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FACULTY OF MEDICINE

PHASE 3

MFAC3501: Medicine

Course Guide 2010

Version 1.0 2010


Table of Contents

Introduction ................................................................................... 3

Course Staff ................................................................................... 3

Course Aims ................................................................................... 4

The approach to learning and teaching ............................................... 5

Assessment .................................................................................... 6

Academic Honesty and Plagiarism ..................................................... 10

Course Schedule ............................................................................ 11

Resources for Students ................................................................... 11

Course Evaluation and Development ................................................. 11

Administrative Matters .................................................................... 11

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Introduction
Welcome to MFAC3501, the Medicine course in Phase 3. Before considering the aims of
the Medicine course, it is worth considering what does the discipline of Medicine, or
alternatively Internal Medicine, cover.

You should already have some appreciation of what Medicine encompasses from Phase 2.
In Health Maintenance, you were introduced to a range of clinical problems which could
represent medical or surgical conditions. That course was not intended to present these
problems as one or the other – it was important for you to appreciate that a patient’s
presenting illness may not be readily evident as a medical or surgical diagnosis and will
often require multidisciplinary treatment. In Ageing & Endings, the emphasis was on
cancer and aged care – again the clinical problems and treatments were not restricted to
either Medicine or Surgery.

The distinction between Medicine and Surgery has traditionally been based on
therapeutic approaches. Physicians have focused on general and pharmacological
approaches while surgery has been characterised by operative techniques. However this
distinction is increasingly blurred as both physicians and surgeons engage in complex
multi-dimensional approaches to treatment including minimally-invasive procedures.
Similarly the traditional view of the physician as the diagnostician and the surgeon as the
technician is no longer valid.

In essence, the Medicine course will allow you to address the Phase 3 graduate
capabilities within the context of clinical experiences which reflect the practice of
physicians.

Course Staff
Course Convenor
Associate Professor Philip Jones
Ph: 9382 2645
Email: Philip.Jones@unsw.edu.au

Student Support
For information on clinics and assessments particular to the hospital you are attending
please contact the appropriate Clinical School coordinator.

Prince of Wales Clinical School:


Jenny Ryall
Ph: 9382 2645
Email: J.Ryall@unsw.edu.au

St Vincent’s Clinical School


Naomi Esselbrugge
Ph: 8382 2023
Email: clinicalschool@stvincents.com.au

St George Clinical School


Natalie du Gard
Ph: 9113 2709
Email: N.dugard@unsw.edu.au

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South Western Sydney Clinical School
Lorinda Carter
Ph: 9828 3844
Email: Lorinda.Carter@sswahs.nsw.gov.au

Sutherland Hospital
Justin Joynes
Ph: 9540 7946
Email: J.Joynes@unsw.edu.au

Contact details for the campuses of the Rural Clinical School are available on the RCS
website.

Units of credit
This course is a 10 UoC course and is a requirement for the completion of the MBBS.

Rural Clinical School and RUSC Rotations


Students attending the campuses of the Rural Clinical School or allocated to another rural
hospital to meet the RUSC requirement will address the same aims and complete the
same course assessments. However the structure of the course may vary depending on
the campus.

Course Aims
You should review the indicator statements for the Phase 3 Graduate Capabilities and
consider how your experiences in Medicine will provide many opportunities to understand
the relevance of these capabilities. Your daily activities will focus upon Patient
Assessment and Management, but you should also use each patient encounter to address
other Graduate Capabilities. For example, consider the biomedical sciences underlying a
patient’s presentation; think about social and cultural factors influencing patients and
their families; or address relevant ethical issues raised by each patient and your
responses.

Upon completion of the course you should be able to:

1. Apply an understanding of abnormalities in human structure and function to the


diagnosis of medical conditions.

2. Gather clinical data through history and examination and demonstrate clinical
reasoning in the interpretation of the data to derive a provisional diagnosis and
differential diagnosis in patients.

3. Formulate a rational approach to the investigation and treatment of medical


conditions.

