Cardiovascular Module
Cardiovascular Studies
Semester 5.1
Student Name (Block Capitals):
_____________________________________________
Student Number:
_____________________________________________
Photo:
Cardiovascular Module
Cardiovascular Module Logbook
Confidentiality
Any breach of confidence in a clinical case is taken extremely seriously by the medical school and
the persons involved may be liable for disciplinary action. The student is referred to the Code of
Conduct as outlined in the 5.1 Handbook.
You must sign this prior to commencing the module
I have read and understood the University Code of Conduct and will abide by this.
___________________________
Signature
_______________________
Date
Cardiovascular Module
CARDIOLOGY (TWO WEEKS)
INPATIENT AND EMERGENCY CARDIOLOGY (ONE WEEK)
CCU/Wards (Two days)
What do I need to do?
The purpose of the CCU/ward day is to give you an insight into the workings of the high
dependency aspects of cardiology. The patients in the coronary care unit are generally post-MI, or
have decompensated heart failure, or some other critical CVS illness, so the learning opportunities
here are extensive. The patients on the ward are generally less unwell but still provide excellent
learning opportunities. In order to get the most of the day, you are obliged to have done the
following prior to the morning ward round:
1. Have taken three patient histories for presentation on the ward round
2. Have examined the same patients
3. Have looked up their recent clinical course, investigations, current medications, and plans
for further management in the patient chart. This includes bloods, xray and CVS
investigations such as ECG and echo
On the morning ward round you should present a succinct summary of the current patient status
using the following format:
1.
2.
3.
4.
5.
Brief summary of HPC, PMH and inpatient course
The patient's subjective symptoms over the last 24 hours
Your objective clinical findings
Results of recent investigations
Plans for further management
Time is limited on the ward round, so you need to deliver as much information as you can in as
short a time as is possible- remember, the consultant or registrars will usually be aware of the
patient's history, so your job is to update them as much as possible. The SHOs and nurses can help
you to prepare.
Patients presented - CCU
Patient's initials and identifier
Date
Signature of Tutor
1 _____________________________________________
________________________
2 _____________________________________________
________________________
3 _____________________________________________
________________________
Cardiovascular Module
Patients presented - Wards
Patient's initials and identifier
Diagnosis
Signature of Tutor
1 _____________________________________________
________________________
2 _____________________________________________
________________________
3 _____________________________________________
________________________
Cardiology Ward Rounds (CCU/Wards)
Date
Signature of Tutor
1 _____________________________________________
________________________
2 _____________________________________________
________________________
3 _____________________________________________
________________________
4 _____________________________________________
________________________
Daily: Start 8.30, Cardiology Department Tutorial Room
Tutor assessment: in each case the student: (circle)
1. Knew the patient history
YES
NO
2. Had examined the patient
YES
NO
3. Knew the patient's recent investigations
YES
NO
4. Had a broad idea of the plan for further management
YES
NO
Tutor comments
Overall assessment
Excellent
Good
Satisfactory
Unsatisfactory
Signature of Tutor: ______________________________ Date: _______________
Cardiovascular Module
Patient Histories
Use this space to write a brief summary of each patient you saw in the CCU or on the wards. This is
subject to evaluation at the end of your rotation.
Patient 1
Patient 2
Patient 3
Patient 4
Cardiovascular Module
ED/MAU (Two days)
What do I need to do?
The emergency department and medical assessment unit provide ample opportunity to interview,
examine and evaluate patients under close supervision. There is an SHO on duty to the ED and
MAU every day (pager number 182) who will have you to find patients and will listen to your case
presentations. During each ED/MAU day, you should see at least three patients. At the end of one
of the ED/MAU days, you go on call until 10pm. This is mandatory. If you do not go on call, you
will not be signed off.
