Students

Overview

Welcome to the Medical Student’s Page.

Here you can find links, case studies and useful resources as well as hints for your exams.

Emegencypedia aims to provide up to date “FOAM” for Medical Students at U-SydUWS and other universities.

All educational resources on this Website will be focused on learning the basics of Acute Medicine and Critical Care.

We will also keep a focus on professional development topics and look at the techniques to help you pass your Exams!

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BASIC CLINICAL SKILLS

  • History Taking Tips
      • We see many medical students starting to take histories cutting the patient off. Don’t do this.
      • Let the patient talk, establish a rapport first and establish the history details later by leading the patient with your questions
      • The patient is an expert in their symptoms AND you are an expert in their management
      • A Demonstration of the importance of open ended questions – CLICK HERE
      • Good history taking is the key to diagnosis and the key to success in OSCE and Long Case Examinations
      • We recommend using ‘SOCRATES’, ‘ICE’ and ABC Social History (see below)
      • Giving a clear and concise description of the patient’s presenting complaint, how it has affected them and their social circumstances are the most important aspects in presenting a case
      • Formulating an investigation and management plan based on this information should be done in an organised manner.
      • We describe how to do this for Long Case Examinations HERE
      • How do you effectively present a case to a collegue – CLICK HERE to view our suggestions on how to develop this skill
  • SOCRATES – for the History of Presenting Complaint
  • Site                  Where is the pain?
  • Onset               When did it come on and how has it changed?
  • Character         What is the pain like?
  • Radiation         Does it go anywhere or does it stay in one place?
  • Alleviation        What makes the pain better?
  • Triggers            What makes the pain worse?
  • Extra                Associated Symptoms…? (I.e. Nausea, Breathlessness…)
  • Severity            Ask the patient to score pain from 1 to 10 (with 0 as no pain)
  • Alternative Method P.Q.R.S.T.
  • Pain – What Provokes the Pain
  • Quality
  • Radiation
  • Severity
  • Timing
  • Ideas, Concerns and Expectations (I.C.E.)
  • Ideas (What are you most worried about?)
  • Concerns (Is there something else?)
  • Expectations (Is there one thing we could do to make you more comfortable?)
    • These questions are possibly the most important from the patient’s point of view and the first to be discarded by the Doctor when time is short…
    • An effective management plan requires patient concordance (including patient understanding and insight).  ICE will help the medical team tailor the plan to the individual patient.
  • Alcohol (important in chronic liver disease and transplant)
  • Bonking (important in male diabetics)
  • Cigarettes (important in all patients)
  • Driving (important in seizures)
  • Employment
  • Finances (Social Supports and Benefits) and Family Support / Carers
  • GHB – and other Illicit Drugs
  • Hobbies
  • Immunisations (e.g. Flu and Pneumonia Vaccination)
  • Journeys – Travel (especially overseas travel)
  • Kangaroos (Pets)
  • LMP – (12-60F pregnant until proven otherwise)

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  • The Clinical Examination 

    • The Overall Patient Assessment includes “3 systematic parts” – History, Examination and Investigations

All 3 aspects of the ‘medical assessment’ are important and all may be used to varying degrees when it comes to making a diagnosis.  Of the 3 aspects of assessment, examination has been ‘relegated’ to the least favoured in modern healthcare.  In the age of ‘Osler‘ it may have been the most important.  The de-emphasis of examination stems from the increased reliance on investigations as well as the non-reproducibility of clinical signs.  Deficiencies in the accuracy of examination have been demonstrated in a number of clinical studies.  In addition, there is a need for early recognition of pathology so more sensitive tests (usually investigations rather than examination) are more likely to lead to a timely diagnosis.

Having said all this, examination skills are an important part of the modern medical curriculum and can be helpful in helping to make a diagnosis in some situations.

We outline the fundamentals of examination below:

    • Basic Examination
      • In all Clinical Examinations:
          • Introduce yourself to the patient
          • Check the patient’s identity
          • Explain the purpose of the examination (and obtain consent)
          • Ask whether the patient has any pain
          • If you are being observed tell the patient you may be ‘talking to your colleague(s) as you go
          • Present your findings at the end of your exam succinctly
      • Generally 4 Main Phases of most clinical examinations:
        • INSPECTION
        • PALPATION
        • PERCUSSION
        • AUSCULTATION

As an Example – The Respiratory Examination

      • or… In a MSK (orthopaedic) Examination
        • LOOK (Inspection)
        • FEEL (Palpation)
        • MOVE (Passive and Active)

