Years 5 - 6 Orthopaedics - Stellenbosch...

Years 5 - 6

Orthopaedics Part of Clinical Rotations 65730 678

2013

MB, ChB Phase IV – Late Clinical Rotations

MB, ChB Phase IV – Late Clinical Rotations

2013

ORTHOPAEDICS Part of Clinical Rotations 65730 678

2013

EDITOR:

Dr ICM Robertson

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 0750617675 (Butterworth And Heindmann Ltd.)

2. Apleys System Of Orthopaedics And Fractures, Apley

3. Clinical Orthopaedic Examination, Ronald McCrae-Churchill Livingstone, 1983

4. Practical Fracture Treatment, Ronald McCrae

5. Physical Examination Of The Spine And Extremities, Stanley Hoppenfeld

ISBN 0-8385-7853

6. Kumar and Clarke (Chapter on Rheumatology)

7. Rheumatology notes, 3rd

year lectures

Websites:

1. Departmental Website: http://www0.sun.ac.za/ortho

2. Webstudies: http://webct.sun.ac.za – Module: Late Clinical Rotations 541 and 687 (MS02363).

If you have trouble logging into this site, or the module is not listed please contact.

[email protected]

3. Orthopaedic Department: http://www.sun.ac.za/orthopaedics

4. Orthogate: http://www.orthogate.org/

5. Wheeless Textbook: http://www.wheelessonline.com/

6. Orthoteers: http://www.orthoteers.com/ (Subscription required)

FULL-TIME LECTURERS

NAME OFFICE E-MAIL TEL

Dr J du Toit C6 B West, TBH [email protected] 021-938 5458

Dr ICM Robertson C6 B West, TBH [email protected] 021-938 5458

Dr A Ikram C6 B West, TBH [email protected] 021-938 5458

Dr H de Jongh C6 B West, TBH [email protected] 021-938 5458

Dr S Pretorius C6 B West, TBH [email protected] 021-938 5458

Dr I Terblanche C6 B West, TBH [email protected] 021-938 5458

Dr G du Preez C6 B West, TBH [email protected] 021-938 5458

Dr JH Davis C6 B West, TBH [email protected] 021-938 5458

Dr T Franken Worcester Hospital [email protected] 023-348 1100

Dr A Basson Worcester Hospital [email protected] 023-348 1100

Dr. A. Hess Caledon Hospital [email protected] 028-212 1070

RHEUMATOLOGY LECTURERS

NAME OFFICE E-MAIL TEL

Dr Mou Manie Room 3127, clin build [email protected] 021 938 5527 / 5731

Dr Riette du Toit Room 3071, clin build [email protected] 021 938 5527 / 5731

Dr Dave Whitlelaw Room 3062, clin build [email protected] 021 938 5527 / 5731

Dr Lisa du Plessis Room 721 , TBH [email protected] 021 938 5527 / 5731

Dr Robert Cooper Room 721 , TBH 021 938 5527 / 5731

Dr Joe Latief Room 3067, clin build [email protected] 021 938 5527 / 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

http://www0.sun.ac.za/ortho

http://webct.sun.ac.za/

mailto:[email protected]

http://www.wheelessonline.com/

http://www.orthoteers.com/







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 021-938-9266) at least 2 weeks before an OSKE scheduled for Tygerberg

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 5th 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 (6th 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 2013.

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.

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

Topics- Late Clinical Rotation

PATIENT PRESENTATION

MUST KNOW & manage

Own Management details

Must Recognise, emergency management and refer

SKILLS REQUIRED OTHER POINTERS

Examination of a patient

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.

Recognize other systematic

problems in your differential diagnosis

Congenital &

Early developmental diseases

Spina Bifida Early referral, Recognise complications of shunts.

Screen of neonate

Developmental dysplasia hip

Ortolani and Barlow's tests

Club Foot Application of appropriate cast

Cerebral Palsy

Be able to identify case needing possible surgery

Blount's disease

Able to distinguish from bow legs which straightens as child develops.

