Download MBBS Programme Phase 4 Student Logbook 2012-13 Child Health, Development and

School of Medicine
If found please return to:
The Academic Centre
Henriette Raphael House
Guy’s Campus
London, SE1 1UL
MBBS Programme
Phase 4 Student Logbook
2012-13
Child Health, Development and
Ageing Block (CHDA)
Student Name
Site
Tel
Email
Clinical Adviser
You must submit your completed logbook at the end of the CHDA rotation to
the Academic Centre
Please ensure you photocopy the pages for skills sign-ups and Clinical
Adviser meetings before submitting the logbook, and keep a copy for your
own reference
A completed & submitted logbook for each rotation, with all clinical skills
signed & all professional development, clinical tutor & Clinical Adviser
sections signed, is a requirement for progression from Phase 4 into Phase 5
PLAGIARISM
Your attention is drawn to the College statement on plagiarism, a
copy of which you will have signed at enrolment. A copy will also
be available on the Virtual Campus.
This statement covers all work that you will submit for
assessment (including all completed SSC submissions in later
years where you will be required to sign a statement confirming
that you have not plagiarised any of the material contained
therein).
You are strongly reminded that any breach of these rules by you
will be the subject of the College’s disciplinary procedures and
could result in the termination of your studentship. Furthermore,
an act of plagiarism is by its very nature dishonest and could
bring into question your Fitness to Practise.
FALSIFYING A LOGBOOK SIGN-UP IS FRAUDULENT AND MAY
LEAD TO DISCIPLINARY ACTION
Contents
Part 1 – Important Information
1.
Introduction
p.1
2.
Educational Contract
p.3
3.
The School of Medicine Confidentiality Code
p.5
4.
Clinical Adviser Visit
p.6
5.
Digital Professionalism
p.7
6.
Feedback
p.8
7.
Career Reflections
p.9
8.
An Important Notice About Infection Control in Clinical Practice
p.10
9.
Code of Practice for Student Examination of Patients
p.14
10.
Fitness to Practise
p.19
11. Simulated and interactive Learning (SaiL)
p.20
12.
p.21
Clinical Teaching Activity Attendance Sheet
Part 2 – Skills and Sign-ups
13.
Summary of Skills to be Acquired in Phase 4
p.22
14.
In-Course Assessment of Clinical Skills: Guidance for Students p.23
15.
Sign-Ups
p.24
16.
Patients Clerked
p.37
17.
Block Feedback
p.39
18.
Integrated Skills List
p.40
1– Introduction
Welcome to the CHDA Phase 4 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 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 each rotation for inspection of satisfactory
completion of skills and authenticity of signatures. Because each year logbooks are mislaid,
you are advised to photocopy all pages with skills sign-ups and Clinical Adviser visits
before handing in.
Gaining competency 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 competency. They are assessed in subsequent year’s OSCEs.
Keeping your skills up-to-date
Clinical practice is constantly changing. New skills are introduced and others change in technique
or equipment used. It is your responsibility to keep up-to-date with changes and to modify your
skills technique accordingly. This is especially important for skills such as BLS. In subsequent
OSCEs, you will be assessed on the updated skills techniques not the method you initially learnt.
Section 4 – Clinical Adviser Visit (p. 6)
This is a record of visits to your Clinical Adviser. 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 to these visits.
Section 9 – Code of Practice (p. 14-18)
This section contains guidelines for general examination and intimate examination of patients.
You should be aware of these guidelines and comply with them at all times.
Sections 13-15 – Skills and Sign-ups (p. 22-36)
This is the official record of your sign up of skills for your year.
In Phases 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.
1
1– Introduction
In Phases 3, 4, 5 there are separate books or pages for each rotation. You should get the incourse assessment skills and attendance at special clinical sessions signed up by the end of each
rotation by a clinician or nurse specialist appropriate to the specialty.
A copy of the integrated skills list for all years of the MB BS programme is on the Virtual Campus.
Section 16 – Patients Clerked (p. 37)
This is a record page for you to list clinical cases you have clerked and examined, and will be
useful for discussion and revision. Patients vary, so you should aim to clerk several patients within
each diagnostic category.
Attendance and satisfactory sign-up
On page 21 you will find the Clinical Teaching Activity attendance sheet. Please ensure that you
have this signed by the clinician who takes you for ward rounds, clinics, theatre lists and other
clinical teaching sessions as you progress through the Block You are expected to attend all
teaching whether lectures, practicals, tutorials, symposia or 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).
Name Badges
You are expected to wear your School of Medicine ID badge at all times in hospital and GP
premises, in community settings and on home visits.
Dress Code
When attending clinical sessions please ensure that you are dressed professionally and
appropriately. The dress code excludes excessively casual clothing such as jeans, shorts,
baseball caps and trainers. Avoid wearing revealing clothing as this may embarrass patients.
Dressing smartly and appropriately indicates to patients and healthcare workers your professional
role as medical students within the clinical setting.
2
2 – Educational Contract
The clinical teaching leads on the individual campuses have overall responsibility for your
placement, timetable and your clinical supervision.
The block leader of RSH (Dr Bruce), CHDA (Dr Waller) or EMTL (Dr Lacy) and then the Head of
Phase 4 (Dr Hannam) have overall responsibility for the placements.
At the outset of the attachment you will be given information about the expectations of the
attachment, including on-call periods. If you have any commitments that conflict with these you
must make them known to the appropriate teaching lead and agree how this will be managed.
You should comply with all aspects of the KCL School of Medicine Student and Doctor,
particularly:
develop skills by:
• attending and participating in learning opportunities
• reflecting on and addressing personal learning needs
• learning to communicate effectively with patients, relatives and professionals
• working cooperatively with patients, peers, teachers and healthcare staff
• becoming proficient in essential clinical examination skills
• becoming proficient in essential practical procedures
and demonstrate appropriate attitudes by:
• treating patients with politeness and consideration, learning to involve them in decisions
about their care
• acting honestly with patients, peers and staff
• showing respect for patients, relatives and colleagues that encompasses, without prejudice,
diversity of background, language, culture and way of life
• recognizing the rights of patients and acting in their best interests, particularly with regard to
confidentiality, informed consent, autonomy and dignity
• recognizing the need for guidance and supervision and the limits of personal competence
and health
• respecting the professional values of competence in performance, reliability and conduct.
Guidance on meeting the requirements of the Educational Contract
1. Patients: you will be expected to take histories and examine patients in inpatient, outpatient
and community settings throughout the attachment with a minimum of two patients clerked and
examined fully every week.
2. Skills: you will be expected to learn and practise the skills listed in the Logbook before having
your competence validated by an appropriate health professional.
