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General Practice | Learning Guide 2012-2013

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University of Western Sydney
School of Medicine

General Practice
Learning Guide 2012/2013

Bathurst Rural Clinical School
University Centre for Rural Health North Coast
Urban Rotations, Department of General Practice




Department of General Practice

Coordinator Jenny Reath Chair and Professor
Lawrence Tan

Jane Barker


Ross Wilson
Urban Course Convenor

North Coast Course
Convenor

Bathurst Course Convenor


Melinda Wolfenden

Georgia Millen
Administrative Officer

Placement Support


(10 Jan 2013)
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Contents
OVERVIEW OF GENERAL PRACTICE TEACHING PROGRAM ......................................................... 3
Welcome ......................................................................................................................................... 3
Program Aims ................................................................................................................................. 3
LEARNING OUTCOMES ........................................................................................................................ 4
Learning activities in urban and rural sites ..................................................................................... 5
Assumed prior learning................................................................................................................... 6
LEARNING IN GENERAL PRACTICE ATTACHMENTS ...................................................................... 7
Student responsibilities................................................................................................................... 7
GP Supervisor roles ....................................................................................................................... 9
Other Health Professionals ............................................................................................................ 9
Schedule of Activities in Urban (5 week) General Practice Attachments ..................................... 11
WHO TO CONTACT... .......................................................................................................................... 12
Department of General Practice ................................................................................................... 12
Rural Clinical Schools................................................................................................................... 12
GENERAL PRACTICE CURRICULUM MAP ....................................................................................... 13
ASSESSMENTS ................................................................................................................................... 20
Satisfactory Assessment and Grading ......................................................................................... 23
EVALUATION ....................................................................................................................................... 24
FORMS AND ASSESSMENT GUIDES ................................................................................................ 26
Practice Based Learning Activity Questions ............................................................................... 26
Practice Based Learning Activity Template .................................................................................. 31
Assessment Criteria for Practice Based Learning Activities ........................................................ 32
General Practice Attachment Learning Plan ................................................................................ 33
General Practice Mini - CEX ........................................................................................................ 35
Health Professional Practice Visits ............................................................................................... 41
Year 5 & Rural General Practice Clinical Attachment Assessment ............................................. 43
General Practice Supervisor Checklist ......................................................................................... 45
General Practice Attachment - Student Evaluation ......................................................................46


END OF GP ATTACHMENT SUBMISSION CHECKLIST ................................................................... 47
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Overview of General Practice Teaching Program
Welcome
Welcome to the General Practice Teaching Program! We hope you will find your time in General
Practice a rewarding experience that will be relevant to your future careers, whatever specialty you
choose. Not everyone can or will become a GP, but a good understanding of General Practice will
assist you to provide better care for your patients.

General Practice offers a distinctive approach to medical practice that is largely practiced in the
community. It is characterised by the following principles:

Continuity of care: the doctor-patient relationship is maintained over time and through different states
of health and illness.
Patient centred care: focus on the patient as a person first and foremost.
Family and community centred care: care that recognises that the patient is a member of a family
and of a community.
Comprehensive care: port of first call for persons seeking healthcare in the community, assessment of
undifferentiated presentations, care of acute, chronic and complex problems, disease prevention and
health promotion across all age groups.
Coordination of care: especially care provided by multidisciplinary teams
A practical clinical approach to the management of uncertainty
Advocacy for individuals and communities
Organisational and practice management skills
Professionalism focused on the doctor-patient relationship, reflective practice and ongoing learning
An interdisciplinary approach to research and use of evidence

Understanding the importance of these principles to improving health outcomes across all health
care systems, and how to apply them to clinical practice are core to the teaching program.

In keeping with the philosophy of the UWS Medical Program, we have focused on experiential
learning, with guidance. There are core and student selected parts to the program so you can
choose areas that interest you, or that you need to address. A 5 week attachment cannot give you
a comprehensive view of General Practice, but should give you a good opportunity to consolidate
your clinical skills in a new clinical setting, as well as learn about the realities and rewards of
community engaged medical practice .

We welcome your feedback as we will be regularly reviewing the program to ensure that it remains
interesting and relevant. You are encouraged to contribute to the formal evaluation, and/or to
contact staff at any time (see page 12).
Program Aims
We aim to give you a broad understanding of the many roles of general practitioners in primary
care and of their central contribution to a well functioning health care system. As graduates, you
should be able to:

Apply a sound understanding of the principles of General Practice and of the roles of general
practitioners to benefit the care of your patients, and
Work collegially with general practitioners to ensure that your patients experience well
coordinated and integrated care.
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Learning outcomes

At the end of the Year 5 General Practice teaching program, you should be able to:

A. Safely perform an initial assessment of common primary care presentations, and formulate a
diagnostic and management plan appropriate to General Practice.
B. Safely perform common clinical procedures and associated processes, including deciding
when they are indicated, obtaining informed consent, explaining results and follow up
information to patients.
C. Apply key principles of General Practice to individual patients and to population groups within a
practice (e.g. persons over 65 years within a practice).
D. Appreciate and explain differences in community based medical practice as compared to other
clinical settings.
E. Reflect on your experiences with patients and colleagues to identify personal strengths and
skills, and areas where attention is required. Plan and carry out learning strategies for your
ongoing professional development.

These outcomes will be achieved through the following approaches to learning:

Guided experiential learning:
Clinical attachments in General Practice
Visits to other health professionals within the GPs referral network
Mini-CEX
Practice based learning activities (PBLAs)

Formal structured learning:
Back to base sessions during your clinical attachment
Conference Weeks

Self-directed and student selected components:
An individualised Learning Plan
Practice based learning activities (PBLAs)
Reading and reflection
Your own ideas!






For further details about specific learning outcomes and how they relate to teaching and learning
activities, and to assessment (see Curriculum Map page 13).
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Learning activities in urban and rural sites
A range of learning opportunities will be offered:
GP Attachment: Urban sites
Experiential learning over 5 weeks with 3 days per week (6 sessions) in General Practices
under the supervision of a GP Supervisor. Some urban students will have the opportunity to
undertake this placement in a special interest attachment such as Justice Health, combined
with a mainstream General Practice attachment. Your learning will be guided by your Learning
Plan and clinical activities such as mini-CEX that you will complete with your Supervisor.
Structured sessions. There will be 3 back to base sessions to (1) introduce key principles in
General Practice (2) review your progress and present one of your Practice Based Learning
Activities, and (3) finish your attachment with a wrap up and debriefing session.
Practice based learning activities (PBLAs). These are short written activities based on actual
patients or practices. You will be required to choose one PBLA that best suits your Learning
Plan, from each of 3 different groups of PBLAs.
GP Attachment: Rural Clinical Schools
For North Coast students
Experiential learning over 8 weeks with 2 days per week in a General Practice being
supervised by a GP Supervisor and approximately half day per week with other health
professionals. Your attachment will be integrated with Indigenous Health.
Structured sessions, to be scheduled by North Coast University Centre for Rural Health.
Practice based learning activities, as above.

For Bathurst students
Experiential learning over 4 weeks with 4 days per week in a General Practice being
supervised by a GP Supervisor and approximately half a day per week with other health
professionals..
Structured sessions, to be scheduled by Bathurst Rural Clinical School.
Practice based learning activities, as above.
Conference Week
All students will return to the Campbelltown campus for Conference Weeks. During these weeks a
variety of structured and interactive sessions will be provided to assist you to achieve the General
Practice learning outcomes.
Dermatology teaching
Skin conditions commonly present in general practice, outpatient and community settings.
Students are often asked to examine and discuss skin conditions during their general practice
attachments. Dermatology is incorporated into the General Practice teaching program, and
includes:
Half-day Conference Week workshop, including lecture overview of Dermatology and hands
on practice in skin biopsies, suturing and topical medications.
Clinical experience, including:
o Urban students: compulsory visit to the Skin and Cancer Foundation
o Rural students: attachments in rural general practices with opportunities to observe
and assist in procedural dermatology.
o Online Skin and Cancer Foundation dermatology modules on vUWS. All students
are required to complete these during their GP term.

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Assumed prior learning

The Year 5 General Practice teaching program was developed in the light of what you should
already have learnt, curriculum standards in General Practice, and in consultation with GPs,
students and the community. It therefore assumes that you have acquired the following
knowledge, skills and experiences. Having these will allow you to add to your learning during the
GP attachment:
Sound knowledge of the basic sciences required for the clinical assessment and management
of the common presenting conditions in General Practice.
Good knowledge of, and many hospital based opportunities to practice basic clinical skills,
including history taking, physical examination, common procedures and investigations.
Practice in advanced communication skills with simulated patients.
Better knowledge in some specialties where youve had clinical attachments.
Good knowledge about working in the community and an understanding of the patient
experience.
Good knowledge of the epidemiology and management of health risks, including national
priority areas such as hypertension, diabetes, obesity, cancer, dementia, mental health,
asthma and chronic obstructive respiratory disease.
Some knowledge of diseases and conditions across the lifespan: from birth, childhood,
pregnancy, aged care and death, and common preventive health activities such as antenatal
care, childhood immunisation and womens health check- ups.
Limited opportunities to independently assess and formulate management plans for patients.

In particular, the Year 5 program aims to build on your Year 3 MiC General Practice placement
and lectures. During this attachment you should have:
Started to appreciate the many roles that GPs can have in the community
Observed how GPs engage and interact with community services
Been introduced to the range of presentations seen in General Practice and the skills required
to assess and manage them.
Started to identify ways in which General Practice differs from hospital based practice in the
approach to diagnosis, investigation, treatment and follow up.
Learnt about the role of General Practice in primary health care, and the place of primary care
in a well functioning health care system.











