MEDIC ST 4018AHO - Musculoskeletal Medicine Part 1

Teaching Hospitals - Semester 1 - 2018

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 4018AHO
    Course Musculoskeletal Medicine 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 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: Associate Professor Mellick Chehade

    Academic
    A/Prof Mellick Chehade
    Course Coordinator
    Location:
    Royal Adelaide Hospital,
    Bice Building, Level 4, Room 31
    Email: Mellick.Chehade@adelaide.edu.au

    A/Prof Susanna Proudman
    Associate Course Coordinator / Senior Rheumatologist  
    Location:
    Royal Adelaide Hospital
    Rheumatology Unit
    Level 4, Eleanor Harrald Bldg
    Email: susanna.proudman@health.sa.gov.au
    Telephone: 08 8222 5190

    A/Prof Vidya Limaye – Rheumatology
    Location:
    Royal Adelaide Hospital
    Rheumatology Unit Level 4, Eleanor Harrald Bldg
    Email: Vidya.limaye@health.sa.gov.au
    Telephone: 08 8222 5190

    Dr Sam Whittle – Rheumatology
    Location:
    The Queen Elizabeth Hospital
    Rheumatology Unit, 5C
    Email: sam@whit.tl
    Telephone: 08 8222 6688

    Dr. Ruth Marshall – Rehabilitation
    Location:
    Hampstead Rehabilitation Centre
    Orthopaedic, Amputee & Spinal Injury Rehabilitation Service
    Email: Ruth.Marshall@health.sa.gov.au
    Telephone: 08 8222 1630
    Course Timetable

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

    Further details on the timetable will be made available on the placement
  • Learning Outcomes
    Course Learning Outcomes
    With respect to musculoskeletal practice the graduating medical student will:

    1. Exhibit professionalism and effective communication skills towards patients and their families, colleagues, co-workers and the general community.

    2. Perform an adequate assessment of the range of common and serious MSK related presentations to distinguish normal from abnormal and develop a limited and reasonable differential diagnosis. This includes the ability to apply knowledge and understanding of normality and the characteristic distinguishing features of MSK conditions in order to take a focussed history, perform a targeted physical examination, select appropriate further investigations and use critical reasoning in the interpretation of findings and formulation of diagnoses.

    3. Develop a holistic, patient focussed and evidence informed management plan based on knowledge and understanding of the key principles of management of the broad spectrum of MSK conditions and the range of related issues that may influence individual management decisions. This includes therapeutic (operative and non- operative); rehabilitation; patient education and self-management; shared care and referral; prevention; and complementary and alternative medicine strategies.

    4. Diagnose and initiate treatment and referral in the management of emergency MSK conditions. This includes the correct and safe performance of basic procedures such as joint injection, limb realignment and splintage.
    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)
    1,2,3,4
    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
    1,2,3,4
    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
    1,2,3
    Career and leadership readiness
    • technology savvy
    • professional and, where relevant, fully accredited
    • forward thinking and well informed
    • tested and validated by work based experiences
    1,2,3,4
    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
    1
    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
    1
  • Learning Resources
    Required Resources
    Apley A E, & Solomon L., 1988, Concise system of Orthopaedics and Fractures, Butterworth & Co Ltd 1988. (ISBN 0-407-00325-8)
    Recommended Resources
    1. Eizenberg, N, Briggs, C, Adams, C and Ahern, G, General Anatomy Principles and Applications, McGraw Hill Medical, Australia
    2. Slater, R B, 1999, Textbook of Disorders and Injuries of the Musculoskeletal System, 3rd Edition, (ISBN 0-683-07499-7)
    3. Therapeutic Guidelines: Rheumatology, version 2, 2010, URL Available: http://www.tg.org.au/index.php?sectionid=117
    4. Sambrook P, Schrieber L, Taylor T.K. F , Ellis A, 2010 , The Musculoskeletal System (Systems of the Body), Churchill Livingstone – ISBN 0-443-07015-6.
    5. Kanoso, J.J, 1997, Rheumatology in Primary Care (W B Saunders and Co)
    6. Penington G.R , Burry H. C, 1990, Introduction to Medical Rehabilitation - An Australasian Perspective, Melbourne University Press, ISBN: 0-522-84391-3
    7. Grundy D, and Swain A, 1996, ABC of Spinal Cord Injury, 3rd Edition, BMJ Publishing Groups

    Medical Journal of Australia, Practice Essentials in Rheumatology 96/97
    · Vol 165, Nos 6-10
    · Vol 166, Nos 1-8
    Harrisons (appropriate chapters 308-331):