3. Identity: during interactions with patients and staff you should always wear you name badge
and identify yourself as a medical student.
4. Dress Code; you must abide by the dress code and infection control procedures for the NHS
Trust to which you have been allocated.
5. Patient records and consent: all entries you make in patient records must be signed, dated,
and your name and status as “medical student” printed legibly. The patients whom you will
look after will be asked to give their permission for your involvement. It is always a patient's
right to decline to be seen by a medical student.
3
2 – Educational Contract
6. Ill health: if you are unable to attend because of ill health, you should inform your firm head as
soon as possible. The School of Medicine will expect you to submit to the Academic Centre a
suitable sickness certificate (self-certification for less than five working days, medical certificate
for five days or longer). There is no holiday leave during the attachment; holidays are built in to
the Phase 4 timetable.
7. Potential complaints: if you are in a situation where you have any reason to think a complaint
might be made against you, you are concerned by a patient’s comments, or believe you may
have acted inappropriately, you should discuss this with your firm head, another senior clinician
or your clinical adviser as soon as possible. Resolving a problem quickly shows respect for
your patient (and is much less likely to result in a formal complaint being made).
8. Education supervision: if you have any concerns over the supervision you are receiving, you
should take this up with your firm head, the site Sub-Dean, the Head of Phase 4 or if the advice
you seek is of a more personal nature, with your Clinical Adviser.
9. Professional indemnity: the School of Medicine requires all students to be a member of a
medical defence organisation during the whole undergraduate course including Phase 4 . If
you follow the guidance in this contract it is difficult to envisage any legal action which would
not be covered through your consultant. However, the medical defence organisation to which
you subscribe would cover you in this unlikely event and also provide additional support. You
should be aware that the medical school has no responsibility to provide cover for students in
such situations.
I accept and agree to abide by the conditions of the Educational Contract
Student:
Signature ………………………………………… Date ……………..
Clinical Advisor:
Signature ………………………………………… Date ……………..
4
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…………………………………………………………………………
5
4 – Clinical Adviser Visits
Name of Clinical Adviser:
Name of student:
You are advised to see your clinical adviser following your mid-rotation interview with your firm head to discuss the
following
Term 1 Campus:
□ Confidentiality Code signed – Rotation 1 (p5)
□ Skills sign-ups reviewed (may not be complete)
□ List of patients clerked and reviewed (optional)
□ Attendance / Health
□ SSCs (Poster Presentation phase 5 only)
□ Responsible use of social media
□ Foundation Programme application discussed
(phase 5)
□ Career ambitions discussed
□ Consent issues (Code of practice for examination
of patients - see p14-18)
□ Exam performance and OSCE feedback
□ Professional development (including
interprofessional education)
□ Fitness to Practise concerns
□ Educational Contract discussed and signed
□ Transfer/ returning students: issues
Clinical Adviser: Signed …….………………………………………………...….. Date ……………………
GMC no./Designation…………………………………………………………………………
Comments:
Term 2 Campus:
□ Skills sign-ups reviewed (may not be complete)
□ List of patients clerked and reviewed (optional)
□ Attendance / Health
□ SSCs & electives
□ Discuss an ethical experience from Term 1
□ Ethical report (phase 3 only)
□ Review clinical grades
□ Professional development (including
interprofessional education) discussed
□ Foundation Programme application discussed
(phase 4 and 5)
□ Career ambitions discussed
□ Fitness to Practise concerns
□ Educational Contract signed
Clinical Adviser: Signed …….………………………………………………...….. Date ……………………
GMC no./Designation…………………………………………………………………………
Comments:
Term 3 Campus:
□ Skills sign-ups reviewed (may not be complete)
□ List of patients clerked and reviewed (optional)
□ Attendance / Health
□ Educational Contract signed
□ Professional development (including
interprofessional education) discussed
□ Review clinical grades
□ Foundation Programme application discussed
(phase 4)
□ Career ambitions discussed
□ Fitness to Practise concerns
□ Exam performance, OSCE feedback and revision
□ Electives (phase 3 &4)
Clinical Adviser: Signed …….………………………………………………...….. Date ……………………
GMC no./Designation…………………………………………………………………………
Comments:
6
5 – Digital Professionalism
Evidence must be shown that the module has been completed.
I have seen evidence that the student has completed the on line Digital Professionalism
module at http://virtualcampus.kcl.ac.uk/vc/tel/social_media_guidance
Signature of Clinical Advisor .………………………………………………
Date ……………………………………………………………………………………
7
6 - Feedback
Receiving feedback from your course tutors and other teachers
Throughout the medical course, you will receive feedback on your work and clinical performance.
Feedback if used constructively helps improve your standards. The GMC’s guidance in Good
Medical Practice states that “you must reflect regularly on your standards of medical practice and
respond constructively to the outcome of appraisals and performance reviews”. <www.gmcorg.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.
8
7 – Career Reflections
Reflecting on the range of career options in medicine
Drawing on your experience of the different specialities in your course, start to think about the
options for your medical career and your aptitude for each speciality.
Use this page to make notes and refer to them in discussion with your clinical adviser.
In relation to each speciality ask yourself the following questions:
• What aspects did I enjoy and why?
• What aspects did I dislike and why?
• What information have I found out on careers in this speciality?
• What more do I want to find out about this speciality? How will I do it?
• Am I suited to working in this speciality?
You are strongly encouraged to look at the Medical Careers website:
http://www.medicalcareers.nhs.uk/medical_students/introduction.aspx
9
8 - An Important Notice About Infection Control In Clinical Practice
The exact infection control regulations enforced in hospitals vary from Trust to Trust, but the following infection control
guidelines should be acceptable at all hospitals. Each Trust will have its guidelines on its ward computer system
(intranet).
Students (and staff) can readily become colonised with pathogenic bacteria and viruses during close contact with
patients. Even a brief examination can be responsible for the spread of MRSA, coliforms and enteric viruses. These
can cause severe harm to patients. Also, occasionally students and staff may be infected by these pathogens, and,
very rarely, Hepatitis B, C HIV and HTLV 1.
These brief guidelines are intended to help you to know what to do in different clinical settings. Note also that
infection control practice is an integral part of many OSCE assessments.
If you are unwell – e.g. diarrhoeal illness, severe cold or any febrile illness – do not go on the wards. If you have a
mild cold without fever – do not visit immunocompromised patients. Ask a senior member of the ward staff, or the
Hospital Infection Control & Prevention team, if in doubt.
