Medicine Taster Lecture – Undergraduate Open Day – June 2020

I’ve got to hit my own consent there there we go hello everyone and a very warm welcome for what is my first ever virtual open day talk I’m delighted you’ve been able to come along and looking forward to spending the next few minutes sharing with you a little bit about my discipline my name is Connie I’ve got a background in medical education and I’m director of something called the Interactive Studies Unit and that’s the team broadly responsible for the teaching and testing of communication and professional development during the course of your MBChB and indeed the other healthcare programmes my other hat is the international elective some of you may be familiar with that that’s a big block later in the clinical years where students go all over the world to experience healthcare in different settings but today I’m talking about my real passion and where my own career started in terms of clinical communication as a subject some of you may recognize this image some of you not I’ve put it in perhaps for a little bit of fun with my tongue slightly in my cheek this is a well-known UK comedienne and one of her characters has the catchphrase am I bovvered and frequently says I ain’t bovvered and I put this up really because during the course of many many years of teaching communication a lot of people have come back and said well is this something we really need to bother about teaching surely when we recruit from six forms we’re recruiting the brightest and best students in the country and they’re all really good socially at communicating interacting with each other talking do we really need to bother about teaching them well I wonder what you think about that in terms of teaching communication and interactions at medical school should we bother I can’t see your chat function on my view but Georgina is monitoring it and I’ll be interested at the end to see if a few have you thought yes or no at this juncture we think really there are lots of good reasons to be bothered I suspect you’ve thought of a few yourself it’s really important it’s fundamental this isn’t about a nice little bit of chitchat some small talk to make people feel at ease communication is a fundamental instrument for keeping you and your patients safe if you’ve got any further comments that you want to add please do and my chat function has now come up so I should be able to get that as we go along clinical communication is taught not just on the MBChB we started doing that 1991 I started doing communication for this programme but it’s taught across dentistry medicine nursing pharmacy physician associate programmes psychology health and social care it is really important numbers of you may have been thinking when I gave that opening statement about yes the doctor-patient relationship many of you I expect have been drawn to this talk today drawn to a medical degree precisely because you’re curious about people you want to engage with patients you want to run consultations that will help you be a bit of a diagnostic detective and then work with them through that relationship to try and make things better and yes the doctor-patient relationship is going to be at the heart of what you study if you join us next year but there are some other areas of communication that are important and interesting and culturally in the current climate lots of areas that we need to stay on top of that are having emerging and increasing importance I wonder what’s in your mind as I say that that’s important other than the traditional doctor-patient relationship because I’m going to touch on one or two things that we’re building into the curriculum right now to try and keep us more up-to-date professionalism is going to be the big thing at the heart of the programme if you come to Birmingham and I mightily hope that you do we don’t teach communication at Birmingham as a set or separate set of communication skills lectures that’s really a bit old-fashioned that’s how people thought about things back in the 1990s we think about professionalism so communication is part of developing as a professional so while yes we will touch on skills in the first year we will think about important skills that you need not using jargon demonstrating empathy active listening the sort of things that are associated as being the tools of communication those are really just a small part of a package that’s actually rooted in professionalism so

the first question we’re going to ask you if you come to Birmingham is what sort of doctor do you want to be that’s the key question that you need to think about and then once you’ve got a few ideas about that in mind what do you need to do to get there and that’s where me and my team come in to help you on the way there’s a picture there from the Lancashire Evening Post of a messy desk why has she puts a picture of a messy desk in this lecture you may ask yourselves and it’s actually a small example of how important professionalism is to many many things it might seem a bit trivial well okay the doctor’s got a really messy desk does it matter you know what it does we know that there’s slight sense of disorganisation inability to prioritize finding things at the last minute those sort of things are early warning signs with students so they may have organisational difficulties later if your desk’s poorly structured your thinking can be too and for taking structured histories and keeping people safe that’s important I’ll come back to my first slide you know you all know somebody that maybe