MB, ChB Phase IV Late Clinical Rotations. Years 5-6. Orthopaedics. Part of Clinical Rotations

Transcription

1 MB, ChB Phase IV Late Clinical Rotations Years 5-6 Orthopaedics Part of Clinical Rotations

2 MB, ChB Phase IV Late Clinical Rotations 2013 ORTHOPAEDICS Part of Clinical Rotations EDITOR:

3 ORTHOPAEDICS INTRODUCTION Welcome to this clinical rotation in Orthopaedics. The aim of this rotation is to give you the opportunity to refresh and practice your clinical skills which you have learned in the Musculo-skeletal module of Phase III. At the end of this module you should be able to do a clinical musculo-skeletal examination of a patient and interpret X-rays meaningfully. Furthermore you will have the opportunity to apply your theoretical knowledge in the field of orthopaedics. After completion of this module, you should be able to confidently diagnose and appropriately manage the common clinical problems with which you will be confronted in practice. In addition. you will gain skills in interventions such as the reduction of closed fractures as well as the applying of Plaster Of Paris casts to all routine fractures. Some students will attend the Rural Clinical School in Worcester and have the opportunity to rotate through the Department of Orthopaedic Surgery at Worcester Hospital. The duty roster of the students allocated to district hospitals will be issued once they arrive at their respective hospitals. Please refer to the description of the Longitudinal Model of the Rural Clinical School. As there are no separate Orthopaedic Department or clinics in these centres, use will be made of portfolios of musculoskeletal patients. The student will be required to compile a portfolio of short and long term Orthopaedic cases. The portfolio will consist of a recording in the form of clinical notes of patients whom you have examined and in which management you were actively involved in, or have followed up. These patient studies may also be used for further questioning in your oral exams. Students rotating at Tygerberg will also be rotating through the Division of Rheumatology. They will attend Rheumatology outpatients where they will have the opportunity to see some of the more common rheumatological conditions. They will also receive tutorials and have interactive sessions focussing on the rheumatological aspects of the musculoskeletal examination as well as the most important rheumatological conditions. You must also pay attention to the profile of the Stellenbosch doctor as introduced in the manual. The aim of the final two years of your course is to train to become a knowledgeable and competent interns REFERENCES AND TEXTBOOKS The following are recommended: 1. Concise System Of Orthopaedics And Fractures AG Apley /L Solomons ISBN (Butterworth And Heindmann Ltd.) 2. Apleys System Of Orthopaedics And Fractures, Apley 3. Clinical Orthopaedic Examination, Ronald McCrae-Churchill Livingstone, Practical Fracture Treatment, Ronald McCrae 5. Physical Examination Of The Spine And Extremities, Stanley Hoppenfeld ISBN Kumar and Clarke (Chapter on Rheumatology) 7. Rheumatology notes, 3 rd year lectures

4 Websites: 1. Departmental Website: 2. Webstudies: Module: Late Clinical Rotations 541 and 687 (MS02363). If you have trouble logging into this site, or the module is not listed please contact. 3. Orthopaedic Department: 4. Orthogate: 5. Wheeless Textbook: 6. Orthoteers: (Subscription required) FULL-TIME LECTURERS NAME OFFICE TEL Dr J du it C6 B West, TBH dutoit.vaatjie@gmail.com C6 B West, TBH ianr@sun.ac.za Dr A Ikram C6 B West, TBH ajmalikram@telkomsa.net Dr H de Jongh C6 B West, TBH hdj@mweb.co.za C6 B West, TBH seandi@mweb.co.za Dr I Terblanche C6 B West, TBH ipsterblanche@gmail.com Dr G du Preez C6 B West, TBH gian@gmail.com Dr JH Davis C6 B West, TBH johanhdavis@yahoo.com Dr T Franken Worcester Hospital tfranken@intekom.co.za Dr A Basson Worcester Hospital alettabasson@gmail.com Dr. A. Hess Caledon Hospital anthess@yahoo.com RHEUMATOLOGY LECTURERS NAME OFFICE TEL Dr Mou Manie Room 3127, clin build mou@sun.ac.za / 5731 Dr Riette du it Room 3071, clin build rdutoit@sun.ac.za / 5731 Dr Dave Whitlelaw Room 3062, clin build dwhit@sun.ac.za / 5731 Dr Lisa du Plessis Room 721, TBH lmdp@sun.ac.za / 5731 Dr Robert Cooper Room 721, TBH / 5731 Dr Joe Latief Room 3067, clin build joe-61218@hotmail.com / 5731 ASSESSMENT DURING CLINICAL ROTATION A. Tygerberg Students 1) Assessment during the module 2) Knowledge/skills 3) Written test 4) OSKE on last day of rotation

