MBBS Year 5 Loogbook-Revised 2014-2015

SCHOOL OF MEDICINE
MBBS
YEAR 5

Family Medicine and Primary Health Care Rotation

LOGBOOK

Student Name..

Student number

Setting
2

School of Medicine Fam Med- PHC Year 5
MBBS
This 8 week block will take place in either Mahalapye or Maun. You will be based either in clinics or Outpatients
department (OPD) in Mahalapye District Hospital or Letsholathebe II Memorial hospital in Maun. In year 5 your
consultation skills and examination skills will be of such a standard that you can manage patients under
supervision. The rotation should be geared to clinical work and feeling in gaps in knowledge and practice. The
Botswana Primary Care Guideline is going to be the main treatment guideline during your practice in primary
care. You need to be comfortable using the guideline. You will to be introduced to research (clinical audit) such
that you may contribute to knowledge about health in Botswana. You will interact with important stake holders in
primary health care; the police, District Health Management Team (DHMT), chiefs and politicians.
You need to recognize that you are junior to all qualified health staff in a facility and that you will learn a lot from
non-medical staff (nurses, dieticians etc.). Faculty will inform important stake holders (police, DHMT, chiefs and
councillors) about the fifth year program and their role in it. Topics of potential interest to you will be discussed
with them (rape, mentally ill people in the community, TB and HIV programs, health budgets, state of clinics and
ambulances etc.).
Family Medicine staffs and residents:
Gaborone
-Dr Vincent Setlhare (Acting. Head of Department)
-Dr Ruth Keele (Part time Lecturer)
Residents (Year1):
Drs Mpho Mpape, Keorapetse Mmualefhe and Tidimalo Ookame
Mahalapye Training Complex Maun Training Complex
-Dr S Tshitenge (Lecturer ): Coordinator. Undergraduate and Residency
program Mahalapye)

- Dr D Mbuka(Lecturer ): (Coordinator Undergraduate and Residency
Program Maun)
-Dr Tsima (study leave)
Residents
Dr M Ramato
Dr K Motlhatlhedi
Dr B Maalakgosi
Dr M Mandiwana
Dr K Chabaesele
Dr N Kenosi
Dr B Tshuma
Dr G Lekgowe
Dr M Ramotsababa
Dr D Johane
Dr C Gobotswang
Dr K Maotwe
Dr K Mosheti
Dr S Maripe
Administration
Solomon Mogapi Ms Galeboe Kefalotse
Clinical
By the end of the rotation, we expect you:
1. To consult and treat patients under supervision, in a clinic or OPD and A&E department. You will independently
consult at least 5 patients in a day. (Use one of the cases for case presentation and management plan discussion
with your tutor)
2. To recognize the patient that is beyond your level of competence and refer them to senior colleagues or
competent health facilities (after consulting senior colleagues).
3. To perform simple procedures done in a primary care setting.

4. To know the role of other stake holders in health care e.g. the role of police in accidents, rape, and mentally ill
people; the role of social workers in TB and HIV care; the members and role of the DHMT in primary care.

3

MBBS
The Weekly Schedule of Activities outlines varies slightly in Mahalapye or Maun. You need to consult
The Mahalapye and Maun semester activities time table.
Weekly Topics:
Week 1: The patient with abnormal weight and height, developmental problems, infant feeding
problems/nutritional problems, obesity
Under 5 card
Abnormal weight in adults and children
Nutritional problems seen in children
Developmental problems in children
Week 2: The patient with a genital lesion or discharge, requiring contraception or with libido or impotence
problems
Contraception in primary care
Loss of libido/importance
STI
Week 3: The patient with fits, falls (including non-accidental injury) or numbness & tingling
Epilepsy
Non Accidental Injury
Stroke
Week 4: The patient with a nose bleed, hearing loss or dizziness
Nose bleed
Difficulty hearing
Dizziness
Week 5: The patient with envenomation or scorpion bite
Snake/Scorpion bite
Human bite
Week 6: The patient with medically unexplained symptoms or sleep disorders (including obstructive sleep
apnoea)
Depression
Anxiety
Substance abuse
Fibromyalgia
Week 7: The patient with low back pain and sciatica or chronic joint pain
Low back pain
Chronic arthritis
Gout
Week 8: The patient with HIV/AIDS, anaemia or lymphadenopathy AND the patient needing palliative care
HIV counselling and testing
HIV symptoms
4

