Seeing through the eyes of patients and carers: an architectural co-design project for mental health and wellbeing - Dr Kay Leedham-Green
Enjoy this short 5-minute presentation showing the incredible scale and impact of this project within the professional values and behaviours strand of our MBBS programme. Second year medical students worked with mostly post-graduate architectural design students from the University of Westminster, as well as clinicians and patient advocates to propose a range of changes to mental health spaces in response to service-users' testimonies.
Browse the final exhibition here: http://www.openstudiowestminster.org/co-production-2020-2021/
Watch our presentation here:
The GMC ASME Prize for Excellence in Medical Education Winner 2019: Codesign for service improvement - Dr Kay Leedham-Green
Figure: A frequency weighted word cloud expressing students’ emergent understanding of the meaning of co-production
If you are a clinician, you can probably remember how you thought about medicine as a student – perhaps seeing your future role as a healer? For most clinicians working in today’s NHS, however, there comes a point when you realise that patients tend to accumulate diagnoses rather than walk away from them. The clinician’s role identity shifts from healer to more of a ‘shoulder-to-shoulder’ stance with patients, families and carers: trying to see the road ahead through their eyes, working with them, often in multidisciplinary teams or with external agencies, negotiating their next steps in chronic disease management. The clinician’s most valuable tool becomes supporting patients’ and carers’ self-efficacy in managing their health. The smoothness of their journey and their experience of services, becomes an important concern.
This shift in focus is a complex learning outcome, requiring an experiential approach to learning. Our objective was for students to see NHS services through the eyes of patients and carers, respecting them as ‘experts through experience’, and to work in collaboration with both service-users and experts from another field (in this case designers) to propose improvements to services. Our service users helped to explain the lived experience of life-impacting health issues including dementia, neurodevelopmental disorders, acute and chronic mental health problems. The services they proposed changes to included family therapy rooms, CAMHS services, community care spaces and acute services including A&E, and students were led on a video tour of local clinical sites. They worked with undergraduate and postgraduate architectural designers from the University of Westminster School of Architecture & Cities.
The module, designed by Wing May Kong(diabetologist and ethics lead) and Jennifer Wallis (historian and medical humanities lead), in collaboration with Ro Spankie and Alastair Blyth from the University of Westminster, consisted of two full days of interactive activities using established co-design methods. It includes protected time for project work and will be assessed through a team-based design proposal and a personal reflection on learning. Their assessments will contribute towards their end-of-phase progression through a programmatic assessment portfolio within their ‘professional values and behaviours’ strand, led by Elizabeth Muir (general practitioner and lead for professional identity formation).
In the first day, over 600 students worked in small inter-disciplinary teams on Miro boards supported by 50 facilitators, service users and experts, run entirely online. This board is one of eight boards, and each had over 140 collaborators in small video-conferenced teams, working on it simultaneously. In the next workshop, students will physically make designs using paper and glue kits and share their proposals with each other. Prize-winning proposals across a range of categories will be exhibited and shared in an online exhibition.
So, how will we know whether we have achieved our aims? This becomes complex, especially when you are aiming high: at no less than a transformational reframing of students’ professional stance with patients. The project is ongoing, so watch this space, but our evaluation will draw on the Wenger Trayner value creation framework for communities of practice. Echoing the Kirkpatrick model this framework considers immediate, intentional, applied and realised value. The Wenger Trayner framework, however, adds on a fifth higher level: “reframing value” which they define as “when learning causes a reconsideration of how success is defined. It includes reframing strategies, goals and values”.
Our analysis is being conducted semi-independently by Kay Leedham-Green from Imperial’s Medical Education Research Unit (@ImperialMERU), and includes observations, coursework analysis, module feedback, and focus groups across stakeholder groups including service-users, facilitators and students. Evidence will be coded according to this value creation framework, and then re-explored through focus groups, trying to analyse not only the effectiveness of this type of educational activity but also the mechanisms of how transformational shifts in perspective and professional identity occur. Kay Leedham-Green has recently co-authored a chapter on professional identity formation for a major Springer series on clinical education.
