Download Medicine Rotation Clinician Guide YEAR 4 2017

Bond University Medical Program
Medicine Rotation
Clinician Guide
YEAR 4
2017
© 2016 Faculty of Health Sciences & Medicine, Bond University (updated 26 Sep 2016)
© 2016 Faculty of Health Sciences & Medicine, Bond University (updated 26 Sep 2016)
Medicine Rotation
The basis of the General Medicine rotation is for students to see patients whose clinical problems
require medical (non-operative) management and to experience first-hand the daily routine and
practice of medicine by a physician and hospital team. Students are expected to learn about the
assessment and management of medical patients in the clinical setting.
During the rotation, students need to learn about a variety of medical illnesses encompassing a
number of sub-specialities, which may include:
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Cardiology
Endocrinology
Gastroenterology
Geriatrics
Haematology
Infectious Diseases
Respiratory
Neurology
Rheumatology
Renal
This rotation may pose a challenge because of the volume of work. The knowledge explosion and
rapid advances in medicine mean that it is impossible to cover the medicine curriculum in one single
rotation. However, knowledge of the common medical presentations and conditions listed below
will provide a firm foundation. To cover a range of medical conditions students need to see as many
patients as possible.
Goals
The goals for the Medicine rotation are:
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To provide students with learning experiences associated with the clinical care of real patients
For students to hone their history taking and examination skills and use clinical reasoning to form
diagnoses and differential diagnoses
For students to learn about and to become comfortable discussing clinical management of
patients
For students to develop clinical knowledge and understanding of the common conditions in
General Medicine
To provide students with a real-life clinical working environment and opportunity to work with a
clinical team.
Timetable and Contacts
Students are expected to be present on a daily basis during their rotation. If students are unable to
attend for any reason, they are required to advise the clinician, hospital co-ordinator (where available)
and the Placements Team at Bond University.
© 2016 Faculty of Health Sciences & Medicine, Bond University (updated 26 Sep 2016)
Expected experiences for Medicine
Learning activities over each clinical placement should include:
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Ward Rounds
Outpatients Department
Multidisciplinary Rounds
Rostered after-hours on call
Core Topics and Learning Outcomes in Medicine
Student involvement in the day-to-day care and management of patients provides the best
opportunity for learning. Students can acquire a great deal of knowledge through interviewing and
examining patients and being involved in clinical decision making at the bed side.
As well as being assessed on clinical knowledge, students will also be required to display other
professional skills during their clinical placement. Ability to work with peers and the multidisciplinary
team, ability to consider the psychological and social impact of the illness on the patient and the
family, ability to show empathy and honesty and to offer choices and respect the patient’s decision,
and also recognise their own limitations and stage of training.
Symptom Based Approach
• Chest Pain
• Seizures
• Abdominal Pain
• Dizziness
• Headache
• Syncope
• Back Pain
• Joint Pain
• Fatigue/Weakness
• Dyspnoea
• Oliguria
• Pyrexia
• Delerium
• Hypotension
Disease Based Approach
• Ischemic Heart Disease / Infarction
• Cardiac Failure
• CVA
• Hypertension
• Seizure Disorders
• Arrythmias
• Syncope
• Bacterial Endocarditis
• Central and Peripheral Neuropathies
• Myalgia and Weakness
• ACLS
• Headache Disorders
• Pneumonia
• Arthritides
• Asthma
• Osteoporosis
• Chronic Airflow Limitation
(Emphysema)
• Autoimmune /Connective Tissue
• Pulmonary Embolus
• Pneumothorax
• Renal Failure (Acute / Chronic)
• Obstructive Sleep Apnoea
• Glomerulonephritis/Nephrotic
• Lung Neoplasm
• Renal Neoplasms
• Hepatobiliary Diseases
• Common Infectious Diseases
© 2016 Faculty of Health Sciences & Medicine, Bond University (updated 26 Sep 2016)
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Inflamatory Bowel Disease
Allergies
Peptic Ulcer Disease
Coeliac Disease
Anaemia
GE Neoplasms
Coagulation Disorders
Oncology Principles
