Download Group – Southmead - University of Bristol

UNIVERSITY OF BRISTOL
MEDICAL SCHOOL
MB ChB PROGRAMME
YEAR 5: 2003/2004
PRHO SHADOWING COURSE
March 15th - March 26th 2004
HANDBOOK
INDEX - PRHO SHADOWING COURSE HANDBOOK
GENERAL INTRODUCTION ..................................................................................................2
DESCRIPTION OF THE COURSE ....................................................................................2
TEACHING AND LEARNING METHODS ......................................................................4
COURSE PROGRAMME
PLENARY Monday 15th March ..........................................................................................5
PLENARY Friday 26th March .............................................................................................6
COURSE PROGRAMME IN TRUSTS ....................................................................................7
JOB SHADOWING IN TRUSTS ........................................................................................7
ON CALL AND WEEKEND WORKING..........................................................................8
COLLABORATIVE INTERPROFESSIONAL ACTIVITY ..............................................9
PRIMARY SECONDARY CARE INTERFACE SEMINAR ..........................................10
DEFINITIONS OF ROLES
PRHO BEING SHADOWED ............................................................................................13
POSTGRADUATE CENTRE MANAGER ......................................................................14
CLINICAL TUTOR...........................................................................................................15
EDUCATIONAL SUPERVISOR .....................................................................................16
ASSIGNMENTS AND ASSESSMENT .................................................................................17
WRITTEN REFELCTIVE ACCOUNT ...........................................................................18
DEANERY ASSESSMENT DOCUMENTS ..........................................................................19
NOTES ON USING THE DOCUMENTS ........................................................................20
LEARNING DEVELOPMENT AND ASSESSMENT DOCUMENT .............................23
WORKSHOPS
Monday March 15th (pm) ...................................................................... (colour coded)…34
Thursday 25th or Friday 26th March ..................................................... (colour coded)…39
LEARNING DIARY ...............................................................................................................44
WORKSHOP LOCATIONS ....................................................................... (colour coded)…47
STUDENT GROUPS...............................................................................................................48
TIMETABLE OF WORKSHOP GROUPS WITH VENUES ..........................................51
PRHO EVALUATION FORMS ................................................................. (colour coded)…53
BIBLIOGRAPHY ....................................................................................................................55
ACKNOWLEDGEMENTS .....................................................................................................56
PRE
SHADOWING
at the University
15th March
SHADOWING IN TRUSTS
16th – 25th March
1
POST
SHADOWING
at the University
26th March pm
GENERAL INTRODUCTION
In order to improve the experience of the transition from fifth year student to PRHO, Bristol
University has developed the current shadowing course in partnership with the Southwest
Deanery and NHS Trusts.
COURSE AIMS:
To prepare students for the transition from their fifth year of medical study to PRHO through
the experience of actual job shadowing, backed up by workshop and plenary sessions.
COURSE OBJECTIVES:
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to enhance and consolidate the knowledge, skills and attitudes that are essential for
beginning the job of the PRHO
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to critically reflect on the working process of the multidisciplinary team and the PRHO’s
role within it
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to identify the skills which are required of a reflective practitioner, and to have the
opportunity to discuss and practise these
LEARNING OUTCOMES:
At the end of the course students will be able to:
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identify the roles and responsibilities of the PRHO
identify, focus and reflect on the clinical skills needed by a PRHO
demonstrate the communication skills required of a PRHO
consider how to prioritise clinical and administrative work
organise the administrative procedures needed to work efficiently as a PRHO
consider the nature of team work in the health professions
recognise the responsibilities of the professionals within the multidisciplinary team
consider when, how and whom to ask for help.
DESCRIPTION OF THE COURSE
Two weeks of the fifth year are specifically devoted to the PRHO shadowing course, which is
divided into three sections:
1. Pre-shadowing at the University
The first day will focus on:
 the role of the PRHO within the Trust
 the role of the PRHO within the multidisciplinary team
 interprofessional working
 the use of appraisal and assessment forms during the PRHO year
Students will identify their own learning needs to be met through shadowing by working
through and discussing a clinical case with a tutor.
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Themes will include:
 looking forward to beginning work as a PRHO
 discussing expectations and fears
 exploring interprofessional working
 examining the role of the PRHO
 sharing coping strategies
 considering when and how to ask for help
2. Shadowing in the Trust
Students will shadow the PRHO whose post they take up in August for ten days including
 experience of on-take and on-call
 Primary Care seminar
 interprofessional working
 keeping a learning diary
 completion of a PRHO ‘Good Start Guide’
The purpose of the course is for students to gain first hand experience of their PRHO job
as a member of the team. During shadowing students will learn how to translate their
academic knowledge into the complex work environment without the ultimate
responsibility that will be theirs from August. Students will record significant incidents
in their Learning Diary (see page 44) for use in writing an assignment reflecting on their
Trust experience and to inform their initial learning objectives for their PRHO post.
Interprofessional working is a theme of the course. The majority of students will be
involved either in working with a student nurse in carrying out an interprofessional
learning task, or shadowing a qualified member of the nursing staff within the Trust.
A Primary Care seminar will be facilitated in partnership with the Clinical Tutor and local
GP tutors.
3. Post-shadowing at the Trust or at the University
This session will focus on:
 case work consolidation
 managing the job
Sessions will include:
 practising a range of skills using a case study
 clarification of the process of assessment and appraisal
There will be two plenary sessions at the University. Students will be grouped according to
the Trusts where they will work and shadow. Plenary sessions will allow for the sharing of
experiences across all of the Trusts involved. The pre-shadowing workshop will be carried
out at the University for the majority of students. The post-shadowing workshop will occur
within the Trusts on Thursday 25th or Friday 26th March.
Students will shadow the PRHO post that they are due to take up after graduation (this will be
the first medical/surgical post in one-year rotations). Shadowing is seen as the student and
PRHO being paired so that the student is totally immersed in observation of the job. This is
designed to allow students to experience their post without the responsibility of actually
being the PRHO.
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TEACHING AND LEARNING METHODS:
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plenary sessions
workshops and seminars
observation of practice
reflection on practice in a learning diary
self directed and experiential learning
Self directed learning is central for students at this important transitional phase of their
medical professional training. Reflection, self-assessment, peer assessment and evaluation
are expected to lay the foundations for lifelong learning. The students’ Learning Diary will
be instrumental in facilitating these skills.
In post-shadowing sessions, students will be referring to their shadowing experience to
facilitate their learning and to consolidate their understanding of the issues that will help to
prepare them for the start of their job.
Tutors will act as facilitators and advisers where appropriate.
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COURSE PROGRAMME
Monday 15th March 2004
Plenary Session
Lecture Theatre, Level 9, BRI
09:00
Welcome to Shadowing
Dr Karen Forbes, Shadowing Course Clinical Lead
09:30
Junior Doctors Hours
Mr Maurice Hakkak
10:00
BMA Presentation - PRHO ‘rights’
Dr Jane Jenkins
10:30
Refreshment break - sponsored by BMA
Distribution of handbooks
11:00
Getting the most out of shadowing and interprofessional working
Dr Karen Forbes, Shadowing Course Clinical Lead
11:20
Appraisal and Assessment
Dr Kathy Feest, Associate Dean PRHOs
11:50
Reflection
Rev Mr Nigel Rawlinson
12:20
PRHOs’ Experience of Shadowing
A group of PRHOs
12:30
Lunch – Dolphin House Bar/Lounge (Provided by Medical Unions)
14:00
Workshop: ‘Roles and responsibilities of the PRHO’
16:30
Depart to Trusts for Shadowing
STUDENTS, PLEASE CHECK YOUR TRUST JOINING INSTRUCTIONS, LOCATED
AT THE LUNCH VENUE OR THE CLINICAL DEAN’S OFFICE
5
Friday 26th March 2004
09:30
13:00
14:00
Workshop:
Self-assessment with Deanery documentation
Casework Consolidation
Lunch – Dolphin House Bar/Lounge (Provided by Medical Unions)
Plenary Session: Med School Lecture Theatre 1.4 (St Michael’s Hill)
Dr Karen Forbes, Mr Nigel Rawlinson, Mrs Kathy Feest
Key course feedback
15:45
MSAS Photosession for all Year 5 outside Royal Fort House
access through the arch at top of Royal Fort Road
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COURSE PROGRAMME IN TRUSTS
Tuesday 16th – Thursday 25th March 2004
JOB SHADOWING
Core Documents: Students will have two core documents for use in both the Trust and at
the University. The first is the shadowing handbook. The second, the PRHO ‘Good Start
Guide’, is a filofax with pages for the students to complete with useful information specific to
their Trust. Post Graduate Centre Managers will be prepared to store these guides for
students until they begin their posts if they wish.
Core tasks: Prior to shadowing, students will have been briefed to:
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Consider ‘significant incidents’ which may highlight personal learning objectives for the
PRHO year or key issues for workshop discussions, or may form the basis of their written
work at the end of the course
Complete their PRHO ‘Good Start Guides’
Observe clinical situations, procedures and practice and identify what they consider to be
good practice
Carry out a few carefully selected clinical procedures which they have identified that they
need to practise
Use this time on the wards to reflect on the realities of their future job
Use half a day off the wards to familiarise themselves with the catchment area of the
hospital (WRVS shop, local shopping centre, local paper, places of worship, suburbs,
local industries, businesses etc.) and talk to people wherever possible
Whilst it is important that students familiarise themselves with the extensive clinical and
administrative procedures and paperwork, they will be encouraged by tutors to resist too
much ‘hands on’ participation. This will enable them to concentrate on shadowing as an
observational and experiential exercise quite distinct from an attachment. The PRHO
shadowing course is constructed so that students have the time to think, reflect and learn
whilst not having, at this stage, the full responsibility of the post. They will then be able to
build on this experience further in the post-shadowing workshops back in the medical school.