Learning point
How might carrying out these student
responsibilities help you both in your GP
attachment and after you graduate?
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Learning in General Practice Attachments
As your time in General Practice will be short, it is important to use your time well to maximise
your learning.
Student responsibilities
Before your first day
Contact your GP Supervisor at least a week before the attachment begins and confirm your
arrival time, practice location, transport and other practical issues such as expected dress,
identification, documentation, and equipment to bring, as practices can vary in style.
Think back to your previous experiences of General Practice and community based healthcare.
What are 3 learning outcomes, preferably linked to your Health Professional (HP) visits that
you would like to achieve during this General Practice attachment? Write these in your
Learning Plan (see Page 33).
Familiarise yourself with key references and resources, in particular
o Murtaghs General Practice,
o the RACGP site MyGeneralPractice and the
o GP Companion produced by the GP Student Network.
These resources have essential clinical information that will help you to make the most of your
practice attachments and to complete your PBLAs. All are available online through the GP
Resources webpage [see vUWS folder General Practices>Resources]
On your first day
First impressions count. Students can gain much from hands-on learning, so help your
Supervisor to know that you can be trusted to see their patients.
Be punctual and dress appropriately.
Actively participate in your own orientation by introducing yourself to all staff members and
understanding their roles.
Meet with your GP Supervisor:
o Schedule a time in your first week to discuss your Learning Plan and the strategies that
will address your learning goals.
o Review the names and contact details of other health professionals in the GPs referral
network, such as pharmacists, imaging services, other specialists, allied health,
community health centres, patient groups, etc whom you can visit to address your
learning goals and GP attachment requirements.
o Ask about upcoming continuing professional educational events such as those
organised by the local Division of General Practice and Regional Training Provider that
you can attend.
o Confirm attendance times and days as per attendance requirements.
Minimum attendance requirements:
o General Practice:
Urban sites: 6 sessions per week over 5 weeks.
North Coast: 4 sessions per week over 8 weeks.
Bathurst: 8 sessions a week over 4 weeks

[One session = one half-day in General Practice]
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o Attendance at other Health Professional practices is counted separately (see page 9).
o Attendance at 3 back to base sessions is counted separately.
o A written record for any absence (> 1 hour) is required, submitted on the Notification of
Absence form to the Department of General Practice as per the Attendance Policy
o It is expected you will inform your GP Supervisor or their practice directly if you are
absent without prior arrangement
o You are encouraged to attend for more than the minimum requirement where it adds to
your learning. This is an assessment criterion in the Clinical Attachment Assessment.
During your attachment
Some of the following advice originates from students and student sources.
1

Ask questions and offer to perform tasks - dont be the invisible student sitting in the corner!
If not introduced to the patient, introduce yourself.
Critically observe, rather than just sitting in on consultations. For example:
o Consider how continuity of care over time influences what is covered, and not covered, in
each consultation. In particular, note how the GP and patient prioritise the problem(s) to be
addressed in this consultation.
o Consider the impact and interrelationships between multiple physical, psychological and
socio-economic factors on the patients health.
o Note effective and less effective communication strategies and how they might be used or
avoided. For example, in cross cultural communication.
o Apply your diagnostic skills to the presenting problem and compare your conclusions by
asking the GP how they arrived at their diagnosis.
o Note how patient presentations may represent the early stages of conditions that you have
seen at a more advanced stage in the hospital setting.
o Note the symptoms or issues that concern patients who have stable chronic conditions.
o Note differences between the patient perspective and the biomedical perspective on the
patients experience of illness and how this is taken into account in the management plan.
o Ask the GP about how they manage uncertainty in consultations where a clear diagnosis or
management plan is not apparent.
Offer to accompany the GP on home visits and nursing home visits.
Offer to assist, or carry out procedures, particularly if you have already learnt them in skills
sessions.
Offer to assist with team care planning, medication reviews and clinical practice audits. This
will also assist with your assessments.
Ask the GP to observe you doing all or part of consultations, including explaining diagnoses
and management to patients, and to give you feedback using the mini-CEX form.
If there is no spare consulting room, ask if there is a private area to practice patient-centred
history taking and present your findings to the GP.

1
With thanks to and acknowledgement of: GPSN Medical Students Guide Aspire 2009,
http://www.gpra.org.au/GPSN%20Documents/Aspire-2009-FA-lowres.pdf
UNSW General Practice Primary Care Course Outline 2010.
http://www.med.unsw.edu.au/SPHCMWeb.nsf/resources/Primary_Care_Handbook_2010.pdf/$file/Primary_Care_Han
dbook_2010.pdf
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Ask to sit in with the registrar or other doctors in the practice if available. Note different
consultation styles and professional interests, and how this may lead to different patient lists
and approaches to care.
Spend time with the practice manager, practice nurse, receptionist and other staff. Ask them
about what they do and how they contribute to patient care. Compare this with other practices
that you have experienced.
GP Supervisor roles
The GP Supervisor will:
Guide and facilitate your learning by reviewing your Learning Plan and supervising your
contact with patients and staff.
Orient and provide you with access to many aspects of their practice.
Within the bounds of the practice facilities and your abilities, provide you with opportunities
to be directly involved in patient care.
Assist you to find learning opportunities with other Health Professionals in the community
and practice referral network.
Provide opportunistic clinical teaching, and where possible teaching sessions on relevant
topics.
Be available to discuss your Practice Based Learning Activities.
Conduct or delegate to another clinician in the practice your mini-CEX assessments and
give feedback on your performance.
Complete your Clinical Attachment Assessment (see Page 43).
Be invited to give evaluation feedback on their experience with UWS students.
Other Health Professionals
General Practitioners will often work with other health professionals in managing patients. These
people may be part of the team within a practice (e.g. physiotherapist ) or located elsewhere (e.g.
radiology services or pharmacy ). Your GP will have a network of such professionals to whom he
or she may refer discussing this early in your attachment is recommended.

You are required to complete 4 visits to other health professionals (HPs) during your General
Practice term. For urban students, a one-day visit to the Skin and Cancer Foundation at
Westmead will be scheduled . This will count as one of the four required HP visits. You will need
to organise visits to 3 other different HPs within your GPs network. For some rural students, HP
visits will be organised for you. For students at Justice Health one of your visits will be organised
for you in that setting..

Urban students should organise their first HP visit in the first week of the attachment. Use the
Letter of Introduction in vUWS> General Practice>Forms. During your visits, make the most of the
HPs expertise to achieve your objectives on your Learning Plan.

Ask them:
About the services that they provide.
What they consider to be appropriate and inappropriate referrals
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How they communicate with and view their interactions with GPs and other community
health providers
To teach you specific knowledge or skills related to your Learning Plan

When obtaining sign-offs for your Health Professional Practice Visits form (see Page 41), please
ensure you correctly note the name and contact details of the HP you visited so we can thank
them for participating in our program.





Flowchart for urban HP visits




A Sample Week in Urban General Practice

Monday Tuesday Wednesday Thursday Friday
am Orientation
to GP and
practice
GP
attachment
Reading and
preparation
of PBLAs
GP
attachment
Back-
to-Base
session
pm GP
attachment
GP
attachment
Other HP
visit
GP
attachment
Online
learning
activity



Review your Learning Plan
and select 3 different HPs
who will be able to assist
you in meeting your learning
goals
Ask your GP for contact
details of these HPs within
his/her referral network
Contact the HP to introduce
yourself and request
permission to visit their
practice
Print off the letter of
introduction from vUWS and
fax it to them, or bring it
with you on the day
Be professional,punctual
and enthusiastic as you learn
from the HP
At the end of the session,
thank them for taking you
and ask them to sign and
stamp your attendance
record
Document what you have
learned on your Learning
Plan
Department of GP will thank
the HP formally after the
end of the placement
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Schedule of Activities in Urban (5 week) General Practice Attachments


Student learning activities GP Supervisor teaching roles
Clinical School Back to Base
session
Wk
1

Participate in orientation to
practice.
With your GP supervisor,
complete your Learning Plan
and discuss how you will
achieve your learning goals.
Visit a Health Professional #1
Participate in back to base
session.
Attempt a formative mini-CEX
Orient student to practice and
negotiate attendance days
and times (minimum of 6
sessions per week NOT
including attendance at other
health professional practices)
Discuss proposed learning
plan and suggest strategies
for how they may be achieved
Suggest Health Professionals
for visits
Introductory session: Workshop
on:
Principles of General Practice
Other topics relevant to
Learning Outcomes
Review your Learning Plan
Wk
2
Formative and summative mini-
CEX #1
Submit Practice Based
Learning Activity #1
Visit a Health Professional # 2
Supervise a mini-CEX
(student to initiate)

Wk
3
Meet with your GP supervisor
to review progress against your
Learning Plan
Visit the Skin and Cancer
Foundation #3
Participate in back to base
session.
Formative and summative mini-
CEX #2
Submit Practice Based
Learning Activity #2
Supervise a mini-CEX
(student to initiate)
Meet with student and discuss
Learning Plan progress,
suggest modifications if
necessary.
Mid-attachment session:
Workshop on:
Student presentations of PBLA
(to be scheduled)
Other topics relevant to
Learning Outcomes
Review on progress with
learning activities and
assessments.
Wk
4
Formative and summative mini-
CEX #3
Submit Practice Based
Learning Activity #3
Visit a Health Professional #4
Supervise a mini-CEX
(student to initiate)

