Download MBBS Programme Phase 5 Student Logbook 2012-13

School of Medicine
MBBS Programme
Phase 5 Student Logbook
2012-13
Student Name
Sites
GP
Surgery
Medicine
Tel
Email
Clinical Advisor
You must submit your completed logbook to the registry by 4pm on Friday 5th April
2013.
Please ensure you photocopy the pages for skills sign-ups and Clinical Advisor
meetings before submitting the logbook, and keep a copy for your own reference
A completed and submitted logbook for Phase 5, with all clinical skills signed and all
professional development, clinical tutor and clinical advisor sections signed, is a
requirement for entry into end of year examinations
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
this 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 MAY
LEAD TO DISCIPLINARY ACTION
Contents
Part 1 – Important Information
1.
Introduction
p.4
2.
Educational Contract
p.6
3.
The School of Medicine Confidentiality Code
p.13
4.
Clinical Advisor Visits
p.14
5.
Feedback
p.15
6.
Career Reflections
p.16
7.
An Important Notice about Infection Control
p.17
8.
Code of Practice for Student Examination of Patients
p.21
9.
Fitness to Practise
p.26
10.
Simulated and Interactive Learning (SaIL)
p.27
Part 2 – Skills and Sign-ups
11.
In Course Assessment of Clinical Skills: Guidance for Students p.27
12.
Summary of skills to be acquired for Phase 5
p.28
13.
Sign-Ups
p.29
14.
Cases Seen
p.64
15.
Phase 5 Campus Block Evaluation Receipts
p.67
16.
Integrated Skills List
p.68
17.
In-course Assessment
p.74
3
1 - Introduction
Welcome to the Phase 5 logbook. This is one of a series of logbooks for the MBBS course which aim to
link skills training across all years and prepare for your early professional career as a doctor. The
logbook provides a record of the competencies you are required to achieve in the essential skills in this
rotation, sign-up of the 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. It is advisable for you to photocopy all pages
with skills sign-ups and clinical advisor visits before handing so that you have your own record
in event your logbook is mislaid. We advise you do this at intervals throughout the year. It is
also highly advisable that you write your name at the top of each page in the sign-ups section.
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 feels 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. Any MBBS skill may be examined in Phase 5.
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/ALS. In subsequent OSCEs,
you will be assessed on the updated skills techniques not the method you initially learnt.
Section 2 – Educational Contract (p. 6)
You and your clinical supervisors sign the educational contract at the start of each attachment to clarify
you and your supervisor’s roles and responsibilities
Section 4 – Clinical Advisor Visit (p. 14)
This is a record of visits to your Clinical Advisor. You should see him or her at least once per rotation.
Your advisor 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 at these visits.
Section 8 – Code of Practice (p21)
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.
Section 13 – Skills and Sign-ups (p. 29)
This is the official record of your sign up of skills for your year.
In Years 1 and 2 some skills and attendances do not require signatures because central records are
kept. The skills listed in this logbook require sign-up by your GP tutor who will take into account your
attendance when assessing your Professional Development.
4
In Phases 3, 4, 5 there are separate books or pages for each rotation. You should get the in-course
assessment skills and attendance at special clinical sessions signed up by the end of each rotation by a
clinician other designated professional appropriate to the speciality.
A copy of the integrated skills list for all years of the MB BS programme is on the Virtual Campus.
Section 14 – Cases Seen (p.64)
This is a record page for you to list patients you have clerked and examined. It will be useful for
discussion and revision, and it is particularly useful for helping you to see what cases you HAVE NOT
seen, and therefore should seek out. Patients vary, so you should aim to clerk several patients within
each diagnostic category.
Attendance and satisfactory sign-up
You are expected to attend all teaching including lectures, practicals, tutorials, symposia and clinical
teaching. Staff will take your attendance into account when signing logbooks. Genuine mitigating
circumstances such as illness or official absence will, however, be taken into account (See your year
handbook for further details).
In Course Assessment
Your firm head will complete your In Course Assessment form at the end of each placement. If you do a
split placement, you should complete one at the end of each part. During each placement you should
do at least one (preferably more than one) Workplace Based Assessment tool (either the miniCEX or
the ECSA, negotiated between you and the placement), which you should show to your firm head after
you have completed your own reflections on what you have learned about your own performance, and
what you recognise you should concentrate on next. The In Course Assessment is formative – it
doesn’t contain “marks” and cannot be “passed” or “failed”. But you must have those from Rotation One
and Two complete, by the time your logbook is submitted.
5
2 – Educational Contract
Educational Contract for Student House Officer Scheme
Medical Attachment
1
The Consultant has overall responsibility for your work and will ensure you work at all times under
the immediate supervision and direction of a qualified Doctor,
(Name of Doctor)…………………………………………………..,
who will have day-to-day responsibility for your supervision (Referred to in this document as your
"Supervisor").
2
At the outset of the attachment you will be given written information concerning your duties and
hours of work, including on-call periods. If you have any commitments which conflict with these you
must make them known to your Consultant at the outset and agree how your duties will be carried
out in your absence.
3
Your supervisor will allocate a number of patients to your care (usually around five), for whom you
will have first responsibility. It is your responsibility to:
i. clerk the patient and write the admission notes
ii. arrange the necessary initial and continuing investigations
iii. explain and justify the plans for the patient to their satisfaction
iv. visit the patient at least daily to check on their progress, examining and performing
additional investigations as necessary and write up continuation notes in the patients
record
v. write up all medications (to be signed only by medically qualified staff)
vi. liase with nursing and other paramedical staff regarding the patient's care
vii. take part in the planning of their discharge (for instance, through the multidisciplinary
meeting)
viii. write the discharge medication for your supervisors agreement and signature
ix. write the discharge letter to the General Practitioner
x. be present when informed consent is being obtained or when any important
communications take place involving your patient.
xi. be present to support and observe your patient during any procedures or other significant
activities.
4
In carrying out these duties you must at all times:
i. identify yourself to the patient as a Medical Student
ii. wear your name badge which identifies you as a Medical Student
iii. Your entries in the patient records must be signed, dated and your name and status as
“medical student” legibly printed.
iv. Patients’ prescriptions, pathology and other request forms should be written, but not
signed by you and agreed and signed by the doctor supervising you. You may be
permitted to sign some pathology forms yourself (refer to local trust guidelines)
5
Your Supervisor or other qualified doctor’s signature implies that they have undertaken legal
responsibility for the drug you have written, action you have proposed, or communication you have
made. A qualified doctor must therefore always check your clerkings and examinations, agree with
you the investigations which are to be performed, agree drugs which are to be prescribed and be
present if you are communicating important news to a patient or relative.
6
6
The patients who you will look after will be asked to give their permission for you to help with their
care. It is always a patient's right to decline to be seen by a Medical Student. When this happens
with a patient you have been asked to see, you should always report it immediately to your
Supervisor or other appropriate member of medical staff, so that the patient's care is not in any way
impaired by their choice not to be seen by a Student.
7
If you are unable to come to work because of ill health, you should inform your supervising doctor or
consultant as soon as possible. The Medical School will expect you to submit to the Academic
Centre a suitable Sickness Certificate (Self-Certification for less than five working days, Doctor's
Certificate if any longer). There is no holiday leave during the attachment; holidays are built in to
the Year 5 timetable.
8
If you find yourself in a situation where you do not have a qualified doctor to supervise you, you
must cease all clinical work until the situation is remedied. This will most usually be through
communication with your Consultant or the DGH Sub-Dean. It is your responsibility as a Student to
let the Consultant or Sub-Dean know immediately if this situation arises.
9
If you find yourself 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 supervisor, 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 complaint etc) being made.
10 If you have any concerns over the supervision you are receiving, you should take this up with your
Consultant, the DGH Sub-Dean, the Head of Phase 5 or if the advice you seek is of a more
personal nature, with your Clinical Adviser.
11 The Medical School requires every student to be a member of a medical defence organisation
during the whole undergraduate course including year 5. 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.
Signature ....................................................................................................................
Student
Signature ....................................................................................................................
Consultant
Signature ....................................................................................................................
Supervisor
Signature ............................................................. Trust ..............................................
Sub-Dean
When skills in this log book are signed off by medical staff they should normally be at 2nd year
Foundation level or above. If AFTER JANUARY 1st 2013 1st year Foundation Trainees with sufficient
experience and competence to assess you and provide appropriate feedback are working on the firm,
their names should be given below, confirmed by your supervisors signature.
FY1 Name……………………………
Signature supervisor…………………………….
FY1 Name…………………………...
Signature supervisor…………………………….
7
Educational Contract for Student House Officer Scheme
Surgical Attachment
1
The Consultant has overall responsibility for your work and will ensure you work at all times under
the immediate supervision and direction of a qualified Doctor,
(Name of Doctor)…………………………………………………..,
who will have day-to-day responsibility for your supervision (Referred to in this document as your
"Supervisor").
2
At the outset of the attachment you will be given written information concerning your duties and
hours of work, including on-call periods. If you have any commitments which conflict with these you
must make them known to your Consultant at the outset and agree how your duties will be carried
out in your absence.