Suggested Model:
The following model may be considered appropriate for use in your Trust. If you decide to
implement this model, please make sure that all members of the team are aware that this
model is being utilised.
1. The PRHO will allocate a number of patients to the student’s care, for whom they will
have first responsibility. It is their responsibility to:
i
ii
iii
iv
clerk the patient and write the admission notes
arrange the necessary initial and continuing investigations
explain and justify the plans for the patient to their satisfaction
visit the patient at least daily to check on their progress, examining and performing
additional investigations as necessary and document this in the patient’s notes
v write up all medications (clearly this must be signed by the PRHO/SHO)
7
vi liase with other members of the multi disciplinary team regarding the patient’s care
vii prepare for and organise a consultant or registrar ward round
viii present a succinct patient summary on the consultant or registrar ward round
ix take part in the planning of the patient’s discharge (for instance, through the
multidisciplinary team meeting)
x write the discharge medication (clearly this must be signed by the PRHO/SHO)
xi write the discharge letter to the General Practitioner
xii be present when any important communications take place involving the patient or
informed consent is being obtained
xiii be present to support and observe the patient during any procedures or other
significant activities
2. In carrying out these duties, the student must at all times:
i identify themselves to the patient as a medical student
ii wear their name badge which identifies them as a medical student
iii in the patient records, sign date and legibly print their name and the fact that they are a
medical student
iv have patients’ prescriptions, pathology and other request forms written by them
agreed and signed by the supervising PRHO
3. The student’s supervisor’s or other qualified doctor’s signature implies that they have
undertaken legal responsibility for the drugs written, action proposed, or communication
made. The supervisor must therefore always check the student’s clerkings and
examinations, agree the investigations to be performed, agree which drugs are to be
prescribed and be present if the student is communicating important news to a patient or
relative.
4. Patients should be asked to give their permission for the student to help with their care. It
is always a patient’s right to decline to be seen by a medical student. If this happens, the
student should be asked to report it immediately to their 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.
On call and weekend working: Students are encouraged to take full advantage of all
shadowing opportunities and experiences. If their PRHO is not on duty for the weekend,
students are asked to arrange for some experience of shadowing on the Saturday or the
Sunday, as hospitals function very differently during weekends.
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Collaborative Interprofessional Activity
This will occur on Thursday 18th March in the south of the region. Nursing and medical
students will be paired to carry out the interprofessional exercise.
Aim
The aim of the interprofessional day is for medical and nursing students to reflect on a
patient’s assessment or management in order to increase understanding of each other’s roles
and where roles overlap and/or complement each other.
Learning outcomes
During this exercise students will
 reflect on their joint roles in carrying out a patient’s assessment or management
 reflect on their separate roles in carrying out a patient’s assessment or management
 discuss the differences and similarities in approach
 agree on five points they have learned or observed, in pairs, to feed back to the group
We would like the nursing and medical students to:
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Select a patient
Ask for the patient’s consent to be the students’ case study
Agree three activities to be carried out independently
Negotiate a time to meet and discuss them
Write three short reflective pieces on the three activities
Bring these reflections to a plenary feedback session towards the end of shadowing
Read and talk about each others reflections in pairs
Identify five bullet points per pair to feed back to the full group
Possible activities to include:
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Admission
Full assessment
Assessment of care
Preparation for an investigation and/or explaining an investigation to the patient
Preparation for theatre and/or explaining a procedure to the patient
Explaining a treatment decision to the patient
Helping the patient with a treatment decision
Talking to the relatives
Talking to another professional about the patient
Planning for a home visit
Planning for discharge
Discharging the patient
Contacts:
Students should be advised to contact the student nurse’s nurse mentor or Maureen Johnson if
they have any queries about the collaborative interprofessional activity.
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COURSE PROGRAMME IN TRUSTS
PRIMARY-SECONDARY CARE INTERFACE SEMINAR
Process:
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This is a two hour seminar held in the Trust. Trusts with very few PRHOs may wish to
hold a joint session with a neighbouring Trust in a convenient venue
The date of the seminar, group size and venue will be decided locally (liaising with lead
clinician to avoid interprofessional clashes). Some may prefer to have two separate
sessions, one for admissions and one for discharge
Students should be allocated preparatory work for the session early in their first week
The seminar will be run by a hospital consultant and a GP. Other people useful to include
in the seminar are PRHOs, SHOs. Both a physician and a surgeon could be included
PRHOs doing general practice as part of their PRHO year will spend one half-day (on
their own) in their future practice
Core Curriculum:
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Interprofessional communication
Administrative processes
Admissions
Discharges
Role of hospital nurses in relation to hospital/primary care interface
Aims:
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To provide insight and understanding of the GP/hospital admission and discharge
interface
To understand the problems for GPs around admissions and discharge, and how these are
different or similar to those of consultants and their teams
To facilitate good quality admission and discharge procedures
To understand the wide ranging reasons for admission
To further professional relationships between junior hospital doctors and GPs
To gain some understanding of each other’s priorities and pressures
To think about how doctors can learn from each other
Admissions: Learning Outcomes:
At the end of the session, students should be able to:
i)
Understand the limitations of treatment and investigation in the community and that the
diagnosis may be unclear. GPs sometimes work in difficult conditions, for example poor
light, hygiene, dogs, violence and other difficult situations
ii) Understand that the GP may not be able to speak freely in some situations eg in patient’s
homes with patient and/or family present
iii) Understand that GPs don’t necessarily complete an examination once they have reached
the decision to admit (for example rectal examination, temperature etc). It may be helpful
to discuss the equipment GPs routinely carry on home visits
10
iv) Understand that other factors may precipitate admission eg social factors, safety at home
in terms of leaving the patient there (ie not admitting) and medico-legal threat of not
adequately assessing a situation. Patients might worsen or improve between GP asking
for admission and the patient arriving in casualty, or the patient may alter their history!
v) Understand that GPs generally know their patients well. What information can the
vi) PRHO obtain from the GP (such as medication), both at the time of admission and
during admission? [GPs can be phoned for more information about patient/family during
the admission eg functioning of the elderly]
vii) Understand that the GP may send an ambulance rather than visit him/herself in certain
situations
viii) Understand what happens between the GP phoning and the patient arriving in hospital
ix) Understand how out of hours work may be organised in primary care - Co-operatives,
Healthcall, own on-call etc
x) Understand bed management and the pressure on junior staff
xi) Consider how stress and fatigue might impact on a hospital doctor’s behaviour,
particularly when admitting patients on take
Death: Learning Outcomes:
At the end of the session, students should be able to:
i)
ii)
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Telephone the GP if patient dies in hospital.
Know how to contact the GP by telephone:
Identify themselves
Ask receptionist which GP a patient normally sees [receptionists are trained to respect
confidentiality]
 Best time to telephone
 GP may phone back
 If urgent say so
iii) Know other methods of contacting GPs: fax, e-mail, messengers such as the patient or
relatives
Discharge: Learning Outcomes:
At the end of the session, students should be able to:
i) Understand who decides the patient is ready to go home and how this decision is made
ii) Understand that discharges of patients with complex needs need to be carefully planned
and may involve different professionals in the community (district nurse, hospice nurse,
GP, OT etc.). Some treatments need to be organised prior to discharge (O 2Concentrator
etc.). For complex discharges a telephone call to GP is very useful
iii) Understand the possibility of ‘hospital at home’ or intermediate care schemes to
facilitate discharge
iv) Appreciate that the trend for increasingly early discharges
v) Agree the importance of a prompt, succinct, legible and informative discharge letters to
the GP and that information is needed as soon as patient leaves the hospital
vi) Know the key items in a discharge letter, including:
 Name of consultant
 Diagnosis
 Other major events, results and investigations
 Referral to other departments and agencies
11
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Drugs to take home - if repeats needed give the GP staff time. When tests needed eg
warfarin. Duration treatment
 Clear follow-up arrangements and tests
vii) Understand the importance of giving patients a clear explanation of their diagnosis or
procedure. Give reasons medication changed
viii) To know the procedure for patients obtaining certificates for absence from work
ix) Relative responsibilities of GPs and nurses
Teaching Methods: Preparatory Work:
Preparatory work undertaken in the Trust by the students before the seminar will be vital.
Consider the following tasks for the students:
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Identifying good and bad practice in terms of both admissions and discharge before they
come to the seminar
Bring examples of admission letters
Make a list of items they would like to see in the letters
Think about the type of information patients will need at discharge
Teaching methods to consider for the seminar include:
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Group work around the learning outcomes
Role play admission and discharge scenarios
Small group work using real discharge letters as examples.
Complete discharge summaries for patient admission scenarios
Contact:
Dr Knut Schroeder, Clinical Lecturer, Division of Primary Health Care, Cotham House,
Bristol BS6 6JL.
