|(1) Using an identified assessment tool(s) or framework (s) compare and contrast advanced
assessment of two clinical cases with altered health states arising from different body
systems. Raw data such as the health assessments and any supporting data should be
included in an appendix. . Word limit: 3500 words.
(2) Objective Structured Clinical Examination (OSCE)
Completion of structured, systematic, and holistic patient/client assessment within an Objective Structured Clinical Examination (OSCE). Students will be required to demonstrate safe practice in the systematic assessment of undifferentiated health problems, identify cues, specify abnormal findings, interpret findings, formulate a differential diagnosis, identify their management plan, engage in shared decision making with the patient and make relevant referrals.
(3) Clinical Log
Completion of five formative clinical examinations and five summative clinical examinations (focussing on at least five different body systems). These must demonstrate safe practice to the satisfaction of the supervisor and marker and include consultation skills, history taking, physical assessment skills, interpretation of findings, differential diagnosis, development of an action plan and critical reflection on cases.
|• Successful completion of Level 3 Physical Assessment of Adults Module (essential for students taking stand alone option)
• Normally three years’ recent experience in an area of autonomous clinical practice
• Evidence of academic credits at level 3 within the last five years
• For students on the MSc programme of study it is recommended that the Decision Making and Advanced Role Concepts modules are completed first.
|To carry out structured systems-based physical examinations and health assessments within their professional practice context.
To focus on the complex skill of assessing undifferentiated health problems, as well as ongoing health problems, to devise differential diagnoses, develop management plans and make appropriate referrals.
To examine knowledge and understanding of normal physiology and pathophysiology of disease using a body systems approach linking this to patient assessments.
To define assessment and examine the purposes of assessment.
To examine clinical judgement by identifying clinical phenomena that manifest in patients/ clients, examining clinical data that refer to clinical phenomena (including assessment data), considering the outcome of assessment (the condition, clinical or health state), and exploring the diagnostic reasoning process.
To critically analyse the evidence base for the assessment and treatment of altered health states, to critically analyse current assessment frameworks, and to evaluate the implications for care.
|On completing this module the student should be able to:
Subject knowledge and understanding
Demonstrate understanding of generic consultation skills and application of clinical frameworks within patient assessments
Recognise professional boundaries and conduct, accountability of the advanced practitioner, referral pathways, safe practice, and understands the issues relating to patient consent and dignity
Use knowledge of health problems and their associated signs and symptoms to make accurate differential diagnoses
Analyse clinical data in the context of health and disease and assess their probable significance
Use a structured and systematic approach in patient assessment, linking clinical data to clinical knowledge within a holistic framework, to arrive at a differential diagnosis of the condition or altered health state
Evaluate the evidence in support of diagnostic theories
Evaluate the evidence in support of clinical decisions and the management plan
Evaluate the effectiveness of approaches to the diagnosis of the health state or condition, and to the promotion of health and management of altered health states
Key transferable skills
Demonstrate effective communication with patients to facilitate systematic physical examinations and health assessments
Draw on research evidence to support clinical judgements about clinical conditions/ altered health states and related interventions
Demonstrate systematic patient assessments and physical examinations within clinical settings
Apply complex skills of systematic and holistic assessment of undifferentiated health problems and ongoing health problems to make accurate differential diagnoses, safe management plans and appropriate referrals
Act autonomously, using skills acquired, within guidelines of supervision.
|• Cognitive Assessment: including clinical judgement and clinical reasoning (includes diagnostic strategies employed in reaching a diagnosis).
• The Health History: Demonstrate advanced communication skills in autonomous healthcare practice.
• Advanced clinical assessment: Of the main body systems to include the central nervous system, respiratory system, cardiovascular system, gastrointestinal system, mental state and cognition, skin, musculoskeletal system and the special senses: (eyes/ vision, vestibulo-cochlear function).
• Differential diagnosis: Analysis of clinical cases including weighting of cues, pattern matching to develop differential diagnosis, including probabilistic reasoning, clinical prediction rules, etc.
