MEDIC ST 5009AHO - Geriatrics and General Practice Part 1

Teaching Hospitals - Semester 1 - 2016

The course information on this page is being finalised for 2016. Please check again before classes commence.

The clinical attachments are a program of clinical education through a selection of placements so that students will be competent in history-taking, patient examination and management. This includes problem formulation, investigations, treatment (pharmacological and non-pharmacological), counselling, good communication skills, the practice of empathetic medicine, and a sound knowledge base that allows diagnosis and management of common disorders to be carried out under appropriate supervision. Some students will have the opportunity to undertake their training for an extended period of time in a rural or remote setting.

  • General Course Information
    Course Details
    Course Code MEDIC ST 5009AHO
    Course Geriatrics and General Practice Part 1
    Coordinating Unit Medicine
    Term Semester 1
    Level Undergraduate
    Location/s Teaching Hospitals
    Contact attachments, common program & research
    Available for Study Abroad and Exchange N
    Prerequisites Year 4 MBBS Exam
    Restrictions Available to MBBS students only
    Course Description The clinical attachments are a program of clinical education through a selection of placements so that students will be competent in history-taking, patient examination and management. This includes problem formulation, investigations, treatment (pharmacological and non-pharmacological), counselling, good communication skills, the practice of empathetic medicine, and a sound knowledge base that allows diagnosis and management of common disorders to be carried out under appropriate supervision. Some students will have the opportunity to undertake their training for an extended period of time in a rural or remote setting.
    Course Staff
    General Practice

    Student Contact:

    Nicky Bennett
    Urban Student Coordinator
    Telephone: 08 8313 3460
    Facsimile: 08 8313 3511
    Email: nicky.bennett@adelaide.edu.au

    GP Contact:
    Dr Simon Vanlint
    Lecturer
    Telephone: 08 8313 4634
    Facsimile: 08 8313 3511
    Email: simon.vanlint@adelaide.edu.au


    Geriatrics

    TQEH
    Assoc./Professor Renuka Visvanathan
    Director & University Academic
    Telephone: 08 8222 8178
    Facsimile: 08 8222 8593
    Email: renuka.visvanathan@adelaide.edu.au

    Adelaide G-TRAC
    Ms Rosie Bonin
    Centre Coordinator
    Telephone: 83132144
    Email: rosie.bonnin@adelaide.edu.au

    RAH
    Dr Robert Prowse
    Contactable via the secretary, Department of Geriatric Medicine
    Extension 25215 at the RAH
    Course Timetable

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

    The course timetable for the Geriatrics and General Practice placement is complicated due to the combining of two separately organised and co-ordinated rotations. Detailed information about the GP rotation timetable is available in the Course Handbook, available via the MLTU website and should be referred to. Information regarding the placement site is available via the University of Adelaide Discipline of GP website http://health.adelaide.edu.au/gp/education/

    As the GP clinics operate independently of the University, students will need to liaise with the clinical director at their placement site to determine useful learning opportunities and develop a timetable that ensures all assessment requirements are met.

    Tutorials will be held in the School of Population health & Clinical Practice, Level 7 Terrace Towers 178 North Terrace on the Monday 3.00pm – 5.00pm, Tuesday 10.00am - 12.30pm & Thursday 9.00am – 11.30am.

    The typical timetable for the 2 week GP rotation can be seen below.  Students will need to ensure that they are aware of School of Medicine Teaching Series session that may be organised during the GP rotation. If a clash occurs, students are to attend SMTS and inform the clinical director of their placement site of their absence in advance.


    Week A
    Monday Tuesday Wednesday Thursday Friday
    GP Tutorial GP Placement GP Tutorial
    GP Tutorial GP Placement


    Week B
    Monday Tuesday Wednesday Thursday Friday
    GP Tutorial GP Tutorial GP Tutorial GP Tutorial GP Tutorial
    GP Tutorial GP Tutorial GP Tutorial

    For the Geriatrics rotation, students will be evenly divided between QEH and RAH. At RAH the group will be split into 2 parallel streams, each doing 2 weeks acute and then 2 weeks rehabilitation with a final combined + GP week.


