SCHOOL OF MEDICINE

MBBS YEAR 5

Family Medicine and Primary Health Care Rotation

LOGBOOK

Student Name..

Student number

SettingThis 8 week block will take place in either Mahalapye or Maun. You will be based either in clinics or Outpatients department (OPD) in Mahalapye District Hospital or Letsholathebe II Memorial hospital in Maun. In year 5 your consultation skills and examination skills will be of such a standard that you can manage patients under supervision. The rotation should be geared to clinical work and feeling in gaps in knowledge and practice. The Botswana Primary Care Guideline is going to be the main treatment guideline during your practice in primary care. You need to be comfortable using the guideline. You will to be introduced to research (clinical audit) such that you may contribute to knowledge about health in Botswana. You will interact with important stake holders in primary health care; the police, District Health Management Team (DHMT), chiefs and politicians. You need to recognize that you are junior to all qualified health staff in a facility and that you will learn a lot from non-medical staff (nurses, dieticians etc.). Faculty will inform important stake holders (police, DHMT, chiefs and councillors) about the fifth year program and their role in it. Topics of potential interest to you will be discussed with them (rape, mentally ill people in the community, TB and HIV programs, health budgets, state of clinics and ambulances etc.). Family Medicine staffs and residents:Gaborone

-Dr Vincent Setlhare (Acting. Head of Department)-Dr Ruth Keele (Part time Lecturer)Residents (Year1):Drs Mpho Mpape, Keorapetse Mmualefhe and Tidimalo Ookame

Mahalapye Training ComplexMaun Training Complex

-Dr S Tshitenge (Lecturer ): Coordinator. Undergraduate and Residency program Mahalapye)

- Dr D Mbuka(Lecturer ): (Coordinator Undergraduate and Residency Program Maun) -Dr Tsima (study leave)

Residents

Dr M RamatoDr K MotlhatlhediDr B MaalakgosiDr M MandiwanaDr K ChabaeseleDr N Kenosi Dr B TshumaDr G Lekgowe Dr M Ramotsababa Dr D JohaneDr C GobotswangDr K MaotweDr K Mosheti Dr S Maripe

Administration

Solomon MogapiMs Galeboe Kefalotse

Clinical By the end of the rotation, we expect you:1. To consult and treat patients under supervision, in a clinic or OPD and A&E department. You will independently consult at least 5 patients in a day. (Use one of the cases for case presentation and management plan discussion with your tutor)2. To recognize the patient that is beyond your level of competence and refer them to senior colleagues or competent health facilities (after consulting senior colleagues).3. To perform simple procedures done in a primary care setting. 4. To know the role of other stake holders in health care e.g. the role of police in accidents, rape, and mentally ill people; the role of social workers in TB and HIV care; the members and role of the DHMT in primary care.

The Weekly Schedule of Activities outlines varies slightly in Mahalapye or Maun. You need to consult The Mahalapye and Maun semester activities time table.Weekly Topics:Week 1: The patient with abnormal weight and height, developmental problems, infant feeding problems/nutritional problems, obesity Under 5 card Abnormal weight in adults and children Nutritional problems seen in children Developmental problems in childrenWeek 2: The patient with a genital lesion or discharge, requiring contraception or with libido or impotence problems Contraception in primary care Loss of libido/importance STIWeek 3:The patient with fits, falls (including non-accidental injury) or numbness & tingling Epilepsy Non Accidental Injury StrokeWeek 4: The patient with a nose bleed, hearing loss or dizziness Nose bleed Difficulty hearing DizzinessWeek 5: The patient with envenomation or scorpion bite Snake/Scorpion bite Human biteWeek 6: The patient with medically unexplained symptoms or sleep disorders (including obstructive sleep apnoea) Depression Anxiety Substance abuse FibromyalgiaWeek 7:The patient with low back pain and sciatica or chronic joint pain Low back pain Chronic arthritis GoutWeek 8:The patient with HIV/AIDS, anaemia or lymphadenopathy AND the patient needing palliative care HIV counselling and testing HIV symptoms HIV staging HIV routine care Anaemia Lymphadenopathy WHO palliative care modelFamily medicine topics:1. The consultation: -The patient centred clinical method -The doctor, patient, and environmental factors in the consultation -Communication skills - Breaking bad news -Motivation interview -Counseling skills 2. Family Oriented Primary Care (Family structure and resources/ family conference)3. Community Oriented Primary Care (COPC): Weekly home visit

Attendance:Attendance of all contact sessions (clinical residency, PBL, whole class lectures, tutorials and others as may be defined by the department) in all courses in phase II is compulsory. Students are expected to have 100% attendance during their clinical clerkship. Students who have attended less than 80% of the contact periods (without valid reasons) will not be allowed to participate in the end of year examination in family medicine. Such students will also fail to qualify for a re-assessment opportunity. They will have to repeat the clinical rotation in family medicine and meet up the minimum 80% attendance before being assessed in family medicine.

