SALFORD INTEGRATED MODULE

Notes for Medical Students

What is it?

  • 4 weeks, 4 cases
  • Achieving your learning objectives through experiences in community and hospital
  • Monday & Friday hospital experience
  • Tuesday, Wednesday, Thursday Community Experience.

Hospital Experience

  • Clinical PBL – You should discuss what clinical resources you will use to learn about objectives in a clinical way.
  • Clinical debrief – You will be expected to present and discuss a full history, including examination & tests
  • Clinical Teaching – Bedside teaching, taking histories/examining patients, tutorials. Your clinical teaching should be related to the PBL case of the week. It is recommended that you practise examining a patient’s abdomen on a weekly basis and that when you are covering The Heavy Drinker case, you ask if you could have a tutorial relating to alcohol abuse.
  • Skills sessions – venepuncture & cannulation, catheterisation, Medicines Management, video sessions – to provide you with the skills you need to be an active learner on the wards.
  • Taking Histories – we expect you to go onto your home wards to take histories in breaks between scheduled activities. Please ask one of the nurses /doctors for a suitable patient politely.

Patient mealtimes are protected from 12noon -1pm, 5-6pm on most

wards. Please see patients at all other times.

  • Signups- You are expected to do a minimum of 6 community signups during the integrated module. This is a compulsory part of your third year undergraduate medical degree and you must attend at least 80% as your attendance will be monitored. If you are not at a GP surgery for 6 days in the block you should also attend appropriate hospital signups and clinics

If you have any problems with a Community signup – i.e. it no longer

runs/doctor has left, please email Philippa Lindsay, the Community

Manager on .

Problems with hospital signups should be reported to

Signups may be cancelled at short notice – please ask for alternative

experience or go to MIU to take histories/skills lab for skills

practice/postgraduate library to use synapse (up to date/find protocols)

if this happens.

Community Experience

GP Days – Please be polite and proactive with your GPs & give positive feedback when you find something useful.

You need to look over the NME student handbook on nmecommunitystudent.doc

Phone before your first day.

Give the practice manager & GP a list of the days you are expecting to be in.

On the first day /first opportunity, discuss what you would like to do. Experiences students found most useful in the last block were:-

  • Sitting in the clinic with the doctor, and getting involved in consultations/practicing examinations.
  • Sitting in with the nurses and practicing taking blood/giving injections
  • Asking the practice to find a patient per week relevant to your case, so that you can take a history (either at the surgery or at their home) – see below for suggestionsof suitable patients this week.
  • Going out on home visits, going out with district nurses, sitting in with diabetic clinics

Community Sign-ups – please sign-up and attend, students in the last block really recommended them. You will need to look over/print out the worksheets/guidance before attending on

Ring up before you attend to clarify details & let them know you are coming.

If you have any problems with please email the community team.

Integrated Module -A proposed student’s learning week

Activity / Number of notional sessions
PBL tutorials / 1
Clinical Teaching
Bedside skills training / 1
Self directed ward work
Clinical debrief / 1
Pathology, skills & seminars / 1
Signups/added value clinical placements / 2
Community / 2
Private study / 1
Sports (Wed pm) / 1

Running order of PBL Cases – Integrated module

TRACK 1 / TRACK 2 / TRACK 3
Weeks / Groups K, N & Q
Firm Lead :
David New / Groups L, O & R
Firm Lead:
Rachel Pyburn / Groups M, P & S
Firm Lead:
Bob Young
Week 1 / Case 1 –
The Heavy Drinker / Case 6 -
And now a management problem / Case 9 –
A Sweet Life
Week 2 / Case 6 -
And now a management problem / Case 9 –
A Sweet Life / Case 12 –
A case of haematuria;
the diplomat’s wife
Week 3 / Case 9 –
A Sweet Life / Case 12 –
A case of haematuria;
the diplomat’s wife / Case 1 –
The Heavy Drinker
Week 4 / Case 12 –
A case of haematuria;
the diplomat’s wife / Case 1 –
The Heavy Drinker / Case 6 -
And now a management problem

Suggestions for the clinical debrief

Cases
/
Diseases in the case
/
Cases for students to see in preparation for the clinical debrief sessions
1 The heavy drinker with severe abdominal pain / Perforated peptic ulcer, surgery and alcohol abuse / Abdominal pain, peptic ulcer and emergency surgery
6 And now, a management problem… / Somatisation; abdominal presentation / Abdominal pain, including IBS
9 A Sweet Life / Diabetes / Diabetes
12 A case of haematuria / Haematuria, carcinoma of the kidneys & bladder / Haematuria; renal and urological neoplasia

What we expect from a 3rd Year Medical student

  • Be as polite, positive and as proactive as possible.
  • You should become well knownto our doctors.
  • You should attend tutorials, teaching sessions and educational supervision sessions reliably and punctually.
  • You should identify your learning needs and make them known to us.
  • You should get stuck in to seeing patients, speak up in discussion and work actively to develop clinical competence.
  • You should read around the situations and cases that you encounter, including the use of electronic literature resources – ‘up to date’ on synapse, gpnotebook.co.uk, bestbets.org, NICE guidelines, hospital protocols
  • During this module you will get some training so that you can be a more active learner on the wards – ie writing up drug cards (but not signing) how to write in notes, taking blood/cannulation. Let the staff on your next placement know that you have these skills &use them!

