MBBS Undergraduate

Rural Clinical Program

2015

Year 4 & 5 Guidelines

C O N T E N T S

1. PURPOSE ...................................................................................................................................................... 5

2. ABOUT THE UTAS RURAL CLINICAL SCHOOL ................................................................................................... 5

2.1 Introduction .................................................................................................................................................. 5

2.2 Rural Medicine Learning Outcomes ............................................................................................................. 5

3. STAFF CONTACTS FOR UNDERGRADUATE PROGRAM ..................................................................................... 6

4. THE PROGRAM ............................................................................................................................................. 9

4.1 Overview of the Program ............................................................................................................................. 9

4.2 Support ......................................................................................................................................................... 9

4.3 Group Learning Programs and clinical attachments..................................................................................... 9

4.3.1 Group Learning Program ................................................................................................................. 9

4.3.2 Clinical Attachments ...................................................................................................................... 10

4.4 Clinical Attachments ................................................................................................................................... 10

4.4.1 Year 4 Clinical Attachment Overview ............................................................................................ 10

4.4.2 Year 4 & 5 Clinical Attachments..................................................................................................... 11

4.4.3 Year 4 Specific Attachments .......................................................................................................... 12

4.4.4 Year 5 Specific Attachments & Requirements ............................................................................... 14

5. STUDENT LEAVE ARRANGEMENTS ............................................................................................................... 18

5.1 Attendance ................................................................................................................................................. 18

5.2 Student Leave ............................................................................................................................................. 18

6. ASSESSMENT .............................................................................................................................................. 19

6.1 Learning Portfolios ...................................................................................................................................... 19

6.2 RCS Formative Assessment Requirements ................................................................................................. 19

6.2.1 Electronic Clinical Log Book ........................................................................................................... 19

6.3 Marking Guides ........................................................................................................................................... 20

6.4 Assessment Process .................................................................................................................................... 20

6.4.1 Assessment Requirements and Timelines ..................................................................................... 20

6.5 Submitting Work ......................................................................................................................................... 20

6.5.1 Viewing your Grades via MyLO ...................................................................................................... 20

6.6 Year 4 Formative Assessment Tasks at the RCS ......................................................................................... 20

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6.6.1 Oral Case presentations (2 for the year) ....................................................................................... 20

6.6.2 Complex Rural Longitudinal GP Oral Case Presentations (2 for the year) ..................................... 21

6.6.3 Year 4 Written Case Histories ....................................................................................................... 21

6.6.4 Global Health Assessment Task ..................................................................................................... 22

6.7 Year 4 Summative Assessment Tasks at the RCS ........................................................................................ 22

6.8 Year 5 Written Cases Summative Assessment Tasks at the RCS ................................................................ 22

6.9 Penalties ..................................................................................................................................................... 22

6.10 Summary of RCS Portfolio Assessment Requirements and Timelines - Year 4 .......................................... 23

6.11 Summary of RCS Portfolio Assessment Requirements and Timelines - Year 5 .......................................... 26

7. REMEDIATION ............................................................................................................................................ 29

8. LEARNING RESOURCES ................................................................................................................................ 29

8.1 Library and Information Technology Support ............................................................................................ 29

9. SIMULATED LEARNING ENVIRONMENT (SLE) ............................................................................................... 29

10. STUDENT SUPPORT ..................................................................................................................................... 29

10.1 Academic Supervisors ................................................................................................................................. 29

10.2 General Mentoring ..................................................................................................................................... 30

10.3 Vertical/Horizontal Integration in the Year 4 & 5 RCS Medical Undergraduate Program ......................... 30

10.3.1 Year 4 Peer Support Program ........................................................................................................ 30

10.3.2 Final Year Peer Support Program ................................................................................................... 30

10.3.3 Horizontal Integration .................................................................................................................... 30

10.4 Additional Educational Support .................................................................................................................. 30

10.5 Professional and Personal Support ............................................................................................................. 31

10.5.1 RCS Staff ......................................................................................................................................... 31

10.5.2 Personal GP Services ...................................................................................................................... 31

10.5.3 Counselling Services ....................................................................................................................... 32

11. APPENDICES ............................................................................................................................................... 33

11.1 2015 RCS Calendar ...................................................................................................................................... 33

11.2 2015 Year 4 Student Attachment Allocations ............................................................................................ 35

11.3 2015 Year 5 Student Attachment Allocations ............................................................................................ 37

11.4 2015 Year 4 CBL Allocations ....................................................................................................................... 39

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11.5 2015 Year 5 CBL Allocations ....................................................................................................................... 40

11.6 Clinical Log Book example – Example of Satisfactorily completed Log Book ............................................. 41

11.7 Clinical Attachment Report ......................................................................................................................... 42

11.8 Short Duration Assessment Form ............................................................................................................... 44

11.9 Mini-CEX Assessment Form ........................................................................................................................ 45

11.10 CBL Assessment Form .................................................................................................................... 47

11.11 Year 4 Oral Assessment Form ........................................................................................................ 48

11.12 Year 4 Complex Rural Longitudinal Oral Case Presentation (GP) Assessment Form ..................... 49

11.13 Year 5 Chronic Rural Longitudinal Oral Case Presentation Assessment Form .............................. 50

11.14 Year 4 Chronic Disease GP Longitudinal Case Written Assessment Form ..................................... 51

11.15 Year 5 Chronic Illness Longitudinal Case including Complex Therapeutics Long Case History

Assessment Form ........................................................................................................................................ 52

11.16 Year 4 Acute Long Case History Assessment Form ........................................................................ 53

11.17 Year 5 Acute Long Case History Assessment Form ........................................................................ 54

11.18 Reflective Piece Assessment Form ................................................................................................ 55

11.19 Core Competency Assessment Forms ........................................................................................... 56

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1. PURPOSE

The Rural Clinical School guidelines are designed to be a practical resource that:

Clearly outlines the learning and assessment requirements for students undertaking the final two years of the five year MBBS course through the Rural Clinical School (RCS).

Provides information on the resources available to medical students at the RCS.

Students should use this document in conjunction with the Year 4 or 5 School of Medicine (SoM) Handbook.

2. ABOUT THE UTAS RURAL CLINICAL SCHOOL

2.1 Introduction

The UTAS Rural Clinical School has a charter to provide a rural and remote health context for learning to ensure that students have competencies and attributes that will equip them to practice in rural and remote settings.