4. Critically evaluate literature on medical topics.

5. Demonstrate appropriate skills and attitudes working as a medical student as part


of a clinical unit.

These are broad skills that are applicable to Medicine and its sub-disciplines, which are
largely based around body systems. Within each of these sub-disciplines, you’ll apply
these skills to a variety of clinical presentations related to the sub-discipline. Clearly you
cannot experience all these presentations and you’ll need to develop an appreciation of
what is common and what is important in assisting you to guide your studies.

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The approach to learning and teaching
The discipline of Medicine is challenging and demanding in the breadth and depth of
knowledge that it encompasses. Clearly there is no expectation that you will master this.
Similarly there is a seemingly never-ending list of medical conditions that you may
encounter but remember “common things occur commonly” and by now you should have
the skills to recognise what is common and what is important.

The practice of Internal Medicine may be undertaken by General Physicians who maintain
a broad expertise across all the sub-disciplines or specialists within specific sub-
disciplines. Students allocated to teaching hospitals within the Sydney metropolitan area
will gain their experiences in Medicine almost exclusively within specialist units whereas
those in regional and rural settings will work within general medical units.

Your learning should be based primarily on your clinical experiences. You’ll understand
basic and clinical sciences if you relate your study of these to the patients you see.
However the range of clinical problems you’ll see in the hospitals does not reflect the
incidence and prevalence of diseases in the community. Thus it is important that you
also broaden your learning to common clinical problems which are less likely to result in
a hospital admission. While patients are frequently admitted to hospital for the
management of a presenting problem, they typically have multiple co-morbidities and it
is important that you take the opportunity to learn from your patients about their other
health problems.

It is essential that you engage as much as possible with the clinical service to which you
are attached. While you will learn from observing what the doctors, nurses and other
staff are doing, you will learn more from actively participating in the care of patients.
You should assess patients yourself to test your clinical skills and your ability to work out
what is wrong. You should review the results of investigations to interpret for yourself
what the result means. While you cannot institute your own treatment, you should make
sure that you understand the rationale for treatment. It is very easy to fall into a passive
role and busy clinical services will not necessarily have the time to try and draw you in –
you have to be pro-active and you will be rewarded.

The types of clinical activities will vary with the clinical attachment but should include:

• Daily assessment of patients, including new admissions. On busy units, you will not
be able to see all patients but you need to understand what is expected of you.
• Participate in ward rounds.
• Attend outpatient clinics.
• Accompany patients when they are undergoing diagnostic or therapeutic procedures
that you have not yet seen. It is important that you understand what a patient
experiences in these procedures if you going to be able to describe the procedure to a
patient.
• Attend the clinical unit’s service meetings e.g. X-ray meetings, pathology meetings.
• Attend the unit’s teaching activities e.g. departmental meetings, peer review
meetings.

Your role in the clinical service will vary. You will usually have more time to focus on
individual patients than the junior medical staff. Use this time to carefully review
patients’ medications to look for possible interactions and adverse events. You should
assist in patients’ care by helping to explain to patients what is happening – clearly there
are limits to what you know and make sure you tell the patient when you do not know.

You should keep a record of interesting cases which stimulated your learning using the
standard clinical log-sheets.

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Coursework
There is no prescribed coursework for the Medicine course. Your clinical school will
arrange tutorials to assist in your learning. A common component of coursework will be
Clinical Pharmacology & Therapeutics which will focus on common therapeutic drug
classes.

During the Medicine and Surgery courses, you will also be expected to attend the hospital
and campus-based tutorials for the Biomedical Sciences program.

It is important that during your Medicine course, you aim to complete several of the NPS
training modules. These mainly have a focus on medical conditions and include common
conditions which you should see during the course. Your clinical school may organise
tutorials which require prior completion of specific training modules.

Your clinical school may schedule training in one or more of the required Phase 3
procedural skills. These skills can only be signed off by designated assessors as
determined by the school.

Assessment
The final mark for the Medicine course is based on the following assessments (weightings
in brackets):

1. Supervisor’s overall grade of the satisfactory achievement of the generic learning plan
(70%).
2. Written case report or case presentation (10%).
3. Observed clinical assessments (20%).

