General Practice Learning Guide 2012-2013

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General Practice | Learning Guide 2012-2013

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University of Western SydneySchool of Medicine

General PracticeLearning Guide 2012/2013

Bathurst Rural Clinical SchoolUniversity Centre for Rural Health North CoastUrban Rotations, Department of General Practice

Department of General Practice

Coordinator Jenny Reath Chair and Professor

Lawrence Tan

Jane Barker

Ross Wilson

Urban Course Convenor

North Coast CourseConvenor

Bathurst Course Convenor

Melinda Wolfenden

Georgia Millen

Administrative Officer

Placement Support

(10 Jan 2013)


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Contents

OVERVIEW OF GENERAL PRACTICE TEACHING PROGRAM ......................................................... 3

Welcome ......................................................................................................................................... 3

Program Aims ................................................................................................................................. 3LEARNING OUTCOMES ........................................................................................................................ 4

Learning activities in urban and rural sites ..................................................................................... 5Assumed prior learning................................................................................................................... 6

LEARNING IN GENERAL PRACTICE ATTACHMENTS ...................................................................... 7

Student responsibilities................................................................................................................... 7GP Supervisor roles ....................................................................................................................... 9Other Health Professionals ............................................................................................................ 9Schedule of Activities in Urban (5 week) General Practice Attachments ..................................... 11

WHO TO CONTACT... .......................................................................................................................... 12

Department of General Practice ................................................................................................... 12Rural Clinical Schools................................................................................................................... 12

GENERAL PRACTICE CURRICULUM MAP ....................................................................................... 13

ASSESSMENTS ................................................................................................................................... 20

Satisfactory Assessment and Grading ......................................................................................... 23

EVALUATION ....................................................................................................................................... 24

FORMS AND ASSESSMENT GUIDES ................................................................................................ 26

Practice Based Learning Activity Questions ............................................................................... 26Practice Based Learning Activity Template .................................................................................. 31Assessment Criteria for Practice Based Learning Activities ........................................................ 32

General Practice Attachment Learning Plan ................................................................................ 33General Practice Mini - CEX ........................................................................................................ 35Health Professional Practice Visits ............................................................................................... 41Year 5 & Rural General Practice Clinical Attachment Assessment ............................................. 43General Practice Supervisor Checklist ......................................................................................... 45General Practice Attachment - Student Evaluation ......................................................................46

END OF GP ATTACHMENT SUBMISSION CHECKLIST ................................................................... 47
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Overview of General Practice Teaching Program

Welcome

Welcome to the General Practice Teaching Program! We hope you will find your time in GeneralPractice a rewarding experience that will be relevant to your future careers, whatever specialty you

choose. Not everyone can or will become a GP, but a good understanding of General Practice willassist you to provide better care for your patients.

General Practice offers a distinctive approach to medical practice that is largely practiced in thecommunity. It is characterised by the following principles:

Continuity of care: the doctor-patient relationship is maintained over time and through different statesof health and illness.

Patient centredcare: focus on the patient as a person first and foremost. Family and community centred care: care that recognises that the patient is a member of a family

and of a community.

Comprehensive care: port of first call for persons seeking healthcare in the community, assessment ofundifferentiated presentations, care of acute, chronic and complex problems, disease prevention andhealth promotion across all age groups.

Coordination of care: especially care provided by multidisciplinary teams A practical clinical approach to the management of uncertainty Advocacy for individuals and communities Organisational and practicemanagement skills Professionalism focused on the doctor-patient relationship, reflective practice and ongoing learning

An interdisciplinary approach to research and use of evidence

Understanding the importance of these principles to improving health outcomes across all health

care systems, and how to apply them to clinical practice are core to the teaching program.

In keeping with the philosophy of the UWS Medical Program, we have focused on experientiallearning, with guidance. There are core and student selected parts to the program so you canchoose areas that interest you, or that you need to address. A 5 week attachment cannot give youa comprehensive view of General Practice, but should give you a good opportunity to consolidateyour clinical skills in a new clinical setting, as well as learn about the realities and rewards ofcommunity engaged medical practice .

We welcome your feedback as we will be regularly reviewing the program to ensure that it remainsinteresting and relevant. You are encouraged to contribute to the formal evaluation, and/or to

contact staff at any time (see page 12).

Program Aims

We aim to give you a broad understanding of the many roles of general practitioners in primarycare and of their central contribution to a well functioning health care system. As graduates, youshould be able to:

Apply a sound understanding of the principles of General Practice and of the roles of general

practitioners to benefit the care of your patients, and

Work collegially with general practitioners to ensure that your patients experience well

coordinated and integrated care.


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Learning outcomes

At the end o f the Year 5 General Pract ice teachin g pro gram, you sho uld b e able to:

A. Safely perform an initial assessment of common primary care presentations, and formulate a

diagnostic and management plan appropriate to General Practice.

B. Safely perform common clinical procedures and associated processes, including deciding

when they are indicated, obtaining informed consent, explaining results and follow up

information to patients.

C. Apply key principles of General Practice to individual patients and to population groups within a

practice (e.g. persons over 65 years within a practice).

D. Appreciate and explain differences in community based medical practice as compared to other

clinical settings.

E. Reflect on your experiences with patients and colleagues to identify personal strengths and

skills, and areas where attention is required. Plan and carry out learning strategies for your

ongoing professional development.

These outcomes will be achieved through the following approaches to learning:

Guided experiential learning: Clinical attachments in General Practice Visits to other health professionals within the GPs referral network Mini-CEX Practice based learning activities (PBLAs)

Formal structured learning:

Back to base sessions during your clinical attachment Conference Weeks

Self-directed and student selected components:

An individualised Learning Plan Practice based learning activities (PBLAs) Reading and reflection Your own ideas!

For further details about specific learning outcomes and how they relate to teaching and learningactivities, and to assessment (see Curriculum Map page 13).


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Learning activities in urban and rural sites

A range of learning opportunities will be offered:

GP Attachment: Urban si tes

Experiential learning over 5 weeks with 3 days per week (6 sessions) in General Practices

under the supervision of a GP Supervisor. Some urban students will have the opportunity toundertake this placement in a special interest attachment such as Justice Health, combinedwith a mainstream General Practice attachment. Your learning will be guided by your LearningPlan and clinical activities such as mini-CEX that you will complete with your Supervisor.

Structured sessions. There will be 3 back to base sessions to (1) introduce key principles inGeneral Practice (2) review your progress and present one of your Practice Based LearningActivities, and (3) finish your attachment with a wrap up and debriefing session.

Practice based learning activities (PBLAs). These are short written activities based on actualpatients or practices. You will be required to choose one PBLA that best suits your LearningPlan, from each of 3 different groupsof PBLAs.

GP Attachment: Rural Cl in ical Schoo lsFor North Coast students

Experiential learning over 8 weeks with 2 days per week in a General Practice beingsupervised by a GP Supervisor and approximately half day per week with other healthprofessionals. Your attachment will be integrated with Indigenous Health.

Structured sessions, to be scheduled by North Coast University Centre for Rural Health. Practice based learning activities, as above.

