CMSA

The Colleges of Medicine of South Africa NPC

Nonprofit Company (Reg No.1955/000003/08)
Nonprofit Organisation (Reg. No. 009-874 NPO)
Vat No. 4210273191

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Tel: +27 11 726 7037; Fax: +27 11 726 4036
www.cmsa.co.za
JOHANNESBURG OFFICE Academic.Registrar@cmsa.co.za

EXAMINATIONS & CREDENTIALS

Diploma in Allergology: Portfolio of Learning

Portfolio Clinical / Practical Training

A. Clinical Case Study Assignments.

General Guidelines.

Clinical case studies make up the majority of the written assignments. They are used to
provide evidence of learning in any of the following areas:

1. Understanding of assessment and management principles in Allergology.

2. Adoption of a patient-centered framework.
3. An appreciation of wider social and cultural factors lending context to the clinical
problem.
4. Application of the principles of evidence-based medicine in diagnostic and treatment
planning.
5. Clinical competence (e.g., patient studies that demonstrate diagnostic reasoning,
understanding of pharmacotherapy and a biopsychosocial approach).
6. Use of Multi-dimensional, and the multi-disciplinary team in management. strategies.
Guide to the presentation of Clinical Studies
7. Clinical case studies should reflect a deep engagement with the clinical and theoretical
subject matter and show evidence of the following specific skills:

 Practising holistically, utilising a biopsychosocial approach, appropriate to the

presenting problem.
 Data gathering and interpretation: Appropriate history taking, examination and
utilisation of investigations to gather information, with a systematic approach to
integration.
 Making diagnoses and decisions:
 Clinical management: Including involvement of the patient in decision making, and
considering best evidence.
 Managing medical complexity: Including integrating the doctor and patients
feelings, viewpoints, differing agendas and interpersonal challenge.
 Working with colleagues and in teams: Appreciation of the role of the multi-
disciplinary team in the treatment of allergic conditions .
 Community orientation: Wider social and cultural contextualization.
 Ethical approaches: Understanding the ethical dimensions of the case, including
sensitivity to patient rights, respect for autonomy and equity.
See Appendix 1 Case-based Discussion Notes Sheet – a more detailed reference on patient
based discussion notes.
See Appendix 2Dip Allerg(SA) Clinical Case Study Assignment - RUBRIC
Five core clinical case study assignments are required for portfolio with focus on specified
clinical distribution below.

Distribution of Core Clinical Case Study Assignments

i. Respiratory allergy = 1 clinical case studies (for adult or child)

ii. Skin allergy = 1 clinical case studies
iii. Food allergy= 1 clinical case studies
iv. Allergy Emergencies = 1 clinical case study
v. Ocular allergy = 1 clinical case study

Any of the following patient clinical conditions may be selected:

I. Respiratory allergy

 Asthma
 Asthma and other allergic conditions in infancy and childhood
 Exercise-induced asthma
 Occupational asthma
 Asthma in pregnancy
 Allergic and non-allergic rhinitis
 Special situations in allergic rhinitis – pregnancy, occupational

II. Skin allergy

 Atopic dermatitis
 Urticaria and angioedema
 Contact dermatitis

III. Food allergy

 Food allergy (IgE/Mixed/Non-IgE)
 Food intolerance
 Seafood allergy

IV. Allergy emergencies

 Anaphylaxis
 Insect venom allergy
 Hereditary angioedema

V. Ocular allergy
 Seasonal allergic conjunctivitis
 Perennial allergic conjunctivitis
 Vernal keratoconjunctivitis
 Atopic keratoconjunctivitis
 Contact dermato-conjunctivitis
What is the purpose of the clinical patient study?