5 INTEGRITY ASSESSMENT DURING THE MODULE COMPRISES THE FOLLOWING: 1. Presence (attendance must be 90%) 2. Punctuality 3. Interest (evident from questions asked) 4. Initiative (read up, suggestions) 5. Empathy with patients 6. Involvement 7. Studiousness 8. Human relationships (patients, nursing staff and co-students) 9. Ability to be an effective member of a team These will be assessed and contribute ± 10% of the class mark. KNOWLEDGE/SKILLS 1. Written test paper consisting of short questions at the end of the 4th week (This contributes 40% of the class mark, only students at Tygerberg need write.). This will test the student s theoretical knowledge (Musculoskeletal lectures, including Rheumatology Middle Clinical Rotation given in 3rd year) as well as knowledge of plaster casts, splinting and traction, and clinical problems such as prevention of deep venous thrombosis and pressure ulcers. Oral and Clinical Tests (OSKE) a) Tygerberg and Worcester Students: OSKE at the end of the rotation (usually the fifth week), consisting of an oral which includes a long clinical case). This assessment contributes to 50% of the class mark. (60% for the RCS students) ASSESSMENT DURING CLINICAL ROTATION B. Longitudinal Model Students Assessment will include the following: 1. Continuous evaluation mark 2. Portfolio Evaluation. 3. OSKE Portfolio evaluation mark The portfolio exam accounts for this mark. It will count 40% towards the class mark. Portfolio. Details of the portfolio are given on page 16. Written test The Worcester and Longitudinal model students will not have to undergo the written test. The 40% allocated to this test (presently written by the Tygerberg Students) will be used for the portfolio assessment. OSKE Longitudinal model students are encouraged to attend Tygerberg Hospital and sit in at up to 2 OSKE tests as practice- these (voluntary) assessments will not count for marks. Arrange with Tygerberg Hospital (Helga -Tel ) at least 2 weeks before an OSKE scheduled for Tygerberg

6 students. Longitudinal Model students must partake in one OSKE at Worcester, to be held at least 2 months before the final examination. This assessment contributes 50% towards the class mark. MARK ALLOCATION TYGERBERG MARK ALLOCATION - RCS Class Mark: Class Mark: OSKE test 50% OSKE test 60% Written Test or Portfolio 40% Portfolio 32% Integrity Assessment 10% Intraining progress report 8% Final Mark Final Exam 50%* Class Mark 50% *It is essential to pass this final exam (OSKE). Students who fail to pass this OSKE will be offered an additional OSKE within 48 hours of publication of the final mark. If this is unsuccessful the rotation may have to be repeated the following year. ROTATIONS Each group will rotate through the Division of Orthopaedic Surgery for 5 weeks. Rheumatolgy clinic visits and tutorials are scheduled for week 1-3, as per roster. (See information booklet for late clinical rotations for details of groups.) As from August both 5 th and 6 th year students will be in the group rotating through the Division of Orthopaedic Surgery. The clinical assessment evaluation (OSKE) will normally take place on the last Friday of the rotation. This evaluation will be scheduled 1 week earlier in April (6 th years) and November (both 5 th and 6 th years) to accommodate the exams. In 2013 the OSKE clinical exams will be 15,16 & 17 April 2013 and 18, 19 & 20 November During the final OSKE, students may be given a rheumatological case / -oral examination as part of their assessment. OUTCOMES The outcome is a student who can competently enter internship and he/she has mastered adequate clinical and cognitive skills to manage emergencies they may encounter and, stabilise these before referral. He/she must be able to competently diagnose/treat orthopaedic and rheumatology patients that do not need referral. He / she must be able to recognise patients who may need referral for elective orthopaedic surgery, and be aware of complications of musculoskeletal surgery. The student should also be able to identify patients that need referral for specialised rheumatological workup and care.

