2020/21 Undergraduate Module Catalogue

MEDI2223 Clinical Assessment, Reasoning, Ethics and patient Safety

Module manager: Dr Abigail Flinders
Email: A.J.Flinders@leeds.ac.uk

Taught: Semesters 1 & 2 (Sep to Jun) View Timetable

Year running 2020/21

Pre-requisite qualifications

Compulsory strand of MBChB programme - runs over year 1-3. For students entering via alternative routes, evidence of satisfactory teaching and academic attainment is mandatory.

Co-requisites

MEDI2201	Control and Movement
MEDI2202	Individuals and Populations 2
MEDI2217	Research, Evaluation and Special Studies 2
MEDI2218	Innovation, Development, Enterprise, Leadership and Safety 2
MEDI2219	Campus to Clinic 2
MEDI2220	RESS 2 Special Studies Project
MEDI2221	Essential Medical Science
MEDI2222	Clinical Pathology

Module replaces

PPD (Personal and Professional Development) & Patient Evaluation. CtoC has been designed to meet the needs of the new MBChB 2010 curriculum, and builds on the strength of the current model.

This module is not approved as a discovery module

Module summary

The CARES 2 course aim to give you a grounding in the Clinical Assessment of patients, diagnostic Reasoning, Ethical and legal aspects of patient care and patient Safety The module will emphasise the central importance of the patient perspective, through development of excellent communication skills and a respectful and caring approach to clinical evaluation of patients from all backgrounds. Other key components of this course include understanding and application of ethical practice in clinical care, inter-professional and team working. CARES integrates closely with other ICUs in years 1-2, with particular linkage with IDEALS.

Objectives

Clinical assessment
• Develop the history taking and examination skills to assess a range of clinical presentations
• Continue to develop communication skills with patients, carers and clinical colleagues in a variety of settings
• Gain an appreciation of the importance of mental health issues.
• Develop skills to assess mental health as part of holistic clinical assessment
• Understand patient and carer strengths, resources and problems in the context of their illness
• Develop an understanding of multidisciplinary team working in a range of settings.
• Understand how different members of the team contribute to the clinical assessment of patients

The Year 2 CtoC course maps directly to following Tomorrow's Doctors (2009)
- Biomedical science in medical practice (8)
- Psychological + Social Science principles, method and knowledge in medical practice (9 &10)
- Consultations with patients (13)
- Diagnosis and management (14)
- Communication with patients and colleagues (including effective multi-disciplinary team working) (15)
- Emergency Care (16)
- Safe, effective drug prescription (17)
- Safe practical procedures (18)
- Use of information in a medical context (19)
- Behaviour in keeping with ethical and legal principles (20)
- Reflection, learning and teaching (21)
- Protect patients and improve care (22)


Reasoning
• To understand how the clinical skills you are learning are used in practice to aid diagnosis or clinical management decisions
• To start to recognise patterns of symptoms and signs that relate to common disease presentations

Ethics
• Understand the ethical and legal principles underpinning patient encounters.
• Develop skills in ethically analysing health care decisions.
Safety
• Be aware of the importance of patient safety, how this is optimised in different clinical setting and the role different team members play in this
• To learn to recognise and respond to acute illness
• Continue to develop year 1 clinical skill and engage with learning and practicing year 2 skills so that you can carry these out safely and efficiently in clinical practice
• Develop the skills of lifelong, reflective learning

Learning outcomes
Students will be able to demonstrate the following as appropriate to the stage of the course:

By the end of year 2 students should be aiming to use their knowledge and skills to attempt a holistic clinical assessment of a patient. You should aim to be able to present a case history and to discuss possible diagnoses and ethical dimensions of the case. We DO NOT expect you to be experts by the end of year 2 but to have gained the confidence to have a good attempt at this, which you will then build on in year 3.

Clinical Science, prescribing and informatics:
- Recognises how conditions present in hospital and primary care, with learning facilitated by a series of clinical cases.
- Demonstrates understanding of the pathophysiology underlying these conditions and how this translates into symptoms and signs.
- Demonstrates an appreciation of the cause and effect of these conditions in the context of a patient's life.
- Maintains confidentiality, understanding the legal and ethical implications of verbal, written and electronically communicated/stored information.
- Demonstrates an understanding of the role of the basic principles of prescribing, recognising the contribution of the patient.

With regards to prescribing, students will:
- become familiar with the use of a standard drug chart;
- Show the factors involved in safe prescribing;
- Show the different routes used when prescribing;
- Use this knowledge in context with a range of common drugs.
(See Basic Formulary 'A')

Skills outcomes
The ability to elicit a clinical history which is thorough yet succinct and integrates the patient's perspective:
From the second year onwards, students will be taught the skills of history-taking, including that of mental state examination, initially supervised, and becoming able to do this independently by the end of the third year.

Students will develop communication skills that enable them to effectively gather information from the patient, taking their ideas, concerns and expectations into account, in a timely manner.

Competence in clinical examination, taking into account patient dignity, privacy, wishes and concerns:
Students will start to learn examination skills in the second year, and should be competent in the process by the end of the third year, although would not be expected to reliably identify abnormal physical signs.

Students should understand the importance of patient comfort, privacy and dignity and when the use of chaperones is appropriate.

Students will be taught specific systems of examination using the Leeds unified teaching model for Physical Examination.

The ability to share mutual understanding clearly and effectively, with patients/carers, medical colleagues and other health professionals:
In addition to history-taking skills, students need to be able to communicate effectively with their patients and their carers, using easily understood language, and be able to pick up on non-verbal cues from them. They should be able to give patients information in a way they can understand and be able to explain when there are areas of uncertainty. They should recognise opportunities for health promotion.