The University of Tasmania’s Rural Clinical School:

Is part of a national rural education and training network funded through the Australian Government’s Department of Health – Rural Clinical School program, a Regional Health Strategy.

Focuses on preparing medical and other health profession students for rural practice.

Provides students with clinical education and training, and supports health practitioners in rural and remote areas.

Delivers clinical education, training and experience through the Tasmanian Health Organisation North West (THO-NW) via the North West Regional Hospital (NWRH) Burnie, the Mersey Community Hospital Latrobe, the North West Private Hospital (NWPH) Burnie, and a network of general practices, district hospitals and community health facilities.

Is one of three Clinical Schools in Tasmania (Hobart, Launceston and the North West region).

2.2 Rural Medicine Learning Outcomes

In addition to the generic themes and principal outcome measures outlined in the SoM Handbook, the following rural medicine learning outcomes will be achieved. 1. Socio-demographic and cultural differences between rural and city life, and their effect on

professional/patient/community relationships. 2. Participation in Community Engagement 3. Aboriginal health care issues in a regional context. 4. Conduct of referrals, and the relationships between the referring rural GP and their city and/or

provincial specialist. 5. Impact of isolation on patient and family behaviour in addressing health problems. 6. Impact of geographic isolation of patients on medical management. 7. Impact of professional isolation on medical practice and on the personal lives of medical and

other health professionals. 8. Inter-relationship between rural and urban health care providers and facilities. 9. Development and operation of a health care team. 10. Medical evacuation of the injured or ill patient. 11. Potential of Telehealth developments for rural health care delivery.

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12. Techniques for maintaining professional competence and standards for professionals outside of tertiary clinical environments.

13. Knowledge of the social services in the community in which they are working.

3. STAFF CONTACTS FOR UNDERGRADUATE PROGRAM

RCS Reception ph: 03 6430 4550. Most staff can be contacted on this number, and also by their UTAS email accounts.

Year 4 & 5 Rural Medical Undergraduate Program (Personnel/roles may change through the year to allow for leave)

RCS ACADEMIC STAFF

Associate Professor Lizzi Shires & Associate Professor Deborah Wilson (Co-Directors)

Co-Directors, Rural Clinical School

Associate Professor Deborah Wilson (Assoc Prof. Rural Acute Medical Education)

Program Co-ordinator, clinical attachments, CBL, tutorial program and student assessments

Associate Professor Lizzi Shires (Assoc Prof. Community Based Medical Education)

Co-ordinator for community based medical education and community engagement

Associate Professor Peter Arvier (Associate Professor Rural Medicine)

Co-ordinator Aboriginal and Global Health, Emergency Medicine CBL’s & mentoring

Mrs Rose Winter (Medical Education Advisor)

Educational support

Dr Alison Tasker & Julie Beechey (Clinical Associate Lecturers – Pharmacy)

Therapeutics programme, tutorial program

Dr Brady Tassicker (Clinical Senior Lecturer - Emergency Medicine Retrieval & Clinical Simulation)

Emergency Medicine clinical attachments, tutorial program, mentoring and simulation

Dr Heinrich Weber (Clinical Senior Lecturer - Paediatrics)

Paediatric teaching and clinical attachments, CBL, tutorial program

Mr Trevor Leese (Clinical Senior Lecturer – General Surgery)

Surgical clinical attachments NWRH, CBL, tutorial program

Dr James Roberts-Thomson (Clinical Senior Lecturer – General Surgery)

Surgical clinical attachments Mersey Hospital, CBL, tutorial program

Dr Albert Nwaba (Clinical Senior Lecturer – Gastroenterology)

General medical clinical attachments, CBL, tutorial program, mentoring

Dr Margo Peart (Clinical Senior Lecturer - Anaesthetics)

Anaesthetic clinical attachments, tutorial program, assessments, mentoring

Dr Nick Towle Head of Clinical Simulation (Clinical Lecturer and Medical Education Advisor)

CBL, tutorial program, assessment, mentoring, educational support in clinical skills and simulation

Dr Roger Bodley (Clinical Senior Lecturer – Radiology)

Tutorial program, mentoring

Dr Rosemary Ramsey (Clinical Senior Lecturer – Nursing Home)

Nursing Home programme, tutorial program

Dr Satish Kumar (Clinical Senior Lecturer - GP)

GP liaison, tutorial program, CBL, assessment, mentoring

Dr Sukesh Chandran (Clinical Senior Lecturer - Medicine)

General medical clinical attachments, CBL, tutorial program, mentoring

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Dr K.Sivanesan (Siva)

(Clinical Senior Lecturer - O&G) O&G clinical attachments, CBL, tutorial program

Dr Thiru Thirukkumaran

(Clinical Senior Lecturer – Palliative Care) Palliative Care attachment, tutorial program

Dr Tom McDonagh

(Clinical Senior Lecturer - Emergency Medicine)

Emergency Medicine clinical attachments, tutorial program,

mentoring

COMMUNITY SUPPORT

Kayla Millhouse Administration Officer (Community Engagement)

Support for MBBS students in the community

RCS CLINICAL SKILLS AND SIMULATION CENTRE

Lynn Greives Clinical Simulation Educator

Clinical Simulation Education

Heather Bryer Clinical Simulation Educator

Clinical Simulation Education

Luanne Steven Clinical Medical Educator

Clinical Simulation Education

Mel White Administration Officer (SLE)

Clinical Simulation Administration

RCS ADMINISTRATIVE STAFF Burnie Campus

Danielle Kidd School & Community Manager

Renee Harvey Academic Administration Supervisor

Kylie Bennett Administration Officer (Academic)

Jessica Bennett Administration Officer (Academic)

Jacqui Clear Administration Officer (Accommodation)

Christine Reynolds Administration Officer (Finance Hub)

Louise Lee Administration Assistant (Reception)

Jennifer Beamish Administration Assistant

Richard Rozendaal Administration Officer (Operations & Projects)

Clinton Weber ICT Officer

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Mersey Campus

Maggie Lea Administration Officer (Primary Care)

Anne-Maree Temple Administration Officer (Mersey & Community Engagement)

RESEARCH STAFF

Colleen Cheek (Research Fellow)

