otago medical school · demonstrate professional and personal attributes (as listed in the graduate...
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OTAGO MEDICAL SCHOOL
UNIVERSITY of OTAGO
WELLINGTON
TRAINEE INTERN HANDBOOK
2016-2017
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CONTENTS
Introduction by the Dean ............................................................................................... 4
PART A. OTAGO MEDICAL SCHOOL, UOW ......................................................................... 5
6th Year Medical Course Dates ....................................................................................... 5
Course Convenors and Administrative Staff .................................................................. 6
Purposes of the Trainee Intern Year .............................................................................. 7
Purpose of Assessment in the TI year ............................................................................ 7
Assessments ................................................................................................................... 8
Arrangements for the Final Week of the Year ............................................................. 10
Trainee Intern Year Convenor and Contact Staff ......................................................... 11
Dress and Appearance.................................................................................................. 13
Course Evaluation and Feedback ................................................................................. 13
Academic Integrity ....................................................................................................... 15
Hawke’s Bay Programme ............................................................................................. 17
Palmerston North Programme ..................................................................................... 20
Wairarapa DHB ……………………………………………………………………...22
Hutt Valley DHB ……………………………………………………………………...23
PART B. DEPARTMENTAL PROGRAMMES ........................................................................ 24
Elective Programme ..................................................................................................... 24
Emergency and Acute Care .......................................................................................... 28
General Practice ........................................................................................................... 30
Medicine ....................................................................................................................... 33
Obstetrics and Gynaecology ......................................................................................... 36
Paediatrics and Child Health ........................................................................................ 37
Psychological Medicine ................................................................................................ 39
Surgery .......................................................................................................................... 42
Professional Skills, Attitudes and Ethics (PSAE) ........................................................... 50
Prizes ............................................................................................................................. 51
PART C. RELATIONSHIPS AND PLACEMENT WITHIN CLINICAL SETTINGS ........................ 55
Introduction .................................................................................................................. 55
Trainee Internship ........................................................................................................ 55
Duty Guidelines ............................................................................................................ 57
Drugs & Other Offences ............................................................................................... 58
Applying for Medical Registration in New Zealand ..................................................... 59
Applying for First Year House Officer (PGY1) Positions in New Zealand ..................... 60
Trainee Intern Training Grant....................................................................................... 61
Emergency Response: Dealing with Exposure to Blood and/or Body Fluids ............... 75
TIMETABLE – 2016/17 ...................................................................................................... 77
TRAINEE INTERN ELECTIVE QUARTERS: 2016/2017......................................................... 79
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Welcome to the final year of your medical degree. The trainee intern year’s apprenticeship model aims for you to be fully integrated within a variety of health care teams, taking responsibility for patient care decisions while knowing when to ask for help, and while remaining under supervision by both the medical school and your clinical team. We encourage you to continue to develop your independent learning and your teamwork, and to ask for feedback and reflect on it. These habits will prove valuable in the challenging years ahead of you. The Otago Medical School, the MB ChB programme and your base campus provide resources and support for this last stage of your undergraduate training. We look forward to seeing you graduate at the end of this year, and to working with you in the future. Professor Tim Wilkinson MB ChB Programme Director
Introduction by the Dean Nau mai, haere mai ki te Whare Wānanga o Otago, ki te Whānganui-ā-Tara me te tau whakamutunga o tō Tohu. Welcome to UOW and your final undergraduate year, with a special welcome to those of you who have transferred from other Schools. I trust you will enjoy your time spent in Wellington and the other learning centres in the region. This year you will grow in clinical confidence, applying the problem solving skills you have already acquired, and increasing your knowledge base. You will have opportunities to develop the individual practice of self-directed learning which will underpin your career as a doctor. This is a busy year with clinical contact provided by hospital and community-based attachments complemented by a formal teaching programme designed to support your clinical learning. Over recent years we have extended the range of clinical attachments to include opportunities to learn in a number of centres outside Wellington. We hope that you will use these attachments along with the twelve-week elective period to reach the high level of clinical competence which will make you a safe and effective clinician. The Trainee Intern year gives you the chance to actively explore possible future career directions and your future contributions to the health of New Zealanders. Enjoy the experience and accept its challenges. I look forward seeing you graduate in Medicine at the end of 2017. Heoi anō tāku mō nāianei! Sunny Collings Dean and Head of Campus University of Otago, Wellington
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PART A. OTAGO MEDICAL SCHOOL, UOW
6th Year Medical Course Dates Monday 21 November 2016 Monday 19 December 2016 to Tuesday 3 January 2017 (inclusive) Wednesday 4 January 2017 Sunday 26 February 2017
First Quarter begins SUMMER VACATION First Quarter continues First Quarter ends
Monday 27 February 2017 Sunday 21 May 2017
Second Quarter begins Second Quarter ends
Monday 22 May 2017 Sunday 13 August 2017
Third Quarter begins Third Quarter ends
Monday 14 August Sunday 27 August 2017 (inclusive)
WINTER VACATION
Monday 28 August 2017
Fourth Quarter begins
Monday 13 November to Wednesday 15 November 2017 Pass/Fail & Distinction exams Trainee Intern Prize-giving and Graduation Dinner, to be advised Sunday 19 November 2017
End of academic year
House Surgeon (Intern) jobs commence 27 November 2017
Please note: Trainee Interns do not get statutory holidays off. Vacation periods substitute for all statutory holidays.
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Course Convenors and Administrative Staff Emergency and Acute Care Dr Andy Swain ext 4535 [email protected] Jennabeth Fuge ext 5191 [email protected]
General Practice Dr Samantha Murton ext 5536 [email protected] Jane Sparkes ext 5995 [email protected]
Medicine Dr Mike Tweed ext 5456 [email protected] Alison Edmonds ext 6923 [email protected]
Obstetrics & Gynaecology Dr Peter Abels ext 4633 [email protected] Rhys Mulholland-Winiata ext 4898 [email protected] Jackie Bell ext 5875 [email protected]
Paediatrics Assoc Prof Lynette Sadleir Dr Anganette Hall Keely McBride
ext 6150 ext 6139
[email protected] [email protected] [email protected]
Psychological Medicine Dr Giles Newton-Howes ext 5587 [email protected] Carol Comber ext 5640 [email protected]
Surgery Dr John Nacey ext 5646 [email protected] Jennabeth Fuge ext 5191 [email protected]
PSAE Dr Ben Gray Jane Sparkes
ext 5166 806 1758
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Purposes of the Trainee Intern Year To introduce students in a gradual manner to full responsibility for patient care, in a variety of medical disciplines and practice environments, while still under continued academic supervision. The role of the trainee intern is that of an increasingly responsible member of the clinical team. By the end of the TI year, students should be able to:
contribute to safe and effective patient care with the level of support available to first year doctors; and
demonstrate professional and personal attributes (as listed in the graduate profile) to enable them to develop and maintain successful careers in medical practice.
The following overarching objectives apply in TI year at UOW: Patient care
Consolidate, synthesise and apply knowledge of health care and health care systems to a broad range of acute and longer term illnesses and patient presentations.
Recognise and initiate management of the acutely unwell patient. Teamwork
Function competently as a member of an inpatient or primary care based health care team.
Function competently as a member of an ambulatory patient based health care team.
Professionalism and ongoing learning Pursue in greater depth an area of medical practice, medical education or research,
of personal interest to the student. Demonstrate further development of professional attitudes and behaviour. Engage in continuing professional development.
Purpose of Assessment in the TI year Good assessment should guide and inform student learning. The TI year aims to complete a student’s journey towards performing as a practising doctor. However, the University has an obligation to the Medical Council and to the public that all graduates are fit to practise. Therefore TI assessment will:
1 encourage ongoing learning and clinical behaviours as expected of competent practising doctors
2 certify overall satisfactory performance; and 3 certify acquisition of relevant competencies
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Assessments Requirements for the Award of Terms (a) A responsible and reliable attitude to patient care, combining humanitarian and scientific principles (b) The interpersonal and professional skills necessary to work with patients, relatives and other professional staff (c) The ability to provide urgent primary management of patients with acute conditions (d) Competence in the performance of basic clinical procedures
University Regulations The Sixth Year will be a Trainee Internship designed to introduce clinical responsibility for patients. It will include clinical attachments and an elective period. To pass the Final Examination a candidate shall normally obtain a passing assessment from each clinical attachment and from the elective period. The assessment will be made on performance of clinical and other work and may include oral and clinical examinations. In the event that a passing assessment is not obtained in one or more attachments a candidate will sit a final clinical examination conducted by examiners from more than one School of Medicine and will pass the Final Examination if, in the opinion of the Board of Examiners, a satisfactory overall performance has been achieved.
Distinction / Pass / Fail The Otago Medical School uses a Distinction / Pass / Fail grading system within the MB ChB degree. The same system applies in the Trainee Intern year. Some clinical attachments may use a separate process for assessing distinction.
School Regulations Trainee Interns will be required to pass each attachment they attend during the year. They will be assessed in each attachment on the basis of on-going assessment during the run. (details of departmental requirements are included in respective sections of this handbook). If the on-going assessment is unsatisfactory, including, for example, failure to attend regularly, the Trainee Intern will be required to repeat the run. A Trainee Intern who fails an examination during the run may be required to repeat it at a later time.
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Student Leave – updated September 2014 It is expected that all students will attend all scheduled learning experiences. It is however acknowledged that a student may wish to have leave from time to time to attend to personal or extracurricular matters. The granting of leave is discretionary and considered case by case. Application for Leave Students are required to seek approval for all leave and should notify in advance, all appropriate convenors, supervisors or tutors. When any leave is taken a Leave Request form needs to be completed and signed off by the appropriate tutor(s)/convenor(s) and handed to the Student Affairs Office. If the leave requested is for longer than 3 days it also needs approval from the Associate Dean Student Affairs (or the relevant Associate Dean in Palmerston North or Hawkes Bay for students on full-year placements there). Consideration of Leave Application When deciding on leave applications, the following points will be taken into consideration: - Learning or professional development opportunities afforded by the activity - The family or community importance of the student attending the activity - Whether the student has extenuating personal circumstances - Whether the student is participating in a national or international sporting or cultural event - Whether the student is presenting, organising or representing a group at a conference or meeting - The proportion of the module being requested as leave - The reason the activity cannot be undertaken during scheduled holidays - The length of leave relative to the activity - The importance of missed teaching or assessment, and the student’s ability to catch up on missed activities - The student’s total leave in that year and any other leave in that module If students wish to discuss the process of applying for student leave the Student Affairs Office can provide information. If a student’s application for leave is denied by the module convenor(s) the student may appeal to the Associate Dean (Student Affairs). An ultimate appeal could be made to the Dean. Sick Leave, Bereavement Leave or other Emergency If a student is unable to attend learning sessions or their attachment due to illness or other reasons the appropriate tutor(s), module convenor(s) and the Student Affairs Office must be notified on the first day of the absence and on any subsequent days. This is the student’s responsibility. It is important not only because of the missed learning opportunities, but also because staff frequently arrange clinics and patients to be available for students so need to know if the student will not be present.
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A medical certificate is required for any student absent because of illness for more than 3 days. Note: Part of professional responsibility is to absent yourself from work if you are ill, in order to avoid infecting vulnerable patients. The length of time taken for bereavement leave is also considered on an individual basis. Please note that evidence of bereavement should be provided i.e.: copy of death certificate, death notice etc. Dealing with Missed Sessions Please note it is the student’s responsibility to arrange any necessary catch up with the relevant module convenor(s). If missed content cannot be completed within the module this will lead to a module result of ‘Incomplete’ and a plan made to allow completion. Failure to contact the tutor(s)/convenor(s) if a session cannot be attended or not attending after a request is declined is considered unprofessional behaviour and will be brought to the attention of the Student Progress Committee. Statutory Holidays These are: Wellington Anniversary Monday and any other relevant regional holidays, Waitangi Day, Good Friday, Easter Monday, Anzac Day, Queen’s Birthday and Labour Day. Trainee Interns should not assume that they can automatically take leave of absence on these days. They should discuss requests for leave of absence with their consultant supervisors, module convenors or GP preceptors, preferably well in advance of the relevant statutory holiday. These regulations are meant to be helpful and not punitive. Always remember that good communication skills will avoid trouble and misunderstanding. Arrangements for the Final Week of the Year
The dates of the final week of the Trainee Intern year are: Monday November 13 - Sunday November 19 2017.
Unless they are sitting Distinction or Pass/Fail exams, Trainee Interns are expected to
fulfil all clinical and teaching commitments up to, and including, Wednesday November 15 unless explicit exemption has been granted by the relevant module convenor.
Trainee Interns with a Fourth Quarter Elective are required to be back in Wellington
on Monday November 13. All elective reports and Supervisors’ reports for 4th Quarter Electives must be handed in to Ann Thornton no later than 4.00pm on Wednesday November 15.
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Trainee Intern Year Convenor and Contact Staff Curriculum Sub Committee
Chair Prof Pete Ellis ext 5656 [email protected] Trainee Intern Specific Matters Lesley Gray ext 4654 [email protected] Jessica Ellis ext 5708 [email protected] Medical Education Advisor Peter Gallagher ext 4095 [email protected] Student Affairs Dr Mark Huthwaite ext 6979 [email protected] Ann Thornton ext 5576 [email protected]
Computer Support Kathleen Johnson ext 6844 [email protected]
Counselling Denise Steers is the counsellor at the medical school. Feel free to contact her if you would like to talk about any worries or stress in your life. She works Mondays and Thursdays part time. Her sessions are confidential and free of charge. Email is the best way to set up a time. She is here to help, so please take the opportunity if you would like some help managing. For more information see www.otago.ac.nz/UOWstudentcounselling
Her office is located on level 5 (E) of the ward support block through the double doors of the physiotherapy common room (near audiology). Phone 918 5648 Email [email protected]
Bullying
The University of Otago regards student welfare as very important and, as well as having clear policies, has dedicated staff who provide pastoral care services to students. No form of bullying, harassment or racism is acceptable. In the main, students have positive experiences when training. Harassment of any nature, including abuse of supervisory authority, is taken very seriously. At the University of Otago, Wellington our Associate Dean Student Affairs Dr Mark Huthwaite and his team of three Associate Deans Regional (Hutt, Hawkes Bay and Palmerston North) are available to provide pastoral care services to those outside the main campuses. In situations where students are working in more remote areas, arrangements are in place so that students can voice their concerns and request support. Follow this link for contact details: http://www.otago.ac.nz/wellington/departments/studentaffairs/otago016817.html
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Email Addresses Many departments within the Otago Medical School, University of Otago, Wellington and the hospitals communicate mainly by email. It is important that you check your email regularly, especially when travelling.
Student Computing
Information on the computing services at UOW can be found online at http://www.otago.ac.nz/wellington/departments/technologyservices/studentcomputing/index.html. Any updated information from Technology Services about the Student Computing setup will be advised via email. If you have any issues visit Technology Services behind reception on Level C or email [email protected].
