Download MBBS Undergraduate Rural Clinical Program 2010

MBBS Undergraduate
Rural Clinical Program
2010
Year 4 GP Supervisor
Guidelines
Contents
TOPIC
PAGE
Introduction
3
Course Content
3
Course Delivery
3
Course Assessment
5
Appendices
Appendix 1 - Clinical Attachment Log Book General Practice
8
Appendix 2 – Assessment forms
12
Appendix 3 – Procedural and Professional Skills List
20
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Introduction
Thank you for being involved with the Rural Clinical School (RCS) Primary Care program (PCP) in
2010, which is part of the Year 4 MBBS Undergraduate Rural Clinical Program at the UTAS School
of Medicine. Primary Care is an important part of the learning environment in these clinical years
and to that end the RCS is looking forward to providing further support and direction to general
practitioners and their Practice staff and other health care providers on how to enhance the
teaching and learning experience of all involved. We hope you enjoy your experience with the
2010 program and we look forward to gaining your feedback and working collaboratively with you
throughout the coming year.
The overall objectives for medical education are to equip students to function with excellence after
graduation, and to provide them with the knowledge and skills required primarily for their intern and
resident years and later entry to vocational training programs.
The PCP takes advantage of the wealth of clinical experience available in the North West Region.
Exposure to the variety of conditions encountered and managed by General Practitioners and
other health care providers gives the students the opportunity to attain a high level of clinical
experience and skills, together with a perspective on health care unique to a rural setting.
Course Content
The Learning Objectives for the PCP are included at the back of this booklet and are also set out in
"Learning Objectives for the Year 4 & 5/6 Clinical Attachments 2010" which the students receive
with their MBBS Handbook. These Objectives outline to students and teachers what students need
to know and form a basis for student assessment.
Course Delivery
Students are allocated to attend a general practice on Tuesdays throughout the teaching year (36
weeks from February to November). Half the student cohort will attend on one Tuesday and the
other half on the next Tuesday i.e. each student will have 18 days in general practice over the
course of the teaching year. The student will change Practices halfway through the year.
On alternate Tuesdays, the student group not in general practice will participate in a structured
program of Primary Care activities under the direction and supervision of RCS GP academics.
This will include participation in other primary care activities (e.g. diabetic educator clinics, nursing
home visits, remote general practice visits), small group case based learning, student case
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presentations from general practice, and consultation and procedural skills in a simulated
environment. Local general practitioners will be invited to help facilitate some of these activities.
In each fortnight, the Primary Care experience will focus on general practice and clinical skills,
patient follow up and Primary Care assessment tasks. Students are encouraged to accompany
patients on other visits and observe health care across the whole team of providers. Students are
expected to discuss with, and be guided by their GP supervisors for these activities.
Students may work with one, or preferably across a team of, GPs but the nominated GP supervisor
will act as a mentor, responsible for all activities to do with Primary Care teaching and learning,
including reviewing student clinical logbooks and written primary care tasks,
completing the
Clinical Attachment assessment (half-yearly), and marking the complex long case presentation. .
Learning Opportunities
Interaction with Patients in General Practice
While there is a need for students to spend some time observing GP consultations, students have
found this to be of limited benefit. For students in the latter part of their undergraduate training,
excessive time in a purely observer capacity can result in a very negative perception of general
practice.
The major focus of student learning is through direct interaction with patients, including being
involved with taking an appropriately focussed history, diagnostic procedures, performing physical
examinations and assisting in delivery of treatment under supervision of doctors and other health
professionals.
During general practice sessions students may be allocated patients for consultation, review their
findings with the doctor and use this to trigger self-directed learning. The program is designed to
provide an in-depth and interactive teaching experience that might include some or all of the
following aspects:
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student pre-reading of patient notes
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student pre-consultation research
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student led history taking with the patient
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student/practice nurse procedural activities
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student/GP de-briefing
♦
student post-consultation research
♦
student accompanying patient on visits to other health-care providers, etc.
