Advanced History Taking and Clinical Examination Neurophysiology

Details

Title

Advanced History Taking and Clinical Examination Neurophysiology

Type

Stage One

Module code

HPS211

Requirement

Compulsory

Module objective

By the end of this module the Clinical Scientist in HSST will be able to analyse, synthesise, evaluate and apply knowledge in obtaining a relevant, focused history. They will be able to perform a limited but focused, relevant and accurate clinical examination in patients with increasingly complex issues and in increasingly challenging circumstances, exercising these higher-level clinical skills as part of the wider multidisciplinary team. The Clinical Scientist in HSST will be able to record the history accurately and synthesise this with relevant and appropriate clinical examination within the scope of practice of a Consultant Clinical Scientist. They should be committed to patient-centred care and consistently demonstrate the attitudes and behaviours necessary for undertaking the role of a Consultant Clinical Scientist.

All Clinical Scientists in HSST working in a paediatric setting or who see patients of paediatric age in their practice must be appropriately trained in child safeguarding.

Knowledge and understanding

By the end of this module the Clinical Scientist in HSST will analyse, synthesise, critically evaluate and apply their knowledge with respect to the:

Communication skills:

• evidence base underpinning effective patient-centred communication that is non-judgemental and promotes equality and values diversity;
• the importance of listening;
• possible barriers to effective communication and strategies to overcome them;
• how to communicate risks and benefits in a way that is meaningful to patients;
• how to break bad news;
• the vocabulary of relevant neurological and ophthalmological symptoms, signs and diseases.

History taking:

• importance of different elements of history, including the role of birth, genetics, smoking, trauma, occupational, environmental and domestic exposures;
• the way in which the patient may disclose their history, which is not always in structured fashion;
• likely causes and risk factors for conditions relevant to mode of presentation;
• the patient’s agenda and that the history should inform examination, investigation and management;
• impact of disorders of the nervous system at different ages on patients’ psyche and behaviour;
• pathophysiology of symptoms;
• anatomical and physiological basis for clinical signs and the relevance of positive and negative physical signs;
• importance of social and cultural issues and practices that may have an impact on health.

Clinical examination:

• protecting patients of paediatric age and vulnerable adults from maltreatment, abuse, neglect, or exploitation (safeguarding);
• informed consent, including Gillick competence/Fraser guidelines;
• need for a relevant and targeted examination as appropriate in the role of Consultant Clinical Scientist;
• constraints (including those that are cultural or social) to performing examinations and strategies that may be used to overcome them;
• limitations of examination, in particular in relation to the role of the Consultant Clinical Scientist and the need for adjunctive forms of assessment to confirm a diagnosis;
• offer/use of a chaperone as appropriate or required;
• the importance of continuity of care and a holistic approach to clinical practice.

Clinical decision making:

• evidence base underpinning clinical decision making and judgement, including the patient’s perception of shared decision making, barriers and enablers, diagnostic errors;
• models of clinical decision making;
• ethical frameworks that support clinical decision making;
• shared decision making with the patient (patient choice) and within the multidisciplinary team;
• aids to clinical decision-making tools, including technology-based systems;
• models for measuring the financial impact of clinical decisions, including the development of new healthcare pathways and assessing outcome versus cost, including cost-benefit, cost-utility and cost-effectiveness;models of clinical decision making;
• the role of UK professional organisations in supporting the adoption of healthcare diagnostics and interventions: Cochrane; NICE.

Technical and clinical skills

By the end of this module the Clinical Scientist in HSST will be expected to work in partnership with patients and the multiprofessional team within the context of patient-centred care and partnership. They will be expected to critically reflect and apply in practice a range of clinical and communication skills and will:

Communication skills:

• communicate clearly, sensitively and effectively with:
  • patients and their advocates, relevant clinicians, the public and other healthcare professionals
  • patients from diverse backgrounds and those with special communication needs, including the use of interpreters where appropriate
• listen carefully and be non-judgemental, and promote equality and value diversity;
• identify and overcome possible barriers to effective communication;
• draw on the breadth of scientific evidence available to provide the best information for patients and their carers about their illness;
• communicate risks and benefits in a way that is meaningful to patients and their carers.

History taking:

• gain informed consent;
• 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;
• assimilate history from the available information from the patient and other sources, including members of the multiprofessional team;
• manage alternative and conflicting views from family, carers, friends and other members of the multiprofessional team;
• focus on relevant aspects of history, maintaining that focus despite multiple and often conflicting agendas;
• elicit and document a structured history with a consistent format;
• recognise the place and importance of both open and disease-specific questions in eliciting a history;
• keep accurate, legible and contemporaneous records.

Clinical examination skills:

• actively elicit important clinical scientific findings;
• perform clinical examinations that are valid, targeted, time efficient and relevant to the presentation;
• the scope, vocabulary content and documentation of a full neurological examination, including assessment of consciousness, mental state, cranial nerves, cerebellar function, extrapyramidal, pyramidal, motor and sensory systems;
• manage expectations of patients with respect to the findings and reporting of clinical investigations;
• manage the scientific investigatory team to ensure that patient safety, comfort and dignity are maintained at all times;
• facilitate balanced and mutually respectful decision making where values and perceptions of health and health promotion conflict;
• recognise the possibility of deliberate harm (both self-harm and harm by others) in vulnerable patients and the need to report concerns to appropriate agencies;
• consider the social, cultural and religious boundaries of the patient and appropriately communicate findings and make alternative arrangements where necessary to accommodate these;
• refer patients to other healthcare professionals in a timely manner, communicating effectively with professional colleagues;
• be aware of their own attitudes, values, professional capabilities and ethics, and critically reflect on (i) their professional practice and (ii) the challenges of applying research to practice in relation to these areas of practice, identifying opportunities to improve practice building on a critique of available evidence.