UMMP STAGE 3 Faculty of Medicine

University of

2015/2016 Malaya

General Handbook

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Message from the coordinator

Welcome to Stage 3! You are now midway through your medical programme and are about

to embark upon three years of intensive clinical training. This will be an exciting and

challenging phase in your medical education. It will involve acquisition of knowledge to build

upon what you have learnt in Stages 1 and 2. More importantly, it will see you develop

important clinical skills that will facilitate your development as a clinician and help you learn

the “art of medicine”. We wish you all the best in your studies and encourage you to spend

as much time as possible in the wards and the clinics learning from the patients.

Associate Professor Lim Kheng Seang

Stage 3 Coordinator
University of Malaya Medical Programme

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Contents

Message from the coordinator ............................................................................................................................... 1

Introduction ............................................................................................................................................................ 3
Stage 3 ................................................................................................................................................................. 3
Table 1: Clinical Rotation in Stage 3 ................................................................................................................ 4
Teaching and Learning Sessions .............................................................................................................................. 5
Structured Teaching ............................................................................................................................................ 5
Lecture (Guided-learning) ............................................................................................................................... 5
Mini-lecture (Guided-learning) ....................................................................................................................... 5
Tutorial (Guided-learning) ............................................................................................................................... 5
Seminar (Guided-learning) .............................................................................................................................. 6
Clinical Reasoning Session (Guided-learning) ................................................................................................. 6
Clinical Area Teaching (Guided-learning) ........................................................................................................ 6
Independent active learning ........................................................................................................................... 7
Education Day ..................................................................................................................................................... 7
Education Day Time Table ............................................................................................................................... 7
Timetable ................................................................................................................................................................ 8
The Student’s Role .................................................................................................................................................. 8
Student’s Clinical Responsibility .......................................................................................................................... 8
Clinical duties .................................................................................................................................................. 8
Student Checklist for the Clinical Postings in Stage 3 ........................................................................................... 10
The student’s role in seeking supervision ............................................................................................................. 10
The Supervisor’s Role ............................................................................................................................................ 11
Case Presentation ................................................................................................................................................. 11
A Few Points About the Patient and Doctor Theme in Stage 3 ............................................................................. 12
Aims................................................................................................................................................................... 12
Learning Outcomes ........................................................................................................................................... 12
Soft Skills and Transferable Skills ...................................................................................................................... 14

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Introduction

Stage 3

Stage 3 consists of Clinical Postings as well as one Elective term and one Pre-Internship
term.This handbook focuses on your Clinical Posting experiences. Information regarding the
Clinical Postings and terms can be found on SPECTRUM.

Each block will be of eight weeks duration . The Clinical Postings in Stage 3.1 and 3.2 are as
follows:

Stage 3.1

 Medicine 1
 Paediatric 1
 Surgery 1
 Otorhinolaryngology and Ophthalmology
 Acute Care
 Psychological Medicine

Stage 3.2

 Medicine 2
 Paediatric 2
 Surgery 2
 Orthopaedic surgery
 Primary care medicine
 Obstetrics & Gynaecology
 Community

These periods will be spent in the clinical departments and associated outpatient services of
the Faculty’s teaching hospitals, affiliated district hospitals and community facilities of the
clinical schools. The emphasis is on learning through involvement in patient care and the
clinical activities of the depaqrtments to which you are attached.

The Clinical Postings are part of a continuum of clinical experience building on knowledge
gained in Years 1 and 2 and extending through Years 3 and 4 to Pre-Internship.

As far as possible there will be integration of inpatient & outpatient services. There will be
exposure to medical imaging, laboratory services and other diagnostic modalities in other
disciplines.

All students will have some exposure to General Medicine and General Surgery, as well as a
number ofthe surgical and medical subspecialties.