For Bathurst students

Experiential learning over 4 weeks with 4 days per week in a General Practice being

supervised by a GP Supervisor and approximately half a day per week with other healthprofessionals.. Structured sessions, to be scheduled by Bathurst Rural Clinical School. Practice based learning activities, as above.

Conf erence Week

All students will return to the Campbelltown campus for Conference Weeks. During these weeks avariety of structured and interactive sessions will be provided to assist you to achieve the GeneralPractice learning outcomes.

Dermatology teaching

Skin conditions commonly present in general practice, outpatient and community settings.Students are often asked to examine and discuss skin conditions during their general practiceattachments. Dermatology is incorporated into the General Practice teaching program, andincludes:

Half-day Conference Week workshop, including lecture overview of Dermatology and handson practice in skin biopsies, suturing and topical medications.

Clinical experience, including:o Urban students: compulsory visit to the Skin and Cancer Foundationo Rural students: attachments in rural general practices with opportunities to observe

and assist in procedural dermatology.

o Online Skin and Cancer Foundation dermatology modules on vUWS. All studentsare required to complete these during their GP term.


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Assumed prior learning

The Year 5 General Practice teaching program was developed in the light of what you shouldalready have learnt, curriculum standards in General Practice, and in consultation with GPs,students and the community. It therefore assumes that you have acquired the following

knowledge, skills and experiences. Having these will allow you to add to your learning during theGP attachment:

Sound knowledge of the basic sciences required for the clinical assessment and managementof the common presenting conditions in General Practice.

Good knowledge of, and many hospital based opportunities to practice basic clinical skills,including history taking, physical examination, common procedures and investigations.

Practice in advanced communication skills with simulated patients. Better knowledge in some specialties where youve had clinical attachments. Good knowledge about working in the community and an understanding of the patient

experience. Good knowledge of the epidemiology and management of health risks, including national

priority areas such as hypertension, diabetes, obesity, cancer, dementia, mental health,asthma and chronic obstructive respiratory disease.

Some knowledge of diseases and conditions across the lifespan: from birth, childhood,pregnancy, aged care and death, and common preventive health activities such as antenatalcare, childhood immunisation and womens health check- ups.

Limited opportunities to independently assess and formulate management plans for patients.

In particular, the Year 5 program aims to build on your Year 3 MiC General Practice placementand lectures. During this attachment you should have:

Started to appreciate the many roles that GPs can have in the community Observed how GPs engage and interact with community services Been introduced to the range of presentations seen in General Practice and the skills required

to assess and manage them. Started to identify ways in which General Practice differs from hospital based practice in the

approach to diagnosis, investigation, treatment and follow up. Learnt about the role of General Practice in primary health care, and the place of primary care

in a well functioning health care system.

Learning pointHow might carrying out these student

responsibilities help you both in your GPattachment and after you graduate?


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Learning in General Practice AttachmentsAs your time in General Practice will be short, it is important to use your time well to maximiseyour learning.

Student responsibilities

Before you r f irst day

Contact your GP Supervisor at least a week before the attachment begins and confirm your

arrival time, practice location, transport and other practical issues such as expected dress,

identification, documentation, and equipment to bring, as practices can vary in style.

Think back to your previous experiences of General Practice and community based healthcare.

What are 3 learning outcomes, preferably linked to your Health Professional (HP) visits that

you would like to achieve during this General Practice attachment? Write these in your

Learning Plan (see Page 33).

Familiarise yourself with key references and resources, in particular

o Murtaghs General Practice,

o the RACGP site MyGeneralPractice and the

o GP Companion produced by the GP Student Network.

These resources have essential clinical information that will help you to make the most of your

practice attachments and to complete your PBLAs. All are available online through the GP

Resources webpage [see vUWS folder General Practices>Resources]

On your f i rs t day

First impressions count. Students can gain much from hands-on learning, so help your

Supervisor to know that you can be trusted to see their patients. Be punctual and dress appropriately.

Actively participate in your own orientation by introducing yourself to all staff members and

understanding their roles.

Meet with your GP Supervisor:

o Schedule a time in your first week to discuss your Learning Plan and the strategies that

will address your learning goals.

o Review the names and contact details of other health professionals in the GPs referral

network, such as pharmacists, imaging services, other specialists, allied health,

community health centres, patient groups, etc whom you can visit to address yourlearning goals and GP attachment requirements.

o Ask about upcoming continuing professional educational events such as those

organised by the local Division of General Practice and Regional Training Provider that

you can attend.

o Confirm attendance times and days as per attendance requirements.

Minimum attendance requirements:

o General Practice:

Urban sites: 6 sessions per week over 5 weeks.

North Coast: 4 sessions per week over 8 weeks.Bathurst: 8 sessions a week over 4 weeks

[One session = one half-day in General Practice]


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o Attendance at other Health Professional practices is counted separately (see page 9).

o Attendance at 3 back to base sessions is counted separately.

o A written record foranyabsence (> 1 hour) is required, submitted on the Notification of

Absence form to the Department of General Practice as per the Attendance Policy

o It is expected you will inform your GP Supervisor or their practice directly if you are

absent without prior arrangemento You are encouraged to attend for more than the minimum requirement where it adds to

your learning. This is an assessment criterion in the Clinical Attachment Assessment.

Dur ing you r at tachment

Some of the following advice originates from students and student sources.1

Ask questions and offer to perform tasks - dont be the invisible student sitting in the corner!

If not introduced to the patient, introduce yourself.

Critically observe, rather than just sitting in on consultations. For example:

o Consider how continuity of care over time influences what is covered, and not covered, ineach consultation. In particular, note how the GP and patient prioritise the problem(s) to be

addressed in this consultation.

o Consider the impact and interrelationships between multiple physical, psychological and

socio-economic factors on the patients health.

o Note effective and less effective communication strategies and how they might be used or

avoided. For example, in cross cultural communication.

o Apply your diagnostic skills to the presenting problem and compare your conclusions by

asking the GP how they arrived at their diagnosis.

o Note how patient presentations may represent the early stages of conditions that you have

seen at a more advanced stage in the hospital setting.

o Note the symptoms or issues that concern patients who have stable chronic conditions.

o Note differences between the patient perspective and the biomedical perspective on the

patients experience of illness and how this is taken into account in the management plan.

o Ask the GP about how they manage uncertainty in consultations where a clear diagnosis or

management plan is not apparent.

Offer to accompany the GP on home visits and nursing home visits.

Offer to assist, or carry out procedures, particularly if you have already learnt them in skills

sessions.

Offer to assist with team care planning, medication reviews and clinical practice audits. Thiswill also assist with your assessments.

Ask the GP to observe you doing all or part of consultations, including explaining diagnoses

and management to patients, and to give you feedback using the mini-CEX form.

If there is no spare consulting room, ask if there is a private area to practice patient-centred

history taking and present your findings to the GP.

