MEDIC ST 3102AHO - Clinical Skills III Part 1

Teaching Hospitals - Semester 1 - 2017

In Year 3, students continue develop and improve on the clinical interviewing skills required to elicit and record a clinical history and to perform a physical examination. Students move out of the clinical skills laboratory and are placed within a teaching hospital for one day a week.

  • General Course Information
    Course Details
    Course Code MEDIC ST 3102AHO
    Course Clinical Skills III Part 1
    Coordinating Unit Medicine
    Term Semester 1
    Level Undergraduate
    Location/s Teaching Hospitals
    Contact Weekly lectures, CBL sessions & resource sessions
    Available for Study Abroad and Exchange N
    Prerequisites Year 2 MBBS Exam
    Restrictions Available to MBBS students only
    Course Description In Year 3, students continue develop and improve on the clinical interviewing skills required to elicit and record a clinical history and to perform a physical examination. Students move out of the clinical skills laboratory and are placed within a teaching hospital for one day a week.
    Course Staff

    Course Coordinator: Dr Josephine Thomas

    Please refer to the Year 3 Clinical Skills Course Handbook for the appropriate Clinical Skills Office for your clinical attachment.
    Course Timetable

    The full timetable of all activities for this course can be accessed from Course Planner.

    Students will receive a manual specifically for their hospital, which will provide them with relevant site specific details and timetables. Information will also be posted on the bulletin board periodically and morning briefings will occur at each site.
  • Learning Outcomes
    Course Learning Outcomes
    1 Able to confidently approach appropriate patients in hospital and general practice settings
    2 Able to take a full history from a variety of patients including exploration of the patient’s presenting problems in detail, maintaining respect for the patient’s cultural, religious and social background
    3 Able to conduct a physical examination on a real patient, appropriate to the history and with respect for patient comfort at all times
    4 Able to detect common physical signs on real patients
    5 Able to process history and examination findings to formulate a problem list, limited differential diagnosis and basic management plan
    6 Able to present findings in both a written and oral presentation (as would be appropriate for clinical attachments e.g. ward rounds)
    7 Develop an awareness of hospital and general practice care, including investigation and management of common conditions
    8 Increase knowledge of medications used for common conditions and familiarisation with hospital medication charts
    9 Behave in a professional manner in all clinical encounters
    University Graduate Attributes

    This course will provide students with an opportunity to develop the Graduate Attribute(s) specified below:

    University Graduate Attribute Course Learning Outcome(s)
    Deep discipline knowledge
    • informed and infused by cutting edge research, scaffolded throughout their program of studies
    • acquired from personal interaction with research active educators, from year 1
    • accredited or validated against national or international standards (for relevant programs)
    2,3,4,8
    Critical thinking and problem solving
    • steeped in research methods and rigor
    • based on empirical evidence and the scientific approach to knowledge development
    • demonstrated through appropriate and relevant assessment
    4,5
    Teamwork and communication skills
    • developed from, with, and via the SGDE
    • honed through assessment and practice throughout the program of studies
    • encouraged and valued in all aspects of learning
    1,6
    Career and leadership readiness
    • technology savvy
    • professional and, where relevant, fully accredited
    • forward thinking and well informed
    • tested and validated by work based experiences
    7
    Intercultural and ethical competency
    • adept at operating in other cultures
    • comfortable with different nationalities and social contexts
    • Able to determine and contribute to desirable social outcomes
    • demonstrated by study abroad or with an understanding of indigenous knowledges
    2,3,
    Self-awareness and emotional intelligence
    • a capacity for self-reflection and a willingness to engage in self-appraisal
    • open to objective and constructive feedback from supervisors and peers
    • able to negotiate difficult social situations, defuse conflict and engage positively in purposeful debate
    3,4,9
  • Learning Resources
    Required Resources
    Students should have already purchased a standard medical examination kit.
    Recommended Resources
    Recommended resources will be advised as appropriate.