1. It demonstrates academic as well as clinical prowess – it is a scholarly endeavour and you thus need
to read and link your study with clinical research evidence .
2. You must be able to demonstrate learning: Integrated assessment, diagnosis, new management,
therapeutics, drugs, communication skills, special needs patients, complexity, social determinants
of health, referral issues, rare conditions, lifestyle issues, disagreement on health beliefs, cultural
diversity, community resources and dealing with limitations of the health care system and medical
profession.
3. Reflect on a situation with a patient, colleague, disease, system etc. that challenged you and used it
as the starting point of your clinical patient study.
4. Be aware of the whole person (context, illness experience vs disease).
5. Synthesize and integrate biopsychosocial, legal and ethical elements into the holistic patient
management.
6. Identify the need for provider well-being: Introspection or caring for the caregiver; what are you
going to do about self-care and stress reduction?
7. Identify our own limitations and knowledge gaps in areas of uncertainty and complexity – it means
you can say “I do not know”. Reflect on the possible barriers and facilitators to care of the patient.
8. Identify and deal with health system limitations that compromise patient care (advocacy role as
health care providers).
9. Reflect on practice and make the necessary changes in practice.
10. You must be able to tell the story of the patient and your own learning, growth, and professional
maturation as a physician.

How do I select the patient I am going to write about?

Be guided by the following ‘test’ questions:

a. Did this patient challenge me? If so, how?

b. Did this patient push my buttons or test my limits in terms of knowledge, skills, professionalism,
emotions, and boundary issues? Did it evoke judgement or provoke judgement?
c. Did I know what to do with this patient? In hindsight, did I do everything I could for this patient?
d. Did this patient trigger my curiosity to learn more?
e. Did I manage my uncertainty around this patient as well as I could have?
f. Did the health system (nurses, colleagues, other specialities, equipment, stock-outs and space
limitations), impact on my ability to do my best / optimally manage my patient?
g. Did you experience something similar in the past and the present patient opened a ‘Pandora’s box’?

**IF YOU SCORE LESS THAN 3 “YES” ON THESE “TEST” QUESTIONS, THEN CHOOSE ANOTHER PATIENT
TO WRITE ABOUT. YOUR ANSWERS TO THESE QUESTIONS SHOULD BE INCORPORATED INTO SECTION
A (INTRODUCTION) OF YOUR PATIENT STUDY.

Format of the Case Study Assignment

 The assignment must not be less than 2000 words and not exceed 3500 words.

It must be typed in double spacing with Font Arial 12.

References: more than seven references using the Vancouver style of referencing.

Structure of the Clinical Case Study Assignment

SECTION A The Patient

Introduction

Motivate the reason for selecting this patient, the main complaints of the patient, the situation in which
you saw the patient, any special features or circumstances:

Where and when did you see this patient?

Why did you decide to do a patient study on this specific patient?

What challenged you about this encounter? (See questions on how to choose a patient).

Can you identify a central issue that led you to write this patient study (e.g. a
‘mistakes’/challenges/gaps in your skills or knowledge and the efforts to address them.

Presentation of Problem List, Patient History, Physical Examination, Investigative Data

This is a summary of the clinical presentation of the patient as it happened at the time of the encounter
(without editorialising and the knowledge that you have at this moment). It covers presenting
complaints or comprehensive problem list; exploration of complaints, history; physical examination;
work-up; initial assessment including differential diagnoses; anything else that happened. With regards
to the allergic condition, it should include the Predisposing, Precipitating, Maintaining and Contextual
factors pertinent to it.

 Biographical data – please note

o no patient names, file numbers, districts or identifiable training sites.
 Patient history - subjective data should include
o The presenting complaints (include duration of complaints; use patient’s words of
SYMPTOMS if possible).
o Allergy focused clinical history and exploration of present illness.
o Include relevant past medical history, detailed history of previous allergies, surgical,
habits, travel, family, spiritual, cultural and social history with genogram or ecomap.
o Genogram: structurally sound; correctness; dates (DoB, DoD and marriage/relationship/
divorce etc); diseases; relationships/interaction; key
o Ecomap: correct structure; key; systems reflected; positive and negative energy flow
indicated and representing narrative.
 Physical examination - objective data which should include
o Vital signs.
o General survey include “JACCOLD”.
o Relevant physical examination – avoid use of the word “normal” when documenting
your physical examination findings.
 Investigative results available after the first encounter with the patient
o Side room investigations.
o Past test results available and interpretation.
 Problem List – this needs to be as comprehensive as possible and should include relevant data
gathered after the 1st contact with your patient
Three-stage assessment
This comprehensive biopsychosocial assessment should be prefaced with a summary statement that
describes your patient.