Continuous assessment:The continuous summative assessment will be as follows: Clinical case presentations (20%): at least one per week (10%), COPC (5%) and reports (5%). PBL: All students will be assessed during their PBL session for attendance, contribution and reflective ability on each case (10%). Directly Observed Clinical &Procedural Skill (DOCPS). Two Mini CEXs shall be administered per student by end of your rotation under the supervision (10%).The continuous assessment component shall carry 30%End of year ExaminationThere shall be a final (exit) examination at the end of the academic year.

Week 1Workshop: Botswana Primary Care GuidelineSession 1 (09:00-10:00)Session 2 (10:00-11:00)Session 3 (11:00-12:00)Session 4 (14:00-15:00)

Day1IntroductionSymptoms[1]Cough[2]Headache[3]Weight lossRoutine care approach to 1 chronic condition[4]Seizures[5] Itchy rash[6] Back pain

Day 2[7] Face problems[8] Chest pain[9]Fatigue[10]Breast symptoms

Day3[11]Lymphadenopathy[12]No symptoms[13]Difficulty breathing, mouth symptoms[14]Insect Bites[15]Palliative care

PBL and DIRECTLY Observed procedures and clinical skills MARKING

Engagement with the PBL processExcellent4Student takes a full part in group discussion. Contributions are insightful and show an in depth approach. In the first session the student shows an ability to analyse the case and apply prior knowledge in determining learning objectives. The student appreciates all aspects of the case (anatomical, physiological/biochemical, pathological, clinical, psychological and public health) and is willing to assess the importance of all aspects.In the report back session the student shows that all objectives have been researched and that some have been covered in depth. Some aspects of the report back show detailed knowledge. Throughout both sessions the student listens carefully to the views of other students and responds to them appropriately and in a balanced way.This mark can be given to a student whose contributions are limited if the contributions always show insight and depth, and add value to the group discussion.

Satisfactory3Student contributes to most aspects of the group discussion but some contributions may be superficial. May find difficulty in reaching appropriate learning objectives, but always tries to do so.May withhold information and be unwilling to contribute, even though is able to do so. May appear to have limited information in report back sessions. May prevent contributions from other people unintentionally by taking up too much of the discussion.

Borderline2Student makes little contribution to group discussion and contributions show little depth. May show unprepared and unresearched objectives in report back session. May show an immature approach to medicine, by being only interested in certain areas, most likely anatomy and clinical presentations. May be unprepared to listen to the contributions of other students.

Unsatisfactory1Student makes no contribution at all to the group discussion or development of learning objectives and does not contribute to report back session.Student may attempt to curtail case development by limiting brainstorming sessions and prevent objectives being reached. Contributions to discussion are limited and tend not to be positive or actively negative. Criticizes work of other students. Blocks establishment of learning objectives in important areas. Is immature, arrogant and disruptive.

0Did not attend the session.

Progression requirement: Students awarded grades of Borderline or Unsatisfactory will be notified to the Fitness to Practice Committee.

PBL week1:

AttendanceSession 1

Session 2score01234Assessors name, signature and dates

Contribution (C) S 1

S 2

Reflective ability (R) S1

S2

Absent: 00

Present:

On time22

Late > 10min11

PBL week2:

AttendanceSession 1

Session 2score01234Assessors name, signature and dates

Contribution (C) S1

S2

Reflective ability (R) S1

S2

Absent: 00

Present:

On time22

Late > 10min11

PBLweek 3:

AttendanceSession 1

Session 2score01234Assessors name, signature and dates

Contribution (C) S1

S2

Reflective ability (R) S1

S2

Absent: 00

Present:

On time22

Late > 10min11

PBL week 4:

AttendanceSession 1

Session 2score01234Assessors name, signature and dates

Contribution (C) S 1

S 2

Reflective ability (R) S1

S2

Absent: 00

Present:

On time22

Late > 10min11

PBL week 5:

AttendanceSession 1

Session 2score01234Assessors name, signature and dates

Contribution (C) S1

S2

Reflective ability (R) S1

S2

Absent: 00

Present:

On time22

Late > 10min11

PBL week 6:

AttendanceSession 1

Session 2score01234Assessors name, signature and dates

Contribution (C) S 1

S 2

Reflective ability (R) S1

S2

Absent: 00

Present:

On time22

Late > 10min11

PBL Week 7 :

AttendanceSession 1

Session 2score01234Assessors name, signature and dates

Contribution (C) S1

S2

Reflective ability (R) S1

S2

Absent: 00

Present:

On time22

Late > 10min11

PBL week 8:

AttendanceSession 1

Session 2score01234Assessors name, signature and dates

Contribution (C) S1

S2

Reflective ability (R) S1

S2

Absent: 00

Present:

On time22

Late > 10min11

DOCPS guidance for markers sheet [The each of the following directly observed clinical and procedural skills (DOCPS) should be completed by the end of the rotation (not necessarily in the prescribed order below). Students should receive a grade of either A or B (if necessary after re-training and re-examination) in each required procedure]. Grading scheme for eachPlacement and removal of plaster cast (Plaster of Paris)

Skill 1....Component (not all will apply in each case)UnsatisfactoryBorderlineSatisfactoryN/A

Demonstrates understanding of indications, relevant anatomy, technique of procedure

