Download MBBS Programme Phase 4 Student Handbook 2012-13

School of Medicine
MBBS Programme
Phase 4 Student Handbook
2012-13
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THE KING’S SCHOOL OF MEDICINE STUDENT AND DOCTOR
On entering the School of Medicine the King’s School of Medicine the student will:
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have a high level of commitment to entering a caring profession
demonstrate an interest in people and their health, and in the importance of health and
cultural issues in society
have achieved high academic standards and have shown qualities of self-motivation
show a sense of personal responsibility and a wide range of personal interests
During the undergraduate course the King’s School of Medicine the student will:
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be educated in a multi-faculty college with the cultural opportunities offered by a central
London location
study medicine in a local community of wide ethnic, cultural and socio-economic diversity
develop an inquiring and critical approach to learning
understand the scientific principles of medicine
learn about patients in a variety of settings – in hospitals, general practice and the
community
learn the essentials of good clinical practice which will be based on the core knowledge,
skills and attitudes required for the safe practice of medicine
The King’s School of Medicine student will learn about:
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health and its promotion
the scientific basis, presentation, management and prevention of common and serious
diseases and the impact of illness on the patient and the patient’s life
the environmental and social basis of health and illness in the context of populations
the ethical and legal issues relevant to the practice of medicine
the organisation, management and provision of health care
The King’s School of Medicine student will develop skills by:
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attending and participating in learning opportunities
reflecting on and addressing personal learning needs
learning to communicate effectively with patients, relatives and professionals
working cooperatively with patients, peers, teachers and healthcare staff
becoming proficient in essential clinical examination skills
becoming proficient in essential practical procedures
The King’s School of Medicine student will demonstrate appropriate attitudes by:
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treating patients with politeness and consideration, learning to involve them in decisions
about their care
acting honestly with patients, peers and staff
showing respect for patients, relatives and colleagues that encompasses, without prejudice,
diversity of background, language, culture and way of life
recognizing the rights of patients and acting in their best interests, particularly with regard to
confidentiality, informed consent, autonomy and dignity
recognizing the need for guidance and supervision and the limits of personal competence
and health
respecting the professional values of competence in performance, reliability and conduct
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Bullying and Harassment
The College and the Medical School are committed to providing students with a learning
environment that is free from all forms of harassment, bullying and discrimination. Being subjected
to such behaviour can lead to stress and anxiety. It is important that students behave towards each
other and staff with dignity and respect, and avoid behaviour and communication that upsets your
colleagues and staff.
If you have concerns about the way you are treated, who you contact depends on where the
incident took place. In College, you should discuss in confidence with your personal tutor and/or
Year Head who will support, help and advise you. If you are on clinical placement, you should raise
your feelings with your Sub-dean or administrator, and Year Head. Further support can be obtained
from your senior house tutors and clinical advisers, the Student Welfare and Advice service, and the
College Harassment Adviser. Further details are available on:
http://www.kcl.ac.uk/college/policyzone/assets/files/students/Policy_on_Harassment_Bullying_and_
Discrimination_for_Students.pdf
The information contained within this handbook is correct at the time of going online although the
details may change before or during the academic session.
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TABLE OF CONTENTS – Part I
1. Introduction to Phase 4
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2. The Aims and Objectives of Phase 4
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3. Code of Practice for Student Examination of Patients
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4. Attendance and Good Philosophy of Work
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5. Phase 4 Term Dates 2012-13
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6. Deadlines and Dates
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7. Course Outline
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8. Phase 4 Key Co-ordinators, Block Leaders and Course Organisers
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9. CHILD HEALTH, DEVELOPMENT AND AGEING BLOCK
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10. EMERGENCY MEDICINE, TRAUMA AND LOCOMOTION BLOCK
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11. REPRODUCTIVE AND SEXUAL HEALTH BLOCK
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12. Vertical Strand Disciplines
90
13. Student Selected Components
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14. Assessments and Examinations
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15. Example Questions
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1. INTRODUCTION TO PHASE 4
Welcome to Phase 4! Congratulations on your success in the Part 3 MBBS examination.
Phase 4 promises to be an enjoyable course offering a wide range of clinical experiences. By the end of phase 4
you will have completed your training in the core subjects of the medical course. With successful completion of the
phase 4 assessments, you will be ready to embark on your Elective and return for the shadow house year in Phase
5.
What does Phase 4 include?
Phase 4 consists of three 12-week blocks of grouped specialities: Child Health, Development and Ageing (CHDA);
Emergency Medicine, Trauma and Locomotion (EMTL); and Reproductive and Sexual Health (RSH). Vertical
strand subjects are integrated into mainstream specialties and symposia and include Clinical Sciences, Ethics and
Law, Pathology and Laboratory Sciences, Psychiatry, Public Health, Clinical Pharmacology and Therapeutics,
Genetics, Palliative Care and General Practice. The learning aims and objectives for phase 4 are outlined in this
handbook and are referenced with the MB BS core curriculum presentations. This is the syllabus for the phase 4
assessments.
The course is delivered consistently across five campuses: Kings College Hospital, Denmark Hill (KCH); University
Hospital Lewisham (UHL); Guy’s and St Thomas’ Hospital (GST); Princess Royal University Hospital, Farnborough
(PRUH); and Queen Elizabeth Hospital, Woolwich (QEH). There are minor variations due to differences in service
provision. Students rotate across the sites during the year. The Community Study and health promotion, the only
longitudinal case study, takes place on Fridays (see timetable for dates). The Community Study in General Practice
enables you to follow the progress of a pregnant patient and her family.
Special study components (SSCs) in phase 4 take place on the Fridays when you are not having your community
study days. You will take two SSCs. One in rotation 1 which will be a taught SSC, the second in rotation 2 will
consist of writing your elective portfolio. There is no SSC in rotation 3. Fridays during rotation 3 are designated for
teaching and consolidation. You can expect to have some timetabled sessions on these Fridays. Alternatively, you
may be able to arrange more self directed learning which can focus on examination technique in preparation for the
OSCEs. If you are on peripheral attachments, you should stay at the DGH on these Fridays. They are not
specifically revision days.
What is different about Phase 4?
The first two rotations begin with an introductory day, continue with 12 weeks clinical teaching, and conclude with a
reading week (week 13). In the rotation 1, some students might have SSC presentations during this week. The last
rotation also includes an introductory day, continues with 12 weeks clinical teaching, and concludes in week 13
with written papers for all three blocks. There is an end of year OSCE and revision sessions will be offered prior to
this. In phase 4, you meet many vulnerable people- patients with disabilities, serious injuries or terminal illness,
frail elderly people with carers, infants with anxious parents, and pregnant women and their partners. You will
undertake very intimate examinations. In preparation, you should read the Code of Practice for Student
Examination of Patients on p7. Common ethical dilemmas in phase 4 are the stuff of everyday newspaper
headlines! It is important to recognise and analyse these in preparation for your career.
There are attachments to district general hospitals during the RSH Block & the CHDA Block for students at Guy’s /
St Thomas’ and Denmark Hill. These are for you to experience medicine away from the teaching hospital
environment where you can really feel part of the clinical team and learn about important common medical
problems.
How to succeed in Phase 4.
With its diverse specialties and large numbers of skills, phase 4 is both stimulating and demanding. In previous
years you may have taken a relaxed approach to studying and concentrated revision prior to examinations. Last
minute revision and cramming is not appropriate for phase 4. You need to study consistently throughout the year in
order to avoid being overwhelmed by the concentration of assessments at the end of each block. Because you will
move swiftly from subject to subject, it is important to consolidate your knowledge, skills and attitudes by taking
maximum opportunity to clerk as many patients as possible as you progress through each block. Bookwork is no
substitute for clinical experience, topic based seminars and integrated teaching in symposia, although further
reading will enhance your learning. Attendance at all teaching is expected.
How can the course be improved?
We constantly seek to improve the course and welcome constructive feedback through SMEC, staff,
questionnaires, and online block feedback. If you wish to discuss matters, please do so.
I wish you all an enjoyable year.
Dr Simon Hannam
Head of Phase 4
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2. AIMS AND OBJECTIVES OF PHASE 4
In Phase 4 you will build on the basic knowledge and skills developed in Phase 3 and extend these to
the special groups of patients found within the Phase 4 specialties. You will acquire the core knowledge,
skills and attitudes in the following disciplines, which will be grouped into three Blocks.
Child Health, Development and Ageing
This teaches about medicine at the extremes of age. Paediatrics, Child Health (including care of the
newborn) and Child Psychiatry form an integrated course with separate clinical attachment for Medicine
and Psychiatry of Old Age which includes Health Care of the Elderly, Palliative Medicine and Old Age
Psychiatry. The subjects will be linked in the symposia by common themes applied to the extremes of
age. Dermatology, as an all age specialty, will be taught throughout the course.
Emergency Medicine, Trauma and Locomotion
This includes experience in Accident and Emergency Medicine, Trauma, Anaesthesia, care of the injured
patient, and specialties relating to locomotion including Orthopaedics, Rheumatology and Rehabilitation
including the management of gait disorders.
Reproductive and Sexual Health
This is a comprehensive course in Women’s Health and Sexual Health. The integrated programme
includes Obstetrics, Midwifery, Gynaecology, Family Planning, Breast Medicine including related
Oncology, and Genitourinary Medicine and HIV.
By the end of Phase 4, students will have achieved the following:
Attitudes
• Developed appropriate attitudes that relate to the vulnerable groups of patients in Phase 4.
Knowledge
• Completed the teaching of core knowledge in the presentation, symptoms, diagnosis, investigation
and management of the Phase 4 disciplines.
• Integrated the anatomical, physiological and pathological aspects of these disciplines with clinical
teaching. This will be achieved through a range of innovative learning methods which will include
seminars on Problem Based Learning for topics within the core curriculum, symposia for a multidisciplinary approach, and small group teaching.
• Gained sufficient complementary clinical experience to support the core curriculum in these
disciplines which will be taught in hospital, community and general practice.
• Be familiar with the range of normal presentation and to be able to distinguish the normal from the
abnormal.
• Gained an appreciation of the psychological and socio-economic circumstances of patients,
particularly of those who are more vulnerable and disadvantaged from age, dependency, and
disadvantage.
• Been introduced to and gained an understanding of the role of the multidisciplinary team in the care of
dependent patients.
• Been introduced to aspects of public health, epidemiology, pharmacology and therapeutics and the
laboratory sciences relevant to the Phase 4 specialties.
• Acquired knowledge through independent learning using a range of methods which will include
Student Selected Components, case-based and problem-based learning, multimedia, and computer
aided learning, and that these combined should comprise up to about 30% of the learning.
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Skills
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Developed the special communication skills required for the groups of patients represented in Phase
4 which will include the taking of a history from a third party as with infants, elderly and disabled
people, and the injured patient, and have developed elementary counselling skills required in their
management.
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Developed appropriate attitudes and professional skills as they relate to the groups of patients in
Phase 4.
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Gained an understanding of ethical issues and their application in the context of the many
controversial and sensitive areas presenting in the management of these patients.
Assessment
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Demonstrated the core knowledge, skills and attitudes through in-course and end of year assessment
that will satisfy the standards required for certification as a medical practitioner before progression to
Phase 5.
Student Support
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Been supported during the course through personal contact with tutors and clinical supervisors in
tutorials and small group teaching and offered appropriate help for educational and personal needs.
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3. CODE OF PRACTICE FOR STUDENT EXAMINATION OF PATIENTS
Medical consultations, examinations and investigations are potentially distressing for patients particularly
when involving intimate areas of the body, and may easily be misinterpreted or misunderstood. The
General Medical Council receives frequent complaints that doctors have behaved improperly,
inappropriately or roughly when undertaking intimate examinations. Many of these allegations prove to
be unfounded and have arisen from patients’ misinterpretations, often of a sexual nature, of the actions
or approach of well-intentioned practitioners. Students are also at risk of allegations from patients.
Students should develop appropriate expertise and sensitivity when undertaking intimate examinations.
For your own and your patients’ protection, you should observe this code of practice:
1. Ensure you maintain your membership of a defence organization. At King’s College London School
of Medicine it is compulsory to be a member of a defence organization throughout the course.
2. Wear an identity badge prominently displayed at all times on the wards, in outpatients, general
practice, and when visiting patients at home. Wear your white coat in specialties where this is
customary.
3. Always ask permission from a qualified doctor or nurse to examine a patient or undertake a
procedure. This is not essential when taking a history from a patient without examination, although it
would be courteous to do so. Discuss the need for a chaperone and, if advised, arrange to have
one.
4. Introduce yourself to the patient by name. Explain that you are a medical student and where you are
studying. Do not pose as a doctor.
5. Explain to the patient what the examination involves and the reason for it. Check that the patient
understands and obtain his or her verbal permission to proceed.
6. For intimate examinations or general examinations in which intimate body areas are exposed,
ALWAYS USE A CHAPERONE. Examples include:
 gynaecological examination
 rectal examination
 examination of female breasts
 examination of male genitalia
 procedures involving any of these areas e.g. urinary catheterisation.
7. You should be supervised by a qualified doctor or specialist nurse when undertaking invasive
examinations and procedures of the rectum, vagina and bladder. Until you have been formally
assessed as competent, you should not undertake these without clinical supervision.
8. Allow the patient privacy to undress and dress, explaining which garments should be removed.
Minimise the patient’s exposure, and provide a covering for exposed parts of the body when not
being examined.
9. Avoid examining patients in poorly lit areas, closed cubicles, or through their garments.
10. Keep any discussion relevant. Do not make personal comments or use names of endearment such
as “pet”, “dear”, “love”.
11. If a patient becomes uncomfortable, difficult, or is aroused, or you feel ill at ease about the situation,
discontinue the consultation or examination courteously.
12. Record and sign any examination in the patient’s notes. Report any adverse comments to a member
of staff and record them in the notes.
Who should be your chaperone?
Discuss with the patient his or her preference for a chaperone or companion. Surveys have shown that
adults of both sexes would prefer a nurse as chaperone and teenagers would prefer a parent. In most
wards and GP surgeries, there are insufficient staff to provide chaperones for patient examinations.
Another student may be acceptable as chaperone, preferably one of the same sex as the patient. If no
one is available, postpone the examination rather than put yourself at risk.
Professional behaviour
There is a professional code for doctors and students concerning behaviour and presentation towards
patients. Observing this helps protect against allegations of familiarity. You should be clean and tidy,
avoiding excessive casualness or fashions that might arouse patients or make them feel uncomfortable
e.g. low cut necklines or open shirts, bare midriffs, or short skirts. A white coat, as a statement of
professionalism, will discourage accusations of impropriety, although in some specialties it is customary
for white coats not to be worn, as in Paediatrics, General Practice, and Psychiatry.
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Examination of special groups of patients
1. Patients with mental illness
On psychiatric wards and clinics, it is the policy of the school that medical students do not see patients
unaccompanied. This is a safety precaution and protects against possible intimidation or violence
particularly from sexually provocative patients. You should always have a chaperone when you clerk a
patient. For all other visits to patients, you should always inform ward staff of your intentions and take
their advice. When you are working with another student, you are advised to choose mixed sex pairs
where possible.
2. Nervous patients and those with personality disorders
Nervous or embarrassed patients may be apprehensive about being examined. A chaperone provides
reassurance. Students should be alert to signals of distress from patients; you should apologise and
discontinue under these circumstances.
3. Adults with learning difficulties
Adult patients with learning difficulties should be treated as fully consenting adults with the capacity to
decide whether to consent or refuse. As with all patients, it is essential to show respect and privacy. If
the patient suffers severe mental disability, discuss your intended examination with an accompanying
family member. This is both as a courtesy and to help put the patient and carers at ease. You should
note that legally no-one can give consent on behalf of another adult without a Court’s permission.
4. Children and adolescents
Infants and children under 16 years of age should always be clerked and examined with a parent,
guardian or member of staff present. Children are easily upset, and need the reassurance that comes
from the presence of their family; they are taught not to talk to strangers and are generally suspicious of
unfamiliar faces. Be aware that child abuse or mishandling is a real fear for parents; students should
avoid situations where their intentions can be misinterpreted.
5. Ethnic, cultural and religious groups
Expectations vary according to individual circumstances, but remember that Muslim and Hindu women
are brought up with a strong taboo against being touched by a man other than their husbands and have
a clear preference for women practitioners when intimate examinations are necessary. Male students
examining women from these cultural groups should have a chaperone at all times. The Islam, Hindu
and Orthodox Judaism religions have taboos about menstruation, so a gynaecological examination
during menstruation is unacceptable except in an emergency.
6. The anaesthetised patient
If you are asked to make an intimate examination on a patient under anaesthesia (EUA), check with the
surgeon or gynaecologist that the patient has given written consent pre-operatively to this examination
and that student examination is automatically covered. If the EUA is additional to the surgical procedure
for the benefit of the student, you need the patient’s signed consent either on the official consent form or
one specifically designed for the situation with an addendum which states that “the EUA will be
undertaken by a medical student under supervision of the consultant”. Once signed this must be filed in
the patient’s notes.
Examination of patients away from King’s College London School of Medicine hospitals
Visiting patients at home
We ask tutors to consider your safety and security whenever you are asked to visit patients at
home. You should always discuss this with your tutor if you have any concerns at all. In earlier years of
the course you are often able to visit patients paired with another student but this will often not be
possible in phase 5. If after discussion with your tutor you remain very uncomfortable or feel pressurised,
you are entitled to decline to visit. If you do visit alone, be sure not to put yourself in a compromising
position, in particular avoid carrying out any examination which could be misconstrued. Your tutor takes
responsibility if you are acting under his or her guidance.
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Overseas visits on short-term attachments
The same considerations apply when undertaking clinical attachments abroad. Customs and
professional etiquette vary in different countries and you will need to be aware of local practice. In
countries where health care provision is scarce, students may feel under pressure to exceed their role.
You must check that you have professional supervision. Always recognise your clinical limitations.
Protocol for Intimate Examinations of Patients by Students in the Healthcare Professions
(Recommendations in this protocol are under consideration by NHS Trusts and are at different stages of
implementation. You will find that clinical practice varies across hospitals.)
Introduction
Consultations with healthcare professionals, examinations and investigations are potentially distressing
for patients when involving intimate areas of the body. Acceptable professional behaviour, good
communication, and respect for patients’ rights to be fully involved in decisions about their care will
reassure patients and avoid misunderstanding.
Complaints are not infrequently made that health professionals have behaved improperly or roughly
when undertaking intimate examinations or invasive procedures. Students in healthcare professions are
at similar risk. For your patients’ and your own protection, you should follow this protocol when
performing intimate examinations. These include:
 vaginal examination and inspection of the perineum
 rectal examination of both sexes
 examination of female breasts
 examination of external male genitalia
Requirements for intimate examinations
You should first practise the examination on a model, mannequin, or a gynaecology teaching assistant.
Before examining a patient, you must have approval from your supervising practitioner at the time of the
examination. For all vaginal and rectal examinations and first examinations of female breasts or male
external genitalia, you must examine the patient in the presence of your supervisor.
The patient must have a chaperone.
You should obtain the patient’s permission and explain that this will be recorded in the patient notes, as
follows;
 Verbal permission for examination with the patient awake
 Written permission for examination under anaesthesia, using a student form
Patient consent for examinations and invasive procedures
It is a requirement of clinical practice that consent for any procedure is obtained from patients by the
clinician who takes responsibility for their care and that the patient is adequately informed about the
procedure, the possible risks and consequences, and alternative management options. This is known as
informed consent. Giving consent requires the patient to have sufficient mental capacity to consent.
Consent can be verbal or written and must be given voluntarily. Students in training are not legally
qualified to obtain informed consent from patients but must obtain the patient’s agreement for history
taking and examination.
Preparing patients for an intimate examination
Before you perform an intimate examination, you must obtain the patient’s permission. Start by
explaining what is involved and asking whether the patient has previous experience of the examination,
whether the experience was painful and if so discuss with your supervisor. Offer an opportunity for
questions and discussion, and supplement with an information leaflet if available- remember that patients
need time to reflect on information. Explain that patients have choices and that declining an examination
will not adversely affect care. Explain that your supervisor will be present during the examination.
Women from some backgrounds and cultures may have beliefs about not being touched by a man other
than their husbands and some women may express a preference for women practitioners for intimate
examinations. Such requests should be respected. You should avoid examining women during
menstruation except in an emergency. You should also be sensitive to the potential for embarrassment
or misunderstanding in other circumstances such as examining the chest of a female with exposure of
the breasts, or examining the eyes by fundoscopy in a dimly lit room.
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Keeping good clinical records
You should record the examination in the patient’s notes. State that the patient gave permission, whether
your supervisor was present, whether the patient was chaperoned and if so by whom. Date and sign
your entry with your name and student status clearly printed. Final year students assessed as competent
in the examination should record their clinical findings as a contribution to team-care.
Who should chaperone the patient?
Whenever students perform intimate examinations, the patient should have a chaperone. The option of a
chaperone should be discussed with the patient and your supervisor. A chaperone should be a member
of staff and may include your supervisor, or a friend or a relative accompanying the patient. The
chaperone should be of the same sex as the patient. Studies have shown that adults of both sexes
prefer a nurse as chaperone, and teenagers prefer a parent. If staff are unavailable, another student may
be acceptable if the same sex as the patient. If no one is available, postpone the examination rather than
examine the patient alone. If asked to be a chaperone stand or sit by the patient unobtrusively and
observe the procedure. If the patient is distressed, report this to the examiner and suggest the
examination is discontinued.
Patient examination under anaesthesia (EUA)
Permission for students to gain experience during EUA must always be obtained from the patient. The
procedure should be explained prior to the “premed” before the anaesthetic and the patient asked to give
written agreement. Ideally this should be done in outpatients or the ward rather than in the operating
theatre, but practicalities on the day of the procedure may preclude this. In some trusts, student consent
forms may be available in the operating theatres, outpatients, wards, or on the Trust intranet. These
forms are different from the standard NHS forms used by staff when obtaining patient consent to a
surgical procedure.
As a student, it is your responsibility to check with your supervising gynaecologist or surgeon that the
patient has agreed to the examination. It is your supervisor’s responsibility to explain the procedure
and obtain the patient’s signature. Consent may be obtained in this way for up to two anonymous
students for each examination or procedure. The consent form must be countersigned by your
supervisor before surgery and filed in the patient notes. If student consent forms are not available,
permission should be verbal and should be recorded in the patient notes. If permission has not been
obtained from the patient, you must not proceed with EUA. If pressed to do so, you should explain
to your supervisor that it is a School requirement to obtain permission.
Intimate examinations during pregnancy and childbirth
Student midwives and medical students are expected to participate under supervision in the care of
pregnant women. This may involve vaginal examination and inspection of the perineum. The most
appropriate time to discuss student involvement is during the antenatal period and should be done by the
midwife or obstetrician with clinical responsibility for the patient. Written information about this may be
included in the patient-held antenatal records. Giving consent is an on-going process throughout the
period of maternity care. During labour and the post-natal period, it is essential that the patient is asked
for verbal permission for a named student to perform vaginal or perineal examination, and that
examinations are recorded in the patient notes.
Intimate Examinations of special groups of patients
Because some patients may not have the capacity to give consent, students should not perform intimate
examinations on the following groups:
1. Patients with severe mental illness
2. Adults with severe learning difficulties
3. Children and adolescents under age 16 years
4. Non-English speaking patients
5. Patients at home, when medical students accompanied by their GP tutor
Examination of patients at District General Hospitals (DGHs)
The same professional and ethical principles apply at DGHs as at campus hospitals. You should follow
this protocol. There will be slight differences in availability and wording of student consent forms. If you
are concerned about what you are being asked to see or do, discuss with your local supervisor or subDean. If this does not satisfy your concerns, you should raise it with your Clinical Adviser. If you feel ill at
ease about performing an intimate examination, do not proceed.
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Examinations in general practice
Before performing an examination, check that your patient has given verbal permission. For intimate
examinations, your GP tutor or clinical supervisor must accompany you. The patient should have a
chaperone of the same sex, unless by mutual agreement, the patients’ partner agrees to chaperone.
After the examination, you should record in the patient’s written or computerised notes that you
examined with the patient’s permission. State: your supervisor, the arrangements for and name of the
chaperone, your findings, and date and sign your entry, stating your course and year of training.
Electives and clinical attachments at home and abroad
The same rules and etiquette apply on clinical attachments or electives abroad. Customs and
professional etiquette vary in different countries. You should be aware of local practice. In countries
where healthcare is scarce, you may feel under pressure to exceed your role. Check that you have
professional supervision and recognize your clinical limitations. Record, date and sign your examination,
stating permission was obtained, and giving the name and status of your chaperone.
Procedures in Clinical Practice
Basic professional requirements for students on clinical practice 1,2
Medical students are required to maintain membership of a defence organisation throughout the course.
Wear an identity badge prominently displayed at all times in hospital and community. Dress should be
professional and appropriate to the specialty. Dress code excludes excessively casual clothing such as
jeans, shorts, baseball caps and trainers. Avoid wearing revealing clothing as this may embarrass
patients. You should be clean and tidy, fingernails short, and long hair tied back. It is unprofessional to
chew gum, eat, or drink in the patient’s presence.
You should be polite and considerate with staff and patients. Avoid unacceptable behaviour and
personal conversations in the patient’s presence or when undertaking professional activities.
Introduce yourself to the patient by your full name. Explain that you are a student; state your course,
and where you are studying. Never pose as a qualified professional.
Always provide privacy for the patient to undress and dress. Draw the curtains around the examination
couch, checking that it is covered with clean paper. Explain which garments should be removed and
where they should be placed. Do not observe the patient undressing. Ask your patient to let you know
when they are ready to be examined.
Explain the position for the examination. Provide a cover for exposed body areas.
Keep discussion relevant to the examination; avoid personal or humorous comments. You should
discontinue if you feel ill at ease, or, if the patient is uncomfortable, distressed, aroused, makes
inappropriate comments, or withdraws consent.
Protocol for vaginal examination (patient awake)
1. Learn and practise vaginal or speculum examination on a simulator or a gynaecology teachingassistant. These are women who train students on themselves and agree to be examined. You
must be signed up for this in your logbook before transferring the technique to a patient. When you
perform vaginal examination, your clinical supervisor must be present throughout. Introduce
yourself to the patient; explain your student status, course and year of study.
2. Explain the examination to the patient and obtain verbal permission. Discuss the need for a
chaperone with your supervisor and if male, arrange for a female chaperone.
Allow patient privacy for undressing. Explain the position for the examination. You should first
examine the abdomen to put the patient at ease and to detect abnormal pathology. It is usual for
the patient to be examined lying on her back (dorsal position) although occasionally, you may see
a patient examined on her side (usually the left lateral position).
3. Before you start, check the examination tray for equipment for a vaginal speculum of correct size,
lubricant jelly, examination gloves, and tissues for wiping body areas after the examination. Check
the examination light is working and is in the correct position.
4. Wear surgical gloves on both hands.
5. Proceed with the vaginal examination as instructed, observing clinical etiquette. Inform your patient
when you have finished, explain your findings and thank your patient. Ask your supervisor for
feedback.
6. Record, date and sign the examination in the patient’s notes, stating that permission was obtained,
name of your supervisor, and name and status of the chaperone.
1 General Medical Council. Good medical practice and duties of a doctor. 2002. www.gmc-uk.org
2 Royal College of Obstetricians and Gynaecologists. Gynaecological Examinations. RCOG. London. 2002
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Protocol for ano-rectal examination
1. Learn and practise rectal or proctoscopic examination on a simulator before you transfer to a
patient. Medical students should learn the technique at the Phase 3 Introductory Course.
2. When you perform ano-rectal examination, your clinical supervisor must be present throughout.
3. Introduce yourself to the patient, explain your student status, course and year of study.
4. Explain the examination to the patient and obtain verbal permission. Discuss the need for a
chaperone with the patient and your supervisor. If your supervisor is of different sex from the
patient, arrange for a chaperone of the same sex as the patient.
5. Allow patient privacy for undressing. Explain the position for the examination. You should start with
an abdominal examination to detect pathology and put the patient at ease. It is usual to examine
the rectum with the patient lying on the left side (lateral position) with knees flexed and drawn
towards the chest.
6. Before you start, check the examination tray for surgical gloves, lubricant jelly, tissues for wiping
body areas after the examination, and a proctoscope if needed.
7. Wear surgical gloves on both hands.
8. Proceed with the rectal examination as instructed by your supervisor, treating your patient gently,
and observing clinical etiquette throughout. Inform your patient when you have finished, explain
your findings, and thank your patient. Ask your supervisor for feedback.
9. Record, date and sign the examination in the patient’s notes, stating that patient permission was
obtained, name of your supervisor, and name and status of the chaperone.
Protocol for examination of female breasts
1. Learn and practise breast examination first on a mannequin or a volunteer patient in a group
teaching session before transferring to a patient. When you first perform breast examination, your
clinical supervisor must be present throughout.
2. Introduce yourself to the patient, explain your student status, your course, and year of study.
Explain the examination to the patient and obtain verbal permission. If your supervisor is male,
arrange for a female chaperone.
3. Allow patient privacy for undressing. Explain the position for the examination starting with the
patient in a supine position with the head end of the couch elevated to 45 degrees, and then rolling
to the side.
4. Proceed with the breast examination as instructed, observing carefully and palpating gently. Inform
your patient when you have finished, allow her to cover herself, explain your findings, and thank
your patient. Ask your supervisor for feedback.
5. Record, date and sign the examination in the patient’s notes, stating that consent was given, the
name of your supervisor and name and status of your chaperone.
Protocol for examination of male external genitalia
1. For your first examination of male external genitalia, your clinical supervisor must be present. You
should examine male external genitalia with great sensitivity and with no more than two students
present one of who should be male if possible.
2. Introduce yourself to the patient; explain your student status, your course, and year of study.
Explain the examination to the patient and obtain verbal permission. If you are examining alone,
you must arrange for a chaperone who should be of the same sex as the patient. This could be a
fellow student. Your hands should be warm. Do not rub them together in front of the patient!
3. Observe clinical etiquette throughout the examination. Start with the patient standing fully exposing
his groins, and your eyes level with the area being examined. Observe the area and ask the patient
to cough. Palpate the scrotum to determine the presence of two normal testes and any abnormal
mass, and then palpate the inguinal and femoral areas for cough impulses. If you notice a swelling
of the groin in the upright position, do not try to reduce it.
4. For the second part of the examination, ask the patient to lie down. The patient should gently
reduce any swelling. You should examine for hernia, palpate the femoral vessels, and scrotum.
Inform your patient when you have finished, explain your findings, and thank the patient.
5. Record, date and sign the examination in the patient’s notes, stating that permission was obtained,
the name of your supervisor, and name and status of your chaperone.
9
4. ATTENDANCE AND GOOD PHILOSOPHY OF WORK
Overnight success
These days the papers are full of stories about people who shoot to fame almost overnight, seemingly
without any effort on their part. They seem to forget that everyone who enjoys success in film, music,
theatre, sport or any other sphere of activity has spent many years practising and training, in order to
achieve their goals! It is the same with a medical career. Success in terms of doing well each year, and
then qualifying with one of the world’s most highly regarded degrees, is not a free gift or a right, but
something that needs to be worked at.
‘Pursuing a course of study’
The General Medical Council indicates that medical students must pursue a course of study and this
means attendance at the activities organised by Medical Schools. Of course the vast majority of
students turn up to most things but problems sometimes arise – including cases where it is perceived
that you have not attended, when in fact you did. So we felt it would be worthwhile outlining some of the
issues at the beginning of the Year rather than later when there are problems.
“What is expected of me?”
You are expected to attend all teaching – whether clinical, symposia, seminars or tutorials. However, it
is recognised that illness and official absence may reduce this. Greater than 90% attendance is
expected. If it is evident that attendance falls below 75%, your Clinical Adviser will be notified.
Persistent non-attendance is a very serious issue that will be dealt with by the Senior Clinical Advisers
and the Site Deans from each campus (see separate information about this process). We are
particularly concerned when a student does not make an appearance at the beginning of a rotation or
block, and does not collect any materials for the forthcoming period. Non-attendance is the major
cause of academic problems, in our experience. However if you feel you have been hard done by in an
assessment of attendance, do let the course organiser or Firm chief know.
“I find it easier to learn from books than going to symposia, lectures or tutorials!”
 We all have different learning styles, but there is an important aspect that you cannot get from books.
In group teaching we interact with teachers and student colleagues or friends. It is also important to
get into the rhythm of getting up in the morning to go to a day’s teaching, it is too easy to start
opting out of more and more sessions until you lose touch completely. We forget how important it is
to be with other people – whether you are an extrovert or introvert – and lack of contact with others
(feeling ‘out of it’) can lead to loss of enjoyment of the course and sometimes depression.
 Developing professional values best happens by contributing to tutorials & practicals on
communications, ethics and taking a wide interest in medico-political and ethical problems in
medicine, and exposing yourself to these issues through meeting them in wards and clinics
 Practising & learning clinical skills, procedures, communications, team working and practical
knowledge of medicine is best and most appropriately learned working with patients and staff in
clinical settings
 Learning the clinical and scientific knowledge base is greatly assisted by drawing on the skills and
experiences of senior clinicians in symposia, lectures and small group sessions, backed up with
conscientious bookwork.
 Medicine is a bit like flying: one would not be happy being flown by a pilot who had passed his exams
brilliantly but had little experience and few flight hours. To learn the practice of medicine requires
both bookwork and flying hours
“How much extra should I try and do?”
Going to special sessions like clinical-pathological meetings, Grand Rounds and post mortem
presentations can be an effort sometimes, but it helps you to feel part of the whole clinical team, as well
as being good for learning. Whenever you see a patient with a particular clinical problem, read up on it
and make notes- it makes it so much more memorable.
10
“What if I am ill or need to go home because of a family problem?”
These kinds of problems happen to everyone. The key issue here is that you should let the relevant
people know what has happened. Just as you would be bothered if someone didn’t meet you when
they said they would, so teachers (especially in small-group work) ought to know why you are not there;
this is part of social and professional courtesy and consideration for others, that we should aim to
have. Always keep any appointments you have made with staff and be on time - and apologise if you
are held up, even if it is not your fault (you may need to phone ahead as the individual may only have a
limited time slot to see you). So if there is a problem:
 Tell the Academic Centre if you are unwell, especially if you are likely to be off sick for more than
a couple of days, or have a moderate to severe illness or admission to hospital.
 Small group work: Tell the tutor you cannot attend (or Firm head) their session, preferably
personally by e-mail or phone call, or, as a last resort, ask a fellow student to let the individual
know.
 Large sessions (Lectures, Symposia): You do not need to inform the lecturer, but make every effort
to catch up with what you missed.

