Clinical Training in Medicine

Core clinical training of medical undergraduates in General Medicine will consist of clerkships in the different stages in the MBBS programme.

These include

• Clinical appointments in General (Internal) Medicine prior to the professorial Medicine Appointment (3rd and 4th Year appointments)
• Clinical clerkships in identified finer specialties related to Medicine (Short appointments- these will be conducted in parallel with the 3rd and 4th year appointments prior to the professorial appointment)
• Professorial Medicine Appointment (i.e. Final or 5th year appointments)

3.1 Clinical appointments in General (Internal) Medicine prior to the Professorial Medicine Appointment (3rd and 4th Year appointments)

These are clinical training in General (Internal) Medicine before the commencement of the Professorial Medicine appointment. The main components in this training should include

·        An introductory programme in Medicine for a minimum of one-week duration

·        A minimum of two clinical appointments in General Medicine

·        Each would be 6-8 weeks duration.

3.1.1 Learning Objectives: Introductory Medicine Appointment

On completion of the programme the student should be able

1.      observe appropriate student-patient relationship and proper ethical conduct showing kindness, care and concern to patients.

2.      learn the basics of communication skills relevant to patient and illness.

3.      be able to list the items of a complete history and record the symptoms of each system in a systematic manner.

4.      be able to describe the basis of physical examination techniques from the knowledge of basic sciences.

3.1.2. Learning Objectives: 3rd year appointment in General (Internal) Medicine

After completing the first appointment in General (Internal) Medicine the student should be able to:

1.      understand the functioning of the ward unit, outpatient clinics, referral system and the different roles played by the members of the health care team.

2.      interview and obtain a comprehensive and accurate history, which should include the following components:

1. defining the presenting and subsidiary complaints and their duration
2. history of present illness in a chronological manner
3. past history of illnesses and surgeries
4. drug and allergy history
5. gynaecological and obstetric history (where relevant)
6. family history, personal, social and occupational history
7. ask relevant questions when exploring symptoms related to presenting compliant(s) and different systems (system review)

3.      perform a systematic physical examination – general and systems examination and detect relevant normal and abnormal physical signs.

4.      analyze the clinical features using pathophysiological mechanisms and arrive at a differential diagnosis.

5.      understand the anatomical, biochemical and pathophysiological basis of symptoms, signs and the results of basic investigative procedures that have been carried out.

6.     Select and describe the investigations that will assist in patient management 

7.      state with reasons the management of patients under your care

8.      describe the procedures done in the ward and be able to perform selected procedures under supervision.

9.      describe how common medical emergencies are managed.

10.   demonstrate empathy and maintain high ethical standards.

11.   develop a good student patient relationship, communicate effectively, understand the psychological and social factors such as beliefs, fears and anxieties patients undergo during illness.

12.   identify the components recorded in a case history during the ward stay, at discharge and in the clinics.

3.1.3.Learning Objectives: 4th year appointment in General (Internal) Medicine

In 4th year medical appointment student should be able to

1.      explain the pathophysiological basis of the common diseases and their investigation and management process.

2.      interview and obtain a comprehensive and accurate history.

3.      preform a relevant physical examination and elicit physical signs.

4.      analyze the clinical information and arrive at a reasonable clinical differential diagnosis,

5.      plan appropriate investigations to arrive at a clinical diagnosis, while considering their utility, efficacy and costs.  

6.      describe with reasons the management carried out on patients and be able to develop individualized care plan.

7.      understand the impact of socio-cultural factors on the illness and the effect of the illness on the patient and family and appreciate relevant ethical issues.

8.      demonstrate empathy and high maintain high ethical standards.

9.      communicate well with patients from different social and cultural backgrounds and with their families with particular reference to giving information, obtaining consent and breaking serious news.

10.   write case notes, daily status, referrals, discharge summaries, notification procedures, clinic notes and prescriptions. document

11.   work as a member of a health care team caring for patient as a part of the health care team while understanding of the limitations as a medical student.

12.   know the support provided by the health system, the social service sector and informal carer’s towards provision of care for patients in hospital and in the community. 

Medical undergraduates will maintain a portfolio/ logbook provided by the Department of Medicine during the pre-professorial appointments.

Basic concepts in history taking in medicine and correct techniques in physical examination should be the main learning outcomes during the first appointment in general medicine. The second and subsequent appointments in general medicine should focus on identification and making a problem list and management of patients with common medical conditions.

3.2. Learning Objectives: Professorial Medicine Appointment

The professorial appointment in Medicine should consist of minimum duration of 8 weeks continuous training during the 5th year. During the professorial appointment students will undergo at least one-week period of working as a shadow house officer.

Learning objectives for the Professorial Medicine Appointment

On completion of the Professorial Medicine Appointment the student should be able to

1.     work in a responsible manner for the wellbeing of the patient assigned to him/her and work independently as a house officer under supervision.

2.     interview and obtain comprehensive histories, perform a systematic physical examination and elicit physical signs.

3.     analyze the clinical information competent to state and arrive at a reasonable clinical differential diagnosis,

4.     plan for investigating the patient, interpret routine laboratory tests, radiological, electrocardiography and other tests

5.     describe common diseases, their pathophysiological basis, clinical presentations, treatment and prognosis.

6.     describe an appropriate plan of management plan and reason out the basis for them

7.     state indications, limitations, patient preparation, consenting process and undesirable effects of common diagnostic and therapeutic procedures

8.     work as a part of the team managing medical emergencies commonly seen in medical wards and emergency medical unit

9.     demonstrate empathy and high maintain high ethical standards

10.  communicate well with patients from different social and cultural backgrounds and with their families with particular reference to giving information, obtaining consent and breaking serious news

11.  write case notes,  daily status, referrals, discharge summaries,  clinic notes and prescriptions. document

12.  know the support provided by the health system, the social service sector and informal carers towards provision of care for patients in hospital and in the community 

Students will maintain a workbook or portfolio during the appointment to document the different leaning activities and clinical exposure they received during the period of clerkship.

3.3 Appointments in identified finer specialties related to Medicine - (Short appointments)

The main objective of these appointments is to provide clinical exposure in finer specialties related to General Medicine which cannot be adequately provided or covered in a General medical  ward.  This  training  will  be  done  during  these  short  appointments  with  relevant specialists.

The following finer specialties have been identified. They have been classified as essential and preferable. In the event that a relevant specialist is not available or an appointment cannot be accommodated due to time constraints, the needed training will be provided during the course of a General Medicine appointment.

Haematology and transfusion medicine – will be covered under General Pathology subject and in General medicine appointment

Family medicine will be done by the Department of Community Medicine and Primary Care

Appointments in finer specialties should be conducted after completion of the first medical appointment. There will be a minimum exposure of 1 week in each essential finer specialty.

All finer specialty appointments must have clearly formulated learning objectives. (See section 5). These objectives are to be developed by each respective faculty and given to students and trainers.

The use of workbooks / portfolio / logbooks for all appointments will be encouraged.