MBBS
HIV staging
HIV routine care
Anaemia
Lymphadenopathy
WHO palliative care model
Family medicine topics:
1. The consultation: -The patient centred clinical method
-The doctor, patient, and environmental factors in the consultation
-Communication skills
- Breaking bad news
-Motivation interview
-Counseling skills
2. Family Oriented Primary Care (Family structure and resources/ family conference)
3. Community Oriented Primary Care (COPC): Weekly home visit

Attendance:
Attendance of all contact sessions (clinical residency, PBL, whole class lectures, tutorials and others as may be
defined by the department) in all courses in phase II is compulsory. Students are expected to have 100%
attendance during their clinical clerkship. Students who have attended less than 80% of the contact periods
(without valid reasons) will not be allowed to participate in the end of year examination in family medicine. Such
students will also fail to qualify for a re-assessment opportunity. They will have to repeat the clinical rotation in
family medicine and meet up the minimum 80% attendance before being assessed in family medicine.

Continuous assessment:
The continuous summative assessment will be as follows:
Clinical case presentations (20%): at least one per week (10%), COPC (5%) and reports (5%).
PBL: All students will be assessed during their PBL session for attendance, contribution and reflective
ability on each case (10%).
Directly Observed Clinical &Procedural Skill (DOCPS). Two Mini CEXs shall be administered per
student by end of your rotation under the supervision (10%).
The continuous assessment component shall carry 30%
End of year Examination
There shall be a final (exit) examination at the end of the academic year.

5

MBBS

Week 1
Workshop: Botswana Primary Care Guideline
Session 1 (09:00-10:00) Session 2 (10:00-
11:00)
Session 3 (11:00-
12:00)
Session 4 (14:00-
15:00)
Day1 Introduction Symptoms
[1]Cough
[2]Headache
[3]Weight loss
Routine care
approach to 1
chronic condition
[4]Seizures
[5] Itchy rash
[6] Back pain
Day 2 [7] Face problems [8] Chest pain [9]Fatigue [10]Breast symptoms
Day3 [11]Lymphadenopathy [12]No symptoms [13]Difficulty
breathing, mouth
symptoms
[14]Insect Bites
[15]Palliative care

PBL AND DIRECTLY OBSERVED PROCEDURES AND CLINICAL SKILLS MARKING
6

MBBS

Engagement with the PBL process

Progression requirement: Students awarded grades of Borderline or Unsatisfactory will be notified to the Fitness to
Practice Committee.

PBL
Session

1

Session 2

score 0 1 2 3 4 Assessors name,
Excellent
4
Student takes a full part in group discussion. Contributions are insightful and show an in depth approach. In the first session
the student shows an ability to analyse the case and apply prior knowledge in determining learning objectives. The student
appreciates all aspects of the case (anatomical, physiological/biochemical, pathological, clinical, psychological and public
health) and is willing to assess the importance of all aspects.
In the report back session the student shows that all objectives have been researched and that some have been covered in
depth. Some aspects of the report back show detailed knowledge. Throughout both sessions the student listens carefully to
the views of other students and responds to them appropriately and in a balanced way.
This mark can be given to a student whose contributions are limited if the contributions always show insight and depth, and
add value to the group discussion.
Satisfactory
3
Student contributes to most aspects of the group discussion but some contributions may be superficial. May find difficulty in
reaching appropriate learning objectives, but always tries to do so.
May withhold information and be unwilling to contribute, even though is able to do so. May appear to have limited information
in report back sessions. May prevent contributions from other people unintentionally by taking up too much of the discussion.
Borderline
2
Student makes little contribution to group discussion and contributions show little depth. May show unprepared and
unresearched objectives in report back session. May show an immature approach to medicine, by being only interested in
certain areas, most likely anatomy and clinical presentations. May be unprepared to listen to the contributions of other
students.
Unsatisfactory
1
Student makes no contribution at all to the group discussion or development of learning objectives and does not contribute to
report back session.
Student may attempt to curtail case development by limiting brainstorming sessions and prevent objectives being reached.
Contributions to discussion are limited and tend not to be positive or actively negative. Criticizes work of other students.
Blocks establishment of learning objectives in important areas. Is immature, arrogant and disruptive.
0 Did not attend the session.
7

MBBS
week1:

Attendance
Contribution (C) S 1 signature and dates
S 2
Reflective ability (R) S1
S2

Absent: 0 0
Present:
On time 2 2
Late > 10min 1 1
PBL
week2:

Attendance
S
e
s
s
i
o
n

1

S
e
s
s
i
o
n

2

score 0 1 2 3 4
Assessors name,
signature and dates
Contribution (C) S1
S2
S2

Absent: 0 0
Present:
On time 2 2
Late > 10min 1 1
PBL
week 3:

Attendance
S
e
s
s
i
o
n

1

S
e
s
s
i
o
n

2

score 0 1 2 3 4
Assessors name,
signature and dates
Contribution (C) S1

S2


S2

Absent: 0 0
Present:
On time 2 2
Late > 10min 1 1
PBL
week 4:

Attendance
S
e
s
s
i
o
n

1

S
e
s
s
i
o
n

2

signature and dates
Contribution (C) S 1
S 2
S2

Absent: 0 0
Present:
On time 2 2
Late > 10min 1 1
PBL
week 5:

Attendance
S
e
s
s
i
o
n

1

S
e
s
s
i
o
n

2

score 0 1 2 3 4
Assessors name,
signature and dates
Contribution (C) S1

S2


S2

Absent: 0 0
Present:
On time 2 2
Late > 10min 1 1

PBL
Session

1

Session 2

8

MBBS
week 6:

Attendance
Contribution (C) S 1 signature and dates
S 2
S2

Absent: 0 0
Present:
On time 2 2
Late > 10min 1 1
PBL
Week 7 :

Attendance
S
e
s
s
i
o
n

1

S
e
s
s
i
o
n

2

score 0 1 2 3 4
Assessors name,
signature and dates
Contribution (C) S1
S2
S2

Absent: 0 0
Present:
On time 2 2
Late > 10min 1 1
PBL
week 8:

Attendance
S
e
s
s
i
o
n

1

S
e
s
s
i
o
n

2

score 0 1 2 3 4
Assessors name,
signature and dates
Contribution (C) S1

S2


S2

Absent: 0 0
Present:
On time 2 2
Late > 10min 1 1

9

MBBS
DOCPS guidance for markers sheet [The each of the following directly observed clinical and procedural skills (DOCPS) should
be completed by the end of the rotation (not necessarily in the prescribed order below). Students should receive a grade of either A or B (if
necessary after re-training and re-examination) in each required procedure].
Grading scheme for each

Skill 1....
Component (not all will apply in each case) Unsatisfactory Borderline Satisfactory N/A
Demonstrates understanding of indications, relevant anatomy, technique of procedure
Obtains informed consent
Demonstrates appropriate preparation pre-procedure
Appropriate analgesia or safe sedation
Technical ability
Aseptic technique (if appropriate)
Seeks help where appropriate
Post procedure management
Communication skills i.e. explains procedure and give feedback to the patient
Consideration of patient/professionalism
Based on the above provide a summative grade below
Summative grade (tick one)
Able to perform without supervision A 4
Able to perform with some supervision B 3
Able to perform with considerable supervision C 2
Not able to perform D 1
Feedback
Assessors name,
signature and date

Skill2..
Technical ability
Feedback

Assessors name,
signature and date

Placement and removal of plaster cast (Plaster of Paris)

Suturing a laceration

10

MBBS
Skill 3..
Technical ability
Feedback
Assessors name,
signature and date

Skill 4..
Technical ability
Feedback

Assessors name,
signature and date

Plotting and interpreting the partogram

Interpreting Chest x ray
11

MBBS
Skill 5..
Technical ability
Feedback
Assessors name,
signature and date

Skill 6..
Technical ability
Feedback

Assessors name,
signature and date

Recording a Glasgow Coma Scale (GCS)

Doing and interpreting ECG
12

MBBS
Skill 7..
Technical ability
Feedback
Assessors name,
signature and date

Skill 8..
Technical ability
Feedback

Assessors name,
signature and date

Plotting and interpreting the Weight for Age graph in the Under-
5
Inserting vesical catheter
13

MBBS
Skill 9..
Technical ability
Feedback
Assessors name, signature
and date

Skill 10..
Technical ability
Feedback

and date

Skill 11..
Shoulder examination
Low back examination
Knee examination
14

MBBS
Technical ability
Feedback
Assessors name,
signature and date

Skill 12..
Technical ability
Feedback

Assessors name,
signature and date

Use of PEF in asthmatic patient
15

MBBS
Skill 12..
Technical ability
Feedback
and date

Skill 13..
Technical ability
Feedback

and date

Incision and drainage of abcess

Examining the ear

16

MBBS
Skill 14..
Technical ability
Feedback
and date

Skill 15..
Technical ability
Feedback
and date

Use of inhalers and spacers

Giving nebulisation for acute asthma attack

17

MBBS

CASE PRESENTATIONS/ MANAGEMENT PLANS

Clerking and presentation of patients.
Formulation of management plan and evidence-based decision making based on the
above
Patients should be clerked using the following scheme based on the Calgary Cambridge
process used in Phase l
Before starting make sure that you have obtained the patients consent both for interviewing
and examining him or her, and for keeping a record. Then record the consent in the hospital or
GP notes

