Logbook for the MMed in Family Medicine
2012
Division of Family Medicine and Primary Care
Registrars Name: ______
Student number: ______
Training complex: ______
Training co-ordinator: ______
Introduction
This logbook should be fully completed during the year and handed in to the University at the end of the year as documentary evidence of your professional experience and clinical competency. It will be required by the University as a pre-requisite for certifying adequate education and training to the HPCSA when you wish to register as a Family Physician. The logbook will become part of your learning portfolio. It is important that you keep your logbook up to date from the beginning. There are 4 sections:
Section 1: Verification of professional experience within the training complex
Section 2: Record of educational meetings
Section 3: Rating of competency in the core clinical skills
Section 4: Annual or end-of-rotation reports
It is important therefore that you complete sections 1, 3 and 4 clearly, accurately and completely at the end of every rotation in the regional hospital or every 6-months at the district hospital or community health centre. In the regional hospital the appropriate section should be signed by the consultant supervising your training and at the district hospital or community health centre by the family physician supervising you. Section 2 should be completed continuously during the programme.
In summary the learning outcomes for Clinical Family Medicine are to:
- Demonstrate competency in all consultations according to the patient-centred clinical method that incorporates effective communication/counselling skills, competent examination skills / investigations, rational decision making, a 3-stage assessment, and a cost-effective, evidence-based and patient-centred management plan.
- Demonstrate competency in emergency, technical and surgical skills necessary for functioning in primary care and the district hospital
- Demonstrate a high degree of professionalism that includes the ability to resolve ethical and medico-legal dilemmas, be aware of one’s own value system, deliver quality care irrespective of one’s own perceptions or prejudices, and the background (with respect to gender, ethnicity, religion or sexual orientation) of your patient and to always deal courteously with patients, colleagues and the public.
MMed students outside South Africa or prior to new HPCSA regulations
While this logbook is designed for the formal training complexes in South Africa the students studying the MMed in other countries or under the old regulations are expected to work in appropriate settings and with suitable supervision – as specified in the programme’s brochure. We have used the term registrar throughout the logbook for simplicity. The sections of the logbook should be completed as follows:
Section 1: By your superintendent, consultant or mentor
Section 2: By your consultant or mentor
Section 3: By your consultant or a senior colleague who works directly with you
Section 4: By your superintendent, consultant or mentor
1
Section 1 Verification of rotations and professional experience within the training complex
Experience received in primary care or district hospital facilities:
Date from: / Date to: / Name of institution / facility and location- Name
- Location
- Primary care
- District hospital
Experience received in a regional, secondary or tertiary hospital:
Date from: / Date to: / Name of institution / facility and location- Name
- Location
Note: 1 week of full time equivalent = 40 hours, 1 month = 80 hours, during office hours and not counting overtime
1
Section 2 Record of educational meetings
During the programme the registrar should meet individually with their immediate supervisor and as a group of registrars with their training complex co-ordinator. These meetings can be alternated weekly (i.e. one week with your supervisor one-on-one and the next week as a group) and should last 1-2 hours and be recorded in the logbook. Use the letters below to record the general focus of the meeting and then describe what was done. The meetings could focus on one of the following learning opportunities:
A: Setting a learning agenda (at the beginning and end of a rotation or every 6-months): Reflection on the registrars experience to date, expectations or progress and planning of learning activities and goals for the next period.
B: Intermittent evaluation: For the registrar and trainer to check progress, discuss any difficulties in their relationship or the organization that impede learning or service delivery, make new plans. Feedback can also be given and received on the programme or registrars performance. More detailed notes can be made at the end of this section under the notes page.
C: Clinical / communication skills: Observation/audio/video-review of communication and consultation skills (the division has a specific assessment sheet) and feedback with role-play or simulation. Other clinical skills might also be demonstrated.
D: Case discussions: Reflect on your actual patients through the use of record review, presentation of problem patients or clinical tutorials on specific topics. The study guides for different clinical domains in Clinical Family Medicine also specify what is expected in terms of patient presentations and discussion of clinical scenarios. Reflect on difficult consultations, emotions or ethical dilemmas that arise from your clinical practice or setting.
E: Evidence based practice: Reflect on and critically appraise current journals and original research.
F: Other: For example co-ordination of on-line learning tasks with the on-site professional experience and service priorities i.e. topic for the quality improvement cycle
The logbook at the end of the year should demonstrate engagement with all of the above activities and a minimum of 2-hours formal tuition per month / 24-hours for the year. This minimum standard is needed to fulfil the University requirements, but in normal circumstances the portfolio should show engagement above the minimum standard.