Wk
5
Formative and summative mini-
CEX #4
Ensure completion of all
assessments and activities and
obtain required sign-offs from
your supervisor.
Participate in back to base
session
Supervise a mini-CEX
(student to initiate)
Complete the Clinical
Attachment Assessment form,
and sign off GP Supervisors
checklist.
Wrap up session Workshop on:
Student presentations of PBLA
(to be scheduled)
Review the Principles of
General Practice
Other topics relevant to
Learning Outcomes
Reflection: What have you
learnt from your attachment that
you can apply to your next term
and as an intern?
Evaluation of attachment.
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Who to contact...
If you have any queries, concerns or suggestions about your General Practice
learning experience, or if you are experiencing any difficulties, please contact the
persons below in the first instance:

Urban
students
Melinda Wolfenden
Administration Officer
melinda.wolfenden@uws.edu.au 02 4620 3896
North
Coast
Christine Everett
Student Co-Ordinator
christine.everett@ucrh.edu.au 02 6620 7276
Bathurst
students
Bronwyn Bauer
Student Co-Ordinator
b.bauer@uws.edu.au 02 6331 0185
Department of General Practice
The Department of General Practice is responsible for overall curriculum
development and for implementing the teaching program, including GP attachments
at urban sites and Conference Week. Department staff will be overseeing the online
component of the Practice Based Learning Activities through vUWS.
Jenny Reath Professor and Chair j.reath@uws.edu.au
Lawrence Tan
Senior Lecturer (Year 5 GP Course
Coordinator)
l.tan@uws.edu.au
Nick Collins Senior Lecturer n.collins@uws.edu.au
Melinda Wolfenden Administrative Officer melinda.wolfenden@uws.edu.au
Georgia Millen Placement Support Officer g.millen@uws.edu.au
Rural Clinical Placements
The Rural Clinical Schools are responsible for implementing the teaching program at
the rural sites, including organisation of clinical attachments, community based visits
and the scheduling and conduct of back to base structured sessions at the Rural
Clinical School venues.

University Centre for Rural Health North Coast
John Graham Clinical Dean john.graham@ucrh.edu.au
Jane Barker Academic Coordinator jane.barker@ucrh.edu.au
Christine Everett Student Coordinator christine.everett@ucrh.edu.au

Bathurst Rural Clinical School
Tim McCrossin Clinical Dean, Associate Professor t.mccrossin@uws.edu.au
Ross Wilson Bathurst GP Course Coordinator suzanne@georgestmedical.com.au
Bronwyn Bauer Student Coordinator b.bauer@uws.edu.au


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General Practice Curriculum Map
The following table provides specific content and objectives for each of the 5 General Practice learning outcomes, and relates them to teaching
and learning activities, and to assessment.

LEARNING OUTCOMES TEACHING and LEARNING ACTIVITIES ASSESSMENT TYPE
A. Safely perform an initial assessment of
common primary care presentations, and
formulate a diagnostic and management plan
appropriate to General Practice.
This learning outcome requires you to integrate
the clinical skills and knowledge you have learnt
throughout the course and apply them to a
General Practice setting, using a patient centred
approach. You should also start to independently
formulate diagnostic and management plans.

Common presentations include:
General
Fever
Tiredness
Chest pain
Respiratory
Cough
Throat discomfort or pain
Wheeze, shortness of breath
Sneezing and nasal congestion
Musculoskeletal
Back pain
Knee complaint
Other joint pain
Skin
Skin rash
Cardiovascular
Hypertension
GIT and Renal
Abdominal or pelvic pain and discomfort
Diarrhoea/change in bowel habit
Nausea/vomiting
General Practice Clinical Attachment
Formative mini-CEX
Structured back to base sessions
Conference Week

Prior assumed learning:
Year 4: Paediatrics, O&G, Mental Health, Oncology Clinical
Attachments
Year 3: MiC GP attachment and communication skills
Year 3: Scientific Streams: Immunology Tired
Year 3: Medicine & Surgery Clinical Attachments
Year 1 & 2: ICM Tutorials

Summative mini-CEX:
history, examination, clinical
judgement, communication

Practice based learning
activity:
(a) Formulate diagnostic
algorithm
(b) Case comparison with
hospital based approach
Clinical attachment
assessment
Year 5 Barrier assessment

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LEARNING OUTCOMES TEACHING and LEARNING ACTIVITIES ASSESSMENT TYPE
Frequency/dysuria
Psychological
Depression
Anxiety
Endocrine
Diabetes
Womens Health
Menstrual problems
Vaginal/Urethral discharge
Family planning
Antenatal & postnatal care
Neurological
Headache
Vertigo/dizziness
Ear
Earache
Eye
Red eye, visual disturbance
Childrens Health
Behavioural and feeding problems
B. Safely perform common clinical procedures
and associated processes, including deciding
when they are indicated, obtaining informed
consent, explaining results and follow up
information to patients.
This learning outcome requires you to
consolidate learning from your procedural skills
sessions and clinical attachments and to apply
them to a General Practice setting. You should be
able to demonstrate how you decide that a
procedure is necessary, what should be
communicated to patients and how it should be
communicated.

Common clinical procedures include:
General diagnostic skills
Aseptic technique and handwashing
Measuring vital signs, assessing hydration,
BMI
General Practice Clinical Attachment
Formative mini-CEX
Conference Week

Prior assumed learning:
Summative mini-CEX:
Write a PBS script (compulsory)

Selected mini-CEX:
Procedures, clinical judgement,
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LEARNING OUTCOMES TEACHING and LEARNING ACTIVITIES ASSESSMENT TYPE
Using otoscope, ophthalmoscope



Diagnostic procedures
Ordering common pathology and imaging
investigations and explaining the results to
patients
Venepuncture
Urine collection (adult, infant & child) and
urinanalysis
Blood sugar level with glucometer
Peak flow & spirometry
12 lead ECG
Preventive activities
Immunisation schedule, techniques and
management processes
Pap smear and use of vaginal speculum
Therapeutic procedures
Medication review and prescription writing,
including drug dose calculation
Drug administration
o Oral
o Eyedrops
o Sublingual
o MDI, spacer, nebuliser
o Rectal
o Intranasal
o Transdermal
o IMI injection
o SC injection
Practical procedures
Basic life support and airway management
Simple dressings and wound care
Year 4: Paediatrics, O&G, Oncology Clinical Attachments
Year 3: Medicine & Surgery Clinical Attachments
Year 3: Conference Week Respiratory SCORPIO,
Rational ordering of lab tests.
Year 3 & 2: Procedural Skills sessions

communication

Practice based learning
activity:
(c) Quality and safety in clinical
procedures
(d) Quality use of medicines and
medication review
Clinical attachment
assessment
Year 5 Barrier assessment

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LEARNING OUTCOMES TEACHING and LEARNING ACTIVITIES ASSESSMENT TYPE
Wound, throat and skin swabs and skin
biopsies
Suturing of simple wound
Application and removal of forearm
plasters
C Apply key principles of General Practice to
individual patients and to population groups
within a practice, which includes being able to:
To achieve this learning outcome you should be
able to apply the principles of continuity of care,
triage, multidisciplinary teamwork, effective
communication, chronic disease self-
management and shared decision making,
disease prevention and health promotion to a
General Practice setting

1. Describe strategies for achieving continuity of care,
including the doctors role as a coordinator of
multidisciplinary team care.

General Practice Clinical Attachment
Health Professional Visits
Structured back to base sessions
Conference Week

Prior assumed learning:
Year 4: Mental Health, Oncology
Practice based learning
activity:
Team Care Arrangements Plan
(compulsory)
Practice based learning
activity:
(e) Patient experience of
continuity of care
(s) Referral pathways and
communication
Clinical attachment
assessment
Year 5 Barrier Assessment
2. Communicate effectively with patients, families,
medical and non-medical health professionals
using written and oral methods, and
communication technologies where appropriate.
a. Demonstrate patient centredness when
General Practice Clinical Attachment
Formative mini-CEX
Conference Week
Prior assumed learning:
Summative Mini-CEX:
Write a referral letter
(compulsory)

Other Mini-CEX: communication

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LEARNING OUTCOMES TEACHING and LEARNING ACTIVITIES ASSESSMENT TYPE
taking a history and giving information to
patients.
b. Demonstrate collegial communications
with medical and other health care
professionals.
c. Describe ways of dealing with difficult
interactions with patients and colleagues.

d. Explain how practice processes for
managing medical records and other
information can assist with continuity of
care, practice audits, improve patient
safety and meet medico-legal
requirements.

e. Describe potential applications of health
informatics to General Practice and
community based health care
Year 4: Paediatrics, O&G, Mental Health, Oncology Clinical
Attachments
Year 3: MiC GP attachment and communication skills
sessions
Year 3: Medicine & Surgery Clinical Attachments
Year 1 & 2: ICM Tutorials: writing in patient notes, medical
note taking

Practice based learning
activities:
(g) Quality of discharge letters

(k) Analysis of difficult or
uncertain encounter

(h) Cross cultural consultations

(o) Ethical dilemmas in General
Practice

(s) Referral pathways and
communication

(f) Information management in
General Practice.

