The Oncology Project

The Oncology Project

The Oncology Project Dr Robert Jones Reader and Consultant in Medical Oncology Cardiff University and Velindre Cancer Centre Oncology Project 2018-2019 Why is it important Learning outcomes Process Tutorials Patient contact Written portfolio Patient feedback

Marking scheme Student feedback Where to get information about the project Oncology Project 2018-2019 Patient as teacher Broad Aims of the project Help students learn to understand what it might be like to have a diagnosis of a life threatening disease

Inform their practise when working as a doctor Develop their communication skills Help them deal with their own issues which can arise when dealing with cancer patients Why is the oncology project important 40% of people will be diagnosed with cancer at some time in their life Factors influencing patients Media TV soaps

Magazines Charity fundraising Internet Cancer Back-up Family and Friends Why is the oncology project important? Whatever discipline of medicine you are in you will be responsible for managing patients with cancer Paediatrics Radiology Surgery Care of the Elderly

GP What do they need to know as a junior doctor? Acute Oncology emergencies Recognise Neutropaenic sepsis What do they need to know as a junior doctor? Acute Oncology emergencies Recognise Neutropaenic sepsis Recognise Spinal Cord Compression

What do they need to know as a junior doctor? Acute Oncology emergencies Recognise Neutropaenic sepsis Recognise Spinal Cord Compression Diagnose Pulmonary Embolus Manage GI complications of cancer treatment Student Guide On Learning Central Applied Clinical Sciences Patient Pathways Oncology Training Wales Website:

https://oncologytrainingwales.wordpress.com/undergraduate-medical-students / Learning Objectives Assessment Guidance for background reading Learning Objectives Improved Understanding of: Natural History of Malignant Disease Epidemiology/screening/pathology Treatment including Palliative care Impact of Malignant Disease and its treatment on patient/family/ carer

Physical/emotional/spiritual Decision Making in Cancer MDT Communication of risks and benefits of treatments Process Tutor allocated September Will run from September to April: hand in date mid April (TBC) 4 months to follow patient but extended deadline as some placements are in North Wales Cannot timetable alongside oncology placement

1 of 2 longitudinal patient reports Must achieve >50% Top 20% receive a certificate of merit (with HFD project) All students > 90% letter of commendation from Oncology Exec Board Velindre Hospital award Prizes for top 3 students Introduction/consolidation teaching for modules Year 3 Applied Clinical

Sciences Clinical Module Hospital Front Door Chronic Disease Oncology 8 weeks 4 Sep 25 Sep-20 Nov 14 May-9 July

Oncology Project September - April SSC 6 weeks 12 MARCH 8 Jan 5 March Deadlines dates

Process Tutor facilitates learning and offers support throughout project Work within groups of about 7 students Tutor will recruit suitable patients One to one relationship with a patient Follow a patient for about 4 months Tutor will run tutorials about one a month Tutor will talk through what should be in the portfolio Tutor with mark your project and provide some written feedback How does it work in practice? Talk to your patient as a person: the patient is your teacher

Go with them to clinics, investigations, treatment Ask about medical history, symptoms, medication, family circumstances Visit them at home once if at all possible Get to know them and their family over time Communicate by phone /email whatever the patient is happy with During the project Keep a good record of their interactions with the patient and family Document their reflections and thoughts as they go Keep notes/copies of tutorials/presentations

Understand the treatment the patient is receiving Describe toxicities and their management To attend an MDT meeting and reflect on what happened and what they learnt Observe patients having treatment such as radiotherapy, chemotherapy or surgery Sit with the patient when they attend clinics for review/results Work out the role the different professionals play and how they communicate with each other and with the patient/family Be critical- could anything have been handled better/how would I have dealt with the situation

Oncology Project Pack Oncology Project Summary (Learning Objectives) Velindre Map/Leaflet Activity Log for Oncology Project University want to know what you are doing Need to get permission to miss timetabled teaching Must submit the form by email to your tutor and TURNITIN when submit the project Letter for patient about patient feedback (English /Welsh) Patient feedback form

You will give this to the patient during the project and it will be returned to the tutor directly Can also be completed online if the patient is happy to do so FAQ Problem travelling to tutorials/clinic visits/patient home Discuss with tutor at the beginning if no access to transport Delay in allocation of patient Need to allocate appropriate patients Is the home visit essential?

Helpful but may not always be feasible or appropriate Intruding at a sensitive time? Written information leaflet Fully discussed by health professional responsible for their care Patients are keen to get involved 82% thought the project helped student to understand what it is like to be a patient with a serious illness 85% felt students valued the patients contribution 81% felt oncology project worthwhile experience for

students 62% patients felt is was worthwhile for them Patients comments (My Student) helped myself and my family through the most difficult time of our lives. We will always be grateful to her. (My Student) talked to me and treated me as a person when everyone else was just treating me like an illness. He reminded me that I still have a life outside cancer. Patients comments This project must continue for years to come. It gives the

students the medical insight and experience they need, but also allows them to see things from our point of view. It is clear to see that (My Student) is 100% cut out for this job. The way she handled the passing of my husband was professional yet compassionate Thank you. Activity Log for Oncology Project No designated time within the curriculum Please request release from your timetabled curriculum event Use your judgement about what is OK to miss either in curriculum or in oncology project

Ideally you Ask permission from the tutor of the timetabled event Ask patient/nurse/doctor to sign the attendance slip Please do not just miss a timetabled event without clearing it first The Portfolio and Marking Summary of patient history and developments over time Refer to the marking scheme Cross reference all learning sources Previous teaching Literature Websites

