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Summary

This interactive on-demand teaching session, tailored for medical professionals, provides essential tips and tricks to pass final exams. Dr. Sara and team of F1 doctors guide attendees through the intricacies of community care planning. Learn how to approach that station and avoid common pitfalls that students frequently make. The session covers various scenarios, exploring advanced care planning, long term conditions, and the relevance of GP based cases. Not just exam-focused, this course offers valuable insights for the journey from medical student to F1 doctor. Previous recordings are available, with open access from the end of January. Pre-recorded cases are also being formatted for upload, ensuring all attendees are thoroughly prepared before their finals.

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Description

The Ultimate Team-Up for the Ultimate guide to Finals OSCEs.

​We're super excited to introduce the Osce Express series.

​We're collaborating with a crack-team of Foundation Doctors to bring you an comprehensive A-Z guide to finals OSCEs.

​Over 11 weeks, our expert team will give you top tips to ace those practical exams.

​Oh and did we mention, we'll be uploading exemplar OSCE videos and of course, free practise cases.

​Join us for the 7th session as we go through community care planning with Dr Sara Sabur

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Learning objectives

  1. To understand the concept and importance of community care planning in a general practice setting.
  2. To learn the techniques and approaches to effectively discuss care planning with patients diagnosed with a long term illness.
  3. To gain an in-depth knowledge on the core topics such as advanced care planning, respect form, Lasting Power of Attorney (LPA) and their significance.
  4. To develop competency in taking a holistic view of patient care incorporating their future wishes, spiritual, psychological needs and their preferred place of care and death.
  5. To learn how to effectively manage sensitive discussions around end of life care with empathy, sensitivity and respect for the patient's wishes.
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Computer generated transcript

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The following transcript was generated automatically from the content and has not been checked or corrected manually.

OK. We'll make a start then let's check the people can see the, the title slide. Yeah. Perfect. Great. OK. So, um if you're having trouble seeing the title slide, best thing to do is just leave and then uh and rejoin initial load. So, welcome back, everyone. Hope you all have a good Christmas and uh a good New Year. So this week, we are coming towards the tail end of, of the program. We'll be looking at community care planning with doctor se and she'll talk you through how to approach that station and the common pitfalls and uh and things that students usually make if you're joining us for the first time. So essentially the team of F one doctors told Lester Base to put this together um uh a guide us as to how best to approach the last finals. Ays top tricks and tips to pass the stations and then what students normally trip up on during the stations. We're coming towards the end of the course now. But all our previous recordings can be found on our metal which we've linked in this presentation. There are one or two sessions which didn't record properly. But we're working on rerecording those and uploading them, but the majority of the sessions should be up. Um Currently access is for people that have attended the sessions. But at the end of January, we we, we will be making it open access as well. And then all the doctors that are running the sessions have written cases. We currently formatting all of those uh into PDF format so we can upload them to the website and you should all be able to access them before finals. The overarching theme is to prep you for finals. Siess. Then there's also the, the theme of how to be a safer one and there will be those tips dropped through all the presentations as well. Just a disclaimer that whilst we have designs to help you with OS prep by no means um medical advice and it shouldn't replace your medical school teaching. Uh We don't take any responsibility for any factual errors, but if you do find anything which you think is wrong, feel free to contact us and we'll, we'll look at it and uh update as quick as we can. So with that, I'll hand over to doctor se and she'll take you through the rest of the presentation. Great. Thank you very much for that. Um Just so I can make sure people can hear me so I can just pop it in the chat. Cool. Thank you. But um, so yeah, hi guys. My name is Sara, I'm one of the F ones, um, currently in LNR, um, did my finals, obviously last year. Um So today we're gonna go through a bit of community care planning. So as you all know, this is one of your stations in your finals, um, and it's sort of all due around sort of GP based cases and what you might see um, in your GP placements. And so we're gonna be focusing on that today. If at any time you can't hear me or can't see the slides again, just pop it in the chat. Let me know and we'll get it sorted. Um And if you do have any questions again, just type it in and I'll answer as we go through or if