Clinical attachment
assessment

Year 5 Barrier assessment
3. Appreciate the role of the GP in care coordination
and the value of a generalist approach to the care
of patients with multiple chronic illnesses and
competing health priorities.
a. Apply the principles of self-management
and shared decision making to the care of
patients with chronic and complex
conditions.
General Practice Clinical Attachment
Structured back to base sessions
Conference Week
Practice based learning
activity:
Team Care Arrangements Plan
(compulsory)
(i) Patient experience of chronic
disease self-management.
(k) Analysis of difficult or
uncertain encounter

Year 5 Barrier assessment
4. Describe preventive activities across the life span:
from infancy, childhood and adolescence,
adulthood and the aged. This includes assisting
General Practice Clinical Attachment
Formative mini-CEX
Summative Mini-CEX:
communication, clinical
judgement
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18


LEARNING OUTCOMES TEACHING and LEARNING ACTIVITIES ASSESSMENT TYPE
patients to achieve well-being, reduce the risk of
disease and minimise the effects of disability and
chronic disease.
Conference Week
Prior assumed learning:
Year 3: MiC Community and General Practice attachment
Scientific Streams: CV Risk, Nutrition
Lectures: Motivational interviewing
Practice based learning
activity:
(j) Motivational interviewing
practice
(i) Patient experience of chronic
disease self-management.
Year 5 Barrier Assessment
D. Appreciate and explain differences in
community based medical practice as
compared to other clinical settings, which
includes being able to:

1. Formulate justifiable and safe strategies in
medically uncertain situations. These include being
able to:

a. Define a clinical approach to presentations
with vague and medically unexplained
symptoms
b. Begin appreciating the range of normal
and self limiting presentations and how
they may be differentiated from the
abnormal and early presentations of
serious illness.
c. Use strategies such as red flags, time,
follow up, patient communication and
partnership, appropriate referral and
informal consultation.
General Practice Clinical Attachment
Structured back to base sessions
Conference Week
Practice based learning
activity:
(k) Analysis of difficult or
uncertain encounter

(l) Identifying serious illness

(c) Formulate diagnostic
algorithm
Year 5 Barrier Assessment

2. Search for high quality evidence and evaluate its
applicability to the needs and preferences of
individual patients.
General Practice Clinical Attachment
Prior assumed learning:
Year 1-3: Population Health teaching program, including
evidence based medicine lectures,
Year 3: MiC projects
Year 4: CMGP

Practice based learning
activity:
(m) Clinical practice guidelines
in chronic and complex care
(n) Evidence based practice
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19


LEARNING OUTCOMES TEACHING and LEARNING ACTIVITIES ASSESSMENT TYPE
Year 5 Barrier Assessment

3. Analyse how role conflicts and professional
boundary issues may arise in General Practice and
describe how they may be addressed in the
following areas:
a. Relationships with individual patients
b. Balancing the needs of the individual
against those of their family and
community
c. Advocacy for individual patients versus the
role of the GP as gatekeeper of public
resources
d. Relationships with commercial interests
such as the pharmaceutical industry and
other health service providers.
e. Safe prescribing of opioids and drugs of
addiction
f. Practicing within your level of competency
General Practice Clinical Attachment
Structured back to base sessions
Conference Week
Prior assumed learning:
Year 1 PBL: The Teacher
Year 1-2: PPD/Health Practice sessions
Year 4: O&G Conference Week, PPD

Practice based learning
activity:
(o) Ethical dilemmas in General
Practice
k) Analysis of difficult or
uncertain encounter
Year 5 Barrier Assessment

4. Explain the doctors role and responsibilities in
common General Practice medico-legal issues:
a. Maintaining privacy and confidentiality
b. Informed consent and treatment of minors
c. Doctors certificates
d. Assessment of fitness to drive
General Practice Clinical Attachment
Conference Week
Prior assumed learning:
Year 1-2 PPD/Health Practice lectures
Year 4: Paediatrics, O&G Conference Week, PPD

Practice based learning
activity:
(p) Medical certification
(o) Ethical dilemmas in General
Practice
Year 5 Barrier Assessment

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20


LEARNING OUTCOMES TEACHING and LEARNING ACTIVITIES ASSESSMENT TYPE
e. Mandatory reporting of suspected child
abuse, infectious diseases, other public
health concerns
5. Describe the impact of the following organisational
factors on clinical practice in the primary care
setting, including:
Practice population,
Practice management and staffing,
Health system factors such as financing,
traditional and newer models of primary care.

General Practice Clinical Attachment
Conference Week
Prior assumed learning:
Year 1-2: Health care systems lectures
Year 3: MiC O and R week
Practice based learning
activity:
(q) Clinical practice variation in
General Practice.
(r) Practice profile and staffing
E. Reflect on experiences with patients and
colleagues to identify personal strengths and
skills, and areas where attention is required.
Plan and carry out learning strategies for your
ongoing professional development.

Learning plan
General Practice Clinical Attachment
Structured back to base sessions
Prior assumed learning:
Year 4:PPD Learning Journal
Year 3: Medicine, Surgery and MiC attachments
Learning plan
Clinical attachment
assessment
Peer review Practice Based
Learning Activity


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21

Assessments
Your performance in the General Practice teaching program will be assessed by the
following:

A. Learning Plan: satisfactory completion
You should discuss and agree with your GP Supervisor on at least 3 initial learning goals
and learning strategies in the first week of your attachment. The Learning Plan has three
parts (see Page 33):
1. Learning goals. These may be revised or added to during the attachment.
2. Learning strategies for achieving these goals.
3. Evaluation of progress against your goals and next steps

B. Mini-CEX: satisfactory completion of FOUR mini-CEX
To satisfactorily complete the mini-CEX, the assessment criteria on the form must be met.
You may make as many attempts as required to pass.
Required: the following two mini-CEX are compulsory:
Prescribe a medication for a patient whose consultation you have observed
(Pages 37-38).
Write a referral letter for a patient whose consultation you have observed
(Pages 39-40).
Selected: At least two different mini-CEX are to be chosen from the following:
Take a patient centred history as part of an assessment of one of the common
presentations in General Practice.
Perform a focused physical examination as part of an assessment of one of
the common presentations.
Formulate and explain to a patient a diagnostic or management plan for one
of the common presentations.
Safely perform one of the common practice procedures.
Counsel a patient about a health promotion or disease prevention activity.
See the Curriculum map (page 13-19) for a list of common presentations, procedures and
processes and the General Practice mini-CEX forms (pages 35-40) for criteria for
satisfactory completion. The mini-CEX may be conducted by any doctor in your practice
attachment, at the discretion of your GP Supervisor. Mini-CEX on counselling patients
about health promotion or disease prevention may be supervised by the practice nurse.

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C. Practice Based Learning Activities: satisfactory completion of THREE
50% of graded assessment
You are to complete three student selected PBLAs, selecting one each of the following
groups: Chronic and Complex Care; Primary Care Systems and Procedures; Principles of
General Practice. See Page 26 for the Template and the questions for each topic. They
should be submitted via vUWS on Weeks 2, 3 and 4 in urban attachments (see schedule
for rural sites in Year 5>Rural Clinical Schools>General Practice>Assessments folder) and
may be completed in any order. One PBLA is to be presented and discussed in the back to
base structured sessions.
All PBLAs should be based on actual General Practice patient consultations or practices.
Your answers should relate directly the actual patient or practice you describe in the first
section. The maximum length for each PBLA is 800 words (excluding references and
patient information). Diagrams, tables and images may be used where they add to the
written or oral presentation.
2

As different topics will be chosen, its important to share what you have learnt with your
peers. This may be in presentations in Back-to-Base sessions, or the PBLA Discussion
Board in vUWS. Selected PBLAs will be posted to a specific list for that topic which will be
accessible to all students in your Year. Your marks and markers comments will go to My
Grades box and will not be accessible to other students.

Flowchart for completion, submission, marking and review of PBLA:



2
Please observe confidentiality and privacy and obtain informed consent if you decide to include images that
may potentially identify patients. It is good practice to obtain consent whether you think the images are
identifiable or not.
Download PBLA
template from GP
Assessments folder
Complete PBLA. Save
with surname and
PBLA number in
filename.
Submit by 5pm on due
date through
designated dropbox in
GP Assessments folder
Marker grades PBLA.
Marks go to My Grades
box
If PBLA Satisfactory or
Excellent, posted to
Discussion Board
All students in Year can
search for PBLA by
topic
All students can leave a
rating on usefulness to
own learning
All students can leave
constructive
comments
Evaluation of topics
and process of peer
review
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23


D. Clinical Attachment Assessment
50% of graded assessment

Your GP Supervisors assessment of your performance during the attachment will be
documented in the Clinical Attachment Assessment, using the marking criteria on the form
that will be provided to you during your first Back-to Base session (see page 32 for an
exemplar).

Year 5 Barrier Assessment

In the Year 5 Barrier Assessment, 20% of all questions in a range of specialty areas will be
based in General Practice and primary care settings.

Satisfactory Assessment and Grading
To pass your General Practice attachment, you must:
Attend all scheduled sessions and attachments - 100% attendance is required.
Attend Conference Week 100% attendance is required.
Submit a written record for any absence of greater than 1 hour, using the Notification
of Absence form, to the Department of General Practice (urban placements) or
Clinical School (rural placements)
Satisfactorily complete and submit all assessments and required learning activities
according to the assessment criteria. These include:
1. Learning Plan
2. At least FOUR mini-CEX
3. Clinical Attachment Assessment
4. At least THREE Practice Based Learning Activities
As record of your attendance, you should also submit the following completed forms:
5. GP Supervisor checklist
6. Health Professional Practice Visits (minimum 4 sign offs including the Skin
and Cancer Foundation visit)
7. PiP Teaching Incentive form
See vUWS>General Practice>Forms for the pdf active form.
This form must be completed electronically to satisfy Medicare requirements.
Submit as many completed print outs as required to document all GP sessions
that you attended.
8. GP Attachment Evaluation

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24

Assessments which are graded will be at the following levels of achievement: non-
submission or plagiarism (0%) unsatisfactory (1-24%), further work required (25-49%),
good (50-74%) and excellent (75-100%). If your assignment has been found to be
unsatisfactory or to require further work, you may be asked to revise and re-submit. You will
have seven days from the date of notification in which to do so, and you may re-submit the
assignment only once. A maximum of 50% (10/20) will be awarded for a re-submitted
assessment.