Tel: 0117 9545508
12
DEFINITION OF ROLES
PRHO BEING SHADOWED
This course is intended to help ease the transition from student to doctor. PRHOs who
shadowed last year tell us it was a very important component of their learning experience.
You are going to be the student’s most important learning resource this week. You can help
them most by being open and honest about what you do and how they are doing.
ROLE DEFINITIONS - PRHO AND JOB SHADOW:
We know that the PRHO year is a very demanding one and our intention is not to create more
work for you. However, it is also important to acknowledge that your shadow is not on
attachment but is observing to make sense of the job. Whilst your shadow may arrive with
specific requests to practise some clinical procedures, the obvious temptation may be to use
them as an extra pair of hands. This is not the intention.
Primarily your shadow is learning how to do your job as opposed to learning medicine.
There will be some overlap, so that they will gain in clinical knowledge, but this is not the
main aim of this shadowing week. Whilst we recognise that shadowing may be challenging
for both parties, we hope you find that exchange of ideas and discussion will be mutually
beneficial. Your shadow will appreciate your support, and we are sure that you will
remember how you felt at this time last year!
We would prefer you to introduce your shadow as the medical student who will be doing
your job in August, as opposed to just introducing your shadow as a student. This will help
to confirm the shadow’s status in your team and will also clarify the role to patients and
colleagues.
Our students are expecting to do your on call rotas with you. However, if you are not on take
or on call during the shadowing period we would appreciate your assistance in helping them
to pair up with a PRHO who is.
As you are well aware your patients are your first priority. If situations arise during
shadowing when you would prefer to be on your own, please tell your shadow that you need
a break and they should attend to some of their set tasks during this time. It may be helpful to
be specific about this, eg ‘I need ten minutes’ or ‘I need half an hour’.
EVALUATION OF THE WEEK:
We would appreciate it if you would complete a short evaluation of the week with any
suggestions for improving the course or any areas that you felt were especially useful. Please
give these forms to the student shadowing you to return to the university. Should you feel for
whatever reason that you cannot fully express your opinions on the forms please contact the
medical school.
In the unlikely event that you have any problems that you cannot deal with yourself during
this week, please refer in the first instance to your Clinical Tutor. If further assistance is
needed contact Maureen Johnson, Course Administrator on 0117 9546515 or 07960 473378
or Karen Forbes, Shadowing Course Clinical Lead on 0117 9283507.
MANY THANKS FOR YOUR HELP AND SUPPORT.
13
DEFINITION OF ROLES
POSTGRADUATE CENTRE MANAGER
We have asked Postgraduate Centre Managers to take responsibility for the administration of
the Trust component of shadowing and to liase with the Trust’s Clinical Tutors, who have
been asked to take overall responsibility for shadowing in partnership with the Undergraduate
Teaching Coordinators and Clinical Sub Deans.
The Postgraduate Centre Managers will be the students’ administrative contact while they are
in the Trust. This will ensure a base for the students within the Postgraduate Centre and will
enable them to meet the Postgraduate Centre Managers who will be their administrative
academic link when they begin their post.
Postgraduate Centre Managers will link students and PRHOs within the Trust.
information they require is posted on the PRHO website.
The
http://www.prho.co.uk/index.cfm
as well as the Clinical Dean’s Website which can be accessed at
http://www.zyworld.com/clive_roberts/Home.htm
http://www.zyworld.com/clive_roberts/Teacher.htm
Please forward the appropriate information regarding this course to Educational
supervisors.
If you have any queries during the shadowing course which are not covered by the handbook
please contact:
Maureen Johnson
Shadowing Course Administrator
Clinical Dean’s Office
Centre for Medical Education (UoB)
39-41 St Michaels Hill
Bristol BS2 8DZ
0117 9546515 or 07960 473378
or Karen Forbes, Shadowing Course Clinical Lead on 0117 9283507
MANY THANKS FOR YOUR HELP AND SUPPORT.
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DEFINITION OF ROLES
CLINICAL TUTOR
We see the Clinical Tutors’ responsibility for PRHOs beginning with this shadowing
fortnight in the 5th Year.
We have asked Postgraduate Centre Managers to take responsibility for the Trust component
of the shadowing administratively and to liase with the Trust’s Clinical Tutors, who have
been asked to take overall responsibility for the shadowing in partnership with the Trust
Undergraduate Teaching Coordinators and Clinical Sub Deans.
The students who are shadowing are going to be working in your Trust as PRHOs from
August, and this is an excellent opportunity for you to meet them and begin to lay down
educational foundations for their important first year.
We are asking students to undertake an interprofessional learning exercise which has been
organised in conjunction with the nursing schools at the Universities of the West of England
(UWE) and Plymouth.
Information regarding this and all other aspects of the Course can be found on the PRHO
website
http://www.prho.co.uk/index.cfm
as well as the Clinical Dean’s Website on
http://www.zyworld.com/clive_roberts/Home.htm
http://www.zyworld.com/clive_roberts/Teacher.htm
If you have any queries during the shadowing course which are not covered by the handbook
please contact Maureen Johnson, Course Administrator on 0117 9546515 or 07960 473378 or
Karen Forbes, Shadowing Course Clinical Lead on 0117 9283507
MANY THANKS FOR YOUR HELP AND SUPPORT.
15
DEFINITION OF ROLES
EDUCATIONAL SUPERVISOR
The students who are shadowing are going to be PRHOs in your hospital from August.
WHAT IS SHADOWING?
Students are not on attachment during these ten days but are shadowing their future jobs.
Primarily the shadowing experience is designed for the student to learn how to do their future
job as opposed to learning medicine. Their role is that of an observer trying to make sense of
the job. Students may arrive with some specific requests for clinical procedures that they
hope to practise and the obvious temptation may well be for them to be used as an extra pair
of hands. This is not the intention.
INTRODUCTIONS:
We have asked PRHOs in post to introduce their shadow as the medical student who will be
doing their job in August, as opposed to just introducing them as a student. This will help to
confirm the shadow’s status in the team and should also clarify the role to patients and
colleagues.
PROCEDURAL ISSUES:
The PRHO shadows are expecting to do on call and on take rotas. However, if their
particular PRHO is not scheduled for this during the shadowing week, they might need your
assistance to help them to pair up with a PRHO who is. In the unlikely event that your PRHO
experiences problems with the shadow that they cannot deal with, you might need to help
them. Can you please inform the university’s medical education centre, via Maureen
Johnson, Course Administrator, if this occurs.
Students appreciate if you would make time to meet them privately during the ten days that
they will be in the Trust.
If you have any queries during the shadowing course which are not covered by the handbook
please contact Maureen Johnson, Course Administrator on 0117 9546515 or 07960 473378 or
Karen Forbes, Shadowing Course Clinical Lead on 0117 9283507.
MANY THANKS FOR YOUR HELP AND SUPPORT.
16
ASSIGNMENTS and ASSESSMENT
ASSIGNMENTS:
1. PRHO ‘Good Start Guide’ (a job checklist). Students are asked to complete the ‘Good
Start Guide’ in the Trust during the shadowing week. These guides will provide useful
information for the PRHO when they commence their posts in August. They may be left
with the Postgraduate Centre Managers who will return them during the first day of
induction in August with more relevant information that is Trust specific.
2. Learning Diary
Students are asked to complete daily entries whilst shadowing. This information is
confidential and will be instrumental in achieving both their own learning objectives and
in completing the written reflective account (see below).
3. Taking Learning Forward
Students will be introduced to the Assessment tools from the Deanery that they will be
using in their PRHO year. They will be asked to self-assess their current level of
performance and to set current learning objectives that are based on this assessment. This
will begin to familiarise students with the process and methods of assessment that they
will undertake in their PRHO year.
ASSESSMENT - FRAMEWORK AND METHODS:
Fundamental to the assessment processes on this course are self-assessment and reflection.
Assessment is based on the following specific principles:
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Self assessment is an integral part of the course
Assessment models future professional practice
Assessments are targeted towards good practice
Students are:
Summatively assessed:
During the fifth year OSCE in June, which will include questions relevant to this course
experience
Formatively assessed by:
The completion of the written reflective account (800 – 1000 words) drawing on their
Learning Diary and structured according to the course themes.
17
Written Reflective Account (800 - 1000 words). Drawing on the experience of shadowing,
students are asked to reflect on their placement in a structured written account.
The student will:
 select and describe one or more significant incidents
 examine and explain reasons for their choice
 consider what they can learn from this incident
 draw out relevant course themes
 identify the specific learning needs this account describes which they need to develop
in their PRHO post
 reflect on how this experience will benefit them as future PRHOs
Procedure for Submitting the Written Reflective Account
i) Students should complete their reflective account (800 words) at the end of the
shadowing course
ii) Students will be asked to indicate if they are not happy for anonymised extracts of
these reflective accounts to be used in the evaluation of the course, for research or for
publication
iii) They should hand this in to Maureen Johnson in the Clinical Dean’s Office by 30th
April 2004
iv) Students will be informed via email when and where they can collect these accounts
v) Three cash prizes will be awarded by the Shadowing Steering Committee for the best
reflective accounts.
Course Evaluation
Students should return an evaluation form to the University at the end of Trust shadowing.
These will be collected during the final plenary session.
18
DEANERY ASSESSMENT DOCUMENTS
INTRODUCTION
The following pages contain the Assessment Tool for PRHOs record of progress and
assessment for 2003 – 2004. These documents are lodged with Post Graduate Centre
Managers, who ensure that they are handed out to PRHOs.