18

MBBS
WEEK 1 CASE PRESENTATION / MANAGEMENT PLAN
Patients problem list (Calgary-Cambridge) (presenting complaint)

Biomedical perspective (history of presenting complaint)
sequence of events; symptom analysis

Patient perspective (history of presenting complaint)
ideas and beliefs; concerns and expectations;
system review effects on life; feelings

Background information past medical history; drug and allergy history; family history; social history INCLUDING GENOGRAM

Analysis of patients history the most likely cause(s) of the patients presentation; other possible causes; the rationales behind your identification of
these as more or less likely causes; findings to be looked for on physical examination to decide between causes

Recording your findings from physical examination underline any you feel are particularly relevant

Analysis of the history and the examination have you changed your view from before? What is now the most likely cause of the patients problem(s)
and why? Are there any other possible causes that still need to be considered at this stage? Which causes could you now discard? (differential diagnosis)

Formulation of the patients problem(s) encapsulate this in a single sentence incorporating physical, psychological and social terms (the Triple
Diagnosis)

Plan of management investigations (WRITE PATHOLOGY FORM); prescription/medical intervention; observation; referral and team working
(WRITE REFFERAL LETTER).

Explanation and planning with the patient what the patient has been told; plan of action negotiated

PATIENT AGE: SEX:
19

MBBS
Outcome A description of the progress of the patient as far as possible. Consider further issues to be resolved. Where appropriate, you should discuss
with your tutor whether to contact the patient by telephone after discharge. If so, you should obtain permission from the patient. INCLUDE HOME
VISIT IF NECESSARY. Describe any ethical issues arising from the patient using the 4 principles of postmodern
ethics where appropriate.

Identification of learning objectives to be developed through discussion with your tutor.

Grading scheme.

A performance graded Unsatisfactory may be revised or repeated so as to obtain a higher grade
Progression requirement for Clerking and presentation and Management plan and evidence-based decision
making. Students should receive a grade of at least Borderline in both components of 8 patients in each course.

Clerking and presentation Grade
(tick 1)
Management plan and evidence-based
decision making
Grade
(tick 1)
Excellent

4
All significant items have been considered.
The student demonstrates an awareness of
matters beyond those that must be addressed.
No further enquiry is needed
All significant items have been considered. The
student demonstrates an awareness of matters
beyond those that must be addressed

Satisfactory

3
All the important items are considered. Any
omissions are minor and unlikely to be of
clinical significance for the diagnosis of a
patient with this presentation. Only minimal
further enquiry is needed
omissions are minor and unlikely to be of clinical
significance for the management of a patient with
this presentation.

Borderline

2
There are significant omissions of detail, or
there are errors of fact or interpretation. These
have the potential to lead to mistakes in
diagnosis of a patient with this presentation.
Considerable further enquiry is needed
There are significant omissions of detail, or there
are errors of fact or interpretation. These have
the potential to lead to mistakes in management
of a patient with this presentation

Unsatisfactory

1
There are important omissions, or significant
errors of fact and/or interpretation, which are
likely to jeopardise the diagnosis of a patient
with this presentation. T he consultation
needs to start again Students will be unable to
count this case against their total unless it is
amended
errors of fact and/or interpretation, which are likely
to jeopardise the management or solution of the
problem of a patient with this presentation.
Students will be unable to count this case against
their total unless it is amended

Feedback comments

Assessors name,
signature and date

20

MBBS







Diagnosis)



PATIENT AGE: SEX:
21

MBBS


Grading scheme.


(tick 1)
decision making
Grade
(tick 1)
Excellent

4

Satisfactory

3
this presentation.

Borderline

2

Unsatisfactory

1
amended

Feedback comments

Assessors name,
signature and date

22

MBBS







Diagnosis)



PATIENT AGE: SEX:
23

MBBS


Grading scheme.


(tick 1)
decision making
Grade
(tick 1)
Excellent

4

Satisfactory

3
this presentation.

Borderline

2

Unsatisfactory

1
amended

Feedback comments

Assessors name,
signature and date

24

MBBS







Diagnosis)



PATIENT AGE: SEX:
25

MBBS


Grading scheme.


(tick 1)
decision making
Grade
(tick 1)
Excellent

4

Satisfactory

3
this presentation.