I'm in the middle of speaking, I'll answer at the end of the slide. Cool. So, what we're gonna do today is gonna go through a couple of scenarios that you might get in your community care planning station. Um We'll go through a bit of case examples and paperwork that you might come across in that station as well. And then at the end, we'll have a sort of summary and a bit of AQ and a cool. So we'll start off with some scenarios. Um So just to go through the layout of the station first before that, um So as you know, you get a stimulated patient and you'll be observed typically by a GP examiner. Um It's a bit of a more complex consultation um because it, these stations focus on more than one area. Um So it'll be kind of a few things that you might have to cover in the station. Um But we'll go, we'll go through that. Um And it will include some obviously, like we said, care planning, but more community based um things as well. So, and as the majority of the stations, it's gonna be 10 minutes to speak to the patient and warning be an eight minute mark. Um And you don't get asked questions in the station, so it's just 10 minutes purely of you talking. OK. We'll just go through the marking criteria first. So if you're struggling to see on the screen, I think you can zoom in and out. Um But this is taken directly from your um ay talk that you get from the med school, but I just want you to go through it just so we're all on the same page. Um So what they're marking you on is sort of identifying the issues first of all. Um So the station might say sort of discuss DNA CPR with the patient, but you just wanna focus on some of why you might fill in the DNA CPR. So just focus on the issues first that can be short term or long term needs that the patient might have um any recent hospital admissions, et cetera. Um Just to get an idea of why you might be filling in the DNA CPR respect form. Um And then sort of appropriately talking to the patient, obviously getting as we all know, I so ideas concerns expectations. Um And to make a shared plan with the patient as well. Um So in this, in this station, it can be easy to just sort of ramble on and because you just want to get everything out and you just want to cover everything you're meant to cover. Um But it is important to realize at the end of the day, it is a GP station, it is a shared care plan. Um And you do want the patient getting involved as much as you can. So what I did in my stations was just sort of taking a break every two minutes or so and just saying, you know, have you understood what we've covered so far? Do you have any questions so far before we move on to the next part of what we're going to discuss? Um And if you are discussing DNA R, um then discussing things like preferred place of care, um during end of life, preferred place of death as well. So these can be quite sensitive um areas to talk about. So just giving the patient kind of like when you do break in bad news, just giving them like a warning shot. Um And just saying, you know, we are discussing quite sensitive issues, but any time if you do want to stop whatever we can. Um, and LPA as well. So we'll go through what LPA exactly is and why you might need to discuss that. Um And then as again, with all the stations that you'll have, um, there'll be the examiner will be looking at your empathy and sensitivity and making sure that you put the patient's wishes first. Um So if just because you recommend something and the patient doesn't want that, um just to be respectful of that and just to go through the risks, the benefits, et cetera with them. Um And then holistic care is really important in the station. Um So obviously, you know, if you're talking about the subject of death for some patients, you know, for them, it's not about where they die or, you know, what you think might be important to you, it might be that they have like a religious person around, um or, you know, that they, that they have like prayers or whatever before. Um So just focusing on what's important for them, um I'm just thinking about sort of spiritually and psychologically as well what they might want um during the last days of life as well. So if you look at the box underneath where it says excellent, that's what you all should be aiming for, obviously. Um So make sure you have a fluent history. Um and the discussion is fluent as well. So, you know, minimum sort of gaps and if you get stuck or whatever. Um Again, excellent interaction with patient, which I'm sure you've all had plenty of patient interaction by now. So I don't think there should be any issues there. Um depth of knowledge. So this is more knowing what a respect form is, knowing what an LP is, knowing what a care plan is. So just to make sure that you, you know what it is that you're discussing um and assured answers with full explanation and deep level of understanding. Um So even if you don't know the answer to a question, a patient asks you, um just make sure you just confidently say that, you know, I don't know the answer to this question. Um but I can find out for you and I can give you a call back and we can discuss it further if you want to. Um So don't be afraid to say that. Um because there will always be something that you're not quite sure of and you might need a bit of help on. Um So just knowing your limit as well, I guess um in the station and how far you can guide the