UNIVERSITY OF DUBLIN - Trinity College, Dublin UNIVERSITY OF DUBLIN TRINITY COLLEGE SCHOOL OF...

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UNIVERSITY OF DUBLIN

TRINITY COLLEGE SCHOOL OF MEDICINE

INTRODUCTION TO CLINICAL PRACTICE AND CLINICAL SKILLS

2nd

MEDICAL YEAR

2009/2010

AMiNCH

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CONTENTS Course Aims and Objectives 3 Morning sessions structure 4 Afternoon session structure 5 Course Format 6 Class List – Groups 8 Time Table – Morning 11 Time Table – Afternoon 12 Small Group sessions – Morning 13 Small Group sessions – Afternoon 14 Clinical Skills sessions 15 Seminar Series 16 Case Presentations 17 Bedside Tutorials 18 Contact Lists – Tutors/ Hospital Depts 19 Course Requirements 21 History Taking Guidelines 22 Physical examination Guidelines 25 Guide to Presentation Preparation 27 Medical History Pro-Forma 28

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Aims The Year 2 Introduction to Clinical Practice & Clinical Skills course aims to introduce students to the basic elements of clinical practice at an earlier stage than previously, so that students can maximise their learning opportunities as they proceed through the clinical undergraduate years.

Objectives At the end of year 2 clinical skills course students should be able to:

• Take a comprehensive clinical history • Be able to perform a systematic and thorough clinical examination • Be capable of summarising and presenting their findings, facilitating

discussion of the important aspects of each case. • Have an understanding of routine tests and investigations in common

practice such as: CXR , ECG, PFT, Basic Blood profiles. • Acquire some practical clinical skills essential for routine practice • Be introduced to aspects of medical professionalism such as:

Multidisciplinary team working, Communication skills, Patient Safety.

Practical Classroom Clinical Skills - Year 2 Vital Sign Assessment- BP, Pulse, Resps, Temp, SaO2. Basic Life Support- Adult Basic Suturing Skills- Simple Interrupted Suture and Instrument Ties Intravenous Cannulation . Standard Operating Procedures -Principles of point of care testing using urine and blood glucose monitoring as examples Breast and Testicular Examination . Eye Examination- Fundoscopy, Ear Examination - Auroscopy

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Year 2: General Structure- Morning 10am-12

Clinical Skills 1

Hx & Exam

CNS

Hx & Exam

MSK

Hosp Dept Visits

Hx & Exam

PNSHx & Exam

ABDO

Clinical Skills 2

Hx & Exam

RESP

Hx & Exam

CVS

MDT 1

Core 9am-

10

Morning

Seminar 12-13.00

LUNCH 13- 14.00

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Year 2: General Structure- Afternoon 2-4pm

Clinical Skills 3 Out

Patients Dept

ECG/ X-Ray

Out Patient Dept

Case Pres-Prep MSK

Practical

History TakingPract

Comm Skills

Clinical Skills 4

Communication Skills

Afternoon

MSK-Practical at SJH

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COURSE FORMAT Time: Tuesdays in Term Time from 9am - 4pm x approx 32 weeks but

includes holidays , revision weeks, research projects. Venue: Tallaght Hospital / St James`s Hospital

Standardised program on 2 sites , only movement is for Tallaght Students to attend MSK Practical session at St James`s.

Format: Medical and dentistry students divided into 10 groups of 9-10

students . Each student is then listed as belonging to a Group from 1-10 and further divided to person A, B, C, D, E, F, G, H, I ,J in that group.

Each student will have 4 sessions per day, arranged as either “common to all” i.e. (9-10 am case presentations and Seminars 12-13.00), or group specific activities. Group specific activities are arranged radially. Each group completes 2 rotations of the wheel over the entire course. Summatively, the program aims to deliver • 24 hours bedside contact teaching to each student • 16 hours practical clinical skills contact time • 3 hrs teaching in interpretation of routine investigations-

X-Ray/ECG/Basic Blood profiles • 6 -7.5 hrs shadowing Allied Health Professionals and learning

the skills of multidisciplinary team working,

Core activity (26 episodes) case presentation based activity. This will be tutor driven for the first week and after holidays otherwise it will be student driven. Direct clinical teaching: see diagram, main aim is to develop proficiency in systems based history taking and clinical examination; namely, CVS, RESP, ABDO, PNS, CNS and MSK. Seminar activity (12-15 episodes) to support professionalism, namely clinical communication, patient safety, ethics. Introduction to clinical practice (20 sessions) Elective care (Out Patient Department - OPD) Communications skills workshop x4 Practical Clinical skills sessions x 8 Practice session (case ppt/ project work hx and exam practice)

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Course Timetable: 9-9.50am Case Presentations x 2 10 -12 Clinical activity (see radial) 12-1 Seminar 2- 4pm Introduction to clinical practice

Assessment

ALL students are required to submit a log book and pass an OSCE .

