Aberdeen, Dundee, Edinburgh, Glasgow and St Andrews competency
based
Learning Outcomes for the Medical Undergraduate in Scotland. March 2000
The starting point for the
development of the outcomes was the definition of the three essential elements
of the competent and reflective practitioner. These are:
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What the doctor
is able to do
(doing the right thing = technical intelligences);
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How the doctor approaches
their practice
(doing the thing right = intellectual, emotional, analytical and creative
intelligences); and
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The doctor as a
professional
(the right person doing it = personal intelligences). |
Twelve
key domains were then identified, each related to one of the three
elements listed above. These are:
What the doctor is able to do
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Clinical skills
-
Practical
procedures
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Patient
investigation
-
Patient
management
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Health
promotion and disease prevention
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Communication
-
Medical
informatics
How the doctor approaches their
practice
-
Basic, social and clinical sciences and underlying principles
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Attitudes, ethical understanding and legal responsibilities
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Decision making skills and clinical reasoning and judgement
The doctor as a professional
-
The
role of the doctor within the health service
-
Personal development
These twelve domains mirror,
but are not identical to, the twelve topics deemed essential for professional
training in the GMC document The New Doctor: Recommendations for General
Clinical Training. The order in which the domains are presented is not
intended to imply any hierarchy of importance. Each is an essential component of
the competent and reflective practitioner.
Each domain was then further
subdivided into the appropriate Learning Outcomes. The task of identifying the
Learning Outcomes was undertaken by the members of the SDMCG in consultation
with colleagues at each school.
What the doctor is able to do
The new medical graduate
should be able to demonstrate competency in a range of clinical skills
unsupervised and to a predetermined standard.
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This
could include:
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Take a history from
patients, relatives and others. |
All age groups; local
multicultural/multiethnic factors;
a wide range of
different contexts and a patient-centred, sensitive, structured and thorough
approach with demonstration of principles of good communication. |
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Undertake physical
examination of patients. |
General and
systems-based; appropriate for patient’s age, gender and state of mental and
physical health, in a thorough, sensitive and systematic manner. |
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Interpret results of
history taking, physical examination and investigations. |
Recognition of
abnormality and correct interpretation of common investigative tests. |
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Make a diagnosis |
Gathering and
analysis of all available information. Recognition of important, life
threatening conditions requiring immediate treatment. |
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Formulate a management
plan |
Focus on patient’s
needs, prioritise, involve patients and other members of the healthcare team
and recognise own limitations. |
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Record findings |
Records concerning
all relevant communications with patients / relatives and colleagues. At a
minimum records are legible, dated, signed, concise and contemporaneous. |
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What the doctor is able to do
Mastery of appropriate
practical procedures at the time of graduation is an essential part of the
smooth transition from undergraduate to PRHO. The following are suggested
procedures that the new graduate should be able to carry out unsupervised. Some
of these procedures also feature in the domain of Patient Investigation and many
others are not specifically mentioned here as they should be covered by normal
physical examination e.g. fundoscopy, visual field testing, otoscopy, rectal
examination etc.
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This could include:
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Measuring and recording |
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radial pulse rate |
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blood pressure
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body temperature
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peak expiratory
flow rate |
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blood glucose using
Reagent sticks with and without a glucometer |
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urinalysis using
Multistix |
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faecal occult blood
testing |
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pregnancy testing
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perform and
interpret a 12 lead ECG |
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manage an ECG
monitor
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Administering and doing |
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First Aid |
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basic resuscitation
and basic life support for adults and children/infants |
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administration of
oxygen therapy |
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venepuncture
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take a blood
culture |
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establish
intravenous access and set up a giving set |
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male and female
urinary catheterisation |
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collection of MSU
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arterial puncture
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scrub up and gown
for surgical and sterile procedures; |
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skin suturing
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wound care and
basic wound dressing |
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make up drugs for
parenteral administration |
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administration of
intravenous, intramuscular and subcutaneous injections |
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dosage and
administration of insulin and use / prescribing of sliding scales
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use iv infusion and
volumetric pumps |
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take nose, throat
and skin swabs |
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What the doctor is able to do
Outcomes for Patient Investigation
As with practical procedures
there are different categories of patient investigation depending on whether or
not we would expect a new graduate to be able to undertake the task themselves
or simply to know how the investigation is carried out and when it is
appropriate to use it. Competency in the general principles of patient
investigation is essential.