7 The student should be able to: 1. Perform musculo-skeletal examination of a patient and request appropriate special investigations. 2. Recognise extra-articular and systemic manifestations of common rheumatological conditions 3. Be able to evaluate and systematically discuss X-rays of the musculo-skeletal system. 4. Apply different traction methods to treat a fracture. 5. Apply POP to a limb, take the necessary precautionary measures recognise the possible complications. 6. Must know how to evaluate a fracture union. 7. Acquire the basic principles of pre-operative preparation and post-operative care. 8. Assist in theatre 9. Acquire skills which you can apply as general practitioner e.g. giving local and regional anaesthesia to limbs. remove nails, treat in growing toe nails, managing wounds, reduction of common fractures, e.g. Colle s, forearm and ankle fractures, closed reduction of dislocations e.g. shoulder, elbows, knee and hips. ESSENTIAL TOPICS The following is a list of core knowledge and competencies required. This list is not exhaustive, but constitutes the important topics and gives a guide as to whether the patient may be managed and treated, or should have initial stabilisation followed by prompt referral. Student Intern Essential Musculoskeletal pics- Late Clinical Rotation

8 PATIENT PRESENTATION Examination of a patient Congenital & Early developmental diseases MUST KNOW & manage Screen of neonate Own Management details Must Recognise, emergency management and refer Spina Bifida Developmental dysplasia hip SKILLS REQUIRED General principles in the examination of a patient with an orthopaedic or rheumatological problem. Interpretation of X-rays and recognition of pathology requiring immediate management. Ortolani and Barlow's tests OTHER POINTERS Recognize other systematic problems in your differential diagnosis Early referral, Recognise complications of shunts. Painful hip Backache Shoulder pain Soft tissue injury (acute and cold) Cerebral Palsy Blount's disease Perthes slipped epiphysis Mechanical backache Slipped Disc Frozen shoulder, rotator cuff syndrome Degloving Extensor tendon injuries All major peripheral nerves Club Foot Sepsis : - TB, Pyogenic ; spondylitis Inflammatory back pain Tumour Cauda Equina Flexor / deep tendons Achilles rupture Peripheral nerve injury Application of appropriate cast Able to distinguish from bow legs which straightens as child develops. Symptoms, signs and X- ray presentation Symptoms, signs and X- ray presentation X-rays, Lab tests Differentiate between radiological features of ankylosing spondylitis and osteoarthritis Exam of shoulder, Steroid injection Clinical examination. examination and transfer Clinical examination. Be able to identify case needing possible surgery Know criteria for surgical treatment Recognise extraarticular features of Spondyloarthropathies Early referral, acute management spinal neurology Know criteria for referral Know how to suture extensor tendons Principles of nerve suture, post operative care Joint pain (general) Contaminated wound, open fracture Approach to inflammatory arthritis including Rheumatoid arthritis, primary osteoarthritis, reactive arthritis Chronic inflammatory arthritis (RA, chronic ReA etc) Refer appropriately to physio-, occupational therapists and social worker Know principles of wound debridement. Must assist at least 1 case. Appropriate diagnostic workup; Know principles and complications of treatment Must know how to examine patient with polyarthritis. How manage a preoperative case with polyarthritis.