• The log book incorporates a record of attendance and competency of essential activities.

• Students failing to submit a completed logbook by the end of May 2010 and students failing to achieve a pass mark in the June 2010 OSCE will be required to attend remedial clinical skills teaching over summer 2010 at a time convenient to the school and will subsequently need to pass a supplementary OSCE in Sept 2010 in order to progress to the 3rd Medical Year.

NB The logbook is the students responsibility and signatures must be secured on the day of attendance of each activity, lecturers and clinicians are not required to provide signatures retrospectively.

Evaluation Students will be asked to evaluate each aspect of the course in June 2010. Students feedback will influence the content and format of subsequent years.

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TRINITY COLLEGE - FACULTY OF HEALTH SCIENCES

School Of Medicine - SECOND MEDICAL YEAR 2009/2010

AMNCH GROUP B1 ( Dr Mary Shuhaibar) GROUP B2 ( Mr Haresh Kumar)

A Izatt Syafieq ABD RASHAD A Farah Ida ABDUL RAHMAN B Jasdeep BADWAL B Breanne BAILEY C Sarah CASEY C Jonathan CAUCHI D Laura DALY D Pranesh DAS E Patrick Fardal E Shawn Shelly F Morgan Roche F Richard Condon G Kung Chai Billy KWOK G Audrey Mary LACEY H Thomas MCGRATH H Conor MCLAUGHLIN I Maedbh RHATIGAN I Amy Marie RIDGE J Ailbhe WHITE- GIBSON J Laura WHITLA

GROUP B3 ( Dr Naveed Sultan ) GROUP B4 (Mr Haresh Kumar /Surg SHO ) A Tunde ABDULSALAM A Ariella ABRAMOVITCH B Sian Bethan Leigh BARRY B Steven David Michael BELL C Vidhyaleha CHANDRAN C Lucy Ellen CHAPMAN D Shane William DAVY D Caoimhe Catherine DELANEY E Emma McAleese E Sarah Hearty F Yoke Teng Teo F Yvonne Macauley G Jaclyn Yee Cheun LAU G James LEE H Fionn MAG UIDHIR H Sean MAGUIRE I Farah Diana SAMAT I Nichola SANDYS J Niamh Catherine WYNNE J Nur Izzah ZABIDI

GROUP B5 ( Dr Anthony O’Connor) GROUP B6 (Dr Andrea Lau) A Shafawati Akmal ADAM A Sophia Waheida AHMAD B Priya BHOLA B Daryl Pamela Mary BLADES C Niamh Mairead CLEARY C Rebecca COLE D John DONAGHY D Noel Edward DONLON E Ruth Morris E Elaine Shore F Paul McPartland F Michael Nolan G Anna Susan LINEHAN G Marie Bernadette LYNCH H Katie MAHER H Samantha MARTIN I Muhammad Al Amin SHAHARUDDIN I Emma SHEEHAN J Alexandra ZABOROWSKI J Jessica ZAKS

GROUP B7 ( Rheum SHO) GROUP B8 ( Dr Mary Shuhaibar ) A Ahmad Fahmi AHMAD TARMIZI A Lylas ALIJOHMANI B John BRAZIL B Kevin BROWN C Chantal Louise COTTER C Stefanie CROGHAN D Aaron DONNELLY D Ross DORMER E Shoun Obana E Rebecca Courtney F Sofiane Mebarek F Slaine McGrath G Deirdre Mary MCCARTAN G Colm James Wiliam MCCORMICK H Ryan Boyd MOFFATT H Maisarah MOHD NAZRI I Sarah SHIELS I Jaroslaw Mikhail SHIROKOV J Eamonn FITZGERALD J Rizwan HAQ

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GROUP B9 ( Dr Sasha Dudina) GROUP B10 ( Dr Anthony O’Connor/

Dr Naveed Sultan) A Mayce AL KURAISHI A Daniel ANGELOV B Claire BUCKLEY B Sarah BURKE C Maire CROWLEY C Maeve Patricia D'ALTON D Michael Gerard DOYLE D Aoife DUIGNAN E Clodagh McCaffery E Orla Carty F Rory Boyd F Shermeen Memon G Ruth Mary MCCULLOUGH G Sean James MCDERMOTT H Michael MOORE H Daniel MULLAN I Dilpreet SINGH I Hannah Margaret SMYTH J Sandeep SIHAG J Ken Neth YAP

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Time Tables The first time table is the overall time table. Here the groups are simply referred to as 1-10. This is applicable to both Groups A and B. For example a number 1 refers to both group A1 and Group B1. A = Students at St James`s and B = Tallaght Based Students The second is a hospital specific tutor list for the bedside teaching. The third is the case presentation time table. The fourth is a hospital specific breakdown of subgroup splits for those rotations that require smaller groupings namely MDT 1 and MDT 2 in the mornings and OPD in the afternoons. This is where the letter A,B,C,D,E,F,G,H,I,J, alongside your name in the list of groups is important. Please attend the correct allocations.