3
Your supervisor will allocate a number of patients to your care (usually around five), for whom you
will have first responsibility. It is your responsibility to:
i. clerk the patient and write the admission notes
ii. arrange the necessary initial and continuing investigations
iii. explain and justify the plans for the patient to their satisfaction
iv. visit the patient at least daily to check on their progress, examining and performing
additional investigations as necessary and write up continuation notes in the patients
record
v. write up all medications (to be signed only by medically qualified staff)
vi. liase with nursing and other paramedical staff regarding the patient's care
vii. take part in the planning of their discharge (for instance, through the multidisciplinary
meeting)
viii. write the discharge medication for your supervisors agreement and signature
ix. write the discharge letter to the General Practitioner
x. be present when informed consent is being obtained or when any important
communications take place involving your patient.
xi. be present to support and observe your patient during any procedures or other significant
activities (including operations)
4
In carrying out these duties you must at all times:
i. identify yourself to the patient as a Medical Student
ii. wear your name badge which identifies you as a Medical Student
iii. Your entries in the patient records must be signed, dated and your name and status as
“medical student” legibly printed.
iv. Patients’ prescriptions, pathology and other request forms should be written, but not
signed by you and agreed and signed by the doctor supervising you. You may be
permitted to sign some pathology forms yourself.- Refer to local trust guidelines
5
Your Supervisor or other qualified doctor’s signature implies that they have undertaken legal
responsibility for the drug you have written, action you have proposed, or communication you have
made. A qualified doctor must therefore always check your clerkings and examinations, agree with
you the investigations which are to be performed, agree drugs which are to be prescribed and be
present if you are communicating important news to a patient or relative.
6
The patients who you will look after will be asked to give their permission for you to help with their
care. It is always a patient's right to decline to be seen by a Medical Student. When this happens
with a patient you have been asked to see, you should always report it immediately to your
8
Supervisor or other appropriate member of medical staff, so that the patient's care is not in any way
impaired by their choice not to be seen by a Student.
7
If you are unable to come to work because of ill health, you should inform your supervising doctor or
consultant as soon as possible. The Medical School will expect you to submit to the Academic
Centre a suitable Sickness Certificate (Self-Certification for less than five working days, Doctor's
Certificate if any longer). There is no holiday leave during the attachment; holidays are built in to the
Phase 5 timetable.
8
If you find yourself in a situation where you do not have a qualified doctor to supervise you, you
must cease all clinical work until the situation is remedied. This will most usually be through
communication with your Consultant or the DGH Sub-Dean. It is your responsibility as a Student to
let the Consultant or Sub-Dean know immediately if this situation arises.
9
If you find yourself 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 supervisor, 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 complaint etc) being made.
10 If you have any concerns over the supervision you are receiving, you should take this up with your
Consultant, the DGH Sub-Dean, the Head of Phase 5 or if the advice you seek is of a more
personal nature, with your Clinical Adviser.
The Medical School requires every student to be a member of a medical defence organisation during
the whole undergraduate course including year 5. 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.
Signature ....................................................................................................................
Student
Signature ....................................................................................................................
Consultant/Supervisor
Signature ............................................................. Trust ..............................................
Sub-Dean
When skills in this log book are signed off by medical staff they should normally be at 2nd year
Foundation level or above. If AFTER JANUARY 1st 2013 1st year Foundation Trainees with sufficient
experience and competence to assess you and provide appropriate feedback are working on the firm,
their names should be given below, confirmed by your supervisors signature.
FY1 Name……………………………..
FY1 Name…………………………...
Signature supervisor…………………………….
Signature supervisor…………………………….
9
Educational Contract for Student House Officer Scheme
General Practice and Community Attachment
BETWEEN
Name of Student……………………………………………………….
Name of GP Tutor……………………………………………………..
Name of Practice……………………………………………………….
At King's College London School of Medicine:
1. Your GP Tutor has overall responsibility for your work and will ensure you work at all times
under their immediate supervision or under a designated member of the Practice Team. The
Community Tutors under whose direction you work are likewise responsible for you.
2. At the outset of the attachment you will be given information concerning your responsibilities
and time-commitments. If you have any conflicting commitments you must negotiate with your
Tutors.
3. Your GP Tutor will expect you to see patients in parallel to his/her own surgery, but with fewer
patients and at extended intervals. There will be time for consultation between you and your
Tutor, and three-way consultation with the patient, as necessary. You will be expected to see
four or five patients each session, and spend four sessions per week in the consulting room,
during which you will for each patient:
•
•
•
•
•
•
•
•
•
•
assess the presented problem, and write the consultation notes
arrange any investigations relevant at this stage of managing the problem
explain and discuss any of your suggestions/plans to the patient, to their satisfaction
arrange to review the patient personally for the duration of the problem, or until you leave
the firm, reassessing the problem, and performing any additional examination or investigations
as are appropriate.
liase with other professional staff regarding the patient’s care
involve yourself in planning future care for the patient, together with any other professionals
that are or might become involved
prepare any prescription indicated
write any referral letters required
be present when any important communications take place involving your patient
be present to support and observe your patients during any procedures or other significant
activities
4. In carrying out these duties you must at all times:
•
Identify yourself to the patient as a Medical Student
•
Wear a name badge which clearly identifies you as a Medical Student
•
When you sign all written communications (e.g. prescription charts, case notes, discharge
summaries, consent forms) your name should be legibly printed adjacent, together with the
words "Medical Student".
Your signature should always be counter-signed by a qualified
Doctor, who will normally be your GP Tutor. Their signature implies that they have undertaken
legal responsibility for the drug you have written, action you have proposed, or communication
you have made.
10
5. Your Tutor must always check your consultation notes, agree with you the investigations which
are to be performed, agree drugs which are to be prescribed and be present if you are
communicating important news to a patient.
6. The patients who you will look after will be asked to give their permission for you to help with
their care. It is always a patient's right to decline to be seen by a Medical Student. When this
happens with a patient you have been asked to see, you should always report it immediately to
your Tutor, so that the patient's care is not in any way impaired by their choice not to be seen by
a Student.
7. If you are unable to come to your course because of ill health, you should inform your GP or
Community Tutor as soon as possible. The Medical School will expect you to submit to the
Academic Centre a suitable Sickness Certificate (Self-Certification for less than five working
days, Doctor's Certificate if any longer). There is no holiday leave during the attachment;
holidays are built in to the Year 5 timetable.
8. If you have any concerns over the supervision you are receiving, you should take this up with
the Year 5 leads in the Department of General Practice and Primary Care, your GP Sub-Dean
(if in Hastings or Canterbury) or the Head of Phase 5. If the advice you seek is of a more
personal nature, you should contact your Clinical Adviser.
9. If you find yourself in a situation where you do not have a qualified Doctor to supervise you, you
must cease all clinical work until the situation is remedied. It is your responsibility as a Student
to let the GP Tutor, Sub-Dean or Phase 5 leads in the Department know immediately if this
situation arises.
10. The Medical School requires every student to be a member of a medical defence organisation
during the whole undergraduate course, including Phase Five. If you follow the guidance in this
contract it is difficult to envisage any legal action which would not be covered vicariously
through your GP Tutor.
11. However membership of a defence organisation would support and protect you if this unlikely
event arose. You should be aware that the medial school has no responsibility to provide cover
for students in such situations
(signed & dated)…………………………………………………………………….…….Student
(signed & dated)…………………………………………………………………………GP Tutor
11
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?
For paper, consign to a bin designated for disposal of
Confidentiality is central to the trust between patients and
confidential information. These are located in
doctors and is part of the professional code.
Academic Centre or in clinical departments.
Patients have a right to expect that medical students and
Do not photocopy clinical notes for projects,
doctors will not pass on confidential information without their
presentations, or for other reasons.
consent except to other health professionals who care for
All information removed from a clinical area must be
them.
anonymized and secured in a folder or case.
Confidentiality should be maintained for all time even after a
Obtaining patient consent. What does this mean in
patient's death.
clinical practice?
What is confidential information? How should you
If it is for the patient’s benefit, information can be
protect it?
shared with the multidisciplinary team caring for the
Confidential information includes all personal details by
patient. This does not extend to research, teaching or
which a patient is identifiable such as name, address and full unqualified staff.
postcode. Such data should not be transmitted verbally, in
Always obtain the patient’s consent orally or in writing
writing, or online r without a patient’s consent.
before you give personal information to a third party
Confidentiality extends to casual social conversation,
such as family or friend who is attending with the
including emails, blogs and social media. Do not discuss
patient.
patient details in public places such as hospital lifts,
You must obtain written informed consent from
cafeterias, and public transport. Confidential information
patients before taking photos. The patient must be
used for teaching, projects, research or audit must be
unidentifiable and you should not take photos of
anonymized.
patients using a mobile phone.
Confidentiality may only be breached in exceptional
Obtaining patient consent. What does this mean
circumstances. Discuss this with your tutor.
for projects and presentations?
Anonymizing data. What should you do?
If you use patient data for projects never include
Patient identifiable information is anonymized by removing
patient identifiable information. If you use clinical
the patient's name, address, post-code, date of birth, NHS
material, explain to the patient how data will be used
number, telephone number or other information that allows
and assure him or her that information will be
access to the patient.
anonymized.
For electronic processing, do not enter patient identifiable
If you photograph a patient for a project, explain
information onto your PC.
how the photo will be used, obtain written consent
Data entered in a clinical setting, such as hospital or GP
and that of your supervisor’s. For presentation or
practice, must be password protected.
publication, the patient's eyes must be occluded.
Destroy all personal information if not needed. Delete on
Carefully consider whether metadata on any
PCs and on handheld mobile internet enabled devices.
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…………………………………………………………………………
12
4 – Clinical Adviser Visits
Name of Clinical Adviser:
Name of student:
You are advised to see your clinical adviser in EACH campus block.