Research Fellow (Burnie)

Penny Allen (Research Fellow)

Research Fellow (Mersey)

ATTACHMENT CO-ORDINATION

Dr Lizzi Shires (via Maggie Lea) General Practice & Rural and Remote

Dr Sukesh Chandran Medical ward teaching and tutorials

Dr Marielle Ruigrok Emergency medicine teaching and tutorials

Dr Heinrich Weber Children’s Health ward teaching and tutorials

Ms Jeanette Hermans

Dr Siva Kanapathippillai Women’s Health ward teaching and tutorials

Mr Russell Furzer (NWRH – Orthopaedics)

Mr Trevor Leese (NWRH – General Surgery)

Dr James Roberts-Thomson (MCH – General

Surgery)

Surgical ward teaching and tutorials

Miranda Stephens Mental Health attachment and tutorials

Dr Thiru Thirukkumaran & Dr Rosemary Ramsey Palliative Care & Nursing Home attachment and tutorials

Dr Margo Peart Anaesthetic attachment and simulation teaching

Professor Michael Buist ICU ward teaching and tutorials

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4. THE PROGRAM

4.1 Overview of the Program

In designing the medical program, careful consideration has been given to the critical skills and experiences required for a medical graduate to act safely and capably as an intern. Medical students will be expected to:

Manage a proportion of patient intakes to their unit, taking an appropriate history, performing examinations, suggesting a plan of investigation and recommending treatment. This information should then be presented to a supervisor who will provide suitable feedback.

Perform basic ward procedures including ordering pathology and other relevant investigations and writing discharge summaries, all of which need to be countersigned by a registered medical practitioner.

Be familiar with appropriate procedures for writing drug charts and prescriptions.

Know the legal and ethical aspects involved in gaining patient consent for a procedure. These issues will be dealt with specifically in the teaching program.

Attend for at least 80% of their clinical attachment unless specific exemption has been granted by the Associate Head Rural Clinical School.

Participate in all activities of the clinical unit to which the student is attached. This may include presenting cases on ward rounds and during unit meetings.

Respond to opportunities during the day, but also after hours, when rostered on-call or the medical staff of the unit suggests there is an opportunity to gain a particular clinical experience or perform or further practice a procedural skill.

Longitudinally follow patients they have met in their clinical attachment, preferably extending beyond their hospital or GP encounter into other community services and into the patients’ homes.

Please refer to the 2015 RCS Calendar in Appendix 11.1. 4.2 Support

To assist in achieving these expectations, medical students will receive:

Structured tutorials, practical procedural skills instruction, CBL sessions and opportunities to reflect on professional practice.

Opportunities for self directed learning around patients.

Support from the team based in the Clinical Attachment site.

Full support and direction from the RCS academic team including regular meetings with your Academic Supervisor.

4.3 Group Learning Programs and clinical attachments

4.3.1 Group Learning Program

The tutorial program occurs during the group learning program (GLP/GLW). The complete

program is available on MyLO (My Learning Online learning management system), although it is

subject to change throughout the year. Students are expected to prepare and participate in

Case Based Learning, CBL’s. Resources for CBL’s will be available through MyLO and will be

updated throughout the year.

The CBL topics form the core curriculum on which most OSCE’s are based.

Please refer to Year 4 2015 CBL Allocations in Appendix 11.4 and Year 5 2015 CBL Allocations in

Appendix 11.5.

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The RCS has an active skills and communication programme which supports the clinical

placements.

4.3.2 Clinical Attachments

Clinical attachment handbooks are available on MyLO. Students should access these at least one week before hand to ensure that they know where to attend and any special requirements for that rotation. During the attachments students should maintain their electronic clinical log book and their log of skills. At the end of rotation, students are expected to get Clinical Attachment Report signed off by the clinical supervisor, refer to Appendix 11.7 or if the placement is of a duration of 2 weeks or less a Short Duration Report will be required, refer to Appendix 11.8. At all times, students are expected to wear their medical student identification, dress and conduct themselves in a professional manner (please refer to the SoM Handbook). Students are reminded that all procedures on patients can only be performed under the direct supervision of relevant nursing or medical staff.

4.4 Clinical Attachments

4.4.1 Year 4 Clinical Attachment Overview

Students will experience 3 x 4 week attachments in semester 1 and 2 x 5 week and 1 x 4 week attachments in semester 2 in different areas of acute services to assist in fulfilling learning objectives and are expected to take part in ward activities during the day, as well as after hours as scheduled, or where learning opportunities arise. Each attachment has an Attachment Timetable that details a series of clinical experiences that students are expected to participate in during their attachment.

The attachments for 2015 at the RCS are:

Medicine

Orthopaedic or General Surgery

Mental Health

Emergency Medicine

Paediatrics and

Obstetrics and Gynaecology Clinical attachments in orthopaedics, medicine, paediatrics, emergency medicine and obstetrics and gynaecology will involve rotations at the North West Regional Hospital or the Mersey Community Hospital campus to maximise clinical learning opportunities. Please see Appendix ? for DHHS Student Placement Guidelines. Throughout year 4, students will attend General Practice every Tuesday. The RCS does not offer speciality attachments, however students are likely to see these core presentations in Emergency and General Practice and their General rotations. Most common presentations in Dermatology, ENT, ophthalmology are seen during attachments and additional self directed study or selective experience may be required. Example overview of a year 4 six week attachment:

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SEMESTER 1

Week 1 Week 2 Week 3 Week 4 Week 5 Week 6

DEM DEM Group Learning

Program DEM DEM

Group Learning Program

SEMESTER 2

Week 1 Week 2 Week 3 Week 4 Week 5 Week 6

DEM DEM DEM DEM DEM Group

Learning Program

Refer to the 2015 Year 4 Attachment Allocations in Appendix 11.2. Students will be grouped into teams of four or five for attachments and will maintain that group for the year. Students are expected to participate in all activities of the clinical unit to which they are attached. This will include presenting cases on ward rounds or at departmental meetings. Students may be rostered on after hours/weekend shifts or required to be on-call during a clinical attachment to gain experience outside normal working hours. 4.4.2 Year 4 & 5 Clinical Attachments

Clinical Attachments are provided at North West Regional Hospital, North West Private Hospital

and the Mersey Community Hospital, and community placements across the North West Coast.