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Year 2 2009/2010 Timetable for Clinical Skills Course on Tuesday Mornings (10-12)

AM Abdo CNS Resp CVS Musculo-skeletal

PNS Classroom

Skill 1 Classroom

Skill 2 MDT 1-

Subgroups MDT 2-

Subgroups

29 Sept Introductory Day 6 Oct 1 2 3 4 5 6 7 8 9 10

13 Oct 10 1 2 3 4 5 6 7 8 9 20 Oct 9 10 1 2 3 4 5 6 7 8 27 Oct 8 9 10 1 2 3 4 5 6 7 3 Nov 7 8 9 10 1 2 3 4 5 6

10 Nov 6 7 8 9 10 1 2 3 4 5 17 Nov 5 6 7 8 9 10 1 2 3 4 24 Nov 4 5 6 7 8 9 10 1 2 3 1 Dec 3 4 5 6 7 8 9 10 1 2 8 Dec REVISION

15 Dec EXAMS 19 Jan 2 3 4 5 6 7 8 9 10 1

26 Jan 1 2 3 4 5 6 7 8 9 10 2 Feb 10 1 2 3 4 5 6 7 8 9 9 Feb 9 10 1 2 3 4 5 6 7 8

16 Feb 8 9 10 1 2 3 4 5 6 7 23 Feb 7 8 9 10 1 2 3 4 5 6 2- 19 Mar RESEARCH

23 Mar 6 7 8 9 10 1 2 3 4 5 30 Mar 5 6 7 8 9 10 1 2 3 4

6 Apr 4 5 6 7 8 9 10 1 2 3 13 April 3 4 5 6 7 8 9 10 1 2

20 April FINAL MED EXAM

27 April 2 3 4 5 6 7 8 9 10 1 4 May REVISION

10-17 May EXAMS 25 May – 11 June

CLINICAL SKILLS REVISION

14 June OSCE - TBC

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Year 2 2009/2010 Timetable for Clinical Skills Course on Tuesday Afternoons (2-4:pm ) PM COMMUNICATION

SKILLS CASE PRESENTATION

PREPARATION ECG/X-Ray Physio Practical (ALL at St James's

Classroom Skill 3

Classroom Skill 4

Elective Care

29 Sept Introductory Day 6 Oct 1,2 3,4 5, 6B 6A 7 8 9,10

13 Oct 9,10 1,2 3,4B 4A 5 6 7,8 20 Oct 7,8 9,10 1,2B 2A 3 4 5,6 27 Oct 5,6 7,8 9,10B 10A 1 2 3,4 3 Nov 3,4 5,6 7,8B 8A 9 10 1,2

10 Nov 1,2 3,4 5B,6 5A 8 7 9,10 17 Nov 9,10 1,2 3B,4 3A 6 5 7,8 24 Nov 7,8 9,10 1B,2 1A 4 3 5,6 1 Dec 5,6 7,8 9B,10 9A 2 1 3,4 8 Dec REVISION

15 Dec EXAMS 19 Jan 3,4 5,6 7B,8 7A 10 9 1,2

26 Jan 1,2 3,4 5,6A 6B 7 8 9,10 2 Feb 9,10 1,2 3A,4A 4B 5 6 7,8 9 Feb 7,8 9,10 1,2A 2B 3 4 5,6

16 Feb 5,6 7,8 9,10A 10B 1 2 3,4 23 Feb 3,4 5,6 7,8A 7B, 8B 9 10 1,2

1- 19 Mar RESEARCH 23 Mar 1,2 3,4 5,6A 5B 7 8 9,10 30 Mar 9,10 1,2 3,4A 3B 5 6 7,8