Date / Group or individual meeting / Code letter from list of activities / Duration (hrs) / Description of content covered / activities / topics / Signature of supervisor23/2/08 / Group / C / 2 / Review of 2 audio tapes and breaking bad news / R Mash
Date / Group or individual meeting / Code letter from list of activities / Duration (hrs) / Description of content covered / activities / topics / Signature of supervisor
Date / Group or individual meeting / Code letter from list of activities / Duration (hrs) / Description of content covered / activities / topics / Signature of supervisor
Date / Group or individual meeting / Code letter from list of activities / Duration (hrs) / Description of content covered / activities / topics / Signature of supervisor
Notes
Section 3 Rating of competency in the core clinical skills
1. Domain: Obstetrics and Gynaecology
The following table lists the clinical skills in this domain that should be acquired or consolidated during the 4-year registrar training in Family Medicine. The list is intended to guide the registrar, training complex co-ordinator or other consultant supervisor on what core practical experience and skills training to focus on. The supervisor should evaluate the registrar’s competency at the beginning and end of their rotation at the regional hospital or at least every 6-months (i.e. February and August) at the district hospital / community health centre. Competency in these skills should be acquired and consolidated by a combination of experience and supervision at the regional hospital, district hospital and community health centre.
It is assumed that while learning these specific skills the registrar will be exposed to an appropriate spectrum of patients and will be supervised in clinical assessment, decision making and management. The practical on-site training will also be complemented by the academic on-line learning that targets clinical knowledge, decision making and application of core family medicine principles.
The skills should be rated according to the following definitions from A to D. The rating should be entered in the table below. If the registrar has not been exposed to the domain at all during the year then leave the column blank. Skills listed elsewhere can also be assessed if they are relevant to the rotation.
After making an entry in the table you should also complete and sign the relevant section underneath.
A: Only Theory:Only theoretical knowledge regarding the skill’s principles, indications, contraindications, performance and complications.
B: Seen or have had demonstrated:
Have theoretical knowledge regarding the skill and have seen or observed the skill demonstrated by someone else
C: Apply/Perform:
Have theoretical knowledge regarding the skill and have performed the skill in question under supervision, at least several times.
D: Routine/Independent:
Have the theoretical knowledge regarding the skill and be competent to perform the skill independently.
Clinical topic / Clinical skills
– aim is D for unshaded skills and C for shaded skills / Use one column to grade the registrar and add date / comments in box underneath
1st 2nd
Antenatal care / Antenatal growth chart
Assess foetal movement / wellbeing
Clinical pelvimetry
Obstetric ultrasound
Amniocentesis
Intra-partum care / Examine progress during labour and use partogram
Apply and interpret CTG
Assess foetal wellbeing during labour
Normal vaginal delivery
Assisted vaginal delivery / vacuum extraction / forceps
Caesarean section (including ability to do sub-total hysterectomy)
Episiotomy and suturing
Repair of 3rd degree tear
Evacuation of uterus
Manual removal of placenta
External cephalic version
Newborn /
Post-partum care / Resuscitate a newborn
Umbilical vein catheterization
Assess gestational age at birth
Kangaroo mother care
Phototherapy
Well newborn check
Women’s health / Microscopy of vaginal discharge (wet mount, KOH)
Endometrial biopsy/sampling
Dilatation and Curettage
Drainage of Bartholin's abscess / cyst
Tubal ligation
FNAB of breast lump
Insertion of IUCD
Papanicolau (cervical) smears
Culdocentesis
Hormone implants
Laparotomy for ectopic pregnancy
TOP (if no religious/ethical objections)
Clinical governance / MOU support, the perinatal audit meetings and PPIP programme, the training and audits of the basic antenatal care and perinatal education programmes and intrapartum audits
Date completed:
Comments on the registrar’s progress, clinical performance or professionalism in this domain / any additional skills acquired.
Name of supervisor
Signature supervisor
Signature student / registrar
Column number used
Date completed:
Comments on the registrar’s progress, clinical performance or professionalism in this domain / any additional skills required
Name of supervisor
Signature supervisor
Signature student / registrar
Email / Telephone
2. Domain: Adult internal medicine
The following table lists the clinical skills in this domain that should be acquired or consolidated during the 4-year registrar training in Family Medicine. The list is intended to guide the registrar, training complex co-ordinator or other consultant supervisor on what core practical experience and skills training to focus on. The supervisor should evaluate the registrar’s competency at the beginning and end of their rotation at the regional hospital or at least every 6-months (e.g. February and August) at the district hospital / community health centre. Competency in these skills should be acquired and consolidated by a combination of experience and supervision at the regional hospital, district hospital and community health centre.
It is assumed that while learning these specific skills the registrar will be exposed to an appropriate spectrum of patients and will be supervised in clinical assessment, decision making and management. The practical on-site training will also be complemented by the academic on-line learning that targets clinical knowledge, decision making and application of core family medicine principles.
The skills should be rated according to the following definitions from A to D. The rating should be entered in the table below. If the registrar has not been exposed to the domain at all during the year then leave the column blank. Skills listed elsewhere can also be assessed if they are relevant to the rotation.
After making an entry in the table you should also complete and sign the relevant section underneath.
A: Only Theory:Only theoretical knowledge regarding the skill’s principles, indications, contraindications, performance and complications.
