Background to development of course
The course operates in the St Matthew’s inner city housing estate, Leicester. The estate, with a ward Jarman index of 64.1, has substantial housing problems, social disadvantage, and unemployment, and many residents have unhealthy lifestyles. A multiagency approach to these problems resulted in the establishment of a centre through which statutory and voluntary organisations and residents communicate more effectively. Multiagency teaching experiences for professionals are provided, and this course is one outcome of this collaborative work.
Development of course
A proposed structure developed by the authors on problem based principles7,8
was presented to members of student and staff committees and to 16 of AL’s teaching groups from years 1 and 2. The proposal included the outline course, including objectives, teaching method, clinical presentations, agencies involved, timetabling, presentations, assessment, and feedback. The purpose of the course and its place in the curriculum were explained. Students understood that they were to refine the course. Their reactions were gauged with a semistructured questionnaire incorporating a 5 point Likert scale. Students were also free to add comments.
All 19 students completed the questionnaire, giving 341 qualitative comments. Table shows how the students’ input helped us to refine the course.
Table 1 Outcome of student involvement in course development
The aim of the course was to use the social and behavioural sciences and the humanities to enable students to gain a richer understanding of the individual patient: to show the range and roles of professionals working to meet the health needs of the population; to develop in the students an understanding of the contribution of economic, practical, and environmental factors in the causes and prognosis of illness and in the use of services; and to provide learning experiences and an exposure to diverse common health problems not normally seen in secondary health care.
The medical students took the course in semester five. About a third of their curriculum had been spent studying human behaviour, psychosocial aspects of health, epidemiology, and communication skills. For the course the students worked in groups of three or four, but were part of a larger cohort of 24.
Each group of students conducted a 45 minute interview with their patient, in three cases in the patient’s home. They aimed to identify the patient’s health problems and the impact of these problems on the physical, psychological, and social aspects of the patient’s life and family. The patient’s priorities and attitudes, as well as their relationship with the agencies, were explored.
The groups then undertook four 20 minute interviews with the agencies involved in their patient’s care. The students discussed points from the patient’s history and the role and links of the agencies in the community. They explored the strengths, weaknesses, accessibility, and priorities of the agencies for their patient, comparing these with those identified by their patient.
Each group had to control its own progress, with experienced health visitor tutors available for facilitation. Each student had a workbook (containing the timetable, reminders on communication skills, the key objectives of the interviews, and how to create a management plan) and a resource pack (containing comprehensive information on primary care, the case histories, and the agencies involved). Each group’s set of experiences was unique, the learning potential being maximised by presentations to the whole cohort.
A management assignment formed the basis of the students’ individual assessments. The student had to interpret accurately the information gained during the interviews and make management decisions.
The St Matthew’s community was involved from the outset through established multiagency networks. Patients and organisations were told about the course structure and their role in the interviews. Patients, particularly those with mental health disorders, were carefully selected to ensure that the course experience would not be detrimental. Where possible, the key agency worker involved with the patient was chosen to participate.
Patient case mix
Table shows the details of the case mix. Criteria used for selection of case mix were (a) wide age range; (b) a range of patient compliance; (c) a range of diseases (physical and mental); (d) social consequences of illness (poverty, unemployment, single parenthood, and isolation or loss of independence); (e) patients articulating health priorities differing from those of the community services; and (f) patients involved with various community organisations.
Details of cases and of professionals and agencies involved
A questionnaire requesting feedback was distributed to all participating students at the end of the course. The questionnaire asked about the course structure, teaching method, tutor, suitability of the patients and agencies, and presentations. It also asked students to comment on the future development of the course, its place in the curriculum, and links with theoretical teaching. A 5 point Likert scale was used for responses (only positively phrased questions were asked). Students were invited to add comments throughout the questionnaire.
Feedback questionnaires were also given to the patients and agencies taking part.