6 Apr 7,8 9,10 1,2A 1B 3 4 5,6 13 Apr 5,6 7,8 9,10A 9B,10B 1 2 3,4 20 Apr FINAL MED EXAMS

27 April 3,4 5,6 7,8A 8B 9 10 1,2 4 May REVISION

10-21 May EXAMS

24 May– 10 June

CLINICAL SKILLS REVISION/ BEDSIDE

ASSESSMENTS 14 June OSCE - TBC

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ACTIVITIES - MDT 1 = INVESTIGATIONS DATE GROUP ECG PFT ENDOSCOPY ANGIO 6 Oct 9 A,B,C D,E,F G,H I,J 13 Oct 8 A,B,C D,E,F G,H I,J 20 Oct 7 A,B,C D,E,F G,H I,J 27 Oct 6 A,B,C D,E,F G,H I,J 3 Nov 5 A,B,C D,E,F G,H I,J 10 Nov 4 A,B,C D,E,F G,H I,J 17 Nov 3 A,B,C D,E,F G,H I,J 24 Nov 2 A,B,C D,E,F G,H I,J 1 Dec 1 A,B,C D,E,F G,H I,J 19 Jan 10 A,B,C D,E,F G,H I,J

26 Jan 9 D,E,F A,B,C I,J G,H 2 Feb 8 D,E,F A,B,C I,J G,H 9 Feb 7 D,E,F A,B,C I,J G,H 16 Feb 6 D,E,F A,B,C I,J G,H 23 Feb 5 D,E,F A,B,C I,J G,H 24 Mar 4 D,E,F A,B,C I,J G,H 31 Mar 3 D,E,F A,B,C I,J G,H 6 Apr 2 D,E,F A,B,C I,J G,H 13 Apr 1 D,E,F A,B,C I,J G,H 27 Apr 10 D,E,F A,B,C I,J G,H

MDT 2- Multi-Disciplinary Team Visits

DATE GROUP Physio S. Worker SALT Dietetics OT Dr Ryan 6 Oct 10 A,B,C D,E H,I F,G 13 Oct 9 A,B,C D,E H,I F,G 20 Oct 8 A,B,C D,E H,I F,G 27 Oct 7 A,B,C D,E H,I F,G 3 Nov 6 A,B,C D,E H,I F,G 10 Nov 5 A,B,C D,E H,I F,G 17 Nov 4 A,B,C D,E H,I F,G 24 Nov 3 A,B,C D,E H,I F,G 1 Dec 2 A,B,C D,E H,I F,G 19 Jan 1 A,B,C D,E H,I F,G

26 Jan 10 E,F,G A,B C,D H,I 2 Feb 9 E,F,G A,B C,D H,I 9 Feb 8 E,F,G A,B C,D H,I 16 Feb 7 E,F,G A,B C,D H,I 23 Feb 6 E,F,G A,B C,D H,I 24 Mar 5 E,F,G A,B C,D H,I 31 Mar 4 E,F,G A,B C,D H,I 6 Apr 3 E,F,G A,B C,D H,I 13 Apr 2 E,F,G A,B C,D H,I 27 Apr 1 E,F,G A,B C,D H,I

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TUESDAY AFTERNOONS- OUTPATIENT VISITS DATE GROUP Dr McCabe Dr Mulcahy Minor OPS Mr Grainger 6 Oct 9 A,B D,E F,G C 13 Oct 7 A,B D,E F,G C 20 Oct 5 A,B D,E F,G C 27 Oct 3 A,B D,E F,G C 3 Nov 1 A,B D,E F,G C 10 Nov 10 A,B D,E F,G C 17 Nov 8 A,B D,E F,G C 24 Nov 6 A,B D,E F,G C 1 Dec 4 A,B D,E F,G C 19 Jan 2 A,B D,E F,G C

26 Jan 9 C,F A,G D,E B 2 Feb 7 C,F A,G D,E B 9 Feb 5 C,F A,G D,E B 16 Feb 3 C,F A,G D,E B 23 Feb 1 C,F A,G D,E B 24 Mar 10 C,F A,G D,E B 31 Mar 8 C,F A,G D,E B 6 Apr 6 C,F A,G D,E B 13 Apr 4 C,F A,G D,E B 27 Apr 2 C,F A,G D,E B

DATE GROUP Dr Gibney Mr Tierney Dr H O Connor Mr Grainger 6 Oct 10 A,B C,D F,G E 13 Oct 8 A,B C,D F,G E 20 Oct 6 A,B C,D F,G E 27 Oct 4 A,B C,D F,G E 3 Nov 2 A,B C,D F,G E 10 Nov 9 A,B C,D F,G E 17 Nov 7 A,B C,D F,G E 24 Nov 5 A,B C,D F,G E 1 Dec 3 A,B C,D F,G E 19 Jan 1 A,B C,D F,G E

