1. Clinical Skills Module 4 th year - 2015

2. Clinical Skills Module Duration 14 weeks From 4/10/2015-5/1/2016 Credit hours : 20hrs. Coordinators: Dr. Sharafeldin & Dr. Sumia

3. Aims & Objectives  On completion of the module, the 4 th year students will be able to: 1. Take proper history from the patient. 2. Elicit all physical signs of organs in their normal state and in their disease state (e.g. changes of vital signs, organomegaly, etc.) 3. Interpret physical signs, order appropriate investigations and suggest a diagnosis. 4. Have a minimal knowledge of management of various diseases.

4. Overall outcome of the CSM 1. Knowledge:  By the end of this module; we would expect the students to able to : 1. Develop the ability to take and report a full history together with acquiring skills in performing a complete physical examination. 2. Discuss cases at bed side teaching/clinical rounds to emphasize pathophysiology of symptoms & signs. 3. Be familiar with the usual instruments in clinical practice, x-rays, pathology jars, slides, etc. 4. Develop the ability to outline management.

5. Overall outcome of the CSM 2. Skills:  Following completion of the course, students will be: 1. Able to present general and specific (system – related) examination skills. 2. Capable for assessing the vital signs (including pulse rate, respiratory rate, blood pressure, body temperature, etc.). 3. Skillful to do various maneuvers including giving injections, conducting basic suturing techniques, inserting cannulas and tubes (e.g. nasogastric tube, Foley’s catheters, etc.), taking blood and fluids samples, get rid of sharp disposable instruments, etc. 4. Administer routine care for the newborn together with some pediatric skills such as measuring head circumference, taking body temperature, measuring blood pressure, etc. 5. Accomplished to perform obstetrical and vaginal examination.

6. Overall outcome of the CSM In summary, all the following skills are going to be included in the module: - General and systemic clinical examination skills. - Anthropometric measures, BMI & body temperature measurement. - Basic life Support and CPR. - Suturing and basic surgical knotting., Injections and cannulation., collection of blood and dealing with sharp instruments. - Pulse assessment and blood pressure measurement., ECG interpretation, arrhythmias,defibrillator, & different signs of valvular heart diseases (Murmurs).

7. Overall outcome of the CSM In summary, all the following skills are going to be included in the module: Abdominal Examination & digital rectal examination., organomegaly, ascites, GIT instruments,& laparoscopy. Nasogastric tube administration, bowel preparations & colostomy.

8. Overall outcome of the CSM In summary, all the following skills are going to be included in the module:  Neurological Examination & different neurological signs, cranial nerves examination,head & neck injuries management.  Urinary catheter& suprapubic cystotomy. haematoruia (Presentation & Managements.)  Thyroid gland examination., diabetic septic foot (examination& management), breast examination.  Ophthalmoscope method of uses & fundus examination

9. Overall outcome of the CSM In summary, all the following skills are going to be included in the module:  Obstetrical examination & normal vaginal delivery  Examination of testicles and scrotum., hernia examination.  Examination of the respiratory system & different Signs of respiratory diseases.  Pneumothorax&Haemothorax -presentation and management (needle decompression & chest tube)

10. Overall outcome of the CSM In summary, all the following skills are going to be included in the module  Airway Patency & Intubation, tracheostomy application and care.  Hand examination, First Aid management of multiple injured patient.  laboratory finding of anaemia, vascular injuries assessment and control of external hemorrhage.  Paediatric Examination, neonatal resuscitation.  Approach to lumps and ulcers., wound care.

11. Overall outcome of the CSM 3. Attitude:  Student should have the attitude and behavior of: 1. Respect for every human being, building confidentiality, and abide by relevant Islamic ethics. 2. A desire to ease pain and suffering. 3. Willingness to work in a team with other health professionals. 4. Responsibility to remain life-long learner and maintain the highest ethical and professional standards. 5. Referring patients to other health professional when needed. 6. A realization that it is not always in the interest of patients to pursue every diagnostic or therapeutic possibility.

