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Griffith University - School of Medicine General Practice Trainer Booklet - Year 4

General Practice Rotation Year 4 Booklet GP Educational Supervisors

2019 Edition


INDEX

No Description Page

1 Introduction 3

2 Aims and objectives 3

3. Clinical experience requirements 4

4. The academic program 5

5. Assessment 7

6. Maximising learning during the GP rotation – optional activities 8

7. Resources for teaching 10

8. Troubleshooting 10

Appendices 12

A1 In-Training Assessment Form 12

A2 Mini-CEX assessment 13

A3 Mid-rotation review 15

A4 Clinical Skills competencies 16

A5 Roles of students on clinical placements 18


1. INTRODUCTION

This GP Trainer Booklet aims to assist you in understanding the GP rotation for Griffith University Medical students. It includes general information about the rotation as well as more specific descriptions of teaching and assessment methods. Should you have any queries, concerns or feedback about academic aspects of the GP rotation, or your role as a GP Trainer, please contact the Liz Fitzmaurice, the General Practice Lead by phoning (07- 5678 0372) or e-mail [email protected].

The general practice rotation is one of the five mandatory rotations that all students are required to successfully complete in their final year of the MD programme, as a requirement for graduating. The other four rotations are in Emergency Medicine, Critical Care/Orthopaedics, a ‘Selective’ rotation at a broad range of posts organised by the School and an ‘Elective’ rotation organised by each student.

2. AIMS AND OBJECTIVES OF THE GP ROTATION

The general practice rotation aims to consolidate and increase the clinical knowledge and skills acquired during the first three years of the medical program.

The specific learning objectives for students are that they will be able to:

Describe the characteristics of general practice and understand its significant contributions to patient

care and the wider health care system; Understand how general practitioners effectively communicate with patients, other health

practitioners, hospitals and the wide range of related health care, professional, regulatory and statutory organisations;

Demonstrate the ability to gather a comprehensive yet focused history in an efficient manner;

Acquire knowledge of specific ‘red flag’ symptoms, signs and clinical conditions that are important in

general practice; Competently perform the physical examinations and procedures that are commonly required in

general practice; Identify and apply the best available evidence in relation to investigating, diagnosing, treating and

educating patients; Appreciate the importance of providing care in a culturally sensitive and safe manner;

Understand the roles and contributions of other health care professionals as part of a

multidisciplinary team; Develop strategies for effectively managing clinical uncertainty;

Gain an appreciation of the value of providing care that is patient-centred, comprehensive, co-

ordinated and continuous; Actively contribute to health promotion and disease prevention efforts;

Consider indigenous, cultural and social issues while formulating management plans through the

process of shared decision-making with patients and their carers/ families;


Be aware of the more common or important legal, ethical and professional issues in general practice.

3. CLINICAL EXPERIENCE REQUIREMENTS

In order to successfully complete the general practice rotation, students must gain clinical experience by observing and working with:

i. The educational supervisor and other GPs ii. Pharmacists iii. Practice staff (manager, reception staff and other administrative team members) iv. Practice nurses v. Allied health professionals

Students are strongly encouraged to gain as much clinical experience as possible during the rotation. Most general practitioners are willing and able to accommodate the requests of students to extend sessions, provide additional sessions or facilitate other learning opportunities. In those rare instances when educational supervisors are unable to provide this support, students may e-mail the Primary Care Lead.

3.1. Educational supervisor / general practitioners

The duration of all general practice rotations is seven (7) weeks. A minimum of 28 sessions must

be spent with a general practitioner during the rotation. [A ‘session’ is typically four to five hours but must be a minimum of three hours]. The Students should therefore aim to spend at least four (4) sessions in each of the seven weeks of the rotation with a GP. We strongly discourage any compromise on a full seven week rotation to maximise and highlight the “continuity of care” aspect of general practice. However, in some instances neither the educational supervisor nor any of her/his colleagues may be available due to other commitments. In these instances, the sessions (n≥28) may be completed in six, rather than seven weeks. It is the responsibility of the student to arrange alternative, mutually convenient ‘catch-up’ sessions with the educational supervisor.

Similarly, if students are unable to attend clinical sessions as a result of personal issues (e.g. illness, family commitments), they are expected to negotiate additional sessions with the practice in order to meet the minimum requirement (n=28).

