Information about Phase 3 Course Guide Course assessments Phase 3 Guide Phase based assessments Vista Course modules Discipline-based modules Biomedical sciences Program website
Information about Phase 3
Course Guide Course assessments
Phase 3 Guide Phase based assessments
Vista Course modules Discipline-based modules Biomedical sciences
Program website
Learning in Phase 3
What do I need to learn? What diseases do I need to know? What do I need to know about them?
Do I just need to know what is clinically relevant?
What things don’t I need to know?
How should I approach learning in Phase 3? Is it better to follow a syllabus or focus on what I
see on the wards, clinics, rooms etc?
Approach to learning - experiential
Based on your clinical experiencesBetter retention (understanding the
relevance and applying knowledge)“Opportunistic”Skewed case mix
Hospitalised patients with complex problems
Consider co-morbidityLimited clinical placements
Approach to learning - structured
Program of topics (“syllabus”)Discipline/system-based
Ensures completeness and avoids gapsOverwhelming list of topicsMay not be able to demonstrate
“credibility”
Focus of learning
Focus on clinical presentations: E.g. an approach to a patient with haematuria
What are the common causes? What conditions may be life-threatening? What features help to distinguish these
causes? What investigations should be performed? What symptomatic treatment is required? What specific treatment is required?
Focus of learning
Focus on syndrome/disease:E.g. glomerulonephritis
AetiologyPathologyEpidemiologyClinical manifestationsDiagnosisTreatment & preventionCourse & prognosis
Learning from a clinical presentation
16 year old male presents with 24 hour history of headache, fever and generally feeling unwell.
On examination, he is febrile and hypotensive. He has neck stiffness and a petechial rash is evident on his limbs.
Learning from a clinical presentation
16 year old male presents with 48 hour history of headache, fever and generally feeling unwell.
On examination, he is febrile and hypotensive. He has neck stiffness and a petechial rash is evident on his limbs.
Pattern recognition
Constellation of symptoms & signs Headache Fever Neck stiffness
Distinguishing epidemiological clues Meningococcus is commonest cause of meningitis
in adolescents.
Distinguishing clinical features Petechial rash is indicative of meningococcus.
Meningitis
Learning approach to a presenting problem
What are the common causes? What conditions may be life-threatening?What features help to distinguish these
causes?What investigations should be
performed?What symptomatic treatment is
required?What specific treatment is required?
Approach to management
Headache, fever & neck stiffness = meningitis
Empirical treatment
Definitive treatment
Clinical assessment
Investigations LP, imaging studies, blood cultures, serology
Epidemiology and clinical features of microbial causes of meningitis
Antibiotics, corticosteroids, supportive treatment (shock, raised intracranial pressure)
Antibiotics, public health measures (isolation, chemoprophylaxis, vaccination)
Lumbar puncture (diagnostic test)
Indications for LPHow is it performed?Interpretation of results
Limitations (sensitivity, specificity)Safety of procedure
Contraindications
Approach to management
Headache, fever & neck stiffness = meningitis
Empirical treatment
Definitive treatment
Clinical assessment
Investigations LP, imaging studies, blood cultures, serology
Epidemiology and clinical features of microbial causes of meningitis
Antibiotics, corticosteroids, supportive treatment (shock, raised intracranial pressure)
Antibiotics, public health measures (isolation, chemoprophylaxis, vaccination)
Empirical antibiotics in meningitis
What antibiotics are used empirically? What is the rationale for the choice?
Specific drugs (penicillin, ceftriaxone, vancomycin) Type of drug Mechanism of action (spectrum of activity) Pharmacokinetics Efficacy Toxicity Mechanisms of resistance
Prevention
Treatment
DiagnosisClinical features
Pathogenesis
Structure
Type of organism
Meningococcus
What do you need to know?
Breadth (scope)Common
Clinical experiencesCourse guidesTextbooks
ImportantLife-threatening “Classical” – illustrates an important concept
What do you need to know?
Depth Common
Emphasis on management – knowledge and ability to diagnose and treat
Important Life-threatening
Recognition and early management “Classical”
Defined area of knowledge
Uncommon/rare Awareness – when to suspect.
Case reports/presentations
Refer to course guide for precise requirements.
Supervisor/school has flexibility in determining number and type.
Assessed by supervisor or school Not submitted to eMed for assessment.
Can be submitted,with completed assessment form,to eMed as supporting evidence,
Observed clinical assessments
Refer to course guide for precise requirements.
Supervisor/school has flexibility in determining number and type.
Assessed by supervisor or school Formative assessments by junior staff
Completed assessment form can be submitted to eMed as supporting evidence.
Clinical log sheets
Record of interesting patients and issuesOptional for most coursesMay be used in end-of-phase Integrated
Clinical Examination Prompt for discussion of clinical problems
Negotiated assignments
Optional.Fill in gaps in portfolioAddress deficiencies.
Negotiate with supervisor or school.No need to submit proposal to eMed.
End-of-Phase Integrated Clinical Examination
Clinical and communication skillsVariable format depending on disciplineStations with real patients
Focussed history and/or examination.Variable duration (10-20 mins)
Stations with surrogates (including professional actors)
Examiner in role-playStations with clinical images or videos