Medical Library The Library is located on level D. You will need your ID card to access the Library when the School of Medicine building is closed. The Library opening hours are available via a link on the Library webpage http://www.otago.ac.nz/wellington/library/. You can program your ID card for printing and photocopying on the multi-functional devices in the Library and computer labs. Funds are added using the kiosk in the Library. You can make basic use of DHB Libraries while on placement; if you need more in-depth assistance, please contact the staff at the Wellington Medical and Health Sciences Library [email protected] or 04 385 5914. Intern Training Trainee Interns are invited to attend the weekly Intern training at their local DHB. There are also useful resources on Moodle in the Reference Information folder.
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Dress and Appearance It is appropriate here to re-iterate the importance of suitable dress, not only in the School and on the wider hospital campus, but particularly in the patient areas. At all times appearance is likely to be one of the ways by which people in the hospital assess the School, and must meet the standards that patients expect. Appropriateness to clinical work must always be considered and is part of the requirement of continued honorary staff status with any District Health Board. Dress should fit the work of clinical students and the required respect for patients. If in any doubt, please talk to colleagues or the staff on modules. Members of staff may expect conformity with particular standards within their departments and will discuss dress with students should they deem it necessary. (a) Culturally Sensitive Issues Health Sciences students are required to participate in all laboratory, practical and clinical activities, which include activities that may not be usual prior experience. In the professional classes, some aspects of the teaching will require individuals to practice certain techniques on each other, which may require students to partly undress and may involve body contact between students. Training is done under close supervision and all students are required to participate, as it is essential for their acquisition of clinical skills. Assistance for students experiencing difficulties in this area is available, on request, from the relevant school. (b) Dress Requirements in Theatre Specifically, in disciplines such as surgery, medical students will be required to conform to standards of dress that meet the high levels of hygiene in operating theatres. Personal garments, such as headgear worn outside the theatre situation, must be replaced by alternative sterilised garments provided by the hospital to meet accepted standards of infection control and asepsis. Students must also adhere to the stringent protocols of scrubbing to involve hands and both forearms to at least elbow level.
Course Evaluation and Feedback Evaluation refers to the process by which Trainee Interns give feedback to Course Convenors, the School and the Faculty about their experiences of the attachments. The TI year is more complicated to evaluate than previous years because of the variety of placements and teaching situations that Trainee Interns experience. This year, evaluations will focus on issues common to all attachments as well as experiences specific to individual departments and placements. The methods used by the school are:
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Evaluation of the TI Year Questionnaire Individual course evaluations related to specific placements and experiences Evaluation focus groups covering specific issues relating to Trainee Interns'
experiences. Feedback to the Trainee Interns on the ways in which their comments and ratings have been taken on board by the relevant departments will be in the form of a report to the Staff/Student Committee. Specific issues relating to the TI curriculum and attachments may be raised via student representatives at the Staff/Student Committee. Lesley Gray is also happy to discuss Trainee Intern specific issues brought to her attention in person or via email. Class Representatives The Wellington Medical Students Association (WMSA) is run solely by UOW Medical students. The association liaises closely with academic and management staff to promote the educational needs and ongoing improvements in the course. It also promotes close interactions between all year levels studying at the school through numerous social, sporting and cultural events with the ultimate aim of ensuring that the overall experience of studying in Wellington is a positive and memorable one. If you want to become involved in the activities of the WSMA, or if you have a problem with any aspect of life at the UOW, feel free to contact the WMSA President or any other member of the WMSA. Email: [email protected]
Complaints Procedure Where a student is concerned that the behaviour of a staff member or colleague constitutes harassment, there are a number of routes of communication. The Associate Dean for Student Affairs is a good first stop. A website is currently under development and is expected to be completed by the start of the TI year. This will offer you further advice. Please refer to the Otago Medical School website in the first instance:
http://micn.otago.ac.nz. NZMSA International Medical Student Welfare Please see NZMSA’s International Medical Student Welfare webpage: http://www.nzmsa.org.nz/projects/international-students/
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Academic Integrity The Student Academic Grievance Procedure policy section 1(e) requires that, ‘A clear statement on the nature and unacceptability of academic dishonesty, including cheating, plagiarism and fabrication or falsification of data will be provided to the students by the course co-ordinator or the department.’ This section fulfils that requirement. Academic integrity means being honest in your studying and assessments. It is the basis for ethical decision-making and behaviour in an academic context. Academic integrity is informed by the values of honesty, trust, responsibility, fairness, respect and courage. Students are expected to be aware of, and act in accordance with, the University’s Academic Integrity Policy.
Academic misconduct, such as plagiarism or cheating, is a breach of academic integrity and is taken very seriously by the University. Types of misconduct include plagiarism, copying, unauthorised collaboration, taking unauthorised material into a test or exam, impersonation, and assisting someone else’s misconduct. A more extensive list of the types of academic misconduct and associated processes and penalties is available in the University’s Student Academic Misconduct Procedures.
It is your responsibility to be aware of and use acceptable academic practices when
completing your assessments.
Academic Integrity Policy
Student Academic Misconduct Procedures
Academic Integrity
Recording lectures, patient interviews and clinical presentations Recording of lectures should only occur if you have personally asked the lecturer whether this is permissible. Recording of patient interviews (or photographing or any digital images of patients) or clinical demonstrations by students is NOT permitted under any circumstances. Patients have not been asked for permission and it is inappropriate for students or others to request permission at the time of the demonstration. Please ensure that you respect the confidentiality implicit in all clinical demonstrations. Confidentiality When writing case histories for submission, avoid using identifying patient information – names, dates of birth, NHI numbers, and refer to individuals as Mr A, Ms B, etc. Keep a record of the NHI number in a secure separate place (without the name attached) in case you are required to provide this information in confirmation of seeing a given patient.
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Confidential patient information When preparing any assignments, case histories or other material including confidential patient information, please remove all patient, doctor, nurse and other allied health professional identifiers in your presentation – it must be completely anonymous. Confidential data on electronic devices Capital & Coast DHB requires that any student using patient data on a portable device must ensure that the device is password protected and the data is protected and/or encrypted. For advice about how to secure information, staff and students should contact the helpdesk – email: [email protected] or phone (64) 3 479 8888 or 0800 479 888. When writing case histories for submission, avoid using identifying patient information – names, dates of birth, NHI numbers, and refer to individuals as Mr A, Ms B, etc. Keep a record of the NHI number in a secure separate place (without the name attached) in case you are required to provide this information in confirmation of seeing a given patient. The use of social media The Internet immediately connects us with the public domain and we must avoid making comments that could be interpreted as breaching the boundaries of patient-doctor confidentiality. While blogging, tweeting and other social networking avenues are, for the most part, well intentioned, there is the potential for these activities to have future adverse consequences. As members of a professional community with high ethical standards, any comments, images and material you may leave on a personal page could embarrass you when seeking future employment. The below link is to the excellent Guide to online professionalism for medical practitioners and medical students. Please read it. http://www.nzmsa.org.nz/resources/social-media-guide/
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Hawke’s Bay Programme If you have been allocated to Hawke’s Bay Hospital for some or all of your TI attachments please read the following information prior to arriving in Hawke’s Bay. PRE-EMPLOYMENT SCREENING:
Tb testing – we no longer require test results for this. We now require you to complete the Tb risk questionnaire at the time of employment (or before if you have received it). We will assess the results at the time of employment and then decide whether further testing is required e.g. Quantiferon Tb Gold test, or CXR.
NB: If you do have previous results, please bring your test results with you (it may exempt you from having to undergo repeat testing)
Hepatitis B Antibody status – within 5 years
MMR immune status
Evidence of Pertussis vaccination in the last 7 years
MRSA swab may be required, but this will be determined by Occupational Health when you arrive.
Your health screening may be arranged at your present place of employment or with your GP or you may choose to come in two weeks prior to your start date to complete your health screening through the Occupational Health Service at Hawke’s Bay Hospital. If your health screening is being done elsewhere, please bring your results with you or forward to: Occupational Health, Hawke’s Bay Hospital Private Bag 9014 Hastings or email to [email protected] prior to your first day. If you have any problems with these requirements please contact the Clinical Nurse Specialist – Occupational Health by phone or email as follows: Jane O’Kane ph: 06 878 8109 ext 2665 or Jude McCool 06 878 8109 ext 2601 Email: [email protected] FIRST DAY You will be met at the Main Reception at 0745 by Julie Barrett, TI Administrator and will meet briefly with Prof Ross Freebairn, Associate Dean. Michelle Deacon, RMO Recruiter, can be contacted during your time in HB to answer any questions you may have regarding future job opportunities at HBDHB. (see back page for contact details) During the morning you will visit Occupational Health to complete health screening, receive your pager and ID card and attend a computer training session.
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You will be given an introductory tour of the Hospital which will include the TI room, Library and Education Centre and offices of the Associate Dean and Administrator. Lockers are available in the TI room for you to securely store your belongings. Once everything is completed you will be taken to your respective specialty areas. COMPUTER ACCESS During your computer training session on Day 1 you will be shown how to use ECA – HB’s patient information database and be given access to the HBDHB computer system. If you miss this training it is otherwise available every Monday at 10.00am or by individual appointment, excluding statutory holiday. There are computers in the TI room for your use at any time. Please note that internet access is to be used only for work/study related purposes. NOTIFICATION OF LEAVE If you are a full year student in Hawke’s Bay you need to email:
the Wellington Module Convenor
your HB Clinical Supervisor
copy to Julie ([email protected])
copy to Prof Ross Freebairn ([email protected]) If you are a part year student in Hawke’s Bay you need to email:
the Wellington Module Convenor
your HB Clinical Supervisor
Dr Mark Huthwaite
copy to Julie ([email protected]) In addition to the above, please ensure you make direct (telephone) contact with your clinical team on days you are unable to attend work. DEPARTMENTAL ORIENTATION/ASSESSMENTS Depending on the department, orientation/assessments will occur in Hawke’s Bay and/or via video link with Wellington. Please refer to individual attachment descriptions for further information. If you are unsure where to go for your first day please contact Julie. If as part of your attachment you are required to submit end of run assessments to the Department in Wellington, please see Julie before the end of each attachment with the completed paperwork before your departure so this can be processed in good time. You will receive additional information about Hawke’s Bay Hospital, educational sessions, and specifics about your attachments upon your arrival, but if you have any questions before then please contact Julie at [email protected] or phone 06 878 1392.
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ACCOMMODATION If you have any queries with regard to finding accommodation in Hawke’s Bay we are happy to discuss and facilitate options for you. For accommodation options in Hawke’s Bay please contact Julie Barrett or Ann Thornton. For your information, the following website will direct you to a hostel which is very close to the hospital: www.kiwiflats.com. You may find useful information about Hawke's Bay at: www.hawkesbay.co.nz CONTACT INFORMATION Ross Freebairn, Associate Dean Ph: 027 447 6887 Email: [email protected] Julie Barrett, Administrator Ph: 06 878 1392 (ddi) or 06 878 8109 ext 4542 Mobile: 027 3157975 Email: [email protected] Michelle Deacon, RMO Recruiter Ph: 06 878 8109 ext 5887 Email: [email protected]
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Palmerston North Programme If you have been allocated to Palmerston North Hospital for some or all of your TI attachments please read the following information prior to arriving in Palmerston North. Housing If you would like assistance with finding a place to live while in Palmerston North please do not hesitate to contact the Palmerston North TI-co-ordinator, Sonya Clifford at [email protected] or 06 350 8329. Pre-Employment Screening If all of your immunisation requirements for the University of Otago-Wellington are up to date you should not require any additional screening or immunisations. Please be sure to bring along a copy of your up to date immunisation record when presenting on your first day to Palmerston North Hospital so it can be viewed by the infection control staff. First Day Please email Sonya Clifford, TI co-ordinator, prior to your first day to receive detailed information about your first day, which is run dependent. If you are unable to connect with Sonya prior to your start date please report at 7:30am on your first day to the Main Entrance, Palmerston North Hospital. Departmental Orientation Most departmental orientations take place on site in Palmerston North on the first Monday of your run. However, prior to coming to Palmerston North please check with Sonya to confirm where to go on your first day as per above. Please do not directly present to the allocated department on your first day unless specifically instructed to do so by Sonya. In almost all cases it is necessary to get things like ID cards and infection control sorted prior to being permitted to clinical areas. If you have any run specific questions prior to your arrival please also feel free to contact either the Associate Dean, Dr Claire Hardie, or the relevant Palmerston North Module Convenor (contact details listed below). Computer Access You will be provided with computer access while you are at Palmerston North. Computers are available for TIs to use in the TI Room in the Education Centre or in the Palmerston North Hospital Library. Please note that internet access is to be used only for work/study related purposes. Notifying of Absenteeism If you are unable to attend your attachment for any reason, please contact Sonya Clifford at (06) 350-8329 AND send an email to Sonya Clifford with cc to the Associate Dean, your Supervising Consultant, your local as well as your Wellington TI convenors. For anticipated leave please refer to the official UOW leave policy.
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Educational Activities You will receive further information upon your arrival in Palmerston North outlining weekly departmental lecture schedules, intern, and Trainee Intern teaching sessions including lectures transmitted via videoconference from Wellington. Palmerston North Administration and Local Convenor Contact Information: TI Co-ordinator (Responsible for all runs): Sonya Clifford – [email protected] Phone: (06) 350-8329 Fax: (06) 350-8010 Associate Dean: Dr Claire Hardie - [email protected] Phone (06) 350-8439 General Medicine Convenor and Acute Care Co-convenor: Dr Veronica Crawford – [email protected] Emergency Medicine Convenor and Acute Care Co-convenor: Dr Boo Abdelhameed - [email protected] Surgery Convenor: Mr Richard Holmes – [email protected] Psychiatry Convenor: tba Paediatric Convenor: Dr Nigel Orr - [email protected] Obstetrics and Gynaecology Convenor: Dr Phil Suisted - [email protected] General Practice Convenor (Wellington based): Dr Samatha Murton – [email protected] If you have any further questions prior or during your stay in Palmerston North please do not hesitate to contact Sonya Clifford or Dr Claire Hardie, at any time.