However, the ultimate responsibility for this booklet lies with the PRHO.
Certificates of satisfactory service forms are contained within this document. They will need
to be signed and returned to the Deanery for both components of 2 x 6 posts and for the three
components of the 3 x 4 posts.
The Deanery Assessment document contains all of the forms needed in order for this
process to be completed.
This process is carried out by the Medical Personnel staff in the Trust in partnership with the
Post Graduate Centre Managers. Ultimately, PRHOs are responsible for making sure that
these forms are completed.
The PRHO year or sixth year of medical education is a training year. The aim of the Deanery
is to help PRHOs to satisfactorily complete this year and become registered with the GMC.
This tool will help PRHOs and their tutors to chart their progress. If PRHOs are not
progressing adequately the Educational Supervisor will refer them, in the first instance, to
their Clinical Tutor. The Clinical Tutor will arrange for additional support as required. The
pathways for managing doctors in difficulty are contained in the appendix.
Name……………………………………………………………………………………………
Medical
School………………………………………………………………………………
Important - PRHOs: This document is essential to allow you to progress to full registration
with the GMC. Please look after it carefully
South Western Deanery
BRISTOL
19
Notes on Using the PRHO Assessment Document
The key concepts are
REVIEW POINTS
First
Principles
GMC DOMAINS
SELF-ASSESSMENT
EVIDENCE
Appraisal – This is a private function, which will occur at the end of the assessment
process.
Assessment – This is a public account of how the PRHO is performing in relationship to
the standards that have been set by the GMC.
Framework
Behind the
Structure
This assessment tool offers a means by which certification with the GMC can occur
following the completion of the PRHO year and as a method for the PRHOs to chart their
progress during their house officer year.
While the document is prescriptive in content, the process by which the information is
gathered is intended to maintain a degree of flexibility.
The main features of the document are explained below:
Initial
Appraisal
and
Learning
Needs
 Review
Points
The first time PRHOs and educational supervisors meet in August they should use the
YELLOW initial assessment document.
At this initial assessment the PRHOs and educational supervisor can discuss the process of
assessment.
The PRHO can create a learning needs analysis with the educational supervisor in
anticipation of future assessment.
Importantly, PRHOs should be encouraged to consider and document their strengths as
well as any perceived areas which cause them concern.
This initial appraisal is a statutory requirement as outlined in ‘The New Doctor’; GMC
 There are points during the PRHO year when the PRHO’s progress is reviewed. These
occur at the beginning, midway and end of each six-month placement, or at the beginning
and end of each four-month placement, depending on their pathway through the PRHO
year.
At these meetings, progress will be discussed and targets for future action agreed. This
document plays a major part in shaping those meetings and in recording the outcomes. The
PRHO should have considered his/her learning needs during the shadowing course.
Two six-month placements or three four-month placements
Weeks 1-2
Initial appraisal and learning needs analysis
Month 3
First review point
Month 5
Second review point
Month 8
Third review
Month 11
Fourth review
* If there is a change in educational supervisor, an additional appraisal may be necessary.
For three-month posts the time of assessment must be agreed and negotiated at the initial
appraisal.
For PRHOs who demonstrate difficulties additional assessments should take place at an
agreed frequency. Forms for these assessments are available from the Deanery.
20
 GMC
domains
 The statements outline the knowledge, competences and attributes that must be
demonstrated at the end of the PRHO year in order to be fully registered by the GMC.
They define the standards expected of newly qualified doctors. They are the criteria
against which judgments of fitness to practice will be made (The New Doctor; GMC).
 Grade
Descriptors
 There are four grades against each descriptor, within each domain. These are explained in
more detail below:
1
Fully competent, with several outstanding features
With regard to the particular aspect being assessed, this grade would indicate that this
PRHO is among the very best PRHOs with whom the educational supervisor has worked.
You should consider the following questions with respect to this grade:
a) what evidence supports this claim?
b) what are the outstanding features of knowledge, practice, competence etc.?
A grade 1 summary judgment in the domains would not be common and should be
considered exceptional.
2
Showing competence with no significant weaknesses
This grade will represent good progress and achievement, and will indicate that the best
use has been made of experiences and opportunities during the PRHO year.
This is the grade which most PRHOs are expected to achieve as a summary judgement in
most domains.
3
Satisfactory, but room for improvement in one or more areas
This grade would be normal for most PRHOs at the beginning of their placements. It
would not necessarily be a cause for concern if the grade persisted, although it might
indicate that progress was not being made. This grade at the final review point would
indicate a priority for ongoing professional development and might be expected to form, in
your first post, the basis of an induction development plan.
4
Does not meet the GMC requirements at this time
Again, it would not be too worrying if this grade was given in a small number of areas
during an early review meeting, although it would indicate a target demanding immediate
attention. It would be a serious cause for concern if it featured anywhere at later review
points.
At the final review point, a grade 4 in any domain could result in failure to be signed up.
UA
Unable to evaluate this aspect
This grade will normally be given in situations where insufficient evidence is available to
base a judgment. Usually, this will be because experiences to date have given few, if any,
opportunities to display the competence, gain the knowledge or develop the attribute
described.
If it is decided that the PRHO has not successfully achieved the necessary requirements to
be signed up for registration, they will receive support and will be referred for further
training.
Their outstanding training needs will be assessed and a programme to help them complete
their training will be devised specifically for them. The Deanery will provide detailed
information regarding this procedure in August at induction. If PRHOs need to be referred
for further training, the Deanery will continue to provide a core salary for the duration of
training.
21
In these parts of the document, PRHOs are expected to make reference to the evidence
upon which their self-assessments (and tutor assessments) are based. In some areas their
ability will be evident in more binary terms (either you can or you can’t). In other areas a
degree of competence will be evident and a more measured judgment will be necessary.
Evidence
Sometimes, evidence will be transient and based upon observation. In these cases, the
signature and status of the observer will be sufficient, or educational supervisors may sign
to show that they are satisfied that PRHOs have developed in this area. In other cases,
documentary evidence will be generated, and PRHOs should refer to this in the ‘notes on
evidence’ section. By implication, PRHOs should develop and maintain their evidence
base throughout the PRHO year. This will form the basis for their record of ongoing
professional development in their first and subsequent posts. We recognise that some
important clinical skills eg working effectively in a clinical team, are difficult to define and
assess though these are fundamental and important skills.
Gathering
Evidence
the
How students gather the evidence for this assessment will be up to Trusts and Clinical
Tutors to decide within those Trusts. Trusts are encouraged to develop local workable
solutions. Some suggestions, which have been suggested by the students, are:
Team Meetings
SelfAssessment and
the
review
meetings

Students felt that a meeting of the clinical team might be an ideal time to gather
evidence to support their grades

A log book can be used in the form of cards (see front page) in conjunction with
this tool to support the PRHOs
PRHOs are expected to evaluate their progress and achievement against the GMC
standards for newly qualified doctors. Therefore, at each review point, and in preparation
for the meeting with the educational supervisor, they are asked to take time to go through
each GMC domain descriptor. PRHOs will pencil in a grade that reflects their
understanding of their current position and think about evidence that supports this grade.
They are asked to be neither too self-critical, nor unrealistically optimistic. A careful
consideration of the evidence they are drawing upon is required - is it public? Does it
derive from the comments of others? If the latter, how and where is it recorded? What
documentary evidence is being used, and where is it filed? How are the grade descriptors
interpreted? Is the educational supervisor likely to agree?
At the review meeting, the educational supervisor will go through the document with the
PRHO. He or she will use the self-grading exercise as a basis for discussing the PRHO
progress before making a summative assessment in each domain based upon the spread of
grades within it. At the end of the review meeting, they will have jointly discussed and
agreed some targets which will form the focus for the PRHOs professional development
for the next phase of training and against which their progress will be evaluated at the next
review point.
Pathways
Support
of
The educational supervisor may suggest the PRHO meet with the Clinical Tutor if
experiencing difficulties during the year. The Clinical Tutor will help to find ways of
receiving further educational support if required. This may mean attending further
courses, receiving counselling support or in a very few cases it may be necessary to repeat
some of the training year.
22
PRHO Learning Development and Assessment Document
Summary Record Sheet
Name of PRHO
GMC NUMBER TO BE
COMPLETED
ON
FULL
REGISTRATION
First Placement
Educational supervisor
Clinical Tutor
First Appraiser
Appraiser’s Judgement2
Pass
Referred
Pass
Referred
Pass
Referred
Second Placement
Educational supervisor
Clinical Tutor
Second Appraiser
Appraiser’s Judgement2
Third Placement1
Educational supervisor
Clinical Tutor
1
Third Appraiser
Appraiser’s Judgement2
Where applicable
23
2
Indicate whether PRHO has successfully passed this stage of training
24
INITIAL APPRAISAL AND LEARNING NEEDS ASSESSMENT
 Before your meeting with your educational supervisor, go through this document and use it as a basis for discussion
during the meeting.
 Read the accompanying notes carefully before you do this, so that you are quite clear as to the meaning of the grades
Date of 1st Meeting
Venue
25
GMC DOMAIN
INITIAL MEETING
1. Essential Skills
1.1
1.2
Calculate
drug
dosage
accurately;
Prescribe
and
administer drugs.
Gaining venous and arterial
access.