Important organisms that may be transmitted in health
Main means of spread
care
Hepatitis B & C, HTLV-1 and HIV
Varicella zoster virus (chickenpox & shingles)
Diarrhoeal diseases e.g. Norovirus, Rotavirus,
Salmonella, Shigella
Resistant Gram negative bacteria e.g. Klebsiella
(especially ‘ESBL’ strains)
Environmental organisms e.g. Pseudomonas
Mycobacterium tuberculosis
Clostridium difficile colitis
Methicillin-resistant Staphylococcus aureus (MRSA),
sensitive Staph aureus, Group A streptococci
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
Hand/patient contact
Via hands or via equipment e.g. instruments left
wet overnight
Respiratory route
Environmental & hand spread (+antibiotics)
Via staff carriers, hands, environment
Practical Guidelines for Day-to-day Infection Control
White Coats etc
Please refer to the dress code on page 14 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).
10
8 - An Important Notice About Infection Control In Clinical Practice
Hand Disinfection with Aqueous Chlorhexidine (or Iodine) or Alcoholic Preparations such as Hibisol, or
Alcohol Gel Sink using the seven stage technique.
First remove any visible contamination (if present) with soap & water
•
•
•
•
•
If you have contaminated your hands with blood and body fluids
Before and after dealing with immunocompromised patients (especially in Protective Isolation) and
with patients in Standard or Strict Isolation
Before doing clinical procedures e.g. venepuncture, IV line insertion, catheterisation
Alcohol preparations as an alternative to soap and water washing if no sink is available.
See note above about not using alcohol for patients with Clostridium difficile & Norovirus
11
8 - An Important Notice About Infection Control In Clinical Practice
In the Operating Theatres
Ask for advice if in doubt.
Change out of outdoor clothing except for underwear (remove socks/stockings)
Change into theatre top + trousers, or tunic; clogs, head covering (balaclava-style if long hair) and filtering mask.
Remove watch and jewellery, & wash hands. Put up mask on entering operating area of theatre. Now you are part of
the “circulating team”. If asked to scrub up: nail brushing; three-minute surgical wash with aqueous chlorhexidine or
povidone iodine up to & just above the elbows (do not scrub the skin with a nail brush). Don’t touch anything 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.
12
8 - An Important Notice About Infection Control In Clinical Practice
What to do if you have a percutaneous or mucosal exposure to potentially HIVinfected blood or other high-risk body fluid:
In all cases – whether the patient is known to be high risk for any infection or not • Encourage the wound to bleed, ideally by holding it under running water
• Wash the wound using running water and plenty of soap
• Don’t scrub the wound while you are washing it
• Don’t suck the wound
• Dry the wound and cover it with a waterproof plaster or dressing
• Mucosal splash (eye, mouth): rinse with a lot of sterile water or saline for 10 minutes
• Note name number and location of ‘donor’ patient, if known. Notify a senior person in the
ward or clinic.
• Attend Occupational Health IMMEDIATELY AND ALWAYS WITHIN AN HOUR IF AT ALL
POSSIBLE. OUT OF HOURS attend ACCIDENT & EMERGENCY; report a ‘needlestick
injury’ and you will be seen quickly.
• The Occupational Health Department or the A & E Department (via the Virologist. Medical
Microbiologist, or HIV/Infectious Disease Physician on duty) should arrange for the
patient's blood to be tested for HIV (and HBV and HCV) with the informed consent of the
patient.
• Fill out an incident form (later). Keep a copy of the accident report.
• When advised to do so, take a single dose of the anti-HIV drugs as soon as possible,
ideally within one hour of the incident. There is unlikely to be any benefit if HIV PEP is
started >72 hrs after the incident. This one dose is unlikely to give side effects. If the
exposure is to blood or body fluids/tissues from a patient shown to be or strongly
suspected of being HIV positive, you should continue to take the anti-HIV drugs for four
weeks, according to the prescription details, with monitoring. You will need to be followedup by the Occupational Health Department, a senior HIV/Infectious Disease Physician, or
a Medical Microbiologist or Virologist.
• If you have been at risk of acquiring HIV infection, you should use condoms and refrain
from donating blood until a blood test at 6-7 months confirms that you are uninfected.
13
9 - Code of Practice for Examination of Patients by Students
Basic professional requirements for students on clinical practice (see Educational Contract)
Interviewing patients
Dress Code
Each NHS trust has its own dress code, but the following principles apply in most trusts. Dress should be professional
and appropriate to the specialty. Dress code excludes excessively casual clothing such as jeans, shorts, baseball
caps and trainers. Avoid wearing revealing clothing as this may embarrass patients.
Most commonly health care workers wear uniforms or tunics, or short-sleeved shirts/blouses and no ties. (If the
medical firm or hospital where you work still requires white coats, make sure your white coat is always clean - change
it regularly.) Ties (if worn) should be tucked into the shirt about half-way down. If you don’t have short-sleeved shirts/
blouses, roll up the sleeves above the elbows for surgical cleansing and procedures. Wrist watches, wrist bands and
jewellery should be removed before work (bare below the elbows). Nails should be kept short and clean, with no nail
varnish or false nails. Long hair should be tied back. Clothing should be of a type that can be hot-washed, i.e. above
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
14
9 - Code of Practice for Examination of Patients by Students
Protocol for Intimate Examinations of Patients by Students in Healthcare Professions
The recommendations of the protocol apply in most NHS trusts in which you will study. You should check the details
with your firm head. For all patients, capacity to give consent must comply with the Mental Capacity Act 2005.
Introduction
Consultations with healthcare professionals, examinations and investigations are potentially distressing for patients
when involving intimate areas of the body. Acceptable professional behaviour, good communication, and respect for
patients’ rights to be fully involved in decisions about their care will reassure patients and avoid misunderstanding.
Complaints are not infrequently made that health professionals have behaved improperly or roughly when undertaking
intimate examinations or invasive procedures. Students in healthcare professions are at similar risk. For your patients’
and your own protection, you should follow this protocol when performing intimate examinations. These include:
• vaginal examination and inspection of the perineum
• rectal examination of both sexes
• examination of female breasts
• examination of external male genitalia
Requirements for intimate examinations
First practise the examination on a model, mannequin, or a patient educator.
Before examining a patient, you must have approval from your clinical supervisor at the time of the examination. For
all vaginal and rectal examinations and first examinations of female breasts or male external genitalia, you must
examine the patient in the presence of your supervisor
The patient must have a chaperone.
