|Title||Advanced History Taking and Clinical Examination R and S|
By the end of this module the Clinical Scientist in HSST, in respect to respiratory and sleep disorders, will be able to analyse, synthesise, evaluate and apply knowledge in taking a relevant focused history and be able to perform a limited but focused, relevant and accurate clinical examination in patients with increasingly complex issues and in increasingly challenging circumstances. The Clinical Scientist in HSST will be able to record the history accurately and synthesise this with relevant and appropriate clinical examination within scope of practice of Consultant Clinical Scientist.
Knowledge and understanding
By the end of this module the Clinical Scientist in HSST will analyse, synthesise, evaluate and critically apply their expert knowledge with respect to the:
- need for a relevant and targeted physical examination as appropriate in the role of Consultant Clinical Scientist.
- pathophysiology of symptoms.
- anatomical and physiological basis for clinical signs and the relevance of positive and negative physical signs.
- importance of different elements of history, including the role of smoking, occupational, environmental and domestic exposures.
- recognition that patients do not present history in structured fashion.
- likely causes and risk factors for conditions relevant to mode of presentation.
- recognition that the patient’s agenda and the history should inform examination, investigation and management.
- importance of social and cultural issues and practices that may have an impact on health.
- recognition of constraints (including those that are cultural or social) to performing physical examination and strategies that may be used to overcome them.
- recognition of the limitations of physical examination, in particular in relation to the role of Consultant Clinical Scientist and the need for adjunctive forms of assessment to confirm diagnosis.
- recognition of when the offer/use of a chaperone is appropriate or required.
- the importance of continuity of care and a holistic approach to clinical practice.
Technical and clinical skills
By the end of this module the Clinical Scientist in HSST will be expected to critically reflect and apply in practice a range of clinical and communication skills to advise and communicate effectively with patients, relevant clinicians, patients and the public and other healthcare professionals and will:
- identify and overcome possible barriers to effective communication.
- communicate effectively with patients from diverse backgrounds and those with special communication needs, including the use of interpreters where appropriate.
- manage time and draw consultation to a close appropriately.
- recognise that effective history taking in non-urgent cases may require several discussions with the patient and other parties over time.
- recognise when to supplement history with standardised instruments or questionnaires.
- manage alternative and conflicting views from family, carers, friends and members of the multi-professional team.
- assimilate history from the available information from patient and other sources, including members of the multi-professional team.
- facilitate balanced and mutually respectful decision making where values and perceptions of health and health promotion conflict.
- recognise and interpret appropriately the use of non verbal communication from patients and carers.
- focus on relevant aspects of history.
- maintain focus despite multiple and often conflicting agendas.
- perform an examination relevant to the presentation and risk factors that is valid, targeted and time efficient.
- recognise the possibility of deliberate harm (both self harm and harm by others) in vulnerable patients and the need to report to appropriate agencies.
- actively elicit important clinical findings.
- perform relevant adjunctive examinations, e.g. abnormal heart sounds.
Attitudes and behaviours
By the end of this module the Clinical Scientist in HSST will be expected to evaluate their own response to both normal and complex situations demonstrating the professional attributes and insights required of a Consultant Clinical Scientist working within the limits of professional competence referring as appropriate to senior staff and will:
- show respect and behave in accordance with Good Scientific Practice.
- ensure that examination, whilst clinically appropriate and within the constraints of the role of Consultant Clinical Scientist, considers social, cultural and religious boundaries; appropriately communicate findings and make alternative arrangements where necessary.