Cardiology Emergency Admissions Clerked and Presented
Patient's initials and identifier
Diagnosis
Signature of Tutor
1 _____________________________________________
________________________
2 _____________________________________________
________________________
3 _____________________________________________
________________________
4 _____________________________________________
________________________
5 _____________________________________________
________________________
6 _____________________________________________
________________________
7 _____________________________________________
________________________
8 _____________________________________________
________________________
Tutor assessment: in each case the student: (circle)
1. Knew the patient history
YES
NO
2. Had examined the patient
YES
NO
3. Knew the patient's recent investigations
YES
NO
4. Outlined a general plan for further management
YES
NO
Cardiovascular Module
Tutor comments
Overall assessment
Excellent
Good
Satisfactory
Unsatisfactory
Signature of Tutor: ______________________________ Date: _______________
This Student has been on call for cardiology (Pass/Fail)
Signature of Tutor: ______________________________ Date: _______________
Inpatient and Emergency Cardiology: Procedures Performed
Supervised IV Cannulation
Patient's initials and identifier
Date
Signature of Tutor
1 _____________________________________________
________________________
2 _____________________________________________
________________________
3 _____________________________________________
________________________
4 _____________________________________________
________________________
Daily, wards and angiography suite; liaise with intern
ECGs
Patient's initials and identifier
Date
Signature of Tutor
1 _____________________________________________
________________________
2 _____________________________________________
________________________
3 _____________________________________________
________________________
Available every day on wards and in cardiac investigations unit. Liaise with interns and technicians.
Cardiovascular Module
Patient histories
Use this space to write a brief summary of each patient you saw in the MAU or in the ED. This is
subject to evaluation at the end of your rotation.
Patient 1
Patient 2
Patient 3
Patient 4
Cardiovascular Module
Patient 5
Patient 6
Patient 7
Patient 8
Cardiovascular Module
OUTPATIENT CARDIOLOGY AND INVESTIGATIONS (ONE WEEK)
Stress Tests Observed
Patient's initials and identifier
Date
1 _____________________________________________
Signature of Tutor
________________________
Daily, cardiac investigations unit
Holter Monitor Interpretation Observed
Patient's initials and identifier
Date
1 _____________________________________________
Signature of Tutor
________________________
Daily, cardiac investigations unit
Pacemaker/ICD Interrogation Observed
Patient's initials and identifier
Date
1 _____________________________________________
Signature of Tutor
________________________
Daily, cardiac investigations unit
Echo (TTE or TOE) Observed
Patient's initials and identifier
Date
1 _____________________________________________
Daily, cardiac investigations unit
Signature of Tutor
________________________
Cardiovascular Module
CATH LAB DAY
What to do
The reason we ask you to attend the cath lab is not to stand on the darkness for hours- it is so you
are exposed to the patients undergoing a cardiac procedure. If you attend at the cath lab, you will
quickly begin to understand why patients have angiograms, why some of them get stents, what the
indications for pacemaker insertion are, why we put in ICDs, and so on. Much of cardiology
nowadays involves some form of intervention, with which you need to be familiar, no matter where
your career might take you. It is also a near-certainty that you will be admitting/clerking/referring a
patient for a cardiac intervention at some stage in the future, so now is the time to learn how to do
it! You should arrive early, so as to start clerking patients and be ready to present to the registrar or
consultant.
How to admit a patient for angiography
The decision to send the patient for angiography has already been made, so your don't need to dwell
too long on the HPC; in general, the patient will have experienced chest pain or dyspnoea. When
admitting a patient for any procedure, you need to establish a few things:
1. Why the procedure is being performed.
2. What the patient's past medical history is (with specific regard to renal function in cases of
angiography)
3. What medications the patient is on
4. If they have any allergies
5. If there is any obvious contraindication to the procedure
6. If there are any examination findings which may preclude angiography (specifically, is there
an easily palpable femoral pulse)
Is the patient on dual antiplatelet therapy?
This is the question the consultant is most likely to ask you- not being on dual antiplatelet therapy
precludes stent insertion, so ask the patient this question specifically.
Admission care pathways are available from the cath lab staff. Liaise with the interns. Remember,
each patient will also need an IV line!