Painful hip Perthes

Symptoms, signs and X-ray presentation

slipped epiphysis

Symptoms, signs and X-ray presentation

Backache

Mechanical backache

Sepsis : - TB, Pyogenic ; spondylitis Inflammatory back pain

X-rays, Lab tests Differentiate between radiological features of ankylosing spondylitis and osteoarthritis

Know criteria for surgical treatment Recognise extra-articular features of Spondylo-arthropathies

Tumour Early referral, acute management spinal neurology

Slipped Disc Cauda Equina Know criteria for

referral

Shoulder pain Frozen shoulder, rotator cuff syndrome

Exam of shoulder, Steroid injection

Soft tissue injury (acute and cold)

Degloving

Extensor tendon injuries

Flexor / deep tendons

Clinical examination. Know how to suture extensor tendons

Achilles

rupture examination and transfer

All major peripheral nerves

Peripheral nerve injury

Clinical examination. Principles of nerve suture, post operative care

Contaminated wound, open fracture

Know principles of wound debridement. Must assist at least 1 case.

Joint pain (general)

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

Appropriate diagnostic workup; Know principles and complications of treatment

Must know how to examine patient with polyarthritis. How manage a preoperative case with polyarthritis.

Sepsis

Pyogenic arthritis

Know how to manage a patient with septic arthritis. How to aspirate synovial fluid from a superficial joint and do arthrotomy of the knee.

Bone / Joint TB

Know appropriate diagnostic tests. Know anti tuberculosis drugs and length of treatment.

Local Infiltration steroids

Indications and contraindications

Know how to inject steroid into shoulder region, hand and wrist.

Pelvic pain (non-trauma)

AVN/TB/Septic arthritis/osteomyelitis

causes examination, clinical and X-ray features and appropriate management. Know how to aspirate a shoulder, elbow and knee.

Operative skills

Be able to competently assist in theatre, know suture technique, how to debride a wound.

peripheral nerve blocks

Indication and able to perform: Brachial/hand/femoral/foot blocks

Post surgery

Pre and postoperative care

Know rehabilitation programs for different injuries.

Consult and append time with physio and occupational therapists.

Confused Patient

Recognising the causes of post injury confusion and how to manage them.

Role of physio therapy

When to refer to a physiotherapist

Role of occupational therapy.

Trauma

Resuscitation

ATLS principles, how to align fractures and backslab. Management of hypovolaemic shock.

Reduction and traction methods of fractures

How to apply: Thomas/Bohler - Braun frame/ Dunlop/Halter traction/skin/Denham Pin/Gallows’

Transport

Be able to competently assist in theatre, know suture technique, how to debride a wound.

Fractures - must be able to treat conservatively all fractures not mentioned in "Must Recognise" column

Ankle Displaced fracture

How to reduce Importance of early reduction

Foot Displaced foot fractures

Recognise Liz Franc and subtalar dislocations.

Be able to treat undisplaced toe and metatarsal fractures.

Tibia shaft Unstable shaft fractures

Reduction and plaster cast

Care of exfix pins

Tibia plateau / Pylon

Respect for soft tissues, immobilisation

Patella (undisplaced)

Displaced Patella fractures

Early referral, what cases can be treated conservatively.

Femur shaft (child)

Adults with femur shaft

How to immobolize and early referral in adult. Conservative treatment of

Thomas traction, Gallows' traction.

child.

Hip Importance of managing medical complications e.g. DVT, dehydration.

Recognising the occult fracture

Pelvis Open pelvic injuries, displaced acetabular #s

Stabilising pelvic ring fractures, recognising other soft tissue and visceral complications.

Recognise which fractures need referral.

Spine (stable) Spine (Unstable)

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 Proximal fractures, irreducible shaft fractures

Conservative treatment of shaft fractures. How to manage the supracondylar fracture in children.