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 Table 1: Clinical Rotation in Stage 3

  Posting A B C D E F G H I J K L

Psych Acute Paeds

Stream 1 Sur 1 ENT/EYE Paeds 1 Med 1 PCM Ortho O&G Med 2 Sur 2
Med Care 2

Psych Acute Paeds

Stream 2 Med 1 Sur 1 ENT/EYE Paeds 1 PCM Ortho O&G Med 2 Sur 2
Med Care 2

Psych Acute Paeds

Stream 3 Paeds 1 Med 1 Sur 1 ENT/EYE Ortho O&G Med 2 Sur 2 PCM

Community
Med Care 2

Elective

BA
Psych Acute Paeds
Stream 4 ENT/EYE Paeds 1 Med 1 Sur 1 O&G Med 2 Sur 2 PCM Ortho
Med Care 2

Acute Psych Paeds

Stream 5 ENT/EYE Paeds 1 Med 1 Sur 1 Med 2 Sur 2 PCM Ortho O&G
Care Med 2

Psych Acute Paeds

Stream 6 ENT/EYE Paeds 1 Med 1 Sur 1 Sur 2 PCM Ortho O&G Med 2
Med Care 2

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Teaching and Learning Sessions

Structured Teaching

While practical clinical experience forms the substrate for learning in the Clinical Postings, a
structured teaching program also takes place during these postings. This will include
problem based learning tutorials and clinical reasoning sessions, lectures and other learning
activities.These sessions will include:

Lecture (Guided-learning)

1. A learning topic is given prior to the presentation.

2. Number of students
a. More than 30 (max number depends of size of lecture hall)
3. Delivery methods
a. Lecture notes (hard or soft copies) are prepared and given before or during
the lecture
b. Structure of the lecture
c. Content of topic of lecture (generally a broad topic and many subtopics)
d. Question and answer session
e. Quiz session (optional if the number of students is smaller)
f. Feedback session
4. Duration of a lecture: 60 to 90 minutes

Mini-lecture (Guided-learning)
1. Students are given a topic/a patient and may discuss only certain aspects of the
topic/patient
2. Number of students
a. Less than 30
3. Delivery methods
a. Objectives of the lecture
b. Focused on relevant subtopics of a lecture
c. Question and answer sessions
d. Quiz sessions (optional)
e. Feedback sessions (optional)
4. Duration of a mini-lecture: 10 to 15 minutes

Tutorial (Guided-learning)
1. A learning topic is given prior to the session
2. Number of students
a. 1-3
3. Delivery methods
a. Face-to-face discussions (a tutor and a student/a small group of students)
b. Recall and reinforcement of learned topic (previously given in a lecture)

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 c. Question and answer sessions
d. Quiz sessions (optional)
4. Duration of tutorial: 15 to 30 minutes

Seminar (Guided-learning)
1. A learning topic is given prior to the session and students are required to read and
prepare relevant materials for the seminar.
2. Number of students
a. 5-10 (small group of students)
3. Delivery methods
a. Each student presents their own findings
b. Active discussion among students and facilitator (facilitated by an academic
staff)
c. Question and answer sessions
d. Quiz sessions (optional)
e. Feedback sessions (optional)
4. Duration of seminar: 30 to 60 minutes

Clinical Reasoning Session (Guided-learning)

1. Interactive
2. Delivery methods
a. Introduction and learning objective
b. Key elements of clinical reasoning process and presentation of a case
c. Data acquisition
d. Problem presentation
e. Generation of clinical hypotheses
f. Disease script and diagnosis
g. Question and answer sessions
h. Quiz sessions
i. Feedback sessions
3. Duration of clinical reasoning: 2 sessions (60 minutes each)

Clinical Area Teaching (Guided-learning)

1. This includes bedside teaching in the wards and clinical presentation in any other
clinical area such as clinics.
2. Interactive
3. No. of students
a. 5 to 8 (*larger numbers may require modification of delivery and duration)
4. Delivery methods:
a. Learning material can be selected by students or teacher
b. Preparation and learning objectives
c. Observation of information acquisition
1. Patient interview (optional)
2. Physical examination
d. Presentation and generations of clinical hypothesis

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 e. Correlation of clinical presentation with acquired knowledge (transferable
knowledge)
f. Question and answer sessions
g. Quiz sessions
h. Summarising of learning objectives
i. Feedback sessions (optional)
5. Duration of clinical bedside teaching: 45 - 60 minutes

Independent active learning

The frequency, time and duration of each session is not formerly scheduled. However,
students’ active participation shall benefit them in regards to soft skills, procedural skills,
professional and personal development.