October Campus Block:
□ 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)
□ Responsible use of social media
□ Foundation Programme application discussed
□ Career ambitions discussed
□ Consent issues (Code of practice for examination
of patients - see p16-21)
□ 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:
Christmas Campus Block:
□ Skills sign-ups reviewed (may not be complete)
□ List of patients clerked and reviewed (optional)
□ Attendance / Health
□ SSCs choice for R2
□ Review In Course Assessment
□ Professional development (including
interprofessional education) discussed
□ Foundation Programme application discussed
□ Career ambitions discussed
□ Fitness to Practise concerns
□ Educational Contract signed
Clinical Adviser: Signed …….………………………………………………...….. Date ……………………
GMC no./Designation…………………………………………………………………………
Comments:
Spring Campus Block:
□ 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 In Course Assessment
□ SSC Reflections
□ 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:
13
5 - 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.
14
6 – 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
15
7 - 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
Main means of spread
care
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
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
Mycobacterium tuberculosis
Clostridium difficile colitis
Methicillin-resistant Staphylococcus aureus (MRSA),
sensitive Staph aureus, Group A streptococci
Practical Guidelines for Day-to-day Infection Control
White Coats etc
Please refer to the dress code on page 20 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).
16
7 - 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
17
7 - 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 nonsterile 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 multiresistant 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.
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.
18
7 - 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.
19
8 - 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
o
60 C, 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
20
8 - 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 available- remember 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 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,
21
8 - Code of Practice for Examination of Patients by Students
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
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
1,2
Basic professional requirements for students on clinical practice
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 teaching-assistant. These
are women who train students on themselves and agree to be examined. You must be signed up for this in your
1 General Medical Council. Good medical practice. www.gmc-uk.org
2 Royal College of Obstetricians and Gynaecologists. Gynaecological Examinations. RCOG. London. 2002
22
8 - Code of Practice for Examination of Patients by Students
2.
3.
4.
5.
6.
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.
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).
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.
Wear surgical gloves on both hands.
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.
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.
23
8 - 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.
24
9 – 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.gmc-uk.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.
25
10 – 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/2-bedded 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.
26
11 - In-Course Assessment of Clinical Skills: Guidance for Students
MAKE SURE EVERY PAGE OF YOUR LOGBOOK IS MARKED WITH YOUR NAME
You are required to be competent in the core skills listed. Each skill has minimum performance criteria,
similar to those in the end of year OSCE. These are included in part four of the handbook for each
block and are also available on the Year 5 web-site. You should practise each skill until you feel reliably
competent. At this stage ask a tutor/ clinical supervisor or appropriate other designated professional to
assess your performance and to sign this logbook. Skills suitable for assessment on manikins or
models are marked with an asterisk, and may be assessed in the skills lab. If you do not achieve the
required standard you should arrange for a repeat assessment later in the block.
Once you have achieved competency in these skills, it is advisable to continue to practice whenever the
opportunity arises. It is your responsibility to maintain your skills and keep up to date with any changes
in practice.
In addition to the skills listed in this section of the logbook you should practice and keep up to date with
resuscitation skills learned on your ILS course and skills learned in previous years.
It is your responsibility to arrange for assessments.
At the end of each block, ask your clinical tutor or supervisor to complete your In Course Assessment.
This is a two way process in which student and tutor discuss whether your overall proformance,
including 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 all the skills of each block in order to complete MBBS Phase 5.
You will be asked to hand in your logbook on the date shown on the front of the book.
Books will be inspected for satisfactory completion of skills.
In Phase 5 you will build on the skills acquired in Phase 3 and 4 and these may be tested in the Phase
5 OSCE.
You should meet your Clinical Advisor at least three times during Phase 5. Please ensure that they sign
part three.
In case you lose your logbook, from time to time make sure you have a photocopy of the relevant
signed pages and keep in a safe place. The photocopies must be of pages already marked with your
name; to mark them subsequently with your name will invalidate the copy.
27
12 – Summary of skills to be acquired for Phase 5
Drug Prescribing and Administration
1.
2.
3.
4.
5.
6.
Administer a drug via a nebuliser
Administer a drug via intramuscular injection
Administer a drug by intravenous injection
Set up and operate a syringe pump
Complete a GP prescription form
Complete an inpatient prescription form
Practical skills
7. Take blood cultures
8. Change a simple dressing and perform wound care
9. Remove skin stables or sutures
10. Measure Doppler index of foot pulses
11. Insertion of Naso-Gastric tube
Verbal and Written Communication
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
Negotiate with patient to agree a mutually acceptable management plan
Break Difficult news to a patient or relative
Communicate effectively and sensitively with a person from a different culture
Communicate effectively with another professional
Explain to patient or relative a procedure or operation
Write a ward referral
Write a letter referring a patient to outpatients
write a discharge notification
Complete a Radiology request
Complete a blood transfusion request form and consent a patient for a blood transfusion
Clinical management
22. Report a PA chest X-ray
23. Report a plain abdominal X-ray
24. Confirm diagnosis of death
Integrated skills
25. Take a swab for bacteriological examination, then in response to the microbiology results
prescribe antibiotics if necessary
26. Complete a blood test form and take blood sample, revising Phase 3 venepuncture skills,
interpret results and understand the clinical indications for a blood test, complete a blood test
form and take the sample, interpret the results and initiate appropriate treatment
27. Assess the patient’s oxygen requirements, interpret blood gases, prescribe and administer
appropriate levels of oxygen
28. Utilise an electrocardiology and monitoring in the assessment and management of an acutely
unwell patient
29. Measure the height and weight of a patient, calculate and interpret body mass index. Explain
the significance to the patient and provide nutritional advice.
30. Measure the physiological parameters of a patient, calculate and interpret an early warning
score, use an algorithm to determine the correct course of action based on the score.
28
13 – Sign-Ups
Skills must be signed up by experienced professionals who have been approved by the firm head.
Name of Student
Y/N
1. Administer a drug via a nebuliser
Ensure you understand the patients underlying respiratory disease and oxygen requirements
Ensure you understand how to assemble/use equipment
Cleanse hands with alcohol gel
Introduce yourself and check patient’s identity
Discuss procedure with patient
Check for history of drug reactions with patient & specifically for this drug
Consult prescription sheet to check validity of prescription (e.g. signed by doctor) and ascertain
drug, dose, diluent, timing and route of administration, allergies)
Assemble nebuliser correctly and attach to appropriate gas supply (air or oxygen)
Measure drug and any diluent into nebuliser with syringe, checking name of medication, strength,
expiry date and amount administered with a colleague (usually nurse) as you proceed
Place mask on patient’s face
Set gasflow according to manufacturer’s instructions.
Ensure patient is comfortable and using equipment effectively
Sign up administration on drug chart
Clean and store equipment correctly after use
‘I have today observed this student perform this skill according to the above protocol and judge them to
be at the level of competence and safety expected of a Phase 5 student.
I have given the student constructive feedback.’
Skill performed signed:
Competency shown signed:
Constructive Feedback given signed:
Name (Print)
Professional Registration No
Job title
Department
Date
Formative feedback:
Self-reflection:
29
13 – Sign-Ups
Name of Student
Y/N
2. Administer a drug via intra-muscular injection
Understand contraindications to this route of administration (eg coagulopathy) and ensure none exist
Cleanse hands with alcohol gel
Introduce yourself and check patient’s identity
Discuss procedure with patient and gain consent
Check for history of drug reactions with patient & specifically for this drug
Consult prescription sheet to check validity of prescription (e.g. signed by doctor) and to ascertain
drug, dose, diluent, time and route of administration, allergies and if taking coagulants
Check patient and drug details with nurse or supervisor
Select appropriate syringe, needles, swab and dressing
Check name, strength and expiry date of drug with nurse or other staff member
Draw up correct volume of drug, expel air
Remove needle used to draw up and replace with correct bore administration needle
Cleanse hands and put on gloves
Expose appropriate site
Identify landmarks to avoid likely nerve damage and vascular routes
Clean site with Chlorhexidine skin preparation and allow to dry
Stretch skin at injection site
Plunge needle into skin at 90° to patient’s skin
Aspirate to ensure not in blood vessel (if blood aspirated select different site)
Inject drug slowly
Withdraw needle rapidly and apply pressure over injection site
Dispose of sharps and non-sharp waste appropriately at point of use
Ensure patients comfort an understanding
Cleanse hands with alcohol gel
Record details of injection given (including batch numbers) on prescription chart
‘I have today observed this student perform this skill according to the above protocol and judge them to
be at the level of competence and safety expected of a Phase 5 student.
I have given the student constructive feedback.’
Skill performed signed:
Competency shown signed:
Constructive Feedback given signed:
Name (Print)
Professional Registration No
Job title
Department
Date
Feedback:
30
13 – Sign-Ups
Name of student
Y/N
3. Administer a drug by intravenous injection
Cleanse hands with alcohol gel
Introduce yourself and check patient’s identity
Discuss procedure with patient
Check for history of drug reactions with patient & specifically for this drug
Consult prescription sheet to check validity of prescription ( e.g. signed by doctor) and ascertain drug,
dose, diluent, time and route of administration, allergies
Check patient drug details with nurse or supervisor
Check drug and dose are appropriate (in BNF or local formulary)
Check name, strength and expiry date of drug and diluent with nurse or other staff member
Put on non-sterile gloves
Dilute drug with appropriate diluent according to manufacturers instructions and ensure mixing
Draw up 5-10 mls of 0.9% sodium chloride (as a flush)
Insert intravenous cannula (revise skill from previous years)
If using cannula previously sited, inspect insertion site, remove cap/bung and clean injection port with
appropriate disinfecting spray or wipe & check patency with saline flush
Prepare to give injection using appropriate sterile technique
Inject drug into vein (speed of injection varies with drug) followed by saline flush
Replace cap/clean bung on injection port of cannula
Check patients comfort and absence of immediate side effects
Dispose of sharps and non-sharp waste appropriately at point of use
Record details of injection on prescription chart
Cleanse hands with alcohol gel
‘I have today observed this student perform this skill according to the above protocol and judge them to
be at the level of competence and safety expected of a Phase 5 student.
