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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: to enhance and consolidate the knowledge, skills and attitudes that are essential for beginning the job of the PRHO to critically reflect on the working process of the multidisciplinary team and the PRHO’s role within it 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: 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. 2 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. 3 TEACHING AND LEARNING METHODS: 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. 4 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 6 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: 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. 8 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: 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: 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. 9 COURSE PROGRAMME IN TRUSTS PRIMARY-SECONDARY CARE INTERFACE SEMINAR Process: 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: Interprofessional communication Administrative processes Admissions Discharges Role of hospital nurses in relation to hospital/primary care interface Aims: 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) 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 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: 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: 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. 14 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: 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