Accommodation is automatically provided in Latrobe for students undertaking attachments at Mersey Community Hospital. Preference for accommodation is given to students with on-call requirements. Students are encouraged to car pool for travel to and from Mersey Hospital. Communications

It will be the student’s responsibility to inform wards of their contact number (eg mobile phone) so they can be contacted out of hours for deliveries, emergencies etc. Academic and administrative staff regularly update students by use of the UTAS email system. Students should check their emails at least twice per day and should ensure that all communication in relation to their program of study is via their UTAS email account. It is important that you also check the Newsfeed section in MyLO on a regular bases and this will be used as a form of communication during 2015. Please refer to MyLO instructions on how to receive instant notifications via email for MyLO updates: https://mylo2012.utas.edu.au/d2l/lor/viewer/viewFile.d2lfile/17347/62528,2/Setting%20Notifications.pdf?ou=17347 General Surgery

Students are requested to download a copy of the Surgical Guidelines document from MyLO prior to commencement of the attachment. Students will be rotated through different general surgical teams to maximise learning opportunities. There will be a mixture of theatre, ward work and clinics. Individual student

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programs will be developed with participating students in the week prior to the commencement of the attachment. Mr Trevor Leese and Mr James Roberts-Thomson will co-ordinate the medical student program in general surgery for 2015. General Medicine Students are requested to download a copy of the General Medicine Guidelines document from MyLO prior to commencement of the attachment. The General Medical attachment year 4 students will be primarily based at the NWRH campus. Year 5 students will be based at both either NWRH or the MCH. Students will be assigned to a Registrar and Consultant during the medical attachment and undertake a range of tasks including ward work, clinics, Unit education program and focused student bed-side teaching and case discussions. Dr Sukesh Chandran will coordinate the student attachment program. A detailed attachment timetable is available on MyLO. Emergency Medicine Students are requested to download a copy of the DEM Guidelines and the Super Suturing documents from MyLO prior to commencement of the attachment. Dr Marielle Ruigrok coordinates the student attachments. Students participate in all activities of the unit including the Wednesday morning DEM teaching program. This includes the 0730 student case presentations. All students are expected to bring along a short case with which they have personally been involved in the preceding week. These case presentations will count towards the overall assessment for the attachment. A roster for each attachment is also available on MyLO. Students are expected to be available for morning, evening, night and weekend shifts. A clinical log book should be completed and is available via the electronic log book. 4.4.3 Year 4 Specific Attachments

Mental Health Attachment The mental health attachment will use the Spencer Clinic at the NWRH, the North West Private Hospital and various community settings on the North West coast. Miranda Stephens, clinical psychologist coordinates the student attachments. Obstetrics & Gynaecology Attachment Students are requested to download a copy of the O&G Guidelines document from MyLO prior to commencement of the attachment. The O&G attachment will be based at either the North West Regional Hospital or the Mersey Community Hospital for the entire attachment. Dr Siva Kanapathippillai and Jeanette Hermans co-ordinate the student attachments.

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Paediatric Attachment Students are requested to download a copy of the Paediatric Guidelines document from MyLO prior to commencement of the attachment. The Paediatric attachment will be based across North West Regional Hospital and the Mersey Community Hospital. Students should note that most clinical experience occurs in the outpatient setting and students should be actively involved in the relevant clinics of these disciplines. Dr Heinrich Weber co-ordinates the student attachments. Orthopaedic Attachment Students are requested to download a copy of the Surgical Guidelines document from MyLO prior to commencement of the attachment. The Orthopaedic attachment is based at the North West Regional Hospital. Mr Russell Furzer co-ordinates the student attachments. Primary Care Attachment (1 day per week)

Each Year 4 medical student will participate in the Primary Care attachment for 35 weeks of the program on a Tuesday. Students will attend two different practices during the year. During general practice sessions students may be allocated patients for consultation, review their findings with the doctor and use this to trigger self-directed learning. The program is designed to provide a longitudinal in-depth and interactive teaching experience. Each week, the Primary Care experience will focus on general practice consultation and clinical skills, patient follow up and Primary Care for one session and the other session can be used for assorted tasks. These tasks can include other primary care visits, audits, in depth consultations with patients with chronic diseases. This will allow time for students to accompany patients on other visits and observe health care across the whole team of providers. Observation and involvement with Practice Nurses and other health professionals is an essential part of this attachment. A detailed workbook for Primary Care is provided. Students may work with one, or across a team of GPs, but the practice GP supervisor will be the facilitator responsible for all activities to do with Primary Care teaching and learning, including marking the Complex Rural Longitudinal GP Oral Case Presentation and completing the Clinical Attachment reports. All students will give the oral presentation to the staff and students at their allocated General Practice and their GP academic supervisor. Advice on the oral and written presentations is available in the GP handbook and on MyLO. See also section 5.9.2. The GP Attachment Roster is available on MyLO for students. Students should consult the Practice Manager the week before they start for advice about local arrangements. It is expected that students would be physically present in their general practices no later than 0845 on the Tuesday. If students are going to be late on a Tuesday, they must inform the Practice Manager and Maggie Lea at the RCS. Practices schedule patients and activities for students and lateness and non attendance is not acceptable. Elective Planning in Year 4 The SoM handbook outlines the requirements for summer elective attachments at the end of Year 4. Students are reminded that electives may be organised in advance, students should

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confirm important university key dates before making firm travel plans. Information about the requirements for electives can be found at: http://www.utas.edu.au/medicine/programs/smile. Please ensure you start planning your elective early in the year. You must inform the Electives Co-ordinator and the RCS of your placement details in writing. The Director of Electives, Dr Nick Cooling will be visiting the RCS during 2015 Orientation Week to speak with Year 4 students. Year 4 Elective reports presented in Year 5 All students are expected to present a report of the elective undertaken during the preceding summer break. For 2015, these presentations will be in the form of a poster presentation during orientation week and a brief oral presentation to the year group and RCS staff. The posters will remain on display to a wider audience of students, RCS academic staff and hospital staff. A suitable template for a 594 mm x 420 mm (A2) poster can be found at www.posterpresentations.com Selective Planning for Year 5 Students will be asked to nominate their preferred attachment dates for selective mid year, once the attachment dates have been finalised. This usually occurs in July. 4.4.4 Year 5 Specific Attachments & Requirements

Students should refer the 2015 Year 5 Attachment Allocations in Appendix 11.3. Selective

The Selective is intended to provide an opportunity to explore an area of medical practice of

interest and which might be considered as a possible vocation. This is an opportunity to

consolidate knowledge in various areas medicine, it is intended that you will be involved in

clinical care of patients as appropriate and to engage with suitable educational opportunities.

