Download MBBS Programme Phase 3 Student Logbook 2012-13

School of Medicine
If found please return to:
Phase 3 Undergraduate Officer
Academic Centre
Henriette Raphael House
Guy’s Campus
SE1 1UL
MBBS Programme
Phase 3 Student Logbook
Rotation A: Basic adult medicine and surgery
including gastroenterology, urology, nephrology,
and endocrinology
2012-13
Student name __________________________________________
You must submit your completed Logbook to the Academic Centre by
Term 1: 4pm Monday 17th December 2012
Term 2: 4pm Monday 25th March 2013
Term 3: 4pm Monday 15th July 2013
A completed Logbook, with all clinical skills signed and all professional
development, firm head and clinical adviser sections signed for each Rotation, is a
requirement for progression from Phase 3 into Phase 4. A student who fails to
submit a completed Logbook by the due date will be required to take the end-of-year
OSCE
Please ensure you photocopy the pages for skills sign-ups and clinical adviser
meetings before submitting the Logbook, and keep a copy for your own reference.
END-OF-ROTATION IN-COURSE ASSESSMENT (ICA) MARKS
Grand Round Marks and Firm head marks are all recorded in this logbook on
p.31 and p.32.
GP marks are submitted directly to the Academic Centre by the GP.
It is your responsibility to ensure these marks are completed.
PLAGIARISM
Your attention is drawn to the College statement on plagiarism, a copy of which you will
have signed at enrolment. A copy will also be available on the Virtual Campus.
This statement covers all work that you will submit for assessment (including all completed
SSC submissions in later years where you will be required to sign a statement confirming
that you have not plagiarised any of the material contained therein).
You are strongly reminded that any breach of these rules by you will be the subject of the
College’s disciplinary procedures and could result in the termination of your studentship.
Furthermore, an act of plagiarism is by its very nature dishonest and could bring into
question your fitness to practise.
FALSIFYING A LOGBOOK SIGN-UP IS FRAUDULENT AND SHALL LEAD TO DISCIPLINARY
ACTION
The information contained within this Logbook is correct at the time of going to press although the details
may change before or during the academic session.
Contents
Part 1 – Important Information
1.
Introduction
p. 2
2.
Educational Contract for Phase 3
p.5
3.
Confidentiality Code
p.7
4.
Clinical Adviser Visits
p.8
5.
Digital Professionalism
p.9
6.
Feedback
p.10
7.
Career Reflections
p.11
8.
An Important Notice about Infection Control
p.12
9.
Code of Practice for Student Examination of Patients
p.18
10.
Fitness to Practise
p.24
11.
Simulated and Interactive Learning (SaIL)
p.25
Part 2 – Skills and Sign-ups
12.
In-Course Assessment of Clinical Skills: Guidance for Students
•
•
In-course marking scheme and performance descriptors
In-course Assessment Marksheets
p.27
p.28
p.31
13.
Sign-Ups
p.33
14.
Additional Mandatory Experiences
• Basic Life Support (BLS)
• Pathology and Therapeutics
• Interprofessional Education
• Ethics Report
• Patient Educator Sessions
p.57
15.
Patients Clerked
p.61
16.
Phase 3 Core Patient Cases
p.63
17.
Integrated Skills List
p.68
18.
Quick contacts list
p.74
1
1 – Introduction
This is one of a series of Logbooks for the MBBS course that aims to link skills training across all Phases
and prepare for your early professional career as a doctor. The Logbook provides a record of the
competences you achieve in the essential skills in this rotation, sign-up of the KCL School of Medicine
Student and Doctor, Educational Contract for Phase 3, Confidentiality Code, professional development, and
visits to your clinical adviser.
You will be asked to hand in your Logbook at the end of the year for inspection of satisfactory completion of
skills and authenticity of signatures. Because each year Logbooks are mislaid, you are advised to
photocopy all pages with skills sign-ups and clinical adviser visits regularly and before handing in.
Gaining competence in skills
Skills are an important part of the work of a doctor. The best way to learn skills is to progress through a
cycle of learning by observing an expert perform a skill, perform it under supervision, and then practise
several times on your own. When you feel competent, ask to be observed for your sign-up.
If your assessor believes you are not competent for sign-up, you will need further practice and
reassessment later in the rotation. You should revisit skills during the medical course to maintain your
competence. They are assessed in subsequent years’ OSCEs.
Keeping your skills up-to-date
Clinical practice is constantly changing. New skills are introduced and others change in technique or
equipment used. It is your responsibility to keep up-to-date with changes and to modify your skills
technique accordingly. This is especially important for skills such as BLS. In subsequent OSCEs, you will
be assessed on the updated skills techniques not the method you initially learnt.
Specific learning outcomes in Phase 3
During Phase 3 students should learn to perform a general clinical assessment of an adult patient,
comprising: full history (including review of systems), general physical examination and specific
examination of associated systems, and mental state and cognitive state examinations. In addition,
students should learn about selecting and interpreting tests and investigations, performing clinical
procedures, and presenting their findings. They should learn to evaluate clinical and pathological
information to generate a differential diagnosis and use this to initiate clinical management (including
practical management such as resuscitation, and medical treatment with medication). Students must be
able to check the correctness of existing prescriptions for medication; they must also be able to write simple
prescriptions (including ascertaining allergies and drug sensitivities, and drug dosage, contraindications
and interactions using the British National Formulary). Students should be able to explain to patients (or
their carers) the nature of their diagnosis, any investigations or procedures they may require, and the
common treatments (medical, surgical or psychological) they might receive.
Most students should expect to achieve basic competence in these tasks by the end of the first term, and
all students may be tested on any aspect of these tasks during the third term. The sign-up skills constitute
the minimal skills to be learned in Phase 3: they are necessary but not sufficient for the complete clinical
assessment and management of the adult patient. Therefore they do not constitute a syllabus for the incourse OSCEs nor the end-of-year OSCE.
2
1 – Introduction
Sections 2-3 – Educational Contract for Phase 3; Confidentiality Code (pp. 5-7)
This section contains important documents that you must read carefully and discuss with your clinical
adviser. They must be signed (and countersigned by your clinical adviser where necessary) before you
commence your first clinical placement.
Section 4-5 – Clinical Adviser Visits; Digital Professionalism (pp. 8-9)
This is a record of visits to your clinical adviser. You should see him or her at least once per term. Your
adviser is invited to write notes on any points to be followed up at future visits, including your reflections on
careers. Please take your Logbook with you to these visits. They must also sign that you have completed
the on line Digital Professionalism module.
Section 9 – Code of Practice (pp. 18-23)
This section contains guidelines for general examination and intimate examination of patients. You should
be aware of these guidelines and comply with them at all times.
Sections 12-13 – Marksheets, Skills and Sign-ups (pp. 31-56)
Grand Round Marks and Firm head marks are all recorded in this logbook.
This is the official record of your sign-up of skills for your year.
In Phase 3 there are three Logbooks one for each rotation. You should get your clinical skills and your
attendance at special clinical sessions signed up by the end of each rotation by a doctor or other clinician
(such as a nurse specialist) appropriate to the specialty and approved by your firm head.
A copy of the integrated skills list for all years of the MB BS programme is on the Virtual Campus.
Section 14 – Additional Mandatory Experiences (pp. 57-60)
Basic Life Support
Pathology and Therapeutics
Interprofessional Education,
Ethics
Patient Educator Sessions
Section 15 – Patients Clerked (pp. 61-62)
This is a record page for you to list clinical cases you have clerked and examined. It should be used for
discussion with your firm head and for revision. Patients vary, so you should aim to clerk several patients
within each diagnostic category, and a minimum of two patients each week. You should ensure you clerk
patients whose diagnosis is not known to you, so that you can develop your differential diagnostic skills.
Section 16 – Core Patient Cases (pp. 63-67)
Core cases and procedures form the basis of adult clinical medicine encountered in Phase 3. You should
try to clerk patients with each of these conditions or undergoing the named procedures in order to build up
your clinical knowledge and skills. You should observe the management of emergencies and the
performance of clinical procedures – you will see some of these only on acute “take”. Whenever you have
clerked a patient with one of these conditions, or observed a procedure, you should read about it so that
you understand it fully. You must also attend post-mortem examinations regularly throughout the year.
3
1 – Introduction
Attendance and satisfactory sign-up
You are expected to attend all teaching whether lectures, practicals, tutorials, symposia or clinical teaching.
During clinical placements, clashes may occur between scheduled clinical (i.e. involving patients) and nonclinical (e.g. formal lectures or symposia) teaching: normally, clinical teaching takes priority, but you must
follow your firm head’s instructions. Your firm head will take your attendance into account when signing-up
your satisfactory completion of the rotation in your Logbook. Genuine mitigating circumstances such as
illness or official absence will also be taken into account. Attendance of at least 90% is expected at all
course components and attendance of at least 75% is required to pass any course component.
Name Badges
You are expected to wear your School of Medicine ID badge at all times in hospital and GP premises, in
community settings and on home visits.
Dress Code
NHS trusts operate mandatory dress codes that must be followed at all times when on NHS sites. See the
Virtual Campus for more details on the dress codes required by each trust.
4
2 – Educational Contract for Phase 3
Name of student:
Your firm head has overall responsibility for your placement, timetable organisation, and your clinical
supervision.
The site/campus Sub-Dean and Head of Phase 3 have overall responsibility for placements.
At the outset of the attachment you will be given information about the expectations of the attachment,
including on-call periods. If you have any commitments that conflict with these you must make them known
to your firm head and agree how this will be managed.
You should comply with all aspects of the KCL School of Medicine Student and Doctor (see Handbook),
particularly:
develop skills by:
•
•
•
•
•
•
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
and demonstrate appropriate attitudes by:
•
•
•
•
•
•
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.
Guidance on meeting the requirements of the Educational Contract
1. Patients: you will be expected to take histories and examine patients in inpatient, outpatient and
community settings throughout the attachment with a minimum of two patients clerked and examined
fully every week.
2. Skills: you will be expected to learn and practise the skills listed in the Logbook before having your
competence validated by an appropriate health professional.
3. Identity: during interactions with patients and staff you should always wear you name badge and
identify yourself as a Medical Student.
4. Dress Code; you must abide by the dress code and infection control procedures for the NHS Trust to
which you have been allocated.
5
2 – Educational Contract for Phase 3
Name of student:
5. Patient records and consent: all entries you make in patient records must be signed, dated, and your
name and status as “medical student” printed legibly. The patients whom you will look after will be
asked to give their permission for your involvement. It is always a patient's right to decline to be seen
by a medical student.
6. Ill health: if you are unable to attend because of ill health, you should inform your firm head as soon as
possible. The School of Medicine will expect you to submit to the Academic Centre a suitable sickness
certificate (self-certification for less than five working days, medical certificate for five days or longer).
There is no holiday leave during the attachment; holidays are built in to the Phase 3 timetable.
7. Potential complaints: if you are in a situation where you have any reason to think a complaint might be
made against you, you are concerned by a patient’s comments, or believe you may have acted
inappropriately, you should discuss this with your firm head, another senior clinician or your clinical
adviser as soon as possible. Resolving a problem quickly shows respect for your patient (and is much
less likely to result in a formal complaint being made).
8. Education supervision: if you have any concerns over the supervision you are receiving, you should
take this up with your firm head, the site Sub-Dean, the Head of Phase 3 or if the advice you seek is of
a more personal nature, with your Clinical Adviser.
9. Professional indemnity: the School of Medicine requires all student to be a member of a medical
defence organisation during the whole undergraduate course including Phase 3. If you follow the
guidance in this contract it is difficult to envisage any legal action which would not be covered
vicariously through your consultant. However, the defence organisations would cover you if this unlikely
event arose and also provide additional support. You should be aware that the medical school has no
responsibility to provide cover for students in such situations.
I accept and agree to abide by the conditions of the Educational Contract
Student:
Signed………………..…………………….…..…
Date………………..
Clinical Adviser:
Signed………………..…………………….…..…
Date………………..
GMC no./Designation…………………………………………...
Rotation 1
firm head:
Signed…………………………………………..…
Date………………..
GMC no./Designation…………………………………………..
Rotation 2
firm head:
Signed…………………………………………..…
Date………………..
GMC no./Designation…………………………………………..
Rotation 3
firm head:
Signed………………..………….……………..…
Date………………..
GMC no./Designation………………………………………….
6
3 – The School of Medicine Confidentiality Code
Name of student:
You MUST sign the declaration below AT THE START of the first term, in discussion with your
Clinical Adviser; this is required by the NHS trusts before you are permitted to see patients.
Why is patient confidentiality important?
Confidentiality is central to the trust between patients
and doctors and is part of the professional code.
Patients have a right to expect that medical students
and doctors will not pass on confidential information
without their consent except to other health
professionals who care for them.
Confidentiality should be maintained for all time even
after a patient's death.
What is confidential information? How should you
protect it?
Confidential information includes all personal details by
which a patient is identifiable such as name, address
and full postcode. Such data should not be transmitted
verbally, in writing, or online r without a patient’s
consent.
Confidentiality extends to casual social conversation,
including emails, blogs and social media. Do not
discuss patient details in public places such as hospital
lifts, cafeterias, and public transport. Confidential
information used for teaching, projects, research or
audit must be anonymized.
Confidentiality may only be breached in exceptional
circumstances. Discuss this with your tutor.
Anonymizing data. What should you do?
Patient identifiable information is anonymized by
removing the patient's name, address, post-code, date
of birth, NHS number, telephone number or other
information that allows access to the patient.
For electronic processing, do not enter patient
identifiable information onto your PC.
Data entered in a clinical setting, such as hospital or
GP practice, must be password protected.
Destroy all personal information if not needed. Delete
on PCs and on handheld mobile internet enabled
devices.
For paper, consign to a bin designated for
disposal of confidential information. These are
located in Academic Centre or in clinical
departments.