1With thanks to and acknowledgement of: GPSN Medical Students Guide Aspire 2009,http://www.gpra.org.au/GPSN%20Documents/Aspire-2009-FA-lowres.pdfUNSW General Practice Primary Care Course Outline 2010.http://www.med.unsw.edu.au/SPHCMWeb.nsf/resources/Primary_Care_Handbook_2010.pdf/$file/Primary_Care_Handbook_2010.pdf
http://www.gpra.org.au/GPSN%20Documents/Aspire-2009-FA-lowres.pdfhttp://www.gpra.org.au/GPSN%20Documents/Aspire-2009-FA-lowres.pdfhttp://www.med.unsw.edu.au/SPHCMWeb.nsf/resources/Primary_Care_Handbook_2010.pdf/$file/Primary_Care_Handbook_2010.pdfhttp://www.med.unsw.edu.au/SPHCMWeb.nsf/resources/Primary_Care_Handbook_2010.pdf/$file/Primary_Care_Handbook_2010.pdfhttp://www.med.unsw.edu.au/SPHCMWeb.nsf/resources/Primary_Care_Handbook_2010.pdf/$file/Primary_Care_Handbook_2010.pdfhttp://www.med.unsw.edu.au/SPHCMWeb.nsf/resources/Primary_Care_Handbook_2010.pdf/$file/Primary_Care_Handbook_2010.pdfhttp://www.med.unsw.edu.au/SPHCMWeb.nsf/resources/Primary_Care_Handbook_2010.pdf/$file/Primary_Care_Handbook_2010.pdfhttp://www.gpra.org.au/GPSN%20Documents/Aspire-2009-FA-lowres.pdf


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Ask to sit in with the registrar or other doctors in the practice if available. Note different

consultation styles and professional interests, and how this may lead to different patient lists

and approaches to care.

Spend time with the practice manager, practice nurse, receptionist and other staff. Ask them

about what they do and how they contribute to patient care. Compare this with other practices

that you have experienced.

GP Supervisor roles

The GP Supervisor will:

Guide and facilitate your learning by reviewing your Learning Plan and supervising your

contact with patients and staff.

Orient and provide you with access to many aspects of their practice.

Within the bounds of the practice facilities and your abilities, provide you with opportunities

to be directly involved in patient care.

Assist you to find learning opportunities with other Health Professionals in the communityand practice referral network.

Provide opportunistic clinical teaching, and where possible teaching sessions on relevant

topics.

Be available to discuss your Practice Based Learning Activities.

Conduct or delegate to another clinician in the practice your mini-CEX assessments and

give feedback on your performance.

Complete your Clinical Attachment Assessment (see Page 43).

Be invited to give evaluation feedback on their experience with UWS students.

Other Health Professionals

General Practitioners will often work with other health professionals in managing patients. These

people may be part of the team within a practice (e.g. physiotherapist ) or located elsewhere (e.g.

radiology services or pharmacy ). Your GP will have a network of such professionals to whom he

or she may refer discussing this early in your attachment is recommended.

You are required to complete 4 visits to other health professionals (HPs) during your General

Practice term. For urban students, a one-day visit to the Skin and Cancer Foundation at

Westmead will be scheduled . This will count as one of the four required HP visits. You will needto organise visits to 3 other different HPs within your GPs network. For some rural students, HP

visits will be organised for you. For students at Justice Health one of your visits will be organised

for you in that setting..

Urban students should organise their first HP visit in the first week of the attachment. Use the

Letter of Introduction in vUWS> General Practice>Forms. During your visits, make the most of the

HPs expertise to achieve your objectives on your Learning Plan.

Ask them:

About the services that they provide.

What they consider to be appropriate and inappropriate referrals


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How they communicate with and view their interactions with GPs and other community

health providers

To teach you specific knowledge or skills related to your Learning Plan

When obtaining sign-offs for your Health Professional Practice Visits form (see Page 41), please

ensure you correctly note the name and contact details of the HP you visited so we can thankthem for participating in our program.

Flowchart for urban HP visits

A Sample Week in Urban General Practice

Monday Tuesday Wednesday Thursday Friday

am Orientationto GP andpractice

GPattachment

Reading andpreparationof PBLAs

GPattachment

Back-to-Basesession

pm GPattachment

GPattachment

Other HPvisit

GPattachment

Onlinelearningactivity

Review your Learning Planand select 3 different HPswho will be able to assist

you in meeting your learninggoals

Ask your GP for contactdetails of these HPs withinhis/her referral network

Contact the HP to introduceyourself and request

permission to visit theirpractice

Print off the letter ofintroduction from vUWS and

fax it to them, or bring itwith you on the day

Be professional,punctualand enthusiastic as you learn

from the HP

At the end of the session,thank them for taking youand ask them to sign andstamp your attendance

record

Document what you havelearned on your Learning

Plan

Department of GP will thankthe HP formally after the

end of the placement


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Schedule of Activities in Urban (5 week) General Practice Attachments

Student learning activities GP Supervisor teaching rolesClinical School Back to Basesession

Wk

1 Participate in orientation to

practice.

With your GP supervisor,complete your Learning Planand discuss how you willachieve your learning goals.

Visit a Health Professional #1

Participate in back to basesession.

Attempt a formative mini-CEX

Orient student to practice andnegotiate attendance daysand times (minimum of 6sessions per week NOTincluding attendance at otherhealth professional practices)

Discuss proposed learningplan and suggest strategiesfor how they may be achieved

Suggest Health Professionalsfor visits

Introductory session: Workshop

on:

Principles of General Practice Other topics relevant to

Learning Outcomes Review your Learning Plan

Wk2

Formative and summative mini-CEX #1

Submit Practice BasedLearning Activity #1

Visit a Health Professional # 2

Supervise a mini-CEX(student to initiate)

Wk3

Meet with your GP supervisorto review progress against yourLearning Plan

Visit the Skin and CancerFoundation #3

Participate in back to basesession.




Meet with student and discussLearning Plan progress,suggest modifications ifnecessary.

Mid-attachment session:Workshop on:

Student presentations of PBLA(to be scheduled)

Other topics relevant toLearning Outcomes

Review on progress withlearning activities andassessments.

Wk4



Visit a Health Professional #4


Wk5


Ensure completion of allassessments and activities andobtain required sign-offs fromyour supervisor.

Participate in back to basesession


Complete the ClinicalAttachment Assessment form,and sign off GP Supervisorschecklist.

Wrap up session Workshop on:

Student presentations of PBLA(to be scheduled)

Review the Principles ofGeneral Practice

Other topics relevant toLearning Outcomes

Reflection: What have youlearnt from your attachment thatyou can apply to your next termand as an intern?

Evaluation of attachment.


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Who to contact...If you have any queries, concerns or suggestions about your General Practicelearning experience, or if you are experiencing any difficulties, please contact thepersons below in the first instance:

Urbanstudents

Melinda WolfendenAdministration Officer

[email protected] 02 4620 3896

NorthCoast

Christine EverettStudent Co-Ordinator


Bathurststudents

Bronwyn BauerStudent Co-Ordinator


Department of General Practice

The Department of General Practice is responsible for overall curriculumdevelopment and for implementing the teaching program, including GP attachmentsat urban sites and Conference Week. Department staff will be overseeing the onlinecomponent of the Practice Based Learning Activities through vUWS.

Jenny Reath Professor and Chair [email protected]

Lawrence TanSenior Lecturer (Year 5 GP CourseCoordinator)

[email protected]

Nick Collins Senior Lecturer [email protected]

Melinda Wolfenden Administrative Officer [email protected]

Georgia Millen Placement Support Officer [email protected]

Rural Clinical Placements

The Rural Clinical Schools are responsible for implementing the teaching program atthe rural sites, including organisation of clinical attachments, community based visitsand the scheduling and conduct of back to base structured sessions at the RuralClinical School venues.