is just about on time the person that rushes in at the last minute and just makes it at the last minute or the person in your group at school or in your social group that’s always just a little bit late just a minute or two are we bothered actually yes we are if you think about how that message communicates to your team the person that’s always slightly late may always have a good reason the bus was late my alarm clock didn’t go off I had to take a phone call actually the message you’re giving everybody else is that you think your time is more important than theirs and on a medical course and in a clinical environment that’s not a good professional message to give when we talk about communication yes we’re going to talk about verbal nonverbal interactions situation management but we’re also going to talk about how you present yourself how you come across as a future doctor and that will involve aspects of your organisation and self presentation too so I’ll move on from the messy desk but it’s something to think about and I want to talk to you about teams some of you may be sports fans out there some of you not I was never very good at sports at school but I do like a bit of athletics which is why I’ve chosen this particular image I’m going to make an educated guess I could be wrong but wherever you’re watching from in the world today you will have a national Olympics team and if you didn’t watch it you will certainly have heard of them and I want to use that as a little bit of a metaphor for communication and personal professional development the lovely lady there Katarina Johnson Thompson when she goes out in an individual event she will not be going out aiming to just about do okay she’ll go out there aiming on the day to be the very best she can be she’ll do everything that’s asked of her and then dig deep for the discretional effort yeah she could probably easily skip a bit of training and romp home in seventh or eighth place but that’s not what she’s looking for every single occasion she’ll want to be the best she can be and that’s what we expect from our students and doctors no one wants their doctor to be the one that put in just enough effort to just about do okay but medicine is arguably a team sport there’s Team GB there and again as I say wherever you are in the world you will have national teams and they represent their brand they represent their country in the same way our medical students and doctors represent the organisation they represent their medical school they represent the NHS and there’s an expectation about the way that they communicate and present themselves that goes with that responsibility some things in medicine are about your individual communication your courage your confidence your own interactions some of your safety your professionalism is tied in with how you interact as the part of the team good team saves lives here’s one from Birmingham a world-class Royal orthopedic hospital which is where our students if you join us you will have placements in the future they’ve saved a lot of lives there and done an awful lot of good in terms of changing people’s quality of life and yes there’s individual effort there but they work and communicate as a team now one of the people in that photograph I don’t know which one within the hierarchy may be more senior than another and yes hierarchy in healthcare is

important you look to the person at the top to communicate the directions to communicate the decisions to take the lead but you’re also going to hear a very important term in your communication training followership leading and following are both important the good leader needs to listen to the person who may not be the most senior in the team what if you as the student are observing a procedure on a ward round and you spot something everybody else has missed you need permission and we give you that to communicate upwards and we want our clinical leaders to understand that although they’re the most senior on paper they need to follow and listen if somebody else on the team has a good idea so our communication teaching ties all this together for you right social media you will have grown up in an era where social media is key and you’ll be native to this in a way that me and my colleagues perhaps are not and it’s marvellous I mean particularly during lockdown the benefits of social media has given the connectivity breaking isolation enabling people to set up social and professional groups I’ve learned a lot it’s been a big learning curve for me but there are some dangers inherent in that for health care students have a look at those three on the board they actually relate to situations I’ve come across during my career but I’ve obviously changed the details and anonymised them for reasons of professional ethics have a quick look now what you might be thinking is it’s okay these are private messages if I send that to my mate late at night or I send that to my brother late at night does it matter is anyone going to be bothered well actually you might feel safe but the problem we have with social media is even if you think your settings are safe often they’re not and whereas a conversation might not be recorded in your parent’s era or your guardians era these things are out there for a very long time now and they leave a footprint that can follow you for a very long time what about the student has had the best night ever singing their heart out to karaoke making new friends on the way what about that look at the message the student’s concern seems to be not getting caught that