Do not photocopy clinical notes for projects,
presentations, or for other reasons.
All information removed from a clinical area must
be anonymized and secured in a folder or case.
Obtaining patient consent. What does this
mean in clinical practice?
If it is for the patient’s benefit, information can be
shared with the multidisciplinary team caring for
the patient. This does not extend to research,
teaching or unqualified staff.
Always obtain the patient’s consent orally or in
writing before you give personal information to a
third party such as family or friend who is
attending with the patient.
You must obtain written informed consent from
patients before taking photos. The patient must
be unidentifiable and you should not take photos
of patients using a mobile phone.
Obtaining patient consent. What does this
mean for projects and presentations?
If you use patient data for projects never include
patient identifiable information. If you use clinical
material, explain to the patient how data will be
used and assure him or her that information will
be anonymized.
If you photograph a patient for a project, explain
how the photo will be used, obtain written consent
and that of your supervisor’s. For presentation or
publication, the patient's eyes must be occluded.
Carefully consider whether metadata on any
images you have taken break patient
confidentiality.
Remember
•
•
•
Every patient has a right to confidentiality
Every student has an obligation to respect that right
Breaching confidentiality is a College disciplinary offence
NB: To be signed at the start of the first rotation in discussion with your Clinical Adviser
I have read and understood the School of Medicine Confidentiality Code
Signature of student …….………………………………………………...….. Date ……………………
Signature of clinical adviser ……………………………………………...… Date ……………………
GMC no./Designation…………………………………………………………………………
7
4 – Clinical Adviser Visits
Name of Clinical Adviser:
Name of student:
You are advised to see your clinical adviser following your mid-rotation interview with your firm head to
discuss the following
Term 1 Campus:
□ Confidentiality Code signed – Rotation 1 (p7)
□ Skills sign-ups reviewed (may not be complete)
□ List of patients clerked and reviewed (optional)
□ Attendance / Health
□ SSCs (Poster Presentation phase 5 only)
□ Responsible use of social media
□ Foundation Programme application discussed
(phase 5)
□ Career ambitions discussed
□ Consent issues (Code of practice for examination
of patients - see p18-23)
□ Exam performance and OSCE feedback
□ Professional development (including
interprofessional education)
□ Fitness to Practise concerns
□ Educational Contract discussed and signed
□ Transfer/ returning students: issues
Clinical Adviser: Signed …….………………………………………………...….. Date ……………………
GMC no./Designation…………………………………………………………………………
Comments:
Term 2 Campus:
□ Skills sign-ups reviewed (may not be complete)
□ List of patients clerked and reviewed (optional)
□ Attendance / Health
□ SSCs & electives
□ Discuss an ethical experience from Term 1 (p.59)
□ Ethical report (phase 3 only)
□ Review clinical grades
□ Professional development (including
interprofessional education) discussed
□ Foundation Programme application discussed
(phase 4 and 5)
□ Career ambitions discussed
□ Fitness to Practise concerns
□ Educational Contract signed
Clinical Adviser: Signed …….………………………………………………...….. Date ……………………
GMC no./Designation…………………………………………………………………………
Comments:
Term 3 Campus:
□ Skills sign-ups reviewed (may not be complete)
□ List of patients clerked and reviewed (optional)
□ Attendance / Health
□ Educational Contract signed
□ Professional development (including
interprofessional education) discussed
□ Review clinical grades
□ Foundation Programme application discussed
(phase 4)
□ Career ambitions discussed
□ Fitness to Practise concerns
□ Exam performance, OSCE feedback and revision
□ Electives (phase 3 &4)
Clinical Adviser: Signed …….………………………………………………...….. Date ……………………
GMC no./Designation…………………………………………………………………………
Comments:
8
5 – Digital Professionalism
Evidence must be shown that the module has been completed during Phase 3.
I have seen evidence that the student has completed the on line Digital Professionalism
module at http://virtualcampus.kcl.ac.uk/vc/tel/social_media_guidance
Signature of Clinical Adviser .……………………………………………………
Date ……………………………………………………………………………………
9
6 – Feedback
Receiving feedback from your course tutors and other teachers
Throughout the medical course, you will receive feedback on your work and clinical performance. Feedback
if used constructively helps improve your standards. The GMC’s guidance in Good Medical Practice states
that “you must reflect regularly on your standards of medical practice and respond constructively to the
outcome of appraisals and performance reviews”. <www.gmc-org.uk>.
Why is feedback important?
Feedback and self-critical appraisal on your performance helps gauge your progress. Knowing what you do
well and how you could improve will build self-confidence. Feedback on your performance in assessments
will help identify your strengths and weaknesses and enable changes to be made. Receiving and accepting
feedback constructively will be important throughout medical school and in your professional life.
How can I ask for feedback in the clinical environment?
There are several sources of potential feedback on your performance.
Decide what you would like feedback on. Be specific on the points you feel need improving, then ask for
feedback from an observer. Patients, peers and your clinical tutors are a useful source of feedback. Use
the skills performance criteria in the Logbooks to assess your own performance.
Useful questions:
•
•
•
How do you think I did with my history taking/ examination/ specified skill?
Am I up to standard in this skill or procedure?
How can I improve in this skill?
How should I react to receiving feedback?
Ways of giving feedback vary. Indeed giving constructive feedback is a difficult skill. Receiving feedback
requires a professional attitude that you need to develop as a student in readiness for your medical career.
So…
•
•
•
•
•
Listen carefully. Be sure you have understood the feedback. If not, clarify.
Thank your teacher or observer for their feedback.
Avoid being defensive. Ask for an explanation if you feel the comments are too critical.
Ask yourself if you reacted appropriately? It is unprofessional to argue with the tutor giving feedback
and to reject their comments.
Use the feedback to improve your performance.
Your feedback and sign ups
The sign-ups section in this book includes space for the clinician assessing each skill to comment on your
strengths and areas for improvement. You are encouraged to make use of this opportunity for receiving
feedback and to record comments in the space provided.
10
7 – Career Reflections
Reflecting on the range of career options in medicine
Drawing on your experience of the different specialities in your course, start to think about the options for
your medical career and your aptitude for each speciality.
Use this page to make notes and refer to them in discussion with your clinical adviser.
In relation to each speciality ask yourself the following questions:
•
•
•
•
•
What aspects did I enjoy and why?
What aspects did I dislike and why?
What information have I found out on careers in this speciality?
What more do I want to find out about this speciality? How will I do it?
Am I suited to working in this speciality?
You are strongly encouraged to look at the Medical Careers website:
http://www.medicalcareers.nhs.uk/medical_students/introduction.aspx
11
8 - An Important Notice About Infection Control In Clinical Practice
The exact infection control regulations enforced in hospitals vary from Trust to Trust, but the following
infection control guidelines should be acceptable at all hospitals. Each Trust will have its guidelines on its
ward computer system (intranet).
Students (and staff) can readily become colonised with pathogenic bacteria and viruses during close
contact with patients. Even a brief examination can be responsible for the spread of MRSA, coliforms and
enteric viruses. These can cause severe harm to patients. Also, occasionally students and staff may be
infected by these pathogens, and, very rarely, Hepatitis B, C HIV and HTLV 1.
These brief guidelines are intended to help you to know what to do in different clinical settings. Note also
that infection control practice is an integral part of many OSCE assessments.
If you are unwell – e.g. diarrhoeal illness, severe cold or any febrile illness – do not go on the wards. If you
have a mild cold without fever – do not visit immunocompromised patients. Ask a senior member of the
ward staff, or the Hospital Infection Control & Prevention team, if in doubt.
Important organisms that may be transmitted in
health care
Main means of spread
Hepatitis B & C, HTLV-1 and HIV
Inoculation injuries with sharps and exposure
from splashing of body fluids onto mucous
membranes
Respiratory route/close contact. Are you
immune?
Hands, faeco-oral route, food
Varicella zoster virus (chickenpox & shingles)
Diarrhoeal diseases e.g. Norovirus, Rotavirus,
Salmonella, Shigella
Resistant Gram negative bacteria e.g. Klebsiella
(especially ‘ESBL’ strains)
Environmental organisms e.g. Pseudomonas
Mycobacterium tuberculosis
Clostridium difficile colitis
Methicillin-resistant Staphylococcus aureus (MRSA),
sensitive Staph aureus, Group A streptococci
Hand/patient contact
Via hands or via equipment e.g. instruments left
wet overnight
Respiratory route
Environmental & hand spread (+antibiotics)
Via staff carriers, hands, environment
Practical Guidelines for Day-to-day Infection Control
White Coats etc
Please refer to the dress code on page 18 and of the Trust where your firm is located.
Hand washing with Soap & Water at a ward or Clinic Sink using the seven stage technique.
•
•
•
•
•
•
At the beginning of the day
Before and after examining a patient
After doing a procedure which might have contaminated your hands (including glove removal)
If your hands look dirty e.g. oil/ink staining
On a ward round if patient examined/hands contaminated/cubicles visited.
If the patient has known or suspected infection with Clostridium difficile or Norovirus (alcohol is
ineffective against spores and most enteric viruses).
12
8 - An Important Notice About Infection Control In Clinical Practice
Hand Disinfection with Aqueous Chlorhexidine (or Iodine) or Alcoholic Preparations such as
Hibisol, or Alcohol Gel Sink using the seven stage technique.
First remove any visible contamination (if present) with soap & water
•
•
•
•
•
If you have contaminated your hands with blood and body fluids
Before and after dealing with immunocompromised patients (especially in Protective Isolation) and
with patients in Standard or Strict Isolation
Before doing clinical procedures e.g. venepuncture, IV line insertion, catheterisation
Alcohol preparations as an alternative to soap and water washing if no sink is available.
See note above about not using alcohol for patients with Clostridium difficile & Norovirus
13
8 - An Important Notice About Infection Control In Clinical Practice
14
8 - An Important Notice About Infection Control In Clinical Practice
In the Operating Theatres
Ask for advice if in doubt.
Change out of outdoor clothing except for underwear (remove socks/stockings)
Change into theatre top + trousers, or tunic; clogs, head covering (balaclava-style if long hair) and filtering
mask. Remove watch and jewellery, & wash hands. Put up mask on entering operating area of theatre.
Now you are part of the “circulating team”. If asked to scrub up: nail brushing; three-minute surgical wash
with aqueous chlorhexidine or povidone iodine up to & just above the elbows (do not scrub the skin with a
nail brush). Don’t touch anything non-sterile with sterile gloved hands. Then put on green sterile gown and
gloves. Now you are part of the “scrub team”.
Entering Side Rooms with Patients in Isolation
Note instructions sign on the door. If relevant, take off white coat & leave outside; put on plastic pinafore
and gloves; mask for particularly infectious cases (ask!).
Dispose of mask and apron into the orange plastic sack, as you are leaving the room, then wash hands
before leaving the room (removing protective clothing can contaminate the hands). Use alcoholic hand rub
afterwards (outside the room), or wash at a sink again if none present.
Barrier Nursing on a main ward (“Cohort nursing”)
This is sometimes required when there are no side rooms or if several patients have for example MRSA or
a multi-resistant Gram negative pathogen. Gloves and a plastic apron may need to be worn with attention
to hand hygiene afterwards. If in doubt ask a senior nurse.
Needles & Sharps
Used disposable needles & sharps: They always go in a sharps bin. Always dispose of sharps, & needle
holder if used, at the point of use.BEWARE OF OVER FILLED SHARPS BINS.
DO NOT CARRY EXPOSED SHARPS THROUGH THE WARD. If possible use a mobile sharps container
and tray, and take these to the patient.
DO NOT RE SHEATH NEEDLES. [If a needle must be re-sheathed, e.g. re-sterilisable steel cannula, use a
single handed technique.]
It is your responsibility to dispose of your own sharps. Never leave them on a tray for someone else to
dispose of. Reusables: e.g. surgical instruments: Place in plastic tray on trolley or as directed by assistant.
These re-usable instruments must never be cleaned by you (high risk of injury) but placed in a special bin
for return to the central sterilisation department. Ask if in doubt.
Gloves
Sterile for surgery & invasive clinical procedures; non-sterile are OK for dressing changes and other ‘dirty’
procedures. Latex and vinyl gloves are available on all wards and departments in small, medium and large
sizes. Ill-fitting gloves can be a hazard during procedures. Allergy to latex does occur; get advice from
Occupational/Student Health.
Plastic Bags
These are ORANGE for clinical waste i.e. items stained with blood or body fluids, and double-bagged
YELLOW for certain specialist items like dialysis equipment. CLEAR or BLACK for domestic-type waste
i.e. drinks cans, paper packaging, hand towels used after social (soap & water) hand drying. NEVER put
broken glass, sharps & needles in plastic bags or laundry bags. Use SHARPS BINS. There are special
bins for non-contaminated broken glass.
15
8 - An Important Notice About Infection Control In Clinical Practice
Spillages of Blood & Body Fluids
If No Broken Glass Involved:
Get someone who knows what to do. Each ward has a yellow spillage kit. Mark off the area and prevent
people walking through it. Open a window if possible because chlorine-based disinfectants can give off
chlorine. Wearing plastic apron & gloves, clear up the majority of the spillage with paper towels (place them
straight into an orange bag). Sprinkle NaDCC (i.e. sodium dichloroisocyanurate – which is similar to
hypochlorite or bleach) granules onto the spillage area. Leave 3 minutes then clear up with scoop & paper
towels, rinse area with water. (ALTERNATIVE: use 1% NaDCC solution (1 in 10 neat NaDCC, = 1 in
10,000 ppm available chlorine) poured onto paper towels. 3 minutes later clean up with more paper towels.
Everything goes into an orange plastic bag for incineration. The local cleaning contractor should clean the
disinfected area to remove excess residue of NaDCC.
TOO MUCH BLEACH & SPILLAGE FLUID = CHLORINE GAS HAZARD! – always open windows before
starting to clear up the spillage; Caution: bronchospasm risk for asthmatics.