I have given the student constructive feedback.’
Skill performed signed:
Competency shown signed:
Constructive Feedback given signed:
Name (print)
Professional Registration No.
Job title
Department
Date
Feedback:
31
13 – Sign-Ups
Name of Student
Y/N
4. Setup and operate a syringe pump
Cleanse hands with alcohol gel
Introduce yourself and check patient’s identity
Discuss procedure with patient
Check for history of drug reactions with patient &specifically for this drug
Consult prescription sheet to check validity of prescription (e.g. signed by doctor) and ascertain drug,
dose, diluent, time and route of administration, allergies
Check patient and drug details with nurse or supervisor
Check drug and dose are appropriate (in BNF or local formulary)
Select correct device (hourly or daily rate) and consult instruction manual. Ensure you understand
how to use equipment safely having received appropriate training
Check power source
Select correct brand and size syringe for infusion to be given (10ml, 20ml or 50ml)
Check name, strength and expiry date of drug and diluent with nurse or other staff member
Calculate appropriate dilution of the drug, and draw it up ensuring you use correct diluent (usually
sterile water or saline) and ensure even mixing of drug and diluent
Fill syringe and extension tubing with drug at correct dilution (manually or primed by pump)
Label syringe with patient and drug details, date and sign
Attach syringe to pump and secure
Calculate correct rate and set it on syringe pump, secure device and fit cover
Test apparatus, check that device is delivering correctly
Insert intravenous cannula (revise skill from previous years)
If using cannula previously sited, inspect insertion site, remove cap/bung and clean injection port with
appropriate disinfecting spray or wipe & check patency with saline flush
Connect extension tubing to cannula and start infusion
Check patients comfort and absence of immediate side effects
Record infusion details by signing prescription chart
Dispose of sharps safely
Cleanse hands with alcohol gel
Students should familiarise themselves with both mains-driven pumps and battery powered drivers for
purposes of end-of-year assessment
‘I have today observed this student perform this skill according to the above protocol and judge them to
be at the level of competence and safety expected of a Phase 5 student.
I have given the student constructive feedback.’
Skill performed signed:
Competency shown signed:
Constructive Feedback given signed:
Name(Print)
Professional Registration No
Job title
Department
Date
Feedback:
32
13 – Sign-Ups
Name of Student
Y/N
5. Complete a GP e-prescription form
Record the following legibly:
Understand; indications, contraindications, major interactions and actions of the prescribed drug(s)
Patient name, address and age (d.o.b)
Drug, including formulation (tabs, caps, suppositories, etc)
Dose (in gram, milligram, microgram, nanogram, etc)
Frequency (times per day, or time between doses), English preferable to Latin (see back of cover of
BNF)
Total quantity (days and /or total number of tabs)
Special instructions (e.g. before/after food)
Total number of items: avoid prescribing more than 3 or 4 items on a form
Sign and date the prescription
Countersignature of registered doctor, adding their details
‘I have today observed this student perform this skill according to the above protocol and judge them to
be at the level of competence and safety expected of a Phase 5 student.
I have given the student constructive feedback.’
Skill performed signed:
Competency shown signed:
Constructive Feedback given signed:
Name(Print)
Professional Registration No
Job title
Department
Date
Feedback:
33
13 – Sign-Ups
Name of Student
Y/N
6. Complete an inpatient prescription form
Record the following legibly:
Understand; indications, contraindications, major interactions and actions of the prescribed drug(s)
Patient name, patient identifier, d.o.b, address
Location of patient (ward address etc)
Details of consultant including hospital code as appropriate
Identify self fully
Dates chart appropriately including year
All writing clearly legible
Signs all medications appropriately
Identify and list allergies including reactions
Complete “prn” as required medication section
Complete regular medication section
Complete ‘stat’ medication section
Complete intravenous fluids section
Complete oxygen administration section
All medications prescribed appropriately and indicated
‘I have today observed this student perform this skill according to the above protocol and judge them to
be at the level of competence and safety expected of a Phase 5 student.
I have given the student constructive feedback.’
Skill performed signed:
Competency shown signed:
Constructive Feedback given signed:
Name(Print)
Professional Registration No
Job title
Department
Date
Feedback:
34
13 – Sign-Ups
Name of Student
Y/N
7. Take blood cultures
Cleanse hands with alcohol gel
Introduce yourself and check patient’s identity
Discuss procedure with patient & obtain consent
Wash hands and put on apron and gloves
Ensure all required equipment is ready and accessible (including sharps bin at bedside)
Cleanse venepuncture site with 2% Chlorhexidine and allow to dry
Remove the flip-off cap from the vial top and inspect the vial for cracks, contamination, excessive
cloudiness of the fluid. Do not use if any defect is noted.
Clean the rubber top of the culture bottle with a sterilising wipe for 30 seconds and allow to dry.
Attach green needle to 10ml syringe
Do not palpate skin after disinfection
Venesect 8-10mls blood and release tourniquet – revise phase 3 skill
Inject 4-5ml of blood into each bottle at the bedside
Label both blood culture bottles before leaving patient’s bedside
Dispose of sharps in an approved sharps container at the point of usage
Dispose of gloves and other waste as clinical waste
Ensure patients comfort and understanding
Cleanse hands with alcohol gel
Send bottles and completed request form to microbiology laboratory, including sample site and details
of antibiotic treatment
Cleanse hands with alcohol gel
Discuss with trained physician the likely pathogenic organisms and appropriate antibiotic prescribing
‘I have today observed this student perform this skill according to the above protocol and judge them to
be at the level of competence and safety expected of a Phase 5 student.
I have given the student constructive feedback.’
Skill performed signed:
Competency shown signed:
Constructive Feedback given signed:
Name(Print)
Professional Registration No
Job title
Department
Date
Feedback:
35
13 – Sign-Ups
Name of Student
Y/N
8. Change a simple dressing and perform wound care
Cleanse hands with alcohol gel
Introduce yourself and check patient’s identity
Discuss procedure with patient
Give due consideration to analgesic requirements
Screen patient from onlookers
Wash your hands with hibiscrub
Put on apron
Place required equipment (unopened) on bottom shelf of clean dressing trolley
Open dressing pack, providing sterile field for contents
Attach disposal bag to side of trolley
Fill gallipots with saline
Put on clean gloves
Remove old dressing
Inspect and palpate wound for signs of infection or inflammation
Decide if new dressing required
Remove gloves and cleanse hands with alcohol gel and put on sterile gloves
Take swab if necessary
Using gauze swabs and saline clean wound, working from inside to outside of wound
Apply new dressing and secure with integral securing adhesive
Fold up sterile field and discard contents
Spray trolley with hard surface disinfectant
Document procedure in notes
Cleanse hands with alcohol gel
‘I have today observed this student perform this skill according to the above protocol and judge them to
be at the level of competence and safety expected of a Phase 5 student.
I have given the student constructive feedback.’
Skill performed signed:
Competency shown signed:
Constructive Feedback given signed:
Name(Print)
Professional Registration No
Job title
Department
Date
Feedback:
36
13 – Sign-Ups
Name of Student
Y/N
9. Take a swab for bacteriological examination
Cleanse hands with alcohol gel
Introduce yourself and check patient’s identity
Discuss procedure with patient
Give due consideration to analgesic requirements
If there is a dressing in place proceed accordingly to dressing change
Wash hands and put on non-sterile gloves
Remove cotton swab from tube, roll culture swab in areas to be examined, replace swab in outer tube
which has culture medium in base. Press swab firmly shut within container
Re-dress wound if required (see dressing change) and discard contents into appropriate clinical
waste bag
Label swab and complete microbiology form
Give details of any antibiotic therapy the patient may be taking and send to microbiology laboratory
Record procedure in patient’s notes
Cleanse hands with alcohol gel
Discuss likely causative pathogenic organisms
Discuss appropriate antimicrobial treatment
‘I have today observed this student perform this skill according to the above protocol and judge them to
be at the level of competence and safety expected of a Phase 5 student.
I have given the student constructive feedback.’
Skill performed signed:
Competency shown signed:
Constructive Feedback given signed:
Name(Print)
Professional Registration No
Job title
Department
Date
Feedback:
37
13 – Sign-Ups
Name of Student
Y/N
10. Remove skin staples or sutures
Cleanse hands with alcohol gel
Check that any sutures to be removed are non-absorbable
Introduce yourself and check patient’s identity
Discuss procedure with patient
Screen patient from onlookers
Put on apron
Wash your hands with hibiscrub
Place required equipment (unopened) on bottom shelf of clean dressing trolley
Open dressing pack, providing sterile field for contents, understands the principles of a sterile field
Attach disposal bag to side of the trolley
Fill gallipots with saline
Put on non sterile gloves
Remove any dressing
Inspect wound for signs of infection or inflammation and ensure wound has healed
Take swab if necessary
Discard gloves, cleanse hands with alcohol gel, put on sterile gloves in a sterile manner
A) For interrupted sutures, pick up one knot of each suture with forceps, and cut suture (with a stitch
cutter) at one end flush with skin (not on the knot). Gentle upward traction on suture will free it from
wound.
B) For continuous subcuticular sutures, cut it at one end (with a stitch cutter) flush with skin and pull it
through wound by traction on other end
C) For staples; Place staple remover over each staple, grip each side of the staple and squeeze
staple remover closed. This bunches and loosens the staple which can then be removed
Reapply dry dressing if appropriate
Fold up sterile field drape and discard contents into appropriate clinical waste unit
Discard gloves and cleanse hands with alcohol gel
Document procedure in notes
Discuss appropriate timing of removal of sutures or staples after insertion
‘I have today observed this student perform this skill according to the above protocol and judge them to
be at the level of competence and safety expected of a Phase 5 student.