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Wairarapa DHB On your first day please report to Main Reception at 08:00am and ask for Debbie O’Neil, SMO/RMO Admin. She will take you to Occupational Health who will have a short discussion with you as related to your health information. Thereafter she will take you to your assigned Department. The SMO/RMO unit will issue you with an access card, IT access login details, a code of conduct and a letter of confidentiality which you need to sign and return to the unit. You will need to supply the unit with a mobile phone number, should they need to contact you. OCCUPATIONAL HEALTH REQUIREMENTS A Pre-employment Health Declaration is to be completed and submitted at least ONE month prior to your starting date. You also need to supply the following: • Evidence (past blood test results) of immune status for Hepatitis B, Varicella, Rubella and Morbilli. • For MRSA screening: everyone is to be asked screening questions prior to the start of each placement. Check swabs will be required if the Trainee Intern has been involved in an MRSA outbreak within the last 6 months, worked in an overseas hospital in the last 6 months, has currently a history of a desquamating skin condition (such as eczema). Trainee Interns returning within a six month period will need to complete the screening questions for MRSA, in case they’ve been exposed to MRSA while working away from here. • Tuberculosis screening questions will be asked of all Trainee Interns, prior to each training period. Investigations (Mantoux or Quantiferon Gold) will be requested if screening question results indicate it. You will also need to complete a VCA form (section 2) and return this along with a copy of your NZ drivers Licence and Passport which have been sighted and signed off by an appropriate professional. (JP, Medical Professional… etc.) MASTERTON ACCOMMODATION The Wairarapa DHB does not provide accommodation for Trainee Interns but you can email debbie.o’[email protected] if you would like to have a list of private accommodation providers.
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Hutt Valley DHB
Travelling at night and accommodation at Hutt If you do not have your own transport then please do not walk to the railway station on your own at night. You can always ask the House Surgeons or the Medical Registrar for a lift (leave early if needed to catch a lift) as most of us live in town. You can stay over in the on call rooms here at Hutt. If you wish to stay over there is free accommodation available - get the code from Rhys Mulholland-Winiata in the Clinical School who will also show you where the rooms are located. The UOW Hutt Clinical School Facility The UOW Hutt Clinical School is your facility at Hutt Hospital on level 2 of the Clocktower building. Rhys Mulholland-Winiata is the Hutt Student Services Co-ordinator and his usual working hours are Monday from 8.00am - 4.00pm, Tuesday – Thursday 8.30am – 12.30pm. Rhys’s role is to support all the UOW Module Administrators and students attached to Hutt Hospital. Rhys will also issue you with your Hutt swipe card and computer login. Dr Judy Ormandy Associate Dean Hutt is also located at UOW Hutt Clinical School and is able to assist with any issues or concerns. If she is in her office she is happy for Trainee Interns to come and see her or you can make an appointment to see her through Rhys. The Hutt Clinical School has a computer room with 8 computers and university wifi, a lunch room with tea and coffee making facilities and some locker space and toilets. There is also a Study room and Tutorial room.
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PART B. DEPARTMENTAL PROGRAMMES The Wellington Trainee Intern Year is divided into four quarters each usually of 12 weeks with two vacations of two weeks. The attachments are as follows: Emergency and Acute Care: six weeks
General Practice: six weeks
Medicine: six weeks
Obstetrics and Gynaecology: four weeks
Paediatrics and Child Health: four weeks
Psychological Medicine: four weeks
Surgery: six weeks
Elective Programme
Specific Educational Objectives for the Elective Programme The objective of the Elective Programme in the Trainee Intern year is to complement an individual student’s education needs through at least one of the following:
Gaining medical experience in different types of health care delivery to that practised in New Zealand
Further developing knowledge in a particular branch of medicine (particularly those not taught in the Trainee Intern year curriculum (e.g. Accident & Emergency Medicine, Sports Medicine)
Gaining medical experience of a particular branch of medicine that may influence subsequent career orientation
Obtaining in-depth experience in medical research methods.
1. All electives undertaken by Trainee Interns of the Otago Medical School, University of Otago, Wellington must be approved by the Elective Convenor. General enquiries should be directed to the Elective Convenor (Dr Jenny Visser: [email protected]).
2. Electives may be planned to extend clinical experience or to study a subject in depth.
All electives are for a minimum of eleven weeks’ study. The 11 weeks can be spent at a single geographical location or split between a maximum of two geographical
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locations. If split, each elective component will be required to be a minimum of 5 weeks.
3. Each Trainee Intern must nominate a supervisor for his/her elective. The supervisor
must be willing to provide a report on the progress and performance of the Trainee Intern. . It is important to remember that the same code of conduct and professionalism that is expected of you here in New Zealand, is expected of you for while you are on your elective. You are an ambassador for the University of Otago while on your elective.
4. Each Trainee Intern must produce a report on his/her elective on return to
Wellington. Guidelines on writing the report are supplied with the elective documents. The report is to be submitted electronically in Microsoft Word format to Ann Thornton: [email protected]. All Trainee Interns will be asked to sign a declaration form, stating that their elective reports may be loaded on to the University’s password-protected website for future reference by medical students planning their electives.
5. Receipt by the Elective Convenor of supervisors’ reports and the student’s elective
report required under (3) and (4) above is necessary before a Trainee Intern may graduate. These must demonstrate that a satisfactory level of performance has been achieved during the elective period.
6. Any Trainee Intern encountering difficulties during the elective should contact the
Elective Convenor. 7. You will be requested to provide a study proposal and agreement by a supervisor
approximately two months prior to commencing your elective. The following information is required in all cases: (a) Your name, address for correspondence, contact phone/fax number and email
address; (b) Brief details of your proposed study topic(s); (c) Your supervisor’s name, title and correct postal address; (d) The exact dates of your elective attachments; (e) A letter of acceptance from your supervisor. 8. You will be notified by the Elective Convenor that your elective proposal has been
formally approved.
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9. Students planning electives overseas will need pre- travel medical preparation. This is likely to include travel vaccinations, antimalarials and medical kits. All students planning an overseas elective must contact the Elective Convenor by email at least 2 months (preferably 3 months) in advance of submitting their proposal. The Elective Convenor will advise on pre-travel health preparation. In addition, those students whose electives are to destinations with high HIV prevalence will be required to see the Convenor prior to elective approval, to discuss minimisation of HIV exposure and what to do in the event of an exposure, including appropriate use of antiretrovirals.
10. All elective students must ensure that they have adequate insurance. Insurances will
need to cover both medical/professional indemnity insurance and personal travel insurance. See following section
Medical Indemnity Cover Students are strongly advised to have medical indemnity cover. Many institutions require such cover (both in NZ and overseas when on elective). The University recommends joining either the Medical Protection Society (MPS) (phone: 0800 22 55 677) or Medicus Indemnity NZ Inc. (www.medicus.co.nz). Having joined, it is your responsibility to contact your organisation to ensure that your indemnity extends to covering you during your overseas elective. It usually does but your provider must have details of your elective in advance. The Medical Protection Society (phone: 0800 22 55 677) provides medical indemnity cover to Trainee Interns in New Zealand and will provide cover whilst on elective in many different jurisdictions worldwide. There is no cost for this cover until the second year as House Surgeon. Without medical indemnity cover Trainee Interns could be personally liable if they were involved in any proceedings brought against them. When Trainee Interns are heading off on elective, MPS are happy to provide a certificate; however there are certain steps you need to take before this can happen: You MUST contact MPS on 0800 225 5677 or email [email protected] * Advising what country you are going to * Dates of elective * Up to date address and phone numbers If your elective is in Australia there is a different procedure and it is important that you contact your indemnity insurer well before your elective. Following changes in Australian medical legislation in July 2003, MPS administrative arrangements for electives in Australia are slightly different to those elsewhere in the world. In brief, this new legislation stipulates that every health care practitioner in
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Australia, including students, must be covered by an insurance policy. As MPS is not an insurance company they have made arrangements with Medical Indemnity Protection Society (MIPS) based in Victoria to cover your elective whilst in Australia. The MIPS Student Members Master Policy is underwritten by the Australian insurance company, Health Practitioners Australia Pty Ltd. (HPIA), which is wholly owned by MIPS. Your MPS student membership will provide you with the benefits of membership whilst in Australia as long as the criteria below are met: All electives should be organised either by you or the Dean of your University All electives must be authorised by the Dean All work must be under the supervision of a fully qualified medical practitioner All work must not exceed the level of your own qualifications or competence You will remain a member of MPS and there will be no additional subscription to pay. The only action you need to take is log onto www.mips.com.au click the student icon and complete the online application form. Ensure that in the field titled “Please enter any message you wish to send here” you provide full details of the intended elective including location, hospitals involved, name of supervisor, nature of your work and the start and end dates of your elective period. However, MPS only have access to the online applications once every two to three weeks. If you need a fast response to acceptance of cover with MPS it would be better to complete the PDF copy instead. The online application can be found at http://www.medicalprotection.org/newzealand/students/join Remember to include your MPS membership number. Once your application has been approved MIPS will issue you with an insurance certificate and policy documents for the duration of your elective.
Travel and Health Insurance while on Elective
VERY IMPORTANT: It is your responsibility to check what your host hospital/ country needs by way of personal insurance/public liability cover as well medical indemnity cover. Some places in Australia, for example, are asking for proof of insurance for personal injury and public liability (if you have injury to yourself or an accident in regards to property and assets). The University of Otago does not have its own cover for this. It is the personal responsibility of each student to arrange appropriate travel insurance. As a guide, travel insurance must cover all planned activities (including recreational activities), and have a high level of cover for injury and/or illness, medical evacuation and repatriation. One option is the “Studentsafe-University Offshore” policy which has been designed, in consultation with the University, specifically for students travelling overseas to study, including on TI electives. The extra item included in this Policy which may not be found in
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any other policies, and is specific to elective students, is the needlestick cover for the accidental puncture from a medical hypodermic needle. Visit the website www.studentassist.co.nz for an online quote OR call the Allianz Student Helpdesk: 0800 486 004 for further information. _______________________________________________________________
Emergency and Acute Care The Emergency and Acute Care module will be 6 weeks long for all students. This module will focus on management of the undifferentiated patient in the emergency and acute setting. This will include Emergency & Acute Hospital Care (five weeks) and Urgent Community Care (one week). If no placement is available in Urgent Community Care, six weeks will be spent in Emergency & Acute Hospital Care. The core objectives for the module are as follows:
Patient care 1. Consolidate, synthesise and apply knowledge of health care and health care systems
to a broad range of acute and emergency illness and injury 2. Efficiently assess, recognise and initiate management of the acutely unwell patient
Teamwork 3. Function competently as a member of emergency and admitting health care teams 4. Function competently as a member of an ambulatory patient health care team
Professionalism and independent learning 5. Pursue in greater depth an area of acute medical practice, of medical education or of
research, which is of personal interest to the student. 6. Develop further professional attitudes and behaviours in preparation for continuing
lifelong learning These objectives will be met through the following attachments: a five-week fulltime emergency and acute care attachment where students will actively participate in patient care in the emergency or admission unit setting, following patients through to definitive care, and a one-week attachment to a community Urgent Care centre. Resuscitation As a Medical Council requirement, all students must achieve the Level 7 standard of adult resuscitation set by the New Zealand Resuscitation Council (NZRC). Successful completion
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of a full NZRC CORE 7 course is ideal but it is acceptable for students to satisfy the following five components:
Adult collapse
Airway management
Use of an automated external defibrillator
Use of a manual defibrillator
Rhythm recognition During the module, students must undergo training and successfully complete the above assessments so that a certificate can be issued. Students attached to outlying hospitals can receive training and assessment at the required standard from any local NZRC CORE Instructor. Assessment Criteria Trainee Interns will be assessed using seven assessment tools.
Professional assessment from the five week Emergency and Acute Care attachment
MiniCEX clinical assessments (x2)
Acute Care case report
Theory paper
Documentation Audit
Urgent Care assessment form
Cases and Procedures Log Book
A satisfactory performance in the seven assessment tools is expected for successful completion of the module. Where deficiencies are identified, students may be reassessed either by repeating the assessment in question or by VIVA examination. Emergency Medicine Prize A prize is awarded annually by emergency medicine staff to the student who demonstrates excellence in the specialty as reflected by high marks for knowledge, clinical ability, and commitment. _______________________________________________
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General Practice
This is a six-week General Practice (GP) module, plus one week equivalent of Urgent Primary Care (UPC) experience. Orientation to this module is delivered in 5th year. This means you go directly to your practice placement for practice based orientation. Therefore, please ensure you familiarise yourself with the arrangements and requirements for this module in the Moodle paper (2017w6 Primary Health Care & General Practice) beforehand, make sure you contact your placement in advance to confirm start time, and if you have any queries about the module requirements contact the Academic Convenor before your run starts. The last Friday of the module is usually scheduled as our tutorial, workshop and summative assessment day. You will have the option of completing the final day in Wellington, Palmerston North, Hawkes Bay or Gisborne if you are located at one of the regional centres, video-linking to Wellington. Programme Administrator Jane Sparkes Telephone: 04 806 1758 Email: [email protected] Academic Convenor Samantha Murton MBChB, FRNZCGP(Dist) FAcadME Mobile: 0274448312 Telephone: 04 385 5536 Email: [email protected]
GP Module Objectives
At the end of this module you should be able to: Doctor-patient communication 1. Competently perform consultations with a broad range of patients integrating history
taking, examination, explanation and shared decision making. 2. Develop a provisional diagnosis and a differential diagnosis list explaining how these are
reached
Additional communication skills 3. Make comprehensive but concise, accurate and legible case records. 4. Write legible clear and accurate prescriptions ready for signing.
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Intraprofessional and interprofessional interactions 5. Function competently as a member of a primary health care team 6. Communicate and collaborate effectively with other health teams involved in the care
of the patient and with health care systems
Procedural skills 7. Perform procedural skills that are common in general practice
Specific Educational Objectives for the GP Module are provided in the Course Documentation section of the Moodle paper. GP Placements
Contracts are in place with a number of teaching practices in rural areas and provincial towns in the lower North Island to ensure you get the quality teaching and good clinical experience necessary to meet the learning objectives for this module. If your GP module is in the first quarter you will receive placement notification in early October. For modules in the second, third or fourth quarter you will usually receive placement notification by the end of December. If you do not receive your placement notification within the timeframe specified, please contact the Programme Administrator ([email protected]). It is not appropriate for Trainee Interns to be supervised by a parent who is a general practitioner, although in larger practices it may be possible to work with other GPs in the practice.
Whole year Palmerston North and Hawke’s Bay Trainee Interns will be offered local GP placements. All other Trainee Interns should expect their placement to be out of Wellington.
Confirming your placement
When the Department emails you the details about your placement, please contact the practice (if specified) within the timeframe provided, to confirm start time, who to report to, and to obtain any directions or accommodation information that may be required. Print and retain a copy of your email notification. You should take your stethoscope, and dress appropriately for seeing patients; other equipment is normally supplied at the practice. At the conclusion of your placement please make sure your Clinical Skills Logbook is signed off. Be sure to thank all the staff at the practice you have met and worked with. Do not
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assume that thanking your supervising GP is sufficient because most practice staff make a considerable effort to ensure you receive quality learning.
Accommodation
Accommodation options vary between placement locations. Please contact the Programme Administrator if you require accommodation options.