12. Anyone who stops learning is old, whether at twenty or eighty !! Henry Ford

13. Course Learning Outcomes - a. Knowledge - Describe normal structure and function of human body and its major organ systems - Define molecular, biochemical, cellular and immunological mechanisms that are important in maintaining homeostasis. - Discuss etiology, mechanisms, morphology and effects of diseases and their clinical significance. - Explain principles of various basic medical and surgical modalities and measures in the management of diseases and patient care. - Outline the ethical considerations in medical practice and the professional principles

14. Course Learning Outcomes - b. Cognitive Skills - Review the structure and functions of the human body in health and disease. - Demonstrate Integration of the basic science concepts in real life clinical practice.

15. Course Learning Outcomes c. Interpersonal Skills and Responsibility - Work with honesty and integrity. - Show professional attributes such as ethical commitment, commitment to maintaining good practice and interpersonal skills. - Work with responsibility and accountability to promote health in a health care system

16. Course Learning Outcomes  d. Numerical and Communication Skills - Communicate effectively, both orally and in writing, with patients, colleagues, relatives, disabled people, media and in breaking bad news - Demonstrate basic skills and positive attitudes towards teaching others, and negotiating and dealing with complaints - Listen and use other appropriate communication techniques including an appreciation of non-verbal communication/body language

17. Course Learning Outcomes  e Psychomotor Skills (if applicable) - Apply sensory cues in motor activities - Show skillful performance of motor activities - Coordinate the activities in internal consistency - Perform high levels of motor skills - Practice general and system based physical examination of patient and record observations

18. Teaching strategies during this course 1. Theoretical (lectures, PBL Case presentations) 2. Skills lab. 3. Bedside teaching.

19. Teaching Staff 1. Lectures: - Staff from medical, surgical, obstetrical and pediatric departments is going to be involved. - Lectures, due to the limitation of allocated time, will put emphasis on certain parts of the topic. However, students are urged to study on their own to cover the whole subject. This will be achieved through reading from the reference books chosen by each department.

20. Teaching Staff 2. Clinical Skills Lab.: - The same faculty staff will cover the skills lab activities. - Demonstration by the teacher will be done first, and handouts to be delivered to the students at the start of each module describing the type(s) of skills to be learned, theoretical background and procedure description. - Debriefing will be made at the end of the session.

21. Teaching Staff 3. Clinical Teaching Rounds:  Selected hospital staff in collaboration with the faculty staff is going to arrange and teach the students in the clinical rounds. - On the day of the clinical teaching session students should:  Prepare at least two fully clerked patients.  Participate in the discussion of one or more cases.  Be able to present a case of a clerked patient during any teaching round.  The clinical teaching sessions are run 2 days a week.  Attendance during all sessions is mandatory. Any missed session will result in one mark deduction.  Students who are absent more than 20 % of the sessions are not illegible to sit for end of posting exam.

22. Clinical Round Logbook  Clinical Round Logbook had been designed to evaluate & assess the overall knowledge, participation & attendance of the students..  It is mandatory for every student to bring with him/her the logbook in each session, and for the supervisor to sign in the concerned table at the END of the session.  At the end of the module, logbook marks will be counted to represent a sensible percentage from the final marks.

23. Clinical Round Logbook Session NocDate: Section:Student Name: Clinical Round Topic(s): No. of Cases Presented:No. of Cases Clerked: No. of Cases Examined: Signature:Supervisor: Case (1) History Examination Investigation Differential diagnosis Diagnosis Treatments

24. Teaching Staff 4. Problem Based Learning (Problem Solving):  The faculty staff is going to arrange clinical clubs.  This will present a clinical scenario related to the covered module, with some key information to explore the problem, assessing what is needed, sharing knowledge, solving the problem and giving feedback.

