UNIVERSITY OF DUBLIN

TRINITY COLLEGE SCHOOL OF MEDICINE

INTRODUCTION TO FUNDAMENTALS OF CLINICAL AND

PROFESSIONSAL PRACTICE

ESSENTIAL CLINICAL SKILLS

2nd Year

2009/2010

St James Hospital (SJH)

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CONTENTS University of Dublin......................................................................... 1

Map ............................................................................................... i

Contents........................................................................................ ii

Aims, Objectives, Clinical Skills Year 2 ............................................... 4

Course Format................................................................................ 5

Assessment, Evaluation, Timetables .................................................. 6

Student Lists .................................................................................. 7

General Structure Radial AM............................................................. 8

General Structure Radial PM ............................................................. 9

MDT and elective care allocation History Taking.............................10-13

Tutor allocation and Contact lists..................................................... 14

Case Presentation Timetable........................................................... 15

Venues & Contacts .................................................................... 16,17

Course requirements .................................................................18-20

History Taking ..........................................................................21-23

Guide to the Presentation ProForma................................................. 24

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Aims The Year 2 Introduction to the Fundamentals of Clinical and Professional Practice & Essential 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, P, 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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COURSE FORMAT

Time: Tuesdays in Term Time from 9am - 4pm x approx 32 weeks but includes holidays , revision weeks, research projects. Venue: Tallagh Hospital / St James’s Hospital

Standardised program on 2 sites, only movement is for Tallagh 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 then listed as belonging to a Group from 1-10 and further divided to person A,B,C,D,E,F,GH,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 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 examination practice)

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Course Timetable: 9.00 - 09.50 Clinical History Presentations x 3; Montgomery Theatre 10.00 – 11.50 Clinical activity 12.00 – 12.50 Seminar ; Montgomery Theatre 14.00 - 16.00 Introduction to clinical practice ; Various Venues

Assessment ALL students are required to submit a log book and pass an Objective Structured Clinical Examination (OSCE)

• The log book incorporates a record of attendance at 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. Student’s feedback will influence the content and format of subsequent years.

Time Tables • The first list is a hospital specific breakdown of subgroups for

those rotations that require smaller groupings. This is where the letter A,B,C,D,E,F,G,H,I alongside your name in the list of groups is important. Please attend the correct allocations.

• The next are the radial wheels of the general structure of the 10am-12md & 2-4pm timetable allocations.

• The next is the overall time table for the AM & PM sessions. Here the groups are simply referred to as 1-10.

• Following on is the specific breakdown of the Am MDT allocation and the PM Clinical Practice (OPD) allocations.

• Next is a hospital specific tutor list for the bedside teaching and case Presentation dates.

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SJH MEDICAL /DENTAL STUDENTS 2009/2010 GROUP A1 Dr Murat GROUP A2 Dr Bee