Independent active learning is one of the learning strategies whereby students shall observe,
actively learn and perform/assist (under supervision) in clinical areas.

Independent active learning includes:

(a) Participating in the clinical service rounds and clinics, radiology, mortuary, accident and
emergency, intensive care unit.
(b) Participating in clinical procedures in areas such as operating theatres (OT) & recovery
areas, endoscopic suites and minor OT’s
(c) Participating in diagnostic events in the Department of BioImaging or post mortems
(d) Participate in patients’ rehabilitation and education
(e) Participate in multidisciplinary meetings.

Education Day

The Education Day Programme will occur on a single day (Tuesdays), each week during the
Clinical Postings. Although individual students will undertake a variety of different clinical
postings, the Education Day Programme will provide a framework for student learning.

Education Day Time Table

The Education Day Time Table is available on SPECTRUM

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Timetable

Individual Clinical Departments are responsible for the timetabling and implementation of
the structured teaching program.

Clinical activities are expected to occupy the majority of the time spent in the hospitals on
Mondays, Wednesdays,Thursdays,Fridays during the Clinical Postings.

There will also be time allocated for self-directed learning and preparation for teaching
sessions, which are held on Tuesdays, Education Day.

The Student’s Role

During the Clinical Postings you are expected to have a real, though limited, role in the
activities of the Clinical Departments to which you are attached. There will be
defined tasks to perform but no direct responsibility for patient care.

Specifically it is intended that students on an inpatient attachment will:

• Clerk and follow the course of patients including investigation and management,
preoperative assessment, operative procedures and post-operative recovery where
appropriate.
• Learn to perform basic clinical procedures under supervision e.g. venepuncture, and
peripheral cannula insertion.
• Be involved in planning for care and follow-up in the community after discharge from
hospital.
• Be involved in communicating information to patients and relatives (though not as the sole
provider of information).
• Attend and participate in clinical unit meetings, ward rounds and case presentations.

Student’s Clinical Responsibility

Clinical duties

Clinical duties start at 8 am to 5 pm every day (except on Education Days). During the
orientation, students will be briefed on their duties and responsibilities in the clinical service
area while performing clinical duties, students will have the opportunity to improve on their
soft skills and procedural skills.

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Independent active learning

During independent active learning, students will have the opportunity to:

1. observe, learn and assist any procedure in the assigned clinical area;
2. participate in the clinical service ward round, clinic, daycare or procedure room;
3. observe how the clinical services are conducted and executed by healthcare
personnel (consultants, clinical specialists and lecturers, medical officers, house
officers, nurses and other healthcare workers); and
4. make a comparison and understand each of their roles in the patients’ management.

Clinical duties also help students learn about soft skills, primarily the leadership, teamwork
skills and the differences in communication methods.

Clinical duties help students learn the administrative aspect of a healthcare system and
understand its’ use and limitations in the following areas:

1. Admission system
2. Appointment system
3. Finance and economics in the healthcare system such as payment and subsidies
4. Discharge system, follow-up and case summary
5. Patients’ feedback on clinical services, complaints and medico-legal issues
6. Referral system (verbal or written)
7. Information technology and retrieving investigation results
8. Risk management and damage-control procedures in health care system
9. Patients’ record keeping system
10. Audit and quality control
11. Ethics, good clinical practice and evidence-based medicine

While participating in clinical duties, students shall learn the roles of

1. Nurses
2. Pharmacists
3. Rehabilitation health workers (e.g. physiotherapists, occupational therapists)
4. Dietician and nutritionist
5. Social worker

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Student Checklist for the Clinical Postings in Stage 3

1. Orientation to the Clinical Postings

At the beginning of each Clinical Posting you should meet with your supervisor who will
provide a general orientation to the clinical department/unit.