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Self Directed Learning
Students will be encouraged to take responsibility for directing their own learning to expand upon
what they have learned in the Primary Care setting.
RCS Primary Care Program
With the intention of complementing the students’ general practice experience,
primary care
conditions and approaches will be integrated in the RCS teaching program, specifically during the
primary care component of the program on alternate Tuesdays for the half of the student group not
in general practice (see course delivery, above).
In addition, Case Based Learning (CBL), tutorials and Professional Issues sessions are delivered
by senior clinical academic staff at the RCS, during scheduled Group Learning weeks.
Course Assessment
Clinical Attachment
At the beginning of each General Practice placement, students should discuss their learning
objectives with their GP Supervisor. These should reflect the MBBS objectives, students' interests,
strengths and weaknesses. At the end of each GP placement, students must submit an attachment
report from the GP supervisor which assesses the student on a variety of professional and
personal attributes (see form in this pack). Supervisor feedback should be given to the student
before completion of the attachment.
Complex Rural Longitudinal Case
These cases should be selected from those patients seen in General Practice (one in each
semester). Early in their attachment, students should discuss with their supervisor a suitable
patient and ask if they can be followed up on the day that the student is in the practice. The patient
should have a chronic illness, whether physical or psychological.
Follow up could include home visits, hospital admission/visits and GP, specialist or allied health
provider appointments as appropriate. The case therefore needs to be relatively complex and
should involve aspects of management that illustrate the particular constraints, psychological
stressors and financial and other challenges experienced by patients in rural settings. The details
of the clinical case should be concisely stated, with the principal discussion focusing on how the
disease itself and the travel away from home, impact on the patient and their family emotionally,
financially and in other ways, as well as aspects of team care management.
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Each case should include details of a visit with the patient to a non-GP health care provider (eg.
specialist, optometrist, physiotherapist). Each case will be assessed by oral presentation to the
GPs/staff in the practice to which the student is attached (eg. at a practice education session) to
enable discussion on what has been learned from following through with this patient. We believe
the oral presentation, the discussion generated and the student’s ability to respond to questions
raised, constitute a very effective form of assessment. The date and time of the presentation
should be negotiated between the practice, the student and the RCS GP liaison academic.
Clinical Log Book
Students are now required to maintain a clinical logbook in each discipline to which they are
attached.
An example is provided in Appendix 1.
These log books will include records of
procedural skills and incorporate a range of cases (previously detailed in the GP Learning
Outcomes).
By recording clinical cases in which students have been involved, they will be encouraged to take
an active role in patient management and to be self-directed learners.
At this stage of their
undergraduate training, exposure to patients in the clinical setting is given increasingly greater
emphasis across the final two clinical years. Students are not expected to record every case they
have seen, rather only those cases in which they have had substantial involvement. As a general
guide, students would be expected to record at least one case from each day in general practice
and these cases should cover a broad range of primary care issues, and the degree of detail
recorded should enable the student to make a brief case presentation using those notes.
Progress of student log books should be reviewed by GP supervisors on a regular basis. In some
disciplines, supervisors review logbooks on a weekly or daily basis. Log books in other disciplines
will also include examples of hospital discharge summaries which students should be using as
examples of learning professional communication.
Students are expected to complete similar
tasks in general practice, and will be expected to bring examples of this correspondence for
discussion with their GP supervisor as part of their overall assessment in Primary Care.
Procedural Skills
Students are required to be assessed across a wide range of practical and procedural skills, many
of which will be encountered in General Practice. these should be recorded in the clinical log book
(see Appendix 3 for list of skills). Some skills are specifically required to be signed off by the GP
but in certain circumstances it may be appropriate for the Practice nurse to sign off on some skills.