9 Pelvic pain (non-trauma) Operative skills Post surgery Trauma Sepsis Local Infiltration steroids AVN/TB/Septic arthritis/osteomyelitis peripheral nerve blocks Pre and postoperative care Role of physio therapy Role of occupational therapy. Resuscitation Reduction and traction methods of fractures Transport Fractures - must be able to treat conservatively all fractures not mentioned in "Must Recognise" column Ankle Foot Tibia shaft Patella (undisplaced) Pyogenic arthritis Bone / Joint TB causes Confused Patient Displaced fracture Displaced foot fractures Unstable shaft fractures Tibia plateau / Pylon Displaced Patella fractures Know how to manage a patient with septic arthritis. How to aspirate synovial fluid from a superficial joint and do arthrotomy of the knee. Indications and contraindications examination, clinical and X-ray features and appropriate management. Know how to aspirate a shoulder, elbow and knee. Be able to competently assist in theatre, know suture technique, how to debride a wound. Indication and able to perform: Brachial/hand/femoral/foot blocks Know rehabilitation programs for different injuries. When to refer to a physiotherapist How to apply: Thomas/Bohler - Braun frame/ Dunlop/Halter traction/skin/denham Pin/Gallows Be able to competently assist in theatre, know suture technique, how to debride a wound. How to reduce Recognise Liz Franc and subtalar dislocations. Reduction and plaster cast Respect for soft tissues, immobilisation Early referral, what cases can be treated conservatively. Know appropriate diagnostic tests. Know anti tuberculosis drugs and length of treatment. Know how to inject steroid into shoulder region, hand and wrist. Consult and append time with physio and occupational therapists. Recognising the causes of post injury confusion and how to manage them. ATLS principles, how to align fractures and backslab. Management of hypovolaemic shock. Importance of early reduction Be able to treat undisplaced toe and metatarsal fractures. Care of exfix pins Femur shaft (child) Adults with femur shaft How to immobolize and early referral in adult. Conservative treatment of Thomas traction, Gallows' traction.

10 child. Pelvis Spine (stable) Hip Open pelvic injuries, displaced acetabular #s Spine (Unstable) Importance of managing medical complications e.g. DVT, dehydration. Stabilising pelvic ring fractures, recognising other soft tissue and visceral complications. Interpretation of x rays. Acute management of the spinal injury. Principles of air evacuation. Clavicle Distal 1/3 Conservative treatment, How to apply a figure of 8 bandage. Humerus Radius and ulna (child) Hand (uncomplicated lacerations) Salter (1 & 2) Proximal fractures, irreducible shaft fractures Displaced R&U, single bone #s Wrist Complex open hand injuries Growth plate injuries (Salter Harris >2) Conservative treatment of shaft fractures. How to manage the supracondylar fracture in children. Conservative treatment in the child. Recognise fracture dislocations and other pitfalls such as Essex Loprezzi lesion with radial head fractures. How to diagnose an occult schapoid fracture. Principles of treatment of hand injuries. Know which injuries can be treated conservatively. Importance of Salter Harris classification, prognosis Recognising the occult fracture Recognise which fractures need referral. Know how to apply an above elbow cast and know the principles of three point pressure. Limb reimplantation, criteria for referral, and how to preserve tissue you send with the patient. Dislocations Ligamentous instability Shoulder Knee Sternoclavicular (anterior) Elbow Knee Ankle Hip Posterior Sterno clavicular dislocation. Displaced ankle fracture Know how to reduce it by at least 1 method. Know how to reduce a posterior dislocation. Postoperative care and recognising acetabluar and other associated injury. Early reduction and arteriogram for possible vascular injury. How to diagnose and refer the posterior dislocation. Recognise importance of associated fractures causing instability. Management of acute knee injuries Conservative treatment. How to immobilise. Recognise and refer recurrent dislocation. Early referral of unstable dislocations... Recognise lipohaemarthrosis. Know which ACL deficient knees need surgery. Importance of early closed reduction by GP before referral Traumatic amputations Unsalvageable amputations Amputations (for possible limb salvage) Levels of amputations. Know when to amputate and when not to.