University Centre for Rural Health North CoastJohn Graham Clinical Dean [email protected]

Jane Barker Academic Coordinator [email protected]

Christine Everett Student Coordinator [email protected]

Bathurst Rural Clinical SchoolTim McCrossin Clinical Dean, Associate Professor [email protected]

Ross Wilson Bathurst GP Course Coordinator [email protected]

Bronwyn Bauer Student Coordinator [email protected]
mailto:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]


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General Practice Curriculum MapThe following table provides specific content and objectives for each of the 5 General Practice learning outcomes, and relates them to teachingand learning activities, and to assessment.

LEARNING OUTCOMES TEACHING and LEARNING ACTIVITIES ASSESSMENT TYPE

A. Safely perform an initial assessment of

common primary care presentations, and

formulate a diagnostic and management plan

appropriate to General Practice.

This learning outcome requires you to integrate

the clinical skills and knowledge you have learnt

throughout the course and apply them to a

General Practice setting, using a patient centred

approach. You should also start to independentlyformulate diagnostic and management plans.

Common presentat ions inc lude:

General

Fever

Tiredness

Chest pain

Respiratory

Cough

Throat discomfort or pain

Wheeze, shortness of breath

Sneezing and nasal congestion

Musculoskeletal

Back pain

Knee complaint

Other joint pain

Skin

Skin rash

Cardiovascular

Hypertension

GIT and Renal

Abdominal or pelvic pain and discomfort

Diarrhoea/change in bowel habit

Nausea/vomiting

General Practice Clinical Attachment

Formative mini-CEX

Structured back to base sessions

Conference Week

Prior assumed learning:

Year 4: Paediatrics, O&G, Mental Health, Oncology Clinical

Attachments

Year 3: MiC GP attachment and communication skills

Year 3: Scientific Streams: Immunology Tired

Year 3: Medicine & Surgery Clinical Attachments

Year 1 & 2: ICM Tutorials

Summative mini-CEX:

history, examination, clinical

judgement, communication

Practice based learning

activity:

(a) Formulate diagnostic

algorithm

(b) Case comparison with

hospital based approach

Clinical attachment

assessment

Year 5 Barrier assessment


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Frequency/dysuria

Psychological

Depression

Anxiety

Endocrine

Diabetes

Womens Health

Menstrual problems

Vaginal/Urethral discharge Family planning

Antenatal & postnatal care

Neurological

Headache

Vertigo/dizziness

Ear

Earache

Eye

Red eye, visual disturbance

Childrens Health

Behavioural and feeding problems

B. Safely perform common clinical procedures

and associated processes, including deciding

when they are indicated, obtaining informed

consent, explaining results and follow up

information to patients.

This learning outcome requires you to

consolidate learning from your procedural skills

sessions and clinical attachments and to apply

them to a General Practice setting. You should be

able to demonstrate how you decide that a

procedure is necessary, what should be

communicated to patients and how it should be

communicated.

Common cl in ica l procedures inc lude:

General diagnostic skills

Aseptic technique and handwashing

Measuring vital signs, assessing hydration,

BMI


Formative mini-CEX

Conference Week


Summative mini-CEX:

Write a PBS script (compulsory)

Selected mini-CEX:

Procedures, clinical judgement,


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Using otoscope, ophthalmoscope

Diagnostic procedures

Ordering common pathology and imaging

investigations and explaining the results to

patients

Venepuncture

Urine collection (adult, infant & child) and

urinanalysis

Blood sugar level with glucometer

Peak flow & spirometry

12 lead ECG

Preventive activities

Immunisation schedule, techniques and

management processes

Pap smear and use of vaginal speculum

Therapeutic procedures

Medication review and prescription writing,

including drug dose calculation

Drug administration

o Oral

o Eyedrops

o Sublingualo MDI, spacer, nebuliser

o Rectal

o Intranasal

o Transdermal

o IMI injection

o SC injection

Practical procedures

Basic life support and airway management

Simple dressings and wound care

Year 4: Paediatrics, O&G, Oncology Clinical Attachments


Year 3: Conference Week Respiratory SCORPIO,

Rational ordering of lab tests.

Year 3 & 2: Procedural Skills sessions

communication


activity:

(c)Quality and safety in clinical

procedures

(d) Quality use of medicines and

medication reviewClinical attachment

assessment



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Wound, throat and skin swabs and skin

biopsies

Suturing of simple wound

Application and removal of forearm

plasters

C Apply key principles of General Practice toindividual patients and to population groupswithin a practice, which includes being able to:

To achieve this learning outcome you should be

able to apply the principles of continuity of care,

triage, multidisciplinary teamwork, effective

communication, chronic disease self-

management and shared decision making,

disease prevention and health promotion to a

General Practice setting

1. Describe strategies for achieving continuity of care,including the doctors role as a coordinator ofmultidisciplinary team care.


Health Professional Visits


Conference Week


Year 4: Mental Health, Oncology


activity:

Team Care Arrangements Plan

(compulsory)


activity:

(e) Patient experience of

continuity of care

(s) Referral pathways and

communication

Clinical attachment

assessment

Year 5 Barrier Assessment

2. Communicate effectively with patients, families,

medical and non-medical health professionals

using written and oral methods, and

communication technologies where appropriate.

a. Demonstrate patient centredness when


Formative mini-CEX

Conference Week


Summative Mini-CEX:

Write a referral letter

(compulsory)

Other Mini-CEX: communication


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taking a history and giving information to

patients.

b. Demonstrate collegial communications

with medical and other health care

professionals.

c. Describe ways of dealing with difficultinteractions with patients and colleagues.

d. Explain how practice processes formanaging medical records and otherinformation can assist with continuity ofcare, practice audits, improve patientsafety and meet medico-legalrequirements.

e. Describe potential applications of health

informatics to General Practice and

community based health care

Year 4: Paediatrics, O&G, Mental Health, Oncology Clinical

Attachments

Year 3: MiC GP attachment and communication skills

sessions


Year 1 & 2: ICM Tutorials: writing in patient notes, medical

note taking

Practice based learningactivities:(g) Quality of discharge letters

(k) Analysis of difficult oruncertain encounter

(h) Cross cultural consultations

(o) Ethical dilemmas in General

Practice

(s) Referral pathways andcommunication

(f)Information management inGeneral Practice.

Clinical attachmentassessment


3. Appreciate the role of the GP in care coordination

and the value of a generalist approach to the care

of patients with multiple chronic illnesses and

competing health priorities.

a. Apply the principles of self-management

and shared decision making to the care of

patients with chronic and complex

conditions.



Conference Week


activity:

Team Care Arrangements Plan

(compulsory)

(i)Patient experience of chronicdisease self-management.

(k)Analysis of difficult oruncertain encounter


4. Describe preventive activities across the life span:

from infancy, childhood and adolescence,

adulthood and the aged. This includes assisting


Formative mini-CEX

Summative Mini-CEX:

communication, clinical

judgement


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patients to achieve well-being, reduce the risk of

disease and minimise the effects of disability and

chronic disease.