Reflections on the MERU Conference 2020 - Prof Sue Smith and Dr Luke Allsopp
Professor Sue Smith, Director of MERU
2020 was a year like no other and one which many of us will look back on with a mixture of disbelief, frustration and regret. However, amongst the sadness, there were some positives, not least, the way Imperial staff demonstrated their outstanding expertise both at the bench and in the (virtual) classroom. It was a year when we changed the way we did almost everything, yet we still managed to rise above the challenges to deliver work of the quality for which the College is rightly famed and the work we heard about at the annual MERU conference was no exception.
MERU took the plunge and went virtual for the first time and we were rewarded by more registrations and attendees for its main annual conference than ever before. Seventy people joined us on the day! Thanks to superb organization by Roxy Hughes, our MERU administrator, we delivered not just a plenary but three parallel breakout sessions, all expertly supported by members of the Collaborative Partnerships Office. Perhaps our most innovative session from the technical point of view, was the dedicated poster viewing time. Imagine the academic version of the silent disco! Following a spoken introduction, people started viewing the posters, which had been preloaded for viewing and, to our delight, after a few minutes of intense silence, readers started to upload comments and questions to the chat and we were able to have a real academic discussion of the research. Feedback from the audience was that they really appreciated having some dedicated time to focus on the posters in a way which they would not have prioritized, had the afternoon not included this slot.
We were delighted to welcome Dr Caitriona Dennis, from Leeds Medical School, as our key note speaker. Cait shared her experience of Leeds’ extensive “Time to Teach” Faculty Development programme and it was easy to see why their Medical School has earned itself an ASPIRE award in this area. There was something for all of us to learn from her presentation and I think we all enjoyed it. Not only did we enjoy it, the following day, I received an email from Cait saying how much she had enjoyed being surrounded by people with a passion for medical education and education research.
We enjoyed breakout sessions on peer education, technology enhanced education and the curriculum. I was personally delighted to chair the breakout session on peer and near peer education, with content delivered by students from the MedEdSoc. It’s truly heartening to see how much time and thought students put into supporting their peers and the skill and creativity they bring to their teaching practice. By setting the bar so high, they encourage us all to improve.
National Heart and Lung Institute
How are doctors taught? This is an interesting question, one that I with my fundamental science background was not sure I know the answer to. So, seeking more answers I recently attend the sixth annual Medical Education Research Unit (MERU) Conference.
The conference was an interesting afternoon and it broadened my knowledge of medical education and delved into active areas of research aiming to assess and improve delivery and outcomes. The key note seminar was entitled: Making TiMEtoTeach: Empowering a diverse and inclusive “universal” faculty by Cait Dennis (University of Leeds, ASPIRE awardee). This talk really focused on seeing medical education with a more holistic environmental focus. All of the interactions that training medical students have with Doctors, other students, nurses, specialists, allied professionals, to even receptionists contribute to their experience and help to shape them, their interactions and their future careers.
A key element of this talk was that patients also contribute to the education of medical students, and that this has been massively underappreciated. Cait’s project tries to educate all stake holders to obtain better medical outcomes and better medical doctors. She highlighted a major issue that medical students experience: that of training in such diverse, non-standard settings, in many different locations from different hospitals, trusts, primary/secondary care, to even prison locations.
Through the use of a Kern needs analysis model Cait and her team identified the key stake holders. Next, they developed a model to identify all the different knowledge exchange scenarios as teaching. They then encouraged participants to see these interactions as teaching, and that this was not just allowed but actively encouraged. Through expanding their network and the development of a brand they recruited enthusiastic champions to intern train and recruit more volunteers across diverse faculties. They established breakfast clubs and peer teaching to promote improved skills such as effective feedback, assessment of skills, bedside teaching etc. Many of these programs were seeded with simple room bookings and biscuits and advertised by ‘piggy-backing’ on other meetings. The TiMEtoTeach program has been supported by the University of Leeds and its ideas transferred to the wider organisation through a people, process, technology framework and has won several awards. I particularly liked Cait’s comment about different people playing a role in medical education. For instance this program has led to more Chaplains actively sharing their thoughts and experiences about end of life/terminal patients. This highlights the role that different people can play in medical education and how low funded programs can improve learning outcomes for all stakeholders.
