Community and Rural Education Route (CARER) Programme

Aerial view of Aberystwyth showing the locations of Bronglais Hospital, Aberystwyth University and the Healthcare Education Centre

The CARER (Community and Rural Education Route) programme, run in partnership with Aberystwyth University, will give third year Cardiff medical students the opportunity to have a year of their education delivered in GP practices and a hospital in Mid Wales, giving them invaluable experience of working closely with clinicians and patients in community settings.

As Wales sees a critical shortfall in the number of doctors to serve the increasing patient demand, generated by a growing and aging population, this programme has been designed to bring young doctors to Mid Wales.  The new programme will build on Cardiff University’s existing practice of ensuring its medical students are offered placements all over the country in a wide variety of settings and complements.

During this year long placement (referred to as a ‘Longitudinal Integrated Clerkship’ or ‘LIC’), students will work towards the same learning outcomes from the same innovative curriculum as their peers in Cardiff, under the guidance of a small, dedicated team of experts.  The first programme of its kind in Wales, initially CARER will only be available for existing third year medical students.

Educational institutions from around the world have been running LIC programmes for over 15 years. Some of the positive elements reported from similar programmes include students acquiring an enhanced understanding of patient needs, better developed communication skills and stronger working relationships with patients, fellow students and healthcare professionals.

Parallel consulting, seeing patients independently and then reporting back to clinicians, ensures active participation which develops and reinforces diagnostic thinking at a much greater rate. In addition, following the patient into the hospital environment gives a unique view of what patients experience as they navigate the NHS. Students will benefit from working within well-developed, fully functioning medical teams. They will also have the unique experience of immersing themselves in a rural community for a year.

Location

The CARER Programme is based at the Healthcare Education Centre which is conveniently situated across the road from Aberystwyth University and Bronglais Hospital. 

Students will live in and around the town of Aberystwyth located on the coast of West Wales, nestled between the Cambrian Mountains and Cardigan Bay with access to many of the facilities of Aberystwyth University including:

The GP Surgeries involved in the CARER scheme are situated in and around Aberystwyth and include: 

Hospital placements will take place in Bronglais Hospital situated on the edge of Aberystwyth town.

Life of a CARER student

You can find out more about the life of a CARER student on the CARER Blog.

FAQ's for CARER

Below is some information in FAQ format about the Community and Rural Education Route (CARER) Programme. It covers the following questions:

  1. What happens in a typical CARER week?
  2. Do I spend the whole year in general practice? Will I be in a hospital at all?
  3. What about leaving Cardiff behind for the year?
  4. What if I miss opportunities others in bigger centres get?
  5. Is CARER a life sentence?
  6. Will CARER harm my exam marks?
  7. If there’s no difference to my exams, then what’s the point?
  8. Where do CARER students live?
  9. Who are the staff to talk to, and what are their contact details?

What happens in a typical CARER week?

Half the week is spent in the GP surgery, usually one-to-one with a member of staff from the practice. This is the core of the experience and it will gradually change from a more passive role watching consultations, to taking the reins and often seeing your own patients with supervision of some kind. There is weekly teaching for one day a week, which ranges from clinical skills or examination, to tutorials delivered by local staff or Cardiff faculty. There may also be recorded lectures from Cardiff if these are needed to meet any outstanding learning outcomes. This variety makes sure you do not miss something the traditional route receives. Finally, one day a week is devoted to working on your SSC, which during CARER is done in a longitudinal format across the year rather than in one block of eight weeks. There is usually some variable amount of white space which students will be able to fill with whatever they think they need to work on, or follow up patients if they are receiving care locally e.g. specialist clinics or procedures.

Do I spend the whole year in general practice? Will I be in a hospital at all?

There are scheduled placements in the hospitals local to Aberystwyth and Bangor, for a total of 4 weeks out of the year. Some of Cardiff’s learning outcomes for year 3 are very specific to hospital: it would be impossible to practice a surgical scrub in general practice, for instance. The time in hospital is usually divided between teams such as emergency medicine and surgery to deliver these outcomes.

What about leaving Cardiff behind for the year?

There are many worries that students have before taking what must seem to each and every one like a leap of faith and a step into the unknown. Bear in mind that, even on a traditional third year, your placements will take you all across the length and breadth of Wales. Those in the traditional third year may move from place to place, out of sync with their friends and housemates, and some only return to Cardiff for the teaching weeks. Living in the same community for a year may offer you the opportunity to make close links with the other students – both your peers in CARER and students from Bangor or Aberystwyth University.

What if I miss opportunities others in bigger centres get?

It is true that to experience specialties like neurosurgery, paediatric orthopaedics, transplant surgery, plastics, genetic medicine, cardiothoracics etc., you would need to be in a large tertiary centre, most probably. However, there are two more years of hospital medicine waiting for you after CARER, which probably afford enough time to experience rarer specialities if you are interested.

Some students worry they will not see the variety of clinical cases that their peers who are in giant teaching hospitals might receive. Especially at the start of CARER, students worry they won’t see enough. The reassuring news is that, if anything, this feeling seems to be inverted during the course of the year. CARER students often report that from the mid-point onward they seem to see a greater variety of presentations, and have deeper involvement with them, than their hospital-based peers. This is probably linked to the sheer volume of cases they get to see in general practice.