26 Jan 10 C,F B,G D,E A 2 Feb 8 C,F B,G D,E A 9 Feb 6 C,F B,G D,E A 16 Feb 4 C,F B,G D,E A 23 Feb 2 C,F B,G D,E A 24 Mar 9 C,F B,G D,E A 31 Mar 7 C,F B,G D,E A 6 Apr 5 C,F B,G D,E A 13 Apr 3 C,F B,G D,E A 27 Apr 1 C,F B,G D,E A

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CLINICAL SKILLS 2nd MEDICAL YEAR - AMiNCH SESSION SKILL TIME TUTOR LOCATION 1 BASIC SUTURE

10-12 Oct-Jan Phillippa Skills Lab

2 CANNULATION

10-12 Oct-Jan Marie Seminar 2

3 IV Cann/Suture

10-12 Feb-April Phillippa Skills Lab

4 Vital Signs

10-12 Feb-April Marie Seminar 2

5 Eyes/Ears Exam

2-4 Oct-Jan Phillippa Skills Lab

6 BLS- Adult

2-4 Oct-Jan Marie Seminar 2

7 POCT- Urine/Blood Glucose

2-4 Feb-April Phillippa Skills Lab

8 Breast/Testes Exam

2-4 Feb-April Marie Seminar 2

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SEMINAR SERIES – 12.00-13.00 VENUE : EDUCATION CENTRE LECTURE THEATRE TOPICS COVERED INCLUDE : TOPIC

SPEAKER

MDT – Roles Physio/Social Worker/ OT/SALT Coroners Court Siobhan Lingwood Patient Safety Siobhan Lingwood Consent Siobhan Lingwood CXR Radiology Reg AXR Radiology Reg Handwashing ICN Stomas CNS- StomaCare Electrolytes Medical Lecturer Mistakes Behavioural Sciences Personality Behavioural Sciences Sexuality Behavioural Sciences Culture Behavioural Sciences Children Behavioural Sciences Wound Care Tissue Viability Leg Ulcers Tissue Viability/Vascular CT Radiology Reg Documentation Siobhan Lingwood History Taking Medical Lecturers Examination Medical Lecturers

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AMiNCH – CASE PRESENTATIONS 9-10am

DATE 6th October Dr O’Connor, Mr Kumar

13th October B3,B4 20th October B1,B2 27thOctober B9,B10

3rd November B7,B8 10th November B5,B6 17th November B3,B4 24rd November B1,B2

1st Dec B9, B10 REVISION/ EXAMS

19th Jan Dr Dudina, B7,B8 26th Jan B5,B6 2nd Feb B3,B4 9th Feb B1,B2

16th Feb B9,B10 23nd Feb B7,B8

RESEARCH 23nd Mar Dr Shuhaibar,B5,B6 30th Mar B3,B4 6th April B1,B2

13th April B9,B10 FINAL MED EXAMS

27th April B7,B8 25th May B5,B6

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2009/10 AMNCH

BED SIDE TUTORIALS – Systems

10-12 PNS CNS Musculo-skeletal CVS Resp Abdo

DATES Introductory Day- 29th Sept

6th Oct Anthony O’ Connor

Mary Shuhaibar Rheumatology SHO

Sasha Dudina Andrea Lau Haresh Kumar


Mary Shuhaibar

Rheumatology SHO Sasha Dudina

Andrea Lau Haresh Kumar

20th Oct

Anthony O’ Connor

Mary Shuhaibar




Mary Shuhaibar



3rd Nov Anthony O’ Connor

Mary Shuhaibar



10th Nov Anthony O’ Connor

Mary Shuhaibar



17th Nov Anthony O’ Connor

Mary Shuhaibar



24rd Nov Anthony O’ Connor

Mary Shuhaibar



1st Dec Anthony O’ Connor

Mary Shuhaibar



19th Jan Anthony O’ Connor

Mary Shuhaibar



26th Jan Anthony O’ Connor

Mary Shuhaibar



2nd Feb Anthony O’ Connor

Mary Shuhaibar



9th Feb Anthony O’ Connor

Mary Shuhaibar



16th Feb Anthony O’ Connor

Mary Shuhaibar



23nd Feb Anthony O’ Connor

Mary Shuhaibar



23nd March Anthony O’ Connor

Mary Shuhaibar



30th March Anthony O’ Connor

Mary Shuhaibar



6th April Anthony O’ Connor

Mary Shuhaibar




Mary Shuhaibar




Mary Shuhaibar



Examinations

REVISION/OSCE

Back up tutors:

Dr Martina Hennessy

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Tutor and Contact lists - AMNCH

