MEDIC ST 5014BHO - Anaesthesia, Pain Medicine & Intensive Care V Pt 2

Teaching Hospitals - Semester 2 - 2017

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 5014BHO
    Course Anaesthesia, Pain Medicine & Intensive Care V Pt 2
    Coordinating Unit Medicine
    Term Semester 2
    Level Undergraduate
    Location/s Teaching Hospitals
    Units 2
    Contact attachments, common program & research
    Available for Study Abroad and Exchange N
    Prerequisites MEDIC ST 4000AHO and 4000BHO
    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

    Course Coordinator: Julia Coldrey

    RAH ICU contact:
    A/Prof Mary White

    RAH Anaesthetics contact:
    Dr Julia Coldrey

    RAH & TQEH Pain and Palliative Care contact:
    A/Prof Pam Macintyre

    The Queen Elizabeth Hospital Anaesthetics and ICU contact:
    Dr Thava Visvanathan

    Lyell McEwin Hospital contact:
    Dr Lynda D’Souza
    Email: Lynda.D'
    Course Timetable

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

    The course timetable for the APIC rotation is made available to students on the first day of the rotation.
  • Learning Outcomes
    Course Learning Outcomes
    The course objectives for the anaesthesia component are:
    1. Preoperative Assessment
    1.1. Rational ordering of Preoperative investigations
    1.2. Assessment Cardiorespiratory reserve
    1.3. Airway assessment
    1.4. Consent
    1.5. Management of peri-operative medications
    1.5.1. Hypoglycaemics
    1.5.2. Anticoagulants/Antiplatelet agents
    1.5.3. Herbal preparations
    1.5.4. Other
    1.6. Fasting Guidelines
    1.7. Pre-medication (bronchodilators, reflux prevention, etc.)

    2. Pharmacology (brief overview)
    2.1. iv induction agents
    2.2. inhalational agents
    2.3. muscle relaxants
    2.4. reversal agents
    2.5. local anaesthetics (safe doses, routes of administration, toxicity & its treatment)

    3. Monitoring (basic overview)
    3.1. Pulse oximetry
    3.2. Capnography
    3.3. ECG
    3.4. Blood pressure

    4. Emergency Anaesthesia
    4.1. EMST principles (primary survey)
    4.2. Rapid Sequence Induction

    5. Gas Exchange
    5.1. Oxygen therapy– routes and delivered concentrations
    5.2. Hypoxia – differential and management
    5.3. Hypercarbia – differential and management

    6. CVS crises
    6.1. BLS/ALS pricinples
    6.2. mangement of cardiac arrest
    6.3. management of anaphylaxis

    7. Co-morbidites (outline of principles and peri-operative implications)
    7.1. Gastro-oesphageal reflux
    7.2. Asthma
    7.3. Sleep Apnoea
    7.4. Diabetes
    7.5. Ischaemic heart disease
    7.6. Obesity

    8. Peri-operative Fluid Management
    8.1. Water, Na+, K+
    8.2. Blood transfusion and transfusion triggers

    9. Recovery
    9.1. Analgesia (see pain week)
    9.2. Confusion
    9.3. Hypo/hypertension
    9.4. Nausea and vomiting
    9.5. Airway/breathing issues

    10. Skills
    10.1. iv cannulation
    10.2. chin lift/jaw thrust
    10.3. oropharyngeal/nasopharyngeal airway insertion
    10.4. bag and mask ventilation.

    The objectives of the pain component are:
    1.    Assessment of pain in relation to clinical diagnosis, classification and response to therapy
    2.    Knowledge of the pharmacology of drugs commonly used in pain management
    3.    Develop a familiarity with drug and non-drug techniques commonly used in pain management
    4.    Develop pain management strategies required to competently fulfil the role of an intern.

    The objectives of the ICU component are:
    1.    Revision of physiology and pharmacology in a case-based, clinical setting
    2.    Approach to the management of critically ill patients
    a.    Essentials of identification, triage and management of critically ill patients
    b.    Principles of life-support and monitoring systems
    c.    Practical aspects of advanced life support
    3.    Understanding of the ethical issues involved in the care of critically ill patients
    4.    Revision of basic and advanced life support skills (BLS, ALS).
    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)
    All of the above
    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
    All of the above
    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
    All of the above
    Career and leadership readiness
    • technology savvy
    • professional and, where relevant, fully accredited
    • forward thinking and well informed
    • tested and validated by work based experiences
    All of the above
    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
    All of the above
    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
    All of the above
  • Learning Resources
    Required Resources
    Recommended Resources
    •    Acute Pain Management: Scientific Evidence 3rd edition, 2010: see
    •    Macintyre and Schug, Acute Pain Management: a practical guide, WB Saunders, 3rd edition 2007
    •    Therapeutic Guidelines: Palliative Care: available via the University of Adelaide library
    •    Australian Medicines Handbook: available via the University of Adelaide library