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This could include:
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General principles of
patient investigation
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Appropriate choice
and use of investigation.
Requesting/ordering
of investigations according to local protocols / guidelines.
Obtaining informed
consent for investigations.
Preparing patients
for investigations practically and with adequate information.
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Laboratory-based
investigations:
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Demonstrable knowledge of the circumstances in which the commoner
laboratory-based investigations are indicated and the procedures required to
obtain the necessary material for investigation. To include:
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Biochemistry |
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Haematology |
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Microbiology |
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Pathology |
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Cytology |
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Genetics |
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Immunology |
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Virology
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Radiological
investigations |
Demonstrable
knowledge of the range of radiological investigations available and their
appropriate use in different circumstances.
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Clinical investigations
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A
number of system-specific investigations which the graduate should know
about and may have observed, but would not routinely be expected to perform
c.f. Practical Procedures.
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Exercise tolerance
test |
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Pleural tap/biopsy |
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Upper and lower GI
endoscopy |
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EEG |
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Lumbar puncture |
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Cystoscopy |
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Cervical smear |
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Colposcopy |
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Skin biopsy |
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Joint aspiration |
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What the doctor is able to do
Outcomes for Patient Management
New medical graduates cannot
be expected to have had unsupervised experience of all aspects of patient
management as many are restricted by law, e.g. drug prescribing. However, it is
reasonable to expect that they will have a demonstrable knowledge of the
important aspects of management in the areas outlined below and that they will
have had supervised involvement in such activities.
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This could include:
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General principles of
patient management |
Use of
patient-centred, holistic approach with careful consideration of all
information available from history, physical examination and investigations
and in full consultation with patient, relatives etc.
Recognition of the importance of teamwork
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Drugs |
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Knowledge of
prescribing. |
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Selecting method of
delivery. |
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Calculating
dosages. |
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Consideration of
interactions and adverse effects. |
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Surgery |
Recognition of
indications for intervention and the available surgical interventions.
Appropriate use of
informed consent and the understanding of principles of pre-, peri and
post-operative care.
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Psychological |
Recognition of
interventions available and their use.
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Social |
Consideration of
patient’s social circumstances, work, family etc, when determining treatment
options.
Available
interventions
The role of other
organisations.
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Radiotherapy |
Knowledge of options
available and their appropriate use.
Understanding the
effect on the patient.
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Therapy services |
Appropriate use. An
understanding of what can be achieved and what is involved for patient and
physiotherapist / occupational therapist / speech therapist etc.
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Nutrition |
Understanding the
role of nutrition as a major non-drug therapy in some medical conditions.
Selecting appropriate
method of ensuring adequate nutrition to meet individual patient’s needs.
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Emergency medicine |
Management of life threatening conditions whether due to trauma or disease
e.g. acute MI, diabetic ketoacidosis, acute asthma, haemorrhage,
anaphylaxis, etc.
Demonstrating
systematic approach with appreciation of local protocols/guidelines and
working effectively as part of emergency care team.
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Acute care |
Management of a
variety of medical and surgical conditions that are not immediately
life-threatening but which require early treatment, or management of more
serious, life-threatening conditions in the period following emergency
management e.g. uncomplicated cerebrovascular accident, exacerbation of
chronic obstructive airways disease, etc. |
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Chronic care |
Consideration
for:
patient’s age; nature
of chronic disease; effect on patient e.g. loss of mobility, psychological
impact
Appropriate use of
drugs, appliances/aids, etc.
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Intensive care |
The circumstances
under which an individual patient might require intensive care.