Obtains informed consent

Demonstrates appropriate preparation pre-procedure

Appropriate analgesia or safe sedation

Technical ability

Aseptic technique (if appropriate)

Seeks help where appropriate

Post procedure management

Communication skills i.e. explains procedure and give feedback to the patient

Consideration of patient/professionalism

Based on the above provide a summative grade below

Summative grade (tick one)

Able to perform without supervisionA4

Able to perform with some supervisionB3

Able to perform with considerable supervisionC2

Not able to performD1

FeedbackAssessors name, signature and date

Suturing a laceration

Skill2..Component (not all will apply in each case)UnsatisfactoryBorderlineSatisfactoryN/A

Demonstrates understanding of indications, relevant anatomy, technique of procedure

Obtains informed consent

Demonstrates appropriate preparation pre-procedure

Appropriate analgesia or safe sedation

Technical ability

Aseptic technique (if appropriate)

Seeks help where appropriate

Post procedure management

Communication skills i.e. explains procedure and give feedback to the patient

Consideration of patient/professionalism

Based on the above provide a summative grade below

Summative grade (tick one)

Able to perform without supervisionA4

Able to perform with some supervisionB3

Able to perform with considerable supervisionC2

Not able to performD1

Feedback

Assessors name, signature and date

Skill 3..Plotting and interpreting the partogram

Component (not all will apply in each case)UnsatisfactoryBorderlineSatisfactoryN/A

Demonstrates understanding of indications, relevant anatomy, technique of procedure

Obtains informed consent

Demonstrates appropriate preparation pre-procedure

Appropriate analgesia or safe sedation

Technical ability

Aseptic technique (if appropriate)

Seeks help where appropriate

Post procedure management

Communication skills i.e. explains procedure and give feedback to the patient

Consideration of patient/professionalism

Based on the above provide a summative grade below

Summative grade (tick one)

Able to perform without supervisionA4

Able to perform with some supervisionB3

Able to perform with considerable supervisionC2

Not able to performD1

FeedbackAssessors name, signature and date

Interpreting Chest x ray

Skill 4..Component (not all will apply in each case)UnsatisfactoryBorderlineSatisfactoryN/A

Demonstrates understanding of indications, relevant anatomy, technique of procedure

Obtains informed consent

Demonstrates appropriate preparation pre-procedure

Appropriate analgesia or safe sedation

Technical ability

Aseptic technique (if appropriate)

Seeks help where appropriate

Post procedure management

Communication skills i.e. explains procedure and give feedback to the patient

Consideration of patient/professionalism

Based on the above provide a summative grade below

Summative grade (tick one)

Able to perform without supervisionA4

Able to perform with some supervisionB3

Able to perform with considerable supervisionC2

Not able to performD1

Feedback

Assessors name, signature and date

Skill 5..Recording a Glasgow Coma Scale (GCS)

Component (not all will apply in each case)UnsatisfactoryBorderlineSatisfactoryN/A

Demonstrates understanding of indications, relevant anatomy, technique of procedure

Obtains informed consent

Demonstrates appropriate preparation pre-procedure

Appropriate analgesia or safe sedation

Technical ability

Aseptic technique (if appropriate)

Seeks help where appropriate

Post procedure management

Communication skills i.e. explains procedure and give feedback to the patient

Consideration of patient/professionalism

Based on the above provide a summative grade below

Summative grade (tick one)

Able to perform without supervisionA4

Able to perform with some supervisionB3

Able to perform with considerable supervisionC2

Not able to performD1

FeedbackAssessors name, signature and date

Doing and interpreting ECG

Skill 6..Component (not all will apply in each case)UnsatisfactoryBorderlineSatisfactoryN/A

Demonstrates understanding of indications, relevant anatomy, technique of procedure

Obtains informed consent

Demonstrates appropriate preparation pre-procedure

Appropriate analgesia or safe sedation

Technical ability

Aseptic technique (if appropriate)

Seeks help where appropriate

Post procedure management

Communication skills i.e. explains procedure and give feedback to the patient

Consideration of patient/professionalism

Based on the above provide a summative grade below

Summative grade (tick one)

Able to perform without supervisionA4

Able to perform with some supervisionB3

Able to perform with considerable supervisionC2

Not able to performD1

Feedback

Assessors name, signature and date

Skill 7..Plotting and interpreting the Weight for Age graph in the Under-5

Component (not all will apply in each case)UnsatisfactoryBorderlineSatisfactoryN/A

Demonstrates understanding of indications, relevant anatomy, technique of procedure

Obtains informed consent

Demonstrates appropriate preparation pre-procedure

Appropriate analgesia or safe sedation

Technical ability

Aseptic technique (if appropriate)

Seeks help where appropriate

Post procedure management

Communication skills i.e. explains procedure and give feedback to the patient

Consideration of patient/professionalism

Based on the above provide a summative grade below

Summative grade (tick one)

Able to perform without supervisionA4

Able to perform with some supervisionB3

Able to perform with considerable supervisionC2

Not able to performD1

FeedbackAssessors name, signature and date

Inserting vesical catheter

Skill 8..Component (not all will apply in each case)UnsatisfactoryBorderlineSatisfactoryN/A