Name Mentor Group

Contacts

Dr Mary Shuhaibar

B1/B8 Medical Lecturer AMNCH

[email protected] Bleep 7128

Dr Anthony o Connor

B5/B10 Medical Lecturer AMNCH [email protected] Bleep 7062

Mr Haresh Kumar

B2/B4 Surgical Lecturer AMNCH

[email protected] 0868362228

Dr Naveed Sultan B3/ B10, Medical Lecturer Naas (AMNCH Tuesday)

[email protected]

B4 Surgical SHO AMNCH

[email protected] Bleep 6237

Dr Andrea Lau B6 Respiratory SPR Bleep 2971

B7 Rheumatology SHO Bleep 1731

Dr Sasha Dudina

B9 Research Fellow- Cardiology [email protected] Bleep 7141

Dr Martina Hennessy

Director of Undergraduate Medicine

086828117 [email protected]

Marie Morris Clinical Skills Course Co-Ordinator / Tutor AMNCH

0860202842 [email protected]

Phillippa Marks Clinical Skills Tutor AMNCH

087 2920014 [email protected]

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Contact Details, Locations : MORNING VISITS

Attachment Name Contact details Bedside Tutorials Variable Tutors will meet groups at Lecture Theatre after

Case presentations. ECG Ann Simpson Go to Cardiology Outpatients then ECG

reception- PFT Richard

Hawksworth Burkitt ward level 3, Lung function Lab 4143091

Angiography Vascular Reg Go to main adult X-ray and follow signs for Angio laboratory Bleep 2635

Endoscopy Gastro- Reg Endoscopy suite at level 2 gastro OPD- Bleep 2969

Gastro- Enterology Outpatients

Dr Mc Loughlin /Dr Ryan

Gastro Outpatients 2nd Floor

Physiotherapy Cliodhna Kelleher Physio reception- ground floor Bleep 2118 Social Work Aoife Coffey Social Work department. Ground Floor. Occupational Therapy John Kelly OT- x 2791 Nutrition and Dietetics Sinead Feehan Dietetics x 2483 Speech and Language Therapy - SALT

Maeve Murphy X 2780

Afternoon Case presentation preparation

Main hospital Various Ward Areas Class Rep to Bleep SHO/Reg to confirm meeting point

Communication Skills Trinity Centre Seminar room 3 Ground floor Practical Classroom Skills

Trinity Centre Clinical Skills Lab /Seminar Room 2

Ground floor

MSK Practical Lecture room Trinity Centre ST JAMES`S

Emer Barrett Room 1.75

OUTPATIENTS

Mr S Tierney Vascular OPD suite 7 To main OPD Dr J Gibney Diabetes Diabetic Day

Centre Past main entrance- end of corridor

Dr D McCabe Neurology OPD suite 1 To main OPD Dr H O’Connor- Gastro-

Enterology Gastroenterology unit

Level 2- follow signs

Mr R Grainger Genito-Urinary GU dept Level 2 Dr D Mulcahy Cardiology OPD suite 2 To main OPD Prof Conlons

SPR- Minor Ops Near Gastro-

OPD 2nd Floor – Bleep 2472

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COURSE REQUIREMENTS

Signing in Each student will be required to sign in by 9AM each Tuesday morning

at the Trinity Centre for the respective site. Remember half the class is

attending at St James’s and half the class at AMNCH.

Unsatisfactory attendance at the 9-10 AM sessions will not be

acceptable unless accompanied by a legitimate sick certificate.

Poor attendance which is uncertificated will be a barrier to progression

to the 3rd medical year.

Sick certificates Non-attendance will not be tolerated unless

accompanied by a legitimate sick certificate which should be handed in

to the School of Medicine for the attention of Dr M Hennessy.

Dress Code: White coats must be worn for all hospital activities.

Students must be smartly dressed with clean practical shoes.

Nails must be short and excessive jewellery avoided to reduce cross

infection.

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History Taking

Without a history you will not be in a position to make any reasonable

decision about patient management. It is essential that you learn the

skills of developing rapport with the patient so that you are able to get

a full and complete history. The basics of history taking will be covered

in the introductory lectures and by the tutors who teach you at the

bedside. Observe and practice the skills that are demonstrated to you.

In the beginning you will find that completing a full history will take

you many hours and possibly more than one attempt with the same

patient. Do not give up. Once you have mastered the art of taking a

history you will be 80% - 90% along the way to making the correct

diagnosis on all your patients.

Read your clinical methods textbook section on history taking and

scour the library for other descriptions of history taking. Observe your

senior colleagues take histories at every opportunity. Inwardly

criticise the technique displayed by colleagues so that you can

understand what works and what does not. The more styles you come

across the more able you will be to develop a style that suites your

personality and that equips you with the best diagnostic tool you will

ever have.

The Clinical History

The following pages give you an overview of both history and

examination. These are useful tools to assist you in ensuring that you

have completed the full history and examination.