patient as well? Cold. Yes, this will be like an example um your reading time before your station. Um So you're working in a GP, you go and see a patient who's been diagnosed with XYZ. Um And then it will say what you're expected to do. So in this case, take a brief history and discuss care planning. So that would be like the typical thing that you might see in front of your station. Ok. So we'll just go through some possible scenarios and then we'll go through some examples after. Um so advanced care planning. So a lot of these patients that you'll see um in the station will have a long term condition. And with these conditions, it's really important to have something called an advanced care plan. Um So what you'll typically talk about through the care plan is like we said, sort of like a holistic um view of the patient. So talking about any future wishes. So if they have a long term condition and they, they're in and out of hospital, you know, what does the patient want to do? Do they want to keep going to hospital? Do they think a community care is sort of better? Um do they want to go further treatment and sort of what level of treatment as well? And what you think, what your opinion is is what's appropriate for them? So, um that's what we mean by feeling of care. So if we, for example, if we have a 90 year old lady um with COPD gets frequent exacerbations, is it really um suitable or appropriate for her to go to itu um if, if she needs to be admitted there, so that the answer to that for most patients would be? No. Um So discussing, see of care. So we normally say sort of ward based care for these types of patients so they can have ward based like N IV, et cetera, but we wouldn't be appropriate for them to go to it. Um And then it might include talking through a respect form as well. And we've got a question, will there be a physical respect form? Um There might not be, but we were told there could be. Um, And I don't think you'll be expected to physically fill it out. Um But you might just be required to talk through it. Um So it's a, it's a more of a talking station, it's not really filling in paperwork and stuff. Um Yeah, exactly. We did, we didn't have a physical copy in our station. Um So it is good to sort of get used to just seeing it and seeing it filled out. Um Yeah, cool. Um ok. Um We were told a relative may or may not be present just to make it more complicated. Um But there were there, there wasn't a relative in our station but just to make you aware that there could be again unless you've been told different. Um And then obviously within the advanced care planning, you're talking about end of life discussions. So like you already said, preferred place of death and um et cetera as well. So that's the sort of brief overview of advanced care planning. OK. So another scenario might be not to do with the care planning, but just review of sort of frequent issues that the patient's been having. So they might be having a high rate of sort of being admitted to hospital. Um, especially if they're frail and elderly and have lots of comorbidities and sometimes a GP review might be required to see again if these hospital visits are necessary. Um So it might just be purely based on one thing, just hospital admissions or you could have like a broad station, like we said, with the advanced care planning. Um So again, we've already sort of been through this but just take into consideration why they're getting admitted um so frequently and whether we can do something more in the community um to prevent further admissions and focus on patient wishes as well. Um Some of the patients in the stations are really sensible. Um And they'll know where that the best managed in the community or this is the only time that I might go into hospital. So they're quite sensible if you talk it through with them. Um So that might be another scenario that you might have. So just do with hospital stuff, another scenario could be assessment of capacity. Um So I'm sure you will know what capacity is. Um So make sure you know how to assess capacity. So, um are they sort of aware of the decision they're making? Can they weigh up the negative and the positives can they relay that information back to you. Um And remember that capacity is time and decision specific. So a patient might have capacity to decide. I want two sugars in my tea, but they might not be able to decide if they need an emergency surgery. Um So make sure that you know what you want the patient to decide on um and explain to them that, you know, this is what we're doing. Um Just to see if you're able to make this decision or if you need a bit of extra help. Um So it could be something like patients refusing to have, I don't know, carers or district nurses, et cetera. And you might just have to assess their capacity to see if they, they can refuse things like that if they have the capacity to do so. So again, that can be another station on its own to make sure you're you're going through how to assess capacity. Um and again, just make sure, you know, it's time and decision specific. Ok. Ok. We'll go through a couple of examples then and get you guys involved. So if we have an example station, so advanced care planning, so it might go a little bit like this. So you're an F one working in her GP surgery, Missus Bell has presented with her husband as she was told to discuss a care plan with her