We have found that some students have had difficulty getting sufficient exposure to some
procedural skills e.g. male students performing vaginal examination and taking a cervical smear
test. The opportunity for students to work with other GPs in the practice and the practice nurses
will usually ensure exposure to the full range of general practice procedures.
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Summative Assessment
Students undergo a formal assessment through MCQ/EMQ written exams and Objective
Structured Clinical Examination (OSCE) stations. This is organised and delivered by the UTAS
School of Medicine. Local GPs and specialists who participate in student teaching are encouraged
to participate as examiners for the OSCEs and are also invited to submit OSCE stations and
written questions for the MCQ/EMQ exams. Please contact the Associate Head, Dr Peter Arvier, if
you would like to know more about this process.
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Appendix 1 – MBBS Undergraduate Clinical Attachment Log Book (will be provided as an A5 booklet)
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Appendix 2 - Assessment forms
Required Assessment Forms
•
Clinical Attachment Assessment Form (to be filled in by GP supervisor)
•
Complex Rural Longitudinal Case (to be assessed by GP supervisor – oral
presentations)
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Clinical Attachment Assessment Form This Clinical Attachment Assessment form should be completed in consultation with the student who has been assigned to you. This appraisal forms a significant part of the student’s portfolio and will form the basis of final year assessment. Please adhere to the following steps: 1.
Student completes section 1 and 2A at the beginning of the attachment 2.
Student completes section 2B and submits to supervisor at least prior to end of attachment. 3.
Supervisor completes section 3. 4.
Student initiates a meeting with supervisor to discuss feedback in the final week of the attachment. Section 1 Student Name Student ID Number Year of Study Title of Attachment Dates of Attachment Doctor to whom student is assigned Attachment Supervisor Supervisor’s address/phone number Section 2 (Student to complete) A. Personal goals for attachment (establish in first week): ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ B. End of attachment review of attainment of learning outcomes (in conjunction with ongoing reflective journal and attachment requirements e.g. case histories, log of patients, workbooks): ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ 11
Section 3 Clinical Attachment Form: Supervisor’s Report To be completed by supervising specialist (or Registrar if more appropriate). Student Name: __________________________ Unsatisfactory Borderline Attachment: Above average Satisfactory Excellent Could not be assessed Human Health & Disease Knowledge Evidence based approach Communication & Collaboration History taking Clinical examination Management Clinical management Use and interpretation of investigations Communication with patients and relatives Procedural skills Community Health and Disease Understands social aspects of disease Disease prevention and health promotion Personal and Professional Development Professional approach Patient confidentiality Motivation and reliability Participates in the teaching of others Teamwork Communication with staff Medical record keeping Appreciation of ethical issues of clinical practice 12
Comments: __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ Areas for improvement __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ Have you provided this feedback to your student? YES / NO ________________________________________ ____________________________________ Please print name Student’s signature ________________________________________ ____________________________________ Please print name Supervisor’s signature ________________________________________ Supervisor’s position ( Specialist / Registrar / Attachment Co‐Ordinator ) Please circle your role 13
Complex Rural Longitudinal Case History Assessment Form Complex Rural Longitudinal Case
Assessment Form
Case Identification
Student name
Assessor/s
Date/GP Semester I or II
Performed
Competently
Performed but
not yet fully
competent
Not performed
competently
Not performed
A.
DEMONSTRATES AN UNDERSTANDING OF THE UNDERLYING CLINICAL CONDITION/S AND MANAGEMENT ISSUES:
1.
Demonstrates appropriate knowledge of the conditions.
2.
Demonstrates appropriate knowledge of
investigations/examinations pertinent to the case.
3.
Adequately describes and discusses the management
plan.
Describes the follow-up process in which the student
has engaged eg., home visits, attendance at community
based specialists, hospital admission/visits and GP
appointments.
Demonstrates an understanding of decision analyses
and cost-effectiveness analysis eg., medications,
investigations.
4.
5.
B.
DEMONSTRATES AN UNDERSTANDING OF ISSUES RELATING TO THE RURAL CONTEXT:
6.