The following history scheme is intended as a guide to history taking.

You should acquire your own system, which you should use every

time. It is important that the way in which a clinical examination is

conducted should become a habit - a good habit. Further details of

history-taking will be covered in the different bedside sessions.

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The Clinical History Personal Details

• Age • Gender • Occupation (Brief as full details should

be collected under social history. This is a useful “icebreaker” as most people are comfortable about talking about their occupation.

• Marital Status • Ethnicity

Presenting Complaint This is a list of the main symptoms, either volunteered by the patient or elicited from them during the interview.

History of the Presenting Illness

• Body location • Quality • Radiation • Severity • Chronology, including when it first

began, mode of onset, mode of ending, the duration, the frequency and any periodicity

• Setting - under what circumstances does it take place

• Aggravating and alleviating factors, including treatment

• Associated manifestations • Overall course and effect on normal

activities • A review of any other symptoms

referable to the body systems under consideration

• Past Medical and Surgical History o Previous hospitalisations o Operations o General health o Accidents and injuries o Diabetes, rheumatic fever,

tuberculosis, jaundice, anaemia

• Drugs and Allergies The drug history should include all current drug therapy, past drug therapy, drugs used for self medication or social drug misuse (if not covered elsewhere). It should include names of individual compounds in any mixture. Known allergies and idiosyncrasies must be listed. Special diets and other forms of treatment (e.g. complimentary) must be recorded. If possible record the generic (pharmacological) and trade (brand) name of any medicines.

• Family History

The patient must be asked about the health and illnesses of their family. This is particularly important when there is a history of familial illness. Details of deaths and ages at death of all deceased first degree relatives must be ascertained sensitively. Constructing a genogram may be helpful.

• Psycho-social History

This should include a history of previous psychiatric illness and treatment. It should also presence of social problems. Where appropriate, it should include a history of suicidal tendencies and sexual activity, impotence or loss of libido. Important social details to include are:-

o occupation (past and current) o finances o alcohol o smoking o drug use o present accommodation o pets o hobbies and pastimes o patient profile - describe an

average working day and a typical day of leisure

Systemic Enquiry

• Cardiovascular/Respiratory Systems o Cough, including sputum,

quantity and appearance, any haemoptysis

o Shortness of breath o Chest pains o Palpitations o Ankle swelling o Venous problems, such as

varicose veins or venous thrombosis

• Gastrointestinal System

o Sore mouth or tongue o Difficulty in swallowing o Acid regurgitation or

waterbrash o Heartburn o Appetite o Weight change o Nausea o Vomiting o Abdominal pain o Abdominal swelling or bloating o Flatulence o Pruritus o Easy bruising o Bowel frequency, consistency,

rectal bleeding

•

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• Urogenital System o Dysuria o Nocturia o Frequency o Haematuria o For men: difficulty in starting,

or dribbling, testicular pain or swelling, sexual orientation

o For women: periods - days of loss, last menstrual period, dysmenorrhoea,

o menorrhagia, how often? Inter-menstrual bleeding, post -

o menopausal bleeding o Breast lumps. Contraception

• Neurological System

o Mood, memory and concentration

o Faints, fits or loss of consciousness

o Headache o Trouble with eyesight o Trouble with hearing, dizziness o Speech o Weakness and lethargy o Clumsiness o Numbness and tingling o Gait

• Endocrine System

o Irritability o Polydipsia, polyuria o Skin and hair - dryness, acne

• Musculoskeletal system

o Back pain or stiffness o Joint pain or swelling o Muscle pain o Limitation to activities upper

and lower limb function

Vital signs Blood Pressure Pulse Respiratory rate Temperature Oxygen saturation Summary of findings Provide a brief summary of case

Differential Diagnosis

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The Physical Examination This is a basic schematic outline of aspects of the physical examination. In individual tutorials, examination of specific systems will be dealt with in much greater depth. Students should also refer to a good basic textbook of clinical examination. General

• General impression: looks ill?, appearance appropriate to age?, alert and co-operative?

• Body size (e.g. obese, thin, cachexia). Height and weight may be useful (e.g. to calculate BMI [body

• mass index = height (m) divided by weight (kg) squared - m/kg2).