Conference Week


Year 3: MiC Community and General Practice attachment

Scientific Streams: CV Risk, Nutrition

Lectures: Motivational interviewing


activity:

(j) Motivational interviewing

practice

(i)Patient experience of chronic

disease self-management.


D. Appreciate and explain differences in

community based medical practice as

compared to other clinical settings, which

includes being able to:

1. Formulate justifiable and safe strategies in

medically uncertain situations. These include being

able to:

a. Define a clinical approach to presentationswith vague and medically unexplainedsymptoms

b. Begin appreciating the range of normaland self limiting presentations and howthey may be differentiated from theabnormal and early presentations ofserious illness.

c. Use strategies such as red flags, time,follow up, patient communication andpartnership, appropriate referral andinformal consultation.



Conference Week

Practice based learningactivity:(k)Analysis of difficult oruncertain encounter

(l) Identifying serious illness

(c) Formulate diagnostic

algorithm


2. Search for high quality evidence and evaluate its

applicability to the needs and preferences of

individual patients.



Year 1-3: Population Health teaching program, including

evidence based medicine lectures,

Year 3: MiC projects

Year 4: CMGP


activity:

(m) Clinical practice guidelines

in chronic and complex care

(n) Evidence based practice


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3. Analyse how role conflicts and professional

boundary issues may arise in General Practice and

describe how they may be addressed in the

following areas:

a. Relationships with individual patients

b. Balancing the needs of the individual

against those of their family and

community

c. Advocacy for individual patients versus the

role of the GP as gatekeeper of public

resources

d. Relationships with commercial interests

such as the pharmaceutical industry and

other health service providers.

e. Safe prescribing of opioids and drugs of

addiction

f. Practicing within your level of competency



Conference Week


Year 1 PBL: The Teacher

Year 1-2: PPD/Health Practice sessionsYear 4: O&G Conference Week, PPD


activity:


Practice

k)Analysis of difficult oruncertain encounter


4. Explain the doctors role and responsibilities in

common General Practice medico-legal issues:

a. Maintaining privacy and confidentiality

b. Informed consent and treatment of minors

c. Doctors certificates

d. Assessment of fitness to drive


Conference Week


Year 1-2 PPD/Health Practice lectures

Year 4: Paediatrics, O&G Conference Week, PPD


activity:

(p) Medical certification


Practice



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20


e. Mandatory reporting of suspected child

abuse, infectious diseases, other public

health concerns

5. Describe the impact of the following organisational

factors on clinical practice in the primary care

setting, including:

Practice population,

Practice management and staffing, Health system factors such as financing,

traditional and newer models of primary care.


Conference Week


Year 1-2: Health care systems lectures

Year 3: MiC O and R week


activity:

(q) Clinical practice variation in

General Practice.

(r) Practice profile and staffing

E. Reflect on experiences with patients and

colleagues to identify personal strengths and

skills, and areas where attention is required.

Plan and carry out learning strategies for your

ongoing professional development.

Learning plan




Year 4:PPD Learning Journal

Year 3: Medicine, Surgery and MiC attachments

Learning plan

Clinical attachment

assessment

Peer review Practice Based

Learning Activity


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AssessmentsYour performance in the General Practice teaching program will be assessed by thefollowing:

A. Learning Plan: satisfactory completion

You should discuss and agree with your GP Supervisor on at least 3 initial learning goalsand learning strategies in the first week of your attachment. The Learning Plan has threeparts (see Page 33):

1. Learning goals. These may be revised or added to during the attachment.

2. Learning strategies for achieving these goals.

3. Evaluation of progress against your goals and next steps

B. Mini-CEX: satisfactory completion of FOUR mini-CEX

To satisfactorily complete the mini-CEX, the assessment criteria on the form must be met.You may make as many attempts as required to pass.

Required: the following two mini-CEX are compulsory:

Prescribe a medication for a patient whose consultation you have observed(Pages 37-38).

Write a referral letter for a patient whose consultation you have observed(Pages 39-40).

Selected: At least two different mini-CEX are to be chosen from the following:

Take a patient centred history as part of an assessment of one of the commonpresentations in General Practice.

Perform a focused physical examination as part of an assessment of one ofthe common presentations.

Formulate and explain to a patient a diagnostic or management plan for oneof the common presentations.

Safely perform one of the common practice procedures.

Counsel a patient about a health promotion or disease prevention activity.

See the Curriculum map (page 13-19) for a list of common presentations, procedures andprocesses and the General Practice mini-CEX forms (pages 35-40) for criteria forsatisfactory completion. The mini-CEX may be conducted by any doctor in your practiceattachment, at the discretion of your GP Supervisor. Mini-CEX on counselling patientsabout health promotion or disease prevention may be supervised by the practice nurse.


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C. Practice Based Learning Activities: satisfactory completion of THREE

50% of graded assessment

You are to complete three student selected PBLAs, selecting one each of the following

groups: Chronic and Complex Care; Primary Care Systems and Procedures; Principles of

General Practice. See Page 26 for the Template and the questions for each topic. They

should be submitted via vUWS on Weeks 2, 3 and 4 in urban attachments (see schedule

for rural sites in Year 5>Rural Clinical Schools>General Practice>Assessments folder) and

may be completed in any order. One PBLA is to be presented and discussed in the back to

base structured sessions.

All PBLAs should be based on actual General Practice patient consultations or practices.

Your answers should relate directly the actual patient or practice you describe in the first

section. The maximum length for each PBLA is 800 words (excluding references and

patient information). Diagrams, tables and images may be used where they add to the

written or oral presentation.2

As different topics will be chosen, its important to share what you have learnt with your

peers. This may be in presentations in Back-to-Base sessions, or the PBLA Discussion

Board in vUWS. Selected PBLAs will be posted to a specific list for that topic which will be

accessible to all students in your Year. Your marks and markers comments will go to My

Grades box and will not be accessible to other students.

Flowchart for comple tion , submiss ion, mark ing and rev iew of PBLA:

2

Please observe confidentiality and privacy and obtain informed consent if you decide to include images thatmay potentially identify patients. It is good practice to obtain consent whether you think the images areidentifiable or not.

Download PBLAtemplate from GP

Assessments folder

Complete PBLA. Savewith surname andPBLA number in

filename.

Submit by 5pm on duedate through

designated dropbox inGP Assessments folder

Marker grades PBLA.Marks go to My Grades

box

If PBLA Satisfactory orExcellent, posted to

Discussion Board

All students in Year cansearch for PBLA by

topic

All students can leave arating on usefulness to

own learning

All students can leaveconstructivecomments

Evaluation of topicsand process of peer

review


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D. Clinical Attachment Assessment

50% of graded assessment

Your GP Supervisors assessment of your performance during the attachment will be

documented in the Clinical Attachment Assessment, using the marking criteria on the form

that will be provided to you during your first Back-to Base session (see page 32 for an

exemplar).


In the Year 5 Barrier Assessment, 20% of all questions in a range of specialty areas will be

based in General Practice and primary care settings.

Satisfactory Assessment and Grading

To pass your General Practice attachment, you must:

Attend all scheduled sessions and attachments - 100% attendance is required.

Attend Conference Week 100% attendance is required.