All of the sessions should be spent under the supervision of the educational supervisor assigned by Griffith, or by the supervisor’s proxy (e.g. a qualified general practitioner working in the same practice as the supervisor). However, not all of the time in each session has to be spent in the physical presence of the supervisor or proxy. For example, students are encouraged to independently consult with patients whenever feasible, observe other GPs and accompany them to home and residential and aged care facilities (RACF) consultations. Up to an hour of each session may also be spent with the practice nurse.

According to Medicare regulations, a maximum of two sessions can be claimed per day, even though the actual time spent in the practice may have been considerably longer (i.e. 9-12 hours clinical experience). However, there is currently no limit on the number of days in a rotation sessions can be claimed. Please note that, according to Griffith University policy, students are not permitted to undertake placement at a practice in which they have been a patient or with a family member/partner, or in a facility where a family member or partner is employed


3.2. Pharmacist

Students are required to spend one (1) session with a pharmacist during the course of the rotation. This session is in addition to the 28 spent with GPs. The educational supervisors are usually able to recommend a local pharmacy and informally introduce the pharmacist(s). However, students are expected to take a ‘letter of introduction’ with them. Suggestions for structuring the session and maximising learning from it are provided. However, the session is intended to be flexible, practical and interactive and should be tailored according to students’ learning needs and pharmacy capacity.

3.3. Practice staff (administrative, management and nursing)

Students should spend a minimum of four hours (equivalent to one session) with the practice nurse and four hours (equivalent to one session) with the non-clinical practice team members during the rotation. However, students are strongly encouraged to spend as much time as possible with practice nurses, as this provides invaluable opportunities to acquire clinical knowledge and skills.

According to Medicare regulations, only sessions that are supervised by a GP can be claimed and counted towards the minimum requirement (n=28). Therefore, if the time with the practice nurse and/or non-clinical staff is spent as a single session, it should not be recorded. However, up to an hour of a GP session may be spent with the practice nurse or non-clinical staff. Over the course of several sessions, the minimum hours can be accrued in this manner. The decision whether the time should be spread over several sessions, or condensed into a single session, should be negotiated with each practice.

Students are advised that they should not contact practices directly to arrange placements. However, once they have received notification of their placement, they should contact that practice two weeks before the clinical rotation to agree mutually convenient dates and times.

3.4. The John Flynn Program

Most students in the John Flynn Placement Program may spend two weeks of the GP rotation in their John Flynn practices or regions. However, they must apply for permission in writing in advance. The General Practice Lead will consider each application and inform students in writing of her/his decision.

4. THE ACADEMIC PROGRAM

The academic program has three main strands:

• Participation in school-based learning activities

• Completion of specific online modules

• Self-directed learning to achieve the learning objectives

The school-based lectures, seminars, case discussions, practical workshops and tutorials are all compulsory, i.e. attendance and participation in all of the activities is a mandatory requirement for successfully completing the GP rotation.

The metro school-based activities were developed in partnership with the Bond University Department of General Practice. Since 2015, the final year students of both universities attend identical school-based activities. The close collaboration between the universities increases the efficiency and quality of general practice training and improves the learning opportunities for our students. There may be differences in school-based activities in rural general practice and on the Sunshine Coast campus.

The usual structure of the metro school-based activities is summarised in Table 1.

Table 1. Structure of the GP rotation school-based activities in the metro area


Week Day Educational activities Location

1 Monday Interactive lectures; practical skills workshop Griffith

2 Wednesday Interactive lectures; Seminars Bond

3 Wednesday Group presentations; interactive lectures; case discussions

Bond

4 NA Self-directed learning Online

5 Wednesday Group presentations; interactive lectures Bond

6 Wednesday Seminar; case discussions Bond

7 Wednesday -sometimes day varies

Individual student presentations including assessment

Griffith

Students undertake the activities of the school-based program within small groups or as individuals. The different types of activities are described below.

4.1. Group activities

Students are expected to prepare and deliver two (2) presentations during the course of the GP rotation. They are assigned specific topics and divided into small groups (n=±5 students per group) on the first day of the rotation. The clinical topics are listed in Table 2. Each group will be assigned only one topic per presentation.

