The Department of Primary Health Care and General Practice in Wellington is involved in teaching 4th, 5th and 6th year students in the Advanced Learning in Medicine (ALM) course, as part of the MB ChB degree.
The ALM course is the clinical component of the MBChb degree which takes place over the final three years of the degree. Students in their ALM years of their MBChB degree are split between Dunedin, Christchurch and Wellington. As part of this course groups of students will rotate through various block and vertical modules across different disciplines of medicine.
The Department of Primary Health Care and General Practice in Wellington convene and administer block modules in all three years of the ALM course, as well the Professional Development and Ethics vertical module which encompasses Clinical Decision Making. The department is also heavily involved in the Tairāwhiti Interprofessional Education Programme (TIPE) as well as the third year medical students Community Contact Week. Further information on these modules and programmes can be found below.
Teaching in the Department is research informed and drives educational research. Recent research topics have included the teaching of Chronic Condition Management, Palliative Care teaching, Interdisciplinary teaching and the teaching of Genital Examination. The courses are regularly evaluated and changes are made as needed.
The fourth year Primary Health Care & General Practice module is taught in conjunction with Public Health – each discipline taking primary responsibility for 5 weeks of the combined 10 week module. This involves clinical tutors in the community, as well as tutors from a number of different disciplines within the School.
The curriculum is similar to that covered in Christchurch and Dunedin Medical Schools, although the structure of the individual courses is different.
One of the most important components of General Practice is the consultation. As Franz Kafka observed: "to prescribe pills is easy but to reach an understanding with people is very hard." Students work in small groups with an actor and experienced clinical tutor to develop their consultation skills, which is also one of the key assessed areas in the program.
Management of common and long term conditions is taught within the medical student group and for some groups interprofessionally in conjunction with partner teaching and professional organisations. Students are asked to interview a patient living with long term conditions in the community and present their perspectives to their group.
End of life care is another important strand of the program with input from the hospital based palliative care team, the local hospice and patients.
Substance abuse issues are specifically addressed in this module, all students attend either an Alcoholics Anonymous or a Narcotics Anonymous meeting as well as tutorial-based teaching.
There are clinical sessions with patients in the community, provided in partnership with local general practices, and the Wellington Accident and Urgent Medical Centre.
Other areas of importance for Primary Health Care and General Practice are taught in small group tutorials.
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As part of the fourth year module students visit patients in end of life care and produce a piece of creative work based on this visit. This work can be found at The Art of Palliative Medicine
The fifth year Primary Health Care and General Practice module runs for 2 weeks and allows for consolidation of the principles of Primary Health Care and General Practice and preparation for the extended clinical placement in the Trainee Intern year.
Students are exposed to advanced General Practice concepts such as travel medicine, dermatology and management of sexual assault. Clinically focused preparation for the TI year includes learning skills such as prescribing, minor surgery and genital examinations. There is also a strong emphasis on professionalism including communication, medico-legal issues and interprofessional practice.
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The Trainee Intern General Practice module is a 6 week module, plus one week equivalent of Urgent Care experience which may be co-located or a stand-alone week.
Students will spend the majority of this module on clinical placement in General Practices in the lower North Island. Contracts are in place with a number of teaching practices in rural areas and provincial towns in the lower North Island to ensure students get the quality teaching and clinical experience necessary to meet the educational objectives of this module. Trainee Interns are sent placement options in August of the year prior.
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Professional Development and Ethics (PDE)
Professional Development and Ethics is a vertical module run throughout the student's 4th, 5th and 6th years. This module is convened by Dr Ben Gray and co-taught with Dr Angela Ballantyne (Bioethics Senior Lecturer.) This module introduces students to an 'Ethical Decision Making Framework' that it used throughout the programme to help students break down clinical ethics scenarios and understand how to integrate ethical principles into healthcare practice.
Ethical issues are a part of all clinical practice – in everyday, extraordinary and controversial situations. Teaching is through a mixture of whole class lectures, specialised tutorial sessions and reflective discussion groups focusing on professionalism.
The curriculum covers material on health law as well as material on main bioethical themes such as research, tissue donation, genetics, ethics and the elderly, ethics and children, abortion and mental health. Professionalism teaching looks at trust, healing, the student code of practice, advocacy for patients and how to manage patient confidentiality. The small discussion group sessions give the students the opportunity to discuss any ethical related issues that they may have encountered. As part of this module we collaborate closely with Dr Estelle Jaine the convener of Clinical Decision Making to enable students to put everything together and make sound ethical and clinical judgments. We aim to develop critical thinkers who can identify ethical issues, weigh competing values and justify their decisions with reasoned arguments.
Assessment for this module includes an ethics essay in 4th and 5th year, a clinical ethics essay in 5th year, a 4th year joint group assignment on clinical decision making and a 'Thought Provoking Episode Report' (TPER) in the students 4th and 6th year.
Tairāwhiti Interprofessional Education Programme (TIPE)
Health Workforce NZ funds this collaborative project with the University of Otago (UoO) and Eastern Institute of Technology (EIT) in Tairāwhiti. This very successful programme brings together undergraduate students from eight different health disciplines to learn and gain clinical experience working with Māori communities and other health providers in rural New Zealand.
TIPE is a fully interprofessional programme for senior health professional students which started in 2012 and includes students in their final year of study from Medicine, Nursing, Occupational Therapy, Pharmacy, Physiotherapy, Dietetics, Dental and Oral Health. As part of this programme Trainee Interns (final year medical students) are residents in Tairāwhiti or Wairoa for 6-7 weeks and will have a general practice clinical home whilst in Tairāwhiti. The IPE component of the programme runs for 5 weeks and is designed to provide a variety of experiences within a students own discipline, across other disciplines and within a variety of settings, (e.g. rural, chronic conditions management, and hauora Māori.)
As part of their studies all University of Otago medical students immerse in a small town or area (in small groups across South Island and lower North Island) for several days to learn as much as they can about that community and how wider health and social needs are being met within each of these smaller towns and areas . An emphasis of the week is on understanding how the community perceives its own health needs and how the special features of the community influence the way in which health care services are provided. These are NOT intended to be solely health care based visits. Each of the three Otago Medical Schools (Dunedin, Christchurch and Wellington) place about 100 students each.
Wellington CCW has been in place in its current form since 2009 and students are placed in one of the following areas: Newtown and surrounding areas, Porirua, Kapiti Coast, Wanganui, Palmerston North, Wairarapa, or Lower Hutt. During this week students will assess the needs of that particular community, access to local and secondary medical care, the range of other services in the town supporting health and well-being. This is an important aspect of being a doctor; learning how context and environment are crucial in causing and preventing ill health.
What do the students get from these placements?
"All of my experiences in the community were extremely positive, and I felt everyone made us feel very welcome. I think experiences such as these are all too rare in our course, and this program was by far the most enjoyable part of the third year course thus far."
"Seeing the problems in the community caused by gaps in the healthcare system. Also, witnessing the effects of domestic violence and substance abuse upon families."
"Gaining an understanding how different health organisations work together to care for patients, particularly outside of hospital. It was also really great to have some real world experience with patients that never end up in hospital, but still need a lot of care.""Getting to meet such a variety of people from different organisations. I really enjoyed the wide range that we visited such as the fire service, which was a really amazing experience, and then the farming school, the physio and the GP. It allowed me to get a variety of perspectives and I learnt something different from each place"