    GERIATRICS AT QEH

    The Geriatrics component of the placement delivered at the QEH is complicated and comprises 3 separate timetables: a master timetable for the lecture series, a rehabilitation medicine clinical placement timetable and the geriatrics clinical placement timetable. Unfortunately, this structure cannot be altered. However, time has been allocated for students during their rotation orientation session on the first day to consolidate these timetables and ask questions directly to A/Prof Visvananathan.

    Students are expected to discuss their individual geriatrics placement timetable with their preceptor. While undertaking the clinical geriatrics placement, students are advised to attend, where it doesn’t clash with other learning commitments:
    1) 0845-0930 Mon unit meeting – Level 5B Seminar Room- except first Monday of every month
    2) 1200-1330 Tuesday Medical Grand Round: Level 2 Lecture Theatre
    3) 1200-1330 Wednesday Unit Clinical Meeting Level 5B Seminar Room (please check withpreceptor or registrars for venue)
    4) 1400-1500 Friday Radiology Meeting Radiology Room behind the information counter,Ground Floor

    Information regarding the Resthaven Day in Week 5 is available in the Course Handbook.


    GERIATRICS AT RAH
    The Geriatrics component of the placement delivered at the RAH has its own detailed timetable available on the MLTU website. Students are advised to consult the MLTU website prior to the commencement of their placement. Further information is also available in the student handbook.

  • Learning Outcomes
    Course Learning Outcomes
    General Practice
    1.    You will demonstrate competence in consulting and communicating with patients, their relatives and their carers and with other health professionals.
    2.    You will develop an understanding of environmental and psychosocial issues and their effect on the patient.
    3.    You will competently discuss management of common and/or important clinical presentations.
    4.    You will demonstrate competence in performing and explaining to patients a range of procedures (listed in year 4/5 objectives).
    5.    You will develop your understanding of the care of people who have one or more chronic illnesses.
    6.    You will demonstrate your ability to understand and use opportunities for disease prevention and health promotion.
    7.    You will help complete an Extended Primary Care assessment of a patient
    8.    You will at all times demonstrate appropriate professional and ethical behaviour when interacting with patients and staff members

    Geriatrics
    During this clinical rotation, students are expected to achieve competencies related to clinical assessment and management of older people including geriatric medicine specific competencies.

    The geriatrics attachment is intended:
    •    To add to the student’s knowledge base and to clarify the management of specific conditions
    •    To permit the student to see the range of services for the elderly, particularly those outside the acute medical wards
    •    To broaden the student’s understanding of the work of the various members of the rehabilitation team
    •    To encourage the student to be thorough in their assessment of disabled patients
    •    To stimulate discussion on some of the wider issues concerning old people

    These are listed in detail in the Course Handbook along with useful learning resources to assist students in meeting the objectives. Students are highly encouraged to view this document.

    Overview of Learning Objectives:
    •    Medication Management
    •    Cognitive and Behavioural Disorders
    •    Falls, Balance, Gait Disorders
    •    Self Care Capacity
    •    Nutritional Health
    •    Hospital Care For Elders
    •    Health Care Planning and Promotion
    •    Pain management and Rehabilitation
    •    Palliative Care

    Clinical Placement Objectives
    Patient Care
    1.    Obtain an accurate and complete history from an elderly patient and/or including caregiver. (include immunization history and legal directives)
    2.    Perform an appropriate physical examination of an elderly patient (including vision, hearing and gait)
    3.    Assessment of patient includes all domains such as cognition (MMSE or RUDAS or CAM or FAB), emotion (GDS-15), physical function (ADL, iADL, TUG), nutrition (MNA-SF), integument (Braden), continence
    4.    Accurate documentation of medications and able to discuss the evidence for and against the use of these medications. Able also to discuss the adverse effects that may occur and the monitoring requirements.
    5.    Perform supervised procedures as deemed appropriate by the preceptor
    6.    Demonstration of ability to interpret data commonly collected on patients (FBE, Electrolytes, Renal Function, Liver Function, Thyroid Function, Blood Gases, ECGs, PFTs, X-Rays, CT Brain)

    Patient care and communication skills
    7.    Create a written record of the history and physical. Ensure a problem list with proposed management plan is developed.
    8.    Where appropriate, determine if patients would benefit from rehabilitation. Where there is likely to be benefit, document the rehabilitation goals and progress on these goals.
    9.    Perform daily reassessments of assigned patients as appropriate and create a progress note
    10.    Verbal presentation and discussion of assigned patients

    Medical knowledge
    11.    Develop a basic foundation of concepts and facts regarding problems of hospitalized and offices patients
    12.    Analyse patient problem using research of the medical literatureProfessionalism
    13.    Interacts with patient and healthcare team in a professional manner. This includes punctuality and attention to dress code.
    14.    Demonstrates an understanding of and adherence to concepts of patient autonomy, benevolence, and distributive justice of healthcare.