You should obtain the patient’s permission and explain that this will be recorded in the patient notes, as follows;
• Verbal permission for examination with the patient awake
• Written permission for examination under anaesthesia, using a student form
Patient consent for examinations and invasive procedures
It is a requirement of clinical practice that consent for any procedure is obtained from patients by the clinician with
responsibility for their care and that the patient is adequately informed about the procedure, possible risks and
consequences, and alternative management options. This is known as informed consent. Giving consent requires
the patient to have sufficient mental capacity. Consent can be verbal or written and must be given voluntarily.
Students in training are not legally qualified to obtain informed consent from patients but must obtain the patient’s
agreement for history taking and examination.
Preparing patients for an intimate examination
Having obtained the patient’s consent, explain what is involved and whether the patient has previous experience of
the examination, whether the experience was painful and if so discuss with your supervisor. Offer an opportunity for
questions and discussion, and supplement with an information leaflet if 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,
15
9 - 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
Logbook before transferring the technique to a patient. When you perform vaginal examination, your clinical
1 General Medical Council. Good medical practice. www.gmc-uk.org
2 Royal College of Obstetricians and Gynaecologists. Gynaecological Examinations. RCOG. London. 2002
16
9 - Code of Practice for Examination of Patients by Students
2.
3.
4.
5.
6.
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.
17
9 - Code of Practice for Examination of Patients by Students
Protocol for examination of female breasts
1. Learn and practise breast examination first on a mannequin or a volunteer patient in a group
teaching session before transferring to a patient. When you first perform breast examination,
your clinical supervisor must be present throughout.
2. Introduce yourself to the patient; explain your student status, your course, and year of study.
Explain the examination to the patient and obtain verbal permission. If your supervisor is
male, arrange for a female chaperone.
3. Allow patient privacy for undressing. Explain the position for the examination starting with
the patient in a supine position with the head end of the couch elevated to 45 degrees, and
then rolling to the side.
4. Proceed with the breast examination as instructed, observing carefully and palpating gently.
Inform your patient when you have finished, allow her to cover herself, explain your findings,
and thank your patient. Ask your supervisor for feedback.
5. Record, date and sign the examination in the patient’s notes, stating that consent was given,
and giving the name of your supervisor and name and status of your chaperone.
Protocol for examination of male external genitalia
1. For your first examination of male external genitalia, your clinical supervisor must be present.
You should examine male external genitalia with great sensitivity and with no more than two
students present one of who should be male if possible.
2. Introduce yourself to the patient; explain your student status, your course, and year of study.
Explain the examination to the patient and obtain verbal permission. If you are examining
alone, you must arrange for a chaperone who should be of the same sex as the patient. This
could be a fellow student. Your hands should be warm. Do not rub them together in front of
the patient!
3. Observe clinical etiquette throughout the examination. Start with the patient standing fully
exposing his groins, and your eyes level with the area being examined. Observe the area
and ask the patient to cough. Palpate the scrotum to determine the presence of two normal
testes and any abnormal mass, and then palpate the inguinal and femoral areas for cough
impulses. If you notice a swelling of the groin in the upright position, do not try to reduce it.
4. For the second part of the examination, ask the patient to lie down. The student should
gently reduce any swelling. You should examine for hernia, palpate the femoral vessels, and
scrotum. Inform your patient when you have finished, explain your findings, and thank the
patient.
5. Record, date and sign the examination in the patient’s notes, stating that permission was
obtained, and giving the name of your supervisor, and name and status of your chaperone.
18
10 – Fitness to Practise
Medical students are entering a profession where appropriate standards of professional behaviour
are expected by the public and this is regulated by the General Medical Council. King's College
London has a Fitness to Practise Committee which deals with misconduct (under the terms of the
College's Misconduct regulations) and matters of behaviour and health that raise issues of fitness
for registration and practice. The School of Medicine also has an internal Fitness to Practise
Advisory Committee that advises the Head of School on these matters.
Students must inform the School through the Academic Centre of any issues of personal health or
behaviour (e.g. blood borne virus infection, mental health issues, police cautions, convictions,
proceedings, infringement of social media) which might affect their fitness to practise status. The
GMC documents "Good Medical Practice" (http://www.gmcuk.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.
19
11 - Simulated and Interactive Learning (SaIL)
The Chantler Clinical Skills Centre offers newly refurbished Simulated Learning Facilities for practical
and clinical communication skills teaching for over 4,000 Medical, Nursing and Midwifery students. The
centre includes a mock GP room, home environment, ward areas and clinical skills classrooms.
Throughout the year additional Kings College clinical skills revision sessions are put on at the centre
which can be found on our website:
http://www.kcl.ac.uk/health/study/facilities/clinicalskills/index.aspx
The Independent Learning Room (ILR) based within The Chantler Clinical Skills Centre: room 1.9
on the first floor of the Centre.
The Independent Learning room is an unsupervised resource set up for both medical and nursing
students to practise skills. To use the room you are required to sign in at the reception desk so we
know who is using the resource. During busy periods the ILR is operated on a sign up basis with two
hourly slots for you to sign up to via our website. The room is set up with equipment including blood
pressure monitors, venepuncture arms, catheterisation models etc. If additional equipment is required
please ask at the reception desk, if available you will be asked to sign for the equipment for use in the
ILR only.
Rules for use of The Chantler Clinical Skills Centre. For us to be able to operate a resource that
works as an unsupervised facility you asked to behave professionally, read and adhere to the ILR rules.
Please use the following link for more information on how to access the facilities and the rules for use:http://www.kcl.ac.uk/health/study/facilities/clinicalskills/teaching/ilroom.aspx
SaIL at St Thomas’ House, hosts a mock GP consulting room, a six-bedded ward, an operating
theatre/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.
20
12 - Clinical Teaching Activity Attendance Sheet
Please ensure that you have this signed by the clinician who takes you for ward rounds,
clinics, theatre lists and other clinical teaching sessions as you progress through the Block
Teaching
Activity
(e.g. ward round,
clinic, tutorial,
etc)
Specialty
Site
Date
Start
time
Teacher’s name
Teacher’s
signature
21
13 - Summary of Skills to be acquired in Phase 4 – CHDA
You must demonstrate your competence in the skills listed below. Skills
checklists are given in detail on the subsequent pages, each of which
must be signed as competent.