seems to be the message there it’s not about going into an Anatomy environment potentially not awake or astute enough to function safely in that environment I hope I don’t get spotted I hope I don’t get caught out that’s showing an attitude and actually quite a difficult and dangerous one if a doctor makes a mistake they need to be able to own it so that’s an early indication that this students about yeah I’ll behave badly but as long as I don’t get caught it’s probably okay it’s not what about the orange bubble there our lady on Ward 6 with the ulcerated leg so that’s okay isn’t it it’s anonymous she’s not named what do you think actually it’s not okay if we’ve only got one lady with an ulcer on Ward 6 you’ve identified her and actually anonymity aside is social media the time and place to address a personal reaction to a clinical scenario perhaps for that student it was uncomfortable perhaps they found themselves finding the consultation difficult not knowing what to say felt very uncomfortable with what they saw but there are other better and more professional ways of managing that reaction and my last one there in consciousness of time okay that might be funny but is it do we want future medical students to think that a fall a trip is something amusing and if you’re in A+E what if you’ve inadvertently captured a member of staff another student all or oh gosh a patient in the background to your footage and that’s now out there that video’s out there I don’t want to spoil your fun I want you to have fun when you’re an undergraduate goodness knows I did but I also want students to be mindful of some of the dangers and cautions inherent in social communication and these again are things we’ll pick up with you on the course and help you with I’m not going to spend more than 10 seconds on governance you’re all going to be looking at this for your interview and you’re all going to be looking at outcomes for graduates I hope and you will see that the old model of the doctor as a scientist a scholar a practitioner a communicator has been turned on its head and communication and values are right at the top of everything the GMC requires it’s not just an add-on for nicety it’s fundamental if doctors don’t communicate well they’re not safe if a patient’s embarrassed to talk to you they won’t come back next time if a patient feels

intimidated by the system or judged by the system next time they’ve got a lump or bump they might think twice about coming in and your chances of quick and early diagnosis are gone if the patient doesn’t understand the instructions you’re giving them they’re not going to be able to follow them safely communication is the tool that keeps you safe and I’m going to keep repeating that message for the whole five years you’re with us so how do we teach it well a lot of simulation a lot of roleplay we’ve got a very well established in-house team of professional simulators some of them have been with me for 20 or 30 years and they are trained to take the roles of patients carers advocates colleagues and others in scenarios so that you can practice safely not because we’re short of patients we have access to thousands of patients and you will spend far more time observing and taking part in authentic consultations than in the classroom with my team doing structured roleplays so this isn’t a substitute it’s preparation for thinking about aviation this is where we get our simulation model from how many of you would like to go in a plane to visit friends or family abroad or to go on a holiday if the first time the pilot was flying live was the first time that they had their hands on those controls and practice the difficult situation pilots practice on the ground to be safe when they go up so our role play situations look at challenging situations interactions with patients carers and colleagues so that you can try things make mistakes safely get individual feedback and work in a group to problem-solve I’m going to give you one example before we part of how we do it’s all a values-based approach I’ve mentioned that already so we’re not just talking about skills remember to make eye contact look at the patient put the chairs at a good angle it’s way more complex than that and we do work in the first year with live role players and we’re working on virtual platforms if we have some COVID restrictions when you come and join us but we will be working with live role players and we also have other methods that we use such as this one so here’s a two-minute taster from a session that we do with the current students in the early years and we use a series of video diaries as the range of characters here’s photographs of two Janko and Tatiana and we position it to our students that these two young people have hit a difficult time in their lives and had a medical problem and we filmed a series of video diaries that our students can watch and then we ask some questions based on those recorded video diaries I’m not going to show you the video diaries because we don’t have time but I’m going to give you a quick excerpt which is a typed up version of a line that Janko says in his first video diary and there it is so take a quick moment to look at that it’s all a bit of a shock really one minute I was on the treadmill in the gym next I was on the floor I woke up in accident and emergency I don’t know what happened I mean I thought it was safe I bought these pills on the internet and well all my mates use them I wanted to beef up a bit you know I wanted results fast just so the student see Janko saying that