Clinical Assessment and Investigation GI and UD

Module details

Title

Clinical Assessment and Investigation GI and UD

Type

Rotation

Module code

SPS301

Credits

10

Requirement

Compulsory

Aim of this module

This rotation will provide the trainee with the opportunity to apply their knowledge and basic skills of clinical assessment and investigation used in  the diagnosis, care and treatment of patients with diseases referred to the Gastrointestinal Physiology and Urodynamic Science service across a range of clinical settings (e.g. Medical Assessment and Integrated Care, Critical Care and community-based services). Fundamental to this rotation is that the trainee has a thorough knowledge and understanding of cardiac, respiratory, sleep and vascular diseases and their signs and symptoms, and how they frequently interact and overlap with each other.

Integral to this module is the opportunity for the trainee to gain a greater understanding of the role of other related diagnostic modalities such as radiology and pathology. This module will give the trainee knowledge and understanding of the interpretation and clinical decision making associated with clinical assessment and investigations in the context of differential diagnosis, together with an understanding of the principles of operation, data acquisition and quality assurance of other diagnostic service modalities.

Competencies

#	Learning outcome	Competency	Action
# 1	Learning outcome 1	Competency Assist with obtaining a clinical history using a logical sequence/framework, which might include: brief biography history of presenting complaint past history smoking/alcohol use medication (prescribed and other) allergies family/social history concerns and expectations summary	Action View
# 2	Learning outcome 2	Competency Assist in a range of diagnostic and therapeutic procedures in a variety of clinical settings, recognising when results deviate from normal values/findings and appreciating the implication of results on patient treatment and care, for example in:  Cardiac, Vascular, Respiratory and Sleep Science Medical assessment units – point of care testing, e.g. blood and urine glucose High dependency settings – blood gas analysis, preparation of monitoring andventilator system. Community settings – spirometry, ankle brachial pressure indices measurements (leg ulcer clinics).  Gastrointestinal Physiology and Urodynamic Science Endoscopy unit – assist with telemetric pH capsule placement; endoscopic placement of manometry Operating theatre – assist with 2D/3D ultrasound pre and post-op assessment, e.g. sphincterotomy, ’search and find‘ Diagnostic imaging – assist in the placement of small bowel manometry Ward – undertake hydrogen breath tests on non-ambulant patients, e.g. small bowel overgrowth. Assist with transrectal ultrasound (TRUS) Continence/flows clinic – fluid management advice, bladder training. Observe pressure/flow studies in patients with special needs, e.g. stoma, mobility issues, neuropathic. Neurosensory Sciences Neurological Neurological monitoring and Life sign Cognitive function and Screening.  See relevant rotational modules for integration of clinical experience, competence and knowledge requirements.	Action View
# 3	Learning outcome 3	Competency View and identify key anatomical landmarks and abnormal pathology related to the relevant body systems on images obtained using ionising and/or non-ionising imaging media.	Action View
# 4	Learning outcome 3	Competency Review and assist in making measurements on images on Picture Archiving Systems (PACS).	Action View
# 5	Learning outcome 4	Competency Assist in performing pathology tests with relevance to the routine investigation of relevant conditions, including the production of results, reference ranges and clinical interpretative reports, e.g. full blood count urea and electrolytes liver function test lipids cerebrospinal fluid monitoring sputum culture and sensitivity therapeutic drug monitoring, e.g. carbamazepine.	Action View
# 6	Learning outcome 5	Competency Critically evaluate the role of calibration and quality assurance in pathology and imaging departments in ensuring accuracy of test outcomes and identifying any potential errors or risks when applied in clinical practice.	Action View
# 7	Learning outcome 6	Competency Devise evidence-based diagnostic plans for presenting signs and symptoms and clinical information.	Action View
# 8	Learning outcome 6	Competency Assimilate reports from pathology and imaging investigations from patients typically referred to cardiac, vascular, respiratory and sleep or neurosensory science or gastrointestinal/urodynamic sciences, present the findings for review by the clinical team and propose a differential diagnosis.	Action View
# 9	Learning outcome 6	Competency Investigate the needs and options for patients referred to physiological services within neurosensory science or gastrointestinal/urodynamic sciences or cardiac, vascular, respiratory and sleep services as relevant.	Action View
# 10	Learning outcome 6	Competency Work within multidisciplinary teams to support the investigation, treatment and management of patients with relevant conditions to neurosensory science or gastrointestinal physiology and urodynamic sciences or cardiac, vascular, respiratory and sleep services as relevant.	Action View

