MD505 – SEMESTER 5.2 Final Medical Year - NUI Galway · Semester 5.2 Welcome to the second semester of the final year of your undergraduate medical curriculum. ... OSCE post clinical

1

College of Medicine, Nursing and Health Sciences

SCHOOL OF MEDICINE

MD505 – SEMESTER 5.2

Final Medical YearStudent Handbook

5MB3

Coláiste an Leighis, an Altranais agusNa nEolaíochtaí Sláinte

2010 - 2011

2

National University of Ireland, Galway

5MB3 Final Year Medical Booklet

Academic Session 2010/2011

Table of Contents

Page

Introduction ……………………………………………………. 3

Lecture Timetable ……………………………………………… 9

Clinical Rotations ………………………………………………. 12

Neurology / Ophthalmology Studies…………………………… 17

Dermatology / Plastic Studies …………………………………. 32

Cancer Studies …………………………………………………. 51

Musculosketal Studies …………………………………………. 69

Nephrology / Urology Studies ………………………………… 86

Summary of Regulations – 5 Year Curriculum ……………… 99

Examination & Vacation Schedule …………………………… 102

3




Introduction

4

Semester 5.2

Welcome to the second semester of the final year of your undergraduate medical curriculum.

Please use the information in this book as a guide to the requirements for successfully completing the

semester at NUI Galway. This is a broad outline of the learning objectives for the semester, but does

not represent a limit to your learning or knowledge. You may be examined on topics that are not

specifically included in this handbook, just as when a patient presents in your future clinical career

with a problem you have not specifically studied. You are encouraged to read beyond this list and to

further your knowledge independent of tuition.

This is the final semester of your undergraduate career and the academic clinical and administrative

staff are available to assist you with issues or concerns you may be having. We welcome you to this

final semester and look forward to guiding you and working with you.

Please be aware of a few basic requirements regarding this year.

Structure

5.2MB is divided into 5 x 3 week integrated modules as follows;

Neurology/Ophthalmology

Cancer Studies

Plastic and maxillofacial surgery/Dermatology

Nephrology/Urology

Orthopedics/Rheumatology

There is also a Lecture programme over 5 days with 40 lectures in total.

5

Eligibility for Examination

Each module has a dedicated logbook which the student is responsible for during the 3 week rotation.

The logbook includes attendance at clinical team activities, self-directed learning opportunities, core

topic attendance and clinical skill learning. In order to be eligible to sit the summative assessments at

the end of semester 2 each student must have a >70% attendance record and > 70% logbook activity

completion record. We would also value your evaluation of the modules so that we can implement

change/revision as appropriate

Assessment

Summative Assessment Prior to 5 MB – Contribution to Final Med Examinations

20% 3MB

40% 4MB

40% 5MB

Assessment in 5.1 and 5.2 MB

Essay Paper – December 17th – 20%

3 hour paper, 4 x 45 minute questions per module.

MCQ – April 20th 2011 - 20%

2 x 2 Hour MCQ Papers

Clinical Exam

Long Case – 30%

Short Cases – 30%

OSCE post clinical attachment

Pass/Fail

6

Study Days

As the modular programme continues right up to the written paper, 4 sessions (half days) will be

included in each module as study time or self directed learning time. You may if you wish attend any

clinical activity on the wards and do not have to stay in the library if there is something of particular

interest to you. This time is study time and should not be taken as free time.

Logbooks

As previously discussed will form the record of student attendance and learning during the module.

Please attach a passport photograph of yourself within the front cover, include your name and contact

details in case you misplace the logbook for the return of the book. Due to the possibility of misplacing

the book you must not in anyway include information that may allow for the patient to be identified ie.

Name, date of birth, board number, address etc etc. In order to ensure accurate information however

we would request that you would use the following system when asked to record such patient details.

These logbooks will be handed in during or prior to the feedback session which will take place with

the tutor during the last week of the module. It is during this session that eligibility to sit examinations

and appraisal of the student performance will occur.

Feedback

As above, timetables for times and locations for these session will be found on Blackboard.

Blackboard

Blackboard will be used to communicate with the students with regard to alterations that occur within

the module, teaching materials and as a support for teaching. Please be aware that posting invites to

social events using Blackboard will be sent to all users registered for that course and therefore should

not be placed.

7

Student Issues

If at any stage the student feels they are struggling academically or if they only need some clarification

regarding the module the appropriate format with which the student should address these concerns is as

follows.

Initial contact should be with the tutor assigned to the module. The tutor may then address your issue

with the clinical or academic lead for the module. It is not appropriate for the student to initially

contact the clinical or academic leads unless there are exceptional circumstances.

8




Lecture Timetable

9

Wednesday January 5th 2011

Morning: Neurology/Ophthalmology9.00-9.45 Diabetic Eye Disease/Retinal Vascular Disease (Dr F Harney)9.45-10.30 Occular Emergencies and Trauma (Dr G Fahy)

11.00-11.45 Seizures and Epilepsy (Dr Lynch)11.45- 12.30 Multiple Sclerosis and Inflammatory CNS Disorders

(Dr Margaret O Brien)

Afternoon: Renal/Urology1.30-2.15 Acute Kidney Disease (Prof M Griffin)2.15-3.00 Chronic Kidney Disease and Management (Dr Reddan)

3.30-4.15 Benign Prostatic Hypertrophy (Mr Durkan)4.15-5.00 Prostate Cancer (Mr Rogers)

Monday January 24th 2011

Morning: Cancer Studies9.00-9.45` General Aspects of Haematological Malignancy (Prof O Dwyer)

9.45-10.30 Bone Marrow Failure (Prof O Dwyer)

11.00-11.45 Principles of Oncology (Dr P Donnellan)11.45- 12.30

Afternoon: Plastic Surgery/Maxillofacial/Dermatology1.30-2.15 Burns/Major Trauma/Reconstruction2.15-3.00 Hand injuries/Hand surgery

3.30-4.15 Acne (Dr P Marren)4.15-5.00 Eczema (Dr LA Murphy)

6.00-6.45 A-Z of Maxillo-facial Surgery6.45-7.30 Bridging the gap. Medicine/Dentistry/Oral manifestations of

systemic disease

10

Monday February 14th 2011

Morning: Rheumatology/Orthopedics9.00-9.45 Osteoarthritis (Dr John Carey)9.45-10.30 Total Joint Replacement (Mr W Curtin)

11.00-11.45 Principles of Fracture Management (Mr W Curtin)11.45- 12.30 Osteoporosis (Dr R Coughlan)

Afternoon: Neurology/Ophthalmology1.30-2.15 Cranial Nerve Palsies (Dr Harney)2.15-3.99 Cataract/Glaucoma (Dr O Donoghue)

3.30-4.15 Neurodegenerative Disease (Dr T Counihan)4.15-5.00 Neuromuscular Disease (Dr Hennessey)

Monday March 7th 2011

Morning: Renal/Urology9.00-9.45 Disorders of fluid electrolytes and acid/base balance (Dr D Lappin)9.45-10.30 Primary Glomerulopathies/Renal `Syndromes (Dr D Lappin)

11.00-11.45 Haematuria (Mr Walsh)11.45- 12.30Renal Colic (Mr Corcoran)

Afternoon: Cancer Studies1.30-2.15 Radiation in Cancer Management (Dr C Small)2.15-3.00 Radiation emergencies (Dr C Small)

3.30-4.15 Palliative Care and Pain Management (Dr E Mannion)4.15-5.00 Caring for patients in the last days of life (Dr D Waldron)5.00-5.45 The role of Radiology in Screening for malignancy (Prof P

McCarthy)

11

Monday March 28th 2011

Morning: Plastic Surgery/Maxillofacial/Dermatology9.00-9.45 Psoriasis (Dr T Markham)

11.00-11.45 Melanoma/Non melanoma skin cancer

Afternoon: Rheumatology/Orthopaedics1.30-2.15 Inflammatory Arthritis (Dr R Coughlan)2.15-3.00 Orthopedic Emergencies

(Mr Shannon/Kearns)

3.30-4.15 Spondyloarthropathies and back pain(Dr John Carey)

4.15-5.00 Orthopedic Surgery and BackDisorders (Mr McCabe/Devitt)

12




Overall Clinical Rotations

Semester 1 & Semester 2

13

Class 2011 5MB3 ACADEMIC SESSION 2010/2011

Semester 1 Sem 1 Sem 1 Sem 1 Sem 1Sept.-December 2010 4 Weeks 4 Weeks 4 Weeks 4 Weeks Exam

Names 30 Aug-24Sept 27Sept-22ndOct 25thOct-19thNov 22Nov-17thDec 17th Dec

1 Binti Nordin, Siti Nur Fariza Cardio- Respiratory Gastro-2 Casby, Caoimhe Vascular Peri- intestinal Gen Medicine3 Dalton, David operative Gen Surgery4 Doyle, Caitriona5 Gately, Ryan6 Binti Mohamad, Muhd Iqbal7 Hussey, Michael Respiratory Gastro- Gen Medicine Cardio-8 Johnston, Ian Peri- intestinal Gen Surgery Vascular9 Keane, Colm operative

10 Kiely, Aoife11 Kyne, Karen Exams12 Loftus, Darragh Gastro- Gen Medicine Cardio- Respiratory13 McLoughlin, Penelope intestinal Gen Surgery Vascular Peri-14 Morcos, Miray operative15 Mhd Jabar, Mohd Kelana Harisa16 O'Callaghan, Niamh17 Raman, Nur Aini Gen Medicine Cardio- Respiratory Gastro-18 Sugrue, Gavin Gen Surgery Vascular Peri-operative intestinal19 Tummon, Ailbhe20 Vaughan, Ruth21 Abdul Razak, Ahmad22 Beatty, Kenneth23 Binti Hashim, Nor Haryanti24 Broderick, Louise25 Daly, Caoimhe2627 Flaherty, Rita28 Gormley, Greta Cardio Respiratory Gastro- Exams29 Haji Razali, Hazdalila Yais Vascular Peri-operative intestinal Gen Medicine30 Heavey, Laura Gen Surgery31 Kelleher, Barry32 Kirtgu Jeyarajah, Shivashini33 Mannion, Maria34 McGovern, Matt35 Mieske, Kelly36 Mohd Asri, Nur Atikah37 Muslim, Azrin38 NicDhonncha, Eilis39 O'Connell, Aine40 Power, Laura41 Puasa, Noremyliana42 Stephen Ambrose,Stephanie C43 Mohd Rosli, Ritzzaleena Rosli4445 Aslam, Tayyab46 Binti-Aziz, Azliana47 Boggs, Jennifer48 Byrne, Meave49 Casby, Caoimhe50 Davies, Katrina51 Duignan, Georgina52 Flood, Laura Respiratory Gastro- Cardio Exams53 Hamza, Moayed Perioperative intestinal Gen Medicine Vascular54 Harkin, Grace Gen Surgery55 Jordan, Adrian56 Kelly, Ronan5758 McAnena, katherine59 McInerney, Angela60 Lau, Alexandra61 Mulligan, Sarah62 Ngimron, Anie63 NiChathasaigh, Maire64 O'Connor, Simon65 Roarty, Ciaran66 Sharma, Kapil67 Sullivan, Tadhg68

Sligo

14


Semester 1 Sem 1 Sem 1 Sem 1 Sem 1

Sept.-Dec Exam

Names 30th Aug-24Sept27thSept-22ndOct 25thOct-19thNov 22ndNov-17thDec17th Dec

69

70 Ballal, Mohamed

71 Brandon, Lisa

72 Burke, Thomas

73 Chan, Justin

74 Coleman, Ciaran

75 Devine, Alan

76 Feinberg, Damon Gastro- Cardio Respiratory

77 Gaffney, Laura intestinal Gen Medicine Vascular Perioperative Exams

78 Healy, Gerard Gen Surgery

79 Ismail, Farhana

80 Joyce, Kenneth

81 Lee, Brian

82 Marion, Mohd Ikhwan

83 McDermott, James

84 McLoughlin, James

85 Mohd Saufi, Siti Safinah

86 Murphy, Stephen

87 Nik Muhamad Affendi, Nik Arsyad

88 O Donoghue, Caroline

89

90 Sheehan, Joseph

91 Sweeney, Eileen92 Gleeson, John

93

94 Tan, Andrew Xia Huang

95 Bin Zanail, Mohamad

96 Brennan, Ronan

97 Cahill, Maeve

98 Che Mat Nor, Sarah Murniati

99 Connolly, Laura

100 Dolan, Steven Cardio Gastro-

101 Fennessy, Paul Gen Medicine Vascular intestinal Exams

102 Gorman, Aine Gen Surgery Respiratory

103 Heerey, Adrienne Perioperative

104 Juman, Sabrina

105 Kane, Nuala

106 Liddy, Emer

107 McDonnell, Christina

108 Md. Almi, Siti Norhidayah

109 Melvin, Martina

110 Muhd Ramdan, Nur Izyan

111 Murphy, Michael

112 Ntoni, Lisani

113 O Tuathail, Maitiu

114 O'Sullivan, Michael

115 Stack, Roisin116 Cummins, Donna

15


Semester 2 Sem 2 Sem 2 Sem 2 Sem 2 Sem 2 Exams InternJanuary -May 2011 3 Weeks 3 Weeks 3 Weeks 3 Weeks 3 Weeks ShadowingNames 4 - 21 Jan 24jan-11Feb 14feb-4Mar 7-25 Mar 28Mar-15Apr 2-27th May

12 Ballal, Mohamed3 Broderick, Louise4 Casby, Caoimhe5 Chan, Justin6 Davies, Katrina7 Duignan, Georgina8 Gaffney, Laura Intern9 Healy, Gerard Cancer Musculos- Renal/ Neurology/ Dermatology/ Shadowing

10 Jordan, Adrian Studies ketal Urology Ophthal Plastics11 Juman, Sabrina Studies Studies Studies Studies12 Kelly, Ronan13 Loftus, Darragh OSCE14 McGovern, Matt 26th&27th15 Mhd Jabar, Mohd Kelana Harisa May16 Mieske, Kelly MCQX217 Muhd Ramdan, Nur Izyan 20/04/201118 NiChathasaigh, Maire19 O'Connor, Simon20 Puasa, Noremyliana21 Stack, Roisin22 Gleeson, John2324 Bin Zanail, Mohamad25 Brennan, Ronan Clinical26 Casby, Caoimhe Exams27 Che Mat Nor, Sarah Murniati 27-29 April28 Daly, Caoimhe Musculos- Renal/ Neurology/ Dermatology/Cancer Intern29 Flood, Laura ketal Urology Ophthal Plastics Studies Shadowing30 Harkin, Grace Studies Studies Studies Studies31 Johnston, Ian32 Kelleher, Barry33 Kirtgu Jeyarajah, Shivashini34 Liddy, Emer35 McDonnell, Christina36 Melvin, Martina37 Mohd Asri, Nur Atikah38 Muslim, Azrin39 NicDhonncha, Eilis40 O'Connell, Aine41 Raman, Nur Aini42 Sheehan, Joseph43 Tummon, Ailbhe44 Vaughan, Ruth45 Cummins, Donna46 Binti Nordin, Siti Nur Fariza47 Binti Hashim, Nor Haryanti48 Brandon, Lisa49 Cahill, Maeve50 Dalton, David51 Doyle, Caitriona52 Flaherty, Rita Cancer Musculos- Intern53 Gormley, Greta Renal/ Neurology/ Dermatology/ Studies ketal Shadowing54 Haji Razali, Hazdalila YaisUrology Ophthal Plastics Studies55 Hussey, Michael Studies Studies Studies56 Keane, Colm57 Lau, Alexandra58 Lee, Brian59 McDermott, James60 McLoughlin, Penelope61 Mohd Rosli, Ritzzaleena Rosli62 Murphy, Stephen63 Ngimron, Anie64 O'Callaghan, Niamh65 Roarty, Ciaran66 Sharma, Kapil67 Sweeney, Eileen68