line a few days after his experience and then early in the teaching we say to them if you were Jango’s doctor or another member of the healthcare team working with him what would you want to think about or know what are the issues just based on those few seconds of dialogue I’d quite like you to type a couple in because I’d quite like to have a look at them afterwards or ask my colleague to share them with me after this so I’m going to give you a moment to think about that you’re part of the healthcare team working with Janko going forward you’ve just heard him say that what’s important I’ve spotted your questions they’re very good I will address them afterwards okay so you’ve had a chance to think about our character there and you’ve had a chance to think about some of the issues just briefly but the sorts of things that came up with my first year group this time round they wanted to talk about or were curious about what happened clinically what was it that had actually happened that caused him to collapse what was the situation around it how did the referrals work who called the ambulance what did the ambulance crew see what would we want to know from

them when he was admitted to frontline pre-hospital trauma an important question when he arrived there what state was he in and who met him who communicated with him what was that conversation about have a look at some of the other issues here peer pressure confidence body image very telling I wanted results fast you know this may be a young man that’s aware that diet and exercise could manage some of his body issue concerns but the amount of time it took was too slow why does he need results quickly what’s the pressure point what’s the pain point here why is he risk taking these tablets to get results fast we need to talk to him and find out how he feels about himself and what’s going on in his peer group there you have the lay referral he bought a tablet on the advice of a friend unlicensed prescribing over the internet gosh young men like him young women like Tatiana can buy a tablet at the push of a button there’s nobody there taking their medical history or looking at what else they might be taking that that drug might interact with did he read the instructions if not why not is there something about written communication on drugs that stops young patients working with that does he need extra support are there other problems is he at college is he at home does he have other support what’s going on for him there’s a lot of big conversations and me and my students can easily have an hour-long discussion based on that 30-second narrative and then later on in the course we build up role plays when you get to work live with role players well my screen jammed give a second I’m not quite sure why I can’t move that oh there we go my final slide I’m going to say a word about COVID it’s impossible not to this is the first time in many many years that I’ve not been able to sit on a table and have the pleasure of meeting you and your families friends and supporters face to face COVID is changing the environment not just for now but the healthcare environment that you’re going to be going into we’re going to do everything we can to keep you safe on the course and we’re planning pretty much every aspect of our learning we’re not going to be maverick about this but the reality is you’re going to be going out and interacting and communicating in a world where COVID exists we can’t pretend it doesn’t and even if we manage to control this very well in the coming years it’s going to be something that stays with us in terms of my discipline that’s meaning a lot of rethinking about what we’re teaching you we’ve always known virtual consulting is important it’s going to take center stage in a way it never has done before so we’re working now creating packages and training experiences authentic and simulated for you to manage that crisis brings opportunity yes patients are being seen more online than they ever were before because of lockdown because of shielding but what about very positive in other ways patients who live on remote islands that don’t have easy access to healthcare patients who aren’t mobile patients who feel vulnerable and don’t want to go into hospital environments for check-ups where they think that they may catch something there’s lots of exciting stuff going on behind the scenes and we’re going to navigate our way through that as best we can we have contingencies in place for communication that are to deliberately teach you remote consulting remote alternatives to face-to-face if we hit periods where it’s just not safe for any of us to leave the bedroom but also a whole range and suite of offers including our traditional face to face teaching that we hope to be able to reintroduce to the programme going forward we’re going to work with you on this and I’m consulting students at the moment about what they would find reasonable helpful and useful I’m going to leave you because I’ve done 25 minutes I’m going leave you with a quote from a book you may have read Adam Kay’s Diaries of a Junior Doctor sometimes they’re hilarious they’re painful they’re very thought-provoking he wrote them a few years ago now so the junior doctor system has changed in terms of working hours directives a little but a lot at the heart of what he’s talked about is very relevant that quote stayed with me long after I’d read the book a great doctor must have a huge heart and a distended aorta through which pumps a vast lake of compassion and human kindness thank you for listening