A Fail in the course is determined as:

• Combined weighted mark of the above assessments <50%.


OR
• An overall supervisor’s grade of Fail for the generic learning plan.

Learning Plan
The Learning Plan in Medicine will address the three generic capabilities of Patient
Assessment and Management, Teamwork and Self-Directed Learning and Critical
Evaluation. Students should meet with their supervisor early in the clinical attachment to
negotiate any additional objectives to develop their portfolio.

The following are standard requirements for the Medicine course.

Attendance
You must attend at least 80% of all scheduled activities included in the attachment. This
includes clinical activities and tutorials organised by the clinical school. If you fail to meet
this requirement your grade for the course would be unsatisfactory and you would be
required to repeat the course.

Performance during the clinical attachment


You are expected to be an active member of the clinical service to which you are
attached. At the beginning of the clinical attachment, the supervisor will explain to you

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what will be expected of you. You will be expected to demonstrate satisfactory
performance in your role in the clinical attachment.

Your performance in meeting these expectations will be determined by the clerkship


supervisor – this may be done in consultation with other staff including other medical
staff (junior and senior), nursing staff and other healthcare workers. The supervisor may
also seek feedback from patients.

Your supervisor may question you about cases recorded in your clinical log-sheets as part
of your assessment.

Written case report or case presentation


The course assessment will include at least one written case report or oral case
presentation as determined by the supervisor. Depending on the supervisor or clinical
school, you may be required to complete one case report and one oral case presentation.

Your case report/presentation should contain two distinct components:

1. A description of the patient’s history, physical examination findings, results of


laboratory investigations and treatment. This is similar to the Phase 2 case-based
assignments. This section should be limited to 500 words in the written report or
5 minutes of the oral presentation.

2. Discussion on one aspect of the patient’s presentation. This may address


underlying biomedical sciences, social/cultural issues, aspects of management,
ethical and/or legal issues. This section should be limited to 700 words in the
written report or 7 minutes of the oral presentation.

The written case report should not exceed 1,200 words (excluding references). It should
be typed and submitted to your supervisor. All written case reports must be submitted by
the end of week 7. The report should not include any identifying details of patients
including the patient’s medical record number. Note these written case reports are not
routinely submitted to eMed. However you may subsequently submit it as supportive
evidence.

An oral presentation should not exceed 12 minutes, unless advised otherwise by your
supervisor or clinical school. Time for questions may be added. The Power Point
presentation is not routinely submitted to eMed. However you may subsequently submit
it as supportive evidence.

The written case report or case presentation will be assessed by your supervisor or
another designated staff member.

The written case report or case presentation will be graded for each component as well
as effective communication. The report (oral or written) should be well structured,
clearly presented, appropriate length and format with good use of visual aids. An overall
grade will contribute 10% towards the course result. In the event that the supervisor or
school requires more than one case report, the final mark will be average of all reports.

Clinical & Communication Skills


You will be assessed on your clinical and communication skills on at least two occasions.
This may take various forms depending on the supervisor e.g. observed long case or
shorter patient encounters focusing on history, examination or communication skills in
explaining diagnosis and treatment to a patient. Each of these clinical assessments will
contribute 10% towards the course result.

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Medicine Course Assignment: Quality Use of Medicines
In addition, all students are required to complete an assignment addressing the quality
use of medicines in patients on multiple drugs. This assignment will contribute to your
Phase 3 Portfolio.

Graduate Capabilities assessed in this assignment:


Focus capabilities:

• Patient Assessment and Management


• Understanding the Social and Cultural Aspects of Health and Disease

Your report will also be assessed for each of the generic capabilities – Effective
Communication, Self-directed Learning and Critical Evaluation and Development as a
Reflective Practitioner.

Introduction:
Polypharmacy, especially in the elderly is known to contribute to adverse events that
constitute an increasingly visible level of medical error1. Poor prescribing practices are
common in all health systems and recent effort has been directed at minimizing this
problem under the umbrella term of “quality use of medicines” (QUM). This assignment
has been developed to give you a deeper understanding of what QUM involves and for
you to analyse and report first hand on how it works.