16


Sem 2 Sem 2 Sem 2 Sem 2 Sem 2 Exams Intern

3 Weeks 3 Weeks 3 Weeks 3 Weeks 3 Weeks Shadowing

17th Dec 4 - 21 Jan 24jan-11Feb 14feb-4Mar 7-25 Mar 28Mar-15Apr 2-27th May

69

70 Abdul Razak, Ahmad71 Binti Mohamad, Muhd Iqbal72 Boggs, Jennifer

73 Byrne, Meave74 Connolly, Laura

75 Dolan, Steven76 Fennessy, Paul Cancer Musculos-77 Gorman, Aine Neurology/ Dermatology/Studies ketal Renal/

78 Hamza, Moayed Ophthal Plastics Studies Urology79 Heerey, Adrienne Studies Studies Studies80 Kane, Nuala

81 Kyne, Karen82 Marion, Mohd Ikhwan

83 McAnena, katherine84 McLoughlin, James85 Mohd Saufi, Siti Safinah

86 Murphy, Michael87 Nik Muhamad Affendi, Nik Arsyad

88 O Tuathail, Maitiu89 Power, Laura90 Stephen Ambrose,Stephanie C MCQX2

91 Sullivan, Tadhg 20/04/2011 Intern92 Shadowing

9394 Aslam, Tayyab95 Beatty, Kenneth Clinical

96 Binti-Aziz, Azliana Exams

97 Burke, Thomas 27-29 April

98 Coleman, Ciaran99 Devine, Alan

100 Feinberg, Damon Cancer Musculos-

101 Gately, Ryan Dermatology/Studies ketal Renal/ Neurology/102 Heavey, Laura Plastics Studies Urology Ophthal

103 Ismail, Farhana Studies Studies Studies104 Joyce, Kenneth105 Kiely, Aoife

106 Mannion, Maria107 McInerney, Angela

108 Md. Almi, Siti Norhidayah109 Morcos, Miray110 Mulligan, Sarah

111 Ntoni, Lisani112 O Donoghue, Caroline

113 O'Sullivan, Michael114 Sugrue, Gavin115 Tan, Andrew Xia Huang116

17

Neurology / Ophthalmology

STUDENT HANDBOOK

Semester 5.2

18

Title: NEUROLOGY/OPHTHALMOLOGY

Year of Module: MB 5 Semester 2

Length of Module: 3 Weeks

Module Leaders: Dr Tim Counihan/Dr Fiona Harney

Neurology Tutor: Dr Anas QureshiModule Teachers: Harney/Counihan/Hennessy/Lynch/ /Fahy/Kinsella/O Donoghue/ ProfPeter Mc Carthy Radiology

Contributing Departments: Ophthalmology/Neurology/Radiology

Module aim: To provide structured, integrated teaching in the diagnosis, investigation

and management of patients with diseases of the nervous system and

eyes.

Facilities: Clinic Space/Eye DepartmentOrthoptics DepartmentGalway Neurology Unit (GNU)Main Eye TheatreMain Day ward theatreRetinal Angiography and Laser SuiteEEG and Nerve Conduction SuiteRadiology DepartmentLibraryComputer SuiteSmall group teaching rooms

Delivery of Module: LecturesRotating TutorialsAttendance in clinical areas e.g. Clinics/theatreEEG/NCS/Laser and angiography suiteE Learning Tutorials in OphthalmologyDirected self learning

19

Educational materials required:Textbooks

Cecils Essentials of Medicine

Textbook of Medicine (Davidsons)

Oxford Textbook of Medicine , Volumes 1-3 Clinical Surgery (Cuschieri)

Clinical Ophthalmology (5th Edition) kanski-Jack

Neurological Differential Diagnosis (Patten)

Pocket Books

The little black book of neurology (Elsevier)

Lecture notes in Ophthalmology

The eye in general practice

Oxford Handbook of Medicine (Oxford University Press)

Physical Examination

Macleods Clinical Examination (Nicol)

Clinical Skills (Cox and Roper, Oxford)

Self Assessment Book

Medicine for examinations (Epstein, Churchill Livingstone)

Aids to Undergraduate Medicine

Medicine MCQs (Dunne/Flaherty)

WebLibrary and Journal AccessDepartment of Medicine Web SiteLinks to BlackboardLinks to other relevant Web sites.Practical Neurology (BMJ publication)

Continuous assessment: Attendance recordLog book

Summative assessment: Contribution to MCQ assessment.Contribution to integrated clinical examination.

Student Evaluation: Students will evaluate each cycle of the module on line with reference tocontent, tutor attendance, teacher feedback and suggestion for change ifappropriate.

20

LEARNING OUTCOMES

At the end of the module the student will have acquired the theoretical knowledgeskills and professional attitudes associated with the followingdisease processes.

Cerebrovascular diseaseSeizures and EpilepsyNeurodegenerative diseaseTumours of the nervous systemInflammatory diseases of the nervous systemInfectious diseases of the nervous systemDiseases of the basal gangliaDisease of the cerebellumHeadache and face pain.Neurological manifestations of systemic diseaseDiseases of the peripheral nervesDiseases of the neuromuscular junction and muscle

Neuro-ophthalmology ( Papilloedema, Pupillary reactions, cranial nerve palsies, optic neuritis,nystagmus, visual pathway disorders)

Diabetic and Retinal Vascular Disease.Dysthroid OphthalmopathyInflammatory eye disorders (rheumatoid, uveitis, scleritis)Common Eye infectionsCataractsGlaucomaSquintIntraocular Tumours (uvea, retina) and metastatic eye disease.Common ocular emergencies and Trauma.

CLINICAL EXAMINATION SKILLS (Outcome 1)

Ophthalmic assessment through history taking.Assessment of neurological symptoms through history taking

Multi-professional approach to careAssessment of higher cortical function.Assessment of cranial nervesAssessment of motor systemAssessment of sensory systemAssessment of cerebellumGait Testing

21

Mini mental state examinationAssessment of peripheral nerves.Assessment of aphasia and languageAssessment of amnesia/agnosia/anosmia/apraxiaAssessment of movement (Tremor, chorea, akinesia, Tics, Myoclonus, dystonia)Assessment of hearing (Weber/Rinne/tinnitus)Assessment of vision (acuity/pupils/fields/eye movements)

PRACTICAL SKILLS (Outcome 2)

Venepuncture

Observe EEGObserve nerve conduction studiesObserve Lumbar PunctureFundoscopyAssessing visual acuity with Snellen chart and reading vision.Observing angiogram and laserApplication of eye dropsInformed consentBreaking bad news

DECISION MAKING and INVESTIGATIONS (Outcome 3,4 and 10)

Evaluate and interpret evidence from the patient history and assessment demonstrating anability to generate a limited list of diagnoses and problems. Participate inthe formulation of plans for further investigation and treatmentrecognising the importance of informed consent.

Lumbar punctureMRI and CT of brain/spinal cord/orbitOrbital ultrasound

Electromyelography (EMG)Electroencephalogram (EEG)Retinal AngiogramDiabetic retinal screening.Ocular computerised tomographyThe role of immunological testing.

22

PATIENT MANAGEMENT (Outcome 4)

Smoking cessation

Secondary Stroke Prevention (Statins/ACE inhibitors/ Antiplatelet and Anticoagulation therapyB12/folateImmunosuppressives and steroids(azathioprine, methotrexate, anti-TNF)PlasmaphoresisAnti-epilepticsAnti-spasmodicsAntibioticsAnalgesiaRadiotherapyChemotherapySurgery (cataract glaucoma)Shunts and stentsAnti-thyroid drugsInsulin/Oral hypoglycaemic agentsSteroid and mydriatic eye dropsLaserBotox treatmentIntraocular injections/VEGF

PROFESSIONAL ATTITUDES (Outcome 7,8,9,11)

Demonstrate the role of the doctor in chronic disease management.Demonstrate the role of the multi-professional team in chronic disease management.Demonstrate an understanding of the importance of high quality care.Demonstrate skills of independence and self direction in theoretical and clinical learning.Understand the role of medical informatics in diagnosis and managementDemonstrate an understanding of the biological and behavioural sciences as an underpinning ofclinical activity.Demonstrate an understanding of the way in which research affects patient care.Communicate effectively and sensitively with patients and their relatives.Communicate effectively and politely with professional colleagues.

23

Semester 5.2 Neurology Timetable

Module Co-ordinator: Dr Anas Qureshi. Contact Number: 085 7380728

You will be assigned to one of 3 “teams” within the neurology department:

Team C: Dr Counihan

Team H: Dr Hennessy

Team L: Dr Lynch

You will be expected to attend whatever clinical activity is taking place, according to your team

assignment.

Clerking: You will be assigned patients either on the Neurology service or consult service on whom to

take a complete history and examination with a view to presenting to one of the team. Please choose 3

patients (preferably one from an outpatient setting, one inpatient Neurology and one from the consult

service) and summarise each case on the Clerking forms in this logbook. These will be useful

discussion points for the feedback session at the end of this module, and will be helpful for revision

purposes.

Small Group Teaching (SGT) will take place in the Comerford Seminar Room

SGT Topics:

Neurological History taking

The Neurological Examination

Fits, Faints and Blackouts

Disorders of movement and Gait

ICU Neurology

The patient with progressive weakness

Clinical Problem-solving

Attendance: Students are reminded that a minimum of 70% attendance at clinical activities is

expected. Attendance sheets will be available for signing at SGT sessions, but no formal record of

attendance will be required at OPD, ward and consult rounds, but clerked patient records will require

sign-off by a member of the neurology team to which you are assigned.

See Logbook for Weekly Teaching Schedules

24

A Clinics

Ophthalmology:Monday AM General Eye Clinic/Diabetic Eye Clinic(6)Monday PM General eye clinic /Diabetic Eye Clinic(6)Monday PM Retinal eye clinic (3)

Tuesday AM Orthoptic clinic (2 per hour)Tuesday AM Diabetic clinic (6)Tuesday PM Corneal eye clinic (6)Wednesday PM Glaucoma clinic (6)Thursday PM Retinal eye clinic (6)Friday AM Diabetic eye clinic/Angiogram /Laser(6)

Neurology:Monday AM EMG/Botox clinic (2)Monday PM Neurology clinic (4)

(1st MS, 2nd EP, 3rd Parkinsons)Tuesday AM Neurology clinic (4)Wednesday AM EMG service (2)Wednesday PM Neurology clinic (New patient clinic)(4)Wednesday pm Lynch (NP clinic) (4)Thursday AM Lynch (Returns/Epilepsy) (4)Friday AM Epilepsy clinic (4)

B Ward RoundsMonday AM Neurology Ward Round(2)Tuesday AM Neurology Ward Round (2)Tuesday PM Neurology Ward round (2)

Thursday AM Neurology WR (2)

C TheatreTuesday AM Eye Theatre (4)Tuesday PM Eye Theatre (2)Wednesday AM Retinal Theatre (4)Wednesday PM Cataract Theatre (2)Thursday PM Corneal TheatreFriday PM Eye Theatre

D OthersThursday AM Multidisciplinary neurology session (6)Thursday Neurology Journal Club (6)Friday AM PG Eye Teaching (8)

25

Principles of Module Delivery

The module will be delivered in UCHG.8 (45 min) lectures will be delivered through the integrated core lecture series for the semester which

will occur on the first Monday of each module change, 4 in neurology and 4 inophthalmology.

There will be 12 fixed teaching/SGT sessions per 3 week block into which core topics will bepredefined and delivered.A module handbook will be developed around these topics. This will be used as a guide by tutors andas a teaching aid by students.A log book will also be created and used by students to direct their learning by suggesting the clinics,ward rounds, theatres and other sessions they need to be exposed to and signed off by a medical orparamedical person covering that area.

LECTURES

Neurology

1 Seizures and epilepsy (Lynch)2 Neurodegenerative disease (Counihan)3 Multiple Sclerosis and Inflammatory CNS disorders (SpR).4 Neuromuscular disease (Hennessy)

Ophthalmology

1 Diabetic eye disease and retinal vascular diseases and toxic and acquiredmacular conditions. (Harney)

2 Ocular emergencies and trauma. (Fahy)3 Cataract/Glaucoma (O Donoghue)4 Cranial Nerve Palsies (Kinsella)

26

Fixed Teaching sessions (12 in 3 weeks)

These will be delivered 6 neurology and 6 ophthalmology.

NEUROLOGY1 The Assessment and management of neurological symptoms and the patient

with Headache (SpR)2 The Focussed Neurological Examination/Higher Cortical Function (SpR3 Assessment of movement gait disorders(Counihan)4 Fits Faints Blackouts and dizzy spells (Hennessey)5 Assessment of the comatose patient/Diagnosing brain death (Lynch)6 Assessment of the patient with rapidly evolving weakness (Lynch)

Neuro-radiology 1 (McCarthy)Neuro-radiology 2 (McCarthy)

OPHTHALMOLOGY7 Revision of neuro-opthalmology8 Glaucoma9 Cataracts10 Orthoptic assessment /Visual Fields (Orthoptist).11 Retinal Vascular Disease12 The red Eye

27

TeachingOutcome

Outcome1-12

TeachingMethodTeachingLocation

MainDepartment

DISEASE STATES

CerebrovascularDisease

1 Clinic/SGT Neurology

Seizures andEpilepsy

1 Lecture/clinic Neurology

NeurodegenerativeDisease

1 Lecture/clinic Neurology

Tumours of the nervous system 1 Clinic NeurologyInflammatory diseases. 1 Lecture NeurologyInfectious Diseases. 1 Clinic Neurology

Diseases of the basal ganglia 1 Clinic NeurologyDiseases of the cerebellum 1 Clinic NeurologyHeadache and face pain 1 SGT NeurologyNeurology in systemic disease 1 Clinic NeurologyDiseases of the peripheralnerves, muscle and NM junction

1 Lecture Neurology

Revision of NeuroOphthalmology

1 SGT Ophthalmology

Diabetic and Vascular eyeDisease.Toxins

1 SGT/Lecture/Clinic Ophthalmology

DysthyroidOphthalmology

1 Clinic Ophthalmology

Inflammatory eyeDisorders


Common eye infections 1 Clinic OphthalmologyCataracts/Glaucoma 1 Lecture/SGT/Clinic Ophthalmology

Ocular emergencies and traumaand The Red Eye

1 Lecture/Clinic Ophthalmology

IntraocularTumours


Squint 1 Clinic Ophthalmology

CLINICAL EXAMINATION

28

SKILLSOphthalmic history taking 1 Clinic OphthalmologyNeurological history taking 1 SGT/Clinic NeurologyMultiprofessional team care 1 Multiprofessional

team meetingOphthalmology

Assessment of higher corticalfunction /confusion.