Paediatrics
Date
completed
1. Take a history from a parent and child
2. Examine a child
3. Examine a baby * Does not include newborn check
4. Perform and interpret a basic developmental assessment of an infant or
young child
5. Explain a common complaint to a child
Dermatology
1. Take a dermatological history
2. Take a drug history in relation to a skin disorder
3. Examine the skin for a common condition
4. Give health advice on risks of excess sun exposure
5. Explain to patient how to apply a skin preparation
Medicine and Psychiatry of Old Age
1. Take a history and examine an older patient including an assessment of
capacity and function
2. Take a history from a third party on behalf of an older patient
3. Formulate a problem list and management plan from admission to
discharge
4. Take and present a psychiatric history within a defined period of time
5. Examine and present the mental state including the cognitive state
within a defined period of time
6. Present a psychiatric summary within a defined period of time
22
14 - In-Course Assessment of Clinical Skills: Guidance for Students
You are required to be competent in the core skills listed under each rotation. 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 Phase 4 web-site. You
should practise each skill until you feel competent. At this stage ask a tutor or clinical
supervisor 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
your performance is unsatisfactory you should arrange for a repeat assessment later in the
block.
It is your responsibility to arrange for assessments.
At the end of each block, ask your clinical tutor or supervisor to sign the section on
professional development. This is a two way process in which student and tutor discuss
whether attendance, punctuality and courtesy to staff and patients have been satisfactory and
if not how this can be remedied.
You must be signed up for all the skills of each block in order to complete MBBS Part 4.
You will be asked to hand in your log-book at the end of block written exam. Books will
be inspected for satisfactory completion of skills.
In Phase 4 you will build on the skills acquired in Phase 3. Phase 3 skills may be tested in the
Phase 4 OSCE. You should revise the Phase 3 skills throughout the year.
You should meet your Clinical Adviser at least three times during Phase 4. Please ensure that
they sign part three.
In case you lose your logbook, photocopy and file the relevant signed pages at the end of each
block and keep in a safe place.
23
15- Sign Ups
Paediatrics & Child Health. Skills must be signed by an experienced clinician who has been
approved by the firm head. Feedback comments can be noted by student or clinician.
Name of student
Y/N
1. Take a history from a parent and child.
Appropriately polite
Involves child appropriately
Obtains relevant information
Explores relevant areas
Summarises history
Highlights key information
I have today observed this student perform this skill and judge them to be at the level
of competence and safety expected of a Phase 4 student. I have given the student
feedback about his/her performance.
Signed:
Name (print)
Professional Registration No.
Job Title
Department
Date
Feedback comments (recorded by clinician or student):
Name of student
Y/N
2. Examine a baby*. Does not include newborn check.
Appropriately polite
Cleanse hands with alcohol gel
Gentle
Fluent
Structured approach (insp, palp, perc, ausc)
Examines appropriate to age (eg. fonanelle, tone, etc)
Discovers or excludes signs
I have today observed this student perform this skill and judge them to be at the level
of competence and safety expected of a Phase 4 student. I have given the student
feedback about his/her performance.
Signed:
Name (print)
Professional Registration No.
Job Title
Department
Date
Feedback comments (recorded by clinician or student):
24
15- Sign Ups
Name of student
Y/N
3. Examine a child.
Appropriately polite
Cleanse hands with alcohol gel
Gentle
Fluent
Structured approach (insp, palp, perc, ausc)
Examines appropriate to age (eg. fonanelle, tone, etc.)
Discovers or excludes signs
I have today observed this student perform this skill and judge them to be at the level
of competence and safety expected of a Phase 4 student. I have given the student
feedback about his/her performance.
Signed:
Name (print)
Professional Registration No.
Job Title
Department
Date
Feedback comments (recorded by clinician or student):
Name of student
Y/N
4. Perform and interpret a basic developmental assessment of an infant or
young child.
Appropriately polite
Gentle
Fluent
Structured approach (gross motor, fine motor, hand-eye)
Uses tests appropriate to age
Attempts vision and hearing checks
Discovers or excludes signs
I have today observed this student perform this skill and judge them to be at the level
of competence and safety expected of a Phase 4 student. I have given the student
feedback about his/her performance.
Signed:
Name (print)
Professional Registration No.
Job Title
Department
Date
Feedback comments (recorded by clinician or student):
25
15- Sign Ups
Name of student
Y/N
5. Explain a complaint to a child.
Appropriately polite
Puts child at ease
Uses age appropriate language
Accurate content
Checks child understands
I have today observed this student perform this skill and judge them to be at the level
of competence and safety expected of a Phase 4 student. I have given the student
feedback about his/her performance.
Signed:
Name (print)
Professional Registration No.
Job Title
Department
Date
Feedback comments (recorded by clinician or student):
26
15- Sign Ups
Name of student
Professional Development: Paediatrics – To be completed at the end of the
attachment. Based on attendance, participation in firm activities, courtesy to staff and
patients, punctuality, acceptance of advice, confidentiality.
Please circle and comment:
Satisfactory
Unsatisfactory
Feedback (recorded by clinician)
Strengths:
Areas for improvement:
*I have no concerns about this student’s fitness to practise.
*I have the following concerns about this student’s fitness to practise. I have referred this
student to _________________________________ (Head of Phase 4 / Senior Clinical
Advisor*)
*delete as appropriate
PAEDIATRICS TUTOR
Name: ______________________________________
Signature: ___________________________________
Date: ____________
ON CALL OR AED SESSION WITH JUNIOR PAEDIATRICIAN
Name: ________________________________________
Signature: ____________________________________
Date: _____________
27
15- Sign Ups
Peripheral Hospital attachment at Teaching campus Hospital (TCH) (based on attendance,
participation in firm activities, overall assessment of performance and conduct)
Please circle and comment :
Attendance on ward rounds:
Satisfactory
Unsatisfactory (if so, why)
Attendance in clinics:
Satisfactory
Unsatisfactory (if so, why)
Clerking and case presentation: Satisfactory
Unsatisfactory (if so, why)
Overall rating:
Unsatisfactory (if so, why)
Satisfactory
Comments
SUPERVISING CONSULTANT:
Name …………………………………………………
Signature ……..………………………………………………………………Date …………………..
Name of Hospital / Institution
……………………………………………………………………………………………………………..
UHL or PRUH Students (no TCH attachment) tick here Students are reminded that peripheral attachments must always be completed in full,
even if all sign-ups are completed earlier.
28
15- Sign Ups
Dermatology
These skills should be performed, observed, and signed-off in Dermatology clinics if possible. Any
outstanding skills will be covered and signed off at the Dermatology Symposium which all students
must attend
Skills must be signed by an experienced clinician who has been approved by the firm head
Name of student
Y/N
1. Take a dermatological history
Appropriately polite; introduces self appropriately
Obtains relevant information
Summarises history
Highlights key information
I have today observed this student perform this skill and judge them to be at the level
of competence and safety expected of a Phase 4 student. I have given the student
feedback about his/her performance.
Signed:
Name (print)
Professional Registration No.