(include relevant subjective and objective data collected)

 Clinical Assessment (Biological)

o You MUST have a DISCUSSION of your 3 most likely diagnoses/reasons your patient has
presented (subjective and objective data should be considered when compiling this):
why do you think each is a likely diagnosis for your patient based on the patient data
you have gathered? Why would negate each possible diagnosis given the patient’s
presentation (you will need to research what the “typical” presentations for each of
your possible diagnoses before writing this section).
o This section is about the Pathology of the body and mind: consider the general state of
the body and mind and the ability of the body to respond to pathology.
o Consider the four C’s of Chronic illness: Complaints, Compliance, Control and
Complications
 Individual Assessment (Psychological) which include consideration of:
o Anything inside the person, I.C.E.D.
o IDEAS, thoughts and beliefs of your patient, spiritual, cultural.
o CONCERNS, fears .
o EXPECTATIONS on the disease, of the clinician or of healthcare, reason for coming.
o EMOTIONS.
o DEVELOPMENTAL stage, the patient’s ability to respond to problems physically and
emotionally. The effect of the problem on the patient’s life and function.
 Contextual Assessment (Social) which include considerations of:
o Anything outside the patient relevant to understanding and managing the patient with
the problem – how the patient’s problem impacts on the items below, and vice versa
o What is the context? Environment, Family, Home, Work, Community, Health services,
Culture, Faith, Spirituality.
o Resources: Ability to respond to problems.

Three-stage Management Plan

 Clinical Plans for your “working diagnosis” (what you think is the most likely diagnosis – should
include the following:
o Diagnostic / Investigative studies (if relevant) – do not include here investigations whose
results you have already documented in the INVESTIGATIVE STUDIES section above –
this is for any additional studies required; indicate WHY each investigative study is
planned.
o Therapeutic – including pharmacologic and non-pharmacologic therapy.
NB: If your plan is to admit the patient, please state this in your clinical plan. A separate
admission plan should accompany your patient study – see addendum for format.
 Individual plans and contextual plans linked to your 3 stage assessment.

Continuity of Care follow-up

 You will need to call / see / follow-up your patient from the first consultation or the day of
admission till the day of discharge.
 You will be expected to generate a progress (SOAP) notes on your patient and document course
or progression of illness.
 On the day of discharge, you will need to generate a discharge plan. See Appendix 3)

SECTION B Learning Needs

This section is for your facilitator to evaluate whether or not you have learnt anything from this patient.
• You will need to do some RESEARCH by literature review.
• No copy & paste will be allowed; write in your own words what you learnt.

Critical Reflection & Introspection

The candidate should think about and critically reflect on all that happened during this patient’s
presentation, assessment and management. Then the candidate should discuss which aspects were
done well and which aspects should have been done differently. How could this patient have been
better managed? How could YOU have contributed more?

Please refer to Rubric (Addendum x) as a guide on what is expected of you.

 Identify clinical learning needs and important incidents regarding the problem solving and
critical thinking process.
 Identify learning needs and important incidents regarding the individual, ethical and
professional issues.
 Self-awareness: academic and social. Deal with weaknesses of self and others. Confront your
own strengths. Identify your limitations, uncertainties, weaknesses, knowledge gaps and areas
of uncertainty.
 Understanding: translate an experience into learning
 Show transformative change of practice

Include the following aspects, as you find them relevant and appropriate to your patient:

 Health promotion and disease prevention

 Ethical practice
 Professional behaviours
 Communication
 Cultural sensitivity
 Administrative policies of healthcare facility

The patient and his/her/their problems or challenges you experienced during the encounter may have
touched you in various ways. Reflect on this and on self-care.

From your critique and reflection identify the areas where you need to learn more about. This can then
be formulated into specific learning needs. It is the heart of the problem. It describes and defines the
learning needs that arose from the challenge(s) mentioned in your reflection.

Discussion of Identified Learning Needs (Evidence of Learning)

Discussion of the learning needs identified above, including relevant and critically appraised literature
where you investigate support for or against what you or others have done. This must be credible,
based on the broader literature, and linked to relevant theory and principles in allergology.