1 SGT/Clinic Neurology

Fits Faints and Blackouts 1 SGT Neurology

Assessment of cranial nerves 1 Clinic NeurologyOphthalmology

Assessment of motor andsensory systems.


Assessment of cerebellum andgait.


Assessment of the dizzy patient 1 SGT Neurology

Mini mental state examination 1 SGT/Clinic Neurology

Assessment of peripheral nerves 1 SGT/Clinic Neurology

Assessment of movementdisorders/weakness


Assessment of aphasia/language 1 SGT/Clinic NeurologyAssessment ofamnesia/agnosia/anosmia/apraxia


Assessment of Hearing 1 SGT/Clinic Neurology

Assessment of coma/brain death 1 SGT Neurology

Assessment of vision 1 SGT/Clinic OphthalmologyPRACTICAL SKILLS

Venepuncture 2 Wards/Clinic NeurologyOphthalmology

Observe nerve conductionstudies

2 Nerve conduction Ssuite

Neurology

Observe lumbar puncture 2 Wards Neurology

Fundoscopy 2 Wards/Clinic NeurologyOphthalmology

Assess VA and reading vision 2 Clinic Ophthalmology

Observe angiogram and laser 2 Laser Clinic Ophthalmology

29

therapyApplication of eye drops 2 Clinic Ophthalmology

Orthoptic assessment 2 SGT/Clinic Ophthalmology

Informed consent 2 Wards/Clinic NeurologyOphthalmology

Breaking bad news 2 Wards/Clinic NeurologyOphthalmology

DECISION MAKING ANDINVESTIGATIONSLumbar Puncture 3,4,10 Ward Neurology

MRI/CT scanning 3,4,10 RadiologyClinics

NeurologyRadiology

Orbital ultrasound 3,4,10 Clinic Ophthalmology

EMG 3,4,10 EMG Room Neurology

EEG 3,4,10 EEG suite Neurology

NCS 3,4,10 EMG Room Neurology

Retinal angiogram 3,4,10 Laser and Eye Clinic Ophthalmology

Use of Ocular ComputerisedTopography

3,4,10 Eye Clinic Ophthalmology

Diabetic retinal screening 3,4,10 SGT/Diabetes Centre Ophthalmology

The role of immunologicaltesting

3,4,10 Wards/Clinics NeurologyOphthalmology

PATIENT MANAGEMENTSmoking Cessation 4 Lectures/Clinics/SGT Neurology/Ophth

Secondary Stroke Prevention. 4 Lectures/Clinics/SGT Neurology/Ophth

B12/Folate 4 Lectures/Clinics/SGT Neurology/Ophth

Immunosuppressives includingsteroids

4 Lectures/Clinics/SGT Neurology/Ophth

Plasmaphoresis 4 Lectures/Clinics/SGT Neurology/Ophth

Anti-epileptics 4 Lectures/Clinics/SGT Neurology

30

Anti-spasmodics 4 Lectures/Clinics/SGT Neurology

Antibiotics 4 Lectures/Clinics/SGT Neurology/Ophth

Radiotherapy 4 Lectures/Clinics/SGT Neurology

Chemotherapy 4 Lectures/Clinics/SGT Neurology

Eye Surgery 4 Lectures/Eye Theatre Ophthalmology

Anti-thyroid drugs 4 Lectures/Clinics/SGT Ophthalmology

Shunts 4 Lectures/Clinics/SGT Neurology

Insulin/OHA 4 Lectures/Clinics/SGT Ophthalmology

Steroid and mydriatic eye drops 4 Lectures/Clinics/SGT Ophthalmology

GlaucomaMedication

4 Lectures/Clinics/SGT Ophthalmology

Laser 4 Lectures/Laser Clinic Ophthalmology

Botulinum toxin 4 Lectures/Clinic Neurology/Ophth

Intra ocular treatments 4 Lectures/Theatre Ophthalmology

PROFESSIONALATTITUDESRole of the doctor 7,8,9,11 All Neurology

OphthalmologyRole of the multiprofessionalteam

7,8,9,11 All NeurologyOphthalmology

High quality care 7,8,9,11 All NeurologyOphthalmology

Skill of self direction All NeurologyOphthalmology

Biological and behaviouralsciences


Research and evidence basedmedicine


Medical informatics 7,8,9,11 All NeurologyOphthalmology

Effective Communication 7,8,9,11 All NeurologyOphthalmology

31

LOG STUDENT EVALUATION OF MODULE TO BE COMPLETED ON BLACKBOARD.

Please mark each section on a scale 1-10.

Neurology Ophthalmology

General Organisation of module

Learning in the Out patient

clinic

Theatre attendance observation

and assistance

Interaction and learning in the

wards.

Fixed Teaching sessions

Content and Teaching

Grand Rounds/Journal Club(s)

Overall tutor attendance

Overall teaching environment

Interaction of team members

32

DERMATOLOGY / PLASTICSSTUDENT HANDBOOK

Semester 5.2

Plastic Surgery,MaxillofacialSurgery and DermatologyUndergraduate Teaching Module

2011

33

Dear student,

Welcome to the plastic surgery, maxillofacial surgery and dermatology undergraduateteaching module.

We hope that you will have an enjoyable and educational experience in ourdepartments.

We have some house rules to make your experience run smoothly:

You are expected to be well groomed and dressed in a professional manner with aclean, ironed white coat.

Punctuality for outpatients, tutorials etc. is essential. All patients, medical and paramedical colleagues must be treated courteously. You must also remember that patient confidentiality is extremely important so do

not discuss patients with other students in the coffee shop, lifts etc. Please remember that the tutors/lecturers have clinical responsibilities outside

their teaching role as well as annual leave and study leave so that tutorials mayhave to be cancelled at short notice. If this happens, use the time constructively!

Don’t be afraid to ask questions- you will get more out of the experience.

If you have any questions or comments, please let me know.

Kind regards

Dr Anne-marie KennedyPlastic Surgery [email protected]

mailto:[email protected]

34

Plastic and Maxillofacial Surgery/Dermatology



Module Leaders: Mr. Padraic Regan / Dr Trevor Markham

Module Teachers: Hussey/Ismael/Kelly/Regan: Plastic and Reconstructive SurgeryP McCann :Maxillofacial SurgeryMarren/Markham/Murphy: Dermatology

Contributing Departments: Plastic Surgery/Dermatology/Maxillofacial Surgery

Module aim: To provide structured, integrated teaching in the diagnosis, investigation

and management of patients with plastic surgery, facial and

dermatological conditions.

Facilities:

Main Outpatient Clinic

Dermatology Department Clinic

Main Theatre-Theatre 4

Main Day Ward Theatre- 3rd floor

Minor ops (in Dept of Dermatology)

Small group teaching rooms

Library

Computer suite

Delivery of Module: Lectures

Rotating Tutorials

Weekly Plastic Surgery

Twice Monthly Multidisciplinary Skin Cancer Meeting

Directed self learning

35

LEARNING OUTCOMESAt the end of the module the student will have acquired the theoretical knowledgeskills and professional attitudes associated with the following disease processes:Plastics

Melanoma Skin Cancer including Sentinel Node Biopsy

Non-Melanoma Skin Cancer, BCC/SCC

Dupuytren’s Disease

Upper Limb Compression Neuropathies

Upper Limb Trauma

Lower Limb Trauma

Breast Reduction /Augmentation /Reconstruction Surgery

Burn Injury

Cleft Lip/Palate Disorders

Compartment Syndromes of the upper and lower limbs

Split and Full thickness skin grafts

Classification and uses of local, regional and free flaps

Maxillofacial

Facial Fractures

Dental Injuries

Orofacial Cancer

Dermatology

Eczema

Psoriasis

Acne Vulgaris/Rosacea

Infections / Infestations

Bullous Eruptions

Pigmented Lesions- Benign and malignant

Non pigmented lesions- Benign and Pigmented

Cutaneous manifestations of systemic disease

36

During the 3-week module you will be focusing on the following key areas:

CLINICAL EXAMINATION SKILLS

PRACTICAL SKILLS

DECISION MAKING and INVESTIGATIONS

PATIENT MANAGEMENT

PROFESSIONAL ATTITUDES

The best way to see these in action is to accompany the interns when they are clerking

patients- this usually happens in St. Mary’s day ward.

You may also accompany the registrars and SHO’s to A&E to observe the initial

management of patients.

Dr Clare Roche, Consultant Radiologist will provide one group lecture in the 3-week

block (Tuesday at 4pm).

The hand physiotherapist and occupational therapist (Alesha Kelly) will also provide

one lecture.

For those of you especially interested in plastic surgery or dermatology, the following

websites are recommended. They contain details of student grants and bursaries and

lecture series:

British Association of Plastic, Reconstructive and Aesthetic Surgery:

http://www.bapras.org.uk

British Association of Dermatology:

www.bad.org.uk

http://www.bapras.org.uk/

http://www.bad.org.uk/

37

Note: Every student will be required to submit a one A4 discussion of a plastic surgery,

maxillofacial or dermatology topic. Your tutor will assign the topic to you.

Plastic Surgery Dermatology Maxillofacial

Interns: Bleep

To be confirmed To be confirmed To be confirmed

To be confirmed

To be confirmed

SHO:

Andreas 544

To be confirmed

To be confirmed

Registrars:

Anne O’Neill

Paul Sullivan

Anne Collins

Anne-marie Kennedy

Eugene Curtin

38


Plastics

Surgical assessment through history taking/Examination.

Multi-professional approach to care

Assessment of Burns

Assessment of skin malignancy symptoms/signs

Assessment of nerve/vascular/tendon injuries of the upper limb

Assessment of nerve/vascular/tendon injuries of lower limb.

Maxillofacial

Assessment of Facial Nerves/Injuries

Assessment of Mouth/Palate

Dermatology

Dermatological assessment through history taking

Assessment of morphology of rash

Assessment of skin

Assessment of nails

Assessment of hair

39

PRACTICAL SKILLS

Plastics

Venepuncture

Observe Skin Biopsies

Observe Minor Operations in Surgical Day ward and Dermatology

Observe Dressing Changes

Suture management

Assess Emergency admissions in A&E

Maxillofacial

Observe Emergency Plastic/Maxillofacial Surgery

Observe Elective Plastic/Maxillofacial Surgery

Dermatology

Skin Swabs

Skin hair and nail samples for fungal culture

Topical application of emollients

Topical application of corticosteroids

Observe skin biopsy

Observe phototherapy

Informed Consent

40

DECISION MAKING and INVESTIGATIONS

Evaluate and interpret evidence from the patient history and assessment demonstrating an ability to generate a limited listof diagnoses and problems. Participate in the formulation of plans for further investigation and treatment recognising theimportance of informed consent.

Plastics

Hand, Upper limb and lower limb X-rays

CT of Thorax, Abdomen and Pelvis in staging melanoma/skin malignancy

MRI / PET scans in evaluation of melanoma patients

FBC, U/E, ECG investigation of pre-op patients admitted for surgery

Use of a tourniquet in theatre

Evaluation of histological results and subsequent future patient management

Maxillofacial

Radiology in staging head and neck malignancy

Dermatology

Skin Biopsy

Skin patch testing

Skin prick testing

Role of immunological testing

Role of haematological testing

Role of radiological investigations

41

PATIENT MANAGEMENT

Plastics/Maxillofacial

Patient work-up for theatre (including age and so-morbidities)

Informed Consent for surgery

Admission / care pathways

Ordering X-rays and pre-op blood investigations

Evaluation of Paediatric patient prior to surgery

Surgical preparation in theatre

Scrubbing / gowning techniques

Infection Control Protocols in theatre/ wards

Use of local anaesthesia

Skin and surgical site preparation

Use of tourniquets

Use of peri-operative antibiotics/analgesics

Documentation of operation notes/post-operative instructions

Monitoring of patients in recovery bay

Follow-up of patients on wards and discharge summary completion

Follow-up of patients in the OPD and readmission policy

Use of Antibiotics in surgery

Use of Analgesia in surgery

Time out (check list prior to surgery)

Dermatology

Antibiotics

Analgesia

42

Topical Emollients

Topical Chemotherapy

Topical Steroids

Topical Immunomodulators

Phototherapy

Conventional systemic therapies (Dapsone, Azathioprine, Cyclosporin, Methotrexate,

Hyroxychloroquine

Biologic Therapies (Infliximab, Etanercept, Adalimumab, Ustekinumab

Wound Care

Cryotherapy

Radiotherapy

PROFESSIONAL ATTITUDES

Demonstrate the role of the doctor in chronic disease management.

Demonstrate the role of the multi-professional team in chronic disease management.

Demonstrate an understanding of the importance of high quality care.

Demonstrate skills of independence and self-direction in theoretical and clinical learning.

Understand the role of medical informatics in diagnosis and management

Demonstrate an understanding of the biological and behavioural sciences as an underpinning of

clinical activity.

Demonstrate an understanding of the way in which research affects patient care.

Communicate effectively and sensitively with patients and their relatives.

Communicate effectively and politely with professional colleagues.