    •    Introductory anaesthetics textbook such as:
    o    Gwinnutt, Lecture Notes: Clinical Anaesthesia, 4th edition, 2012
    o    Harley and Hore, Anaesthesia an introduction, 5th edition, 2012  
    Online Learning
    Students are recommended to review the SMTS pain and palliative care content available on MyUni as well as the relevant lectures on pain and analgesia from the MLTU website.
  • Learning & Teaching Activities
    Learning & Teaching Modes
    Core teaching process for ICU includes:
    1.    Small and large group teaching sessions ie. lectures and tutorials
    2.    Skills sessions (simulator sessions)
    3.    Case presentations
    4.    Clinical attachments with ward rounds
    5.    Self-directed study
    6.    Presentation of ICU related topics.

    The pain component learning is delivered via:
    1.    Lectures
    2.    Clinical attachments to acute pain, chronic pain and palliative care
    3.    Tutorials
    4.    Group work and group presentation
    5.    Case based discussion of chronic pain and palliative care
    6.    Self-directed learning

    The anaesthetics teaching and learning modes include:
    1.    PBL sessions
    2.    Clinical attachments in theatre, OPD and recovery
    3.    Simulator sessions
    4.    Self-directed learning

    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
    For all components, students are expected to attend all clinical rounds and rostered tutorials and participate actively in these.

    RAH: Students will be provided with handouts on initial assessment and management of trauma, management of shock and preoperative care and will be expected to have read this in preparation for the PBL sessions, along with material available on the MLTU website.

    TQEH: Students are requested to pre-read the PBL on local anaesthetics available on the MLTU website for their PBL on the first Monday afternoon. All other PBLs and rostering will be notified during orientation and material will be available on website.

    Students are expected to complete the recommended readings:
    1.    Revisit 4th year lectures on pain and analgesics
    2.    Macintyre and Schug – Acute Pain Management
    a.    Chapter 3 – Assessment of pain
    b.    Chapter 4 – pharmacology of opioids
    c.    Chapter 6 – non-opioid and adjuvant analgesic drugs
    d.    Chapter 7 – routes of systemic opioid administration
    e.    Chapter 8 – patient-controlled analgesia
    f.     Chapter 9 – epidural analgesia
    g.    Chapter 12 – acute neuropathic pain
    h.    Chapter 14 – elderly, opioid-tolerant and substance abuse patients
    3.    Therapeutic Guidelines – Palliative Care
    a.    Chapter – Getting to know your drugs
    b.    Chapter – Pain
    4.    Macintyre PE, Loadsman JA, Scott DA. Opioids, ventilation and acute pain management. Anaesth Intensive Care. 2011 Jul;39(4):545-58
    5.    Coldrey JC, Upton RN, Macintyre PE. Advances in analgesia in the older patient. Best Pract Res Clin Anaesthiol. 2011 Sep; 25(3):367-78
    6.    Huxtable CA, Roberts LJ, Somogyi AA, Macintyre PE. Acute pain management in opiod-tolerant patients: a growing challenge. Anaesth Intensive Care. 2011 Sep;39(5):804-23 

    Specific Course Requirements
    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 for the APIC rotation is a combination of the individual assessments for each sub-rotation. It is based on attendance, presentation assessments and clinical competency.
    Assessment Related Requirements
    See Assessment Detail
    Assessment Detail
    1.    Attendance at and participation in clinical rounds and tutorials
    2.    MCQ paper based on material covered in acute pain and pharmacology lectures in year 4. See chapters 3,4,6,7 in Macintyre and Schug.
    3.    Group presentation of allocated clinical “patient in pain” case
    a.    The presentation should not exceed 30 min
    b.    The presentation is a group effort – all students should discuss the case and be prepared to answers any questions asked by the examiners

    1.    Attendance at and participation in clinical activities  including simulator session
    2.    Participation in PBL sessions
    3.    TQEH: in addition to 1&2, each student is required to research and present a 15-20 minute presentation on a preoperative scenario at the end of their second week.
    4.    LMH: in addition to 1&2, student are required to present a case.

    1.    Professional behaviour
    2.    Participation in clinical activities
    a.    Attendance, including out of hours (minimum 95% attendance required to pass rotation)
    b.    Actively seeks learning opportunities
    c.    Contributes to patient discussion
    3.    Medical competence
    a.    Thorough history and physical examination skills
    b.    Concise and accurate case presentations
    4.    Theoretical knowledge
    a.    Good knowledge base with ability to apply to clinical situations
    5.    ICU presentation
    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.

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


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


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

    Submission details will be outlined at the beginning of the attachment.
  • 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 ( 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.
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