Table 2. Presentations and topics for students in the metro area (NB These may change in 2019)

Presentation 1 (week 3): Important issues in general practice

Presentation 2 (week 5): Screening

Diagnostic dilemmas Breast cancer

Multimorbidity / Continuity of care Prostate cancer

Infections and disease control Hyperlipidaemia

Cultural, social, economic and health interplay

Colorectal cancer

Communication difficulties in GP consultations

Cervical cancer

Occupational injuries Osteoporosis

Reciprocal effects of mental and physical health issues

Skin cancer

4.2. Individual student activities

Students undertake the individual activities in their assigned general practices before they attend the related sessions in the academic program. The sessions provide opportunities to reflect on the activities, share experiences and learning points and receive feedback from tutors.

The minimum requirements for students in the metro area are that they should:

• Perform brief behaviour change interventions with at least two patients;

• Prepare one health assessment or one GP management plan;

• Conduct one carer interview;

• Perform one medication review

• POEM (for assessment) – see section 5 Each of these activities is described below.


Brief behaviour interventions

Students should perform brief behaviour change interventions with two (2) different patients. Examples of common issues that the interventions may be directed at include: smoking; nutrition; alcohol/substance misuse; sedentary lifestyle; and obesity. Students should be prepared to share their experiences with their peers and reflect on the outcomes, challenges and required skills for effective interventions.

Health assessments and GP management plans

Students are expected to undertake at least one of these two activities during their placements. GP educational supervisors should help to identify suitable patients for this purpose.

Carer Interview

Carer interviews provide important opportunities for students to explore and better understand the practical aspects of ‘living with’ medical conditions. The intention is to increase empathy and awareness of ‘balancing’ medical decisions while providing care for patients with disabilities. GP educational supervisors should help identify suitable patients and their carers for this purpose. The ‘interview’ can be conducted in the practice or the home of the patient/carer. The latter is preferred as it provides additional, contextual information.

Home Medication Review

Students should perform at least one Medication Review (MR) during the GP rotation. The review can be undertaken in the practice or, preferably, with a pharmacist as part of a ‘home medication review’ (HMR).

5. ASSESSMENT

5.1. In-Training Assessment (ITA) and Attendance forms

Submission of a satisfactory ITA is a mandatory requirement for successfully completing the GP rotation. The ITA form should be completed by the educational supervisor during a face-to-face meeting with the student at the end of the rotation. The ITA template is provided as Appendix 1.

Students and their GP educational supervisors also have to complete ‘Attendance forms’ for supervised clinical sessions. The attendance forms should include details of all the clinical sessions and include dates, start and finish times. Attendance forms are collated within students’ records and are required for Medicare Practice Incentive Payments (PIPs).

ITAs and Attendance forms should be submitted by students within one (1) week of completing the GP rotation to the clinical placement co-ordinators.

5.2. Mini-Clinical Evaluation Exercise (Mini-CEX)

The Mini-CEX method should be well known to all students as it is widely used in other specialties for summative assessment purposes. In the specialty of general practice, it is a compulsory formative assessment exercise, as it was originally designed to be. In other words, the Mini-CEX is being used primarily as a teaching tool, providing students with feedback about their clinical performance but the grade does not contribute to their general practice or DHC end of year grade.


Students are required to complete two (2) Mini-CEXs during their GP rotation. You (the GP educational supervisor) are to please give feedback as to whether the clinical skills were performed to the level of a safe competent intern. Each Mini-CEX should focus on a single clinical task related to the student-patient encounter. For example:

Taking a history from a patient presenting with tiredness Examining the lower limb of a patient with knee pain Examining the ears, throat, sinuses and chest of a patient with an URTI Counselling about smoking cessation Advising a patient on managing future exacerbations of their asthma

When setting up a Mini-CEX it is important that the patient and the task under assessment is chosen by the GP educational supervisor, not the student. Verbal consent of the patient for involvement in the Mini-CEX should be obtained before commencing. The student should complete the task while the GP trainer observes without interrupting. The trainer should then complete the mini-CEX evaluation form provided by the student and use this form to guide feedback to the student. Where appropriate, the patient can be invited to give feedback to the student in areas such as their degree of comfort with the history taking process or physical examination or the clarity of the student’s explanation of a treatment program.

5.3. POEM (Patient Oriented Evidence that Matters)

Patient oriented evidence that matters (POEM) presentations require a short synopses of a clinical case the student encountered during a clinical sessions, and a specific questions that was raised by patients. Students have to search the international literature to find the best available evidence, critically appraise the one article they select, and provide a patient-centred answer. They should also summarise the main findings and learning points for their peers.