B: Seen or have had demonstrated:
Have theoretical knowledge regarding the skill and have seen or observed the skill demonstrated by someone else
C: Apply/Perform:
Have theoretical knowledge regarding the skill and have performed the skill in question under supervision, at least several times.
D: Routine/Independent:
Have the theoretical knowledge regarding the skill and be competent to perform the skill independently.
Clinical topic / Clinical skills
– aim is D for unshaded skills and C for shaded skills / Use one column to grade the registrar and add date / comments in box underneath
1st 2nd
Adult health - general / Femoral vein puncture
Lumbar puncture
Arterial sampling radial artery
Blood culture technique
Injections - intra-dermal, subcutaneous, intra-muscular, deep intramuscular, sub-conjunctival,
Adults- Abdomen / Interpret the AXR in an adult
Proctoscopy
Adults- Chest / ECG - set-up, record and interpret 12 lead ECG
Interpret CXR
Pleural tap
Measure PEF
Nebulise a patient
Use inhalers and spacers
Exercise stress test
Perform and interpret office spirometry
Pleural biopsy
Date completed:
Comments on the registrar’s progress, clinical performance or professionalism in this domain / any additional skills acquired
Name of supervisor
Signature supervisor
Signature student / registrar
Email / Telephone
Date completed:
Comments on the registrar’s progress, clinical performance or professionalism in this domain / any additional skills acquired
Name of supervisor
Signature supervisor
Signature student / registrar
Email / Telephone
3. Domain: Adult surgery
The following table lists the clinical skills in this domain that should be acquired or consolidated during the 4-year registrar training in Family Medicine. The list is intended to guide the registrar, training complex co-ordinator or other consultant supervisor on what core practical experience and skills training to focus on. The supervisor should evaluate the registrar’s competency at the beginning and end of their rotation at the regional hospital or at least every 6-months (e.g. February and August) at the district hospital / community health centre. Competency in these skills should be acquired and consolidated by a combination of experience and supervision at the regional hospital, district hospital and community health centre.
It is assumed that while learning these specific skills the registrar will be exposed to an appropriate spectrum of patients and will be supervised in clinical assessment, decision making and management. The practical on-site training will also be complemented by the academic on-line learning that targets clinical knowledge, decision making and application of core family medicine principles.
The skills should be rated according to the following definitions from A to D. The rating should be entered in the table below. If the registrar has not been exposed to the domain at all during the year then leave the column blank. Skills listed elsewhere can also be assessed if they are relevant to the rotation.
After making an entry in the table you should also complete and sign the relevant section underneath.
A: Only Theory:Only theoretical knowledge regarding the skill’s principles, indications, contraindications, performance and complications.
B: Seen or have had demonstrated:
Have theoretical knowledge regarding the skill and have seen or observed the skill demonstrated by someone else
C: Apply/Perform:
Have theoretical knowledge regarding the skill and have performed the skill in question under supervision, at least several times.
D: Routine/Independent:
Have the theoretical knowledge regarding the skill and be competent to perform the skill independently.
Clinical topic / Clinical skills
– aim is D for unshaded skills and C for shaded skills / Use one column to grade the registrar and add date / comments in box underneath
1st 2nd
Adult health - general / Wound care and dressings
Lymph node excision biopsy
Adults- Abdomen / I&D of perianal haematoma
Proctoscopy
Appendicectomy
Interpret barium swallows
Adults-Urology / Penile block
Reduce a paraphimosis
Circumcision
Drain hydrocoele
Insert a urinary and suprapubic catheter
Hydrocoelectomy
Interpret IVP for renal colic
Vasectomy
Orchidectomy and anchoring of torted testis
ENT / Drain a peritonsillar abscess
Tonsillectomy / adenoidectomy
Skin / Excise sebaceous cyst (other lumps-bumps)
Skin biopsy (punch and fusiform), skin scrapes
Wide Needle Aspiration Biopsy lymph node in HIV
Cryotherapy/cauterization
Skin graft
Phenol ablation of ingrown toenail
Inject keloids
Emergency / Give a blood transfusion
Gastric lavage
Debride wounds or burns
I&D abscesses
Laparotomy for initial damage control in stabbed abdomen
Date completed:
Comments on the registrar’s competency or professionalism in this domain / any additional skills acquired
Name of supervisor
Signature supervisor
Signature student / registrar
Email / Telephone
Date completed:
Comments on the registrar’s competency or professionalism in this domain / any additional skills acquired
Name of supervisor
Signature supervisor
Signature student / registrar
Email / Telephone
4. Domain: Orthopaedics
The following table lists the clinical skills in this domain that should be acquired or consolidated during the 4-year registrar training in Family Medicine. The list is intended to guide the registrar, training complex co-ordinator or other consultant supervisor on what core practical experience and skills training to focus on. The supervisor should evaluate the registrar’s competency at the beginning and end of their rotation at the regional hospital or at least every 6-months (e.g. February and August) at the district hospital / community health centre. Competency in these skills should be acquired and consolidated by a combination of experience and supervision at the regional hospital, district hospital and community health centre.