43

SGT = Small group teaching PlasticsWGT = Whole Group teaching (all 25 students)

Teaching Schedule Week 1: Plastic Surgery

Monday Tuesday Wednesday Thursday Friday8-9 am L Surgical

GrandRounds

PlasticSurgeryTeachingR4/ 1st floor

9AM

L Mr. HusseyOPD9 30-11 (2)11-12 30 (2)

Main PlasticTheatreMr. Regan9 30- 11 (2)11-12 30 (2)

Skin Triage ClinicMr. Hussey/Mr.Regan (2)9.30-11.00

Main PlasticSurgery theatre Mr.Kelly9 30- 10 45 (2)10 45 -11 45 (2)

SGT Tutor/SpR1145- 12 30(12)

Outpatient ClinicMr. Kelly (4)

9-30-11 (2)11-12-30(2)MainPlasticSurgerytheatre Mr.Hussey9 30-11(2)11-12 30(2)

Main PlasticSurgery theatreMr. T Ismael9 30-11 (2)11- 12 30 (2)

1-2 pm LPM L Main Plastic

SurgeryTheatreMr. Regan1 30-3 (2)3-4 00 (2)

Minor List(2)

Radiology DrRoche4-5pmWGT

Main PlasticSurgery theatre Mr.Kelly9.30-11 (2)11-12 30(2)

Minor List (2)

5-5.45pm SGT MrJ Kelly/SpR

Main PlasticSurgerytheatre Mr.Hussey1-30-3 (2)3-4-30(2)

Surgical Dayward list 3rd

Floor1 30-3 (2)3-4 30 (2)

WGTDermatology2-4.30pm

44


Monday Tuesday Wednesday Thursday Friday8-9am

SurgicalGrandRounds

PlasticSurgeryTeachingRoom 3 / 4 1st

floor (4)

AMOutpatientClinic Mr.Regan9 30-11 (2)11-12 30 (2)

SGT MrRegan/SpR11 45-12 30(12)Main PlasticSurgerytheatre9 30-11 (2)11-12 30 (2)

Outpatient ClinicMr. Hussey

9 30-11 (2)

11-12 30 (2)

Main PlasticSurgerytheatre Mr.Regan9 30-11 (2)11- 12 30(2)

Regan/HusseySkin Triageclinic (2)Plastics9.30 -11.0

Main Plastictheatre Mr.Kelly9 30-10 45 (2)10 45-11 45(2)SGTTutor/SpR1145- 12 30(12)

OutpatientClinic Mr.Kelly9 30-11(2)11-12 30(2)

Main Plastictheatre Mr.Hussey9 30-11 (2)11-12 30(2)

Main Plastictheatre Mr. TIsmael9 30-11(2)11-12 30(2)

1-2pmPM Main Plastic

Surgerytheatre130-3 (2)3-4 30 (2)

Surgical Dayward Mr.Hussey1 30- 3 (2)3– 4 0 (2)SGT MrHussey/SpR4 15-5

Main Plastictheatre Mr.Regan1 30- 3(2)3- 430(2)

Minor List(2)

Main Plastictheatre Mr.Kelly1 30-3(2)3-4 30(2)

Minor List(2)

5-5.45pmSGT Mr JKelly/SpR

Main PlasticSurgerytheatre Mr.Hussey1 30-3 (2)3-4 30 (2)


floor1 30 –3 (2)3- 4 30(2)

OutpatientClinic Mr TIsmael1 30-3 (2)3-4 30(2)

SGTIsmael/SpR3 45 4 30(12)

45



SurgicalGrandRounds

Plastic SurgeryTeachingRoom 3 / 4 1st

floor (4)

AM

Outpatient Clinic Mr.Regan

9 30-11 (2)

11 –12 30 (2)

SGT MrRegan/SpR1145-1230(12)

Main PlasticSurgerytheatre 9-30-11(2)11 –12 30 (2)

OutpatientClinic Mr.Hussey9 30-11(2)11-12-30 (2)

Main PlasticSurgerytheatre Mr.Regan9 30-11(2)11-12 30 (2)

Skin CancerTriageRegan/Hussey(2)9.30-11.00

Main Plastictheatre Mr. Kelly9 30-10 45 (2)10 45-11 45 (2)

SGTTutor/SpR1145- 12 30(12)

OutpatientClinic Mr. Kelly9 30-11 (2)11-12 30 (2)

Main Plastictheatre Mr.Hussey9 30-11 (2)11-12 30 (2)

Main Plastictheatre Mr. TIsmael9 30-11 (2)11-12 30 (2)

1-2pm

Skin CancerMDM NursesHome 3rd and4th Mondays

PM Main PlasticSurgery theatre1 30-3 (2)3-4 30 (2)

Surgical Dayward Mr.Hussey1 30-3 (2)3- 4 (2)SGT MrHussey /SpR4 15-5 (12)

Main Plastictheatre Mr.Regan9 30-11 (2)11-12 30 (2)

Minor List (2)

Main PlasticSurgery theatreMr. Kelly1 30-3(2)3-4-30(2)

Minor List (2)

5-5.45pm SGTMr J Kelly/SpR

Main PlasticSurgery theatreMr. Hussey1 30-3 (2)3-4 30(2)


Floor1 30-3 (2)3-4 30 (2)

SGTPlasticSurgeryConsultant /SPR ledOverview ofPlasticSurgery forwholegroup(25)2 –4 -30

46

Teaching Schedule Week 1: Dermatology/Maxillofacial


L Medicalconference

Maxillofacial theatreBallinasloe(2)

Medical GrandRounds

9AM

L

L

SELFDIRECTEDLEARNING

Maxillofacial theatre(2)maintheatreMaxfaxminor opsSt Endas(1)

Skin TriageClinicDr Marren9-12(2)

MaxillofacialClinic StEndas(1)


Dr MurphyOutpatient clinic(2)Dr MarkhamOutpatient clinic(2)

MaxillofacialTheatre (2)maintheatreMaxfax minor opsSt Endas(1)

1-2pm

L SGT/ SpRMaxillofacial

PM L

Maxillofacial WardActivities(1)

DrMarkhamOutpatients 2- 5 (2)

Dr MurphyOutpatientclinic2-3.30(2)3.30-4 (2)

Maxillofacial theatre(2)maintheatre

Dr MarkhamOutpatientclinic1.30-4.30 (2)


DERMATOLOGYTEACHINGWHOLE GROUP2- 4 30pm

47

Teaching Schedule Week 2: Dermatology/Maxillofacial

Monday Tuesday Wednesday Thursday Friday8-9 am Medical conference Maxillofacial

theatreBallinasloe(2)

Medical GrandRounds

9AM

Maxillofacialtheatre (1)StEndas

12.00Dr MarrenSGT (11)

Maxillofacialtheatre (2)


Skin Triage ClinicDr Marren (2) SELF

DIRECTEDLEARNING

Dr MurphyOutpatientclinic (2)Dr MarkhamOutpatientclinic (2)

1-2 pm SGT SpRMaxillofacial

PM Dr MarkhamOutpatientclinic2-5 (2)

Dr MurphyOutpatientclinic2-5 (2)

Dr MarkhamOutpatient clinic2- 5 (2)


Maxfax OPD(5)

48

Teaching Schedule Week 3: Dermatology

Monday Tuesday Wednesday Thursday Friday8-9 am Medical

conferenceMaxillofacialtheatreBallinasloe(2)

Medical GrandRounds

9AM

Maxillofacialclinic St.Enda’s ward(1)

12.00Dr MurphySGT (8)

Minor SurgeryDr Markham/Dr Murphy (2)


Skin Triage ClinicDr Marren9-12 (2)


Dr MurphyOutpatientclinic (2)Dr MarkhamOutpatientclinic (2)

1-2 pm SGT SpRMaxillofacial

PMMaxillofacialWardActivitiesDr MarkhamOutpatientclinic2-5 (2)


Dr MurphyOutpatientclinic2-3.30(2)3.30-5

Dr MarkhamOutpatient clinic(2)

4.30pm DrMarkham SGT(8)


PLASTICSTEACHINGWHOLEGROUP (25)2-4 30pm

49

Suggested text books (most are available in the library, you are not expected to buythese!)

Textbooks

Greens Textbook of Hand Surgery Volumes 1 and 2

Total Burn Care by DN Herndon

Grabb and Smiths Plastic Surgery by WC Grabb and J

Smith


Davidsons Textbook of Medicine

Oxford Textbook of Medicine

Self Assessment Picture Tests in Dermatology (Kavanagh

GM/Savin JA)

Rooks Textbook of Dermatology (Burns, Breathnach,

Cox and Griffiths)

Pocket Books

Plastic and Reconstructive Surgery by Henk Giele/Oliver

Cassells

Lecture Notes in Dermatology 9th Edition Robin Graham-

Briwn, Tony Burns

Oxford Handbook of Medicine




50

Self- Assessment Book

Medicine for Examinations (Epstein, Churchill

Livingstone)



Web

Library and Journal Access

Department of Surgery Web Site

Links to Blackboard

Links to other relevant Web sites.

Medscape Surgery

www.dermatology.org/morphology

www.dermnetnz.org/

www.emedicine.com/derm/contents.htm

Continuous assessment:

Attendance Record (70%)

Log book Activities (70%)

Summative assessment:

Contribution to written assessment at the end of Semester 2

Contribution to integrated clinical examination at the end of

Semester 2

http://www.dermatology.org/morphology

http://www.dermnetnz.org/

http://www.emedicine.com/derm/contents.htm

51

CANCER STUDIES

STUDENT HANDBOOK

Semester 5.2

52

Title: Cancer studies



Academic lead: Professor M. O’DwyerCo-ordianting tutor: Dr. Triona Walshe (contact: [email protected])Module Teachers:Haematology: Professor M. O’Dwyer, Dr. M. Murray, Dr. HayatOncology: Dr. P. Donnellan, Dr. M. Keane, Dr. G. Leonard, Dr. S.Blazkova.Radiology: Professor P. McCarthy, Dr. J. Murphy, Dr. J. BruzziPalliative Care: Dr. D. Waldron, Dr. E. MannionRadiotherapy: Professor F. Sullivan, Dr. C. Small, Dr. J. Martin, Dr. M. Pomeroy

Contributing Departments: Haematology, Radiology, Radiotherapy, Oncology, Palliative care

Module aim: To provide structured, integrated teaching in the diagnosis, investigationand management of patients with haematological and oncologicaldiseases.

Facilities: Haematology and Oncology wards (St. Joseph’s ward,St. Patrick’s ward, St. Teresa’s ward)Radiotherapy DepartmentRadiology DepartmentOut-patient department (Haematology/ Oncology/Palliativecare/ Radiotherapy)LibraryComputer SuiteSmall group teaching room

Delivery of Module: LecturesRotating TutorialsAttendance in clinical areas e.g. Clinics/theatreAttendance at multidisciplinary meetingsDirected self learning

Educational materials required:Textbooks


Textbook of Medicine (Davidsons)

Oxford Textbook of Medicine , Volumes

Pocket Books

Oxford Handbook of Medicine (Oxford Un




Self Assessment Book

Medicine for examinations (Epstein, Church



WebLibrary and Journal AccessDepartment of Medicine Web SiteLinks to BlackboardLinks to other relevant Web sites:

Continuous assessment: AttendanLog book

Summative assessment: ContributioContributio

Student Evaluation: Students wicontent, tutoappropriate

Haematology module books: Essential Haematology 2011 edition (Hoffbrand)

53

1-3

iversity Press)

ill Livingstone)

ce record

n to MCQ assen to integrated

ll evaluate eachr attendance, t

.

Haematology: Clinical Cases Uncovered (Shaun McCann)

Radiology module books: Clinical Radiology for Medical Students.

Roberts, Hughes and Hourihan Radiology and Imaging for Medical

Students. Sutton

Reference radiology books (available in thelibrary):

Diagnostic Imaging Series (Publishers

ssment (semester 2)clinical examination (semester 2)

cycle of the module on line with reference toeacher feedback and suggestion for change if

Amirsys)

54

LEARNING OUTCOMESAt the end of the module the student will have acquired the theoretical knowledge skills andprofessional attitudes associated with the following topics:

Haematology: Acute leukaemia (ALL, AML) Chronic leukaemia (CLL, CML) Myeloproliferative diseases: Polycythaemia Vera, CML, Primary myelofibrosis, Essential

thrombocytosis Multiple myeloma Lymphoid neoplasms: Hodgkin/non-Hodgkin Bone marrow failure (presentation, management of anaemia, neutropenia, transfusion support,

growth factors, central venous access etc.) Bone marrow failure (presentation, management of anaemia, neutropenia, transfusion support,

growth factors, central venous access etc.)

Radiology: The principles underpinning the generation of an x-ray image and basic radiography. The importance of radiation protection both for patients and for staff. The differences between the various complex and newer computed imaging technologies e.g.

MRI, CT and Ultrasound. The role and indications for each of these imaging techniques in screening, diagnosis and

staging of various disease processes, with particular reference to oncological screening,diagnosis and staging

The role of interventional radiology in routine patient care (and oncology patient care) Principle of informed consent for radiologic procedures.

Radiotherapy: Principles of radiotherapy, how it is delivered. Indications for “curative” radiotherapy. Indications for “palliative” radiotherapy. Differences between curative and palliative radiotherapy. the conditions that need emergency radiotherapy

e.g. spinal cord compression, superior vena caval obstruction Early side effects of radiotherapy e.g. tiredness, Skin reactions, mucositis, nausea & Vomiting,

Diarrhoea, Dysphagia, Cystitis, Bone marrow suppression. Management of these problems Late reactions to radiotherapy depend on the area that received radiotherapy.

e.g Lung – pneumonitis, fibrosis.GU – fertility problemsGI – strictures, fistulae

55

CNS – spinal cord myelopathy, brachial plexopathyEndocrine – Panhypopituitarism, hypothyroidSecondary cancers

Palliative Care: Principles of palliative care and chronic pain control Common causes of nausea/vomiting in patients with advanced cancer Managing the complications of acute and chronic analgaesia Psychosocial concerns of the patient Communication with the family Helping the patient cope with increased disability Looking for evidence of depressive illness Involvement of other professionals, e.g. counselors Providing end of life care in the patients home/hospice care Knowledge of the analgaesia ladder, antiemetic ladder and laxative ladder Basic knowledge of commonly utilized medication in palliative care (use, mechanism of action,

contraindications etc)

Oncology: Diagnosis and staging of common malignancies (breast, lung, bowel, prostate,ovarian and

lymphoma) Approach to the patient with a metastatic tumour of unknown origin Approach to staging and monitoring Principles of chemotherapy Principles of hormonal biologic and targeted therapies Ethical issues in cancer care Managing the complications of cancer and cancer treatment

-Management of the neutropoenic patient and opportunistic infection- sepsis- Hypercalcaemia of malignancy- Carcinoid syndrome- Paraneoplastic syndromes- Tumour lysis syndrome- Spinal cord compression- Superior vena caval obstruction- Tumour cystitis syndrome- Pain- Raised intracranial pressure.

56


Assessment of symptoms through history taking Multi-professional approach to care Multisystem examination as necessary in onclology patients with specific reference to:

Haematological examination – splenomegaly, lymphadenopathy etc. Patients with suspected spinal cord compression Patients with suspected raised intracranial pressure Patients with neutropaenic sepsis Patients with superior vena caval obstruction Examination of a patient for complications of therapy


Venepuncture Haematological and biochemical investigations indications and interpretation Observe blood cultures being taken and interpretation of results Observe Lumbar Puncture (diagnostic or intrathecal chemotherapy administration) Observe bone marrow Observe chemotherapy administration Observe blood products transfusion Observe central venous lines in use Informed consent Breaking bad news Observe the use of syringe drivers (palliative care nurses) Observe pleural tap/paracentesis (symptomatic/palliative) Observe interventional radiology procedures (including image guided biopsies) Observe informed consent for these procedures

DECISION MAKING and INVESTIGATIONS (Outcome 3, 4 and 10)

Evaluate and interpret evidence from the patient history and assessment demonstrating anability to generate a limited list of diagnoses and problems. Participate in the formulation ofplans for further investigation and treatment recognising the importance of informed consent.

