History Taking and Anatomical Planes & MovementsSESSION 1

9th February 2011

Tutors’ WelcomeIeuan ReeceChuan ZhangJennifer KwanJoanid Farid

Chole ThompsonLauren TomsPaul Dodds

Andrew MabeyAnna weatherill

Alexandra Dunlop

Aims of Doc-to-Doctor?

• Help integrated knowledge from across modules using ESA style questions•To teach history taking and clinical examination• Provide consistent practice of history taking and clinical examination

How will this be achieved?• Work in small groups, each assigned to a tutor• Structured, scenario based questions which incorporate:• History taking• Clinical examination• Short answer questions on the previous weeks lectures, and ESA 1 content

• Hints, tips and memory aids

You may not be able to get through all questions each week

Doc-to-Doctor is NOT:

• A substitute for self-directed learning

• Going to cover all learnt material from the current Semester

• Suggestive of content in ESA 2

Clinical Skills 1: Anatomical Planes, Relations and Movements

2: Cardiovascular Examination3: Shoulder Examination

4: Blood Pressure and Pulse Points 5: Dermatomes of the Upper Limb

6: Cardiovascular Exam 7: Shoulder Examination

8: Hip Examination9: Knee Examination and Blood Pressure

10: Hip Examination

PATIENT HISTORY EACH WEEK

Structure of the Session

Teaching – 30 minutesHistory Taking & Anatomical

Planes

Move into small groups rooms• Groups A-E: KE Room 324• Groups F-J: KE Room 528

With Tutors, work through:• Pt. history• SAQs• Anatomical Planes & Movements• Explanation to pt.

Debrief and Feedback• Tutor feedback• Student feedback

History Taking - Basics• Introduce yourself: Full name, position and intent

• “Good morning/afternoon Mr Smith, please take a seat. My name’s X and I’m a first year medical student, here at Leicester. I was just hoping I could have a chat with you today before you go in to see the doctor”

• Gain consent and thank patient• “Would that be okay?”

• Confirm patient’s full name, DOB and occupation• “Before we begin, Mr Smith, could I just take your full name, DOB and occupation please?”• Retired?

HPC• Begin with these two open questions:

• “Why have you come to see the doctor today”• “Can you tell me a bit more about that please?”

• SQITAR(P)S• Site: Where exactly? Radiation?• Quality: Description of how the pain feels• Intensity: How has the pt. been affected?• Timing: Start? Onset – sudden/insidious? Changed with time? Why now? (Happened previously?)• Aggravating factors: What makes it worse?• Relieving factors: Anything that makes it better?• Previous episodes• Secondary symptoms – ? >1 symptom

Summarise• Pt. should think this is for your benefit:

• “To check I haven’t misunderstood anything, I’m just going to go over what you’ve told me so far”

• When reflecting back, use the SQITAR(P)S layout, so you’ll notice if you’ve missed anything out.

• Finish with:

• “Is there anything you’d like to tell me at this point?”

ICE• Ideas:

• “Do you have any ideas about what this could be?”

• Concerns:• “Is there anything in particular that you’re worried about?”

• Expectations:• “What is it you’d like to take away from the doctors today?”

• LEICESTER IS VERY BIG ON THIS

PMHx• Have they been well recently?• Any other serious illness before?• Have they ever been in hospital?• When, why and for how long.

• Are you currently being treated for anything?

DHx• Currently taking prescribed medications?• Ever been on long term medication?

• When, why and for how long.

• Any OTC drugs• Allergies? i.e. Penicillin; Elastoplast• If appropriate – Illicit drug use

FHx• Are there any problems which run in the family?• Health of:

• Mother and Father/Siblings• Siblings• Spouse• Children

SHx• Smoking? Pack-years• Alcohol? Ask pt. to describe their understanding• Dietary habit?• Living conditions and support• Hobbies• Occupation and financial stability - clarify

Finishing the Interview• You may wish to summarise again

• Ask the pt. if they’d like to add anything

• Thank the pt. and show them to the doctor’s room

Hints & Tips• Try and maintain a good structure, but do not interrogate the pt.

• SQITAR(P)S must be satisfied, but you do not have to do it in this fixed order – go with the patient

• If pt. has more than one symptom, take a Hx of them both independently• Be empathic• Don’t try and think of questions whilst the patient is speaking – just listen and the questions will come easier.

If you get stuck…• There are a few things you can do

•Panic…..

•Ask the patient if the patient a if you can just gather your thoughts for a minute.

•Summaries what they have said

If you get stuck…• There are a few things you can do:

• Panic…

• Reflect back to the patient, using SQUITAR(P)S layout – this way you’ll realise what you’ve left to ask

• Ask for a second to think

Explanation

• 1 Station in the year 1 OSCE

• Explanations can be on diseases or investigations.

How to start

• Introduce yourself and state your intentions

• Check what the patient wants to be called

• Ask the patient what they already know

Hints and Tips

• Small pieces of information

• Check the patients understanding

• Respond to the patients verbal and non verbal cues.

• Avoid jargon.

• Don’t blag it

How to end explanation

• Summaries everything you have said

• Ask the patient if they have any more questions.

• Give them a leaflet with the information

Anatomical Planes

• Coronal

• Horizontal

• (Mid)Sagittal

http://www.anatomy.tv/StudyGuides/StudyGuide.aspx?guideid=9&NextID=0&customer=primal

Anatomical Relations

• Proximal/Distal

• Superficial/Deep

• Medial/Lateral

• Superior/Inferior

• Anterior/posterior

Anatomical Movements• Flexion/Extension – Narrowing/increasing the angle of a joint

• Abduction/Adduction – Movement away/towards the midline

• Medial rotation/Lateral rotation – Rotary movement about the longitudinal axis of a bone

• Lateral flexion

Anatomical Movements•Ankle: Dorsiflexion/Plantarflexion/Inversion/Eversion

• Scapula: Protraction/Retraction

• Mandible: Protrusion/Retrusion

• Thumb: Opposition/Flexion/Extension/Abduction/Adduction

QUESTIONS?

Groups Room TutorGroup 1 KE 526 Ieuan

rakesh parmar parth patel

rebecca newman Jenny Fraser

group 2 KE 526 Chuan

ruthie brewster

immanuel Rhema Karen Barnes Becky acres

group 3 KE 526 Jennifer

Helen Johnson

Rashi Malhotra Philip Smith Megan Roberts

group 4 KE 526 Lauren

Laura Butler Misha Patel Iza Akhtar Zeeshan afzal