11 Plaster casts Limb Casts Spica Know how to apply a back slab, above and below knee plaster. Spica syndrome. Instructions to a patient with newly applied cast. Early follow up of a cast. Recognising compartment syndrome and how to manage it. reflex sympathetic dystrophy Pin care Extra skeletal fixation recognize signs and symptoms and refer Prevention and treatment of pin tract sepsis. Osteomyelitis Acute Management of acute osteomyelitis. Chronic osteomyelitis Recognise complications such as Marjolin's ulcer. Head Injury Subdural haematoma Head injury Importance of early intubation Bone Tumours Benign Recognise these and as a cause of pathological fractures in children. Sport's injury Overuse injuries Special Investigations X Rays Orthoses Metabolic diseases Interpretation of Systematic approach to Be familiar with common orthoses Crystal synovitiscauses, risk factors etc Primary malignant Metastasis Recognise on X ray. Know appropriate special investigations and be able to explain the management to patient. Know common tumours metastasising to bone e.g., prostate. Be able to ask for appropriate special investigations. Recognise Tendon Achilles rupture, stress fractures. carpal tunnel, Tennis & golfer's elbow, De Quervain's, trigger finger ESR, common blood tests,serological markers (Rheumatoid factor, ACPA / accp, HLA B27) interpretation and analysis of joint aspirate. When to request stress views, and safely do them Shoe raises, ankle foot orthosis, crutches osteoporosis Causes, complications, X- ray signs and appropriate referral. Know which metastases in long bones may benefit from internal fixation. Be able to diagnose / advise patients on common sport's injuries. how to treat acute and chronic gout. EXAMINATIONS There will be a final assessment during your sixth year. The exam consists of a clinical long case, X-ray discussions and an oral by a panel of examiners comprising of consultants of the Department of Orthopaedics and an external examiner. The final mark will be determined by adding up 50% of the late rotation module class mark and 50% of the (final) exam mark during the final examination. The student must obtain at least 50% in the final examination (final exam mark) to pass Orthopaedics. A student can possibly qualify for re-examination if he/she gets between 40% and 50% for the final examination.

12 ensure a uniform standard, students studying at Worcester and other hospitals will be required to travel to Tygerberg Hospital and be assessed together with the local students. AWARD An award for the best student in orthopaedics will be determined at the end of the 6th year by a panel of examiners. The prize is donated by the firm Smith & Nephew (subject to availability). TIMETABLES AND DUTY ROSTERS Tygerberg Students Students must report Dr. S. Pretorius in the (Middle of C6B passage Tygerberg Hospital) at 8 am, on the first day of their rotation. Students will be designated to participate in the activities of the firm on call each day. Every weekday morning at 7.30 am, a student from the previous night s duty call, will be required to present a trauma case of interest. In addition, a student will be required present a summary of a (peer reviewed) journal article of Orthopaedic interest.

13 TIMETABLE FOR LATE CLINICAL ROTATION AUGUST DECEMBER 2013 WEEK 1 TIME MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY SUNDAY 07:30 08:30 Introduction Dr H de Jongh Dr J du it Articla review Dr Smith/Consultant Tuesday Firm 09:00 10:30 10:30 13:00 Dr J du it Paedicatric LMOH G6 / Wednesday Firm C6B East POP room POP technique Hand Clinic C6B West F4 6 th years Dr D Whitelaw C7B East 5 th years 12:00 Dr Pretorius Examination of the pelvis and hip joint, knee Prof Vlok or Registrar Spinal clinic LUNCH Hip clinic Dr H de Jongh 12:00 Dr Terblanche Examination of the Foot and ankle Prof GJ Vlok / Dr Davis Registrar Tuesday Firm Cold POP room 12:00 Dr Ikram or Hand Registrar Examination of the Upper limbs, shoulder, Elbow, hand On Call And Ward work As per timetable On Call And Ward work As per timetable 14:00 15:00 Prof Vlok / Dr J Davis Tuesday Firm Take clinical history Examine spine and neck - 13:30 Academical Program According to Timetable 16:00 11 Phase IV: (Late) Clinical Rotations DEPARTMENT OF ORTHOPAEDICS Faculty of Health Science, University of Stellenbosch All rights reserved.