1.3
Suturing.
1.4
Perform an ECG
1.5
Basic cardiopulmonary resuscitation
1.6
Administer oxygen therapy safely
1.7
Use a nebuliser correctly
1.8
Bladder catheterisation
1.9
Lumbar puncture (diagnostic)
1.10 Validating and certifying death
This is your first meeting with
your educational supervisor to
identify areas on which to focus
26
GMC DOMAIN
Review Point Review Point
1
2
Review Point
3
Review Point
4
1. Essential Skills
1.1
Calculate
drug
dosage
accurately;
Prescribe
and
administer drugs.
Gaining venous and arterial
access.
1 2 3 4
UA
1 2 3 4
UA
1 2 3 4
UA
1 2 3 4
UA
1 2 3 4
UA
1 2 3 4
UA
1 2 3 4
UA
1 2 3 4
UA
1.3
Suturing.
1 2 3 4
UA
1 2 3 4
UA
1 2 3 4
UA
1 2 3 4
UA
1.4
Perform an ECG
1 2 3 4
UA
1 2 3 4
UA
1 2 3 4
UA
1 2 3 4
UA
1.2
1.5
Basic cardiopulmonary resuscitation
1 2 3 4
UA
1 2 3 4
UA
1 2 3 4
UA
1 2 3 4
UA
1.6
Administer oxygen therapy safely
1 2 3 4
UA
1 2 3 4
UA
1 2 3 4
UA
1 2 3 4
UA
1.7
Use a nebuliser correctly
1 2 3 4
UA
1 2 3 4
UA
1 2 3 4
UA
1 2 3 4
UA
1.8
Bladder catheterisation
1 2 3 4
UA
1 2 3 4
UA
1 2 3 4
UA
1 2 3 4
UA
1.9
Lumbar puncture (diagnostic)
1 2 3 4
UA
1 2 3 4
UA
1 2 3 4
UA
1 2 3 4
UA
1.9
Validating and certifying death
1 2 3 4
UA
1 2 3 4
UA
1 2 3 4
UA
1 2 3 4
UA
27
Notes on evidence
Essential Skills (continued)
Grade Descriptors
Areas for further
development:
1 = Fully competent with several
outstanding features.
2 = Showing competence with no
significant weaknesses
3 = Satisfactory, but room for
improvement in one or more
areas.
4 = Does not meet the GMC
requirements at this time.
UA = Unable to evaluate this
aspect
In identifying these, bear in mind the
following:
1. How did you identify your area for
development?
2. How do you plan to address the
identified need?
3. What evidence can you produce to
demonstrate you have achieved
your objectives?
28
GMC DOMAIN
INITIAL MEETING
2. Good Clinical Care
2.1
Perform a clinical clerking, elicit
and define key findings in the
history and examinations.
2.2
Identify
and
arrange
investigations as appropriate.
2.3
Initiate immediate and longerterm treatment as required.
2.4
Participate actively in emergency
situations and suitably prioritise.
This is an initial meeting with
your educational supervisor to
identify these areas on which
to focus
29
GMC DOMAIN
Review Point Review Point Review Point Review Point
1
2
3
4
2. Good Clinical Care
2.1 Perform a clinical clerking, elicit
and define key findings in the
history and examinations.
1 2 3 4
UA
1 2 3 4
UA
1 2 3 4
UA
1 2 3 4
UA
2.2
1 2 3 4
UA
1 2 3 4
UA
1 2 3 4
UA
1 2 3 4
UA
Identify
and
arrange
investigations as appropriate.
2.3
Initiate immediate and longerterm treatment as required.
1
2 3
UA
4
1 2 3 4
UA
1 2 3 4
UA
1 2 3 4
UA
2.4
1
2 3
UA
4
1 2 3 4
UA
1 2 3 4
UA
1 2 3 4
UA
Participate actively in emergency
situations and suitably prioritise.
Areas for further
development:
30
Notes on evidence
GMC DOMAIN
INITIAL MEETING
3. Maintaining Good
Medical Practice
3.1
Recognise own learning needs
and develop a plan to fulfil them.
3.2
Recognises
and seek
needed
3.3
Demonstrate good note keeping,
admission, follow up, hand over
and discharge
limitations/mistakes
help/advice when
.
3.4
Demonstrating
adequate
attendance and participation at
clinical
meetings/
teaching
sessions
This is an initial meeting with
your educational supervisor to
identify these areas on which
to focus
31
GMC DOMAIN
Review Point Review Point Review Point
1
2
3
Review Point
4
Notes on evidence
3. Maintaining Good
Medical Practice
3.1
Recognise own learning needs
and develop a plan to fulfil them.
1
2 3
UA
4
1
2 3
UA
4
1
2 3
UA
4
1
3.2
Recognise
and seek
needed
limitations/mistakes
help/advice when
1
2 3
UA
4
1
2 3
UA
4
1
2 3
UA
4
3.3
Demonstrate good note keeping,
admission, follow up, hand over
and discharge
1
2 3
UA
4
1
2 3
UA
4
1
2 3
UA
4
1
2 3
UA
4
Demonstrating
adequate
attendance and participation at
clinical
meetings/
teaching
sessions
1
2 3
UA
4
1
2 3
UA
4
1
2 3
UA
4
1
2 3
UA
4
1
2 3
UA
2 3
UA
4
4
.
3.4
Grade Descriptors
Areas for further
development:
In identifying these, bear in mind the
following:
1. How did you identify your area for
development?
2. How do you plan to address the
identified need?
3. What evidence can you produce to
demonstrate you have achieved
your objectives?
1 = Fully competent with several
outstanding features.
2 = Showing competence with no
significant weaknesses
3 =
Satisfactory, but room for
improvement in one or more
areas.
4 = Does not meet the GMC
requirements at this time.
UA = Unable to evaluate this aspect
32
GMC DOMAIN
4.
4.1
4.2
Relationship
Patients
INITIAL MEETING
With
Develop and maintain respect for
the dignity, privacy and rights of the
patients and concern for their
relatives.
Develop
and
maintain
good
communication skills.
5. Personal Health
5.1
5.2
5.2
6
Develop an appropriate attitude
towards personal health and well
being.
Recognise and respond to the
effects of other colleagues on your
performance.
Working With
Colleagues
6.1
Demonstrate effectiveness as a
member of the clinical team.
6.2
Actions show an understanding of
the
unacceptability
of
poor
professional behaviour (public and
personal) in self and others.
.
This is an initial meeting with
your educational supervisor to
identify these areas on which
to focus
33
Review Point Review Point Review Point Review Point
1
2
3
4
GMC DOMAIN
Notes on evidence
4. Relationship With
Patients
4.1
Develop and maintain respect for
the dignity,privacy and rights of
the patients and concern for their
relatives.
1
2 3
UA
4
1
2 3
UA
4
1
2 3
UA
4
1
2 3
UA
4
4.2
Develop
and
maintain
communication skills.
1
2 3
UA
4
1
2 3
UA
4
1
2 3
UA
4
1
2 3
UA
4
good
5. Personal Health
5.1
Develop an appropriate attitude
towards personal health and well being.
5.2
Recognise and respond to the
effects of other colleagues on
your performance.
6
Working With
Colleagues
6.1
Demonstrate effectiveness as a
member of the clinical team.
6.2
Actions show an understanding
of the unacceptability of poor
professional behaviour (public
and personal) in self and others.
Where there are causes for concern or learning
objectives to be set please make notes in the
evidence section
Areas for further
development:
34
WORKSHOP
Monday 15th March 2004, 14.00 – 16.30
Roles and Responsibilities of the PRHO
Rationale: New PRHOs need to examine their unique role and understand where it fits
within the health care team so that they can do their job with clarity and confidence.
Aims: The general aims of this session are for you to identify and examine the range of
duties and responsibilities you will have as PRHOs and to understand how this role fits
within the multidisciplinary team. More specifically, you will:




explore what you are looking forward to in the job
explore what you are apprehensive about
think about the coping strategies available to you
discuss when and whom to ask for help
Learning Outcomes: At the end of this session students should be able to:




identify and clarify the scope and uniqueness of the PRHO role
recognise the roles of other colleagues in the multidisciplinary team and your contribution
to patient care
consider and clarify your job expectations
begin to develop strategies for knowing how, when and whom to ask for help
Timings are given as a guide only.
INTRODUCTORY TASK: SETTING GROUND RULES FOR THE GROUP (10 minutes):
Description of Activity:




Any or all group members to contribute at least one idea for how you are going to work as
a group
Write up on a flip chart which students edit, prioritise, order etc
Group members agree on final list of rules
One group member undertakes to be responsible for distributing rules to other tutors or
participants when necessary
EXERCISE: WHAT ARE YOU LOOKING FORWARD TO? (15 minutes):
Aim: To focus on the aspects of the PRHO job that students are looking forward to engender
a positive environment in which to conduct the workshop.
Description of Activity:
This will be done by asking students to consider the aspects of the PRHO job you are looking
forward to. This may be by brainstorming the topic, or asking students to discuss in pairs,
then feed back to the whole group.
35
EXERCISE: EXAMINING THE RANGE OF THE PRHO ROLE (60 minutes)
This exercise is designed to pull together the experiential learning which will occur during
shadowing. In working through this case before shadowing you should identify your own
learning needs for the shadowing period. In repeating the same case after shadowing your
learning should be consolidated, thus preparing you for the reality of your PRHO post. The
role of other professionals should run as a theme throughout the exercise.