Socio-demographic and cultural differences between
rural and city life, and their effect on
professional/patient/community relationships including
aboriginal health care issues where appropriate.
Conduct of referrals, and the relationships between the
referring rural GP and the city and/or provincial
specialist.
Impact of isolation (personal and geographic) on patient
and family behaviour in addressing health problems and
medical management.
7.
8.
9.
Inter-relationship between rural and urban health care
providers and facilities.
10. Knowledge of the social services in the community in
which they are working.
C.
DEMONSTRATES WELL DEVELOPED COMMUNICATION SKILLS:
11. Provides useful summary of current research and its
impact on ideas about best practice re rural context and
clinical management.
12. Uses communication tools effectively.
13. Engaged audience in effective and relevant discussion
issues raised by the case.
Assessment Feedback:
ASSESSMENT RESULT:
____________________________
Examiner’s Signature
_______________________________
Position
_________________________
Please print name
________________________
Date
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Log of Clinical Skills ‐ Summary Sheet Please use the following summary sheets as you compile your evidence. A separate sheet should be submitted at the end of each attachment. Where possible competence should be demonstrated using simulation models before being demonstrated in the context of delivering patient care. If a skill has been demonstrated under simulated conditions please note as (S). Where possible identify a patient by UR number or initials. Cardiopulmonary resuscitation and use of automatic defibrillator are the only skills expected to be demonstrated using simulation alone. No of times demonstrated in simulation 4th year Procedure (should be able to perform independently) No of times demonstrated in patient care 4th year Comments Cardiopulmonary resuscitation (S) Use of semi‐automatic or automatic defibrillator (S)
Maintenance of the airway Venepuncture IV cannulation Urinary catheter insertion ‐ male Urinary catheter insertion ‐ female ECG recording & interpretation Administration of parenteral therapy by: Cervical pap smear ‐ subcutaneous,
‐ intramuscular 15
No of times demonstrated in simulation 4th year Procedure (should be able to perform independently) No of times demonstrated in patient care 4th year Comments Blood glucose estimation Surgical knots & simple wound suturing Administration of inhaled medications Application of plaster cast/splint limb immobilisation
Spirometry Fluoroscein stain of cornea Scrub, gown and glove Assist at operation Urine dipstick analysis New born examination Infant/child dehydration score estimate Apgar score estimation Anterior rhinoscopy 16
No of times demonstrated in simulation 4th year Procedure (should be able to perform independently) No of times demonstrated in patient care 4th year Comments Auroscopy/otoscopy Collection of throat swab Faecal occult blood analysis Alcohol withdrawal scale use Mini‐mental state examination Psychiatric mental state examination Focal neurological sign identification Glasgow coma score estimation Neck stiffness testing Direct ophthalmoscopy Eye bandage application Eye drop administration Eye irrigation 17
No of times demonstrated in simulation 4th year Procedure (should be able to perform independently) No of times demonstrated in patient care 4th year Comments Visual field assessment Visual acuity assessment Suture removal Primary trauma survey In‐line immobilisation of the cervical spine Cervical collar application Pressure haemostasis Digital rectal examination ‐ male Urethral swab collection Peripheral neurovascular assessment Blood pressure measurement Temperature measurement Blood culture collection 18
No of times demonstrated in simulation 4th year Procedure (should be able to perform independently) No of times demonstrated in patient care 4th year Comments Wound swab collection Infant respiratory distress assessment Peak flow measurement Procedure observed, performed in simulation or, under supervision in patient care No. of times observed 4th yr No of times demonstrated in simulation 4th year No of times demonstrated in patient care 4th year Comments Drainage of joint effusions Joint injections Arterial blood gases Removal of foreign bodies from: ‐ eyes ‐ ears or nose 19