Understanding the indication for and interpretation of lumbar puncture Understanding the indication for and interpretation of Bone marrow biopsy Biopsy (including radiological guided biopsy) Radiological diagnosis: Plain radiography, Ultrasound, CT, MRI, Fluorography, Nuclear

medicine (including PET CT), Image guided biopsy Radiological staging Diagnosis of dying and decision of withdrawal of care

57

Understanding the role of the Multidisciplinary meeting in patient care Deciding on the optimal treatment and timing of treatment e.g. neo-adjuvant therapy or surgery


Radiotherapy (curative/palliative) Radiological management (Interventional radiology e.g. stent insertion/ radiofrequency

ablation/ tumour embolisation etc) Chemotherapy Surgery Pain control Management of the complications of therapy Withdrawal of care

PROFESSIONAL ATTITUDES (Outcome 7, 8, 9, 11)

Demonstrate the role of the doctor in oncological disease management. Demonstrate the role of the multi-professional team in care of the oncology patient. Demonstrate an understanding of the importance of high quality care. Understand the need for professionalism, confidentiality and respect for this vulnerable patient

group. Demonstrate skills of independence and self direction in theoretical and clinical learning. Understand the role of medical informatics in diagnosis and management Demonstrate an understanding of the biological and behavioural sciences as an underpinning of

clinical activity. Demonstrate an understanding of the way in which research affects patient care. Demonstrate an understanding of the importance of health informatics and evidence based

medicine. Understand the role of clinical trials in oncology Communicate effectively and sensitively with patients and their relatives. Communicate effectively and politely with professional colleagues.

Te

Th

58

Week A: Medical Oncology

Time Monday Tuesday Wednesday Thursday Friday8-9 Radiology

OncologyMeeting

(A +B +C)

UrologyMDM(A +B +C)

Breast MDM(A +B +C)

Haem/OncCPC(A +B +C)

9-10 PDWR(A)

MKWR(B)

ChemotherapyAdministration(A)

GL OPD(C)

PD OPD(A)

GI MDM(A +B +C)

10-11 PDWR(A)

MKWR(B)

ChemotherapyAdministration(B+C)

GL OPD(C)

PD OPD(A)

11-12 PDWR(A)

MKWR(B)

Pharmacy visit(B +C)

GL OPD(C)

PD OPD(A)

12-1 Pharmacy visit(A)

GL OPD(C)

PD OPD(A)

BreastcheckMDM(A +B +C)

1-2 1.30-2.30OncSeminar(A+B+C)

Small groupteaching(A +B +C)

Small groupteaching(A +B +C)

GrandRounds(A +B +C)

2-3 GL WR(C)

MK OPD(B)

Self -directedlearning(A +B +C)



3-4 GL WR(C)

MK OPD(B)




4-5 4.30 LungMDM(A +B+C)

MK OPD(B)




5-6 Small Groupteaching(A +B +C)

SpR TeachingTeleconference

aching schedule

e 3 week rotation will be divided into 3 main sections with 3 groups of students

Group A: Student 1, 2, 3Group B: Student 4, 5Group C: Student 6, 7, 8

Time

8-9

9-10

10-11

11-12

12 -1

1-2

2-3

3-4

4-5

5-6

GroupGroupGroupGroup

59

Week B: Radiotherapy & Palliative Care

Monday Tuesday Wednesday Thursday Friday

Medical caseconference(A+B+C+D)

Medical caseconference(A+B+C+D)

BrachytherapyFS(A)

PallWRUHG(B)

CSOPD(C)

TutorialJM(D)

HospiceRound(C)

WRFS(B)

PallWRMPH(D)

HospiceRound(D)

JMOPD(B)

PallWRUHG(A)

BrachyTherapyFS(C)

BrachytherapyFS(A)

PallWRUHG(B)

CSOPD(C)

HospiceRound(C)

CSWR(10:30)(D)

FSOPD(B)

PallWRMPH(D)

WRMP(C)

HospiceRound(D)

JMOPD(B)

PallWRUHG(A)

BrachyTherapyFS(C)

BrachytherapyFS(A)

PallWRUHG(B)

CSOPD(C)

HospiceRound(C)

CSWR(D)

FSOPD(B)

PallWRMPH(D)

WRMP(C)

TutorialCS(C)

HospiceRound(D)

JMOPD(B)

PallWRUHG(A)

BrachyTherapyFS(C)

BrachytherapyFS(A)

PallWRUHG(B)

CSOPD(C)

FSOPD(B)

Small groupteaching(A+B +C+D)

Grand Rounds(All)

WRJM(A)

TutorialMP

(B)

Self - Directed learning(All)

PallOPDMerlin(B)

MPOPD(A)

JMOPD(D)

TutorialFS(A)

WRJM(A)


PallOPDMerlin(B)

MPOPD(A)

JMOPD(D)


WRJM(A)


PallOPDMerlin(B)

MPOPD(A)

JMOPD(D)


Small groupteaching(A+B +C+D)

SpRTeachingTeleconferen

A: Student 1, 2B: Student 3, 4C: Student 5, 6D: Student 7, 8

CS: Dr. C. SmallFS: Prof. F. SullivanMP: Dr. M. PomeroyJM: Dr. J. Martin

60

Week C: Haematology & Radiology

Time Monday Tuesday Wednesday Thursday Friday

8-9 Medical caseconference(A+B+C)

Medical caseconference(A+B+C)

9-10 HaemWR(C)

BreastclinicRadiol(A)

Small GroupSession(A+B+C)

Breastclinicradiol(B)

HaemWR(A)

HaemWR(B)

BreastclinicRadiol(C)

10-11 HaemWR(C)

BreastclinicRadiol(A)

HaematologySeminar (Joes)(A+B+C)

Breastclinicradiol(B)

HaemWR(A)

HaemWR(B)

BreastclinicRadiol(C)

HaematologyMorphology(A+B+C)

11-12

12 -1 HaematologyradiologyMeeting(A+B+C)

RadiologyMuseum (12:30)(A+B+C)

NeurologyradiologyMDM(A+B+C)

RadiologyMDMpreparationSGT (A+B+C)

1-2 RadiologyCasepresentations(weeks 2+3)

HaematologySeminar (CSI)(A+B+C)

GrandRounds(A+B+C)

2-3 Haem OPD(A+B)

HaemOPD(C)

Intervent.Radiology(B)

InterventionalRadiology(C)

InterventionalRadiology(A)

Self-directedlearning(A+B+C)

3-4 Haem OPD(A+B)

HaemOPD(C)

Interven.Radiology(B)

InterventionalRadiology(C)

InterventionalRadiology(A)


4-5 Haem OPD(A+B)

HaemOPD(C)

Interven.Radiology(B)


5-6 Small groupteaching(A+B +C)

Small groupteaching(A+B +C)

SpR TeachingTeleconference

Group A: Student 1, 2, 3Group B: Student 4, 5Group C: Student 6, 7, 8

61

A Clinics

Medical oncology:Tuesday PM Dr. M. KeaneWednesday AM Dr. G. LeonardThursday AM Dr. P. Donnellan

Radiotherapy:Monday AM Dr. C. SmallTuesday AM Prof. F. SullivanWednesday PM Dr. M. PomeroyThursday AM Dr. J. MartinThursday PM Dr. J. Martin

Haematology:

Monday PM Haematology OPDTuesday PM Haematology OPD

62

B Ward Rounds

Medical oncology:Monday AM Dr. P. DonnellanMonday AM Dr. M. KeaneMonday PM Dr. G. LeonardThursday PM Dr. P. DonnellanFriday AM Dr. P. Donnellan

Radiotherapy:Monday PM Dr. J. MartinTuesday AM Dr. C. SmallWednesday AM Dr. M. Pomeroy

Palliative Care:Monday AM UHGTuesday AM HospiceWednesday AM Merlin Park HospitalThursday AM HospiceFriday AM UHG

Haematology:Monday AM Haematology WRThursday AM Haematology WR

63

C Meetings

Meeting Time LocationHaematology radiology meeting 12 Nurses building conference roomOncology Seminar 1:30

Monday

Respiratory Oncology MDM 4:30 Nurses building conference roomTuesday Oncology radiology meeting

(1st, 2nd and 4th Tuesday of the month)8 Conference room, Radiology Dept

Urology MDM 8 Nurses building conference roomWednesdayENT radiology conference

(first Wednesday of each month)8:15 Conference room, Radiology Dept

Breast MDM 8 Nurses building conference roomThursdayHaematology Seminar 1 CSIHaematology/ Gynae Oncology(alternate weeks)

8 Nurses building conference roomFriday

GI oncology MDM 9 Nurses building conference room


The module will be delivered in UCHG.8 (45 min) lectures will be delivered through the integrated core lecture series for the semester whichwill occur on the first Monday of each module change.There will be 12 fixed teaching/SGT sessions per 3 week block into which core topics will bepredefined and delivered.A module handbook will be developed around these topics. This will be used as a guide by tutors andas a teaching aid by students.A log book will also be created and used by students to direct their learning by suggesting the clinics,ward rounds, theatres and other sessions they need to be exposed to and signed off by a medical orparamedical person covering that area.

Courtesy and ProfessionalismOncology patients are a particularly vulnerable and often seriously ill patient group. Accordingly thehighest standards of professionalism and respect are expected, from everyone having contact withthese patients, their relatives and visitors.Strict confidentiality regarding patient information and a courteous and considerate attitude to patientsare absolute requirements, at all times.

64

Core Lectures

1. General aspects of Haematological Malignancy (Prof O’Dwyer) Jan 24th, 2011, am

2. Bone marrow failure (presentation, management of anaemia, neutropaenia, transfusion support,growth factors, central venous access etc.) (Prof O’Dwyer) Jan 24th 2011, am

3. Principles of Chemotherapy (Dr. P. Donnellan) Jan 24th 2011, am

4. Radiation in cancer management (Dr. C.Small) March 7th 2011, pm

5. Radiation emergencies (Dr. C. Small) March 7th 2011, pm

6. The principles of palliative care and pain management (Dr. Eileen Mannion)March 7th 2011, pm

7. Diagnosing dying and care of the patient in the last days of life (Dr. Dympna Waldron)March 7th 2011, pm

8. The role of radiology in screening for malignancy – Prof McCarthy March 7th 2011, pm


1. Leukaemia and Myeloma

2. Lymphoma

3. Radiotherapy case discussion – Dr. Small/ Professor Sullivan

4. Radiotherapy side effects – Dr. Martin/ Dr. Pomeroy

5. Radiology MDM preparation - Prof P. McCarthy –Friday midday

6. The role of Interventional radiology in Oncology - Dr. Bielek (Interventional fellow)

7. Oncology emergencies – Dr. Donnellan / Dr. Blazkova

8. Causes and management of GI symptoms in advanced cancer - Dr. Dympna Waldron

9. Breaking bad news - Dr. Eileen Mannion

65

TeachingOutcome

Outcome1-12


MainDepartment

DISEASE States/TopicsAcute leukaemia (ALL, AML) 1 Lecture/clinic/SGT HaematologyChronic leukaemia(CLL, CML)

1 Lecture/clinic/SGT Haematology

Myeloproliferative diseases 1 Lecture/clinic/SGT HaematologyMultiple myeloma 1 Clinic/Lecture/SGT HaematologyBone marrow failure 1 Lecture/WR HaematologyLymphoma 1 Lecture/clinic/SGTGeneration of an x-ray image 1 Lecture/SGT RadiologyPrinciples of basic radiography 1 Lecture/SGT RadiologyRadiation protection both forpatients and staff.

SGT/X-ray dept Radiology

Imaging technologies e.g. MRI,CT and Ultrasound.(Indications and role)

1 SGT/Lectures/X-raydept/MDM

Radiology

Role of interventional radiology 1 SGT/X-ray dept RadiologyRadiological screening formalignancy

1 Lectures/SGT Radiology

Radiological staging 1 Lectures/ SGT RadiologyInformed consent 1 SGT/ X-ray dept RadiologyPrinciples of radiotherapy anddelivery

1 Clinic Radiotherapy

Differences between curative andpalliation radiotherapy.

1 Clinic Radiotherapy

Conditions that need emergencyradiotherapy

1 Lecture/SGT/Clinic Radiotherapy

Early side effects of radiotherapy 1 Lecture/Clinic RadiotherapyLate reactions to radiotherapy 1 Clinic RadiotherapyPrinciples of acute and chronicpain control

1 Lecture/ SGT/WR Palliative Care

Nausea/vomiting in patients withadvanced cancer

1 Lecture/ SGT/WR Palliative Care

Depressive illness 1 Lecture/ SGT/WR Palliative Care

Diagnosis of commonmalignancies (breast, lung, bowel,prostate,ovarian and lymphoma)

1 Lecture/SGT/Clinic Oncology

Staging and monitoring of 1 Lecture/SGT/Clinic Oncology

66

common malignanciesPrinciples of chemotherapy andof hormonal biologic and targetedtherapies


Managing the complications ofcancer and cancer treatment


CLINICAL EXAMINATIONSKILLSHistory taking 1 Clinic AllMultiprofessional team care 1 Multidiscsiplinary

team meetingAll

Assessment of patient withhaematological disease

1 SGT/Clinic/WR Haematology

Assessment of patient withsuspected spinal cordcompression

1 SGT/WR/Clinic Haematology/Oncology/Radiotherapy

Assessment of patients withsuperior vena caval obstruction

1 Clinic/WR/SGT Haematology/Oncology/Radiotherapy

Assessment of patients withcomplications of therapy

1 SGT/Clinic/WR Haematology/Oncology/Radiotherapy

PRACTICAL SKILLS

Venepuncture 2 Wards/Clinic All

Haematological and biochemicalinvestigations and interpretation

2 Wards/Clinics All

Observe taking of blood cultures 2 Wards All

Observe lumbar puncture 2 Wards All

Observe bone marrow biopsy 2 Wards Haematology/Oncology

Observe chemotherapyadministration

2 Wards Oncology/Haematology

Observe blood productstransfusion

2 Wards Haematology/Oncology

Observe use of central venouscatheters

2 Wards Haematology/Oncology

67

Observe use of syringe drivers 2 Wards Palliative careInformed consent 2 Wards/Clinic/

Radiology deptAll

Breaking bad news 2 Wards/Clinic All

Observe pleural tap/paracentesis 2

Observe radiology examinations 2 X-ray Dept RadiologyObserve interventional radiologyprocedure

2 X-ray Dept Radiology

DECISION MAKING ANDINVESTIGATIONSLumbar Puncture 3,4,10 Ward Haematology/

OncologyBone marrow biopsy 3,4,10 Ward Haematology/

OncologyBiopsy (including radiologicalguided)

3,4,10 X-ray Dept Radiology

Radiological diagnosis 3,4,10 X-ray Dept RadiologyRadiological staging 3,4,10 X-ray Dept RadiologyDiagnosis of dying 3,4,10 Ward Palliative careDecision of withdrawal of care 3,4,10 Ward Palliative careDecision of optimal treatment andoptimal timing

3,4,10 Clinics/Ward/Multidisciplinarymeeting

All

PATIENT MANAGEMENT

Radiotherapy (curative) 4 Lectures/Clinics/SGT Radiotherapy

Radiotherapy (palliative) 4 Lectures/Clinics/SGT Radiotherapy

Brachytherapy 4 Lectures/Clinics/SGT Radiotherapy

Chemotherapy 4 Lectures/Clinics/SGT Oncology

Curative and Palliative surgery 4 Lectures/Clinics/SGT All

Pain control 4 Lectures/SGT/ WR Palliative careWithdrawal of care 4 Lectures/ SGT/WR Palliative careManagement of complications oftherapy

4 Lectures/SGT/ WR All

68

PROFESSIONALATTITUDESRole of the doctor 7,8,9,11 All All

Role of the multidisciplinaryteam

7,8,9,11 All All

High quality care 7,8,9,11 All All

Professionalism andconfidentiality

All

Skill of self direction All AllBiological and behaviouralsciences

7,8,9,11 All All

Research and evidence basedmedicine

7,8,9,11 All All

Medical informatics 7,8,9,11 All All

Effective Communication 7,8,9,11 All All

69

MUSCULOSKETAL STUDIES

STUDENT HANDBOOK

Semester 5.2

70

Module Title:

Musculoskeletal: Rheumatology & Orthopaedics



Clinical Module Leaders: Drs John Carey & Robert Coughlan (Rheumatology)Mr. William Curtin (Orthopaedics)

Academic Module Leaders: Profs. Timothy O’Brien & Martin on Donnell.

