MEDIC ST 4016BHO - Surgical Home Unit Part 2

Teaching Hospitals - Semester 2 - 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 4016BHO
    Course Surgical Home Unit Part 2
    Coordinating Unit Medicine
    Term Semester 2
    Level Undergraduate
    Location/s Teaching Hospitals
    Units 6
    Contact Attachments, common program & research
    Available for Study Abroad and Exchange N
    Prerequisites MEDIC ST 4016AHO in previous Semester, MEDIC ST 3000A/B, MEDIC ST 3101A/B, MEDIC ST 3102AHO/BHO, MEDIC ST 3103A/B, MEDIC ST 3104A/B or by approval of the Dean of Medicine.
    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: Adrian Anthony

    Clinical and academic staff from the Discipline of Surgery
    Course Timetable

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

    The course timetable is available in the Course Handbook. As students undertake their placements at different hospitals and in different clinics, timetables will vary. Students are advised to consult the Course Handbook for details regarding the weekly tutorial program, end of rotation assessments and discuss with their allocated team what their particular timetable and activities are. This information should be obtained from interns and/or registrars on the allocated team.
  • Learning Outcomes
    Course Learning Outcomes
    The aim of any clinical clerkship in the MBBS curriculum is to provide the student with the opportunity to experience the art of medicine first hand. The emphasis of learning for the student should be based on the following fundamentals:
    1.To develop an understanding and appreciation of professional behaviour shown by medical practitioners in the course of their duties
    2. To develop the clinical skills of history taking, physical examination and case presentation, and be able to apply these skills with confidence
    3.  To obtain sufficient knowledge to complement the attitudes and clinical skills learnt as an undergraduate and to be able to understand and apply this knowledge in the clinical context

    4. To a certain degree, these are skills that are learnt from watching others in action and interacting with patients and colleagues, but more importantly, they are skills that are only really learnt by involvement of the student with the patient and the health professional. Whereas many of these skills can be learnt in any healthcare setting the attachments to hospital clinics should allow the student to focus on the following objectives:
    * To become competent in and to learn the importance of thorough history taking
    * To appreciate the art of listening to the patient
    * Be able to undertake a competent physical examination
    * To be able to accurately elicit and interpret physical signs
    * To learn the value and place of investigations in the management of a particular illness
    * To understand the principles of decision-making and management
    * To display appropriate communication skills with patients and health professionals
    * Appreciate the concerns, anxieties and fears of patients, their families and those providing care in the acute setting
    * To appreciate the ethical, moral and social issues involved in patient care
    * To develop an appreciation of cost-benefit analysis in medical practice
    * To develop a critical faculty based on evidence-based medicine

    5. Whilst the above principles apply to any and all branches of medicine, within the discipline of surgery, students should appreciate the following aims:
    * Develop an understanding of the principles of surgery
    * Acquire the clinical skills to manage patients with surgical disease
    * Learn the core curriculum
    * Develop a sense of perspective of surgery in the arena of health care

    6. By the end of Year IV a student should be able to demonstrate:
    * Attitudes and communication skills appropriate to working with patients, peers and staff on surgical units
    * Competence in taking a history and performing a physical examination on surgical patients
    * The ability to produce a clear and concise surgical case write-up of history and examination findings, with appropriate differential diagnoses
    * The ability to give a clear oral surgical case presentation based on summary and synthesis of history and examination findings
    * The ability to generate an appropriate differential diagnosis, and demonstrate problem solving skills for important and commonly seen surgical conditions
    * Knowledge of routine/common investigations in surgical patients (laboratory, radiological, etc) including their appropriate sequence and urgency and correlation of results with diagnostic hypotheses
    * An understanding of the principles of surgical management, particularly with respect to an understanding of the relevant anatomy, physiology and pathology underlying important and common surgical diseases.
    * The ability to safely and competently perform basic practical procedures (e.g. venepuncture, urethral catheterisation and injections)

    Clinical Problems in Surgery
    7. Students are expected to have a thorough understanding of the following by the end of Fourth Year:
    * Acute abdominal pain
    * Digestive tract bleeding
    * Jaundice
    * Vomiting
    * Change in bowel habit
    * Weight changes
    * Neck swellings
    * Scrotal swellings and pain
    * Calf pain
    * Groin swellings
    * Skin lesions
    * Breast lesions
    * Haematuria
    * Acute and chronic limb ischaemia
    * Venous thromboembolic disorders