Job Title
Department
Date
Feedback comments (recorded by clinician or student):
Name of student
Y/N
2. Take a drug history in relation to a skin disorder
Obtains relevant information
Asks about topical and oral therapy
Asks about known drug sensitivities
I have today observed this student perform this skill and judge them to be at the level
of competence and safety expected of a Phase 4 student. I have given the student
feedback about his/her performance.
Signed:
Name (print)
Professional Registration No.
Job Title
Department
Date
Feedback comments (recorded by clinician or student):
29
15- Sign Ups
Name of student
Y/N
3. Examine the skin for a common condition
Is polite and explains what is happening to patient
Cleanse hands with alcohol gel
Fluent examination (including scalp, hair, and nails where appropriate)
Asks patient to report any pain or discomfort during examination
Summarises findings
I have today observed this student perform this skill and judge them to be at the level
of competence and safety expected of a Phase 4 student. I have given the student
feedback about his/her performance.
Signed:
Name (print)
Professional Registration No.
Job Title
Department
Date
Feedback comments (recorded by clinician or student):
Name of student
Y/N
4. Give health advice on risks of excess sun exposure
Gives clear concise summary of need for sun protection
Uses understandable layman’s terms
Gives advice on adequate sun protection measures, especially for children
I have today observed this student perform this skill and judge them to be at the level
of competence and safety expected of a Phase 4 student. I have given the student
feedback about his/her performance.
Signed:
Name (print)
Professional Registration No.
Job Title
Department
Date
Feedback comments (recorded by clinician or student):
30
15- Sign Ups
Name of student
Y/N
5. Explain to patient how to apply a skin preparation
Gives clear and appropriate instructions
I have today observed this student perform this skill and judge them to be at the level
of competence and safety expected of a Phase 4 student. I have given the student
feedback about his/her performance.
Signed:
Name (print)
Professional Registration No.
Job Title
Department
Date
Feedback comments (recorded by clinician or student):
ATTENDANCE AT:
DERMATOLOGY TEACHING SESSION
Signature ……..………………………………………………………………Date …………………..
31
15- Sign Ups
Medicine & Psychiatry of Old Age
Skills must be signed by an experienced clinician who has been approved by the firm head
Name of student
Y/N
1. Take a history and examine an older patient including an assessment
of function
Appropriately polite; introduces self appropriately
Treats patient with respect
Explains what is happening
Obtains relevant information
Cleanse hands with alcohol gel
Fluent examination using a structured approach
Asks patient to report pain or discomfort
Summarises findings
Highlights key information
I have today observed this student perform this skill and judge them to be at the level
of competence and safety expected of a Phase 4 student. I have given the student
feedback about his/her performance.
Signed:
Name (print)
Professional Registration No.
Job Title
Department
Date
Feedback comments (recorded by clinician or student):
Name of student
Y/N
2. Take a history from a third party on behalf of an older patient
Appropriately polite; introduces self appropriately
Treats patient and third party with respect
Explains what is happening
Obtains relevant information
Fluent, uses a structured approach
Summarises findings
Highlights key information
I have today observed this student perform this skill and judge them to be at the level
of competence and safety expected of a Phase 4 student. I have given the student
feedback about his/her performance.
Signed:
Name (print)
Professional Registration No.
Job Title
Department
Date
32
15- Sign Ups
Name of student
Y/N
3. Formulate a problem list and management plan from admission to
discharge
Constructs a problem list, including most of patient’s problems, particularly main
problems
Defines management plans for each problem which are appropriate at least for
main problems
Plans cover the period until discharge
I have today observed this student perform this skill and judge them to be at the level
of competence and safety expected of a Phase 4 student. I have given the student
feedback about his/her performance.
Signed:
Name (print)
Professional Registration No.
Job Title
Department
Date
Feedback comments (recorded by clinician or student):
Name of student
Y/N
4. Take and present a psychiatric history within a defined period of time
Covers key areas of history including history from third party
Uses structured approach
Patient reports experience with student acceptable or enjoyable
I have today observed this student perform this skill and judge them to be at the level
of competence and safety expected of a Phase 4 student. I have given the student
feedback about his/her performance.
Signed:
Name (print)
Professional Registration No.
Job Title
Department
Date
Feedback comments (recorded by clinician or student):
33
15- Sign Ups
Name of student
Y/N
5. Examine and present the mental state including cognitive state
within a defined period of time
Uses structured approach
Covers all key areas of mental state, including emotional state
Uses standardised screening test (MMSE, AMTS or similar)
Reports both the emotional state of the patient and their own
I have today observed this student perform this skill and judge them to be at the level
of competence and safety expected of a Phase 4 student. I have given the student
feedback about his/her performance.
Signed:
Name (print)
Professional Registration No.
Job Title
Department
Date
Feedback comments (recorded by clinician or student):
Name of student
6. Present a psychiatric summary within a defined period of time
Y/N
Uses structured approach
Indicates salient features of history and diagnosis
Identifies possible psychological processes present
Constructs differential psychiatric diagnosis
Indicates principles of management of most likely diagnosis
I have today observed this student perform this skill and judge them to be at the level
of competence and safety expected of a Phase 4 student. I have given the student
feedback about his/her performance.
Signed:
Name (print)
Professional Registration No.
Job Title
Department
Date
Feedback comments (recorded by clinician or student):
ATTENDANCE AT:
PALLIATIVE CARE CLINICAL TEACHING - Optional
Signature ……..………………………………………………………………Date …………………..
34
15- Sign Ups
Name of student
Professional Development: Medicine of Old Age – To be completed at the end of the
attachment. Based on attendance, participation in firm activities, courtesy to staff and
patients, punctuality, acceptance of advice, confidentiality.
Please circle and comment:
Satisfactory
Unsatisfactory
Feedback (recorded by clinician)
Strengths:
Areas for improvement:
*I have no concerns about this student’s fitness to practise.
*I have the following concerns about this student’s fitness to practise. I have referred this
student to _________________________________ (Head of Phase 4 / Senior Clinical
Advisor*)
*delete as appropriate
TUTOR IN MEDICINE OF OLD AGE
Name: ______________________________________
Signature: ___________________________________
Date: ____________
35
15- Sign Ups
Name of student
Professional Development: PSYCHIATRY OF OLD AGE – To be completed at the end
of the attachment. Based on attendance, participation in firm activities, courtesy to staff and
patients, punctuality, acceptance of advice, confidentiality.
Please circle and comment:
Satisfactory
Unsatisfactory
Feedback (recorded by clinician)
Strengths:
Areas for improvement:
*I have no concerns about this student’s fitness to practise.
