Royal College of Surgeons in Ireland Coláiste Ríoga na Máinleá in Éirinn

Junior Cycle

Introduction

A key priority in international medical education is to provide students with an opportunity to meet patients early in their undergraduate training and to learn the clinical skills necessary for future learning. To facilitate this, the Department of General Practice co-ordinates the Introduction to Clinical Practice (ICP) course in Junior Cycle in RCSI.

There is an increasing evidence base in support of this approach. The ICP course aims to contextualise theoretical learning of knowledge, skills and attitudes. Patient contact appears to foster appropriate professional attitudes, as well as enhancing students' learning experience. It can improve interpersonal skills and empathy. Other studies have highlighted that students gain confidence with people through encounters early in their training and learn to respect the courage and tenacity of patients with chronic illnesses.

Junior Cycle comprises three semesters. ICP is delivered throughout the Junior Cycle. ICP has two components: a) Clinical Competencies (CC); and b) Early Patient Contact (EPC). The portion of ICP taught in JC1 and JC2 is called ICP1. The portion of ICP taught in JC3 is called ICP2.

Junior Cycle 
 Introduction to Clinical Practice 1 (ICP1)  Introduction to Clinical Practice 2 (ICP2)
Junior Cycle 1
In Semester One
Junior Cycle 2
In Semester Two
Junior Cycle 3
In Semester Three

Moodle Virtual Learning Environment (VLE)

There is an emphasis in the course on preparation and self-structured learning. To facilitate this we utilise VLE for Clinical Competencies and Early Patient Contact. The VLE includes an overview of the CC and EPC components, including lectures, information relating to small group teaching, useful additional reading material and a discussion forum. The Clinical Competencies VLE Page has a variety of folders, which include written material and video links to examination techniques for each of the systems. The Early Patient Contract VLE page also hosts the educational content for the course, as well as the EPC Discussion Forum. The VLE Discussion Forum (for CC and EPC) will be used by teaching staff to update students with information relating to the course.

Curriculum and learning outcomes

The Introduction to Clinical Practice Curriculum is mapped to the RCSI Graduate Medical Profile. In addition it has been adapted to students' evaluations.

ICP Learning Outcomes 
Clinical Competencies Learning Outcomes  Early Patient Contact Learning Outcomes
Attitudes
  • Demonstrate professional behaviour towards patients and colleagues
  • Display an understanding of the ethical issues underlying doctor-patient interactions
  • Recognise issues arising for doctors practicing in multicultural environments
  • Be aware of what influences doctors when making clinical decisions
Knowledge and skills
  • Take a structured history from a patient
  • Demonstrate basic competence in physical examination of cardiovascular, respiratory, gastrointestinal and neurological systems
  • Demonstrate an understanding of the basic principles of evidence-based medicine (EBM) as applied to the clinical care of individual patients
  • Recognise the basic principles of therapeutics and issues involved in prescribing for patient 
  • Identify the challenges faced by patients living with a chronic disease
  • Discuss the impact a chronic disease can have on a patient's family
  • Reflect on the doctor patient relationship
  • Understand how patients access the healthcare system
  • Recognise the social and cultural influences on health
  • Explain the ethical principles that are the cornerstone of patient care
  • Know when to engage in ‘critical reflection’ to learn from experiences.

Introduction to Clinical Practice 1

ICP1 is delivered over two semesters, in Junior Cycle 1 and Junior Cycle 2.

Clinical competencies (CC)

Clinical competencies is delivered throughout the Junior Cycle. During JC1 and JC2, students learn the knowledge, skills and attitudes necessary to take a cardiovascular and respiratory history and examination (during JC1) and a gastrointestinal history and examination (during JC2). This is taught through a combination of lectures and small group tutorials.

CC involves a demonstration lecture on a system (e.g. the cardiovascular system) and video links to form a standardised approach to the basic clinical skills needed to examine each systems. After each lecture the students get the opportunity to practice the clinical skills needed to examine each of the systems in small groups. These groups are facilitated by experienced GP tutors who use task-based OSCE-style questions as a means of preparing the students for their end of term OSCE assessment. Students also receive a lecture on evidence based medicine in JC2, followed by a small group EBM quiz where the students get the opportunity to work as a team to answer questions related to the use of evidence based medicine in practice. There are a series of lectures on therapeutics and prescribing. Further lectures include Medical Ethics as it relates to clinical competencies, and a lecture on Cultural Competencies. As a means of consolidation at the end of the course there is a large group revision lecture which concentrates on the assessment and answering student questions relating to the course content.

Early Patient Contact (EPC)

Early Patient Contact offers an overview of how patients and families experience disease and learn about common chronic medical conditions through the eyes of a patient. They learn about the concept of cultural and social influences on health. Students are taught that respect for the patients autonomy and protection of the patients confidentiality are cornerstones of a GP consultations. Students also learn to engage in critical reflection, in order to learn from complex or difficult experiences. EPC is taught through a series of lectures, through patient-delivered symposia (healthcare symposia and expert patient sessions). Once the student learns about this broad concept of health care service and delivery, the student meets a patient with a chronic disease or disability, in the community. This takes place either in the patients home or in a GP surgery and is facilitated by the patients GP. This allows the students to experience first hand, the challenges these patients face on a daily basis. They can observe chronic disease management in a primary care setting. They can also identify the social context of the patient's lives and how this influences their health.

Assessment in ICP1

The CC and EPC components of ICP1 are summatively assessed in two ways:

1. Clinical OSCE (30%)

  • JC1: There is a one-station OSCE in December of JC1 (assessing cardiovascular/ respiratory examination skills)
  • JC2: There is a two-station OSCE in April of JC2 (assessing cardiovascular, respiratory and GIT examination and history-taking skills).
2. ICP1 Portfolio (70%)
  • Portfolio assignments will need to be submitted throughout ICP1. These are based upon the patient experiences, which students encountered throughout ICP1. The portfolio will assess the impact of chronic disease on patient and family, the impact of social/ cultural determinants of health, critical reflection, prescribing, evidence based medicine and ethics.

Introduction to Clinical Practice 2

ICP2 is delivered in Junior Cycle 3 (Semester 3).

Clinical Competencies (CC)

Clinical Competencies continues on from ICP1, into ICP2. During JC3, students learn the knowledge, skills and attitudes necessary to take a neurological history and examination. This is taught through a combination of lectures and small group tutorials. The theme of therapeutics continues and other lectures include Clinical Decision Making and Ethical Case Analysis.

Assessment in ICP2

1. Clinical OSCE (75%)

  • There is a three-station OSCE in December of JC3 (assessing cardiovascular, respiratory, gastrointestinal and neurological history and examination skills).

2. ICP2 Data Paper (25%)

  • Written paper based on the overall content of the course.