Aim: To identify and discuss the unique and shared role of the PRHO
Learning Outcome: At the end of this exercise students should be able to:


list and consider the main tasks and responsibilities of the PRHO role
list and consider the tasks and responsibilities that are unique and which are shared
The aim is not for students to carry out the tasks, but to identify what they are, who should be
involved and whether you have a personal learning need around the task(s) identified.
Case Information 1
Case details on admission:
John Smith, 6/1/1930, 11 Sweets Lane, Knowle West, Bristol BS5 32Z
Mr Smith, aged 70, widowed, was admitted on take with abdominal pain. He was seen by
your SHO in A&E where you admitted him for observation.
Current drugs:
bendroflumethiazide (bendrofluazide) 5mg once a day, aspirin 75mg once a day, cocodamol
30/500 as necessary for pain due to osteoarthritis. Allergies nil known.
Student Task
What needs to be done for this man?
Who needs to do it?
Are these tasks unique to the PRHO or shared, and if so, with whom?
Case Information 2
Mr Smith has been less well for the last three hours with nausea and vomiting. Your SpR has
reviewed him and arranged for him to:
1. (If a Medical PRHO) Have an urgent endoscopy because of vomiting blood
2. (If a Surgical PRHO) Have an urgent laparotomy because of intestinal obstruction
Your SpR asks you to cross match four units of blood and to prescribe IV fluids 4 litres over
24 hours
Student Task
What needs to be done for this man?
Who needs to do it?
Are these tasks unique to the PRHO or shared, and if so, with whom?
36
Case Information 3
Mr Smith’s endoscopy showed inoperable stomach cancer/laparotomy inoperable colon
cancer.
The acute pain team advise on his post-op pain control. Three days later the nurses ask you
to see him. He is unwell, sweaty, breathless and coughing up discoloured sputum. He has a
temperature of 38.5C. You examine his chest and he has dullness to percussion and crackles
at his left base.
He is not yet eating and drinking after his procedure.
Student Task
What needs to be done for this man?
Who needs to do it?
Are these tasks unique to the PRHO or shared, and if so, with whom?
Case Information 4
A staff nurse asks you to give the first dose of IV antibiotic.
Student Task
Discuss why the nurse is asking you to give the first dose of IV antibiotic.
Case Information 5
Mr Smith’s chest infection has improved on antibiotics but when you review him he is
complaining of upper abdominal pain not relieved by cocodomol 30/500, which the nurses
have been giving regularly.
On the ward round, your registrar tells Mr Smith he thinks he needs oral morphine because
his pain is not controlled.
Student Task
What needs to be done for this man?
Who needs to do it?
Are these tasks unique to the PRHO or shared, and if so, with whom?
Case Information 6
You go back after the ward round, he is still in pain and says he hasn’t had any of the new
medicine. You check with the staff nurse and she explains that one member of staff has gone
off sick and the only other trained member of staff is at her coffee break. She can’t give him
his pain relief until she comes back.
37
Student Task
Discuss why the patient may not have had any morphine yet.
Case Information 7
The nurses tell you that Mr Smith’s son is particularly worried that he has now been started
on morphine. He wants to know what is the matter with his father.
Student Task
What needs to be done?
Who needs to do it?
Are these tasks unique to the PRHO or shared, and if so, with whom?
Case Information 8
On the ward round two days later, he is feeling much better, is well pain controlled and
asking when he can go home. He lives alone. He was managing with help from an elderly
neighbour to do his shopping previously, but is now more frail.
Student Task
What needs to be done for this man?
Who needs to do it?
Are these tasks unique to the PRHO or shared, and if so, with whom?
Case Information 9
OT assessment shows whilst Mr Smith can wash and dress himself and walk a short distance
to the toilet, he is restricted by fatigue and breathlessness. He can make a hot drink, but
certainly not a meal. A social worker meets with the patient and his family. His son lives
away and has young children and both he and his wife are in full time employment. The
elderly neighbour has told the son she cannot do any more than the shopping.
Student Task
What needs to be done to try to get this man home?
Who needs to do it?
Are these tasks unique to the PRHO or shared, and if so, with whom?
Case Information 10
You arrive at work on Monday morning. Mr Smith deteriorated suddenly in the small hours
of the morning. Your PRHO colleague was asked to see him. Clinically he had had a
pulmonary embolus and he died shortly after at 08:45, just before you arrived on the ward.
He has not been certified.
38
Student Task
What needs to be done for this man?
Who needs to do it?
Are these tasks unique to the PRHO or shared, and if so, with whom?
Summary: What are your learning objectives raised by this session?
EXERCISE: RECOGNISING BOUNDARIES
Aims: To consider personal strengths and weaknesses, how they influence what are
appropriate and inappropriate duties for the new PRHO and coping strategies for dealing with
the inappropriate.
Learning Outcomes: At the end of this exercise students should be able to:




Identify aspects of your future job that you are apprehensive about
Identify inappropriate duties for you
Consider strategies for saying ‘no’
Discuss how and whom to ask for help
Description of first activity: (20 minutes)
Students are asked to identify aspects of the job that are worrying for a new PRHO.
 Students call out ideas about worrying aspects
 Tutor-facilitator writes up flip chart/whiteboard
 Individually, students select and record items from your group list that you perceive as
being potentially worrying for you in your future job
 Tutor-facilitator helps students to categorise what is difficult but appropriate for new
PRHOs and what is inappropriate for new PRHO or even outside the role
Description of second activity (Brainstorm): (10 minutes)
Students are asked to identify personal coping strategies

Tutor-facilitator writes up on flip chart/whiteboard
Students are now asked to identify professional coping strategies

Tutor-facilitator writes up on flip chart
Tutor-facilitator and students discuss the value and importance of knowing and understanding
the pros and cons of these strategies.
Description of third activity (Group discussion): (15 minutes)
The group may need help in seeing how many of the professional coping strategies which
will have been generated in the last session could happen in practice. Discuss some ideas of
how to ask for help, how to prioritise, how to delegate etc.
Summary: Consider one thing you have learned and one thing you need to learn over the
next two weeks.
39
WORKSHOP
Thursday 25th or Friday 26th March 2004
Casework Consolidation
THIS WORKSHOP WILL BE HELD IN THE TRUST FOR MOST STUDENTS
allowing time to travel back to Bristol for the plenary session on the afternoon of
Friday 26th March
Rationale: The students’ learning experience during the shadowing course will be
consolidated by considering a case study, using request forms relevant to your particular
Trust.
Aims: The aim of this session is for you to consolidate your learning and to familiarise
yourselves with the assessment process that you will encounter as a PRHO.
Learning Outcome: At the end of this session students should be able to:



Identify outstanding learning objectives to take to your educational supervisor at your
first meeting as a PRHO
Identify your responsibility for your own ongoing professional growth
recognise how to keep your own professional progress on course through understanding
assessment, appraisal and self review
Description of Activity One: Assessment and Appraisal (30 minutes)
Using the Deanery documents in this handbook, students should self assess their current
learning needs. Students should appraise each other in pairs using the completed documents
and then feed back to the group about the experience.
Description of Activity Two: Case Study (90 minutes)
This exercise pulls together much of the experiential learning during the course. Students
will work both individually and collaboratively to complete this case study exercise which
has been constructed with the aim of incorporating as many opportunities as possible to
consolidate your learning and prepare you for the reality of your PRHO post. The role of
other professionals in the patient’s care should run as a theme through the exercise.
Case Information 1
Case details on admission:
John Smith, 6/1/1930, 11 Sweets Lane, Knowle West, Bristol BS5 32Z
Allergies nil known
Mr Smith, aged 70, widowed, was admitted on take with abdominal pain. He was seen by
your SHO in A&E where you admitted him for observation. Current drugs:
bendroflumethiazide (bendrofluazide) 5mg once a day, aspirin 75mg once a day, cocodamol
30/500 as necessary for pain due to osteoarthritis.
40
Student Task
Write up his drug chart and request routine investigations.
Does anything else need to be done for him?
Case Information 2
Mr Smith has been less well for the last three hours with nausea and vomiting. Your SpR has
reviewed him and arranged for him to:
1. (If a Medical PRHO) Have an urgent endoscopy because of vomiting blood
2. (If a Surgical PRHO) Have an urgent laparotomy because of intestinal obstruction
Your SpR asks you to cross match four units of blood and to prescribe IV fluids 4 litres over
24 hours
Student Task
Fill in the forms to request four units of blood.
Write up IV fluid chart.
Discuss how to arrange an endoscopy/put someone on a theatre list.
Does anything else need to be done for him?
Case Information 3
Mr Smith’s endoscopy showed inoperable stomach cancer/laparotomy inoperable colon
cancer.
The acute pain team advise on his post op pain control. Three days later the nurses ask you to
see him. He is unwell, sweaty, breathless and coughing up discoloured sputum. He has a
temperature of 38.5C. You examine his chest and he has dullness to percussion and crackles
at his left base.
He is not yet eating and drinking after his procedure. What should you do?
Student Task
Request any relevant investigations and write up his drug chart.
Does anything else need to be done for him?
Case Information 4
The staff nurse asks you to give the first dose of IV antibiotic.
Student Task
Discuss.