    Multi-disciplinary skills
    15.    Develop an understanding of how multi-disciplinary skills work together. Understand how geriatricians work with other team members to achieve best health outcomes for their patients
    University Graduate Attributes

    No information currently available.

  • Learning Resources
    Required Resources
    Geriatrics – not applicable
    GP – not applicable
    Recommended Resources
    Geriatrics: The Course Handbook contains a wealth of journal articles, reports and links to online material that has been carefully selected to assist students in meeting clinical and placement learning objectives. Students are advised to consult the handbook.

    GP: General Practice is a broad field, and students are advised to seek out resources that will assist them to consolidate their clinical learning.
    Online Learning
    Geriatrics: The Course Handbook contains a wealth of journal articles, reports and links to online material that has been carefully selected to assist students in meeting clinical and placement learning objectives. Students are advised to consult the handbook. An extremely useful website is the Victorian Geriatric Medicine Training Program portal, which has a number of interactive modules that are extremely relevant: http://anzsgm.org/vgmtp/

    GP: students are expected to have completed the e-learning module on Medicare and prescribing prior to attending their tutorials in the first week of the GP block. It is available here:http://www.medicareaustralia.gov.au/provider/business/education/e-learning.jsp

    Other useful online resources are:
    Therapeutic Guidelines: available via The University of Adelaide Library
    The Clinical Practise Guidelines Portal: http://www.clinicalguidelines.gov.au/
    Online databases such as UpToDate: available via The University of Adelaide
  • Learning & Teaching Activities
    Learning & Teaching Modes
    Geriatrics
    Teaching during the Geriatrics component of the rotation is primarily delivered in the clinical setting but supplemented with lectures and tutorials.

    Clinical teaching
    Students are expected to attend and participate in ward rounds, outpatient clinics and academic teaching sessions such as unit meetings and hospital grand rounds. Students need to discuss with their preceptor when these activities take place and how they should engage themselves in them.

    Students are also expected to work up and present patients and as part of the clinical learning experience, students must clerk at least one patient during their geriatric medicine placement for formal assessment. The mode of the assessment of this case write up will be up to the student’s preceptor.

    Lectures
    Each week will have four topics covered by specific lectures- 2 at TQEH (Tuesday afternoons) and 2 at RAH (Thursday afternoons)

    Visits
    To: Aged Care Assessment Team, Aged care complex (nursing home), Domiciliary care, Alzheimer’s association, Centre for physical activity in Ageing


    General Practice
    Teaching during the GP component of the rotation is delivered primarily in the clinical setting. It is supplemented by the tutorials and lectures in Week 1.

    As there is limited clinical session time in which to achieve the learning objectives for this program, it is important that time spent observing in clinics is kept to a minimum and that you take a hands-on role as much as possible, reflecting on your learning and making patient management decisions under supervision. You should make every effort to undertake an Extended Primary Care Assessment for a patient. Examples of this include the 75+ Assessment, Asthma 3+ assessment, Indigenous Health Assessment other chronic disease management items.
    Workload

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

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

    Workload for the individual students will vary from week to week but students can assume that on average they will work a 45 hour week which will include clinic sessions, lectures (both delivered and online), seminars, tutorials and private study but does not include after hours call.
    Learning Activities Summary
    See Teaching & Learning Modes above
    Specific Course Requirements
    Geriatrics: A copy of your valid (within 2 years) police check and the original (to be sighted) on the first day of placement.
  • 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
    The final mark comprises both the individual marks for GP and Geriatrics. A pass in both the Geriatric and GP areas of Geriatrics & General Practice is required to achieve a pass in this subject.