Demonstrates understanding of indications, relevant anatomy, technique of procedure

Obtains informed consent

Demonstrates appropriate preparation pre-procedure

Appropriate analgesia or safe sedation

Technical ability

Aseptic technique (if appropriate)

Seeks help where appropriate

Post procedure management

Communication skills i.e. explains procedure and give feedback to the patient

Consideration of patient/professionalism

Based on the above provide a summative grade below

Summative grade (tick one)

Able to perform without supervisionA4

Able to perform with some supervisionB3

Able to perform with considerable supervisionC2

Not able to performD1

Feedback

Assessors name, signature and date

Skill 9..Shoulder examination

Component (not all will apply in each case)UnsatisfactoryBorderlineSatisfactoryN/A

Demonstrates understanding of indications, relevant anatomy, technique of procedure

Obtains informed consent

Demonstrates appropriate preparation pre-procedure

Appropriate analgesia or safe sedation

Technical ability

Aseptic technique (if appropriate)

Seeks help where appropriate

Post procedure management

Communication skills i.e. explains procedure and give feedback to the patient

Consideration of patient/professionalism

Based on the above provide a summative grade below

Summative grade (tick one)

Able to perform without supervisionA4

Able to perform with some supervisionB3

Able to perform with considerable supervisionC2

Not able to performD1

FeedbackAssessors name, signature and date

Low back examination

Skill 10..Component (not all will apply in each case)UnsatisfactoryBorderlineSatisfactoryN/A

Demonstrates understanding of indications, relevant anatomy, technique of procedure

Obtains informed consent

Demonstrates appropriate preparation pre-procedure

Appropriate analgesia or safe sedation

Technical ability

Aseptic technique (if appropriate)

Seeks help where appropriate

Post procedure management

Communication skills i.e. explains procedure and give feedback to the patient

Consideration of patient/professionalism

Based on the above provide a summative grade below

Summative grade (tick one)

Able to perform without supervisionA4

Able to perform with some supervisionB3

Able to perform with considerable supervisionC2

Not able to performD1

Feedback

Assessors name, signature and date

Skill 11..Knee examination

Component (not all will apply in each case)UnsatisfactoryBorderlineSatisfactoryN/A

Demonstrates understanding of indications, relevant anatomy, technique of procedure

Obtains informed consent

Demonstrates appropriate preparation pre-procedure

Appropriate analgesia or safe sedation

Technical ability

Aseptic technique (if appropriate)

Seeks help where appropriate

Post procedure management

Communication skills i.e. explains procedure and give feedback to the patient

Consideration of patient/professionalism

Based on the above provide a summative grade below

Summative grade (tick one)

Able to perform without supervisionA4

Able to perform with some supervisionB3

Able to perform with considerable supervisionC2

Not able to performD1

FeedbackAssessors name, signature and date

Use of PEF in asthmatic patient

Skill 12..Component (not all will apply in each case)UnsatisfactoryBorderlineSatisfactoryN/A

Demonstrates understanding of indications, relevant anatomy, technique of procedure

Obtains informed consent

Demonstrates appropriate preparation pre-procedure

Appropriate analgesia or safe sedation

Technical ability

Aseptic technique (if appropriate)

Seeks help where appropriate

Post procedure management

Communication skills i.e. explains procedure and give feedback to the patient

Consideration of patient/professionalism

Based on the above provide a summative grade below

Summative grade (tick one)

Able to perform without supervisionA4

Able to perform with some supervisionB3

Able to perform with considerable supervisionC2

Not able to performD1

Feedback

Assessors name, signature and date

Skill 12.. Incision and drainage of abcess

Component (not all will apply in each case)UnsatisfactoryBorderlineSatisfactoryN/A

Demonstrates understanding of indications, relevant anatomy, technique of procedure

Obtains informed consent

Demonstrates appropriate preparation pre-procedure

Appropriate analgesia or safe sedation

Technical ability

Aseptic technique (if appropriate)

Seeks help where appropriate

Post procedure management

Communication skills i.e. explains procedure and give feedback to the patient

Consideration of patient/professionalism

Based on the above provide a summative grade below

Summative grade (tick one)

Able to perform without supervisionA4

Able to perform with some supervisionB3

Able to perform with considerable supervisionC2

Not able to performD1

FeedbackAssessors name, signature and date

Examining the ear

Skill 13..Component (not all will apply in each case)UnsatisfactoryBorderlineSatisfactoryN/A

Demonstrates understanding of indications, relevant anatomy, technique of procedure

Obtains informed consent

Demonstrates appropriate preparation pre-procedure

Appropriate analgesia or safe sedation

Technical ability

Aseptic technique (if appropriate)

Seeks help where appropriate

Post procedure management

Communication skills i.e. explains procedure and give feedback to the patient

Consideration of patient/professionalism

Based on the above provide a summative grade below

Summative grade (tick one)