I particularly enjoyed the short talk by Kay Leedham-Green (Imperial College London): Supporting diversity in the clinical academic career pathway. This focused on the ‘leaky pipeline’ and how women are lost from the medical/university ranks which is abundantly clear especially at the most senior levels. By doing a systematic review using a qualitative approach, Kay and her team have identified and collated many of the factors. They effectively demonstrated that this approach was deep and wide ranging, which for me was interesting as I am a much more a numbers focused person (the published article can be found here). I completely agree that it is a multifactorial picture and that we need to educate and self-reflect on why these differences are present. This is especially true as whilst some drivers that limit women’s equality are right in your face for example direct discrimination, others are much more unconscious or almost invisible. An example Kay used was that some forms of bias are only observed by other males whilst the women experiencing it do not realise they are treated differently. One point that did not resonate with me was the suggestion that more money for individuals could be part of the answer. I disagree with this as many medical practitioners get paid quite well and far about the average wage and above what most scientists with a PhD earn (which also takes a considerable amount of training time). However, I think something that was missed from the talk was the working hours of medicine. I partially understand the pressures and financial restraints of the system but from on outsider’s perspective it seems shocking that many medical roles have 12 hour shifts as common place and that engrained frameworks like this disproportionally affect women (which raises the question of why as well). I look forward to seeing the outcomes and further research stemming from this work.
‘Through others I examined myself’ was the central theme of Ana Baptista talk entitled: The transformative nature of Faculty development on self and others: some reflections. This talk was focused on self-assessment in education using a human factors framework and had an arts/philosophy focused delivery designed to stimulate further thinking. An interesting take on reflection from different viewpoints (we/I/us). Changing culture and practice can be a difficult task. Here a key message was that we spend so much time just reacting, rather than reflecting and talking action to improve education processes.
The next talk I attended was delivered by two Imperial medical students Arwa Hagana and Noura Houbby. This talk was centred about peer learning and how it has significant advantages for both the tutee but also the skill development and knowledge retention for the tutor. They additionally touched on drivers for why students get involved with such programs. Having experienced PEER learning myself, I completely agree that it is a great delivery mode for teaching.
The talk by Telak Ghosh focused on online meetings and pros/cons. This talk stimulated some interesting discussion and I completely agree that they are useful, timesaving and here to stay.
Linda Sonesson presented a case study about the development of complex scenarios for civilian/military trauma medical education and preparedness. I was particularly struck by the complexities required for these scenarios to be effective training tools for multi-team units.
In a very ‘Ready Player One’ vein Adam Misky talk discussed an application of virtual reality headsets and their potential future role in medical education. Many boundaries still need to be ironed out but new technology offers fantastic capabilities for learning and assessment.
Overall from the MERU conference I think the take away message was on REFLECTION on education and on our interactions with others. We all have a role to play in our environment and we, each individual, can make it a better place which fosters better learning outcomes.
Student Reflections on AMEE 2020 - Yuri Aung, Siddharth Basetti and Felyx Wong
Yuri Aung and Siddharth Basetti:
Attending the AMEE digital conference was a unique and novel experience. Although the conference was not in the format we had anticipated due to the COVID-19 pandemic, attending digitally was in fact really interesting and beneficial in other ways. The content of the conference, its speakers, presentations, posters and more were cutting-edge, and allowed us to reflect on our own experiences of medical education and its processes. We learned about and discovered novel outlooks on teaching and the various innovations taking place in medical education, and were exposed to educational researchers from all around the world. Not to mention, the simulated platform that AMEE hosted their conference on was amazing and extremely interactive! Indeed, who would have thought we could be walking around and interacting with so many people in a virtually simulated building? It was also great to be able to peruse the exhibitions, posters and live sessions in our own time. Finally, and most importantly, presenting our work on our MERU educational research projects, one on international medical electives and one on peer teaching, was a wonderful experience. Learning Toolbox was a new and exciting way of presenting our work, and it was amazing to see the diversity of poster formats available. Overall, we are extremely grateful to MERU – firstly; for allowing us this unique opportunity for mentorship and involvement in medical education research at our own institution, and secondly; for awarding us grants to attend this conference and represent Imperial College on such a large scale.
