King’s Undergraduate Medical Education in the Community (KUMEC)

MEDICAL STUDENTS – POTENTIAL CONTRIBUTORS TO SMOKING CESSATION PROVISION: THE ADDED BENEFITS OF THE ONLINE NCSCT TRAINING

King’s Undergraduate Medical Education in the Community (KUMEC)Department of Primary Care and Public Health Sciences

NCSCT London Friday 13th June 2014

Dr Ann Wylie Senior Teaching FellowKUMEC King’s undergraduate medical education in the community Ann.wylie@kcl.ac.uk

KUMEC - King's Undergraduate Medical Education in the Community

AIMSTo describe the background to our cessation

teaching and challenges

The opportunity NCSCT offered

The benefits and limitations

Future of cessation teaching in one medical school

Smoking cessation in medical curriculum

Basic skillsSchool and

NCSCT

Assessment School and

NCSCT

Certificates; School and

NCSCT

Apply in context Clinical

placements

Win win! Students skills and patient support

KUMEC - King's Undergraduate Medical Education in the Community

Doctors’ responsibilities for lifestyle modification – a norm!

Background

Behaviour change skills essential for medical education (GMC)

Specifically smoking cessation

Students need some theory and evidence base as well as technique

Been in KCL core curriculum for a decade, with assessment but various challenges

Challenges

Only recently seen as essential for clinical therapeutics

Limited number medical teachers with smoking cessation skills

Students getting “mixed messages”, not necessarily evidence based

Core teaching time only 90 mins in 3rd year!

KUMEC - King's Undergraduate Medical Education in the Community

The Stages of Change: students identify where the patient is on this journey

Action:Making

Changes

Maintenance:Maintaining

change

Relapse:Relapsing back

Contemplation:Thinking about

change

Commitment:Ready to change

Current teaching With scenarios and facilitators

Focused on applied techniques stages of change 5 As motivational interviewing brief interventionthe normality and response to relapseenabling students to see this as a treatment and

management

Small groupsCurrently groups of 20 clinical students

From 2014 moving to start of first clinical year to enable students to link this to their clinical placements and repeated learning opportunities

Smaller groups if possible - suitable facilitators and room availability can be problematic

NCSCT – a new opportunitySince 2011-12 senior medical students

completing online Stage 1 and /or 2 received a certificate

Students advised of the potential benefit of this training however this was not compulsory

Suggested they did it around their core teaching and respiratory training

Constant promotion was needed!

Complementary learningDuring the Behaviour Change teaching sessions

students with Stage 1 and or 2 displayed confidence, knowledge and skills

Prompted other students to do NCSCTSome students with Stage 1 and or 2 did GP

practice based cessation projects – helpful to GP practices

Some students did hospital based cessation project to prepare for NICE secondary care implementation

Current dataStudents from 3-5th year with Stage 1

N = 140 (12%)

Students from 3-5th year with Stage 2N = 46 (3%)

Graduating final year students with one or more certificate N = 116 (30%)

Disseminating Students have used their skills to design posters and presentations

for GP practices (46 students based at 13 practices)

for GP conferences (3)for presentations to policy makers (3)for research (2)for further academic workfor encouraging other students

Medical students – significant contributorsAbout 6000 medical students graduate each year

in UK – becoming FY1 doctors in Aug

At KCL about 400 graduates and currently about 120 have an NCSCT certificate

In their final 3 years medical students have substantive patient contact and opportunities to talk to patients

Potential problemsEarly evaluation qualitative research findings suggested:Students had limited opportunities to “apply &

practice” skills in clinical arena – danger of “atrophy”

The online process (now improved) was onerousNeeded to repeat the course for exam revisionLimited exposure to good clinical role modelling

KUMEC - King's Undergraduate Medical Education in the Community

2014 Graduating cohortWill be junior doctors in

Aug Assessing new patient

admissions for smoking status

Providing appropriate therapy including NRT

30% of KCL graduates have Stage 1

5% have Stage 2

FutureOnline learning/e-learning now the norm

Need to ensure students are given time to do this, at appropriate junctures in curriculum at linked to clinical contact/patient context

Integrate into wider curriculum and assessment

Other medical schools adopting NCSCT option

GP practices and NHS training hospitals can expect students to have competences and be contributors to cessation provision/policy

Smoking cessation in medical curriculum

Basic skillsSchool and

NCSCT

Assessment School and

NCSCT

Certificates; School and

NCSCT

Apply in context Clinical

placements

Win win! Students skills and patient support

Students as learners and contributors

KUMEC - King's Undergraduate Medical Education in the Community

It also enables us to critically assess the functioning of the GP practice …in terms of what smoking cessation services they provided and how efficient they were.”

            It was beneficial to be able to put what we learn into context. We learnt about GP community practice and we learnt about smoking cessation