If Broken Glass is Present in the Spillage:
Disinfection as above: Get help. Never never never pick up broken glass with fingers, even if wearing
gloves - sharps injury will occur! Use a plastic scoop provided in the spillage kit. Discard broken glass into
a sharps bin. Then proceed as above.
Resources:
Ask any trained nurse or clinician about hand disinfection. Infection control nurses are present in all
hospitals. An infection control CAL program (‘ICTAP’) shows good hand disinfection technique and much
more, it is available on the KCL server; similar e-learning programs are available at most Trusts.
16
8 - An Important Notice About Infection Control In Clinical Practice
What to do if you have a percutaneous or mucosal exposure to potentially HIVinfected blood or other high-risk body fluid:
In all cases – whether the patient is known to be high risk for any infection or not • Encourage the wound to bleed, ideally by holding it under running water
• Wash the wound using running water and plenty of soap
• Don’t scrub the wound while you are washing it
• Don’t suck the wound
• Dry the wound and cover it with a waterproof plaster or dressing
• Mucosal splash (eye, mouth): rinse with a lot of sterile water or saline for 10 minutes
• Note name number and location of ‘donor’ patient, if known. Notify a senior person in the
ward or clinic.
• Attend Occupational Health IMMEDIATELY AND ALWAYS WITHIN AN HOUR IF AT ALL
POSSIBLE. OUT OF HOURS attend ACCIDENT & EMERGENCY; report a ‘needlestick
injury’ and you will be seen quickly.
• The Occupational Health Department or the A & E Department (via the Virologist. Medical
Microbiologist, or HIV/Infectious Disease Physician on duty) should arrange for the
patient's blood to be tested for HIV (and HBV and HCV) with the informed consent of the
patient.
• Fill out an incident form (later). Keep a copy of the accident report.
• When advised to do so, take a single dose of the anti-HIV drugs as soon as possible,
ideally within one hour of the incident. There is unlikely to be any benefit if HIV PEP is
started >72 hrs after the incident. This one dose is unlikely to give side effects. If the
exposure is to blood or body fluids/tissues from a patient shown to be or strongly
suspected of being HIV positive, you should continue to take the anti-HIV drugs for four
weeks, according to the prescription details, with monitoring. You will need to be followedup by the Occupational Health Department, a senior HIV/Infectious Disease Physician, or
a Medical Microbiologist or Virologist.
• If you have been at risk of acquiring HIV infection, you should use condoms and refrain
from donating blood until a blood test at 6-7 months confirms that you are uninfected.
17
9 - Code of Practice for Examination of Patients by Students
Basic professional requirements for students on clinical practice (see Educational Contract)
Interviewing patients
Dress Code
Each NHS trust has its own dress code, but the following principles apply in most trusts. 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.
Most commonly health care workers wear uniforms or tunics, or short-sleeved shirts/blouses and no ties.
(If the medical firm or hospital where you work still requires white coats, make sure your white coat is
always clean - change it regularly.) Ties (if worn) should be tucked into the shirt about half-way down. If
you don’t have short-sleeved shirts/ blouses, roll up the sleeves above the elbows for surgical cleansing
and procedures. Wrist watches, wrist bands and jewellery should be removed before work (bare below the
elbows). Nails should be kept short and clean, with no nail varnish or false nails. Long hair should be tied
back. Clothing should be of a type that can be hot-washed, i.e. above 60oC, so any pathogens are killed
off. It is unprofessional to chew gum, eat, or drink in the patient’s presence.
Special Groups of Patients
Nervous patients
Nervous or embarrassed patients may be apprehensive about being interviewed. Students should
be alert to signals of distress from patients; you should apologise and discontinue under these
circumstances.
Adults with cognitive impairments or learning difficulties
Adults with cognitive impairments or learning difficulties should be treated as fully consenting with
the capacity to decide whether to consent or refuse. As with all patients, it is essential to show
respect and privacy.
Children and adolescents
When interviewing a child or adolescent under age 16 years, always obtain permission from the
parent or guardian and ask them to be present throughout the interview. Children are easily upset
and need reassurance from 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.
Ethnic, cultural and religious groups
Expectations vary according to individual circumstances, but remember that some Muslim and
Hindu women may have have a clear preference for women practitioners when intimate
examinations are necessary due to their strong religious beliefs. Male students examining women
from these cultural groups should have a chaperone at all times. The Islam, Hindu and Orthodox
Judaism religions have specific beliefs regarding menstruation so a gynaecological examination
during menstruation may be considered unacceptable except in an emergency. Verbal consent for
any physical examination is imperative regardless of creed.
Visiting patients at home
Tutors are asked to consider your safety and security whenever you are visit patients at home. You
may be paired with another student or alternative arrangements should be agreed with a member of
staff. Discuss with your tutor if you have any concerns.
Recommended reading
General Medical Council. “Good Medical Practice”. www.gmc-uk.org
18
9 - Code of Practice for Examination of Patients by Students
Protocol for Intimate Examinations of Patients by Students in Healthcare Professions
The recommendations of the protocol apply in most NHS trusts in which you will study. You should check
the details with your firm head. For all patients, capacity to give consent must comply with the Mental
Capacity Act 2005.
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
First practise the examination on a model, mannequin, or a patient educator.
Before examining a patient, you must have approval from your clinical supervisor 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 with responsibility for their care and that the patient is adequately informed about the procedure,
possible risks and consequences, and alternative management options. This is known as informed
consent. Giving consent requires the patient to have sufficient mental capacity. 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
Having obtained the patient’s consent, explain what is involved and 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 availableremember 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.
Requests for gender specific practitioners are often based on cultural beliefs and should be respected.
Avoid examining women during menstruation except in an emergency. You should also be sensitive to the
19
9 - Code of Practice for Examination of Patients by Students
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.
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?
When students perform intimate examinations, the patient must have a chaperone who should be the same
sex as the patient. A chaperone could be a member of staff, your supervisor, or a friend or a relative
accompanying 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 be obtained from the patient. The procedure
should be explained prior to the administration of a sedative medication 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 clinician 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, 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
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
Some patients may not have the capacity to give consent. Students should not perform intimate
examinations on the following groups:
1.
2.
3.
4.
5.
Patients with severe mental illness
Adults with severe learning difficulties
Children and adolescents under age 16 years
Non-English speaking patients
Patients at home, when medical students are not accompanied by their GP tutor
20
9 - Code of Practice for Examination of Patients by Students
Examination of patients at Teaching Campus Hospitals (TCH) and General Practice
The same professional and ethical principles apply at TCH and in General Practice as at campus hospitals.
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 clinical supervisor or Sub-Dean. If you are
not satisfied, you should raise your concerns with your clinical adviser. If you feel ill at ease about
performing an intimate examination, do not proceed.
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, 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 practice1,2
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).
1 General Medical Council. Good medical practice. www.gmc-uk.org
2 Royal College of Obstetricians and Gynaecologists. Gynaecological Examinations. RCOG. London. 2002
21
9 - Code of Practice for Examination of Patients by Students
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,
and giving the name of your supervisor, and name and status of the chaperone.
Protocol for ano-rectal examination
1. Learn and practise rectal or proctoscopic examination on a manikin 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, and giving the name of your supervisor, and name and status of the chaperone.
22
9 - Code of Practice for Examination of Patients by Students
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, and
giving 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 student 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,
and giving the name of your supervisor, and name and status of your chaperone.
23
10 – Fitness to Practise
Medical students are entering a profession where appropriate standards of professional behaviour are
expected by the public and this is regulated by the General Medical Council. King's College London has a
Fitness to Practise Committee which deals with misconduct (under the terms of the College's Misconduct
regulations) and matters of behaviour and health that raise issues of fitness for registration and practice.
The School of Medicine also has an internal Fitness to Practise Advisory Committee that advises the Head
of School on these matters.
Students must inform the School through the Academic Centre of any issues of personal health or
behaviour (e.g. blood borne virus infection, mental health issues, police cautions, convictions, proceedings,
infringement of social media) which might affect their fitness to practise status. The GMC documents "Good
Medical Practice" (http://www.gmc-uk.org/guidance/good_medical_practice.asp) and “Medical students:
professional values and fitness to practise” (http://www.gmcuk.org/education/undergraduate/professional_behaviour.asp) are essential reading for undergraduate
medical students.
Medical students also have a duty to report issues that relate to the fitness to practise of other students or
staff of the College or associated NHS trusts. This can be done in confidence to a senior member of the
College such as a year head, personal or senior tutor, clinical or senior clinical advisor. Taking this action is
an important duty for the safety of patients, staff and students"
The KCL information ‘Regulations concerning students’ can be found at
http://www.kcl.ac.uk/aboutkings/governance/regulations/students.aspx
KCL information on ‘Fitness for Registration and Practise Regulations’ (B5) is to be found at
http://www.kcl.ac.uk/college/policyzone/index.php?id=425
High standards of behaviour are expected at all times. You should be courteous to all staff including
teaching, Academic Centre and clerical staff as well as other health professionals. Rudeness to staff,
whether verbally or in writing is unprofessional and may lead to disciplinary action.
24
11 - Simulated and Interactive Learning (SaIL)
The Chantler Clinical Skills Centre offers newly refurbished Simulated Learning Facilities for practical
and clinical communication skills teaching for over 4,000 Medical, Nursing and Midwifery students. The
centre includes a mock GP room, home environment, ward areas and clinical skills classrooms.
Throughout the year additional Kings College clinical skills revision sessions are put on at the centre which
can be found on our website:
http://www.kcl.ac.uk/health/study/facilities/clinicalskills/index.aspx
The Independent Learning Room (ILR) based within The Chantler Clinical Skills Centre: room 1.9 on
the first floor of the Centre.
The Independent Learning room is an unsupervised resource set up for both medical and nursing students
to practise skills. To use the room you are required to sign in at the reception desk so we know who is
using the resource. During busy periods the ILR is operated on a sign up basis with two hourly slots for you
to sign up to via our website. The room is set up with equipment including blood pressure monitors,
venepuncture arms, catheterisation models etc. If additional equipment is required please ask at the
reception desk, if available you will be asked to sign for the equipment for use in the ILR only.
Rules for use of The Chantler Clinical Skills Centre. For us to be able to operate a resource that works
as an unsupervised facility you asked to behave professionally, read and adhere to the ILR rules.
Please use the following link for more information on how to access the facilities and the rules for use:http://www.kcl.ac.uk/health/study/facilities/clinicalskills/teaching/ilroom.aspx
SaIL at St Thomas’ House, hosts a mock GP consulting room, a six-bedded ward, an operating theatre/2bedded ICU ward, a home environment and a surgical simulation room. For more information please go to
their website below:
http://www.guysandstthomas.nhs.uk/healthprof/education/simulation_centre/simulation.aspx
Clinical skills facilities are also available at other sites and at the teaching campus hospitals.
Please see your site administrator for more information.
25
11 - Simulated and Interactive Learning (SaIL)
Whilst these skills are not compulsory during Phase 3, you are advised strongly to take the opportunity to
practise these at this stage. If your practice is observed by a member of staff you may obtain an additional
sign-up that you should show to your Firm Head. This may be taken as evidence of your motivation and
commitment to learn when your in-course assessment marks are being considered.
Skill
Date
Practice observed by
Suture a skin wound
Insert an intravenous cannula
Set up drip/infusion
Give I-V injection
Write up fluid chart
Give intramuscular injection
Insert a nasogastric tube
Administer oxygen therapy
26
12 - In-Course Assessment of Clinical Skills: Guidance for Students
You will have learned to perform a basic general clinical interview and examination during the Introductory
Course for Phase 3. The core clinical skills listed here develop and extend the general clinical interview
and examination for use in specific clinical contexts. You are required to be competent in the core skills
listed under each rotation. In addition, resuscitation (basic life support/CPR) is a basic emergency skill
introduced in Phases 1 and 2 and students are expected to remain competent throughout the course.
Each skill has minimum performance criteria, similar to those used in the in-course and end-of-year OSCE
assessments. These are included in the Logbook for each rotation and are also available on the Phase 3
web page of the Virtual Campus. You should practise each skill until you feel competent. Some skills are
suitable for assessment on manikins or models and may be assessed in the Clinical Skills Centre. At this
stage ask your firm head or tutor to observe and assess your performance and to sign this Logbook.
Do not be distressed if your performance is unsatisfactory: seek feedback from your assessor (see p. 10).
Practise the skill using the tutor’s feedback before requesting a repeat assessment later in the rotation.
It is your responsibility to arrange for assessments.
At the end of each rotation, ask your firm head to sign the section on professional development. This is a
two way process in which student and supervisor discuss whether attendance, punctuality and courtesy to
staff and patients have been satisfactory and if not how this can be remedied.
You must be signed up for each of the Phase 3 skills in order to complete Phase 3 MBBS successfully. At
the end of each rotation you must hand in your Logbook to the Academic Centre. It will be inspected for
satisfactory completion of skills.
Your Firm Head may inspect your Logbook at any time. In addition, random audits of Logbooks take place
throughout the year. Usually a Campus administrator approaches a firm and photocopies a sample of
Logbooks. These are checked – including signatures of staff who have signed up skills. It is a serious
offence to forge a signature (see your Phase 3 Handbook for further details).
You should meet your clinical adviser at least three times during Phase 3. Please ensure that he or she
signs section 4.
In case you lose your Logbook, photocopy and file the relevant signed pages at the end of each
block and keep in a safe place.