A Ciara DUNLEAVY A Renuka Rasmani DURGANAUDU

B Helen Mary FOGARTY B Ann Therese FORAN

C Leanne HANRAHAN C Elizabeth HARBOTTLE

D Vhari JAMES D Grace KEARNEY

E Ali Altaf E Bibi Fathima Patel

F Edward Fahy F Ciara O’Reilly

G Claire Anne MURPHY G Grainne Marie MURRAY

H Shane David O'SULLIVAN H Sing Ying PANG

I Callum Patrick SWIFT I Kelsey TALLON

GROUP A3 Dr Donoghue GROUP A4 Dr Woo A Nahla Ahmed EL-ERAKY A Noha EL-ERAKY

B Ara FRANCIS B Brian GALLAGHER

C Eimear Marie HAYES C Lydia Iris HEALY

D Bronagh Marie KELLY D Cathal KELLY

E Ciara Ni Uallachain E Davina Graham

F Caroline Marron F Rikotamenee Hange

G Jean Teresa MURTAGH G Ananya NARENDRA

H Hadia PARYANI H Aathiththan PATHMANATHAN

I Liam TOWNSEND I Teresa TREACY

GROUP A5 Dr. Sundaram GROUP A6 Dr Nash A Sinead FAHY A Hayley Rebecca FAIRBAIRN

B Catriona Mary GALLAGHER B Sarah GOREY

C Naoimh HERLIHY C Kate Mary HOLOHAN

D Cheryl KEMSLEY D Patrick Joseph KERR

E Hamed Fesharaki E Karen Grealis

F Fatimah Al Jumah F Nural Aminuddin

G Rachel NICKEL G Nik Nurul Athirah NIK KAMARUDIN

H Sarah PHELAN H Clare QUIGLEY I Richard Kevin VARINI I Robert Barry VARLEY

GROUP A7 Dr Lee GROUP A8 Dr Picardo

A Gary Gerard Charles FAUGHNAN A Iseult FINN

B Irene GORMAN B Sean GRACE

C Kathryn HUNTER C Christopher HYNES

D Fatima Mousa KHADADAH D Amarah KHAN

E Michelle Dunne E Sinead O’Sullivan

F Graham Campbell F Peter McDonnell

G Cian Francis O'CARROLL- LOLAIT G Molly O'CONNELL

H Eoghan QUIGLEY H Syazwani RAHIM

I Joan Kar On WAI I Donal WALLACE J Samantha Martin

GROUP A9 Dr Gallagher GROUP A10 Dr Kunal A Margaret FLANAGAN A Rachael Mary FLOOD

B Conor Francis GRANT B Orna GRANT

C John HYNES C Demetri IOANNOU

D Varun KHANNA D Allan KLOMPAS

E Laurna McNamara E Gayahri Vasanthakumar

F Mohammad Nawab F Folake OGUNLEYE

G Eabhann O'CONNOR G Aoife O'HANRAHAN

H Leona Marie REILLY H Ian REYNOLDS

I Rebecca Claire WEEDLE I Ivan WELARATNE

J Niamh O’ Dwyer J Ahman AL QATTAN

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Year 2: General Structure - Tuesday AM

Clinical Skills 1

Hx & Exam CNS

Hx & Exam MSK

Hosp Dept Visits

Hx & Exam PNS Hx &

Exam ABDO

Clinical Skills 2

Hx & Exam RESP

Hx & Exam CVS

MDT 1

Core 10am-12md

AM

Seminar 12-13.00

LUNCH 13.00- 14.00

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Year 2: General Structure - Tuesday PM

Clinical Skills 3 Out

Patients Dept

ECG/ X-Ray

Case Hx

Prep

Case Hx

Prep MSK Practical

ECG/ X-Ray

Comm Skills

Clinical Skills 4

Comm Skills

2-4pm

PM

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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 & 5

Classroom Skill 2 & 6

MDT 1 MDT 2

29 Sept Introductory Week 6th Oct 1 2 3 4 5 6 7 8 9 10 13th 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 03-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 01-Dec 3 4 5 6 7 8 9 10 1 2 REVISION + 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 02-Feb 10 1 2 3 4 5 6 7 8 9 09-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 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 06-Apr 4 5 6 7 8 9 10 1 2 3 12-Apr 3 4 5 6 7 8 9 10 1 2 FINAL MED EXAM 27-Apr 2 3 4 5 6 7 8 9 10 1 3-21 May REVISION & EXAMS 24 May – 10 June