My experience at the AMEE 2020 Virtual Conference was enlightening and also refreshing. Attending academic conferences is often one of the first early exposures to research for university students, it is also a fantastic opportunity for us to explore our interests and future career directions. However, you are often financially constrained; the fact that some conferences where ‘student-friendly’ tickets may cost up to £90 (or even more) really makes you think twice about your decisions. The funding from MERU has granted me the opportunity to broaden my horizon; speaking to like-minded individuals from other countries and learning about their educational infrastructure was something that was really insightful during my time at the conference. Over the past few years, we have come to realise that there are often a lot of opportunities for students to teach. However, not a lot of support is offered for students interested in developing their teaching skills further. For me, teaching has always been something that I enjoy; I have come to realise that good teaching skills not only benefit you as a teacher, but it is fundamentally interlinked with other skills that are important for personal development (e.g., public speaking). During my time at medical school, my team and I set up a course to help students develop these core skills and wanted to use AMEE 2020 as an opportunity to further promote this practice at other institutions. Imperial is very lucky to have MERU’s support and nurture for the students who will become teachers of the future.
Clinical Teaching Fellow Reflections – Dr Lucy Williams, Dr Estelle Dcunha, Dr Ryan Laurence Love and Dr Ran Xiong
Dr Lucy Williams
During my full-time teaching year at Imperial, I attended both the MERU core and advanced workshops. These carefully crafted workshops were invaluable experiences to learn from experienced members of the academic and teaching community and apply these lessons to my practice. Importantly, they provided a regular opportunity to meet with like-minded junior educators and discuss our teaching and research ideas to receive feedback on these.
Previously, I had not undertaken any significant educational research but through the MERU workshops, I was fortunate enough to team up with a clinical teaching fellow (CTF) working at a different site and start a research project together. The guidance from Kay and our peers was crucial in the initial steps, particularly when designing the project and facing the daunting challenge of approaching multiple new experiences. I now feel more competent and comfortable in undertaking educational research and try to share this learning and these experiences with other work and social spheres.
Looking back, I can see how fortunate we were to have the MERU core and advanced CTF programmes in place to support us as junior educators and it truly inspired a sense of belonging to Imperial College and the wider academic community. Furthermore, I am pleased to say this feeling of belonging is ongoing; I am currently undertaking a different project with past and current CTFs and am still in touch with my colleagues from last year. MERU has provided significant support to our CTF Network and I believe this has helped ensure its sustainability so that I may continue to collaborate and work with these colleagues into the future.
Dr Estelle Dcunha
Starting as a novice medical education fellow this year was daunting. Developing new and transitioning existing skills to meet the challenges of facilitating medical student teaching sessions was difficult at the start of this job. Attending and completing the MERU course delivered by Imperial College London was key in supporting me through those challenges.
MERU provided me with the resources to create a strong foundation and helped me to develop skills to successfully engage in key aspects of medical education. It helped me focus on exploring the methods of effective lesson planning, techniques in the delivery of content and how to engage in designing appropriate assessments. The MERU course has been instrumental in shaping the way I have evolved my own educational methods. I am now better able to understand the needs of the learner and my own needs as a teacher. This course has been a vital first step in my journey as an educator.
Dr Ryan Laurence Love
During my time as an obstetrics and gynaecology clinical teaching fellow at Northwick Park Hospital, I was fortunate enough to be afforded the time to complete the MERU educators course. I firmly believe that my time with MERU has not only facilitated my development as an educator, but as a clinician too. In particular, during my day-to-day job as an O&G trainee in North West London, I can now regularly rely on the skills of presentation, audience engagement and collection of feedback that were so keenly focused on in the educators course.