Procedure observed, performed in simulation or, under supervision in patient care No. of times observed 4th yr No of times demonstrated in simulation 4th year No of times demonstrated in patient care 4th year Comments Observation of delivery Observation of breaking bad news Insertion of nasogastric tube Pleural effusion/pneumothorax aspiration Central venous line insertion Anterior nasal pack insertion Ext. auditory canal ear wick insertion External auditory canal irrigation Abdominal paracentesis Anoscopy/ proctoscopy Application of Mental Health Schedule Psychiatric mental state examination Suicide risk assessment 20
Procedure observed, performed in simulation or, under supervision in patient care No. of times observed 4th yr No of times demonstrated in simulation 4th year No of times demonstrated in patient care 4th year Comments Lumbar puncture Papilloedema identification Slit lamp examination Eyelid eversion and foreign body removal Complex wound suturing Administering local anaesthesia Simple skin lesion excision Volume resuscitation Joint relocation Secondary trauma survey Intravenous drug administration Intravenous fluid and electrolyte therapy Intravenous infusion set up 21
Procedure observed, performed in simulation or, under supervision in patient care Neonatal CPR No. of times observed 4th yr No of times demonstrated in simulation 4th year No of times demonstrated in patient care 4th year Comments The following skills should be demonstrated by producing mock documents. The mock documents should be generated from actual de‐identified patient encounters and destroyed after assessment. No. of times demonstrated in Comments Specific professional skills patient care 4th year Write up drug chart Write a discharge summary or letter Fill out order forms for investigations Write out a death certificate Write a referral to other health professional 22
University of Tasmania SCHOOL OF MEDICINE LEARNING OBJECTIVES FOR THE YEARS 4, 5 & 6 CLINICAL ATTACHMENTS GENERAL PRACTICE 2010 23
GENERAL PRACTICE General Practice is ‘the provision of primary continuing comprehensive whole‐
patient medical care to individuals, families and their communities.’ (RACGP, 2007) Students should be able to demonstrate that they have, and can safely and appropriately apply, the following skills and knowledge: 1. Consulting Skills In all settings consider the patient’s perspective (ideas, beliefs, concerns, expectations, effects on life and feelings) and have an understanding of the dynamic relationship between the disease, the illness (the patient’s experience of the disease) and the person. ƒ
Clinical skills ƒ Be able to take an appropriate history and perform a physical examination (including of children and pregnant patients) relevant to the presenting issue(s) ƒ Be aware that you are treating the patient with a disease and not the disease in a patient i.e. that you are delivering whole‐patient care. ƒ Be aware that general practices and practitioners vary in the care provided dependant on the context of the patient, their family and community, and the capabilities of the GP and their team. 24
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Diagnostic skills ƒ Be aware of common presenting symptoms in General Practice and the potential causes. ƒ Be aware of the need to deal with uncertainty and early presentations that may not lead to a clear diagnosis at a particular consultation. ƒ Be aware of the need to provide a safety net to diagnostic formulations and how the use of time may reveal a clearer diagnosis. ƒ Be able to formulate a differential diagnosis for the presenting issue(s). ƒ Demonstrate appropriate use of investigations and screening tools. ƒ Be familiar with the network of diagnostic services that can be used both in the private and public systems of health care. ƒ Be aware of the need to guide the patient through the process of accessing health care, aiming to minimise harm. ƒ
Communications skills Demonstrate effective communication skills within the context of a consultation. These include: ƒ Appropriate opening and closing of a consultation ƒ Obtaining informed consent ƒ Building rapport ƒ Using open ended questions with specific questions only to clarify detail ƒ Speaking clearly ƒ Demonstrating active listening and reflective skills ƒ Using appropriate language, avoiding medical jargon ƒ Picking up patient cues ƒ Being aware of body language ƒ Making eye contact ƒ Developing an open, relaxed, respectful manner, recognising the patient’s expertise in patient centred holistic care. 25