14 WEEK 2 TIME MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY SUNDAY 07:30 08:30 09:00 10:30 10:30 13:00 1 Case Presentation Dr J du it Ward G6 LMOH G6 Hand Clinic F4 6 th years Dr D Whitelaw C7B East 5 th years 10:30 12:00 Dr J Davis Plaster Technique Clinical Skills Lab Dr H de Jongh Prof Vlok or Registrar Thursday Firm - Spine - Trauma Thursday firm Cold Clinic C6B East Dr H de Jongh Dr J du it Articla review Hip clinic Dr H de Jongh Paediatric Clinic Dr J du it Dr Smith/Consultant Prof GJ Vlok/Dr J Davis POP room Registrar Tuesday Firm Cold On Call And Ward work As per timetable On Call And Ward work As per timetable 12:00 Dr A Ikram Approach to X-rays, local steroid injections LUNCH 12:00 Open fracture Resus emergency 14:00 15:00 13:30 Academical Program According to Timetable B5 Ms L Arendse (0369) Physiotherapy Dr Robertson POP s, splints, Ex Fixators. Indication for Internal fixation General Orthopaedic Operations. Bone Transplants,arthrodesis Arthroplasty,osteotomy 16:00 12 Phase IV: (Late) Clinical Rotations DEPARTMENT OF ORTHOPAEDICS Faculty of Health Science, University of Stellenbosch All rights reserved.

15 WEEK 3 TIME MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY SUNDAY 07:30 08:30 Case Presentation Dr H de Jongh Consultant Tuesday Firm Dr Smith/Consultant Tuesday Firm 09:00 10:30 Dr J du it Paedicatric LMOH G6 Dr D Whitelaw 6 th years C7B East F4 5 th years Prof Vlok/or Registrar Spinal clinic Prof GJ Vlok / Dr J Davis On Call And Ward work As per On Call And Ward work As per timetable timetable 10:30 13:00 Consultant Tuesday Firm Dr A Ikram Hand Clinic 12:00 Dr A Ikram or Hand registrar Approach to the Painful wrist, hand Iinfections, the hand in Rheumatoid arthritis C7B East RA C7B East RA LUNCH Hip clinic Dr H de Jongh Paediatric Clinic Dr J du it 11:00 12:00 Clinical Skills Lab Dr G du Preez Joint Injection/Asperation 12:00 Dr N Terblanche Septic arthritis Osteitis 14:00 15:00 Dr D Whitelaw Ruma lecture Clinical approach to Arthritis, principles in Treatment of Rheumatoid arthritis 13:30 Academical Program According to timetable Dr J du it Paediatric Orthopaedics (CTEV) SUFE Perthes, DDH Limping child 16:00 13 Phase IV: (Late) Clinical Rotations DEPARTMENT OF ORTHOPAEDICS Faculty of Health Science, University of Stellenbosch All rights reserved.