PBLA assessments should be submitted by 5pm on the due date. If submitted up to 10
calendar days late without prior agreement from the GP Course Coordinator or delegate,
they will be penalised by 10% of the total mark per calendar day. (See Page 12 for contact
details)

In the event of borderline or unsatisfactory performance, non-graded learning activities and
attendance will be taken into account. It is therefore recommended that you attend all
activities, make a good attempt at all required activities and submit all your work, including
formative attempts at mini-CEX, to document your learning.

In order to pass the GP attachment term, you are required to pass both the CAA and PBLA
components, with no other outstanding concerns regarding your clinical performance and
professional behaviour. In the event of failure to pass all components of the teaching
program remediation will be offered following consultation with the relevant Curriculum
Committees.

All Attachment forms (see Checklist page 47) should be signed off by your GP Supervisor
and submitted in ONE folder, either in person to:
Melinda Wolfenden, Department of General Practice for urban attachments, or
Christine Everett, for North Coast Clinical School, or
Bronwyn Baur, for Bathurst Clinical School
by 5pm of the last day of your GP attachment
or returned by post with the envelope postmarked no later than the last day of your
attachment. No reminders will be sent if your forms are not received.
All Practice Based Learning Activities must be submitted by the due date through vUWS.

Evaluation
Students and Supervisors are encouraged to evaluate their experiences and contribute to
the ongoing improvement of the teaching program. A student evaluation form should be
submitted at the end of each rotation. Including your name is optional and only aggregated
feedback is returned to GP Supervisors. Supervisors will also be asked to evaluate their
teaching experience with UWS students. Students and Supervisors are also welcome to
General Practice | Learning Guide 2012-2013

25

contact the Department of General Practice and/or Rural Clinical School at any time with
queries and suggestions (see page 12 for contact details)
General Practice | Learning Guide 2012-2013

26

Forms and Assessment Guides
Practice Based Learning Activity Questions and Template
Select one PBLA from each of the following groups (complete three in total):
I. Chronic and Complex Care
II. Primary Care Systems and Procedures
III. Principles of General Practice.
Use the format in the Template (see page 30). A Word version of the Template
can be downloaded from vUWS: Year 5>General Practice>Forms. Please save
your assignment with the file name [surname]_PBLA [number of PBLA] so that it
may be identified easily.
Ensure that you answer all questions
Include references to any literature or clinical information that you use on your
answer.
Please adhere to the 800 word limit. References and patient information are NOT
included in the word count.
See the GP Online Resources at vUWS>General Practice>Resources and GP
Conference Week Study Guide at vUWS>General Practice>Learning Guide to
assist with your research on particular topics.
Submit your Activity through the vUWS dropbox for each due date.


I. Chronic and Complex Care
(A) Team Care Arrangement exploration
For a patient with chronic conditions and co-morbidities requiring ongoing
multidisciplinary care via a Team Care Arrangement:
1. Interview the patient and document all the steps the patient needs to take to carry
out the plan. Include phone calls and communications to make appointments,
transport, buying medications and over the counter products, having investigations,
physical activity programs, making dietary changes, the ways in which family
members and friends assist as a minimum.
2. With reference to the literature,
a. What worked well for the patient with this TCA
b. What could the team care providers have done differently to assist the
patient in carrying out the TCA?

(B) Patient experience of continuity of care
Interview a patient with chronic condition(s) and review their health record. For this
patient:
1. Describe the role(s) of all healthcare providers who have been involved in the
care of the patients current conditions. Include other general practitioners and
primary health care providers whom the patient may have consulted.
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27

2. Evaluate whether the care provided is well coordinated from the patients
perspective. Include any miscommunications, adverse events, gaps or duplication
in care that have arisen from a lack of coordination and continuity.
3. What strategies could improve the patients experience of continuity of care?

(C) Patient experience of chronic disease self management
Interview a patient with chronic condition(s) about a recent presentation with a new
symptom or exacerbation of their chronic condition(s).
1. Document this recent presention and its management, as well as any resulting
change in the ongoing management of their concurrent conditions.
2. Describe the patients role in making decisions about the management of the
recent presentation and of the concurrent conditions.
3. How does the patients experience compare with models of chronic disease self-
management and shared decision-making?
Reference: General Practice Online Resources: Chronic Disease Self-Management


II. Primary Care Systems and Procedures
(A) Quality and safety in clinical procedures
1. Outline the usual procedures for performing one of the common clinical
procedures in the practice where you are based, as applied to a patient.
2. What processes and systems are in place to ensure the quality and safety of the
procedure? Issues to consider include infection control, handling of equipment
and specimens, processes for handling of results and staff training.

(B) Medication review and quality use of medicines (QUM)
For a patient with co-morbidities who is on multiple regular medications:
1. Document all of the patients prescribed and non-prescribed medications.
2. Apply the Medication Review or QUM Medication Related Problem Checklist, and
3. Suggest how any medication issues may be addressed.
Reference: General Practice Online Resources Medication Review Template, Quality Use of
Medicines Medication Related Problem Checklist

(C) Information management in General Practice
Examine how information is managed in the practice where you are based.
1. Describe the types of information collected and managed by the practice.
2. How is this information stored and accessed, and by whom?
3. How do information management processes assist with continuity of care,
practice audits and meet medico-legal requirements?

(D) Quality of discharge letters
For a patient who has recently been discharged from hospital:
1. Describe the content and quality of the communication received by the GP.
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28

2. Ask the GP how helpful this communication was for their ongoing care of this
patient and document their response.
3. Formulate a list of the types of information that GPs require when patients are
discharged. How and when should this information be delivered to the GP?

(E) Clinical practice guidelines in chronic and complex care
For a patient presenting with multiple chronic condition(s) and co-morbidities:
1. Identify clinical practice guidelines concerning at least two of their conditions.
2. What is the quality of evidence that has been used to develop these guidelines?
3. Discuss with your GP (and patient if appropriate) how applicable are the
guidelines to the care of this patient, and to their individual needs and
preferences?
Reference: General Practice Online Resources: Clinical Practice Guideline portals

(F) Clinical practice variation in General Practice
Comparison of local practice with national General Practice data (BEACH survey)
1. Document 25 consecutive consultations, including the reason(s) for the
presentation and diagnoses.
2. Compare this list with the top 10 list of reasons for presentations and diagnoses
in the most recent BEACH survey.
3. What factors might lead to differences between the two lists?
Reference: General Practice Online Resources: General Practice Activity Data (BEACH)

(G) Practice profile and staffing
Interview practice staff and if available, ask for access to practice audit information.
1. Describe the features of the practice where you are based, including (a) staffing
and the roles of each staff member, (b) fees and billing arrangements, including
how the level of fees is decided and whether to bulk bill patients (c) the range of
services provided, including after hours services and home visits, and (d) the age
and demographic features of patients who typically attend this practice.
2. How do the features of the practice match with the needs of the patients who
choose to attend this practice?

(H) Referral pathways and communication
For a patient with chronic and/or complex conditions:
1. List all the referral services (including healthcare and non-healthcare, and all
community and hospital based services) involved in their care.
2. Document in a flow chart the types of information required or generated by each
of these services and how it is communicated between the different services.
3. Where are the breakdowns in communication likely to occur, and what effect
would these have on the patients care?



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29

III. Principles of General Practice.

(A) Formulate a diagnostic and management algorithm
For a consultation for one of the common presentations listed in the learning
outcomes:
1. Document the steps taken in the consultation to diagnose and manage the
presenting problem(s).
2. Formulate your own diagnostic and management algorithm (flow chart) for the
same problem(s) presenting in a primary care setting. Reference your sources
(e.g. Murtaghs General Practice).
3. Explain how your algorithm is similar or different to the observed consultation.

(B) Case comparison with hospital based approach
For a consultation for one of the common presentations listed in the learning
outcomes:
1. Document the steps taken in the consultation to diagnose and manage the
presenting problem(s).
2. Compare these with a clinical practice guideline for an equivalent presentation(s)
to an Emergency Department or to a hospital specialist outpatient clinic
3. Describe and explain the reasons for the similarities and differences between the
observed steps and the hospital based guideline.
Reference: General Practice Online Resources: Clinical Practice Guideline portals

(C) Cross cultural consultations
For a consultation involving a patient whose first language is not English:
1. Describe the steps that were taken to ensure that communication was effective.
2. What cross-cultural issues could arise with this patient and their family?
3. When formulating diagnostic and management plans how can these
communication and cultural issues be taken into account?

(D) Motivational interviewing practice
For a patient who requires counselling for one of the key lifestyle risk factors
(smoking, nutrition, alcohol or physical activity):
1. Practice motivational interviewing with this patient, addressing one of the risk
factors. Obtain consent from the patient to contact them at least 2 weeks later to
ask how they have progressed.
2. Document your counselling session and the results of your follow up.
3. Reflect on the success or otherwise of your counselling session and the factors
that make lifestyle counselling more effective.
Reference: General Practice Online Resources: SNAP Population Health Guide

(E) Analysis of difficult or uncertain encounter
For a consultation where the presenting problem was vague and the diagnosis and/or
management difficult or unclear:
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30

1. Document the steps taken in the consultation to diagnose and manage the
presenting problem(s).
2. Compare the steps taken to a textbook diagnostic and management approach
for the same presenting symptom(s). What factors made the presentation vague
and the consultation difficult or unclear?
3. What strategies did the GP use to manage uncertainty in the consultation?