Submit a written record for any absence of greater than 1 hour, using the Notification

of Absence form, to the Department of General Practice (urban placements) or

Clinical School (rural placements)

Satisfactorily complete and submit all assessments and required learning activities

according to the assessment criteria. These include:

1. Learning Plan

2. At least FOUR mini-CEX

3. Clinical Attachment Assessment

4. At least THREE Practice Based Learning Activities

As record of your attendance, you should also submit the following completed forms:

5. GP Supervisor checklist

6. Health Professional Practice Visits (minimum 4 sign offs including the Skin

and Cancer Foundation visit)

7. PiP Teaching Incentive form

See vUWS>General Practice>Forms for the pdf active form.

This form must be completed electronically to satisfy Medicare requirements.

Submit as many completed print outs as required to document all GP sessions

that you attended.

8. GP Attachment Evaluation


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Assessments which are graded will be at the following levels of achievement: non-

submission or plagiarism (0%) unsatisfactory (1-24%), further work required (25-49%),

good (50-74%) and excellent (75-100%). If your assignment has been found to be

unsatisfactory or to require further work, you may be asked to revise and re-submit. You will

have seven days from the date of notification in which to do so, and you may re-submit theassignment only once. A maximum of 50% (10/20) will be awarded for a re-submitted

assessment.

PBLA assessments should be submitted by 5pm on the due date. If submitted up to 10calendar days late without pr ioragreement from the GP Course Coordinator or delegate,they will be penalised by 10% of the total mark per calendar day. (See Page 12 for contactdetails)

In the event of borderline or unsatisfactory performance, non-graded learning activities and

attendance will be taken into account. It is therefore recommended that you attend allactivities, make a good attempt at all required activities and submit all your work, including

formative attempts at mini-CEX, to document your learning.

In order to pass the GP attachment term, you are required to pass both the CAA and PBLA

components, with no other outstanding concerns regarding your clinical performance and

professional behaviour. In the event of failure to pass all components of the teaching

program remediation will be offered following consultation with the relevant Curriculum

Committees.

All Attachment forms (see Checklist page 47) should be signed off by your GP Supervisor

and submitted in ONE folder, either in person to:

Melinda Wolfenden, Department of General Practice for urban attachments, or

Christine Everett, for North Coast Clinical School, or

Bronwyn Baur, for Bathurst Clinical School

by 5pm of the last day of you r GP attachm ent

orreturned by post with the envelope postmarked no later than the last day of your

attachment. No reminders will be sent if your forms are not received.

All Practice Based Learning Activities must be submitted by the due date through vUWS.

Evaluation

Students and Supervisors are encouraged to evaluate their experiences and contribute to

the ongoing improvement of the teaching program. A student evaluation form should be

submitted at the end of each rotation. Including your name is optional and only aggregated

feedback is returned to GP Supervisors. Supervisors will also be asked to evaluate theirteaching experience with UWS students. Students and Supervisors are also welcome to


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contact the Department of General Practice and/or Rural Clinical School at any time with

queries and suggestions (see page 12 for contact details)


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Forms and Assessment Guides

Practice Based Learning Activity Questions and Template

Select one PBLA from each of the following groups (complete three in total):

I. Chronic and Complex CareII. Primary Care Systems and ProceduresIII. Principles of General Practice.

Use the format in the Template (see page 30). A Word version of the Templatecan be downloaded from vUWS: Year 5>General Practice>Forms. Please saveyour assignment with the file name [surname]_PBLA [number of PBLA] so that itmay be identified easily.

Ensure that you answer all questions Include references to any literature or clinical information that you use on your

answer.

Please adhere to the 800 word limit. References and patient information are NOTincluded in the word count. See the GP Online Resources at vUWS>General Practice>Resources and GP

Conference Week Study Guide at vUWS>General Practice>Learning Guide toassist with your research on particular topics.

Submit your Activity through the vUWS dropbox for each due date.

I. Chron ic and Complex Care

(A) Team Care Arrangement exploration

For a patient with chronic conditions and co-morbidities requiring ongoingmultidisciplinary care via a Team Care Arrangement:

1. Interview the patient and document all the steps the patient needs to take to carry

out the plan. Include phone calls and communications to make appointments,

transport, buying medications and over the counter products, having investigations,

physical activity programs, making dietary changes, the ways in which family

members and friends assist as a minimum.

2. With reference to the literature,

a. What worked well for the patient with this TCAb. What could the team care providers have done differently to assist the

patient in carrying out the TCA?

(B) Patient experience of continuity of care

Interview a patient with chronic condition(s) and review their health record. For this

patient:

1. Describe the role(s) of all healthcare providers who have been involved in the

care of the patients current conditions. Include other general practitioners and

primary health care providers whom the patient may have consulted.


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2. Evaluate whether the care provided is well coordinated from the patients

perspective. Include any miscommunications, adverse events, gaps or duplication

in care that have arisen from a lack of coordination and continuity.

3. What strategies could improve the patients experience of continuity of care?

(C) Patient experience of chronic disease self management

Interview a patient with chronic condition(s) about a recent presentation with a new

symptom or exacerbation of their chronic condition(s).

1. Document this recent presention and its management, as well as any resulting

change in the ongoing management of their concurrent conditions.

2. Describe the patients role in making decisions about the management of the

recent presentation and of the concurrent conditions.

3. How does the patients experience compare with models of chronic disease self-

management and shared decision-making?Reference: General Practice Online Resources: Chronic Disease Self-Management

I I. Primary Care System s and Procedures

(A) Quality and safety in clinical procedures

1. Outline the usual procedures for performing one of the common clinical

procedures in the practice where you are based, as applied to a patient.

2. What processes and systems are in place to ensure the quality and safety of the

procedure? Issues to consider include infection control, handling of equipmentand specimens, processes for handling of results and staff training.

(B) Medication review and quality use of medicines (QUM)

For a patient with co-morbidities who is on multiple regular medications:

1. Document all of the patients prescribed and non-prescribed medications.

2. Apply the Medication Review o rQUM Medication Related Problem Checklist, and

3. Suggest how any medication issues may be addressed.Reference: General Practice Online Resources Medication Review Template, Quality Use of

Medicines Medication Related Problem Checklist

(C) Information management in General Practice

Examine how information is managed in the practice where you are based.

1. Describe the types of information collected and managed by the practice.

2. How is this information stored and accessed, and by whom?

3. How do information management processes assist with continuity of care,

practice audits and meet medico-legal requirements?

(D) Quality of discharge letters

For a patient who has recently been discharged from hospital:

1. Describe the content and quality of the communication received by the GP.


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2. Ask the GP how helpful this communication was for their ongoing care of this

patient and document their response.

3. Formulate a list of the types of information that GPs require when patients are

discharged. How and when should this information be delivered to the GP?

(E) Clinical practice guidelines in chronic and complex care

For a patient presenting with multiple chronic condition(s) and co-morbidities:

1. Identify clinical practice guidelines concerning at least two of their conditions.

2. What is the quality of evidence that has been used to develop these guidelines?

3. Discuss with your GP (and patient if appropriate) how applicable are the

guidelines to the care of this patient, and to their individual needs and

preferences?Reference: General Practice Online Resources: Clinical Practice Guidelineportals

(F) Clinical practice variation in General PracticeComparison of local practice with national General Practice data (BEACH survey)

1. Document 25 consecutive consultations, including the reason(s) for the

presentation and diagnoses.

