Insights Medical student placement success: a nurse-led unit Alison Colhoun1,2, Hamza Ahmed3, Robert Lord1 and Gail Miles4 1 Rotherham NHS Foundation Trust, PGME, UK Sheffield Teaching Hospitals NHS Foundation Trust, UK 3 University of Sheffield, UK 4 BreathingSpace, Nurse-led Respiratory Unit, Rotherham, UK 2 Hospitals need to place more students without overcrowding clinical areas INTRODUCTION W ith increasing numbers of medical students and the UK General Medical Council requirements for quality placements for all,1 hospitals need to place more students without overcrowding clinical areas. We include a student perspective of the placement experience, and report our experiences of placing students within a nurse-led off-site specialist respiratory unit, which we think also helps address a gap in current education programmes to reflect the increasing role of out-of-hospital care models.2 BreathingSpace is a community service based in Rotherham for people with chronic obstructive pulmonary disease (COPD) and other respiratory conditions. The unit is situated approximately 2 miles from the hospital, with 20 in-patient beds and out-patient services. BreathingSpace offers: a pulmonary rehabilitation programme; home oxygen assessment services; respite care; hospice care; patient education; smoking cessation support; as well as supporting early hospital discharge and admission avoidance. A MEDICAL STUDENT EXPERIENCE The day at BreathingSpace begins at 0900 h and finishes 292 © 2017 John Wiley & Sons Ltd and The Association for the Study of Medical Education. THE CLINICAL TEACHER 2017; 14: 292–294 at 1630 h. My placement (HA) at BreathingSpace allowed me to develop confidence in practical skills, such as venepuncture, peak expiratory flow measurement and spirometry. Although BreathingSpace focuses primarily on the management of chronic respiratory disease, it was not uncommon to find patients with co-morbidities such as diabetes, ankylosing spondylitis and aortic stenosis. This made it extremely applicable and relevant to the end-of-year exams, providing a tremendous number of opportunities for history taking and learning basic examinations when compared with being placed on a specific hospital ward. The placement also offered opportunities to be the first clinician to review new patient admissions and present the findings to the specialist nursing staff. A timetable of learning opportunities is listed in Table 1. WHY WAS THE PLACEMENT CHOSEN? This nurse-led unit provided a previously student-free environment, with supportive and engaging staff. From a student perspective this provided greater patient to student ratios than an average hospital ward. Consequently, it provided more patients from which to take histories without the feeling that you were depriving other students of opportunities or inflicting boredom on the patient through excessive repetition. Similarly, the increased staff to student ratios resulted in what we felt was excellent and supportive supervision. There were numerous opportunities to ask questions when performing a procedure or considering the management plan: this is a luxury that is often not possible in a fast-paced hospital environment. This was supplemented by the greater accessibility to senior staff, allowing numerous opportunities to practise presenting case histories with greater room for discussion than we feel students would have had from a hospital environment. [The placement] provided greater patient to student ratios than an average hospital ward Intended learning outcomes matched those assigned by the medical school for students undertaking a general medical placement, and broadly covered competency in: history taking, examination, communication and practical skills. Students of all years were also encouraged to formulate patient management plans and actively participate in the multidisciplinary team. Table 1. Timetable of learning opportunities Day Morning Afternoon Monday Introduction to BreathingSpace Learning needs assessment In-patient assessment Practical Skills History taking Tuesday General respiratory clinic In patient assessment Practical skills Wednesday Phlebotomy Asthma liaison nurse clinic Nurse consultant clinic Thursday Phlebotomy Specialist interstitial lung disease clinic Oxygen assessment clinic Pulmonary rehabilitation Friday Medical consultant chest clinic Review of learning Reflection on experience HOW THE PLACEMENT WORKS To allow as many students to gain this experience as possible, we sent students on a rotational basis from their 3-week hospital placement (Figure 1). This method allowed more students to gain the BreathingSpace experience as well as experience in respiratory medicine in a hospital setting. During the other 2 weeks of the placement in hospital, students took part in acute medical ward rounds, out-patient clinics and Figure 1. Illustration of rotational method used © 2017 John Wiley & Sons Ltd and The Association for the Study of Medical Education. THE CLINICAL TEACHER 2017; 14: 292–294 293 Nursing staff competent at procedures could sign-off the students spent time with junior medical staff. Guidelines were written for both students and staff to identify learning opportunities and to set expectations. Students were expected to complete one Direct Observation of Procedural Skills (DOPS), for example venepuncture or cannulation, as well as one mini-clinical evaluation exercise (mini-CEX), for example presenting a patient history or formulating a management plan. Initially students reported concerns regarding the medical school acceptance of the completed DOPS and mini-CEX, but later the medical school confirmed that nursing staff competent at procedures could sign-off the students. The hospital has since received acknowledgement from the university regarding the success of the placement, and funding has been secured to support it. PLACEMENT EVALUATION Based on our experiences, we would advocate the use of alternative units to support medical education, highlighting the need for careful planning, supportive administration and enthusiastic educators. We urge other teachers to look for learning opportunities for their students, and advocate a rotational method to ensure maximum student exposure (Figure 1). We hope that this placement goes some way to So far 22 (third- and fifth-year) medical students undertaking their general medicine placements have been to BreathingSpace. The placement received positive feedback from both students and nursing staff. Many students fed back that this was the most enjoyable week of the 3 weeks, and wished that they could have been there longer. meeting the educational needs of students to experience out of hospital care models.2 LESSONS LEARNED • Off-site placements seem able to provide a supportive learning environment, with opportunities that can often be limited during hospital placements because of time and staffing pressures. • Rotational placements allow more students to gain the experience offered. REFERENCES 1. General Medical Council. Clinical placements for medical students. 2011. Available at http://www. gmc-uk.org/education. Accessed on 1 August 2016. 2. Klaber RE. Training and learning for the future: making change happen. Postgrad Med J 2014;90:183–184. Corresponding author’s contact details: Alison Colhoun, Rotherham NHS Foundation Trust, PGME, Rotherham, S60 2UD, UK. E-mail: alison.colhoun@hotmail.com Funding: None. Conflict of interest: None. Acknowledgements: Mrs Kay Jaques, Undergraduate Manager, PGME Rotherham NHS Foundation Trust. Ethical approval: Not required. doi: 10.1111/tct.12616 294 © 2017 John Wiley & Sons Ltd and The Association for the Study of Medical Education. THE CLINICAL TEACHER 2017; 14: 292–294