CLINICAL SKILLS REVISION

TBC OSCE

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COMPLIMENTRY MORNING ACTIVITIES (MDT) –AM- SJH

MDT AM

Sub group Angio PFT ECG

Endos copy SALT Xray

Resp Assess

Unit Sub

group

Medel Day

Centre Physio Xray OT MDT - Medel

Cardiac Rehab

6th Oct 9 A B C D,J E,F G,H I 10 A B,C,D,E F G H,J I

13th Oct 8 A B C D E,F G,H I 9 A B,C,D,E F G H,J I 20-Oct 7 A B C D E,F G,H I 8 A B,C,D,E F G H I 27-Oct 6 A B C D E,F G,H I 7 A B,C,D,E F G H I 03-Nov 5 A B C D E,F G,H I 6 A B,C,D,E F G H I 10-Nov 4 A B C D,J E,F G,H I 5 A B,C,D,E F G H, J I 17-Nov 3 A B C D,J E,F G,H I 4 A B,C,D,E F G H I 24-Nov 2 A B C D E,F G,H I 3 A B,C,D,E F G H I 01-Dec 1 A B C D E,F G,H I 2 A B,C,D,E F G H I Revision & Exams 19-Jan 10 A B C D E,F G,H I 1 A B,C,D,E F G H I 26-Jan 9 G H I,A B C,J D,E F 10 D G,H,I,A B E,J F C 02-Feb 8 G H I,A B C D,E F 9 D G,H,I,A B E,J F C 09-Feb 7 G H I,A B C D,E F 8 D G,H,I,A B E F C 16-Feb 6 G H I,A B C D,E F 7 D G,H,I,A B E F C 23-Feb 5 G H I,A B C D,E F 6 D G,H,I,A B E F C

Research 23-Mar 4 G H I,A B C,J D,E F 5 D G,H,I,A B E, J F C 30-Mar 3 G H I,A B C,J D,E F 4 D G,H,I,A B E F C 06-Apr 2 G H I,A B C D,E F 3 D G,H,I,A B E F C 12-Apr 1 G H I,A B C D,E F 2 D G,H,I,A B E F C Finals Exam 27-Apr 10 G H I,A B C D,E F 1 D G,H,I,A B E F C

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

SKILLS CASE PRESENTATION

PREPARATION ECG/X-Ray MSK practical

(ALL at St James's

Classroom Skill 3 & 7

Classroom Skill 4 & 8

Elective Care

29 Sept Introductory Week 6th Oct 1,2 3,4 5 6 7 8 9,10 13th Oct 9,10 1,2 3 4 5 6 7,8 20-Oct 7,8 9,10 1 2 3 4 5,6 27-Oct 5,6 7,8 9 10 1 2 3,4 03-Nov 3,4 5,6 7 8 9 10 1,2 10-Nov 1,2 3,4 6 5 8 7 9,10 17-Nov 9,10 1,2 4 3 6 5 7,8 24-Nov 7,8 9,10 2 1 4 3 5,6 01-Dec 5,6 7,8 10 9 2 1 3,4 REVISION & EXAMS 19-Jan 3,4 5,6 8 7 10 9 1,2 26-Jan 1,2 3,4 5,6 7 8 9,10 02-Feb 9,10 1,2 3,4 5 6 7,8 09-Feb 7,8 9,10 1,2 3 4 5,6 16-Feb 5,6 7,8 9,10 1 2 3,4 23-Feb 3,4 5,6 7,8 9 10 1,2 RESEARCH 23-Mar 1,2 3,4 5,6 7 8 9,10 30-Mar 9,10 1,2 3,4 5 6 7,8 06-Apr 7,8 9,10 1,2 3 4 5,6 12-Apr 5,6 7,8 9,10 1 2 3,4 FINAL MED EXAMS 27-Apr 3,4 5,6 7,8 9 10 1,2 3-21 May REVISION & EXAMS 24 May – 10 June CLINICAL SKILLS REVISION/ BEDSIDE ASSESSMENTS TBC OSCE

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INTRODUCTION TO CLINICAL PRACTICE (OPD) -PM-SJH MDT 1 MDT 2

OPD PM Subgroup

Prof Nolan OPD

Dr Walsh/ Cunningham

Mr McCarthy/

Mr McKenna Subgroup

Mr McDermott

Dr O' Connell

Mr Butt/

Dr Connolly

Dr B Silke AMAU

06-Oct 9 A,B C,D,G, H,I,J 10 A B,C D,G (R1) H,I,J 13-Oct 7 A,B C,D,G H,I 8 A B,C D,G (R2) H,I,J 20-Oct 5 A,B C,D,G H,I 6 A B,C D,G (R1) H,I 27-Oct 3 A,B C,D,G H,I 4 A B,C D,G (R2) H,I 03-Nov 1 A,B C,D,G H,I 2 A B,C D,G (R1) H,I 10-Nov 10 A,B C,D,G H,I,J 9 A B,C D,G (R2) H,I,J 17-Nov 8 A,B C,D,G H,I,J 7 A B,C D,G (R1) H,I 24-Nov 6 A,B C,D,G H,I 5 A B,C D,G (R2) H,I 01-Dec 4 A,B C,D,G H,I 3 A B,C D,G (R1) H,I