Students have to submit three documents/files as email attachments to their assigned University examiner at least two working days before their assessment. The files are:

• Their POEM presentation;

• The article selected for the POEM:

• The completed ‘POEM Confirmation form’. This template is available online at Learning@Griffith.

The POEM presentation is normally assessed in the final week of the GP rotation. It contributes 15/40 marks of the DHC theme. We hope the majority of students will publish these POEMs.

6. MAXIMISING LEARNING DURING THE GP ROTATION

– OPTIONAL ACTIVITIES

6.1. Clinical experience in specific areas of general practice or in other

medical specialties

Optional, additional clinical sessions are available in: Dermatology Ophthalmology Musculoskeletal and Sports Medicine


These sessions are limited in number and will be allocated on a first-come, first-served basis. Even though these sessions are optional, students still have to submit attendance forms. Clearly, if a student has been offered with a placement, these sessions become mandatory. The sessions do not contribute to the minimum clinical experience (n=28 sessions).

Students are encouraged to use the following tools to maximise learning:

6.2. General Practice ‘learning plan’

Some students may benefit from preparing a General Practice learning plan prior to or early in the GP rotation. The potential value of the learning plan is that it helps structure the experience and learning of students and provides a potential measure for evaluating their progress. If they do, the learning plan should be discussed with you at the beginning of the rotation, mid-rotation and again at the end.

6.3. Case LOG System (CLOGS)

Some students used the Case LOG System (CLOGS) during year 3. Some students may benefit from continuing to use CLOGS to record and monitor their clinical exposure and development of procedural skills. The relevant sections can be used to help guide meetings with you. The list of conditions and procedures relevant to general practice can also be used as a checklist to monitor progress.

6.4. Schedule meetings with the GP educational supervisor

We strongly recommended that students arrange meetings with their GP educational supervisors at the beginning of the rotation, at some point in the middle of the rotation (Appendix 3) and again in the last week. The meetings provide opportunities for reciprocal feedback and planning to optimise the learning experience.

The meetings are flexible and do not always require formal documentation. However, students may wish to take their learning plans and/or CLOGS printouts.

We encourage all Practices taking Final Year students to provide students with opportunities for active, clinical participation, including: allowing students to take responsibility for history taking and examination of patients along with opportunities to practice diagnostic clinical reasoning, determine and organize investigations and management. Students appreciate opportunities to participate in procedure. Some practices have created innovative solutions when there is limited availability of office space, IT or patients. Some examples of strategies previous students and other GPs have used to optimise learning include:

selecting suitable patients for future sessions and requesting for them, through reception, to come

in early to meet with the student ahead of their GP consultation seeing patients in another room before the GP trainer when he/she is behind schedule, then

handing over arranging supervised home visits for patients with complex problems who may be the focus of

student assignments scheduling sessions at times when there is a spare room available in the practice eg over lunch or

before or after some GPs finish Seeing patients while the GP completes paperwork in a different space using the treatment room to interview patients and requesting that other GPs in the practice invite the student in when they have a patient with a

problem of interest


7. RESOURCES FOR TEACHING

Copies of the “Teaching on the Run” TIPS sheets can be found at:

http://www.meddent.uwa.edu.au/teaching/on-the-run/tips

The School of Medicine also organises a series of GP trainer workshops and producing GP trainer newsletters relating to both teaching practices and standardisation of assessment throughout the academic year.

8. “TROUBLE SHOOTING”

Despite our best efforts, it is inevitable that a small minority of students will encounter problems in progressing through the program. In situations where professional behaviour, attendance or academic issues are recognised, clinical supervisors are encouraged to notify the School as soon as possible and not to wait until the end-of-block assessment. The processes outlined below should be followed in the relevant circumstances.

8.1. Professional behaviour

Griffith University has a strict policy with regards to student behaviour. A copy of this policy can be found at: www.griffith.edu.au/policylibrary

Any concerns regarding professional behaviour issues and attendance should be flagged to the Primary Care Lead as soon as possible so that causes can be explored and, if necessary, a process of remediation instigated in line with Griffith University policies.