Patients Clerked for Angiography / Pacemaker / ICD
Patient's initials and identifier
Date
Signature of Tutor
1 _____________________________________________
________________________
2 _____________________________________________
________________________
3 _____________________________________________
________________________
4 _____________________________________________
________________________
Daily, Angiography Suite; patients arrive at 8am; start clerking then; liaise with the duty intern
Cardiovascular Module
Diagnostic Angiography Observed
Patient's initials and identifier
Diagnosis
1 _____________________________________________
Signature of Tutor
________________________
Daily, angiography suite
Record the abnormalities below
Percutaneous Coronary Intervention Observed
Patient's initials and identifier
Diagnosis
1 _____________________________________________
Daily, angiography suite
Record the abnormalities below
Signature of Tutor
________________________
Cardiovascular Module
Pacemaker/ICD Insertion Observed
Patient's initials and identifier
Date
1 _____________________________________________
Signature of Tutor
________________________*
Daily, angiography suite
Tutor assessment: in each case, the student:
1. Knew the patient history and indication for procedure
YES
NO
2. Had examined the patient
YES
NO
3. Knew the indications for and complications of the procedure
YES
NO
Tutor comments
Overall assessment
Excellent
Good
Satisfactory
Unsatisfactory
Signature of Tutor: ______________________________ Date: _______________
Patient Histories
Use this space to write a brief summary of each patient you saw during your cath lab day
(procedure, indication, intervention, medications on discharge). This is subject to evaluation at the
end of your rotation.
Cardiovascular Module
Clinic Day
What to do
There are two types of patient in clinic: the new patient and the review patient. With a new patient,
you take a full history, perform a full examination, come up with a differential diagnosis and think
of what investigations you want to perform. You then present the patient to the registrar or
consultant, go see the patient together and come up with a plan.
With review patients, the diagnosis has already been made and the patient is presenting for routine
evaluation of symptoms and their clinical condition. Here, a SOAP format is useful- ask the patient
about relevant subjective symptoms, examine them for objective clinical findings, put these
together to get an assessment of their condition and make a plan for further investigation or
management.
Times and places
The main cardiology clinics are on all day Wednesday (9.45 – 1pm and 2pm-5pm) and on Thursday
morning (9.45 – 1pm), on the first floor of the outpatient department. There is also a heart failure
clinic on Friday mornings after journal club.
Cardiology Clinic – Patients Clerked and Presented
Patient's initials and identifier
Diagnosis
Signature of Tutor
1 _____________________________________________
________________________
2 _____________________________________________
________________________
3 _____________________________________________
________________________
4 _____________________________________________
________________________
5 _____________________________________________
________________________
Wednesday 10am -5pm, Thursday 10am-1pm, First Floor, Outpatient Department
Three Sessions, two to three students per session
Tutor comments
Overall assessment
Excellent
Good
Satisfactory
Unsatisfactory
Signature of Tutor: ______________________________ Date: _______________
Cardiovascular Module
Patient histories
Use this space to write a brief summary of each patient you saw in clinic. This is subject to
evaluation at the end of your rotation.
Patient 1
Patient 2
Patient 3
Patient 4
Patient 5
Cardiovascular Module
Consultations
What to do
The cardiology department runs a busy inpatient consult service. In such cases, a medical or
surgical team submits a formal consult, which is a request for a cardiology opinion on further
management of the patient. For example, a routine blood test post-op may demonstrate an elevated
troponin; the team may be unsure how to interpret the test result and ask for a formal consult. This
usually involves a review of the patient's history, physical examination, a review of investigations
and formulation of a set of recommendations. You should see at least two patients.
When you go to see a consult, you should link with the consult registrar before and after you have
seen the patient; before so they can tell you what to look for, after so you can present your history.
The consult registrar may be contacted on page 761. You should only take a copy of the consult- the
original should stay with the SpR.
Cardiology Consults – Patients Clerked and Presented
Patient's initials and identifier
Diagnosis
Signature of Tutor
1 _____________________________________________
________________________
2 _____________________________________________
________________________
3 _____________________________________________
________________________
Tutor comments
Overall assessment
Excellent
Good
Satisfactory
Unsatisfactory
Signature of Tutor: ______________________________ Date: _______________
#
Cardiovascular Module
Patient histories
Use this space to write a brief summary of each patient you saw on consults. This is subject to
evaluation at the end of your rotation.
Allied services
In addition to seeing patients in clinic, in the cath lab, and on consults, you should attend the cardiac
rehabilitation services and the nurse-led heart failure clinic. These services provide excellent
learning opportunities- you get a chance to see patients in the few weeks post-MI when they are
coming to terms with their illness and in a good position to describe the effects it has had on their
lives. Similarly, attending the heart failure clinic gives good insights into the realities of having a
chronic long-term illness.
