MEDIC ST 5009BRU - Geriatrics and General Practice Part 2

Teaching Hospitals - Semester 2 - 2023

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 5009BRU
    Course Geriatrics and General Practice Part 2
    Coordinating Unit Medical Studies
    Term Semester 2
    Level Undergraduate
    Location/s Teaching Hospitals
    Units 4
    Contact Attachments, common program & research
    Available for Study Abroad and Exchange N
    Prerequisites MEDIC ST 5000AHO, MEDIC ST 5005ARU, MEDIC ST 5006ARU MEDIC ST 5007ARU, MEDIC ST 5009ARU, MEDIC ST 5014ARU, MEDIC ST 5015ARU and MEDIC ST 5016ARU in addition to all previous years core courses, or by approval of the Dean of Medicine
    Restrictions Available to MBBS students on rural placement only
    Assessment Details provided at start of year
    Course Staff

    Course Coordinator: Dr Katrina Morgan

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

    Year 5 Rural Program Coordinator: Bronwyn Herde
    Phone: 0438 821 744
    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.

    Geriatrics:

    Course component 1: Video Conference Tutorials & Video Presentation on a medical condition
    Duration: 2 hours
    Enrolment capacity: na
    Quantity: 11 x 2 hours

    Course component 2: Geriatric Medicine 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 Exposure
    Duration: semester
    Enrolment capacity: na
    Quantity: 16 weeks

    Course component 4: Geriatric quizzes (4 quizzes x 5 questions)

    Geriatrics tutorials are generally on a Tuesday afternoon from 3.30pm - 5.30pm

    General Practice:

    Semester 1
    - Self directed learning- 10, one hour online modules on a range of topics. Contribution to Padlet discussion after each module. Two Q & A Zoom sessions to discuss modules.

    Semester 2 - Fortnightly Zoom tutorials on a range of topics relevant to professional development in general practice. 

  • 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

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

    E. Students will demonstrate competency, as expected of a Year 5 student, in the following areas of clinical skills and reasoning:
    1. diagnostic reasoning skills including integration and weighted interpretation of findings from history and physical examination to arrive at an initial differential diagnosis
    2. selecting and justifying common investigations, with regards to the pathological basis of disease, utility, safety and cost effectiveness, and interpret their results
    3. applying therapeutic reasoning skills including identification of appropriate therapeutic objectives in both differentiated and undifferentiated clinical problems
    4. 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
    5. 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

    F. Students will demonstrate the following professional attributes:
    1. the ability to communicate effectively and professionally, in a variety of media, with patients, colleagues and others
    2.accepting responsibility to protect and advance the health and wellbeing of individuals, communities and populations
    3.understanding the environmental, social and psychological determinants of disease, including issues relating to health inequalities, 4.cultural diversity, and socio-economic and physical environment factors
    5. 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)

    Attribute 1: Deep discipline knowledge and intellectual breadth

    Graduates have comprehensive knowledge and understanding of their subject area, the ability to engage with different traditions of thought, and the ability to apply their knowledge in practice including in multi-disciplinary or multi-professional contexts.

    A, B, C, D, E, F

    Attribute 2: Creative and critical thinking, and problem solving

    Graduates are effective problems-solvers, able to apply critical, creative and evidence-based thinking to conceive innovative responses to future challenges.

    B, E

    Attribute 3: Teamwork and communication skills

    Graduates convey ideas and information effectively to a range of audiences for a variety of purposes and contribute in a positive and collaborative manner to achieving common goals.

    B, C, E, F

    Attribute 4: Professionalism and leadership readiness

    Graduates engage in professional behaviour and have the potential to be entrepreneurial and take leadership roles in their chosen occupations or careers and communities.

    C, F

    Attribute 5: Intercultural and ethical competency

    Graduates are responsible and effective global citizens whose personal values and practices are consistent with their roles as responsible members of society.

