Sex, Drugs and Alcohol;

bringing communities to life in the MBBCh programme

Professor Kamila Hawthorne, Cardiff University Dr Lucy Jones, Cwm Taf Health Board Dr Alan Stone, Cardiff University

To create great doctors, who understand patients and the world in which we all live - C21 Mission Statement

Many routine patient presentations have their roots in social factors that affect lifestyle choices and health outcomes(1). Medical Students (and their teachers) value the biomedical perspective and often forget the social and psychological determinants of health(2). This results in a misalignment of expectations and objectives with their patients(3). Tomorrows Doctors 2009(4) requires medical curricula to include significant psycho-social scholarly content, so graduates can understand the factors underlying many common medical presentations to doctors. The problem for medical educators is how to link this to clinically relevant examples that enable students to recognise its importance(5). Experience in other institutions shows that this type of learning can be highly effective(6)(7).

The CBL, clinical situations, anatomy and lectures fit one another wonderfully. Learning has been greatly enhanced and helpful to put into long term memory - Year 1 Medical Student

Students learn their biomedical science content in Years 1 and 2 via a series of virtual clinical case scenarios. These cases have been selected so that the aligned off campus learning can include role play on sexual health issues, seminars on raising awareness of domestic violence and visits to a variety of drug and alcohol services across South Wales (including Cardiff Prison). Visits to patients homes, amongst many other learning opportunities, has also enabled students to appreciate the social context of illness and disability. Engagement with local service providers has been enthusiastic and highly productive. Formal evaluation of the student experience is ongoing which will inform future development of the programme. Initial feedback has been positive indicating that students appreciate linking their biomedical learning with real the patient contexts.
References 1. 2. 3. 4. 5. 6. 7.

The C21 Community Clinical Learning programme is making that linkage from the first year of the MBBCh course. The challenge has been to enable students to appreciate the importance of these social and psychological perspectives in the development and experience of illness. We also tackled the important risk behaviours associated with sex, drugs and alcohol. Obstacles included the logistics of finding quality clinical learning opportunities for 300 students over a 2 week case window. We used a multitude of placements across rural and urban South Wales and engaged with Local Health Boards (LHBs) and busy clinicians in delivering these learning seminars. With their help, and contribution from colleagues in the Schools of Psychology and Social Sciences, we have designed course content that relevantly links these clinical placements with concurrent on campus biomedical science.

Social Determinants of Health; The Solid Facts , 2nd Edn. Wilkinson R. and Marmot M. The World Health organisation http://www.euro.who.int/__data/assets/pdf_file/0005/98438/e81384.pdf Ewan C. 1988 Social issues in medicine: a follow-up comparison of senior-year medical students' attitudes with contemporaries in non-medical faculties. Med Educ. Sep;22(5):375-80. Knight A. 2013 Patient-centred prescribing. Aust Prescr 36:199-201 Tomorrows Doctors 2009 http://www.gmc-uk.org/education/undergraduate/tomorrows_doctors_2009.asp Yardley S et al 2010 What has changed in the evidence for early experience? Update of a BEME systematic review Med Teach 32(9):740-6 Chastonay P, et al. 2013 Development and evaluation of a community immersion program during preclinical medical studies: a 15-year experience at the University of Geneva Medical School. Adv Med Educ Pract. Apr 22;4:69-76 Jarris YS, et al. 2012 A preclinical medical student curriculum to introduce health disparities and cultivate culturally responsive care. J Natl Med Assoc. Sep-Oct;104(9-10):404-11.