    QEH GERIATRICS ASSESSMENT SUMMARY
    All TQEH Clinical Placement students are expected as a minimum to attend a mini CEX session with the advanced trainee (or basic trainee) in each of the 2 weeks in geriatric medicine. In terms of rehabilitation mini CEX sessions, these will be coordinated by Dr Nigel Quadros who will provide you with details at the start of you rehabilitation clinical placement attachment. Further information is available in the student handbook.

    Students must clerk at least one patient during their geriatric medicine placement and the preceptor will determine how they will assess this.

    Formative Assessment
    Mini CEX opportunities and clinical skills development opportunities have been scheduled and feedback will be provided to students during these learning opportunities. Mini CEX are short 5-15 minute sessions with approximately 5 minute feedback opportunity. They may be completed in a group or individually depending on clinician preference.

    Summative Assessment
    •    95% expected attendance rule and where leave is because of an illness, a sick certificate needs to be handed in to preceptor. Any other leave needs to be applied for prospectively and it should not be taken for granted that it will be approved.
    •    Completion of the log book
    •    Completion of 4 mini CEX and signed off
    •    Preceptor Assessments for both clinical geriatrics and rehabilitation medicine rotations.
    •    Submission of completed log book (with all 4 mini CEXs), and the 2 preceptor assessments on the final day of rotation
    •    Pass on the MCQ test on the final day of rotation
    •    Pass on the OSCE on the OSCE on the final day of rotation

    RAH GERIATRICS ASSESSMENT SUMMARY
    This will be gathered from 5 components

    1.    Rehabilitation case presentation: Students are asked to select a patient, and prepare a case presentation which illustrates the problems involved in assessing and planning the rehabilitation of an elderly disabled person. Detailed information regarding the case presentation is available in the student handbook.
    2.    Case Taking: During the acute program students are expected to take a history and perform a thorough examination on one patient for presentation to the consultant in the second week. Each student will present their case; with the aim to practise thorough, accurate, concise and logical case taking.
    3.    Lecture attendance
    4.    Summary session participation
    5.    Clinical tutorial performance

    GENERAL PRACTICE ASSESSMENT:
    Assessment in the GP requires completion of the GP Workbook, found in the Course Handbook and completion of the assessment for, also in the Course Handbook by the student’s preceptor.

    The Assessment Form provides a banded grade for the placement and must be completed by the GP and returned in the envelope provided to:
    Nicky Bennett
    Student Coordinator
    Discipline of General Practice
    The University of Adelaide
    Level 11Terrace Towers
    178 North Terrace
    Ph: 08 8313 3460
    Fax: 08 8313 3511
    Email: nicky.bennett@adelaide.edu.au

    Please note that it is the student’s responsibility to ensure that the Assessment Form is returned to Nicky Bennett. Failure to do this could result in failing the GP component of Geriatrics & General Practice.
    Assessment Related Requirements
    See Assessment Summary above
    Assessment Detail
    Geriatrics (TQEH) Assessment

    Grades/Marks
    25% - MCQ
    25% - OSCE
    25% - Geriatric Medicine Clinical Placement as assessed by preceptor
    25% - Rehabilitation Medicine Clinical Placement as assessed by preceptor

    Geriatrics (RAH) Assessment
    This will be gathered from 5 components
    6.    Rehabilitation case presentation (25%)
    7.    Case taking (second week) (25%)
    8.    Lecture attendance (15%)
    9.    Summary session participation (15%)
    10.    Clinical skills demonstrated – clinical tutorials (20%)
    Submission
    Not applicable
    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.

    MEDIC ST 5009 AHO

    Grades for your performance in this course will be awarded in accordance with the following scheme: GS4

    GS4

    Grade Description
    NGP Non-Graded Pass
    S Satisfactory
    U Unsatisfactory
    F     Fail

    In addition, students will receive a banded result upon completion of their attachment.

    Five bands are available to determine the assessment for the Geriatrics and General Practice rotation in fifth year of MBBS.  The Bands available for determining student performance are:
    A  Above expected competency for Year 5
    B  Clearly at expected competency for Year 5
    C  Just reaches expected competency for Year 5
    D  Below expected competency for Year 5
    E  Far below expected competency for Year 5



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

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