Is this the case in your Trust?
41
Case Information 5
Mr Smith’s chest infection has improved on antibiotics but when you review him he is
complaining of upper abdominal pain not relieved by cocodomol 30/500, which the nurses
have been giving regularly.
On the ward round, your registrar tells Mr Smith he thinks he needs oral morphine because
his pain is not controlled. He asks you to prescribe oral morphine 5mg 4 hourly.
Student Task
Write this up along with any other drugs that should be prescribed with it.
Does anything else need to be done for him?
Case Information 6
You go back after the ward round, he is still in pain and says he hasn’t had any of the new
medicine. You check with the staff nurse and she explains that one member of staff has gone
off sick and the only other trained member of staff is at her coffee break. She can’t give him
his pain relief until she comes back.
Student Task
Discuss why the patient may not have had any morphine yet.
Case Information 7
You are on the ward and the nurses ask you to speak to Mr Smith’s son, who wants to know
what is the matter with his father. He is particularly worried that he has now been started on
morphine.
Student Task
Role-play this conversation in pairs, each taking a turn as PRHO.
Case Information 8
On the ward round two days later, he is feeling much better, is well pain controlled and
asking when he can go home. Your registrar asks you to convert his oral morphine 10mg 4
hourly to modified release morphine.
Student Task
Write this up.
42
Case Information 9
Mr Smith is very anxious to go home, but lives alone. He was managing with help from an
elderly neighbour to do his shopping previously, but is now more frail.
Student Task
Discuss what needs to be done to try to get this man home.
Who needs to do it?
Are these tasks unique to the PRHO or shared, and if so, with whom?
Student Task
Telephone the GP and discuss with him his views about Mr Smith being discharged home.
Case Information 10
OT assessment shows whilst Mr Smith can wash and dress himself and walk a short distance
to the toilet, he is restricted by fatigue and breathlessness. He can make a hot drink, but
certainly not a meal. A social worker meets with the patient and his family. His son lives
away and has young children and both he and his wife are in full time employment. The
elderly neighbour has told the son she cannot do any more than the shopping.
Student Task
What is your role in discharging this man?
Case Information 11
On Friday, a discharge date for next Monday is arranged with the GP, district nurses,
community palliative care team and home care support.
Student Task
Write up his drugs ready to take out for discharge on Monday.
Case Information
You arrive at work on Monday morning. Mr Smith deteriorated suddenly in the small hours
of the morning. Your PRHO colleague was asked to see him. Clinically he had had a
pulmonary embolus and he died shortly after at 08:45, just before you arrived on the ward.
The nurses ask you to certify him.
Student Task
Write in the notes that you have certified him.
Fill in his Death Certificate.
43
Student Task
Mr Smith’s son has been called in by the nurses and was told on the telephone that he had
deteriorated. He arrived after his father had died. In pairs role-play telling the son that Mr
Smith has died.
How is the GP informed in your Trust?
What are the other arrangements around bereavement in your Trust?
Summary
Summarise the case and consider what you have learned and any other issues the case has
raised for you.
Consider and record any personal learning objectives identified that you need to take to your
educational supervisor at your first meeting as a PRHO.
44
LEARNING DIARY
The Learning Diary is one of the core documents of the PRHO shadowing course. The
Learning Diary is a daily reflection in which students will record their personal observations,
and will become the focus for the written assignment. In addition, students will identify their
personal learning objectives based on their notes. On return to the University, the students’
own data will enable them to choose incidents that reflect both good practice and practice
which concerned them. Thus, they will be setting the agenda for their own learning, drawn
from actual events and incidents that they have observed.
Students will be reminded that the general course themes are as follows:





Roles and Responsibilities
Clinical Administrative Procedures
Organisational Skills
Communication Skills
Clinical Skills
Students will be expected to apply these themes in their assignment (see Assignments) and
should therefore make sure that they identify the themes as they occur in their Learning
Diary. (See LEARNING DIARY sample on the next two pages which students can make
copies of to use throughout their shadowing)
Rationale: Through personal reflection and observation during shadowing, significant
incidents can be explored and personal learning objectives devised.
Aims: To help students focus on the shadowing experience and reflect on their professional
development, which will enable them to identify personal learning needs, that are relevant to
their future PRHO jobs.
Intended Learning Outcomes:





For every student to appreciate situations where they felt confident during the week clinically and emotionally - and build on this identified knowledge in order to compile
their personal learning objectives
For every student to identify where they felt less confident clinically and emotionally, and
to use these incidents to explore and develop effective strategies in the safe environment
of the workshops
To compile notes that will form the basis for the course assignment
To develop an ability to articulate the differences between their pre- and post-shadowing
perceptions of the job of PRHO
To take away personal learning objectives that will inform their initial appraisal with their
educational supervisors when they begin their posts as PRHOs in August
45
LEARNING DIARY
Date:
Time:
Context of significant incident: where, time, staff, personal state or mood of self and others
where relevant
What happened?
Identify the positives:
Identify what could be improved:
What were the issues?
What can you learn from this incident?
Which course themes are illustrated by this incident? Roles and Responsibilities, Clinical
Administrative Procedures, Organisational Skills, Communication Skills, Clinical Skills?
Learning Objectives:
Continued/…
46
PERSONAL ACTION PLAN:
At the end of this course students will translate their Learning Objectives into an Action Plan
to take forward to their PRHO job.
Which of my learning objectives do I need to work on during my PRHO year?
What action (s) do I propose to take?
What support can others give me?
How will I monitor/evaluate the action that I take?
Who will I get feedback from?
47
WORKSHOP VENUES
BRI Old building (opposite EdwVII entrance). Faculty room/Board Room are on ground level 2.
Turn right or left along corridors from main entrance. Key return from reception in lobby.
Dental School Seminar Rooms. Use main entrance, go straight through corridor, across the
courtyard to Chapter House.
Get swipe card from office, room 311, L3 for entry.
Meet in foyer to 106B.
Medical School Tutor rooms, Park Place, below CDO office, St Michaels Hill.
Rooms 1.1a/b, 1.2, 2.1, 2.2, 2.3. Entry code 3412.
Milnes Walker seminar room is on level 7 of the B.R.I. Opposite the lifts, card access from Surgery
Dept.
Surgery Meeting room is on level 7 of the B.R.I. Behind the lifts, card access
Rheumatology seminar room is in the back yard of the BRI Old building. Use entryphone.
Royal Fort House Annexe through gatehouse arch at top of Royal Fort Rd, which is a turning up to
your left off St Michael's Hill . Enter Annexe door and follow signs upstairs.
Terrell St Training rooms are at the back of the BRI, behind A&E, or off Alfred Parade. Obtain
keys from UBHT Med Educ Centre (as below).
UBHT Medical Education Centre Upper Maudlin Street, opposite BRI main entrance. Tutor rooms
on Level 4. card access
Clinical Deans Offices, 39-41 St Michaels Hill, Bristol BS2 8DZ. Entryphone at No 41, or coded
entrance (7840) at No 39.
NB Please be in and out of tutor rooms promptly, and leave tables free of paper.
TUTORS BRIEFING VENUE
Seminar Room, Dolphin House is a meeting room adjacent to Dolphin House Bar lounge.
Use bar entrance and code entrance to the room.
LUNCH VENUE
Dolphin House Bar. Entry via Edward VII BRI entrance on Marlborough St. Turn immediately right
up few steps into Dolphin House lobby. Bar and lounge on first floor. Code entry.
49
STUDENT GROUPS
Group– B.R.I. (A) (UBHT)
Group – B.R.I. (B) (UBHT)
Group –Glos’shire Hospital
(Glos Hospitals Trust)
AL-NAJJAR Haida
BHATTI Imran
CHELVANATHAN Anushya
COFFEY Sean (St George’s)
DE GIORGIO-MILLER ……
Nicholas
FINCH Louise
GUNASEKERA Wiranthi
HANDLEY Axexandra
HAYWARD Tamsin
HEMPENSTALL Jonathan
HOPKINS James
HUNTER Rachel
(Leeds)
JOHNSON Robert (Manch)
JONES Matthew
McHUGH Beth
McKERRELL Tom
McNAIR Angus
MIDDLEDITCH Alexander
MITTAL Rahul
MYERS Gillian
OFFORD Jenny
PLATT Andrew
REED Aaron
REED Lee
SANDAY Julia
VEALE David
VIVEKANANDARAJA Jaisun
WALKER Ronald
WINDSOR David
(
)
BAKER Sarah
BHATNAGAR Rahul
GILL Alison
GRIMSHAW Ben
HASLEHURST Kirstine
KASSAM Shelina
LEVY Samantha
MOLLER Maaika
ODURO-DOMINAH Louise
PYNN Michael
SINNOT DROVER Alison
SMITH Emma
WILKINSON Christopher
*DANDO Julie (Leics)*
EVERETT Thomas
HALFORD William
HYDE Edward
Group – Plymouth Hospitals
Trust
AUSTIN Jemma
BOWLES Andrew (Dund)
BOYD Nicholas
*CAMERON Steve
(Notts)*
CUMBERS Mary
*FARRANCE Michael
(Dubl)*
GARDNER Fiona
GOLDIN Matthew
*KINGSTON Elizabeth
(Lpool)*
MORGAN Nicola
(
)
Group – Southmead (A)
(N Bris Trust)
ARDRON Caroline
*ARMSTRONG Michael
(Birm)*
ASTIN Jeremy
BACON Naomi
BARNEBY Elizabeth
BEARD Glenda
BONNER Kate (St
George’s)
CARLTON Edward
COOPER Lucy
ECKHOLT Stephanie
FELSTEAD Andrew
GRAINGER-ALLEN Emma
Group– Southmead (B)
(N-Bris Trust)
HART Clare
(Barts)
HAYDEN Lucy
LAIRD William
MANSFIELD Alice
NEESON Anne
NEWMAN Alexander
NIJJER Sukhjinder
OLIVER Matthew
SAVANOVIC-ABEL
Ognjenka
THURTLE Rebecca
TRAYNOR Seamus
Notes:
i) Bracketed blank space ( …………………) indicates unallocated job.
ii) Starred name *….* indicates student not able to attend our course.
