By the end of the 3 week placement the PA student will be able complete a consultation (history, physical examination, suggest and interpret relevant investigations) relative to older patients with common, acute and chronic illnesses. The student may have some areas of weakness but will, overall, be safe.  

History Taking and Consultation Skills

The student will be able to obtain from a patient, relative, or other informed party, information sufficient to conceptualise the medical problem. The student will demonstrate:

1.       Use of a problem-oriented approach to gathering subjective information.

2.       Ability to collect comprehensive data pertinent to the patient's problem(s) from the following areas:

·         Presenting complaint

·         History of presenting complaint

·         Past medical history

·         Family medical history

·         Personal/social history

·         Review of systems

·         Previous medical records

·         Patient profile

3.       Use of effective interview methods

4.       Evaluation of historical facts

Physical Examination

The student will be able to perform an appropriate physical examination demonstrating the ability to:

1.       Identify normal and abnormal physical findings.

2.       Perform proper examining techniques.

3.       Utilize the physical examination data to support or modify tentative diagnostic impressions developed from the history.

Clinical Judgment in Diagnosis and Management

The student will be able to: 

1.  Order indicated tests

2.  Obtain technically valid specimens

3.  Perform office lab procedures

4. Evaluate results of diagnostic tests to support or modify the tentative diagnostic impressions

When considering the therapeutic benefit of costly tests, students will be able to:

1. Develop a plan of investigation and be able to determine the appropriate laboratory, radiography, and/or other diagnostic studies and tests that are indicated.

2. Based on historical, physical, laboratory, and/or radiographic data, develop a tentative clinical diagnosis and/or master problem list for physician consideration, review and comment.

3. Formulate a differential diagnosis.

Clinical Planning and Procedures

Students will be able to recognise indications for physician consultation.

Formulate and assist in implementation of a management plan including:

1.       Medical therapies, procedures, and treatments.

2.       Patient education and counselling procedures.

3.       Preventive measures.

4.       Follow-up care.

5.       Realistic treatment goals.

Develop skills necessary to perform or assist in the performance of common diagnostic and therapeutic procedures.

Prescribing and Therapeutics

Be familiar with problems in pharmacotherapy including polypharmacy, compliance, drug interactions, bioavailability, and side effects in the geriatric patient.

Below is an extensive but not exhaustive list of conditions that PA students are encouraged to see by the end of their 3 week rotation in General Medicine. Once qualified, PAs are expected to diagnose a patient on initial presentation with these conditions and will not usually require further referral. 

Students will be able to describe for each of these conditions:

1.       Signs and symptoms

2.       Cause and natural history

3.       Diagnostic lab tests

4.       Appropriate therapeutic and management consideration

Cardiovascular

• Cardiovascular disease                                         

• Angina - Myocardial Infarction                          

• Congestive Heart Failure                                          

• Hypertension                                                               

• Dysrhythmias                                                               

• Postural Hypotension

• Decubitus Ulcer 

Neurological

• Dementia

• Delirium

• Cerebrovascular Accident

• Tremors

• Parkinsonism

Ophthalmology

• Glaucoma/Cataracts

Infections

Respiratory

• Pneumonia

Endocrine and Metabolic disorders

• Diabetes      

Gastro-Intestinal

• Cholecystitis     

• Hiatus Hernia                                            

• Diverticulitis    

Renal and GU 

• Urinary Incontinence

• Cystitis vs. Asymptomatic bacteriuria

• Chronic Renal Failure

Palliative Care

• Understand common cancers:

  • Lung

  • Breast

  • Prostate

  • Uterus

  • Colon/Rectum

Haematological

Rheumatological

• Osteoporosis 

Musculoskeletal 

• Osteoarthritis

Mental Health

• Depression    

Other

• Elder abuse 

• Falls in the elderly

• Rehabilitation therapy in patients with CVA, fracture, arthritic limitation and amputations