Recognition of
interventions / monitoring capabilities offered by intensive care and the
implications for patient and family including psychological.
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Palliative care |
Recognition of what
palliative care can offer, where it can be delivered and by whom. Knowledge
of how to involve patient, family, friends as well as healthcare
professionals and other relevant bodies.
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Pain control |
Specific knowledge of
pharmacological, physical and psychological interventions.
Selecting the most
appropriate method and knowledge of when to initiate pain relief.
Understanding the role of the pain management specialist.
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Rehabilitation |
Understanding of the
integral role of rehabilitation in recovery especially after major illness,
significant trauma or surgery e.g. myocardial infarction, spinal injury or
transplantation. Appreciation
of the need for a specific programme of rehabilitation and the role of other
healthcare professionals in providing this.
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Complementary therapies |
Appreciation of what
is available.
Outline of what is
involved in most commonly practised therapies; how alternative and
conventional therapies might be combined.
Keeping an open mind
and remaining impartial regarding the use of complementary therapies.
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Patient referral |
Making appropriate
referrals to the right professionals.
Assessing at what
stage of management referral may be indicated.
Giving and receiving
the appropriate information.
Keeping the patient
informed.
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Blood Transfusion
Services |
Nature and extent of
service.
How blood products
are obtained through donors and by manufacture including issues of safety.
Diversity of blood
products available and how they are used in different circumstances.
Making the most
efficient and appropriate use of the Blood Transfusion Service in the care
of patients |
What the doctor is able to do
Outcomes for
Health Promotion and Disease Prevention
Every contact between a
doctor and a patient can be seen as an opportunity for health promotion and
disease prevention. It is therefore essential that the new graduate knows how to
make the most of these opportunities through demonstrable knowledge of the
principles involved both for individual patients and populations.
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This could include:
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Recognition of the
causes of disease and the threats to the health of individuals and
populations at risk
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Assessment of
distribution of risk factors in the population. |
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To be able to implement,
where appropriate, risk reduction strategies for individual patients
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Knowing how to change
risk factors. The use of
evidence-based
medicine and effective interventions. |
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Appreciate that health
promotion and disease prevention depend on collaboration with many other
professionals and agencies
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Identify who the
other professionals and agencies are and what their role is. |
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Plan health promotion
taking into account barriers to preventing disease and promoting health both
in the individual and the population
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Consideration of;
political, economic, behavioural and
organisational
barriers. |
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Screening |
Criteria for
determining appropriate implementation of screening programmes. |
What the doctor is able to do
Outcomes for Communication
Good communication underpins
all aspects of the practice of medicine. All new graduates must be able to
demonstrate effective communication skills in all areas and in all media e.g.
orally, in writing, electronically, by telephone etc.
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This could include:
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General principles of
good communication |
Being able to listen
and use other appropriate communication techniques including an appreciation
of non-verbal communication / body language (one’s own and the
interviewee’s).
Gathering and giving
information with good record keeping and correspondence skills.
Mediating,
negotiating and dealing with complaints.
Making oral
presentations and writing reports / papers.
Telephone usage
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Communicating with
patients / relatives |
Answering questions and giving explanations and/or instructions.
Strategies for
dealing with the “difficult” consultation including defusing aggression,
breaking bad news and admitting lack of knowledge or mistakes.
Making requests e.g.
post-mortem, organ donation.
Obtaining informed
consent.
Confidentiality.
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Communicating with
colleagues |
Transfer of
information orally, in writing and electronically.
The “art” of the good
discharge summary and patient referrals.
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Communicating with
Police and Procurator Fiscal/Coroner |
Proper procedure when
such communication is necessary and how to relay appropriate information
without breaking rules of confidentiality.
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Communicating with media
and press |
A clear understanding
of who should give information to the media and press and what form it
should take including the need to maintain confidentiality where individual
patients are concerned.
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Communicating as a
teacher |
Recognising the
importance of sticking to what you know, knowing your own limitations and
admitting when you don’t know.