*I have the following concerns about this student’s fitness to practise. I have referred this
student to _________________________________ (Head of Phase 4 / Senior Clinical
Advisor*)
*delete as appropriate
TUTOR IN PSYCHIATRY OF OLD AGE
Name: ______________________________________
Signature: ___________________________________
Date: ____________
36
16- Patients Clerked
Information should be anonymised using a pseudonym or initials
You are expected to spend as much time as possible on the wards, in out-patients or general
practice talking to and clerking patients. This is crucial for gaining the clinical experience
required for managing the wide range of patients you will meet after qualification. Staff on the
wards or out-patients expect students to clerk patients and will generally encourage you to
spend unsupervised time in this way. Before clerking a patient please check with the medical
and/or nursing/midwifery staff that the patient is suitable and is willing to be seen by a medical
student.
The list below gives a range of conditions you might encounter during your clinical time. You
may not see all of these conditions, but record those that you do, and make an effort to see
patients with as many conditions as possible. Please also record any patients you see with
conditions not included on this list.
CLINICAL TOPICS/SUGGESTED
CLINICAL CASES (CHDA)
Medicine & Psychiatry of Old
Age
Medicine
DATES
SEEN
DETAILS
Stroke
Parkinson's disease
Osteoporosis leading to
Complications
Patients with communication
problems (e.g. deafness,
blindness)
Falls
Mobility problems due to
musculoskeletal disease
Psychiatry
Dementia
Depression
37
16- Patients Clerked
Paediatrics and Child Health
Asthma
Acute respiratory infection
Cystic fibrosis
Epilepsy
Febrile convulsion
Eczema
Developmental delay
Gastroenteritis
Failure to thrive
Urinary tract infection
Diabetes Mellitus
Orthopaedic surgery
ENT surgery
Other surgery
Accidental injury/trauma
Eczema
Psoriasis
Skin tumour/moles
38
17 – Block feedback
COMPLETE THE FEEDBACK FORM ON THE VIRTUAL CAMPUS AT THE END OF YOUR
ROTATION BLOCK & THEN STAPLE THE RECEIPT TO THIS PAGE.
STUDENTS ARE EXPECTED TO COMPLETE FEEDBACK
AS PART OF THEIR PROFESSIONAL RESPONSIBILITY
39
18 – Integrated Skills List
To progress to Phase 5, students must be competent in the skills shown below Years 1-4:
Skills Practice Available denotes which skills can be practiced outside of normal teaching.
The key is as follows
IL - Independent Learning
C – Curriculum teaching
SU – Sign up skills
PT - Peer teaching
PE - Patient Educator teaching
Further information on the availability of those sessions relevant to your year will be forwarded to you
throughout the year.
Please note – This list is not exhaustive. The skills may change during the medical course and it is your
responsibility to keep up to date with these changes.
Integrated Skills List
1. Fundamental skills
1.1 Numeracy
1.2 Presentation - Oral
1.3 Presentation - Poster
1.4 Professional Development
1.4.1 Courtesy to staff and patients
1.4.2 Punctuality
1.4.3 Accepting advice from tutors
1.4.4 Obtaining consent from patient
1.4.5 Confidentiality: Respect and protect patient information
1.4.6 Know about, understand and respect the roles and expertise
of other healthcare professionals
1.5 Communicate with patients
1.6 Take and record a patients history, including their family history
1.6.1 Introduce yourself to patient
1.6.2 Put a patient at ease and build rapport
1.6.3 Ask about activities of daily living
1.6.4 Elicit a patient's concerns, ideas and expectations
1.6.5 Check a patient's understanding
1.6.6 Make a problem list after clerking a patient
1.6.7 Gather information from notes and other sources
1.6.8 Write a distillation of problems
1.6.9 Present a clinical history to tutor
1.7 Perform a full physical examination and a mental state examination
1.8 Participate as a member of the healthcare team
1.9 Document clinical details in patient notes
1.10 Handwashing and infection control
2. Communication skills
2.1 Adapt history taking to specialty inc. psychiatry, gynaecology,
urology, dermatology, musculo-skeletal
Year
Introduced
Year first
signed-up
or tested
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
2
1
1
1
2
2
3
3
3
3
3
3
3
1
3
2
2
2
2
2
2
2
3
3
3
3
3
5
5
2
3
3
Skills
Practice
available
C, IL
40
18 – Integrated Skills List
Integrated Skills List
2.2 Present clinical cases at grand rounds
2.3 Take a drug history e.g. aetiology of skin rashes
2.4 Discuss information with patient and relative e.g. child and parents
2.5 Give health advice on relevant lifestyle/risks e.g. smoking, sun
2.6 Take a history from third party e.g. parent/child; carer/elderly
2.7 Explain a common complaint to a child
2.8 Take a history from a patient with a serious illness as in A&E
2.9 Make a genogram from a patient with significant genetic history
2.10 Make a management plan for a patient
2.11 Communicate effectively with a person from a different culture
2.12 Present findings, conclusions and management plans to a
professional
2.13 Record concise and accurate history in patients' notes
3. Assessment of special groups of patients
3.1 Take a history from a patient with chest pain
3.2 Take a history from a patient with breathlessness
3.3 Take a history from a patient with abdominal pain
3.4 Take a history from a patient with depression
3.5 Assess the mental state and cognition of an adult
3.6 Assess psychotic symptoms (delusions & hallucinations)
3.7 Assess alcohol intake (AUDIT)
3.8 Assess a suicidal patient
3.9 Make a preoperative anaesthetic assessment
3.10 Assess the mental state of an older patient
3.11 Observe the assessment of an unconscious patient
3.12 Observe the assessment of a patient requiring pain relief
3.13 Assess a newborn baby including screening
3.14 Assess an infant/child to include growth and development
3.15 Assess a pregnant woman
3.16 Assess a patient with limb trauma
4. Clinical examination skills
4.1 Take a temperature, radial pulse and respirations