You are encouraged to think carefully about what you wish to achieve on the selective you

choose, while also being open to a range of alternative possibilities. There is little use in fixating

on a particular highly specialized area and narrow your choices unreasonably.

Student Initiated Process

At this stage of your education students should have the understanding and confidence to

approach practicing specialist clinicians who have a current affiliation with the University of

Tasmania and ask to conduct their selective activities with them. The student may have an

existing mentoring or recent working relationship with this supervisor which would be

beneficial. Students are encouraged to undertake their selective in pairs where possible, to

facilitate peer learning.

Alternatively considerations may be sought from the individual clinical schools to undertake the

selective outside of Tasmania. This will be considered on the individual merits and

circumstances of each case. Once the supervisor’s agreement is obtained and details are

confirmed by the clinical school the student is obligated to undertake their selective under those

terms.

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Selective Outcomes

The outcomes of a selective are to include aspects of the medical specialty in which a junior medical doctor would not normally be involved, to allow students to observe facets of the career beyond the scope of their upcoming internship. As with many rotations the emphasis should be placed on following patients through the health system as they progress, as this is considered very useful in understanding how that particular medical discipline works longitudinally. The Selective allows medical students to gain a more thorough understanding of how Fellows in a particular medical discipline are able to provide high quality, safe patient care, while also gaining a preview of their own possible career path. The selective allows students the following opportunities:

Pursue an area of interest that has not been covered in depth

Pursue an area that the rural clinical school does not offer

Further develop an area of particular interest relevant to the undergraduate curriculum

Allow additional experience in an area of study where remediation may be indicated

Conduct approved research activities

Choose a clinical area of uncertainty, to either exclude or include it in vocational

considerations.

Attachment Report

Clinical supervisors are required to complete an assessment report to evaluate the performance

of the student during the selective. This report will be discussed with the student during the last

week, prior to finishing and will consist of a review of cases encountered using the UTAS logbook

format.

The selective attachment carries with it certain requirements: Students must notify the Unit Coordinator in writing of their proposed study, the venue

and contact details, their supervisor and any additional assessment tasks or requirements.

It is recommended that selectives be conducted locally or within Australia, rather than overseas (electives at the end of fourth year are the preferred time for overseas placement). Students are also reminded to take account of the timing of the final year formative and summative assessment tasks to ensure that they are able to complete these. OSCE exams and portfolio interviews must be attended in person.

Students should submit the Selective Certificate of Performance no later than one week after completion of the attachment.

If students have changed clinical schools between Years 4 and 5, the Selective should be used to compensate for differences in clinical attachments between schools.

Roles and responsibilities All UTAS students undertaking Professional experience placements are required to comply with the policy and procedures in the Safety in Practice kit. Details can be found on the Faculty of Health Science website: http://www.utas.edu.au/health-science/professional-experience-placement/safety-in-practice-kit On all selective placements, students must identify themselves to patients and staff as a medical student who is working as part of the treating team. Students should at all times wear their Hospital and University name badge.

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It is expected that students work under supervision at all times during their Selective attachment, and will be expected to undertake a variety of clinical activities such as involvement in the care of patients admitted under the team with which the student in placed. Suitable patients and tasks will be allocated and supervised by the clinical team. Sensitive communication such as breaking bad news, dealing with distressed patients and relatives or communicating about adverse events is left to qualified doctors, but where possible observed as these communication skills are vital to all students' future careers. Students may observe sensitive communication provided the patient gives consent for the student to be there. Students on community placements may also be required to produce their police checks and immunisation status so these should be kept with you. Anything written in the medical record or on a form is to be signed by the student, defining medical student status, and countersigned by a doctor. Students should not fill out drug charts, prescriptions or death certificates because of the medico-legal implications but are encouraged to fill out mock forms for actual patients to get experience. These must be de-identified, clearly marked “practice forms”, and after being assessed as adequate by your supervisor, placed in your portfolio. Guidelines for students on clinical placement with the Department of Health and Human

Services can be found on The Code can be found on the Faculty of Health Science website:

http://www.utas.edu.au/health-science/professional-experience-placement/SiP/CPEC.

Remote Medical Practice

Remote attachments are located in the communities such as Smithton, King Island, Oatlands and West Coast (Queenstown/Strahan). Students will have an attachment of five weeks at one location. Students are required to liaise with the Remote GP Administration Officer (Maggie Lea – 6430 5903) prior to commencing this attachment. Students who wish to undertake remote attachments at other locations must discuss this with the Associate Professor Lizzi Shires. An accommodation kit is available for collection and students are expected to make personal contact with the Practice to confirm their attendance at least a week prior to taking up their attachment. To appreciate the particular challenges and limitations of medical care in remote communities, it is strongly recommended that students remain in their community for the full duration of the attachment.

Students are required to complete and present a Complex Rural Longitudinal Oral Case Presentation on return from their attachment as part of the formative assessments. It is expected that students will do their summative Chronic Disease Case including Complex Therapeutics written case based on the oral case and this should be submitted on the Friday at the end of your remote attachment. Further advice on the oral and written presentations is available on MyLO.

Anaesthetics/ICU During this rotation you will be attending a wide range of Departmental activities ranging from ward rounds to attending elective and emergency lists in theatre.

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Your primary point of reference for any queries/help is the Departmental Anaesthetics Supervisor of Training, Dr Margo Peart. Students are required to report to ICU at 0800 on the Monday of their first week of the attachment for briefing with Prof Mike Buist. A Medical Student Anaesthetic Logbook & Orientation Manual should be completed. The log book is also available within your electronic log book. Nursing Home and Palliative Care A two week placement in a residential care home and palliative care will give students experience in managing ageing patients and patients requiring palliative care. This rotation has a detailed rotation book with resources and learning activities that should be accessed before the placement starts. Dr Thiru Thirukkumaran and Dr Rosemary Ramsey coordinate this rotation.

