Information about Phase 3

Course Guide Course assessments

Phase 3 Guide Phase based assessments

Vista Course modules Discipline-based modules Biomedical sciences

Program website

Learning in Phase 3

What do I need to learn? What diseases do I need to know? What do I need to know about them?

Do I just need to know what is clinically relevant?

What things don’t I need to know?

How should I approach learning in Phase 3? Is it better to follow a syllabus or focus on what I

see on the wards, clinics, rooms etc?

Approach to learning - experiential

Based on your clinical experiencesBetter retention (understanding the

relevance and applying knowledge)“Opportunistic”Skewed case mix

Hospitalised patients with complex problems

Consider co-morbidityLimited clinical placements

Approach to learning - structured

Program of topics (“syllabus”)Discipline/system-based

Ensures completeness and avoids gapsOverwhelming list of topicsMay not be able to demonstrate

“credibility”

Focus of learning

Focus on clinical presentations: E.g. an approach to a patient with haematuria

What are the common causes? What conditions may be life-threatening? What features help to distinguish these

causes? What investigations should be performed? What symptomatic treatment is required? What specific treatment is required?

Focus of learning

Focus on syndrome/disease:E.g. glomerulonephritis

AetiologyPathologyEpidemiologyClinical manifestationsDiagnosisTreatment & preventionCourse & prognosis

Experiential

(clinical or disease focus)

Structured

(clinical or disease focus)

Learning from a clinical presentation

16 year old male presents with 24 hour history of headache, fever and generally feeling unwell.

On examination, he is febrile and hypotensive. He has neck stiffness and a petechial rash is evident on his limbs.

Learning from a clinical presentation

16 year old male presents with 48 hour history of headache, fever and generally feeling unwell.

On examination, he is febrile and hypotensive. He has neck stiffness and a petechial rash is evident on his limbs.

Pattern recognition

Constellation of symptoms & signs Headache Fever Neck stiffness

Distinguishing epidemiological clues Meningococcus is commonest cause of meningitis

in adolescents.

Distinguishing clinical features Petechial rash is indicative of meningococcus.

Meningitis

Learning approach to a presenting problem

What are the common causes? What conditions may be life-threatening?What features help to distinguish these

causes?What investigations should be

performed?What symptomatic treatment is

required?What specific treatment is required?

Approach to management

Headache, fever & neck stiffness = meningitis

Empirical treatment

Definitive treatment

Clinical assessment

Investigations LP, imaging studies, blood cultures, serology

Epidemiology and clinical features of microbial causes of meningitis

Antibiotics, corticosteroids, supportive treatment (shock, raised intracranial pressure)

Antibiotics, public health measures (isolation, chemoprophylaxis, vaccination)

Lumbar puncture (diagnostic test)

Indications for LPHow is it performed?Interpretation of results

Limitations (sensitivity, specificity)Safety of procedure

Contraindications

Approach to management

Headache, fever & neck stiffness = meningitis

Empirical treatment

Definitive treatment

Clinical assessment

Investigations LP, imaging studies, blood cultures, serology

Epidemiology and clinical features of microbial causes of meningitis

Antibiotics, corticosteroids, supportive treatment (shock, raised intracranial pressure)

Antibiotics, public health measures (isolation, chemoprophylaxis, vaccination)

Empirical antibiotics in meningitis

What antibiotics are used empirically? What is the rationale for the choice?

Specific drugs (penicillin, ceftriaxone, vancomycin) Type of drug Mechanism of action (spectrum of activity) Pharmacokinetics Efficacy Toxicity Mechanisms of resistance

Treatment

DiagnosisClinical features

Aetiology(Microbiology)

Prevention

Meningitis

Leptospirosis

Other bacteria

Pneumococcus

Meningococcus

Viral meningitis

Aetiology(Microbiology)

Prevention

Treatment

DiagnosisClinical features

Pathogenesis

Structure

Type of organism

Meningococcus

What do you need to know?

Breadth (scope)Common

Clinical experiencesCourse guidesTextbooks

ImportantLife-threatening “Classical” – illustrates an important concept

What do you need to know?

Depth Common

Emphasis on management – knowledge and ability to diagnose and treat

Important Life-threatening

Recognition and early management “Classical”

Defined area of knowledge

Uncommon/rare Awareness – when to suspect.

Case reports/presentations

Refer to course guide for precise requirements.

Supervisor/school has flexibility in determining number and type.

Assessed by supervisor or school Not submitted to eMed for assessment.

Can be submitted,with completed assessment form,to eMed as supporting evidence,

Observed clinical assessments

Refer to course guide for precise requirements.

Supervisor/school has flexibility in determining number and type.

Assessed by supervisor or school Formative assessments by junior staff

Completed assessment form can be submitted to eMed as supporting evidence.

Clinical log sheets

Record of interesting patients and issuesOptional for most coursesMay be used in end-of-phase Integrated

Clinical Examination Prompt for discussion of clinical problems

Negotiated assignments

Optional.Fill in gaps in portfolioAddress deficiencies.

Negotiate with supervisor or school.No need to submit proposal to eMed.

End-of-Phase Integrated Clinical Examination

Clinical and communication skillsVariable format depending on disciplineStations with real patients

Focussed history and/or examination.Variable duration (10-20 mins)

Stations with surrogates (including professional actors)

Examiner in role-playStations with clinical images or videos

End-of-Phase Integrated Clinical Examination

Management vivaAssessment of knowledge in management

(diagnosis & treatment) of common clinical presentations including emergency presentations.

Variable format depending on disciplineBased on clinical cases

Released and new cases