By the end of the 9 week placement the students will be able to elicit and record a problem-oriented medical history, perform a pertinent physical examination, obtain and interpret indicated lab studies, formulate a management plan and implement appropriate therapy for common general medical problems. 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 and record a complete and accurate medical history from any patient, demonstrating ability to:

1.  Establish effective rapport with patients and their families in a manner that will enhance the history-taking process.

2.  Utilise a problem-oriented approach to gather historical information

3.  Obtain and record a complete and accurate medical history from the following areas:  presenting complaint, history of the presenting complaint, past medical history, past surgical history, family history, personal and social history, and review of systems.

4.  Obtain and record an interval history pertaining to ongoing disease states, or a follow-up history of improved or deteriorating patient condition.

5.  Obtain pertinent information from the patient’s medical records.

Physical Examination 

The student will be able to perform a complete or directed physical examination on any patient, demonstrating ability to:

1. Gain patient confidence and provide reassurance about the examination in a manner that will enhance the collection of data.

2. Utilise data from the medical history to determine which organ systems should be emphasised in the physical examination.

3. Distinguish normal from abnormal physical examination findings in all patient groups.

4.  Appropriately utilise the various instruments and tools of physical examination with a technique that provides protection to the patient and examiner from blood-borne pathogens or injury.

5.  Perform and record the findings from a comprehensive, logical, systematic physical examination.

6.  Alter the sequence and content of the physical examination to correspond with the special needs of the patient.

7.  Perform and record directed and limited physical examinations when indicated.

8.  Incorporate special physical examination procedures that are indicated from the medical history or other physical examination findings.

9. Seek out 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 order, perform (or assist with), and interpret routine primary care diagnostic procedures and laboratory tests, demonstrating ability to:

1. Order indicated tests in a cost-effective and rational manner, based upon the differential diagnosis made from the history and physical exam.

2. Obtain technically valid specimens.

3. Demonstrate knowledge of the indications for and the ability to perform laboratory tests and diagnostic procedures common in family practice.

4. Discuss the benefits, risks, specificity, and sensitivity of common laboratory tests and diagnostic procedures.

5. Demonstrate skills in collecting routine specimens including but not limited to:

   • Wound cultures

   • Blood samples

   • Sputum samples

   • Urine samples

   • Tissue samples

   • Throat cultures

6. For the following basic laboratory tests, the student will be able to obtain an appropriate sample in the correct clinical setting and be able to interpret the results. The student will be able to perform those tests marked in bold type:

• Complete blood count with differential

• Erythrocyte sedimentation rate and C-reactive proteins

• Stool analysis for presence of blood, WBC’s, enteric infection, and ovum and parasites

• Urinalysis (dipstick and microscopic)

• Culture and sensitivity of various samples, including urine

• Pregnancy testing

• High Vaginal Swab

• Blood glucose testing with glucometer

• Electrolytes, glucose, liver functions, and other common serum tests

• Thyroid function testing (sensitive TSH, free T4 and T3)

• Lipid panel / cholesterol screening and long-term monitoring

• Hemoglobin A1C

• BNP other markers of myocardial function

7. Be familiar with how to perform and be able to interpret 12 lead ECGs and rhythm strips.

8. Order and perform basic interpretation of X-ray studies of the chest and extremities.

9. Be able to order and interpret pulmonary function tests.

10. Understand indications for and uses of the following imaging modalities:                                             

• Cardiac treadmill testing

• Ultrasound studies, including echocardiography

Therapeutics and Prescribing

Discuss and observe prescription of pharmacologic therapy, demonstrating understanding of the indications, contraindications, major side-effects/adverse reactions and correct dosing schedules for medications commonly used in family practice.

Clinical Planning and Procedures

The student will analyse information obtained from the history, physical examination, laboratory tests and diagnostic procedures to:

1. Recognise and diagnose medical emergencies.

2. Formulate a problem list.

3. Develop a comprehensive, prioritized differential diagnosis.

4. Utilise all available clinical data to accurately determine the diagnosis.

The student will be able to identify, order, discuss, and perform therapeutic treatment modalities for the management of commonly occurring primary care entities, demonstrating ability to:

Perform common procedures, demonstrating knowledge of the indications and proper techniques of each, including, but not limited to:

1. Suturing lacerations.

2. Excising skin lesions or administering cryotherapy.

3. Incision and drainage of abscesses.

4. Therapeutic injection of joints and soft tissues.

5. Administration of nebulizer treatments to patients of all ages.

6. Administration of injections intradermally, subcutaneously, intravenously, and intramuscularly.

Provide education and counselling for a wide variety of primary care issues, including:

1. Age-appropriate health maintenance guidelines and preventive medicine issues.

2. General nutritional requirements, the treatment of nutritionally related health problems such as complications of obesity, weight reduction diets, diabetic diets, low fat diets, low sodium diets, low cholesterol diets, and nutritional/vitamin deficiencies.

3. Appropriate indications for antibiotic treatment.

4. Contraception and pregnancy issues.

5. Immunisation guidelines.

Arrange appropriate medical or surgical consultations or referrals.

Be knowledgeable of community resources and refer the patient to the appropriate agency when indicated.

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

• Hypertension

• Hypotension- Low blood pressure

• Vascular Disease

• Conduction Disorders

• Cardiac Failure

• Cardiomyopathy

• Congenital Heart Disease

• Ischaemic Heart Disease

• Valvular Disease

Neurological

• Bells Palsy

• Diabetic peripheral Neuropathy

• Parkinson's

• Alzheimer's disease

• Tremors

• Headaches

• Shingles

• Neoplasm

• CVD

• Meningitis 

Dermatological

• Tinea Infections

• Eczematous eruptions

• Papulosquamous diseases

Respiratory

• Pneumonia

• Chronic obstructive Pulmonary disease

• Asthma

• Childhood respiratory diseases: croup, RSV, epiglottitis, influenza

• Pleural Diseases

• Neoplastic Pulmonary Disease

• Restrictive Pulmonary Disease

Endocrine and Metabolic disorders

• Diseases of the Thyroid

• Diabetes Mellitus, Type I &Type II

• Hypercholesterolaemia

• Electrolyte and acid-base disorders

• Corticoadrenal insufficiency

Gastro-Intestinal

• Oseophagitis 

• Neoplasms

• Dyspepsia

• GORD

• Gastritis

• Peptic ulcer 

• H Pylori infections 

• Stomach Ca

• IBD

• IBS

• Malabsoroption

• PR bleed

• Haemmarrhoids

• Anal fissure 

• Cholecystitis 

• Coeliac disease

• GI perforation 

Renal and GU 

• Benign conditons of the GU tract

• Cystitis

• Balanitis 

• Prostatitis 

• Epidydimitis

• Orchitis

• Prostate Ca

• Bladder Ca

• Acute and chronic renal failure

Female Health

• Dysfunctional uterine bleeding 

• PCOS

• Prolapse

• Fibroids

• Abnormal smears

• Vaginitis

• Neoplasms

• Bartholins cyst

• Un/Complicated pregnancy

• Breast abscess

• Fibroadenoma

• Breast cancer

Palliative Care

• End of Life care 

Haematological

•  Anaemia

• Coagulation disorders

• Haematological malignancies

Sexual health

• Contraception

• Sexual Dysfunction

• Safe Sex Advice

• Bacterial Disease

• Syphilis

• Viral disease

ENT

• Dizziness

• Epistaxis

• Rhinitis 

• Tonsilitis 

• Quinsy

• Acoustic Neuroma