Diabetes Mellitus / DKA
Breast Cancer
Thyroid Disease
Prostate Cancer
Adrenal Disease
Hodgkin’s Disease / Lymphoma
Procedural Skills in Medicine
Measurement
Urinalysis
ECG
Spirometry
Intravenous
Venepuncture
Injection
IV Cannula
IV infusion
IV drug administration
IV fluid and electrolyte therapy
Performing dipstick urinalysis testing
Perform and interpret an ECG
Perform and interpret basic spirometry
Performing venepuncture
Performing injections – IVI, IMI, SC
Insertion of an IV cannula
Set up an IVI
Describe the safe administration of an IV drug
Explain fluid and electrolyte balance, how to
calculate and the correction of imbalance
Diagnostic
Blood sugar
Blood culture
Wound swab
Nebuliser/inhaler
Oxygen therapy
Estimate the blood sugar using a glucometer
Take blood for culture
Take a swab from a wound
Instruct a patient on using a nebuliser/inhaler
Demonstrate the use of oxygen by mask and nasal
prongs
Cardiopulmonary
12 lead ECG
Peak flow measurement
Spirometry
Arterial blood gas sampling
Pleural effusion/pneumothorax aspiration
Perform and interpret a normal & common
conditions on a 12 lead ECG
Perform and interpret a peak flow measurement
Perform and interpret a spirometry reading
Observe and describe indications for taking an
arterial blood gas sampling
Observe and describe the indications and principles
for inserting a chest drain
© 2016 Faculty of Health Sciences & Medicine, Bond University (updated 26 Sep 2016)
Gastrointestinal
Nasogastric Tube
Fecal occult blood analysis
Proctoscopy
Abdominal paracentesis
Insertion of a nasogastric tube
Perform a fecal occult blood analysis
Observe and describe indications for performing a
proctoscopy
Observe and describe the indications and principles
for abdominal paracentesis
Neurological
Lumbar puncture
Observe and describe the indications and principles
for performing a lumbar puncture
These are examples and represent what is considered reasonable in terms of procedural skills.
Clinical Supervision and Assessment
Formal education sessions will be conducted every week throughout the clinical rotation and will
deliver to all students undertaking this rotation (from all clinical sites) a standardised component of
the curriculum. The timing and location for these mandatory sessions will be posted on the website.
These formal educational sessions should be case based and students should go prepared with
relevant case histories and related questions. These cases should be used to assist students:
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interpret clinical data
discuss possible diagnoses
discus principles of clinical management
discuss medico-legal, ethical, psychosocial aspects of the case
During the clinical placement, students will be supervised and ultimately assessed by a Consultant
and often with the Registrar from the allocated team. This assessment will occur during and on
conclusion of the rotation.
The assessment will involve:
1. Supervising and assessing students regarding their clinical history taking and clinical examination
skills. Students should be assessed formally on their examination technique on at least two
occasions during their rotation. Students should ensure/request this of the supervising clinician.
2. Monitor students’ performance and professional conduct during clinical rotations including
completion of a formal assessment (ITA). This formal assessment process will involve:
a. completion of a midterm formative assessment (ITA) which will be discussed with the
individual student and fed back to the University; and
b. completion of an end of term summative assessment (ITA) which is returned directly to
the University and does not need to be discussed with the student. Note: Students must
pass the summative ITA in order to achieve a pass in the clinical rotation.
© 2016 Faculty of Health Sciences & Medicine, Bond University (updated 26 Sep 2016)
3. Students will be required to submit :
a. one (1) clerked case (written) by Week 4 in each rotation.
b. One (1) clerked case will then be written and presented during Week 8 of the clinical
rotation.
Students will be allocated a grade for their respective cases (clerked/presentation) however a Pass/
Fail grading will be noted on the student ITA (formative and summative).
Any concerns regarding any aspect of student behaviour and/or performance should be immediately
relayed to the Deputy Head, School of Medicine.
Bi-monthly Clinical Lead meetings will be held to discuss the previous clinical rotations and student
performance.