27
12 - In-Course Assessment of Clinical Skills: Guidance for Students
Phase 3 In-Course Marking Scheme & Expanded Performance Descriptors
For use by Firm Head / GP Assessor for formative feedback to students
Grade
Exceptional
Outstanding performance
A minority of students only
Good
Student is above the
requirements
Pass
Student has met
requirements
A broad range encompassing
the majority of students
Borderline
History Taking
(including communication skills)
Excellent history taking with some
aspects demonstrated to a very
high level of expertise and no
flaws at all
Descriptors
Clinical Examination
Clinical knowledge
(including mental state exam)
(including clinical reasoning)
Thorough, accurate and
Comprehensive and detailed
comprehensive clinical
knowledge in most topics with no
examination demonstrating
gaps
excellent skills throughout
Professional development
(including contribution to the Firm)
Highest standards of conduct at all
times; highly organized; excellent
attendance and enthusiastic
member of firm
Consistently good history taking
with some aspects demonstrated
to a high level of expertise and
few flaws
Thorough, accurate and
detailed clinical examination
demonstrating good skills
throughout with minimal errors
Detailed and accurate knowledge
in most topics with no significant
gaps
High standards of conduct and
organization at all times;
enthusiastic participation in all firm
activities
Well structured, methodical and
sensitive history taking; no
significant errors or omissions
Comprehensive and proficient
examination with no significant
errors or omissions
Good knowledge of most topics
with depth in some areas, and no
significant gaps
High standards of conduct and
organization most of the time; full
attendance and participation
Adequately structured,
methodical, sensitive; no
important omissions
Able to perform examination
covering all the essential
aspects of case
Satisfactory knowledge with few
gaps
Maintains appropriate standards of
conduct, attendance and
organization at all times
Barely adequate in structure, but
without major errors or omissions.
May improve with effort
Barely adequate examination,
with some errors or omissions.
May improve with effort
Barely adequate level of
knowledge, with several errors or
gaps. May improve with effort
Occasional lapses in conduct or
organization that must be
improved. Must improve with effort
Poor and badly structured history Inadequate examination, with
Inadequate knowledge, with
Clearly below the required
Fail
with
significant
omissions
poor
technique
and
significant
several
significant
errors
or
standards of professional conduct
Student has not met
suggesting
lack
of
practice
errors
or
omissions
omissions
and behaviour
requirements
A minority of students only:
Very poor and incomplete.
Rudimentary examination with
Rudimentary knowledge with
Displays serious lack of
the student should be
Unlikely to be capable of passing
serious errors or omissions.
many serious errors or omissions. professional standards (e.g. rude,
informed how he or she
Unlikely to be capable of
Unlikely to be capable of passing
disorganized). Unlikely to be
this rotation
might improve with effort
passing this rotation
this rotation
capable of passing this rotation
Non-attendance
Insufficient evidence
Insufficient evidence
Insufficient evidence
Seriously inadequate attendance
and participation
Excessive absence not
permitting award of a grade
In an average firm of 8 students, a firm head should rarely award an “Exceptional” grade.
The majority of students should be expected to achieve a “Pass” grade.
Only a small minority of students are likely deserve a “Fail” grade. These, and any whose attendance does not permit a grade to be awarded, should be reported directly to
the Academic Centre and Head of Phase 3.
28
12 - In-Course Assessment of Clinical Skills: Guidance for Students
Name of student:
Rotation Student Grand Rounds
Sign-up criteria
• Students must attend and contribute actively to ALL student grand rounds during the Rotation.
• Students should present at least two cases at student grand rounds in each rotation.
• The tutor in charge of the student grand rounds will award a grade based on these two
presentations (or on the best two if more than two cases are presented).
• Tutors may take into account the complexity of the case presented.
• Tutors will take account of the student’s overall attendance and participation in all student grand
rounds in the Rotation.
• It is the student’s responsibility to ensure that the tutor is fully aware of their attendance and
participation in grand rounds.
Students should consider the following criteria carefully when preparing a grand round
presentation
Tutors may refer to these criteria in awarding grades
1
Presentation skills including clarity, conciseness, and use of visual aids or handouts
2
Description of clinical and pathological features
3
Use of relevant tests and investigations
4
Assessment of principal clinical problems and differential diagnosis
5
Development of management plan
6
Evaluation of associated problems (e.g. ethical or public health issues)
7
Use of clinical sciences and literature review to illustrate case
8
Handling of questions and discussion
9
Reflective elements of this case for the student
In each rotation, students will be awarded one of the following grades by the firm head or grand
round tutor
Grade
Outstanding presentations, demonstrating personal knowledge and
Exceptional
involvement with clinical case and clear understanding of the clinical and
non-clinical issues. Consistently useful contributions to grand round
Outstanding performance
discussions.
At least 2 presentations of good quality.
Personal assessment and knowledge of the cases. Understanding of the
Good
clinical and non-clinical issues
Frequent useful contributions to discussion.
Pass
At least 1 presentation of good quality and one other of adequate quality.
Adequate assessment and knowledge of the cases. Regular useful
Student has met
contributions to discussion.
requirements
Borderline
At least 2 presentations of adequate quality. Acceptable assessment and
knowledge of the cases. Occasional contributions to discussion.
Fail
Student has not met
requirements
Non-attendance
Excessive absence not
permitting award of a grade
Very poor presentations, without evidence of personal effort in clerking
patients and researching background.
Inadequate presence at the grand rounds to be awarded a grade.
The Tutor should enter the grade awarded on the student’s mark sheet
29
12 - In-Course Assessment of Clinical Skills: Guidance for Students
Name of student:
Rotation A: Academic Clinical and Professional Development
Based on attendance, performance and participation in firm activities, courtesy to staff and
patients, punctuality, acceptance of advice and feedback, confidentiality
Mid-rotation Review of Progress:
Satisfactory
Unsatisfactory (if so, why)
Comment on strengths and areas for improvement (For formative assessment see Expanded
Performance Descriptors)
* I have no concerns about this student's fitness to practise
* I have the following concerns about this student's fitness to practise and I have referred this
student to Head of Phase 3 or Senior Clinical Adviser
The matrix on p.28 may be used by the Firm Head to give mid-rotation formative feedback and
encourage improvement.
Firm Head Name …………………………………..……
GMC no …………….
Signature ……..………………………………………….
Date …………………
30
12 - In-Course Assessment of Clinical Skills: Guidance for Students
Name of student:
King’s College London School of Medicine
Phase Three in Course Assessment Mark sheet 2012/13
Name:_______________________________ Student Number:__________
Firm: _______________________________
Rotation: A
Term: 1 / 2 / 3
(please circle as appropriate)
Grand Rounds
FINAL GRADE AWARDED (please sign in ONE BOX ONLY as appropriate):
Grade
Exceptional
Good
Pass
Borderline
Fail
Non-attendance
Signature
Where any grade other then “Pass” is awarded, the reasons should be documented in the section
for Additional Comments. Note that in an average firm of 8 students, a firm head should rarely
award an “Exceptional” grade.
Name (Print):
GMC no./Designation:
Date:
Feedback:
31
12 - In-Course Assessment of Clinical Skills: Guidance for Students
Firm Head
End-of-rotation
FINAL GRADE AWARDED (please sign in ONE BOX ONLY as appropriate):
Grade
Exceptional
Good
Pass
Borderline
Fail
Non-attendance
Signature
Where any grade other then “Pass” is awarded, the reasons should be documented in the section
for Additional Comments. Note that in an average firm of 8 students, a firm head should rarely
award an “Exceptional” grade.
Name (Print):
GMC no./Designation:
Date:
Feedback:
* I have no concerns about this student's fitness to practise
* I have the following concerns about this student's fitness to practise and I have referred this student to
Head of Phase 3 or Senior Clinical Adviser
32
13 – Sign-Ups
ROTATION A: Basic adult medicine and surgery including gastroenterology,
urology, nephrology, endocrinology and related topics
Skills must be signed by an experienced clinician who has been approved by the
firm head
PREPARATION
Name of Student:
Cleanse hands in the clinical environment
See Logbook section 5: Infection control in clinical practice
Importance of hand cleansing in control of cross infection in the ward and clinic
Hand cleansing or washing to be performed before and after each physical examination of procedure
Use of water, soap, nail brush
Use of alcohol gel cleansing agent
Correct technique: palms and dorsal surfaces; each finger individually; finger tips and nails
Correct duration of washing/cleansing
Hand drying if washed in water
Feedback given
I have observed this student display a level of competence appropriate to Phase 3
Signed:
Name(Print)
GMC no./Designation
Date
Feedback comments (recorded by clinician or student):
33
13 – Sign-Ups
Name of student:
Set up a sterile field
Cleanse hands
Collect a dressing trolley and clean with a antiseptic wipe, over all flat edges and legs
Collect all equipment needed and place on the bottom of the trolley
Clean hands with alcohol gel
Put on a disposable plastic apron
Open the outer cover of the sterile dressing pack and slide the contents onto the top shelf of the trolley.
Open the sterile field using an aseptic non-touch technique
Open all of the equipment into the field using a aseptic non touch technique
Open cleaning solution using aseptic non touch technique and pour into receiver
Clean hands with alcohol gel
Put on sterile gloves
Maintain asepsis throughout procedure
I have observed this student display a level of competence appropriate to Phase 3
Signed:
Name(Print)
GMC no./Designation
Date
Feedback comments (recorded by clinician or student):
34
13 – Sign-Ups
Name of student:
Sterile glove technique
Perform hand hygiene before an “aseptic procedure” by handrubbing or hand washing
Check the package for integrity. Open the first non-sterile packaging by peeling it completely off the
heat seal to expose the second sterile wrapper, but without touching it
Place the second sterile package on a clean, dry surface without touching the surface. Open the
package and fold it towards the bottom so as to unfold the paper and keep it open
Using the thumb and index finger of one hand, carefully grasp the folded cuff edge of the glove
Slip the other hand into the glove in a single movement, keeping the folded cuff at the wriest level
Pick up the second glove by sliding the fingers of the gloved hand underneath the cuff of the glove
In a single movement, slip the second glove on to the ungloved hand while avoiding any contact/resting
of the gloved hand on surfaces other than the glove to be donned (contact/resting constitutes a lack of
asepsis and requires a chance of glove)
If necessary, after donning both gloves, adjust the fingers and interdigital spaces until the gloves fit
comfortably
Unfold the cuff of the first gloved hand by gently slipping the fingers of the other hand inside the fold,
making sureto avoid any contact with a surface other than the outer surface of the glove (lack of asepsis
requiring a change of gloves)
The hands are gloved and must touch exclusively sterile devices or the previously disinfected patient’s
body area
Feedback given
I have observed this student display a level of competence appropriate to Phase 3
Signed:
Name(Print)
GMC no./Designation
Date
Feedback comments (recorded by clinician or student):
35
13 – Sign-Ups
Name of student:
Sterile scrub technique and gowning
Removes jewellery, except wedding ring
Dons a theatre cap and mask in theatre
Lays out gown and gloves in aseptic manner
Opens scrub brush before wetting hands
Turns on taps ensuring optimal water temperature
Scrubs with appropriate skin disinfectant
Scrubs from fingertips and washes to elbows, concentrating on glove area
Uses scrubbing brush appropriately
Rinses from fingertips to elbows keeping fingers higher than elbows
Uses elbows to turn off taps
Dries hands
Picks up gown and inserts arms, ensuring outside is not touched
Stands still while assistant fastens gown
Puts on gloves in sterile manner
Keeps hands above waist
Maintains sterility throughout
Feedback given
I have observed this student display a level of competence appropriate to Phase 3
Signed:
Name(Print)
GMC no./Designation
Date
Feedback comments (recorded by clinician or student):
36
13 – Sign-Ups
ASSESSMENT
Name of student:
Interview a patient to elicit a full clinical history (including the history of the presenting complaint)
Cleanses hands
Introduces him/herself to patient
Identifies patient positively (name, date of birth and wrist-band for inpatient; name and date of birth for
outpatient)
Puts patient at ease and establishes rapport
Asks patient to describe presenting complaint in his/her own words
Ensures all presenting symptoms are elicited
Explores and clarifies vague symptoms
For each presenting symptom, asks about:
• mode of onset
• severity, location and other characteristics
• duration and evolution over time
• provoking, exacerbating and relieving factors
Asks about associated symptoms in any system (including psychiatric)
Asks about impact of symptoms on patient’s life
Uses direct questioning to elicit symptoms in other systems (review of systems)
Asks about previous medical (including psychiatric) history and treatment
Asks about medication and allergies
Asks about smoking, alcohol and illicit drugs
Asks about family medical history
Asks about social circumstances
Asks about personal history (including developmental, academic, occupational, psychosexual, forensic)
Obtains collateral history when appropriate (e.g. carer, friend, neighbour)
Uses appropriate language
Appropriate use of questions; open, closed and clarifying
Encourages patient’s questions and deals with them appropriately
Acknowledges patient concerns
Appropriate summary and analysis of history. Use the information obtained from the history to formulate
a differential diagnosis
Record details of the history in the patient’s clinical record
Feedback given
I have observed this student display a level of competence appropriate to Phase 3
Signed:
Name(Print)
GMC no./Designation
Date
Feedback comments (recorded by clinician or student):
37
13 – Sign-Ups
Name of student:
Interview a patient who complains of abdominal pain
Cleanses hands
Introduces him/herself to the patient
Identifies patient positively (name, date of birth and wrist-band for inpatient; name and date of birth for
outpatient)
Establishes rapport with patient
Asks about location of pain
Asks about the onset and duration of pain
Asks about nature of pain
Asks about radiation
Asks about provoking and relieving factors
Asks about associated symptoms i.e. N&V, urinary symptoms, diarrhoea/constipation, rectal bleeding etc
Asks about other common symptoms (review of systems)
Asks about past medical history including previous pain
Asks about family history
Asks about medications and allergies
Asks about smoking and alcohol
Asks about social history
Uses appropriate language
Appropriate use of questions; open, closed and clarifying
Encourages questions from patient and deals with them appropriately
Acknowledges patient’s concerns
Appropriate summary and analysis of history. Use the information obtained from the history to formulate
a differential diagnosis
Record details of the history in the patient’s clinical record
Feedback given
I have observed this student display a level of competence appropriate to Phase 3
Signed:
Name(Print)
GMC no./Designation
Date
Feedback comments (recorded by clinician or student):
38
13 – Sign-Ups
Name of student:
Interview a patient with a urological complaint
Cleanses hands
Introduces him/herself to patient
Identifies patient positively (name, date of birth and wrist-band for inpatient; name and date of birth for
outpatient)
Establishes rapport with patient
Enquires about main complaint
Asks about pain including duration, periodicity, radiation and provoking factors
Asks about prostatic symptoms
Asks about haematuria
Asks about dysuria
Asks about urethral discharge and sexual contacts
Asks about other common symptoms (review of systems)
Asks about previous medical history
Asks about medication and allergies
Asks about family history
Asks about social history and diet
Uses appropriate language
Appropriate use of questions, open, closed and clarifying
Encourages questions from patient and deals with them appropriately
Acknowledges patient’s concerns
Appropriate summary and analysis of history. Use the information obtained from the history to formulate
a differential diagnosis
Record details of the history in the patient’s clinical record
Feedback given
I have observed this student display a level of competence appropriate to Phase 3
Signed:
Name(Print)
GMC no./Designation
Date
Feedback comments (recorded by clinician or student):
39
13 – Sign-Ups
Name of student:
Examine the abdomen
Introduces him/herself to the patient
Identifies patient positively (name, date of birth and wrist-band for inpatient; name and date of birth for
outpatient)
Establishes rapport with patient
Explains examination and gains permission to examine
Ensures adequate privacy for the examination
Cleanse hands with alcohol gel
Positions the patient appropriately and exposes maintaining dignity
Examines the hands
Examines the eyes and mouth
Examines the neck for nodes
Inspects the abdomen
Asks to cough looking for hernias
Asks if anywhere hurts
Palpates generally
Palpates each quadrant systematically
Examines liver, spleen and kidneys appropriately
Feels for aortic swelling
Examines inguinoscrotal areas (see below)
Checks femoral pulse appropriate
Suggests rectal examination
Encourages questions from patient and deals with them appropriately
Acknowledges patient’s concerns
Assists replacing patient’s clothing/bedclothes
Appropriate summary and analysis of findings. Use the information obtained from the examination to
formulate a differential diagnosis
Record details of the examination in the patient’s clinical record
Feedback given
I have observed this student display a level of competence appropriate to Phase 3
Signed:
Name(Print)
GMC no./Designation
Date
Feedback comments (recorded by clinician or student):
40
13 – Sign-Ups
Name of student:
Examine the inguinal region including hernial orifices and lymph nodes
Introduces him/herself to patient
Identifies patient positively (name, date of birth and wrist-band for inpatient; name and date of birth for
outpatient)
Establishes rapport with patient
Explains examination and ensures consent
Cleanse hands with alcohol gel
Positions patient appropriately and exposes, maintaining dignity of patient
Warms hands
Gets patient to cough and looks for hernias
Examines femoral triangle
Examines inguinal canal
Feels for cough impulse in femoral and inguinal hernias
Examines femoral pulses
Restores patient clothing
Encourages questions from patient and deals with them appropriately
Acknowledges patient’s concerns
Assists replacing patient’s clothing/bedclothes
Appropriate summary and analysis of findings. Use the information obtained from the examination to
formulate a differential diagnosis
Cleanse hands with alcohol gel
Record details of the examination in the patient’s clinical record
Feedback given
I have observed this student display a level of competence appropriate to Phase 3
Signed:
Name(Print)
GMC no./Designation
Date
Feedback comments (recorded by clinician or student):
41
13 – Sign-Ups
Name of student:
Examine the male external genitalia
(may be practised on a model)
Introduces him/herself to patient
Identifies patient positively (name, date of birth and wrist-band for inpatient; name and date of birth for
outpatient)
Establishes rapport with patient
Asks permission to examine and explains examination (normally follows examination of the abdomen)
Cleanses hands with alcohol gel. Warm hands.