Some basic teaching
techniques e.g. demonstrating practical procedures, using various teaching
aids, etc.
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Communicating as a
patient advocate |
How to recognise when
this is appropriate and how it may be accomplished effectively. |
What the doctor is able to do
Outcomes for Medical Informatics
Collecting, storing and
using information has always been an integral part of the practice of medicine.
It has, however, become more complex and technology-based thereby creating an
increasing need for medical graduates to be competent in basic information
handling skills ranging from simple record-keeping to accessing and using
computer-based data. As well as having the technical skills to undertake such
tasks it is important that graduates appreciate the role of informatics in the
day-to-day care of patients and the advancement of medical science in general.
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This could include:
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Keeping patient records |
Maintaining high
quality of recording (whether in writing or on computer); accuracy and data
quality; legibility.
Knowledge of:
the different types
of records and how records are stored and retrieved (manually and
electronically);
coding and
classification;
confidentiality –
including legislation governing access to medical records and data.
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Accessing data sources |
Using library and
other systems to access data and information from sources such as
computerised databases and the Internet.
How routinely
collected health information is used in service planning and delivery of
care.
Using information in
evidence-based practice.
Identifying and using
professional guidelines.
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IT Skills / Computing
skills |
Use of E-mail,
word-processing, databases, statistical packages, spreadsheets, Medline /
BIDS and on-line journals, etc.
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Personal record keeping
for professional development |
The role and use of
log books and portfolios. |
How the doctor approaches their practice
Outcomes for Basic, Social and Clinical Sciences and Underlying Principles
The competent graduate
recognises, explains and manages health problems using the principles of current
scientific knowledge and understanding that underpin medicine.
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This could include:
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Normal structure and
function of the individual as an intact organism and of each of its major
organ systems
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Anatomy, physiology,
biochemistry, genetics.
Molecular,
biochemical and cellular mechanisms that are important in maintaining
homeostasis |
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The life cycle |
The different stages
and how these affect normal structure and function e.g. the foetus; the
neonate / infant; childhood; adolescence; adulthood; old age; death.
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Behaviour and
relationships between an individual and his/her:
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Family / partners |
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Immediate social
groups |
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Society at large and
the general population |
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Physical environment |
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Behavioural sciences,
psychology and sociology |
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The causes of diseases
and the ways in which these diseases affect the body (pathogenesis) |
Knowledge and
understanding of the following causes of disease: genetic, developmental,
metabolic, toxic, microbiological, autoimmune, neoplastic, degenerative,
traumatic, environmental, social, occupational.
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The alteration in
structure and function of the body and its major organ systems resulting
from various diseases and conditions
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Appropriate pathology
and pathophysiology. |
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Pharmacological
principles of treatment using drugs
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Pharmacokinetics and pharmacodynamics.
Mechanisms of action
/ interaction.
Side effects /
adverse reactions.
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Principles of
therapeutic measures in the management and symptomatic relief of diseases
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Drugs, surgery,
complementary therapies.
Evidence base for use
of therapeutic measures. |
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Public health |
Knowledge and
understanding of scientific reasoning in the practice of public health in
the NHS.
Principles of
healthcare planning, prioritisation of service and communicable disease
control.
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Health economics |
Knowledge and
understanding of basic concepts including the cost of patient management to
NHS and society and rationing.
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Disease prevention |
Knowledge and
understanding of causes of disease and evidence of causes.
Disease aetiology and
relationships between risk factors and disease – high risk approach and
population approach
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Epidemiology |
Knowledge and
understanding of principles of demography,
biological
variability and clinical trials.
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Education |
Knowing about and
applying basic theories of learning and teaching.
Basic organisation of
medical teaching and training in the UK. |
How the doctor approaches their practice
Outcomes for Attitudes, Ethical Understanding and Legal Responsibilities
The demonstration of
appropriate attitudes by new medical graduates, as shown by their professional
behaviour, is a key area of concern for educators and employers alike and is
obviously also of great importance to patients and the public in general. It is
therefore important to have attitudes as an outcome for undergraduate medical
education even if it is more difficult to define what we mean by this in
comparison to some of the other outcomes. The legal responsibilities of even new
graduates are numerous and relate to all aspects of practice. A firm grasp of
ethical principles and their appropriate application must be gained before
graduation.