Radius and ulna (child)

Displaced R&U, single bone #s

Conservative treatment in the child. Recognise fracture dislocations and other pitfalls such as Essex Loprezzi lesion with radial head fractures.

Know how to apply an above elbow cast and know the principles of three point pressure.

Wrist How to diagnose an occult schapoid fracture.

Hand (uncomplicated lacerations)

Complex open hand injuries

Principles of treatment of hand injuries. Know which injuries can be treated conservatively.

Limb reimplantation, criteria for referral, and how to preserve tissue you send with the patient.

Salter (1 & 2) Growth plate injuries (Salter Harris >2)

Importance of Salter Harris classification, prognosis

Dislocations

Shoulder Know how to reduce it by at least 1 method.

Hip Know how to reduce a posterior dislocation. Postoperative care and recognising acetabluar and other associated injury.

Recognise and refer recurrent dislocation.

Knee Early reduction and arteriogram for possible vascular injury.

Sterno-clavicular (anterior)

Posterior Sterno clavicular dislocation.

How to diagnose and refer the posterior dislocation.

Elbow Recognise importance of associated fractures causing instability.

Early referral of unstable dislocations...

Ligamentous instability

Knee Management of acute knee injuries

Recognise lipohaemarthrosis. Know which ACL deficient knees need surgery.

Ankle Displaced ankle fracture

Conservative treatment. How to immobilise.

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.

Plaster casts

Limb Casts Know how to apply a back slab, above and below knee plaster.

Instructions to a patient with newly applied cast. Early follow up of a cast. Recognising compartment syndrome and how to manage it.

Spica Spica syndrome.

reflex sympathetic dystrophy

recognize signs and symptoms and refer

Pin care Extra skeletal

fixation 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.

Primary malignant

Recognise on X ray. Know appropriate special investigations and be able to explain the management to patient.

Metastasis Know common tumours metastasising to bone e.g., prostate. Be able to ask for appropriate special investigations.

Know which metastases in long bones may benefit from internal fixation.

Sport's injury

Recognise Tendon Achilles rupture, stress fractures.

Be able to diagnose / advise patients on common sport's injuries.

Overuse injuries

carpal tunnel, Tennis & golfer's elbow, De Quervain's, trigger finger

Special Investigations

Interpretation of

ESR, common blood tests,serological markers (Rheumatoid factor, ACPA / aCCP, HLA B27) interpretation and analysis of joint aspirate.

X Rays Systematic approach to

When to request stress views, and safely do them

Orthoses Be familiar with common orthoses

Shoe raises, ankle foot orthosis, crutches

Metabolic diseases

Crystal synovitis- causes, risk factors etc

osteoporosis Causes, complications, X-ray signs and appropriate referral.

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.

To 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 AOTC – (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.

TIMETABLE FOR LATE CLINICAL ROTATION – AUGUST – DECEMBER 2013 WEEK 1

TIME MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY SUNDAY

07:30

To

08:30

AOTC Dr S Pretorius Introduction

AOTC Dr ICM Robertson Discussion of fracture Case presentation Article review

AOTC Dr H de Jongh Discussion of fracture Case presentation Article review

AOTC Dr J du Toit Discussion of fracture Case presentation Articla review

AOTC Dr Smith/Consultant Tuesday Firm Discussion of fracture Case presentation Article review

On Call

And

Ward work

As per

timetable

On Call

And

Ward work

As per

timetable

09:00

To

10:30

Dr J du Toit Ward round Paedicatric LMOH G6

Dr ICM Robertson Ward round F4 6

th years

Dr D Whitelaw C7B East 5

th years

Prof Vlok or Registrar C6B East O/P C6B West O/P Spinal clinic

Dr S Pretorius Ward round

Prof GJ Vlok / Dr Davis Ward round

10:30

To

13:00

Dr S Pretorius / Wednesday Firm C6B East POP room POP technique Hand Clinic C6B West