Inspects patient standing (or lying on the couch): note gynaecomastia and distribution of body hair
Inspects groin and genitalia with patient lying on the couch
Examines skin of penis.
Retracts foreskin and examines glans and external urethral meatus (express discharge)
Examines scrotum: note both testes; and presence of lumps
Palpate each testis, epididymis and vas deferens; and any lumps
Tests for translucency of any lump
Test for cough impulse
Suggests standing to assess for varicocoele or saphenofemoral varix
Palpates inguinal lymph nodes in the inguinal crease
Respects patient’s dignity throughout
Encourages questions from patient and deals with them appropriately
Acknowledges patient’s concerns
Cleanses hands with alcohol gel
Appropriate summary and analysis of findings. Use the information obtained from the examination to
formulate a differential diagnosis
Record details of the examination in the patient’s clinical record
Feedback given
I have observed this student display a level of competence appropriate to Phase 3
Signed:
Name(Print)
GMC no./Designation
Date
Feedback comments (recorded by clinician or student):
42
13 – Sign-Ups
Name of student:
Perform a rectal examination
(should be practised on a model)
Introduces him/herself to patient
Identifies patient positively (name, date of birth and wrist-band for inpatient; name and date of birth for
outpatient)
Explains examination and ensures consent (normally follows examination of the abdomen)
Cleanses hands with alcohol gel. Warm hands; wears gloves
Positions patient appropriately: left lateral position at edge of couch, knees drawn up to chest
Separates buttocks, inspects anus and skin
Asks patient to strain and inspects mucosa
Inserts lubricated finger gently into anus and rectum. Assesses anal tone
Rotates finger to palpate internal surface of anal canal and rectum
Palpates prostate in male (or cervix in female) patient
Notes consistency of faeces
Withdraws finger and inspect for faeces, blood and mucus
Wipes anal area clean of lubricant and faeces
Disposes of gloves and soiled material
Respects patient’s dignity throughout
Encourages questions from patient and deals with them appropriately
Acknowledges patient’s concerns
Cleanses hands with alcohol gel
Appropriate summary and analysis of findings. Use the information obtained from the examination to
formulate a differential diagnosis
Record details of the examination in the patient’s clinical record
Feedback given
I have observed this student display a level of competence appropriate to Phase 3
Signed:
Name(Print)
GMC no./Designation
Date
Feedback comments (recorded by clinician or student):
43
13 – Sign-Ups
Name of student:
Examine the neck
Introduces him/herself to patient
Identifies patient positively (name, date of birth and wrist-band for inpatient; name and date of birth for
outpatient)
Establishes rapport with patient
Asks about relevant symptoms
Asks permission to examine and explains examination
Cleanse hands with alcohol gel
Ensures appropriate position to examine patient
Exposes neck adequately and observes lump
Asks about pain and tenderness
Asks about changes in size of lump
Palpates lump and tests if lump moves on swallowing or protruding tongue
Examines lymph nodes
Assesses tracheal position
Auscultates over lump
Restores patient clothing
Encourages questions from patient and deals with them appropriately
Acknowledges patient’s concerns
Appropriate summary and analysis of findings. Use the information obtained from the examination to
formulate a differential diagnosis
Cleanse hands with alcohol gel
Record details of the examination in the patient’s clinical record
Feedback given
I have observed this student display a level of competence appropriate to Phase 3
Signed:
Name(Print)
GMC no./Designation
Date
Feedback comments (recorded by clinician or student):
44
13 – Sign-Ups
INVESTIGATION
Name of Student:
Perform a BM glucose test
Introduces him/herself to patient
Identifies patient positively (name, date of birth and wrist-band for inpatient; name and date of birth for
outpatient)
Establishes rapport with patient
Explains procedure and ensures consent
Ensures patient is sitting or lying down
Assembles equipment
Inserts strip and calibrates machine appropriately
Chooses an appropriate place for test and ensures warm and well perfused
Cleanse hands with alcohol gel and puts on gloves
Takes autolet and inserts sharply into skin drawing blood
Obtains a hanging drop of blood without undue squeezing of puncture site
Drops blood onto test strip
Waits until machine records a reading
Disposes of sharp safely
Checks haemostasis
Disposes of strip and gloves
Reads correctly and records
Acknowledges patient concerns and deals with questions from patient
Appropriate interpretation of value. Use the information obtained from the test results to formulate a
differential diagnosis
Lists factors which might contribute to an inaccurate recording
Record details of the procedure in the patient’s clinical record
Feedback given
I have observed this student display a level of competence appropriate to Phase 3
Signed:
Name(Print)
GMC no./Designation
Date
Feedback comments (recorded by clinician or student):
45
13 – Sign-Ups
Name of Student:
Test urine and interpret results
Identifies patient positively (name, date of birth and wrist-band for inpatient; name and date of birth for
outpatient)
Givens patient correct instructions to pass mid-stream urine sample
Puts gloves on
Checks container for correct stick and expiry date
Opens container and takes out single stick, closes bottle
Decants urine over lab stick into bowl
Taps off excess urine
Holds strip horizontal until test is complete
Reads stick after appropriate time
Records result
Disposes of stick and gloves
Cleanse hands with alcohol gel
Interprets results appropriately. Use the information obtained from the test results to formulate a
differential diagnosis
Acknowledges need to send urine to laboratory for an MSU
Record details of the procedure in the patient’s clinical record
Feedback given
I have observed this student display a level of competence appropriate to Phase 3
Signed:
Name(Print)
GMC no./Designation
Date
Feedback comments (recorded by clinician or student):
46
13 – Sign-Ups
Name of Student:
Nutrition (BMI)
Introduce him/herself to the patient and identifies the patient positively (name, date of birth and
wristband for in patient: name and date of birth for outpatient)
Familiarise him/herself with nutritional assessment tools utilised by the NHS
Cleanse hands with alcohol gel
Obtains a nutritional history of the patient’s daily dietary intake. Asks about unintentional weight loss or
weight gain in the past 3-6 months
Explore any indicators for clinical concern of nutritional status
Discuss the procedure for assessing a BMI
Position patient correctly in the stadiometer (stand erect, footwear removed, facing away from wall,
heels to wall, head such that external auditory meatus is on same horizontal as lateral canthus)
Move reading arm of stadiometer to touch patients head firmly
Read and record height correctly
For weighing, check patient in indoor clothing and footwear removed
Check balance (steelyard type not bathroom scales)correctly zeroed
With patient on platform, adjust weight to achieve balance
Read and record weight
calculate BMI score
Explains the results of the BMI to the patient and provide advice on nutritional intake, exercise and
support as appropriate
Feedback given
I have observed this student display a level of competence appropriate to Phase 3
Signed:
Name(Print)
GMC no./Designation
Date
Feedback comments (recorded by clinician or student):
47
13 – Sign-Ups
Name of Student:
Examine a plain abdominal x-ray in the adult
Use of plain abdominal X-ray as extension of the examination of abdomen
Identify patient: name, date of birth, hospital number, date of X-ray
Position of patient: straight or rotated?
Bony skeleton: identify and check integrity of components of skeleton in abdomen and pelvis
Identification of major structures and organs
Presence of air or fluid levels in the hollow viscera
Presence of air under the diaphragm
Presence of calcification of soft tissues, e.g. aorta.
Record details of the examination in the patient’s clinical record. Use the information obtained to
formulate a differential diagnosis
Feedback given
I have observed this student display a level of competence appropriate to Phase 3
Signed:
Name(Print)
GMC no./Designation
Date
Feedback comments (recorded by clinician or student):
48
13 – Sign-Ups
Name of Student:
Interpretation of clinical chemistry test results
Choosing clinical chemistry tests and investigations in adult patient
Identify patient: name, date of birth, hospital number, date of tests
Making use of reference ranges to interpret test results
Interpretation of routine tests e.g. urea and electrolytes; cardiac enzymes; liver function tests.
Interpretation of endocrinological tests e.g. thyroid function tests; glucose and HbA1c
Interpretation of metabolic tests (e.g. cholesterol and triglycerides; calcium, phosphate, alkaline
phosphatase)
Interpretation of immunological tests: immunoglobulins; etc
Record details of the test results in the patient’s clinical record. Use the information obtained to
formulate a differential diagnosis
Feedback given
I have observed this student display a level of competence appropriate to Phase 3
Signed:
Name(Print)
GMC no./Designation
Date
Feedback comments (recorded by clinician or student):
49
13 – Sign-Ups
TREATMENT
Name of Student:
Checking patients’ prescription charts
Identifies patient positively (name, date of birth, hospital number)
Allergies stated (allergies to be written in red ink)
Correct drug name
Correct dosage
Correct route e.g. oral/i-v/i-m/rectal
Drugs written in correct area of drug chart
Correct frequency and timing of dosage
Duration of treatment stated if required
Name and signature of prescriber
Date of signing
Aware of different prescription charts used in different settings e.g. Inpatient, inpatient TTO, outpatient
(HP10), GP/community (FP10).
