8-14
STAGE 1:
(about 1-2
weeks)
Instructors
take the lead;
students
observe.
POSSIBLE STAGES IN CLINICAL PRACTICE
What health workers can do
• mostly observe
• look up the problem in
their books and try to
figure it out
• ask instructor some
questions (but with
care not to disturb the
sick person)
• practice filling out
record sheets about
the sick person
What instructor can do
During the consultations:
• ask the sick person or family if students may observe
• conduct the consultation
• explain steps of history taking, physical exam,
diagnosis, and treatment to both the sick person and
the students (with care not to disturb the sick person)
• ask occasional questions of the students to help them think
things through
• be sure information gathered is clear enough for students to fill
out record sheets properly
• discuss appropriate preventive measures with the sick
person (or family)
• ask
instructor questions
After
•
the consultations:
discuss important points of the consultation and the health
and comment on
problem, pointing out what was typical and what was not
what they saw and
learned
• practice
typical
•
•
review student record sheets and compare with her own
demonstrate and help students practice relevant tests and
on each other any
physical exam skills
physical exam skills
• make sure students understand the inter-relationship and
used
•
review
how consultation
was carried out
importance of each part of the consultation (observation,
history, physical exam, tests, diagnosis, management and/or
treatment, prevention, education)
• discusswithstudentstheirdoubts,abilities,limits,and
how they could best handle a similar problem when they
confront it in their villages (what to do or not do; if and
when to refer)
STAGE 2:
(2-3 weeks)
Instructor still
leads;
but students
take a more
responsible
role.
What health workers can do
• help take history
• perform parts of the
physical exam that
they have already
studied and practiced
• fill out record sheets
• use their books to
diagnose and determine
treatment (with help
from instructor)
• help with simple
curative measures
• give preventive advice
or read preventive
measures from
their books for the
sick person (or
family)
What instructor can do
During the consultations:
• let students take the lead in history taking and
examination when problems appear to be those with
which they have experience, but be quick to step in when
they need help
• makesuggestionsandaskquestionstohelpstudents
remember to make the right tests, interpret results
correctly, and ask the sick person appropriate questions
• makesurethesickpersonandfamilyfeelcomfortable
with the consultation process
• take over when necessary
• makesurestudentsusetheirbookswellandexplainthings
to the sick person
• if necessary, repeat tests or physical exam to check if
students did things right
• reviewtreatment(medicine,dosage,etc.)andadvicegiven
by students
• besurestudentsgivepreventiveadvice,inafriendlyway
After the consultations:
• as in STAGE 1, but by now students can also take turns leading the review
discussions and asking each other questions