Attached are simplified marking guides for the Clerked Cases (formative and summative) and Oral
Presentation. Please note that students are required to do a 250 word abstract as part of the
requirements for the end of rotation (summative) clerked case.
© 2016 Faculty of Health Sciences & Medicine, Bond University (updated 26 Sep 2016)
FORMATIVE CLERKED CASE CRITERIA AND MARKING GUIDE
Student Name:
Clinical Rotation:
Assessor:
Evaluation Type:
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Standard
Meets
Standard
Above
Standard
Criterion
1. Presentation of history, medication and physical examination
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2. Clinical Summary (Differential diagnosis)
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3. Investigations
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4. Management Plan
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5. Case discussion
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6. Research, analyse and connect
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Comments
Note: This is important feedback for the Summative Clerked Case.
Marking Guide available on reverse side
© 2016 Faculty of Health Sciences & Medicine, Bond University (updated 26 Sep 2016)
Clerked Case (1500 words)
Criterion
Presentation of history, medication and
physical examination
Below Standard
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Clinical Summary (Differential diagnosis)
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Minimal or missing relevant information
presented
Incorrect medical terminology
Demonstrates poor/insufficient clinical
knowledge and understanding
Poorly sequenced
Incoherent or missing list of potential
diagnoses
Minimal or inappropriate rationale for
diagnoses presented
Illogical ranking of diagnoses
Incoherent and/or insufficient report of
investigations and implications
Meets Standard
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Most of the relevant information
presented
Correct medical terminology most of the
time
Demonstrates good clinical knowledge and
understanding
Logical sequence most of the time
Coherent list of most of the potential
diagnoses
Appropriate rationale for most of the
diagnoses presented
Mostly logical ranking of diagnoses
Mostly coherent report of investigations
and implications
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Fully coherent report of
investigations and implications
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All relevant information presented
Correct medical terminology
Demonstrates excellent clinical
knowledge and understanding
Logical sequence
Coherent list of potential diagnoses
Clear and appropriate rationale for all
diagnoses presented
Logical ranking of diagnoses
Investigations
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Management Plan
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Minimal and/or insufficient reporting and
justification of management plan
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Mostly sufficient reporting and justification
of management plan
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Fully reports and justifies
management plan
Case Discussion
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Insufficient and/or incoherent discussion
and analysis of the diagnostic and decision
making process
Demonstrates minimal and/or inadequate
clinical reasoning
Discussion minimally supported by
literature
Overall, insufficient critical analysis and
synthesis of information relating to the case
Overall, discussion insufficiently and/or not
well supported by quality and relevant
literature
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Mostly sufficient and coherent discussion
and analysis of the diagnostic and decision
making process
Discussion supported in parts by literature
Demonstrates adequate clinical reasoning
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Overall, mostly sufficient critical analysis
and synthesis of information relating to the
case
Overall, discussion supported in most parts
by quality and relevant literature
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In-depth discussion and analysis of
the diagnostic and decision making
process
Discussion fully supported by quality
and appropriate literature
Demonstrates excellent clinical
reasoning
Overall, critical analysis and synthesis
of information relating to all aspects
the case
Overall, discussion is well supported
by quality and relevant literature
Overall, poor presentation
Not coherent and/or illogical
Many grammatical and/or spelling errors
Incorrect or missing citation of literature
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Overall, presentation is satisfactory
Mostly coherent and logical
Minor grammatical and/or spelling errors
Minor Inconsistencies in citation of
literature
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Research, analyse and connect
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Presentation
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Above Standard
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Overall, presentation is excellent
Coherent and logical
No grammatical or spelling errors
Correct citation of literature
© 2016 Faculty of Health Sciences & Medicine, Bond University (updated 26 Sep 2016)
SUMMATIVE CLERKED CASE CRITERIA AND MARKING GUIDE
Student Name:
Clinical Rotation:
Assessor:
Evaluation Type:
Clerked Case - Oral Presentation and Written (1500 words and 250 word abstract)
Below
Standard
Meets
Standard
Above
Standard
Criterion
1. Abstract
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2. Presentation of history, medication and physical examination (written)
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3. Clinical Summary (Differential diagnosis)
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4. Investigations