Aims:
It is anticipated that by the completion of this assignment you will be able to:
• Take a comprehensive history of a patient's medication use (past and present)
including prescribed, pharmacy only (over-the-counter) and complementary
medicines.
• Properly complete all the details on the medication review - indication, cost and
access.
• Select suitable measurements with which to monitor the patient beyond the
hospital stay.
• Display an understanding of the key components of 'quality use of medicines' and
your role in ensuring this in practice.
• Critically assess factors influencing drug selection and outline appropriate
measure to ensure quality use of medicines is achieved in your patient.
• Critically appraise the gaps between your patient’s therapy and the goal of
achieving ‘quality use of medicines’ for that patient.

Task description:
• Find a current inpatient receiving multiple medications (i.e. >6 different
medications).
• Register the patient’s MRN with the clinical school– only one report per patient.
• Review the following document (listed in full in the references below):
o The National Strategy for Quality Use of Medicines – Plain English Edition 1.
• Include the following in your report:
o A brief summary of the patient’s history, including a description of the
patients Social/ Cultural and lifestyle factors and how that might or should
have influenced the choice of medications.
o A completed medication chart review for this patient (using the form
provided in Vista) with a discussion of the medications prescribed and their
appropriateness in the light of the history and social and cultural factors.
o Select suitable measurements with which to monitor the patient and their
treatment beyond the hospital stay taking into account the patient’s socio-
cultural and lifestyle factors mentioned previously. Describe and discuss

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your choice of measurements and how this was influenced by your
knowledge of the patient,
o An overview of the three components to the definition of the Quality Use of
Medicines1 detailing the areas of significance for this case.
o A summary of the six building blocks supporting quality use of medicine1
showing where these have been utilised effectively in relation to this case.
Further explore where these building blocks were used to the full potential
for this patient and conversely where this could have been improved.
o A brief discussion of the key principles of QUM and your role in learning
about this and turning these principles into practice (this should make up a
major part of the reflective component of this assignment).

Report requirements
Reports should be up to 2000 words in length (excluding the medication chart review).
Please include a word count on the front sheet.

Format your report in accordance with the specifications on the Medicine program
website and refer to the website for details of penalties for overlong assignments.

The report must be submitted to eMed by 5.00pm on the last day of the course.

Remember to include a short (<500 word) reflection on the process of the assignment
and what you have learnt from it.

Assessment criteria
For a P grade, the written report should meet the following criteria:

Patient Assessment and Management


• Describes and discusses the individual medications of the chosen patient using a
medication chart review to inform and illustrate this process.
• Analyses the management of the patient in terms of quality use of medicines and
determines whether the key national strategies have been used effectively in
prescribing of medications to this particular patient.

Understanding the Social and Cultural Aspects of health and Disease


• Analyses how the patient’s social, culture and lifestyle factors have impacted on the
medications prescribed and discusses how this has affected the quality use of
medicine in this case.
• Discuss where there were deficiencies in achieving quality use of medicines related to
social, cultural and lifestyle factors.
• Shows how the quality management of this patient can continue after discharge home
and how the social-cultural and lifestyle factors mentioned above may affect this.

References:
1. Department of Health and Ageing. (2002). The National Strategy for Quality Use of
Medicines, Plain English Edition. Canberra: Commonwealth of Australia. Retrieved
24.11.09:
http://www.health.gov.au/internet/main/publishing.nsf/Content/nmp-pdf-natstrateng-
cnt.htm

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Academic Honesty and Plagiarism
What is Plagiarism?
Plagiarism is the presentation of the thoughts or work of another as one’s own.* Examples
include:

• direct duplication of the thoughts or work of another, including by copying material, ideas or
concepts from a book, article, report or other written document (whether published or
unpublished), composition, artwork, design, drawing, circuitry, computer program or software,
web site, Internet, other electronic resource, or another person’s assignment without
appropriate acknowledgement;
• paraphrasing another person’s work with very minor changes keeping the meaning, form
and/or progression of ideas of the original;
• piecing together sections of the work of others into a new whole;
• presenting an assessment item as independent work when it has been produced in whole or
part in collusion with other people, for example, another student or a tutor; and
• claiming credit for a proportion a work contributed to a group assessment item that is greater
than that actually contributed.†

For the purposes of this policy, submitting an assessment item that has already been submitted for
academic credit elsewhere may be considered plagiarism.