Timetable clashes: teachers may not know about the details of your SSC teaching that clashes
with their tutorial, so do let them know if there is a conflict, and you have go off to a clinic or an
SSC activity for example.
“Sometimes the teachers don’t attend!”
This does happen sometimes for a whole host of reasons. The hospitals and campuses are large and
complex organisations and things do go wrong organisationally. Staff can get stressed and
disorganised too! We try and minimise this but if it does happen, we hope you will be told what went
wrong, and if a replacement session can be scheduled. Sometimes informal ward teaching does not
happen because of some clinical emergency, but if you find a Firm is not delivering teaching please
inform the Phase head (this will be in confidence).
Money problems
Students who take on employment are at serious risk of failing. The School’s view is that it is not
acceptable to take days out of the week to do jobs. We understand the problems some people have, but
you will always have to put your studies first. Make contact with those responsible for hardship funds and
other sources of funding as soon as you can, if you are getting into difficulties.
A philosophy of working…
If you get behind in your studies it can have a very negative effect and inhibit concentration (‘I’ve so
much to do, I can’t do any of it!’). Also, if you fall behind in background reading and other work, you
can begin to lose confidence in clinics and on wards, and then with patients. Forgetting about clinical
skills can also have the same effect so it is important not to leave them all for sign-ups or OSCEs but
keep practising as you go along. Once signed up that does not mean you have the skill mastered – as
many found out in previous years when even simple things like blood pressure measurement in the
OSCEs were done badly! Sometimes we have to delay gratification i.e. defer something nice that we
want to do, in order to achieve a goal. This can actually enhance our enjoyment in life because we have
a greater sense of achievement - rather than a last minute panic - and our leisure time is deserved. Plan
work to meet your deadlines well in advance!
A philosophy of NOT working…
It is also important to know how and when to relax, to have a day a week doing nothing much and just
enjoying yourself!
11
Structure of Phase 4
The 3 main blocks in Phase 4 are clinically very exciting, and also demanding. You will attend a diverse
range of clinical teaching, and the weekly timetables are busy and variable. You will therefore need to be
organised, punctual and conscientious to ensure that you attend and get the maximum benefit from this
year. This is part of showing that you are ready to assume the professional responsibilities that are
required as a medical graduate.
Peripheral Placements in Paediatrics, and Obstetrics & Gynaecology
During the CHDA and RSH Blocks most students will undertake a three week placement at either a DGH,
or at an overseas twinned institution, or at a self-arranged placement organized by the individual student.
The main reason for arranging these attachments is for you to experience medicine away from the teaching
hospital environment, where you can really feel part of the DGH team, and where you can learn about
important common medical problems. It is, as with most things, a case of what you get out of it depending
on what you put into it. We therefore strongly encourage you to really “immerse” yourself in the clinical
experience during these valuable attachments. This includes staying at the weekend if you can. You may
be able to arrange to continue with your SSC work on the Friday whilst staying at the DGH. However if the
particular SSC requires that you return to campus, then the DGH consultants are aware of this requirement.
Your attendance at the DGH will be monitored by the supervising consultant.
Those students undertaking CHDA at PRUH and UHL, and those students undertaking RSH at PRUH,
QEH and UHL, do not require this three week placement as they receive equivalent clinical experience at
these hospitals.
Enjoy the Year!
12
Holidays
FIRST ROTATION
Week
1
Start Date
10-Sep-12
2
3
4
5
6
7
8
9
10
11
12
17-Sep-12
24-Sep-12
01-Oct-12
08-Oct-12
15-Oct-12
22-Oct-12
29-Oct-12
05-Nov-12
12-Nov-12
19-Nov-12
26-Nov-12
13
03-Dec-12
SSCs, Community Study & Assessments
SSC Start date 14/09/12
Reading week
Community Study (Stream A) 21/09/12
Community Study day (Stream B) – 07/12/12
SSC 1 Submission date 07/12/12
10-Dec-12
17-Dec-12
Christmas Holiday
24-Dec-12
SECOND ROTATION
New Year's Day
Bank Holiday
1
2
3
4
5
6
7
8
9
10
11
12
13
Easter Monday
Third Rotation
Early May Bank
Holiday
1
2
3
4
5
6
7
8
(31-Dec-12)
(01-Jan-13)
02-Jan-13
07-Jan-13
14-Jan-13
21-Jan-13
28- Jan-13
04-Feb-13
Careers Day Fri 11/01/13
Stream A ½ Day Global Health ½ day Tropical Health Fri 18/01/13
Stream B ½ day Global Health ½ day Tropical Health Fri 08/02/13
11-Feb-13
18-Feb-13
25-Feb-13
04-Mar-13
11-Mar-13
18-Mar-13
25-Mar-13
(01-Apr-13)
02-April-13
08-Apr-13
15-Apr-13
22-Apr-13
29-Apr-13
(06-May-13)
07-May-13
13-May-13
9
10
11
20-May-13
(27-May-13)
28-May-13
03-Jun-13
10-Jun-13
12
17-Jun-13
13
24-Jun-12
01-Jul-13
Spring Bank Holiday
Health promotion and elective portfolio planning (A&B)
Community Study (Stream A) 04/01/12
08-Jul-13
Community Study (Stream A) 15/02/13
Community Study day (Stream A) – 15/03/13
Community Study day (Stream B) – 22/03/13
Submission of Elective portfolio 29/03/13
Community Study presentations (Stream A) – 12/04/13
Community Study presentations (Stream B) – 19/04/13
Consolidation and review Stream A 26/04/13
Consolidation and review Stream A 03/05/13
Consolidation and review Stream B 10/05/13
Consolidation and review Stream B 17/05/13
Written Assessment – See virtual campus for Exam Dates
Part A OSCE – Timetable published 2 weeks before on the VC
Re-sit Written Assessment/ Part B OSCE –
Final Exam results to be published
15-Jul-13
13
6. DEADLINES AND DATES
Item
Application for Elective attachments in
twinned institutions
Elective Proposal Form
Elective Portfolio
Completed logbook
Mitigating Circumstances
(Assessments) Form* for Written
Examinations
Elective emergency contact details
Mitigating Circumstances
(Assessments) Form for OSCE
Mitigating Circumstances
(Assessments) Form* for Resit Written
Examinations
Publication of MBBS Part 4 Results
Elective period
Deadline
End of November 2012 (see dates
on VC)
Early Feb– See dates on
VC/Elective Handbook
29/03/13
Rotation 1- 3rd Dec
Rotation 2 – 25th March
Rotation 3 - 25th June
7 days before exam. If exam is
taken you must submit the form 7
days after exam.
Mid July 2013 - See dates on
VC/Elective Handbook
7 days before exam. If exam is
taken you must submit the form 7
days after exam.
7 days before exam. If exam is
taken you must submit the form 7
days after exam.
Please refer to Virtual Campus
Examination Information page
See VC & Elective Handbook
14
Submitted to / Location
Academic Centre
Academic Centre
Academic Centre
Academic Centre
Academic Centre
Academic Centre
Academic Centre
Academic Centre
Guy’s Exam Noticeboard
7. COURSE OUTLINE
•
The Phase 4 course extends over 41 weeks. There will be a total of 4 weeks holiday: 2 weeks at
Christmas and the New Year, and two after the completion of Phase 4, in addition to Bank Holidays.
There is no holiday at Easter.
•
Each rotation lasts 13 weeks: 12 weeks teaching and a final reading week in week 13 (Rotation 1 &
2). Rotation 3 lasts 13 weeks: 12 weeks teaching and written assessment in Week 13. There is no
SSC in Rotation 3
•
Fridays (except for Community Study Days as outlined below) are for Student Selected
Components but are also designated for teaching and consolidation, you can expect to have some
timetabled sessions on these Fridays.
•
After the final rotation, there are two further weeks for assessment, to include the OSCE and the
resit end of block written examinations.
•
Symposia: first symposia Monday afternoon, otherwise weeks 1-12 on most Wednesday mornings.
Most symposia are block specific for all students on all campuses.
•
Seminars: Mondays, Tuesdays and Thursdays for one hour (2 hours for PBL in the EMTL Block at
King's College Hospital campus), and are block specific; for CHDA at GST, KCH and PRUH,
seminars are all delivered in weeks 1, 2, and 12 of the Block.
For timetables see the Virtual Campus and Coursebooks.
•
Community Study days will take place on the following Fridays: Rotation 1 - Week 2 (Stream A) &
Week 13 (Stream B). Rotation 2 - Weeks 1 and 11 (Stream A) and weeks 6 and 12 (Stream B).
Rotation 3 – CS Presentation Week 2 (Stream A) – HP & CS Presentation Week 3 (Stream B).
All students will also attend the Community Study symposium on the morning of week 1, rotation 2
(6th Jan 2012).
Outline Timetable
13 weeks
•
2
weeks
Child Health,
Development
and Ageing
Reproductive
and Sexual
Health
13 weeks
Child Health,
Development
and Ageing
Emergency
Medicine,
Trauma and
Locomotion
13 weeks
1 week
1 week
Part B OSCE•
Re-sit written examinations•
Emergency
Medicine,
Trauma and
Locomotion
Reproductive
and Sexual
Health
Week
Week
Week
starting starting starting
01/07/13 08/07/13 15/07/13
Part A OSCE
Introductory Day
Emergency
Medicine,
Trauma and
Locomotion
Reproductive
and Sexual
Health
Holiday
Introductory Day
Child Health,
Development
and Ageing
Rotation THREE
02/04/13-28/06/13
Part A OSCE
Rotation TWO
02/01/13-29/03/12
Introductory Day
Rotation ONE
10/09/12-07/12/12
1 week
Each rotation begins with an introductory programme, scheduled for the first day of each rotation.
On this day, the whole year will assemble in the morning before splitting into the three group blocks.
The timetable for each introductory day applies for all three rotations, and is as follows:
15
Timetable for Introductory Days
Morning programme:
 Rotation 1 (Monday 10/09/12): 09:00am – 1pm
Introduction, Greenwood Lecture Theatre, Weston St, Guy’s; follow-up sessions in Anatomy Lecture
Theatre (Hodgkin) and Harris Lecture Theatre (Hodgkin) and for CHDA Waterloo Campus (CHDA
students will be split into two groups –see Introduction Timetable and attachment).
 Rotation 2 (Wednesday 02/01/12): 8.30am – 1pm
Introduction, Greenwood Lecture Theatre, Weston St, Guy’s; follow-up sessions Anatomy Lecture
Theatre, Tower Lecture Theatre & Greenwood LT.
 Rotation 3 (Tuesday 02/04/12): 8.30 am – 1pm
Introduction, Greenwood Lecture Theatre, Weston St, Guy’s; follow-up sessions in Anatomy Lecture
Theatre, Harris Lecture Theatre (Hodgkin) & New Hunts House Lecture Theatre 2.
Afternoon programme:
 Rotations 1, 2 and 3: from 2pm
First symposium of each course block. See Symposium timetable (available on the VC) for full details.
You should make sure you have the following:
•
MBBS Phase 4 Student Handbook – only available on the VC
•
MBBS Phase 4 Logbooks (CHDA, EMTL, RSH) - Distributed on Rotation 1 intro day.
•
MBBS Core Curriculum (available from the Virtual Campus)
•
MBBS Phase 4 Community Study Guide – Distributed on Rotation 1 intro day.
•
MBBS Elective Handbook (available from the Virtual Campus)
16
8. PHASE 4 KEY CO-ORDINATORS
Head of Phase 4
Phase 4 Academic Centre Contact
Dr Simon Hannam
Department of Paediatrics
King’s College Hospital
Denmark Hill
London SE5 9RS
020 3299 4000 ext 4644
Selina McClure
Phase 4 Undergraduate Officer
Academic Centre
2nd Floor Henriette Raphael House
Guy’s Campus
London SE1 1UL
020 7848 6720
FAX 020 7848 6730
[email protected]
[email protected]
Deputy Head of Phase 4
Dr Rachael Morris-Jones
Dermatology Consultant
Kings College Hospital
London
SE5 9RS
020 3299 4000 ext ext 4634
[email protected]
Lead Co-ordinator for Community Study/Health
Promotion & SSCs
SSC Academic Centre Contact
Dr Ann Wylie
Paul Jones
Undergraduate Officer for Phase 4 (SSCs)
2nd Floor Henriette Raphael House
Guy’s Campus
London SE1 1UL
020 7848 6711
FAX 020 7848 6730
[email protected]
Department of Primary Care and Public
Health Sciences
4th Floor, Capital House, 42 Weston Street
LONDON SE1 3QD
0207 848 8705
FAX 020 7848 8705
[email protected]
Phase 4 Administrator: Simon Power
Tel 0207 848 8689
[email protected]
Co-ordinator for Elective
Dr Anthea Tilzey
C/o Academic Centre
2nd Floor Henriette Raphael House
Guy’s Campus
London SE1 1UL
FAX 020 7848 6730
[email protected]
17
Phase 4 Block Leaders and Student Co-ordinators
Child Health Development and Ageing Block
Paediatrics and Child Health Sub-block
Medicine and Psychiatry of Old Age Sub-block
Dr Simon Waller
Consultant Paediatric Nephrologist
Evelina Children's Hospital
Guy's and St Thomas' NHS Trust
Lambeth Palace Road
London, SE1 7EH
Dr Thomas Ernst
Consultant acute physician and geriatrician
St Thomas’ Hospital
Tel: 020 7188 2516
[email protected]
Administrator:
0207 188 4586 (Sec)
0207 188 4585
0207 188 3026 bleep 1341
Sandra Gray
Tel: 020 7188 2515
[email protected]
[email protected]
Emergency Medicine, Trauma and Locomotion Block
Dr Chris Lacy
A&E Department
King’s College Hospital
Denmark Hill
London SE5 9RS
020 3299 1941
Secretary:
Sophy Dunn
020 3299 1584
[email protected]
[email protected]
Reproductive and Sexual Health Block
Ms Deborah Bruce
Annelie Mojzis
Department of Women’s Health
10th Floor, North Wing
St. Thomas’ Hospital
London SE1 7EHF
Undergraduate Teaching Administrator/PA to Ms
Bruce:
[email protected]
[email protected]
020 7188 3631
FAX 0207 620 1227
Medical Student Co-ordinators
GST Campus
GST Campus
KCH Campus
(CHDA & EMTL Loco)
(EMTL Anae & A&E)
(EMTL & CHDA)
Maria Fernandes
Site Secretary and Co-ordinator
Sub Dean For Teaching Office
Prideaux Building, Block 9
St. Thomas Hospital
Lambeth Palace Road
SE1 7EH
Tel: 020 718 85183
[email protected]
Farhana Begum
Sheinaz Mahomedally
Anaesthetics Dept
MBBS Curriculum Administrator
Guy's & St Thomas' NHS
2nd Floor Borough Wing
2nd Floor, Weston Education
Centre
Great Maze Pond
Denmark Hill Campus
London. SE1 9RT.
Tel: 0207 848 5224
Tel: 020 7188 0645 (Int: 80645)
email:
[email protected]
[email protected]
QEH Campus (EMTL & RSH)
UHL Campus
Joanna Woollard
Education Centre
Stadium Road
Woolwich
London
SE18 4QH
0208 836 6788
Fax: 020 8836 6785
[email protected]
Samantha Newman
Education Centre
University Hospital Lewisham
High St.
Lewisham
London SE13 6LH
020 8333 3000 ext. 8734
PRUH Campus
Shayron Hegarty (RSH & CHDA)
TBC (EMTL)
The Education Centre
Princess Royal University Hospital
Farnborough Common
Orpington BR6 8ND
01689 864347
[email protected]
TBC
18
[email protected]
Phase 4 Examiners
Head of Examinations
Deputy Head of Examinations
Rob Feneck
Anaesthetics Dept.
East Block,
St Thomas' Hospital,
Lambeth Palace Road,
London SE1 7EH
Dr Simon Hannam
Department of Paediatrics
King’s College Hospital
Denmark Hill
London SE5 9RS
020 3299 4000 ext 4644
[email protected]
c/o [email protected]
Phase 4 Examinations Academic Centre
Contact
OSCE Co-ordinator and Administrator
Philip Wright
Academic Centre
2nd Floor Henriette Raphael House
Guy's Campus
London SE1 1UL
020 7848 6723
FAX 020 7848 6730
[email protected]
Co-ordinator:
Dr Vip Gill
Administrator:
Mr James Hollands
Chantler Clinical Skills Centre
Ground Floor Shepherd’s House
Guy's Campus
London SE1 1UL
020 7848 6101
FAX 020 7848 6730
[email protected]
Block Senior Examiners
Child Health, Development and Ageing Block
Written Assessment
OSCE
Dr Simon Hannam
Dr Simon Hannam
Emergency Medicine, Trauma and Locomotion
Block
Written Assessment
OSCE
Dr Arsenyj Powroznyk
Dr Chris Lacy
Reproductive and Sexual Health Block
Written Assessment
OSCE
Mr Mike Marsh
MS Deborah Bruce
19
Course Organisers by Block and Campus
Child Health, Development and Ageing Block
Module
KCH
GST
PRUH
UHL
Child Health
Dr S Hannam
Dr S Waller
Dr M De Silva
Dr J Lawrence
Neonatology
Dr S Hannam
Dr G Lee
Dr M De Silva
Dr J Lawrence
Child
Psychiatry
Dr S Bernard
Dr S Bernard
Dr S Bernard
Dr S Bernard
Community
Paediatrics
Dr M Davie
Dr R Healy
Dr S Sharma
Dr G Siggers
Dermatology
Dr R Morris-Jones Dr Clive Archer
Dr K Watson
Dr P Banerjee
Medicine of
Old Age
Dr R Pathansali
Dr T Ernst
Dr B Kessel
Dr Patel
Dr V Mak
Dr C Sebastian
Dr C Goddard
Dr T Beynon
Dr L Exton
Dr K Emmitt
Psychiatry of
Old Age
Dr N. Funnell
Palliative Care Dr P Edmonds
Emergency Medicine, Trauma and Locomotion Block
Module
KCH
GST
UHL
PRUH
QEH
Emergency
Medicine
Dr TJ
Lasoye
Dr B Christian
Mr N
Harrison
Dr Sam
Thenabadu
Dr F Ohanusi
Anaesthetics
Dr S Peat
Dr V Gill
Dr G Mathew
Dr Andrew
Turvey
Dr S Gupta
Pain
Dr S Peat
Dr J
Azzopardi
Dr G Mathew
Dr Sam
Thenabadu
Dr S Gupta
Orthopaedics
Mr M
Wilkinson
Mr I Jones
Dr J Bird
Mr Max
Edwards
Mr A Tindall
&
Mr A Dutta
Dr T Garrood
Rheumatology Dr P
Gordon
Dr G Yanni
Dr Sarah
Medley
Dr C
Mathews
Reproductive and Sexual Health Block
Module
KCH
GST
PRUH
UHL
QEH
Obstetrics &
Gynaecology
Mr M Marsh
Ms Deborah
Bruce
Miss K. Omar
Ms R
Cochrane
Mr N Perks
Genitourinary
Medicine
Dr A MenonJohansson
Dr A MenonJohansson
Dr A MenonJohansson
Dr A MenonJohansson
Dr J Russell
Breast
Medicine
Dr J Marsden
Mr H Hamed
Mr P Sinha
Dr H Hamed
Mr B Kald
Family
Planning
Ms M Nowicki
Ms M Nowicki
Ms M Nowicki Ms M Nowicki Ms M Nowicki
20
9. CHILD HEALTH, DEVELOPMENT AND AGEING BLOCK (CHDA)
9.1 An Overview of the Block
23
9.2 Course Organisers and Contact Details
24
9.3 Block Aims and Objectives
26
9.4 Orientation
33