2. Compare this list with the top 10 list of reasons for presentations and diagnoses

in the most recent BEACH survey.

3. What factors might lead to differences between the two lists?Reference: General Practice Online Resources: General Practice Activity Data (BEACH)

(G) Practice profile and staffing

Interview practice staff and if available, ask for access to practice audit information.1. Describe the features of the practice where you are based, including (a) staffing

and the roles of each staff member, (b) fees and billing arrangements, including

how the level of fees is decided and whether to bulk bill patients (c) the range of

services provided, including after hours services and home visits, and (d) the age

and demographic features of patients who typically attend this practice.

2. How do the features of the practice match with the needs of the patients who

choose to attend this practice?

(H) Referral pathways and communicationFor a patient with chronic and/or complex conditions:

1. List all the referral services (including healthcare and non-healthcare, and all

community and hospital based services) involved in their care.

2. Document in a flow chart the types of information required or generated by each

of these services and how it is communicated between the different services.

3. Where are the breakdowns in communication likely to occur, and what effect

would these have on the patients care?


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I II . Princ iples of General Practice.

(A) Formulate a diagnostic and management algorithm

For a consultation for one of the common presentations listed in the learning

outcomes:

1. Document the steps taken in the consultation to diagnose and manage the

presenting problem(s).

2. Formulate your own diagnostic and management algorithm (flow chart) for the

same problem(s) presenting in a primary care setting. Reference your sources

(e.g. Murtaghs General Practice).

3. Explain how your algorithm is similar or different to the observed consultation.

(B) Case comparison with hospital based approach

For a consultation for one of the common presentations listed in the learning

outcomes:1. Document the steps taken in the consultation to diagnose and manage the


2. Compare these with a clinical practice guideline for an equivalent presentation(s)

to an Emergency Department or to a hospital specialist outpatient clinic

3. Describe and explain the reasons for the similarities and differences between the

observed steps and the hospital based guideline.Reference: General Practice Online Resources: Clinical Practice Guidelineportals

(C) Cross cultural consultationsFor a consultation involving a patient whose first language is not English:

1. Describe the steps that were taken to ensure that communication was effective.

2. What cross-cultural issues could arise with this patient and their family?

3. When formulating diagnostic and management plans how can these

communication and cultural issues be taken into account?

(D) Motivational interviewing practice

For a patient who requires counselling for one of the key lifestyle risk factors

(smoking, nutrition, alcohol or physical activity):1. Practice motivational interviewing with this patient, addressing one of the risk

factors. Obtain consent from the patient to contact them at least 2 weeks later to

ask how they have progressed.

2. Document your counselling session and the results of your follow up.

3. Reflect on the success or otherwise of your counselling session and the factors

that make lifestyle counselling more effective.Reference: General Practice Online Resources: SNAP Population Health Guide

(E) Analysis of difficult or uncertain encounter

For a consultation where the presenting problem was vague and the diagnosis and/ormanagement difficult or unclear:


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1. Document the steps taken in the consultation to diagnose and manage the


2. Compare the steps taken to a textbook diagnostic and management approach

for the same presenting symptom(s). What factors made the presentation vague

and the consultation difficult or unclear?

3. What strategies did the GP use to manage uncertainty in the consultation?

(F) Identifying Serious illness

For a consultation concerning an acute presentation that could be an early stage ofserious illness:1. Document the steps taken in the consultation to diagnose and manage the


2. What steps were taken to identify and manage the risk of serious illness?

3. How applicable are hospital guidelines for the recognition of serious illness in

adults and children to general practice?Reference: General Practice Online Resources: Clinical Practice Guidelineportals

(G) Evidence based practice

For a consultation where a clinical question requiring further information was raised:

1. Formulate a searchable PICO (Problem Intervention Comparison Outcome)

question.

2. Locate and appraise a paper that answers this question.

3. Apply the evidence you have found to the clinical consultation that triggered the

question by presenting your findings to your Supervisor. Ask your Supervisor

what factors make this evidence (a) useful, and (b) not useful for this consultationand their clinical practice and document them.

Reference: General Practice Online Resources: Evidence based practice

(H) Ethical dilemmas in General Practice

For an encounter between patients, health professionals or staff that you observed

which raised ethical, professional or legal issues or dilemmas:

1. Briefly describe what happened and who was involved in the encounter.

2. What ethical, professional and/or legal issues did this encounter raise?

3. How does the General Practice or community setting influence the issues raisedand the possible responses?


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Student Name: (please enter)

Student ID No: (please enter)

Supervisor Name: (please enter)

Practice Name: (please enter)

This is my first /second /third PBLA (delete as applicable)

Word count: (please enter)(maximum 800 words, excluding Patient Information and references)

By su bm it t ing this Learning A ct iv i ty, I agree that: Any persons reported upon in this activity have given consent for their personal information to be

included and understands that they will not be identifiable. I hold a copy of this assignment if the original is lost or damaged. I certify that no part of this assignment has been copied from any other students work or from any

other source except where due acknowledgement is made in the assignment. No part of the assignment/product has been written or produced for me by any other person

except where collaboration has been authorised by the Course Coordinator I am aware that this work may be reproduced and submitted to plagiarism detection software

programs for the purpose of detecting possible plagiarism, which may retain a copy on itsdatabase for future plagiarism checking.

Copies of this work will be retained by the School of Medicine and will be made available viavUWS to other students after it has been marked as satisfactory.

TOPIC NAME: (please enter)

PATIENT INFORMATION (where applicable)

Patients Age: Gender:

Relevant background information:

Presenting problem(s):

Answers to questions:1.

2.

3. (where applicable)

Practice Based Learning Activity (PBLA)


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Assessment Criteria for Practice Based Learning ActivitiesA maximum of 20 points can be awarded for each Activity.

Unsatisfactory = 1 pointBorderline (Further work required)

= 2 pointsGood = 3 Excellent = 4

Knowledge &

use of evidence

Little or no evidence of reading or

reference to literature. Relies on non-

reviewed internet sources.

Uses and refers to key resources and

references. Little or no reference to

other sources.

As well as using key resources, uses and

demonstrates understanding of

information from other sources.

Appraises the strength of the evidence

and information found.

As well as meeting criteria for Satisfactory,

use of wide ranging information sources

relevant to the topic. Evaluation of gaps in

the evidence, suggestions for other

sources and/or research required.

Relevance to

problem &

question

Poorly defined problem or unclear

description of patient or practice. Does

not answer all parts of the question.

Does not address related learning

outcomes as per GP Curriculum Map.

Basic description of the patient or

practice. Partial answers to all parts of

the question. Partially addresses

related learning outcomes as per GP

Curriculum Map.

Clearly describes patient or practice,

provides more detail where relevant.

Answers all parts of the question and

relates answer to patient or practice.

Addresses all related learning outcomes.


relates answers to broader issues in

patient care and practice management.

Application of

concepts

Incomplete or incorrect description of key

concepts relevant to the topic. No

attempt to link concepts to patient or

practice example.