GP after her recent hospital admission. So you ought to take a brief history and discuss care planning with the patient and you have 10 minutes. So skip that one for now. So what would you ask in the brief history? So this is where you guys get involved. So start typing. What might you ask in that case? I'll go back to this so you can read up. Yep. So Raja, yeah. So factor are on your recent admission. Yep. So why is she getting admitted? What condition? Yeah. So is it for one condition? Is it for multiple conditions? Uh w what's changed since the admission? Yeah. So does she need any extra help at home? Um Does she think she's worse off after being in the hospital? Um What kind of symptoms she has? And does she have any now as well? Um Yeah, any new diagnoses. Um Exactly because old people do have multiple comorbidities. Any medication changes call. Yeah, if she wants a husband in the room, um, that's really good. That's a really good thing to think about as well because obviously they turn up together. So just making sure that she's ok for him to be there. What are her current worries? Yeah. So focusing on her concerns. Um Yeah, past medical history, definitely. And drug history. Um Yeah. What does the husband think so? Yeah. Um just because we are obviously focusing on the patient but it is important to get husband involved as well if he is there. So asking him sort of what what he thinks might be the best way forward. Um, how many admissions? Exactly. Yeah. So we normally give it over a time frame. Like how many in the last year? Um, any difficulties with morbidity or self care? Nice. And how did she feel about the treatment? She had a hospital? Yeah. Exactly. So, any treatments that she might not want again or she thinks probably didn't help that much, uh, any recent falls? Yeah. Any confusion. Exactly. Yeah. Where in hospital was you treated? So was it just more of a ward based thing which might have been in the community? Um Yeah. What are her priorities? So does she want to um be admitted to hospital? Would she, would you rather just be treated in the community? Yeah. Patient wishes exactly what she's looking for in the consultation. Um So what does she think we might discuss today? Does she know anything about advanced care planning or what that might mean? Yeah, those are, so those are all really good suggestions. Well done guys. Thank you. So um oh, got some more coming through. Will the patient normally be forthcoming in their dislike hospital in the station? Oh, this question for me. Ok. Um Yeah, so the patients are pretty honest in the in the station, there's nothing that says in their script that they have to deceive us. Um So yeah, if you ask them a question that will be pretty straightforward with you really? It's more, it's more us that sort of beat around the bush. Um, because we go. So, um, well, uh, so just if you wanna know a straight answer, just give a straight question. So they will give you a, a pretty straight answer in return. Um Yeah, so well done guys all good suggestions. So, yeah, I do remember to treat you like any other consultation. So, um, I don't think anyone said sort of identify the patient appropriately, introduce you. Um Exactly. And someone did say clarify who they fought with them so well done. Um So do please do do that in every station. Um Yeah, so brief history. So about her hospital admission. Why was she admitted? What did they do? Um how she feels about it? Um Vaccinations and things like that if that's important. Um And yeah, remember she's with her husband. So like um someone said, one of your colleagues said that make sure they ask if it's ok for him to be in there with her. Um So remember to keep the patient your first priority. Cool. So this is what she tells you. So she's been in hospital again due to an infective exacerbation of COPD. She was given IV antibiotics and discharged on an oral course and she doesn't really like going to the hospital and she only wants to go if it's absolutely necessary and her husband's quite supportive and agrees with the plan. So in terms of advanced care planning, I just wanted to put in a little definition in there. Um Just so you guys, we've been through this, but just so you guys are aware that there's like an actual definition for this internationally. So it's called the Gold standard framework. So, um it's something that supports any adult of any age in any stage of health in understanding their personal values, their preferences regarding future medical care. Um And the goal of an ACP is that people receive medical care that's consistent with their preferences and their chronic illness. Um So it is really patient specific. So an ACP for an 80 year old with COPD might not be the same as another 80 year old with COPD. So it's not like a set framework, it's individualized to that patient. Um So yeah, all those questions you asked were exactly what we're looking for, make it really individualized. Um Could you recommend rescue packs for her? Yeah. Um Yeah, you can definitely recommend stuff for the patient. Um If you think that might help them not going into hospital, definitely, or she might have some already. Um And then just to um sort of give you a framework of how to lay out your station. Um So you can sort of follow this as you go along the station. So this is for the patients. They think. So what's important to them, what do they want