Assessment
Successful completion of the GP module requires: Completion and sign off for a range of clinical skills in your module logbook Satisfactory feedback from your clinical preceptor(s) Satisfactory assessment of general practice consultation skills in a simulated
consultation Satisfactory completion of a medications review Participation in Discussion Forums on Moodle, and in end of module sessions
NB - Your TI TPER, whilst not part of the GP module, also falls due towards the end of this module.
Awards and Prizes
Trainee interns assessed as having overall potential distinction in their GP Module will be invited to take a Distinction Viva at the end of the year. If more than six have achieved this recommendation, students will be invited in order of merit. There are two prizes awarded and donated by the Wellington Faculty of the Royal New Zealand College of General Practitioners. They consist of an amount of money and a medal from the RNZCGP. The first is awarded annually to the Trainee Intern with the best performance in the Distinction Viva. The second award for professionalism in general practice, goes to the student who has demonstrated the best all round performance in the module, with an emphasis on respect for patients, good teamwork, and sound integration of theory and practice.
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Medicine The module allows you, as TIs, to develop and demonstrate practice with regard to patient care, teamwork and professionalism and independent learning within the setting of hospital based Internal Medicine. You will have opportunities to:
1. Consolidate, synthesise and apply knowledge of health care and health care systems to a broad range of acute and longer term illnesses and patient presentations, both for the context of on call/acute/admitting, on-going in-patient care.
2. Recognise and initiate management of the acutely unwell patient. 3. Function competently as a member of an inpatient based health care team. 4. Pursue in greater depth an area of medical practice of personal interest. 5. Demonstrate further development of professional attitudes and behaviour. 6. Engage in continuing professional development.
Some TI attachments will allow opportunities for ambulatory based patient care (eg outpatients). You are expected to gain expertise in clinical medicine by undertaking supervised clinical responsibility for patients allocated and being responsible for their documentation and day to day attention. You are expected to pursue learning through practical experience, discussion, clinical meetings, learning resources and the ‘Preparing for practice’ sessions. The supervising staff will ensure that: clinical techniques are appropriate; understanding the applied medical knowledge is at the required level; communication with patients, family and colleagues is appropriate; demonstrated behaviours are in keeping with the professional role of a doctor. You are expected to be available throughout the period specified. You are expected to attend the daily handover meetings and clinical conferences organised within each hospital. There may be the opportunity to attend PGY1 and/or PGY2 training sessions organised within the hospitals. TIs are expected to be on-call, undertaking at least one weekend and four weekday evenings, during the course of the module. This on-call time is when most likely to gain opportunity to “recognise and initiate management of the acutely unwell patient”. Subject to availability, you will be able to opt, for up to a half day each week, for experience in an additional field of choice, such as MAPU/assessment units, inpatient, outpatients, clinical meetings, procedure lists or radiology. You must negotiate this with the ward
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supervisor, the ward team and the additional experience team. This must not adversely affect the experience or learning of a colleague. ‘Preparing for Practice’ sessions Sessions are held on Thursday afternoons throughout the year. You are expected to attend these sessions in person or via videoconference. The timetable for Thursday sessions is given out for each module. These sessions consist of: case presentation with prescribing and practice learning points, led by TIs; and preparing for PGY1 sessions, led by staff. Assessments There are four elements of assessment.
1. Supervisor report and multi-source feedback (MSF) Towards the end of each medical attachment, physicians supervising you are asked for a report on the performance. Grades and comments are given for the areas of: patient care, teamwork and professionalism and independent learning. You will have distributed MSF forms (online link) that are returned to the supervisor and onto the Department. These are used to supplement information and are especially useful with regard to comments on teamwork. A supervisor report recording satisfactory performance in assessable areas is a requirement to pass the module.
2. Observed long case This assessment is held during the attachment. You will be assessed by an experienced clinician, who is not your ward supervisor, in the conduct of an observed long case examination. The long case will constitute a history, clinical examination and discussion of diagnosis and immediate management. Undertaking a satisfactory observed long case is usually required to pass the module.
3. Preparing For Practice sessions The quality of presentations by you will be judged by staff and peers. The results from each of these are aggregated to an overall result. Undertaking a satisfactory presentation and providing useful feedback for peers is a requirement to pass the module.
4. Palliative Medicine and case based discussion
During the course of the module you will gain two days experience in community based Palliative Medicine which may include experience in a hospice, time spent with palliative care clinicians e.g. home or hospital visits. Satisfactory performance regarding attendance, engagement in learning, professional practice is a requirement to pass the module.
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Satisfactory performance on the case-based discussion is usually required to pass the module.
Possible Results for the Module
As for Year 4 and Year 5 there are several results possible for the module: incomplete; fail; conditional pass; pass; and potential distinction. The conditions of a Conditional Pass may include demonstrating satisfactory performance in one or more of these elements either within other modules, as stand-alone assessments, or further medical team attachments. Awards and Prizes Distinction in Medicine Those TIs who have been assessed at an appropriately high standard will be invited to attend additional assessment which is usually held at the end of the TI year. James Roberts Boyd Prize is awarded for the best overall attainment in Clinical Medicine in the Trainee Intern Year. _____________________________________________________________
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Obstetrics and Gynaecology Trainee Interns are attached to the Department of Obstetrics and Gynaecology for four weeks. Placements are available for up to four TIs at Wellington Hospital, two in Palmerston North under the supervision of Dr Phil Suisted, two in Hastings Hospital under the supervision of Drs Jeremy Meates and Kirsten Gaerty, two in Hutt Hospital under the supervision of Dr Roopi Gill and one in Masterton under the supervision of Drs Maha Jaber and David Cook. Students in Hastings, Masterton and Palmerston North are responsible for arranging their own accommodation. Students will be sent an email with details of where to report on their first day. Students start their clinical assignments on day 1 and report directly to their centre. Students will receive a handbook containing the objectives for the run, log book, and assessment forms. Clinical case scenario questions and other important information are on the Moodle site. Some tutorials and role-play activities are delivered to the group. Check Moodle for details of these. As many as possible will be video linked. The Trainee Intern is expected to be part of the medical team. They have definite clinical responsibilities and have a very important role to play in the day to day running of the clinical O & G department. Their presence at scheduled clinics, theatres and in Delivery Suite is very important. The specific duties vary with each training centre. Please consult your supervising consultant as to your specific duties. In Wellington, each Trainee Intern spends 5 nights on duty. While on night duty the Trainee Intern has an important role assisting the on call registrar and house officer. The nights start on a Saturday night and finish the following Thursday morning. This can be a demanding role for many Trainee Interns but is an integral part of becoming a Junior Doctor. In Delivery Suite, the Trainee Intern is expected to be present during the assigned time and period, monitor labour and deliveries, and to assist or perform procedures under the guidance of midwives, registrars and consultants. All clinical experience should be recorded in the Trainee Intern Handbook. Please note the minimum experience required to be documented. The experience recorded in your 5th year logbook will also be taken into account, as we consider the course to encompass both years. All tutorials and department teaching sessions must be attended, unless leave is sought and granted. Leave should be applied for before the attachment starts; fill in a leave form and submit it to administrators Rhys Mulholland-Winiata or Jackie Bell, the Trainee Intern Coordinators in Wellington, Hutt, and Masterton, and to the Associate Dean in Palmerston
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North and Hastings. While it may be possible to arrange leave, missed time will have to be made up later in the year. There are five assessments: four academic and one professional. A pass is required in every component. The final academic aggregate mark is based on:
1. Gaining a pass in Clinical Assessment (Obstetric) 25% 2. Gaining a pass in Clinical Assessment (Gynaecological) 25% 3. Gaining a pass in Topic Presentation 25% 4. Gaining a pass in CCS/Viva (one Obstetrics and one Gynaecology clinical case scenario) 25% 5. Gaining a pass in professional attitudes
A pass is also required in the professional attitudes assessment. A distinction invitation will be sent to students showing excellence in both academic and professional assessments. All assessment and marking sheets from Hutt, Palmerston North, Masterton and Hastings are to be emailed/posted to the Department by the UOW administrators from those Hospitals.
Awards and Prizes The Kenneth Pacey Prize is awarded annually for the best overall attainment in O & G in the Trainee Intern year at the Otago Medical School, University of Otago, Wellington. _______________________________________________________________
Paediatrics and Child Health
Specific Educational Objectives for Paediatrics and Child Health
1. To refine skills in paediatric history taking and in examination of the newborn, infants, children and adolescents.
2. To understand the principles of resuscitation of the newborn. 3. To be able to undertake a developmental assessment of a young child. 4. To be able to assess and manage common paediatric medical and surgical clinical
problems presenting acutely in the wards and in the outpatient setting including an introduction to the principles of paediatric prescribing.
Trainee Interns will be attached to the Children’s wards and Newborn Units at Wellington, Hutt, Hawkes Bay, Palmerston North and Whanganui Hospitals.
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You will be members of the Paediatric team, will assist the junior medical staff and become actively involved in the care of children on the wards. You should consolidate your history taking and examination skills learnt in 5th year. Emphasis will be placed on the development of diagnostic and management plans for the cases that you admit. As Trainee Interns, you will have your own roster for evening and weekend duties. This is regarded as a very important component of the attachment as more than half the acute admissions occur after 4 p.m.
Newborn Medicine You should be familiar with the technique of examination of the newborn. You should attend deliveries and understand the principles of neonatal resuscitation. You should be familiar with the common disorders presenting in the term neonate in the first weeks of life.
Paediatric Hospital Medicine You will assess children in the acute assessment unit, admit children acutely to the Paediatric wards, follow them through their hospital stay and attend Paediatric Out-patient Clinics. During the ward rounds you should present the history and physical findings of the children you have admitted. You should perform technical procedures under the guidance of junior medical and other staff when appropriate.
Structured Learning The objective of your trainee intern paediatric module is to gain clinical experience. You have previously received extensive didactic lectures and problem based tutorials in 5th year. In the trainee intern module we expect that you will consolidate that learning by applying it to the clinical situation. There will therefore be very little formal teaching in the way of tutorials etc. In addition to using your 5th year notes you will be expected to read around the clinical material that you come across in your attachment.
Assessment The granting of terms will be based on the following assessments:
1. Observational Assessment – this is assessment by your supervisors, Senior and Junior Medical Staff and on your performance in the following areas:
Enthusiasm and attendance during the attachment
Clinical competency
Knowledge of Paediatric Conditions as displayed during clinical work and on ward rounds
Standard of case records
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Case presentation skills on ward rounds
Interaction with parents and children
Interaction with the clinical team
2. Paediatric History and Examination assessment: This consists of an observed history taking and clinical examination and is assessed by your local supervisor. You should be prepared to take a full medical history and undertake an examination that can be focussed to the clinical problem.
3. Developmental Case Assessment This consists of a 15 minute long developmental examination of child aged between 10-24 months observed by your local supervisor.
4. Case Presentation assessment: You will be expected to formally present a case and related topic review to the members of the clinical team during your attachment. This should be based on a patient you have seen yourself. This presentation should be formally presented as a PowerPoint presentation.
Further details regarding the run are included in the Trainee Intern Hand-out provided at the start of the attachment.
Awards and Prizes Those doing well in the assessment will be invited to compete with students from Christchurch and Dunedin for the J. M. Watt Prize and also a possible distinction pass in Paediatrics. There is an additional prize, the Jeff Weston Prize, presented by the Wellington Branch of the Paediatric Society of New Zealand for the best Wellington student in Paediatrics over both 5th and 6th years. ______________________________________________________________
Psychological Medicine
Goals By graduation, students are expected to have the knowledge, attitudes and skills in psychological medicine to:
Appreciate the relevance of the processes of human development to the
understanding of people in states of health and illness Understand the key underlying principles that inform a biological, psychological,
sociological and cultural understanding of people, mental illnesses, their treatment and prevention
Carry out a psychiatric assessment and make an appropriate diagnosis
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Be knowledgeable about the principles of management of the main groups of psychiatric disorders
Be able to manage (under supervision) common uncomplicated presentations and psychiatric emergencies
Work effectively with consumers and carers to facilitate consumers’ recovery processes.
Learning Objectives The objectives of the 6th year course in psychological medicine are to build on the learning from previous years, in order to achieve these goals, with particular focus in the following areas:
Knowledge Objectives By the end of the attachment students will have an understanding of:
The clinical features, natural history, treatment options and prognosis of common psychiatric conditions
Basic phenomenology The principles of some common forms of psychological therapies The principles of common pharmacological therapies Basic psychological concepts e.g. responses to illness, death and loss The influences of culture, particularly Māori culture, on the presentations and
management of psychiatric disorders The interaction between ‘nature’ and ‘nurture’ in the aetiology of psychiatric illness The principles of risk assessment. Understanding of the principles of recovery as they apply in psychiatry
Attitude Objectives By the end of the attachment the student is expected to:
Appreciate the particular ethical dilemmas arising in the provision of psychiatric care, particularly in relation to compulsory treatment
Demonstrate initiative and the ability to direct their own learning Appreciate the importance of an awareness and understanding of their own feelings
and attitudes and how these influence their interactions with patients Use available learning opportunities Demonstrate respect for patients, their families and other team members
Skill Objectives By the end of the attachment the student is expected to be able to:
Take a comprehensive psychiatric history
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Identify gaps in that history and their significance Perform a competent mental state examination Reach a plausible differential diagnosis Construct a formulation Construct an appropriate management plan Perform a competent and appropriate risk assessment Present a case verbally and in writing Prescribe appropriate pharmacotherapy under supervision Work with other team members as appropriate.
Trainee Interns spend four weeks with the Department of Psychological Medicine. During this time they undertake clinical responsibilities in a variety of inpatient and community teams, in Wellington, Porirua, Palmerston North, Masterton, Gisborne or Hawkes Bay. These include opportunities for working in specialty settings e.g. Māori Mental Health/Child Psychiatry, Psychiatry of the Elderly, Forensic Psychiatry, Child and Adolescent Psychiatry and Consultation-Liaison. These placements provide an informal tutorial programme, which is complemented by tutorials held weekly in the Department. Trainee Interns based out of Wellington generally attend tutorials by videoconference. During the attachment Trainee Interns are expected to:
1. Function actively as part of a multi-disciplinary team 2. Be involved with the assessment and planning of management for patients under
the supervision of the consultant/registrar 3. Present at least three patients to the consultant 4. Participate fully in all tutorial sessions 5. Accompany the CRS team on one weekend and one evening acute duty.
Assessment Assessment is by report from clinical supervisors, by a formal viva in the Department at the end of the attachment, and by a written personal reflection up to 600 words on how recovery plays a central role in psychiatry. Vivas for remote Trainee Interns are generally by videoconference, unless the Trainee Intern prefers to travel to Wellington for the examination, or if videoconference facilities are not available at the remote location.
Awards and Prizes The College of Psychiatrists’ Prize is a sum of money and is awarded to the TI who performs best in the Distinction Viva in Psychological Medicine each year.