I have given the student constructive feedback.’
Skill performed signed:
Competency shown signed:
Constructive Feedback given signed:
Name(Print)
Professional Registration No
Job title
Department
Date
Feedback:
38
13 – Sign-Ups
Name of Student
Y/N
11. Measure Doppler index of foot pulses
Cleanse hands with alcohol gel
Introduce yourself and check patient’s identity
Discuss procedure with the patient
Position patient supine with no pressure on proximal vessels
Allow patient to rest for 10-20 minutes
Place appropriately sized cuff around arm
Locate brachial pulse by palpitation and apply ultrasound contact gel
Angle hand-held Doppler probe at 45° and move to locate the best signal
Inflate cuff until signal is abolished
Deflate slowly and record pressure at which the signal returns
Record pressure (brachial systolic) then repeat process for other arm
Use the highest of these two values to calculate the ABPI
Place an appropriate sized cuff around the ankle immediately above the malleoli (having first
protected any ulcer that may be present)
Locate dorsalis pedis pulse by palpitation or with Doppler probe and apply ultrasound contact
Continue as for brachial pressure reading
Record pressure
Repeat measurement for posterior tibial pulse (and if required peroneal pulse)
Use the highest reading obtained to calculate ABPI for that ankle
ABPI= highest ankle Doppler pressure (for each leg)/highest brachial Doppler pressure
Repeat for other leg
Wipe ultrasound contact gel from skin
Restore patient’s clothing
Encourage questions from patient and deal with them appropriately
Clean the handheld Doppler probe with appropriate cleanser
Wash hands
give an appropriate summary and analysis of findings to your supervisor & record results in patient’s
notes
‘I have today observed this student perform this skill according to the above protocol and judge them to
be at the level of competence and safety expected of a Phase 5 student.
I have given the student constructive feedback.’
Skill performed signed:
Competency shown signed:
Constructive Feedback given signed:
Name(Print)
Professional Registration No
Job title
Department
Date
Feedback:
39
13 – Sign-Ups
Name of Student
Y/N
12. Insertion of Naso-Gastric tube
Understand indications for insertion of a nasogastric tube
Aware of contraindications to insertion of nasogastric tube and ensure not present in patient
Cleanse hands with alcohol gel
Introduce yourself and check patient’s identity
Discuss procedure with patient, including discussion of nasal patency or problems
Set up trolley including a naso-gastric tube of appropriate size, lubrication gel, disposable gloves,
spigot or bag to attach to tube, tape and vomit bowl, water
Sit patient upright
Measure the anticipated length of insertion of tube (cumulative distance from nose to patient’s ear,
and then from ear to two finger-breadths above umbilicus or similar reliable method.)
Lubricate end of tube with sterile water gel
Slowly pass tube down nose
Ask patient to start swallowing, with or without use of water
If patient coughs stop advancing tube and withdraw until coughing stops before proceeding
Stop inserting the tube at desired length
Ask patient to open mouth (look for oral coiling of tube) and ensure lumen patency (able to inject air)
Tape tube to nose and side of face
Test correct placement in stomach by following local protocols either;
A) Attempt to withdraw liquid stomach contents using a bladder syringe, and confirm acidity using pH
paper (pH <5.0).
Note: This is unreliable if patient has taken antacids/PPls when pH of gastric contents will be
>5
B) Discuss with qualified staff the requisition of a chest x-ray to confirm appropriate placement of the
tube
Attach tube to spigot or collecting bag
Cleanse hands with alcohol gel
Correctly determine site of naso-gastric tube on a chest x-ray
Document procedure in patients notes
‘I have today observed this student perform this skill according to the above protocol and judge them to
be at the level of competence and safety expected of a Phase 5 student.
I have given the student constructive feedback.’
Skill performed signed:
Competency shown signed:
Constructive Feedback given signed:
Name(Print)
Professional Registration
Job title
Department
Date
Feedback:
40
13 – Sign-Ups
Name of Student
Y/N
13. Negotiate with patient to agree a mutually acceptable management plan
Establish identity including relationship to patient
Elicit patient’s expectations
Explore patient’s main concerns
Acknowledge patient’s ideas’ beliefs
Demonstrate verbal and non verbal empathic responses
Explain the medical view clearly using language patient understands
Encourage questions
Discuss options and possible outcomes with patient
Check for understanding from patient and doctor perspectives
Avoid defensive or intransigent behaviours
Reach mutual agreement on course of action
Summarise and conclude interview effectively
‘I have today observed this student perform this skill according to the above protocol and judge them to
be at the level of competence and safety expected of a Phase 5 student.
I have given the student constructive feedback.’
Skill performed signed:
Competency shown signed:
Constructive Feedback given signed:
Name(Print)
Professional Registration No
Job title
Department
Date
Feedback:
41
13 – Sign-Ups
Name of Student
Y/N
14. Break Difficult news to a patient or relative
Establish identity including relationship to patient
Prepare yourself and patient/relative
Ensure your information is correct
Ensure sufficient time is available
Ensure privacy (quiet room, no bleep etc)
Elicit understanding so far
Pace information carefully in small chunks at a time (appropriate use of silence)
Demonstrate empathic responses
Check for mutual understanding (encourage questions)
Mutually agree next step
Summarise and conclude interview effectively
‘I have today observed this student perform this skill according to the above protocol and judge them to
be at the level of competence and safety expected of a Phase 5 student.
I have given the student constructive feedback.’
Skill performed signed:
Competency shown signed:
Constructive Feedback given signed:
Name(Print)
Professional Registration No
Job title
Department
Date
Feedback:
42
13 – Sign-Ups
Name of Student
Y/N
15. Communicate effectively and sensitively with a person from a different culture
Establish identity and level of English/cultural group or religious implication (arrage for interpreter if
required)
Establish the purpose of the consultation
Elicits individuals ideas, concerns and expectations
Demonstrates positive behaviour concerning individuals beliefs
Offers accurate clinical advice
Uses visual aids if indicated
Uses alternative words and phrases-avoids repeating words not previously understood
Checks for understanding
Acknowledges need for advocacy or interpreting support
Checks for mutual agreement
Avoid being patronising, judgemental, coercive
‘I have today observed this student perform this skill according to the above protocol and judge them to
be at the level of competence and safety expected of a Phase 5 student.
I have given the student constructive feedback.’
Skill performed signed:
Competency shown signed:
Constructive Feedback given signed:
Name(Print)
Professional Registration No
Job title
Department
Date
Feedback:
43
13 – Sign-Ups
Name of Student
Y/N
16. Communicate effectively with another professional
States purpose of interview/meeting/conversation
States issue/concern/complaint/problem factually
Elicits and acknowledges colleague’s perception of issue/concern/complaint/problem
Demonstrates effective listening skills
Demonstrates empathy
Offers or accepts support/advice (as appropriate)
Summarises main points
Agrees next step with colleague
‘I have today observed this student perform this skill according to the above protocol and judge them to
be at the level of competence and safety expected of a Phase 5 student.
I have given the student constructive feedback.’
Skill performed signed:
Competency shown signed:
Constructive Feedback given signed:
Name(Print)
Professional registration No
Job title
Department
Date
Feedback:
44
13 – Sign-Ups
Name of Student
Y/N
17. Explain to a patient or relative a procedure or operation
You should have seen, understood and be able to explain common procedures/operations/treatments
Your explanation should include:
Ensure your information is correct for this patient (identity & procedure)
Preparation for the procedure (investigations, consent, marking, fasting)
The procedure itself (anaesthetic room procedures, overview of procedure)
Post intervention (recovery room procedures, how patient will feel, pain control, care [in-patient and
day case requirements], likely recovery times, outcome and follow up)
Intervention results: expected outcome, possible problems
Note: you are not consenting the patient
(this can only be done by someone capable of performing the procedure)
You should:
Use language your patient understands and avoid unexplained medical jargon
Elicit patient’s concerns and encourage questions
Demonstrate verbal and non verbal empathic responses
Check patient understands what you have said
Summarise main points of discussion and patient’s concerns
Reach mutual agreement about course of action to be taken
Conclude interview effectively
‘I have today observed this student perform this skill according to the above protocol and judge them to
be at the level of competence and safety expected of a Phase 5 student.
I have given the student constructive feedback.’
Skill performed signed:
Competency shown signed:
Constructive Feedback given signed:
Name(Print)
Professional Registration No
Job title
Department
Date
Feedback:
45
13 – Sign-Ups
Name of Student
Y/N
18. Write a ward referral
Record the following legibly:
Writing must be legible
Patients details
Name of referring consultant
Patient location
Consultant name, address and to whom referral is being made
Description of clinical problem
Reason for referral: what question should this referral answer
Urgency
Summary of presenting complaint and examination findings
Relevant past, psychological, family and other history
Relevant investigations (including relevant negatives and tests still outstanding)
Medication and drug sensitivities
What patient has been told and patient’s understanding of the problems
Sign and write your name and status
Countersignature of doctor (inc name, bleep)
‘I have today observed this student perform this skill according to the above protocol and judge them to
be at the level of competence and safety expected of a Phase 5 student.
I have given the student constructive feedback.’
Skill performed signed:
Competency shown signed:
Constructive Feedback given signed:
Name(Print)
Professional Registration No
Job title
Department
Date
Feedback:
46
13 – Sign-Ups
Name of Student
Y/N
19. Write a letter referring a patient to outpatients.
May use ‘Choose and Book’ scheme
Record the following legibly:
Writing must be legible
Patients details, stat if interpreter required, transport needed
GP details
Description of clinical problem
Reason for referral: what question should this referral answer?