. In all instances it is important that you please keep your own documentation relating to any incident and that this be done as soon as possible after an incident has occurred

8.2. Student attendance

Student attendance for all structured and informal timetabled activities is obligatory in Years 3 and 4 of the Medical Program. Clear guidelines for monitoring of student attendance on clinical placements have been outlined in the School’s Student Participation Policy for Years 3 and 4. A copy of this can be obtained from the School.

Where clinicians have concern regarding a student’s attendance, they should contact the Primary Care/ GP lead as soon as possible. Attendance does form part of the student’s assessment and unsatisfactory performance in this domain will have significant consequences for the student concerned. Attendance is specifically covered in the ITA form and this is a useful way to give feedback to students and to highlight issues to the School.

8.3. Students in academic difficulty



http://www.griffith.edu.au/policylibrary

http://www.griffith.edu.au/policylibrary


Any concerns about a student’s academic progress should be flagged to the Primary Care Lead as soon as possible so that causes can be explored and, if necessary; a process of remediation can be instigated. We are aware that GP supervisors are often first to notice the knowledge gaps in students, as usually the students are in groups when in the Hospital environment but in a one to one setting in general practice.

If, despite remediation, a student’s performance remains substandard, supervising clinicians should not be afraid to indicate this in the In-Training Assessment Form. Whilst clinicians may be apprehensive of potential repercussions of “failing” a student, they should rest assured that the responsibility for deciding whether a student should fail to progress in the Medical Program lies with the School of Medicine and specifically with the Assessment Board. The use of multiple assessment methods and an integrated approach to the progression decision process ensures that failure to progress will never be determined by any single clinician or academic, but instead will be based on a broad range of assessment items.

8.4. Medical indemnity

Students are indemnified by the University whilst undertaking work experience, student placement, study, research, lectures, lecture tours or other related activities as part of their study course with the University. The indemnity covers clinical activities commensurate with their level of skill and training. To learn, students need to extend themselves into new areas and move a little out of their comfort zones. The further this is, the greater the level of supervision required.

A list of procedures which the students are expected to be competent in and have practised during

their clinical placements is attached as Appendix 4 and the student’s role is defined in Appendix 5.

Students acquire a broad range of skills in their hospital-based placements that precede the GP

placement are so they are the first people to ask if you are giving them a new task or skill to master.

Essentially, the further the new task or skill goes beyond the student’s level of skill and training the

less certain you may be about the medical indemnity provided by the University’s insurance policy. For

example, a student performing rotation flaps with skin cancer excisions are less likely to be covered in

the case of a patient complaint. If uncertainty remains about the medicolegal implications of giving

them this new task or skill, you should contact to the Primary Care Lead to discuss the matter.

8.5. Consent

Medical Students in the Griffith Medical Program have been advised that they must obtain appropriate consent from any patient before undertaking any physical examination or procedure. In the case of a competent adult patient this is a straight forward matter. In other circumstances, such as a child or an adult with a mental disability, additional steps are necessary (e.g. consent from a parent or guardian). Students have been advised that the same principles of obtaining appropriate consent should be applied in all circumstances and that they should not proceed with an examination or procedure if they feel at all uncomfortable from an ethical perspective.

GrifFith University - School of Medicine

General Practice Trainer Booklet- Year 4

D

APPENDIX 1. IN-TRAINING ASSESSMENT FORM

YJ Griffith UNIVERSITY Medical Student In-Training Assessment Form

BOND UNIVERSITY

The information on this form contributes to progression decisions about medical students from Griffith and Bond Universities during clinical placement and provides students \'\lith feedback on their perfonnance and professional development. This form should be completed by the student's clinical supervisor at the end of each

block/rotation (with input from other members of the team where appropriate).

Instructions Ph Climcal Supervisor/s to tick (.f) appropnate boxes 1n columns prov1ded. oto Where a student's performance is assessed as below the level expected for the1r Year of Program (*1" column),comments by the climcal supervisor on this form are requ1red Although not required, comments by clinical supervisors are encouraged for all other grades of assessment.

student's Name First Name SURNAME D ClinicalYear 4

0 Clinical Year 5

0 Griffith University

D Bond University

Name of Practice ................................................................................. Block/rotation- General Practice

CRITERIA *Below level expected for

Year of Pro ram

Borderline

satisfactory for Year of Program

Performance

satisfactory for Year of Program

Above

expected for Year of

Program

Not

observed

lj!U11!·1! Knowledge base- Demonstrates adequate knowled e of basic and clinical sciences