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Surgery Within the Department of Surgery we recognise the importance of the continuum of learning from medical school through PGY1 and PGY2. The Trainee Intern year provides an essential link towards achieving the skills and attributes required in the first postgraduate years. We also recognise that proficiency in achievement of the capabilities will occur at different stages in your training. In this attachment you should take advantage of the particular opportunities provided to help you achieve this goal. From 2015 the Medical Council of New Zealand has introduced e-port. This is a web-based database where all PGY1 interns are required to record and track their progress through the four PGY1 attachments. As a Trainee Intern you have received a personal logon and password to enable you to record your acquisition of skills on e-port and we would strongly encourage you to take advantage of this. This will make the transition to PGY1 more seamless for you. The following is a brief guide to the skills and attributes that you should be acquiring during the trainee Intern year. Most of these are common to all disciplines. The clinical problems and conditions and procedures and interventions are those either specific to surgery or those you would expect to encounter in a surgical patient. For example, the management of chest pain and shortness of breath are essential skills for the care of the surgical patient. Further details for each section will be made available at the start of the six weeks Surgical Module. Clinical Management Doctors should be able to provide safe treatment to patients by carrying out appropriate clinical management. The following outcome statements apply to all aspects of clinical management. By the end of Trainee Intern year you should be able to demonstrate a number of clinical management skills, while recognising the limits of their personal capabilities. You should be able to recognise complex or uncertain situations and seek advice appropriately.
Safe Patient Care Adverse events and near misses Infection control Medication safety Radiation safety Risk and prevention
Patient Assessment Evidence-based practice History and examination
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Investigations Patient identification Problem formulation Emergencies Advanced Cardiac Life Support Assessment Basic life support Prioritisation Patient Management Ambulatory and community care Discharge planning / transfer of care End of life care Fluid, electrolyte and blood product management Management options Pain management Therapeutics
Professionalism Doctors should be able to provide safe treatment to patients by practising medicine in a professional manner. The following outcome statements apply to all aspects of professionalism.
Doctor and Society Access to healthcare Cultural competence Health promotion Healthcare resources Medicine and the law Professional standards Professional Behaviour Doctors as leaders Ethical practice Personal well-being Professional development Practitioner in difficulty Professional responsibility Time management Teaching, Learning and Supervision Assessment and feedback Self-directed learning
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Communication Doctors should be able to provide safe treatment to patients through effective communication. The following outcome statements apply to all aspects of communication. Patient Interaction Breaking bad news Complaints Meetings with families and whānau, or carers Open disclosure Providing information Respect Working in Teams Communication in healthcare teams Team structure Working in healthcare teams Managing Information Electronic Resources Health records Demonstrate high quality written skills in all clinical communications Clinical Problems and Conditions Doctors should be able to adequately identify common or important conditions through history taking, eliciting the relevant signs at examination and investigations. They should then formulate a differential diagnosis for and establish and monitor an initial management plan. The following outcome statements apply to clinical problems and conditions that you are likely to encounter during your surgery attachment. Many of these you will have encountered during your previous undergraduate years. Always take the opportunity to improve your knowledge and skills by getting exposure to these problems and conditions. Abnormal blood tests
Abnormal INR and / or coagulation profile
Electrolyte abnormalities
Red cell abnormalities
White cell abnormalities
Arterial blood gasses Circulatory
Hypertension
Heart failure
Shock
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Chest pain
Cardiac arrhythmias
Electrolyte disturbances
Ischaemic heart disease
Leg ulcers
Limb ischaemia
Thromboembolic disease
Critical care/ Emergency
Adrenal disease
Injury prevention
Minor trauma
Postoperative care
Shock Dermatological
Skin malignancies for example basal cell carcinoma (BCC), squamous cell carcinoma (SCC), melanoma
Ear, Nose, Throat
Epistaxis Endocrine
General management of diabetes
Post operative diabetic management Eyes (Ophthalmology)
Red eye
Sudden loss of vision
Foreign body identification
Refractive difficulties Gastrointestinal
Nausea and Vomiting
Abdominal pain
Gastrointestinal bleeding
Constipation
Diarrhoea
Jaundice
Common liver disease for example alcoholic liver disease, hepatitis, non-alcoholic fatty liver disease
Recognition of acute abdomen
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General
Initial clinical management
Recognition of the deteriorating patient Urology
Dysuria and /or frequent micturition
Pyelonephritis and UTIs
Reduced urinary output
Renal failure
Urinary retention
Urinary Incontinence Haemopoietic
Abnormal bleeding including over anticoagulation
Bleeding in the anticoagulant patient
Anaemia
Cytopenia
Thromboembolic Immunology
Anaphylaxis
Drug reactions
Urticaria Infectious Diseases
Non-specific febrile illness
Septicaemia
Local infections Musculoskeletal
Acute joint swelling
Sprains and strains
Joint disorders Neurological
Loss of consciousness
Seizure disorders
Syncope
Delirium
Falls, especially in the elderly
Acute headache
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Stroke/TIA
Subarachnoid haemorrhage Nutrition / Metabolic
Weight gain
Weight loss Respiratory
Respiratory failure
Breathlessness
Asthma
Cough
Chronic Obstructive Pulmonary Disease
Pneumonia / respiratory infection
Upper airway obstruction Procedures and Interventions Doctors should be able to provide safe treatment to patients by competently performing certain procedural and assessment skills. The following outcome statements apply to procedures and interventions that you are likely to encounter during your surgery attachment. Many of these you will have encountered during your previous undergraduate years. Always take the opportunity to improve your knowledge and skills by getting exposure to these procedures and interventions.
Decision-making
Explain the indications and contraindications for common procedures Informed consent
Understand the principles of informed consent to be applied in day to day clinical practice
Preparation
Arrange appropriate equipment and describe its use
Prepare and position the patient appropriately
Recognise the indications for local, regional or general anaesthesia Procedures
Arrange appropriate support staff and define their roles
Provide appropriate analgesia Post-procedure
Identify and understand the principles of management of common complications
Interpret results and evaluate outcomes of treatment
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Monitor the patient and provide appropriate aftercare
Procedures and interventions list:
Cardiopulmonary
12 lead electrocardiogram recording and interpretation
Oxygen therapy
Oropharyngeal airway
Bag and Mask ventilation
LMA placement
Completed ACLS level 7 Diagnostic
Blood Glucose Testing
MSU
Wound swab
Throat swab
Nasal swab
Urethral swab
Blood culture Ear, Nose and Throat
Anterior rhinoscopy
Anterior nasal pack insertion
Injections
Subcutaneous injections
Intramuscular injections Intravenous / Intravascular
Venepuncture
Intravenous cannulation
Intravenous infusion set-up
Intravenous fluid and drug administration
Intravenous electrolyte administration
Blood transfusion
Arterial and venous blood gas sampling and interpretation Ophthalmic
Eyelid eversion
Eye irrigation
Eye drop administration
Eye bandage application
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Corneal foreign body removal Respiratory
Nebuliser/inhaler therapy Surgical
Scrub, gown and glove
Wound debridement
Wound dressing
Administration of local anaesthesia
Simple skin lesion excision
Surgical knots and simple wound suturing
Suture removal Trauma
Pressure haemostasis
Apply splints and slings
In-line immobilisation of cervical spine
Cervical collar application
Urogenital
Bladder catheterisation (Male and Female) Assessment Criteria During your surgery run the Consultant and Registrar for your Surgical Team will complete an assessment form. You will be assessed in the follow areas:
Personal interaction
Clinical knowledge and skills
Attitudes and behaviour
Those students failing this assessment will be required to sit an oral examination at the end of the final week of the run Students failing this oral exam may be required to complete extra team time and /or sit an end of year pass/fail examination. Awards & Prizes The David Whyte Prize in Clinical Surgery is awarded to the top ranked Trainee Intern in each year of the course. _______________________________________________________________
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Professional Skills, Attitudes and Ethics (PSAE) PSAE in the TI Year follows on from the 4th and 5th year course. Most learning relating to Professional Skills and Ethics will take place as a result of seeing patients on all the runs. Assessment of this is through the PASAF forms.
Teaching and learning: In 2016/17 there will be:
One Thought Provoking Episode Report (TPER). Thought Provoking Episode Report The details of what a TPER is and when it is due is on the Professional Skills Attitudes and Ethics MedMoodle page that is part of the Trainee Intern 2017 UOW module and also accessible on the 2017 Trainee Intern General Practice module. This is due on the 5th Thursday of the General Practice run and should be submitted by the drop box on MedMoodle and each TI will have an individual meeting with a reader to discuss the TPER. Resources:
The TI 2017 PSAE Manual is part of the Professional Skills Attitudes and Ethics Med Moodle page that is part of the Trainee Intern 2017 UOW paper. This lists the objectives for PSAE.
The Reference Collection brings together the Oaths that Doctors Use, Codes of Ethics, Code of Health and Disability Services, Health Information Privacy Code and statements from the NZMA NZ Medical Council and the World Medical Association. If you are wanting ethical guidance on any particular issue this is a good place to start.
Assessment:
1. Completion of one TPER to a satisfactory standard. 2. Satisfactory PASAF comments in all modules.
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Prizes
The Emergency Medicine Prize This prize is awarded to the TI with the best performance in the Emergency Department attachment. Recent awards: 2015
2014 2013
Rose Cameron and Annelise Neal Aimee Norman Shannon Carter
The James Roberts Boyd Prize in Clinical Medicine James Roberts Boyd was an eminent consulting physician, who practised in Wellington from 1924 till 1953, and who was a physician at Wellington Hospital from 1926 until 1946. Born in 1886 in Scotland, a graduate of Edinburgh University, he was awarded the Military Cross for his services in World War I. After being in general practice in Kaponga and Lower Hutt, he became one of the first to devote himself purely to consulting medicine and to his duties as a hospital physician. He was a foundation Fellow of the Royal Australasian College of Physicians and a Fellow of the Edinburgh College. He was Senior Physician at Wellington Hospital from 1933 till 1946 and on his retirement was appointed to the consulting staff. Throughout World War II he served in the Middle East as Consulting Physician 2.N.Z.E.F. and was awarded the C.B.E. He was Chief Medical Officer to the A.M.P. Society from 1946 until 1956 when he retired from medical practice. He died in 1960. He inspired all who knew him by his knowledge, his clinical acumen, his humanity and his wit. He strongly advocated the importance of bedside teaching to final year Trainee Interns, and was the first to establish this practice in Wellington. The James Roberts Boyd Prize in Clinical Medicine is awarded to the Trainee Intern achieving the highest marks in a clinical examination held towards the end of the Trainee Intern year. Invitations to attend this examination are based on the formal on-going assessments in clinical medicine during the year. The James Roberts Boyd Prize is a monetary award, and is offered annually by the Combined Medical Staff of the Wellington Hospital. Recent awards: 2015
2014 2013
Annelise Neal Hamish Green Elizabeth Dickie and Mairi Lucas
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The David Whyte Prize in Clinical Surgery David Whyte had been a leading Consultant Surgeon in Wellington for 25 years at the time of his death in 1950 at the age of 61. A 1912 graduate of the University of Otago, he served with the R.A.M.C. in World War I in France and India and then took his English Fellowship in 1922. Entering Consultant practice in Wellington he was appointed Assistant Surgeon on the Visiting Staff of the Wellington Hospital in 1924, Senior Surgeon in 1926 and he was First Senior Surgeon from 1940 until his retirement in 1949. He possessed unusual qualities of character and temperament that fitted him for surgical leadership, and gave him great influence over his colleagues. He had an absorbing devotion to surgery almost exclusive in its intensity. A classical scholar, he was also deeply versed in the literature of his profession. He had a deep and sympathetic insight that made him beloved of patients and colleagues alike. The David Whyte Prize in Clinical Surgery is awarded to the Trainee Intern who attains the highest mark in the end of the Sixth year Surgery Distinction viva. It consists of an amount of money and is awarded annually by the Combined Medical Staff of the Wellington Hospital. Recent awards: 2015
2014 2013
Hannah Pincott Robbie Fyfe Devlin Elliott
General Practice Prizes These prizes are donated by the Wellington Faculty of the Royal New Zealand College of General Practitioners. They consist of an amount of money and are awarded annually for professionalism and excellence during the Trainee Intern General Practice attachment. Recent awards: Professionalism Excellence 2015
2014 2013
Lucy Barber Ciaran Edwards Devlin Elliott
Nessie Sharpe Sophie Swart Michael Chen-Xu
The College of Psychiatrists’ Prize The Royal Australian and New Zealand College of Psychiatrists makes this award under the auspices of the Dawn Short Fund. This fund was created through the generosity of the late Ms Dawn Short who intended it to be used for furthering psychiatric education and research. The College hopes that this award will provide a stimulus for undergraduates of the Otago
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Medical School, University of Otago, Wellington to strive for excellence in the study of Psychological Medicine. The prize is a sum of money. The prize is awarded to the TI who performs best in the Distinction Viva in Psychological Medicine in each year. Recent awards: 2015
2014 2013
Nessie Sharpe Lewanna Pentecost Teresa Stempa
Elective Support: The Dawn Short Trust Fund has provided some support for Trainee Interns undertaking an elective in psychiatry in the past. For further information please contact Prof Ellis. Early application is strongly recommended.
The Kenneth Pacey Prize in Obstetrics and Gynaecology Kenneth Pacey was one of New Zealand's most distinguished obstetricians and gynaecologists, the founder of Wellington Hospital's Obstetrics & Gynaecology Unit, and for many years the leading consultant in his speciality in this city. The prize is a monetary award, donated by the trustees of the Kenneth Pacey Fund. The prize is awarded to the best all-round Sixth Year Trainee Intern for each year. Recent awards: 2015
2014 2013
Nessie Sharpe Sandeep Naik Michael Chen-Xu
The Royal Australian & New Zealand College of O & G prize This is awarded to the most outstanding student across the three Schools who has not already won a prize for the current year. Recent awards: 2015
2014
Meaghan Kelly Alice Hickey
H.J. Weston Prize for Best Performance in Paediatrics Professor H. Jeffrey Weston after working at Hutt and then Wellington Hospitals from 1960 as a consultant paediatrician was the foundation Professor and Head of Paediatrics and Child Health at the School from 1975 to 1992.