Able to perform without supervisionA4

Able to perform with some supervisionB3

Able to perform with considerable supervisionC2

Not able to performD1

Feedback

Assessors name, signature and date

Skill 14..Use of inhalers and spacers

Component (not all will apply in each case)UnsatisfactoryBorderlineSatisfactoryN/A

Demonstrates understanding of indications, relevant anatomy, technique of procedure

Obtains informed consent

Demonstrates appropriate preparation pre-procedure

Appropriate analgesia or safe sedation

Technical ability

Aseptic technique (if appropriate)

Seeks help where appropriate

Post procedure management

Communication skills i.e. explains procedure and give feedback to the patient

Consideration of patient/professionalism

Based on the above provide a summative grade below

Summative grade (tick one)

Able to perform without supervisionA4

Able to perform with some supervisionB3

Able to perform with considerable supervisionC2

Not able to performD1

FeedbackAssessors name, signature and date

Skill 15..Giving nebulisation for acute asthma attack

Component (not all will apply in each case)UnsatisfactoryBorderlineSatisfactoryN/A

Demonstrates understanding of indications, relevant anatomy, technique of procedure

Obtains informed consent

Demonstrates appropriate preparation pre-procedure

Appropriate analgesia or safe sedation

Technical ability

Aseptic technique (if appropriate)

Seeks help where appropriate

Post procedure management

Communication skills i.e. explains procedure and give feedback to the patient

Consideration of patient/professionalism

Based on the above provide a summative grade below

Summative grade (tick one)

Able to perform without supervisionA4

Able to perform with some supervisionB3

Able to perform with considerable supervisionC2

Not able to performD1

FeedbackAssessors name, signature and date

CASE PRESENTATIONS/ MANAGEMENT PLANSClerking and presentation of patients.Formulation of management plan and evidence-based decision making based on the abovePatients should be clerked using the following scheme based on the Calgary Cambridge process used in Phase l Before starting make sure that you have obtained the patients consent both for interviewing and examining him or her, and for keeping a record. Then record the consent in the hospital or GP notes

WEEK 1 CASE PRESENTATION / MANAGEMENT PLANPATIENT AGE: SEX:

Patients problem list (Calgary-Cambridge) (presenting complaint)

Biomedical perspective (history of presenting complaint)sequence of events; symptom analysis

Patient perspective (history of presenting complaint)ideas and beliefs; concerns and expectations;system review effects on life; feelings

Background information past medical history; drug and allergy history; family history; social history INCLUDING GENOGRAM

Analysis of patients history the most likely cause(s) of the patients presentation; other possible causes; the rationales behind your identification of these as more or less likely causes; findings to be looked for on physical examination to decide between causes

Recording your findings from physical examination underline any you feel are particularly relevant

Analysis of the history and the examination have you changed your view from before? What is now the most likely cause of the patients problem(s) and why? Are there any other possible causes that still need to be considered at this stage? Which causes could you now discard? (differential diagnosis)

Formulation of the patients problem(s) encapsulate this in a single sentence incorporating physical, psychological and social terms (the Triple Diagnosis)

Plan of management investigations (WRITE PATHOLOGY FORM); prescription/medical intervention; observation; referral and team working (WRITE REFFERAL LETTER).

Explanation and planning with the patient what the patient has been told; plan of action negotiated

Outcome A description of the progress of the patient as far as possible. Consider further issues to be resolved. Where appropriate, you should discuss with your tutor whether to contact the patient by telephone after discharge. If so, you should obtain permission from the patient. INCLUDE HOME VISIT IF NECESSARY. Describe any ethical issues arising from the patient using the 4 principles of postmodern ethics where appropriate.

Identification of learning objectives to be developed through discussion with your tutor.

Clerking and presentationGrade(tick 1)Management plan and evidence-based decision makingGrade(tick 1)

Excellent

4All significant items have been considered. The student demonstrates an awareness of matters beyond those that must be addressed. No further enquiry is neededAll significant items have been considered. The student demonstrates an awareness of matters beyond those that must be addressed

Satisfactory

3All the important items are considered. Any omissions are minor and unlikely to be of clinical significance for the diagnosis of a patient with this presentation. Only minimal further enquiry is neededAll the important items are considered. Any omissions are minor and unlikely to be of clinical significance for the management of a patient with this presentation.

Borderline

2There are significant omissions of detail, or there are errors of fact or interpretation. These have the potential to lead to mistakes in diagnosis of a patient with this presentation. Considerable further enquiry is neededThere are significant omissions of detail, or there are errors of fact or interpretation. These have the potential to lead to mistakes in management of a patient with this presentation

Unsatisfactory

1There are important omissions, or significant errors of fact and/or interpretation, which are likely to jeopardise the diagnosis of a patient with this presentation. The consultation needs to start again Students will be unable to count this case against their total unless it is amendedThere are important omissions, or significant errors of fact and/or interpretation, which are likely to jeopardise the management or solution of the problem of a patient with this presentation. Students will be unable to count this case against their total unless it is amended

Feedback comments

Assessors name, signature and date

Grading scheme.

A performance graded Unsatisfactory may be revised or repeated so as to obtain a higher gradeProgression requirement for Clerking and presentation and Management plan and evidence-based decision making. Students should receive a grade of at least Borderline in both components of 8 patients in each course.

