Community and Rural Education Route (CARER) placement at Cardiff University School of Medicine

Details of the placement

Cardiff University School of Medicine offers a unique opportunity to third year medical students to undertake an extended placement in community primary care, known as the Community and Rural Education Route (CARER) or the Llwybr Addysg Wledig (LLAW) in Welsh.

The CARER programme is a year-long longitudinal integrated clerkship (LIC), a community-based model where students work closely with GPs and primary care teams. Learning takes place predominantly in GP practices in Mid and North Wales, along with four weeks in the local district general hospital. Students undertake weekly group learning sessions throughout the placement facilitated by the locally based clinical senior lecturer. They also receive clinical skills teaching, have weekly formal case-based discussions with GP tutors and follow patients through the healthcare system to understand the patient journey. Students benefit from academic teaching at Aberystwyth and Bangor Universities, as well as learning from the wider multi-professional team and GP Mentors in their community practices.

During CARER I had the chance to work with a variety of healthcare professionals, including the practice nurses, physio, audiologist and district nurses. This allowed me to see the importance of a variety of healthcare roles in patient care.
Medical student

Good and innovative elements

  • The CARER programme is the first medical LIC in Wales. The placement was first piloted in the 2018/2019 academic year to twelve students following evidence of the educational and personal benefits from similar LICs in Australia and Canada. By 2023 over one hundred students had completed the CARER programme.
  • Students are immersed in a multi-professional environment throughout the placement, including learning from and working alongside nurses, paramedics, pharmacists, and physician associates. Students therefore develop a greater understanding of how the different healthcare professions complement one another.
  • There is a strong focus on professionalism. The extended placement structure allows students to become part of the practice team and be fully embedded into the practice. Students are the first point of contact for some patients and follow a specific group over the year and gain a deeper understanding of patient care journeys.
  • Small group numbers on placement means that students are accommodated well. The length of time students spend on the placement means more time and energy can be invested into the teaching and learning process, including formal weekly case-based discussions.
  • Students are encouraged to share personalised learning outcomes as well as the standard learning outcomes. The ongoing nature of the placement also means they have time to develop and focus on their individual goals and provides then with a well-rounded knowledge base ahead of specialising.
I was given more opportunity to obtain a history from, examine, investigate and diagnose patients with minimal input from my tutor. This experience is often limited in secondary care but is more effective in supporting learning.
Medical student
...we were able to follow-up on patients for a longer period of time. We understood the prognosis of chronic diseases better and how it develops.
Medical student

Positive outcomes

  • The LIC has led to the creation of a medical learning community in rural areas where this was previously missing. Students have the opportunity to return to their childhood communities during the placement. Where other ex-CARER students have returned to the area as Foundation Year 1 and Foundation Year 2 doctors they act as buddies and take on educator roles for new students embarking on the programme.
  • Findings from the longitudinal evaluation show students undertaking the LIC reported a greater sense of self-accomplishment and confidence. Students become self-motivated and have a high sense of professionalism as they see patients throughout the care journey and develop vital skills with family interface.
  • The placement has also given Welsh-speaking students greater opportunities to practise their language skills and conduct consultations in Welsh. This also greatly benefits those in the local community who require Welsh-speaking doctors.
  • The extended nature of the CARER programme means the depth of learning in the placement is robust and sustainable enhancing preparedness for clinical practice.
I was able to develop a very close working relationship with the health care professional I was delivering care alongside. They were able to give more relevant, detailed and individualised feedback on my performance.
Medical student