Guy’s/St Thomas’ Campus
33

King’s College Hospital Campus
34

Princess Royal University Hospital Campus
35

University Hospital Lewisham Campus
36
9.5 Outside and Overseas Attachments
37
9.6 Symposia Information
38
9.7 Aims and Objectives for Symposia
38
9.8 Seminar Titles
41
9.9 Aims and Objectives for Seminars (Medicine and Psychiatry of Old Age)
42
(For Paediatrics & Child Health Seminar Aims and Objectives please refer to Paediatrics
Seminar Guide)
9.10 Recommended Reading and Computer-Aided Learning
21
46
9.1 An Overview of the Block
Introduction
The Child Health Development and Ageing (CHDA) course arose from a shared vision of the similarities in a number
of respects between the clinically disparate specialties of geriatric medicine and paediatrics. The course incorporates
dermatology - a clinical specialty highly relevant across the age spectrum - and palliative medicine. At King’s College
Hospital, Guy’s and St. Thomas’s and Princess Royal University Hospital there are two introductory
seminar/symposia weeks and one final seminar/symposia and revision week. The remaining 9 weeks of the block
consists of 3 weeks of paediatrics (including hospital paediatrics, community child health and the care of the
newborn) and child psychiatry based at GST or KCH; for those students based at KCH and GST, a 3-week
placement in paediatrics at a local DGH, or at a hospital in the Overseas Exchange Programme, or at a hospital
arranged independently; and 3 weeks of Medicine and Psychiatry of Old Age. Students at University Hospital
Lewisham & Princess Royal Hospital (Orpington) have a fully integrated block, with seminars throughout the 12
weeks, and equivalent paediatric experience obtained during 8 weeks on campus, as well as 4 weeks of Medicine
and Psychiatry of Old Age.
The Block has a series of seminars covering Medicine and Psychiatry of Old Age, Paediatrics, Dermatology, Child
Psychiatry and Palliative Medicine. The symposium programme is integrated across the CHDA block as a whole.
Thus the changes in drug handling (pharmacokinetics) across the age spectrum from neonate to extreme age are
considered in the Therapeutics Across the Ages symposium jointly run by a geriatrician and a paediatrician.
Similarly, communication problems and abuse, violence and neglect are all considered from a multidisciplinary standpoint.
It is expected that students will not only acquire the attitudes, knowledge and skills appropriate to the clinical
disciplines but also the attitudes and knowledge relevant to the consideration of ageing and its implications.
The Medicine & Psychiatry of Old Age
The Medicine and Psychiatry of Old Age module brings the medicine and psychiatry of old age together. It includes a
small but crucial component of palliative medicine. The strength of this joint approach between medicine and
psychiatry is that it not only enables overlap areas to be taught jointly (e.g. seminars on delirium, and the law) but
also ensures that the two subjects are taught in an integrated manner. The core curriculum includes a variety of
conditions that students should be familiar with. This familiarity can be achieved by self-directed learning, clerking
patients and presenting cases to teachers as well as by attending bedside teaching sessions. The sub-block aims to
strike a balance between clinical teaching and self-directed activities. In addition to the skills logbook, where formal
assessment of clinical skills will be documented, students will be given guidance as to the range of cases they should
see. Medicine and Psychiatry of Old Age is taught in the seminars symposia and, importantly, in the clinical setting
including the ward, outpatient clinics, Day Hospitals and community teams.
Dr Thomas Ernst, Consultant acute physician and geriatrician
Paediatrics, Child Health & Child Psychiatry
Whether you choose to become a GP, work in an A&E, as a surgeon or even a Paediatrician - at some point in your
career you will have to look after children. This block offers you the only real focused opportunity to develop the skills
you need to do this before you qualify. Children differ from adults in many ways. It is not just the difference in
physiology, pharmacokinetics and spectrum of pathology that you need to be aware of. Children need their doctors to
understand them in the context of their families and society and to consider their developmental, social and
educational needs. You also need to develop skills to communicate with both children and their often anxious
parents.
During your attachment in Paediatrics you will spend time in Neonatology, Community Paediatrics, Child Psychiatry,
and Dermatology. Learning about children's medicine starts with an in-depth knowledge of basic child sciences and
a clear understanding of how and why children, especially babies, differ from adults. Once the first two years of life
are past most children in developed countries live healthy lives but they can easily be blighted by conditions that are
readily preventable through accident control, immunisation, wholesome food, parental education and clean water.
The way we teach paediatrics and child health is changing. The emphasis is on knowing where to look rather than
keeping vast stores of knowledge in one's head. We will try to point the way through formal teaching. We hope you
will appreciate that child health is best promoted through teamwork and that you learn much from therapists and
nurses. Your real teachers are children and their parents. Learn how to listen to them.
Dr Simon Waller Consultant Paediatric Nephrologist & Lead for undergraduate Paediatric teaching
Dr Simon Hannam, Department of Neonatal Paediatrics, KCH and head of phase 4
22
9.2 Course Organisers and Contact Details
Paediatrics and Child Health
GST
KCH
020 7188 7188
020 7737 4000
Dr Simon Waller
Dr Simon Hannam
[email protected]. 020 3299 4000
uk
ext 4644
simon.hannam@
0207 188 4586 (Sec)
nhs.net
PRUH
01689 863000
Dr Menaka de Silva
[email protected]
UHL
020 8333 3000
Dr Joanna Lawrence
Direct line: 0203 192 8760
[email protected]
Sec: Ms Sue Crome
Direct line: 0203 192 6763
[email protected]
Sheinaz Mahomedally
sheinaz.mahomedally
@nhs.net
020 7848 5224
Child Psychiatry
GSTT
0203 228 2570
KCH
0203 228 2570
PRUH
UHL
Sarah Bernard,
Sarah Bernard,
Sarah Bernard,
Sarah Bernard,
[email protected]
k
[email protected]
.uk
[email protected]
KCH
020 7737 4000
PRUH
01689 863000
UHL
020 8333 3000
Dr Max Davie
0203 049 6004
[email protected]
Dr Sujata Sharma
020 8466 9988
Sujata.Sharma@
bromleypct.nhs.uk
Dr G Siggers
Sec Sharon Nelson
Georgie.siggers@lewishamp
ct.nhs.uk
[email protected]
hs.uk
Community Paediatrics
GST
020 7188 7188
Dr Ros Healy
0203 049 8143
ros.healy@
southwarkpct.nhs.uk
Sec. Teresa Edwards
Tel: 0207 138 1566
Teresa.edwards@lewishamp
ct.nhs.uk
Dermatology
GST
020 7188 7188
Dr Clive Archer
[email protected]
KCH
020 3 299 4238
PRUH
01689 863000
UHL
020 8333 3000
Dr Rachael Morris-Jones
rachael.morris-jones@
nhs.net
Dr Karen Watson
01689 865070
[email protected]
Dr Pui Banerjee
[email protected]
Sec: Rebecca Riley
[email protected]
020 8333 3000 ext 6181
Medicine of Old Age
GST
020 7188 7188
KCH
0203 299 6071
PRUH
01689 863000
UHL
020 8333 3000
Dr Rohan Pathansali
[email protected]
Dr Belinda Kessel
01689 865851
[email protected]
Dr Mehool Patel
[email protected]
Dr Tom Ernst
Tel: 020 71882516
Email:
[email protected].
uk
Neonatology
GST
020 7188 7188
KCH
020 7737 4000
PRUH
01689 863000
UHL
020 8333 3000
Dr Geraint Lee
Dr Simon Hannam
Dr Menaka de Silva
Dr Joanna Lawrence
Sec: Jill Faal ext 6609
Sec: Val Albert ext 8177
23
[email protected]
020 3299 4000 ext 4644
[email protected]
[email protected]
Tel: 0208 333 3000 ext
8760
[email protected]
Sec: Ms Sue Crome
Direct line: 0203 192 6763
[email protected]
Psychiatry of Old Age
GST
020 7188 7188
Dr Vivenne Mak
020 7411 6201
vivienne.mak@
slam.nhs.uk
Palliative Medicine
GST
020 7188 7188
Dr Teresa Beynon
Teresa.Beynon@gstt.
nhs.uk
KCH
020 7737 4000
PRUH
01689 863000
UHL
020 8333 3000
Dr Nicola Funnell
[email protected]
Sec: Jean Anderson
020 32281620
Dr Cherian Sebastian
0208 462 3183
Cherian.Sebastian@Oxleas.
nhs.uk
Dr Cait Goddard
KCH
020 7737 4000
PRUH
01689 863000
UHL
020 8333 3000
Dr Rachel Burman
[email protected]
Dr Elizabeth Jones
01689 865667
[email protected]
Dr Katie Emmitt
katie.emmitt@
nhs.net
020 8333 3017
UHL Student
Coordinator
Samantha Newman
020 8333 3000 ext
8734
samantha.newman@
nhs.net
PRUH Student Coordinator
Shayron Hegarty
01689 864347
[email protected]
24
[email protected]
hs.uk
9.3 Block aims and objectives
Paediatrics & Child Health Paediatrics & Child Health
1. Attitudes
You should develop appropriate attitudes during the
course, which will include:


a child-centred approach
respecting the developing rights through
childhood
2. By the end of the paediatric course you should be
able to:

recognise when a child is ill

explain the importance of prevention in child
health

demonstrate the skills of obtaining a history
from parent and child

adapt clinical examination skills to the needs
of the child

describe the difference between the child and

adult patient

sharing with the patients an advocacy role

recognise the importance of the stages of child
development
connect the clinical situation with basic
sciences (especially genetics and embryology)
analyse the role of the family, society and
environment
plan a management strategy for the individual
child patient




3. Emergencies
You should read about the initial management of the following paediatric emergencies during your paediatric
firms. You should have a chance to see some of these during your time on take.

cardio-respiratory arrest

dehydration (secondary to gastroenteritis,
diabetic ketoacidosis)

acute asthma

burns

upper respiratory tract obstruction (croup)

the severely injured child (accident, child

septicaemia (including meningococcal)
abuse)

meningitis

accidental poisoning

status epilepticus

cardiac failure

coma

4. Skills and procedures
You should observe the following

You should be competent in the following skills:

take a history from a parent and child

Examine a baby * Does not include newborn
check

examine a child

Perform and interpret a basic developmental
assessment of an infant or young child

Explain a common complaint to a child









Try to follow your patient through the
investigations or treatment so you can
appreciate the impact that these have on the
child and the family as well as familiarising
yourself with techniques
setting up of an IV infusion
insertion of a nasogastric tube
accurate measurement of height and weight
administration of nebulised bronchodilators
lumbar puncture ultrasound examination of
abdomen and head
CT, MRI scan
renal isotope scan
tracheal intubation
insertion of a chest drain
5. Preventive Paediatrics
It is important for you to understand the principles and methods in child surveillance and prevention such as
immunisation and screening. You should have the opportunity to participate in a developmental assessment
session, immunisation clinic and to discuss the importance and difficulties involved in child protection.
25
6. Core curriculum presentations
You should try to see examples of the following conditions. Using your contact with the child as the centre
of your learning, expand your knowledge of the epidemiology, pathology, clinical features and management by
reading around the subject. Try to clerk as many patients as possible, preferably one of each of the following
although some of the neonatal cases may not be directly accessible to you. There will be children with other
conditions and by clerking these also it will help you in your skills of history taking, clinical examination and creating
organised notes.
respiratory distress syndrome
tonsillitis (82)
oesophageal atresia +/- tracheo-oesophageal
febrile child (121)
fistula diaphragmatic hernia
chickenpox (102)
chronic lung disease of prematurity bronchiolitis
herpes simplex stomatitis (102)
asthma (3, 4)
febrile convulsions (69)
cystic fibrosis (3,4)
infectious mononucleosis (60, 82)
innocent murmur
AIDS
heart failure
epilepsy (69)
patent ductus arteriosus ventricular
septal defect coarctation of aorta
cerebral palsy (95) spina bifida
Fallot's tetralogy arrhythmias
(95) developmental delay
feeding difficulties (134)
(126) learning difficulties (126)
brain tumours
failure to thrive: starvation (124)
vomiting (18)
diarrhoea (23)
coeliac disease constipation (24) faecal
incontinence (27) recurrent abdominal
pain (10, 11)
urinary tract infections (31, 32,33,36)
diabetes mellitus (1B)
short stature (125)
hypothyroidism delayed puberty
(125) acute otitis media (75, 76)
recurrent otitis media (75,76)
deafness (78) delayed speech
(126) Squint (87)
arthritis (92, 93)
eczema (104)
enuresis (32) vesico-ureteric reflux
nephrotic syndrome (10B) acute renal
failure chronic renal failure
hypertension (2B) rickets (91, 95)
impetigo (105)
infestations (lice, scabies) (100)
osteomyelitis
sickle cell disease (5B) iron deficiency
(5B)
idiopathic thrombocytopenic purpura
leukaemia
haemophilia
child abuse (120, 94, 109, 124)
neglect
congenital dislocation of hip (95)
behavioural difficulties
anorexia nervosa
psychological response to illness
26
Child Psychiatry
1. Attitudes:
Throughout the course, you should aim to be non -judgmental in understanding how a child’s emotional and
behavioural status can result from abnormalities of the inter-relationship within the child’s genetic loading,
development, family functioning, education and leisure/social activities. This bio-psycho- social model should
be considered
2. Knowledge:
By the end of the course, you should be able to
describe:

the assessment of childhood
psychiatric/behavioural disorder

the epidemiology of childhood psychiatric
disorder

Neurodevelopmental disorders including
ADHD, ASD, Tic disorders OCD,
behaviourand epilepsy

Emotional and behavioural disorders including
mood disorder, eating disorders, conduct
disorder)




child abuse and its impact (120)
interventions
service development

Communication with children/adolescents of
different ages
3. Skills:
You should observe:

Important features in taking a history from
parents, children, adolescents and a family
interview
Dermatology
1. Knowledge
By the end of the course you should be able to •
describe the:
•
•
normal skin anatomy and physiology
•
2. Skills
By the end of the course you should be able to:
•
take a dermatological history
•
take a drug history in relation to a skin
disorder
•
Examine the skin for a common condition
3. Core curriculum presentations

Nail disorders (97)

Hair loss (98)

Hairiness (99)

Pruritus (100)

Pigmented skin leisions (pigmentary disorders,
moles and melanomas) (101)
scientific basis and pathogenesis of core skin
conditions
principles of treatment of the skin disease
the management of a patient with skin
disease
•
explain to a patient how to apply a skin
preparation
•
give health advice on the risks of excess sun
exposure






27
Acute rashes (102)
Chronic rashes (103)
Eczema and dermatitis (104)
Skin infections (105)
Bruising and purpura (106)
Lumps in the skin (107)
Medicine & Psychiatry of Old Age
1. Attitudes
During the course, you should:
•
develop a positive attitude to ageing and older
people
•
recognise the value of older people’s
experience
•
appreciate the importance of equal right of
access to health and local authority services
•
be aware of the potential for health
improvement in older people
2. Knowledge
By the end of the course, you should be able to:
(a) Service Provision
•
list the health care professionals who comprise
the multidisciplinary team
•
describe the roles of these individuals with
reference to common clinical/situational
problems e.g. patients with stroke or fractured
neck of femur
•
describe the objectives and components of an
effective service for meeting the health care
needs of elderly patients
•
describe the interfaces between primary and
secondary health care services for elderly
patients
(b) Gerontology
•
describe the present and future population
structure with regard to age and predict the
implications of these changes for health care
delivery
•
outline the epidemiology of prevalent age
related disorders
•
discuss the main theories of ageing and the
physiological and biochemical changes in cell
biology associated with ageing
•
list the physiological changes seen in organs
with ageing and differentiate where possible
from pathology
•
outline (a) the concepts of functional reserve
and increased variability as applied to ageing;
(b) the causes, presentation and management
of elder and carer abuse
(c) Clinical medicine
•
recognise the non-specific presentation of
disease and the, often different, specific
presentations of disease in later life
3. Core curriculum presentations
You should try to see examples of the following
conditions:




Delirium (64)
Dementia (70)
Anxiety and depression (56, 57)
Falls, blackouts, syncope and their sequelae
•
be aware of societal ageism and paternalism
be aware of patients' and relatives' reactions
to loss of function and bereavement
•
recognise the importance of physical and
psychological care for patients with advanced
incurable diseases and their carers
•
•
•
•
recognise the presence of multiple pathology
and co-existence of chronic diseases
be aware of the effect of environment on
presentation and management
recognise common syndromes with which
patients present rather than restricting the
approach to the diagnoses that are made after
full assessment
(d) Primary/secondary care interface
•
describe the main community based agencies
in both public and voluntary sectors which
provide services for older people, what
services they provide and how these services
can be accessed
•
describe the roles of the GP and primary
health care team members in co-ordinating
hospital discharge
•
describe the indications for referral to hospital
based services: acute admission, outpatient
consultation, Day Hospital and domiciliary
visiting
•
clerk a new referral to the Day Hospital or
Community Mental Health Team and
contribute towards the formulation of a
problem list and plan of management. This
patient should be reviewed with a member of
the multidisciplinary team after at least two
visits
•
visit a community based facility for elderly
patients
•
describe the principles of management of
dying patients
•
describe the presentations and management
of carer fatigue
•
describe the meaning of the terms disability,
impairment and handicap and how disease
processes lead to disability, impairment and
handicap







28
Weight loss (19)
Common infective presentations (6,7)
Mobility problems (68)
Functional problems
Ankle swelling (9, 50)
Chronic skin ulceration (48, 49)
Weakness, tiredness and fatigue (60)
(63, 65, 69)
Bowel and bladder problems (31,32, 33,34)

Breathlessness (3,4)
4. Skills

By the end of the course you should be able to:
In addition, you should:
•
take a history and examine an older patient
and include an assessment of function
•
take a history from a third party on behalf of
an elderly patient
•
formulate a problem list and management plan
from presentation to discharge
•
perform a full examination & systematic
assessment of a patient with depression
•
perform a full examination & systematic
assessment of a patient with dementia
• observe members of the core multidisciplinary
team consider the discharge arrangements for
patients needing an occupational therapy
home visit before discharge and home care
services after discharge.
• have contributed towards a multidisciplinary
needs assessment of a patient prior to long
term placement including discussion with the
patient concerning the patient's wishes and
alternative strategies
Vertical Strand disciplines: an all age perspective
Communication Skills
You should be able to:

communicate with the young, their parents, elderly people and their relatives

develop good listening skills and empathic responses

explore the implications of different courses of treatment and check for understanding.

use appropriate verbal and non-verbal communication skills i.e.: effective listening, questions styles
and empathic responses

develop flexibility of every day use of language to match the child and parents and use or suggest
aids to help with explanation and follow up support

break news of serious illness and treatment to patients communicate effectively in clinical teams
Knowledge
1. Clinical Genetics
You should be aware of genetic conditions that affect children and adults, including late onset genetic
disorders and the genetic basis of common diseases. Areas to be covered include:
 Assessment of children with developmental delay.
 Unusual modes of inheritance and their clinical significance in paediatric disease, including chromosome
microdeletions, mosaicism and imprinting.
 The use and limitations of genetic testing for diagnosis.
 Counselling and ethical issues surrounding testing for genetic disease in children.
 Issues surrounding pre-symptomatic testing for genetic disease - e.g. Huntingtons disease.
 The Genetic basis of common diseases – e.g. breast cancer.
 New approaches to treatment for disease – stem cells and cloning.
2. Clinical Pharmacology & Therapeutics
You should be able to describe the following:

changes in pharmacokinetics and pharmacodynamics across the ages

the application of these changes to prescribing

the factors leading to the excess prevalence of adverse reactions in older patients

the completion of a Yellow Card report to the Committee on Safety of Medicines

a prescribing checklist

the role of non pharmacological treatments in physical and mental illnesses, giving examples
3.




Clinical Sciences
the embryology of kidneys, heart and enteric system in relation to paediatric nephrology, heart
murmurs and paediatric surgery
forensic pathology: sudden infant death syndrome (SIDS) and infanticide
nutrition and aspects of care
gerontology: socio-demographic issues of ageing
29
4.








Ethics, the law & older people
confidentiality and patient autonomy
informed consent, capacity and competence
advance directives/living wills
medical intervention in advanced physical and mental illness
euthanasia
Power of Attorney
Court of Protection
Mental Health Act (relevant sections)
5.
•
•
•
•
Palliative Medicine
symptom control
care of the dying patient, focusing on elderly patients
ethical issues at the beginning and end of life
communication skills - checking understanding and giving information sensitively
6.
•
•
•
•
•
•
Pathology & Laboratory Sciences
nutrition: bone chemistry, bacteriology of gut, iron deficiency anaemia
abuse, violence and neglect: forensic pathology
dermatology: simple histopathology of core presentations
bacteriology and virology of common infections; common immunisations
basic haematological knowledge of sickle cell disease and childhood leukaemia
the correlation of autopsy with pre-mortem findings in the elderly
7.
Primary Care and the Community Study
The community study offers students an opportunity to study the following topics from the perspectives
of the child’s family and primary care:

Impact of new baby on mother and family – social, cultural and psychological factors.

Infant feeding including breast feeding and weaning.