WEEK 2 CASE PRESENTATION / MANAGEMENT PLANPATIENT AGE: SEX:

Patients problem list (Calgary-Cambridge) (presenting complaint)

Biomedical perspective (history of presenting complaint)sequence of events; symptom analysis

Patient perspective (history of presenting complaint)ideas and beliefs; concerns and expectations;system review effects on life; feelings

Background information past medical history; drug and allergy history; family history; social history INCLUDING GENOGRAM

Analysis of patients history the most likely cause(s) of the patients presentation; other possible causes; the rationales behind your identification of these as more or less likely causes; findings to be looked for on physical examination to decide between causes

Recording your findings from physical examination underline any you feel are particularly relevant

Analysis of the history and the examination have you changed your view from before? What is now the most likely cause of the patients problem(s) and why? Are there any other possible causes that still need to be considered at this stage? Which causes could you now discard? (differential diagnosis)

Formulation of the patients problem(s) encapsulate this in a single sentence incorporating physical, psychological and social terms (the Triple Diagnosis)

Plan of management investigations (WRITE PATHOLOGY FORM); prescription/medical intervention; observation; referral and team working (WRITE REFFERAL LETTER).

Explanation and planning with the patient what the patient has been told; plan of action negotiated

Outcome A description of the progress of the patient as far as possible. Consider further issues to be resolved. Where appropriate, you should discuss with your tutor whether to contact the patient by telephone after discharge. If so, you should obtain permission from the patient. INCLUDE HOME VISIT IF NECESSARY. Describe any ethical issues arising from the patient using the 4 principles of postmodern ethics where appropriate.

Identification of learning objectives to be developed through discussion with your tutor.

Clerking and presentationGrade(tick 1)Management plan and evidence-based decision makingGrade(tick 1)

Excellent

4All significant items have been considered. The student demonstrates an awareness of matters beyond those that must be addressed. No further enquiry is neededAll significant items have been considered. The student demonstrates an awareness of matters beyond those that must be addressed

Satisfactory

3All the important items are considered. Any omissions are minor and unlikely to be of clinical significance for the diagnosis of a patient with this presentation. Only minimal further enquiry is neededAll the important items are considered. Any omissions are minor and unlikely to be of clinical significance for the management of a patient with this presentation.

Borderline

2There are significant omissions of detail, or there are errors of fact or interpretation. These have the potential to lead to mistakes in diagnosis of a patient with this presentation. Considerable further enquiry is neededThere are significant omissions of detail, or there are errors of fact or interpretation. These have the potential to lead to mistakes in management of a patient with this presentation

Unsatisfactory

1There are important omissions, or significant errors of fact and/or interpretation, which are likely to jeopardise the diagnosis of a patient with this presentation. The consultation needs to start again Students will be unable to count this case against their total unless it is amendedThere are important omissions, or significant errors of fact and/or interpretation, which are likely to jeopardise the management or solution of the problem of a patient with this presentation. Students will be unable to count this case against their total unless it is amended

Feedback comments

Assessors name, signature and date

Grading scheme.

A performance graded Unsatisfactory may be revised or repeated so as to obtain a higher gradeProgression requirement for Clerking and presentation and Management plan and evidence-based decision making. Students should receive a grade of at least Borderline in both components of 8 patients in each course.

WEEK 3 CASE PRESENTATION / MANAGEMENT PLANPATIENT AGE: SEX:

Patients problem list (Calgary-Cambridge) (presenting complaint)

Biomedical perspective (history of presenting complaint)sequence of events; symptom analysis

Patient perspective (history of presenting complaint)ideas and beliefs; concerns and expectations;system review effects on life; feelings

Background information past medical history; drug and allergy history; family history; social history INCLUDING GENOGRAM

Analysis of patients history the most likely cause(s) of the patients presentation; other possible causes; the rationales behind your identification of these as more or less likely causes; findings to be looked for on physical examination to decide between causes

Recording your findings from physical examination underline any you feel are particularly relevant

Analysis of the history and the examination have you changed your view from before? What is now the most likely cause of the patients problem(s) and why? Are there any other possible causes that still need to be considered at this stage? Which causes could you now discard? (differential diagnosis)

Formulation of the patients problem(s) encapsulate this in a single sentence incorporating physical, psychological and social terms (the Triple Diagnosis)

Plan of management investigations (WRITE PATHOLOGY FORM); prescription/medical intervention; observation; referral and team working (WRITE REFFERAL LETTER).

Explanation and planning with the patient what the patient has been told; plan of action negotiated

Outcome A description of the progress of the patient as far as possible. Consider further issues to be resolved. Where appropriate, you should discuss with your tutor whether to contact the patient by telephone after discharge. If so, you should obtain permission from the patient. INCLUDE HOME VISIT IF NECESSARY. Describe any ethical issues arising from the patient using the 4 principles of postmodern ethics where appropriate.

Identification of learning objectives to be developed through discussion with your tutor.

