MEDIC ST 5009ARU - Geriatrics and General Practice Part 1

Teaching Hospitals - Semester 1 - 2019

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 5009ARU
    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 MEDIC ST 4000AHO/BHO, MEDIC ST 4013AHO/BHO, MEDIC ST 4014 AHO/BHO, MEDIC ST 4015 AHO/BHO, MEDIC ST 4016 AHO/BHO, MEDIC ST 4017 AHO/BHO, MEDIC ST 4018 AHO/BHO, or by approval of the Dean of Medicine
    Restrictions Available to MBBS students on rural placement 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

    Course Coordinator: Dr Lawrence McArthur

    Course Coordinator - Dr Toby Commerford
    Email: toby.commerford@sa.gov.au
    Location: Royal Adelaide Hospital

    Year 5 Rural Program Coordinator: Bronwyn Herde
    Phone: +61 8 8313 4528
    Email: bronwyn.herde@adelaide.edu.au
    Location: Adelaide Rural Clinical School, The University of Adelaide
    Course Timetable

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

    Course component 1: Video Conference Tutorials & Medical Case Presentations
    Duration: 1.5 hours
    Enrolment capacity: na
    Quantity: 11 x 1.5 hours

    Course component 2: Geriatric Rehab Case Presentation & Clinical Skills Day
    Duration: 1- 2 days
    Enrolment capacity: na
    Quantity: 1 each per rural site

    Course component 3: Rural Geriatrics Outpatient Clinics, Residential Care Visits, Domiciliary Care & ACAT Eposure
    Duration: semester
    Enrolment capacity: na
    Quantity: 16 weeks

    Geriatrics tutorials are generally on a Tuesday afternoon from 3.30pm - 5.00pm


  • Learning Outcomes
    Course Learning Outcomes

    Geriatrics


    A. On completion of Year 5 Geriatrics, students will demonstrate knowledge and understanding of the:
    1. concepts and facts regarding problems of hospitalized patients and patients in the community
    2. physiologic changes related to ageing
    3. consequences of iatrogenesis on health outcomes
    4. management of conditions common to older people, including geriatric syndromes
    5. range of services for the elderly, including those outside the acute hospital setting
    6. work of the various members of the healthcare, aged care and rehabilitation teams
    7. influence of environmental, social and financial circumstance on the older person’s health outcomes

    B. Students will demonstrate competency, as expected of a Year 5 student, in the following areas of clinical skills and reasoning:
    1. obtaining a history, performing an appropriate physical examination and assessing elderly patients in all domains including cognition, emotion, physical function, falls, nutrition, integument, bone health and continence
    2. documenting medications, discussing the evidence for and against the use of these medications, the adverse effects and drug interactions that may occur, and the monitoring requirements
    3. performing supervised procedures as deemed appropriate by the preceptor
    4. interpreting data commonly collected from patients
    5. documenting the history and physical examinations and developing a problem list with proposed management and review plan
    6. verbal presentation and discussion of assigned patients
    7. the concept and application of advanced care planning and capacity assessment
    8. communicating with general practitioners, allied health members in the community and family about management plans, ensuring clinical handover

    C. Students will demonstrate the following professional attributes:
    1. working and communicating with other members of the healthcare team to achieve best outcomes for their patient
    2. interacting with the patient and the healthcare team in a professional manner that includes punctuality, attention to appropriate dress code, ensuring dignity in care and attention to confidentiality
    3. understanding of and adherence to concepts of patient autonomy, benevolence, and distributive justice of healthcare


    General Practice

    On completion of Year 5 General Practice, students will demonstrate knowledge and understanding of:
    the normal structure and function of the body (at all levels from molecule to organism), epidemiological, social and behavioural sciences
    the common problems presenting to general practice and the approaches for their recognition, investigation, treatment and prevention
    integrating and applying core medical and scientific knowledge to individual patients, population and health systems
    integrating the principles of disease prevention and health promotion into clinical practice
    environmental and psychosocial issues and their effect on the patient
    the care of people who have one or more chronic illnesses
    Identifying, accessing, critically appraising, interpreting and applying evidence from the medical and scientific literature


    Students will demonstrate competency, as expected of a Year 5 student, in the following areas of clinical skills and reasoning:
    diagnostic reasoning skills including integration and weighted interpretation of findings from history and physical examination to arrive at an initial differential diagnosis
    selecting and justifying common investigations, with regards to the pathological basis of disease, utility, safety and cost effectiveness, and interpret their results
    applying therapeutic reasoning skills including identification of appropriate therapeutic objectives in both differentiated and undifferentiated clinical problems
    formulating and justifying appropriate management options, individually and as a member of a team
    prescribing therapy safely, effectively and economically, using objective evidence, in acute, chronic and palliative care settings
    performing and explaining to patients a range of procedures (listed in year 4/5 objectives)
    assisting with completion of an Extended Primary Care assessment of a patient