them to have? What do they want uh to happen? To them when they get unwell, um talk, so talking with their family or friends or if they have an LP. Um, so an LPA is the lasting power of attorney. So there are two types, there's one for um health and there's one for finance. I just remember it as health and wealth. Um So the finance one is all to do with the property side and stuff. Um So we don't have to worry about that. We're more concerned with the health LPA. Um So health and welfare. Um so with this one, so this is something the patient signs back when they have capacity. So it might have been 10 years ago, it might be five years ago. It might, might have been last week. Um But basically what this says is when the patient loses capacity, the patient has nominated someone to be the LPA. Um So that person can speak on the patient's behalf and sort of say, um no, my mom wouldn't want to go into a care home or, you know, my mom would want an IV antibiotics, et cetera. And what they can basically do is make some of the health decisions on their behalf. Um So it can be really useful because it does mean that a patient who doesn't have capacity now has someone to speak up for them, which is good. Um But sometimes it can be a bit conflicting with medical advice. Um So we might recommend her not to have anti IV antibiotics. But the LP might disagree and then it can sort of go to court and all that stuff. And so that's a bit complicated but just know what an LPA is. Um, and what that might mean. Um, record. So, yeah, so ACP comes as like a, a big plan. I think it's an ice. Um, so you can fill that out and you can give a print out to the state to the patient and they can take, they can keep that with them at home. So if you know, they do call 999, the ambulance crew can look at the care plan and say, oh, it says here if she has this, she can go to hospital et cetera and they can make a decision based on that as well. And it also says obviously to discuss which we would be doing that consultation and again, share it out. So make sure the family and et cetera know that this plan is in place. Cool and that's just a little layout of what we would fill out. Um as well. That's there on the sides if you wanted to have a look at that later. Cool. Yeah, so we've kind of been through all this. Um The only thing I just wanna highlight is when you're talking through, obviously in advanced care plan, it will talk through DNA CPR as well. Um It is a big subject to talk about and it's not easy. Um, it's not easy in real life as well, never mind in an ay. Um, and some of the other stuff as well, like we talked about, preferred place of death, et et cetera. They're quite sensitive, um, things to talk about, right. Um So the patient might not want to discuss that at, at this time. So it's important to not pressurize the patient. So you can say, you know, we are gonna talk about some sensitive things if you don't want to discuss it. Now, that's absolutely fine. You can go and think about it. Um because in this station, what we're all, what we're really doing is just giving them an idea. So there doesn't have to be a firm plan at the end of it. So you can say, or you can go away and we can discuss it at another date. Um So that's fine. You're not gonna lose any marks for that. Um As long as that's what the patient wants. Cool. So any questions about the first case? So talking about a CPS. No. Cool, great. So another case might be just to discuss end of life planning, it can overlap a little bit with um the ACP, but this focuses on sort of more about the respect form and what we talked about. Um So I have put you may be asked to fill out, but ii highly doubt that would be the case. Um And respect form is not DNA CPR. Um that part that is just one part of it, but there are other sections as well which you need to know about. Um And it does need cosigning by, I think they have to be higher than ST three or consultant level for it to be valid. So you can sign it, but it just needs to be cosigned as well as an F one. I mean, cool. So ready to get involved again guys. So what are the components of a respect form? Um When would you fill out a respect form? And is the respect for a medical decision or not? Yeah. So we are focusing on priorities of care. Exactly. So we can again talk about the ceiling of care. So are we focusing more on ward based or are we escalating a bit further? Yeah, treatment escalation, et cetera. Um D A CPR. Yep. So that is one part of it exactly where they would like to die. Yep. So the sort of end of life um environment uh capacity. Yeah, that is a, that is a part of it. Well done. Um to see if patient has capacity or not. Power of attorney. Yes, there is a section where it asks you if there is a power of attorney or an advanced physician to refuse treatment. Yeah, definitely. Cool good answers guys again. So yeah, so that's what spectro form looks like. So it's double sided. Um So the first box um is just sort of a summary of the patient. So their comorbidities, et cetera um relevant to the respect form that you're filling out. Um So we just popped out on the first box. The second box is talking about um if they have an advanced care plan and what does that say? Um if they have an advanced decision to refuse treatment? Um So if you haven't heard of this, it's basically something else that a patient can fill out when they have capacity to