Resources

• S – Specific
• M – Measurable
• A – Achievable
• R – Relevant
• T – Time-based

Help them stay on target in their study time:

• 2022 RACGP curriculum and syliabus
• ACRRM curriculum
• BEACH/IPC2 Data

Example Study Schedule

Please note this is only an example. Due consideration should be given to the requirements of the relevant College, and each registrar should devise a study plan based on their own curriculum and learning needs.

Baker EA, Ledford CH, Fogg L, Way DP, Park YS. The IDEA Assessment Tool: Assessing the Reporting, Diagnostic Reasoning, and Decision-Making Skills Demonstrated in Medical Students’ Hospital Admission Notes. Teach Learn Med. 2015;27(2):163-73

Random Case Analysis – A new framework for Australian General Practice Training

GPSA Guide Random Case Analysis

GPSA How to… do Random Case Analysis

Case Based Discussion (CbD) Question Generator for General Practice Supervisors

EXAMPLE CBD STUDY

Michael Stevens a 59 year old male, attends the practice as a fit in on the day with a 2 day history of feeling dizzy.  He describes a sensation that is similar to stepping off a playground merry-go-round.  He was last seen by another doctor in your practice 5 months ago for a BP check which was normal.  Michael has a past medical history of hypertension, hypercholesterolemia and gastroesophageal reflux disease for which he takes, perindoprol 10mg orally daily, atorvastatin 10mg orally daily and exomeprazole 20 mg orally gaily.  He has no known allergies and no significant family medical history.  Michael works as a boiler maker.

On examination, Temperature is 36.7C, blood pressure is 130/85 mmHg, heart rate is 78/min regular, respiratory rate is 14/min and boady mass index is 32kg/m2.

• ‘The one-liner’ at the end of a presentation…‘putting it in their own words’
• For example: A previously well, 2-year-old unimmunized girl presents with an acute history of respiratory distress. She is febrile, looks unwell, and is drooling
• Semantic qualifiers – acute/chronic, severe/mild, localized/diffuse, previously healthy/significant PMH

You Too Can Teach Clinical Reasoning!

GPSA How to Clinical Reasoning

GPSA Guide Clinical Reasoning

EXAMPLE PROBLEM PREPRESENTATION

A 59 year old male presents with acute vertigo for the last 2 days.  He has a background of hypertension, hypercholesterolaemia, gastroesophegeal reflux and obesity.  His medications include perindopril, atorvastatin and exomeprazole.  Vital signs are within normal limits.

What is the most likely diagnosis for Michael’s presentation?

• What is the most important diagnosis to consider for Michael’s presentation?
• What differential diagnoses should be considered for Michael’s presentation?

Question Qualifiers

• Initial
• First line
• Definitive
• Immediate
• Most likely
• Most common
• Most important
• Next most important

Mnemonic comes from the Greek word ‘mnemon’ which means ‘to remember’ – Mnemosyne was the goddess of memory. Mnemonics are useful as an adjunct to study; however, registrars are required to have a higher level of understanding of the material in addition to just recall of facts.

Murtagh’s PROMPT diagnotic strategy

Probability Diagnosis

Red Flag’s – Infection, Malignancy, Metabolic (serious disorders)

Often Missed (pitfalls)

Masquerades

Patient Telling me

Ely, John W. MD; Graber, Mark L. MD; Croskerry, Pat MD, PhD Checklists to Reduce Diagnostic Errors, Academic Medicine: March 2011 – Volume 86 – Issue 3 – p 307-313

• What further aspects of history should be obtained regarding the patient’s presentation?
• What red flags were important to consider in this consultation?
• In establishing a diagnosis for the patient’s presentation, what further history should be elicited?
• GPSA History Teaching Plan

• What were the key features you looked for on examination and why? Include relevant positive and negative results.
• What physical examination findings should be sought for Michael’s presentation?
• What features on examination should be elicited to determine if Michael requires admission?
• Describe how to perform the following examination…
  – Dix Hallpike
  – HiNTs test and how do you interpret it?
• What are the following examination findings suggestive of?
• Diagnosing the unsafe ear article

• What first line investigations, if any, are appropriate for Michael’s presentation?
• What initial investigations are appropriate for Michael’s presentation?
• What is the next most important investigation to arrange for Michael’s presentation
• Describe the following investigation to your patient..
• Interpret this Investigation….
• Describe what a patient should expect with Caloric testing?

  Meniere’s disease article

• What non-pharmacological management actions are appropriate for Michael’s presentation?
• What pharmacological management options are appropriate for Michael’s presentation?
• What advice is important given Michael’s presentation?
• What are the immediate management actions for Michael’s presentation?
• Considering the most likely underlying cause for Michael’s symptoms, what management actions should be arranged?
• What is the next step in management?

• Small group case presentation and discussion for calibration
• Horizontal reading exercise
• Script sorting exercise
• ‘Persuade the MD’ or simulated patients
• Direct observation or reverse direct observation
• Inbox review

Illness Script Template

• An illness script is an organised mental summary of a provider’s knowledge of a disease.
• Illness scripts often include a disease’s pathophysiology, epidemiology, time course, salient symptoms and signs, diagnostics, and treatment.

• What is the differential diagnosis for this condiition? Try to list five (5) differential diagnoses.
• What are the key features on history for this condition? Be specific.
• What are the key examinations findings for this condition? Be specific
• What are the key investigations for this condition? Be specific
• What advice is important for this presentation?
• What non-pharmacological management options are appropriate for this (include dose and frequency)?