• Appears short of breath • Oedematous (where - how high) • Pallor • Cyanosis • Dehydration • Jaundice • Pigmentation • Lymphadenopathy (where) • Goitre • Breasts • Hair • Mouth • Tongue • Teeth • Clubbing

Cardiovascular System

• Pulse: rate, rhythm, character, peripheral pulses

• Blood pressure • Capillary circulation • Jugular venous pressure • Oedema • Abnormalities of venous circulation • Examination of the Heart

o Inspection : precordial and apical pulsation

o Palpation: apical position, character of cardiac pulses

o Auscultation: heart sounds, added sounds, murmurs

Respiratory System

• Inspection: respiratory rate, chest shape, symmetry, movements including use of accessory muscles of respiration, expansion (possibly measured with tape measure)

• Palpation: tracheal deviation or position of cricoid, tactile vocal fremitus

• Percussion: percussion note, liver dullness

• Auscultation: breath sounds, crackles (crepitations), wheezes

Abdomen

• Inspection: size, scars, bruising, visible masses, visible peristaltic movements, stomata or drains

• Palpation: tenderness, masses, • Percussion: organs, hernial orifices,

dullness • Auscultation: bowel sounds, bruits,

borborygmi • Rectal examination • Male external genitalia

Nervous System

• Level of consciousness (include. Glasgow Coma Scale when appropriate), orientation, mood, memory, general knowledge

• Speech • Cranial Nerves I - XII (generally

excluding taste) • Motor Symptoms: wasting and

involuntary movements, tone, power, co-ordination

• Reflexes • Sensory System: touch, pain and

temperature, vibration sense, proprioception (joint position sense)

• Position and Gait Musculoskeletal System G.A.L.S Regional examination of joints Look, feel, move, function

• Limbs: deformity, swelling, full range of movements active and passive , tenderness, fluid, crepitus

Lumps If any masses or enlarged organs are palpable, the following characteristics should, where appropriate, be described:

• location • size, shape and number • consistency • character of surface • tenderness • colour • temperature • mobility • transillumination • pulsation • involvement of adjacent or associated

structures (e.g. fixation to deep tissues, regional lymphadenopathy)

• resonance to percussion • auscultation

Gynaecological Examination Mental State Examination

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Preparation and Practice Sessions These are scheduled for the afternoons. The afternoon before you are

due to present a case to your hospital group is set aside for

preparation. You will be expected to use this time to find a case, take

the history, do the examination and to start preparing your PowerPoint

presentation. Your group mentor will help you find the case. Please get

advice from them on how to do your presentation. You will have seen

2 example presentations before you start doing your own.

The other session is for you to take time to take a full history and to

do examinations that you are comfortable with on a patient in the

wards. The tutor who takes you in the morning should be asked for a

number of suitable cases for history and examination. We would like

you to do this in pairs (or as groups of 3) initially. Please remember to

do this politely and properly. Introduce yourself to the ward sister and

ask their permission to be in the ward. Check with the ward sister if

the suggested patient is well enough to spend a few hours discussing

their history with you. (They may have procedures or other activities

scheduled). Remember to wash your hands on entering the ward.

Then introduce yourself to the patient and ask permission to take their

history. Explain that you are a junior medical student and that you will

not be in a position to comment on their medical condition. Ask them if

they can spare some of the afternoon to talk to you. If they say no

respect this and go to another patient. The ward sister should be able

to help you identify someone else. Once completed the history should

be written out and then handed in to your group mentor.

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Guide to the Presentation

Please choose a patient with a good history as this is the main

objective at this stage in your training. You should also present your

examination findings. Develop a diagnosis, anatomical, pathological

and special pathological (with investigations). Summarise your findings

into a typical clinical summary. Finally if there are relevant features

that you have covered in anatomy, physiology etc. please review these

as part of the presentation. This will help you and your audience

reinforce the learning that you have already done in medical school.

Please use Power Point for your presentations. Use a good font size

(nothing smaller than 18pt), only use 6 lines per slide and use a colour

combination that projects well. Avoid the use of the special features in

power point unless they do not distract from your presentation.

You may use graphics where appropriate. It is not usual to take

photographs of your patients without proper consent. The hospitals

usually limit this to the photography section in the hospital.

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MEDICAL HISTORY PRO-FORMA MRN:………………………… DOB/AGE:…………………………… GENDER:……………………………….. ETHNICITY:………………… MARITAL STATUS:……………… OCCUPATION:………………………. PRESENTING COMPLAINT: HISTORY OF PRESENTING COMPLAINT: PAST MEDICAL HISTORY: PAST SURGICAL HISTORY: MEDICATION; ALLERGIES; PSYCHOSOCIAL HISTORY; FAMILY HISTORY: SYSTEMATIC ENQUIRY: CVS RS GI/ABDO NEURO /PNS/CNS GU MSK ENDOCRINE GENERAL IMPRESSION; VITAL SIGNS: TEMP PULSE BP RESPS O2 SATS SUMMARY: DIFFERENTIAL DIAGNOSIS;

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