Borderline

2

Unsatisfactory

1
amended

Feedback comments

Assessors name,
signature and date

26

MBBS

Mini-CEX ASSESSMENT
Supplementary Mini-CEX
(A process partly or wholly observed by the assessor)

Date: _______ Group____________ Year________
Please circle the appropriate response or tick the score box.

Assessors position Academic Consultant Resident MO Other:
Clinical Setting A/E OPD In-patient Acute admission GP Outreach
Mini-CEX Number --------
Patient Diagnosis
Please tick the appropriate boxes: Expected standard: 3
rd
Year Medical Student
Components assessed (NB not all needed for MiniCEX) Not Assessed 0 Below Expectation 1 Border Line 2 Meets Standard 3 Above Expectation 4
1. History
2. Physical examination
3. Communication / empathy
4. Clinical knowledge
5. Presentation skills
6 .Overall performance
COMMENTS BY ASSESSOR for feedback

AGREED ACTION / LEARNING OBJECTIVE after discussion with student:
Assessors Name
Was the student given oral feedback (please circle) Assessor Signature:
Yes No
27

MBBS

Mini-CEX ASSESSMENT
Mini-CEX 1

Date: _______ Group____________ Year________

Progression requirement: students who are awarded a grade of below expectations on both patients
will be examined on a third. If the grade is unchanged then the student will be unable to progress.

Patient Diagnosis
rd
1. History

Assessors Name
Yes No
28

MBBS

Mini-CEX ASSESSMENT
Mini-CEX 2

Date: _______ Group____________ Year________

Progression requirement: students who are awarded a grade of below expectations on both patients
will be examined on a third. If the grade is unchanged then the student will be unable to progress.

Patient Diagnosis
rd
1. History

Assessors Name
Yes No
29

MBBS

This sub-section should involve documentary proof of activities such as guest lectures, conferences,
workshops, seminars, weekly Wednesdays presentations and etc.

Week
no
Date Topic presented Presenter
s Name
Presenters
signature
Supervisors
signature
1

2

3

4

5

6

7

8

30

MBBS

This sub-section should involve documentary proof of activities such as meeting with Primary Health
care stakeholder.
Week Date Topic discussed Stakeholder designation Stakeholder /
Supervisors
signature

This sub-section should involve documentary proof of activities such as call during weekday or weekend.
Week Date Weekday/Weekend Supervisors name Supervisors
signature
1
2
3
4
5
6
7
8
9

31

MBBS

This sub-section should involve documentary proof of activities such as clinical attendance (Clinic, OPD,
A & E).
Date Supervisors name & signature Date Supervisors name & signature
Week1
Monday

Thursday

Tuesday

Friday

Wednesday

Comment if any:
Week 2
Monday

Thursday
Tuesday

Friday
Wednesday

Comment if any:

Monday

Thursday
Tuesday

Friday
Wednesday

Comment if any:
Week 3
Monday

Thursday
Tuesday

Friday
Wednesday

Comment if any:
Week 4
Monday

Thursday
Tuesday

Friday
Wednesday

Comment if any:
Week 5
Monday

Thursday
Tuesday

Friday
Wednesday

Comment if any:
Week 6
Monday

Thursday
Tuesday

Friday
Wednesday

Comment if any:
Week 7
Monday

Thursday
Tuesday

Friday
Wednesday

Comment if any:
Week 8
Monday

Thursday
Tuesday

Friday
Wednesday

Comment if any:

32

MBBS

END OF ROTATION MARKING SHEET

Family Medicine rotation was completed in: Mahalapye/ Maun (please circle)
Component Student Marks Indices Final student
marks (reduce to
one place decimal only)
Maximum
Marks
Case presentation
history and physical
examination
/16 X 0.625 / 10%
Management plan /16 X 0.625 / 10%
Total Case
presentations
XXXXXXXXXXX
XXXXXXXXXXX
XXXXXXXXXXX
XXXXXXXXXXX
/ 20 %
Mini-CEX 1 /4 X 0.625 / 2.5%
Mini-CEX 2 /4 X 0.625 / 2.5%
DOCPS /60 X 0.00138 / 5%
Total Mini-CEX +
DOCPS
XXXXXXXXXXX
XXXXXXXXXXX
XXXXXXXXXXX
XXXXXXXXXXX
/ 10%
PBL

/160 X 0.0625 / 10 %

Total XXXXXXXXXXX
XXXXXXXXXXX
XXXXXXXXXXX
XXXXXXXXXXX
/ 40%

Name of Rotation Coordinator:.

Signature:

Date:

33

MBBS

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