2. Clarify the major objectives of the Clinical Postings

It is important that both you and your supervisor understand the expectations of the student
during the clinical postings and that limits on student involvement and responsibility for care
are clearly set.

The student’s role in seeking supervision

When performing any procedural skills such as venepuncture, peripheral cannula insertion,
arterial puncture or needle paracentesis, it is important that you (the student) have taken
the following steps before approaching patients to request their permission to proceed with
procedures:

1. You have read about the procedure and know how it is done
2. You have seen another person perform the procedure
3. You have practised the procedure on a model
4. You have a staff member, skilled in that procedure (doctor or nurse) to supervise you
for the first time when you are doing the procedure on a patient

HOW NOT TO DO IT

Patient: Have you done this procedure before?

Student: Yes, I have watched lots and you will be fine

A BETTER WAY

Patient: Have you done this procedure before?

Student: I am a medical student. I have never done this particular procedure but I have seen
it done a number of times and have done other similar procedures. I feel confident doing
this but I want you to feel comfortable too. I have asked Dr … to supervise me, and he (she)
is very experienced in performing this procedure.

Students must seek out a supervisor if they are performing the procedure for the first time
on a patient.

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The Supervisor’s Role

The supervisor is essential for the education and progress of the student in the Clinical
Postings of Stage 3.The supervisor will help ensure the continuity of supervision and
reliability of assessment. Supervisors should interact with students regularly on ward rounds,
in clinics and operating theatres. In addition, they are expected to meet with each student
regularly to discuss a patient known to the student. One-to-one discussion will provide a
better opportunity to explore strengths and weaknesses, progress and provide more
meaningful assessment than usually occurs in a working clinical setting. The topic and
content of these discussions will be set by the supervisor and the
focus could include diagnostic and management issues.

Within individual Clinical Postings, other clinicians, consultants, clinical specialists and lecturers,
medical officers, house officers, nurses and other healthcare workers will play a role in
contributing to the student’s learning and experience. These people are encouraged to
contribute to the supervisor’s assessment and evaluation of the student’s performance.

Case Presentation

Case presentation associated with ward rounds or bedside teaching will emphasise the
clinical reasoning processes which show how a clinician arrives at a particular diagnostic or
treatment decision.This helps develop an understanding of how clinical
decisions are made.

Case pressentations will cover

• Which items are / were important in the patient’s presenting history, and why?
• What are / were the alternative diagnoses?
• On what basis are / were alternatives accepted or rejected?
• What factors must be considered when making decisions regarding treatment?

Students will be encouraged to apply their existing knowledge from Stages 1 and 2 and to
identify and utilise additional resources which can help them to better understand their
patients’ problems.

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A Few Points About the Patient and Doctor Theme in Stage 3

Aims

The aims of the Patient–Doctor Theme are largely covered by the Clinical Departments
during the Clinical Postings. Students develop their knowledge, skills and clinical reasoning
abilities in a practical setting.They are expected to assume a real, though limited, role in the
activities of their clinical departments, with defined tasks to perform, but without direct
responsibility for patient care.

Learning Outcomes

By the end of Stage 3 students should be able to:

Knowledge and (a) Acquire and/or deepen the knowledge and comprehension of principle of
medical illnesses.
Comprehension
(b) Integrate the knowledge of basic clinical science in medicine and recall
transferable knowledge.

Clinical skills (a) Able to identify, prioritize and treat life threatening conditions.

(b) Able to interview a patient and obtained relevant information for

(critical thinking and
diagnostic purposes and other clinical management.
problem solving)
(c) Able to perform physical examination and able to identify signs.