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Management skills ƒ Be able to manage common emergencies occurring in General Practice (e.g. acute anaphylaxis, acute asthma, acute pulmonary oedema, snake bite, hypoglycaemia, status epilepticus, AMI, unstable angina). ƒ Have a working knowledge of Australian resuscitation guidelines. ƒ Understand the role of Care Plans in General Practice. ƒ Develop an approach to a management consultation. This includes establishing the patient’s existing knowledge and perspective of the diagnosis and management, patient education, considering preventative and health enhancement opportunities, evaluating the consultation, providing take home information and arranging follow up. ƒ
Educative Skills ƒ Develop skills to educate patients in regard to their health issues and ways to enhance their health. ƒ Involve the patient as an active participant in their health. ƒ Be able to assess the stages in the cycle of behaviour change and implement effective lifestyle change using basic motivational interviewing techniques. ƒ Have an awareness of Health Promotion. ƒ Understand that patient self management is an ideal aspect of chronic disease management and how this might be delivered. ƒ
Counselling skills ƒ
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Have an initial understanding of some commonly used techniques. Use a patient centred solution orientated/problem solving approach. Have an understanding of the factors influencing mental health. Have an understanding of stress and stress management and be able to teach some simple relaxation techniques. ƒ Be familiar with evidence based psychological therapies and their use. 26
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Prescribing Skills ƒ Be aware of the guidelines for use, dosing, limitations, side effects and interactions of common medications and the resources available to assist in prescribing less commonly used medications. ƒ Have an understanding of the evidence base for, use and drug interactions of commonly used Complementary Therapies. ƒ Be aware of resources available to assist in rational prescribing such as the National Prescribing Service (NPS). ƒ Be aware of the recommended contents of the General Practitioner’s ‘doctor’s bag’ and their uses. ƒ Understand the role of the Home Medicines Review. ƒ Have an understanding of the legal aspects of prescribing such as prescribing to minors and scheduled drugs. ƒ Understand the practical prescribing issues in the Australian health care setting such as writing a script and obtaining an authority. ƒ
Co‐ordination of care skills ƒ Be able to write a referral letter to another health professional. ƒ Be aware of the range of resources and referral options available to assist patients. ƒ
Complex Consultations ƒ Develop an approach to more complex consultations such as: ƒ Dealing with strong emotions – grief, angry patient etc ƒ Crisis intervention ƒ Delivering unexpected or ‘bad’ news ƒ Non English speaking patients and use of interpreters ƒ Issues of violence ƒ Sexual health issues ƒ Travel medicine ƒ Drug seeking patients ƒ Refugee health ƒ Adolescent medicine ƒ Behaviour change and motivation in the unaware / unmotivated patient ƒ Multiple problems – define priorities and develop plan. 27
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Outline of Curriculum Areas in General Practice (RACGP 2007) ƒ
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Aboriginal and Torres Strait Islander health Acute serious illness and trauma Aged Care Children’s and young people’s health Chronic conditions Common Problems in general practice Critical thinking and research Dermatology Disability Doctor’s health Drug and alcohol medicine Genetics GPs as teachers and mentors Integrative medicine Men’s health Mental health Multicultural health Musculoskeletal health Occupational health and safety Oncology Pain management Palliative care Philosophy and foundations of general practice Population health and public health Practice Management Rural General Practice Sexual health Sports medicine Undifferentiated problems in general practice Women’s health 28
2. Procedural Skills ƒ