Basic description of key concepts.

Partial application of concepts to

patient or practice example.

Demonstrates sound understanding of

key concepts, for example by explaining

in own words. Applies concepts to patient

or practice example.


evaluates concepts for their value and

applicability. Considers alternative

perspectives. Makes original points.

Organisation of

material

Sequence of material is difficult to follow,

no apparent structure or connection

between different parts of answer.

Indiscriminate use of tables and figures.

Materially exceeds word limit.

Sequence of material is able to be

followed, some connection between

different parts of answer. Tables and

figures do not add substantially to text.

Material is presented in a logical

sequence. Tables and figures used

effectively to communicate points.

Adheres to word limit.


material tells a focussed and coherent

story and is presented creatively.

Language &

referencing

Incomplete or incorrect referencing. Non-

standard referencing. Inappropriate

language for academic or clinical

audience. Repeated spelling and

grammatical errors.

Use of standard referencing system.

Most sources referenced. Appropriate

language for audience. Occasional

spelling and grammatical errors.

All sources referenced using standard

referencing system. Effective use of

language for audience. Negligible

spelling and grammatical errors.


sophisticated use of language to make

original points.

Oral

presentation

(Where

applicable. Not

included in

grading)

Poorly prepared, does not appear to

know material. Does not acknowledge or

confuses audience.

Basic description of the patient or

practice. Refers to recommended

references and attempts to link

material to patient. Partial coverage of

questions. Some acknowledgement of

audience.

Clearly describes patient or practice,

providing more detail where relevant.

Uses different communication modes

(e.g. visual) where relevant. Covers all

parts of the topic. Multiple attempts to

interact with audience in different ways.


effective and creative use of different

communication modes. Active engagement

between audience and presenter to explore

other aspects of the topic relevant to the

learning outcomes.


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Student Name: _______________________________________________ Student ID No:_________________

Supervisor Name: ___________________________________________________________________________

Practice Name: ___________________________________Dates of attachment: _________________________

Learning goals should be SMART: Specific, Measurable, Achievable, Relevant and Time Limited. For example, Learn about diabetes management is not as SMART asGive initial dietary advice to diabetic patients, and know when to refer to dietitians.

By the end of this attachment,I will be able to:

To achieve these goals, I will: How have I achieved these goals?What are my next steps?

e.g. Give initial dietary advice to diabetic patients,and know when to refer to dietitians

Visit a dietitian who sees diabetic patients andinterview the dietitian about appropriate referrals.

I observed a dietitian give advice to a diabetic patient andnoted the referral indications we discussed. I have arrangedwith my Supervisor to practice taking a dietary history anddiscuss management with a patient.

1.

2.

3.

The Learning Plan has been discussed and reviewed throughout the attachment. Yes No Supervisor Signature:___________________________ Student Signature:______________________________ Date:_____________

General Practice Attachment Learning Plan

The Student and GP Supervisor shoulddiscuss and agree on 3 initial learning goalsand learning strategies in the first week ofthe attachment. Progress against the Planshould be reviewed during and at the end ofthe attachment.


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By the end of this attachment, I will be ableto:

To achieve these goals, I will: How have I achieved these goals?

What are my next steps?

4.

5.

6.

7.

8.


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Student Name: ______________________________________________ Student No: _________________

Supervisor (or Delegates Name & Position):____________________________________________________

Practice Name: ___________________________________________________________________________

Patient Problem/Diagnosis: _________________________________________________________________

TIME TAKEN SETTING FOCUS CASE COMPLEXITY ASSESSMENT TYPE

Observationtime (mins):______

Feedbacktime (mins):______

General Practice

Community based

service Other

Prescription

Referral Letter

History Examination

Communication

Diagnosis Procedure

Low

Moderate

High

Practice session

For AssessmentNB: At least 4 differentminiCEX are to besubmitted. (2 required,at least 2 selected )

PLEASE TICK APPROPRIATELEVEL of ACHIEVEMENT(see over) Unsatisfactory Borderline Good Excellent Not Observed

History taking skills

Examination skills

Communication skills

Professional behaviours

Clinical judgement (includingdiagnostic or management plan)

Procedural techniques / skills

Overall competence in relation tostage of training

SUPERVISOR FEEDBACK What was done well? What could have been done differently?

PATIENT FEEDBACK (if appropriate) What was done well? What could have been done differently?

Supervisor Signature: ___________________________________________ Date: / /

Student Signature: _________________________________________________ Date: / /

General Practice Mini - CEX


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What is a mini-CEX?The mini-CEX is an assessment tool for testing how students interact with actual patients. It focuses on core skillsrequired in routine patient encounters. With the exception of the writing of a referral letter and a prescription, eachmini-CEX requires observation of a student/patient interaction over 10 minutes and immediate feedback to the studentfor 5-10 minutes. Research shows that over time, multiple mini-CEX are a valid, reliable measure of students clinicalperformance. The student may make as many attempts as required to reach a satisfactory standard.

How to carry o ut a mini-CEXSetting up Select a patient who has consented to participate

The student is examined as in a short case. For example, examine Mrs Smiths abdomen, or takea history from Mr. Lee about his chest pain, or perform spirometry on Ms. Emad.

Give the student some background information about the presenting problem. Ask the student to relate to the patient as if they would in an actual consultation.

Observation

(approx 10 minutes) Silently observe the interaction. Do not prompt except in exceptional circumstances.

Feedback

(5-10 minutes) Ask the patient for feedback, if appropriate. As soon as practicable, give feedback to the student (generally away from the patient if possible).

You may ask the student to report their findings, clinical reasoning, and management. Complete the mini-CEX form and give the form to the student.

Recommended mini-CEX activitiesRequired: the following two mini-CEX are compulsory (may be completed after the observed consultation):

Prescribe a medication for a patient whose consultation you have observed Write a referral letter for a patient whose consultation you have observed.

Selected: At least two different mini-CEX can be chosen from the following list:

Take a patient centred history as part of an assessment of a common presentation. Perform a focused physical examination as part of an assessment of a common presentation. Explain to a patient a diagnostic or management plan for a common presentation. Safely perform a common practice procedure. Counsel a patient about a selected health promotion or disease prevention activity.

Criteria for satisfactory level of achievement in mini-CEX

Prescription3: Patient details correct, date Prescriber details correct, including

prescriber number Drug name (generic), dose and form Correct drug dose, frequency, quantity and

route of administration

No abbreviations or decimal points Student should provide relevant information

to the patient regarding adherence to themedication, instructions on how to take themedication, and common side-effects

Other factors to dis cuss: drug selection, non-pharmacological management, contraindications,drug interactions, likely side effects, cost and convenience for patient.

Referralletter

4:

Patient details correct Referrer details correct, including provider

number and practice details Consultant details correct Date Legible (or typed)

Purpose of referral clearly stated Relevant patient history: current symptoms

and medical conditions, previous medicalhistory, medications and prior treatments.Family, social, other history as appropriate.

Other factors to dis cuss: urgency ofreferral, referrers opinion, use of professional language

Other mini-CEX:

History: Facilitates patients telling of story, elicits concerns and uses questions effectively to obtain accurate

and adequate information. Responds appropriately to non-verbal cues.Physical Ex

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