4.2 Hand washing and infection control
4.3 Mental state of an adult
4.4 Superficial masses in neck and other parts of the body
4.5 Examine a superficial mass
4.6 Cardiovascular system including pulses
4.7 Respiratory system
4.8 Abdomen including the ano-rectum
4.9 Inguino-scrotal region
4.10 Neurology in the limbs (including gait)
4.11 Cranial nerves
4.12 Cerebellar function to include gait and co-ordination
4.13 Female breast
4.14 Female pelvis
4.15 The skin
4.16 Locomotion to include mobility, limbs and back
Year
Introduced
3
3
3
3
3
4
4
4
3
3
Year first
signed-up
or tested
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
3
3
3
3
3
3
3
3
3
3
4
1
1
3
3
3
3
3
3
3
3
3
3
4
4
4
4
Skills
Practice
available
C
C
C
IL
C,IL, PT
C,IL
C,IL
C,IL
C,IL
IL
C,IL
IL
41
18 – Integrated Skills List
Integrated Skills List
4.17 Examine the musculo-skeletal system of the limbs in an adult (GAL)
system, inc back, neck, hip, knee, ankle, foot, shoulder, elbow, hand
5. Examination using instruments
5.1 Measurement of blood pressure
5.2 The eye using an ophthalmoscope
5.3 The ear using an auriscope
5.4 Uterine cervix using Cusco speculum, take cervical smear and
endocervical swab
5.5 Doppler index of foot pulses
6. Procedures to observe and explain: Imaging
6.1 CT scan
6.2 MRI scan
6.3 Lumbar puncture
6.4 Ultrasound including abdomen and pelvis
6.5 Angiography
6.6 IVU
6.7 Radionuclide scanning
7. Procedures to observe & explain: diagnostic procedures
7.1 Abdominal paracentesis
7.2 Spirometry and other respiratory function
7.3 Echocardiography/angiography
7.4 Barium enema
7.5 Gastroscopy and endoscopy of upper gastrointestinal tract
7.6 Colonoscopy
7.7 Sigmoidoscopy
7.8 Bronchoscopy
7.9 Cystoscopy
7.10 Pleural aspiration
7.11 Joint aspiration
7.12 Suprapubic catheterisation
7.13 Observe V/C Scan
7.14 Barium meal
7.15 Exercise ECG
7.16 Venography
7.17 Laparoscopy
7.18 Insertion of an arterial line
7.19 Fine needle aspiration of breast
7.20 Pre-natal testing e.g. amniocentesis
7.21 Observe calibration of a CVP monitor and interpretation of results
7.22 Arterial blood gas measurement
8. Practical skills 1: Basic skills
8.1 Take a venous blood sample
8.2 Perform sterile scrub technique and gown up
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
Year
Introduced
Year first
signed-up
or tested
Skills
Practice
available
4
4
1
3
3
1
3
3
C,IL, PT
IL
IL
4
3
4
5
IL
IL
3
3
3
3
3
3
3
5
5
3
3
3
3
3
3
3
3
3
3
4
3
3
3
3
3
3
3
4
4
4
5
5
5
5
5
5
5
5
5
5
5
5
5
3
3
3
3
3
3
5
3
SU, IL
IL
IL
IL
1
3
1
3
C,IL
IL
42
18 – Integrated Skills List
Integrated Skills List
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 Prepare and administer a subcutaneous injection
12.3b Prepare and administer a intramuscular injection
12.4 Prepare and administer an intravenous drug
12.5 Prescription checking
12.6 Write a prescription
12.7 Report an adverse drug reaction using the yellow card system
12.8 Contraceptives: use of barrier methods
12.9 Give drug using nebuliser
12.10 Give Oxygen at appropriate % concentration
12.11 Set up and operate a syringe pump and medication
12.12 Instil eye drops/eye ointment
12.13 Use of nasal spray
12.4 Explain to a patient a skin preparation
13. General patient management
13.1 Height and weight measurement charting with BMI calculation
13.2 Record BMI
13.3 Sterile technique
13.4 Record and interpret 12 lead ECG
Year
Introduced
4
4
4
5
3
4
1
2
1
3
3
3
3
4
5
3
3
4
3
Year first
signed-up
or tested
4
4
4
5
Skills
Practice
available
IL
IL
4
IL
1
2
1
3
3
5
5
5
5
C,IL,PT
IL
C,IL,PT
4
3
3
3
3
3
1
3
2
3
3
2
3
3
4
3
3
5
3
3
4
1
4
2
4
5
2
3
5
4
5
5
5
1
1
1
3
1
1
1
3
C,IL
C,IL, PT
C, IL
C, IL, PT
IL
C, IL,SU
C, IL
C,IL,SU
4
IL
C,IL,SU
IL,SU
43
18 – Integrated Skills List
Integrated Skills List
13.5 Interpret results of investigations inc a) haematological b) clinical
chemistry c) neurological d) psychiatric
13.6 Female catheterisation
13.7 Insert a naso-gastric tube
13.8 Male catheterisation
13.9 Remove wound drains
13.10 Perform wound care
13.11 Remove sutures and staples
13.12 Immobilise the cervical spine
14. Specialist skills
14.1 Suture a wound
14.2 Assess a patient's ability to function at home
14.3 Participate in a multi-disciplinary needs assessment
14.4 Deliver a baby
14.5 Observe the assessment of a patient with delirium
15. Patient management on the wards or in community
15.1 Plan investigations and treatments
15.2 Complete a ward admission, make continuation notes
15.3 Complete investigation request forms: lab tests, X-rays
15.4 Complete a blood transfusion request form
15.5 Complete a GP prescription
15.6 Complete an inpatient prescription
15.7 Negotiate with a patient to agree an acceptable management plan
15.8 Explain procedure or operation to patient or relative
15.9 Write a discharge notification
15.10 Write a ward referral
15.11 Write an out-patient referral
15.12 Set up a blood transfusion
15.13 Certify death
15.14 Complete a death certificate
15.15 Observe the reporting of a death to a coroner
Year
Introduced
Year first
signed-up
or tested
3
3
3
3
3
4
4
4
3
4
5
3
5
5
5
3
3
3
4
3
4
4
4
4
3
5
3
5
5
3
5
3
5
5
5
5
5
5
5
5
5
5
5
5
3
5
5
5
5
5
5
5
Skills
Practice
available
C,IL,SU
IL,SU
C,IL,SU
IL
IL,SU
C
C
44
18 – Integrated Skills List
Acronyms
Core Patient Cases
COPD [Chronic Obstructive Airways Disease]
CABG [Coronary Artery Bypass Graft (CABG)]
ECG [Electrocardiogram ECG)]
GTN spray ([Glyceryl Trinitate (GTN)]
CVP [Central Venous Pressure]
MI [Myocardial Infarct (MI)]
GI [Gastrointestinal haemorrhage (GI)]
CT scan [Computerised Tomography (CT)]
EEG [ Electroencephalography (EEG)]
EMG [Electromyography (EMG)]
MRI (add “scan” Magnetic Resonance Imaging (MRI)]
PET add scan [Positron Emission Tomography (PET)]
ECT [Electroconsulsive therapy (ECT])
Integrated Skills List Update 2012 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)]
45
18 – Integrated Skills List
13.1 and 13.2 BMI [Body Mass Index (BMI)]
13.12 ECG (As 7.15)
46
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