16 WEEK 4 TIME MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY SUNDAY 07:30 08:30 09:00 10:30 10:30 13:00 14:00 15:00 Case Presentation 1 Dr J du it Paedicatric LMOH G6 Consultant Tuesday Firm Dr Ikram Hand Clinic Dr J Davis or RegistrarTuesday Firm Approach to low back Pain, causes, treatment 16:00 Dr D Whitelaw 6 th years C7B East F4 5 th years 10:30 13:00 Rheumatoid Arthritis C7B East 13:00 Dr Pretorius AVN of bone myositis Ossif. Pagets Osteoporosis / osteomalacia / bursitis / tendinitis / tendinosis Dr H de Jongh Dr D Whitelaw Rheumatoid Arthritis C7B East Rheumatoid Arthritis C7B East LUNCH 13:30 Academical Program Dr J du it Hip clinic Dr H de Jongh 12:00 Diff. Diagnosis and approach to shoulder pain, tennis elbow, cubitis varus/valgus Dr Smith/Consultant Tuesday Firm Prof GJ Vlok / Dr J Davis POP room Dr N Terblanche Written test Petrusa Groenewald, 4 th Floor, Clinical Building On Call And Ward work As per timetable On Call And Ward work As per timetable 14 Phase IV: (Late) Clinical Rotations DEPARTMENT OF ORTHOPAEDICS Faculty of Health Science, University of Stellenbosch All rights reserved.

17 WEEK 5 TIME MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY SUNDAY 07:30 08:30 1 Case Presentation Dr H de Jongh Dr J du it OSKE C6 B West Long case, X-rays 09:00 Dr J du it Prof Vlok or Registrar 10:30 Paedicatric LMOH G6 F4 5 th & 6 th years Spinal clinic 10:30 13:00 Consultant Tuesday Firm Dr Ikram or Registrar C6B West Paediatrics POP room Spinal Clinic Dr N Terblanche Hip Clinic Paediatric Clinic Hand Clinic LUNCH 14:00 13:30 12:00 15:00 Dr G du Preez Acute dislocation of Joints mechanism Case study Trauma Academical Program According to Timetable Dr N Terblanche Case study Cold complications and demonstration of reductions 16:00 15 Phase IV: (Late) Clinical Rotations DEPARTMENT OF ORTHOPAEDICS Faculty of Health Science, University of Stellenbosch All rights reserved.

18 TIMETABLE FOR LATE CLINICAL ROTATION LONGITUDINAL MODEL STUDENTS TIME TABLE FOR ACADEMIC DAY AT WORCESTER HOSPITAL THIS WILL BE PUBLISHED BY WORCSTER HOSPITAL PRIOR TO STARTING YOUR ROTATION. Students allocated to the Longitudinal Model will be given the opportunity to attend the Academic Day at Worcester Hospital. The duty rosters of the students allocated to district hospitals will be issued once they arrive at their respective hospitals.

19 PORTFOLIO ASSESSMENT OF STUDENTS IN THE RCS A portfolio of patients managed by students will form part of the discipline based assessment. 1. Number of patient in portfolio per discipline: a. Worcester Hospital Int Psyc O&G Paed Surg Orth tal Duration of module in weeks No of Patients in portfolio during module Chronic patients through year for 6 patients 6 Family Medicine tal 54 b. Longitudinal model Block 1 Block 2 Block 3 tal 3/1-24/4-8/8 - Int Psyc O&G Paed Surg Orth tal Chronic patients through year for 6 patients Family Medicine 6 tal Instructions to students for completing portfolio entries: All case notes must be handwritten as a carbon copy of the original patient notes you place in the patient s folder Once you have written a set of case notes you should edit the notes according to the discussion you have with the doctor/registrar/consultant supervising you. The editing should be done in red ink and should help improve the quality of the notes written All hospital patients clerked by you must have daily patient notes in the SOAP (subjective, objective, assessment, plan) format. We expect to discuss the patient during the portfolio exam. All results of investigations FBC, CEUG, LFT, ABG, blood/sputum/urine cultures, ECG, CxR must be written into portfolio notes. We expect to discuss these results during the portfolio exam. For the longitudinal module all portfolio entries are to be indexed according to discipline..portfolios that do not have an index will be penalised in the portfolio exam. Copying of case notes is forbidden. Students found copying notes will fail the portfolio exam and will be subject to university disciplinary action.