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5. STUDENT LEAVE ARRANGEMENTS

5.1 Attendance

As outlined in the SoM Handbook, students must attend a minimum of 80% of scheduled teaching and learning sessions. To ensure that minimum standards are met for successful completion of the year, students are required to sign the attendance register for Group Learning Programs and other group sessions such as tutorials. Signing for colleagues and signing without attending the education session are regarded as serious breaches of professional behaviour. Students must notify on the appropriate form available from the RCS office for absences due to illness/other reason, either before, or as soon after the event as possible. Supporting evidence, eg medical certificates may be required. Satisfactory Clinical Attachment reports are needed to be able to sit the end of year exams and progress. These will be affected by attendance and involvement on the wards. 5.2 Student Leave

Students are required to complete the Student Leave Application which can be found in a Dropbox on MyLO for any sick leave, leave for conference attendance or research/study related purpose, and any other personal leave that may be required. Please submit in the relevant attachment Dropbox. These applications will be approved by the Associate Head and you will receive notification of approval or otherwise via MyLO. Students should notify Supervisor of sick leave prior to shift commencement and email rcsstudent.enquiries@utas.edu.au or should notify Practice Manager if absent during Primary Care time and email maggie.lea@utas.edu.au Students who are still sick after day 3 should reconfirm their absence with rcsstudent.enquiries@utas.edu.au Sick leave of 5 days, or more, will need to be supported by a Medical Certificate. Please see 8.6.2 for Personal GP contact details, should you wish to utilise. If students are away for more than 1 week, they are required to include in their leave submission, plans to make up for loss of time and discuss this with attachment Supervisor/s and/or GP contact prior to submission.

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6. ASSESSMENT

Summative assessment requires the satisfactory completion of all formative and summative components. This includes submitting a complete and satisfactory portfolio over years 4 & 5 and obtaining a pass in the written and practical (OSCE) examinations (further information available in the SoM Handbook)

6.1 Learning Portfolios

Students will commence collecting their Portfolio in Year 4 and continue to collect assessed work for their Portfolio into Year 5. The components include evidence of procedural and professional skills (log book and log of skills) including the six core competencies (these competencies are normally formally signed off in the final year), written case presentations/histories, reflective pieces, clinical attachment reports, Mini-CEX, evidence of involvement in CBL tasks, as well as the required formative and summative assessment reports. Please consult the SoM Year 4 or Year 5 Handbook for the details of the summative components (word counts, topics etc). See Appendix 11.9 for Mini-CEX Assessment Form and Appendix 11.10 for CBL Assessment Form.

6.2 RCS Formative Assessment Requirements

6.2.1 Electronic Clinical Log Book

This will be provided to you on a USB stick. Each attachment (including General Practice/Primary Care) has a clinical log book that students will be expected to maintain for the duration of the attachment. Clinical supervisors will expect to review progress of the log book and students will have to print it off and show it to supervisor before they can be assessed and signed off at the end of the attachment. The log book is to record details of cases with which students have been personally and substantially involved. The log books will summarise such information as:

Summarised case details, clinical diagnosis and outcomes

Any other involvement such as discharge visits to the patients GP, attendance with the patient at allied health or medical specialist consultations, case conferences etc.

Learning opportunities and references used for this case.

Procedural skills observed, simulated or performed (linked to those skills set out in the SoM Handbook);

Forms, discharge letters, drug charts, certification, other correspondence completed by the student; (de-identified copies to be included in portfolio)

The logbooks are electronic. A generic example is provided in the appendix. The front page of the log book lists those procedural and other skills relevant to the attachment, and also a summary of the Learning Objectives from the SoM Handbook. Students do not need to record every case encountered but as a minimum, students should aim to record at least three significant cases per day (1 in depth, 2 short – with a maximum of 5 in-depth cases per week) while on a clinical attachment. It is expected that cases recorded will be those with which the student has had significant involvement. An example of electronic logbook entries is included in Appendix 11.6. Log books will be submitted through MyLO at the end of each attachment. Plagiarism of log books will be treated as a significant breach of conduct and reported to Head of School

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The supervisor’s clinical attachment assessment report will be scanned and uploaded to the relevant Dropbox on MyLO at the end of each attachment. The electronic log book will be uploaded to the relevant Dropbox on MyLO. The hard copy of the log book that was printed for the supervisor should be filed in your portfolio.

6.3 Marking Guides

Marking Guides for all assessment tasks can be found on MyLO located in Content > Assessments. Marking sheets for assignments common to all clinical schools are found in the SoM Handbook; those for RCS specific formative assessment tasks are included as part of the appendices to these Guidelines. These should be used to guide students in the content of the assignment and the standard of performance that is required to gain a satisfactory pass. Assessors will also use these Guides to grade assessment tasks.

Please note that the Portfolio Assessment (which includes Formative Assessment) becomes Summative at the end of the academic year. All formative assessments must be satisfactorily completed to be able to sit the summative assessment. 6.4 Assessment Process

6.4.1 Assessment Requirements and Timelines

Please refer to the Assessment Requirements and Timelines tables for each year group (Pages

20 & 21). You will also find Assessment Due Dates contained in the MyLO Dropbox.

If you have any issues following these tables, please don’t hesitate to contact us via

rcsstudent.enquiries@utas.edu.au and we will be happy to help.

6.5 Submitting Work

Please see the following link on how to upload assessment pieces to MyLO: http://www.utas.edu.au/__data/assets/pdf_file/0008/336554/Submitting-an-Assignment.pdf 6.5.1 Viewing your Grades via MyLO

http://www.utas.edu.au/__data/assets/pdf_file/0005/336659/Viewing-Your-Grades.pdf

6.6 Year 4 Formative Assessment Tasks at the RCS

6.6.1 Oral Case presentations (2 for the year)

These histories should demonstrate students’ ability to take a history from and examine a patient, reach a diagnosis (with differential), justify relevant investigations and then develop an appropriate management plan. Students will choose their cases based on the patients they come into contact with on each of their clinical attachments.