    General principles of Surgery
    Familiarity and general understanding of the following areas is expected:
    * Indications for surgery
    * Preoperative assessment
    * Informed consent
    * Venous thromboembolism prophylaxis
    * Antibiotic prophylaxis
    * Patient safety in the operating room
    * Post-operative care
    * Pain management
    * Fluid balance
    * Wounds and wound healing
    * Fever
    * Shock
    * Discharge arrangements
    * Long-term follow-up and surveillance
    * Late complications

    8. Students are expected to become familiar with the following subjects during Fourth Year and competent with regard to knowledge and understanding of these areas by the time of graduation:

    Essentials of Surgical Practice:
    * Pre-operative assessment
    * Post-operative management
    * The acute abdomen
    * Trauma
    * Skin, soft tissue and hernias

    Gastrointestinal Surgery:
    * Carcinoma of the oesophagus
    * Carcinoma of the stomach
    * Peptic ulcer disease
    * Gallstone disease
    * Pancreatitis
    * Carcinoma of the pancreas
    * Inflammatory bowel disease
    * Appendicitis
    * Colorectal cancer
    * Diverticular disease
    * Anal and perianal disorders

    Breast-Endocrine Surgery:
    * Carcinoma of the breast
    * Benign breast disease
    * Goitre
    * Thyroid tumours
    * Adrenal gland disease

    Vascular Surgery:
    * Abdominal aortic aneurysm
    * Peripheral vascular disease
    * Carotid artery disease
    * Deep venous thrombosis
    * Varicose veins

    Head & Neck Surgery:
    * Salivary gland tumours
    * Carcinoma of the larynx
    * Oropharyngeal tumours
    * Deafness
    * Ear infections
    * Facial nerve palsy
    * Sinusitis
    * Nasal polyps

    Urology:
    * Stone disease
    * Renal cell carcinoma
    * Carcinoma of the prostate
    * Bladder neck outflow obstruction
    * Testicular cancer
    * Testicular torsion

    Plastic Surgery:
    * Principles of wound healing
    * Common hand problems
    * Brachial plexus problems
    * Burns* Soft tissue infections
    * Skin tumours

    These lists are not exclusive and students are expected to have a working knowledge of all the conditions they come into contact with through patients on the wards or in the rooms.
    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 - 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
    6
    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
    1,4
    Career and leadership readiness
    • technology savvy
    • professional and, where relevant, fully accredited
    • forward thinking and well informed
    • tested and validated by work based experiences
    1 - 8
    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
    6
    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
    2
  • Learning Resources
    Required Resources
    Not applicable
    Recommended Resources
    * Essential Surgery. Burkitt HG, Quick CRG, Reed JB. Fourth Ed. Churchill Livingstone. 2007
    * Clinical Problems in Medicine and Surgery. Devitt PG, Mitchell J, Hamilton-Craig C., Elsevier. Edinburgh. 2011. www.fleshandbones.com
    * Textbook of Surgery. Tjandra JJ, Clunie GJA, Kaye AH, Smith JA. Blackwell Publishing. 2006
    Online Learning
    http://www.emedici.com: this site contains the online case studies. To gain access to the eMedici cases go to www.emedici.com. Please register there to gain access to your cases. Details of many of the problems, topics and diseases with which the graduating student is expected to have a clear understanding with respect to their recognition and principles of management can be found in the eMedici modules.
  • Learning & Teaching Activities
    Learning & Teaching Modes
    Whilst this nine-week component of the MBBS program is mainly focused on individual clinic attachments there are a number of central activities to which all students are expected to attend and contribute.

    These involve weekly tutorials, starting at 2pm and held either at the Royal Adelaide Hospital (Conference Room, Level 6, Eleanor Harrald Building) or the Queen Elizabeth Hospital (Main lecture theatre, 2nd Floor).

    Rural students are only expected to attend the final Friday session in person.

