University of Leicester Medical School syllabus for teaching with PKB

Vision

• To prepare medical students for 21st century healthcare in which the medium of communication will include:

  • asynchronous remote text-based consultation

with

• patients having access to all their healthcare records, including test results, and

• patients having the means to interpret their test results with Internet-based interconnectivity.

Purpose

Skills

• How to manage asynchronous remote text-based consultation as opposed to control synchronous in-person oral-based consultation.

• How to develop a relationship, understanding and empathy with the patient in an environment of asynchronous remote text-based consultations.

Knowledge

• Understand the difference in the dynamics of asynchronous remote text-based consultation and synchronous in-person oral-based consultation, such as when and how to close a consultation.

• Understand that illness is not the same as disease, and that peoples’ experiences (i.e. illness) of a disease varies between people and over time.

Delivery

• Students were allocated to study groups of about 8 students.  To facilitate effective group dynamics, each student completed a Belbin Self-Perception Inventory so that their study groups could be Belbin-balanced across their cohort year.

• ‘Patients’ were initially administrative staff operating behind an allocated avatar profile with questions given to them by the academic staff based on what they had taught the students in the previous week.  By the end of the first semester, students worked out that this was happening and the lack of authenticity reduced the students’ engagement.

• When real patients and carers were involved, the students’ engagement improved significantly.  So, the rest of this document refers to when real patients and carers were involved.

• Administration involved:

  • recruitment and vetting of patients or carers

  • training of patients or carers together in a single location (so that they can learn from each other)

  • allocation of patients or carers to student study groups (each patient or carer had one student study group and each student study group had one patient or carer)

  • setting up of accounts in PKB for:

    • individual patients or carers

    • individual students

    • groups of students based on their study group

  • monitoring of the interactions between patients or carers and the student study groups.

• Patients or carers were introduced to their student study group in person at the start of the academic year.  They were allowed to converse freely with each other for about 30 minutes so that they got to know something about each other and not just a ‘label’.

• Patients or carers and their student study group used PKB to interact with each other for the rest of the academic year.  The patients or carers were told to interact with the student study groups using their personal real life experiences.

• Patients or carers were brought back to see their student study group in person at the end of the academic year.  They were allowed to converse freely about their experiences in the past year, whether or not they involved PKB, so that the students shared what it was like being a medical student in the past year, whilst the patient or carer shared what it was like being a patient or carer in the past year.

Requirements

• Study groups of between 4 and 8 students kept together throughout the period of study:

  • a minimum of 4 students is to enable a discussion with varied perspectives with the need for negotiation should there be different views within the group

  • a maximum of 8 students is to reduce the likelihood of more than two subgroups forming in the group.

• Patients or carers needed to commit to initiating an interaction at least once a week when students were present for teaching at the University (i.e. during the term or semester).

• Students needed to commit to:

  • responding to their patient or carer within two working days (i.e. excluding weekends and statutory holidays)

  • discuss within their study group as to how to respond

  • rotate the student who responds on behalf of their study group.

This syllabus has been written by Dr Ronald Hsu
Retired Associate Professor of Epidemiology and Public Health
Leicester Medical School

Example of questions

The following are questions that patients were suggested to ask students:

1. How do body builders develop big "pecs"?

2. My [adult relative or adult friend] has been told that they have angina. The cardiologist has said that they may need to stent one of the coronary arteries or possibly do a coronary artery bypass operation if more than one artery is involved. Where exactly are the coronary arteries and what has happened to block them up?

3. My family are [religious belief] and my [elderly relative] passed away. The doctors are asking permission to conduct a post-mortem. Is this really necessary? Who benefits from this? Can this be compatible with my religious belief?

4. What is the difference between saturated and unsaturated fatty acids? What do they do for our cells? Do we really need to have both in our food? Can we not eat just saturated fatty acids and unsaturate them in our bodies, or saturate unsaturated fatty acids?

