Faculty of Medicine & Health Sciences

School of Graduate Entry Medicine & Health

2010/12

Personal & Professional Development (PPD) Study Guide (A12P1G & A12P2G)

TABLE OF CONTENTS

OVERVIEW

SECTION 1: EARLY CLINICAL EXPERIENCE - General Practice Visits

KEY THEMES

LOG-SHEETS

ASSESSMENT

STUDENT FEEDBACK

COMPLAINTS ABOUT GP VISITS

SECTION 2: PROFESSIONAL COMPETENCIES (CLINICAL SKILLS) LEARNING OBJECTIVES

CLINICAL SKILLS CENTRE

ASSESSMENT

SECTION 3: PROFESSIONALVALUES(ATTITUDES AND BEHAVIOUR)

PPD ASSESSMENT……………………………………………………………………………………. .…14

PPD COURSEWORK ESSAYS...... 15

SECTION4: MAINTAINING YOUR PORTFOLIO...... 17

LEARNING RESOURCES

GEM COURSE OVERVIEW

The GEM course comprises two key themes:

  • Basic and Clinical Sciences (BCS)
  • Modules 1 to 6 (GEM year 1)
  • Modules 7 to 9 (GEM year 2)
  • Personal and Professional Development (PPD)
  • Module 1 (GEM year 1)
  • Module 2 (GEM year 2)

The Personal and Professional Development modules of the GEM course centre aroundthe concept of professionalism. They integrate basic communication and physical examination skills and encourage you to develop professional behaviour and attitudes and an awareness of how ethical principles underpin clinical practice. These are core skills for doctors and their importance is emphasised by the General Medical Council in the publication “Good Medical Practice”.

Areas covered under the umbrella of PPD include:

  • Early Clinical Experience (ECE)

(General Practice visits) – led by the Director of Clinical Skills

  • Professional Competencies

(practical clinical and technical skills) – led by the Director of Clinical Skills

  • Professional Values

(attitudes and behaviour) – led by the Head of PPD

This document provides an overview of the PPD activities and requirements embedded within the GEM course and the portfolio that you are required to maintain for the duration of the eighteen month course. The Professional Competencies (Clinical skills) sections of the module are further detailed in separate workbooks and other material which will be issued to accompany each BCS module.

General PPD aims

  • To stimulate and maintain enthusiasm for clinical medicine
  • To provide experience of patient contact
  • To practise history taking, clinical examination and clinical procedures
  • To learn and apply basic principles of emergency care
  • To develop the ability to evaluate ethical and legal issues in patient care
  • To encourage the development of professional attitudes towards patients and colleagues
  • To develop skills of self-evaluation and appraisal leading to reflective medical practice
  • To learn to communicate with patients of different ages and from diverse social and ethnic backgrounds with different diseases, capacity and prognoses
  • To learn to analyse factors influencing the relationship between doctor and patient - particularly culture, religion, age, gender and sexuality
  • To encourage understanding of the roles of the different health professionals involved in patient care and develop team working skills
  • To develop a willingness to contribute to teaching, training, appraising and assessing
  • To gain an understanding of health promotion issues in relation to yourselves, the individual and the community

Learning Opportunities

The PPD theme comprises a range of taught classes and learning opportunities:

  • Visits to General Practice
  • Clinical and Communication Skills training and practice
  • PPD seminars and workshops
  • PPD coursework
  • Development of a portfolio
  • PBL cases (most cases have important PPD outcomes)

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Section 1: eARLY CLINICAL EXPERIENCE- General Practice Visits

As future doctors you are expected to behave appropriately on clinical visits and when dealing with patients. The following notes are to help you get started on the right foot!

1.Dress smartly - jeans and tee-shirts are not considered acceptable. The dress code in the Student Handbook and also in the WebCT course administration section must be followed. ID badges must be worn.

2.Be punctual - but remember that clinical staff may be delayed due to their other commitments.

3.Be courteous to patients and staff at all times.

4.Always ask for a patient’s permission to interview or examine them, making sure they know that you are a student doctor.

5.Treat all patient information as confidential - it is not to be discussed outside appropriate clinical settings. Written notes should exclude identifying information (e.g. name, address).

6.If you are delayed or unable to attend ring the surgery as soon as possible. They may have made special arrangements for your visit.

7.Remember to take this guide and a stethoscope with you to each visit.

Key Themes

Learning on your clinical visits has to be opportunistic. General Practitioners are unable to predict exactly who will be visiting their surgery on any given day, but we can guarantee that the visits will generate a wealth of learning opportunities.

Themes we would like you to consider on the visits are:

  1. The Doctor-Patient Relationship

Doctors all have different consulting styles and differ in the way they relate to patients. Think about the strengths of the style adopted by the doctors that you meet. Are there disadvantages in the approach they adopt? What style are you comfortable with? How do you think the relationship between GPs and patients differs from that of hospital doctors and patients?