Child growth and developmental progress – the 6 week check and use of parent held record

Immunisation

Parental stress – presentation of children in A+E ; emergency care - lay and professional
perspectives

Non-accidental injury in primary care
Links to core curriculum

Professional attitudes (6)

Communication skills (7)

Knowledge: infant feeding problems (134); non-accidental injury (120); failure to thrive (124);
developmental delay (126); acute rashes (102) (immunisation)
8.
Public Health
1. Epidemiology of common diseases

describe the basic epidemiological features of the following conditions; Paediatrics: infectious
disease, neural tube defects, asthma, sudden infant death; Medicine & Psychiatry of Old Age: stroke,
dementia, osteoporosis; Dermatology: skin cancer

demonstrate a clear understanding of the following epidemiological terms when applied to the above
diseases – incidence, prevalence, crude mortality, age-sex specific death rates, standardised
mortality ratios, standardised death rates, population attributable risk, population attributable risk
fraction,

identify modifiable social and environmental risk factors for these diseases (eg. poverty, occupation,
housing, indoor air quality, outdoor air quality, smoking, obesity, diet, exercise)

interpret Standardised Mortality Ratios, odds ratios, relative risks, population attributable risks,
population attributable risk fractions and other epidemiological data as they relate to these diseases
And in addition for Paediatrics

interpret data on perinatal mortality, neonatal mortality and infant mortality to identify what measures
can be taken to improve outcome
30
2. Screening

apply the WHO (Wilson and Junger) criteria for screening to the following programmes and discuss,
using their knowledge from their clinical teaching whether these programmes are likely or unlikely to
fulfil the criteria: Paediatrics: neonatal screening; Medicine & Psychiatry of Old Age: osteoporosis

identify social and health service factors associated with low uptake of screening and strategies that
can be adopted to improve uptake

outline how screening programmes can be audited and evaluated

interpret data concerning the sensitivity, specificity and positive predictive value of tests used for the
above screening programmes and demonstrate an understanding of how they influence what
information should be given to patients if they undergo screening tests
3. Health promotion

describe primary, secondary and tertiary prevention of the following conditions, demonstrating an
understanding of measures that can be taken at an individual and population level to reduce the
incidence and/or prevalence of: Paediatrics: accidents, infectious disease, sudden infant death
syndrome, exposure to environmental tobacco smoke; Medicine & Psychiatry of Old Age: accidents
(including falls); Dermatology: skin cancer
and in addition for Paediatrics

describe the health benefits of breast feeding and discuss what measures can be taken at an
individual and population level to increase breast feeding rates
4. Infectious diseases
Paediatrics:

describe the rationale behind the current immunisation programme in children.

explain the importance of herd immunity

describe how diseases are notified and how this information can be used to monitor the epidemiology
of notifiable diseases

identify the major steps required in controlling an outbreak of meningitis in children

describe the epidemiology and public health measures required to prevent spread of threadworm,
head lice, scalp ringworm, scabies
5. Health Services
•
describe current important demographic changes in the UK and internationally
•
discuss how demographic changes in the UK could impact on the prioritisation of health services in
the UK
•
list factors that should be considered when deciding whether to invest resources in a new drug
treatment or health service
Students are reminded that the public health sciences does not wish to overburden students with factual
knowledge. However students are expected to be able to apply basic epidemiological, public health,
sociological and economic principles to the conditions above using their medical knowledge to identify
the issues that might be of relevance for that condition.
31
9.4 Orientation
The blocks and campuses to which you have been allocated are displayed on the Phase 4 Virtual
Campus before the start of each rotation.
•
This section shows progression through the Block and any relevant sub-blocks and disciplines.
•.
More detailed timetables will be posted on the Virtual Campus and students will also be notified
by email.
Please ensure that you check both regularly. http://virtualcampus.kcl.ac.uk/ and click on
MBBS 4 for up-to-date course information
Guy’s and St Thomas’ Campus
The rotation has seminar blocks in weeks 1& 2, and week 12. Weeks 3-11 consist of clinical teaching: 3
weeks of Medicine and Psychiatry of Old Age; and 6 weeks of Paediatrics, consisting of 3 weeks of
Paediatrics at GST; and 3 weeks of Paediatrics at a District General Hospital or approved self-arranged
placement. The Block has teaching at both Guy’s and St Thomas’ hospitals but the timetable is designed
to ensure a minimum of crossing between hospitals during any one day.
Group and Firm allocations
Students will be assigned to a Paediatric firm (A-E), and a Group (1-3). Groups 1, 2 and 3 define which
of the periods of 3 weeks out of the 9 you will spend in Medicine and Psychiatry of Old Age:
Group 1 (A1-E1) = 1st 3 weeks, Group 2 (A2-E2)= 2nd 3; and Group 3 (A3-E3) = 3rd 3 weeks
Group allocations
weeks 3-5 weeks 6-8 weeks 9-11
PAEDS DGH
group 1 (A-E1) MPOA
MPOA
PAEDS
group 2 (A-E2) DGH
MPOA
group 3 (A-E3) PAEDS DGH
Dermatology
Dermatology will be organised in relation to tutorial groups A1, B3 etc
Week
1-2
Rotation 1
Seminar Block
Tues
10/09/1221/09/12
24/09/12 12/10/12
Rotation 2
Seminar Block
Thurs
03/01/1311/01/13
14/01/1302/02/13
Rotation 3
Seminar Block
Tues
02/04/1313/04/13
15/04/1303/05/13
6-8
15/10/12 02/11/12
04/02/1322/02/13
9-11
05/11/12 23/11/12
25/02/1315/03/13
12
Seminar Block
26/11/12
03/12/12
Seminar Block
18/03/13
25/03/13
Tue
07/05/1324/05/13
Tues
28/05/13 14/06/13
Seminar Block
17/06/13
24/06/13
3-5
13
32
Group 1
Group 2
Group 3
Medicine and
Psychiatry of
Old Age
Paediatrics
DGH/
Peripheral
attachment
Medicine and
Psychiatry of
Old Age
Paediatrics
Paediatrics
DGH/
Peripheral
attachment
DGH/
Peripheral
attachment
Medicine and
Psychiatry of
Old Age
Rotation 1& 2- Reading week;
Rotation 3 Written Assessment
King’s College Hospital Campus
The rotation has seminar blocks in weeks 1& 2, and week 12. Weeks 3-11 consist of clinical teaching: 3
weeks of Medicine and Psychiatry of Old Age; and 6 weeks of Paediatrics, consisting of 3 weeks of
Paediatrics at KCH; and 3 weeks of Paediatrics at a District General Hospital or approved self-arranged
placement.
group 1
group 2
group 3
Group allocations
weeks 3-5 weeks 6-8 weeks 9-11
MPOA
PAEDS DGH
DGH
MPOA
PAEDS
PAEDS DGH
MPOA
Dermatology
Dermatology outpatients will be on Tuesdays, either in the morning or the afternoon.
Week
1-2
Rotation 1
Seminar Block
Tues
10/09/1221/09/12
24/09/12 12/10/12
Rotation 2
Seminar Block
Thurs
03/01/1311/01/13
14/01/1302/02/13
Rotation 3
Seminar Block
Tues 02/04/1313/04/13
6-8
15/10/12 02/11/12
04/02/1322/02/13
9-11
05/11/12 23/11/12
25/02/1315/03/13
12
Seminar Block
26/11/12
03/12/12
Seminar Block
18/03/13
25/03/13
Tue
07/05/1324/05/13
Tues
28/05/13 14/06/13
Seminar Block
17/06/13
24/06/13
3-5
13
15/04/1303/05/13
Group 1
Group 2
Group 3
Medicine and
Psychiatry of
Old Age
Paediatrics
DGH/
Peripheral
attachment
Medicine and
Psychiatry of
Old Age
Paediatrics
Paediatrics
DGH/
Peripheral
attachment
DGH/
Peripheral
attachment
Medicine and
Psychiatry of
Old Age
Rotation 1& 2- Reading week;
Rotation 3 Written Assessment
Peripheral Attachments in Paediatrics
Students will be given information by e-mail and referred to the relevant pages of the Virtual Campus for
further information.
33
Princess Royal University Hospital Campus
Rotation 1
10/09/1207/12/12
Mon
10/09/12
Rotation 2
02/01/1329/03/12
Weds
02/01/13
Rotation 3
02/04/1328/06/13
Tues
02/04/13
Seminars
From Tue
11/09/12
From Thurs
03/01/13
From Thurs
04/04/13
Symposia
(Wednesday)
From Wed
12/09/12
From Mon
07/01/13
From Wed
03/04/13
Clinical Rotation
and Induction at
PRUH
24/09/12
14/01/13
15/04/13
Course dates
Introductory Day
(Guy’s Campus)
34
Time and Venue
Morning Programme (see VC for
details)
Afternoon Symposium: from
2pm (see VC for timetable)
Seminars take place in weeks 1,
2, and 12. Please see your
seminar timetable for further
details
Students to attend Wednesday
morning symposia at GST, KCH
or UHL (see VC for timetable).
Report to the Education Centre,
Princess Royal University
Hospital for 8.15am
University Hospital Lewisham Campus
Rotation 1
10/09/1207/12/12
Mon 10/09/12
Rotation 2
02/01/1329/03/12
Weds 02/01/13
Rotation 3
02/04/1328/06/13
Tues
02/04/13
Seminars
From Tue
11/09/12
From Thurs
03/01/13
From Thurs
04/04/13
Symposia
(Wednesday)
Clinical Rotation
From Wed
12/09/12
11/09/1230/11/12
From Mon
07/01/13
03/01/1322/03/12
From Wed
03/04/13
02/04/1321/06/13
Course dates
Introductory Day
35
Time and Venue
Morning Programme (see VC
for details)
Afternoon Symposium: from
2pm (see VC for timetable)
Seminars take place in the
Owen Centre from 9am weeks
1, 5, 9 and 12 (and
Wednesday’s weeks 4, 7, 10).
See VC for Symposia timetable
Meet with Community Paeds
Lead at 8:45am, Owen
Centre, UHL
9.5 Peripheral and Overseas Attachments
A three week peripheral attachment will be part of the Child Health, Development & Ageing Block
(CHDA) for the Paediatrics module for students based at KCH and GST. This will either be a placement
at a DGH* allocated by the Academic Centre, or at an overseas twinned institution via the Exchanges
Office, or an independently arranged placement (the deadline for these latter two options was earlier in
2010/11). Students based at UHL and PRUH obtain similar clinical experience at those campuses.
*Placements will be at one of the following hospitals: William Harvey Ashford, Darent Valley, Mayday
Croydon, Eastbourne, Maidstone, Queen Elizabeth the Queen Mother Margate, Maritime Medway,
Pembury, Queen Mary’s Sidcup, Conquest St Leonard’s, Queen Elizabeth Woolwich, Worthing.
Health-screening and Immunisation requirements for DGHs
Most DGHs require you to present them with evidence of relevant vaccinations/status: .HepB, HepB
surface antigen, Rubella & MMR vaccinations. Hep C, HIV, VzV,& TB Status. You cannot commence on
the wards without health clearance. You must therefore make an appointment with Occupational Health
at the beginning of the year, to make sure that this information is immediately available for DGHs.
Students must also contact the DGH at least 4 weeks before your placement to see if there are any
forms or additional screening is required. Failure to do this will result in you missing your attachment,
and therefore failing the block. We advise you to bring a spare copy of your status with you on induction
day.
Occupational Health currently test for Hepatitis B antibodies, Rubella antibodies, and evidence of T.B.
vaccination. Chicken pox antibodies are only tested for if the student does not have a positive history of
the disease.
Please ensure that you regularly check the DGH section on the Virtual Campus and your email
for up-to-date details on what is required for your allocations
36
9.6 Symposia
In the Child Health, Development and Ageing block, your first symposium will be on the introductory day
of the rotation. Following that, you will have a symposium every Wednesday morning but please note
that some may fall on a Wednesday afternoon or a Monday – please ensure you see the Virtual Campus
for an up-to-date timetable.
Topics covered by the CHDA symposia are:
Communicating with Children, the Elderly and Relatives
Clinical Ethics and Law
Violence, Abuse and Neglect
Child Development
Therapeutics Across the Ages
Genetics
Care of the Child with Surgical Illness: Aspects of Paediatric Surgery
The Dying Patient
Nutrition
The Management of Disability in Children and Adults
Dermatology
9.7 Aims and Objectives for Symposia
By the end of each symposium you should have achieved the learning objectives listed;
(CC Presentations: Core Curriculum Presentations)
• Mutually agree the next stage in management
Communication
• Use every day language at a level the child will
understand and check for understanding
Organisers: Ms E Gill
• Appropriately use aids to help understanding
CC Presentations: All CHDA
• Elicit the child’s and parent/s concerns
• Encourage the child to ask questions
To be able to:
• Allow parent/s time to talk about concerns and
• Elicit relatives’ own beliefs and wishes,
acknowledge such concerns
demonstrating appropriate questions styles,
•
Reach a stage of mutual agreement with child
good listening skills and empathic responses
and parent/s as to what will happen next
• Explain the implications of different courses of
• Refer to relevant literature/research regarding
treatment and checking for understanding
communicating with the young, elderly and
• Allow time for relatives to absorb information
relatives
and use of silence
• Acknowledge and share patients' known
Clinical Ethics and Law
wishes, if any, with relatives
• Mutually agree the next stage of decision
Organiser: Mr P Haughton
making and treatment
CC Presentations: All CHDA
• Explore a common childhood problem with
parents and child
To be able to:
• Elicit concerns and anxieties
• Discuss the normative dimensions of clinical
• Use appropriate verbal and non-verbal
decisions, so that (a) identify which aspects of
communication skills i.e. effective listening,
decisions are technical in nature and which are
questions styles and empathic responses
ethical; (b) assess how technical and ethical
• Demonstrate flexibility of every day use of
aspects relate to each other
language to match the child's and parent/s and
use or suggest aids to help with explanation
• Develop and acquire skills in analysing the
and follow up support
normative dimension of clinical decisions
• Check for understanding with both child and
(identifying moral principles and rules; critically
parents
analysing moral arguments)
37
• Develop and acquire skills in exploring and
justifying personal decisions regarding ethical
issues as they arise in specific clinical contexts
Genetics
Organiser: Dr Dragana Josifova
At the end of the block, students should have
achieved the following:
 To be able to take a full family history
 To use family history to identify common
patterns of inheritance, and their importance in
the clinical setting (autosomal dominant,
autosomal recessive, X-Linked inheritance,
mitochondrial inheritance)
 To understand types of mutations and the
clinical implications of these
 To understand imprinting and mosaicism in
relation to genetic disease
 To understand the uses and limitations of DNA
testing in clinical genetics
 To understand the approach to clinical
dysmorphology, and the importance of making
the correct diagnosis for genetic counselling
 To be aware of late onset genetic disorders for
which testing is possible, and the implications
of such testing for the at-risk individual
 To understand the role of Clinical Genetics in
counselling patients affected by common
multifactorial diseases, with emphasis on
assessment of cancer risk
Violence, Abuse and Neglect
Organiser: Dr Bola Adeyemi
CC Presentations: 120, 124, 126, 134
Aim: To recognise and respond to the effects of
family violence.
To know:
• What constitutes abuse
• Types and ranges of abuse (including
domestic violence and elder abuse)
• Underlying principles – welfare of child,
Convention on the Rights of the Child
• How to recognise abuse (signs and symptoms)
• Vulnerability to abuse and risk factors within
the child and within the family
• What to do within the health system
• Multiagency and legal framework
• Consequences of violence and abuse – short
and long term
• Principles of management and treatment
• Ethical/confidentiality issues
• Need for prevention
Therapeutics across the Ages
Organisers: Prof S Jackson
CC Presentations: All CHDA
Care of the Child with Surgical Illness:
Aspects of Paediatric Surgery
Organiser: Miss M Agrawal
CC Presentations: 10, 13, 18, 24, 39, 71, 72,
73, 124, 134
• Describe the changes in pharmacokinetics
from birth to old age
• List the factors that would determine the dose,
dose regimen and packaging requirements in
both children and elderly patients
• Comment critically on inpatient prescription
sheets and be able to write prescriptions for
commonly prescribed medications
• Describe the implications of the Medicines Act
as they relate to prescribing
• Differentiate the legal categories of drugs and
give examples of each category
To be able to describe:
• The differences between children and adults in
terms of common surgical problems
• The presentation, management and long-term
effects of common congenital malformations
• List the items on a prescribing checklist
Child Development
Organiser: Dr Max Davie
CC Presentations: 95, 126
• Understanding factors which influence
developmental progress
• Forming a picture of developmental
expectations
• Recognising when to be concerned: ‘red flags’
• Knowing what questions to ask
38
The Dying Patient
Organiser: Dr P Edmonds
CC Presentations: 127, 135
The Management of Disability in Children
and Adults
Organiser: Dr A Sharma
CC Presentations: 32, 56, 64, 65, 68, 126
Aim: To describe the physical and psychosocial
needs of dying patients and their carers, and
clinical and organisational strategies to meet
those needs.
To be able to:
• List the common causes of death in the UK
• Identify the symptoms and signs that suggest
that a patient is in the last days of life
• List common symptoms in the last week of life
• Describe the indications for use of syringe
drivers, and be able to convert a patient from
oral morphine to subcutaneous diamorphine
• Outline factors suggesting that a carer is ‘at
risk’ following a bereavement
To be able to describe:
• The consequences of disability
• The process of rehabilitation, including the
WHO definitions of impairment/disability
(ability)/ handicap/participation
 The prevalence, process of identification and
management of common impairments
leading to disability
• The roles and functions of members of the
multi-disciplinary team
Dermatology - Clinical Demonstration
Organisers: Dr R Morris-Jones and Dr Clive
Archer
Clinical Nutrition
Organiser: Dr John Jackman
CC Presentations: 19, 29, 124, 134
Aim:

CC Presentations: 48, 97, 103, 104, 105, 107
• To consolidate the clinical skills required to
examine the skin and to demonstrate physical
signs of common dermatoses in hand
picked patients (Guy’s St. Thomas’ & King’s
students only)
• To consolidate clinical and investigative skins
(UHL students only
• To become familiar with the principles of
topical therapies
• To address any gaps in core knowledge at the
end of the course
to know the major nutritional issues
faced in medical practice, through
focusing on four clinical situations.

Objectives - by the end of the session students
should:
 be able to make informed decisions
about nutrition in dying patients, patients
with swallowing difficulties and patients
with intestinal failure.
 Know the principles and practicalities of
providing parenteral nutrition
 Understand the medical and social
consequences of excess nutritional
intake
Students will learn through participation in four
study sessions:



Intestinal failure and the issues
surrounding parental nutrition
Managing nutrition in the terminally ill
patient with difficulty swallowing
The medical and social issues
associated with obesity
39
9.8 Seminar Titles

*Child Health & Paediatrics
•
Dehydration & Fluid Balance 18, 23, 35, 1B
•
The Child with Wheeze and Cough 4, 6
•
The Acutely Infected Child 1, 7, 61, 79
•
Growth 124, 125, 19, 23, 99
•
Neurological problems in childhood 62,
69, 132, 131, 130
•
Heart Problems 3
•
Problems with Micturition & Defaecation
24, 25, 27, 31, 32, 33, 36
•
Paediatric Haematology 106, 127, 135,
5B




Cutaneous Infections, Acne, and Roseacea
103
Benign and Malignant Tumours of the Skin
101, 107
Allergic Conditions and Photosensitivity
100, 102
The Skin and Systemic Disease 105
Introduction to Blistering Disorders 102
Medicine & Psychiatry of Old Age

Assessment of the older person (medical
aspects) and atypical presentation of
disease 65

Assessment of the older person (psychiatric
aspects) 64

Symptom Control (Palliative Medicine) 127

Ageing, Disease and Disability

Healthy ageing versus disease

Delirium 64

Dementia: clinical features and brain
changes 70

Dementia: behavioural problems and impact
on carers and services 70

Bowel and Bladder problems 31, 32, 33,
34

Functional mental illness

Anxiety and Depression 56, 57, 128

Law and the older person

Ageing in the 21st century: evidence from
sociology, demography, social policy and
economics
Psychological approaches to management
of disorders 70, 12
*Neonatology
•
Common problems of the Normal Neonate
134
•
Low birth weight babies (preterm and SGA
babies) 134
*Child Psychiatry
•
Deliberate Self Harm 51, 56, 59
•
Neuro-psychiatry 59, 126
•
Emotional and Behavioural Disturbance
55, 56, 57
•
Mind and Body in Paediatrics, 11, 17, 24,
27, 60, 62, 104
**Dermatology

Introduction to dermatology

Eczema and Psoriasis

Cutaneous infections

Skin tumours

The skin and systemic disease.
* For Seminar Aims & Objectives, please refer to Paediatrics and Child Health Study Guides (the ‘blue
book’)
** Seminar Aims & Objectives are available on the VC
40
9.9 Aims and Objectives for seminars
Medicine & Psychiatry of Old Age
By the end of each seminar session you should have achieved the following educational objectives:
Medicine & Psychiatry of Old Age
By the end of each seminar session you should have achieved the following educational objectives:
Assessment of the older person (medical
• to list the common presentations of medical
aspects) and atypical presentation of disease
problems that lead elderly patients to lose their
• to list the common problems that may be
independence
identified on history taking that may or may not be
•
to describe the ways in which elderly patients may
presenting complaints
present differently compared with younger adults
• to list the common problems that may be
• to list the key professionals providing assessment
identified on examination that may or may not be
of older patients both in the hospital and
presenting complaints
community settings
Assessment of the older person (psychiatric
aspects)
• to know 3 categories of the history/mental state
examination that often require greater attention
than in younger people
• to know at least 3 sources of information (other
than that from the patient) that aid the diagnostic
process
• to know 7 aspects of the social history relevant to
older people with mental disorders
• to know 3 tests of frontal lobe function used in
bedside testing
• to list at least 2 techniques for introducing
cognitive testing to older people without upsetting
or annoying them
• to test memory, orientation (time and place),
concentration, praxis and calculation
• to describe the principle of confidentiality in
respect of informant history
Symptom Control (Palliative Medicine)
Aim: For students to develop an understanding of • to be aware of the range of options available for
symptom management, including
symptom assessment in palliative medicine,
pharmacological and non-pharmacological
including psychosocial issues.
strategies
• to list the basic principles underlying effective
symptom control
42
Ageing, Disease and Disability
• to describe normal ageing changes in the kidney,
liver, cardiovascular, musculo-skeletal,
thermoregulatory and immune systems and the
brain
• to list criteria for the definition of normal ageing
• to describe the concept of ‘reserve’
• to understand the WHO criteria for handicap,
impairment and disability
• to describe two examples of how normal ageing
and disease interact to produce symptoms
Delirium
• to indicate 3 cardinal features and a further 3
symptoms and signs of the syndrome
• to list at least 6 main categories of disease that
might lead to delirium in an older person
• to list 3 common iatrogenic causes of delirium
• to describe the approximate prevalence of the
syndrome in a) older medical in-patients and b)
older post-operative surgical patients
• to list 2 possible pathophysiological mechanisms
of delirium
• to describe general measures that may reduce
the frequency and impact of delirious phenomena
in individual patients
• to list 4 indicators that might distinguish delirium
from dementia
• to describe the 3 advantages and 3
disadvantages each of using lorazepam and
haloperidol in delirium in an older person
• to know that delirium may not reverse for many
months
Dementia: clinical features and brain changes
• to list the features that make up the syndrome of
dementia
• to describe the common causes of dementia
• to describe the histopathological features
differentiating the common forms of dementia
• to list the investigations that may be performed in
a patient presenting with the syndrome of
dementia
• to describe the assessment of a patient referred
for cholinesterase inhibitor therapy for Alzheimer’s
disease
Dementia: behavioural problems and impact on
carers and services
• to list at least 5 behavioural problems in dementia
that have impact on carers, indicate why this
impact is felt, and estimate their frequency
• to list 3 categories of intervention with behavioural
problems in dementia, and an example of each,
together with its advantages and disadvantages
• to describe the epidemiology of caring: gender,
age, and rates of depressive and other
psychological indices of stress in carers
• to list the 3 most common requests of carers
• to define the word "need" in at least 2 ways
• to describe the approximate current financial
costs of caring for dementia in the UK- direct and
indirect and compare that with expenditure on
anti-dementia medication
• to describe 3 different types of respite care
Atypical Presentation of Disease
 to list 4 common non-specific presentations of
illness in old age
 to list 4 common medical conditions that
commonly present in a non-specific manner in
older patients
43
Falls, Dizziness, Blackouts
• to recognise the key features in a history to
suggest locomotor, cardiovascular and CNS
causes for falls
• to list 10 common causes of falls
• to explain the causes of instability and gait
disorder in older people
• to summarise the clinical and haemodynamic
presentation of patients with carotid sinus
syndrome
• to plan a strategy for the investigation of patients
presenting with falls
• to list major complications resulting from falls
• to describe the roles of the physiotherapist and
the occupational therapist in the management of
patients who fall
• to list other key professionals and their roles in
preventing falls in older people
Bowel and Bladder problems
• to describe the physiology of micturition and
defaecation
• to describe the prevalence of urinary and faecal
continence problems in adults
• to identify the key features on history and
examination of stress and urge urinary continence
problems
• to summarise the role of urodynamics in the
investigation of urinary continence problems
• to describe the key features of a management
strategy for both urge and stress continence
problems
• to list the indications for and complications
associated with the use of urethral and
suprapubic urinary catheters
• to list 3 common causes of faecal continence
problems
• to describe the management options available to
help patients with established faecal continence
problems
Functional mental illness
• to describe 3 differences and 3 similarities between
schizophrenia-like disorders in younger and older
people
• to describe the prevalence of schizophrenia-like
disorders in the community
• to describe 3 common delusions in older people
with schizophrenia-like disorders in older people
Anxiety and Depression
• to list at least 6 major symptoms of a depressive
syndrome in an older person
• to describe the prevalence of depressive
syndromes in older people a) in the general
population b) general practitioner's surgeries, c)
under home care services d) in medical wards e) in
old people's homes f) after stroke
• to quote the current suicide rate for young and old
men, and young and old women, in the UK
• to list at least 3 ways in which depression might
more typically present in older rather than younger
people
• to quote the relative risk of dying within 1 year in
older people versus those without such a syndrome
44
• to list 4 factors epidemiologically associated with
• to list the names, class, and 3 adverse
consequences each of at least 3 different oral
and 3 different depot medications used in
schizophrenia-like disorders in older people
• to rehearse 3 general reasons for intervention
and 3 reasons not to intervene in
schizophrenia-like disorders in older people
• to describe a simple protocol for the medical
management of the first moderate depressive
disorder in a 75 year old man
• to list 3 advantages and 3 disadvantages of ECT
in severe depression in an older person
• to list 3 similarities and 3 differences between
depressive and anxiety states
• to list at least 5 anxiety syndromes (e.g.
agoraphobia, social phobia) in older people
• to list 1 advantage and 452 disadvantages to
using benzodiazepines in the management of
anxiety in old age
Law and the older person
• to define mental capacity
• to understand the meaning of consent to treatment
• to understand the use of the Mental Health Act for
older people and to describe Sections 2, 3 and 25
• to understand the use of Common Law to
enable treatment for those who cannot consent
• to describe safeguards for the use of the Mental
Health Act and Common Law
• to describe continuing powers of attorney and
enduring powers of attorney
Ageing in the 21st century: evidence from
sociology, demography, social policy and
economics
The aim of this session is to outline the key
challenges of an ageing population, and the
implications for health in the next 30 years.
By the end of the seminar students will be able:
• to describe future trends in mortality, morbidity and
dependency
• to describe future trends in family formation,
dissolution and living arrangements relevant to
older people
• to describe how the interaction of these trends
will affect future formal and informal sources of
care
• to describe the social and economic implications
of such trends
• to describe their impact on the role of the
welfare state in the 21st century
• to answer the question “can we continue to
afford the present Welfare State” with supporting
arguments
Psychological approaches to management of
disorders
• to list at least 3 medical conditions common in older
people in which psychological management is at
least as important as medical management
• to list at least 3 aspects of "person-centred care" of
dementia
• to describe a simple behavioural programme for
agoraphobia in an older person, and list 2 ways in
which it might be easier and 2 ways it might be
more difficult to execute than in a younger person
• to describe at least 3 different coherent
psychological interventions that might be
applicable to an older person with a moderate
depressive syndrome
• to describe at least 3 features of grief
management
• to list 3 ways in which the settings in which the
students are working with older people (e.g.
wards, clinics) might have adverse psychological
consequences for the older people and for the
students
45
9.10 Recommended Reading and Computer-aided learning
Please refer to VC
46
10. EMERGENCY MEDICINE, TRAUMA AND LOCOMOTION BLOCK (EMTL)
10.1 An Overview of the Block
49
10.2 Course Organisers and Contact Details
50
10.3 Block Aims and Objectives
51
10.4 Orientation
56