Suggested learning experiences for Integrated module cases

SITUATION 6: AND NOW, A MANAGEMENT PROBLEM…

  • Patients taking an antidepressant
  • Patients being diagnosed with depression for the first time
  • Screening diabetic and CHD patients for depression
  • Using depression screening/diagnostic tools
  • Patient with irritable bowel syndrome
  • Patient with tension headache
  • Patients who present as ‘Tired all the time’
  • Assessing severity of depression
  • Assessing suicidal risk
  • Alcohol history
  • Explaining links between mind and body to a patient
  • Being sensitive to patient beliefs in descriptions of somatisation
  • Coping with patients who become upset in a consultation.
  • Discussing forms of treatment for depression
  • Defining depression and distinguishing unhappiness
  • How GPs manage patients with multiple somatic complaints.
  • Role of voluntary and non-statutory agencies in the community in helping people with emotional problems.
  • Discussion of the “heartsink” patient.
  • Communication between hospital and community doctors
  • Choose and Book systems
  • Mental state examination
  • PHQ-9 questionnaire
  • HAD depression score
  • BDI depression score

SITUATION 9: A SWEET LIFE

Suitable Patients, Situations and Activities

  • A patient with recently diagnosed Type II diabetes
  • A patient with Type I diabetes
  • A patient with diabetic complications e.g. neuropathy, nephropathy, retinopathy, cardiovascular disease, retinopathy, autonomic neuropathy.Foot clinic/podiatry
  • Patient education: diet, treating hypoglycaemia, managing medication, what to do when you are ill; why cholesterol, blood pressure and sugar are important
  • Negotiating changes in behaviour
  • A diabetic patient attending for annual review
  • diabetes review bloods, HBA1C in and out of range, lipids in and out of range, diagnostic levels of glucose for diabetes, impaired fasting glycaemia or impaired glucose tolerance.
  • Treating to Target in diabetes: QOF and effect on patient care
  • Organisation of diabetes care in the community
  • Role of the Diabetes Specialist Nurse – nurse consultations
  • Primary and secondary prevention in diabetes
  • Chronic illness and driving (see DVLA guidelines).
  • Diabetes UK (Patient support organisation)
  • Examination of the retinaOpthalmologist / ophthalmology/laser
  • Examination of the peripheral vascular system}
  • Examination of the peripheral nervous system}
  • Blood Pressure measurementGP consultations
  • Blood Glucose measurement using a meter
  • Testing urine for protein, ketone, glucose and microalbuminuria

Core Content:

The main ICS is: 042Diabetes mellitus

Other ICS covered are:060 Hypoglycaemia

SITUATION 12: (1) A CASE OF HAEMATURIA.

  • A patient presenting or who has presented with haematuria
  • Taking an occupational history
  • Urine testing: including dipstick, microscopy, culture and cytology
  • Patient with a history of bladder carcinoma
  • Patient who goes for regular check cystoscopies
  • Patient with a stoma following bladder surgery
  • Two week/HSC referral criteria for a patient with suspected urinary tract cancer
  • Abdominal, pelvic and rectal examination.
  • Urethral catheterisation skills

Core Content:

The main ICS is:141Haematuria

Other ICS covered are:096Post operative care

097Pre operative care

171Carcinoma of bladder

SITUATION 12: (2) THE DIPLOMAT’S WIFE

  • A patient seeking health advice before travel abroad
  • A patient attending for holiday vaccinations
  • A patient attending for malaria prophylaxis
  • A patient with pyrexia
  • A patient with (h/o) renal carcinoma
  • Taking a travel history from a patient
  • Breaking bad news.
  • Ensuring confidentiality when talking to relatives
  • Discussing risks and benefits of malaria prophylaxis

Core Content:

The main ICS is:171 Carcinoma of kidney

157PUO

Other ICS covered are:072Malaria

096Post-operative care

097Pre-operative care

198Tiredness

SITUATION 1: THE HEAVY DRINKER WITH SEVERE ABDOMINAL PAIN.

Suitable Patients, Situations and Activities

  • A patient with chronic alcohol problems – likely found on H2, H3, EAU
  • Taking an alcohol history from any patient
  • A patient taking anti-ulcer medication
  • Normal and abnormal LFT results
  • Management of upper GI disease in secondary care
  • Alcohol support groups and links with secondary care.
  • ‘GI Endoscopy – upper’ signup
  • ‘CT body’ signup
  • GI/gastroenterology clinics
  • Ultrasound
  • Protocols on synapse – GI bleeding/haematemesis, how to do an ascetic tap, vitamin prophylaxis in alcoholism, prevention/treatment of withdrawal symptoms.
  • Examination of Abdomen and Mouth

Core Content/ ICS

087Peptic Ulcer

125Abdominal pain

091Peritonitis

097Pre-operative care

096Post-operative care

(140Haematemesis

023Carcinoma stomach)