Faculty of Life Sciences and Medicine Department of Primary Care & Public Health Sciences Stage 2 GP longitudinal placement learning outcomes Description This block focuses on how people and their health and illnesses, life events and concerns are managed in general practice, acting as a foundation for the eight-week General Practice placement in Stage 3. Block Structure Students will be based in general practices, allocated to one practice and working with tutors within practice and in campus based supporting seminars. This will be in the context of team learning and team work with other members of the primary health care team. Additional Information Roles and Responsibilities The responsibilities of the named Clinical Supervisor (GP tutor) for this Block are: The named Clinical Supervisor will be responsible for ensuring that students have access to learning opportunities that will enable them to acquire and develop the outcomes and competences set out in the Curriculum. The named Clinical Supervisor is responsible for ensuring that systems are in place for safeguarding patient and student safety. The Clinical Supervisor must ensure that students complete a General Practice induction. This may well be provided by the Practice Manager. The Clinical Supervisor or their nominated Deputy (at times of leave or illness) meets with their student weekly to review progress, agree priorities for the rest of the block and sign the weekly journal. At the end of the block, the named Clinical Supervisor should seek feedback from colleagues who have contributed to the student s education and complete the end of block report. This report should be discussed with the student before the end of the block. The responsibilities of the student for this block are: The student should meet with their named Clinical Supervisor or nominated Deputy after seeing every patient (no patient can leave the practice without being seen by a qualified clinician), as well as weekly to discuss the expected learning outcomes, the learning opportunities available and any specific learning needs.
The student meets with their Clinical Supervisor or their nominated Deputy (at times of leave or illness) weekly to review progress, agree priorities for the rest of the block and sign the weekly journal. At the end of the block, the student should meet with their named Clinical Supervisor to discuss the end of block report created by their named Clinical Supervisor. Learning Outcomes By the end of this Block, student will be able to: 1. Recognise the importance of continuity of care in General Practice and describe the generalist and ongoing nature of the relationship between the General Practitioner and the patient 1.1. Describe the nature of General Practice consultations as brief and cumulative episodes of care on a background of continuing care. [23c] 1.2. Recognise the importance of contextual background knowledge of the patient in contributing to focused General Practice consultations. [10b-d, 11a, 11j, 17h, 20f] 1.3. Describe the range of conditions managed in General Practice, recognising the broad knowledge base required in Primary Care. [8a-b, 9a-d, 9f-g, 10a-e, 11g-h] 1.4. Reflect on, and discuss with the GP tutor, experiences that demonstrate the therapeutic importance of developing a trusting patient-doctor relationship. [20b-f, 21c] 1.5. Acknowledge the impact of contextual information and knowledge of the patient in individualised management plans. [10b-d, 11a, 11j, 17h, 20f] 2. Develop and apply an approach to patients problems that is appropriate for the general practice environment and that results in coordinated care across services. 2.1. Demonstrate knowledge of structure, organisation and function of the NHS and can compare this to other healthcare systems. [23c] 2.2. Demonstrate knowledge of services accessed from Primary Care. [22a-b] 2.3. Show an appreciation of the General Practitioner s responsibility for the community in which they work. [20a-g] 2.4. Demonstrate knowledge of the Primary Secondary interface. [22a-b] 3. Respond to people s health needs in the context of their social situation, culture and environment 3.1. Take a history, and present it to the GP tutor, that includes an exploration of the patient s social situation, culture and environment. [10b, 11g, 13a, 14e, 15b, 20d] 3.2. Demonstrate an awareness of the importance of social, cultural and environmental factors in health and well-being, and illness and disease. [10b, 11a, 11g, 13a-b, 14a] 3.3. Observe, experience and discuss how they and their clinical teachers adapt their communication with the patient according to the patient s social situation, culture and environment. [14g, 14h, 15a-g] 3.4. Demonstrate both individual and population perspectives of social, cultural and environmental factors. [11a-j] 3.5. Be respectful of and responsive to the needs of diverse patients in accessing health care. [20d] 3.6. Observe, experience and discuss how they and their clinical teachers act as advocates for vulnerable patients. [14i-j, 15b, 15e-h, 20e-f, 23a] 3.7. Describe the doctor s remit in tackling social, cultural and environmental problems, where appropriate liaising with and signposting other agencies. [14i-j, 15b, 15e-h, 20e-f, 22a-d, 23a]
