The Royal Derby Hospital

Taken from NRAS Magazine: Autumn 2013

Kate Gadsby (Advanced Clinical Educator and Nurse Specialist): I have been qualified for 29 years and before coming to rheumatology I worked in cardiology, general medicine and renal dialysis and transplantation. I started working in rheumatology 24 years ago and have been privileged to have been able to develop the nurse specialist role to an advanced level. About 10 years ago I was asked to deliver rheumatology teaching, within the department, to medical students from the University of Nottingham medical school.  Since then I have combined my rheumatology specialist nurse role with that of the teaching role. As you can see below, the team has expanded from just me to me and the five other rogues who I work with.  We support all the rheumatology consultants in Derby in different ways, both with the teaching and in our own specialist field. I can honestly say that we are delivering true multidisciplinary teaching to the medical students that hopefully will create a better awareness of their allied health professional colleague’s skills. I think I probably have the best job in the world and the thing that makes it so good is the patients who I work with and for, and my supportive colleagues.

Joanne Rayner (Senior Clinical Educator and Occupational Therapist): I have been qualified for 17 years and have worked in several clinical areas. I have always had an interest in rheumatology and have worked as a clinical educator in this speciality for eight years. It’s rewarding to work together with the students and volunteer patients.

Sue Kennedy (Senior Clinical Educator and Physiotherapist): I have been qualified for 29 years and have a background in upper limb physiotherapy and education. I have a special interest in progressive strength training in patients with rheumatology conditions.

Clare Webb (Senior Clinical Educator and Occupational Therapist): I have been qualified since 1997 and have worked as an OT in many different specialities around the country including rheumatology. I started work at the Royal Derby Hospital in 2009 teaching medical students in rheumatology. I love the mix of patient and student contact.

Adam Munks (Senior Clinical Educator and Nurse Specialist): I am a former paratrooper who has worked in nursing for the past 12 years within orthopaedics and am one of the Trust’s spinal injury specialists. I have been in rheumatology for a year and have enjoyed the new challenges this brings.

Sandra Haywood (Clinical Educator and Staff Nurse): I am a registered nurse qualified for 18 years and clinical educator for four years. I enjoy the mixture of patient care and facilitating students.

Teaching medical students happens for almost 52 weeks per year.  From February to June we teach the students in their first experience of clinical practice (CP1) followed by the more senior final year students in their final clinical practice year (CP3).  This article was written during our CP1 weeks when we have 12 students a week for 14 weeks, so repeat the same timetable each week. Some people might think this is perhaps a bit repetitive like ‘Groundhog Day’, but each week we see different students and have the assistance of different volunteer patients to make every week different.

Monday

The week begins with coffee and a team chat at 8.30am while we plan the week ahead. Half an hour later the students arrive and Kate welcomes them to the department explaining the timetable and giving them a guide to the rheumatology department. After that the hard work starts with our first rheumatology patient workshop where the students will take a history of the patient before presenting their findings and discussing the inflammatory process and management of RA with Dr Deighton* who has taken time out of his busy presidential duties to join us for some teaching and clinical work! (*as well as being a rheumatology consultant in Derby, Dr Chris Deighton is also the President of the British Society for Rheumatology)

Finally it is lunchtime, although it is certainly not a lunch ‘break’. We all get together to grab a bite to eat and catch up on our morning’s work. Kate also uses the opportunity to complete the prescriptions for her patients who are on anti-TNF drugs and who need repeat prescriptions.

In the afternoon Adam and Sandra both run a nurse led clinic while the students look at cases of different rheumatological conditions. They need to think of possible differential diagnoses and the investigations they would want to order to confirm the diagnosis and what a typical management plan for this patient would be. Next we do what we call ‘spectrum of conditions quiz’ where points mean prizes for the students who aim to get the answers right and in the quickest time. It is amazing how the reward of sweets can encourage education!

The day ends at 4.30pm and Adam goes home to get ready for his JuJitsu training while Kate, Clare and Sue walk their dogs and Jo takes her sons to water polo.

Tuesday

Tuesday morning is our staff planning meeting where we discuss forward planning of teaching, new changes to our workshops and any evaluations we have done or need to do.
Sue will then meet students on the orthopaedic wards to take histories and discuss orthopaedic issues. Clare meets patients who have been invited in for history taking sessions. Jo and Kate go on to the day case unit for students to take histories and practice clinical skills such as cannulation. Emphasis on the histories taken on the day case unit is not so much on disease activity but rather on the psycho-social side of disease and the effect rheumatological conditions can have on a person’s life, both at home and at work.

Tuesday lunchtime is slightly more relaxed and Clare, Jo and Kate take the opportunity to escape the confines of the hospital to get some daylight and exercise by walking around the perimeter.

In the afternoon the students watch a video and practice using the GALS (gait, arms, legs and spine) examination on each other before trying it out on patients with pathology. The aim of this session is to help students recognise the normal range of movements of the joints and to identify different rheumatological conditions.

Before the day is over, Kate attends the departmental management team meeting.

Wednesday

Wednesday is a busy day with Kate juggling day case patients, joint injections and teaching the students often all at the same time. Several students visit the consultants in clinic to observe how things are run and how the patients are managed.

Again there is no lunch break as Kate catches up with consultants and colleagues regarding research projects and future plans.

The afternoon begins with Sue and Clare running an outpatient clinics in OT and physio while Sandra books patients for upcoming sessions and Adam catches up on professional development, an important part of the continuing education process for all healthcare professionals. Kate catches up on management and clinical issues before finishing her NHS work for the week.

Once the day is over, Kate dashes off to attend her Pilates class with her    husband, whilst Sue goes home to walk her dog before it gets too dark to be alone on the country roads.

Thursday

Students arrive and are split into groups to have a mixture of day case, invited patients and orthopaedic work depending on what has been covered previously in the week.

There was a bit more of a break on this particular Thursday as a member of staff was retiring so there was plenty of cake, Excellent! Jo and Clare then went for their walk round the outside of the hospital to try and move that cake from their hips!

In the afternoon, all the students had to attend an osteoporosis workshop. We discuss the definition of osteoporosis, risk factors, management and provide a patient’s perspective of living with the condition. This is carried out using a mixture of interactive quizzes, history taking and powerpoint presentation.

Jo sets up for an evidence based patient education group for a small group of patients to learn about RA and learn new ways of managing their lives in order to deal with the condition.

As Thursday draws to a close it is the end of the paid working week for Clare and Jo although not necessarily the working work as they begin their chores at home and taking care of their families.

Friday

The final day of the week begins with Adam and Sue finalising any student issues including the signing off of the students log books. Before carrying out an interactive presentation on interpreting musculoskeletal x-rays. Students learn a simple approach to interpreting x-rays and then try to identify any abnormalities in some patient x-rays before leaving the department to return to the medical school for further teaching.

In the afternoon, Sue carries out her NRAS Patient in Focus award winning resistance exercise class for people with RA within    the physio department.

At the end of the day everyone looks forward to the weekend ahead and Sue takes the opportunity to Skype some of her family.