    See Course Handbook for more details.
    Online Learning
    MyUni
    Orthopaedics
    Each learning resource follows a specific format consisting of:
    • Module objectives: Each module will be prefixed with the relevant objectives that students should aim to achieve by completing the module.
    • Modules are located within the Topics Section of MyUni

    Rheumatology
    The on-line lectures and videos provided are essential pre-requisites before commencing any part of the Rheumatology component of the Musculoskeletal Medicine course. The lectures "Assessing the patient with joint pain" and "Immunology for Rheumatology" and the video on the musculoskeletal examination are especially important for developing your knowledge base in Rheumatology.
    Lecture 1: Assessing the patient with joint pain
    Lecture 2: Immunology for rheumatology
    Lecture 3: Clinical immunology and treatment in RA

    Online discussions
    Online Dicussion Boards will be used to facilitate asynchronous learning. Students may be asked to post any questions on any given topic. Each question should start a new thread. Please do not post questions that have already been submitted. However, please feel free to answer and contribute to any questions posted by other students that you would like to attempt. The questions posted will be reviewed via the discussion board and feedback will be provided online by a tutor shortly after.

    Other
    It is highly recommended that students register and access the Rheumatology Website, www.jointzone.org*. Go to ‘Approach to Patient’, to access the Musculoskeletal examination and watch the video for the Quick Screening Examination (GALS).
    • www.rheumatology.org.au* (Australia Rheumatology association website). Go to Patient: patient information sheets for information about drugs used in rheumatology and information sheets for patients.Osteoporosis Australia http://www.osteoporosis.org.au/
    • Arthritis UK: http://www.arthritisresearchuk.org/health-professionals-and-students.aspx
    • Radiopolis
    • Other websites as directed by the e-learning modules
  • Learning & Teaching Activities
    Learning & Teaching Modes
    Online
    See Online Learning

    Anatomy teaching
    Anatomy sessions will be held at the Ray Last Laboratory in the Medical School Basement. Please note: students must wear white coats during these sessions in week one.

    Tutorials
    Representative cases are used to direct your learning about the more common types of arthritis Clinical Tutorials will be scheduled on a weekly basis throughout the rotation. Students are expected to attend each tutorial offered, unless prevented from doing so by illness and or extenuating circumstances. At the RAH, all tutorials will be located in the Orthopaedics and Trauma Department Lecture Room unless otherwise advised.

    It is critical that students review the relevant tutorial content prior to attending tutorials. The success and strength of this program is dependent on the pre-tutorial preparation which is directed on-line. Student participation and interaction with the content on MyUni is monitored and staff are able to view a very detailed report of which sections have been accessed on an individual student basis.

    Clinical teaching

    Outpatient clinics
    Oupatient sessions in rheumatology and orthopaedics are scheduled at the Royal Adelaide, Modbury Hospital and The Queen Elizabeth Hospitals. All outpatient clinics are themed and you may be scheduled to attend one or more of the different themed clinics. It is expected that students attend all of their allocated OPD sessions, and non-attendance will require justification.

    Operating theatre 
    All students should get the opportunity to see the operations listed below. The trauma cases can usually be seen on one of the orthopaedic “takes” or alternatively on the “mop up” trauma lists on the day following the “take”.  Theatre sessions are rostered by Sarah Downey and placed on MyUni.  

    Students must ensure that they adhere to the Guidelines for Medical Students in RAH Operating Theatres.

    Recommended Surgical Procedures to Have Been Observed

    Elective    Emergency
    Total Knee Arthroplasty Wrist fracture – closed reduction
    Total Hip Arthroplasty Intramedullary nailing of fractured tibia or femur
    Open reduction and internal fixation of ankle +/- forearm fracture
    Fixation of fractured NOF

    One-on-one case-taking (rheumatology)
    This is an opportunity for you to spend time taking a detailed history and examination focussed on all systems, drawing on your clinical skills training from previous years. This case needs to be written up and submitted via MyUni by the end of week 6.  

    RAH Orthopaedic “takes”
    During the six-week rotation students are expected to attend at least one weekend take and two weekday takes- students should arrange a roster amongst themselves to ensure no more than two students per take.

    Ward Rounds
    Ward rounds begin at 7.30 am every morning. Each student is expected to have two patients at all times (the intern will assist in finding suitable patients), and to follow their progress through their hospital stay. Students can take the patients history, examine them daily as appropriate, and document their findings in the patient’s notes. It is at the morning ward round that the student should present their patients to the registrars, informing them of pertinent (succinct) information on the patient’s progress.

    Trauma / X-ray Meeting
    Each morning, following the ward round, there is an x-ray/trauma meeting. These start at 08:30 except on Wednesday mornings when there is an 8:15 start.  The Trauma meetings on Thursday morning’s are optional.