As an Example – The Knee Examination

    • Inspection
      • What are the key aspects on Inspection?
        • General Inspection (end of the bed inspection – take a step back – look around the bed and look at the patient – I recommend telling the patient you are doing this and an the same time saying that you “are going to talk to your colleagues” as you go – this can put the patient at ease when you say things like “there is no evidence of clubbing” to the observing doctors/students
        • Focused Inspection (e.g. hands, face, abdomen) – moving on in the examination requires inspection of the new area as the first step each time
        • Vital Signs (NB – vital signs are vital) – vital signs are especially important in critically unwell patients as a first step but are usually integrated into the clinical exam routines as you proceed – for example Blood Pressure is normally taken in the respiratory and cardiovascular examination).
            • Vital signs include Respiratory Rate, Blood Pressure, Oxygen Saturations, Temperature and Pulse Rate.

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THE ART OF PRESCRIBING

  • Fluid Prescribing is a poorly taught and frequently confusing topic:
  • Moving from being a senior medical student to an Intern (or foundation doctor) can be a big jump – everyday tasks such as prescribing can be a challenge:
    • We recommend spending extra time on writing out drug charts (and checking them carefully against a reliable resource such as MIMS, BNF or AMH)
    • Gently ‘avoid’ interruptions as these can lead to significant mistakes:
      • Junior Doctor to Nurse: ‘Thanks for letting me know, I’ll get to that as soon as I can, could you come back in 5 minutes after I’ve checked this drug chart carefully. Come straight back and get me if anything changes with the patient or you are concerned.’

    • Here is a guidance on acceptable terminology for Prescribing
    • Click Here for more discussion on Human Factors

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ACEING YOUR OSCE

  • EmergencyPedia’s Review of Surgical Topics for Finals – DOWNLOAD HERE
  • Overview of How to Pass Clinical Examinations such as ‘OSCEs’ – DOWNLOAD HERE
  • McLeod’s Examination Demonstration Videos – CLICK HERE
  • Talley and O’connor Examination Series Videos – CLICK HERE
  • Ask Doctor Clarke – CLICK HERE
    • (Login requires an academic email or a request to the site for a password)
  • Clinical Examination can be confusing: Our helpful Heart Sounds tutorial can be downloaded online: CLICK HERE

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THE EMERGENCY DEPARTMENT FOR STUDENTS

The practice of Emergency Medicine is different to the traditional teaching of history and examination outlined above. You may have minimal information on which to base your decisions, a lack of time, competing priorities and multiple patients at once.

Therefore, the primary roles of the emergency doctor or nurse are to:

  1. Resuscitate
  2. Risk stratify
  3. Care coordinate

The ethics of our practice should follow the classic “benefit to patient”, “don’t harm” and “respect patient autonomy” principles but additionally with a utilitarian approach to all our patients being a priority. Out of sight (in the waiting room) should not be out of mind.

CORE TOPICS FOR STUDENTS 

(1) Chest Pain

NSW Chest Pain Pathway

(2) Syncope

Review of Syncope

(3) Shortness of Breath

(4) ECG

Review of the 12 Lead ECG

(5) Blood Gases

Review of the Emergency Arterial Blood Gas

(6) Sepsis

Sepsis Guidelines

Sepsis Case

(7) Abdominal Pain

(8) Resuscitation

Westmead ACTS Course – CLICK HERE

Westmead Intermediate Life Support (ILS) Manual and Resources

Changes to the 2010 Resus Guidelines

Australian Resuscitation Council Website

(9) Dealing with Consultants and Colleagues

Team Training and Human Factors

Presentation Skills for Medical Students

Communication Summary

Tips for the New Doctor

Presenting a Patient Case

(10) An Approach to the “Crashing Patient” or “Trauma Patient”

Adult Emergencies Handbook

DETECT Course NSW

DETECT A-G Assessment:

A-G assessment

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LINKS FOR STUDENTS

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CRITICAL CARE CASEBOOK FOR STUDENTS

Case 1 – Bradycardia in the Emergency Department

CLICK HERE

Case 2 – Toxicology 

CLICK HERE

Case 3 – Ventilators

CLICK HERE

Case 4 – Local Anaesthetics

CLICK HERE

Case 5 – Suturing and Wound Care

CLICK HERE

Case 6 – Dosing and Dilutions

CLICK HERE

Case 7 – Albumin

CLICK HERE

Case 8 – Chest Pain and Pacemakers/BBB

CLICK HERE

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RADIOLOGY RESOURCES

Interpretation of X-rays and CT Scans is learned over time attend as many X-ray meetings as possible and learn from your local Radiologist and Radiographers:

 

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