Clinical skills- Elicits accurate, complete history and clinicalexamination findin s

Clinicalreasoning skills- Organises and synthesises information and applies knowledge base

Procedural skills -Performs procedures to standard specified in the program guidelines

COMMUNICATION Patient and family- Interacts effectively and sensitively with patients and families/care givers

Medicalrecords/clinical documentation Provides clear,comprehensive and accurate records

PERSONAL AND PROFESSIONAL Professionalresponsibility- Demonstrates punctuality,reliability,honesty, appropriate attitudes and behaviours, and self-care

Attendance -Attends as required by the universi rogram

Time management skills -Organises and prioritises tasks to be undertaken

Teamwork- Contributes effectively to peer-group learning and to the clinicalteam

OVERALL PERFORMANCE

Comments: Please give specific examples, where possible. If a student's performance is assessed as below the level expected for their Year of Program (*1' 1 column), comments by the clinical supervisor are required here.

Supervisor's Name ... ...................... Signature ..... ..... Date ....... Please return this fonn to the Gold Coast Division of General Practice in the attached reply paid envelope.


APPENDIX 2. MINI-CEX ASSESSMENT FORM

Medical Student Mini-CEX Assessment Form - Year 4 General Practice Rotation

Student’s Name ...……………………….……………………………….…….

Assessor’s Name...……………………….……………………………….…….

Task …..…………………………………………………………………… Date ………….…….…….

Task Complexity ❑ Low ❑ Moderate ❑ High (*see back of page for levels)

Instructions: Clinical Supervisor/s to circle appropriate numbers for student’s performance as assessed. (**see back of page for rating standards) If a domain is not relevant to the task please tick (not observed) and do not score.

Extremely Poor Outstanding

1. History Taking Skills (❑ Not observed)

1 2 3 4 5 6 7 8 9

2. Physical Examination Skills (❑ Not observed)

1 2 3 4 5 6 7 8 9

3. Professionalism/Humanistic Qualities

1 2 3 4 5 6 7 8 9

4. Counselling Skills (❑ Not observed)

1 2 3 4 5 6 7 8 9

5. Clinical Judgment (❑ Not observed)

1 2 3 4 5 6 7 8 9

6. Organisation/Efficiency

1 2 3 4 5 6 7 8 9

7. Overall Competence

1 2 3 4 5 6 7 8 9

Comments: On Student’s Performance (Describe what was effective and ineffective and your overall

impression)

…………………………………………… …………………………….………………….. Student Signature Assessor Signature


* TASK COMPLEXITY

LOW MODERATE HIGH

History or examination of a common

medical condition; coherent co- operative patient; ideal setting; standard clinical task.

History or examination of a less

common medical condition; slightly difficult patient or situation; unusual clinical task. Simple counselling/advice.

History or examination of a rare

medical condition; demented or psychologically disturbed patient; complicated setting; high level clinical task; Complex counselling/advice.

**YEAR 4 MINI-CEX STANDARDS

1 - 3 4 - 6 7 - 9

1. History Taking Skills Mainly uses closed questions; fails to obtain pertinent clarification; obtains insufficient information to formulate an opinion; insensitive to affect and non-verbal cues; is rude or inappropriate during interaction.

Uses open ended questions to

facilitate patient’s telling of the story; uses directed questions to add detail; obtains adequate information to formulate an opinion; responds appropriately to non-verbal cues; may have a few errors of omission or odd awkward moment.

Allows patient to relate an accurate story with minimal cuing or questions; yields additional (previously unknown) information; obtains sufficient information to provide a diagnosis; responds very well to non-verbal cues.

2. Physical Examination Skills

Fails to make introductions; does not obtain consent or fails to inform patient of procedure; disorganised sequence to examination; misses major clinical signs.

Makes pleasant introduction and obtains consent to examination; performs standard screening examination; may make a few errors of omission, but overall obtains sufficient clinical information to formulate an opinion.

Very good bed side manner; obtains consent; informs patient regarding examination process; balances screening versus diagnostic steps; obtains sufficient information to confirm a diagnosis.

3. Professionalism/Humanistic Qualities

Is disrespectful or rude; fails to establish

trust; inattentive to patient’s comfort or modesty; hurts patient; breaches confidentiality; untidy appearance or inappropriate attire.