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This prize donated by the Wellington Branch of the Paediatric Society is awarded to the Trainee Intern obtaining the best overall marks in 5th and 6th years. The prize consists of a monetary award intended for the purchase of a text book of the winner’s choice. Recent awards: 2015
2014 2013
Rose Cameron Frederica Steiner Andrea Peat
Pasifika Prize for Excellence in Scholarship and Community Service This prize is awarded annually to the graduating student who has achieved excellence in academic scholarship and has provided outstanding service to the Pacific community. The prize is a monetary award. Recent awards: 2013 Victoria Dol
Graham Francis Hall Prize This prize is named in honour of Professor Hall who was the foundation Dean of this school from 1972 to 1975. It is awarded annually to the graduating student who has achieved the best overall result in the three clinical years. The prize is a monetary award. Recent awards: 2015
2014 2013
Annelise Neal Thomas Wilkinson Elizabeth Dickie
The JM Watt Prize in Paediatrics and Child Health This prize is awarded by the Faculty of Medicine to the student from the three clinical schools who performs to the highest standard in the end of year distinction orals. Professor Watt was appointed as the Inaugural Professor of Paediatrics and Child Health in Otago in Dunedin in 1967. Prof Watt was an athlete, an All Black in 1937, served in the Middle East and Italy, had postgraduate experience in London after demobilisation and worked in Wellington prior to his appointment to the chair. He was highly regarded as both a teacher and clinician. Recent awards: 2014
2013
Frederica Steiner Alexandra Jacobson
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PART C. RELATIONSHIPS AND PLACEMENT WITHIN CLINICAL SETTINGS
Introduction
The overarching goals in the TI year are to prepare students for PGY 1 and 2, and create a lifelong career in medicine including awareness for further training. In brief, the purpose of the TI year is to work as an apprentice within a healthcare team. As such, skills need to be developed in clinical assessment and prioritisation, in some medical procedures, in time management and in teamwork. The TI year will extend learning in generic attributes and will fill context and content gaps remaining at the end of 5th year. Overall, however, the TI year develops professional competency in decision making, in patient care, in clinical skills, in self-reflection, and in life-long learning. The University of Otago, Wellington, has close links to District Health Boards in the lower North Island. Trainee interns are placed within hospital and general practice settings within the areas administered by Capital and Coast District Health Board, Hutt Valley Health District Health Board, Wairarapa District Health Board, Mid-Central District Health Board, Hawke's Bay District Health Board and Taranaki District Health Board. The University is committed to maintaining a strong relationship with these District Health Boards and it is recognised that there is an advantage to the people of New Zealand to be serviced by teaching hospitals with accompanying academic rigour. It is important that you wear your University identification when within the clinical areas of the hospital and general practices. You will act as junior members of the clinical teams where you are placed. You do not require patient permission to engage in activities regarding their routine care however where a patient is being used for a teaching activity you must request permission to interview or examine the patient. All patients as part of their general consent to operation either accept or decline that there may be students in theatre with them. Where you are acting as an assistant in theatre as part of the team you do not require special permission from the patient to be there other than this general consent.
Trainee Internship 1. A Trainee Intern is both a full-time student and an apprentice house officer having both educational and service components to his or her work. Trainee interns are responsible to the Consultant head of the team in which they are placed for the quality of their patient care, and through them to the Director or Head of the service. On academic matters they are responsible through the run convener to the Head of the academic department concerned. If personal conduct professional behaviour or competence is called into question then this will be considered by the run Convener, Head of the appropriate academic department and Consultant head of the team in which they were placed. In
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exceptional circumstances the Dean of the medical school and the Chief Medical Officer of the DHB will take appropriate action. During community attachments the Trainee Intern will be responsible through the supervising general practitioner to the Head of the appropriate academic department. 2, An annual training grant will be paid by the University to 6th year Trainee Interns in good standing. In order to receive the grant, trainee interns must:
1. Be enrolled with the University. 2. Hold Trainee Intern status with any district health board to which he or she is
attached 3. Be a recognised member of a medical indemnity programme (Medical Protection
Society will give free membership to Trainee Interns) 4. Be diligent and punctual in attendance and participation in designated clinical
activities including the acting house officer duty as appropriate 5. Agree to follow the policies and procedures of the District Health Board in which they
work.
_______________________________________________________________
Expected responsibilities and working conditions of the Trainee Intern (TI) in the Hospital environment
Employment Trainee Interns receive a training grant from Vote Education that is administered by the University of Otago. They are not paid by the District Health Board, and should not be asked to perform excessive service tasks that have no educational value. They should be supervised at all times by Senior and RMO medical staff of their particular attachment.
Expected responsibilities and working conditions in the Hospital environment The TI should be responsible to the Consultant/Registrar/ House surgeon for the care of up to one third of the patients cared for by the team. To maximise their educational experience, every TI should seek and receive feedback throughout their attachment from their team (Consultant/Registrar/House Surgeon).
Acute Call Trainee Interns are expected to participate in their team’s acute call days, and to present patients to their team on the post intake ward round. However if there is a cluster of acute call days, Trainee Interns may work far longer hours than the Team House-surgeon or Registrar. If this is the case they should be excused from ward duties on non-intake days.
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Trainee Interns acting as House Surgeons The undertaking of acting House surgeon duties by Trainee Interns are voluntary and assessment is not affected by declining them. Trainee Interns may be asked to act as House Surgeons for short periods of time during their year, provided the following conditions are met:
1. The Trainee Intern has been approached by the Consultant not the RMO office, and the Consultant has assessed the Trainee Intern as being competent for the tasks.
2. The Trainee Intern Convener for the run has been advised and approves; any
concerns the TI has with respect to acting as a HS must be discussed with and addressed by the TI Convener
3. May not be undertaken in the first 2 weeks of attachment to any team; the duties
must be with that particular clinical team
4. It must not be for more than 12 weeks per year
5. The TI must be under the direct supervision of a Consultant and ward Registrar
6. Must not be for more than 48 hours per week or 9.5 hours per day
7. The TI cannot be left on their own, as the acute admitting house officer for that team Once a Trainee Intern accepts some responsibility for patient care, even under careful supervision, he or she accepts liability for negligent practice or accidental harm. This may be shared by his supervisors and the District Health Board. For this reason it is compulsory that Trainee Interns have a current membership of a medico legal organisation such as the Medical Protection Society. _______________________________________________________________
Duty Guidelines The prescribing of drug treatment and ordering of diagnostic tests have medico-legal implications. The following regulations must therefore be observed: 1. Trainee Interns may write out AND sign the following: 1.1 Laboratory Request Forms; 1.2 Patient Referral Forms. (NB: Always print your name alongside your signature and add the letters “TI”.)
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2. Trainee Interns may write out the following, but these MUST be CHECKED and
SIGNED by a REGISTERED MEDICAL PRACTITIONER: 2.1 Prescriptions for drugs (Inpatient and Outpatient prescriptions); 2.2 Intravenous fluid orders; 2.3 X-Ray Request Forms; 2.4 ACC Forms; 2.5 Social Welfare Certificates. 3. Trainee Interns must NOT write out OR sign the following: 3.1 Patient Consent Forms; 3.2 Death Certificates; 3.3 Cremation Certificates; 3.4 Mental Health Act Certificates.
_______________________________________________________________
Drugs & Other Offences Trainee Interns should take note of the following: 1. In line with its policy that: “members of the staff convicted under the Misuse of
Drugs Act 1975 will be summarily dismissed”, Capital & Coast District Health Board has indicated that it would withdraw the right of entry to wards and other hospital areas of any Trainee Intern so convicted. This would, in effect, make it impossible for that Trainee Intern to continue in the school.
2. While the Medical Council of NZ has no jurisdiction over medical Trainee Interns,
nevertheless a Trainee Intern’s conduct prior to graduation, particularly in relation to offences against the law, may have some bearing on his/her future eligibility for registration.
3. Since medical practitioners are privileged in dealing with drugs the Medical Council
recognises a particular responsibility in relation to the abuse of such substances, or any conviction for crime in relation to drug usage or sale.
With reference to the above, Section 16 of the Health Practitioners Competence Assurance Act 2003 reads: (in part, only) “No person shall be registered [under this Act] if -
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(a) He or she does not satisfy the Council that he or she has a reasonable ability to communicate effectively for the purposes of practising [medicine] or that his or her ability to communicate in and comprehend English is sufficient to protect the health and safety of the public; or (b) He or she has been convicted by any court in New Zealand or elsewhere of any offence punishable by imprisonment for a term of 3 months or longer, and he or she does not satisfy the Council that the offence does not reflect adversely on his or her fitness to practise medicine; or (c) The Council is satisfied that the person is unable to perform the functions required for the practice of medicine by reason of some mental or physical condition.” At the time of applying for medical registration all applicants will be required to complete an application form in which they are asked, among other things, whether or not they have been subject to a police investigation or have been convicted of any offence against the law and to give details where applicable. Failure to give this information may jeopardise a graduate’s right to registration. If in doubt consult the Associate Dean for Undergraduate Students. _______________________________________________________________
Applying for Medical Registration in New Zealand
PROVISIONAL GENERAL REGISTRATION
1. If you intend practising medicine in New Zealand on completion of the MB ChB course, you are required to apply for provisional general registration with the Medical Council of New Zealand (Council).
An application pack for registration is issued to you electronically via your University by early August in your sixth year of medical school.
2. You must obtain a first year house officer position with an accredited training
provider before you can apply for provisional general registration. Following a successful application and payment of your registration and practising certificate fee, Council will issue you with a letter of eligibility for provisional general registration, pending confirmation from your University that you have satisfied the requirements of your qualification.
You cannot commence clinical duties until a practising certificate (PC) has been
issued to you. Upon receipt from your University that you have passed your medical degree, your PC will be sent to your employer who will in turn pass this to yourself
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during orientation week. Your PC will enable you to work as a house officer in accredited attachments under the supervision of a prevocational educational supervisor to enable you to complete prevocational training requirements.
3. Since the Medical Council requires all application forms to be returned by the end of
September, it is essential that year six medical students going on a Fourth Quarter elective send their application forms to the Council before departure on their elective. Please note that you must submit an original certified copy of your identification document, usually a passport.
4. On satisfactory completion of your first post graduate year you will be eligible to
apply for GENERAL REGISTRATION. In order to be granted a practising certificate to complete your second postgraduate year (PGY2), your must have an approved professional development plan and you must continue to work in accredited attachments. An endorsement on your PC will reflect this requirement. Upon successful competition of PGY2 you will be able to apply to have the endorsement on your practising certificate removed.
_______________________________________________________________
Applying for First Year House Officer (PGY1) Positions in New Zealand
To apply for first year house officer positions with the New Zealand hospital system, you must apply through Advanced Choice of Employment (ACE) scheme. For information on the ACE process and rules please visit http://www.kiwihealthjobs.com/ace/graduate-doctors. Applications will open here http://www.acenz.net.nz/ in February 2017. For direct queries related to the ACE scheme please contact the ACE Coordinator on 0800 223 236 or email [email protected] You will be advised of the date and venue of the Wellington Roadshow in early 2017. Representatives from both ACE and the District Health Boards around the country attend the Roadshow and should be able to answer any questions that you may have.
Other information you may need if preferencing Capital & Coast Health: If you are successfully matched to Capital & Coast Health, we will send offer letters, run preference forms and other information to your pigeonholes at the Medical School in
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August. For those of you who are on elective this will be posted to the mailing address given in your application unless you request otherwise prior to leaving on your elective. If you have an Elective during the 3rd or 4th Quarter, you must provide a contact email or nominate a contact person who can act on your behalf. It is important that the RMO Unit is able to contact you or your nominated contact person during that time. It is also essential that you provide an up-to-date contact address, including email address. ______________________________________________________________
Trainee Intern Training Grant
Information regarding entitlement to payment
All enrolment procedures MUST BE COMPLETED prior to the commencement of the Trainee Intern year on 21 November 2016. Sixth year students who have not enrolled and/or paid their fees, will not be eligible for payment of the training grant, nor will they be entitled to clinical privileges in the hospital. Trainee Interns wishing to join the University student clubs, obtain cheap airfares etc., must also pay the OUSA levy.
Trainee Intern Training Grant - Information regarding entitlement to payment
The training grant comes from Vote Education funding and is only administered by the University of Otago for the Dunedin, Christchurch and Wellington Schools of Medicine. The funds are forwarded to the University monthly and are distributed to the Trainee Interns’ bank accounts for payment on the 1st Wednesday of each month.
The training grant is $26,756 per annum, tax-free and paid in 12 monthly payments of $2,229.66. This grant is non-taxable. It is important to note that those intending to apply, or receiving Student Allowance payments through Studylink, understand that the training grant is classed as income, and you do not qualify for both.
The Trainee Intern year normally runs from approximately mid-November for a period of 12 months. The first payment is made on the 1st Wednesday of December and the last in November the following year.
A bank deposit form, which must be either a preprinted deposit slip, or one obtained and printed from the bank with the account details, including the students name should be provided to the Trainee Intern Course Co-ordinator on Orientation Day. Accuracy is particularly important for those taking their elective overseas in the first quartile to avoid the possibility of payment being delayed due to potential contact problems. NB. If you do not provide a preprinted deposit form, you will not be paid, so please action immediately and pass the form onto the TI Course Co-ordinator.
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The elective quarter cannot be paid in advance, as the funds are only received for payment monthly.
If there is a need to resit one or more 5th year examinations, there will be a delay in commencing the TI year for one quarter, or even repeating the 5th year. The Training grant will begin when the student commences sixth year.
Student Allowance. For Student Allowance purposes the Training Grant is classed as income therefore Student Allowance is not available for anyone receiving the Training Grant.
In special circumstances students may be eligible for extra assistance e.g. Childcare Assistance, the Training Grant is treated as assessable income. Due to the amount of the grant, you will need to check out your entitlement with Studylink.
Eligibility for the grant is determined by whether or not an individual is assessed for domestic fees. Those assessed for international fees are not eligible for the grant.
Any interns transferring to or from Auckland Medical School will be paid the grant by the School teaching the 6th year of the course, so please ensure you check with the TI Course Co-ordinator to ensure all of your details are forwarded so you may be paid.
The same applies to transfers between the three schools at Dunedin, Christchurch and Wellington. Make sure the TI Course Co-ordinator at the School where you are working/studying has all your details so you may be paid.
You may be required to work in the wards by the District Health Boards as acting House Surgeons. This is a requirement of your course and no extra payment is made for this.
If you require a letter for evidence of income of the Training Grant by banks,
referees, for loans etc., then please contact Ann Thornton.
For further Studylink enquiries, please call 0800 88 99 00 or visit www.studylink.govt.nz
Code of Practice for Fitness to Practise 23 November 2010
1 Preamble
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Medical students are part of the medical profession. Whilst students do not yet enjoy the privileges accorded to qualified practitioners, and are not yet bound by the full professional constraints imposed upon practising doctors, it is vital that issues that may affect their current or future fitness to practise are fairly and transparently addressed by the Otago Medical School and its component Schools and programmes. This document outlines the policy and mechanisms of the University of Otago Medical School to assess and act on issues fairly and equitably concerning a student’s Fitness to Practise. It is expected that, at graduation our students will meet the expectations of the University of Otago Medical Graduate Profile, through their personal attributes, teaching and learning during the course, and support from staff. The University of Otago MBChB Graduate Profile is attached as an Appendix (1). The outcomes expected by the Australian Medical Council (AMC) Appendix (2) and the ‘Domains of Competence’ by the Medical Council of New Zealand (MCNZ) Appendix (3) are also provided, in the appendices. Throughout the undergraduate programme, the assessment processes will include steps to identify and monitor any students who might not meet the graduate profile standards through problems with health, or with professional attitudes and behaviour, both within and outside the course. In the normal course of events, the assessment will be conducted by the relevant Student Progress and Assessment Committee (SPAC) within the programmes of the Schools within the Otago Medical School. To assist in the determination of Fitness to Practise issues, and to provide support, remediation and monitoring of potential or actual Fitness to Practise needs of students, the Otago Medical School has a Fitness to Practise Committee. Reference to the Committee is also included in the Memorandum of Understanding with the Medical Council of New Zealand, (Appendix (4)). Referral to the Fitness to Practise Committee (FtPC) will be made where there are repeated, consistent, or serious issues which may impinge on a student’s capacity to meet the standards. The threshold for referral will be high. The aim will be to ensure consistency and continuity of monitoring of students over a sustained period which is important for the small number of students who may not meet or who do not meet graduate profile standards.