Assessments

You must complete:

• 1 case-based discussion(s)
• 1 of the following DOPS/ OCEs:

Use IT systems to produce a report	DOPS
Assimilate reports from pathology and imaging investigations with diagnostic results appropriate to the theme and be able to present the findings for review by the clinical team	DOPS
Take an appropriate history using a logical sequence	OCE

Learning outcomes

1. Record and integrate a patient history with the outcome of clinical examination and determine appropriate diagnostic investigations for patients commonly referred to cardiac, vascular, respiratory and sleep OR gastrointestinal, urodynamic science OR audiology, neurophysiology, or ophthalmic and vision science diagnostic services in conjunction with the wider clinical team.
2. Assist in performing a range of diagnostic and therapeutic procedures, recognising abnormal results/findings and appreciating the implication of results on patient treatment and care.
3. Identify key anatomical landmarks on images obtained using ionising and non-ionising imaging media in the investigation of patients with cardiovascular, respiratory, sleep OR with gastrointestinal and lower urinary tract (LUT) disorders OR conditions resulting in referral to audiology, neurophysiology, or ophthalmic and vision science services, and describe the limitations and impact of results on patient diagnosis, treatment and care.
4. In a supportive role assist in performing pathology tests that patients with cardiovascular, respiratory, sleep OR with gastrointestinal and LUT disorders OR conditions resulting in referral to audiology, neurophysiology, or ophthalmic and vision science services will commonly undergo as part of an individual diagnostic plan.
5. In a supportive role assist in performing safety checks, calibration and quality assurance of imaging and pathology equipment using local, national or international standards.
6. Devise a diagnostic plan for a patient based on the presenting symptoms and clinical information available, and indicate what the next steps might be (diagnostic or therapeutic), dependent on the outcome of the initial results from a mix of diagnostic modalities.

Learning outcomes

1. Describe how different Gastrointestinal and Urological assessments and investigations can contribute to a holistic patient approach in the diagnosis, management, prognosis and care.
2. Explain how these assessments and investigations are used in different care environments, e.g. community endoscopy, operating theatre, etc.
3. Explain how frequently used clinical assessments and diagnostic investigations are selected, the clinical rationale and how they are utilised in decision making.
4. Explain the principles and applications of diagnostic imaging (ionising and non-ionising, e.g. CT, MRI, nuclear medicine, PET, ultrasound) undertaken to investigate patients with gastrointestinal and lower urinary tract disorders.
5. Explain the principles and applications of routine pathology tests, including normal ranges, undertaken to investigate patients with gastrointestinal and lower urinary tract disorders.
6. Recognise recent advances in biomarkers and pharmacogenomics and  the impact of these new technologies on Gastrointestinal Physiology and Urodynamic Sciences.
7. Explain how diagnostic imaging and pathology data are captured and stored,  including issues  relating to  storage capacity and  access to  data across care delivery sectors.
8. Describe the calibration and safety testing procedures (including the legislative aspects of use of radiation) applied in diagnostic imaging and pathology services, relating these to the processes used in physiological science services and patient safety.
9. Describe the quality assurance procedures used in diagnostic imaging and pathology services, relating these to the processes used in physiological science services and patient safety.
10. Evaluate patient care pathways relating to common pathological conditions associated with gastrointestinal and lower urinary tract disorders.
11. Discuss the major risk factors for gastrointestinal and lower urinary tract disorders.
12. Describe major abnormalities of physiological control mechanisms in the gastrointestinal tract and lower urinary tract.
13. Describe cellular, tissue and systems responses to gastrointestinal and lower urinary tract disorders, concentrating on disorders of growth, tissue responses to injury, cell death, inflammation, neoplasia, normal and abnormal immune responses, atheroma, thrombosis, embolism and infarction.
14. Describe the common diseases and the basis of common infections of the gastrointestinal and urinary systems.
15. Discuss the role of interprofessional team working in the diagnosis and treatment of patients.