Clerking and presentationGrade(tick 1)Management plan and evidence-based decision makingGrade(tick 1)

Excellent

4All significant items have been considered. The student demonstrates an awareness of matters beyond those that must be addressed. No further enquiry is neededAll significant items have been considered. The student demonstrates an awareness of matters beyond those that must be addressed

Satisfactory

3All the important items are considered. Any omissions are minor and unlikely to be of clinical significance for the diagnosis of a patient with this presentation. Only minimal further enquiry is neededAll the important items are considered. Any omissions are minor and unlikely to be of clinical significance for the management of a patient with this presentation.

Borderline

2There are significant omissions of detail, or there are errors of fact or interpretation. These have the potential to lead to mistakes in diagnosis of a patient with this presentation. Considerable further enquiry is neededThere are significant omissions of detail, or there are errors of fact or interpretation. These have the potential to lead to mistakes in management of a patient with this presentation

Unsatisfactory

1There are important omissions, or significant errors of fact and/or interpretation, which are likely to jeopardise the diagnosis of a patient with this presentation. The consultation needs to start again Students will be unable to count this case against their total unless it is amendedThere are important omissions, or significant errors of fact and/or interpretation, which are likely to jeopardise the management or solution of the problem of a patient with this presentation. Students will be unable to count this case against their total unless it is amended

Feedback comments

Assessors name, signature and date

Grading scheme.

A performance graded Unsatisfactory may be revised or repeated so as to obtain a higher gradeProgression requirement for Clerking and presentation and Management plan and evidence-based decision making. Students should receive a grade of at least Borderline in both components of 8 patients in each course.

WEEK 4 CASE PRESENTATION / MANAGEMENT PLANPATIENT AGE: SEX:

Patients problem list (Calgary-Cambridge) (presenting complaint)

Biomedical perspective (history of presenting complaint)sequence of events; symptom analysis

Patient perspective (history of presenting complaint)ideas and beliefs; concerns and expectations;system review effects on life; feelings

Background information past medical history; drug and allergy history; family history; social history INCLUDING GENOGRAM

Analysis of patients history the most likely cause(s) of the patients presentation; other possible causes; the rationales behind your identification of these as more or less likely causes; findings to be looked for on physical examination to decide between causes

Recording your findings from physical examination underline any you feel are particularly relevant

Analysis of the history and the examination have you changed your view from before? What is now the most likely cause of the patients problem(s) and why? Are there any other possible causes that still need to be considered at this stage? Which causes could you now discard? (differential diagnosis)

Formulation of the patients problem(s) encapsulate this in a single sentence incorporating physical, psychological and social terms (the Triple Diagnosis)

Plan of management investigations (WRITE PATHOLOGY FORM); prescription/medical intervention; observation; referral and team working (WRITE REFFERAL LETTER).

Explanation and planning with the patient what the patient has been told; plan of action negotiated

Outcome A description of the progress of the patient as far as possible. Consider further issues to be resolved. Where appropriate, you should discuss with your tutor whether to contact the patient by telephone after discharge. If so, you should obtain permission from the patient. INCLUDE HOME VISIT IF NECESSARY. Describe any ethical issues arising from the patient using the 4 principles of postmodern ethics where appropriate.

Identification of learning objectives to be developed through discussion with your tutor.

Clerking and presentationGrade(tick 1)Management plan and evidence-based decision makingGrade(tick 1)

Excellent

4All significant items have been considered. The student demonstrates an awareness of matters beyond those that must be addressed. No further enquiry is neededAll significant items have been considered. The student demonstrates an awareness of matters beyond those that must be addressed

Satisfactory

3All the important items are considered. Any omissions are minor and unlikely to be of clinical significance for the diagnosis of a patient with this presentation. Only minimal further enquiry is neededAll the important items are considered. Any omissions are minor and unlikely to be of clinical significance for the management of a patient with this presentation.

Borderline

2There are significant omissions of detail, or there are errors of fact or interpretation. These have the potential to lead to mistakes in diagnosis of a patient with this presentation. Considerable further enquiry is neededThere are significant omissions of detail, or there are errors of fact or interpretation. These have the potential to lead to mistakes in management of a patient with this presentation

Unsatisfactory

1There are important omissions, or significant errors of fact and/or interpretation, which are likely to jeopardise the diagnosis of a patient with this presentation. The consultation needs to start again Students will be unable to count this case against their total unless it is amendedThere are important omissions, or significant errors of fact and/or interpretation, which are likely to jeopardise the management or solution of the problem of a patient with this presentation. Students will be unable to count this case against their total unless it is amended

Feedback comments

Assessors name, signature and date

Grading scheme.

A performance graded Unsatisfactory may be revised or repeated so as to obtain a higher gradeProgression requirement for Clerking and presentation and Management plan and evidence-based decision making. Students should receive a grade of at least Borderline in both components of 8 patients in each course.