    Consultant Rounds
    Consultant patient rounds at the RAH are conducted following the Grand Round presentations on Wednesdays at 10.30am for unit 051. For 052 it is a "computer round" that follows the presentations.The only exception being if they are rostered to Early Arthritis Outpatients (students only have one opportunity to attend this clinic, therefore should miss Grand Round and Consultant Round, in order to be at the clinic by 9.30am).

    Rehabilitation visit – Hampstead Rehabilitation Centre
    Activities relating to Rehabilitation are organised primarily at the QEH (in second week of each groups 2 week rotation) and Hampstead centre (weeks 3 and 4 or course).  There is an online tutorial and test
    At the QEH there is are focus sessions on:
    - Amputation Rehabilitation
    - Gait disorders
    At Hampstead there is exposure to:
    - Cases with amputations
    - post elective surgery (e.g. hip and knee replacements)
    - Post trauma surgery (e.g. fractured NOF)
    - Spinal Cord Injuries (SCI) (major focus)
    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

    More detailed information about learning activities and the course schedule is available via MyUni and the course handbook.
    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.

    When participating in Theatre sessions, students must ensure that they adhere to the Guidelines for Medical Students in RAH Operating Theatres. Please see “Guidelines for Medical Students in RAH Operating Theatres” document available via MyUni.
    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
    You will be assessed based on participation and performance (including "professionalism") on a variety of activities throughout the course.
    These may include:
    1. Attendance at meetings (trauma and other meetings as directed)
    2. Attendance and participation at tutorials (Ortho, Rheumatology, Rehab)
    3. Ward attendance and involvement
    4. Patient Journal Entries (SOAPEs)
    5. Attendance and participation in OPD and theatre
    6. OPD and theatre reflections Journal Entry
    7. Participation in other online journals/discussions/forums etc
    8. Nailed in 90 Seconds, student presentation
    9. Completion of online formative* quizzes associated with on-line tutorials such as
    • a/ pain management
    • b/ Tumours
    • c/ Spinal Cord Injury
    • d/ others as posted
    10. Orthopaedic MCQ development assignment
    11. Rheumatology MCQ development assignment
    12. Rheumatology Case Write up
    13. End of rotation OSCE (Friday week 5)
    14. Online test (Thursday Week 6)

    More specific details will be available on-line in advance of assignments.
    *Note that even though assessments are marked as “formative” they are all mandated and failure to complete will be graded as “Unsatisfactory”.

    Assessment breakdown for Rheumatology
    1. Formative assessment:
    • A formative on-line quiz is held in week 6. This is accessible for 24 hours only via the Assignments menu from 9.00 am on the Wednesday morning. A one hour tutorial to review the answers and to discuss any queries that have arisen during the course, not addressed elsewhere, is held on the Thursday of week 6.
    • Rheumatology MCQ development assignment (submit through Turnitin)
    • Online mini quizzes before attempting each case are planned (pending)

    2. Summative assessment:
    • Case – on line marking (up-load via Turnitin by end of week 6) Summative assessment forms can be accessed via the Grade Centre, usually the week after completion of the course
    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.

    Relevant activities are: Clinical meetings (eg. trauma),  tutorials (Ortho, Rheumatology, Rehab),  OPD and theatre
    Assessment Detail
    See Assessment Summary
    More detailed information about course assessment is available via MyUni and can be found in the course handbook.
    Submission
    The Rheumatology case write up must be submitted via Turnitin on the MyUni website by 9.00am of the Monday following the end of week 6. Assessment results will be available via the Grade Centre on MyUni, usually the week after completion of the course.le via the Grade Centre on MyUni, usually the week after completion of the course.
    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.

    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.

    A Student Experience of Learning and Teaching (SELT) will be used to evaluate the course at the end of the attachment. Some online modules will have specific feedback surveys attached At any point feedback, constructive criticisms or other, can be directed to A/Prof Mellick Chehade.
  • Student Support
  • Policies & Guidelines
  • Fraud Awareness

    Students are reminded that in order to maintain the academic integrity of all programs and courses, the university has a zero-tolerance approach to students offering money or significant value goods or services to any staff member who is involved in their teaching or assessment. Students offering lecturers or tutors or professional staff anything more than a small token of appreciation is totally unacceptable, in any circumstances. Staff members are obliged to report all such incidents to their supervisor/manager, who will refer them for action under the university's student’s disciplinary procedures.

The University of Adelaide is committed to regular reviews of the courses and programs it offers to students. The University of Adelaide therefore reserves the right to discontinue or vary programs and courses without notice. Please read the important information contained in the disclaimer.