Students should also be able to communicate in situations that present further challenges, including those patients where English is not their first language, those who are hearing-impaired or those with speech or learning difficulties.

Students need to become fluent in medical language, to be able to communicate effectively and efficiently (both written and verbally) to other health professionals. They should be able to write out a full history and examination and present this verbally in a clinical scenario.

Students must be aware of their own communication limitations and be prepared to ask for assistance in order to improve this where appropriate.

Communication skills teaching will be delivered through the Leeds model, which is broadly based on the existing Calgary Cambridge framework.

Proficiency in a range of basic practical procedures:
Second year students will learn a range of basic practical skills in a non-clinical environment and then practice these under supervision in the clinical environment. Attainment will be recorded in an (electronic) skills portfolio that will map across the whole MBChB course.

Syllabus

There are many aspects to CARES and there are therefore multiple strands of teaching:
• Clinical cases teaching
• Clinical examination teaching
• Ethics & Law
• Communication skills
• Clinical skills
• RRAPIDS
• Mental Health
• Community visits

Clinical placements will bring all of these aspects together as you begin to assess patients, work with team members and use your clinical skills in the community and hospital environment. Students will spend time in both Primary and Secondary care environments, working with clinicians and the wider team. RRAPIDS teaching will be delivered on secondary care placements.
Clinical cases teaching: during timetabled sessions students will work through an interactive online learning package of clinical cases. These scenarios are based on common presentations of illness that you will come across while on clinical placements.
Clinical examination teaching will be delivered in a combination of face to face and on line sessions in terms 1 and 2 and further consolidated through practice on placement. Major body systems will be covered in year 2 aiming towards a fully integrated examination in year 3.

Medical ethics is taught via small group interactive sessions. Topics will include capacity and consent; autonomy and confidentiality; end of life decisions.
Medical law is taught via an online course. Topics are mental capacity; life-limiting decisions.
Communication teaching will be delivered through the Leeds model, which is broadly based on the existing Calgary Cambridge framework. In addition to developing consultation techniques there will be a strong focus on patient perspective and early development of skills in difficult conversations.

Clinical skills in year 2 are: performing Injections (intramuscular, intradermal, subcutaneous, blood capillary glucose); Venepuncture; Aseptic cannulation;Basic Life Support (including recovery position & choking & use of an AED). Students are also expected to regularly practice year 1 skills and receive feedback on progress via the Clinical Skills Passport.
RRAPIDS (Recognising & Responding to Acute Patient Illness & Deterioration) –helps develop knowledge and skills to care for patients who become acutely unwell. Building on the 1st Year workshops, the ABCDE approach using NEWS scoring and SBARR communication skills.

Mental Health The sessions in Mental Health aim to introduce students to the knowledge, skills and attitudes needed to evaluate the mental health of any patient. Students will learn that mental health conditions can present in a variety of ways to all health care settings. In addition the interface between substance use and mental health services will be covered.

Community visits to voluntary sector organisations aim to help students recognise the role of the doctor as part of a team of health professionals and as part of the wider community in which they practise. Though visiting or interviewing a chosen organisation, students will develop an understanding of the role and operating environment of the voluntary, community and faith sector [the Third Sector] in promoting inclusion, community health and well-being.

Teaching methods

Delivery type	Number	Length hours	Student hours
Placement	30	4.00	120.00
Lecture	20	1.00	20.00
Tutorial	20	2.00	40.00
Private study hours			0.00
Total Contact hours			180.00
Total hours (100hr per 10 credits)			180.00

Private study

Due to Covid-19, teaching and assessment activities are being kept under review - see module enrolment pages for information:https://students.leeds.ac.uk/info/10103/module_enrolment/1329/module_enrolment_and_covid-19_arrangements

Please note that the hours listed will vary between clinical placement and teaching content. Some of the clinical placements will contain small group (often bedside) teaching. Due to the variability in clinical timetables, the proposal can only illustrate fixed teaching for all students within the Medical School

*Private study is incorporated within programme, and in placements.

Opportunities for Formative Feedback

Students will be required to document progress through an electronic portfolio throughout the CARES strand, with a range of clinical activities, work place learning (and assessment) and feedback. The portfolio will incorporate access to monitoring and tracking of students' progress towards the intended learning outcomes. In addition, communication training, clinical examination teaching and clinical skills training will allow for direct feedback and support to students. Monitoring of progress in this strand will follow the student support model (with local monitoring and feedback from (clinical) teachers and ICU management team and regular meetings with tutors to look at overall progress and a review of student progression via examination boards and the Student Progress committee, incorporating academic and personal tutoring mechanisms.

Methods of assessment

Exams

Exam type	Exam duration	% of formal assessment
Practical Exam / OSCE	1 hr 20 mins	0.00
Total percentage (Assessment Exams)		0.00

There is no separate written exam for this module; Material will be integrated into an end of year common single best answer paper. FOSCE - Students will participate in an Formative Objective Structured Clinical Examination (OSCE) during term 3 in year 2. The FOSCE will not be graded, but attendance is obligatory as the School wishes the option of failing students who do not engage. Students will receive feedback on their performance which should assist them in year 3 where the OSCE is a major assessment and must be passed for progression. A mop-up OSCE will be run each year in September instead to ensure that students and dentists joining in year 3 have the opportunity to experience an OSCE. Fail students will also sit this OSCE. Non-attendance at the September OSCE will be dealt with on an ad hoc basis depending on circumstances but the School would reserve the right to exit a student or make them resit the year.

Reading list

The reading list is available from the Library website

Last updated: 09/09/2020 15:31:39

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