C6B East O/P C6B West O/P

C6B East O/P C6B West O/P Hip clinic Dr H de Jongh

Registrar Tuesday Firm Cold C6B East O/P POP room

AOTC – 12:00

Dr Pretorius Examination of the pelvis and hip joint, knee

AOTC – 12:00

Dr Terblanche Examination of the Foot and ankle

AOTC – 12:00

Dr Ikram or Hand Registrar Examination of the Upper limbs, shoulder, Elbow, hand

LUNCH

14:00

To

15:00

AOTC Prof Vlok / Dr J Davis Tuesday Firm Take clinical history Examine spine and neck

AOTC - 13:30

Academical Program According to Timetable

16:00 On Call and ward work Per timetable

On Call and ward work Per timetable




11 ___________________________________________________________________________________________________________________

Phase IV: (Late) Clinical Rotations – 65730 678 DEPARTMENT OF ORTHOPAEDICS

Faculty of Health Science, University of Stellenbosch. 2012. All rights reserved.

WEEK 2 TIME MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY SUNDAY

07:30

To

108:30

AOTC Dr S Pretorius Discussion of fracture Case Presentation Article review



AOTC Dr J du Toit Discussion of fracture Case presentation Articla review

AOTC Dr Smith/Consultant Discussion of fracture Case presentation Article review

On Call And Ward work As per timetable


09:00

To

10:30

Dr J du Toit Ward round Ward G6 LMOH G6


th years

Dr D Whitelaw C7B East 5

th years

Prof Vlok or Registrar Thursday Firm C6B West O/P- Spine C6B East O/P- Trauma


Prof GJ Vlok/Dr J Davis Ward round

10:30

To

13:00

C6B East O/P C6B West O/P Hand Clinic

10:30 – 12:00 Dr J Davis Plaster Technique Clinical Skills Lab

Thursday firm Cold Clinic C6B East Dr H de Jongh

C6B East O/P C6B West O/P Hip clinic Dr H de Jongh Paediatric Clinic Dr J du Toit

C6B East O/P POP room Registrar Tuesday Firm Cold

AOTC – 12:00

Dr A Ikram Approach to X-rays, local steroid injections

AOTC – 12:00

Dr S Pretorius Open fracture Resus emergency

LUNCH

14:00

To 15:00

AOTC – 13:30

Academical Program According to Timetable

B5 Ms L Arendse (0369) Physiotherapy

AOTC Dr Robertson POP’s, splints, Ex Fixators. Indication for Internal fixation General Orthopaedic Operations. Bone Transplants,arthrodesis Arthroplasty,osteotomy






12

___________________________________________________________________________________________________________________ Phase IV: (Late) Clinical Rotations – 65730 678

DEPARTMENT OF ORTHOPAEDICS Faculty of Health Science, University of Stellenbosch. 2012. All rights reserved.


07:30

To

08:30




AOTC Consultant Tuesday Firm Discussion of fracture Case presentation Article review


On Call

And

Ward work

As per

timetable

On Call

And

Ward work

As per

timetable

09:00

To

10:30


Dr D Whitelaw 6

th years C7B East


th years

Prof Vlok/or Registrar C6B East O/P C6B West O/P Spinal clinic


Prof GJ Vlok / Dr J Davis Ward round

10:30

To

13:00

Consultant Tuesday Firm C6B East O/P Dr A Ikram C6B West O/P Hand Clinic

C7B East RA

C7B East RA

C6B East O/P C6B West O/P Hip clinic Dr H de Jongh Paediatric Clinic Dr J du Toit

11:00 – 12:00

Clinical Skills Lab Dr G du Preez Joint Injection/Asperation

AOTC – 12:00

Dr A Ikram or Hand registrar Approach to the Painful wrist, hand Iinfections, the hand in Rheumatoid arthritis