    A, C, D, F

    Attribute 6: Australian Aboriginal and Torres Strait Islander cultural competency

    Graduates have an understanding of, and respect for, Australian Aboriginal and Torres Strait Islander values, culture and knowledge.

    .

    Attribute 7: Digital capabilities

    Graduates are well prepared for living, learning and working in a digital society.

    B, E

    Attribute 8: Self-awareness and emotional intelligence

    Graduates are self-aware and reflective; they are flexible and resilient and have the capacity to accept and give constructive feedback; they act with integrity and take responsibility for their actions.

    C, F
  • 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. 

    Geriatrics:
    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.

    Geriatric outpatient clinic: Attendance at Outpatient Clinic if available.
    Residential care visits: Visits to a nursing home (high level care) or hostel (low level care) accompanying the general practitioner as available at each rural location.
    Domiciliary care and ACAT: Exposure to Domiciliary Care and the Aged Care Assessment Teams Psycho-geriatric services as available at each rural location.
    General Practice and inpatient care: Involvment in clinical care will provide opportunites to manage geriatric patients. 

    General Practice:
    Diverse opportunities in general practice include obeservation, parallel consulting, care planning and working alongside practice nurses. 


    Workload

    No information currently available.

    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
    Summative and Formative Assessments:

    Assessment Task Task Type Barrier? Weighting Course Learning Outcomes
    Geriatric Medicine Case Presentation Summative

    N

    25% Geriatrics (G) CLO's 1-22
    Geriatric Video Presentation on a Medical Condition Summative N 20% G CLO's 1-22
    Geriatric Tutorial quizzes Summative N 20% G CLO's 1-22
    Multi-source feedback x 3 Summative N 10% GP CLO's A 1-5, B 1-5, C 1-5
    GP Clinical case write up Summative N 25% GP CLO's A 1 - 5, B 1-5, C1-5
    Completion of online training modules (e.g. urinary incontinence, dizziness) Formative N N/A G 7, 16
    Multi-source feedback x 3 Formative N N/A NA
    Monthly Quizzes MCQ Formative N N/A G 1 - 22
    ARCS Midyear OSCE Formative N N/A

    G 1 – 22,

    GP B 1-5

    Students not participating in scheduled sessions will be given feedback Formative N N/A N/A

    In addition to the above, in order to pass this course and the Fifth Year MBBS Examination Annual Examination Part 2 course, students must obtain:

    •    a satisfactory result in each of the components of the summative assessment in semesters 1 and 2; and
    •    a satisfactory performance in the examinations overall

    If an overall borderline grade is achieved in the examinations, a student may be offered an opportunity to sit a Replacement/Additional Assessment examination.

    Academic Progression Requirements
    Progression from one year to the next in the MBBS is dependent on the student successfully completing a compulsory annual examination course in which a full year’s learning is assessed.

    To successfully complete the MEDIC ST 5000AHO and MEDIC ST 5000BHO Fifth Year MBBS Examination Part 1 and Part 2 courses, the student must pass the end of year examinations and have successfully completed all year level component courses (24 units).

    IF a student fails the compulsory examination course no passing grade will be received for any core medical studies courses.

    IF a student has not completed all required MEDIC ST units of the year they may be offered an appropriate remedial course of the same or greater value as specified in Term 4 of the same academic year.

    Assessment Related Requirements
    Students are expected to attend all core structured learning activities to achieve a pass in this course. Exemptions to attendance requirements may be granted by the Education Lead 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.

    The University has developed a Scope of Practice document which outlines appropriate activities for Year 5 students. Students should be familiar with this document, and adhere to its guidelines. The document can be found in MyUni and here.




    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

    No information currently available.

    Course Grading

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

    GS8 (Coursework Grade Scheme)
    Grade Description
    CN Continuing
    FNS Fail No Submission
    NFE No Formal Examination
    F Fail
    NGP Non Graded Pass
    P Pass
    C Credit
    D Distinction
    HD High Distinction
    RP Result Pending

    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.
    Please refer to CANVAS with regards to the academic response to SELTs.
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