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Even if the patient is only seen once (such as in DEM), the report should include not just what was done at the time, but a proposed management plan with consideration of psychosocial and rural factors which may impact on diagnosis and management. The histories are to be oral presentations to a peer group during a Group Learning Program or at departmental meetings and will be assessed at the time by RCS academic staff or supervisors. Oral presentations give an opportunity for students to “defend” their work and demonstrate they have researched and explored the clinical issues beyond the bare facts of the case. The discussion generated and the responses to questions from the floor are important aspects of learning from these cases. A hard copy of the presentation will need to be retained in the student portfolio of work. See marking sheet in Appendix 11.11.

6.6.2 Complex Rural Longitudinal GP Oral Case Presentations (2 for the year)

These cases should be selected from those patients seen in General Practice (one in each semester). Early in each GP attachment, students should discuss with their GP supervisor a suitable patient and ask if they can be followed up on the day that the student is in the practice. The patient should have a significant chronic illness, whether physical or psychological. Follow up should include home visits, hospital admission/visits and GP, specialist or allied health provider appointments as appropriate. The case therefore needs to be relatively complex and should involve aspects of management that illustrate the particular constraints, psychological stressors, financial and other challenges experienced by patients in rural settings. The details of the clinical case should be concisely stated, with the principal discussion focusing on how the disease itself and the travel away from home, impact on the patient and their family emotionally, financially and in other ways, as well as aspects of team care management. These cases are presented as oral presentations in the student’s general practice. The slides and handout notes pages from a PowerPoint presentation are to be submitted as part of the portfolio. In the assessment of these cases, the emphasis is on the oral presentation and the discussion generated. Each case must be presented orally to the GPs/staff/students in the practice to which the student is attached (eg at a practice education session) to enable discussion on what the student has learned from following through with this patient. Presentation dates are organised by Maggie Lea at beginning of semester one in conjunction with the practice and a copy of dates given is to RCS GP liaison academic. See marking sheet in Appendix 11.12. 6.6.3 Year 4 Written Case Histories

The acute written Case History should be submitted after the Emergency Medicine rotation by 8.30 am on the last day of rotation (usually Friday prior to GLP), with the exception where DEM rotation falls in Attachment 6, these students will be expected to submit Case History at the end of Surgical rotation by 8.30am on the last day of rotation. A second Acute Case should be submitted after the Medicine rotation by 8.30 am on the last day of rotation (usually Friday prior to GLP), with the exception where Medicine rotation falls in Attachment 6, these students will be expected to submit Case History at the end of Surgical rotation by 8.30am on the last day of rotation.

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See marking sheet in Appendix 11.16. The Chronic Disease GP Longitudinal Case History should be submitted on 13th June by 8.30 am (this is usually based on one of the oral cases presented in General Practice). Additional guidance and exemplars are available on MyLO. The report should include supporting references listed according to the Vancouver method. Each written report should be a maximum of 1500 words. See marking sheet in Appendix 11.14. 6.6.4 Global Health Assessment Task

This task will be negotiated with Assoc. Prof. Peter Arvier.

6.7 Year 4 Summative Assessment Tasks at the RCS

Students will be required to write two Reflective Pieces as per SoM Handbook.

6.8 Year 5 Written Cases Summative Assessment Tasks at the RCS

Year 5 Chronic Illness longitudinal Case with a focus on Complex Therapeutics The guidelines for Chronic Illness case are in the SoM handbook. Further guidance and exemplars are available on MyLO. These written cases should be submitted by Friday at the end of each Rural and Remote rotation, with the exception where Rural & Remote falls in Attachment 6, these students will be expected to submit Case History at the end of the Nursing Home rotation by 8.30am on the last day of rotation to the relevant Dropbox on MyLO. See marking sheet in Appendix 11.15. Year 5 Acute Case

The guidelines for Acute Cases are in the SoM handbook. A case should be selected during the Emergency Medicine rotation and should be submitted by the last Friday of this rotation, with the exception where DEM falls in Attachment 6, these students will be expected to submit Case History at the end of Surgical rotation by 8.30am on the last day of rotation to the relevant Dropbox on MyLO. See marking sheet in Appendix 11.17

6.9 Penalties

MyLO assessment Dropboxes will only be open until the stated deadline. If you require an extension you need to complete an Application for Extension Form – which is available in a Dropbox on MyLO. Please submit in the relevant attachment Dropbox. These applications will be approved by the Associate Head and you will receive notification of approval or otherwise via MyLO.

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6.10 Summary of RCS Portfolio Assessment Requirements and Timelines - Year 4

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6.11 Summary of RCS Portfolio Assessment Requirements and Timelines - Year 5

*Students should consult with their clinical supervisors and academic supervisors to determine opportunities for gaining these points in their clinical and academic program. If students would like to gain research points, contact Dr Mark Reeves or Colleen Cheek about involvement in research activities. Note: Paper copies of all work should be filed in your white portfolio folder

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7. REMEDIATION

If assessments are not completed to a satisfactory standard, the assessor, clinical supervisor or academic supervisor in conjunction with the RCS Associate Head will discuss resubmission or a remediation plan with the student. This may involve remediation occurring during an elective term or during University vacation. Students are strongly advised to not make unchangeable plans for vacations (or at least ensure adequate insurance cover) in the event that remediation time or supplementary examinations are required.

8. LEARNING RESOURCES

Clinical teaching is based on the Case Based learning and discipline topics listed in the SoM Handbook. The RCS will supply useful reading and references to support many of these topics via MyLO, however students will be expected to supplement their learning through extensive reading and electronic resources.

8.1 Library and Information Technology Support

An excellent clinical library is located at the North West Regional Hospital with a satellite branch at the Mersey. Students have access to additional library support through the hospital library and to the statewide University library network, through the RCS computers The Cradle Coast Campus offers an additional access point into web based services.

9. SIMULATED LEARNING ENVIRONMENT (SLE)

The RCS has a well equipped Simulated Learning Environment (SLE) at Burnie RCS and the Mersey hospital, with trained and dedicated staff, where students learn and practice procedural and other practical and professional skills, including videotaping to improve consultation skills. This may be in a multi-disciplinary learning environment with nurses, paramedics or other health professionals. The SLE’s provide an excellent opportunity to learn the essentials and practice these skills before performing them on a patient. Students wishing to obtain additional practice in clinical skills outside scheduled sessions must contact Mel White, Lynn Greives, Heather Bryer or Luanne Steven to make suitable arrangements. The simulated environment complements, but does not substitute for the clinical environment. Students are strongly encouraged to take full advantage of the vast amount of clinical opportunities available in the hospital and general practice settings.