Feedback given
I have observed this student display a level of competence appropriate to Phase 3
Signed:
Name(Print)
GMC no./Designation
Date
Feedback comments (recorded by clinician or student):
50
13 – Sign-Ups
Name of Student:
Complete a replica inpatient prescription chart (downloaded from the Virtual Campus)
(only to be completed after “checking patients’ prescription charts” skill signed off)
Phase 3 students are not expected to be familiar with prescribing for children nor prescribing a controlled
drug
Read “How to write a prescription chart” on the VC (download a sample chart for practice)
http://virtualcampus.kcl.ac.uk/vc/medicine/coursebooks/coursebooks.aspx?course=year3
Be familiar with the British National Formulary (BNF)
Write all entries legibly
Sign all entries correctly (full signature, not initials, and print name)
Identify patient positively (name, date of birth, hospital number, address). Use a patient sticker if
available
State location of patient (ward, unit, etc)
Write consultant details including hospital code as appropriate
Identify self fully (name, medical student)
Date new chart started (dd/mm/yyyy)
Allergies: identify and list all allergies and drug reactions (allergies to be written in red ink). Sign and
date entry. Amend if new reaction occurs
Prescribe each medication according to BNF guidance:
Print drug name
Correct dosage (patient’s age, pregnancy, hepatic and renal function)
Correct route (oral/i-v/i-m/s-c/rectal/inh)
Correct frequency and timing of doses
Duration of treatment (esp. for antibiotics)
Sign (and print name) and date (dd/mm/yyyy)
Complete once only (“stat”) medication section
Complete regular medication section
Complete as required (“PRN”) medication section
Complete oxygen administration section
Check all entries written in correct area of prescription chart
Aware of different prescription charts used in different settings e.g. Inpatient, inpatient TTO, outpatient
(HP10), GP/community (FP10)
Feedback given
I have observed this student display a level of competence appropriate to Phase 3
Signed:
Name(Print)
GMC no./Designation
Date
Feedback comments (recorded by clinician or student):
51
13 – Sign-Ups
Name of Student:
Administer a subcutaneous injection
e.g. Insulin
Introduces him/herself to patient
Identifies patient positively (name, date of birth and wrist-band for inpatient; name and date of birth
for outpatient)
Establishes rapport with patient
Explains procedure and ensures consent
Checks patient details against prescription chart
Checks for allergies on prescription chart & with patient
Checks drug prescription on chart
Cleanse hands with alcohol gel
Puts on fresh gloves
Checks ampoule contains correct drug & correct concentration
Checks drug expiry date
Assembles appropriate equipment
Checks any specialist syringe used matches concentration of drug (if appropriate)
Decontaminates surface of multi-dose vial with alcohol (if appropriate)
Draws up correct dose
Cross-checks drug dose with staff
Changes needle to subcutaneous needle (if appropriate)
Selects appropriate site for injection
Decontaminates site with alcohol
Inserts needle subcutaneously & injects at appropriate speed
Safely disposes of sharps
Records drug administration on prescription chart
Acknowledges patient concerns and deals appropriately with questions/concerns
Record details of the procedure in the patient’s clinical record
Feedback given
I have observed this student display a level of competence appropriate to Phase 3
Signed:
Name(Print)
GMC no./Designation
Date
Feedback comments (recorded by clinician or student):
52
13 – Sign-Ups
Name of Student:
Insert a urinary catheter into a male patient (breakdown of the skill)
Confirms patients identity, explains the procedure and obtains verbal consent (remember to check for
any allergies i.e. latex, local anaesthetic)
Collect equipment and place on the bottom of a clean trolley
Catheter pack
Appropriate size catheter
Syringe for balloon inflation
Water for injection for balloon inflation
Cleaning solution
Local anaesthetic gel (11mls)
Clinical waste bag
Sterile Gloves x2
Catheter bag
Wash Hands and put on a disposable apron
Open catheter pack using sterile technique. Carefully open onto the sterile field the supplementary
equipment
Open the syringe from package and remove carefully, only touching the handle-end of the syringe.
Twist the cap off the water for injections and draw up volume according to manufactures instructions.
lay syringe on the side of sterile field with the handle-end positioned off the sterile field as this part is
now un-sterile
Correct positioning of patient and expose the patient, maintaining privacy and dignity
Cleanse hands with alcohol gel and apply gloves (or double gloves)
Lay sterile drape over the patient so genitalia are exposed
Holding the penis upright with a gauze swab cleanse penis from urethral
meatus down the shaft. Only cleaning in one direction. Retract foreskin if present when cleaning
Insert all the local anaesthetic gel into the meatus. Wait 3-5 minutes
Remove outer pair of gloves carefully or change gloves, decontaminating hands
Position kidney dish/tray between the patients thighs to catch any spillages
Remove tip of plastic wrapper around the catheter. Hold the penis upright with a sterile gauze swab,
insert catheter tip into the urethral meatus, advance slowly feeding the catheter out of the remaining
paper
Negotiate the prostatic bend. On entering the bladder urine should start to drain. Advance the catheter
fully to ensure the balloon is in the bladder
Inflate balloon with correct volume of water for injection via the catheter port. If patient experiences any
pain then stop
Once the balloon is inflated gently withdraw catheter until resistance is felt. Do Not Pull on the catheter
Attach sterile drainage system (catheter bag)
Reposition foreskin to prevent paraphimosis
Clean and redress patient as necessary. Address any concerns
Clean up, removes gloves and apron and put all waste in clinical waste bin. Wash hands
Record in the patients notes; Date and Time, reason for catheter, size and make of catheter, batch No,
Balloon size, residual urinary volume and sign
Feedback given
I have observed this student display a level of competence appropriate to Phase 3
Signed:
Name(Print)
GMC no./Designation
Date
Feedback comments (recorded by clinician or student):
53
13 – Sign-Ups
Name of Student:
ROTATION A ON CALL SHIFTS
You must spend at least one on call shift with
a junior or other suitable doctor during this
rotation.
Participating in more than one shift may be
taken as evidence of your motivation and
commitment to learn when your in-course
assessment marks are being considered.
Practice observed by:
Name(Print):
GMC no./Designation
Date
Practice observed by:
Name(Print):
GMC no./Designation
Date
Practice observed by:
Name(Print):
GMC no./Designation
Date
54
13 – Sign-Ups
Name of Student:
Rotation A Scenario - record of completion
Students should attend all Scenario teaching sessions where provided.
PLEASE ATTACH YOUR PRINTED CONFIRMATION OF COMPLETION BELOW
_____________________________________________________________________________________
Rotation A Online Firm Feedback confirmation
Shortly before the end of your clinical rotation you will receive an email asking you to complete an online
feedback form for your firm.
THE ONLINE FIRM FEEDBACK IS MANDATORY
PLEASE ATTACH YOUR PRINTED CONFIRMATION OF COMPLETION BELOW
_____________________________________________________________________________________
55
13 – Sign-Ups
Name of Student:
Feedback Training Workshop – record of completion
Students must attend a Feedback Training Workshop during Phase 3.
PLEASE ATTACH YOUR SIGNED PRINTED CONFIRMATION OF COMPLETION BELOW
_____________________________________________________________________________________
56
14 – Additional Mandatory Experiences
Name of Student:
Basic Life Support Session
At the start of Phase 3 you will be required to attend a Basic Life Support session either in the 2nd
introductory week on your allocated site, or in the first few weeks of your rotation. This is compulsory.
Record of attendance
Please ensure you complete the below after your session
Date and Venue
Student
Sign
Print
Pathology and Therapeutics
Attendance at Post-Mortems
You must attend at least one post-mortem examination at any time during the year. Please enter the
details below:
Date:
Hospital:
Rotation:
Indication for PM:
Hospital:
Rotation:
Indication for PM:
Brief findings:
Date:
Brief findings:
Shadow a Ward Pharmacist
You should ask a Ward Pharmacist if you may shadow him/her for a ward round in order to view drug
charts and discuss issues of prescription writing. This must be done at least once at any time during the
year.
Date:
Hospital:
Ward:
Rotation:
Name of Pharmacist:
57
14 – Additional Mandatory Experiences
Name of Student:
Visit a Pathology Laboratory
Offer to take one or more urgent samples to the Pathology laboratories and note the laboratory procedures
for in-hours and out-of-hours urgent & non-urgent sample collection and submission. It may be possible for
you to visit the laboratories, please contact one of the local Pathologists. This must be done at least once
at any time during the year.
Date:
Hospital:
Laboratory
Rotation:
Type(s) of sample:
Gordon Museum visit
You are required to visit the Gordon Museum at least once during each rotation in Phase 3 to study the
pathological specimens relevant to the rotation.
Signed by Gordon Museum staff:
Print name:
Date:
Rotation/s visited:
58
14 – Additional Mandatory Experiences
Name of Student:
Interprofessional Learning in Practice (ILP)
As part of your clinical experience in Phase 3 you may be invited to participate in an interprofessional
learning seminar.
Health care students that are based in the Trust are invited to attend. The seminar will be patient focused
and will involve either talking with a patient about their experiences or working with a patient in the clinical
area. As far as possible the patients’ health care needs will be related to the rotation you are in.
Students will discuss their differing responsibilities and perspectives of the patient and thereby learn more
about each other’s roles and responsibilities.
If you are included you will be notified and provided with preparatory information. You will be expected to
join the other students in attending the session. Time spent will count towards your professional
development and you will receive a certificate of attendance. You will be expected to reflect upon what you
have learnt from the session and record your reflections on the certificate of attendance.
The GMC places great importance on interprofessional learning. If you are requested to attend you should
do so.
Record of attendance
Please ensure that the facilitator verifies your participation in this exercise
Date and Venue
Facilitator
Sign
Print
Ethics Report
For your second meeting with your clinical adviser towards the end of your first rotation, you are required to
submit to your clinical adviser, in advance, a reflective account of some aspect of clinical practice which
you found interesting. The reflective account should be typed, and about 800 words in length. You should
briefly describe the clinical situation (keep the names of patients and staff anonymous).
You should then reflect on the practice you encountered, identifying those aspects that you found
interesting and why you found it so. You should draw upon the relevant literature, in particular the GMC's
Good Medical Practice. Your reflective practice account will form part of the discussion with your clinical
adviser. Clinical adviser will forward to the Head of Year and the Senior Adviser in Medical Ethics those
accounts that they consider worthy of a prize.
59
14 – Additional Mandatory Experiences
Name of Student:
Patient Educator Sessions
You must attend at least one patient educator session during the year.
If you sign up online for a patient educator session you must attend that session.
On completion of the session the student will have:
Practised a complete physical examination of the system stated below using the appropriate
guide/checklist
Demonstrated patient-centred communication skills in an integrated fashion before, during and after the
examination
Received and responded appropriately to feedback and related this to personal learning needs.
NB. Failure to attend a session you have signed up for may be regarded as unprofessional
conduct and lead to reprimand by the head of Phase 3.
System:
Patient Educator:
Name ……………………………………………….…
Signature ……..………………………………………………………………Date …………………..
System:
Patient Educator:
Name ……………………………………………….…
Signature ……..………………………………………………………………Date …………………..
System:
Patient Educator:
Name ……………………………………………….…
Signature ……..………………………………………………………………Date …………………..
60
15 – Patients Clerked
Name of Student:
At least 2 patients must be clerked and examined fully (i.e. all systems) and recorded in the
Logbook each week
Patient information should be anonymized
Anonymized
Patient
Identifier
Brief Clinical
Summary
Dates Seen
Further involvement
Reflection
(tick box)
□
□
□
□
□
□
□
□
□
□
□
□
□
□
□
□
□
□
□
□
□
□
□
□
□
61
15 – Patients Clerked
Anonymized
Patient
Identifier
Brief Clinical
Summary
Dates Seen
Further involvement
Reflection
(tick box)
□
□
□
□
□
□
□
□
□
□
□
□
□
□
□
Notes
62
16 – Phase 3 Core Patient Cases
The core cases and procedures form the basis of adult clinical medicine encountered in Phase 3. You
should try to clerk patients with each of these conditions or undergoing the named procedures in order
to build up your clinical knowledge and skills. You should observe the management of the emergencies
and the performance of clinical procedures – you will see some of these only on acute “take” or during
your on-call shifts. Whenever you have clerked a patient with one of these conditions, or observed a
procedure, you should read about it so that you understand it fully. You must also attend post-mortem
examinations regularly throughout the year.
In the Phase 3 student Handbook, you will see that many of these cases are linked to weekly topic
teaching on the firms. It is your responsibility to ensure that you see and clerk these patients.
By the end of Phase 3, you should be able to understand the basic science and pathology underlying
these conditions, their diagnosis and their management. You should also understand their social and
psychological impact on the patients, their implications for public health, and any ethical issues they
raise for the patient, the doctor or society at large.
Level of knowledge expected (see Miller’s hierarchy of clinical competence)
1. Knows of: you should have some knowledge of all the cases and their associated procedures listed
here. In Phase 3 you should be able to state the main clinical features of each case, and know the
indications for the procedures listed.
2. Knows about or how to: you should be able to describe the presentation or procedure, be able to
use clinical information to build up a differential diagnosis, and be able to present this to a member
of staff. In Phase 3 you should observe procedures so that you are able to describe them in detail
(e.g. ECT or bronchoscopy) and others in outline only (e.g. echocardiography, psychosurgery).
You should be able to explain diagnoses and their treatments (medical, surgical or psychological)
to a patient.
3. Shows how to: you should be able to perform the procedure or manage the condition. In Phase 3
you should be able to perform those procedures (skills) listed in your Logbook and use them to
diagnose and manage common conditions.
Differential diagnosis
You must apply clinical reasoning to clinical information from the patient’s history or examination,
pathological information from tests and investigations, and collateral information from the patient’s
carers or family in order to formulate a differential diagnosis Both positive and negative findings must
be considered. The following schema may assist in organizing information to arrive at a differential
diagnosis.