Guy’s/St Thomas’ Campus
56

King’s College Hospital Campus
57

Queen Elizabeth Hospital Campus
58

University Hospital Lewisham Campus
59
10.5 Symposia Information
60
10.6 Aims and Objectives for Symposia
60
10.7 Seminar Titles
63
10.8 Aims and Objectives for Seminars
63
10.9 Recommended Reading and Computer-Aided Learning
69
47
10.1 An Overview of the Block
During this Block, you will learn from specialists in Anaesthetics, Emergency Medicine, Intensive
Care, Orthopaedics, Trauma, Rehabilitation and Rheumatology. A large component of the
course will be offered as 'hands on' experience. This will enable you to gain the diagnostic and
practical experience necessary to manage patients requiring emergency treatment following a
wide range of traumatic and acute medical conditions, diagnose and manage chronic diseases
affecting the locomotor system, and to understand the principles of anaesthetics, pain
management and Intensive Care Medicine.
The course is divided into two six-week sub-blocks. The Emergency Medicine sub-block
consists of three weeks of Emergency Medicine and three weeks of Anaesthetics which
includes sessions in pain management and Intensive Care Medicine. The Locomotion subblock is a fully integrated course covering Rheumatology, Trauma and Orthopaedics.
In the Emergency Department a day and evening 'shift system' will be used in the course to
provide students with experience of a range of acute presentations. Seminars will be timed to fit
in with overlapping shifts. The seminars and symposia cover areas relevant to the course
content, and will cover basic science topics in histopathology, anatomy, therapeutics clinical
biochemistry, integrated with the clinical disciplines such as radiology.
On completion of this Block you will have gained the knowledge, skills and confidence required
to manage a wide range of potentially difficult situations you will face in your future practice.
Dr Chris Lacy
Department of Emergency Medicine
48
10.2 Course Organisers and Contact Details
ED
GST
020 7188 7188
Dr Shumontha
Dev
shumontha.dev
@gstt.nhs.uk
KCH
020 3299 9000
Dr Tunji Lasoye
020 3299 3235
[email protected]
Anaesthetics
GST
020 7188 7188
Dr Vip Gill
020 7188 0645
[email protected]
QEH
020 8836 6788
Mr
Ferdinand Ohanusi
UHL
020 8333 3030
Mr Nigel Harrison
[email protected]
PRUH
[email protected]
0208 836 4364/
4366, bleep 651
KCH
020 3299 9000
Dr Sue Peat
020 3299 3358
sue.peat@
nhs.uk
EMD PA : Janet Forest
020 8333 3058
QEH
020 8836 6788
Dr Sanjay Gupta
020 8836 5986
[email protected]
et
UHL
020 8333 3030
Dr George Mathew
PRUH
[email protected].
uk
Sec: Val smith
0208 333 3413
Dr Robert Feneck
020 7188 0653
[email protected]
m
Pain
GST
020 7188 7188
Dr Joseph Azzopardi
Joseph.Azzopardi@
gstt.nhs.uk
Orthopaedics
GST
020 7188 7188
Mr Ioan Jones
020 7188 4474
[email protected]
s.uk
KCH
020 3299 9000
Dr Sue Peat
020 3299 3358
[email protected]
KCH
020 3299 9000
Mr Mike Wilkinson
020 3299 3649
michael.s.marsh@
kcl.ac.uk
QEH
020 8836 6788
Dr Sanjay Gupta
020 8836 5986
[email protected]
QEH
020 8836 6786
Mr Dutta
020 8836 4159
[email protected]
[email protected]
49
UHL
020 8333 3030
Dr George Mathew
George.mathew1@n
hs.net
PRUH
UHL
020 8333 3030
Mr Jonathan Bird
020 8333 3000
Jonathan.bird@n
hs.net
PRUH
Rheumatology
GST
020 7188 7188
Dr Toby Garrood
[email protected]
KCH
020 7737 4000
Dr Patrick Gordon
020 3299 1735
[email protected]
GST Administrator
Maria Fernandes
020 7188 5183
[email protected]
KCH Administrator
Sheinaz Mahomedally
[email protected]
UHL
020 8333 3030
Dr Ghada Yanni
020 8333 3030 ext 6215
[email protected]
UHL Student Coordinator
Samantha Newman
020 8333 3000 ext 8734
samantha.newman@
nhs.net
PRUH
020 7848 5224
PRUH Administrator
50
QEH
020 8836 6788
Dr Catherine Mathews
020 8836 5025
catherinemathews@
nhs.net
QEH Administrator
Joanna Woolard
0208 836 6788
[email protected]
10.3 Block aims and objectives
Aims
The aims of the Emergency Medicine, Trauma and Locomotion course are to ensure that you
understand:
•
the presentation and management of patients with common and life threatening
emergencies including those with critical injuries
•
the management of patients who need high dependency care and anaesthesia
•
the features of pain and pain control
•
the presentation, assessment and management of patients with disorders affecting the
locomotion system including rehabilitation
Objectives
•
•
•
To achieve competence in skills needed for the practice of emergency medicine, trauma
and locomotion subjects
To acquire the core knowledge required for the practice of emergency medicine, the
understanding of pain control, and the management of locomotion disorders
To demonstrate appropriate attitudes in the management of emergency patients, patients
with locomotion disabilities, and their relatives and carers
1. Attitudes
By the end of the course, you should have
achieved the following:
• awareness of the moral and ethical •
responsibilities involved in individual patientcare in the provision of emergency medicine,
and management of disability
awareness of the need to manage patients in
the context of self-care, and care by others in
the context of the injured patient and those
with disability and dependency needs
• awareness of personal limitations, a willingness
to seek help when necessary and to work as a
member of a team in the context of the
Accident and Emergency Department and in
the care of patients with disability
2. Knowledge
By the end of the course you should be able to
describe:
(a) Locomotion system
• The clinical science, presentation, pathology and
management of disorders of locomotion that relate
to the musculo-skeletal system
•The anatomy of the limbs, back and joints
(b) Emergency Medicine and high dependency
care
Core clinical presentations:
•
back pain and sciatica (89)
•
neck pain (90)
•
musculoskeletal deformity (91)
•
acute joint pain (92)
•
chronic joint pain (93)
•
osteoporosis (6B)


•
The presentation, pathology, basic sciences and •
clinical management of common and life •
threatening emergencies.
•
•
The following core clinical presentations:
•
•
chest pain (1)
•
•
circulatory collapse (2)
•
51
substance abuse and alcoholism (52)
acute headache (61)
loss of consciousness (63)
confusion (64)
acute loss of function (65)
fits and convulsions (69)
head injury (71)
chest injury (72)
abdominal injury (73)
acute red eye (83)
•
•
•
•
acute and chronic breathlessness (3)
acute and chronic wheezing (4)
haemoptysis (5)
upper respiratory infections (coughs, colds
and sore throats) (7)
•
acute abdominal pain (10)
•
haematemesis and malaena (20)
•
acute and chronic swelling of limbs (9, 50)
•
acute poisoning/suicide and attempted
suicide (51)
3. Skills
•
•
•
•
•
•
•
•
By the end of the course you should be able to:

(a) Emergency medicine:
•
take a history from a patient with a serious
illness attending the ED
•
assess a patient with a medical emergency
•
assess a patient with limb trauma
•
suture
•
undertake basic life support
•
ALS (a) demonstrate understanding of the
ALS algorithm - (i.e. discriminate between a
shockable and non-shockable rhythm and
know use of 1 adrenaline and atropine in a
cardiac arrest scenario), (b) demonstrate
safe defibrillation on a mannikin, (c)
demonstrate bag valve mask ventilation on a
mannikin
•
demonstrate bag valve mask ventilation of the
lungs on a patient
•
insert a laryngeal mask airway
•
insert a cannula and set up an intravenous
infusion
•
make a preoperative assessment and explain
peri-operative care, including pain relief
(b) Locomotion:
•
take a history from a patient with musculoskeletal symptoms including assessment of
function
•
examine the back and neck (including
neurology)
•
examine the musculo-skeletal system of the
limbs in an adult (GAL system)
4. Investigation and Procedures
sudden loss of vision (85)
eye trauma (88)
fractures and limb trauma (94)
bruising and purpura (106)
burns (108)
facial pain (81)
neck pain (90)
cancer pain and palliation (135)
examine the main joints in an adult: (a) hip, (b)
knee, (c) ankle and foot, (d) shoulder and
elbow, (e) hand
Phase 3 General Skills – revision
You should be able to:
•
measure BP using a sphygmomanometer
•
measure peak expiratory flow using a
Wright’s peak
flowmeter
•
demonstrate basic airway skills
•
take a 12 lead electrocardiogram
•
take a venous blood sample
•
do blood stick testing
•
test urine with labsticks and interpret the
result
•
give an intravenous injection
•
set up a blood infusion
•
insert a urinary catheter into a male
•
demonstrate knowledge of sterile techniques,
including scrubbing up for theatre
There are many other skills in the EMTL Block that
you will be expected to have acquired and also
many that you will witness. The list in the logbook
will identify the full range of skills you should
practise in EMTL.
You should observe and be able to explain the
reasons for undertaking the following:
You should observe and understand the following
management procedures:
•
•
Use of life support systems - IPPV
•
Insertion of a CVP line
•
Insertion of an arterial line
•
Lumbar puncture
•
Use of transducers
•
Insertion of a chest drain
•
Insertion of an epidural catheter
•
Patient controlled analgesia, e.g. syringe
driver
•
•
•
•
Laboratory tests on blood, urine and other
body fluids
Emergency medicine: blood gas analysis,
acid-base balance, coagulation profiles
Neuromusculoskeletal: auto-immune profiles
X-rays: demonstrating fractures,
pneumothorax, haemothorax, bone and joint
diseases
Radionuclide scanning: bone and dexa
52
•
scans, CT and MRI scans. (To recognise on
head scans: midline shift, intracranial bleeds
and infarcts, and, on MRI scans, gross spinal
compression)
Physiological measurements for high
dependency patients to include: fluid balance
charting, arterial, CVP, pulse oximetry
waveforms, ECG monitoring
•
•
•
•
Feeding by percutaneous gastrostomy (PEG)
Application of and removal of plaster cast and
backslab
Joint aspiration and injection
Soft tissues injection
Vertical Strand Disciplines
You should be able to describe or outline details of the following:
1. Clinical Pharmacology & Therapeutics
(a) Emergency medicine, anaesthetics, critical care, pain control
•
resuscitation and Emergency Drugs with reference to cardiac arrest, CCF, asthma,
hypovolaemia
•
use of oxygen, adrenaline, atropine, inotropes
•
oxygen therapy
•
acute respiratory failure
•
fluid therapy
•
pain relief
•
sedation
•
management of nausea and vomiting
•
basic pharmacology: principles of pharmacokinetics and pharmacodynamics
•
corticosteroids, bronchodilators, anti-histamines
•
poisoning and antidotes
•
thrombolytics, anticoagulants, vasodilators
•
antibiotics: effective and appropriate prescribing
•
antiseptics
•
local anaesthetics
•
wound care and dressings
•
immunisation and tetanus prophylaxis
(b) Locomotion
•
drugs used in treatment of musculo-skeletal conditions and arthropathies: NSAIDS, gold,
penicillamine, azathioprine, methotrexate, corticosteroids and anti-malarials
•
drugs used in management of osteoporosis: bisphosphonates, calcium and vitamin D
•
antibiotic prophylaxis for orthopaedic surgery
•
pain control in chronic conditions
2. Clinical Sciences



anatomy of locomotion system (spine and joints)
forensic pathology: trauma
pain: anatomy, physiology
3. Ethics & Law
In relation to:
(a) Emergency Medicine
 Consent and capacity issues
 End of life decisions
 Mental Health Act
 Children’s Act and NAI
(b) Chronic diseases (rheumatological)
53
4. Palliative Medicine
•
•
pain in advanced disease
breaking bad news
5. Pathology & Laboratory Sciences
The pathological processes concerned in and the role of the clinical laboratory disciplines in the
diagnosis and management of:
(a) Emergency Medicine
•
respiratory failure
•
shock
•
systemic infections
•
organic brain failure
•
acute poisoning
•
head injury
•
meningitis, encephalitis and cerebral abscess
•
use of blood products and management of massive transfusion
•
thrombosis prophylaxis
(b) Locomotion
•
infective, neoplastic, metabolic and other inflammatory disorders involving the
musculoskeletal system
6. Primary Care and the Community Study
The community study enables students to consider emergencies and related issues from the
perspectives of patients and primary care.

common emergencies in pregnancy, puerperium and infancy presenting in primary care

stresses of parenting, and support available in the community

non-accidental injury and child protection issues

interactions between the mother/baby, and Health Services – particularly GP services,
Emergency Department Services, Out of Hours Emergency Services, and Community Health
Services, including consideration of “appropriate” and “inappropriate” use of emergency
services
Links to core curriculum



Professional attitudes (6)
Communication skills (7)
Knowledge: non-accidental injury (120)
7. Radiology/Imaging

Fractures and dislocations

bone and joint diseases e.g. arthritis and osteoporosis

use of imaging in truncal trauma
use of imaging in head injury

8. Public Health
1. Epidemiology of common diseases

describe the basic epidemiological features of the following conditions: Emergency
Medicine: accidents, low back pain, osteoporosis

demonstrate a clear understanding of the following epidemiological terms when applied to
the above diseases – incidence, prevalence, crude mortality, age-sex specific death rates,
standardised mortality ratios, standardised death rates, population attributable risk,
population attributable risk fraction,

identify modifiable social and environmental risk factors for these diseases (eg. poverty,
occupation, housing, indoor air quality, outdoor air quality, smoking, obesity, diet, exercise)

interpret Standardised Mortality Ratios, odds ratios, relative risks, population attributable
risks, population attributable risk fractions and other epidemiological data as they relate to
these diseases
54
2. Health promotion

describe primary, secondary and tertiary prevention of the following conditions,
demonstrating an understanding of measures that can be taken at an individual and
population level to reduce the incidence and/or prevalence of: accidents, disasters
3. Health Services

describe current important demographic changes in the UK and internationally

discuss how demographic changes in the UK could impact on the prioritisation of health
services

list factors that should be considered when deciding whether to invest resources in a new
drug treatment or health service
Students are reminded that the public health sciences does not wish to overburden students with factual
knowledge. However students are expected to be able to apply basic epidemiological, public health,
sociological and economic principles to the conditions above using their medical knowledge to identify
the issues that might be of relevance for that condition.
55
10.4 Orientation
•
•
•.
The blocks and campuses to which you have been allocated are displayed on the Phase 4 Virtual
Campus before the start of each rotation.
This section shows progression through the Block and any relevant sub-blocks and disciplines.
Any changes to the timetable will be posted on the Virtual Campus and students will also be
notified by email.
Please ensure that you check both regularly. See http://virtualcampus.kcl.ac.uk/and click on
MBBS 4 for up-to-date course information
Guy’s and St Thomas’ Campus
Students will be issued with a detailed site-specific timetable at the beginning of their rotation.
The Block is divided into two 6-week sub-blocks: one covering Emergency Medicine which consists of
three weeks of A&E and three weeks of Anaesthetics and the other sub-block covering Locomotion,
consisting of a 6-week integrated course of Rheumatology, Orthopaedics and Trauma. The Emergency
Medicine sub-block divides students into two groups. The Locomotion sub-block divides students into 4
firms.
Week
1-3
4-6
7-9
Rotation 1
Tuesday
11/09/12 –
28/09/12
01/10/12 –
19/10/12
22/10/12 –
09/11/12
Rotation 2
Thursday
03/01/1318/01/13
21/01/13 –
08/02/13
11/02/13 –
01/03/13
Rotation 3
Thursday
04/04/13 –
19/04/13
22/04/13 –
10/05/13
13/05/13 31/05/13
Emergency Medicine
Groups
Group A
Group B
Emergency
Medicine
13
12/11/12 –
30/11/12
03/12/12
04/03/13 22/03/13
25/03/12
03/06/13 21/06/13
Firm
C1
Firm
C2
Firm
D1
Firm
D2
Loco
Loco
Loco
Loco
Anaesthetics
Anaesthetics Emergency
Medicine
Emergency
Medicine
Loco Loco
10-12
Locomotion Firms
Loco
Firm Firm Firm
A1
A2
B1
Locomotion Firms
Anaesthetics
Loco
Firm
B2
Anaesthetics Emergency
Medicine
Group C
Group D
Emergency Medicine
Groups
Rotation 1& 2- Reading week;
Rotation 3 Written Assessment
24/06/13
56
King’s College Hospital Campus
Students will be issued with a detailed site-specific timetable at the beginning of their rotation.
The Block is divided into two 6-week sub-blocks: one covering Emergency Medicine which consists of
three weeks of A&E and three weeks of Anaesthetics and the other sub-block covering Locomotion,
consisting of an integrated 6-week course of Rheumatology, Orthopaedics and Trauma. The Emergency
Medicine sub-block divides students into two groups. The Locomotion sub-block divides students into 4
firms.
Week
1-3
4-6
7-9
Rotation 1
Tuesday
11/09/12 –
28/09/12
01/10/12 –
19/10/12
22/10/12 –
09/11/12
Rotation 2
Thursday
03/01/1318/01/13
21/01/13 –
08/02/13
11/02/13 –
01/03/13
Rotation 3
Thursday
04/04/13 –
19/04/13
22/04/13 –
10/05/13
13/05/13 31/05/13
Emergency Medicine
Groups
Group A
Group B
Emergency
Medicine
13
12/11/12 –
30/11/12
03/12/12
04/03/13 22/03/13
25/03/12
03/06/13 21/06/13
Firm
C1
Firm
C2
Firm
D1
Firm
D2
Loco
Loco
Loco
Loco
Anaesthetics
Anaesthetics Emergency
Medicine
Loco
10-12
Locomotion Firms
Loco
Loco
Loco
Firm Firm Firm
A1
A2
B1
Locomotion Firms
Firm
B2
Emergency Anaesthetics
Medicine
Anaesthetics Emergency
Medicine
Group C
Group D
Emergency Medicine
Groups
Rotation 1& 2- Reading week;
Rotation 3 Written Assessment
24/06/13
57
Queen Elizabeth Hospital Campus
Students will be issued with a detailed site-specific timetable on arrival at QEH. On the first day of your
Attachment, please report to Joanna Woolard in the Education Centre (located at the West Entrance of
the Hospital opposite the Conference Centre) at 9.30am
The Block is divided into two 6-week sub-blocks: one consists of three weeks of A&E and three weeks of
Anaesthetics and the other sub-block consists of an integrated course of Rheumatology, Orthopaedics
and Trauma.
Week
Rotation 1
Rotation 2
Rotation 3
1-3
Tuesday
11/09/12 –
28/09/12
01/10/12 –
19/10/12
22/10/12 –
09/11/12
Thursday
03/01/1318/01/13
21/01/13 –
08/02/13
11/02/13 –
01/03/13
Thursday
04/04/13 –
19/04/13
22/04/13 –
10/05/13
13/05/13 31/05/13
4-6
7-9
10-12
13
12/11/12 –
30/11/12
03/12/12
04/03/13 22/03/13
25/03/12
03/06/13 21/06/13
Emergency Medicine Groups
Groups A&B Groups C&D
Students 1-8 Students 9-16
Emergency Anaesthetics
Medicine
Locomotion Groups
Groups 1-8
Students 17-32
Locomotion
Anaesthetics Emergency
Medicine
Emergency
Medicine
Anaesthetics
Locomotion
Groups 1-8
Students 1-16
Locomotion Groups
24/06/13
Groups A&B
Emergency
Medicine
Groups C&D
Emergency Medicine Groups
Rotation 1& 2- Reading week;
Rotation 3 Written Assessment
58
Anaesthetics
University Hospital Lewisham Campus
Students will be issued with an Induction Pack on the first day of the clinical rotation (collect from
Samantha Newman at 9:30am in the Education Centre, UHL).
The Block is divided into two 6-week sub-blocks: one consists of three weeks of A&E and three weeks of
Anaesthetics and the other sub-block consists of an integrated course of Rheumatology, Orthopaedics
and Trauma.
Week
1-3
4-6
7-9
Rotation 1
Tuesday
11/09/12 –
28/09/12
01/10/12 –
19/10/12
22/10/12 –
09/11/12
Rotation 2
Thursday
03/01/1318/01/13
21/01/13 –
08/02/13
11/02/13 –
01/03/13
Rotation 3
Thursday
04/04/13 –
19/04/13
22/04/13 –
10/05/13
13/05/13 31/05/13
12/11/12 –
30/11/12
04/03/13 22/03/13
03/06/13 21/06/13
Group A
Emergency
Medicine
Anaesthetics Emergency
Medicine
Rheumatology,
Orthopaedics, Trauma
Emergency Anaesthetics
Medicine
Anaesthetics Emergency
Medicine
Rotation 1& 2- Reading week;
Rotation 3 Written Assessment
10-12
13
Group B
Anaesthetics Rheumatology,
Orthopaedics, Trauma
Princess Royal University Hospital Campus
Students will be issued with a detailed site-specific timetable on arrival at PRUH. On the first day of your
Attachment, please report to Andrew Jones in the Education Centre (located at the West Entrance of
the Hospital opposite the Conference Centre) at 8.30am
The Block is divided into two 6-week sub-blocks: one consists of three weeks of A&E and three weeks of
Anaesthetics and the other sub-block consists of an integrated course of Rheumatology, Orthopaedics
and Trauma.
Week
Rotation 1
Rotation 2
Rotation 3
1-3
Tuesday
11/09/12 –
28/09/12
01/10/12 –
19/10/12
22/10/12 –
09/11/12
Thursday
03/01/1318/01/13
21/01/13 –
08/02/13
11/02/13 –
01/03/13
Thursday
04/04/13 –
19/04/13
22/04/13 –
10/05/13
13/05/13 31/05/13
4-6
7-9
10-12
13
12/11/12 –
30/11/12
03/12/12
04/03/13 22/03/13
25/03/12
03/06/13 21/06/13
Emergency Medicine Groups
Groups A&B Groups C&D
Students 1-8 Students 9-16
Emergency Anaesthetics
Medicine
Locomotion Groups
Groups 1-8
Students 17-32
Locomotion
Anaesthetics Emergency
Medicine
Emergency
Medicine
Anaesthetics
Locomotion
Groups 1-8
Students 1-16
Locomotion Groups
24/06/13
Groups A&B
Emergency
Medicine
Groups C&D
Emergency Medicine Groups
Rotation 1& 2- Reading week;
Rotation 3 Written Assessment
59
Anaesthetics
10.5 Symposia
In the Emergency Medicine, Trauma and Locomotion block, your first symposium will be on the
introductory day of the rotation. Following that, you will have a symposium every Wednesday morning.
Please see the Virtual Campus for an up-to-date symposia timetable for your EMTL block.
Topics covered by the EMTL symposia are:
The Multi-trauma Patient
Anatomy and Radiology of the Joints
Rheumatoid Arthritis
The Failing Joint
Control of Chronic Pain
Anaesthetic Discoveries
Communication: Dealing with Crisis
Back Pain
Ethics & Law
Neurological Gait
Deliberate and Accidental Self-Harm
Rehabilitation and Real Life
10.6 Aims and Objectives for Symposia
By the end of each symposium you should have achieved the following learning objectives:
(CC Presentations: Core Curriculum Presentations)
The Multi-trauma patient
Organisers: Dr Nigel Harrison /Dr P Gordon/
Dr T Lasoye
CC Presentations: 2, 63, 71, 72
To be able to:
• Describe the principles of treating the multiply
injured patient in the A&E Department
• Recognise the importance of pre-hospital and
immediate hospital treatment in the golden
hour
• Describe the function and roles of a trauma
team
• Outline the primary and secondary survey
• Describe the biomechanics of injury and
forensic pathology
Rheumatoid Arthritis
Organiser: Dr P Gordon
CC Presentations: 92, 93
To be able to describe:
• The pathology, recognise the clinical features
and management of inflammatory arthritis.
• The impact of the disease on the health
service both in hospitals and in the community
• Management of rheumatoid arthritis; nonsteroidal anti-inflammatory drugs, COX-2
inhibitors, disease modifying drugs, steroids,
physiotherapy, occupational therapy, and
surgery
The Failing Joint
Organiser: Mr M Wilkinson
CC Presentations: 93
To be able to describe:
• The nature of the disease/wear process which
leads to joint failure
• The anatomy and function of typical joints (eg.
hips and knee) then the pathological
processes involved
• The size of the problem in the general
population and the costs to the individual and
society in general
• The treatment options:
conservative/therapeutics
Anatomy and radiology of the joints
Organisers: Prof Harold Ellis
CC Presentations: 89
To be able to:
• List the advantages and limitations of standard
radiography
• Define the A.B.C.S. of plain film examination
• Describe the histology of the different joint
types
• Describe the anatomical features of clinical
relevance at the shoulder, knee, hip and spine
60
• The indications for surgery and the nature of
the surgical options
Preassessment:
 To understand the importance of the
preoperative assessment process
 To know the ASA and Mallampati
classifications
 To know the importance of Body mass index
Control of Chronic pain
Organiser: Dr Stephanie Jarrett
CC Presentations: 81, 89, 93, 135









