Teaching and learning in general practice: third year student-patient encounters

1. Teaching and learning in general practice: third year student-patient encounters Ramon PG Ottenheijm and Job FM Metsemakers Maastricht University Department of General Practice The Netherlands

2. Context In September 2001 the medical curriculum of the Maastricht University was revised.

3. Highlights of the Educational Programme • Student-centred • Problem-based, project-based and patient-based • Cooperation in small groups (e.g.tutorial groups) • Horizontally and vertically integrated curriculum • Thematic, mulidisciplinary educational units • Clinical skills training throughout the curriculum • Gradual transition from theoretical learning to clinical training • Assessment is learning • Promotion of students’ professional behaviour • Student mentoring and counselling

4. Year C o n t e n t 1 Emergency care and regulatory systems 2 Stages of lifeand diagnostics 3 Chronic disorders 4 Theory and practice / Clerkships 5 Clerkships 6 Participation in research and patient care The 2001 Curriculum Practice Theory

5. The 2001 Curriculum: Year 3 Chronic Disorders ClustersA. Abdomen B. Locomotor apparatus C. Circulation and lungs D. Psychomedical problems • Patient encounters on a weekly base at several settings • Student-centered outpatient clinics of the academic hospital • Mental health institutes • General practices

6. Patient vignette/case The Learning cycle of the student Preliminary dicussion tutorialgroup Selfstudy Discussion tutorialgroup Patient contact Feedback Physician Selfstudy

7. Objectives of this presentation To describe the family medicine part of the programme To report some early results

8. Design 2003-2004 Programme features • Every student visits one GP 10-11 times (1-3 times each cluster) • 240 students and 223 GP’s • Student must see at least 3-5 patients independently (each time) • Student takes a history and performs a physical examination • Student pays attention to chronic conditions (5 general themes) • Student writes structured report (SOAP) • Student adds Elaboration and Learning goals (SOAPEL)

9. GP observes (partly) student’s-patient encounters • GP provides structured feedback on patient encounters and SOAPEL report • SOAPEL reports are used at the Faculty in the tutorial groups • Assessments by GP: • Students’professional behaviour • Structured evaluation regarding students’performance • Paper about a patient with a chronic disorder

10. Task of GP • Selection of 3 to 5 patients • Supervisor • Observation of the student • Providing feedback Task of student • Informing GP 2 weeks before contact about topic • Preparation of expected patient encounters • Writing of SOAPEL report

11. Task of General Practice Department • Providing enough GP’s • Tuning to and integration of faculty programmes • Providing information for students and GP’s • Developing supporting material for GP’s (e.g. software outlines) • Workshops for GP’s

12. EvaluationQuestionnaires for students and GP’s on a 5 point Likert scale Reply: Students 81% (195 out of 240) GP’s 57% (126 out of 223) ( ) Standard Deviation * average number per day: NOT on a Likert scale ** mark on a 10-point scale

13. Conclusion • Students, GP’s and faculty teaching staff are enthusiastic • High standard deviations in evaluation results • GP’s average time spent is about 1 hour per day • GP’s can tune the programme on their daily practice • Special attention to: • Observation • Independent patient encounters • Adaptions for 2004-2005 • 320 students (80 students extra) • 8 visits (2 each cluster) • Seeing at least 2 patients independently