In addition, there is a journal club and case conference every Friday that the people on the
cardiology part of the rotation should attend.
Cardiac Rehabilitation Session Attended (1 hour)
Date
Signature of Tutor
_____________________________________________
________________________
Daily, Cardiac Rehabilitation Unit, Link Corridor to Obs/Gynae
Nurse-Led Heart Failure Clinic Attended (1 hour per student)
Date
Signature of Tutor
_____________________________________________
________________________
Daily, HF Unit, Link Corridor to Obs/Gynae
Cardiology Journal Club Attended
Date
Signature of Tutor
1 _____________________________________________
________________________
2 _____________________________________________
________________________
Friday 8 am-9am, Cardiology Department
Cardiovascular Module
VASCULAR SURGERY (ONE WEEK)
Go-to people
Mr Wael Tawfick (Lecturer in Vascular Surgery)
Mr Sultan (Consultant Vascular Surgeon)
What to do
During the vascular surgery week you should aim to see all aspects of vascular surgery- inpatient,
outpatient, investigations and surgical management of vascular disease. You should attend all
available ward rounds (with patients clerked and ready to present), clinics, and theatre sessions. You
should also attend the vascular lab and observe an ABPI, Arterial and venous duplex. Finally, a
minor vascular clinic is conducted Monday to Thursday in the ArtAssist room; here, patients with
peripheral vascular disease and vein disease are evaluated- this is an excellent learning opportunity.
Why should I bother turning up?
Vascular disease is very common and is seen with great frequency in clinical practice (and in
clinical examinations!). Having a knowledge of how to evaluate and treat vascular disease will
serve you well regardless of what specialty you end up in.
Do I really have to go on-call?
Yes. If you don't, you don't get signed off.
Schedule – Team Activities
Monday
7:45 am
Ward Round
St Nicholas' Ward
Tuesday
Wednesday
Ward Round
St Nicholas’ Ward
Thursday
Friday
Vascular/
Radiology MDM
Conference
Vascular Department
1st Floor
Vascular Journal
Club
Vascular
Department
1st Floor
Ward Round
St Nicholas’ Ward
Ward Round
St Nicholas’ Ward
Theatre 12
(All Day)
Major Vascular
OPD (2nd Floor)
(Morning)
Surgical Grand
Rounds
8:00 am
Ward Round
St Nicholas’ Ward
8:30 am
9:00 am
Arrange with
Vascular Lab for
time to attend
Theatre 12
(All Day)
10:30 am
Vascular Core
Topic Tutorial
CSI: Room 315
Minor Vascular
Veins/Ulcer Clinic
Vascular Bedside
Tutorial
Minor Vascular
Veins/Ulcer Clinic
14:00 pm
Minor Vascular
ArtAssist Clinic
Minor Vascular
Veins/Ulcer Clinic
Minor Vascular
ArtAssist Clinic
Minor Vascular
Veins/Ulcer Clinic
Monday -Friday: Vascular Lab
Monday-Thursday: Minor Vascular Clinic, ArtAssist Room, Ground Floor, Outpatient Department
(Monday/Wednesday: Peripheral Vascular Disease; Tuesday/Thursday: Veins/Ulcers)
Cardiovascular Module
Vascular Surgery Ward Rounds Attended
Date
Signature of Tutor
1 _____________________________________________
________________________
2 _____________________________________________
________________________
3 _____________________________________________
________________________
4_____________________________________________
________________________
5_____________________________________________
________________________
Times as scheduled in previous timetable, St Nicholas' Ward. Liaise with Vascular team
How to clerk a patient for vascular surgery
When admitting a patient for surgery, the decision to operate has already been made, so the
emphasis is placed more on ensuring the patient can safely go through with the operation. This
involves:
1.
2.
3.
4.