Equipment:
 To know and recognise the equipment for
delivering oxygen to a patient
 To know the some of the differences between
a child and adult airway
 To know the basic differences in anaesthetic
circuits
 To know the basic technique and
complications for inserting a central venous
line and how monitoring is interpreted
 To know the basic technique and
complications in inserting neuraxial blocks
To be able to describe chronic pain as a
multi-factorial
symptom,
including
biological, psychological and social
factors
To understand the differences between
acute and chronic pain, requiring
different approaches
To revise the basic pathophysiological
mechanisms of chronic pain
To be able to obtain a basic chronic pain
history, understanding the differences
between nociceptive, neurogenic, and
neuropathic pain, how these can overlap
and how it is possible to have pain of
unknown origin
To appreciate that neuropathic pains are
often not sensitive to opiates
To understand the role of medical
interventions in chronic pain
To know how to initiate and titrate oral
Morphine for cancer pain
To understand the role played by
patients’ beliefs about their pain
To be aware of the importance of good
communication in enabling patients to
best manage their chronic pain
Resuscitation:
 To know and understand Basic and Advanced
Life support algorithms (not taught in the
symposium)
 T o appreciated some of the ethical and legal
issues around resuscitation
 To know what is meant by the ‘do not
resuscitate’ policy
Communication: dealing with crisis
Organiser: Ms E Gill
CC Presentations: All EMTL
Anaesthesia - What You Need to Know!
Organiser: Dr Vip Gill
To understand the principles of:
• Ensuring a patient gets assessed appropriately
(ie. knows triage system)
• The use of skills to calm an angry friend
• Ensuring safety of self, patient and staff
• Using rapport and empathy skills and
demonstrating emotional support for the
patient
• Giving information, using silence appropriately
and clarifying and checking for understanding
• Using support for emotional state of patient
and companions
• Offering an explanation for what is happening
in a sensitive way
Drugs:
• To understand the basic theory of mechanism
of action of general and local anaesthetics
• To be able to give an example of a commonly
used inhalational and intravenous anaesthetic
• To be able to draw and understand the general
structure of a local anaesthetic
 To be able to classify different local
anaesthetics
 To understand what determines the duration of
action and potency of a local anaesthetic
 To know the toxic doses of commonly used
local anaesthetic drugs
Concepts:
 To understand the concepts of the ‘triad of
anaesthesia’ and ‘depth of anaesthesia’
 To be able to make an assessment of
anaesthetic risk
 To understand what is meant by ‘fitness for
surgery’
Back pain
Organiser: Ms K Payne
CC Presentations: 89, 90
Physiotherapy perspective
61
• To understand the role of physiotherapy in the
management of back pain and its relevance to
medical practice
• To be aware of biomechanical vs structural
diagnostic terms
• To gain insight into the physical assessment
and management of back pain via practical
demonstration
• To understand the impact of psychosocial
factors on prognosis
• To be aware of the physical treatment options
available and their evidence base
Aim: To provide the student with an overview of
medical
and
psychiatric
aspects
of
management of deliberate self-harm and
attempted suicide.
Objectives: To understand the following basic
information in relation to deliberate self harm
and attempted suicide:
• major epidemiological and aetiological factors
• techniques of assessment of the patient
presenting with deliberate self harm or
attempted suicide
• acute medical and psychiatric management
• uses of common law and statute law
Neurological Gait
Organiser: Dr J Lin
CC Presentations: 95
Rehabilitation and real life
Organiser: Prof L Turner-Stokes
Dr Julian Harriss
CC Presentations: 67, 68, 95, 96
• To be able to recognise common disorders of
gait
• To be able to describe the functional anatomy
of the neurological systems which are impaired
in gait disorders
• To be able to describe the role of the multidisciplinary rehabilitation team in the
management of gait disorders
• To be able to describe the four constructs of
rehabilitation
–
pathology,
impairment,
disability and handicap
• To be able to describe the link between
impairment and disability
• To be able to describe the link between
disability and handicap
• To develop general applications of this
learning experience to any situation involving
impairment
• To be able to describe the clinical relationships
of the anatomy and function of the spine and
spinal cord
Deliberate and Accidental Self-harm
Organisers: Dr G Ranjith
CC Presentations: 51
62
10.7 Seminar Titles
Emergency Medicine Sub-Block:
Anaesthetics/Pain

Emergency Drugs

Preoperative assessment and preparation for
surgery

Acute pain relief 90, 92, 135

Care of the unconscious patient 63

Oxygen Therapy and ventilatory support

Multiple organ failure and patient at-risk teams

Acid Base Balance, fluids and electrolytes
Emergency Medicine

BLS/ALS 2, 8

Shock 2, 20, 72, 73

Head injury 63, 64, 71

Drugs and poisoning 51, 52, 63, 64

Alcohol 52

Burns 108

Wounds and wound closure 49
Locomotion Sub-Block:
Orthopaedics

Infections and tumours

Paediatric Orthopaedics: CDH to slipped
femoral epiphysis 95

Hip and Knee surgery 92, 93

Foot and ankle surgery 92, 93

Hand surgery 92, 93

Shoulder and elbow surgery 92, 93
Trauma

Fractures and methods of management

Complications of fractures 94

Distal Limb injuries 94
94
Rheumatology (GST & UHL students only)

Musculoskeletal history, examination and
imaging

Seronegative inflammatory arthropathies
and crystal arthritis 91, 92

Regional pain, back pain and soft tissue
rheumatic diseases 89, 90, 91

Osteoarthritis and metabolic bone disease
91

Connective tissue diseases (Systemic
Lupus Erythematosus, Scleroderma) 92

Polymyalgia Rheumatica, giant cell arteritis
and vasculitis 92, 61, 62
10.8 Aims and Objectives for seminars
By the end of each seminar session you should have achieved the following educational objectives:
Anaesthetics/Pain
Emergency Drugs
By the end of the session you will be able to:

List the essential emergency drugs used in
clinical practice

Define the actions of these drugs and their
basic pharmacology
Preoperative assessment and preparation for
surgery
By the end of the session you should be able to:

List the universal questions asked to patients
before a general anaesthetic

List the conditions needing further
investigation

Reproduce the physiological data required for
safe general anaesthesia

Reproduce the treatment of chronic conditions
in the perioperative period (diabetes,
hypertension)

List the indications for the use of each drug
and their routes and methods of administration

Explain the need for investigations (blood
tests, ECGs, X-rays)
Describe the process of anaesthesia and
appropriate analgesia
Identify problems and when to consult an
anaesthetist


63
Acute pain relief
By the end of the session you should be able to:

Describe how to assess pain

List the standard methods of acute pain relief
which are available and be able to describe
them to a surgical patient
Care of the unconscious patient
By the end of the session you should be able to:

Outline principles of assessment and airway
management in unconscious patients

List the components of the Glasgow Coma
Score

List the precautions to be taken when looking
after an unconscious patient
Oxygen Therapy and ventilatory support
a) Oxygen Therapy
i) Knowledge Objectives
By the end of the session you should be able to:

List the common indications for oxygen
therapy

Draw the haemoglobin oxygen dissociation
curve

List the main factors which shift the curve to
the left

Give the formula for the calculation of oxygen
delivery

Describe in which patients a fixed performance
mask should be used

List the main hazards of oxygen therapy
ii) Skills Objectives

Differentiate between arterial blood gases
taken from patients with Type I and Type II
respiratory failure

Identify the commonly used fixed performance
and variable performance face masks
Multiple organ failure and patient-at-risk teams
i) Knowledge Objectives
By the end of the seminar you should be able to:

Summarise the important pathophysiologic
mechanisms that lead to the development of
multiple organ failure

List the clinical features of multiple organ
failure

Compare and contrast the haemodynamic and
metabolic effects of:
i)
Adrenaline
ii)
Noradrenaline
iii)
Dobutamine
iv)
Dopamine
v)
Dopexamine
Acid Base Balance, fluids and electrolytes
i) Knowledge Objectives
By the end of the seminar you should be able to:

List the common causes of metabolic and
respiratory acidosis and alkalosis

List the causes of hyperkalaemia,
hypokalaemia, hypernatraemia and
hyponatraemia

List the main pharmacological properties,
including side effects, of the principal groups of
analgesic drugs

List the physiological monitors required when
caring for an unconscious patient
List the methods of assessing recovery from
unconsciousness

b) Ventilatory Support
i) Knowledge Objectives
After the seminar you should be able to:

List the main indications for mechanical
ventilation

Understand the meaning of the abbreviations
PEEP and CPAP

Explain how oxygenation can be improved by
the application of PEEP/CPAP

Explain the difference between volume and
pressure controlled ventilation

Give the formula for calculating minute
ventilation
ii) Skills Objectives

Suggest appropriate modifications to ventilator
settings when given a selection of blood gases
and clinical scenarios





Define ARDS
List the common conditions associated with
ARDS
Compare the advantages and disadvantages
of TPN versus enteral nutrition
List the clinical abnormalities which are
present in patients at risk of developing
multiple organ failure
Identify patterns of acid base abnormalities

Explain the management of patients with
hyperkalaemia, hypokalaemia, hypernatraemia
and hyponatraemia

Show knowledge of how to prescribe IV fluids
ii) Skills Objectives
64

Define the complications and presenting
features of hyperkalaemia, hypokalaemia,
hypernatraemia and hyponatraemia

Interpret arterial blood gases and basic serum
biochemistry

Adequately ventilate a mannikin with a bag
valve mask
Outline the algorithms for the management of
cardiac arrest including the use of adrenaline
and atropine
Demonstrate safe defibrillation of a mannikin
Emergency Medicine
BLS/ALS
By the end of the session you should be able to:

Describe the assessment of a collapsed
patient

Demonstrate basic life support competently,
both single handed and in pairs

Discriminate between shockable and nonshockable rhythms
Shock
By the end of the session you should be able to:

Define shock

Describe the clinical findings in shock

Outline the pathophysiology of shock

List the common causes of shock
Head injury
By the end of the session you should be able to:

Describe the pathophysiology of severe head
injury

Describe the assessment of the head injured
patient and the clinical tools for evaluation

Demonstrate understanding of the priorities in
head injury management
Drugs and poisoning
By the end of the session you should be able to:

List the common drugs taken in overdose, both
accidental and deliberate

Outline the management priorities for poisoned
patients
Alcohol
By the end of the session you should be able to:

Describe the pathophysiological and
pharmacological effects of alcohol both acute
and long term

Outline the major complications of alcohol
abuse

Evaluate the interventions available to prevent
abuse including community agencies
Burns
By the end of the session you should be able to:

Describe the pathophysiology of burns

Describe the epidemiology of burns

Assess the burnt area

List the common complications of burns
Wounds and wound closure
By the end of the session you should be able to:

Evaluate the need for wound closure in a
given wound

Describe different types of wounds

Describe the principles behind local
anaesthetic administration


















65
Evaluate a given set of clinical observations as
to the severity of shock
Determine the management priorities in a
given shock scenario
List the common investigations and evaluate
their importance
Outline the management plan in a given
scenario
Describe the epidemiology of head injury
Determine the likely substances ingested in
common given scenarios
Describe the common antidotes
Demonstrate understanding of the role of the
National Poisons Centre
Describe the management of acute alcohol
withdrawal in a dependent patient
Demonstrate how to assess alcohol use and
its effect on the patient
Determine the management priorities in
severely burned patients
Evaluate the common treatments for burns
Demonstrate competence in managing burns
in a given scenario
Demonstrate competence in suturing a
simulated wound
List the common complications of wound
closure
Describe the appropriate dressing for a range
of wounds
Orthopaedics
Infections and Tumours
By the end of the seminar you should be able to:

Understand the principles behind musculoskeletal infections and tumours

Describe the clinical presentation (i.e. history
and findings on examination) of musculoskeletal infections and tumours
Paediatric Orthopaedics
By the end of the seminar you should be able to:

Understand the principles of common
paediatric orthopaedic disorders

Describe the clinical presentation of common
paediatric orthopaedic disorders
Hip and Knee Disorders
By the end of the seminar you should be able to:

Understand the principles of common
disorders of the hip and knee

Describe the clinical presentation (i.e. history
and findings on examination) of disorders of
the hip and knee
Foot and Ankle Disorders
By the end of the seminar you should be able to:

Understand the principles of common
disorders of the foot and ankle

Describe the clinical presentation of disorders
of the foot and ankle
Hand Disorders
By the end of the seminar you should be able to:

Understand the principles of common
disorders of the hand

Describe the clinical presentation of disorders
of the hand
Shoulder and Elbow Disorders
By the end of the seminar you should be able to:

Understand the principles of common
disorders of the shoulder and elbow

Describe the clinical presentation of disorders
of the shoulder and elbow
Trauma
Fractures and methods of management
By the end of the session you should know:

How to diagnose a fracture

How to select an appropriate method of
management
Complications of fractures
By the end of the session you should know:

The common complications that occur
following fractures
Distal limb injuries
By the end of the session you should know:

How to assess a patient presenting with a
hand injury

How to assess a patient presenting with a foot
injury












Plan the appropriate investigations of such
infections and tumours
Understand the principles of treatment of
musculo-skeletal infections and tumours
Plan the appropriate investigations of common
paediatric orthopaedic disorders
Understand the principles of treatment of
common paediatric orthopaedic disorders
Plan the appropriate investigations of
disorders of the hip and knee
Understand the principles of treatment of
disorders of the hip and knee
Plan the appropriate investigations of
disorders of the foot and ankle
Understand the principles of treatment of
disorders of the foot and ankle
Plan the appropriate investigations for hand
disorders
Understand the principles of treatment of hand
disorders
Plan the appropriate investigations for
shoulder and elbow disorders
Understand the principles of treatment of
shoulder and elbow disorders

How fractures are stabilised

How complications can be missed
How complications are managed


66
How to manage common soft tissue and bony
hand and foot injuries
Rheumatology
Musculoskeletal history, examination and imaging
i) Aims
You should learn how to take a history, examine and investigate a patient with musculoskeletal
complaints.
ii) Knowledge Objectives
iii) Skills Objectives
By the end of the session you should:
By the end of the session you should be able to:

Know the symptoms that characterise

Perform a screening examination of the
inflammatory and mechanical joint diseases
musculoskeletal system such as the GALS

Know the principles of joint examination and
method
how to perform a more detailed examination of
the musculoskeletal system

Know the basic investigations that are
commonly used in the diagnosis and
assessment of rheumatic diseases
Seronegative inflammatory arthropathies and crystal arthritis
i) Aim
To introduce you to various inflammatory arthropathies that are seronegative for rheumatoid factor.
ii) Objectives
By the end of the session students should:

Know the association between HLA-B27 and

Know the clinical features of ankylosing
seronegative arthritis
spondylitis, reactive arthritis and psoriatic

Be familiar with the clinical features,
arthritis
investigations and management of gout and
pseudogout
Regional pain, back pain and soft tissue rheumatic diseases
i) Aims
You should be familiar with the clinical features, investigations and management of regional pain, back
pain and soft tissue rheumatism.
ii) Objectives
By the end of the session you should:

Learn to distinguish inflammatory from

Learn the management of mechanical back
mechanical back pain
pain and sciatica

Be able to recognise the clinical features and

Learn the clinical features, investigations and
predisposing factors of mechanical back pain
management of patients with common soft
and sciatica
tissue rheumatic diseases such as adhesive

Be able to arrange appropriate investigations
capsulitis and tenosynovitis
for back pain and sciatica
Osteoarthritis and metabolic bone disease
i) Aims
You should learn the clinical features, pathologies, investigations and management of osteoarthritis and
metabolic bone diseases.
ii) Objectives
By the end of the session you should:

Learn the epidemiology, clinical, pathological

Learn the clinical features, investigations and
and radiological features of osteoarthritis
management of osteomalacia and Paget's

Know the management of osteoarthritis
disease

Learn the causes, assessment and
management of osteoporosis
Connective tissue diseases (Systemic Lupus Erythematosus, Scleroderma)
i) Aims
To introduce you to connective tissue diseases as multi-system disorders. You should be familiar with
the main clinical features and learn how to investigate connective tissue diseases especially systemic
lupus erythematosus and scleroderma.
ii) Objectives
By the end of the session you should:

Understand the clinical implications of different

Learn the main systemic manifestations of
auto-antibodies especially anti-nuclear
connective tissues diseases
antibodies

Learn the preliminary investigations in
connective tissue diseases
67
Polymyalgia Rheumatica, giant cell arteritis and vasculitis
i) Aims
To learn the clinical manifestations, differential diagnoses and management of polymyalgia rheumatica,
giant cell arteritis and common forms of vasculitis.
ii) Objectives
By the end of the session you should:

Be able to recognise the presenting features of  Know the management of polymyalgia
polymyalgia rheumatica and temporal arteritis
rheumatica and temporal arteritis

Appreciate the differential diagnoses of

Learn the main clinical features of different
polymyalgia rheumatica and exclude these by
vasculitidies
eliciting the relevant clinical history, identifying
the clinical signs and organising appropriate
investigations
68
10.9 Recommended Reading and Computer-aided learning
Please refer to the VC for reading list
Internet Resources
1. Arthritis Research Campaign http://www.arthritisresearchuk.org/
3. British Society for Rheumatology http://www.rheumatology.org.uk/
4. Royal College of General Practitioners http://www.rcgp.org.uk/
5. National Osteoporosis Society http://www.nos.org.uk/
6. Annals of Rheumatic Diseases http://ard.bmj.com/
7. Cochrane Library http://www.cochrane.co.uk/
8. National Library of Medicine http://www.nlm.nih.gov/
9. New England Journal of Medicine http://content.nejm.org/
10. Doctor on line http://www.arthritis.co.za
CD-rom: Interactive Hand. <www.primalpictures.com>
CD-rom: Interactive Knee. <www.primalpictures.com>
CD-rom: Interactive Foot and Ankle. <www.primalpictures.com>
CD-rom: Shoulder. <www.primalpictures.com>
CD-rom: Spine. <www.primalpictures.com>
CD-rom: Hip. www.primalpictures.com
• Internet Resources
Anaesthesia Online (includes Medline access http://www.priory.com/anaes.htm
South Eastern School of Anaesthesia www.sesa.org.uk
69
11. REPRODUCTIVE AND SEXUAL HEALTH BLOCK(RSH)
11.1 An Overview of the Block
72
11.2 Course Organisers and Contact Details
73
11.3 Block Aims and Objectives
74
11.4 Orientation
80

Guy’s/St Thomas’ Campus
80

King’s College Hospital Campus
81

Princess Royal University Hospital Campus
82

Queen Elizabeth Hospital Campus
82

University Hospital Lewisham Campus
83
11.5 Outside and Overseas Attachments
84
11.6 Symposia Information
85
11.7 Aims and Objectives for Symposia
85
11.8 Seminar Titles
88
(For RSH Block Seminar Aims and Objectives please refer to ‘RSH Block – Seminar
Guidelines’ booklet)
11.9 Recommended Reading and Computer-Aided Learning
70
89
11.1 An Overview of the Block
Welcome to the Reproductive and Sexual Health Block. During this Block, students will be based at
KCH, GST, UHL, QEH or PRUH. During this Block we hope that you will acquire core knowledge and
skills relevant to obstetrics and gynaecology, genitourinary medicine, and breast medicine. As far as
possible we have ensured that the same experience will be gained on the different campuses. With
regards to obstetrics and gynaecology, at Guy’s and St Thomas’, King’s and Lewisham we have
persevered to maintain a firm structure. Students based at KCH and GST will spend three weeks at a
peripheral hospital. The reasons for the peripheral attachments are: the support for them from previous
students and our concern that the core curriculum, particularly in gynaecology, will not be able to be
delivered on the teaching hospital site, primarily because of sub-specialisation amongst the consultants.
Those students based at PRUH, QEH and UHL will obtain similar broad clinical experience at this
campus. As with the other Blocks there will be a symposium every Wednesday morning and there will be
three seminars (tutorials) throughout each week. The subjects of the seminars across all campuses will
be identical. Fridays are for Student Selected Components, although in Term 2 we expect you stay at
your peripheral attachment on Fridays as you do not have to return to campus to complete your elective
portfolios.
If you encounter any problems during your attachment please approach your course organiser. We
hope that you will enjoy your time in the Reproductive and Sexual Health Block, and although reading
around subjects is important, the best place to learn clinical medicine is where the patients are, namely
the wards and the clinics.
Ms Deborah Bruce
Department of Women’s Health
71
11.2 Course Organisers and Contact Details
Obstetrics & Gynaecology
Ms Deborah Bruce
020 7188 3631
[email protected]
k
Undergraduate Teaching
Administrator:
Mrs Annelie Mojzis
020 7188 3631
[email protected]
Mr Mike Marsh
020 3299 3629
[email protected]
Miss Kazal Omar
Tel: 016 8986 4892
[email protected]
Mrs Ruth Cochrane
020 8333 3066
[email protected]
Secretary:
Ms Agatha Palmer
020 3299 3629
[email protected]
Administrator:
Shayron Hegarty
Tel: 016 8986 4347
[email protected]
Student Coordinator:
Samantha Newman
020 8333 3000 ext 8734
[email protected]
Course Administrator:
Pat Riddle
020 3299 3546
[email protected]
QEH
Mr Nigel Perks
020 8836 4500
[email protected]
Medical Undergraduate
Administrator:
Joanna Wollard
020 8836 6788
[email protected]
Genito-Urinary Medicine
GSTT
020 7188 7188
KCH
020 7737 4000
PRUH & UHL
QEH
Mr Anatole Menon-Johansson
[email protected]
Mr Anatole Menon-Johansson
[email protected]
See Guy’s/St Thomas’
Dr Judy Russell
0208 836 5765
[email protected]
PA: Davina Austin-Harvey
[email protected]
PA: Davina Austin-Harvey
[email protected]
Administrator:
Dr Hannah.Alexander
[email protected]
Administrator:
Dr Hannah Alexander
[email protected]
Breast Medicine
GSTT
020 7188 7188
KCH
020 7737 4000
PRUH
01689 863000
UHL
020 8333 3000
Mr Hisham Hamed
[email protected]
020 7188 4245
Dr Jo Marsden
[email protected]
Mr Prakesh Sinha
Tel: 016 8986 4441
[email protected]
Mr Hisham Hamed
020 7955 5000 ext 3776
020 8333 3000 ext 3161/8508
[email protected]
QEH
Mr Bengt Kald
[email protected]
[email protected]
72
Family Planning / Reproductive Health
GSTT
020 7188 7188
Dr M Nowicki
KCH
020 7737 4000
As GSTT
PRUH
01689 863000
As GSTT
UHL
020 8333 3000
As GSTT
QEH Student Coordinator
Joanna Woollard
Tel: 020 8836 6788
[email protected]
PRUH Student Coordinator
Shayron Hegarty
016 8986 4347
[email protected]
UHL Student Coordinator
Samantha Newman
020 8333 3000 ext 8734
[email protected]
t
[email protected]
020 3049 4006
73
11.3 Block aims and objectives
Objectives
During the Reproductive and Sexual Health course, you should:
•
Achieve core knowledge
•
Demonstrate core professional values
Obstetrics & Gynaecology
1. Aims
The aims of the course in Obstetrics and
Gynaecology are to:
•
Understand the disease of women with
regard to prevention, recognition, and
management of gynaecology disease
2. Attitudes
By the end of the course you should be able to:
•
recognise patients’ rights in all respects, and
particularly in regard to confidentiality and
informed consent
3. Knowledge
You should be able to describe:
(a) The clinical presentations relevant to obstetrics
and gynaecology as follows:

acute abdominal pain (10)

pelvic mass (14)

uterovaginal prolapse (26)

acute retention of urine (30)

urinary frequency and urgency (31)

urinary incontinence (32)

pain of micturition (33)

vaginal discharge (109)

amenorrhoea (112)

disorders of menstruation (113)

dymenorrhoea and pelvic pain (114)

unwanted pregnancy and termination (116)

painful sexual activity (117)
4. Skills
By the end of the course to be able to:
•
take a comprehensive gynaecological history
including breast, genito-urinary medicine and
sexual histories
•
take a comprehensive obstetric history
•
examine a pregnant woman
•
perform a competent breast examination
•
perform a bimanual pelvic examination
•
•
Recognise and manage psychological
problems in human reproduction, including
psychosexual disorders
Understand normal pregnancy and labour
•
Appreciate that a person’s sexuality is
complex and personal and a person’s privacy
must be respected with regard to history taking
and examination at all times






failure to conceive (118)
contraception (119)
genital ulcers and warts (122)
abnormal vaginal bleeding in the first 24 weeks
of pregnancy (110)
abnormal vaginal bleeding after 24 weeks of
pregnancy (111)
normal pregnancy (115)
(b) The symptomless problems relevant to
obstetrics and gynaecology:

high blood pressure (2B)

anaemia, including haemoglobinopathy (5B)

osteoporosis (6B)

abnormal cervical smear (7B)

proteinuria (10B)
•
•
•
•
insert a Cusco speculum, examine the cervix,
and take a cervical smear and endocervical
swab
catheterise a female patient
explain to a patient the use of pessaries and
suppositories
participate in a normal delivery
Sexual and Reproductive Health (Family Planning)
1. Aims
The aims of the family planning course are to
ensure that you are able to:

identify the family planning and sexual health
needs of patients during their work as preregistration house officers and to respond to
these or refer appropriately


74
provide basic information on contraception,
genital infection, and management of the
unplanned pregnancy in a non-judgmental
manner
promote sexual health when appropriate and
in a sensitive manner
2. Attitudes
You should recognise and practice the following:
•
the importance of a non-judgmental approach
towards a range of sexual lifestyles and the
termination of pregnancy
3. Knowledge
You should be able to describe:
•
all currently available methods of
contraception
•
medical therapies which might put a patient at
risk of pregnancy or a complication of their
contraceptive method. This will include: the
prescription of antiepileptics or anti retrovirals
to those on the combined pill; major surgical
operations or immobilisation in those on the
combined pill; e.g. when a broken leg is set in
plaster or strict bed rest is advised.
4. Additional Skills
•
Take a sexual history relevant to a family
planning consultation
•
Discuss the advantages and disadvantages
of the combined oral contraceptive, injectable
and implant contraceptives, male and female
barriers, intrauterine contraceptives and
emergency conraception
•
the responsibilities of doctors in relation to
confidential information
•
appropriate conduct during intimate
examinations (see Code of Practice for
student examination of patients, page 4)
•
Contraceptive methods which cause or
exacerbate medical conditions. This will
include: pelvic pain in a patient using the IUD
for contraception; severe migraine/DVT/PE in
a patient on the combined oral contraceptive
•
General issues which relate to sexual and
reproductive health (SRH) and which are also
relevant to other specialties
•
the legal issues which relate to the provision
of contraception to those under the age of consent
and the barriers experienced by clients in
accessing sexual health services
•
Demonstrate condom use to a patient