Shows respect, compassion, empathy; establishes trust; is sensitive to patient’s comfort and modesty; manages confidential issues; may have occasional awkward moment; adequate appearance.

Is very respectful, compassionate, and empathetic; easily establishes trust; is very considerate of patient’s comfort and modesty; deals sensitively with confidential issues; appropriately dressed.

4. Counselling Skills

Has a poor understanding of test or treatment proposed; fails to educate or counsel appropriately; makes major factual errors or omissions that may be unsafe.

Explains basis for a test or treatment; obtains consent; educates or counsels appropriately regarding management; may make some factual errors or omissions but overall skills are safe.

Explains rationale for a test or treatment well; obtains fully informed consent; educates or counsels appropriately regarding management without deficiencies.

5. Clinical Judgement

Suggests unreasonable or unlikely diagnoses; has little or no understanding of the clinical problem; suggests inappropriate or potentially hazardous investigations or management options; unsafe approach to emergency or critical situations.

Suggests reasonable diagnosis or formulation of problem; suggests appropriate investigation or further avenues of information gathering; balances risks/benefits of management strategy; safe approach to emergency or critical situations.

Spot on diagnosis/differential;

structured approach to appropriate investigation; clear consideration of risks/benefits for management options; textbook approach to emergency or critical situations.

6. Organisation/Efficiency

Inefficient, illogical approach; disorganised;

unduly slow; rambling or incoherent. Efficient, logical approach; sensible approach to prioritisation; timely; may be a little discursive but generally keeps on track.

Highly efficient and logical approach;

well organised; succinct and accurate.

7. Overall Competence

Makes errors or omissions which would be dangerous; unable to synthesise issues; uncaring.

Able to synthesise issues; effective and caring; may make minor/non- critical omissions or errors.

High level synthesis; very effective and caring; makes few or no omissions or errors; level of functioning exceeds expectations.


APPENDIX 3. MID-ROTATION REVIEW

YEAR 4 GP ROTATION MID-ROTATION REVIEW

The aim of this review is for the GP trainer and student to check if student learning and perfor mance are progressing as planned and to take action if deficiencies are identified. It should be scheduled toward the end of week 4 in the rotation. We recommend that the student’s Learning Plan and the In- training Assessment Form be used to ascertain progress and to prompt discussion. We recommend that the article, the ABC of Learning and Feedback, accompanying this booklet be reviewed in preparation for the mid-rotation review

The following questions are designed to help you trigger improvement, anticipate any problems with students and prompt any other areas requiring attention.

Is your student on track with?

meeting their learning objectives outlined in the learning plan? their clinical skills in general practice? their personal and professional behaviour? their preparation of a

- health assessment And/or GP management plan?

- GP case and preventive activity for presentation in tutorials?

Please emphasise areas where your student is performing well, but also point out areas where improvements can be made.

It is also helpful to ask the student for feedback on:

opportunities for learning provided by you and your practice; and your teaching style. where are you performing well? can any changes be made in these areas to assist the student in achieving their learning

objectives?


APPENDIX 4. CLINICAL SKILLS COMPETENCIES

The following table indicates the level of competency expected of students prior to the commencement of the relevant clinical placements in Year 3. The competency levels relate to the level of instruction and training the students have received to this point. In many cases they have also been specifically assessed in these skills. The key to the competency levels is as follows:

. Competency Key

1 = Taught/demonstrated - requires further instruction before practising 2 = Practised in simulated setting

(model or standardised patient) - requires supervision in clinical setting 3 = Practised in a live patient or standardised patient and assessable in Years 1 and 2 - requires

minimal supervision

By the time students commence the GP rotation in Year 4, it is likely that they will have exceeded the Year 3 competency levels for many of the skills designated in this table.

It is expected that students will achieve a basic level of competency in all of the skills listed by the time they complete the Medical Program.