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This could include:
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Appropriate professional
attitudes |
Establishing trust
between doctor and patient and respect for patients and colleagues.
Adopting an empathic,
holistic approach to patients and their problems.
Valuing and
preserving patient autonomy and involving patients in decisions affecting
them.
Respect for
professional institutions and health service bodies.
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Basic ethical principles
and standards |
Knowledge and
understanding of contemporary medical ethics and the main ethical principles
of autonomy, beneficence, non-maleficence and justice.
The duties of a
doctor.
Practical application
of theories e.g. consequentialism, deontology (duty) and double effect.
The importance of
confidentiality, truthfulness and integrity.
Dealing effectively
with complaints about own performance.
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Legal responsibilities |
Particularly with
respect to:
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Death |
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Drug prescribing |
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Physical and sexual
abuse of children and adults |
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Reporting of
adverse medical care / standards involving other practitioners |
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Codes of conduct |
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Human rights issues
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Practice of medicine in
a multicultural society |
Knowledge of and
respect for differing cultures, views, beliefs and practices relating to the
human body and healthcare.
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Psychosocial issues |
Those arising from
patients and colleagues and relating to the multitude of differing
characteristics making up the human personality.
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Economic issues |
Knowledge and
appreciation of financial constraints affecting the NHS and their impact on
delivery of care.
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Contributing to the
advancement of medicine |
Progress in medical
science and how it is achieved, particularly the potential for every doctor
to contribute to such progress.
The doctor’s role in
ethical regulated clinical trials.
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How the doctor approaches their practice
Outcomes for Decision Making Skills, and Clinical Reasoning and Judgement
Decision making, and
clinical reasoning and judgement are activities in which medical undergraduates
should be proficient. The new medical graduate must continue to display such
skills with the additional burden of increasing responsibility for their
decisions and actions. This is undoubtedly one of the most stressful aspects of
the transition between undergraduate and PRHO and therefore the achievement of
these outcomes to a high standard is essential.
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This could
include:
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Clinical reasoning |
How to recognise and
define the problem, analyse and interpret information and cope with
limitations of information and personal limitations.
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Evidence-based medicine |
How to seek the best
available evidence and keep up to date.
How to analyse and
interpret evidence and work with guidelines and protocols.
Recognising the link
between evidence-based medicine and audit and the reasons for variation in
clinical practice.
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Critical thinking |
The importance of
adopting an inquisitive and questioning attitude and applying rational
processes.
Recognising
irrationality in oneself and others.
The importance of own
value judgements and those of patients.
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Research and scientific
methodologies |
Knowledge and
appreciation of quantitative and qualitative methodology including the
differences between them and their appropriate usage.
Using research and
scientific methodologies to interpret investigations.
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Statistical
understanding and application |
How to think and
communicate quantitatively.
Choosing and applying
appropriate statistical tests with some understanding of the underlying
principles and their strengths and weaknesses.
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Creativity /
resourcefulness |
Creative use of
techniques, technologies and methodologies.
Demonstration of
self-reliance, initiative and pragmatism.
The importance of
sometimes looking outwith conventional boundaries.
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Coping with uncertainty
and error in decision making |
Appreciating that
uncertainty exists and that sources of uncertainty might include:
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oneself |
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the environment |
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the patient |
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limits of knowledge |
How to use cognitive
and intellectual strategies when dealing with uncertainty and the need to be
adaptable to change.
How to harness one’s
own emotional resilience and courage.
The importance of
making decisions in partnership with colleagues and patients.
An outline of levels
of responsibility in the healthcare system. |
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Prioritising |
Knowledge and
understanding of the factors influencing priorities.