Mini-CEX ASSESSMENT Supplementary Mini-CEX (A process partly or wholly observed by the assessor)

Date: _______Group____________ Year________Please circle the appropriate response or tick the score box. Assessors positionAcademicConsultantResident MO Other:

Clinical SettingA/E OPD In-patient Acute admission GP Outreach

Mini-CEX Number --------

Patient Diagnosis

Please tick the appropriate boxes: Expected standard: 3 rd Year Medical Student

Components assessed (NB not all needed for MiniCEX)Not Assessed 0Below Expectation 1Border Line 2Meets Standard 3Above Expectation 4

1. History

2. Physical examination

3. Communication / empathy

4. Clinical knowledge

5. Presentation skills

6 .Overall performance

COMMENTS BY ASSESSOR for feedback

AGREED ACTION / LEARNING OBJECTIVE after discussion with student:

Assessors Name

Was the student given oral feedback (please circle) Assessor Signature:

Yes No

Mini-CEX ASSESSMENT Mini-CEX 1 (A process partly or wholly observed by the assessor)

Date: _______Group____________ Year________Please circle the appropriate response or tick the score box. Assessors positionAcademicConsultantResident MO Other:

Clinical SettingA/E OPD In-patient Acute admission GP Outreach

Patient Diagnosis

Please tick the appropriate boxes: Expected standard: 3 rd Year Medical Student

Components assessed (NB not all needed for MiniCEX)Not Assessed 0Below Expectation 1Border Line 2Meets Standard 3Above Expectation 4

1. History

2. Physical examination

3. Communication / empathy

4. Clinical knowledge

5. Presentation skills

6 .Overall performance

COMMENTS BY ASSESSOR for feedback

AGREED ACTION / LEARNING OBJECTIVE after discussion with student:

Assessors Name

Was the student given oral feedback (please circle) Assessor Signature:

Yes No

Progression requirement: students who are awarded a grade of below expectations on both patients will be examined on a third. If the grade is unchanged then the student will be unable to progress.

Mini-CEX ASSESSMENT Mini-CEX 2 (A process partly or wholly observed by the assessor)

Date: _______Group____________ Year________Please circle the appropriate response or tick the score box. Assessors positionAcademicConsultantResident MO Other:

Clinical SettingA/E OPD In-patient Acute admission GP Outreach

Patient Diagnosis

Please tick the appropriate boxes: Expected standard: 3 rd Year Medical Student

Components assessed (NB not all needed for MiniCEX)Not Assessed 0Below Expectation 1Border Line 2Meets Standard 3Above Expectation 4

1. History

2. Physical examination

3. Communication / empathy

4. Clinical knowledge

5. Presentation skills

6 .Overall performance

COMMENTS BY ASSESSOR for feedback

AGREED ACTION / LEARNING OBJECTIVE after discussion with student:

Assessors Name

Was the student given oral feedback (please circle) Assessor Signature:

Yes No

Progression requirement: students who are awarded a grade of below expectations on both patients will be examined on a third. If the grade is unchanged then the student will be unable to progress.

This sub-section should involve documentary proof of activities such as guest lectures, conferences, workshops, seminars, weekly Wednesdays presentations and etc.

Week noDateTopic presentedPresenters NamePresenters signatureSupervisors signature

1

2

3

4

5

6

7

8

This sub-section should involve documentary proof of activities such as meeting with Primary Health care stakeholder. Week DateTopic discussedStakeholder designation Stakeholder / Supervisors signature

This sub-section should involve documentary proof of activities such as call during weekday or weekend.WeekDateWeekday/WeekendSupervisors nameSupervisors signature

1

2

3

4

5

6

7

8

9

This sub-section should involve documentary proof of activities such as clinical attendance (Clinic, OPD, A & E).DateSupervisors name & signatureDateSupervisors name & signature

Week1Monday

Thursday

Tuesday

Friday

Wednesday

Comment if any:

Week 2Monday

Thursday

Tuesday

Friday

Wednesday

Comment if any:

Monday

Thursday

Tuesday

Friday

Wednesday

Comment if any:

Week 3Monday

Thursday

Tuesday

Friday

Wednesday

Comment if any:

Week 4Monday

Thursday

Tuesday

Friday

Wednesday

Comment if any:

Week 5Monday

Thursday

Tuesday

Friday

Wednesday

Comment if any:

Week 6Monday

Thursday

Tuesday

Friday

Wednesday

Comment if any:

Week 7Monday

Thursday

Tuesday

Friday

Wednesday

Comment if any:

Week 8Monday

Thursday

Tuesday

Friday

Wednesday

Comment if any:

END OF ROTATION MARKING SHEET

Family Medicine rotation was completed in: Mahalapye/ Maun (please circle)ComponentStudent MarksIndicesFinal student marks (reduce to one place decimal only)Maximum Marks

Case presentation history and physical examination/16X 0.625/ 10%

Management plan /16X 0.625/ 10%

Total Case presentationsXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX/ 20 %

Mini-CEX 1/4X 0.625/ 2.5%

Mini-CEX 2/4X 0.625/ 2.5%

DOCPS /60X 0.00138/ 5%

Total Mini-CEX + DOCPSXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX/ 10%

PBL/160X 0.0625 / 10 %

TotalXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX/ 40%

Name of Rotation Coordinator:.

Signature:

Date:

School of Medicine Fam Med- PHC Year 5 MBBS

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