Skill Description Competency History and Communication 1 2 3

History History taking X X X

Sexual History Sexual history X X Psychiatric History Psychiatric history X Communication Skills Effective communication skills X X X

Counselling Providing advice or outlining treatment/management X

Clinical Reasoning Application of clinical reasoning X X X

Cognitive Assessment Bedside cognitive testing X Mental State Examination Mental state examination X Haematology Results Interpretation of haematology results X X Biochemistry Results Interpretation of biochemistry results X X Physical examination

General

Vital signs Pulse, Blood Pressure, Respiratory Rate X X X

Lying/Standing BP Taking of blood pressure in lying and standing positions X X X

Hydration State Assessment of hydration state X X Skin/Burns Examination Examination of the skin and burn injuries X Paediatric Examination Examination of a child Cardiovascular

Cardiovascular Examination Cardiovascular examination X X X

Vascular Examination Vascular examination X X X

Respiratory

Respiratory Examination Respiratory examination X X X

Neurological

Neuro - Cranial Nerve Examination

Examination of the cranial nerves X

X

X

Neuro - Upper Limb Examination Neurological examination of the upper limbs X X X

Neuro - Lower Limb Examination Neurological examination of the lower limbs X X X


Skill Description Competency GIT

Abdominal Examination Abdominal examination X X X

Urogenital and breast

Breast Examination Examination of the breast X X Rectal Examination Digital rectal examination X X Male Genitalia Examination Examination of male genitalia X X PV - Speculum Examination Per vaginum examination using a speculum X X PV - Bimanual Examination Bimanual per vaginum examination X X Pregnant Abdomen Examination Examination of the pregnant abdomen Musculoskeletal 1 2 3

Joint Examination Examination of joints X X X

Neck/Back Examination Examination of the neck and back X X X

ENT

Ear Nose and Throat Examination Examination of the ears, nose and throat X Otoscopy Examination of the ear with an otoscope X Eyes

Visual Acuity Testing of visual acuity using a Snellen chart X X X

Fundoscopy Fundal examination using an ophthalmoscope X X X

Procedures

Urinalysis Performing dipstick urinalysis testing X X X

ECG Performing an ECG X X X

Spirometry Performance and interpretation of basic spirometry X X Venepuncture Performing venepuncture X X X

Injection (IV, IM, SC) Performing injections X X X

IV Cannula Insertion of an IV cannula X X X

Bag and Mask Use of a bag and mask X X Cardiopulmonary Resuscitation Basic life support for use in immediate resuscitation

attempts (ABC)

X

X

Urinary Catheter Insertion of a urinary catheter (male or female) X Nasogastric Tube Insertion of a nasogastric tube X POP Backslab Application of POP backslab Suturing Suturing of a wound X Basic Airway Management Performing basic airway assessment and management X Arterial Blood Gas Taking of arterial blood for blood gas analysis IV infusion Administration of an intravenous infusion X Sterile Technique Performance of aseptic procedure X X Wound Care Cleaning and dressing of a simple wound X X Other

Prescribing Writing of prescriptions


APPENDIX 5. ROLES OF STUDENTS ON GP CLINICAL PLACEMENTS

1. History Taking – students should be able to, and be prepared to, take a history from patients and record this accurately in the medical record.

2. Examining patients (non-intimate) – students should be able and willing to undertake basic

clinical examinations in most clinical settings and be able to record this accurately in the medical record. The same provisos exist as for (1) above but in addition students must be aware of the following:

a. Consent for examination must be obtained first b. If an examination involves any degree of intimacy the examination must not be performed

without a suitable chaperone c. All “positive” clinical findings should be confirmed by the general practitioner.

3. Intimate examinations – students should be able to perform intimate examinations under

supervision only: a. Students should never undertake intimate examinations except when directed to by a

clinician and when being directly supervised b. A suitable chaperone should be present

4. Completion of investigation request forms and referral letters – students should be able and

willing to assist the medical team in completing paper work for investigation requests and referral letters. In all instances these should be countersigned by the general practitioner. The following exceptions where students should not complete forms are death certificates and consent forms

5. Completion of medical records – with the permission of the general practitioner, students may

make entries into written or computerised medical records. Every effort should be made to ensure the data entered is accurate and reflects the true clinical situation at the time. For legal purposes this should be clearly labelled as the student’s entry. In written records this should be with student’s signature with their name printed legibly alongside. In computerised records, this may be either with an ‘electronic signature’ by setting them up temporarily as a user on the system or by entry under the general practitioner’s name with a note including the student’s name and a clear statement that the notes were entered by the student. In either case, the notes must be checked and endorsed by the general practitioner with a note to this effect that follows the student’s entry.

6. Patient advocate and friend – it is reasonable for students to act in a patient’s interests and act

as facilitator through the medical process. However, students should not offer advice or attempt to counsel patients.

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