2 Primary goal of the Fitness to Practise policy and associated processes The primary goal of the present Fitness to Practise Policy and associated processes is to ensure assessment and remedial / support mechanisms that will enable the student to remain in and successfully complete the programme wherever possible. Staff will use their utmost endeavours to achieve this outcome, provided that the proposed remedial action does not place the public, the student or the University at risk either during the medical programme or following graduation. It is anticipated that in most cases any matter in relation to Fitness to Practise will be resolved at an early stage, with the student’s cooperation. Where that risk is considered to be continuing despite an appropriate remedial action programme, then it is the responsibility of the FtPC to ensure that the student will not pose any risk to himself / herself or to any member of the public with whom they might interact. This policy is not meant to encompass the normal minor day to day issues that are dealt with on attachments by supervisors, programme coordinators or by the relevant Associate Deans of Student Affairs, or interrupt the good processes that are
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already in place in teaching and learning programmes and Departments to guide and support students. This is a structure to help identify more serious issues and ensure that appropriate steps to protect the student and the public are entered into.
3 The Fitness to Practise Committee The scope of the FtPC activities and responsibilities will be limited to dealing with students who may fail to reach or demonstrate breaches of the minimally acceptable standards in professional attitudes and behaviour, or who for other reasons e.g. personal health issues, are considered to be potentially unfit to practice.
The FtPC is a subcommittee of the Board of the Otago Medical School. 3.1 Membership
Dean of Faculty (ex-officio)
Dean of one of the Otago Medical Schools (usually an Advanced Learning in Medicine School) (convenor)
Associate Deans of Student Affairs from each of the four schools
3.2 Terms of Reference and Tasks of the FtPC The primary responsibilities of the FtPC are to ensure that:
in the conduct of their training, medical students in the Otago Medical School at the University of Otago do not pose a risk to patients or others with whom they have professional contact, for reasons of their personal health or because of identified serious deficiencies or lapses in personal attitudes, conduct or behaviour.
that where serious impairments, deficiencies or lapses have been identified or have occurred, remedial steps have been undertaken and fulfilled such that the perceived risks are no longer present
The tasks of the FtPC are:
To consider and review the “Fitness to Practise” issues for students referred to the FtPC, and to make recommendations to the relevant Associate Dean (Student Affairs) and SPAC for that student’s help and support towards achieving improvements in personal health or attitudes, conduct and behaviour.
To monitor the progress of students who have been referred to the FtPC, and to ensure that all recommendations designed to help and support students to achieve improvements in their attitudes, conduct and behaviour (where appropriate) are being followed and the desired outcomes are being achieved.
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To refer individual cases where necessary to the Dean of the Otago Medical School, Faculty Board, other appropriate Faculty and Division of Health Sciences Committees or Boards, and to the University Disciplinary Authority (Proctor, Provost) as appropriate.
To make recommendations to the appropriate Student Progress and Assessment Committee, or in exceptional circumstances to the Faculty Board and Dean of the Faculty, regarding the granting of Terms for individual students who have been referred to the FtPC.
To notify the appropriate Student Progress and Assessment Committees, Faculty Board and the Dean of the Faculty, regarding any students who should be notified to MCNZ under the condition of the Memorandum of Understanding between the Otago Medical School, University of Otago and the Medical Council of New Zealand. (see Appendix 4)
To consider and review all relevant issues pertaining to “Fitness to Practise” policy and make recommendations to the individual programmes, Schools and to the Faculty Board for action, including any proposed changes to the Code of Practice for students in the Otago Medical School.
1.3 Responsibilities and reporting
Within its Terms of Reference, the FtPC will have the authority to make recommendations regarding individual students’ fitness to be awarded terms and fitness to graduate to the relevant Student Progress and Assessment Committee (SPAC), Boards for Examinations, Faculty Board and Dean of Faculty. The FtPC will:
Determine the circumstances in which a student requires to be referred to and monitored by the FtPC (see below).
(Student Affairs) or Dean of School (see below).
Make recommendations to the relevant Associate Dean of Student Affairs, and through him / her to SPACs and Heads of Departments regarding steps to be taken in the ongoing support of the student. This will include conditions which are required to be met in order to enable the student to discontinue supervision by the FtPC.
Monitor and subsequently determine whether the reasons for the referral of individual students have been satisfactorily addressed and conditions have been met,
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and whether the student should continue to be monitored or may be removed from FtPC supervision.
Determine whether any ongoing concerns are of sufficient importance to recommend: 1. that the student should be denied terms 2. that the student should be excluded from the programme. 3. that the student should be notified to the Medical Council of New Zealand under the conditions of the Memorandum of Understanding between the Otago Medical School and the Medical Council of New Zealand regarding Fitness to Practise. 4. other courses of action which will satisfactorily resolve all the concerns which prompted initial referral.
Report regularly to the relevant Student Progress and Assessment Committee, relevant Associate Dean (Student Affairs), Dean of School, Faculty Board and Dean of Faculty regarding: 1. the student’s status in respect of the FtPC 2. recommendations regarding measures to alleviate or improve the student’s health status or professional conduct. The relevant Associate Dean of Student Affairs will be responsible for monitoring compliance and progress, and reporting back to the FtPC. 3. recommendations made with respect to the gaining of terms, exclusion from the programme, or notification to the New Zealand Medical Council. These will also be reported to the Faculty Board for final decision and to the Dean of Faculty.
3.4 Additional administrative requirements for Fitness to Practise issues
Referrals to the FtPC will be documented by letter to the Convenor of the Committee outlining the situation, and attaching any relevant information.
Copies of the details of all Fitness to Practise issues will be kept in the student’s Faculty record. This is to be held securely in the Student Affairs office of each of the Schools.
The FtPC Committee will provide its recommendations in writing, and these will be provided to the student. Further written communications will be sent if/when recommendations change or are updated.
The FtPC will keep written records of all meetings, decisions, recommendations and reports.
The Faculty Board will record the final decisions on any recommendations made to it by the FtPC.
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4 Conduct of the Fitness to Practise Committee towards students and natural justice
The Committee will use due and fair process when dealing with all FtP issues.
The chair of the relevant Student Progress and Assessment Committee, either for the Early Learning in Medicine programme, or in the Advanced Learning in Medicine programme (where the Chair will usually be the Dean of the appropriate School) shall inform the student, in writing, that their case has been referred to the FtPC and shall inform the student of the reasons for the referral.
The student will be advised that he or she has the right to make a written submission to the FtPC.
In most cases face-to-face interaction with the student will take place with the Chair of the SPAC and Associate Dean of Student Affairs. In rare circumstances, consideration will be given to the student meeting with the Fitness to Practise Committee.
Students will be advised that they are able to bring a support person to any face-to- face meeting and will be encouraged to do so.
The Committee will normally meet by teleconference, but may convene as appropriate to meet with a student in person.
The Committee will, in consultation with and through the relevant Associate Dean for Student Affairs, endeavour to recommend reasonable and possible means whereby Fitness to Practice issues may be constructively remedied, and will continue to monitor the individual student’s progress in fulfilling these recommendations.
The student will be advised of all FtPC recommendations in writing. These will include the conditions to be met in order for the monitoring processes to be discontinued, as well as the rare circumstances in which it is being recommended that Terms should be denied or where other actions are recommended.
5 Fitness to Practise: Policy and its Scope The Otago Medical School Fitness to Practise Policy encompasses Fitness to Practise (FtP) in three separate areas: Area 1: Health or Personal Issues
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Students who become aware that they are suffering from any medical or personal condition which is likely to threaten their fitness to practise, and which may compromise or lead them to discontinue their programme of study, should seek advice at the earliest opportunity through the Associate Dean of Student Affairs. Issues that are likely to affect the student’s future ability to practise medicine, include but are not limited to:
Mental health disorders
Physical impairment
Infectious diseases including transmissible blood-borne viral infections
Drug and alcohol issues These are likely to:
Expose the student, patients or staff members to potential risk
Expose the Faculty or partner organisations to potential risk Area 2: Professional Attitudes and Behaviours Issues of concern regarding professional attitudes and behaviours include: General
Failure to develop and maintain attitudes and behaviours which are expected of medical professionals in their conduct towards patients and colleagues. These include but are not limited to honesty, reliability, responsibility, accountability.
Specific
Plagiarism or any other form of academic and professional dishonesty
Poor attendance without adequate explanation
Inappropriate behaviour, where this is in breach of or judged to be below minimally acceptable standards, including: 1. Serious unreliability in fulfilling assigned tasks or assignments 2. Irresponsible behaviour likely to pose risk to patients, other students or other health care professionals 3. Inability or unwillingness to reflect on and improve their own clinical practice 4. Inability to receive and process constructive feedback and / or modify inappropriate behaviours and attitudes 5. Lack of respect or rudeness towards patients and their families/whanau, other students, staff or other health care professionals and members of the public 6. Not maintaining appropriate professional boundaries, or breaching ethical codes or policies 7. Exceeding appropriate scope of practice for a particular level of experience and training
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Area 3: Issues External to the Programme Students are required to bring any issues that may adversely affect their future ability to register as a Doctor with the New Zealand Medical Council to the attention of the Otago Medical School and the relevant Associate Dean (Student Affairs). This includes any charges brought by the police in relation to a criminal offence. Issues regarding the actions of students occurring outside the study programme, such as an offence which is potentially to be brought before the criminal courts excluding minor traffic offences (e.g. alcohol or drug related convictions, pornography offences) will come under this category. The student will be seen by the relevant Associate Dean (Student Affairs). Once the issue is discussed, the Associate Dean will provisionally classify it as non-critical, critical or extraordinarily critical.
6 Classification of Concerns Concerns raised are classified into three groups as follows: 1. Non-critical An issue that raises concerns about future fitness to practise that would best be dealt with through support and counselling. Examples include poor attendance or relatively minor inappropriate behaviour. 2. Critical Issues that raise much more significant concerns in regards to future fitness to practise or career options. Examples include dishonesty, serious health issues, significant contravention of a policy, and drug and/or alcohol abuse. Repeated non-critical concerns may escalate to this category. 3. Extraordinarily critical An unpredicted event giving rise to the need for immediate action because of the likelihood of significant harm, either involving a medical student, or resulting from the action of a medical student. It is the responsibility of the relevant Associate Dean (Student Affairs) in consultation with the Dean of the School to determine the status of the event or issue. The Dean of the appropriate School and the Dean of Faculty shall be notified immediately of any such extraordinarily critical incident. If there are implications for the safety of patients, staff, or students, the Dean of Faculty has the authority to temporarily suspend the student or place limits on the continuation of his/her study and/or clinical attachment
7 Relationship to the Medical Council of New Zealand
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The Medical Council of New Zealand (MCNZ) has no direct jurisdiction over medical students but recognises that their health and conduct prior to graduation may have a significant bearing on their future eligibility for registration and subsequent practice. The guidelines produced by the Medical Council and contained within the document “Good Medical Practice” (Appendix (3)) provide the framework for a medical student’s conduct. The clear and stated linking of the Fitness to Practise policy to professional standards expected by the MCNZ helps to ensure continuity and consistency with what is expected of graduates once they qualify as practising clinicians. At present, MCNZ does not register students, but does expect medical schools to have a defined Fitness to Practise policy. A Memorandum of Understanding exists between the Otago Medical School and the Medical Council of New Zealand with respect to Fitness to Practice considerations for medical students (Appendix (4)). Prior to and following admission to the course, students are expected to indicate to Faculty their awareness of any issues that may affect their later ability to practise medicine. Each of these self-reports will be assessed by the Associate Dean of Student Affairs, and where necessary referred to the FtPC. The Health Practitioners Competence Assurance Act (2003) (HPCA Act) creates a statutory duty on any health practitioner or employer of health practitioners to notify the Medical Council if any graduating student has a health problem that would not enable them to perform the functions required for practice. Parts of the relevant section of the HPCA Act are as follows: 45. Notification of inability to perform required functions due to mental or physical
condition – 5) If a person to whom this subsection applies has reason to believe that a student who
is completing a course would be unable to perform the functions required for the practice of the relevant profession because of some mental or physical condition, the person must promptly give the Registrar of the responsible authority written notice of all the circumstances.
The Faculty must therefore notify the Medical Council of New Zealand (MCNZ), at graduation, of any students who fall into this category. The MCNZ Health Committee functions to assess, support and monitor doctors with health issues and helps them practise within their capacity. Graduating students will be advised where any such information is passed to the MCNZ. The MCNZ must also be sure under section 16 of the HPCA Act (Fitness to Practise) that any student being registered to practise will not endanger the safety of the public. With this in mind, the Faculty will also pass information to the MCNZ about significant behavioural issues pertaining to graduating students which might endanger the health or safety of the public, but as of April 2010, this requires the student’s consent.
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At present other issues impinging on Fitness to Practise are not notifiable to the MCNZ, unless with the consent of the student. You should be aware, however, that where a graduate applies for registration they are required to declare to the MCNZ, themselves, any disciplinary action related to fitness to practise which may have arisen during the MB ChB programme, as well as other matters, including any health issues or previous criminal investigations or convictions.
8 Identification of Students at Risk and Referral to Fitness to Practise Committee (FtPC) The process of referral may be via (but is not exclusive to): a. Student Progress and Assessment Committee
This will be the most common route of referral in relation to attitudes, conduct and behaviours (Section 5 above: Policy and its Scope. Area, Professional Attitudes). The Otago Medical School has already in place a system which assesses students’ professional functioning during each attachment. The Professional Attitudes and Summary of Achievement Form (PASAF) is filled out for every clinical attachment and for each course component for ELM (currently under development). Students of concern are identified and discussed by the Committee responsible for monitoring student progress (both ELM and ALM). Students will be referred to the FtPC by the relevant SPAC (in addition to any other “normal” support and remedial measures having been undertaken) where PASAF evaluations include a “conditional pass” or “fail” in relation to “attitudes and behaviours” on two or more occasions. This may occur within one academic year, or cumulatively over more than one academic year. This event will normally be defined as critical and must be referred to the FtPC. Progression within the Programme SPACs are responsible for recommending to the relevant Board of Examinations that Terms should be granted. The FtPC may recommend to SPACs and Boards of Examinations that unresolved Fitness to Practise issues mean that a student should not be granted terms and/or should not progress further within the programme. SPACs and Boards of Examinations will normally follow the FtPC recommendation when making final recommendations to the Faculty Board. If SPACs and Boards of Examinations decide not to follow the FtPC recommendation, this action should be justified and material forwarded to Faculty Board for final determination.