(F) Identifying Serious illness
For a consultation concerning an acute presentation that could be an early stage of
serious illness:
1. Document the steps taken in the consultation to diagnose and manage the
presenting problem(s).
2. What steps were taken to identify and manage the risk of serious illness?
3. How applicable are hospital guidelines for the recognition of serious illness in
adults and children to general practice?
Reference: General Practice Online Resources: Clinical Practice Guideline portals

(G) Evidence based practice
For a consultation where a clinical question requiring further information was raised:
1. Formulate a searchable PICO (Problem Intervention Comparison Outcome)
question.
2. Locate and appraise a paper that answers this question.
3. Apply the evidence you have found to the clinical consultation that triggered the
question by presenting your findings to your Supervisor. Ask your Supervisor
what factors make this evidence (a) useful, and (b) not useful for this consultation
and their clinical practice and document them.
Reference: General Practice Online Resources: Evidence based practice

(H) Ethical dilemmas in General Practice
For an encounter between patients, health professionals or staff that you observed
which raised ethical, professional or legal issues or dilemmas:
1. Briefly describe what happened and who was involved in the encounter.
2. What ethical, professional and/or legal issues did this encounter raise?
3. How does the General Practice or community setting influence the issues raised
and the possible responses?




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31


Student Name: (please enter)
Student ID No: (please enter)
Supervisor Name: (please enter)
Practice Name: (please enter)
This is my first /second /third PBLA (delete as applicable)
Word count: (please enter)
(maximum 800 words, excluding Patient Information and references)

By submitting this Learning Activity, I agree that:
Any persons reported upon in this activity have given consent for their personal information to be
included and understands that they will not be identifiable.
I hold a copy of this assignment if the original is lost or damaged.
I certify that no part of this assignment has been copied from any other students work or from any
other source except where due acknowledgement is made in the assignment.
No part of the assignment/product has been written or produced for me by any other person
except where collaboration has been authorised by the Course Coordinator
I am aware that this work may be reproduced and submitted to plagiarism detection software
programs for the purpose of detecting possible plagiarism, which may retain a copy on its
database for future plagiarism checking.
Copies of this work will be retained by the School of Medicine and will be made available via
vUWS to other students after it has been marked as satisfactory.

TOPIC NAME: (please enter)
PATIENT INFORMATION (where applicable)
Patients Age: Gender:
Relevant background information:


Presenting problem(s):


Answers to questions:
1.


2.


3. (where applicable)

Practice Based Learning Activity (PBLA)
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Assessment Criteria for Practice Based Learning Activities
A maximum of 20 points can be awarded for each Activity.
Unsatisfactory = 1 point
Borderline (Further work required)
= 2 points
Good = 3 Excellent = 4
Knowledge &
use of evidence
Little or no evidence of reading or
reference to literature. Relies on non-
reviewed internet sources.
Uses and refers to key resources and
references. Little or no reference to
other sources.
As well as using key resources, uses and
demonstrates understanding of
information from other sources.
Appraises the strength of the evidence
and information found.
As well as meeting criteria for Satisfactory,
use of wide ranging information sources
relevant to the topic. Evaluation of gaps in
the evidence, suggestions for other
sources and/or research required.
Relevance to
problem &
question
Poorly defined problem or unclear
description of patient or practice. Does
not answer all parts of the question.
Does not address related learning
outcomes as per GP Curriculum Map.
Basic description of the patient or
practice. Partial answers to all parts of
the question. Partially addresses
related learning outcomes as per GP
Curriculum Map.
Clearly describes patient or practice,
provides more detail where relevant.
Answers all parts of the question and
relates answer to patient or practice.
Addresses all related learning outcomes.
As well as meeting criteria for Satisfactory,
relates answers to broader issues in
patient care and practice management.
Application of
concepts
Incomplete or incorrect description of key
concepts relevant to the topic. No
attempt to link concepts to patient or
practice example.
Basic description of key concepts.
Partial application of concepts to
patient or practice example.

Demonstrates sound understanding of
key concepts, for example by explaining
in own words. Applies concepts to patient
or practice example.
As well as meeting criteria for Satisfactory,
evaluates concepts for their value and
applicability. Considers alternative
perspectives. Makes original points.
Organisation of
material
Sequence of material is difficult to follow,
no apparent structure or connection
between different parts of answer.
Indiscriminate use of tables and figures.
Materially exceeds word limit.
Sequence of material is able to be
followed, some connection between
different parts of answer. Tables and
figures do not add substantially to text.
Material is presented in a logical
sequence. Tables and figures used
effectively to communicate points.
Adheres to word limit.
As well as meeting criteria for Satisfactory,
material tells a focussed and coherent
story and is presented creatively.

Language &
referencing
Incomplete or incorrect referencing. Non-
standard referencing. Inappropriate
language for academic or clinical
audience. Repeated spelling and
grammatical errors.
Use of standard referencing system.
Most sources referenced. Appropriate
language for audience. Occasional
spelling and grammatical errors.
All sources referenced using standard
referencing system. Effective use of
language for audience. Negligible
spelling and grammatical errors.
As well as meeting criteria for Satisfactory,
sophisticated use of language to make
original points.

Oral
presentation
(Where
applicable. Not
included in
grading)
Poorly prepared, does not appear to
know material. Does not acknowledge or
confuses audience.
Basic description of the patient or
practice. Refers to recommended
references and attempts to link
material to patient. Partial coverage of
questions. Some acknowledgement of
audience.
Clearly describes patient or practice,
providing more detail where relevant.
Uses different communication modes
(e.g. visual) where relevant. Covers all
parts of the topic. Multiple attempts to
interact with audience in different ways.
As well as meeting criteria for Satisfactory,
effective and creative use of different
communication modes. Active engagement
between audience and presenter to explore
other aspects of the topic relevant to the
learning outcomes.


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Student Name: _______________________________________________ Student ID No:_________________
Supervisor Name: ___________________________________________________________________________
Practice Name: ___________________________________Dates of attachment: _________________________
Learning goals should be SMART: Specific, Measurable, Achievable, Relevant and Time Limited. For example, Learn about diabetes management is not as SMART as
Give initial dietary advice to diabetic patients, and know when to refer to dietitians.

By the end of this attachment,
I will be able to:
To achieve these goals, I will: How have I achieved these goals?
What are my next steps?
e.g.
Give initial dietary advice to diabetic patients,
and know when to refer to dietitians
Visit a dietitian who sees diabetic patients and
interview the dietitian about appropriate referrals.
I observed a dietitian give advice to a diabetic patient and
noted the referral indications we discussed. I have arranged
with my Supervisor to practice taking a dietary history and
discuss management with a patient.
1.


2.


3.


The Learning Plan has been discussed and reviewed throughout the attachment. Yes No
Supervisor Signature:___________________________ Student Signature:______________________________ Date:_____________

General Practice Attachment Learning Plan
The Student and GP Supervisor should
discuss and agree on 3 initial learning goals
and learning strategies in the first week of
the attachment. Progress against the Plan
should be reviewed during and at the end of
the attachment.
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34




By the end of this attachment, I will be able
to:
To achieve these goals, I will: How have I achieved these goals?
What are my next steps?
4.


5.


6.


7.


8.



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Student Name: ______________________________________________ Student No: _________________


Supervisor (or Delegates Name & Position):____________________________________________________


Practice Name: ___________________________________________________________________________


Patient Problem/Diagnosis: _________________________________________________________________

TIME TAKEN SETTING FOCUS CASE COMPLEXITY ASSESSMENT TYPE

Observation
time (mins):______

Feedback
time (mins):______

General Practice
Community based
service
Other
Prescription
Referral Letter
History
Examination
Communication
Diagnosis
Procedure
Low
Moderate
High
Practice session

For Assessment
NB: At least 4 different
miniCEX are to be
submitted. (2 required,
at least 2 selected )


PLEASE TICK APPROPRIATE
LEVEL of ACHIEVEMENT (see over)

Unsatisfactory

Borderline

Good

Excellent

Not Observed
History taking skills

Examination skills

Communication skills

Professional behaviours

Clinical judgement (including
diagnostic or management plan)

Procedural techniques / skills

Overall competence in relation to
stage of training

SUPERVISOR FEEDBACK What was done well? What could have been done differently?



PATIENT FEEDBACK (if appropriate) What was done well? What could have been done differently?