    Students will demonstrate the following professional attributes:
    the ability to communicate effectively and professionally, in a variety of media, with patients, colleagues and others
    accepting responsibility to protect and advance the health and wellbeing of individuals, communities and populations
    understanding the environmental, social and psychological determinants of disease, including issues relating to health inequalities, cultural diversity, and socio-economic and physical environment factors
    the ability to contribute to the teaching and professional development of others
    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)
    1,2
    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
    B 1,2,4,6,7
    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
    B 8, C 1,2
    Career and leadership readiness
    • technology savvy
    • professional and, where relevant, fully accredited
    • forward thinking and well informed
    • tested and validated by work based experiences
    C 3
    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
    C 1,2,3
    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
    B 6,8
  • Learning Resources
    Recommended Resources
    Learning Textbooks:
    Kane. Essentials of Clinical Geriatrics – 5th Edition (American) Ratnaike. Practical Guide to Geriatric Medicine – (Australian)
    Isaacs. The Challenge of Geriatric Medicine –1992, Oxford University Press
    Coni. Lecture Notes on Geriatric Medicine – 6th Edition, 2003, Blackwell Publishing Jackson. Prescribing for Elderly Patients – 1st Edition,2009, Wiley-Blackwell

    Resource Texts
    Evans. Oxford Textbook of Geriatric Medicine – 2nd Ed, 2000
    Brocklehurst. Textbook of Geriatric Medicine and Gerontology – 5th Ed, 1998 Hazzard. Principles of Geriatric Medicine and Gerontology – 5th Ed, 2003

    Journals
    Age and Ageing; Journal of American Geriatrics Society Australasian Journal on Ageing International Journal of Geriatric Psychiatry

    Internet sites
    www.anzsgm.org
    http://www.racgp.org.au/silverbookonline

    Online Learning
    MyUni Online Course
    Content:  Video lectures, topic pre readings and related articles
    Communication: Announcements and discussion boards will be used for asynchronous communications.

    Web Conference Tutorials
    Weekly video/web conference tutorials will be held with students at all rural placement sites.
  • Learning & Teaching Activities
    Learning & Teaching Modes
    Rural Placement:  This course is part of an community based, longitudinal, integrated year of clerkship, clinical placement and training in rural hospitals and clinical settings.  Teaching during the Geriatrics component of the rotation is primarily delivered in the clinical setting but supplemented with lectures and tutorials.

    Topic tutorials by video conference: Tutorials will be interactive, based on themes of self-directed learning and the clinical sciences program. Resources are available here in MyUni. Students are encouraged to seek other resources and references.

    Medical case history: Preparation and ORAL presentation of a Medical Case involving history, examination and case discussion

    Rehabilitation case: Preparation and ORAL presentation of a Rehabilitation Case. The case should be followed over several weeks, where possible, from time of presentation to hospital, through rehabilitation and monitoring progress on discharge. See the Rehab Case guidelines provided

    Geriatric outpatient clinic: Attendance at Outpatient Clinic with Dr Mykyta (Port Lincoln, Whyalla, Barossa) or Dr Prowse (Port Augusta)

    Residential care visits: Visits to a nursing home (high level care) or hostel (low level care) accompanying the general practitioner Domiciliary care and ACAT: Exposure to Domiciliary Care and the Aged Care Assessment Teams Psycho-geriatric services: Clare and Kadina only when available
    Workload

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

    Please refer to MyUni.
    Learning Activities Summary
    LECTURE TOPICS:

    Week 1: Course Overview
    Week 2: Introduction to Geriatrics, Demography
    Week 3: Rehabilitation Principles / Sleep
    Week 4: Falls / Osteoporosis
    Week 5: Cognitive Dysfunction Part 1
    Week 6: Cognitive Dysfunction Part 2
    Week 7: Nutrition / Polypharmacy & Iatrogenic Disease
    Week 8: Incontinence / Pressure Area Care / Sexuality
    Weeks 9 - 12: Medical Case Presentations


  • 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
    Satisfactory completion of all components of the formative and summative assessments is required to pass this course. Students will require a minimum total score of 50% from all the components below to pass. The total score for the year is based on the following components:
    1. Medical case 25%
    2. Rehabilitation Case 25%
    3. Clinical knowledge 25%
    4. Clinical skills 25%
    5. Topics from the geriatrics course will be incorporated as part of the fifth year end-of-year final examination.
    Assessment Related Requirements
    Students must attend 90% of the core structured learning activities to achieve a pass in this course. Exemptions to mandatory attendance requirements may be granted by the Program Coordinator in consultation with the relevant course coordinator and year level advisor if there are exceptional medical, compassionate or extenuating circumstances as defined by the Modified Arrangements for Coursework Assessment Policy.
    Assessment Detail
    Formative Assessment
    Students must participate satisfactorily in all components of the geriatrics course, i.e. tutorials, medical case, rehabilitation case, geriatrics outpatient clinics, visits to aged care facilities, ACAT, Domiciliary Care. The tutor must be informed should the student not be able to attend tutorials or any of the visits for a valid reason. Where possible, students must try and organize an alternative time for these experiences (except for tutorials). If the geriatrics tutor has concerns with student participation or attendance, feedback will be provided via e-mail, telephone, in person or via GP preceptors. Tutorial attendance and participation is very important. Failure to provide an explanation for absence will result in a score of 0. Absence without explanation at 3 or more sessions will mean that the student has not completed this component satisfactorily.

    Summative Assessment
    It is the responsibility of the student to be aware of the date of their medical and rehabilitation case presentations. If changes are required, it is their responsibility to make the tutor and coordinator aware of this. Failure to do this may result in a fail grade in that component.
    Submission
    Please refer to MyUni.
    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.

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

  • 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
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