AOTC – 12:00

Dr N Terblanche Septic arthritis Osteitis

LUNCH

14:00

To 15:00

AOTC Dr D Whitelaw Ruma lecture Clinical approach to Arthritis, principles in Treatment of Rheumatoid arthritis

AOTC – 13:30

Academical Program According to timetable

AOTC Dr J du Toit Paediatric Orthopaedics (CTEV) SUFE Perthes, DDH Limping child






13 ___________________________________________________________________________________________________________________




07:30

To

1

08:30




AOTC Dr J du Toit Discussion of fracture Case presentation Article review




09:00

To

10:30


Dr D Whitelaw 6

th years C7B East


th years

Dr D Whitelaw Rheumatoid Arthritis C7B East


Prof GJ Vlok / Dr J Davis Ward round

10:30

To

13:00

Consultant Tuesday Firm C6B East O/P Dr Ikram C6B West O/P Hand Clinic

10:30 – 13:00

Rheumatoid Arthritis C7B East

Rheumatoid Arthritis C7B East

C6B East O/P C6B West O/P Hip clinic Dr H de Jongh

C6B East O/P POP room

AOTC – 13:00

Dr Pretorius AVN of bone myositis Ossif. Pagets Osteoporosis / osteomalacia / bursitis / tendinitis / tendinosis

AOTC – 12:00

Dr S Pretorius Diff. Diagnosis and approach to shoulder pain, tennis elbow, cubitis varus/valgus

LUNCH

14:00

To

15:00

AOTC Dr J Davis or RegistrarTuesday Firm Approach to low back Pain, causes, treatment

AOTC – 13:30

Academical Program

AOTC Dr N Terblanche Written test Petrusa Groenewald, 4

th

Floor, Clinical Building






14 ___________________________________________________________________________________________________________________




07:30

To

108:30




AOTC Dr J du Toit Discussion of fracture Case presentation Article review

OSKE C6 B West Long case, X-rays Per timetable

09:00

To

10:30

Dr J du Toit

Ward round Paedicatric

LMOH G6

Dr ICM Robertson

Ward round F4

5th

& 6th years

Prof Vlok or Registrar

C6B West O/P

Spinal clinic

C6B East O/P

Dr S Pretorius

Ward round

10:30

To

13:00

Consultant Tuesday Firm

C6B East O/P

Dr Ikram or Registrar

C6B West O/P

Hand Clinic

Dr S Pretorius

C6B East O/P

C6B West Paediatrics

POP room

C6B East O/P

C6B West O/P

Spinal Clinic

Dr N Terblanche

C6B East O/P

C6B West O/P

Hip Clinic

Paediatric Clinic

LUNCH

14:00

To

15:00

AOTC

Dr G du Preez

Acute dislocation of

Joints mechanism

complications and

demonstration of

reductions

AOTC

Dr ICM Robertson

Case study

Trauma

AOTC – 13:30

Academical Program

According to Timetable

AOTC – 12:00

Dr N Terblanche

Case study

Cold

16:00 On Call and ward work

Per timetable

On Call and ward work

Per timetable


Per timetable


Per timetable

15 Phase IV: (Late) Clinical Rotations – 65730 678

DEPARTMENT OF ORTHOPAEDICS Faculty of Health Science, University of Stellenbosch. 2012. All rights reserved.

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.

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 Total

Duration of module in weeks 7 7 6 6 5 5

No of Patients in portfolio during

module

10 10 8 8 6 6 48

Chronic patients through year for

Family Medicine

6 patients 6

Total 54

b. Longitudinal model

Block 1 Block 2 Block 3 Total

3/1- 24/4- 8/8 -

Int 3 4 3 10

Psyc 3 4 3 10

O&G 3 3 2 8

Paed 3 3 2 8

Surg 2 2 2 6

Orth 2 2 2 6

Total 16 18 14 48

Chronic patients through year for

Family Medicine

6 patients 6

Total 54

2. 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.

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

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 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

c 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.

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.

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