Supervisor Signature: ___________________________________________ Date: / /

Student Signature: _________________________________________________ Date: / /

General Practice Mini - CEX
General Practice | Learning Guide 2012-2013

36

What is a mini-CEX?
The mini-CEX is an assessment tool for testing how students interact with actual patients. It focuses on core skills
required in routine patient encounters. With the exception of the writing of a referral letter and a prescription, each
mini-CEX requires observation of a student/patient interaction over 10 minutes and immediate feedback to the student
for 5-10 minutes. Research shows that over time, multiple mini-CEX are a valid, reliable measure of students clinical
performance. The student may make as many attempts as required to reach a satisfactory standard.
How to carry out a mini-CEX
Setting up Select a patient who has consented to participate
The student is examined as in a short case. For example, examine Mrs Smiths abdomen, or take
a history from Mr. Lee about his chest pain, or perform spirometry on Ms. Emad.
Give the student some background information about the presenting problem.
Ask the student to relate to the patient as if they would in an actual consultation.
Observation
(approx 10 minutes)
Silently observe the interaction.
Do not prompt except in exceptional circumstances.
Feedback
(5-10 minutes)
Ask the patient for feedback, if appropriate.
As soon as practicable, give feedback to the student (generally away from the patient i f possible).
You may ask the student to report their findings, clinical reasoning, and management.
Complete the mini-CEX form and give the form to the student.
Recommended mini-CEX activities
Required: the following two mini-CEX are compulsory (may be completed after the observed consultation):
Prescribe a medication for a patient whose consultation you have observed
Write a referral letter for a patient whose consultation you have observed.
Selected: At least two different mini-CEX can be chosen from the following list:
Take a patient centred history as part of an assessment of a common presentation.
Perform a focused physical examination as part of an assessment of a common presentation.
Explain to a patient a diagnostic or management plan for a common presentation.
Safely perform a common practice procedure.
Counsel a patient about a selected health promotion or disease prevention activity.
Criteria for satisfactory level of achievement in mini-CEX

Prescription
3
:
Patient details correct, date
Prescriber details correct, including
prescriber number
Drug name (generic), dose and form
Correct drug dose, frequency, quantity and
route of administration
No abbreviations or decimal points
Student should provide relevant information
to the patient regarding adherence to the
medication, instructions on how to take the
medication, and common side-effects
Other factors to discuss: drug selection, non-pharmacological management, contraindications,
drug interactions, likely side effects, cost and convenience for patient.

Referral
letter
4
:
Patient details correct
Referrer details correct, including provider
number and practice details
Consultant details correct
Date
Legible (or typed)
Purpose of referral clearly stated
Relevant patient history: current symptoms
and medical conditions, previous medical
history, medications and prior treatments.
Family, social, other history as appropriate.
Other factors to discuss: urgency of referral, referrers opinion, use of professional language

Other mini-
CEX:
History: Facilitates patients telling of story, elicits concerns and uses questions effectively to obtain accurate
and adequate information. Responds appropriately to non-verbal cues.
Physical Exam: Follows efficient, logical sequence. Informs patient and is sensitive to patients comfort.
Communication: Clearly explains natural history, prognosis, treatment options and rationale for recommended
course of action. Elicits patient perspective. Obtains consent and explains required follow-up. Demonstrates
strategies for ensuring that the patient understands.
Procedural skill: Clearly explains why procedure is needed and what to expect. Obtains consent. Prepares for
procedure appropriately, including handwashing, conducts procedure and manages equipment safely, provides
post-procedure advice to patient.
Clinical J udgement: Considers risks, benefits, evidence, patient preferences and practical constraints when
ordering and interpreting tests, and formulating diagnoses and management plans
Professionalism: Shows respect, compassion and empathy. Establishes trust and attends to patients needs.
Considers patient safety and maintains patient confidentiality.

3
Adapted from Australian Medicines Handbook: Guide to Prescribing, January 2010
4
Reference: Jiwa 2009 et al Qual Prim Care: 2009;17:31-6. Piterman et al Intern Med J 2006;36:271-2
UWS Mini-CEX GP Prescribing
Please complete each section by filling in only ONE appropriate circle for your assessment of this student.
e.g.




37


Instructions
A student will initiate an assessment using the Mini-CEX in line with the procedures set out in their
Guide to the attachment. The assessor MUST be a doctor of registrar level or higher. The
process should take no longer than 30 minutes, including feedback. During the General Practice
rotation we are particularly interested in assessing students prescribing skills. Judge the students
performance against your expectations of a student at their stage of training the majority will be
Satisfactory or Good with only a few at the extremes. Please remember that you only need to
complete those items that you can comment on. Generally Communication Skills and
Professional Behaviour can be assessed in most patient interactions.
PLEASE REMEMBER TO COMPLETE THE OVERALL COMPETENCE SCALE.
Remember also that the observation should take 10-15 minutes and the feedback a similar
amount of time.



CLINICAL ENCOUNTER (To be completed by ASSESSOR)


PRESENTING PROBLEM

SETTING
INPATIENT OUTPATIENT GENERAL PRACTICE

OTHER




Reference: Jiwa 2009 et al Qual Prim Care: 2009;17:31-6. Piterman et al Intern Med J 2006;36:271-2


STUDENT & ASSESSOR DETAILS
Please PRINT FULL NAMES




FULL STUDENT ID (e.g. 200312345)
STUDENT
NAME:



ASSESSOR
NAME:




ASSESSOR
POSITION:

REG VMO SS GP Other






DETAILS OF OTHER:





TEACHING SESSION:






CLINICAL LOCATION:
MCS BCS MDCS Other





DETAILS OF OTHER:


PRESCRIBING
MINI-CEX


UWS Mini-CEX GP Prescribing
Please complete each section by filling in only ONE appropriate circle for your assessment of this student.
e.g.




38


BODY SYSTEM
*Can be multiple
CVS CNS ENDO
GIT HAEM MSK
PSYCH RENAL RESP Other







COMPLEXITY OF PATIENT CASE
LOW MODERATE HIGH


TASK MAIN FOCUS
*Can be multiple
PROF
BEHAVIOUR
HISTORY EXAMINATION COMMUNICATION
CLINICAL
JUDGEMENT






NOT
SATISFACTORY

BORDERLINE

SATISFACTORY

GOOD

EXCELLENT

NOT APPLICABLE
CORRECT INDICATION FOR
PRESCRIPTION


SELECTION OF
MEDICATION, DOSAGE AND
DURATION OF TREATMENT



CONSIDERATION OF
FACTORS THAT WOULD
PROMOTE ADHERENCE

CONSIDERATION OF
POSSIBLE SIDE EFFECTS
AND INTERACTIONS

EXPLANATION TO PATIENT
AND FAMILY

SAFETY NETTING &
FOLLLOW_UP
ARRANGEMENTS

Ratings above this line are for FORMATIVE feedback only

OVERALL CLINICAL
COMPETENCE











This Rating is a SUMMATIVE hurdle Assessment

Any scores of Not Satisfactory or Borderline in Overall Clinical Competence means that
the student must repeat the Mini CEX within the attachment until a Satisfactory is achieved.



COMMENTS (particularly required if grade is borderline or not satisfactory)










Concerns about student progress

Yes


No



UWS Mini-CEX GP Referral
Please complete each section by filling in only ONE appropriate circle for your assessment of this student.
e.g.




39

Instructions
A student will initiate an assessment using the Mini-CEX in line with the procedures set out in their
Guide to the attachment. The assessor MUST be a doctor of registrar level or higher. The
process should take no longer than 30 minutes, including feedback. During the General Practice
rotation we are particularly interested in assessing students ability to write useful referral letters.
Important data such as identification details, current medications and allergies may be generated
automatically by the computer software, but the student should demonstrate the ability to prioritise
relevant information. Judge the students performance against your expectations of a student at
their stage of training the majority will be Satisfactory or Good with only a few at the extremes.
Please remember that you only need to complete those items that you can comment on.
Generally Communication Skills and Professional Behaviour can be assessed in most patient
interactions.
PLEASE REMEMBER TO COMPLETE THE OVERALL COMPETENCE SCALE.
Remember also that the observation should take 10-15 minutes and the feedback a similar
amount of time.


CLINICAL ENCOUNTER (To be completed by ASSESSOR)
PRESENTING PROBLEM

SETTING
INPATIENT OUTPATIENT GENERAL PRACTICE

OTHER



Reference: Jiwa 2009 et al Qual Prim Care: 2009;17:31-6. Piterman et al Intern Med J 2006;36:271-2


STUDENT & ASSESSOR DETAILS
Please PRINT FULL NAMES




FULL STUDENT ID (e.g. 200312345)
STUDENT
NAME:



ASSESSOR
NAME:




ASSESSOR
POSITION:

REG VMO SS GP Other






DETAILS OF OTHER:





TEACHING SESSION:






CLINICAL LOCATION:
MCS BCS MDCS Other





DETAILS OF OTHER:


REFERRAL
LETTER
MINI-CEX


UWS Mini-CEX GP Referral
Please complete each section by filling in only ONE appropriate circle for your assessment of this student.
e.g.




40


BODY SYSTEM
*Can be multiple
CVS CNS ENDO
GIT HAEM MSK
PSYCH RENAL RESP Other







COMPLEXITY OF PATIENT CASE
LOW MODERATE HIGH


TASK MAIN FOCUS
*Can be multiple
PROF
BEHAVIOUR
HISTORY EXAMINATION COMMUNICATION
CLINICAL
JUDGEMENT






NOT
SATISFACTORY

BORDERLINE

SATISFACTORY

GOOD

EXCELLENT

NOT APPLICABLE
REASON FOR REFERRAL


PROVISIONAL DIAGNOSIS

CONCISE MEDICAL
HISTORY AND CLINICAL
FINDINGS



RELEVANT BACKGROUND
INFORMATION (including
social and family situation,
smoking, drug and alcohol etc.)

RELEVANT INVESTIGATION
RESULTS

PRIOR TREATMENT

Ratings above this line are for FORMATIVE feedback only

OVERALL CLINICAL
COMPETENCE











This Rating is a SUMMATIVE hurdle Assessment

Any scores of Not Satisfactory or Borderline in Overall Clinical Competence means that
the student must repeat the Mini CEX within the attachment until a Satisfactory is achieved.