Urgency (2 week rule for suspected cancer)
Summary of presenting complaint and examination findings
Relevant past, psychological, family and other history
Relevant investigations (including relevant negatives)
Medication and drug sensitivities
What patient has been told an patient’s understanding of problem
‘I have today observed this student perform this skill according to the above protocol and judge them to
be at the level of competence and safety expected of a Phase 5 student.
I have given the student constructive feedback.’
Skill performed signed:
Competency shown signed:
Constructive Feedback given signed:
Name(Print)
Professional Registration No
Job title
Department
Date
Feedback:
47
13 – Sign-Ups
Name of Student
Y/N
20. Write a discharge notification
Writing must be legible
Patient details (name, address, d.o.b, hospital number)-label may be used
GP details (check with patient that GP name is correct-notes may be out of date)
Admission and discharge dates, admitting consultant
Contact name and ward contact number
Reason for admission/diagnosis (e.g. ‘unable to stand following fall’, ‘collapse’)
Outcome of admission (e.g. ‘R hip replacement’, no further collapses but cause unclear’)
Outstanding problems and tests and potential solutions
Home care arrangements (e.g. District nurse, meals on wheels, specialist nurse to visit)
Follow up arrangements and tests for GP to arrange (include consultant name and contact number;
other service)
Drugs prescription-see notes on prescription writing
Duration of drug treatment? (most trusts prescribe for two weeks only, important for GP etc to know
longer term medication plan)
‘I have today observed this student perform this skill according to the above protocol and judge them to
be at the level of competence and safety expected of a Phase 5 student.
I have given the student constructive feedback.’
Skill performed signed:
Competency shown signed:
Constructive Feedback given signed:
Name(Print)
Professional registration No
Job title
Department
Date
Feedback:
48
13 – Sign-Ups
Name of Student
Y/N
21. Complete a radiology request form/process
If using Electronic patient record system, use options in right hand boxes
Record the following legibly:
Patient details
Select correct patient on electronic patient record
system (EPR)
Barcode label if required
Referring doctor details
Special needs e.g. transport, interpreter
Allergies or reaction to contrast media
Infection risk if present e.g. MRSA, Hepatitis
Urgency of request
Brief, relevant clinical history including, details of other relevant investigations
Clinical questions to be answered by investigations
Sign and print name, status, contact details
Insert correct contact information on EPR
Obtain counter-signature of supervising
Supervising practitioner to review information and
practitioner
submit request
Special Situations:
Pregnant: if ionising radiation request, discuss risks/benefits with department
‘I have today observed this student perform this skill according to the above protocol and judge them to
be at the level of competence and safety expected of a Phase 5 student.
I have given the student constructive feedback.’
.
Skill performed signed:
Competency shown signed:
Constructive Feedback given signed:
Name(Print)
Professional Registration No
Job title
Department
Date
Feedback:
49
13 – Sign-Ups
Name of Student
Y/N
22. Complete a nuclear medicine request form/ process
If using Electronic patient record system, use options in right hand boxes
Record the following legibly:
Patients details
Select correct patient on electronic patient record
system (EPR)
Barcode label if required
Referring doctor details
Special needs e.g. transport, interpreter
Allergies or reaction to contrast media
Infection risk if present e.g. MRSA, Hepatitis
Urgency of request
Brief, relevant clinical history including, details of other relevant investigations
Clinical questions to be answered by investigations
Sign and print name, status, contact details
Insert correct contact information on EPR
Obtain counter-signature of supervising
Supervising practitioner to review information and
practitioner
submit request
Special Situations:
Pregnant: if ionising radiation request, discuss risk/benefits with department
MRI: confirm absence of any ferromagnetic metal in the body
Breast feeding: discuss with department
‘I have today observed this student perform this skill according to the above protocol and judge them to
be at the level of competence and safety expected of a Phase 5 student.
I have given the student constructive feedback.’
Skill performed signed:
Competency shown signed:
Constructive Feedback given signed:
Name(Print)
Professional Registration No
Job title
Department
Date
Feedback:
50
13 – Sign-Ups
Name of Student
Y/N
23. Complete a blood transfusion request form
Cleanse hands with alcohol gel
Introduce yourself and check patient’s identity verbally and with patient’s identity band (including full
name, d.o.b & hospital number)
Discuss procedure with patient & obtain consent
Venesect 10ml venous blood into correct container (clotted sample: revise venesection skill Year 3)
Label bottle by hand in capitals with patient’s name, d.o.b, hospital number, date and time taken
Complete request form or EPR including:
full patient identifying details
reason for request,
urgency,
service required (Gp & save, x-match ‘n’ units)
type of product required
Special patient requirements (e.g. irradiated or CMV negative products)
patient’s transfusion history
Include relevant contact details, date & time,
Place sample in transport bag and dispatch to lab
‘I have today observed this student perform this skill according to the above protocol and judge them to
be at the level of competence and safety expected of a Phase 5 student.
I have given the student constructive feedback.’
Skill performed signed:
Competency shown signed:
Constructive Feedback given signed:
Name(Print)
Professional Registration No
Job title
Department
Date
Feedback:
51
13 – Sign-Ups
Name of Student
Y/N
24. Report a PA chest x-ray
You are expected to be able to recognise rib fractures, pneumothorax, effusion, consolidation,
pulmonary oedema, cardiomegaly and correct placement of a nasogastric tube
Justify the decision to take a chest x-ray
Check name of patient on x-ray and date of examination
Quality of film, PA, film right way round (left/right) correct penetration
Orientation of patient-is patient rotated or straight?
Bony skeleton: identify and check integrity
Heart and mediastinum: size, shape and position
Trachea: central or deviated?
Diaphragm: visible to each side; shape and position; cardiophrenic angles
Lung fields: identification and systematic examination of upper, mid and lower zones.
Lung fields: identification and systematic examination of upper, mid and lower zones.
Placement of any lines and tubes
Document summarised findings in the patients notes
‘I have today observed this student perform this skill according to the above protocol and judge them to
be at the level of competence and safety expected of a Phase 5 student.
I have given the student constructive feedback.’
Skill performed signed:
Competency shown signed:
Constructive Feedback given signed:
Name(Print)
Professional Registration No
Job title
Department
Date
Feedback:
52
13 – Sign-Ups
Name of Student
Y/N
25. Report a plain abdominal x-ray
You are expected to be able to recognise bony abnormalities (e.g. pelvic metastases), patterns
of bowel obstruction, faecal impaction, significant calcification in renal tract, aortic
calcification
Justify the decision to take an abdominal x-ray
Check name of patient on x-ray and date of examination
Quality of film, supine or erect ap, film right way round (left/right) correct penetration
Identify and check integrity of components of skeleton
Identification of major structures and organs
Presence of air or fluid levels in hollow viscera
Presence of air under diaphragm
Presence of calcification of soft tissues, e.g. Aorta
Document summarised findings in the patients notes
‘I have today observed this student perform this skill according to the above protocol and judge them to
be at the level of competence and safety expected of a Phase 5 student.
I have given the student constructive feedback.’
Skill performed signed:
Competency shown signed:
Constructive Feedback given signed:
Name(Print)
Professional Registration No
Job title
Department
Date
Feedback:
53
13 – Sign-Ups
Name of Student
Y/N
26. Confirm diagnosis of death
Confirm patient identity (wrist band/carers)
Establish patient not for resuscitation or resuscitation declared unsuccessful
Establish estimated time of death
Establish who was present
Observe respiratory movements (min 60 secs)
Palpate major pulses (femoral or carotid)
Auscultate for heart sounds (min 30 secs)
Establish pupils fixed to light
Opthalmoscopy for tracking/railroading of fundi
Obtain patient records
Record time and date of death
Record your name and signature
Record people present at time of death
Cleanse hands with alcohol gel
Complete death certificate appropriately with cause of death and document cause in patients notes
‘I have today observed this student perform this skill according to the above protocol and judge them to
be at the level of competence and safety expected of a Phase 5 student.
I have given the student constructive feedback.’
Skill performed signed:
Competency shown signed:
Constructive Feedback given signed:
Name(Print)
Professional Registration No
Job title
Department
Date
Feedback:
54
13 – Sign-Ups
Name of Student
Y/N
27. Complete a blood test form and take blood sample, revising Year 3 venepuncture skills,
interpret results and understand the clinical indications for a blood test
Understand indications for basic haematological and biochemical tests
Writing must be legible
Fill in relevant patient details including name,
Select correct patient on electronic patient record
hospital number and d.o.b. Use sticker if
system (EPR)
available (check details on it are accurate) and
label all copies of form
Fill in details of requesting doctor/team: consultant name, location for results
Give brief relevant clinical summary
What clinical question is this test to help answer?
Record any hazards to lab staff (e.g. Hep B Ag risk)
Indicate urgency (discuss with lab if required)
Sign form indicating status
Insert correct contact information on EPR
Print contact name and bleep number
Obtain countersignature of clinical supervisor
Supervising practitioner to review information and
submit request
Take blood sample safely, revising Year 3 venepuncture skills
Label specimen container using label or with adequate identification details (e.g. name d.o.b, hospital
number, ward location, date of sample) before leaving patient bedside
Dispatch to lab in sealed plastic bag ( you may need to take urgent requests there personally)
Interpret results of basic biochemical and haematological tests appropriately and discuss implications
for the patients management
‘I have today observed this student perform this skill according to the above protocol and judge them to
be at the level of competence and safety expected of a Phase 5 student.