25. 5.Cases Presentation  Each group of students should present one – two cases scenario which were prepared during their clinical l rounds  All students should be participated in the dissection.  Cases scenario should include history, clinical examination and differential diagnosis.

26. Who’s On First The patient comes first Listen to your patient Difficult patients are people, too

27. Assessment Assessment Tasks and Percentages: Proportion of Final AssessmentAssessment Task 5 % Attitude& log book 5 % Attendance 30% 15% MCQs Mid-term Examination OSCE 15% 60% 15 %MCQs Final Examination 25 % OSCE 20%Clinical Case Examination

28. Assessment 1.Mid-term Examination (30 %): (week 7) The exam will consist of MCQs, and Objective Structured Clinical Examination (OSCE). 1. Multiple Choice Questions -MCQs (15 %): ( Venue: Class, Duration: 2 hr.) - Multiple choice items consist of a stem and a set of 5 options. Only one answer can be keyed as correct. The exam consists of 60questions, with a total mark of 15, and no penalties will be given for wrong answers.

29.  Objective Structured Clinical Examination – OSCE (15 %):  (Venue: Skills Lab. Centre. Duration: 2 hrs or more).  The OSCE assesses a range of clinical, data interpretation and knowledge application skills. It is made up of two exams : A) The clinical OSCE B) B)The data OSCE

30.  A). Clinical OSCE:  This comprises clinical stations. Each station will have an examiner and/ or clear written instructions to tell the student what to do. It includes:  History taking  Clinical examination  Skills application  The assessment by check list

31.  B). Data OSCE:  This comprises 10 or more data questions. Some of these questions will require the student to interpret the data provided on the question sheet and/ or on the screen.

32. Assessment 2.Final Examination (60 %): (week 14)  The exam will consist of three parts; MCQs, Clinical Cases Examination and OSCE.  Multiple Choice Questions -MCQs (15 %): (Venue: Class room. Duration: 2hrs.)  The exam contains 60 questions with a total mark of 15.  Clinical Cases Examination (20%): (Venue: Hospital. Duration: 1 hr.). Short Cases Examination (20 %): Two short cases for each student and each have an examination time of 10 minutes. Each case is assessed by check list  Objective Structured OSCE (25 %):  (Venue: Skills Lab. Centre. Duration: 100 minutes).  The OSCE assesses a range of clinical, data interpretation and knowledge application skills. It is made up of two exams – the clinical OSCE and the data OSCE.

33. Everyone looks good in a lab coat..

34. Curriculum Map 1. Course sections: Section Lecture s Clinical Skills Lab. Clinical Teaching Rounds PBL (Problem Solving) Clinical Meetings Case presentation No. of Sessions 52382210125 Session Duratio n (hrs.) 223222 Teaching Hours (300) 1047666202410

35. Curriculum Map 2. Modules & Requirements: No.TopicLecturesSkills Lab. ActivitiesClinical RoundsPBL (Problem Solving) 1Introduction48 2Cardiovascular system4421 3Respiratory system4421 4Gastrointestinal system4421 5Nervous system4321 6Endocrine system5221 7Reproductive system341 8Musculoskeletal system421 9Renal system5221 10Infectious diseases&421 11Skin22 1 12Hematology52 13General210 Total52382210

36. Doctors become what they expect themselves to become !!

37. References (TEXT-BOOKS) o Required Textbooks Macleod's Clinical examination 12 th -13 edition o Essential References 1. Browse's Introduction to the Symptoms & Signs of Surgical Disease - 4 th edition. 2. Schwartz's Principles of Surgery - 8 th edition. 3. Harrison's Principles of Internal Medicine - 18th Edition. 4. Obstetrics by Ten Teachers - 19 th edition. o Electronic Materials  www.studentconsult.com www.studentconsult.com  www.emedicine.com www.emedicine.com  www.uptodate.com www.uptodate.com

38. Follow the three R’s : Respect for self Respect for others Responsibility for all your work..

39. Clinical Skills Module 4 th year - 2015