50
STUDENT GROUPS
Group Frenchay (N-Bris
Trust)
Group – Exeter (Royal
Devon Trust)
ASTIN Charlotte
BOLSTRIDGE Mark
CHAPPELL Simon
DAVIES Hugh
DAWSON John
DIACON Tom
DRINNAN Kyra
DROOG Sarah †
EDWARDS Helen
FINCH Clare
GOYAL Amit
HAMILTON Charles
LAI Wesley
LEONG Su Lyn
MARSH Rebecca
MONTONEN Heta (Leics)
MORGAN Patrick
SUKHTANKAR Priya
BAIRD Claire
BAYLEY Rebecca
GRIFFITHS Kate
SADNICKA Anna
SWANBOROUGH Nicola
Group – Taunton and
Somerset Trust &
Yeovil (E Somerset Trust)
Group - Truro & Penzance
(Royal Cornwall Hospitals
Trust)
Group - Torbay (S Devon
Trust)
CHUBB Christopher
CLISSOLD Rhian
EGAN Janice
GOSNELL Elizabeth
LIM Fong
*ROWE Emily
(née Williams)
(UWCM)*
SEWELL Matthew
TORRIE Alex (Peter)
WALLIS Adam
WILES Anna
(
)
AMARAKONE Keith
FREEMAN Nicola
HOPE Suzanne
MANSER Lisa
McCALL Hannah
PAUL Sarah
PHILLIPS Katie
REYNOLDS Henry
WILLIAMS Emma
(
CLARK Thomas
FLEMING Julia
GAUNT Claire
KAMATHIA Goolam
MAY Jolyon
MITCHELL Samantha
RIYAT Sharanjit
SADIGH Parviz
SELLMAN Ben
SIMMS Rebecca
WHITEHOUSE Anne
(
)
CHAN Howard
*CHANDRAN Manikandan
(Ind)*
DUBASH Sayam
KIM Hyun
PANESAR Anujeet
KNIGHT Philip
*LACEY Ben
Group - Weston (Area
Health Trust) &
Barnstable (N Devon Trust)
AVIS Duncan
HARRISON James
LAW Andrew
MAIER Rebekka
(Vienna)
MATONE Luciana
NASREEN Syma
ROY Matthew
SILVERMAN David
THAMBURAJA Sree
BENNETT Sean
HAWKINS Simon
KHALID Shahril
)
(Edin)*
Notes:
i) Bracketed blank space ( …………………) indicates unallocated job.
ii) Starred name *….* indicates student not able to attend our course.
51
Surg/Orthopaeds rotations
Students opting out of this
matching scheme
NB
A number of students have to
shadow at Frenchay in this
case. Please check your trust
joining instructions at lunch on
Monday 15th for notification.
DHAR Jyoti
DROOG Sarah† (NBris/Forces)
WIGLEY Carley
(WMid)
RAMASWAMY Preeti
(Glasg)
52
TUTORS BRIEFING SESSION
By request we have arranged for you to meet the course clinical lead who will
give a 20-25 minute pre-workshop briefing and answer any questions:
regarding the running of the workshops.
Session, date,time
Facilitator
Venue
Karen
Forbes
(UBHT)
Mon 15/3 1 00pm
Seminar Room, Dolphin House.
use Dolphin House Bar entrance.
BUFFET LUNCH, REFRESHMENTS PROVIDED
TIMETABLE OF WORKSHOP GROUPS WITH VENUES
Group - BRI (A)
Session, date,time Tutor
Venue
Mon 15/3 2 00pm
Rebecca Aspinall
Board Room, BRI old bldg
Fri 26/3 9 30am
Rebecca Aspinall
Faculty Room, BRI old bldg
Group - BRI (B)
Session, date,time Tutor
Venue
Mon 15/3 2 00pm
Nigel Rawlinson
Board Room, BRI old bldg
Fri 26/3 9 30am
Nigel Rawlinson
Faculty Room, BRI old bldg
Group –Gloucester Hospitals
Session, date,time Tutor
Venue
Mon 15/3 2 00pm
Eve Blundell/ Liz
Spencer
At PGC in the Trust
Fri 26/3 9 30am
Liz Spencer/Eve
Blundell
At PGC in the Trust
Group - Barnstable & Weston
Session, date,time Tutor
Venue
Mon 15/3 2 00pm
Milnes Walker Seminar Room
Fri 26/3 9 30am
PRHO lead/clinical tutor At PGC in Trusts
Group – Southmead (A)
Session, date,time Tutor
Venue
Mon 15/3 2 00pm
Terrell Street Room 2
Fri 26/3 9 30am
Kathryn Holder
At PGC in Trust
53
Group – Southmead (B)
Session, date,time Tutor
Venue
Mon 15/3 2 00pm
Med 1.1b., Park Place, StMHill
Fri 26/3 9 30am
Kathryn Holder
At PGC in Trust
Group – Frenchay
Session, date,time Tutor
Venue
Mon 15/3 pm.
Jason Kendall
Med 1.2, Park Place, StMHill
Thur 26/3 am
J Kendall/P Younge
At PGC in Trust
Group – Exeter & Plymouth
Session, date,time Tutor
Venue
Mon 15/3 2 00pm
Karen Forbes
Med 2.2, Park Place, StMHill
Fri 26/3 9 30am
Clinical tutors
At PGC in Trust
Group – Taunton & Yeovil
Session, date,time Tutor
Venue
Mon 15/3 2 00pm
Richard Welbourn
Med 1.1a., Park Place, StMHill
Fri 26/3 9 30am
PRHO lead/clinical tutor At PGC in Trust
Group – Truro
Session, date,time Tutor
Venue
Mon 15/3 2 00pm
Robert Marshall
At PGC in the Trust
Fri 26/3 9 30am
Robert Marshall
At PGC in the Trust
Group – Torbay
Session, date,time Tutor
Venue
Mon 15/3 2 00pm
Karen Forbes
Clive Roberts
Med 2.1, Park Place, StMHill
Fri 26/3 9 30am
Nualla Campbell
At PGC in theTrust
54
EVALUATION FORMS
PRHO FEEDBACK AND EVALUATION:
Name of shadow .........................................................................................................................
Trust ............................................................................................................................................
What worked well with your shadow? (Shadowing structure, domestic arrangements, impact
on staff etc.)
What could work better? (Shadowing structure, domestic arrangements, impact on staff etc.)
Is there anything else you wish to add? (Was anything left out or redundant?)
(RETURN FORM TO MAUREEN JOHNSON, CLINICAL DEANS OFFICE, BRISTOL BS2 8EW)
55
56
BIBLIOGRAPHY
Adams R. Dominelli L. & Payne M. (eds) 1998 Social Work: Themes Issues and Critical
Debates Basingstoke Macmillian Press.
Dowling S & Barrett S 1991 Doctors in the Making: The Experience of the Pre-Registration
Year Bristol :SAUS Publs.
GMC 1997 The New Doctor
Goleman D 1995 Emotional Intelligence New York: Bantam Books
1998 Working with Emotional Intelligence London: Bloomsbury Pub Co.
Greenhalgh, Trisha 1997 How to Read a Paper London: BMJ
Harris D. Peyton R. & Walker M. 1996 Training the Trainers: Learning and Teaching
London: Royal College of Surgeons of England
Mitchell H.E. & Laidlaw, J.M. Make Induction Day More Effective-Add a Few Problems
Medical Education 1999;33:424-428
Royal College of Physicians of London 1997 Improving Communication Between Doctors
and Patients
Schon D. Argyris C. 1989 Theory in Practice: Increasing Professional Effectiveness San
Francisco: Jossey-Bass
Schon D. 1987 Educating the Reflective Practitioner: San Francisco. Jossey- Bass
Walker G. Bradburn J. Maher J. 1996 Breaking Bad News London: King’s Fund Pub.
57
ACKNOWLEDGEMENTS
Researched and Produced by:
Dr Karen Forbes
Consultant and Macmillan Senior Lecturer
Palliative Medicine
UBHT
Kathy Feest
Lecturer in Medical Education
University of Bristol
Nursing Advisors:
Shadowing
Clinical Lead:
Original version
written by:
Mrs Jenny Temple
Adult Pathway Lead
Institute of Health
University of Plymouth
Professor Kath Ross
Professor of Nursing
University of the West
of England
Dr Karen Forbes
Consultant and Macmillan Senior Lecturer
Palliative Medicine
UBHT
Kathy Feest, Karen Forbes, Nigel Rawlinson,
Helen Stoddart
58