Clinical Tutors: Dr. Ausaf MohammadMr. Khalid Mohamed.Mr. Michael O’Keefe.

Module Teachers: Drs. Carey, Coughlan, Silke, Whelan, SpRs and Regs Rheumatology.Mrs. Curtin, Devitt, Kaar, Kearns, McCabe, O’Sullivan, Shannon, SpRsand Regs Orthopaedics.Drs. Diane Bergin and Derek Lohan, Radiology.Dr. Vincent Tormey, Immunology

Other:1. Nursing: Geraldine Mannion, Anne Marie , Mary Langan and NanoBurke, Rheumatology. Catherine Armstrong, Assumpta O’BrienOrthopaedics.

2. Podiatry: Mr. Nigel Roberts and David Watterson.

3. Physiotherapy: Ms. Edel Callan, Ms. Joan Moynihan

4. Occupational Therapy: Ms. Valerie Flattery

Contributing Departments: Rheumatology, Orthopaedics, Immunology,Radiology, Occupational & physiotherapy, & Podiatry.

Module aim: To provide structured, faciltated, integrated teaching in the diagnosis,

investigation and management of patients with diseases of the

musculoskeletal and immune systems.

71

Facilities: Rheumatology Department Unit 1, MPUH.- Outpatient Clinic, unit 1.- Rheumatology Day ward and clinic, Unit 1.- Rheumatology teaching room, Unit 1.Rheumatology Inpatients Hospital ground, MPUH.

Dedicated Trauma unit at UCHG comprising:- St. Finbars Ward including meeting room- 2 Orthopaedic trauma theatres

Elective unit at MPUH comprising- Hospital 2- 2 Theatres for elective surgery- Nursing, Physiotherapy, Occupational Therapy staff- Plaster Services- Trauma and Elective outpatient sessions, Unit 2- Orthopaedic study area, Admin Building

Radiology Department, Main Hospital Block, MPUH.HSE library, Administration Building, MPUH.

Delivery of Module:

8 Core Lectures: 4 Orthopaedic, 4 Rheumatology Small group teaching sessions: 9 Rheumatology, 14 Orthopaedics

Include- Tutorials- Interactive discussion groups- Videos

Attendance in outpatient clinics areas Orthopaedic Theatres: Elective and trauma Ward Rounds and inpatient wards Rheumatology Day ward Radiology department, Merlin Park Rheumatology and Orthopaedic conferences Directed self learning

Educational materials required:

72

1. All students are assumed to have a good reference textbook in Medicine, surgery and clinical skills.

2. Students are assumed to have internet access to a variety of learning materials listed in the

bibliography, via the library, and on Blackboard. Included in particular are several appropriate

websites which have excellent, free and extensive downloadable material.

3. Students should consider a small specialty textbook in the following areas:

a) Examination of the Musculoskeletal System.

b) Rheumatology e.g. Primer on the Rheumatic Diseases, John H Klippel.

c) Orthopaedics e.g. Pcoketbook of Orthopaedics and Fractures, Ronald Mcrae

4. Students are expected to wear a white coat and clean and professional clothing.

5. Students are expected to have on their person all their clinical utensils including: Stethoscope,

Reflex hammer, tuning fork, measuring tape, pen light, magnifying glass, pen and Notepad.

Students will be expected to read and prepare in advance of their teaching sessions in order that they

get the most out the interactive discussion sessions.

Formative assessment: Attendance RecordStudent Log book

Summative assessment: Contribution to integrated MCQ and EMQ assessment atthe end of Semester 2Contribution to integrated clinical examination at the end of Semester 2

Student Evaluation: Students will evaluate each cycle of the module on line with reference tocontent, tutor attendance, teacher feedback and suggestion for change ifappropriate.

73

Principles of Module Delivery:

Modules will be delivered in both MPUH and UCHG.The module base will be in Merlin Park University Hospital

A total of 30 Small Group teaching sessions will be delivered throughoutthe 3 week block.

A Module Handbook will be given at the start of the rotation and will also be availableon blackboard.

A Log Book will be provided to each student outlining a series of learning exercisesthat must be signed off on in order to complete the rotation. These need to be signed offas the rotation progresses, not at the end. It is the students responsibility to ensure theseare signed off by the appropriate person.

An Attendance Record will also be kept for each student. It will be the studentsresponsibility to make sure they are in attendance and signed off.

8 Core Lectures will be delivered to the entire class on the morning of 14th February2011and the afternoon of 28th March 2011, 4 in Rheumatology and 4 in Orthopaedics.

LEARNING OUTCOMES

At the end of the module the student will be expected to understand:

1. The epidemiology and societal impact of musculoskeletal diseases2. Assessment of patients presenting with musculoskeletal problems3. Derive appropriate differential diagnoses4. How to assess the impact of MSK diseases on daily living5. Radiologic and laboratory investigations for MSK disorders.6. Basic management plans for common disorders including patienteducation, multidisciplinary approach, pharmacology, common proceduresfor managing some disorders.7. Common musculoskeletal disorders, rheumatic diseases and orthopaedicproblems encountered in daily practice (see list of core topics next page).8. Student’s will also be expected to provide a reflective summary of howthis module changed one of their pre-module perceptions of MSKDs.

74

Core Topics:

1. Joint Disease: Rheumatoid, Osteo, Psoriatic, Ankylosing Spondylitis, Inflammatory Bowel

Disease arthropathy, infectious, gout, pseudogout. Juvenile, Polymyalgia Rheumatica, Reiter’s

Syndrome, traumatic injuries, tumours

2. Bone Disease: Osteoporosis, osteomalacia, Paget’s Disease, avascular necorosis, Osteitis,

infections and tumours of bone.

3. Soft tissue disorders: adhesive capsulitis, tendonitis, bursitis, traumatic injuries,

4. Fractures: type, specific sites, principles of management, complications

5. Joint Replacement: Indications, types, procedures, complications.

6. Multiple severe trauma injury

7. Orthopaedic Emergencies: tumors, infections, acute spinal cord injuries, compartmen

syndrome, vascular and neurologic injuries.

8. Connective tissue diseases: Raynaud’s Phenomenon, Sjogren’s Syndrome. Systemic Lupus

Erythematosus, Scleroderma, vasculitis, myositis, mixed connective tissue disease and overlap

syndromes, Behcet’s Syndrome

9. Regional Pain Syndromes: Fibromyalgia, reflex sympathetic dystrophy, carpal tunnel

syndrome, acute nerve injuries, chronic back pain, spinal stensis

10. Miscellaneous: Auto-inflammatory disorders; Diffuse idiopathic skeletal hyperostosis,

75


Assessment of history taking of musculoskeletal conditions, fractures, joint injuries, arthritis andsystemic connective tissue diseases

Joint Examination: Includes swelling, tenderness, range of movement, specific manoeuvresSpecific joints including knee, shoulder, back, small joints.

Nerve, vascular and Muscle Function ExaminationExamination of Raynaud’s patients including skin, capillaroscopy, tendon friction rubs.Functional assessment including how condition affects activities of daily living and psychosocial well-

being.Multi-disciplinary approach to care


Some practical skills: splint placement, arthrocentesis, nailfold capillaroscopy, DXA, cast placement,sling placement.

Observer performance of nailfold capillaroscopyObserve a DXA (Dual-energy X-ray Absorptiometry) being performedPlace a patient in a slingPlace a patient in a castObserve arthrocentesis video and perform on model.Observe synovial fluid analysis.Observe ANA and ANCA reporting.Perform 1 calcium intake questionnairePerform 1 HAQ, or other functional assessment.

DECISION MAKING and INVESTIGATIONS (Outcomes 3,4 and 10)

Evaluate and interpret evidence from the patient history and assessment demonstrating anability to generate a limited list of diagnoses and problems.Participate in the formulation of plans for further investigations*Use and abuse of diagnostic testing including risks, cost and understanding sensitivity,specificity, positive and negative predictive values.Establish and understand basic treatment plans.Understand the role and importance of informed consent both from the doctor’sperspective and the patients perspective.

*Plain filmsMRI and CT scanUltrasoundDXANuclear MedicineESR, CRP, other laboratory testsANA, ANCA, Rheum Factor, CCP, ENA, C3/C4 and DSDNA testing.

76


Compassionate careTincture of TimeSpecific Therapeutic InterventionsRisks and Benefits of Interventions and principles of evidence based medicineAnalgesia (includes paracetamol, NSAIDs, Tramadol, TCADs, SSRIs and narcotics)Corticosteroids: topical, oral and Injectable.Immunosuppressives (Traditional: hydroxychloroquine, salazopyrin, azathioprine, methotrexate,

cyclophosphamide, allopurinol, colchicine.Biologics: anti-TNF, IL-6, Cd-28 and CD-20)

Calcium, vitamin D, bisphosphonates and other bone drugsManagement of Raynaud’s: non-drug, drugSurgery: examination, arthroscopic, open fixation, closed fixation.

PROFESSIONAL ATTITUDES (Outcome 7,8,9, & 11)

Demonstrate the role of the doctor in chronic disease management.Demonstrate the role of the multi-professional team in chronic disease management.Demonstrate an understanding of the concept and importance of quality care.Demonstrate skills of independence and self direction in theoretical and clinical learning.Understand the role of medical informatics in diagnosis and managementDemonstrate an understanding of the complex biopsychosocial nature of MSK diseases.Understand importance of research and how it benefits patient care.Communicate effectively and sensitively with patients and their relatives.Communicate effectively and politely with professional colleagues.

77

Example of Schedule: Week 1


Lectures SGT Unit 1MPUH

SGTMPUH

SGTMPUH

OrthoConference(7.30am)

9-12AM

Lectures clinictheatreWardsLibraryRadiology

clinictheatreWardsLibraryradiology

clinictheatreWardsLibraryradiology

Rheum SGTUnit 1Arthritis

1-2pm

Lectures SGT Ortho SGT Ortho Med Conference Medical GR

PMLectures

clinictheatreWardsLibrary



Library

Weeks 2 and 3 will be similar with exception of Monday which Will start withorthopaedic Fracture Conference at 7.30am in CSI or UCHG

Week 3 will finish with a wrap up session following the rheumatology SGT session.

Please see log-book for details of student experiences required for this rotation.

78

A Schedule

Merlin Park University Hospital Rheumatology Service Weekly Schedule

TIME Monday Tuesday Wednesday Thursday Friday08.00 - 09.00 Medical

ConferenceU.C.H.G.

MedicalConferenceU.C.H.G.

09.00 10.00 Ward Round Wards Wards Ward Round Journal Club10.00-12.00 Ward Round Wards Wards Ward Round Ward12.30-13.00 Radiology

conferenceWard

13.00-14.00 MedicalConferenceM.P.U.H.

MedicalConferenceU.C.H.G.

14.00-18.00 OutpatientClinic

OutpatientClinic

OutpatientClinic

OutpatientClinic

Note: There will be a post-call round where appropriate. Ward rounds start 30mins following am conference in Merlin, 10 mins UHG.

Outpatients Schedule:

Monday Tuesday Wednesday ThursdayWeek 1 General RA New /Shoulder C.T.D.#Week 2 General RA New /Shoulder J.I.A.Week 3 General RA New /Shoulder C.T.D. #Week 4 General AS New /Shoulder OsteoporosisWeek 5 General RA New /Shoulder C.T.D. #Week 6 General Gout New /Shoulder Osteoporosis# Connective Tissue Disease clinics also attended by Dr. Vincent Tormey

Consultant Immunologist U.H.G. and his specialist registrar.

79

Orthopaedics:Monday AM Theatre UCHG and MPUH

Ward Rounds UCHG and MPUHClinics MPUH

Monday PM Theatres UCHG and MPUHClinics MPUH

Tuesday AM Theatre UCHG and MPUHWard Rounds UCHG and MPUHClinics MPUH

Tuesday PM Theatres UCHG and MPUHClinics MPUH

Wednesday AM Theatre UCHG and MPUHWard Rounds UCHG and MPUH

Wednesday PM Theatres UCHG and MPUHClinics MPUH

Thursday AM Theatre UCHG and MPUHWard Rounds UCHG and MPUH

Thursday PM Theatres UCHG and MPUHClinics MPUH

Friday AM Theatre UCHG and MPUHWard Rounds UCHG and MPUH

80


The module will be delivered both in Merlin Park University Hospital, Merlin Park, Galway andUniversity College Hospital, Newcastle, Galway

The module will be delivered by a series of lectures, interactive discussions, video and hands ondemonstrations.

8 (45 min) lectures will be delivered through the integrated core lecture series for the semester whichwill occur on the first Monday of each module change, 4 in rheumatology and4 in orthopaedics.

There will be several fixed teaching/SGT sessions per week allowing 23 sessions of fixed teachingover a 3 week block during which core topics will be covered.A module handbook will be provided as a guide including schedules, core topics and a bibliographyfor all students. This will also include a log book which the students will be expected to completeduring their rotation; students will need to have this signed off by a Consultant physician and surgeonin order to get credit for their module before they finish their 3 week module.