    Suggested texts
    Talley & O’Connor, Clinical Examination
    Swartz, Textbook of Physical Diagnosis: History and Examination
    Tierney & Henderson, The Patient History: Evidence-based Approach
    Lloyd & Bor, Communication Skills for Medicine
    Hampton, The ECG Made easy
    Australian Medicines Handbook (AMH)
    SGRHS DVD, A Guide to Clinical Examination

    Clinical Education Offices Resources
    There are also limited numbers of neurological examination kits, copies of the AMH, textbooks and Physical Examination DVDs available in the clinical education offices.
    Online Learning
    MyUni
    https://myuni.adelaide.edu.au/webapps/login/
    Resources for this course can be found on the MyUni website, under year 3 clinical skills.

    Details for allocation and clinical placement requirements will also be provided through the dedicated medical curriculum website: http://curriculum.medicine.adelaide.edu.au/index.asp

  • Learning & Teaching Activities
    Learning & Teaching Modes
    The clinical skills course includes lectures, bedside tutorials, case presentations, case write-ups, workshops. There is also an emphasis be self-directed learning.
    Clinical Learning
    The core element of the clinical program is learning from patients seen on the wards. Students must see patients in pairs and should see at least one patient per week per pair. It is expected one student takes the entire history and perform a physical examination on the patient while the other student observes. The following week roles will be reversed
    Case Write-Ups:
    The examining student will then submit a case write-up by the end of the day. Students will be expected to enter their details and the patients’ details on the sign-off sheet for every case write up that they hand in to ensure patient confidentiality and to authenticate the patient. Students are encouraged to take notes even when acting as the observer, so as to provide feedback to their colleague
    (see "assessment" for sunbmission details).
    Oral Presentations:
    Students will be rostered to small group tutorials in which they will present a patient they have seen on the wards. This will usually encompass discussion on various aspects of the case, including formulating a problem list with differential diagnoses and demonstrating clinical reasoning to support differential diagnoses. Some time may be spent discussing an appropriate management plan. Time will also be spent on discussing presentation skills such as communication skills/ format and chronology of presentation/ amount of relevant detail to include etc. The aim of the oral presentations is to introduce students to what will be expected of them on ward rounds in their clinical years.
    Bedside Tutorials:
    Students will have a bedside tutorial most weeks, where they will meet as a small group with a clinical tutor (intern, resident, registrar or consultant) to see patients and develop techniques in physical examination and history taking.
    Checklists for components of specific clinical examinations are included in the handbook all students receive at the beginning of their rotation (also available online in MyUni). There will be timetabled topics to be covered each week – see the list for your Hospital.
    Lectures:
    Each week students may receive a lecture/s regarding that week’s specific learning objectives. The lecture may be given by their specific Clinical Education Lecturer or other academic/clinical staff
    Pre-reading:
    Pre-reading is required most weeks (see MyUni website)
    Workshop activities:
    All students will be rostered to attend a number of sessions outside of their main hospital site:
    • Adelaide Health Simulation & Skills Centre simulation sessions- will include ECG lead placement, basic life support, venepuncture, injection technique and sharps safety.
    • Hampstead Rehabilitation Centre – you will be exposed to the challenges of living with spinal injury.
    • Sexual Health Workshop – sexual health history and intervention will be covered in this session
    • Eye (ophthalmology) outpatient visits at Hospital sites
    • Ear (ENT) outpatient visits at Hospital sites
    • Vascular 'round robin' involving real patients
    • Cancer voices discussion groups with patient tutors
    Workload

    The information below is provided as a guide to assist students in engaging appropriately with the course requirements.