Full history and examination
ECG
Chest Xray, and usually pulmonary function testing
Bloods, including renal function, FBC, coagulation studies, and grouping and crossmatching
blood
5. Anaesthesia assessment
You should liaise with the vascular NCHDs in this regard- they will help you admit the patient and
will supervise you in performing procedures such as IV cannulation
Tutor comments
Overall assessment
Excellent
Good
Satisfactory
Unsatisfactory
Signature of Tutor: ______________________________ Date: _______________
Cardiovascular Module
Ward Patients clerked for Vascular Surgery
Patient's initials and board number
Diagnosis
Signature of Tutor
1 _____________________________________________
________________________
2 _____________________________________________
________________________
3 _____________________________________________
________________________
4 _____________________________________________
________________________
Inpatients admitted on the wards – liaise with surgical intern/SHO
Tutor comments
Overall assessment
Excellent
Good
Satisfactory
Unsatisfactory
Signature of Tutor: ______________________________ Date: _______________
Vascular Surgeries Observed
Patient's initials and identifier
Diagnosis
Signature of Tutor
1 _____________________________________________
________________________
2 _____________________________________________
________________________
3 _____________________________________________
________________________
4 _____________________________________________
________________________
Note: of these surgeries, at least one should be aortic (open or endovascular), one peripheral
revascularisation, and one carotid surgery. The availability of surgeries may vary. You should have
clerked the patient before the surgery.
Cardiovascular Module
Major Vascular Clinic – Patients Clerked and Presented
Patient's initials and identifier
Diagnosis
Signature of Tutor
1 _____________________________________________
________________________
2 _____________________________________________
________________________
3 _____________________________________________
________________________
4 _____________________________________________
________________________
Friday 9am – 1pm Outpatient Department
Tutor comments
Overall assessment
Excellent
Good
Satisfactory
Unsatisfactory
Signature of Tutor: ______________________________ Date: _______________
Minor Vascular Clinic – Patients Clerked and Presented
Patient's initials and identifier
Diagnosis
Signature of Tutor
1 _____________________________________________
________________________
2 _____________________________________________
________________________
3 _____________________________________________
________________________
4 _____________________________________________
________________________
Monday – Thursday (ArtAssist/Venous Clinic) Outpatient Department
Tutor comments
Overall assessment
Excellent
Good
Satisfactory
Unsatisfactory
Signature of Tutor: ______________________________ Date: _______________
Cardiovascular Module
Emergency Vascular Surgery Admissions Clerked and Presented
Patient's initials and identifier
Diagnosis
Signature of Tutor
1 _____________________________________________
________________________
2 _____________________________________________
________________________
Emergency Department. Liaise with duty SHO
This student has been on-call for vascular surgery (pass/fail)
Signature of Tutor: ______________________________ Date: _______________
Vascular Lab Session – Procedures Observed
Patient's initials and identifier
Diagnosis
Signature of Tutor
1 _____________________________________________
________________________
2 _____________________________________________
________________________
Daily, Vascular Lab, Outpatient Department
Vascular Surgery Bedside Tutorial
Date
Signature of Tutor
_____________________________________________
________________________
Wednesday Mornings, 10:30am, St Nicholas Ward
Vascular/Angiography MDM Conference Attended
Date
Signature of Tutor
_____________________________________________
________________________
Thursday Mornings, 7:45am, Western Vascular Institute, First Floor, Admin Dept
Vascular Journal Club Attended
Date
_____________________________________________
Signature of Tutor
________________________
Friday Mornings, 7:45am, Western Vascular Institute, First Floor, Admin Dept
Cardiovascular Module
CARDIOTHORACIC SURGERY (ONE WEEK)
Go-to people
Mr Mark DaCosta
Mr Deve Veerasingham
What to do
The cardiothoracic part of the rotation gives you an opportunity to observe the surgical treatment of
cardiovascular and respiratory disease. You should place emphasis on seeing patients in the
outpatient and inpatient settings, particularly patients going for surgery. It is also mandatory to
attend the cardiothoracic intensive care unit for at least half a day.
How to follow patients
During the CTS rotation, you should clerk your inpatients on Monday or Tuesday then follow their
progress for the week- that is, watch their surgery, evaluate them in CT-ICU and follow their
clinical course.