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In cases where Terms are granted, the FtPC may still recommend that students will remain under supervision until the FtPC is assured that supervision and monitoring are no longer required.
b. The Associate Dean (Student Affairs)
Where an issue under Areas 1, 2 or 3 (Section 5 above: Policy and its Scope) has been raised either via a PASAF review, or by a student (self-reporting), or in writing by a member of Faculty or honorary teaching staff e.g. an attachment convenor, it will be reviewed by the relevant Associate Dean of Student Affairs and classified as noncritical, critical, or extraordinarily critical. Critical and extraordinarily critical issues must be referred to the FtPC by the Associate Dean of Student Affairs or Dean of School. Thereafter the decision pathway to be followed will be determined by the non-critical or critical nature of the issue. A summary of decision processes is given in the Table.
Handled by Non-critical Critical Extremely critical
Referral to FtPC Discretionary Yes Yes Action Devise an agreed
action plan with student, which is monitored by Associate Dean (Student Affairs)
Devise an agreed action plan with student, which is monitored by Associate Dean (Student Affairs)
Case by case action depending on circumstances
Study programme Student may continue with their study.
Student may continue with their study if appropriate. No student should continue in clinical placements if this would compromise their health or treatment or create safety concerns for patients
Suspension or withdrawal from clinical attachment, pending investigation No student should continue in clinical placements if this would compromise their health or treatment or create safety concerns for patients
Reporting by FtPC
To SPAC via Associate Dean (Student Affairs) To Dean of School
To SPAC via Associate Dean (Student Affairs) To Dean of School
To Dean of Faculty To SPAC via Associate Dean (Student Affairs) To Dean of School To MCNZ (health issues)
9 Outcomes of Process
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In general, the desired outcome will be to address and resolve the reason(s) for referral. The aim in all cases will be to provide recommendations which include “conditions to be met” such that supervision is no longer required. For specific issues, the possible outcomes available will vary according to the reason for referral. Area 1: Health or Personal issues The primary goal of the process and /or FtPC recommendations is to provide the student with a plan and support framework that will enable the student to remain within the Faculty and complete their undergraduate degree, provided that such an action does not potentially place the public at risk. Such a plan may involve monitoring, mentoring and counselling and will be agreed between the student and either the relevant Associate Dean (Student Affairs) and the chair of the relevant Student Progress and Assessment Committee, the School Dean where appropriate, or the FtPC (depending on whether it is non-critical or critical). The plan is regarded as a condition of remaining within the course. Area 2: Professional attitudes and behaviours raised within the programme Where referral to the FtPC has occurred because of two or more non-critical issues an agreed action plan will be tracked to completion, with appropriate support. In most circumstances the referral will be from the Student Progress and Assessment Committee. The FtPC will monitor compliance and successful completion of the agreed action plan. If this is satisfactory, then the student will no longer require to be supervised by the FtPC. Where this is inadequate the FtPC will continue supervision, and may recommend that Terms will be denied. For a critical issue the student will be placed on a formal reporting regime, with a clearly defined reporting period during which the issue must be resolved, and, where applicable, “conditions met”. This will be supervised in the first instance by the Associate Dean (Student Affairs). In some circumstances where this involves a period of leave, if conditions are met, then the student can continue with the programme of study. A written caution will also be given to the student. This is also likely to be the usual response of the FtPC where two or more non-critical attitude / behaviour issues arise. For an extraordinarily critical issue, the likely appropriate action will be that the student will be suspended from the programme, until there is a complete investigation and a decision made by the FtPC. It is anticipated that this will mostly result in temporary suspension or withdrawal, but continuation may be an option. More than one critical attitude/behaviour issue will may result in the student being asked to withdraw temporarily from the programme, until further consideration and recommendation is made by the FtPC.
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If a decision is made to recommend withdrawal from the programme, this will require confirmation by the Faculty Board and the Dean of Faculty. He/she will be responsible for ensuring that the student is given appropriate advice about other options, which, if appropriate might include:
transferring to an alternative programme; or
interrupting his or her studies while receiving appropriate therapy/ counselling/mentoring.
Area 3: Issues external to the programme The guidelines for the Fitness to Practise Committee for Area 3 issues will be similar to those that would apply to a practising doctor who was referred to the Medical Council for similar reasons; the FtPC will consider the issue in this light. For students appearing as a result of a criminal conviction, the FtPC will not consider matters of guilt. If the student has been convicted then they will be considered to have committed the offence and the issue will be considered in this light. The guidance issued by the MCNZ regarding students convicted of an offence against the law will be used as the baseline for making recommendations and decisions in this area. If the FtPC considers that there are sufficient grounds for judging that the student is unfit for entry to the profession, its first step will be to ensure that the student is given appropriate advice and the opportunity to accept the advice. The convenor of the FtPC will notify the Faculty Board and the Dean of Faculty.
10 Right of Appeal Students will have the right to seek leave to appeal through the University, including if the outcome of a FtPC recommendation and thereafter the final Faculty Board decision is that a student is required to restart a year or withdraw from the programme. The appeals processes will follow the usual University regulations.
11 Advising all students of Fitness to Practise Policy
Students will be provided with a copy of the Policy document and asked to declare their acceptance to study within its framework at the commencement of their studies in the MB ChB programme. The Policy document will be available on the Faculty website. Discussion of this document and the issues of Fitness to Practise should form the basis of some of the learning in the Professional Development area during the early years of the course.
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Emergency Response: Dealing with Exposure to Blood and/or Body Fluids Actions required by staff member/student/individual exposed to blood and/or body fluids: 1. If skin is splashed or penetrated, wash the area well with soap and water. 2. If the eyes are contaminated, rinse the eyes using the emergency eye wash facility. 3. If there is a splash into the mouth spit it out and rinse thoroughly. 4. Contact your supervisor or manager immediately. 5. Document the date and time of exposure, how the incident occurred and the name of
the source if known.
Actions required by supervisor / manager / other responsible person: 1. Ensure area has been washed. 2. Assess the type of exposure and need for testing and intervention. For the following
types of exposure, consultation within 24 hours is mandatory: • A needle stick injury or other sharp instrument injury when the needle or sharp
instrument is contaminated with blood or body fluids from another person. • Mucous membrane contact with, or ingestion of blood or body fluids of another
person. • Contamination of fresh unhealed cut or broken skin surface with blood or body fluids
from another person. • Bites where the skin surface is broken, or scratches where blood or body fluid
contamination from another person is likely. 3. CONTACT:
Wellington: ring the Occupational Health Nurse at Wellington Hospital (385 5999 ext. 6331 - pager 6331) or After Hours Manager if outside normal working hours, please ring the Wellington Hospital operator.
For incidents that occur in other hospitals or other health care environments: immediate notification of the local hospital staff member responsible for blood and /or body fluids exposure is essential.
The Associate Dean for Undergraduate Students, Head of Department, Dean or other senior staff member should also be contacted.
4. Arrange for 10 mL blood to be taken from the exposed individual as soon as possible.
The screening must include HIV, HBsAg, HBsAb and HCV. 5. If the source is known, contact and arrange for 10 mL blood sample to be taken. 6. Provide support for the student or staff member involved. 7. Complete the accident/incident form and forward to the HOD, Office of the Dean, and
the (Occupational) Health & Safety Team. Contact details for Health & Safety staff and
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the accident/incident form are available on the Health & Safety website: http://www.otago.ac.nz/healthandsafety/
Immediate assessment It is important that the individual is medically assessed by an expert immediately so that treatment can be commenced if deemed necessary. It is important to arrange follow up with the emergency contacts provided. Issues for the medical services to consider include:
Action will depend on the status of the individual and the status of the source
Is there a need for immediate antiretroviral treatment?
Is there a need for hepatitis B immunoglobulin?
Is there a need for hepatitis B vaccination?
Has follow up been arranged?
Other University of Otago / Otago Medical School Policies can be found at http://micn.otago.ac.nz
Student Support when away from Campus / Travel & Accommodation Policy For information on financial support for students on ‘away from main campus’ attachments, please refer to http://micn.otago.ac.nz/faculty-policies. The immunisation guidelines are currently under review and will be posted on the faculty website when available.
For further information contact: Lesley Gray Phone: +64 4 385 5541 ext. 4654 Email: [email protected] Jessica Ellis Phone: +64 4 385 5541 ext. 65708 Email: [email protected] Otago Medical School University of Otago, Wellington PO Box 7343 Wellington South. This handbook can also be accessed on Moodle.
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TIMETABLE – 2016/17
FIRST QUARTER SECOND QUARTER
21.11.16 - 26.2.17 27.2.17 - 21.05.17
21.11.16 to
18.12.16
4.1.17 to
29.1.17
30.1.17 to
26.2.17
27.2.17 to
26.3.17
27.3.17 to
23.4.17
24.4.17 to
21.5.17
1
1ST QUARTER ELECTIVE
25
1
Medicine
13
Surgery
14 Surgery
25
Medicine
26
O&G
34
Psych Med Paediatrics
26
2ND QUARTER ELECTIVE 51
35 Paediatrics
42 O&G Psych Med
43 Psych Med
51 Paediatrics O&G
52
Emergency and Acute Care
64
General Practice
52
O&G
59
Psych Med Paediatrics
60
Paediatrics
68
O&G Psych Med
65 General Practice
76
Emergency and Acute Care
69
Psych Med
76
Paediatrics O&G
77
Medicine
89
Surgery
77
Emergency and Acute Care
89
General Practice
90
Surgery
102
Medicine
90 General Practice
102
Emergency and Acute Care
78
THIRD QUARTER FOURTH QUARTER 22.05.17 - 13.08.17 28.08.17 - 19.11.17
22.5.17 to
18.6.17
19.6.17 to
16.7.17
17.7.17 to
13.8.17
28.8.17 to
24.9.17
25.9.17 To
22.10.17
23.10.17 to
19.11.17
1
Emergency and Acute Care
13
General Practice
1
O&G
8
Psych Med Paediatrics
9
Paediatrics
17
O&G Psych Med 14 General Practice
25
Emergency and Acute Care
18
Psych Med
25
Paediatrics O&G
26
Medicine
38
Surgery
26
Emergency and Acute Care
38
General Practice
39 Surgery
51
Medicine
39 General Practice
51
Emergency and Acute Care
52
3RD QUARTER ELECTIVE
76
52
Medicine
64
Surgery
65 Surgery 76
Medicine
77 O&G
85
Psych Med Paediatrics
77
4TH QUARTER ELECTIVE 102
86 Paediatrics
93
O&G Psych Med
94 Psych Med
102
Paediatrics O&G
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TRAINEE INTERN ELECTIVE QUARTERS: 2016/2017
FIRST QUARTER 21.11.16 – 26.2.17 THIRD QUARTER 22.5.17 – 13. 8.17
1 Raja PATEL 52 Joshua SMITH (PN)
2 Ryan CULLEN 53 Thomas PETT (27.2.17)
3 Jeremy BRANKIN (transfer) 54 Hannah MORLEY (HB)
4 Ruby FAULKNER (27.2.17) 55 Helen YU
5 Sam CLARK 56 Qatriyah NOKMAN (PN)
6 Niamh HAMMOND (HB) 57 Charlotte DEROLES
7 Stephen YU 58 Grace ROSS
8 Caroline SHIE (PN) (27.2.17) 59 Chandula WIJEWEERA
9 60 Charlotte O’LEARY
10 Georgia BROWNLEE 61 Sarah COX
11 Fauzul AYOB (27.2.17) 62 Mary FURNISS
12 Natalie OLDS 63 Thomas JUDD
13 64 Alex HEDLEY (HB)
14 Nerissa JONES (HB) 65 Amelia EDDOWES
15 Asha PRAKASH (PN) (27.2.17) 66 Jonny MAIR
16 Saskia CAMPBELL 67 Logitha SRITHARAN (PN)
17 Jacob COLLINS 68 Ashleigh PARROTT
18 Daymen HUBAND 69 Richard KENNEDY
19 Grace LI 70 Wendy ZHU
20 Jacky LU 71 Gina KIOA
21 Muhammad BIN ISMAIL (PN) (27.2.17) 72 Holly EGAN
22 Stewart STEVENS 73 Nicholas ROBILLIARD (PN)
23 Mohammed ALSINAN 74 Alexandra CARSWELL
24 Anwen MADDOCK (HB) 75 Olivia CARLETON (HB)
25 Dylan VAN OPDORP (27.2.17) 76 Daniel SCOTT
SECOND QUARTER 27.2.17 – 21.5.17 FOURTH QUARTER 28.8.17 – 19.11.17
26 77 Merryn NG-WAI SHING (PN)
27 78 Joshua STEWART (HB)
28 Julia TURNBULL 79 Leah BOYLE
29 Alice LI (PN) 80 Rosalind POULGRAIN
30 81 Merrin RUTHERFORD
31 Imogen WHYTE 82 Sophie WILKINSON
32 Madeline BURTON (HB) 83 Nic WIGHTMAN (PN)
33 Douglas WOOD 84 Jessica NAIRN
34 Bonnie WHITE 85 Phil DE LATOUR
35 86 Rebecca WONG
36 Printha RAMACHANDRAN (PN) 87 Chris CLEWS
37 Shreeja MEHROTRA 88 Julie COOK
38 Gabrielle SHAW 89 Shaun COLLINGS
39 Sarah BUSH (HB) 90 Hinerangi TEMARA (HB)
40 Megan CHATFIELD 91 Kieran BUNN (PN)
41 Roza BRAJKOVICH-PAYNE 92 Katie SCORRINGE
42 Chris ARTHUR 93 Sophia SHERWOOD
43 94 Emily DWIGHT
44 ChoWool KIM (PN) (27.2.17) 95 Sam SILJEE
45 Isaac RYAN (transfer) (27.2.17) 96 Markus HO
46 Nicholas JONES 97
47 Olivia BADCOCK 98 Dan FOUHY (HB)
48 Thomas BECKER (transfer) 99 Harry CLEGG
49 Auzita IRANI 100 Lucy SULZBERGER
50 Henry SCHOFIELD 101 Emma WOODHOUSE
51 Tim FOSTER (HB) 102 Jhanvi DHOLAKIA (PN)
Summer Vacation 19.12.16 - 4.1.17 (inclusive) Winter Vacation 14.8.17 – 27.8.17 (inclusive)
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