    On most days students will be expected to arrive at 8.00 a.m. and stay until 5.00 p.m. not including personal study and preparation time. In Years 1-3, the standard total student workload for 24 units is 48 hours a week.
    Learning Activities Summary
    The structure of the Year 3 Clinical Skills Program will be provided and discussed at the start of the program and is discussed in detail in the student handbook (provided to students on the first day of their rotation).
    Specific Course Requirements
    All students will be allocated to a hospital site (NALHN, TQEH, RAH). However, students will need to travel to other sites for some sessions.
    All students must complete "ready for practice" requirements and maintain up to date documnentation on their Mahara "ready for practice page" to be elible to attend clinical placement. This includes:
    • Medical indemnity Insurance (must be valid)
    • Criminal history clearance x3 (these are valid for 3 years)
      • Child related
      • Vulnerable person
        • Aged care sector
          • Nb. overseas students need local clearance after they have been in Australia for 3 years, but must have clearance from their country of origin up until that time.
      • TB screening completion – copy of email from SATB or Chest Clinic slip
      • Health care worker screening and vaccination statement of compliance
      • Hand hygiene certificate (valid in the year of completion)

      Further details are available on MyUni and Mahara e-portfolio.



      Small Group Discovery Experience
      The predominant learning method for the MBBS Program is small group discovery learning.
    • Assessment

      The University's policy on Assessment for Coursework Programs is based on the following four principles:

      1. Assessment must encourage and reinforce learning.
      2. Assessment must enable robust and fair judgements about student performance.
      3. Assessment practices must be fair and equitable to students and give them the opportunity to demonstrate what they have learned.
      4. Assessment must maintain academic standards.

      Assessment Summary
      Assessment Task Task Type Timing Weighting
      Case write ups (x6) Formative

      semester 1 and 2

      0
      Case write ups (x2) Summative

      semester 2

      60%
      Assignment tasks- Spinal injury reflection, Cancer voices reflection. Summative after scheduled attendance at workshop sessions 40%
      Simulation sessions- competence in BLS, injection technique, venepuncture Summative- hurdle as scheduled 0
      Confidentiality quiz. Summative- hurdle semester 1 (before attending wards) 0


      All assessment items will be standard set for competency and the marks used to calculate the composite score adjusted according to standard setting. Students are required to attain an overall composite score from all assessment tasks equal to or greater than 50% to achieve an NGP

      An additional assessment will be offered to students who fail the course with a composite score of 45-49%

      Formative assessment tasks, including
      a) 2 oral case presentations
      b) Professional behaviour (punctuality, engagement, workload management, respectful behaviour)
      will occur in Semester 1 or 2 and students will receive feedback.

      In circumstances where students do not meet the hurdle requirements but satisfactorily pass the course, the course coordinator may use their discretion to offer additional assessment.

      Material covered during the Year 3 Clinical Skills course will also be tested during mid-year and end-of-year written examinations as well as end of year OSCE examinations.
      Assessment Related Requirements
      Students should review the Assessment Document provided at the beginning of the year.  This outlines the assessment requirements for Clinical Skills.
      Assessment Detail
      Students are advised to read in detail the information in the Year Level Assessment Document - Part A and Part B. Students will be expected to be aware of the contents of these documents and to abide by the requirements as stated. Students should note that requirements for professional behaviour standards are set out in the year level assessment documents. As medical students, you are registered with the Medical Board of Australia. Students are required to maintain the expectations of the professionalism standards and associated behaviours required of the profession.

      There are formative and summative tasks which must be completed (see summary for weightings)

      In this course, students will be assessed on the following:

      Professional Behaviour
      • Attendance (students are required to sign in for sessions)
      • Punctuality
      • Work load management and ability to adhere to deadlines
      • Display active engagement with clinical skills activities
      • Demonstrates respectful behaviour towards others including staff, lecturers, clinicians, patients and fellow students
      • Maintaining a high level of confidentiality at all times.