Schedule of Activities- Cardiothoracic Surgery
9.00am
Monday
Tuesday
Wednesday
Thursday
Friday
Ward Round
Ward Round
Ward Round
Ward Round
Ward Round
Theatre
Theatre
Theatre
Theatre
9.30am
1.00pm
Respiratory/
CTS MDM
Meeting Room 2,
Nursing
Administration
Cardiothoracic Clinic – Patients Clerked and Presented
Patient's initials and identifier
Diagnosis
Signature of Tutor
1 _____________________________________________
________________________
2 _____________________________________________
________________________
3 _____________________________________________
________________________
Cardiovascular Module
Cardiothoracic Surgeries Observed
Patient's initials and identifier
Diagnosis
Signature of Tutor
1 _____________________________________________
________________________
2 _____________________________________________
________________________
Note: these are viewed remotely; liaise with CTS
Cardiothoracic Surgery Ward Rounds Attended
Date
Signature of Tutor
1 _____________________________________________
________________________
2 _____________________________________________
________________________
3 _____________________________________________
________________________
Daily, CTU 9am
Cardiothoracic Surgery Admissions Clerked and Presented
Patient's initials and identifier
Diagnosis
Signature of Tutor
1 _____________________________________________
________________________
2 _____________________________________________
________________________
3 _____________________________________________
________________________
Daily; liaise with duty SHO
How to clerk a patient for cardiothoracic surgery
When admitting a patient for surgery, the decision to operate has already been made, so the
emphasis is placed more on ensuring the patient can safely go through with the operation. This
involves:
1.
2.
3.
4.
5.
Full history and examination
ECG
CXR, PFTs
Bloods
Anaesthesia assessment
You should liaise with the cardiothoracic NCHDs in this regard- they will help you admit the
patient and will supervise you in performing procedures such as IV cannulation
Cardiovascular Module
This student has attended the cardiothoracic ICU (Half Day)
Signature of Tutor: ______________________________ Date: _______________
What to do in the CTS-ICU
Here, you will see similar patients as in the ICU part of the RPOCCM rotation. Most will be postCTS surgery and may have postoperative complications. You should evaluate each patient using an
intensivist systems-based approach (Airway, breathing, circulation, neurology, feeding, electrolytes,
fluid balance, acid base and so on).
Cardiothoracic / Respiratory MDM Attended
Date
_____________________________________________
Mondays, 4.30, Classroom 4, Ground Floor, Nurses' Home
Signature of Tutor
________________________
Cardiovascular Module
Tutorials
Note to tutors: for the bedside tutorials, the students should have identified and prepared at least
two patients for this tutorial, and should have approached you in this regard a day in advance. If
this has not been done, the tutorial should be deferred.
Note to students: the tutor must be alerted to the above before the tutorial.
Cardiology Bedside Tutorials
Week 1
Week 2
_____________________________________
Date _____________
_____________________________________
Date _____________
_____________________________________
Date _____________
_____________________________________
Date _____________
Times: Tuesday 2pm (I/E Group), Wednesday 9.30am (I/E Group), Thursday 3pm (O/I Group ),
Friday 2pm (O/I Group)
Where: Cardiology Tutorial Room
Note: The Wednesday/Friday Tutorials are consultant provided, the Tuesday/Thursday tutorials
NCHD provided; you should be exposed to the same number of both
Cardiothoracic Surgery Bedside Tutorials
Week 1
_____________________________________
When/where: Mondays 2pm, CTS ward
Date _____________
Cardiovascular Module
Cardiology- Core topics
Cardiovascular medications
_________________________
Date _____________
Hypertension and hypotension
_________________________
Date _____________
Atrial fibrillation
_________________________
Date _____________
Murmurs
_________________________
Date _____________
ECG interpretation
_________________________
Date _____________
Acute Coronary Syndromes
_________________________
Date _____________
Arrhythmias and antiarrhythmics
_________________________
Date _____________
Emergencies, and when to
get help
_________________________
Date _____________
When/Where: Tuesdays and Thursdays, 5-6pm, Room 312, CSI
Vascular Surgery- Core Topics
PVD and
_____________________________________
Acute Limb Ischaemia
Date _____________
Carotid Disease
____________________________________
Date _____________
Venous/ Lymphatic
_____________________________________
Date _____________
AAA+Mesenteric
_____________________________________
Date _____________
When/where: Monday 10:30am Room 315 CSI; liaise with Mr Tawfick
Cardiothoracic Surgery- Core Topics
Thoracic Outlet
Syndrome
_____________________________________
When/where: Fourth Monday of Rotation, Room 312 CSI
Date _____________
Cardiovascular Module
Appendix 1
General Organisation
There are four groups. Each group rotates through Vascular Surgery, Cardiothoracic Surgery, and
Cardiology. At all times, two groups are with the surgical disciplines (one with Vascular, one with
CTS), and two groups with Cardiology (one on Inpatient and Emergency, one on Outpatients and
Investigations). Thus,
Vascular
CTS
Cardiology
(I/E)
Cardiology
(O/I)
Week 1
Group A
Group B
Group C
Group D
Week 2
Group B
Group A
Group D
Group C
Week 3
Group C
Group D
Group A
Group B
Week 4
Group D
Group C
Group B
Group A
In Vascular Surgery and CTS, the group attends the same clinical activities as the team; you should
liaise with Mr Tawfick in this regard. The same goes for CTS.