Indicative content

Clinical assessments and investigations

• Signs and symptoms
• Blood pressure
• Temperature
• Respiratory rate
• Pulse rate
• Oxygen saturation levels
• Assessment of tachy and brady arrhythmias
• Differential diagnosis of typical and atypical chest pain
• Level of dyspnoea
• Walking distance
• Impact on activities of daily living
• Rectal examination
• Quality of Life questionnaires

Pathology

• Routine blood tests, including U&E, blood gases, liver function
• Haematology
• Clotting
• Biopsies

Diagnostic imaging

• X-ray plain and contrast
• MRI
• CT
• Nuclear medicine
• Ultrasound
• Pet CT

Blood and urine glucose testing

• Point of care testing
• Normal ranges
• Analysis
• Quality assurance of test

Imaging diagnostics

• Principles of technology used in radiology
  • Technology developments and advances of differential diagnosis
• Diagnostic imaging
  • Image reconstruction techniques
  • Image display characteristics
  • Clinical application and overview of normal and pathological appearances within the image
  • X-rays, X-ray production; film viewing
  • RF and magnetic fields, lasers and ultrasound
  • The physics and mathematics of image formation; radiological image; CT scanning
• Key anatomical features
  • Features of a plain abdominal X-ray splenic and hepatic flexures
  • Ascending, transverse and descending colon
• Patient and personal safety management in imaging
• PACS
• CT scanning and reporting
• Ultrasound scan/imaging of soft tissue area
• Transducers for measuring pressure and flow
• Quality assurance
• Image quality and artefacts

Patient care pathways

• Diabetes
• Breathlessness
• Wheezing
• Dyspepsia
• Incontinence
• Stroke
• Dysphagia
• Epidemiology, public health and psychosocial aspects of common gastrointestinal and urological disease
• Cellular, tissue and systems response to common gastrointestinal and urological diseases
• Risk factors and risk assessment for gastrointestinal and urinary tract disorders
• Basis of common infections affecting the gastrointestinal and urinary tracts

Team working

• Team formation and functions
• Role of single-discipline and multiprofessional teams in the care and management of patients
• Role of single-discipline and multiprofessional teams in the delivery of services
• Effective interprofessional team working

Activities

The clinical experiential learning for this module should take place in a range of healthcare environments/services that contribute to the screening, primary prevention, diagnosis, treatment and rehabilitation of patients commonly referred to cardiac, vascular, respiratory and sleep OR gastrointestinal and urodynamic science OR audiology, neurophysiology and ophthalmic and vision science services. Trainees should also be encouraged by their trainer to gain wider experience that spans other local, novel procedures within their work place.

Clinical experiential learning should span both primary and secondary care and should include at least three different experiences gained across a range of ages, selected from the list below:

Secondary care

• Medical assessment unit
• Neonatal care unit
• Intensive care unit or operating theatre
• Endoscopy unit
• Healthcare for older people service, which may include sensory, cognitive function and wellbeing

 Primary care

• General practice
• Community services
• Walk-in/Drop-in centres
• District nursing
• Health visiting
• Postnatal clinics
• One-stop sexual health clinics

 Other healthcare providers

• Independent sector, including hearing acuity, visual acuity, colour acuity
• Social services
• Other support services, e.g. drug and alcohol services

Following each experience trainees should reflect on the experience and discuss with their supervisor: (a) the patient experience in the setting; (b) the potential for improvement in service delivery to enhance the patient experience and outcomes; and (c) implications for their own future professional practice.

Trainees are also expected to:

• Assist experienced imaging staff in the safety checks, calibration and quality assurance of imaging equipment using local, national or international standards, and discuss the relevant health and safety policies for the imaging department with your trainer.
• Assist experienced pathology staff in routine maintenance, calibration and quality assurance checks on pathology test instrumentation using local, national or international standards, and gain experience of using a range of laboratory equipment, which could include pipettes, balances, centrifuges, refrigerators, water baths, incubators, pH meters, freezers, radioactive counters, sample preparation units and automated and semi-automated analysers.