      Medical Competence
      • Case write-ups: at least 4 to be completed in each semester, including:
      - 1 formative case write-up in semester 1
      - 2 summative case write-ups in semester 1
      • Oral Case presentations (formative)
      • Satisfactory completion of simulation Training
      • Reflective tasks for spinal injury and cancer voices workshops

      Material covered during the Year 3 Clinical Skills course will also be tested during mid-year and end-of-year written examinations as well as end of year OSCE examinations.In Semester I, at least four case write-ups will be submitted for Formative Assessment and in Semester II each student will select two case write-ups for Summative Assessment as well as another at least two formative case write-ups.

      Students have specific submission dates for case write ups based on their allocated A or B grouping (alternating weeks for A and B).
      Submission is due by midnight on the day following the clinical skills Tuesday session (ie. Wednesday).
      Swapping the date of submission is at the discretion of each site coordinator on an individual student basis.
      Students see patients in pairs and partners but may NOT use the same patient for their case write-up.

      Case write-ups receive a grading out of 6 possible points.

      LATE SUBMISSION: 1-2 days late penalty is one point, 3-6 days lose 2 points. After 7 days, “NOT SUBMITTED” will be recorded.
      EXTENSION TO SUBMISSION DEADLINES: If a student is absent from the Clinical Skills day, they may be allocated an alternative week for case write up submission. If a student feels they are unable to complete the patient assessment on the Clnical Skills day, they may apply to the clinical skills lecturer (in person or by email) at that site for a 2-day extension. If there is any other reason that a case write up cannot be submitted on time, a student may apply to the clinical skills lecturer (in person or by email) at that site for an extension.


      Complete assessment requirements for the MBBS Program are set out in the year level assessment documents distributed at the start of each year.
      Submission
      As outlined above
      Course Grading

      Grades for your performance in this course will be awarded in accordance with the following scheme:

      NOG (No Grade Associated)
      Grade Description
      CN Continuing

      Further details of the grades/results can be obtained from Examinations.

      Grade Descriptors are available which provide a general guide to the standard of work that is expected at each grade level. More information at Assessment for Coursework Programs.

      Grades for your performance in this course will be awarded in accordance with the following scheme: GS4 Non-graded pass.

      For the purpose of feedback to students a banded result will be provided for each course and examination. This result will not appear on students’ academic transcripts.

      Bands of achievement are:
      A Above expected competency for year level
      B Clearly at expected competency for year level
      C Just reaches expected competency for year level
      D Below expected competency for year level
      E Far below expected competency for year level

      Final results for this course will be made available through Access Adelaide.

      Students should familarise themselves with the University Policy on Additional Assessment/Replacement Assessment.
    • Student Feedback

      The University places a high priority on approaches to learning and teaching that enhance the student experience. Feedback is sought from students in a variety of ways including on-going engagement with staff, the use of online discussion boards and the use of Student Experience of Learning and Teaching (SELT) surveys as well as GOS surveys and Program reviews.

      SELTs are an important source of information to inform individual teaching practice, decisions about teaching duties, and course and program curriculum design. They enable the University to assess how effectively its learning environments and teaching practices facilitate student engagement and learning outcomes. Under the current SELT Policy (http://www.adelaide.edu.au/policies/101/) course SELTs are mandated and must be conducted at the conclusion of each term/semester/trimester for every course offering. Feedback on issues raised through course SELT surveys is made available to enrolled students through various resources (e.g. MyUni). In addition aggregated course SELT data is available.

      The MBBS Program has a regular program of evaluation.  In addition, student representatives are appointed to MBBS committees and are encouraged to report on issues of importance to students.
    • Student Support
    • Policies & Guidelines
    • Fraud Awareness

      Students are reminded that in order to maintain the academic integrity of all programs and courses, the university has a zero-tolerance approach to students offering money or significant value goods or services to any staff member who is involved in their teaching or assessment. Students offering lecturers or tutors or professional staff anything more than a small token of appreciation is totally unacceptable, in any circumstances. Staff members are obliged to report all such incidents to their supervisor/manager, who will refer them for action under the university's student’s disciplinary procedures.

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