With regard to cardiology, the two weeks are divided into Inpatient and Emergency Cardiology and
Outpatient and Cardiology Investigations. During I+E, the student:
1.
2.
3.
4.
Spends two days on CCU and the wards
Spends two days in ED/MAU
Goes on call for at least one evening
Takes a day off
During O + I, the student:
1. Goes to available clinics on a rotating basis (i.e. students 1+2 Wednesday Morning, students
3+4 Wednesday afternoon etc)
2. Spends a day in cardiac investigations (Echo/ECG/Stress/Holter etc)
3. Spends a day in the cath lab (clerking patients and observing procedures)
4. Goes to the heart failure clinic and cardiac rehab for an hour or so
Who divides us into the 4 groups and decides on a rota for the cath lab, CCU, wards, clinic, etc?
You do. In your professional lives you will be organising rotas, splitting jobs and assigning tasks.
You can start now.
How do I get the most out of my rotation?
Be proactive. The rotation is designed to expose you to aspects of clinical care which are not found
in books- the real-world encounter, the decision making process of experienced clinicians, the
realities of your future job as a doctor. It is not a tutorial series with some ward rounds thrown in.
You are in the wards to see patients and to see how doctors work in the real world. Nothing you will
read, and no tutorial you will receive is a substitute for direct interaction with patients, and the
experiences you accumulate as a result. The books may tell you what someone looks like when
Cardiovascular Module
they're having a heart attack but no amount of description will ever take the place of seeing the real
thing- the panic, the expression on the patient's face, the ED nurse doing about five things all at
once while you try to keep your thoughts straight and remember what drugs to give. Similarly,
seeing a patient being counseled in clinic about their claudication, or being consented for cardiac
surgery is infinitely more instructive than reading about it.
In essence:
1.
2.
3.
4.
Be around, and be on time
You get out what you put in
At all times, be professional and treat patients with the respect they deserve
Have respect and consideration for the doctors and the nursing staff, especially when they
are tired or overworked.
5. Show some initiative.
6. Finally, have respect for each other; look out for the other people in your group; if they're
struggling, help them out or let one of the tutors know
Appendix 2
Tutorials in Cardiology
The tutorial timetable looks like this, but is subject to change depending in whether the tutor can
make it or not:
Monday
Tuesday
Wednesday
Thursday
Friday
Bedside
Tutorial
(Consultant)
O+I
9:30 am
Bedside
Tutorial
(Consultant)
I+E
Morning
(Cardiology
Department)
Afternoon
2pm
(Cardiology
Department)
Bedside
Tutorial
(Reg/SHO)
I+E
Bedside
Tutorial
(Tutor)
O+I
Afternoon
5pm
(CSI)
Core topic
tutorial
(Cardiology
Consultant)
All
Core topic
tutorial
(Cardiology
Registrar/
Tutor)
All
I+E: Inpatient and emergency group
O+I: Outpatient and investigations group
Cardiovascular Module
Appendix 3
Tutorials in Vascular and Cardiothoracic Surgery and Cardiovascular Radiology
Monday
Tuesday
Wednesday
CTS Core Topic
Tutorial
Morning
CSI Room 312
8.30am
Fourth Week of
Attachment
10:30 am
Afternoon
2pm
CSI Room 315
Vascular Surgery
Core Topic (All)
Cardiothoracic
Bedside Tutorial
(CTS Group)
St Nicholas’ Ward
Vascular Surgery
Bedside Tutorial
(Vascular group)
Thursday
Friday
Cardiovascular Module
Frequently Asked Questions
Where is everything?