(d) Able to analysis and correlate symptoms and signs in order to make a
clinical hypothesis (differential and provisional diagnosis).

(e) Able to identify and select appropriate investigations (based on safety,

specificity and sensitivity and cost-effectiveness) for diagnostic purposes,
monitoring progression of a pathology and treatment response.

(f) Able to design a treatment plan for current illness (based on safety,
efficacy and specificity and cost benefit).

(g) Able to design a plan for rehabilitation, patient’s education and

prevention.

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Communication skills (a) Able to speak and ask appropriate questions for an intended purposes
during patient’s interview

(b) Able to advice the patient in regards to diagnosis and option of treatment.

(c) Able to educate patient in regards to the prevention and treatment.

(d) Able to presentation a case and differentiate different type of

presentation in different scenario (exam scenario, service round or referral).

(e) Able to compose a relevant text, organizing their knowledge, ideas and
thoughts; and choosing the relevant information for oral presentation.

Procedural skills (a) Able to understand a procedure *(knowledge)

(b) Able to explain a procedure (as a presentation or an education to

colleague or a patient) *(communication skills)

(c) Able to perform a taught procedure and repeat it in a similar manner

(d) Able to apply transferable skills (procedure)

Professionalism (a) Have an insight about one’s limitation.

(b) Understand and adhere the medical ethics.

(c) Behave appropriately (professionally) as what the profession and the

society expected.

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Soft Skills and Transferable Skills

Soft skills and transferable

Skills/Technique (MUST KNOW)
skills

Communication Skills Presentation technique:

(a) Formal oral presentation (exam)

(b) Clinical teaching and clinical service oral presentation.

(c) Referral (Making one-to-one referral, over-the-phone referral)

(d) Giving instructions to healthcare staff

(e) Educating healthcare staff and patients

(f) Patient-Doctor Rapport

Critical Thinking and Problem (a) Choose and design a diagnostic plan, focusing on safety, specificity
Solving Skills and sensitivity, cost effectiveness.

(b) Choose and design a treatment plan (evidence-based medicine),

focusing on safety, efficacy and specificity, cost benefit.

(c) Incorporating psychosocial health, rehabilitation, patient’s education

and prevention in patient’s care (whole-patient approach)

(d) Execution of plan, time management

(e) Identify limitations in the plan and synthesise new idea to solve the
limitation issues.

Team Work Skills Working as a team: Identify the role Within a team, there are:
of
(a) Listening
(a) Encourager
(b) Questioning
(b) Compromiser
(c) Persuading
(c) Leader
(d) Respecting
(d) Summarizer/Clarifier
(e) Helping
(e) Ideas person
(f) Sharing
(f) Evaluator

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Life Long Learning and
Information Management
Entrepreneurial Skills
Professional, Ethics and Moral
(g) Recorder (g) Participating
Attending CME sessions
Self-directed learning using a range of sources and tools including online
applications.
Documentation (Organisation, Maintenance, Safekeeping and
Duplication of information)
How to write entries to patient case note.
How to write a referral and how to reply a referral.
How to complete request forms (biochemical studies, bioimaging
studies).
How to retrieve investigation results using information technology
Evaluating, comparing and choosing
(a) methods of diagnoses
(b) methods of treatment
Focusing on cost effectiveness, distribution of finite resources and cost
benefit of each investigation and treatment
Understand and adhere to medical Patient-doctor relationship skills
professionalism
Reflective skills
(a) Moral and Ethical Behavior
Time management
(b) Responsibility
Inter-professional relationship
(b) Trustworthy skills
(c) Competent
(d) Commitment
(e) Confidentiality
(f) Altruism
(g) Honesty and integrity
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Leadership Initiating ideas/vision, skills

Motivates and inspires people to engage the ideas/vision

Leaders are people who do the right thing; Manage delivery of an idea/vision
managers are people who do things right.
Professor Warren G. Bennis Build a team for more effective execution of an idea/vision

Leadership is the art of getting someone

else to do something you want done
because he wants to do it

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