I have given the student constructive feedback.’
Skill performed signed:
Competency shown signed:
Constructive Feedback given signed:
Name(Print)
Professional Registration No
Job title
Department
Date
Feedback:
55
13 – Sign-Ups
Name of Student
Y/N
28. Assess patients oxygen requirements, interpret blood gases, prescribe and administer
appropriate levels of oxygen
Cleanse hands with alcohol gel
Introduce yourself and check patient’s identity
Discuss procedure with patient
Turn on oximeter machine
Ensure calibration has occurred
Select fingernail and ensure it is un-obliterated by nail varnish or false nails
Apply finger probe of oximeter correctly, and ensure oximeter is picking up patient’s pulse reliably
Record haemoglobin oxygen saturation
Assess requirement for further information from arterial blood gases interpret available blood gas data
Decide, with agreement of a trained doctor, percentage inspired oxygen to be
prescribed/administered
Discuss oxygen administration with the patient
Select appropriate mask and fittings or nasal cannulae
Connect via tubing to oxygen source
Adjust correct flow rate of oxygen delivery
Explain oxygen requirements and method of delivery to the patient
Apply mask/cannulae
Determine, in conjunction with a trained doctor, time patient will be reassessed and whether
appropriate to repeat arterial blood gases
Document appropriately and prescribe oxygen correctly countersigned by supervising doctor
‘I have today observed this student perform this skill according to the above protocol and judge them to
be at the level of competence and safety expected of a Phase 5 student.
I have given the student constructive feedback.’
Skill performed signed:
Competency shown signed:
Constructive Feedback given signed:
Name(Print)
Professional Registration No
Job title
Department
Date
Feedback:
56
13 – Sign-Ups
Name of Student
Y/N
29. Measure the height and weight of a patient and calculate and interpret body mass index
explaining significance to patient
Cleanse you hands with alcohol gel
Introduce yourself and check the patient’s identity
Discuss the procedure with the patient
Position the patient correctly in the stadiometer (stand erect, footwear removed, facing away from the
wall, heels to wall, head such that external auditory meatus is on same horizontal as lateral canthus
Move reading arm of stadiometer to touch patient’s head firmly
Read and record height correctly
For weighing check patient in indoor clothing with footwear removed
Check balance correctly zeroed (steelyard type, not bathroom scales)
With patient on the platform, adjust weights to achieve balance
Read and record weight
Calculate body mass index
Plot on centile chart
Appreciate acceptable range of values (20-25)
Explain significance of BMI to patient <18 malnourished 18-20 Underweight 25-30 Overweight 30-35
Obese >35 Morbidly Obese
Provide nutritional advice as required
‘I have today observed this student perform this skill according to the above protocol and judge them to
be at the level of competence and safety expected of a Phase 5 student.
I have given the student constructive feedback.’
Skill performed signed:
Competency shown signed:
Constructive Feedback given signed:
Name(Print)
Professional Registration No
Job title
Department
Date
Feedback:
57
13 – Sign-Ups
Name of Student
Y/N
30.Measure the physiological parameters of a patient, calculate and interpret an early warning
score for early detection of the deteriorating patient
Cleanse your hands with alcohol gel
Introduce yourself and check the patients identity
Discuss the procedure with the patient
Check patient identity against the details present on the Trust physiological observation (early
warning score) document. Enter details if starting new document
Measure and record temperature correctly (revise year 1 skill)
Measure and record pulse correctly (revise year 1 skill)
Measure and record blood pressure correctly (revise year 1 skill)
Measure and record respiratory rate correctly (revise year 3 skill)
Measure and record oxygen saturations correctly (revise year 3 skill)
Measure and record urine output correctly
Measure and record responsiveness correctly (revise year 3 skill)
Calculate the early warning score used in the Trust and document appropriately
Interpret calculated score
Discuss management of the patient relating to the score using any algorithms in use in the Trust for
escalation of care
Cleanse your hands with alcohol gel
Discuss required future frequency of observations with supervising practitioner
‘I have today observed this student perform this skill according to the above protocol and judge them to
be at the level of competence and safety expected of a Phase 5 student.
I have given the student constructive feedback.’
Skill performed signed:
Competency shown signed:
Constructive Feedback given signed:
Name(Print)
Professional Registration No
Job title
Department
Date
Feedback:
Practice all these skills as frequently as possible, you will be expected to do these
faultlessly.
58
13 – Sign-Ups
Name of Student
Intermediate Life Support Certificate (ALS also acceptable)
Signature of RTO Tutor….………………………………………………………...
RTO Name and Hospital……………………………………………………………
Date……………………………………………………………………………………
Psychiatry session – sign up on VC whilst on GP rotation
Location of session....................................................................................
Signature of attendance.............................................................................
Date...........................................................................................................
GP and Community Specific – Hospice Visit
(Students in London have a hospice visit arranged for them. Students in Independent placements are
expected to arrange a visit themselves with help from staff at their practice. Call Ruth Sugden on: 020
7848 8695 if you are having problems)
Name of Hospice...…………………………………………………………………
Hospice Stamp/ Signature of Supervisor…………………………………………
Date……………………………………………………………………………………
Clinical Simulation Experience
Site:
Date of Simulation experience:
Signed
Name of Student
Shadow a member of the overnight team on a whole overnight shift including
handovers. i.e. Hospital @ night scheme.
Name of hospital…………………………………………………………………..
Name of doctor shadowed……………………………………………………….
Signature…………………………………………………………………………..
59
13 – Sign-Ups
Speciality…………………………………………………………………………..
Date………………………………………………………………………………...
Observe ALL the following procedures and obtain your supervisor’s signature for each skill.
ENDOSCOPY UPPER GI TRACT
Student: I now feel confident I can explain their experience and preparation for this procedure
to a patient if required.
Signed:
COLONOSCOPY
Student: I now feel confident I can explain their experience and preparation for this procedure
to a patient if required.
Signed:
SIGMOIDOSCOPY
Student: I now feel confident I can explain their experience and preparation for this procedure
to a patient if required.
Signed:
BARIUM ENEMA
Student: I now feel confident I can explain their experience and preparation for this procedure
to a patient if required.
Signed:
BRONCHOSCOPY
Student: I now feel confident I can explain their experience and preparation for this procedure
to a patient if required.
Signed:
CYSTOSCOPY
Student: I now feel confident I can explain their experience and preparation for this procedure
to a patient if required.
Signed:
60
13 – Sign-Ups
ULTRASOUND EXAMINATION
Student: I now feel confident I can explain their experience and preparation for this procedure
to a patient if required.
Signed:
CT SCAN
Student: I now feel confident I can explain their experience and preparation for this procedure
to a patient if required.
Signed:
MRI SCAN/ISOTOPE SCAN
Student: I now feel confident I can explain their experience and preparation for this procedure
to a patient if required.
Signed:
INSERTION OF CVP LINE, INCLUDING MEASUREMENT & INTERPRETATION OF CVP
Student: I now feel confident I can explain their experience and preparation for this procedure
to a patient if required.
Signed:
NURSING DRUG ROUND
Student: I have attended a nursing drug round and understand the processes involved for the
patient and nursing staff
Signed:
Name of Student
Carry out or observe under direct supervision as many of these procedures as you are
able, in each case indicate if the procedure was carried out or observed by you.
ASSESS A PATIENTS FLUID REQUREMENTS
Date…………………………………
Carried out / Observed
PRESCRIBE APPROPRIATE FLUID
Date…………………………………
Carried out / Observed
61
13 – Sign-Ups
FEMORAL VENEPUNCTURE
Date…………………………………
Carried out / Observed
SPIROMETRY
Date…………………………………
Carried out / Observed
COMPLETION OF YELLOW CARD ON ADVERSE
DRUG REACTIONS
Date…………………………………
Carried out / Observed
REMOVAL OF WOUND DRAINS
Date…………………………………
Carried out / Observed
ARTERIAL BLOOD SAMPLING
Date…………………………………
Carried out / Observed
Observe only, as many of these procedures as you are able
REPORING OF A CASE TO THE CORONER
Date………………………………….
LUMBAR PUNCTURE
Date………………………………….
SUPRAPUBIC CATHETERISATION
Date………………………………….
LIVER/RENAL BIOPSY
Date…………………………………
ANGIOGRAM
Date………………………………….
INSERTION OF A CHEST DRAIN
Date………………………………….
HAEMODIALYSIS
Date………………………………….
CHEST ASPIRATION
Date…………………………………
JOINT ASPIRATION
Date…………………………………
ABDOMINAL PARACENTESIS
Date…………………………………
62
13 – Sign-Ups
Once you have graduated, you will be required to keep a personal development portfolio of
evidence of your on-going learning and development. This will include signups for procedural,
examination, communication and organisational skills as well as evidence of experience
gained in particular elements of the post graduate curriculum. An important part of the portfolio
is your reflection on your experiences and formulation of future learning objectives.
To prepare for this process keep a portfolio of the experiences and learning you achieve this
year with regard to one skill:
THE SAFE ADMINISTRATION OF A TRANSFUSION OF BLOOD PRODUCTS
Below are listed some of the individual skills required to understand blood transfusion
and examples of the ways of acquiring the skills and evidence you could keep in your
portfolio;
Skill: Indications for transfusion and transfusion thresholds
Evidence: discussion with trained practitioner / lectures/Reflections on the content of the
Hospital Maximum Surgical Blood Ordering Schedule (MSBOS)
Skill: Venesection for transfusion
Evidence: Supervised practice, logbook of procedures formed, phase 5 skill sign up
Skill: Knowledge of issues to be explained to patients prior to transfusion
Evidence: Observed consent process, lecture, patient information leaflets
Skill: Understands importance of traceability of blood products and cold chain process
Evidence: Phase 5 transfusion lecture, discuss with nursing staff administering blood products,
review hospital protocols
Skill: Appreciation of the patient monitoring required for blood product administration
Evidence: hospital protocols, observation with nursing staff, practice observations and charting
Skill: Awareness of the hazards of blood transfusions and transfusion reactions,
immediate management and documentation required
Evidence: medical literature and lectures, ILS, hospital protocols, Simulation training, reflection
on where in the process mistakes can occur.