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5. Management Plan
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6. Case discussion
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7. Research, analyse and connect
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8. Presentation (oral)
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Comments
Clerked Case
 Pass
 Fail
 Borderline
Marking Guide available on reverse side
© 2016 Faculty of Health Sciences & Medicine, Bond University (updated 26 Sep 2016)
Criterion
Abstract
Presentation of history,
medication and physical
examination
Below Standard
Minimal or missing relevant information
Poorly structured
Illogical or incoherent
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Contains most of the relevant information
Satisfactory structure
Mostly logical and coherent
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Contains all relevant information
Well structured
Logical and coherent in all aspects
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Minimal or missing relevant information presented
Incorrect medical terminology
Demonstrates poor/insufficient clinical knowledge
and understanding
Poorly sequenced
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Most of the relevant information presented
Correct medical terminology most of the time
Demonstrates good clinical knowledge and
understanding
Logical sequence most of the time
Coherent list of most of the potential
diagnoses
Appropriate rationale for most of the
diagnoses presented
Mostly logical ranking of diagnoses
Mostly coherent report of investigations and
implications
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All relevant information presented
Correct medical terminology
Demonstrates excellent clinical knowledge
and understanding
Logical sequence
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Incoherent or missing list of potential diagnoses
Minimal or inappropriate rationale for diagnoses
presented
Illogical ranking of diagnoses
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Investigations
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Incoherent and/or insufficient report of
investigations and implications
Management Plan
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Minimal and/or insufficient reporting and
justification of management plan
Insufficient and/or incoherent discussion and analysis
of the diagnostic and decision making process
Demonstrates minimal and/or inadequate clinical
reasoning
Discussion minimally supported by literature
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Overall, insufficient critical analysis and synthesis of
information relating to the case
Overall, discussion insufficiently and/or not well
supported by quality and relevant literature
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Overall, poor presentation
Not coherent and/or illogical Many grammatical
and/or spelling errors
Incorrect or missing citation of literature
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Overall, presentation is satisfactory
Mostly coherent and logical
Minor grammatical and/or spelling errors
Minor inconsistencies in citation of literature
Disorganised in structure and content
Factually incomplete
Minimal clear clinical reasoning
Poor presentation skills
Shows little understanding of case and content
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Satisfactory effort and content appropriate
Satisfactory structure and organised content
Mostly Factual and complete
Satisfactory clinical reasoning
Satisfactory presentation skills
Satisfactory understanding of case and
content
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Case Discussion
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Research, analyse
and connect
Presentation (written)
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Presentation (oral)
Above Standard
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Differential diagnoses
Meets Standard
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Mostly sufficient reporting and justification of
management plan
Mostly sufficient and coherent discussion and
analysis of the diagnostic and decision making
process
Discussion supported in parts by literature
Demonstrates adequate clinical reasoning
Overall, mostly sufficient critical analysis and
synthesis of information relating to the case
Overall, discussion supported in most parts by
quality and relevant literature
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Coherent list of potential diagnoses
Clear and appropriate rationale for all
diagnoses presented
Logical ranking of diagnoses
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Fully coherent report of investigations and
implications
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Fully reports and justifies management plan
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In-depth discussion and analysis of the
diagnostic and decision making process
Discussion fully supported by quality and
appropriate literature
Demonstrates excellent clinical reasoning
Overall, critical analysis and synthesis of
information relating to all aspects the case
Overall, discussion is well supported by
quality and relevant literature
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Overall, presentation is excellent
Coherent and logical
Few grammatical or spelling errors
Correct citation of literature
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Excellent presentation
Clearly well organized in structure and
content
Comprehensive
Displays excellent clinical reasoning
Appropriate referencing
Excellent presentation skills
Excellent understanding of case and content
Confident presentation skills
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© 2016 Faculty of Health Sciences & Medicine, Bond University (updated 26 Sep 2016)