10. STUDENT SUPPORT

10.1 Academic Supervisors

All Year 4 students will be allocated a clinical Academic Supervisor. Students will be expected to meet with their academic supervisor on several occasions during the year, usually within the GLP/GLW weeks. While the meetings will be relatively informal, they should follow an agenda which reflects the student’s interests and concerns. Students will be expected to bring a hard copy of end of attachment assessments to these meetings. Students are to contact their Academic Supervisor to arrange such meetings during GLP/GLW weeks. Academic Supervisors are available by email and phone at other times and students may arrange additional

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meetings. Students should make contact with the Academic Supervisor at least 1 week prior to GLP/GLW to organise a suitable time to meet. 10.2 General Mentoring

Other staff are also available for mentoring if required. Dr Lizzi Shires may be available to assist students having difficulties with professional issues such as the doctor-patient relationship, breaking bad news, dealing with grief etc. Rose Winter (nee Moore) is available to students for issues that they feel they are unable to take to their usual Academic Supervisors / clinical supervisors or have been unable to resolve through the usual channels.

10.3 Vertical/Horizontal Integration in the Year 4 & 5 RCS Medical Undergraduate Program

10.3.1 Year 4 Peer Support Program

The RCS is committed to a program where vertical integration is an important aspect of the learning environment. Year 4 and Year 5 students learn on the wards, Year 5 students provide peer support to Year 4 students. In turn, when Year 1, 2 and 3 students visit the campus on short attachments, Year 4 and 5 students provide them with peer support. Part of the Year 4 Peer Support Program can include Year 5 students, along with an Intern/Junior Medical Officer/Registrar (JMO) (in particular RCS graduates), offering support for practice OSCEs during the year. Students also provide support for one another in a variety of ways including such activities as inter-

professional skills learning at the Emergency Skills Weekend.

10.3.2 Final Year Peer Support Program

Year 5 students are supported by NWRH interns (especially RCS graduates) and there are a number of common tutorials and discussion groups. On the wards, interns provide valuable support to Year 5 students. In particular, final year students “shadow” the interns of the clinical unit to which they are attached. Interns, SLE educators and RCS academics/other clinicians can provide opportunities for practice OSCEs and further skills practice. 10.3.3 Horizontal Integration

One of the strengths of the RCS program is the availability of other health professionals to assist with learning opportunities. Students may find themselves learning from, or alongside, people in other disciplines, a situation which mirrors, and best prepares them for real life situations on the wards and in the community. The concept of teamwork to share the load and deliver the best outcomes for patients is integral to the Teaching and Learning at RCS.

10.4 Additional Educational Support

Additional Educational support is co-ordinated by Rose Winter (nee Moore) and provided by onsite academic staff, with some visiting staff from Tasmania or further afield.

Conferences Students may be eligible for support from the RCS to attend relevant conferences and other educational events. Application to the Associate Head should be made well in advance of the event (appropriate forms available on MyLO). Students attending conferences and educational events with

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support from the RCS or in RCS time, are expected to provide a brief report on what they have gained from these experiences and will generally be required to make a brief presentation to their peers. Consideration for support will only be given to activities that do not conflict with the RCS teaching program. Research Students wishing to undertake research projects should discuss this with Assoc Prof. Lizzi Shires, Professor Isabelle Ellis and Research Fellow, Dr Mark Reeves before commencing any involvement. In special circumstances, presentation of a research project may substitute for a formative assessment task. Students should be aware that involvement in research projects may require a heavy time commitment that must not detract from the requirements of the MBBS curriculum.

10.5 Professional and Personal Support

10.5.1 RCS Staff

Professional and personal support for students is a priority for the Rural Clinical School. We have a small staff committed to the successful implementation of the Rural Clinical Program. Please refer to ‘Administrative Staff’ list on page 7 for RCS staff available to assist with operational matters ranging from accommodation, transport and educational requirements including IT support within the broader rural health workplace. The Rural Clinical School aims to provide a safe learning and safe living environment for students. While every effort has been made to ensure students’ time is safe and secure, in the event of an emergency or personal crisis, support is available.

10.5.2 Personal GP Services

Should a student require medical assistance, the following practices have agreed to see students and bulk bill a consultation, provided that when seeking an appointment at any of the practices below, the student identifies themselves as a medical student from the Rural Clinical School Burnie. International students will be given an account which they can claim through Medibank and the rebate will be accepted as full payment of account. Please contact Maggie Lea (Primary Care Program administration officer) x5903 if you have any queries.

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10.5.3 Counselling Services

Students can contact Student Support Services at the Cradle Coast Campus for psychological health issues. Telephone 03 6430 4949 or ext 4949 from any internal UTAS phone.

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11. APPENDICES

11.1 2015 RCS Calendar

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11.2 2015 Year 4 Student Attachment Allocations

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11.3 2015 Year 5 Student Attachment Allocations

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11.4 2015 Year 4 CBL Allocations

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11.5 2015 Year 5 CBL Allocations

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11.6 Clinical Log Book example – Example of Satisfactorily completed Log Book

http://www.patient.co.uk/

doctor/hypothyroidism

http://www.uptodate.com/

contents/initial-

assessment-and-

management-of-acute-

stroke?source=search_resul

t&search=stroke&selectedT

itle=1%7E150

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11.7 Clinical Attachment Report

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11.8 Short Duration Assessment Form

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11.9 Mini-CEX Assessment Form

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11.10 CBL Assessment Form

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11.11 Year 4 Oral Assessment Form

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11.12 Year 4 Complex Rural Longitudinal Oral Case Presentation (GP) Assessment Form

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11.13 Year 5 Chronic Rural Longitudinal Oral Case Presentation Assessment Form

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11.14 Year 4 Chronic Disease GP Longitudinal Case Written Assessment Form

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11.15 Year 5 Chronic Illness Longitudinal Case including Complex Therapeutics Long Case History

Assessment Form

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11.16 Year 4 Acute Long Case History Assessment Form

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11.17 Year 5 Acute Long Case History Assessment Form

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11.18 Reflective Piece Assessment Form

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11.19 Core Competency Assessment Forms

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