Primary Medical Care and Long Term Conditions | MEDI3041

Module overview

This module provides the students with the opportunity to gain experience of history taking and clinical examination in the primary care environment.

The BM programmes are however highly contextualised and integrated programmes in which the application of knowledge and understanding, clinical skills and professional practice applicable to medicine are learned through a range of modules none of which are stand- alone modules, therefore this module should be recognised by students and teachers alike as part of the whole year and programme. The Primary Care and Long Term Conditions module in BM Year THREE is studied along with 2 other clinical teaching modules in Surgery and Orthopaedics and General Medicine and Elderly Care and 2 Assessment Modules (Applied Knowledge and CPSA).

The emphasis of the assessments for each of the modules aligns with the focus of learning for that module, however the integrated nature of the course means that there will undoubtedly be overlap and aspects of the assessment in each module will draw upon learning from modules studied in earlier years as well as modules studied in that year. In addition, the BM Year THREE assessment modules have been purposely designed to assess learning outcomes covered in any of modules within the programme.

This module will normally take the format of a placement in one or more GP Practices and group teaching on a Wednesday morning. The timing will vary for different student groups and the teaching staff will vary for different practices and student groups. As is the nature of clinical placements, the exact learning experiences of each student will be variable however all students will receive the same broad opportunities sufficient to achieve the learning outcomes of the module and it is expected that students will take responsibility for making the most of the opportunities provided and being pro-active in securing experiences in areas in which they feel they are weak and/or they have had least learning experiences.

Aims and Objectives

Learning Outcomes

Having successfully completed this module you will be able to:

Demonstrate awareness of professional responsibility both to patients and to members of the multi-professional team and to student colleagues and reflect on how poor performance or poor professional behaviour should be addressed
Demonstrate respect for patients and colleagues
Understand the use of time as a diagnostic tool
Interact with patients and colleagues whose cultural backgrounds, beliefs and values may differ from your own in a sensitive and non-judgmental manner
Demonstrate understanding of the diversity and complexity of presentations in primary care and the factors that influence how patients present
Explain the use of clinical investigations and their impact on the patient and health services
Demonstrate an ability to reflect and use appropriate resources including IT to support your own learning and aid patients’ understanding
Conduct an appropriate examination and communicate with the patient including patients and relatives of those who have a cognitive or sensory impairment.
Show an understanding of the duties of confidentiality in your contact with colleagues and patients
Take a focused history in order to reach a differential diagnosis
Demonstrate competency in the clinical skills as per the student portfolio requirements
Take responsibility for your own learning and your continuing professional development
Have gained understanding regarding the presentation and impact of some common long term conditions/ disabilities which are often managed in primary care
Understand the concept of the primary care team and have an awareness of the roles of its members
Understand and have experience of the principles and methods of improvement including audit, and how to use the results of audit to improve practice
Assess and recognise the severity of a clinical presentation and a need to immediate emergency care
Take a medication history, including details of any complementary or alternative therapies the patient is using, and begin to consider the role of medication on the presentation and management of patients
To recognise symptoms and signs of common diseases seen in primary care
Show awareness of a wide variety of ways in which you learn in the workplace, often not defined by the curriculum, and which includes role models
Develop insight into your learning needs in the professional workplace and recognise the need for support and guidance in managing challenging situations; and reflect on your own learning style and how it may need to be adapted to the clinical environment
Demonstrate that you can establish a relationship with a patient, explore and acknowledge their concerns

Syllabus

Students will spend most of the week in a general practice although approximately half day a week will be spent doing student selected modules in the university. A lot of the learning will be informed by the patients that present during the students’ time in primary care and they will be expected to identify their knowledge gaps and be self-directed in their learning to fill these

The broad areas that are covered will be:

Communication skills
Focused history taking
Examination skills where possible
Use and interpretation of investigations
Common diseases seen in general practice
Long Term conditions – including pathology, psychology, sociology, management and public health
Prescribing of common treatments
Role of primary care in the NHS
Use of health information
Risk management
Coping with uncertainty
Multidisciplinary team working within primary care and with secondary care
The use of reflection

Suggested topics to cover a breadth of long term conditions are:

Diabetes
COPD
Hypertension and heart failure
Osteoarthritis
Dementia
Stroke
Childhood atopic disease
Cancer

In the BM(EU) Programme, some clinical sessions will be with community specialists to enable students to gain an equivalent experience of clinical scenarios in a different healthcare system

Learning and Teaching

Teaching and learning methods

The module will be taught through a range of learning and teaching strategies which may include:

One to one teaching with GP and other members of the primary care team
Face to face
Online learning including SCRIPT
Patient based learning
Small group learning
Symposia
Reflection
Case based learning
Personal learning logbooks
Peer discussion groups
Lectures

Within this module there may be some activities that will take place in the evenings, nights or weekends, students are encouraged to make the most of these opportunities.

Study time
Type	Hours
Placement	192
Teaching	24
Independent Study	159
Total study time	375

Resources & Reading list

Internet Resources

Healthtalk online (formally DiPEX) is a useful site for students to hear about patient experiences of various conditions and their feelings about what is important in their care.

Resources for this module will be signposted to you through the Blackboard Page for this module. An indicative content is provided in the Resources, however the blackboard module and/or log book will provide the most up to date guidance on resources for this module.

YouTube has a lot of useful teaching material, including listening to heart murmurs, how to do the Epley Manoeuvre, and home nasal irrigation. It is a medium many students are happy with and can be used really productively.

Journal Articles

C Heneghan, P Glasziou, M Thompson, P Rose, J Balla, D Lasserson, C Scott, R Perera (2009). Diagnosis in General Practice: Diagnostic strategies used in primary care. BMJ, 338, pp. 946.

(2013). Patients with long-term condtions, their carers, and advocates. Review McEvoy P.BJGP, 63, pp. 148-149.

Textbooks

Peter Tate Radcliffe (2003). The Doctor’s Communication Handbook. Medical Press.

Storr E et al (2008). Clinical Cases Uncovered. Wiley Blackwell.

Simon C et al (2002). Oxford handbook of General Practice. Oxford University Press.

(2011). Intelligent Kindness: Reforming the culture of Healthcare. John Ballatt: P Campling Bell and Bain.

Kumar PJ, Clark M. Editors (2005). Kumar & Clark Clinical Medicine. Edinburgh: WB Saunders.

(2009). Managing Long-Term Conditions and Chronic illness in Primary Care: A guide to good practice. Carrier J.: Routledge.

Fraser RC. (1999). Clinical Method: a General Practice approach. Editor Butterworth Heinemann.

Stephenson A.. A textbook of General Practice. Editor Arnold.

Neighbour R (1989). The inner consultation: how to develop an effective and intuitive consulting style. Petroc Press.

Assessment

Assessment strategy

For assessments with no percentage contribution recorded, students will be assessed on a pass/fail basis.

This module will be assessed by two end of module sign off form to include elements of:

Professional behaviour
Evaluation of clinical and overall performance relative to learning outcomes
Satisfactory learning log book recording the breadth of their activity and experience during the course
Satisfactory completion of an audit
A case presentation related to a long term condition
Formative ACC

Summative

This is how we’ll formally assess what you have learned in this module.

Breakdown
Method	Percentage contribution

Referral

This is how we’ll assess you if you don’t meet the criteria to pass this module.

Breakdown
Method	Percentage contribution
Supplementary activity	100%

Repeat Information

Repeat type: Internal