Revision & Exams 19-Jan 2 A,B C,D,G H,I 1 A B,C D,G (R2) H,I 26-Jan 9 G,H I,J,A,B C,D 10 C D,G H,I,J(R1) A,B 02-Feb 7 G,H I,A,B C,D 8 C D,G H,I,J(R2) A,B 09-Feb 5 G,H I,A,B C,D 6 C D,G H,I(R1) A,B 16-Feb 3 G,H I,A,B C,D 4 C D,G H,I(R2) A,B 23-Feb 1 G,H I,A,B C,D 2 C D,G H,I(R1) A,B

Research 23-Mar 10 G,H I,J,A,B C,D 9 C D,G H,I,J(R2) A,B 30-Mar 8 G,H I,J,A,B C,D 7 C D,G H,I(R1) A,B 06-Apr 6 G,H I,A,B C,D 5 C D,G H,I(R2) A,B 12-Apr 4 G,H I,A,B C,D 3 C D,G H,I(R1) A,B

Finals Exam 27-Apr 2 G,H I,A,B C,D 1 C D,G H,I(R2) A,B

Tutor lists 2nd year 2009-2010

Name Mentor Group

System Taught

Collection/ Session

Title

Dr Murat Kirca A1 SJH Medical lecturer

Dr Chong Bee A2 Resp Montgomery Theatre

SJH Haematology

Dr Claire Donohoe

A3 MSK Montgomery Theatre

SJH Surgical Lecturer

Dr. Sundaram A5 CVS Montgomery Theatre

SJH Medical

Dr Mary Nash A6 PNS Montgomery Theatre

SJH Medical

Dr Lynn Lee

A7 PNS Montgomery Theatre

SJH Medical

Dr Susan Picardo

A 8 Abdo Montgomery Theatre

SJH Surgical Lecturer

Dr Paul Gallagher

A9 CNS Montgomery Theatre

SJH Medicine SPR Pharmacology

Dr Kunal Patel A10 ECG X Ray

Mcnevin Seminar Room (upstairs Trinity Centre)

SJH Vascular

Dr Martina Hennessy

School of medicine Cirriculum Advisor

mhenness@tcd.ie

Dr Jim Woo A4 OSB 1.12/ Clinical Skills Centre

SJH Registrar Clinical Skills Tutor wooj@tcd.ie

Clare Martin OSB 1.12/ Clinical Skills Centre

Clinical Skills Tutor SJH martinc4@tcd.ie

Triona Flavin OSB 1.15/ Clinical Skills Centre

Clinical Skills Tutor- SJH tflavin@tcd.ie 087-2218735

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SJH – CASE PRESENTATIONS 9-10am

Date 6th Oct Dr Woo, Dr Murat 13th Oct 3,4 20-Oct 1,2 27-Oct 9,10 03-Nov 7,8 10-Nov 5,6 17-Nov 3,4 24-Nov 1,2 01-Dec 9, 10 EXAMS 19-Jan 7,8 26-Jan 5,6 02-Feb 3,4 09-Feb 1,2 16-Feb 9,10 23-Feb 7,8 Research 23-Mar 5,6 30-Mar 3,4 06-Apr 1,2 12-Apr 9,10 Final Med Exams 27-Apr 7,8 EXAMS TBC OSCE

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Fundamentals of Clinical & Professional Practice Location & Contact Details

Site Room Directions

History Presentations & 12o’clock Seminars

SJH Montgomery Theatre

Trinity Centre

Communication Skills SJH Old Stone Building 0.15 and 0.16

Downstairs in Old Stone Building

Classroom Skills 1

SJH Clinical Skills Room 1.12 & 1.15

Upstairs Old Stone Building

2

SJH Clinical Skills Centre (CSC)