Cardiology and Cardiothoracics are both on the first floor of the main hospital block. CT-ICU is on
the third floor beside ICU. Theatre is on the second floor. Cardiac rehabilitation and the CNS led
Heart Failure clinic are on the link corridor to Obstetrics. The Vascular Lab is off the corridor to
outpatients. Cardiology and CTS OPD take place on the first floor of outpatients, vascular on the
second.
Do I really have to go on call?
Yes. Lots of acute presentations of CVS disease come in at night, or during the evening. This
represents a unique opportunity to learn and is invaluable for handling on-call during your intern
year.
The team seem really busy. Would it be better if I went to the library?
No! Help out instead. See patients, do jobs, put in lines, do bloods, and be proactive.
There wasn't a pacemaker insertion/PCI/ the day I was on for the cath lab. Can I go back again to
try and see one?
Yes, by all means, as long as the cath lab staff are okay with more than one student being there. Ask
first.
How do I get in contact with the SHO or Registrar?
Page them. To use the pager system, dial 81, the number of the pager, and then the number of the
extension you're at. If you need a number, call switch by dialling 9. Be polite when you call.
How do I know what's on in the Cath Lab in the morning?
There's a list in the office beside the cath lab with the patient's name, planned procedure, and
location. Use it when you're trying to find patients to clerk for your cath lab day.
How do I know what surgery is going on tomorrow?
The team will get a list of patients the day before surgery, so ask them for a copy- the intern will
certainly have one. You should aim to clerk these patients for their surgery and present them on the
morning ward round.
What preparation do I have to do for the bedside tutorial?
You have to have taken a history from and performed a physical examination on two patients. The
SHOs and registrars will help you find them. The task can be split between two students. You also
need to contact the designated tutor and confirm that the time is convenient for them – they could
be in the middle of an arrest. You should rotate the responsibility within the group.
Cardiovascular Module
The registrar couldn't do the tutorial because they were running late in clinic. What do I do?
Page them and reschedule. It's easier for you to find them rather than the other way around.
I've arrived to clinic but none of the team are there yet. What should I do?
Grab a chart and a room and start seeing a patient. You'll be ready to go when the tutor gets there.
What do I do with patients in clinic?
There are two types of patient in clinic- reviews and new cases. With review cases, it is useful to
apply a SOAP (subjective, objective, assessment, and plan) template to each patient you see. Think
about what you would do in terms of management and compare this with what actually happens.
For new patients, you take a full history and perform a full examination, formulate a differential
diagnosis and decide on a plan of investigation and management.
How should I introduce myself to patients?
“Student doctor” is the clearest term; patients tend to understand it better than “medical student”
(which, to be fair, could be anything). Be sure to identify your role, obtain informed consent, and
reassure the patient that they will be seen by a senior doctor in due course.
Can I obtain consent for procedures?
No. This can only be obtained by qualified practitioners, but you are advised to sit in on the process
and observe how it's done.
When do I have to hand in this logbook?
On the last day of the rotation.
What safety precautions do I need to take in the cath lab and vascular theatre?
Both environments use flouroscopy (i.e. radiation), so you have to wear lead coats and thyroid
shields as protection. Ask the nurses or doctors where you can find them.
What do I do if a patient suddenly becomes unstable while I'm interviewing them?
Call for help! If the patient becomes unresponsive, commence CPR and ask the nurses to call an
arrest.
What preparation do I need to do for the core topic tutorials?
You should have read around the topic and made a list of things that don't make sense to you, and
ask about them.
Is the logbook the be-all and end-all?
No. It helps us figure out how much you've been turning up, and what you've been seeing. It also
guides you towards those things we want you to see.
Cardiovascular Module
Appendix 4
Feedback
This logbook is an ongoing project; we would appreciate your feedback on the layout and ease of
use. We also welcome your comments on the overall structure of the rotation, what works, what
doesn't and where you learned the most.
Comments
Appendix 6
For tutor use only
Logbook
Tutorials
Remedial action required
No