Clinical, pathological or collateral information
Differential
diagnoses
Supporting this
diagnosis
Neither supporting nor opposing
this diagnosis
Opposing this
diagnosis
Diagnosis 1
Probable/most likely
Diagnosis 2
Possible/less likely
Diagnosis 3
Improbable/least
likely
63
16 – Phase 3 Core Patient Cases
RESPIRATORY TOPICS
Emergencies
Acute respiratory failure
Acute asthma
Acute pulmonary oedema
Pulmonary embolism
Procedures / operations
Aspiration of pleural effusion
Blood gas estimation
Bronchoscopy
Chest drain
CT Scan
Respiratory function testing
Smoking cessation advice
Ultrasound
Ventilation-perfusion tests
Cases
Acute exacerbation of COPD
AIDS
Asthma
Atopy
Bronchiectasis
Bronchitis
Carcinoma of the bronchus
COPD
Cough
Cystic fibrosis
Emphysema
Fibrosing alveolitis
Hay-fever
Infection in the immuno-compromised patient
Lung abscess
Pleural effusion
Pneumonia
Pneumothorax
Pulmonary secondaries
Sleep disorders
Tuberculosis
Coronary arteriography
Doppler
ECG
Echocardiography
Exercise testing
GTN spray
Insertion of a CVP line
MRI Scan
Rehabilitation post-CABG or MI
Resuscitation (basic life support/CPR)
Thoracotomy
Valve replacement
Cases
Aneurysms: aortic / popliteal / other
Angina
Arrhythmias
Arterio-venous fistulae, congenital
abnormalities & trauma
Arteritis, Buerger’s disease
Atheroma
Blue, gangrenous or dead leg
Cardiomyopathy
Congestive cardiac failure
Cor pulmonale
Deep vein thrombosis
Embolism
Heart block
Hypertension
Left and right heart failure
Painful, swollen or paralysed leg
Pericardial disorders
Post myocardial infarction
Post-phlebitic limb
Raynaud’s / vasospasm
Thrombosis
Varicose veins
Venous ulcers
CARDIAC AND VASCULAR TOPICS
Emergencies
Anaphylaxis
Arrhythmias
Cardiac arrest
Cellulitis
Endocarditis
Haemorrhage
Malignant (accelerated) hypertension
Myocardial infarction
Shock (cardiogenic / hypovolaemic)
Unstable angina
Procedures / operations
Amputation
Angiography
CABG
Cardioversion
GENERAL MEDICAL AND MULTI-SYSTEM
TOPICS
Emergencies
Alcohol related emergencies (intoxication,
delirium tremens, hepatitis, rum fits)
Drugs overdose
Septicaemia
Sickle cell crisis
Procedures / operations
Gastric lavage
Haematological tests
Incision and drainage of abscess
Local anaesthesia
Muscle relaxants
Pain relief / analgesia
Cases
Alcohol related problems
64
16 – Phase 3 Core Patient Cases
Anaemias (iron, B12, folate, chronic disease)
Arthritides (including osteoarthritis)
Carcinomas (prostate, breast etc.)
Carcinomatosis
Chest wall problems
Clotting disorders
Gout
Leukaemias
Lymphomas
Rheumatoid and seronegative arthropathies
Vasculitic and granulomatous disorders (SLE,
giant cell arteritis, Wegener’s)
Oesophageal stricture
Peptic ulcer disease
Reflux oesophagitis
GENERAL SURGICAL TOPICS
Emergencies
Abdominal sepsis
Abdominal trauma
Acutely ill surgical patient
Ruptured abdominal viscus
Procedures / operations
General anaesthesia
Pre-operative preparation
Post-operative management (pain / analgesia /
fluid balance)
Suturing
Wound healing
Cases
Hernia
- inguinal
- femoral
- incisional
- umbilical
Lumps, bumps and abscesses
LOWER GASTROINTESTINAL TOPICS
Emergencies
Abdominal ultrasound
Acute appendicitis
Acute diverticulitis
Acute inflammatory bowel disease
Large bowel obstruction
Peritonitis
Rectal bleeding
Procedures / operations
Appendicectomy
Barium enema
Colectomy
Colonoscopy
Formation of a stoma
Proctoscopy
Sigmoidoscopy
Cases
Anal problems
- haemorrhoids
- abscess
- fissure
- fistula
Carcinoma of the colon
Constipation
Diarrhoea
Diverticular disease
Inflammatory bowel disease
Stomas
UPPER GASTROINTESTINAL TOPICS
Emergencies
Acute gastritis
Exacerbation of peptic ulcer
GI Haemorrhage / haematemesis
Small bowel obstruction
Procedures / operation
Abdominal ultrasound
Barium meal
Gastroscopy
Emergency endoscopy
Cases
Achalasia
Carcinoma of the oesophagus
Carcinoma of the stomach
Cirrhosis
Dysphagia
Hepatitis
Hiatus hernia
Malabsorption
Nausea
Oesophageal motility disorders
HEPATO-PANCREATO-BILIARY TOPICS
Emergencies
Acute cholecystitis / biliary colic
Acute pancreatitis
Hepatic encephalopathy
Procedures / operations
CT scan
ERCP
HIDA scan
Laparoscopic cholecystectomy
MRI scan
Ultrasound
Cases
Carcinoma of the pancreas
Cholecystitis
Chronic pancreatitis
Cirrhosis
Gallstones and complications
Hepatitis
Liver tumours
Obstructive jaundice
Portal hypertension
65
16 – Phase 3 Core Patient Cases
RENAL / UROGENITAL TOPICS
Emergencies
Acute electrolyte disturbances
Acute renal failure
Acute retention of urine
Torsion of testis
Ureteric colic
Urinary tract infection
Procedures / operations
Catheterisation (male and female)
Cystoscopy
Haemodialysis
Hernia repair
Intravenous urogram
Isotope scanning
Nephrectomy
Peritoneal dialysis
Prostate radiology (U/S)
Renal transplantation
Renal ultrasound
TURP
Urinalysis
Urodynamics
Cases
Bladder tumours
Carcinoma of the kidney
Carcinoma of the prostate
Chronic renal failure
Chronic retention
Epididymal cyst
Haematuria
Hydrocele
Hydronephrosis
Nephritis
Nephrotic syndrome
Polycystic disease of kidneys
Prostatic hypertrophy
Renal and ureteric stones
ENDOCRINE / METABOLIC TOPICS
Emergencies
Acute hypoglycaemia
Addisonian crisis
Hyperglycaemic coma
Procedures / operations
Blood glucose estimation
Glucose tolerance test
Nuclear medicine and ultrasound
Thyroidectomy
Cases
Cushing’s syndrome
Diabetes mellitus (types 1 and 2, and
complications)
Hypercholesterolaemia
Hyperparathyroidism
Hyperthyroidism
Hypothyroidism
Lumps in the neck
Metabolic bone disorders (Paget’s,
osteomalacia, osteoporosis)
Parathyroid disease
Pituitary disorders
Salivary gland disorders
NEUROLOGICAL TOPICS
Emergencies
Cerebrovascular accidents (including cerebral
infarction)
Coma
Head injury
Meningitis, encephalitis & brain abscess
Raised intracranial pressure
Status epilepticus
Subarachnoid haemorrhage
Subdural haemorrhage
Transient ischaemic attacks
Procedures / operations
EEG / evoked potentials
EMG
Evoked potentials
MRI
PET
Cases
Blackouts
Brain tumours
Epilepsies
Headache, migraine, facial pain
Infections of the nervous system
Inflammatory diseases of the nervous system
Limb sensorimotor dysfunction
Movement disorders incl. gait and tremor
Multiple sclerosis
Neuropathies
Parkinson’s
Wilson’s
PATHOLOGY TOPICS
Procedures
Description of pathological specimens (“pots”)
Chemical pathology investigation
Haematology investigation
Histopathology investigation
Microbiology investigation
Post mortem examination
Cases
Pathological basis of core cases
See separate Pathology course handbook
PSYCHIATRIC TOPICS
Emergencies
Acute brain syndromes (delirium)
66
16 – Phase 3 Core Patient Cases
Attempted suicide / suicidal intent
Deliberate self harm
Drug overdose
Mania
Serotonergic syndrome
Neuroleptic malignant syndrome (malignant
hyperthermia)
Violent behaviour
Procedures / operations
Cognitive state examination (including simple
screening tests such as Mini-mental state
examination, Abbreviated mental test score)
Depot injection
ECT
Mental capacity act
Mental health act (“Sections”)
Psychosurgery
Cases
Acute and transient psychoses
Adjustment disorders
Alcohol misuse / dependence
Amnesic syndromes
Anxiety (including generalized anxiety disorder)
Asperger’s syndrome
Autistic spectrum disorders
Bipolar disorders (including cyclothymia)
Chronic brain syndromes and cognitive
impairment (dementias)
Delirium
Delusional disorders
Dementias (Alzheimer’s, Creutzfeldt-Jakob,
Lewy body and vascular)
Depressive disorders (including dysthymia)
Developmental disorders and learning
difficulties
Dissociative disorders
Drug misuse disorders
Eating disorders
Habit and impulse disorders
Insomnia
Neuroleptic-related syndromes (akathisia,
parkinsonism, tardive dyskinaesia, metabolic
syndrome, cardiac dysrhythmias)
Obsessive-compulsive disorder
Panic disorder
Personality disorders
Phobic anxiety
Post-traumatic stress disorder (PTSD)
Psychosexual dysfunction (including gender
identity)
Schizophrenia
Sleep disturbance
Somatoform disorders (somatization,
hypochondriacal disorder)
OPHTHALMOLOGICAL TOPICS
Emergencies
Acute glaucoma
Acute red eye
Eye trauma (including foreign body)
Retinal detachment
Sudden loss of vision
Procedures / operations
Electroretinogram
Eye drops / ointment
Fundoscopy
Slit lamp examination
Visual evoked potentials
Cases
Cataract
Glaucoma
Gradual loss of vision
Ptosis
Sticky eye
Unequal pupils
Visual disturbance (including diplopia)
OTOLARYNGOLOGICAL TOPICS
Emergencies
Acute severe throat infection
Otitis media
Procedures / operations
Auditory evoked potentials
Otoscopy
Tympanometry
Cases
Dizziness and vertigo
Dysphagia
Epistaxis
Facial pain (see also Neurology)
Hearing loss
Hoarseness and voice change
Lump in the neck
Nasal obstruction
Otalgia
Otorrhoea
Vertigo
THERAPEUTICS TOPICS
Emergencies
Acute poisoning
Drug allergy
Drug interactions
Drug sensitivity
Procedures / operations
Prescription checking
Prescription writing
Use of the British National Formulary
Cases
Clinical pharmacology and therapeutics of core
cases
See separate Therapeutics course handbook
67
17 – Integrated Skills List
To progress to Phase 4, students must be competent in the skills indicated from 1 – 3:
Skills Practice Available denotes which skills can be practiced outside of normal teaching.
The key is as follows
IL - Independent Learning
C – Curriculum teaching
SU – Sign up skills
PT - Peer teaching
PE - Patient Educator teaching
Further information on the availability of those sessions relevant to your year will be forwarded to you
throughout the year.
Please note – This list is not exhaustive. The skills may change during the medical course and it is your
responsibility to keep up to date with these changes.