Patient information Treatment protocols and guidelines such as NICE Reflections 4000 (+/- 10%) word count Student name Project marking criteria Clinical History and Basic Clinical Knowledge Communication, understanding and decision making

Holistic Assessment of the patient Professional assessment of the student Quality of the written portfolio and reflectiion Scor e

Subtotal Concise summary of patient history including risk factors /4 /25 Concise summary of patient meetings /4

Treatment received and planned, including side effects /7 Diagnostic process, staging and prognostication, including screening if relevant /5 Pathology and molecular biology

particularly relating to your patient Decision making in the MDT /5 /5 Decision making from the patients perspective: a) Communication between staff and patient b) Between patient and carers /5

The Patients understanding of the risks and benefits of treatment /5 Psychological assessment the patient /10 /10 Coping mechanisms including religion and spirituality

/6 Hope and Fears /4 Loss and bereavement (including loss of function/health/independence) /6

Impact on social circumstances and access supportive services /4 Ability to develop a professional relationship with the patient and carers /8 Commitment, approach and attitude to the patient

/6 Commitment, approach and attitude to the tutorial /6 Grammar, presentation and referencing /5

Reflection /15 /15 /30 /20 /20 Feedback/comments

Demonstrate an understanding of the medical decision making process and the MDT 3% points I was unable to attend my patients MDT as this happened before I was introduced to the patient but I have attended other cancer related MDTs and they provide an opportunity for health professionals to discuss individual cases and decide on a treatment plan Score 1/3 I was unable to attend my patients MDT as this happened before I was introduced to the patient but I have attended other cancer related MDTs. A wide range of professionals were present including a respiratory physician, radiologist, surgeon, oncologist, clinical trials nurse, clinical nurse specialist and MDT co-ordinator. During the discussion all possible treatment

options were considered and the nurses ensured that the patients views are represented Score 2/3 add your own observation about how well/badly the meeting went was everyones opinion considered equally, were the views of the patient considered, was the discussion constructive Any criticism? time consuming, time taken to prepare for the meeting so very costly

Score 3/3 Side effects and management My patient lost all her hair after the second cycle of chemotherapy and she found this very distressing as she was reluctant to go out of the house Which drug was responsible? Do all chemotherapy drugs cause hair loss What can be done to reduce hair loss Was cold cap considered. What are its limitations What psychological support can be offered if patient experiences loss of

confidence or worries about body image Confidentiality patients must know that what they tell in private remains private Do NOT use patient name, initials, DOB in the portfolio Doctor/nurse should NOT be identified in the portfolio write-up the markers know their colleagues and it is not appropriate. Do not photograph/copy the notes Do not put identifiable material onto memory sticks or CDs Do not discuss patients in public areas such as corridors Do not keep patient name/address alongside their medical details

Student safety Use common sense when considering home visits with a patient. Do not agree to a home visit until you have met the patient, and if in doubt contact your tutor. Student support This is a challenging project for many Personal issues friends and family with cancer May get distressed if patient becomes unwell Not the usual doctor-patient relationship

more like a friend - but only for a few months May be difficult to move on at end of project Student Support 94% of students felt supported Students shouldnt be afraid to ask for support from tutors as an individual, if not within the group Steffanie is also available to guide you to the correct support

services Any issues, especially feeling inadequately supported: contact us STUDENT SUPPORT CENTRE [email protected] 029 2087 4844 Contacts Medical School Office Hannah Lister [email protected]

T:029 2068 8102 Education Department Velindre Steffanie Pothecary Medical Education and Development CoOrdinator T: 029 2061 5888 [email protected] Ext 4646 Velindre Hospital Medical Organisers Dr Rob Jones, Consultant Oncologist [email protected] Dr Jo Ocen, Oncology Registrar

[email protected] Student feedback Encouraged to complete the online feedback Presented at the annual tutor meeting Tutors are given individual feedback Helps us to improve if needed Written FAQs New tutor guidance Student comments enjoyed the experience of meeting a patient with

cancer on my own, rather than in a pair as it allowed me to face my fear of cancer my patient was the best bit.this project as a whole played a vital role for my enjoyment this year as it was very rewarding Student feedback 2017-2018

Tutor feedback 96% thought tutors were accessible 96% felt they had opportunities to discuss their perceptions of their patients issues The majority of tutors carried out 3-4 tutorials (57%) 78.4% didnt experience any difficulties in attending tutorials and patient-related Oncology Project sessions Student feedback 2017-2018 Learning

95% found that learning opportunities were ample (35%)/adequate 95% found opportunities to increase knowledge of patients with cancer were ample (41.5%)/adequate 87% found opportunities to increase understanding of the role of the MDT and support services available ample (37%)/adequate Student feedback 2017-2018 Patient care 80% feel more confident in approaching

patients with a life-threatening illness 75% feel more confident in dealing with patients symptoms and distress Feedback 81% received written feedback from their tutors 78% found the feedback useful Student feedback 2017-2018 Overall 74% felt adequately supported during the difficult stages of my patient's illness (22% N/ a)

97% felt their communication skills continued to improve 87% felt the learning outcomes were completely/largely achieved SHO tutor feedback comments Very accessible, was easy to ask questions and got good responses. They knew information on our patients so could give

us more information Engaged well with the group -Allowed us to highlight any concerns about our patient Tutor was very approachable and tried to find a time to suit the whole group Excellent organisation, very accessible and useful when I encountered difficulties with my

Patient Very easy to get hold of and willing to discuss any problems with the project. Well structured tutorials too! Deadline dates enjoy 54

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