Overview
The eight-week Advanced Learning in Medicine fourth-year (ALM4) Medicine module comprises two four-week attachments in acute medicine and geriatric medicine. An ambulatory medicine programme occurs alongside the two attachments, for half to one day most weeks.
Teaching and learning on the Medicine attachment occurs in a variety of settings including on ward rounds, at the bedside, during tutorials, simulation exercises, home visits, and seeing patients in ambulatory medicine.
This provides a foundation of core knowledge and clinical skills.
Acute medicine
This will consist of a four-week attachment to a general medicine team based at Dunedin or Timaru Hospitals.
Each student will be incorporated into an Acute Medicine team as a junior member.
They will gain experience in the presentation and management of acute general medical conditions. They will also learn how to function within the context of a team and in-patient ward environment. Clinical skills will be developed.
Specific objectives
- Gain experience in acute inpatient admission and management:
- Demonstrate the ability to systematically complete a medical history and physical examination
- Be able to follow inpatients over the course of an acute admission and efficiently present these inpatients to the ward team on a daily basis
- Develop a systematic approach to common medical conditions
- Understand and interpret commonly used investigations (laboratories, ECG, radiologic studies)
- Demonstrate understanding of the treatment plan for common acute medical conditions
- Communicate effectively with the patient, being sensitive to their needs and paying attention to any related psycho-social-spiritual issues
- Work as an integral member of an acute inpatient medical team
Assessment
All of these must be completed in order to finish the acute internal medicine run:
- Case conference presentation
- Logbook
- PASAF (please see your consultant to arrange a time to complete this section of your logbook)
- Written exam (in week 8). This is a short answer exam. Questions will be drawn from ambulatory, geriatric, and acute Medicine portions of the eight-week attachment. A sample exam is available in the MICN 401 student handbook.
Repeat assessments will be given as needed.
Geriatric medicine
This attachment recognises that an increasing percentage of inpatient care relates to the care of the elderly.
Students will be assigned to one of the geriatric medicine teams at Dunedin Hospital or at ISIS for the four-week attachment.
During this time they will function as a junior team member and will be assigned patients to clerk and help manage. They will be exposed to all aspects of the multidisciplinary team work that is a core aspect of the care of the elderly.
Specific objectives
- Demonstrate the ability to complete a medical history and physical examination on an older person. The student will learn to develop a problem list, differential diagnosis and plan of management based upon this clinical assessment.
- Demonstrate an understanding of the processes of assessment, treatment and rehabilitation in both older patients and younger patients with chronic disability.
- Appreciate the relationships amongst patients, family members, carers and home or institutional services in the support of older people or those with chronic disability.
- Appreciate the range of community and institutional facilities available for older people.
- Develop a knowledge of the process of ageing and how this affects health and the presentation of illness.
- Appreciate the importance of health professional teamwork in rehabilitation.
Assessment
All of these must be completed in order to finish the geriatric medicine attachment. Repeat assessments will be given as needed.
- Formal case presentations and written case history and appreciation.
- Logbook
- PASAF (you need to arrange a time to meet with your consultant to have the PASAF section of your logbook completed)
- Written exam (in week 8). This is a short answer exam. Questions will be drawn from ambulatory, geriatric and acute medicine portions of the eight-week attachment. A sample exam is available in the MICN 401 student handbook.
Ophthalmology
Each week, two or three students attend ophthalmology teaching clinics.
Specific objectives
- Gain further experience in acute inpatient admission and management:
- Demonstrate the ability to systematically complete a medical history and physical examination
- Follow inpatients over the course of an acute admission and present these inpatients to the ward team
- Develop a systematic approach to common medical conditions
- Understand and interpret commonly used investigations (laboratories, ECG, radiologic studies)
- Demonstrate understanding of the treatment plan for common acute medical conditions
- Communicate effectively with the patient and their family, being sensitive to their needs and paying attention to any related psycho-social-spiritual issues
- Work as an integral member of the medical team
Ambulatory medicine
The Ambulatory Medicine programme spans both ALM4 and ALM5, and consists of either a half-day or full-day of teaching most weeks during the medicine module. This programme recognises that, with the increasing prevalence of chronic illness, at least half of all medical care is provided in the community on an outpatient basis.
The main objective is to enhance clinical skills in medicine by providing focused teaching and interaction with patients who have common, chronic medical conditions that may not be encountered in the hospital setting. The programme is based in a simulated outpatient clinic in the Otago Clinical Skills Laboratory.
Teaching includes a combination of tutorials, simulation and procedural skills and interaction with patients from the community (ambulatory) who are chosen to allow demonstration of relevant clinical signs, with supervision and feedback from senior clinicians. Students also have the opportunity to do a home visit to learn about discharge planning and the interface between hospital and community services.
Overarching objectives
- Provide focused teaching on particular organ systems with an emphasis on clinical presentations and physical examination
- Develop clinical skills in medicine (i.e. history, examination, clinical and diagnostic reasoning) by providing interaction with patients who have relevant, chronic medical conditions, with supervision and feedback from senior clinicians
- Gain an understanding of chronic illness and its impact on the patient
Specific objectives
By the end of the ambulatory medicine attachment the student will:
- Demonstrate the ability to competently and systematically complete a medical history and physical examination relevant to each specialty
- Be familiar with the pathophysiology, presentation, and management of conditions related to each medical specialty
- Develop skills in interpreting and understanding the results of common investigative procedures
- Demonstrate an appreciation for the workings of the multi-professional team including relevant community services
Vertical modules
Curriculum vertical module sessions are small group tutorials that cover generic aspects of knowledge and professional practice. They will be interspersed throughout the medicine module.
Topics are chosen to complement the clinical situations encountered by students during the medicine module.