Is CARER a life sentence?

The short answer is: no, it’s not a life sentence. When you pass the third year, you progress as normal into fourth year. If you are a graduate student (GEM) at the Bangor site, then you will continue your studies in Bangor. However, if you are an undergraduate medical student in Bangor, or if you do CARER in the Aberystwyth site, you return to your schedule of traditional hospital based placements for fourth year, wherever in Wales that is organised (or begin an intercalated degree if that is your plan).

Will CARER harm my exam marks?

Again, the short answer is no. There are several years of data which Cardiff have on the academic performance of CARER students in progress tests compared to their peers in the traditional third year. So far, there is no statistically significant evidence that doing CARER will disadvantage students.

If there’s no difference to my exams, then what’s the point?

Most of the benefits reported by students who have done CARER can’t be measured by an examination that year. In a typical year of hospital placements you meet new teams all the time, sometimes as often as every week. In CARER the staff who you learn alongside remain the same throughout the year, and most students report this gives them the feeling they are better known and understood. This translates to teaching better tailored to their knowledge and their interests. A feeling of being genuinely valued as part of the clinical team is something very commonly stated by students completing CARER. Over the course of the year you will probably see more patients (by an order of magnitude!) than your colleagues in hospital – and not just see them, but speak to them, formulate their diagnosis and be involved in their management. You may also have the opportunity to have them return to see you personally and monitor their progress.

The locations CARER runs in are also beautiful. Both sites are university towns surrounded by natural beauty: Aberystwyth sits in the middle of Cardigan Bay and is surrounded by rolling green hills, dramatic cliffs and to the North the lower reaches of Snowdonia. Bangor lies between Angelsey’s beaches and Snowdonia’s mountains. Having the opportunity to be in such a beautiful situation while studying may appeal to many of you.

If you are interested in a career in general practice, a year attached to a practice will give you invaluable experience and opportunity to see not just clinical medicine but the running of a business and learn from all the staff who make a practice tick.

If general practice does not interest you, one-on-one teaching, a large case volume under supervision and a deeper student-mentor relationship may still tempt you. There is also a broader variety of cases than simply what is expected in year 3, so those with interest in specialties such as psychiatry, paediatrics, gynaecology, dermatology or rheumatology will likely see cases that in a hospital would be the remit of these specialities which students normally have to wait until fourth year to experience.

Where do CARER students live?

This has varied from year to year. Many choose to organise private student accommodation, just as you would in Cardiff, for the year’s duration; an alternative taken up by some students in different years has been accommodation in halls of residence, offered in both sites at Aberystwyth and Bangor. Typically, students live within the town they are based in, as this is where most rental properties are located and it also allows students to commute easily and experience the social life of the local university.

Who are the staff to talk to, and what are their contact details?

If you have questions which aren’t answered, please ask and we will answer to the best of our abilities.

The generic email to address any questions about CARER is ugmedicyr2@cardiff.ac.uk. This is staffed by Cardiff university rather than either of the CARER sites, but would undoubtedly be able to signpost you onward if they couldn’t answer a question directly.

The lead for the Aberystwyth arm is Dr Sue Fish, who is a GP in Borth surgery just north of Aberystwyth. Her email is FishS2@cardiff.ac.uk. The administration of the Aberystwyth arm is carried out by Vicki Jones, who can be reached at cmestaff@aber.ac.uk.

The lead for the Bangor arm and the C21 north programme is Dr Ffion Williams who is a GP near Bangor. Her email address is ffion.williams@bangor.ac.uk. The email for the administrators of the C21 North programme is medicine@bangor.ac.uk.

The author of this FAQ can be reached at Edward.Hatfield@wales.nhs.uk.

CARER Team: Aberystwyth University

Enquiries can be made via the following email addresses:

Name Role Email
Dr Sue Fish Programme Lead Aberystwyth FishS2@cardiff.ac.uk 
Vicki Jones Administrator Aberystwyth cmestaff@aber.ac.uk 
Enquiries Cardiff University UGMedicYr2@cardiff.ac.uk 

Educational benefits of a Longitudinal Clerkship

  • Identical curriculum to traditional year 3
  • One to one teaching with GP tutor and educational supervisor who can tailor learning to the students’ needs
  • Small group teaching with the same students throughout the year
  • Clinical skills are easy to complete
  • Learn through following a bank of patients throughout the year

Educational Theory / Additional Educational Benefits to CARER

  • Positive experiences provide feedback, improve confidence and influence learning
  • Learning in a social context with reciprocal interaction of the person, environment and behaviors improve learning
  • Learning from observation over time allows modification of performance
  • Communities of practice within the primary care team provides a greater learning experience

Assessments

  • Complete the same assessments as traditional year 3
  • Easier to find patients for longitudinal projects
  • Longitudinal SSC
  • GP Portfolio easy to complete
  • Opportunity to increase position in cohort for Progress Tests
  • Increased confidence in ISCEs

Other Opportunities

  • SSC project can be submitted for conferences and competitions
  • A number of students are doing iBScs
  • An additional learning experience to add to CVs when applying for future training posts after leaving medical school