COMMENTS (particularly required if grade is borderline or not satisfactory)










Concerns about student progress

Yes


No




General Practice | Learning Guide 2012-2013

41





Student Name: ________________________________ Student ID
No:_________________
Dates of GP attachment: ______________________________________________________

Details of Practice Visits (please copy and attach more pages if required)
Please ensure that names and contact details are correct


Date of visit
Practice Name and
Description


Practice Stamp
Practice Address
Telephone number
Health Professional
(please print name)

(signature


Date of visit
Practice Name and
Description


Practice Stamp
Practice Address
Telephone number
Health Professional
(please print name)

(signature


Date of visit
Practice Name and
Description


Practice Stamp
Practice Address
Telephone number
Health Professional
(please print name)

(signature


Health Professional Practice Visits

42


Date of visit
Practice Name and
Description


Practice Stamp
Practice Address
Telephone number
Health Professional
(please print name)

(signature


Date of visit
Practice Name and
Description


Practice Stamp
Practice Address
Telephone number
Health Professional
(please print name)

(signature


Date of visit
Practice Name and
Description


Practice Stamp
Practice Address
Telephone number
Health Professional
(please print name)

(signature


Thank you - your contribution to student teaching is much appreciated. If you have any questions,
comments or other feedback about the student or the teaching experience, please do not hesitate
to contact the Department of General Practice: Melinda Wolfenden
melinda.wolfenden@uws.edu.au 02 4620 3896.
Year 5 Urban and Rural GP - UWS Clinical Attachment Assessment
Please complete each section by filling in only ONE appropriate circle for your assessment of this
student. e.g.



43
CAA Jan 2011




















COMMENTS & FEEDBACK




Concerns about student progress

Yes


No



Please fill in the circle that is appropriate to the students level of performance. If you are unable to assess a criterion
please note in the comments section above.

Unacceptable Room for improvement Acceptable
Above expectations
(within top 25%)
Outstanding
(Top 5%)

1. FUND AND APPLICATION OF KNOWLEDGE AND UNDERSTANDING OF DISEASE MECHANISMS

Inadequate knowledge
&/or understanding of
disease mechanisms.
Has limited overall
knowledge base, but
shows ability in
application
Solid fund of knowledge
& understanding of
disease mechanisms for
common conditions
Solid fund of knowledge
& understanding of
disease mechanisms,
with frequent
demonstrable ability to
apply this knowledge
Outstanding fund of
knowledge and
understanding of disease
mechanisms with
excellent ability to apply
to case material

2. COMMUNICATION SKILLS

Very poor
communication skills.
Not aware of patients
agenda, cues or
emotions. No empathy.
Poor communication
skills. Limited
awareness of patient
related issues. Relates
poorly to patients.
Good communication
skills with the good
historian
Competent
communication skills.
Good listener and
develops positive
relationships with
patients.
Outstanding
communication skills




STUDENT & ASSESSOR DETAILS
Please PRINT FULL NAMES



FULL STUDENT ID (e.g. 200312345)
STUDENT
NAME:



ASSESSOR
NAME:





ASSESSOR
POSITION:

GP REG Other



DETAILS OF
OTHER:




TEACHING
SESSION:




CLINICAL
LOCATION:
URBAN
North
Coast
Bathurst Other


DETAILS OF
OTHER



Assessor Signature: ______________________________ Date :__________

Term Supervisor Signature: ____________________________ Date :_________

44

Unacceptable Room for improvement Acceptable
Above expectations
(within top 25%)
Outstanding
(Top 5%)
3. HISTORY AND EXAMINATION

History & examination
disorganised,
unstructured and not
able to elicit basic
information. Findings
presented without
thought or organisation
Able to take a structured
history and perform an
appropriate examination,
but not able to respond
to unexpected or
complex issues.
Presentation of findings
disorganised.
Can demonstrate the
techniques but
sometimes not able to
interpret the findings
Competent sound history
& examination, but some
trouble with difficult
patients. Findings
presented in a structured
and organised manner
Outstanding history &
examination even with
the most difficult of
patients. Detailed
succinct presentations
incorporating
investigations and
management.

4. PROBLEM FORMULATION AND DIAGNOSIS

Implausible problem list
or provisional diagnosis.
No link between clinical
findings and diagnosis.
Plausible provisional
diagnosis. Limited or
incomplete problem
formulation.
Reasonable provisional
diagnosis. Considers
plausible differential
diagnoses. Sound link
between findings and
diagnoses.
In addition to Acceptable,
comprehensive problem
formulation, including
psychosocial aspects of
presentation.
A comprehensive
patient-centred
consideration of all
existing and potential
health problems and a
mature approach to
dealing with uncertainty

5. INVESTIGATIONS AND MANAGEMENT PLAN

Does not consider
investigation and
management options.
Chooses almost any
option
Aware of investigation
and management
options, but unable to
develop a coherent plan
Safe management, but
lacks ability to explore all
options
Considers most
important investigation
and management
options. Patient
preferences considered
Well thought through and
presented patient-
centred investigation and
management options.

6. PROCEDURAL SKILLS

Very limited ability to
carry out simple technical
skills
Only able to undertake
basic technical skills
Performs basic
procedures competently,
Able to undertake most
technical activities
High level of dexterity.

7. FEEDBACK FROM PRACTICE TEAM

Insensitive to needs,
feelings and wishes of
others. Poorly integrated
into practice team
Sometimes has difficulty
relating to other group
members
Relates well with peers,
but difficulty with other
members of team
Relates well to most of
the group, most of the
time. Functions well
within practice team
Highly integrated and
outstanding in respecting
feelings, needs and
wishes of other practice
staff

8. PROFESSIONAL BEHAVIOUR

Unreliable, uncaring, at
times verging on abusive
Professional in approach
most, but not all of the
time
Behaves in a
professional manner the
majority of the time
Professional in
approach. Very
occasional lapse in
behaviour
Highly professional in all
aspects


Attendance Mandatory Component



Unsatisfactory Satisfactory

Rarely seen at the practice / Attends most
days when specific activities planned, but
not at other times
Attends regularly including when activities
not planned / Informs of absences /
Makes self available outside regular hours


45
CAA Jan 2011



Student Name: ________________________________ Student ID No:_________________
Supervisor Name: ___________________________________________________________
Practice Name: _____________________________________________________________
Dates of attachment: ________________________________________________________
NB: It is the students responsibility to collect the relevant forms
and obtain your sign-offs by the end of the attachment.

Please tick where an attempt has been made at the learning activity, and sign-off the relevant
forms. Please see reverse of this form and the Clinical Attachment Assessment form for criteria for
satisfactory and other levels of performance.

A. Learning Plan
The Learning Plan has been discussed and reviewed during the attachment.

B. Mini-CEX at least 4 completed to satisfactory level

Compulsory:
A prescription for a medication for a patient whose consultation the student has observed, using
either prescribing software or a PBS prescription pad.
A referral letter for a patient whose consultation the student has observed.

Selected:
See reverse for suggested activities
See reverse for suggested activities

C. Other Health Professional visits

The student has visited _____________(insert number) health professionals in my referral
network.

D. Clinical Attachment Assessment

This assessment will be graded and assigned marks. Please be honest in your assessment.
Participation in the clinical attachment at a level as described on the form.




Signature:_____________________________________________________Date:_______________


Thank you for your much appreciated contribution to student teaching. If you have any questions,
comments or other feedback about the student or the teaching experience, please do not hesitate to
contact the Department of General Practice: Melinda Wolfenden 4620 3896
melinda.wolfenden@uws.edu.au
General Practice Supervisor Checklist

46
CAA Jan 2011

Practice Name & Location:
_____________________________________________________________________
PLEASE NOTE: Only de-identified and aggregated results will be returned to Supervisors.


PLEASE TICK the appropriate box
Strongly
Agree

Agree

Dont know

Disagree
Strongly
Disagree
The GP attachment met the learning outcomes for
attachments in the Learning Guide.

I can see the relevance of the health professional
visits to my medical training.

The Clinical School Back-to-Base sessions helped
my learning.

The online resources helped my learning.

I was adequately oriented to the practice and
introduced to practice staff.

I had sufficient opportunities to practice my clinical
skills.

I received useful feedback on my learning from my
GP Supervisor.

The GP Supervisor was a good role model.

Please describe the best aspects of your GP attachment.


In what ways have the assessment tasks (PBLAs, mini-CEX, CAA) helped your learning?
Describe the most useful insight or skill you have learnt during the GP placement that you will be able to use
in your future profession:
Please suggest what could have been done differently to better support your learning.

I would recommend the practice where I was attached to other students YES NO


THANK YOU Your feedback will be used to review and improve General Practice attachments.
Evaluation results are returned to the UWS SoM Evaluation Committee to improve the MBBS program.
General Practice Attachment Student Evaluation

47

End of GP Attachment Submission Checklist


By 5pm of the last day of your GP attachment...

Have you included the following completed forms in ONE folder to be submitted?

Learning Plan
at least FOUR mini-CEX forms
Health Professional Practice Visits form
Clinical Attachment Assessment form
PiP Teaching Incentive form
See vUWS General Practice>Forms for the pdf active form.
This form must be completed electronically to satisfy Medicare requirements.
Please submit as many print outs as required to document all GP sessions that
you attended.
GP Supervisor checklist
GP Attachment student evaluation form



Have you submitted at least THREE Practice Based Learning Activities through vUWS?
It would be wise to keep a photocopy of these forms if submitted by mail