Expected skills ƒ Administration of parenteral therapy by subcutaneous, intramuscular and intravenous routes ƒ Administration and instruction for use of inhaled medications ƒ Administration and instruction for use of pessaries and suppositories ƒ Application and removal of plaster cast and management of plaster casts ƒ Arterial blood gases (ABGs) ƒ Assessment of hydration status ƒ Cervical smear and vaginal examination ƒ Clinical breast examination ƒ Contraception advice ƒ CPR and maintenance of airway including bag to mask ventilation, mouth to mask ventilation, mouth to mouth ventilation and insertion of oropharyngeal airway. Practical application of resuscitation guidelines, including the use of a defibrillator ƒ ECG recording and interpretation ƒ Finger prick BSL ƒ Glasgow coma scale assessment ƒ IV Cannulation ƒ Observation of delivery ƒ Ophthalmic examination of the eye including fluoroscein staining of cornea and assessment of colour vision (Ishihara) ƒ Rectal examination ƒ Recognition and management of the seriously ill child ƒ Recognition and management of arrhythmias ƒ Spirometry and peak flow measurements – recording and interpretation ƒ Urinary catheter insertion ƒ Venepuncture. ƒ
Expected skills (to be observed or performed under supervision or undertaken through simulation) ƒ Drainage of joint effusions ƒ Joint injections ƒ Observation of delivery ƒ Removal of foreign bodies from eyes and ears or nose ƒ Suture simple laceration/skin repair including infiltrating wound with local anaesthetic. 29
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Recommended Skills ƒ Correct application of; dressings (e.g. wound dressings and burns), bandages (e.g. strapping a sprained ankle) and slings (e.g. broad arm sling, collar and cuff). ƒ Correct use of crutches ƒ Collection and preparation of pathological specimens ƒ Emergency treatment of tension pneumothorax ƒ Eyelid eversion ƒ Use of nasal speculum to examine the nasal passages ƒ Intradermal injection technique ƒ Removal of foreign bodies (e.g. splinters, ticks) ƒ Use of splints (e.g. finger) ƒ Vaccination of infants and children. 30
3. Personal and Professional Development ƒ
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Australian Health Care System ƒ Have an understanding of Medicare Australia health funding and practical issues for General Practice such as item numbers. Self Care ƒ Understand the concept of stress and apply strategies for self care and stress management. ƒ Be familiar with appropriate resources to assist doctors in self care. ƒ Be aware how to maintain a healthy and balanced lifestyle and how to apply behaviour change strategies to you. ƒ
Ethical, legal and professional aspects of medical care ƒ Understand the guidelines for professional conduct – boundaries, confidentiality, duty of care ƒ Be able to deal with uncertainty in medical practice ƒ Understand the need for continued professional development in a medical career ƒ Understand medical information is constantly changing and being updated and you will be engaged in a career long process of learning. ƒ Be confident in medical information technology ƒ Be able to work effectively as a member of a team in health care ƒ Understand the role of Medical Council of Tasmania ƒ Have an understanding of particular prescribing issues – prescribing to minors, self prescribing ƒ Have an understanding of certification issues – WorkCover, Death Certification, Motor Accident Insurance Board (MAIB). ƒ
Evidence based practice ƒ Understand the use of an evidence based approach to medical care ƒ Understand the resources available to assist in practising evidence based medicine. 31
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Role of research ƒ Understand the opportunities for and role of research in General Practice ƒ Be competent in performing a literature search and critically appraising medical research. 4. Community Health ƒ Be aware of the personnel, resources and agencies available in the community to assist patients in both urban and rural areas, their roles and how to access them. ƒ Understand of the role of various allied health care professionals. ƒ Have an understanding of the provision of services to disadvantaged groups. The current National Health Priority Areas (2009) are cancer control, injury prevention and control, cardiovascular health, diabetes mellitus, mental health, asthma, arthritis and musculoskeletal conditions, and obesity. Students are advised to access the following reference with regard to the activities that they will encounter in general practice attachments: ƒ
Bayram C, Britt H, Charles J, Fahridin S, Harrison C, Henderson J, Miller GC, O'Halloran J, Pan Y & Valenti L. 2008; General practice series 22; AIHW cat. no. GEP 22; 160pp. Canberra: Australian Institute of Health and Welfare. This is available online at http://www.aihw.gov.au/publications/gep/gpaia07‐
08/gpaia07‐08.pdf . 32