Simon Thornton and Ciaran Conway organised year 3 GP teaching using Microsoft Teams. They used a Teams space with a channel for each GP practice to connect home-based students with their assigned placements. The spaces worked well, with interaction increasing as the placements progressed. Some elements, including weekly GP drop-in sessions, will be retained in future years.
Full story
GP placements are an integral part of medical training. They offer insight into day-to-day clinical practice, an experience of a new community and an opportunity to learn valuable hands-on skills. In a good placement, students will build on their confidence and knowledge, shape their professional identity and help consolidate or develop clinical skills.
Traditionally, students attend a GP teaching practice for a whole day every other week in groups of six. This gives them the opportunity for clinical contact, to see and talk to patients, have tutorial time with the GP and some self-directed learning. In feedback, students consistently rate patient contact as being very important.
Simon and Ciaran faced the challenge of converting the Year 3 GP placements into an online learning experience. This journey began in May 2020, when they began to investigate how they could continue to deliver teaching. The first challenge was how to connect home-based students with home-based patients and their GP teachers, with all the inherent data protection issues. Simon and Ciaran researched a number of platforms to deliver the teaching including Zoom and Blackboard Collaborate before deciding on Microsoft Teams.
Simon and Ciaran created a channel for each of the 45 GP practice. They had to use open channels – there is a limit of 30 private channels in Teams at the time of writing. it was made clear that no-one should be using patient identifiable data. Additionally they created a private training and support channel for the GP teachers to drop into and to ask questions.
Results
There was a great deal of interaction between students and between the GPs and the students – for learning, for administration and and for community building. GPs created icebreaker videos to introduce themselves to students. Several GP practices posted short videos showing students round the practice, to give students the feeling that they were part of the team. They did start to become a community in their own right. Interaction increased as the placements progressed and teachers began to get to know each other. Initially Simon and Ciaran were answering most of the questions, but by the end of the teaching block, participants were answering each others’ queries.
Within a private channel, the GPs could communicated with each other. Teachers valued having a private area, much like a staff common room, where they could have discussions unseen by students.
There was a great deal of interaction between students and between the GPs and the students for learning, for administration and and for community building. GPs created icebreaker videos to introduce themselves to students. Several GP practices posted short videos showing students round the practice, to give students the feeling that they were part of the team. They did start to become a community in their own right. Interaction increased as the placements progressed and teachers began to get to know each other. Initially Simon and Ciaran were answering most of the questions, but by the end of the teaching block, participants were answering each others’ queries.
Patient remote consultations
Most of the GP remote practice work is done by telephone. Video consultations, most practices use AccuRx – adopted rapidly at the start of COVID. Simon and Ciaran have been able to use for teaching with the students. AccuRx supports up to four people on a call, the patient, the GP and two students. The system is secure and has been approved by NHS Digital for remote consulting. Whilst patients consulted via AccuRx, students and the GP teachers communicated via Teams. Whilst there are some layout differences between Teams and AccuRx, they are similar. Using Teams is a good way of mimicking AccuRx.
Within a private channel, the GPs could communicated with each other. Teachers valued having a private area, much like a staff common room, where they could have discussions unseen by students.
One of the elements which Simon and Ciaran intend to retain is the fortnightly drop-in session for the GP teachers. Initially they were flooded with queries during these sessions. As the year went on the questions reduced, and the drop-in session became more of a social space, developing into a community of practice. With such geographically disparate teachers, Simon and Ciaran found this was a great way for everyone to get to know each other and experienced this as a silver lining of the pandemic.
Another advantage of the online sessions was the quick resolution of many practical issues. If one of the GP teachers had to self-isolate it was relatively easy to redistribute the students to other practices at short notice. Previously there would be a wide geographical spread, and to move students between locations was quite an undertaking.
Whilst there are many benefits, Simon and Ciaran and their colleagues agree that remote teaching is not as good as face-to-face teaching. There have been many unexpected successes that they would like to take forward but getting the students back to the surgeries and face-to-face teaching and learning is a high priority.
A logistical problem was that the only way to add people to Teams is manually by administrators for all students and all actors. Note – the University will automatically create Teams at a unit level, with students added automatically.
GPs also reported technical problems as they are not registered with the university. They often found their permissions were restricted and that they couldn’t use the Chat function or access the Stream content.
Many of the GPs were anxious about data protection. There was a data protection issue early on with AccuRx due to international students studying from home across the globe. Simon and Ciaran got advice from Henry Stuart, the University Data Protection Officer. They also got a draft data protection impact assessment for Teams and AccuRx. They reached out to data protection officers from the LMNCs (the local medical committees that represent GP practices) and the DPIA.
Simon and Ciaran are in agreement that the biggest disadvantage in the virtual placements has been the lack of clinical skills. You can’t substitute hands-on clinical experience, such as otoscopy (looking in ears) which you just can’t do from home. Whilst Simon and Ciaran worked hard to ensure that they have covered most of the academic learning outcomes, there are significant gaps in the practical outcomes which they’ve had to pass on to the Year 4 leads. They plan to create another Team for this year with everyone already added on in case students need it, but very much hope for a return to face-to-face teaching and learning.
Tips
- Be patient. This process is very time consuming, ensure you clear your diary!
- Be pragmatic. Don’t underestimate the data protection issues and do explore these concerns early. Seek out and review data impact assessments. It took Simon and Ciaran from April to the end of the summer to resolve this area.
- Be positive. There’s a wealth of options out there, and you’re not the only person facing these problems.
- Recognise the anxieties people have about using technology. For 99% of people it wasn’t an issue and they were surprised about how well it worked. It was useful to communicate that to new people we were bringing on to Teams.
- Make use of good IT support. Simon and Ciaran report having good back up from the TEL Team, especially during the Academy Day.
- Know your technology and take advice from the experts. Simon and Ciaran invested time looking into different technologies and reaching out to a variety of sources, including a Microsoft consultant who has been involved in running Teams for a Formula One Team, and from a school in Bristol who were using Teams. This helped them to get a feel for what can be achieved.
- Build in the equivalent of a ‘car journey’. Much of students’ learning happens on the way to events, or around the water cooler. Incorporate some time when the GP teacher isn’t there for the students to share and cross-pollinate ideas.
- Nurture your community and respond quickly to its changing needs. Simon and Ciaran recommend real-time feedback. This allowed them to teach more responsively, adjust what they were doing on the fly and make changes from one teaching day to the next.
- Prioritise feedback. Feedback was collected both informally and formally, via the GPs’ attendance sheets (which had sections for what went well and what went badly) and through a biannual student survey. Simon and Ciaran added an extra feedback opportunity in the middle of the placement. To obtain as many responses as possible, feedback time was built into the teaching sessions.
- Value your team. Simon and Ciaran expressed the importance of recruiting enough practices to deliver the teaching. Both stated that key to the success of this challenging project was the enthusiasm of the GP teachers and their dedication to bringing the next generation through.