Clinical teaching and learning on the job with ‘real’ patients is at the core of medical education. Most healthcare professionals have been on placements and had the opportunity to experience a specialty to see if it ignites their passion for learning and future career aspirations.
I have been teaching undergraduate medical students at Leeds University for 14 years in my role as a GP partner. Since 2018 I have also run a medical aesthetic clinic with my team consisting of a plastic surgeon, pharmacist and two therapists. Many of the students on GP placements show a keen interest in my aesthetics role, so it seemed a natural progression for me to consider how I could offer placements for them in my aesthetic clinic.
By involving fifth-year medical students in aesthetics, it is hoped that we can raise awareness of this exciting speciality amongst medical schools and undergraduates who are early on in their career. A placement in aesthetics allows students to gain an understanding of the skillsets that are necessary to become competent professionals, better their knowledge of the types of procedures performed, and identify if this career path is for them.
While you may be interested in teaching students in your clinic, it can be difficult to know how to put this thought into action. To begin my journey, I contacted Leeds University School of Medicine and offered elective placements for any fifth-year students interested in aesthetics. In my initial email, I explained what aesthetic medicine involves and how it is evolving. This helped the School of Medicine understand this relatively new specialty, and why it’s so important to provide students with the opportunity to explore it. In particular, I highlighted that the specialty attracts a breadth of experts – GPs, surgeons, dermatologists, dentists and nurses – and emphasised the crossover of skills between traditional medicine and aesthetics. Universities want reassurance that its students will be in a safe environment, with educators that have the skills to teach and nurture,1 and are being taught skills that will help them meet the professional standards as set out in documents such as GMC Good Medical Practice.2 As such, the university tutors were signposted to the BCAM, BCAN and JCCP websites so that they could see that aesthetics is a growing and serious branch of medicine. I also listed the potential areas of learning that students could gain experience in, such as aesthetic consultations, skin conditions, minor surgery, and head and neck anatomy. I provided a sample timetable to give an overview of what the learning may involve. Opportunity for projects/audits such as writing up a case-based report for publication or auditing impact of treatments is attractive for students looking to gain some additional experience in writing skills, so I also included the possibility of this.
As a result, the School of Medicine approved the clinic initially for elective placements and I had students spend six weeks with us over the summer. By preparing an engaging placement we were able to make it rewarding for both ourselves and the students.
Students interested in the placement submitted their CV and reason for wanting to spend time in aesthetics, and in total we had seven apply. After a telephone discussion to fully understand their motivation and what they hoped to gain from the placement, three students were chosen to attend from July to September. We limited numbers as this was the first time we had medical students attending.
Preparation and setting out clear objectives were imperative for an engaging placement that was rewarding for both students and tutor. We planned a four-day per week placement over six weeks and planned to utilise a range of teaching methods, from direct patient consultations to tutorials, to keep the placement engaging.3
The students were allocated teaching with clinicians for two days per week, one day with the therapist and one day doing their own research, study, reception, and admin at the clinic.
As adult learners, the students were involved in setting their own learning objectives and were expected to participate in patient consultations. Objectives set included: learning how to conduct an aesthetic consultation, building on facial anatomical knowledge, and understanding how to run a business. The placement involved a combination of teaching methods, but predominantly used ‘real patients’ where students progressed from observing to conducting consultations using an apprenticeship model.4
There were many opportunities to take aesthetic medical histories and understand the importance of eliciting a patient’s ideas, concerns, expectations, and motivations as it forms the basis of developing trust and a treatment plan that meets patients’ expectations – an aspect of aesthetic medicine that is important to get right. Fifth-year students are at the end of their undergraduate training and usually skilled enough to conduct solo consultations and present the case to the clinician in charge of the patient. Being involved in the assessment and treatment planning of the patient further involves them in that patient’s journey, helping them to learn about the nuances of treating patients in aesthetics.
The students learnt about common skin conditions, the ageing process, and its anatomical basis, and how we address patient concerns. They were not allowed to inject toxin or fillers but were given the opportunity to learn about the different types of filler, types of toxin, how to reconstitute and assist in many surgical, injectable and therapist-led treatments.
As part of the placement students were encouraged to write up a short case-based discussion around an interesting case study or conduct an audit for submission to the university. Topics chosen included a patient with scleroderma wanting dermal fillers for ‘smoker’s lines’, and an audit of the use of botulinum toxin for medical conditions within the clinic. The topics were chosen by the students where they had found an interesting case or an area that they wanted to explore. Writing reports such as these helps students to develop useful writing skills and provides them with a platform to be involved in scientific writing.
