General practice sits at the heart of the BM BS curriculum and the community and in-house GP teaching makes up around 15% of the course. Placements in GP are an opportunity to experience medicine in the community, where serious disease is less common and patients are more likely to attend with an illness that is mild, psychological or social in origin. This helps students to develop their consultation skills, learn the range of clinical ‘normality’ and understand how the management of patients in general practice differs in the hospital.
General practice placements take place in Years 1, 2 and 4 of medical school. In Years 1 and 2, 'Clinical and Community Practice' is all about preparation for working in the clinical environment; it has been developed to complement other modules, such as ‘Foundations of Health and Disease’; ‘Heart, Lungs and Blood’; and ‘Nutrition, Metabolism and Excretion’.
Year 1
In Year 1 this starts with a visit to a GP for two afternoon’s teaching. This introduces clinical medicine and enables students to integrate their learning from the modules of the system into the clinical setting. Students are exposed to the basic communication skills involved in taking a medical history and everyone is given opportunities to practice clinical skills later in the academic year.
Students will have the opportunity to observe a range of doctor/patient and health professional/client consultations both in the surgery and on home visits. There will also be opportunities to listen to, take histories from and examine patients. Students experience healthcare delivery by the general practice healthcare team and are given the chance to make notes on what they see and reflect on this in their digital portfolio.
As well as primary care visits, students also rotate between visits to community teams and secondary care providers.
These visits help students to:
- demonstrate concern for the interests, dignity and respect of patients
- describe how an optimum healthcare team works together constructively and effectively
- perform a basic clinical examination within specific systems in a systematic but sensitive manner, appropriate to the age, gender, culture and clinical condition of the patient
- demonstrate the application to the clinical practice of scientific learning gained and begin to identify signs of disease, reach diagnostic conclusions and assess their implications for the patient
- elicit and record basic medical histories in a manner that is structured but patient-centered
- reflect on practice, assess the appropriateness of action taken and how this may affect future practice
This is a good opportunity for students to sum up their learning points from their time in GP before moving on to Year 2.
Year 2
In Year 2 the foundations gained from the two sessions are really built upon. Students are expected to retain and develop their clinical skills and knowledge from Year 1 and be able to relate the new skills in 201 to the learning from the scientific modules. Many of the clinical themes in Clinical & Community Practice modules relate to the scientific systems teaching, which consists of Neuroscience and Behaviour; Reproduction and Endocrinology and Musculoskeletal and Immune System.
In Year 2 there are four distinct ‘Immersion Weeks (IW) across the year. The term will ‘pause’ while students engage with an IW. One of these weeks is dedicated to GP placement and teaching. The teaching will include principles of generalism in medicine, the principles of managing risk and uncertainty in medicine and writing a case-based discussion, plus some additional psychiatry teaching.
The general practice placement element is where students have six sessions of immersive placement in a GP surgery, observing the wider clinical team and specific GP consultations. Not only will students shadow and learn from the GP teacher, but also spend time with other HCPs, including practice nurses, paramedics, pharmacists or community nurses.
Students are encouraged to consult patients, take a history and perform basic examinations – these skills are super beneficial and mean that students are completely immersed in the practice team.
Year 4
In Year 4 GP experience is enhanced by students becoming integrated into a practice team for four consecutive weeks. By spending time with all members of the healthcare team students get to see every aspect of primary care. Once the supervising GP is happy that the student is competent and confident to see patients independently, students have their own sessions to take histories from patients. These student-led surgeries encourage independent consulting and thinking about clinical management plans. Student-led surgeries are the essence of Year 4 and promote an understanding of key concepts like incremental management and safety netting.
Students also receive in-house teaching: “bookend days” and three “simulated surgeries”. The four bookend days include topics such as minor illness for GP, mental health for GP, therapeutics for GP and consultation skills. BSMS students are taught consultation through an approach known as ‘strategic principles’ and these are put into practice through further simulation.
Patient communication and clinical skills are integral to your studies at BSMS. Working with professional actors, our simulation rooms will allow you to practise patient consultations, preparing you to manage complex problems and undertake key clinical examinations in general practice.
The Year 4 curriculum has been produced around presentations of illnesses commonly seen in GP. This is in order for students to be ready to sit the GMC’s forthcoming Medical Licensing Assessment. This includes a ‘curriculum’ for student learning, including a list of presentations in general practice. Students are assessed on attendance, completing their logbook and end-of-year examination (OSCE/single best answers).
The GP placement evaluation is extremely positive across all of the years where placements are undertaken. One of the comments from the current academic year was “Helen was a great mentor – so passionate and this really helped motivate us and show us what a great career GP is. The practice was organised, ready for us and had a personalised timetable. It was great to experience other members of the MDT team and going on home visits with GP and paramedics was an excellent experience and showed another element of primary care. We got to sit in on consultations and perform certain examinations. We were encouraged to get involved and the team was so welcoming. Best placement so far in degree – would recommend to all students and hope to go back!”.
The GP placement provider and overall experience have influenced some students’ career decisions and we are delighted that students as early as Year 2 decide that they wish to specialise in GP as a career as a result of their placements. We hope students come away with a rounded view of GP, prioritising patient care and an understanding of the importance of teamwork within the practice. Students should also leave feeling confident in the art of generalist medicine, including triage, sign-posting and social prescribing. We are passionate about general practice and we hope students are too.