20 3. Format of portfolio entries a. Subjective (History) b. Objective (Clinical findings, side room investigations, laboratory results, X-rays and ultrasound investigations) c. Assessment i. Clinical (Problem list, chronic active problems) ii. Individual (Patient s ideas, fears and expectations) iii. Contextual/ Cultural (Family, work/financial situation, living environment) d. Plan i. Non drug management ii. Therapuetic management iii. Health promotion and prevention iv. Relevant Ethical issue(s) v. Interdisciplinary management e. Identify at least one learning needs as show evidence how the learning need has been met. You are required to formulate a clinical question relevant to each patient in your portfolio. The questions should specifically address a personal learning need i.e. some issue about the patient s presentation, the diagnosis, investigation or treatment of the patient s condition that you would like to know more about. The list of Core Clinical Problems should guide you in formulating a question each week. You should write a single A4 page response to the question, including your reference source. You will be required to present your Portfolio of Learning at an oral examination at the end of the module. One or more of these learning needs may form the basis of part of the oral examination. 4 Chronic patients: Your portfolio should have six patients with a chronic condition that you will follow-up through the year. Preferably you should identify these patients as soon as possible but definitely within the first two months of the year. Make arrangement to follow this patient at regular intervals. Ideally you should be aware of any contact the patient makes with the health service e.g. outpatient/clinic visit, emergency visit, admission to hospital and referral to specialists or allied health professionals. You can choose 6 patients from the following categories but one patient must be a patient receiving rehabilitation: i. HIV/AIDS ii. TB iii. Obstetric patient to be followed from early pregnancy to post partum care iv. Paediatric patient with a chronic condition v. Rehabilitation patient (compulsory) vi. Chronic condition e.g. DM, HT, Asthma, COPD, Epilepsy vii. Psychiatric patient viii. Terminally ill/ Palliative care patient ix. Orthopaedic patient with a chronic condition b. In one of these patients you should identify an ethical dilemma and discuss this. See LO

21 c. In one of these patients you should identify a EBM question and discuss this for your EBM task. see LO d. We expect you to do at least one home visit on each of the six patients and reflect on your experience. 5. Assessment of portfolio The assessment of the portfolio of patients will be both formative (ongoing and used as a learning opportunity) and summative i.e. at the end of the module or at the end of the year for the longitudinal module. a) Formative assessment a. Worcester Hospital 1. On ward rounds 2. With your consultant 3. During academic days b. Longitudinal module 1. On ward rounds with Family Physician tutor 2. On ward rounds/clinics with visiting specialists 3. During academic days b) Summative assessment i Worcester Hospital 1. Discipline specific portfolio: End of rotation in portfolio OSCE 2. Chronic patients (Family Medicine): End of year b. Longitudinal module 1. Discipline specific portfolio: End of year in portfolio OSCE 2. Chronic patients: End of year in portfolio OSCE b c Format for OSCE assessment of portfolio (Summative) but can also be used as template for formative discussion of portfolio i. What diagnosis did you make? ii. Justify the diagnosis you made? iii. What other diagnoses did you consider? iv. How did you confirm your diagnosis? v. How did you manage the patient? vi. A basic science principle relevant to the case The summative portfolio assessment will form part of the discipline end of the rotation class/ward mark: i Worcester hospital: 1. Internal medicine -35% 2. Psychiatry 40% 3. O&G 50% (25% each for obstetrics and gynaecology) 4. Paediatrics 40% 5. Surgery 50% (oral simulated clinical case) 6. Orthopaedics 40% 7. Family Medicine 25% x. Longitudinal model 1. The portfolio assessment will form 40% of the class mark.

22 2. The assessment of the portfolio will be done in the form of a OSCE where the student will present his/her portfolio to a panel of examiners representing all the relevant disciplines. 3. The examiners can choose any patient in the portfolio to discuss. TIMETABLE FOR LATE CLINICAL ROTATION AT WORCESTER HOSPITAL Students allocated to Worcester Hospital are to present at ward C3 at 07h30 on the first day of their rotation. A detailed timetable of ward rounds and tutorials will be supplied on or before this date.