Lt of Luas Line SJH, Downstairs (CSC)

ECG / X-ray Tutorial Dr Kunal Patel

Trinity Centre SJH

McNevin Seminar Room

Upstairs Trinity Centre

MSK Practical Emer Barrett

Trinity Centre SJH

Lecture room Please bring Shorts & T-shirt

Clinical Skills Centre

SJH Multidisciplinary Team (MDT) AM

MDT 1 Contact Name/Number Location

ECG

Noelle McElholm 4162792

Off Xray (cardiology)

ANGIO Mary Nolan/Anne CNM Sinead Teehan CNS

Off Xray (cath lab)

Pulmonary Function Test (PFT)

Michelle Agnew 4162794

Off Xray (respiratory testing)

*X-RAY Dr Mary Keogan 4162765

Main Xray Lt, 1st rt , 3rd door Lt

Speech & Language therapy (SALT)

Gina O Donough 4162398 Ceire Daly

Red brick building at Rialto Gate @10.30am

Endoscopy Carla Flanagan CNM2 Lt in Main hosp to Route 2, Endoscopy on Right

MDT 2 PHYSIO 1st 2 Stds 2nd 2 Stds

• Sinead Coleman - 4162149 • Barry Kehoe - 4162503

• Hosp 2- 1st fl (middle floor gym)

• Main physio dept Hosp 7 gym

Medel Day Centre SPR/ CNM 4162608 Office

Robert Mayne day Centre

*X-RAY As above Main Xray

O.T. Aoife O Gorman 4164832 Tara Sec 4162307

Near hosp 4

MDT Medel Meeting

Meeting on since 9.30am Prof Walsh

Lt in Hosp 2, through ward doors, 1st door on Rt

Resp Assess Unit Marie Kane Next rt past OPD Route 1. 1st door on Rt

Cardiac Rehab Geraldine Fitzgerald Mary Kerins

Lt Rialto gate

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SJH MDT Location - Tuesday PM

Elective Care

OPD Route 1 take rt before reception

R = Route S = Suite

Group 1

OPD = 2nd rt

Prof J Nolan GI 01-4162488

To main OPD R1 2nd Rt

R1 S5

Prof Walsh/ Dr.Cunningham

Medel OPD Care of Elderly

To main OPD R1 2nd Rt

R1 S1

Mr. McCarthy / McKenna

Orthopaedics 01-4162829

To main OPD R1 2nd Rt

R1 S2

Group 2

Mr McDermott Urology 01-4162160

To main OPD R1 2nd Rt

R1 S2

Dr F O’Connell Respiratory 01- 4162196

To main OPD R1 S3

Mr Butt/ Dr L Connelly

Gems OPD Breast Clinic 01-4162196

R2 1st Corridor on Lt Turn 1st Rt on R1

R2 Phase 1H R1

Dr Silke General Medicine

Contact AMAU SPR. Declan Byrne

AMAU William Wilde ward

Mr. McCarthy / Mr McKenna

Orthopaedics 01-4162829

To main OPD R1 S2

Clinical Skills 2nd year - SJH SESSION SKILL LOCATION 1 Basic Suture Old Stone Building 1.15 2 IV Cannulation Old Stone Building 1.12 3 Eyes/Ears Exam Old Stone Building 1.15 4 BLS- Adult Clinical Skills Centre 5 IV Cann/Suture Old Stone Building 1.15 6 Vital Signs Old Stone Building 1.12 7 POCT- Urine/Blood

Glucose Old Stone Building 1.15

8 Breast/Testes Exam Old Stone Building 1.12

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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.

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.

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

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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.

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

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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.

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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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

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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

• 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

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Summary of findings Provide a brief summary of case

Differential Diagnosis 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

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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:

o TEMP o PULSE o BP o RESPS o O2 SATS

• SUMMARY: DIFFERENTIAL DIAGNOSIS;

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