An understanding of the diagnosis and
management of common HIV related
complications
•
•
A recognition of psychosexual problems
An understanding of the basis of psychiatric
aspects of patients with genitourinary diseases
and/or HIV
Sexual Health and HIV
1. Aims
•
An understanding of the aetiology, clinical
presentation, diagnosis and management of
common sexually acquired infections
2. Attitudes
To show the following:
•
A recognition of the range of sexual
behaviour
•
An awareness of sexuality and sexual
orientation
•
An understanding of confidentiality as applied
to patients attending a GUM service
3. Knowledge
(a) The clinical presentations relevant to genitourinary medicine/HIV:
•
genital ulcers and warts (12, 20)
•
pelvic mass (14)
•
urinary frequency and urgency (31)
•
pain on micturition (33)
•
testicular pain (37)
•
testicular swelling (38)
•
vaginal discharge (109)
•
urethral discharge (123)
•
dysmenorrhoea and pelvic pain (114)
•
painful sexual activity (117)
(c) The clinical presentations related to HIV
medicine:
•
acute and chronic breathlessness (3)
•
haemoptysis (5)
•
acute headache (61)
•
fits and convulsions (69)
•
memory loss (70)
•
weight loss (19)
•
diarrhoea (23)
•
skin infections (105)
•
fever (121)
•
the dying patient (127)
(b) The core knowledge related to HIV medicine
should include:
•
the natural history and epidemiology of HIV
75
infection
the diagnosis and management of common
HIV-related opportunistic infections and
tumours
•
the principles of antiretroviral and prophylactic
therapy in HIV infection
4. Additional skills
To be able to:
•
take an appropriate sexual history in a variety
of clinical situations
•
perform a male and female genital
examination
•
discuss the relevant issues with patients
undergoing HIV testing
•
•
•
offer basic health education and promotion to
patients presenting with sexually-acquired
infections
utilise clinical skills gained in Phase 3 to
assess patients presenting with acute HIVrelated complications
Breast Medicine
1. Aims
The aims of the course in Breast Medicine are to
be able to:
•
take a clinical history from a patient
presenting with breast symptoms
•
carry out a competent clinical examination of
the breasts and axillae
2. Objectives
•
To achieve core knowledge
3. Core Clinical presentations

lump in breast (40)

mastalgia (41)

nipple discharge (42)
The symptomless problems relevant to breast
medicine are:

abnormal screening mammogram (8B)

family history of breast cancer (11B)

epidemiology of benign and malignant breast
disease

clinical presentation of breast disease

pathology of breast disease

investigation of breast problems

•
understand breast disease with regard to
screening, diagnosis and management
give information to patients with breast
disease, including giving bad news
•
To demonstrate core professional skills

imaging of the breast - including X-ray,
mammography, and ultrasound
breast cancer screening - theory, practice,
advantages/disadvantages
staging of breast cancer
treatment of breast cancer
palliative and terminal care (127, 135)
genetics of breast cancer (136)
psychological aspects of breast cancer
breast infection







Vertical Strand Disciplines
Communication skills
You should be able to:

demonstrate effective patient centred interviewing using communication skills learnt earlier in the
course

physically examining patients taking into account the need for sensitivity, explanation and privacy

explain common medical and surgical procedures, investigations and treatments in language patients
understand and check for understanding
76
Knowledge
1. Clinical Genetics
You should be aware of different issues involved in pregnancy where there is a family history of a
genetic disease. These include:
 Patterns of inheritance and interpretation of pedigrees
 Methods of assessment of risk of inherited disease in a pregnancy.
 The techniques for genetic testing, their uses and limitations in pregnancy.
 Chromosome abnormalities and their clinical implications.
 Screening for genetic disease in pregnancy.
 Counselling and ethical issues arising from testing in pregnancy.
Pre-implantation genetic diagnosis, its uses and limitations.
2. Clinical Pharmacology & Therapeutics
(a) Obstetrics, New-born, and Gynaecology
•
Drugs and teratogenesis
•
Prophylaxis for pregnancy
•
Use of drugs in pregnancy
•
Management of medical disorders in pregnancy
•
Drugs and induction of labour
•
Analgesia in labour
•
Drugs and lactation
•
Ergometrine
•
Hormone replacement therapy
•
Fertility Drugs
•
Contraception
(b) Sexual Health / HIV
•
Principles of antibacterial therapy
•
Principles of anti-retroviral therapy
•
Treatment of gonorrhoea
•
Treatment of chlamydia trachomatis
•
Anti-retroviral therapy
3. Clinical Sciences
•
Embryology relating to newborn variations and neonatal problems
•
Preterm and babies with low weight for gestational age (LWGA)
•
Anatomy of pelvis
•
Physiology of pregnancy
•
Fetal physiology and teratogenesis
•
Physiology of parturition
•
Adaptation to extra-uterine life and prematurity
•
Forensic pathology: abortion, maternal death
4. Ethics & Law relating to Human Reproduction
•
Ethical debates about, and the legal status of, the embryo and fetus
•
The maternal-fetal relationship: ethical tensions
•
Abortion: professional guidelines, legal requirements and debates about the use of tissue from
aborted fetuses
•
Sterilisation: ethical and legal issues
•
Pre and post-natal screening and testing: ethical issues concerning informed consent and the
determination of the future interests of the child
•
Assisted conception: legal boundaries and ethical disputes, resource allocation
•
Benefits and dangers of genetic testing and screening after birth: risks of unwelcome information
and of genetic stigmatisation
•
Genetic counselling relating to the above issues
77
5. Palliative Medicine
To know about:
•
HIV
•
Palliation of advanced breast & gynaecological cancers (135)
6. Pathology & Laboratory Sciences
To be able to give an account of the role of the clinical laboratory disciplines in the diagnosis and
management of:

Tumours of the cervix, endometrium, myometrium and ovaries particularly the histopathology and
cytology, including cervical screening

Infections of the pelvis

Breast tumours and breast screening

Sexually transmitted diseases presenting as vaginal and urethral discharge

AIDS and HIV

Basic abnormalities of pregnancy

Haematological abnormalities in pregnancy including haemolytic disease of the newborn, anaemia
and thrombocytopenia

Thrombosis and disseminated intravascular coagulation
7. Primary Care and the Community Study
The Community Study enables students to study pregnancy and the puerperium from the perspectives of
patients and primary care:

Antenatal care in the community

Common health problems in pregnancy presenting in the community

Women’s views on and experiences of antenatal care, antenatal screening and delivery

Post-natal physical health and illness, including breast problems

the 8 week postnatal examination

Family planning choices

Post-natal mental health and illness

The impact of having a baby on the mother and her family in terms of daily activities, roles, selfimage and changing relationships.

Primary care and community sources of support and resources for the mother and family.
Links to core curriculum

Professional attitudes (6)

Communication skills (7)

Knowledge: normal pregnancy (115); depression (post-natal depression) (56); contraception (119);
fever (puerperal infection) (121); pain in breast (41)
8. Radiology & Imaging

Ultrasound scanning and fetal monitoring

Mammography
9. Public Health
1. Epidemiology of common diseases

describe the basic epidemiological features of the following conditions: sexually transmitted disease,
breast cancer, cervical cancer

demonstrate a clear understanding of the following epidemiological terms when applied to the above
diseases – incidence, prevalence, crude mortality, age-sex specific death rates, standardised
mortality ratios, standardised death rates, population attributable risk, population attributable risk
fraction,

identify modifiable social and environmental risk factors for these diseases (eg. poverty, occupation,
housing, indoor air quality, outdoor air quality, smoking, obesity, diet, exercise)

interpret Standardised Mortality Ratios, odds ratios, relative risks, population attributable risks,
population attributable risk fractions and other epidemiological data as they relate to these diseases

describe the epidemiology of maternal mortality and measures taken to collect information regarding
maternal deaths

describe the epidemiology of teenage pregnancy in the UK, identifying local and national measures
that can be taken to reduce teenage pregnancy
78
2. Screening

apply the WHO (Wilson and Junger) criteria for screening to the following programmes and discuss,
using their knowledge from their clinical teaching whether these programmes are likely or unlikely to
fulfil the criteria: cervical screening, breast screening, antenatal screening

identify social and health service factors associated with low uptake of screening and strategies that
can be adopted to improve uptake

outline how screening programmes can be audited and evaluated

interpret data concerning the sensitivity, specificity and positive predictive value of tests used for the
above screening programmes and demonstrate an understanding of how they influence what
information should be given to patients if they undergo screening tests
3. Health promotion

describe primary, secondary and tertiary prevention of the following conditions, demonstrating an
understanding of measures that can be taken at an individual and population level to reduce the
incidence and/or prevalence of: sexually transmitted disease, unplanned pregnancy, neural tube
defects, intrauterine growth restriction, perinatal mortality;
4. Infectious diseases

describe the epidemiology and prevention of sexually transmitted disease
5. Health Services

describe current important demographic changes in the UK and internationally

discuss how demographic changes in the UK could impact on the prioritisation of health services in
the UK

list factors that should be considered when deciding whether to invest resources in a new drug
treatment or health service
Students are reminded that the public health sciences does not wish to overburden students with factual
knowledge. However students are expected to be able to apply basic epidemiological, public health,
sociological and economic principles to the conditions above using their medical knowledge to identify
the issues that might be of relevance for that condition
79
11.4 Orientation
The blocks and campuses to which you have been allocated are displayed on the Phase 4 Virtual
Campus before the start of each rotation.
•
This section briefly outlines progression through the Block and any relevant sub-blocks and
disciplines.
•
Any changes to the timetable will be posted on the Virtual Campus and students will also be
notified by email.
Please ensure that you check both regularly. http://virtualcampus.kcl.ac.uk/vc/medical.htm and click on
MBBS 4 for up-to-date course information
Guy’s and St. Thomas’ Campus
Students are allocated to rotation sets. Students will rotate through the following modules:
Module
1
Genitourinary Medicine
2
Obstetrics and Gynaecology
3
Breast Medicine
4
Outside Attachment in Obstetrics & Gynaecology
Week Rotation 1 Rotation 2 Rotation 3 Set Set
A
B
Tuesday
Thursday Thursday B
1
OG
11/09/12
03/01/13
04/04/13
2
17/09/12
07/01/13
08/04/13
GU GU
3
24/09/12
14/01/13
15/04/13
P
B
4
01/10/12
21/01/13
22/04/13
P
OG
5
08/10/12
28/01/13
29/04/13
P
OG
Tuesday
6
15/10/12
04/02/13
OG OG
07/05/13
7
22/10/12
11/02/13
13/05/13
OG OG
8
29/10/12
18/02/13
20/05/13
OG OG
Tuesday
9
05/12/12
25/02/13
OG P
28/05/13
10
12/12/12
04/03/13
03/06/13
OG P
11
19/12/12
11/03/13
10/06/13
OG P
12
26/12/12
18/03/13
17/06/13
OG OG
13
03/12/12
25/03/13 24/06/13
Key
GU
OG
B
P
Set Set
C
D
OG OG
Set
E
OG
Set
F
OG
Set
G
OG
Set
H
OG
Set
I
OG
Set
J
OG
Set
K
OG
GU
OG
B
OG
OG
GU
OG
OG
B
P
GU
P
P
P
B
GU
OG
OG
OG
OG
GU
OG
OG
OG
OG
GU
OG
OG
OG
P
GU
P
P
P
OG
GU
OG
OG
OG
P
GU
OG
OG
OG
P
OG
OG
P
P
P
OG
OG
OG
OG
B
OG
P
OG
B
P
P
P
B
OG
OG
OG
P
P
OG
P
P
OG
OG OG P
P
OG B
OG OG P
P
OG OG
OG OG OG OG OG OG
Rotation 1& 2- Reading week;
Rotation 3 Written Assessment
OG
B
OG
OG
OG
B
P
P
OG
Peripheral Attachments in Obstetrics and Gynaecology
Students will be given information by e-mail and referred to the relevant pages of the Virtual Campus for
further information.
80
King’s College Hospital Campus
Students will receive their own individual timetable. Students will rotate through the following modules:
Module
Gynaecology
Genitourinary Medicine
Breast Medicine/Outpatient Gynaecology
Outside Attachment in Obstetrics &
Gynaecology
Week Rotation 1
Rotation 2
Rotation 3
Tuesday
Thursday
Thursday
1
11/09/12
03/01/13
04/04/13
2
17/09/12
07/01/13
08/04/13
3
24/09/12
14/01/13
15/04/13
4
01/10/12
21/01/13
22/04/13
5
08/10/12
28/01/13
29/04/13
Tuesday
6
15/10/12
04/02/13
07/05/13
7
22/10/12
11/02/13
13/05/13
8
29/10/12
18/02/13
20/05/13
Tuesday
9
05/12/12
25/02/13
28/05/13
10
12/12/12
04/03/13
03/06/13
11
19/12/12
11/03/13
10/06/13
12
26/12/12
18/03/13
17/06/13
13
03/12/12
25/03/13
24/06/13
1
2
3
4
Rotation 1& 2- Reading week;
Rotation 3 Written Assessment
For the first day of each module, students are to report to Mr Mike Marsh, Seminar Room, 9th Floor,
Ruskin Wing, King's College Hospital.
For details on HIV/GUM week (week 2) please refer to the relevant section of your introductory handout.
Peripheral Attachments in Obstetrics and Gynaecology
Students will be given information by e-mail and referred to the relevant pages of the Virtual Campus for
further information.
81
Princess Royal University Hospital Campus
Students should report to the Education Centre at 8.30am on the first day where there will be a short
induction tour and students will receive individual timetables and information relevant to their rotation.
Students will rotate through the following modules:
Module
1
Genitourinary Medicine (at GST) ) – Weeks 1 & 2
2
Obstetrics and Gynaecology
3
Breast Medicine
Week Rotation 1
Rotation 2
Rotation 3
Tuesday
Thursday
Thursday
1
11/09/12
03/01/13
04/04/13
2
17/09/12
07/01/13
08/04/13
3
24/09/12
14/01/13
15/04/13
4
01/10/12
21/01/13
22/04/13
5
08/10/12
28/01/13
29/04/13
Tuesday
6
15/10/12
04/02/13
07/05/13
7
22/10/12
11/02/13
13/05/13
8
29/10/12
18/02/13
20/05/13
Tuesday
9
05/12/12
25/02/13
28/05/13
10
12/12/12
04/03/13
03/06/13
11
19/12/12
11/03/13
10/06/13
12
26/12/12
18/03/13
17/06/13
13
03/12/12
25/03/13
24/06/13
Rotation 1& 2- Reading week;
Rotation 3 Written Assessment
Queen Elizabeth Hospital Campus
Students will be issued with a detailed site-specific timetable on arrival at QEH. Please report to the
Education Centre (located at the West Entrance of the hospital opposite the Conference Centre) at 9.15 am
on the first day of your clinical rotation. The first Tuesday and Thursday of each rotation will be induction
days. Students will rotate through the following modules:
Module
1
Genitourinary Medicine (at GST) – Weeks 1 & 2
2
Obstetrics and Gynaecology
3
Breast Medicine
Week Rotation 1
Rotation 2
Rotation 3
Tuesday
Thursday
Thursday
1
11/09/12
03/01/13
04/04/13
2
17/09/12
07/01/13
08/04/13
3
24/09/12
14/01/13
15/04/13
4
01/10/12
21/01/13
22/04/13
5
08/10/12
28/01/13
29/04/13
Tuesday
6
15/10/12
04/02/13
07/05/13
7
22/10/12
11/02/13
13/05/13
8
29/10/12
18/02/13
20/05/13
Tuesday
9
05/12/12
25/02/13
28/05/13
10
12/12/12
04/03/13
03/06/13
11
19/12/12
11/03/13
10/06/13
12
26/12/12
18/03/13
17/06/13
13
03/12/12
25/03/13
24/06/13
Rotation 1& 2- Reading week;
Rotation 3 Written Assessment
82
University Hospital Lewisham Campus
Students will be given their own individually designed and tailored timetables on the first clinical day.
Students will rotate through the following modules:
Rotation 1
10/09/1207/12/12
Mon 10/09/12
Rotation 2
02/01/1329/03/12
Weds 02/01/13
Rotation 3
02/04/1328/06/13
Tues
02/04/13
Clinical Rotation
11/09/1230/11/12
03/01/1322/03/12
02/04/1321/06/13
Seminars
From Tue
11/09/12
From Thurs
03/01/13
From Thurs
04/04/13
Symposia
(Wednesday)
From Wed
12/09/12
From Mon
07/01/13
From Wed
03/04/13
Course dates
Introductory Day
83
Time and Venue
Morning Programme (see VC
for details)
Afternoon Symposium: from
2pm (see VC for timetable)
Collect individual timetables
on first clinical day. Meet
Samantha Newman at 9:30am
in the Education Centre to
collect Induction Packs
Seminars take place in weeks 3
- 12 inclusive. Please see UHL
timetable for details
See VC for Symposia timetable
11.5 Outside and Overseas Attachments
A three week peripheral attachment will be part of the Reproductive and Sexual Health Block for the
Obstetrics and Gynaecology module for students based at KCH and GST. This will either be a
placement at a DGH* allocated by the Academic Centre, or at an overseas twinned institution via the
Exchanges Office, or an independently arranged placement (the deadline for these latter two options
was earlier in 2009). Students based at PRUH and UHL obtain similar clinical experience at these
campuses.
*Placements will be at one of the following hospitals: St Richard’s Chichester, Eastbourne, Queen
Elizabeth the Queen Mother Margate, Maritime Medway, Poole, Queen Mary’s Sidcup, Queen Elizabeth
Woolwich, Worthing.
Health-screening and Immunisation requirements for DGHs
Most DGHs require you to present them with evidence of relevant vaccinations/status: .HepB, HepB
surface antigen, Rubella & MMR vaccinations. Hep C, HIV, VzV,& TB Status. You cannot commence on
the wards without health clearance. You must therefore make an appointment with Occupational Health
at the beginning of the year, to make sure that this information is immediately available for DGHs.
Students must also contact the DGH at least 4 weeks before your placement to see if there are any
forms or additional screening is required. Failure to do this will result in you missing your attachment,
and therefore failing the block. We advise you to bring a spare copy of your status with you on induction
day.
Occupational Health currently test for Hepatitis B antibodies, Rubella antibodies, and evidence of T.B.
vaccination. Chicken pox antibodies are only tested for if the student does not have a positive history of
the disease.
Please ensure that you regularly check the DGH section on the Virtual Campus and your email
for up-to-date details on what is required for your allocations
84
11.6 Symposia Information
In the Reproductive and Sexual Health block, your first symposium will be on the introductory day of the
rotation. Following that, you will have a symposium every Wednesday morning.
Please see the Virtual Campus for an up-to-date symposia timetable for your RSH block.
Topics covered by the RSH symposia are:
Reproductive & Sexual Health History and Examination
Clinical Aspects of Breast Diseases
Pregnancy in Perspective
Termination of Pregnancy
Clinical Ethics and Law
Prescribing and Breastfeeding in Pregnancy
Abnormal Cervical Smear / Pelvic Pain
Gynaecological Cancers
How to Practice Medicine and Stay Out of Jail
Genetics
11.7 Aims and Objectives for Symposia
By the end of each symposium you should have achieved the following learning objectives:
• Discuss the importance of the Triple Approach
Reproductive and Sexual History and Pelvic
to breast diagnosis
Examination
• Discuss the different treatment pathways for
malignant breast disease
Organiser: Ms Deborah Bruce
• Understand how radiological and pathological
CC Presentations: None
techniques can be used together for the
diagnosis of breast problems
To learn about the key issues in taking:
 A gynaecological history
 A breast health history
Pregnancy in Perspective
 An obstetric history
 A sexual history
Organsier: Prof A Shennan / Mr M Marsh
 A psychosexual history
CC Presentations: 115
To be able to:
 Perform a pelvic examination and take a
To be able to discuss and describe:
cervical smear
• The aim of caring for pregnant women in the
 Understand the correct procedure for
community
examining a pregnant abdomen
• A woman’s perspective of pregnancy
Clinical Aspects of Breast Diseases
Organisers: Dr C Peacock/Mr H Hamed
CC Presentations: 40, 41, 42
Termination of pregnancy
Organisers: Dr Itty Samuel
CC Presentations: 116, 119
To be able to:
• Take an appropriate history from a patient
presenting with a breast lump
• Discuss the concerns/fears that a patient may
have when presenting with a breast lump
• Carry out a clinical examination of the breast
• Describe (briefly) the epidemiology of
termination of pregnancy in the UK
• Explain the law in relation to the termination of
pregnancy in the UK
• Describe the role of contraceptive services in
the prevention of unplanned pregnancy
To be able to:
 Opportunity to Explore personal feelings
around Termination of Pregnancy
• Describe the techniques of termination of
pregnancy according to duration of pregnancy
Clinical Ethics and Law
Organiser: Mr P Haughton
CC Presentations: All RSH
• To be able to discdouguss the normative
dimensions of clinical decisions, so that
85
(a) they are able to identify which aspects of
decisions are technical in nature and what are
ethical and (b) they are able to assess how
technical and ethical aspects relate to each
other
• To develop and acquire skills in analysing the
normative dimension of clinical decisions
(identifying moral principles and rules; critically
analysing moral arguments)
• To develop and acquire skills of exploring and
justifying personal decisions regarding ethical
issues as they arise in specific clinical contexts
• To be able to discuss the interface between
clinical topics and ethical issues

• The main problems which may face a patient
as a result of commencing anti-HIV (antiretroviral) treatment

Prescribing in Pregnancy
Breastfeeding
Organiser: Dr S Clarke
CC Presentations: 115
and






List the differential diagnosis of pelvic pain
List the sequelae associated with different
causes of pelvic pain
Take a relevant history from a woman with
pelvic pain
Describe how different elements of the history
discriminate between causes of pelvic pain
Describe different findings on examination
which discriminate between different causes of
pelvic pain
Explain indications for carrying out further
investigations and how these investigations
are useful
Describe appropriate management for each
cause of pelvic pain
Identify which causes of pelvic pain are
preventable and strategies to prevent them
Gynaecological cancers
Organiser: Dr G Culora / Dr A Winship
CC Presentation: 113, 114
during
To be able to:
• Describe the presentation and management of
the most important gynaecological cancers
(invasive cervical squamous carcinoma,
endometrial adenocarcinoma, and surface
epithelial tumours of the ovary)
• Describe the basic clinical pathology, including
the principles of tumour staging
• Describe the role of imaging (MRI and other
modalities) in the pre-treatment staging of
gynaecological cancer and in follow up
• Describe the relative roles of surgery,
radiotherapy and chemotherapy in the
management of these cancers
•Talk to and learn from the experiences of
cancer patients under current therapy
To be able to describe:
• pharmocokinetics and pharmakodynamics in
pregnancy
• Importance of good prescribing in pregnancy
•Common disorders and prescribing principles
• Drug and alcohol misuse in pregnancy and
whilst breast-feeding
• Epilepsy and asthma medication during
pregnancy and with breastfeeding
•Management of thrombo-embolic disease in
pregnancy
Abnormal Cervical Smear and Pelvic pain
Organiser: Dr Ali Kubba
CC Presentations: 7b, 114, 117
How to practise medicine and stay out of jail
Organiser: Ms R Cochrane
CC Presentations: 111, 113, 115, 119
To be able to:
• List the pros and cons of cervical screening
• Explain the objectives of the National Cervical
Screening Programme
• Describe the cervical transformation zone and
explain its significance
• Define dyskaryosis and explain its significance
• Describe patient attitudes to cervical
screening, their response to both a normal and
abnormal smear results and to discuss
informed consent in relation to this test
• Explain the importance of HPV in cervical
pathology
• Explain the importance of colposcopy to detect
and treat cervical pathology
 Describe the health promotion opportunities in
a cervical screening consultation
 Describe the epidemiology of pelvic pain
To be able to:
• Describe the concepts of risk management in
general, including good note-keeping, the use
of agreed protocols, informed consent,
preventative action in high-risk cases
• Describe the mechanisms for dealing with
difficult cases and complaints
• Discuss the skills relating to risk management
Genetics
Organisers: Dr Dragana Josifova
CC Presentations: 11b
At the end of the symposium, students should
have achieved the following:
86





To be able to estimate risk of fetal abnormality
in a pregnancy from family history of genetic
disease and other relevant information
To understand the uses and limitations of DNA
testing in pregnancy
To understand the concept of linkage and its
uses in pre-natal diagnosis
To understand the uses and limitations of
different invasive tests in pregnancy, including
chorionic villous biopsy, amniocentesis and
cord blood sampling



To understand the use of ultrasound scanning
in the pre-natal diagnostic setting
To understand the issues involved in screening
tests in pregnancy
To be aware of the different forms of
chromosomal abnormalities that can arise,
their clinical effects and significance to other
family members
To understand the ethical issues surrounding
different aspects of pre-natal testing for
genetic disease
Medical disorders in pregnancy
Organiser: Dr K Harding
At the end of the symposium students will be able to describe
 A systematic approach to women with medical disorders
 How to counsel women prior to pregnancy to achieve optimum outcome
 The long term affect of illness on reproductive health
 To demonstrate an
 understanding of how pregnancy affects maternal physiology and the impact on maternal health
 Examples of models of illness will include diabetes, maternal cardiac disease, sickle cell disease and
cancer
87
11.8 Seminar Titles
Obstetrics
•
Maternal physiology in pregnancy and labour 115
•
Pre-pregnancy counselling 115, 11(B)
•
Anaemia in pregnancy 115, 5
•
Hypertension and Proteinuria in pregnancy 2(B), 10
•
Antepartum haemorrhage 2, 10, 111, 5(B)
•
The anomaly scan and prenatal diagnosis 115, 116, 11(B)
•
The Booking visit / Normal antenatal care 115
•
Monitoring the fetus 115
•
The management of labour/delivery 115
•
The third stage and puerperium 115, 134
•
Prematurity (non-core)
•
Preterm birth (non-core)
•
Medical disorders in pregnancy
•
Domestic violence
Gynaecology
•
Menstrual disorders 113, 114, 5(B)
•
Subfertility 19, 53, 54, 112, 113, 118
•
Urinary problems 28, 30, 31, 32, 33
•
Uterovaginal prolapse 26
•
Dysmenorrhoea: Chronic pelvic pain and endometriosis 11, 113, 114
•
Acute pelvic pain including cysts 10, 110, 112
•
Pelvic mass 10, 11, 12, 13, 115
•
Amenorrhoea 112, 113, 115, 118
•
Miscarriage and ectopic pregnancy 112, 113
•
Menopause and osteoporosis 1, 89, 91, 112, 6(B)
•
Female genital mutilation