say if I use my capacity, I don't want an operation or I don't want this. So it's not, they can't request treatment on there. So they can't say yes, I do want an operation. They can only refuse stuff and they sign it. So when it comes to retire, when they lose their capacity, we know that's not what they would have wanted. Um So that's another legal document you can fill out or not you, but the patient can fill out. Um Yeah, so that's the second box. Um The third one is about if I think it's more if they have any responsibilities, et cetera, legal welfare. Um We don't really fill down to be honest. Um The fourth bit. So the where it says number three, what matters to me in decisions about my treatment? So this is a really important one to know. Uh So one side of the scale is living as long as possible, the other side is comfort and quality of life. Um And what I normally do is I'll tell the patient, you know, this is the scale, just draw a cross or just circle where you think, where you feel that you'd be more comfortable, what you'd be more comfortable doing and a lot of patients just go right down the end of the scale and just focus on um quality of life. Um So we know that's what the patient wants. They don't want to extend their life, they just want to be comfortable as possible. Um And then underneath that again, is about patient wishes and goals. So what they value and what they want to avoid as well. Um And then as you go further down, um there's a little red box that says CPR 10 is not recommended. Um So that is where you can sign, so you can sign that bit and I've been told by people who can't, but you can as an F one as long as someone co signs it on the other side of the page. Cool. So if you go on to the other side, then, so capacity, so it does ask about capacity. Um And if they don't have capacity, do they need anyone to help them uh make decisions, et cetera. Um And then sort of who did they involve in making the plan as well? And then where it says clinician signatures, that's where you need to get it cosigned if you have signed it as an F one and then emergency contact. I think it's really important to fill this one out. Um Because if there is an emergency and someone looks at the spect form is everything is there so they can contact next of care and et cetera quite easily. Um And yeah, that's basically the whole respect form. Um So I would advise for you guys to go through it um with someone like with an F one or something um and have a look at the form and maybe take a copy home as well. And that would be really useful for if you do have this kind of station in your cool. Um So we're nearing the end. So it's quite a short presentation that I had. I don't want to overload you guys. Um But yeah, those are the main things that would come up in the community care planning station. Um Let's just go through my top tips. So, um everyone says practice and it's like, how much can you really practice? Um It is difficult to do it. Um Especially in finally ask you because a lot of the stations are a bit, you know, wishy washy. So it's like, can I really practice this at home? Um But this one you actually can practice at home uh honestly. Um So just pretend someone wants someone to you to be a patient or whatever and you know, you're talking through advanced care plan or you're talking through a respect form, we're talking through end of life planning with your friend and then stop over. Um and aim for concise history. So these stations obviously with an advanced care plan, you have to discuss history, you have to discuss um what they want. You have to discuss DNA CPR. It's a lot of things to do in 10 minutes. Um And you actually have to let the patient speak as well. Um So really concise history taking. So all those um questions that you guys were asking, you know, like, how long were they in the hospital? What meds are they on past medical history? Those that's concise history taking. Um So do practice that and try and keep to time. Um This station actually goes really fast. Um So because it's just a lot to talk about. Um And II bet like 90% that it's gonna be about advanced care plan because that's the most you can talk about. Um when it comes to splitting time, how long would you recommend? So I'd say about 2 to 3 minutes on the history and then the rest of it for the advanced care plan. Um Just because you obviously want an idea of the background before you start to discuss care planning if you don't know what you're planning about. Um So I spent about 23 minutes on history and then the rest of it was all just care plan stuff. Um And it's fine if you don't go through everything honestly. Um As long as you've gone through the majority of the things and you've got the patient involved and the wishes taken into account, it'll be fine. So don't try and like make it seem rushed. Um If you want to spend a bit more time in history, fair enough. Um, but just try and get through as much as the advanced care plan as you can as well. Um And GKI Medics actually has a useful page on this. Um So if you type in Gki Medics advanced care plan or I think it's end of life plan, um it does come up and it's like a checklist of everything that you can cover again. There's a lot of things on there. Um So being sort of concise and making it patient specific, um because you might have a patient if you ask, are you quite religious? Do you have any