Knowingly permitting your work to be copied by another student may also be considered to be
plagiarism.

Note that an assessment item produced in oral, not written, form, or involving live presentation,
may similarly contain plagiarised material.

The inclusion of the thoughts or work of another with attribution appropriate to the academic
discipline does not amount to plagiarism.

The Learning Centre website is main repository for resources for staff and students on plagiarism
and academic honesty. These resources can be located via:

www.lc.unsw.edu.au/plagiarism

The Learning Centre also provides substantial educational written materials, workshops, and
tutorials to aid students, for example, in:

• correct referencing practices;


• paraphrasing, summarising, essay writing, and time management;
• appropriate use of, and attribution for, a range of materials including text, images, formulae
and concepts.

Individual assistance is available on request from The Learning Centre.

Students are also reminded that careful time management is an important part of study and one of
the identified causes of plagiarism is poor time management. Students should allow sufficient time
for research, drafting, and the proper referencing of sources in preparing all assessment items.

* Based on that proposed to the University of Newcastle by the St James Ethics Centre. Used with
kind permission from the University of Newcastle
† Adapted with kind permission from the University of Melbourne.

The Faculty of Medicine regards the maintenance of academic integrity by staff and
students as a matter of the highest priority. The Faculty participates in the University’s
use of the similarity detection software Turn-It-In (See
http://www.turnitin.com/static/home.html). Student work submitted to the eMed:
Portfolio system will be compared to other items in the eMed system, to material on the
Internet, and to items in the Turn-It-In database.

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Course Schedule
The clerkship supervisor will provide you a timetable showing the clinical activities and
other Unit activities that you will be required to attend.

The clinical school will provide you with a timetable showing coursework and other
activities that you will be required to attend. This will include the timetable for the
Biomedical Sciences tutorials.

Resources for Students


The Phase 3 Blackboard module contains general information and resources for the
Medicine course. Access via the TELT Gateway http://telt.unsw.edu.au/

The school will also have facilities including library services and online resources available
through the school’s website.

Course Evaluation and Development


At the completion of the clerkship, you will be asked to complete an evaluation form to
provide feedback to the clerkship supervisor and school.

Student evaluative feedback on the course is gathered using UNSW's Course and
Teaching Evaluation and Improvement (CATEI) Process and by informal means. Student
feedback is taken seriously and the annual revisions to the course are informed by
student feedback.

Administrative Matters
Special Consideration
If you feel your performance during the course could be effected by illness or other
factors, contact you school coordinator/administrator. It is essential that your supervisor
is also informed about any absences. If necessary, you should complete a formal request
for Special Consideration through the usual University process.

Dress at hospital sites


While there is no defined dress code, you are expected to dress in a manner respectful of
patients’ expectations. Observe the manner of dress of staff involved in patient care.

The wearing of white coats is not compulsory.

Your supervisor has the final say in whether your dress or appearance is acceptable.

Security
All students must have a hospital identification card. The card should be attached to a
lanyard supplied by the clinical school and be clearly visible at all times. The card should
be used to identify you to staff and patients.

Confidentiality
At all times, students must be mindful of patient’s confidentiality.

• You should not include identifying details when discussing a patient’s condition
with other students or staff who are not involved in the patient’s care.
• You should never discuss a patient in a public place eg in elevators or in corridors,
even if the patient is not identified. A relative could readily identify whom you are
talking about and hear information not disclosed by the patient.
• You cannot photocopy medical records.
• You cannot use the hospital’s computer clinical information system to obtain
information on a person, which is not relevant to their clinical care.

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