• Evaluation: Critical analysis of current frameworks for assessment. Critical analysis and reflection on the practitioner’s role and evidence of contribution to the development of the role. Evidence of autonomous and advanced practice and critical analysis of the evidence for practice.
|Methods of Teaching/Learning
|Taught: 68 hours
Workshops 36 hours
Practice: 2 hours per week with clinical mentor
Lectures, demonstration and practice of assessment techniques, facilitated ‘differential diagnosis’ workshops and simulated cases, formative Objective Structured Clinical Examinations and tutorials.
CD ROMS, videos, audiotapes, and supervised practice.
|ESSENTIAL READING LEVEL
Bickley L S 2003 Bates’ guide to physical examination and history taking, 8th edn. Lippincott Williams and Wilkins, Philadelphia
(Pocket companion also available)
Epstein O, Perkin D G et al. 2003 Clinical examination 3rd edn. Mosby, Edinburgh
Douglas G Nicol F Robertson C eds. 2005 Macleod’s clinical examination 11th edn. Elsevier Churchill Livingstone, Edinburgh
Talley N J, O’Connor S 2006 Clinical examination A systematic guide to physical diagnosis 5th edn. Elsevier Churchill Livingstone, Edinburgh
Heneghan C Glasziou P Thompson et al 2009 Diagnostic strategies used in Primary Care. British Medical Journal, Vol 338, 1003-06.
RECOMMENDED READING LEVEL
Ballinger A Patchett 2003 Saunders’ pocket essentials of clinical medicine 3rd ed. Saunders Elsevier, Edinburgh
Carnevali D L Thomas M D 1993 Diagnostic reasoning and treatment decision making in nursing J B Lippincott Company, Philadelphia
Crow R Chase J and Lamond D 1995 The cognitive component of nursing assessment: an analysis Journal of Advanced Nursing 22 (2): 206-212
Hopcroft K Forte V 2003 Symptom sorter 2nd edn. Radcliffe Medical Press Ltd., Abdingdon
Jarvis C 2004 Physical examination & health assessment 4th ed. Saunders, St Louis
(Pocket companion also available)
Kumar P Clarke M 2005 eds. Clinical medicine 6th edn. Elsevier Saunders, Edinburgh
Longmore M Wilkinson I B et al 2004 Oxford handbook of clinical medicine 6th edn. Oxford University Press, Oxford
Marieb E N 2004 Human anatomy and physiology 6th ed. Pearson Benjamin Cummings, London
McGee s 2007 (2nd ed) Evidence based Physical Diagnosis Saunders.
Moon G, Gould M et al. 2000 Epidemiology: an introduction. Open University Press, Buckingham
Porth C M 2004 Essentials of pathophysiology. Concepts of altered health states Lippincott Williams & Wilkins, Philadelphia
Raftery A T 2005 Differential diagnosis 2nd ed. Elsevier Churchill Livingstone, Edinburgh
Silverman J Kurtz S Draper J 2005 Skills for communicating with patients 2nd edn. Radcliffe publishing, Oxford
Thompson A Dowding D 2002 Clinical decision making and judgement in nursing Churchill Livingstone, Edinburgh
Wulff H R Gøtzsche P C 2000 Rational diagnosis and treatment. Evidence-based clinical decision-making 3rd edn. Blackwell Science, Oxford
BACKGROUND READING LEVEL
See reference lists accompanying sessions
Journals and websites
British Medical Journal www.bmj.com
The Department of Health www.dh.gov.uk
Emedicine accessed 13/2/07 http://www.emedicine.com/
Feied C Handler J Pulmonary embolism Emedicine accessed 13/2/07 http://www.emedicine.com/emerg/topic490.htm
Clinical skills on line St George’s e-learning unit accessed 13/2/07 www.etu.sgul.ac.uk/cso/
University of California A practical guide to clinical medicine accessed 13/2/07 http://www.medicine.ucsd.edu/clinicalmed/lung.htm
|3RD AUGUST 2010