LECTURES:

Orthopaedics and Rheumatology will team up for these 2 sessions:

Session 1 – Monday AM February 14th

1. Epidemiology of Musculoskeletal Diseases and Osteoarthritis (Dr. John Carey)2. Total Joint Replacement (Mr. William Curtin)3. Osteoporosis, Osteomalacia and Paget’s Disease of bone (Dr. Robert Coughlan)4. Principles of fracture management (Mr. William Curtin)

Session 2 – Monday PM March 28th

5. Orthopaedic Emergencies (Mr. William Curtin)6. Inflammatory Arthritis (Dr. Robert Coughlan)7. Spondyloarthropathies and back pain (Dr. John Carey)8. Orthopaedic surgery and back disorders (Mr. John McCabe)

81


These will be delivered by Orthopaedics (14) and Rheumatology (9), Radiology (2), Multidisciplinary(4), Immunology (1)

Orthopaedics (14)

History and Examination of:1. Shoulder and arm Mr. K. Kaar2. Wrist and hand Mr. M. O’Sullivan3. Neck and upper spine Mr. J. McCabe4. Back and lower spine Mr. A. Devitt5. Hip Mr. W. Curtin6. knee Mr. F. Shannon7. Foot and ankle Mr. S. Kearns

Common problems of the:8. Shoulder and arm Mr. K. Kaar9. Wrist and hand Mr. M. O’Sullivan10. Neck and upper spine Mr. J. McCabe11. Back and lower spine Mr. A. Devitt12. Hip Mr. W. Curtin13. knee Mr. F. Shannon14. Foot and ankle Mr. S. Kearns

Rheumatology (9)

Week 1. Arthritis

Week 2 OsteoporosisBack pain, fibromyalgia and soft tissue disorders

Week 3 Immunologic testing and Connective Tissue Diseases

82

TeachingOutcome

Outcome1-12


MainDepartment

DISEASE STATES

1 SGT1 Wards/Theatres/clinics

CLINICALEXAMINATIONSKILLS


PRACTICALSKILLS


DECISIONMAKING ANDINVESTIGATIONS

3,4,10 SGT

3,4,10 Wards/Theatres/clinics

3,4,10 Radiology DepartmentPATIENTMANAGEMENT


PROFESSIONALATTITUDES

7,8,9,11 SGT7,8,9,11 Wards/Theatres/clinics

83

STUDENT EVALUATION OF MODULE

(COMPLETED ON BLACKBOARD)

Mark each section on a scale 1-5 where 1 is worst and 5 is best, except last three

sections where text is warranted

FEEDBACK RHEUMATOLOGY ORTHOPAEDICS TOTAL

General Organisation

Clarity of Objectives

Core Lectures

Small Group Teaching

Outpatient Clinics

Operating Theatres

Inpatient Ward

Dayward

Best features of module

Worst features of module

Suggestions for Improvement

84

BIBLIOGRAPHY:

Textbooks:

Your general medical and surgical textbooks.

Primer on the Rheumatic Diseases www.arthritis.org

Pocketbook of Orthopaedics and Fractures. Ronald McRae, Churchill Livingstone.

Web References:

1. Bone health and Osteoporosis 300 page PDF and executive summaryhttp://www.surgeongeneral.gov/library/bonehealth/content.html

2. Arthritis Foundation: A voluntary health organization about arthritis and related conditions:http://www.arthritis.org/

3. National Osteoporosis clinicians Guide: http://www.nof.org/professionals/clinical-guidelines

4. International Society for Clinical Densitometry Position Statements:http://www.iscd.org/visitors/positions/OfficialPositionsText.cfm

5. Introduction to bone densitometry and vertebral fracture assessment:http://www.iscd.org/visitors/resources/

6. The scleroderma foundation: www.scleroderma.org

7. The Lupus Foundation: www.lupus.org

8. The Myositis foundation: www.myositis.org

9. The Vasculitis Foundation: www.vasculitis.org

10. British Orthopaedic Association: www.boa.ac.uk

11. American Orthopaedic Association: http://www.aoassn.org/

12. The Paget Foundation: http://www.paget.org/

http://www.arthritis.org/

http://www.surgeongeneral.gov/library/bonehealth/content.html

http://www.arthritis.org/

http://www.nof.org/professionals/clinical-guidelines

http://www.iscd.org/visitors/positions/OfficialPositionsText.cfm

http://www.iscd.org/visitors/resources/

http://www.scleroderma.org/

http://www.lupus.org/

http://www.myositis.org/

http://www.vasculitis.org/

http://www.boa.ac.uk/

http://www.aoassn.org/

http://www.paget.org/

85

You will find many journal articles in the various journals in the library.

We have suggested a few references from The New England Journal of Medicine below which youmight find useful:

1. Acute Monoarthritis. Baker DG. N Engl J Med 1993; 329:1013-1020.2. Gout. Terkeltaub RA. N Engl J Med 2003; 349:1647-1655.3. New Drugs for Rheumatoid Arthritis. Olsen NJ. N Eng J Med 2004; 350:2167-79.4. Therapeutic Strategies for Rheumatoid Arthritis. O’Dell J.R. N Eng J Med 2004;350:2591-602.5. Second-line drug therapy for rheumatoid arthritis. Cash JM. N Eng J Med 1994;330:1368-75.6. Osteoarthritis of the knee. Felson DT. N Eng J Med 2006; 354:841 - 8487. Osteoarthritis of the Hip. Lane NE. N Engl J Med 2007; 357:1413 - 14218. Screening for Osteoporosis. N Eng J Med. 2005; 353:164-71.9. Postmenopausal Osteoporosis. Rosen CJ. N Eng J Med 2005; 353:595-603.10. Paget's disease of bone. Whyte MP. N Engl J Med. 2006; 355:593-600.11. Small-vessel vasculitis. Jennette JC. N Eng J Med. 1997; 337: 1512-23.12. Medium- and Large-Vessel Vasculitis. Weyand CM. N Eng J Med 2003;349:160-9.13. Raynaud’s Phenomenon. Wigley F.M.N Engl J Med 2002; 347:1001 - 100814. Scleroderma. Gabrielli A. N Engl J Med 2009; 360:1989 - 200315. Polymyalgia rheumatica and giant cell arteritis. Salvarani C. N Eng J Med 2002;347:261-271.16. A controlled trial of arthroscopic surgery for osteoarthritis of the knee. Moseley JB.N Engl J

Med 2002; 347:81 – 88.17. Minimally Invasvive total knee arthroplasty for osteoarthritis of the knee. Leopold SS.N Engl J

Med 2009; 360:1749 – 1758.18. Infections Associated with Prosthetic Joints. Del Pozo JL. N Engl J Med 2009; 361:787 – 79419. Vertebral Osteomyelitis. Zimmerli W. N Engl J Med 2010; 362:1022 – 1029.

20. Lumbar Spinal Stenosis. Katz JN. N Engl J Med 2008; 358:818 – 825.

21. Surgical versus nonsurgical therapy for lumbar spinal stenosis. Weinstein JN. N Engl J Med 2008;358:794 – 810

22. Surgical versus nonsurgical therapy for lumbar degenerative spondylolisthesis. Weinstein JN. NEngl J Med 2007; 356:2257 – 2270.

23. Surgery versus prolonged conservative treatment for sciatica. Peul WC. N Engl J Med 2007; 356:2245 - 2256

24. Anterior Cruciate Ligament Tear. Spindler KP. N Engl J Med 2008; 359:2135 - 214225. Video of Knee Arthrocentesis. Thomsen TW et al. N Engl J Med 2006;354:e19, May 11, 2006.

86

NEPHROLOGY / UROLOGY STUDIES

STUDENT HANDBOOK

Semester 5.2

87

Welcome to the Nephrology/Urology ModuleContact for Module coordinator:Dr Bairbre McNicholas 087 [email protected]

Bleep numbers for teamsUrology RegistrarsMr Frank Darcy, Mr Nadeem, Mr FarhadCall via switch to bleeps

Nephrology RegistrarsDr Sinead Kinsella, Dr Michelle O Shaughnessey, DrLockmann Abdul 461, 590Consult SHO 598

mailto:[email protected]

88

At the end of the module the student will have acquired thetheoretical knowledge skills and professional attitudes associated with thefollowing disease processes.

Nephrology:

Acute Kidney InjuryPrimary GlomerulopathiesFluid and Electrolyte DisordersDisorders of Acid-BaseRenal TransplantationHypertension/Renovascular hypertensionSystemic VasculitisPrescribing in Renal DiseasePeritoneal DialysisHaemodialysisHereditary Kidney DiseaseNephrotoxicity and Drug Induced Kidney Disease

Urology:

Benign Prostatic HypertrophyProstate cancer (localised and metastatic)Renal CancerTransitional cell cancerRenal stonesHaematuriaUrinary Tract InfectionsIncontinenceTesticular pain/massesPaediatric UrologyErectile Dysfunction


Nephrology:

General assessment of the patient for signs of uremia and renal replacement therapy.Physical examination of the kidneys and urologic tract and abdominal examination for evidence of PD,renal transplantation or urologic surgery.Accurate measurement of blood pressure, physical examination for complications of hypertension andfor secondary causes of hypertension

89

Examination a patient for evidence of nephritic or nephrotic syndromes including evidence ofassociated systemic diseases.Examination of a patient for complications of chronic immunosuppressive therapy.

Urology:Urological History takingAssessment of lower urinary tract symptomsAssessment of haematuriaAssessment of renal colicAssessment of testicular massesDigital rectal examinationBalloting kidneyAbdominal examination

PRACTICAL SKILLS (performance and interpretation).

Nephrology:Interpretation of the electrolyte panel and renal profileCalculation and interpretation of true GFR and estimated GFR.Interpretation of serological investigations (ANA, ANCA, complement, immunoglobulins)Interpretation of urinalysis and microscopic examination of the urine sediment.Basic interpretation of urine osmolality, pH, electrolytes and stone constituents.Drawing of venous and arterial blood samplesInterpretation of arterial blood gas and calculation of anion gapInterpretation of hematologic profile in chronic kidney diseaseInterpretation of calcium, phosphorous, PTH and bone markers in chronic kidney diseasePreparation for haemodialysis (understanding commencement and vascular access)Preparation for peritoneal dialysisPreparation for contrast radiology investigations in CKDTransplantation work-upWithdrawing dialysisBreaking bad news (outcome 6)Interpretation of 24 hour BP monitoring

UrologyVenepunctureObserve flow rate and residual urineObserve prostate biopsyCatheterisation of modelObserve cystoscopy/TURP/TURBTObserve renal ultrasoundObserve lithotrypsy

90

RadiologyChest x rayAbdominal USIVPIsotope RenogramsAbdominal CT/angiographyAbdominal MRI/MRARenal ultrasoundTesticular ultrasound

91

NEPHROLOGY SCHEDULE – University Hospital Galway Week 1Mon Tues Wed Thurs Fri

8am-9am SurgicalGrand Rounds(All)

Case ConferenceUHG (all)

ConferenceUHG (all)

Journal Club MPUH(8.15am start 1,2,3,4)

Lectures all day9am-12pm

12-1pm

Ward RoundSpR(1,2,3,4,5)

Half day study6,7,8,9,10,11

OPD MPUHUnit 1(6,7,89,10,11)

Ward WorkMPUH HospGround(1,2,3,45)

Consultant WardRound MPUHHosp Ground(1,2,3)Consultant WardRound UHG(4,5)

PD nursetutorial6-11

10 am. CAPD OPD:MPUH Unit 1(9,10) seenoteWard Work MPUHHosp Ground(7,8,9,10,11)

1pm-2pm

CPC MPUHBoard Room (1-10)

Grand Rounds UHGCSI (All)

2pm-5pm

Ward WorkMPUH HospGround(6,7,8,9,10,11)

Half day study1,2,3,4,5

Merlin ParkTutorial (ALL)

Diabetes RenalOPD UHGdiabetes centrethird wed (Seenote)

Half day study1-10

Ward WorkMPUH HospGround (6-11students)

Ward Work MPUH HospGround (1,2,3,4,5)

Half day study(6,7,6,9,10,11)

5-6PM St Pius Ward,Mr Walsh tutorial(ALL)

92

UROLOGY WEEKLY SCHEDULE – University Hospital Galway Week 1

Mon Tues Wed Thurs Fri




9am-1.30pm

1PM

Lectures all day Theatre(12,13)St Pius Ward(14,15)Surgical DayWard (16,17)

Ultrasound(21 22)

St Pius Ward(12,13,14)Surgical DayWard (15,16)

Theatre (21,22)

Ultrasound 19,20

RAPC (15,16)

Theatre (19,20)

St Pius Ward(17,18)

Surgical DayWard (12)

Half day study21,22Ultrasound 13,14

RAPC (21,22)

Theatre 17,18

St Pius Ward (19,20)

Surgical Day Ward(15,16)Ultrasound (12,13)

1pm-2pm

Grand rounds MedicineUCHG

2pm-5pm

Theatre(18,19)

Surgical DayWard(20,21,22)


Theatre (15,16)

Half day study13, 14,

Ultrasound 17,18

Urology clinic(21,22)

Theatre (14,15)All others Half day study



93

NEPHROLOGY SCHEDULE – University Hospital Galway Week 2Mon Tues Wed Thurs Fri


Case ConferenceUHG All

ConferenceUHG


9am-1.30pm

1PM

OPD MPUHUnit 1 (11-14)Ward WorkMPUH HospGround (19-22)

Half day study15,16,17,18

Prof McCarthytutorial All

Ward RoundSpR (19-22)

Half day study11-18

OPD MPUHUnit 1 (15-18)

Ward WorkMPUH HospGround (19-22)

Consultant WardRound MPUHHosp Ground(11,12,13)Consultant WardRound UHG(14,15)

PD nursetutorial16-22

10 am. CAPD OPD:MPUH Unit 1(See note)Ward Work MPUHHosp Ground (15-18)

1pm-2pm

CPC MPUHBoard Room(All)


2pm-5pm

Consultant wardround UHG(15,16)ConsultantWardRoundMPUH HospGround ( 17,18)

Half day study 11-14, 19-22

Ward WorkMPUH HospGround(15-18)


Diabetes RenalOPD UHGdiabetes centrethird wed (Seenote)

Ward WorkMPUH HospGround (11,14students)

Ward Work MPUH HospGround (19-22)

Half day study 11-18


94

UROLOGY SCHEDULE – University Hospital Galway Week 2Mon Tues Wed Thurs Fri

8am-9am Students 1-8 are toattend prostatebiopsy clinic withProfessorMcCarthy (seenote)

SurgicalGrand Rounds(All)



9am-1.30pm

1PM

RAPC (1,2)Theatre (3,4)St Pius Ward (5,6)Surgical Day Ward(7,8)

Prof McCarthytutorial ALL

Theatre (1,2)St Pius Ward(3,4)Surgical DayWard (5,6)Ultrasound(7,8)

St Pius Ward(9,10,11)Surgical DayWard (3,4)