4. Manage acute emergencies and common conditions in a General Practice context. 4.1. Start to diagnose common conditions which present in General Practice including performing a range of diagnostic procedures and measuring and recording the findings (see Appendix B). [18a-c] 4.2. Demonstrate the correct use of measures to prevent the spread of infection. [23h] 4.3. Recognise common conditions which present in General Practice. [8a-f, 9a-g, 10a-e, 14g-j, 17b-f] 4.4. Observe and discuss how their GP tutor differentiates acute emergencies and urgent cases from routine presentations of disease. [8g, 16a-e] 4.5. In tandem with their GP tutor, assess and initiate treatment of the acutely unwell patient in a Primary Care context and escalate care as needed. [16a-e, 21e, 22a-c, 23a] 4.6. In tandem with their GP tutor, activate the emergency and urgent referral pathways in Primary Care when indicated. [16a, 21e, 22a-c, 23a] 4.7. Manage time and prioritise tasks and works autonomously when necessary and appropriate. [21d] 5. Evaluate and manage the needs of people with long term conditions including co-morbidity and poly pharmacy, and the effective use of resources. 5.1. Observe, experience and discuss how they and their clinical teachers adapt their consultation styles for patients with long term conditions to explore the patient's bio-psychosocial experience of their conditions and related treatments. [13b, 13f, 14g, 15a, 15d-h, 17h, 20b, 23a] 5.2. Identify and review the patient's immediate and ongoing priorities and needs. [14g, 20b] 5.3. Contribute to the provision of tailored information to patients including explaining results, treatments, support options and self-management information in a way that the patient can understand. [8a-f, 9a-g, 10a-d, 13f-g, 14g, 17e] 5.4. Under close supervision, agree a patient-centred goal with a shared care plan to achieve that goal including support as necessary, and agree arrangements for ongoing review. [13b, 13e-g, 14c, 14g, 14h, 15a, 20b, 23a] 5.5. Start to use and apply resources, targets and evidence-based treatment pathways appropriately; monitor and review a patient's medication, making adjustments according to clinical need, patient preference, adherence, and current guidelines. [11d, 12a, 12c, 17a-h, 21a, 23e] 5.6. Demonstrate understanding of the role of health professionals in screening for complications of long-term conditions, specifically strategies that will delay or minimise the progression of diabetes, cardiovascular and respiratory diseases. [11a, 11i, 22a-c] 6. Identify and implement evidence-based interventions for disease prevention and the health promotion of individuals and general practice populations 6.1. Identify common risk factors that are modifiable determinants of health, and start to be able to broach these with patients appropriately. [11a-b, 11f-I, 15a-b] 6.2. Start to demonstrate appropriate behaviour change skills, including improving concordance with treatment, such a brief intervention and motivational interviewing, in a clinical setting. [13g, 15a-b] 6.3. Observe and discuss Social Prescribing as a tool for health promotion and disease prevention. [8e, 13b, 14g-h, 15a-b, 20b, 20h] 6.4. Explain what type of resources and referral options are available for promoting health and preventing disease. [23c, 23g]
6.5. Critically evaluate local and national health promotion strategies and interventions. [12a] 6.6. Review guidelines (e.g. NICE public health guidelines) and suggest improvements for local health promotion interventions linked to modifiable social determinants, taking account of local context. [12a, 12c] 6.7. Demonstrate an awareness of the basic principles of Quality Improvement including how to evaluate social prescribing programmes and health promotion interventions and their potential impact on improving patient outcomes. [11a, 11c, 11d, 12a, 12c] 7. Acknowledge and navigate uncertainty when faced with undifferentiated presentations using problem solving skills to safely manage risk 7.1. Take an appropriate history for the patient s presentation. [17a] 7.2. Start to interpret the patient s presentation, including, where necessary, examination and investigation findings, to come up with possible causes and diagnoses. [8a-d, 8g, 9a-d, 10a-d, 14a, 14d-e] 7.3. Recognise that uncertainty is a normal part of the diagnostic pathway and that not everything has a medical diagnosis. [14f, 23b] 7.4. Recognise own personal and professional limits and seeks help from colleagues and supervisors when necessary. [21e] 7.5. Acknowledge uncertainty to the patient and can contribute to a shared plan with appropriate safety-netting. [13b, 13g, 14g, 23a-b] 8. Understand the importance of clinical leadership within the evolving NHS, using opportunities and examples within the community setting to demonstrate personal development of skills relevant to organisational leadership. 8.1. Describe different styles of leadership and their impact on team behaviour. [22d] 8.2. Develop insight into personal attributes and preferences for roles within teams. [22d] 8.3. Understand that emotional intelligence can influence and motivate teams. [22d] 8.4. Understand the concepts of strategic planning and workforce development in the planning and delivery of health care. [11d]
Appendix A: Presenting patient complaint During their time on the GP longitudinal placement students will see many other presenting patient complaints. All are invaluable learning opportunities. 1. Abdominal pain 2. Anxiety 3. Cough 4. Depression 5. Ear pain 6. Fever 7. Headache 8. Indigestion 9. Musculoskeletal pain 10. Obesity 11. Shortness of breath 12. Skin problem 13. Substance / alcohol abuse 14. Throat pain 15. Urinary symptoms 16. Wheeze
Appendix B: Investigations and clinical skills 1. Measuring pulse rate and blood pressure 2. Measuring body temperature 3. Measure weight, BMI and abdominal girth 4. Measure blood glucose 5. Instruct patients in the use of devices for inhaled medication 6. Measure peak flow 7. Advise patients on how to collect a mid-stream urine specimen 8. Urine multi dipstick test 9. Urine pregnancy testing 10. Take nose, throat or skin swabs 11. Safe disposal of clinical waste, needles and other sharps
Appendix C: Students should be able to describe the presentation, investigation and management of the following diagnoses, and preferably see all of the following conditions During their time on the GP placement students will see many other conditions and presentations, some without a diagnostic label. All are invaluable learning opportunities. 1. Asthma 2. Anxiety and depression 3. Chronic obstructive pulmonary disease 4. Cancer 5. Diabetes mellitus 6. Eczema 7. Gastro-oesophageal reflux disease 9. Migraine 10. Musculoskeletal pain including osteoarthritis and back pain 11. Obesity 12. Substance misuse 13. Tension headache 14. Upper respiratory tract infection 15. Urinary tract infection 8. Hypertension