Gynaecology oncology
Genitourinary & psychosexual medicine
•
HIV infection: Clinical manifestations of early disease and the principals for antiretroviral therapy
3, 5, 6, 16, 17, 19, 23, 62
•
HIV infection: Clinical Manifestations of advanced disease 61
•
Sexual History Taking (Communications Skills and Genitourinary Medicine/The pre and post HIV
test discussion) 56, 57
•
Genital Ulcer disease/Genital Dermatoses 48, 105, 106, 109, 122
•
Female Genital Mutilation (None)
•
Psychosexual Medicine 56, 57
2
Breast medicine
•
Imaging, diagnosis and screening 40, 41, 42, 43
•
Pathology and natural history of breast cancer
•
Treatment of breast cancer
For Seminar Aims & Objectives please refer to the RSH Block - Seminar Guidelines booklet
3
11.9 Recommended Reading and Computer-aided learning
Please refer to the Reading List online.
https://readinglist.kcl.ac.uk/module.cgi?module=117MBBS4
4
12. VERTICAL STRAND DISCIPLINES
12.1 An Overview
91
12.2 Course Organisers and Contact Details
94
12.3 Recommended Reading and Computer-aided Learning
95
5
12.1 Vertical Strand Disciplines: An Overview
Clinical Genetics
In Phase 4, you should be able to apply the knowledge of basic genetics and modes of inheritance
gained in Phase 2 to clinical situations. The Clinical Genetics course consists of 2 genetics symposia
included in the CHDA and RSH blocks. The symposia are a balance of clinical lectures and small group
tutorials. These cover the important areas within clinical genetics which are applicable to all branches of
medical and surgical practice. Attendance at 1 genetics outpatient clinic in the RSH block is optional.
Some important aspects of clinical genetics, especially the basic approach to a genetic consultation
and the communication skills used, can only be learnt in the genetics clinic. Only one student can sit in
on each consultation which is also a one to one tutorial. The student should therefore book in advance
by signing up online. Details of available clinics/relevant links will be emailed and posted on the VC.
Alternatively, telephone the department on 0207 188 1364, or come in person to reception in the
Department of Genetics on the 7th Floor of New Guys House. A range of SSCs are also available in
Genetics. Each SSC consists of individually supervised project, and provides the opportunity to
participate in on general and specialist genetics clinics.
Dr Dragana Josifova
Department of Genetics
Guy’s Hospital
Clinical Pharmacology and Therapeutics
Understanding the principles of clinical pharmacology is essential for safe and effective clinical practice.
You should learn the general principles of the subject, and how these are applied in the management of
common clinical conditions. In Phase 4, there will be three relevant symposia, one in each block (on
drugs at the extremes of age, drugs in pregnancy, and on the therapeutic aspects of movement). In
learning about therapeutics of common acute and chronic diseases you should integrate your
knowledge of the mechanism of drug action (basic pharmacology) with relevant pathophysiology. Think
about therapeutic goals (e.g. alleviating symptoms, slowing disease progression etc) for classes of
patients and for individual patients. Learning clinical pharmacology is effective only if accompanied by
clinical experience: it is a practical subject and the patient is the best teacher. Always take a drug
history, always read the prescription chart of in-patients and review medications being taken by outpatients. Learn about these drugs as you encounter them and you will rapidly build up your knowledge
of drugs used in current practice. For each such drug, learn about clinical use, mechanisms of action,
adverse effects and contraindications, relevant pharmacokinetics (i.e. relevant to clinical use, route of
administration and frequency of administration) and clinically important drug interactions. Special
situations (e.g. the use of drugs at extremes of age, in pregnancy, or in-patients with coexisting disease
of major organ systems) are particularly relevant in the context of Phase 4.
Prof Jim Ritter & Dr Albert Ferro
Department of Clinical Pharmacology
St Thomas’ Hospital
Communication Skills
The integrated Communication Skills course reinforces the value and need for effective communication
in healthcare and encourages ethical communication practice. You have already acquired core skills in
communicating with patients and will be expected to develop and add to these skills throughout Phase
4. Two symposia offer communication skills training: one in the Child Health, Development and Ageing
Block entitled Communicating with the Young, Elderly and Relatives, and one entitled Dealing with
Crisis in the Emergency Medicine, Trauma and Locomotion Block. An introductory session in the
Reproductive and Sexual Health Block will cover communication relating to taking sexual histories and
intimate examinations. Sessions will involve small group work, directed reading, video and role-play
using actors. Additional sessions on communication skills will be available during Phase 4 through a
6
rolling programme. These will be offered on a sign up basis in the Skills Centre, and will be shared with
nursing students nearing finals and newly qualified nurses. You will need to check the notice board in
the reception of the Chantler Clinical Skills Centre for topics and to sign up.
Ms Elaine Gill
Chantler Clinical Skills Centre
Shepherd’s House
Guy's Campus
Ethics and Law
Phase 4 has a substantial ethical element. Key concepts acquired in the Practice of Medicine course
(Phases 1&2) are put into effect. Thus while the focus in the early years was understanding concepts
such as personal autonomy, capacity, competence and liberty, in Phase 4 the aim is to apply them in
practice. The formal delivery of Ethics takes place through the symposia programme as well as
informally within the context of clinical learning and reflection. Topics covered include the ethical and
legal issues within such topics as abortion, decision making with the young and elderly, HIV, screening,
sub-fertility, suicide, and transplantation. Ethics will be assessed in the OSCE.
Peter Haughton
Department of Medical and Dental Education
4th floor, Henriette Raphael House
Guy’s Campus
Palliative Medicine
In Phase 4 students will be introduced to the clinical aspects of the care of patients with advanced
disease, building on the teaching that students have had in the previous three years. The focus of
Palliative Medicine in Phase 4 is on the care of the dying patient, the principles of symptom control and
the pharmacology of drugs to treat pain and other symptoms. This is undertaken through symposium
teaching (care of the dying patient, chronic pain), a seminar (symptom control) and the opportunity to
join a clinical session (either in outpatients or on a ward round.) These aspects of Phase 4 will be
assessed in the written papers and OSCE.
Dr Polly Edmonds
Palliative Care Team
King’s College Hospital
Pathology and Laboratory Sciences
The aim of the pathology teaching in Phase 4 is to build on your basic science knowledge derived from
the Scientific Basis of Disease Course in Phase 2, the general clinical pathology learned in Phase 3,
and apply this to further clinical settings. You should aim to increase your understanding of the
pathological processes of patients you encounter, develop data interpretation skills, and begin to
appreciate the optimum use of clinical laboratory services. Histopathology and the other laboratory
sciences will be integrated into Phase 4 symposia with contributions from the following specialties:
histopathology, cytopathology, forensic pathology, embryology, chemical pathology, haematology,
infection, immunology and toxicology.
7
Primary Care, the Community Study and applied health promotion
Primary Care, the Community Study, applied health promotion and consolidation and reveiw
Please note you will be issued with a specific handbook at the Phase 4 opening session in September.
In Phase 4, you will participate in a Community Study where, in pairs, you will visit a pregnant woman
and her family to follow progress from pregnancy to the birth and early months of the child. The
Community Study aims to provide you with an opportunity to develop a relationship with a family over
time enabling you to:






Study the impact of pregnancy, childbirth and a new baby on the physical, social and psychological
health of a mother and her family.
Learn about the growth and development of a baby in the early months of life.
Make links with hospital based learning by looking at several core curriculum topics, relevant to all
three rotations, from the perspectives of the woman, her family, primary care and the community.
Reflect on and discuss related social and ethical issues.
Develop communication skills and professional attitudes
Be aware of the role of health promotion during this time
The study occupies four Fridays and students are allocated to either Steam A or B. You will be advised
of the actual dates but in principle stream A students Friday week 2 rotation 1, Week 1 rotation 2, week
11 rotation 2 and week 1 rotation 3 ( assessments). Stream B Week 13 rotation 1, week 6 rotation 2,
week 12 rot 3 and week 2 rotation 3( assessment).
During each day, you and your partner will visit the mother and baby in the morning, followed by a
tutorial with your GP, and then meet for an afternoon seminar in the SLC except on day 2. A reading list
will be provided as preparation for the first and second seminars.
In addition you will in pairs review a l health promotion intervention and report this review in
presentation format to your assigned practice on your assessment morning. In order to help with this,
and to prepare for relevant sections of the Elective SSC, a symposium will be held early morning 4th
Jan 2012. You will be allocated time during your community days for the health promotion review. The
study will be assessed in the Student Learning Centres with students presenting in pairs their learning
from the study. This will take place in April 2012 with the seminar leader. In addition there will be end
of phase 4 OSCE stations based on the study.
The sessions with your GP tutor will be the only contact that you have with primary care in Phase 4. As
GPs deal with many of the problems pertaining to maternal and child health, this provides a valuable
opportunity for you. Also, this is the only part of the course in which you will have the opportunity to
study a patient over an extended period of time.
The Consolidation and review sessions will be in Rotation 3 on two Fridays and will enable you to self
select topics to revisit enabling you to hone and practise your skills with patients in various settings
covering a range of conditions associated with Phase4, and use the mini-Cex with your GP tutor.
Ann Wylie, Senior Teaching Fellow
Department of Primary Care and Public Health Sciences
Guy’s Campus
8
12.2 Course Organisers and Contact Details
Module
Clinical Pharmacology and
Therapeutics
Communication Skills
Ethics and Law
Genetics
Course Organiser
Dr Jackson
[email protected]
Ms Elaine Gill
020 7848 6350/3
[email protected]
Ms Bernadette O’Neill
020 7848 6354
bernadette.o’[email protected]
Peter Haughton
020 7848 6993
[email protected]
Dr Dragana Josifova
[email protected]
Palliative Medicine
Dr Rachel Burman
[email protected]
Primary Care and the Community
Study
Dr Ann Wylie
020 7848 8075
[email protected]
9
12.3 Recommended Reading and Computer-aided learning
Clinical Pharmacology and Therapeutics

Recommended Reading:
A Textbook of Clinical Pharmacology. (4th ed). 1999. Ritter JM, Lewis LD, Mant TG, Arnold. London.
British National Formulary Pharmaceutical Society of Great Britain. Available from the Academic
Centre and on-line at www.bnf.org
Communication Skills
•
Recommended to purchase:
Silverman J, Kurtz S & Draper J [1998] Skills for Communication with Patients. Radcliffe Medical Press
•
Reference :
Doyal L, & Wilsher D. [1994] Witholding and Withdrawing Life Sustaining Treatment from Elderly
People: Towards Formal Guidelines. British Medical Journal Vol. 308: 1689-1692
Lipp [2nd ed. 1995] Respectful treatment
Maguire P [2000] Communication Skills for Doctors. Arnold
Murray Parkes C, Markus A (eds) [1998] Coping with Loss: helping patients and their families. BMJ
Publishing
Platt F W, & Gordon GH [1999] Field Guide to the Difficult Patient Interview. Lippincot, Williams and
Wilkinson (especially Part III – Dealing with Patient Emotions).
Ostergaad, MS. [1998] Childhood Asthma: parents’ perspective – a qualitative interview study. Family
Practice 15: 153-157
Stewart K [1995] Discussing cardio-pulmonary resuscitation with patients and relatives. Postgraduate
Medical Journal 71: 585-589
Ethics and Law
New Dictionary of Medical Ethics. 1997. Boyd Pinching and Higgs (Eds). BMJ.
Medicine, Patients and the Law, 2nd ed. 1992. M Brazier: Penguin
Causing Death and Saving Lives. 1990. J Glover, Penguin
The Value of life, An Introduction to Medical Ethics, 1985. J Harris: RKP
Should the Baby live? 1985. Kuhse & Singer: Oxford
Pathology

Histopathology
General and systematic pathology. 3rd ed. 2000. Underwood J. Churchill Livingstone.

Microbiology
Notes on Medical Bacteriology (Student notes): JD Sleigh & MC Timbury, 5th edition, 1998
Microbiology in Clinical Practice: DC Shanson, 3rd edition, 1999
Human Virology: 2nd ed. 2000 L Collier & J Oxford,
Principles and Practice of Infectious Diseases: Mandell, Bennett & Dolin, 5th edition, 2000

Haematology
Essential Haematology. Hoffbrand AV, Pettit JE. 4th edition 2001. Blackwell Scientific Publications
Paediatric Haematology. Lilleyman, Hann & Blanchette. 2nd edition 1999. Churchill Livingstone
ABC of Transfusion. Contreras. 3rd edition 1998. BMJ Books
Clinical Haematology. Wintrobe MM. 10th edition, 1999. Lea & Febiger, Philadelphia

Chemical Pathology
Clinical Chemistry (4th ed.) 2000. Marshall W J. Mosby.
Lecture Notes on Clinical Chemistry. 5th ed. 1993 Whitby LG, Percy-Robb IW & Smith AF. Blackwell,
Oxford.
A Workbook of Clinical Chemistry, case presentations and data interpretations. 1994. Mayne PD, Day
AP, Arnold E.
Cases in Chemical Pathology - A diagnostic approach. 4th ed. 1999. Walmsley RN, Watkinson LR,
Koay ES.
10
Disorders of Fluid and Electrolyte Balance. 1984. Walmsley RN, Guerin MD.

Immunology
Medical Immunology for Students. Playfair JHL and Lydyard PM (1995) Churchill Livingstone
Essentials of Clinical Immunology (4th ed) 1999. Chapel H, Haeney M, Misbah S and Snowden N.
Blackwell Scientific Publications. (also available on-line at www.netlibrary.com)
Medical Immunology (7th ed): 1997. Stites DP, Terr AI (1987) Appleton and Lange
Immunisation against infectious diseases. 1996. HMSO
Primary Care and the Community Study
The Pregnancy Book 1999 published by the Health Education Authority
Birth to Five 1999 published by the Health Education Authority
Public Health Medicine
Essential public health medicine. 2nd ed. 2000 Donaldson & Donaldson.
Lecture notes on epidemiology and public health medicine. 4th ed. 1996. Farmer & Miller
Clinical epidemiology: the essentials. 3rd ed. 1996. Fletcher, Fletcher & Wagner
Clinical epidemiology: a basic science for clinical medicine. 1991. Sackett et. al.
11
13. STUDENT SELECTED COMPONENTS
For details of SSC assessment, merits, credits and annual progression requirements please
consult the SSC regulations on the Virtual Campus.
Students in Phase 4 are expected to complete two SSCs. In rotation 1 you will take a taught SSC, a
library project, a self designed SSC or a language SSC. In rotation 2 you will complete the Elective
Portfolio. Guidelines for the portfolio can be found in the Elective Handbook which will be available in
the first rotation.
For students who are repeating Phase 4:
You are required by the King’s College London Regulations to repeat the year in its entirety and that
includes the 2 SSCs. If you have already completed your Elective at the end of last Phase 4 then you
will need to do an alternative SSC in rotation 2 instead of the Elective Portfolio SSC. We advise you to
choose a clinically based SSC in any Phase 4 subject with which you have found difficulty in the past.
You are advised to discuss this with your Clinical Adviser and with Rachael-Morriss Jones, Deputy
Head of Phase 4 as soon as possible in rotation 1.
Elective Portfolio SSC
The elective SSC has a total value of 2 SSC units. In rotation 2 of phase 4 you will complete the
elective portfolio SSC which is worth 1 SSC unit. You should start to think about your elective at the
beginning of Phase 4 and read the elective handbook which contains essential information about
planning your elective, travel advice and writing your elective portfolio. You should make two
appointments to see your Clinical Advisor during the second rotation. At the first appointment you
should discuss your provisional plans and your Advisor should sign the Elective Proposal Form,
which should be submitted by early Feb 2013 (Check VC/Elective Handbook for date details). At
the second appointment you should discuss a draft of your Elective Portfolio. The Elective Portfolio
must be submitted to the Academic Centre by early April ((Check VC/Elective Handbook for date
details), unless there are mitigating circumstances in which case you should discuss beforehand with
the Academic Centre and your Clinical Advisor. Please consult your Elective handbook for more
details.
Primary Care and Community Study Days
In Phase 4, you will participate in a Community Study (see section on Vertical Strands for more
information). The 4 Fridays that this takes place on are not SSC days and your supervisor will be aware
that teaching should not be scheduled on these days.
Due to the large size of the student body the cohort will be split into one of two groups for your
Community Study. The group that you are allocated to will depend on your SSC allocation and you
should check that your supervisor is aware of these days when you start the SSC.
Group A: Community study days on 23rd September 2011, 6th January 2012, 16th March 2012
and 13th April 2012.
Group B: Community Study days on 9th December 2011, 10th February 2012, 23rd March 2012
and 20th April 2012.
12
14. ASSESSMENTS AND EXAMINATIONS
What will the Phase 4 exams be like?
There will be two types of examination in Phase 4: written papers at the end of the third Block as an
objective in-course assessment and a comprehensive Objectively Structured Clinical Examination
(OSCE) at the end of Phase 4.
Written examination
There will be three 2 ½ -hour written papers at the end of the third Block which will include all the
subjects taught in Phase 4. This will include single best answer questions and extended matching
questions. Questions may include photographs, clinical histories or investigation results as the
introduction and then a series of choices for you to choose the best one. There will be no negative
marking for incorrect answers. These assessments are not competitive but the graded marks you will
be awarded will reflect your performance against a standard set by the Board of Examiners. The
content of the papers is based on the core curriculum for the subjects taught in the Blocks including
the symposia as well as the vertical strands: public health medicine, pathology, communication, ethics
and law, therapeutics, palliative medicine, genetics and clinical science with which they are integrated.
A comprehensive knowledge of the common or ‘dangerous if missed’ conditions is expected by your
examiners. We hope that very few or no candidates will fail to reach the standard to pass in the written
examinations. It will be compulsory to take these examinations. Success in all these written
examinations grants exemption from the end of Phase 4 written examinations in July 2012.
OSCE
There will be a 22 station (19 active stations) part A OSCE over 6 days - from Wednesday 4th July to
Wednesday 11th July 2012 with a part B OSCE (24 active stations) around 10 days later (actual date
TBC).
The End of Phase 4 OSCE will test the skills taught in Phase 4 and will involve material from all the
constituent subjects of this year including the Community Study.
You are expected to be signed-up for all the skills in each of the Phase 4 skills log-book, and
ensure you hand in your completed books at the required deadline.. If you lose your log-book
please contact the Phase 4 Academic Centre contact or the Head of Phase 4 ASAP. YOU ARE
REMINDED TO PHOTOCOPY YOUR LOGBOOK.
What if you fail to achieve the standard to pass in the Block examinations?
If you do not reach the pass mark in one or more of written examination(s), you will not be exempt from
the written examination for that Block or Blocks in July. If you fail any July examination you will fail the
year..
In exceptional circumstances, with documentary evidence of incapacitating illness, you may be allowed
to miss a written examination and take it at the next available opportunity i.e. in July.
What if you fail to achieve the standard to pass the OSCE?
If you do not reach the minimum competence level for the OSCE you will fail the year.
In exceptional circumstances, with documentary evidence of an incapacitating illness which might
prevent you from sitting the OSCE at the correct time, attempts will be made to allocate you to a
session late in the OSCE week. If this is not possible, a replacement OSCE will take place after the
July written examinations. Failure to take or pass the OSCE will necessitate your failing the year..
13
What if you do really well in one Block but badly in another?
There is no process for carrying over marks between the Blocks. You must achieve the pass mark for
all three written examinations.
However the vertically integrated subjects of public health medicine, palliative medicine, pathology,
communication, ethics and law, therapeutics, genetics and clinical science will be tested within each of
the papers.
What if you do really well in these examinations?
Excellent performance will be rewarded by a nomination for a commendation in that subject. .
Full information about the regulations governing the assessment in Part 4 can be seen in the Part 4
Marking Guide which is can be found on the Virtual Campus.
Will you get any feedback on your performance?
Yes, details of your performance in the subjects of the examinations will be reported back to you.
Although the pass mark is not calculated in a competitive way, it can be useful for you to know how well
you performed compared with your peers. We will supply you with a centile score for each subject and
an accumulation of the scores on questions which test elements from the vertical strands following the
last Block examination in the year. We hope that this will be a guide to your future studying tactics.
If you felt that you worked really hard but achieved only low centile scores it would be worth discussing
your study methods with your Clinical Adviser or book an appointment with the Education Advisers.
14.1 PHASE 4 MARKING SCHEME 2012-13
The Phase 4 Marking Scheme is available each year in the Exam Information section of the Virtual
Campus. You should familiarise yourself with these at the beginning of the year.
14.2 REGULATIONS FOR THE DEGREES OF
BACHELOR OF MEDICINE AND BACHELOR OF SURGERY (MB BS) 2012-13
The regulations governing the MBBS degree programme that you are currently following are updated
each year and placed on the Virtual Campus in the Exam Information section. You should familiarise
yourself with these at the beginning of the year.
14.3 MITIGATING CIRCUMSTANCES
You will find full information on the mitigating circumstances regulations here: either
http://www.kcl.ac.uk/college/policyzone/index.php?id=280.
http://www.kcl.ac.uk/college/policyzone/assets/files/students/MCF_11_12_Final.pdf
Please note that the School Examination Board deems any student who attended an assessment to
have declared themselves fit to take that assessment. It is therefore only in extremely rare cases that
retrospective withdrawal is approved. All students are expected to take responsibility for judging
whether they are genuinely unfit to take an assessment, seeking appropriate pastoral and regulatory
guidance over any concerns and following the appropriate procedures.
14.4 ACADEMIC REGULATIONS
The College’s full set of Academic Regulations is available here:
http://www.kcl.ac.uk/about/governance/regulations/acregs. These should be read in conjunction with the MBBS
Marking Scheme, Regulations and your handbooks and logbooks.
14
15. EXAMPLE QUESTIONS
There are a number of question formats, which may be used in the End of Block and End of Year
Written examinations. To illustrate the types of questions and to provide you with some potentially
lifesaving revision of road knowledge and skill here are some examples of these formats.
Single-Best-Answer questions
Another format of this type of question with an initial stem followed by a series of words or phrases is
the Single-Best-Answer question. These are particularly useful for testing decisions between fairly
close options and for descriptions of photographs or figures. One answer only is awarded marks and if
more than one answer is given by candidates then zero is awarded even if one of the answers would
have been correct. This is why it is essential that you read the questions very carefully.
Example of Single-Best-Answer question:
4.
When you are driving at 70 mph, which ONE of the following stopping distances (a combination of
both thinking distance and braking distance) is most likely:
(a)
(b)
(c)
(d)
(e)
18 car lengths
6 car lengths
9 car lengths
24 car lengths
13 car lengths
4. Answer Key (d)
5.
Following a collision of two cars on a motorway, one car is lying on its side on the grass verge.
You are a medical student travelling in a car 500m back. Your driver stops on the hard shoulder
and you note that no one seems to be coming to help. Your driver is phoning the emergency
number, your highest priority is to:
(a)
(b)
(c)
(d)
(e)
maintain the airways of any casualties
record the positions of the cars and any casualties
ensure your own safety
light cigarettes for casualties who are suffering from shock
claim a fee for medical assistance from casualties’ insurance company
5. Answer Key (c). Hopefully you had to really think whether to opt for (a) or (c). This type of
question often contains close options where you need to analyse the introductory stem very carefully
for evidence to help make you decision. The above example clearly states that no one else is helping
and your colleague is making the essential call.
It also easy to put a series of these Single-Best-Answer questions together following an introductory
case description or a series of photographs or xrays.
Extended Matching Questions
This format uses an initial list or menu of options from which you choose after reading a number of
clinical vignettes or questions. Continuing with our road travel revision but keeping the concept of a
menu in mind, here is an example of an Extended Matching Question:
Example of Extended Matching Question:
Theme: food for travelling
Options:
(a) beef-burger and chips
(b) vegetarian salad
(c) sushi
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(d)
(e)
(f)
(g)
(h)
(i)
(j)
(k)
(l)
croissants and strong coffee
seafood pasta
hot curry and rice
fruit salad
chicken soup and bread roll
steak and kidney pie
cheese roll
bar of chocolate
all day full English breakfast
Instructions:
For each of the situations described below choose the SINGLE most likely food from the above list of
options. Each option may be used once, more than once or not at all.
In each of the situations you are a driving up a long motorway with a close friend who is making a
telephone call during a stop at the service area. You are in a very long queue to order food and you
had forgotten to ask your friend what he/she wanted. You do not have time to leave the queue and your
friend cannot be signalled to in the telephone box. Choose the food for your friend which is most likely
to be acceptable.
1.
a
2.
a
3.
a
4.
a
5.
This is the first date with your friend who you met at an animal rights campaign meeting. Your
friend is so anxious about obesity that previously you had wondered about an eating disorder.
b
c
d
e
f
g
h
i
j
k
l
You and your friend have just returned to UK after a long elective period in Japan. You have just
driven from Strasbourg and caught the 5.30am Shuttle through the Channel Tunnel. You were
unable to buy food in France due to lack of francs, your friend is phoning about the rugby tour he is
about to organise.
b
c
d
e
f
g
h
i
j
k
l
Your friend has diabetes mellitus and you were both anxious about reaching this service area
because you were delayed by having to change a tyre and your friend unwisely had no emergency
food rations available but had taken the regular insulin dose.
b
c
d
e
f
g
h
i
j
k
l
You are travelling through France and to save money on overnight accommodation you are
alternating driving with your friend as well as crossing the Channel on the night ferry. Two hours
driving and two hours sleeping seems to have suited you well but your friend looks tired and its
your turn to have a sleep although it is morning.
b
c
d
e
f
g
h
i
j
k
l
Your friend has been very impressed with all the tourist attractions in London and you are driving
to Windsor Castle. Your friend has been homesick recently and that is the reason for this
telephone call to Japan. You have stopped at one of the best services catering areas around
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London which has an excellent selection of international food.
a
b
c
d
e
f
g
h
i
j
k
l
EMQs are also useful ways of testing clinical photograph recognition skills. Again this could be used to
check your knowledge of road signs but it is very easy to substitute clinical photographs or charts either
in the menu of options or in the items.
Word Substitution Questions
This is a version of a series of Single-Best-Answer questions imbedded in a description or technical
explanation. They are potentially good tests of understanding and may be introduced increasingly in
your examinations.
Here is an example
Instruction: Select the most appropriate word in the list by entering the letter of that word on the mark
sheet.
The most ecological transport in cities is by
1(a) pedal-power, (b) lead free petrol, (c) diesel,
(d) steam.
1
[a]
b
c
d
This is because the main danger to public health
from transport is 2(a) accidents, (b) air pollution,
(c) teratogens in water, (d) noise.
2
a
[b]
c
d
3
a
[b]
c
d
For there to be a major change in city
environments there would need to be 3(a) civil
war, (b) money to be made on alternative
transport, (c) invasion from outer space,
(d) global conversion to virtual reality.
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