religious views? And they might say no, and then you've just skipped a whole part. You've just saved like five minutes talking about religion. Um But if someone says, yeah, I'm very religious. They obviously there's a cue to talk about it a bit more. Um So you might spend a bit more on that bit and a bit less time on other things. So that's fine. As long as it's patient specific, you don't need to rush and cover everything. Um And for those of you who've already had your GP placement, um, I hope you've done something like this. Um But for those of you who have it coming up, um, just try and find someone, um, who might be doing an advanced care plan. There are a lot of people um because I discharge people every day, um asking GPS to review a patient and do an advanced care plan. So there are a lot of people out there who are waiting advanced care plans and you might be the one to do that for them. So try and find someone who, who needs one. And you know, just have a go at doing it um with supervision or without and just focus on your consultation skills and your empathy and someone might be with them. So you're, you know, working on your TriC skills as well. Um So GP is a really good place to do to do this in hospital, I would say less. So, unless you're on like a Jerry's ward or something, they, they do them quite often. Um So if you're on Joy's, you might come across advanced care plan a bit more. Um Yeah, again, just remember to have empathy obviously. Um Leo big on that. Empathy and ice is all they want. OK? It doesn't matter what you say as long as you're empathetic about it, um listen to the patient, they will tell you everything. Um So just let them speak if they're speaking, just let them speak and don't pressurize the patient. So it's quite a lot of few big decisions to be made. Um Don't sort of force them into giving you an answer and again, just acknowledge anyone who else who is present and there will be a lot of queues in the station. I do remember quite a few cues. So the patient might say, you know, oh, I heard about that um like that CPR thing when they press on your chest or whatever. Um And they are really obvious cues. Um So yeah, keep an eye out for them. Um Yeah, be familiar with the legal stuff. So we went through um majority of the things that might come up like um LPA or advanced decisions and like I said, this station is all about getting the patient to think about things. Um So you might not actually reach a decision at the end, but as long as you've given them food for thought, um th th that, that will do the station to be honest. Um And just summarize if you blank out. So there can be a part in the station where you're just like, I have absolutely no idea what I'm gonna um talk about at the moment. So you can just summarize and just say so far we've talked about XYZ. Do you have any questions? And then something might pop into your head as well? So we have a few questions. So difference between advanced care, so advanced care plan is focusing on all everything that we've just been through. Um So, you know about the hospital admission about any spiritual thoughts, end of life, thoughts, et cetera. Um End of life planning is purely um their last like few weeks or days of life. So where they want to die, do they want CPR? Um did they have any, any other wishes about the end of life, et cetera? So it's not to do with, it's more to do with just the last few weeks and days of life, advanced care plan can be done when you're like 60 like a fit 60 year old and just just say these are my wishes and this is why I want to happen in the future. Um Oh, ok. Um I can, I can have a look at that for you do on geeky medics. Um I'm pretty sure mine was on me. Um But I will get, I'll get either or sim to pop that on one of our socials when I find that. Thanks for pointing it out. Um Our next session is on the seventies. Um So do please join? Um I hope this one was useful as well. Um Before you all disappear, please please please fill out feedback. Um It's really important for our portfolios as an F one and you guys will know how important it is next year when you start being F ones. Um So please do fill out the feedback. Um I don't care if you think I was a bit rubbish as long as you fill it out. Um That would be great. Can you put the feedback link in the chat? Can we do that? Sed? Yeah, I'll, I'll get it in a second and cool, thanks. Um And yeah, advanced care plans can be renewed. Um Yeah, exactly. Like N said, it's not um not legally binding, it's just what they want, so what they want can change. Um And even with respect forms, although it's quite unlikely um you can reverse decisions on respect forms so someone can be put down as DNA CPR, but that can be reversed so it can be changed. Um I think that has to be read or above to do that. Um But yeah, even respect forms can be changed, but thank you guys um for keeping up with me um on a cold January night. Um I hope it was useful. Um And good luck, you know, with Aussies and stuff and oh, I do have a last slide as well. Um take a screenshot or whatever um and email me whenever you want. Um I'm in LNR anyway, so if you did wanna, I'm in plastics right now. So if you did wanna, you know, do a bit of suturing or popping some blisters, give me a shout and I'll be happy to avoid and the link is in the chat as well. Cool. Thanks guys. Thank you so much Sarah for the wonderful.