For all of the above you should reflect on your learning and any feedback you have received
and formulate future learning objectives in this area.
You will be required to produce your learning portfolio for this skill at the end of the year if
asked by your head of year.
63
14 – Cases Seen
Medicine Rotation – Log Cases Seen
Anonymized
Patient
Identifier
Brief Clinical
Summary
Dates Seen
Further involvement
Reflection
□
□
□
□
□
□
□
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64
14 – Cases Seen
Surgery Rotation – Log Cases Seen
Anonymized
Patient
Identifier
Brief Clinical
Summary
Dates Seen
Further involvement
Reflection
□
□
□
□
□
□
□
□
□
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65
14 – Cases Seen
General Practice Rotation – Log Cases Seen
Anonymized
Patient
Identifier
Brief Clinical
Summary
Dates Seen
Further involvement
Reflection
□
□
□
□
□
□
□
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66
15 – Phase 5 Campus Block Evaluation Receipts
A receipt is required for proof that each student has completed the Campus Block Evaluations, please
complete the evaluation at the end of each Campus Block, which will be available on the Virtual
Campus, print off the receipt and paste it below:
October Campus Block Evaluation Receipt:
December Campus Block Evaluation Receipt:
March Campus Block Evaluation Receipt:
67
16 – Integrated Skills List
To pass Phase 5, students must be competent in all the skills shown in bold below. In the Phase 5 OSCE you can
be examined on all logbook skills from Phase 1-5.
Skills Practice Available denotes which skills can be practiced outside of normal teaching.
The key is as follows
IL - Independent Learning
SU - Sign up teaching
C - Curriculum teaching
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 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)
Integrated Skills List
1. Essential 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
68
Year
Introduced
Year first
Tested
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
2
1
1
1
2
3
2
2
2
2
2
2
Skills
Practice
available
16 – Integrated Skills List
Integrated Skills List
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
2. Communication skills
2.1 Adapt history taking to specialty inc. psychiatry, gynaecology, urology,
dermatology, musculo-skeletal
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
69
Year
Introduced
2
3
3
3
3
Year first
Tested
2
3
3
3
3
3
3
3
3
5
5
3
3
3
3
3
3
4
4
4
3
3
3
3
3
4
4
3
4
4
4
5
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
1
1
3
3
3
Skills
Practice
available
C
C
C
IL
C,IL
C,IL,SU
16 – Integrated Skills List
Integrated Skills List
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
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 Isotope Scan
7.14 Barium meal
7.15 Exercise ECG
7.16 Venography
7.17 Laparoscopy
70
Year
Introduced
3
3
3
3
3
3
3
3
3
3
4
Year first
Tested
3
3
3
3
3
3
3
4
4
4
4
Skills
Practice
available
C,IL,PT
C,IL,PT
C,IL,PT
IL
C,IL,PT
IL
4
4
1
3
3
2
3
3
C,IL,SU
IL
IL,SU
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
5
5
5
5
5
5
5
5
5
5
5
5
16 – Integrated Skills List
Integrated Skills List
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
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 x-ray
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 Give drug by different route: subcutaneous
12.3b Give drug by different route: intramuscular
12.4 Explain to a patient a skin preparation
12.5 Contraceptives: use of barrier methods
71
Year
Introduced
3
4
4
4
5
Year first
Tested
Skills
Practice
available
3
3
3
3
3
3
5
3
C
IL
1
3
4
4
4
5
3
4
1
3
4
4
4
5
C,IL,SU
IL
IL
IL
4
IL
1
2
2
3
3
3
3
4
5
3
3
4
3
1
2
2
3
3
5
5
5
5
C,IL,SU
IL
C,IL,SU
IL
4
IL
3
3
3
3
3
1
3
2
3
4
4
1
4
2
4
4
4
C,IL,SU
IL
16 – Integrated Skills List
Integrated Skills List
12.6 Write a prescription
12.7 Report an adverse drug reaction using the yellow card system
12.8 Prepare and give an intravenous drug
12.9 Give drug using nebuliser
12.10 Give Oxygen at appropriate % concentration
12.11 Set up and operate a syringe pump and medication
12.12 Instil eye drops/eye ointment
12.13 Use of nasal spray
12.14 Administer a subcutaneous injection
12.15 Prescription checking
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 a 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 Take and interpret a 12 lead ECG
13.13 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
72
Year
Introduced
3
3
3
3
3
5
3
3
2
2
Year first
Tested
3
5
5
5
5
5
Skills
Practice
available
IL
IL,SU
IL
IL,SU
2
2
1
1
1
3
1
1
1
3
3
3
3
3
3
4
4
3
4
3
3
5
3
5
5
5
3
3
3
3
4
3
4
4
4
4
3
5
3
5
5
3
5
3
5
5
5
5
5
5
5
5
5
5
5
3
5
5
5
5
5
5
IL
IL,SU
IL,SU
IL,SU
IL,SU
IL,SU
IL
IL,SU
16 – Integrated Skills List
Year
Introduced
5
4
Integrated Skills List
15.15 Observe the reporting of a death to a coroner
15.16 Taking Observations and E.W.S.
73
Year first
Tested
5
Skills
Practice
available
In Course Assessment for Rotation One (October-December 2012)
Workplace Based
Mini- CEX / ECSA
http://virtualcampus.kcl.ac.uk/vc/medicine/coursebooks/coursebooks.aspx?course=year5
Assessment used
:
Student’s own reflections on what they have learned about their performance, and what needs to be addressed
next
Global Assessment for MBBS-5
Name of Student
Dates of Placement
Name of Assessor (please PRINT)
This global assessment is based on (tick all that apply)
• My own observations of the student in clinical contact
• Other members of the firm who have observed the student in clinical contact
• Workplace based assessments submitted by student
• Other…………………………………….
Has the student made progress whilst on the firm
YES
NO
What particular areas have improved?
What particular areas does the student need to concentrate
on now?
On current form, do you consider this student is likely at the
end of the year to be
PASS
The students motivation (attendance) is
>90%
The student’s reliability (punctuality) is
Excellent
BORDERLINE
75-90%
Occasional
lapses
YES – please identify:
Do you have any concerns?
FAIL
50-75%
<50%
Frequent lapses
NO
If concerns are identified, indicate whom you have agreed
with the student that they will now see:
Sub-Dean
(on site)
Clinical
Adviser
Head of
Phase
Signed……….…………………………………………………………………………………………….. Date……………………………..........
74
InCourse Assessment for Rotation Two (January-March 2013)
Workplace Based
Mini- CEX / ECSA
http://virtualcampus.kcl.ac.uk/vc/medicine/coursebooks/coursebooks.aspx?course=year5
Assessment used
:
Student’s own reflections on what they have learned about their performance, and what needs to be addressed
next
Global Assessment for MBBS-5
Name of Student
Dates of Placement
Name of Assessor (please PRINT)
This global assessment is based on (tick all that apply)
• My own observations of the student in clinical contact
• Other members of the firm who have observed the student in clinical contact
• Workplace based assessments submitted by student
• Other…………………………………….
Has the student made progress whilst on the firm
YES
NO
What particular areas have improved?
What particular areas does the student need to concentrate
on now?
On current form, do you consider this student is likely at the
end of the year to be
PASS
The students motivation (attendance) is
>90%
The student’s reliability (punctuality) is
Excellent
BORDERLINE
75-90%
Occasional
lapses
YES – please identify:
Do you have any concerns?
FAIL
50-75%
<50%
Frequent lapses
NO
If concerns are identified, indicate whom you have agreed
with the student that they will now see:
Sub-Dean
(on site)
Clinical
Adviser
Head of
Phase
Signed……….…………………………………………………………………………………………….. Date……………………………..........
75
InCourse Assessment for Rotation Three (March-April 2013)
Workplace Based
Mini- CEX / ECSA
http://virtualcampus.kcl.ac.uk/vc/medicine/coursebooks/coursebooks.aspx?course=year5
Assessment used
:
Student’s own reflections on what they have learned about their performance, and what needs to be addressed
next
Global Assessment for MBBS-5
Name of Student
Dates of Placement
Name of Assessor (please PRINT)
This global assessment is based on (tick all that apply)
• My own observations of the student in clinical contact
• Other members of the firm who have observed the student in clinical contact
• Workplace based assessments submitted by student
• Other…………………………………….
Has the student made progress whilst on the firm
YES
NO
What particular areas have improved?
What particular areas does the student need to concentrate
on now?
On current form, do you consider this student is likely at the
end of the year to be
PASS
The students motivation (attendance) is
>90%
The student’s reliability (punctuality) is
Excellent
BORDERLINE
75-90%
Occasional
lapses
YES – please identify:
Do you have any concerns?
FAIL
50-75%
<50%
Frequent lapses
NO
If concerns are identified, indicate whom you have agreed
with the student that they will now see:
Sub-Dean
(on site)
Clinical
Adviser
Head of
Phase
Signed……….…………………………………………………………………………………………….. Date……………………………..........
76
77
What to do if you have a percutaneous or mucosal exposure to potentially
HIV-infected 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
78