From the first event I attended, my pre-existing experiences and interests in medical education were explored by the facilitators with a genuine fascination and appreciation – and I can honestly say that many of the ideas and thoughts that I previously held were challenged. It became immediately clear that MERU exists to promote high quality and effective teaching practices, and to explore new frontiers in medical education, and I wanted to be a part of that. The MERU community is friendly, endlessly helpful and collaborative.
In the short space of one academic year, with the help of MERU I was able to gain professional accreditation with the Academy of Medical Educators, design and be awarded funding for my own research project, and have my work accepted for presentation at an International conference. To cap it all off, I was also acknowledged with the ‘Outstanding Teacher’ award from the Imperial College Student Union. These experiences have been invaluable to me in my professional development and I can honestly state that without the excellent teaching programme and faculty within MERU, none of this would have been possible.
Dr Ran Xiong
Prior to starting my clinical teaching fellowship, like many others, my experiences in teaching were largely made up of informal peer-to-peer teaching for OSCES/PACES and from tutoring children. This meant MERU was an important part of my first exposure to educational theory which built up my confidence when starting my PGCert in Medical Education. It also provided me with valuable practical teaching advice as well as the opportunity to meet other teaching fellows, which definitely made learning more engaging and collaboration more fun. I had met two other teaching fellows in O&G through MERU, and throughout the year we had exchanged ideas on teaching and worked together on a research project on abortion care teaching. It's impossible to talk about MERU without mentioning Kay. Kay has been and is still incredibly supportive and always happy to help. She helped me with my fellowship application to the Higher Education Academy as well as guidance on our research project. I cannot recommend MERU's clinical fellowship course enough as a supportive environment to find your feet and developing into an experienced clinical teacher.
President’s Award Project – Sarah Herler
In the summer of 2020, a few days before I would receive my 1st year exam results, a message from one of our welfare representatives caught my eye. It was an advertisement for a staff-student partnership named: “Thriving, not just surviving: how do we build diversity and inclusivity into the undergraduate student experience in Faculties of Medicine and Natural Sciences?” What stood out to me the most about the project brief was not the name itself, but that it was a co-creation project. Although staff and student action are not to be understated in any way, I believe that it is extremely powerful when these two powerhouses collectively tackle the presenting issue. Either way, I knew that the project brief seemed to unlock several deep seated feelings which I had subconsciously accumulated over my first year of medical school. I immediately began to formulate my application, as terms such as “imposter syndrome”, “competition”, “representation” and “sexism” swirled through my thoughts. What began as a gentle current, rapidly evolved into a maelstrom of ideas and flashbacks of both shared and observed experiences during my first year of medical school. A few weeks later, I received the news that I would be working with four other first and second year undergraduate medical students, as well as Dr Ana Baptista and Professor Sue Smith from the Medical Education Unit in the Faculty of Medicine, and Professor John Seddon from the Faculty of Natural Sciences. The widely known saying “time flies when you’re having fun” could not be better suited to the six-week period that followed, in which I met with the student co-creators and staff twice a week to collectively produce a recommendation report detailing our interventions to identified biases within the medical school. It was especially enlightening to work together with other students in my year of medical school. I was able to further develop my empathy, through the hearing and understanding of others’ personal and shared stories. From the light-hearted tales of our lanyard-filled, innocent and confused months as freshers, to more heavy and profound stories of true resilience and strength in the face of adversity. A moment which will forever stay ingrained in my mind, was when one of the male co-creators shared that he had recently finished reading “The Bell Jar” by the fantastic Sylvia Plath, and, following an unrelated discussion with a female flatmate about some of her experiences as a woman, he had come to the realisation that the core themes of the book such as the hollow nature of conventional expectations, the restrictions placed upon women by society and the stigma related to mental health remains pervasive in today’s society. Only following this seemingly unrelated conversation, did he begin to make the connection between the constraints of modern society and those of the 1950s detailed by Sylvia Plath. This epiphany, as well as the collective enlightenment experienced by all members of the group following our conversations, led us to produce several interventions, some more intensive and resource-heavy than others, with the prime goal of sparking conversation, and ultimately: change.