Theatre (5,6)Ultrasound (1,2)Study 7,8

RAPC (5,6)

Theatre (9,10,11)

St Pius Ward(7,8)

Surgical DayWard (1,2)Study (3,4)

RAPC (9,10,11)

Theatre (7,8)

St Pius Ward (1,2)

Surgical Day Ward(5,6)

1pm-2pm


2pm-5pm

Urology clinic(9,10,11)

Theatre (1,2)Ultrasound (3,4)

Half daystudy5,6,7,8

Theatre (7,8)

Surgical DayWard(9,10,11)Ultrasound(5,6)


Theatre (3,4)Ultrasound (9,10)

Urology clinic(7,8)

Theatre (3,4)


95

NEPHROLOGY SCHEDULE – University Hospital Galway Week 3




ConferenceUHG (all)


OPD MPUHUnit 1(7,8,9,10,11)Ward WorkMPUH HospGround (5,6)

Half day study(1,2,3,4)

9am-12pm

12-1pmProf McCarthyRadiology tutorial(all)

Ward RoundSpR(6,7,8,9,10,11)


OPD MPUHUnit 1 (1.2.3.4.5)

Ward WorkMPUH HospGround(6,7,8,9,10,11)

Consultant WardRound MPUHHosp Ground(6,7,8)Consultant WardRound UHG(9,10,11)

PD nursetutorial1,2,3,4,5

10 am. CAPD OPD:MPUH Unit 1(3,7,9) seenoteWard Work MPUHHosp Ground(6,7,8,10,11)

1pm-2pm

CPC MPUHBoard Room (1-10)


2pm-5pm

Consultant wardround UHG (1,2)ConsultantWardRoundMPUH HospGround ( 3,4)

Ward WorkMPUH HospGround(1,2,3,4,5)



Diabetes RenalOPD UHGdiabetes centrethird wed(9,10,11)

Half day study1-10

Ward WorkMPUH HospGround(1,2,3,7students)

Ward Work MPUH HospGround (1,2,3,4)

Half day study (others)


96

UROLOGY SCHEDULE – University Hospital Galway Week 3


8am-9am Students 9,10, 21,22 are to attendprostate biopsyclinic withProfessorMcCarthy (seenote)

SurgicalGrand Rounds(All)



9am-1.30pm

1PM

RAPC (21,22)Theatre (19,20)St Pius Ward(13,14)Surgical Day Ward(15,16)

Prof McCarthytutorial All

Theatre(15,16)St Pius Ward(17,18)Surgical DayWard(19,20,21)

St Pius Ward(12,13,14)Surgical DayWard (15,16,17)

Theatre (19,20)

RAPC (17, 18)

Theatre(20,21,22)

St Pius Ward(17,18,19)

Surgical DayWard (13,14)

Half day study17-22

RAPC (13,14)

Theatre (15,16)

St Pius Ward (17,18)

Surgical Day Ward(19,20,21)

1pm-2pm


2pm-5pm


Theatre (12)

Theatre(14,22)

Surgical DayWard(11,12,13)

Merlin ParkTutorial (ALL)Theatre (21,22)

Half day study13,14,17,18


Theatre (12,22)All others Half day study


97

Group 1 (4 - 21 Jan) Group 2 (24jan-11Feb) Group 3 (14 Feb -4 Mar)1. Binti Nordin, Siti Nur

Fariza 1. Bin Zanail, Mohamad 1. Ballal, Mohamed2. Binti Hashim, Nor

Haryanti 2. Brennan, Ronan 2. Broderick, Louise

3. Brandon, Lisa 3. Casby, Caoimhe 3. Casby, Caoimhe

4. Cahill, Maeve4. Che Mat Nor, Sarah

Murniati 4. Chan, Justin

5. Dalton, David 5. Daly, Caoimhe 5. Davies, Katrina

6. Doyle, Caitriona 6. Flood, Laura 6. Duignan, Georgina

7. Flaherty, Rita 7. Harkin, Grace 7. Gaffney, Laura

8. Gormley, Greta 8. Johnston, Ian 8. Healy, Gerard9. Haji Razali, Hazdalila

Yais 9. Kelleher, Barry 9. Jordan, Adrian

10. Hussey, Michael10. Kirtgu Jeyarajah,

Shivashini 10. Juman, Sabrina

11. Keane, Colm 11. Liddy, Emer 11. Kelly, Ronan

12. Lau, Alexandra 12. McDonnell, Christina 12. Loftus, Darragh

13. Lee, Brian 13. Melvin, Martina 13. McGovern, Matt

14. McDermott, James 14. Mohd Asri, Nur Atikah14. Mhd Jabar, Mohd Kelana

Harisa

15. McLoughlin, Penelope 15. Muslim, Azrin 15. Mieske, Kelly16. Mohd Rosli, Ritzzaleena

Rosli 16. NicDhonncha, Eilis 16. Muhd Ramdan, Nur Izyan

17. Murphy, Stephen 17. O'Connell, Aine 17. NiChathasaigh, Maire

18. Ngimron, Anie 18. Raman, Nur Aini 18. O'Connor, Simon

19. O'Callaghan, Niamh 19. Sheehan, Joseph 19. Puasa, Noremyliana

20. Roarty, Ciaran 20. Tummon, Ailbhe 20. Stack, Roisin

21. Sharma, Kapil 21. Vaughan, Ruth 21. Gleeson, John

22. Sweeney, Eileen 22. Cummins, Donna

Group 4 (Mar 6-Mar 25) Group 5 (Mar 28-Apr 15)

1. Aslam, Tayyab 1. Abdul Razak, Ahmad

2. Beatty, Kenneth 2. Binti Mohamad, Muhd Iqbal

3. Binti-Aziz, Azliana 3. Boggs, Jennifer

4. Burke, Thomas 4. Byrne, Meave

5. Coleman, Ciaran 5. Connolly, Laura

6. Devine, Alan 6. Dolan, Steven

7. Feinberg, Damon 7. Fennessy, Paul

8. Gately, Ryan 8. Gorman, Aine

9. Heavey, Laura 9. Hamza, Moayed

10. Ismail, Farhana 10. Heerey, Adrienne

11. Joyce, Kenneth 11. Kane, Nuala

12. Kiely, Aoife 12. Kyne, Karen

13. Mannion, Maria 13. Marion, Mohd Ikhwan

14. McInerney, Angela 14. McAnena, katherine15. Md. Almi, Siti

Norhidayah 15. McLoughlin, James

16. Morcos, Miray 16. Mohd Saufi, Siti Safinah

17. Mulligan, Sarah 17. Murphy, Michael

18. Ntoni, Lisani 18. Nik Muhamad Affendi, Nik Arsyad

19. O Donoghue, Caroline 19. O Tuathail, Maitiu

98

20. O'Sullivan, Michael 20. Power, Laura

21. Sugrue, Gavin 21. Stephen Ambrose,Stephanie C

22. Tan, Andrew Xia Huang 22. Sullivan, Tadhg

FIXED TEACHING SESSIONS (SGT) (9)Nephrology (5):Kidney transplant (Prof Griffin)Renal replacement therapy (Dr Reddan)Hypertension(Dr Lappin)Polycyctic kidney disease/hereditary kidney disease (Dr Reddan)Diabetic nephropathy (SpR)

Wednesdays 2-3PM Beside Coffee shop in Merlin ParkAdditional tutorial will be on Thursday 2-3, Groups will be informed of this inadvancePD session with PD nurse will be scheduled for a Wednesday during rotation:Groups will be emailed at start of sessionregarding this date

Urology (4)Urological history, examination and interpretation of urological investigations(SpR)Testicular lumps (Mr Jaffrey)Incontinence (Mr Walsh)Erectile dysfunction (Mr Rogers)

Radiology teaching sessionsEach student must attend

1. Prof McCarthy tutorial 12-1pm every Monday (no rescheduling for Bankholidays)

2. Attend and observe a prostate biopsy3. Attend an ultrasound session

PD nurse teaching session:10:30- 1PM in the PD unit (bottom of Unit 1 Merlin Park Galway)

99




Summary of Regulations

5 year Medical Curriculum

100

Summary of the most relevant regulations for the 5-year medical curriculum at NUIG

This summary is an attempt to summarise the main provisions of the Regulations governing the Degrees of M.B., B.Ch.,B.A.O. It may not be read in place of the Regulations or taken as the Regulations. Students are advised to refer to theCollege Calendar following links from http://www.nuigalway.ie/medicine/ where the Regulations are set out.

1- Progression to the next year will only be possible after successful completion of all modules of the previous year.

2- You may be refused entry to the examinations in any module if your attendace has been unsatisfactory or you have notcompleted specific required assignments during the course of the module. In this case, the specific requirements will havebeen appropriately specified with an announcement in Blackboard at the beginning of the course.

Satisfactory attendance is generally regarded as attendance and participation in not lessthan 70% of the Compulsory components of the programme. All such components areappropriately notified in the course information material provided to students. Attendanceat not less than 70% of these components is a pre-requisite for taking the assessments andexaminations of the relevant semester and /or year-of-programme. Students deemed to haveunsatisfactory attendance will be excluded from the examinations of that programmecomponent, or of the module(s) in which these components occur, and in the event thatexaminations are taken, any results will be rendered null. The provisions of this requirementmay only be varied by the approval of the School Executive Board where exceptionalcircumstances beyond the control of the student are clearly demonstrated to its satisfaction.

3- Repeat examinations or re-sits. Examinations of all modules failed or deferred in the corresponding regular session(Christmas and/or May) can be re-taken in the August session.

4- Deferral (i.e. sitting at next available session) and leave are permitted only in cases of particular and seriouscircumstances such as bereavement, personal or medical circumstances, which can be professionally orindependently verified. Request should be made to the appropriate Module Director or to the Year Co-ordinator who willforward it to the Student Affair Committee. For foreseen conditions (e.g. pregnancy) requests should be made at least 3months in advance. Short notice will only be accepted in urgent or acute circumstances. Deferring first sitting exams willnot imply any mark penalties (e.g. see point 11)

5- Continuous Assessments are obligatory. Exemption from taking continuous assessment tests can apply only in case ofparticular and serious circumstances (see point 4) provided that the corresponding Module Directors agree. In this case thefinal module mark will be calculated on the basis of the rest of the performance in the particular module(s). Request can bemade to the individual Module Director or to the Year Co-ordinator

6- If any module remains failed or incomplete following the August examinations the year as a whole has been failed andthe student cannot progress to the following year.

7- Students who do not successfully pass their year of programme (as per par. 6 above), and provided they remain within theoverall time-limit for the completion of the Medical degree (as per par. 9 below), are required to register for the repeatyear, to re-attend and complete continuous assessments and examinations in all failed modules. This requirement canonly be varied in exceptional circumstances on the recommendation of the Student Affairs Committee, and agreed by theHead of the Medical School.

8- A student who fails a year for the second time (the same year twice or two different years) may not continue and mustwithdraw from the Medical degree programme.

http://www.nuigalway.ie/medicine/

101

9- Notwithstanding the requirement to repeat, and the provision of repeat facilities in any year of programme, as set out above(Paragraphs 1, 6, 7 and 8), there is an overall time-limit for the successful completion of the Medical Degree. The five-year programme must be completed within six academic years (12 semesters) overall. Any combination of failed years thatmakes this impossible to attain, results in immediate withdrawal from the Medical programme.

10- The Compensation rule may apply to students at the end of the year:

Where a student has a failing mark (less than 50%) in a module or modules to a total not exceeding a maximum of 6credits, but has attained 45% or more in this /these module(s), this element of the programme may be deemed to bepassed by compensation.For this to happen, the student needs to have

failed a total of not more than 6 ECTS credits, if they fail a greater component of the programme,compensation cannot apply, even though some modules may have marks between 45 and 49%.o Possible combinations include a single 6 module up to 6 credits or 2 x 3 credit modules

a surplus of marks across the remaining modules which is at least double the deficit;o e.g. if a student has failed failed a single module (of 6, of 4 or of 3 credits) at 46% they are 4 marks

short and need 8 marks to spare above the pass mark across the other modules of the year.o Where they have failed 2 modules (of 3 credits each) they must have double the total marks that are

short of the Pass [e.g if the module marks are 45% and 47% they are (-5)+(-3) = - 8 marks and require16 marks surplus across the remaining modules.

Attained not less than 45% in any failed moduleNotes:Compensation may be calculated on the Summer examination session or the Autumn (repeat) session, but cannot becalculated across any combined result of the two sessions.

Students failing the examination through any other combination of results will have to repeat the examination in anymodules which were failed.

11- Independent of the score achieved, passing a module in a repeat session, will automatically result in a mark of 50%for that particular module. This will be the module mark used for calculating the final mark of the year, which in turnwill impact on the final graduation mark (see points 13 & 14).

12-13- Exemptions from taking specific modules can be granted in 1MB3 and 2MB3 on the basis of previous academic

achievement and at the discretion of the corresponding Module Coordinator. Request must be made to the ModuleDirector who will forward it to the Student Affair Committee. In case of exemptions, the mark of the correspondingmodule will automatically become 50%. This mark will be the module mark used for calculating the final mark for theyear, which will in turn impact on the final graduation mark (see point 13).

14- For students who entered 1MB3 in September 2008 or later, the final graduation mark will take into considerationthe performance in the examinations for the entire 5-year course according to the following scheme:

1MB3 will account for 10%2MB3 will account for 10%3MB3 will account for 20%4MB3 will account for 30%5MB3 will account for 30%.

14- For students who entered 1MB3 before 2008 the final graduation mark will only take into consideration the resultsfrom the examination for years 3MB3, 4MB3 and 5MB3 and will be calculated according to the following scheme:

3MB3 will account for 20%4MB3 will account for 40%5MB3 will account for 40%.

15- Students who receive a late offer can enter 1MB3 if no less than 2 weeks of the course has run, if later than 2 weeksstudents have to enter into the Foundation Year.

16- Change of mind to switch from 1MB3 to Foundation Year is only possible within the month of September.

102

EXAMINATION & VACATION SCHEDULE2010/2011

FINAL MEDICAL YEAR

Semester I : 30/08/2010 - 17/12/2010

Teaching ends December 17th - Final Medical Written Exam December 17th

( 3 Hour Exam)

Christmas Vacation: 19/12/2010 - 03/01/2011

Semester II : 04/01/2011 - 21/04/2011

Easter Vacation: 22/04/2011 - 25/04/2011

MCQ x 2 April 20th , Combined Clinical Exams April 27th – 29th

(2 x 2 Hour MCQ’s + Clinical Exams)

Semester II (Contd.): 02/05/2011 - 27/05/2011(Intern Shadowing)Skills OSCE May 26th & 27th

Easter Sunday in 2011 is on April 24th

Documents

MD505 – SEMESTER 5.2 Final Medical Year - NUI Galway · Semester 5.2 Welcome to the second semester of the final year of your undergraduate medical curriculum. ... OSCE post clinical