How to prioritise
one’s own time as well as prioritising the care of patients both of which
include management of tasks, events, time and stress.
How to use protocols
to aid prioritisation. |
The doctor as a professional
Outcomes
for The Role of the Doctor within the Health Service
This is a rapidly changing
area of medical education and practice, which is subject to many external
influences including political, legal and economic. However, there are a number
of key outcomes applicable to the new graduate, awareness of which should
provide a firm basis for dealing with future developments and changes within the
health service.
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This could include:
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Healthcare systems |
An outline of:
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the structure of
the medical profession in the UK |
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the professions
allied to medicine |
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roles and
relationships of primary, secondary and tertiary care |
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NHS organisation
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the origin and
history of medical practice |
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systems that impact
on the NHS e.g. private medicine, EU, complementary therapies, etc.
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The clinical
responsibilities and role of a doctor |
The “Duties of a
Doctor” as defined by the General Medical Council.
Appreciation of the
medical profession as a voice in society and an agent of change.
The importance of
valuing and participating in professional audit.
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Code of conduct and
required personal attributes
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Duties of a Doctor
(GMC)
Local codes where
applicable. |
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The doctor as researcher |
Appreciation of the
value of medical research and how this is organised and funded in UK and
Europe.
Outlining the
potential role of research in career progression and the opportunities for
research even as an undergraduate.
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The doctor as mentor and
teacher |
The importance of
reflecting on and analysing own experience of mentors and teachers
identifying the “positive” and the” negative” and how to use this in one’s
own practice as a teacher of others.
The importance of
adopting a culture of life-long learning and fostering this in the health
service.
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The doctor as manager |
Managing people and
resources e.g. financial.
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The doctor as a member
of a multi-professional team and the roles of other healthcare professionals |
The opportunity to
learn with and be taught by other healthcare professionals during
undergraduate education with an understanding of the benefits to be gained
by all concerned including patients.
Working with other
healthcare professionals in the context of patient care as an undergraduate
in order to better develop team-working, leadership and facilitative skills.
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How the doctor approaches their practice
Personal development within
the context of undergraduate medical education is a complex issue. The
underlying personality of the individual graduate and his/her life experiences
outwith the university have a major influence on personal development, as do
experiences relating specifically to their training. Personal development is, of
course, an ongoing, life-long process but it is possible to identify a number of
important outcomes for the undergraduate period.
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This could include:
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Self-awareness |
The ability to
conduct oneself as a reflective and accountable practitioner including
seeking out sources of informed criticism and valuing, reflecting and
responding to them appropriately.
Enquiring into own
competence and evaluating own capabilities and personal effectiveness
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Self-learner |
The ability to manage
own learning as demonstrated by:
searching out and
selecting appropriate learning resources of all types
making use of all
available technical aids
employing appropriate
and effective study skills
recognising
limitations of current personal understanding and capabilities and
identifying areas needing refreshed or extended
setting realistic and
appropriate personal learning goals
selecting learning
strategies that take account of personal learning preferences and that are
likely to succeed
setting challenging
personal learning goals as a basis for personal growth
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Self-care |
Recognition of the
pressures of a demanding professional life on health, well-being and
relationships with others and the need to maintain a balance between
personal, professional and social goals and activities.
Evidence of attention
to lifestyle, diet, exercise and relaxation.
Making use of
available help and advice in stressful circumstances.
Recognition of the
hazards of self-medication or substance abuse in dealing with stress.
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Career choice |
Identify short and
long-term career and personal plans and aspirations and work towards these
by establishing realistic development plans involving relevant activities.
Participate fully in
the life of the professional community and make use of professional and
other networks of all types.
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Motivation |
Recognising key
personal motivating factors and their importance in sustaining a high level
of motivation.
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Commitment |
Demonstrating
dedication to one’s chosen career pathway through adherence to the codes of
conduct and behaviour expected of undergraduate medical students and doctors
and an acceptance of any limitations that might be associated with them. |
Source:
The Scottish Deans’ Medical Curriculum Group
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