Orthopaedic Surgeons Vice Presidential Address]
As a child growing up in Nottingham, I remember our family doctor came to our house during times of illness. Living and working in Sheffield, the only time I can recall a doctor seeing me at home was after childbirth. I am sure this is not unusual as general practice has been undergoing significant changes.
In this context, it was surprising to discover that the initial patient experience for first year medical students at the University of Sheffield consists of an opportunity for students to meet patients in their own homes. It is part of the 'Community Attachment Scheme' and provides a unique opportunity for students to meet patients at an early stage of the pre-clinical course. It is not intended as a clinical placement, the idea is to find out about the patient and the impact of illness in the context of their lives.
How does the community attachment scheme work?
I took part in the programme this year acting as a tutor, working alongside a General Practitioner (GP), for two groups of eight medical students.
This is my first year as a tutor and although initially apprehensive about who I would be working with, I was pleased to be paired up with an experienced GP who had been involved with the programme previously.
We ran three tutorials between October 2014 and February 2015 with presentations forming a part of the assessment process at the third and final tutorial.
Working in pairs, the students make three visits to the patient and are asked to find out about the patient, their medical condition and the impact of this on the patient's life and others in their wider community.
Confidentiality forms a key component of the visits to patients, tutorial sessions and assessment requirements.
Reflections
Taking part as a tutor has been a stimulating and illuminating experience. Reflecting on the involvement, what struck me most is:
- Time with the patients - the three visits to the patient gave a chance for students to talk with the patient and to find out about their illness in the context of their lives. Being in a home setting, lends both intimacy and an insight into the patient's life. The students are guided to allow up to an hour for each visit. With the patients agreement they can do more than three visits if they wish to. This is a rare opportunity. Typically, a patient-doctor consultation in a general practice lasts for ten minutes.
- Patient commitment - each of the patients give their time on a voluntary basis and thanks are due to each of them. The University runs a 'Patients as Educators' programme which provides opportunities for patients to get involved.
- The hunger of starting out - the community attachment takes place very early on in the course. Students are going through many adjustments which can include: getting used to a new city, living away from home, making new friends, as well as the excitement of starting out on becoming a medical professional. The tutorials for the community attachment scheme all take place in the evening during the winter months. The students usually have a full programme of lectures/placement experience during the day. Ours were all between 19.00 - 21.00. I was thinking what it must be like to go into this intensity at the beginning of your studies and decided to take some homemade provisions to the tutorials. I took homemade cakes (baked mostly by my wonderful daughter) to the first two tutorials . The GP treated us all by providing homemade samosas and pakoras for the last tutorials (which were delicious!).
- Learning about the patient's story - it has been a privilege to hear about the patients.
It has been a memorable experience for me and I've really enjoyed meeting with the medical students and working with the GP. I imagine that these first experiences with patients have left an impression upon the students.
_______
For more information about the University of Sheffield medical course go to:
https://www.sheffield.ac.uk/prospectus/courseDetails.do?id=A1002016
If you'd like to take part in the 'Patients as Educators' programme, you can find further information here:
http://www.sheffield.ac.uk/aume/pae_dept
Terry Canale in his American Academy of Orthopaedic Surgeons Vice Presidential Address: http://healthcarecomm.org/wp-content/uploads/2011/05/Tongue-2005-.pdf
Photo credit: Neil Moralee under a Creative Commons licence.
_______