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. 2020 Nov 26;10(11):e040575.
doi: 10.1136/bmjopen-2020-040575.

Undergraduate exposure to patient presentations on the acute medical placement: a prospective study in a London teaching hospital

Chee Yeen Fung  1 , Zhin Ming Tan  1 , Adam Savage  1 , Mahdi Rahim  1 , Fatima Osman  1 , Mohammed Adnan  1 , Emilia Peleva  1 , Amir H Sam  2
Affiliations

Undergraduate exposure to patient presentations on the acute medical placement: a prospective study in a London teaching hospital

Chee Yeen Fung et al. BMJ Open. .

Abstract

Objectives: To identify the availability and variability of learning opportunities through patient presentations on an acute medical placement at a teaching hospital.

Design: A prospective study evaluating all acute admissions to the Acute Medical Unit over 14 days (336 hours). Clinical presentations and the day and time of admission were recorded and compared with the learning outcomes specified in the medical school curriculum.

Setting: An Acute Medical Unit at a London teaching hospital.

Outcomes: (1) Number of clinical presentations to the Acute Medical Unit over 14 days and (2) differences between the availability and variation of admissions and presentations between in-hours and out-of-hours.

Results: There were 359 admissions, representing 1318 presentations. Of those presentations, 76.6% were admitted out-of-hours and 23.4% in-hours. Gastrointestinal bleeding, tachycardia, oedema and raised inflammatory markers were over three times more common per hour out-of-hours than in-hours. Hypoxia was only seen out-of-hours. Important clinical presentations in the curriculum such as chest pain and hemiparesis were not commonly seen.

Conclusions: There is greater availability of presentations seen out-of-hours and a changing landscape of presentations seen in-hours. The out-of-hours presentation profile may be due to expanded community and specialist services. Medical schools need to carefully consider the timing and location of their clinical placements to maximise undergraduate learning opportunities.

Keywords: clinical audit; internal medicine; medical education & training.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Number of patients in various age ranges admitted to the Acute Medical Unit during the 2-week period.
Figure 2
Figure 2
Number of admissions in each time frame during the 2-week period.
Figure 3
Figure 3
Frequency of selected core presentations admitted to the Acute Medical Unit per hour in-hours compared with out-of-hours during the 2-week period.
See this image and copyright information in PMC

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