MD - Ambulatory Care (Information for GPs and Practice Staff)

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Curriculum and Learning Objectives

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Principles of Clinical Practice 2 (PCP2) is a year long subject run in the second year of the four year post graduate medical course (Doctor of Medicine - MD) at the University of Melbourne. The rotations for this subject include Ambulatory Care, Surgery and Medicine. Students spend 8 weeks in each rotation, and within the Ambulatory Care term will spend 4 single days at a general practice, participate in rostered shifts in the emergency department, attend a session in a rehabilitation facility, and sessions in outpatient clinics.

The focus of the Ambulatory Care term is for students to learn from patients attending the emergency department with acute health problems and the ambulatory (or outpatient) areas with more chronic health problems. During this term students will:

• gain an understanding of diseases that are commonly managed in an ambulatory setting, and the role each health professional plays in the care of a patient with that condition e.g. diabetes, dermatology, many rheumatological conditions, most endocrine conditions, and a large proportion of ophthalmological and ENT disorders; and
• gain an understanding of the roles of different parts of the health care system, and an awareness of the importance of communication in good patient care

 

Placement Information

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These students are in the second year of the MD and will be assigned to your clinic for four single days during their Ambulatory Care term.  During this placement students will:

• gain an understanding of where general practice sits within the health care system;
• develop an introductory experience of clinical work and patients’ experiences of care in the health care setting to which they transition after leaving hospital; from which they enter hospital; and in which most are managed without ever going to hospital; and
• practise clinical history and examination skills under supervision and guidance.

Learning activities during this placement may include:

• interviewing a patient to ascertain: level of concordance between the doctors’ explanation or management plan and the patient’s understanding of this; degree of patient input into decisions about care and patient’s experiences of care in the primary health care system and during transitions into and out of this system
• analysing examples of communication between the GP and the hospital and/or other specialist, for example via referral letters, telephone calls or care plans;
• determining how the GP mobilises a care team for a chronic illness or other complex conditions, understanding the choice of allied health involvement;
• describing a ‘day in the life’ of a general practice or general practitioner noting the variety of cases and activities that occur  and noting the various systems assisting the process of care : appointment systems, triage,  follow-up, monitoring and referral.

 

Guidelines for Ethical Conduct on Clinical Attachments

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The doctor should set the ground rules for ethical and professional behaviour at the beginning of the clinical placement. This is important in guiding students in their own professional and personal development. It is also important to discuss the learning objectives of the placement with your student(s).

What the students have been told:

The following guidelines are emphasised for students attending General Practice placements:

Patients
Many of the patients you meet in the clinical setting will be unwell and concerned about their illness. You need to communicate with them sensitively and to treat them with respect, never forgetting the privilege and responsibilities of your position. It is important to respect people’s privacy.  Before commencing a physical examination, obtain consent and explain to the patient what you are going to do. Make sure only the area being examined is exposed at any one time. Do not leave a patient exposed for longer than necessary.

Consent

• Your clinic staff will explain the process of obtaining consent to interview a patient. You must not proceed to the patient unless you have this consent.
• If consent is granted, it is important that you introduce yourself to the patient you wish to interview, explaining that you are a medical student and why you are there.
• Your clinic will need to obtain consent from each patient you interview and/or examine.
• Patients must be made aware that their participation is voluntary - they are free to agree or refuse and need to be reassured that their medical care will in no way be affected by their decision.

Confidentiality

• You are expected to uphold the same standards of confidentiality as doctors.
• Take care not to identify or reveal the name of any patient to anyone not involved in the care of the patient.
• Remember that details other than name can be identifying in some circumstances so take care with these details.
• Discussing the patients you have seen with your tutors and fellow students is an important part of medical education.
• It is normal and acceptable to ‘debrief’ about your experiences with family and trusted friends but do so in a way that is respectful to patients and, again, avoids identifying them.

Other

• Remember to thank patients for agreeing to have you present - they are helping you with your education.
• Dress appropriately, out of regard and respect for the patients and doctors who will be helping you with your education.
• Remember to wear your photo ID.
• Mobile phones MUST be turned off when you are interacting with patients.

Patient Consent

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Patient consent must be obtained for all medical placements; either written or verbal (as a minimum).
Practices will be provided with a sample patient information and consent form.  Additional copies can be downloaded from the forms and resources section of this website.
Practices can use this document and attach to the patients file. Practice staff need to tick which type of student will be seeing the patients.

Attendance and PIP

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Student attendance at this placement is compulsory. Students will be provided with an attendance form which should be signed by the supervising GP or Practice Manager, and the student.  Students must return it to the University prior to the end of semester. This form will be used by the Department of General Practice to generate the PIP form (for eligible practices).  Students can download a spare copy of the attendance form from this website.