5. I was told that medical research has shown that it is possible to live forever if our cells stopped from dying. How do cells die? Why do they die?

6. My [adult relative or adult friend] has been prescribed amiloride by a hospital doctor. What does it do? How does this work? They are already taking spironolactone as a repeat prescription from their GP

7. Why do women need to feel in their armpit?

8. My [newborn relative or newborn friend] has been born with a "hole in the heart". They mentioned "VSD". Apparently they detected a loud murmur, but they have said there is no need to operate and will just monitor his progress. Is this OK? If the murmur is loud does this mean it is bad?

9. My [relative or friend] had a bee or wasp sting. It swelled up and really hurts. Why does it swell up? What is its purpose as all it seems to do is hurt a lot?

10. A biology [student or teacher] told me that cells are negatively charged inside. How does that happen? Where does all the positive charge go?

11. Why are some people's limbs longer than others?

12. When testing for sensation, why do doctors use both a tissue and needle?

13. My [adult relative or adult friend] fainted a few times recently and the GP has suggested that it is a "vasovagal response". He mentioned the "vagus nerve" and the "autonomic nervous system". What are these and how do they affect the heart?

14. My [adult relative or adult friend] has been told to take two antibiotics to treat a germ so that they do not get stomach ulcers. What is the germ? How does the germ cause ulcers in the stomach? Can I catch the germ off them?

15. My [adult relative or adult friend] has been told that they have too much potassium in their blood and this would affect how their cells work electrically.  How does that happen?

16. I heard that sometimes heroin drug addicts are given buprenorphine rather than methadone because it is a "less effective" form of heroin. What do they mean when they say "less effective"?  Why don't heroin drug addicts just take lots of buprenorphine if it is "less effective"?

17. Why does a bad back make the back of my thigh hurt?

18. My [relative or friend] has psoriasis. How is this different from eczema? Are they both inflammation of the skin? If so, surely their treatments are the same?

19. What is a sprain and why does it hurt?

20. My [adult relative or adult friend] has been told that their arterial blood pressure is too high. Is arterial blood pressure the same as blood pressure? What does systolic blood pressure and diastolic blood pressure mean?

21. Why does the hand change shape in osteoarthritis?

22. How does the kneecap tendon work?

23. I heard that smoking leads to blockage of blood vessels. How does that happen? Does this affect all blood vessels and all body parts equally?

24. According to Wikipedia, Viagra increases cGMP. What is cGMP? What does it do? Where does it occur?

Sore throat case:

Presenting Symptom, i.e. presenting concern in first message:

Sore throat.

Site of Symptom, i.e. response to question “Where is it?”:

In the back of my throat, under the angle of my jaw and down the side of my neck.

Quality of Symptom, i.e. response to question “What is it like?”:

Burning.

Intensity of Symptom, i.e. response to question “How bad is it?”:

Neck aches all the time.

Timing of Symptom, i.e. response to question “What is its duration, onset, progression, variation?”:

Started this week.

Aggravating Factors, i.e. response to question “What makes it worse?”:

Eating and drinking, especially foods such as toast or crisps.

Relieving Factors, i.e. response to question “What makes it better?”:

Paracetamol helps a bit.

Ibuprofen seems to be better.

Aspirin gargles give only temporary relief.

Secondary Symptoms, i.e. response to question “Any other symptoms?”:

Feverish.

Dry cough.

Slight earache.

Voice becoming husky.

Additional Symptoms, i.e. information volunteered only if directly asked for:

None.

Ideas, i.e. information about your own ideas only if directly asked for (you may make up some of your own):

I think I have an infected throat.

Concerns, i.e. information about your own concerns only if directly asked for (you may make up some of your own):

I am concerned that I will have to put up with this sore throat for a long time.

Expectations, i.e. information about your own expectations only if directly asked for (you may make up some of your own):

I would like to have an antibiotic to speed up my recovery.