Introduction to Stages 3 & 4

• Clinically focused learning
• Clinical reasoning
• Stage 3 – Integrated Clinical Attachments (ICAs)
• Stage 4 – Clinical Rotations
• Elective term
• Pre-Internship term

Clinically focused learning

The core curriculum for Stages 3 and 4 builds on the basic and clinical science knowledge of Stages 1 and 2. A further set of problem based learning cases explores the clinical diagnostic and management aspects more closely (see Clinical Reasoning, below).

Practical clinical experience is the focus for all learning in Stages 3 and 4 (see Clinical experience). In general, formal teaching sessions are reduced in frequency as students move from the early part of Stage 3 clinical attachments to the last practice rotations in Stage 4, leading to full clinical immersion in the Pre-Internship Term. Problem-based learning is continued throughout Stages 3 and 4 but with a strong focus on clinical diagnosis and management (see program calendar).

Clinical reasoning

In Stages 3 and 4, the focus shifts toward full-time learning in a clinical practice setting. During Stage 3, students undertake a series of integrated clinical attachments (see Stage 3 - Integrated Clinical Attachments, below) in medicine and surgery. In Stage 4, students rotate through placements which focus on women's and children's health, psychological medicine and community practice. With this shift in emphasis, a hybrid form of PBL has been adopted and implemented in a way that further advances reasoning skills in the context of clinical practice. This process is supported by an online application – the Clinical Reasoning Guide.

Each Clinical Reasoning Guide case is structured to include "reasoning prompts", to stimulate thinking about the case, as well as pointing out how an experienced clinician might respond at each stage. Additional information about each case is provided as the case unfolds at the prompts. (see the demo)

The completed guide is used by each student in turn as they take on the role of facilitating a small-group PBL tutorial; or, by Stage 4, as preparation of an actual patient case to use for the tutorial activity they will lead.

In practice the process works something like this:

The student is assigned a PBL topic and progresses through four steps:

• Working through the case outline for a particular case on the USydMP website and augmenting the case data with their own reading and clinical experience.
• Completing a clinical reasoning guide, to be used to facilitate each of two 1.5 hour sessions.
• Discussing the preparation with their PBL tutor.
• Acting as facilitator for their PBL group.

Walk through an interactive online demonstration of the clinical reasoning guide.

Stage 3 – Integrated Clinical Attachments

Integrated Clinical Attachments (ICA) in Stage 3 involve 8 x 4-week attachments to the main medical and surgical ward services and associated ambulatory clinics in urban and rural hospitals. The precise arrangement of these ICA varies at each clinical school, reflecting the different pattern of service delivery operating at each site (see Clinical experience).

Up to 20% of the time is devoted to structured teaching/learning sessions including problem-based learning (see Clinical reasoning, above). Topics are drawn from all four curricular theme areas. Time is provided for self-directed learning. About half of each week is spent directly involved in the clinical activities of the service to which the student is attached. A progressive increase in clinical attendance and responsibility occurs over the total duration of these attachments.

Stage 4 – Clinical Rotations

Stage 4 of the USydMP commences with one 9-week clinical rotation in the final part of third year of the course, followed by the Elective term (8 weeks during the December – February period), followed by the other three rotations (each 9 weeks in length).

Problem based learning now places emphasis on student facilitation of actual patient cases.

The four Clinical rotations, each including time for assessment and review, cover:

• Psychological Medicine
  including Drug & Alcohol, Community Psychiatry, Psychogeriatrics, Paediatric Psychiatry and Adolescent Medicine
• Perinatal & Women's Health
  including Obstetrics, Fetomaternal Medicine, Neonatal Medicine and Gynaecology (plus Dermatology)
• Child & Adolescent Health
  including Paediatric and Adolescent Medicine and Surgery
• Community Health
  in both urban and rural settings, including General Practice, Geriatric Medicine and Sexual Health Medicine

Rural placements are provided and are of varying length (see Clinical experience - Rural).

Elective term

The Elective term in Stage 4 offers students an opportunity to undertake supervised experience in clinical or community work or research, anywhere in the world. It may be seen as an opportunity to prepare for a particular career direction or to explore different experiences or to enhance skills in areas in particular areas. The Elective Term is normally taken from mid-December to the end of February (see Elective term for more detail).

On satisfactory completion of all Rotations and the Elective term, students progress to the Pre-Internship (PRINT) Term.

Pre-Internship (PRINT) term

Internship is a challenging and rewarding experience. The aim of the pre-internship (or PRINT) term is to simulate the experience of being a hospital intern in order to ease the transition into this role.

Following the Integrated Clinical Attachments students have completed a variety of specialty rotations and an elective. The PRINT term provides an opportunity to revise clinical knowledge and skills that will be needed during internship.

In the PRINT term students are responsible for their own learning, but with clear requirements for a final "signing off" at the end of Stage 4. The term supervisor or nominee commits one hour per week to the formative/summative assessment process and is responsible for making a recommendation to the Board of Examiners concerning the student's readiness for graduation and internship.

In general, PRINT terms:

• Are accredited by the Institute of Medical Education and Training (IMET) of NSW;
• Are opportunities designed to meet the special needs of final-year students;
• Provide achievable term objectives for accreditation by IMET.