Integrated Skills List
1. Fundamental skills
1.1 Numeracy
1.2 Presentation - Oral
1.3 Presentation - Poster
1.4 Professional Development
1.4.1 Courtesy to staff and patients
1.4.2 Punctuality
1.4.3 Accepting advice from tutors
1.4.4 Obtaining consent from patient
1.4.5 Confidentiality: Respect and protect patient
information
1.4.6 Know about, understand and respect the roles and
expertise of other healthcare professionals
1.5 Communicate with patients
1.6 Take and record a patients history, including their family
history
1.6.1 Introduce yourself to patient
1.6.2 Put a patient at ease and build rapport
1.6.3 Ask about activities of daily living
1.6.4 Elicit a patient's concerns, ideas and expectations
1.6.5 Check a patient's understanding
1.6.6 Make a problem list after clerking a patient
1.6.7 Gather information from notes and other sources
1.6.8 Write a distillation of problems
1.6.9 Present a clinical history to tutor
1.7 Perform a full physical examination and a mental state
examination
1.8 Participate as a member of the healthcare team
1.9 Document clinical details in patient notes
1.10 Handwashing and infection control
2. Communication skills
2.1 Adapt history taking to specialty inc. psychiatry,
gynaecology, urology, dermatology, musculo-skeletal
Year
Introduced
Year first
signed-up
or tested
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
3
2
2
1
1
1
2
2
3
3
3
3
2
2
2
2
2
2
3
3
3
3
3
3
3
1
3
5
5
2
3
3
Skills
Practice
available
C, IL
68
17 – Integrated Skills List
Integrated Skills List
2.2 Present clinical cases at grand rounds
2.3 Take a drug history e.g. aetiology of skin rashes
2.4 Discuss information with patient and relative e.g. child and
parents
2.5 Give health advice on relevant lifestyle/risks e.g. smoking,
sun
2.6 Take a history from third party e.g. parent/child; carer/elderly
2.7 Explain a common complaint to a child
2.8 Take a history from a patient with a serious illness as in A&E
2.9 Make a genogram from a patient with significant genetic
history
2.10 Make a management plan for a patient
2.11 Communicate effectively with a person from a different
culture
2.12 Present findings, conclusions and management plans to a
professional
2.13 Record concise and accurate history in patients' notes
3. Assessment of special groups of patients
3.1 Take a history from a patient with chest pain
3.2 Take a history from a patient with breathlessness
3.3 Take a history from a patient with abdominal pain
3.4 Take a history from a patient with depression
3.5 Assess the mental state and cognition of an adult
3.6 Assess psychotic symptoms (delusions & hallucinations)
3.7 Assess alcohol intake (AUDIT)
3.8 Assess a suicidal patient
3.9 Make a preoperative anaesthetic assessment
3.10 Assess the mental state of an older patient
3.11 Observe the assessment of an unconscious patient
3.12 Observe the assessment of a patient requiring pain relief
3.13 Assess a newborn baby including screening
3.14 Assess an infant/child to include growth and development
3.15 Assess a pregnant woman
3.16 Assess a patient with limb trauma
4. Clinical examination skills
4.1 Take a temperature, radial pulse and respirations
4.2 Hand washing and infection control
4.3 Mental state of an adult
4.4 Superficial masses in neck and other parts of the body
4.5 Examine a superficial mass
4.6 Cardiovascular system including pulses
4.7 Respiratory system
4.8 Abdomen including the ano-rectum
4.9 Inguino-scrotal region
4.10 Neurology in the limbs (including gait)
4.11 Cranial nerves
4.12 Cerebellar function to include gait and co-ordination
4.13 Female breast
Year
Introduced
3
3
Year first
signed-up
or tested
3
3
3
4
3
3
4
4
4
3
4
4
4
3
4
5
3
5
3
3
5
5
3
3
3
3
3
3
3
3
3
3
3
3
4
4
4
4
3
3
3
3
3
3
3
3
4
4
4
4
4
4
4
4
1
1
3
3
3
3
3
3
3
3
3
3
3
1
1
3
3
3
3
3
3
3
3
3
3
4
Skills
Practice
available
C
C
C
IL
C,IL, PT
C,IL
C,IL
C,IL
C,IL
IL
C,IL
IL
69
17 – Integrated Skills List
Integrated Skills List
4.14 Female pelvis
4.15 The skin
4.16 Locomotion to include mobility, limbs and back
4.17 Examine the musculo-skeletal system of the limbs in an
adult (GAL) system, inc back, neck, hip, knee, ankle, foot,
shoulder, elbow, hand
5. Examination using instruments
5.1 Measurement of blood pressure
5.2 The eye using an ophthalmoscope
5.3 The ear using an auriscope
5.4 Uterine cervix using Cusco speculum, take cervical smear
and endocervical swab
5.5 Doppler index of foot pulses
6. Procedures to observe and explain: Imaging
6.1 CT scan
6.2 MRI scan
6.3 Lumbar puncture
6.4 Ultrasound including abdomen and pelvis
6.5 Angiography
6.6 IVU
6.7 Radionuclide scanning
7. Procedures to observe & explain: diagnostic procedures
7.1 Abdominal paracentesis
7.2 Spirometry and other respiratory function
7.3 Echocardiography/angiography
7.4 Barium enema
7.5 Gastroscopy and endoscopy of upper gastrointestinal tract
7.6 Colonoscopy
7.7 Sigmoidoscopy
7.8 Bronchoscopy
7.9 Cystoscopy
7.10 Pleural aspiration
7.11 Joint aspiration
7.12 Suprapubic catheterisation
7.13 Observe V/C Scan
7.14 Barium meal
7.15 Exercise ECG
7.16 Venography
7.17 Laparoscopy
7.18 Insertion of an arterial line
7.19 Fine needle aspiration of breast
7.20 Pre-natal testing e.g. amniocentesis
7.21 Observe calibration of a CVP monitor and interpretation of
results
7.22 Arterial blood gas measurement
8. Practical skills 1: Basic skills
8.1 Take a venous blood sample
8.2 Perform sterile scrub technique and gown up
Year
Introduced
3
3
4
Year first
signed-up
or tested
4
4
4
Skills
Practice
available
4
4
1
3
3
1
3
3
C,IL, PT
IL
IL
4
3
4
5
IL
IL
3
3
3
3
3
3
3
5
5
3
3
3
3
3
3
3
3
3
3
4
3
3
3
3
3
3
3
4
4
5
5
5
5
5
5
5
5
5
5
5
5
4
5
3
3
3
3
SU, IL
IL
70
17 – Integrated Skills List
Integrated Skills List
8.3 Perform pulse oximetry
8.4 Perform a rectal examination
9. Practical skills 2: Resuscitation skills
9.1 Basic life support for an adult (CPR)
9.2 Ventilation of an apnoeic patient using bag valve and mask
9.3 Insert a laryngeal mask airway
9.4 Advanced life support: demonstrate understanding of
algorithms
9.5 Defibrillator: demonstrate use of
9.6 Resuscitation: Intermediate Life Skills certification
9.7 Endotracheal intubation: Observe
9.8 Basic Life support for a child
10. Practical skills 3: Investigation skills
10.1 Take a peak flow measurement
10.2 Perform a stick test for glucose-BM test
10.3 Perform a dip-stick test on a mid stream urine specimen
10.4 Examine and interpret x-rays inc chest x-ray, abdominal xray
10.5 Interpret clinical laboratory test results e.g. virology,
microbiology
10.6 Take swabs for microbiology: a) wound b) throat c) skin
10.7 Take blood for culture
10.8 Perform joint aspiration
10.9 Perform femoral venepuncture
10.10 Observe lumbar puncture
10.11 Observe chest aspiration
10.12 Perform urine pregnancy test
10.13 Observe a arterial blood gas sample on a manikin
11. Treatment procedures
11.1 Observe a liver/renal biopsy
11.2 Observe CVP line insertion
11.3 Observe haemodialysis
11.4 Observe insertion of chest drain
11.5 Life support systems i.e. IPPV
12. Medication administration
12.1 Use of inhaler
12.2 Suppository/pessary insertion
12.3a Prepare and administer a subcutaneous injection
12.3b Prepare and administer a intramuscular injection
12.4 Prepare and administer an intravenous drug
12.5 Prescription checking
12.6 Write a prescription
12.7 Report an adverse drug reaction using the yellow card
system
12.8 Contraceptives: use of barrier methods
12.9 Give drug using nebuliser
12.10 Give Oxygen at appropriate % concentration
Year
Introduced
3
3
Year first
signed-up
or tested
5
3
Skills
Practice
available
IL
IL
1
3
4
1
3
4
C,IL
IL
IL
4
4
5
3
4
4
4
5
IL
4
IL
1
2
1
1
2
1
C,IL,PT
IL
C,IL,PT
3
3
3
3
3
4
5
3
3
4
3
3
5
5
5
5
4
3
3
3
3
3
1
3
2
3
3
1
4
2
4
5
C,IL
2
3
2
3
C, IL,
PT
IL
3
4
3
3
5
4
5
5
C, IL,SU
C, IL
C,IL, PT
C, IL
71
17 – Integrated Skills List
Integrated Skills List
12.11 Set up and operate a syringe pump and medication
12.12 Instil eye drops/eye ointment
12.13 Use of nasal spray
12.4 Explain to a patient a skin preparation
13. General patient management
13.1 Height and weight measurement charting with BMI
calculation
13.2 Record BMI
13.3 Sterile technique
13.4 Record and interpret 12 lead ECG
13.5 Interpret results of investigations inc a) haematological b)
clinical chemistry c) neurological d) psychiatric
13.6 Female catheterisation
13.7 Insert a naso-gastric tube
13.8 Male catheterisation
13.9 Remove wound drains
13.10 Perform wound care
13.11 Remove sutures and staples
13.12 Immobilise the cervical spine
14. Specialist skills
14.1 Suture a wound
14.2 Assess a patient's ability to function at home
14.3 Participate in a multi-disciplinary needs assessment
14.4 Deliver a baby
14.5 Observe the assessment of a patient with delirium
15. Patient management on the wards or in community
15.1 Plan investigations and treatments
15.2 Complete a ward admission, make continuation notes
15.3 Complete investigation request forms: lab tests, X-rays
15.4 Complete a blood transfusion request form
15.5 Complete a GP prescription
15.6 Complete an inpatient prescription
15.7 Negotiate with a patient to agree an acceptable
management plan
15.8 Explain procedure or operation to patient or relative
15.9 Write a discharge notification
15.10 Write a ward referral
15.11 Write an out-patient referral
15.12 Set up a blood transfusion
15.13 Certify death
15.14 Complete a death certificate
15.15 Observe the reporting of a death to a coroner
Year
Introduced
5
3
3
4
Year first
signed-up
or tested
5
Skills
Practice
available
C,IL,SU
4
1
1
1
3
1
1
1
3
3
3
3
3
3
4
4
4
3
4
5
3
5
5
5
3
3
3
4
3
4
4
4
4
3
5
3
5
5
3
5
5
5
5
5
3
5
3
5
5
5
5
5
5
5
5
5
5
5
5
5
5
IL
C,IL,SU
IL,SU
C,IL,SU
IL,SU
C,IL,SU
IL
IL,SU
C
C
72
17 – Integrated Skills List
Core Patient Cases Acronyms
COPD [Chronic Obstructive Airways Disease]
CABG [Coronary Artery Bypass Graft (CABG)]
ECG [Electrocardiogram ECG)]
GTN spray ([Glyceryl Trinitate (GTN)]
CVP [Central Venous Pressure]
MI [Myocardial Infarct (MI)]
GI [Gastrointestinal haemorrhage (GI)]
CT scan [Computerised Tomography (CT)]
EEG [ Electroencephalography (EEG)]
EMG [Electromyography (EMG)]
MRI (add “scan” Magnetic Resonance Imaging (MRI)]
PET add scan [Positron Emission Tomography (PET)]
ECT [Electroconsulsive therapy (ECT])
Integrated Skills List Acronyms
3.7 AUDIT [Alcohol Use Disorder Identification Test (AUDIT)]
4.17 (GAL) [Gait and Locomotion]
6.1 CT scan [Computerised Tomography (CT)]
6.2 MRI scan [Magnetic Resonance Imaging (MRI)]
6.6 IVU [Intravenous Urography (IVU)]
7.13 Observe VC scan [Vital Capacity (VC)]
7.15 Exercise ECG [Electrocardiograph (ECG)]
7.21 CVP [Central Venous Pressure (CVP)]
9.1 CPR [Cardiopulmonary resuscitation (CPR)]
10.2 Perform a stick test for glucose BM test [Boehringer Mannheim (glucose BM test)]
11.2 Observe CVP line insertion (As 7.13)
11.5 Life support system i.e. IPPV [Intermittent positive pressure ventilation (IPPV)]
13.1 and 13.2 BMI [Body Mass Index (BMI)]
13.12 ECG (As 7.15)
73
18 - Quick Contacts for Key Organizers and Campus Administrators
(Key staff addresses are in the Phase 3 Handbook)
HEAD OF PHASE 3
Dr Teifion Davies
[email protected]
020 7848 0100
CHAIR OF PART 3 BOARD OF EXAMINERS
Dr Chris Kosky
[email protected]
Examinations & Assessments Administrator
Philip Wright
[email protected]
020 7848 6723
OSCE Administrator
James Hollands
[email protected]
020 7848 6101
ROTATION B HEAD
Prof Leone Ridsdale
[email protected]
020 7848 5182
HEAD OF SSCs for Phase 3
Dr Eithne MacMahon
[email protected]
20 7188 1285 (PA)
Medical Student Administrator - St Thomas’ & Guys
Maria Fernandes
[email protected]
020 7188 5183
Medical Student Administrator – King’s
Sheinaz Mahomedally
[email protected]
020 7848 5224
Undergraduate Administrator – Canterbury
Abigail Ballard
[email protected]
01227 866394
Undergraduate Administrator – Ashford
Brenda Harden
[email protected]
01233 616717
Undergraduate Administrator – Margate
Lisa Fletcher
[email protected]
01843 225544 Ext: 62042
DEPUTY HEAD OF PHASE 3
Dr Amy Iversen
[email protected]
020 7848 5509
Phase 3 Undergraduate Officer
Lucy Watts
[email protected]
020 7848 6102
Senior Assessments Officer (MB BS)
Jo Wilson
[email protected]
020 7848 6706
ROTATION A HEAD
Mr Simon Atkinson
[email protected]
020 7188 4195
ROTATION C HEAD
TBC
SSC queries (Phase 3)
Ms Gillian McCormack
[email protected]
020 7848 6725
Medical Student Administrator-St Thomas’ & Guys
Rachel Bates
[email protected]
020 7188 3735
MBBS Administrator – King’s
Mary McCarthy
[email protected]
020 7848 5618
Undergraduate Administrator – Kent & Medway
Debbie Monticolombi
[email protected]
01227 812189
Medical Student Manager - Chichester
Nissrine Tollaz
[email protected]
01243 788122 ext 2795
Medical Student Administrator – Medway
Daniella James
[email protected]
01634 8300000 ext 3238
Medical Student Administrator – Lewisham
Samantha Newman
[email protected]
020 8333 3000 ext 8734
Psychiatry and Neurology Teaching Administrator
Wiktor Madejczyk
[email protected]
020 7848 5182
General Practice Teaching Lead
Dr Kerry Boardman
[email protected]
020 7848 8696
General Practice Administrator
Simon Power
[email protected]
020 7848 4311
74
18 - Quick Contacts for Key Organizers and Campus Administrators
Psychiatry Coordinator
Dr Paola Dazzan
[email protected]
020 7848 0590
Ophthalmology Coordinator – St Thomas’
Mr Danny Morrison
[email protected]
020 7188 4334
Senior Clinical Adviser – Joseph Lister House
Dr John Philpott-Howard
[email protected]
020 3299 3213
Senior Clinical Adviser – Astley Cooper House
Dr Anne Stephenson
[email protected]
020 7848 8704
Education Advisor
Michelle Robinson
[email protected]
020 7848 6855
ENT Coordinator
Miss Elfy Chevretton
[email protected] (Secretary)
020 7188 2217 (Secretary)
Ophthalmology Coordinator – King’s & Lewisham
Mr Tim Jackson
[email protected]
020 3299 3385
Senior Clinical Adviser – Thomas Addison House
Dr Sonji Clarke
[email protected]
020 7188 6865
Senior Clinical Adviser - Cicely Saunders House
Prof Mary Seller
[email protected]
0207 188 6098
75
What to do if you have a percutaneous or mucosal exposure to potentially HIVinfected blood or other high-risk body fluid:
In all cases – whether the patient is known to be high risk for any infection or not • Encourage the wound to bleed, ideally by holding it under running water
• Wash the wound using running water and plenty of soap
• Don’t scrub the wound while you are washing it
• Don’t suck the wound
• Dry the wound and cover it with a waterproof plaster or dressing
• Mucosal splash (eye, mouth): rinse with a lot of sterile water or saline for 10 minutes
• Note name number and location of ‘donor’ patient, if known. Notify a senior person in the
ward or clinic
• Fill out an incident form (later)
• Attend Occupational Health IMMEDIATELY AND ALWAYS WITHIN AN HOUR IF AT ALL
POSSIBLE
• OUT OF HOURS attend ACCIDENT & EMERGENCY; report a ‘needlestick injury’ and you
will be seen quickly.
HIV PROPHYLAXIS, IF NEEDED, MUST BE STARTED WITHIN ONE HOUR OF THE
EXPOSURE IF AT ALL POSSIBLE