Exposure to the business side of aesthetics was gained by participating in reception desk duties, being involved in invoicing, and being part of team meetings.
Feedback from students
By the end of the placement student feedback was positive overall. We had comments like, ‘the opportunity to have a placement in aesthetics is sparse so it was really valued’, ‘I developed a more well-rounded understanding of the similarities and differences between aesthetics and other branches of medicine’, ‘I have a better understanding of the ethics involved’, and, ‘I am now more well-informed as to whether to embark on a career in this field’.
Benefits for your clinic
Not only do aesthetic placements benefit medical students, but they can also benefit you/your clinic. Inevitably, teaching inquisitive, young minds leads to an improvement of your own knowledge, a need to keep updated and overall having to ‘raise your game’. Indeed, those that provide clinical teaching report greater job satisfaction and morale as teaching provides variety.5 These benefits extend to the wider team, including therapists, who can be involved in teaching as they are often a font of knowledge on areas such as energy-based devices.
We found our placement students to be very keen and enthusiastic. They can offer a useful pair of extra hands in managing patients and as fifth-year students, they had the skills to take a thorough, detailed medical history from a patient so that when the clinician starts the consultation there is a lot of information to hand.
In addition, having an affiliation with a University brings with it a certain kudos and stamp of approval. It’s a great advertisement to your patients that you and your team are knowledgeable enough to be teaching future healthcare professionals, in turn helping to build up patient trust in your clinic.
While having a student placement is extremely rewarding, there can be challenges when it comes to organisation. Teaching is time consuming and when you are trying to run a business, and time is money. In my experience, renumeration from universities will either be nil or minimal, so teaching undergraduates has to be done by those with a passion to pass on their skills and expertise. Time constraints and impact on finances can be managed by offering a limited number of placements e.g. one six-week block per year or offering a regular day per week but over a longer time frame.
Knowing in advance when our students were spending time at the clinic enabled us to ensure they were timetabled in with the correct clinician/therapist to get the most out of their placement.
Other capacity issues which may prevent teaching are concerns around being a single-handed practitioner, however single-handed practitioners can offer a fantastic teaching experience as very rarely will students get one-to-one training. Remember every patient interaction or treatment can be a teaching opportunity – simply asking them to take the calls and deal with patient enquiries teaches students a myriad of communication skills.
Many clinicians will have no specific training in teaching but should not be put off from exploring teaching opportunities as clinicians usually already possess a number of skills that make an effective teacher – approachable, knowledgeable, enthusiastic, good role model.6 Training modules in teaching are easily accessible from sites such as e-Learning For Health (free for NHS staff) and the Royal Colleges.7 These can provide an understanding of how adults learn, different teaching methods and how to adapt your style. As well as the longstanding red-brick universities, remember there are also a number of newer schools of medicine that may be looking for innovative placement ideas. Teaching undergraduates doesn’t have to be limited to medical students as nursing, dental and other allied healthcare undergraduates could also benefit. Teaching healthcare undergraduates from different backgrounds is possible so long as you are able to understand and meet the teaching requirements of that group.
Remember to also check with your insurer whether you require any amendments to your insurance e.g. employer’s liability.
Share your knowledge
Having undergraduate students come to spend time in aesthetics clinics sends out the message that increasingly, science and evidence-based decisions underpins what we do in aesthetics. By reaching out to those starting out in their careers, we can hopefully encourage a desire for high standards, attract practitioners who want to strive for excellence and are patient centric, whilst at the same time adding a rewarding dimension to our day jobs.
Ultimately, I felt that this was a small step towards improving the perception of aesthetic medicine to those on the outside and helping shape the minds of those already showing an interest in this field. Our team found the whole process enjoyable, and we are really looking forward to welcoming our next undergraduate student.
1. GMC, Promoting excellence: standards for medical education and training -GMC, 2015, <https://www.gmc-uk.org/-/media/documents/promoting-excellence-standards-for-medical-education-and-training-0715_pdf-61939165>
2. GMC, Good Medical Practice – duties of a doctor, <https://www.gmc-uk.org/ethical-guidance/ethical-guidance-for-doctors/good-medical-practice>
3. Peter online, Washer, ‘Teaching medical students’, 2011
4. The apprenticeship model of clinical medical education: time for structural change The New Zealand Medical Journal, 2017
5. S Hartley 1 et al., ‘Influence on general practitioners of teaching undergraduates: qualitative study of London general practitioner teachers’, British Medical Journal, 1999
6. Shvaita Ralhan et al., ‘Effective teaching skills—how to become a better medical educator’British Medical Journal, 2012
7. ELH, E-learning for healthcare from NHS Health Education England, <https://www.e-lfh.org.uk/>