    Home Units and Specialist clinic attachments.
    During this attachment, students are expected to integrate into the Home Unit and participate in all that unit's activities. Activities on the Home Unit are expected to take priority over other curriculum activities, and these will include attendance and participation in:
    * Out-patients
    * Ward rounds
    * Operative procedures
    * Admission of elective and emergency cases

    Students must realise that the amount of formal tuition (lectures, tutorials) on a home unit will be limited and every interaction, such as a ward round or out-patient clinic should be considered a learning opportunity. These opportunities may involve presentation of a case or discussion of a patient’s problem. To get the most out of the attachment, students will become actively involved in patient management to the extent of trying to see each patient when they attend the out-patient clinic, emergency department or are admitted to the ward. Students should try and present clinical material (to the interns, registrars or consultants) whenever possible.

    Details of the home unit’s activities can be obtained either from that particular unit’s secretary, or more practically, from the junior staff on that ward.

    Attendance in the operating room
    Whilst the focus of a surgical clinic might be considered the operating room, a lot of time can be wasted standing around watching members of the unit operate. If student’s cannot scrub up or there is minimal communication from the staff at the operating table, there is probably little point in being in the operating room, and their time would be better spent on the wards or at an outpatient clinic. Students do not need to attend every clinic operating list. However if there is a particular patient they have seen in the outpatient clinic or on the ward, they should try and get involved in any procedure that might be performed on that particular patient.

    The emergency room
    Every general surgical unit is involved in the hospital’s emergency call roster. Often the best time to see and experience clinical medicine as it happens, is when the unit is on take. Students should ensure that they are available to attend emergencies when they are admitted, and often this is best done by giving mobile phone details to one of the unit’s interns. Depending on the hospital and friendliness of the emergency room staff, this attachment provides good opportunities for doing simple emergency room tasks, such as inserting intravenous cannulae and suturing.

    Admissions for elective surgery
    Most patients are admitted on the day of surgery and the short time interval prior to the procedure is insufficient for students to see them. However, these patients usually attend a hospital clinic in the week preceding their operation for assessment by the interns and/or the anaesthetists. Students should try and attend these pre-admission clinics.

    Attendance at other units’ clinics
    It is important that during the nine-week attachment students try to see a broad range of surgical problems. With the current numbers of students it is difficult to provide a broad-based surgical experience for everyone. Even in the hospitals where students have rotations to two units, it is unlikely that the full spectrum of general surgery will be seen within the confines of those units. To see the broad perspective of general surgical problems, it is appropriate that students consider what learning opportunities might be offered by other surgical clinics at the hospital to which they are attached.

    For example, attendance at a breast or ENT clinic might provide a valuable learning opportunity for students who might not otherwise see patients with such problems during their nine-week attachment. A request to the medical practitioner running a particular out-patient clinic will generally be met with a positive response.

    Self-directed study, online learning and formative assessment
    Whilst the focus of the Surgical Home Unit attachment is clinical experience, students are expected to allocate the equivalent of half a day a week to self-directed study. Depending on the particular Unit’s work schedule, it may not always be possible to allocate an exact half-day to such activities and students must use their own initiative to make such time available.

    The eMedici website (www.emedici.com) has been specifically designed to provide case-based studies to supplement the clinical program and to promote self-directed study.

    Attendance at the School of Medicine Teaching Series is mandatory. Attendance will be monitored and will form a component of the assessment process of the Surgical and Medical Home Unit attachments.

    Intra-hospital activities
    Each of the hospitals will have other activities which students are encouraged to attend. These include medical and surgical grand rounds and specialists meetings. Details are available from the Clinical Studies office in each particular hospital.
    Workload

    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 Learning & Teaching Modes above
    Specific Course Requirements
    It is an MBBS entry requirement to obtain a police checks as set out in letters of offer to prospective students. Other requirements will be advised at the start of the course.
    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 Assessment type Percentage Hurdle?
    Ward based assessment Summative 40% No
    Topic write-up Summative 20% No
    Written exam Summative 40% No
    Simulation session Formative 0% No
    Assessment Detail

    No information currently available.

    Submission
    Not applicable
    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.

    MEDIC ST 4016BHO

    Grades for your performance in this course will be awarded in accordance with the following 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 in fourth year of MBBS.  The Bands available for determining student performance are:
    A  Above expected competency for Year 4
    B  Clearly at expected competency for Year 4
    C  Just reaches expected competency for Year 4
    D  Below expected competency for Year 4
    E  Far below expected competency for Year 4        

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

    Any 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 (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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