  1. Reason for the Consultation

A common cause of problems in consultations is that the doctor fails to identify the problem that concerns the patient. Patients are sometimes hesitant about revealing the true reason for their attendance; they may be concerned that the doctor will judge them or ridicule them. Patients see their GP for all sorts of reasons not just to establish a diagnosis. For example, it may be for reassurance about a symptom or to legitimise absence from work. Each time you observe a consultation, try and identify the reason for the patient’s attendance. Does the GP you are working with agree with your problem definition?

  1. Psychosocial Consequences of Illness

Even minor illness can have a significant effect on a patient, disrupting their life and causing anxiety. There is often a complex mix of psychosocial and physical dimensions to consultations. Observe how the psychosocial components impact on the patient’s presentation.

  1. Ethical Issues in Doctor-Patient Encounters

Medical ethics is concerned with the moral principles and rules of conduct followed by the medical profession. During visits you are asked to identify ethical issues that may occur in normal consultations. Although you may not encounter a major ethical dilemma, you should consider how elements of what you have already learnt apply to all the consultations you observe. The four main ethical principles are: respect for autonomy, beneficence, non-maleficence and justice.

We hope that on each visit you will be able to meet a patient with a problem which relates to the current module you are studying. GP tutors will do their best to arrange this but it will not always be possible. Throughout the visits you should apply the learning you have achieved in communication workshops to the consultations you observe.

Log-Sheets

During or after each GP visit you are required to complete a log-sheet which must then be filed in your portfolio. The purposes of these are to enable you to:

  1. Record your encounters with patients and to identify what you have learnt from them and areas that you need to learn more about.
  2. Provide a basis for undertaking PPD coursework.
  3. Provide you with material for discussion in group learning.
  4. Allow you, your personal tutor and the course organisers to evaluate the range of experiences that you are receiving.

In common with all medical records, your log should be ‘contemporaneous’, which means that it is completed at the time, or just after seeing the patient. Each record should be dated, legible and concise. Discuss the best way of doing this with your GP tutor, since it can sometimes be disconcerting for a patient if you are writing about them whilst they are in the room. Do not record any ‘patient identifiable’ information (e.g. names or dates of birth) in your log. You are expected to see at least six patients on any GP visit, and your log-sheet should reflect this. A MS Word template file can be downloaded from WebCT to print further sheets and to adapt them to provide more space for entering notes if you so wish.

Assessment

At the end of each year, individual GP Tutors are required to confirm that their student has achieved baseline progress requirements in order to proceed: these include appropriate attendance, attitudes and behaviour. Any student failing to achieve such criteria without adequate explanation will be discussed at the GEM Examination Board;in this instance failure to achieve the required level of competence is normally recommended. The GP visit forms (an example of which can be seen on WebCT) must be filed in your portfolio. GP Tutors should refer to the summary of course objectives in the ECE Tutor’s Guide before completing this form in consultation with the student.

STUDENT FEEDBACK

At the end of your first and second year visits you should complete a Student Evaluation of Early Clinical Experience feedback form about your Practice and return it to the GEM School Office. These forms can be found on WebCT.

COMPLAINTS ABOUT gp visits

a)Any student who feels that they are not gaining adequate experience on their GP visits should attempt to discuss and resolve the matter with their individual GP tutor in the first instance.

b)In circumstances where discussion with individual tutors does not result in a mutually acceptable solution, or where the student does not feel able to talk to the tutor, then the matter should be raised with the Director of Clinical Skills. This should be done in writing, with adequate detail about the problems encountered. The Director of Clinical Skills will then arrange to meet the student to discuss the matter and agree possible means of resolution. The Director of Clinical skills will then liaise with the individual GP Tutor concerned.

c)Where possible, an adequate resolution should be found with the existing tutor. However, if this is impracticable, then the student should be offered an alternative placement for their GP visits, although this may be outside usual curricular hours.

d)If difficulties continue, or cannot be resolved, the matter will be discussed with the Director of Undergraduate Studies.

SECTION 2: PROFESSIONAL COMPETENCIES

(Clinical Skills) Learning Objectives

Below are the generic clinical learning objectives for the GEM course. More specific objectives and checklists for individual clinical skills sessions are included in each workbookwhich will be issued during the course.

You should be able to:

  1. Approach a patient considerately and respectfully, make appropriate introductions, and gain informed consent for undertaking whatever clinical skill you are hoping to practise.
  1. Apply professional and ethical principles in dealing with patients, in particular those of confidentiality and respect for patients.
  1. Take a brief clinical history from a patient with defined clinical symptoms in terms of the history of the presenting problem and basic background information.
  1. Enquire about the impact of symptoms on a patient in both physical and psychosocial terms, whilst recognising and acknowledging the patient’s own beliefs, concerns and expectations about the problem.
  1. Recognise the importance of gaining an overall impression of a patient in terms of physical characteristics and mobility, and to recognise and list signs of pain, distress or serious illness.
  1. Recognise the importance of examining peripheral aspects of a patient before focusing on particular systems and, in particular, to be able to list clinical signs which might be detected by examining the hands, eyes, mouth and skin.
  1. Palpate any part of the body, using an appropriate technique, in order to elicit signs of tenderness or presence of masses, but without causing unnecessary discomfort to the patient.
  1. Correctly percuss any part of the body, using an appropriate technique, in order to distinguish dullness and resonance.
  1. Correctly use a stethoscope, with appropriate positioning of earpieces, and choice of bell or diaphragm, in order to auscultate body sounds.
  1. Report and/or record the findings from a clinical history or examination in a concise, coherent and comprehensible manner.
  1. For any clinical system describe the basic patho-physiology of common clinical conditions, and be able to explain such problems to patients using appropriate lay terminology.
  1. For any clinical system, describe the common laboratory tests which might be performed in relation to it, and to be able to interpret these.
  1. For any clinical skill, make a concise, dated and legible record of the findings and recognise the importance of this for clinical and medico-legal purposes.
  2. Adequately assess and approach an emergency situation and undertake appropriate basic immediate necessary first-aid care, including cardiopulmonary resuscitation, as necessary.

Clinical Skills CENTRE

The GEM Clinical Skills Suite is situated on the top floor (Level 5) at the University of Nottingham Medical School at Derby. The centre provides a venue for learning and practising those skills and procedures that involve direct patient contact. It contains a range of facilities including video links, demonstration videos, and models. In addition to timetabled sessions, you can use the Clinical Skills Centre for self-directed learning. Specific times are allocated for this purpose (labelled ‘drop in sessions’) and these are published on the timetable on the notice board outside the Clinical Skills Centre on a regular basis.

The following regulations apply to the use of the Clinical Skills Suite:

  1. All students must wear an ID badge on entering the Clinical Skills Suite and must sign the register on entry to the centre.
  2. No eating, drinking or smoking is allowed in the Clinical Skills Suite.
  3. The Clinical Skills Suite is only available for student-directed learning when a technician or appropriate member of academic staff is in attendance.
  4. No invasive procedures should be performed without a registered clinical practitioner in attendance.
  5. Equipment should only be used with adequate prior instruction.
  6. Students must inform the Clinical Skills Suite technician of any faults/problems with the equipment.
  7. No equipment is to be removed from the Clinical Skills Suite or put to inappropriate use.

In case of any problem or query about the use of the unit, contact the Clinical Skills Technician, Telephone number 01332 724630 (internal 24630).

Learning clinical skills takes time and practise. You will be given an introduction to basic interviewing, examination skills and procedures and following this, there will be the opportunity to practise. It is very important that you come to these sessions prepared to participate, both in terms of performing examination and being examined. This will form the foundation for further learning during the full-time clinical practice course. The aim in the first eighteen months is to learn the basic skills well. You will also learn how to integrate your communication skills with all the other skills you learn in the centre.

You should bring appropriate clothing (e.g. shorts and tee-shirts) and change into them before the session. Whilst we will respect any cultural or religious reasons that prevent full participation, we do encourage everyone to co-operate as much as possible. Optional provision will be made for students who wish to practise in segregated single sex groups.

ASSESSMeNT

Summative Skills Certification - Years 1 and 2

a)At regular intervals, GEM students will have the opportunity to be assessed on the performance of required clinical skills.

b)Each student will be assessed on a limited number of skills – usually those taught and practised by that stage of the course.

c)Details of all the required skills will be made available to students on the GEM website. Specific criteria against which students will be assessed will be provided in the skills instruction sessions. It is each student's responsibility to familiarise themselves with this information.

d)After the assessment, students will be given feedback on their performance. When a student achieves the Required Level of Competence for a skill, this will be recorded by the Assessor. A copy of the checklist will be provided for the student later.

e) You will receive a copy of the completed checklist, plus any qualitative feedback following the assessment, and this must be kept in your portfolio.

e)You will also be certified as competent in certain skills (eg: pulse rate, peak flow etc) during some sessions. At the end of the session you will be provided with a certificate of competence signed by your assessor. This certificate should be kept in your portfolio for submission at the end of the year.

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Section 3: professional values

(ATTITUDES AND BEHAVIOUR)

The core themes below comprise the learning objectives of the Professional Values section of the PPD modules. These will be achieved by participation in a combination of seminars and lectures, completion of pieces of coursework, PBL cases, the Shared Family Study project, Early Clinical Experience and self-directed learning.

Core themes:

  1. Principles of Healthcare

Students should be familiar with key principles in healthcare. These principles are relevant in all areas of medicine and support a process of clinical reasoning and team work.

  1. Medical ethics and law

Learning objectives: Students should be:

aware of their own beliefs and engage in critical reflection on their own and their colleagues’ moral beliefs.

know the four basic principles of beneficence, non-maleficence, autonomy and justice and be able to apply them to common medical problems.

able to describe the legal principles inherent in UK law.

able to describe the professional duties expected of a doctor by the GMC.

able to explain the role of the defence unions.

able to explain the principles of double effect, the Sanctity of Life and ordinary and extra-ordinary means.