1. Information about Phase 3 Course Guide Course assessments Phase 3 Guide Phase based assessments Vista Course modules Discipline-based modules Biomedical sciences Program website

2. Learning in Phase 3 What do I need to learn? What diseases do I need to know? What do I need to know about them? Do I just need to know what is clinically relevant? What things don’t I need to know? How should I approach learning in Phase 3? Is it better to follow a syllabus or focus on what I see on the wards, clinics, rooms etc?

3. Approach to learning - experiential Based on your clinical experiences Better retention (understanding the relevance and applying knowledge) “Opportunistic” Skewed case mix Hospitalised patients with complex problems Consider co-morbidity Limited clinical placements

4. Approach to learning - structured Program of topics (“syllabus”) Discipline/system-based Ensures completeness and avoids gaps Overwhelming list of topics May not be able to demonstrate “credibility”

5. Focus of learning Focus on clinical presentations: E.g. an approach to a patient with haematuria What are the common causes? What conditions may be life-threatening? What features help to distinguish these causes? What investigations should be performed? What symptomatic treatment is required? What specific treatment is required?

6. Focus of learning Focus on syndrome/disease: E.g. glomerulonephritis Aetiology Pathology Epidemiology Clinical manifestations Diagnosis Treatment & prevention Course & prognosis

7. Experiential (clinical or disease focus) Structured (clinical or disease focus)

8. Learning from a clinical presentation 16 year old male presents with 24 hour history of headache, fever and generally feeling unwell. On examination, he is febrile and hypotensive. He has neck stiffness and a petechial rash is evident on his limbs.

9. Learning from a clinical presentation 16 year old male presents with 48 hour history of headache, fever and generally feeling unwell. On examination, he is febrile and hypotensive. He has neck stiffness and a petechial rash is evident on his limbs.

10. Pattern recognition Constellation of symptoms & signs Headache Fever Neck stiffness Distinguishing epidemiological clues Meningococcus is commonest cause of meningitis in adolescents. Distinguishing clinical features Petechial rash is indicative of meningococcus. Meningitis

11. Learning approach to a presenting problem What are the common causes? What conditions may be life-threatening? What features help to distinguish these causes? What investigations should be performed? What symptomatic treatment is required? What specific treatment is required?

12. Approach to management Headache, fever & neck stiffness = meningitis Empirical treatment Definitive treatment Clinical assessment Investigations LPLP, imaging studies, blood cultures, serology Epidemiology and clinical features of microbial causes of meningitis Antibiotics, corticosteroids, supportive treatment (shock, raised intracranial pressure) Antibiotics, public health measures (isolation, chemoprophylaxis, vaccination)

13. Lumbar puncture (diagnostic test) Indications for LP How is it performed? Interpretation of results Limitations (sensitivity, specificity) Safety of procedure Contraindications

14. Approach to management Headache, fever & neck stiffness = meningitis Empirical treatment Definitive treatment Clinical assessment Investigations LP, imaging studies, blood cultures, serology Epidemiology and clinical features of microbial causes of meningitis AntibioticsAntibiotics, corticosteroids, supportive treatment (shock, raised intracranial pressure) Antibiotics, public health measures (isolation, chemoprophylaxis, vaccination)

15. Empirical antibiotics in meningitis What antibiotics are used empirically? What is the rationale for the choice? Specific drugs (penicillin, ceftriaxone, vancomycin) Type of drug Mechanism of action (spectrum of activity) Pharmacokinetics Efficacy Toxicity Mechanisms of resistance

16. Meningitis Prevention Aetiology (Microbiology)Microbiology Clinical features DiagnosisTreatment

17. Aetiology (Microbiology) Viral meningitisMeningococcusPneumococcusOther bacteriaLeptospirosis

18. Meningococcus Type of organism StructurePathogenesis Clinical features DiagnosisTreatmentPrevention

19. What do you need to know? Breadth (scope) Common Clinical experiences Course guides Textbooks Important Life-threatening “Classical” – illustrates an important concept

20. What do you need to know? Depth Common Emphasis on management – knowledge and ability to diagnose and treat Important Life-threatening Recognition and early management “Classical” Defined area of knowledge Uncommon/rare Awareness – when to suspect.

21. Case reports/presentations Refer to course guide for precise requirements. Supervisor/school has flexibility in determining number and type. Assessed by supervisor or school Not submitted to eMed for assessment. Can be submitted,with completed assessment form,to eMed as supporting evidence,

22. Observed clinical assessments Refer to course guide for precise requirements. Supervisor/school has flexibility in determining number and type. Assessed by supervisor or school Formative assessments by junior staff Completed assessment form can be submitted to eMed as supporting evidence.

23. Clinical log sheets Record of interesting patients and issues Optional for most courses May be used in end-of-phase Integrated Clinical Examination Prompt for discussion of clinical problems

24. Negotiated assignments Optional. Fill in gaps in portfolio Address deficiencies. Negotiate with supervisor or school. No need to submit proposal to eMed.

25. End-of-Phase Integrated Clinical Examination Clinical and communication skills Variable format depending on discipline Stations with real patients Focussed history and/or examination. Variable duration (10-20 mins) Stations with surrogates (including professional actors) Examiner in role-play Stations with clinical images or videos

26. End-of-Phase Integrated Clinical Examination Management viva Assessment of knowledge in management (diagnosis & treatment) of common clinical presentations including emergency presentations. Variable format depending on discipline Based on clinical cases Released and new cases