Here the candidate should report on the study he or she did to answer the specific learning needs
identified above. The candidate should also apply the information to the specific patient in this patient
study. It is not acceptable to copy and paste from other sources without further comments and
references and applying it to this particular patient.

 Plagiarism is completely unacceptable . Any patient study found to have learning needs that are
plagiarised will receive a zero for that patient study; no resubmission for that patient study will
be permitted.
  Please ensure that you relate your identified learning needs to the patient you have seen. It is
not enough to simply write an essay about what you read: how does the information you have
gathered relate to your patient
 Please note: including a long section on the normal structure and function of what you feel is
the relevant system will not be accepted: the focus should be management and therapeutics
relating to pathophysiology.

Conclusion.

Address your initial challenges and learning needs. Now that you know all these things, what would
you change or do differently in future, bearing in mind what you did initially? In other words: what
was the seismic shift in your knowledge or understanding? This section must be written in the first
person. Make it clear that you are taking ownership for your own learning and/or learning needs.
You can include issues for further study as well as practical steps for transformative change.

References

 Indicate the sources you used in the discussion of learning needs.

 Your submissions must cite references used, utilising the Vancouver referencing method.
 At least seven references required. .

Section C: Pharmacotherapy Component

For every patient study your assignments have to include the following under appropriate headings:

 The reasons (indications) and effectiveness and efficacy for each medicine prescribed for this
patient, considering alternative therapeutic options.
 The 3 most common adverse effects that could be expected from each of the medications.
Consideration and interpretation of the drug interactions and food-drug interactions that could
be expected with this prescription. Indicate how the interactions may influence the
management of the patient.
 Critically comment on the prescription: Do you fully agree? Does it meet all the legal
requirements for a prescription? How can it be improved to ensure the best possible quality of
life for the patient? How can it be changed to reduce costs without compromising the health of
the patient?
 Describe the education that you would give to the patient regarding each of the medicines
prescribed. Why do you think it is important to spend the time educating your patient about
this information? Do you believe that this is an important aspect? If your relative was being put
on these medications, and you were in charge of ensuring that the patient is compliant, what
information would you want?
 References: in Vancouver style.

Format of the Case Study Assignment

The study must not be less than 2000 words.

It must be typed in double spacing with Font Arial 12.

Proper academic writing and language skills, including style, punctuation, spelling, grammar and syntax
are recommended.

VERY IMPORTANT: The only identification on this document will be your name and student
number – no patient names, file numbers, districts or identifiable training sites are required.
You can use any name for the site that you work e.g. Site X, hospital AA, clinic Z etc. An
 informed consent for the use of the patient in the study should be taken, but needn’t be
shared unless specifically asked for.

B. POSTGRADUATE PORTFOLIO ASSESSMENT TOOL (PAT) FOR DIP ALLERG (SA)

A satisfactory portfolio assessment and score (>60/100%) is required for verification to the CMSA that
the candidate is ready for Dip Allerg (SA) exam. Your PAT score will count towards 20% of your final
mark.
 1. Learning Plans – minimum of 2 learning plans required. Take the average of the scores (../10)
for individual learning plans to get final average mark (../10)

Learning Plans First Second Third Final Average

(../10) /10 /10 /10 /10

2. Learning Reflection Report - minimum of 2 learning reflection reports required. Take the
average of the scores (../10) for individual learning plans to get final average mark (../10)

Learning Reports First Second Third Final Average

(../10) /10 /10 /10 /10

3. Patient Case Study Assignments – Take the average of all the required case study assignments. A
missing assignment will be allocated a mark of zero.

Number Domains Clinical Topics Mark (…./100) Final MARK

1 Respiratory

2 Skin

3 Food

4 Allergy
emergencies

5 Ocular

/500 /100%

4. Logbook Practical Training Hours – Supervised 5 points per hour to minimum of 100 points,
Unsupervised 1 point per hour to maximum 50 points. Total maximum 150 points.

Practical Training Supervised Unsupervised Final MARK

 Hours

Total Hours (20 hrs min) (50 hrs max)

Points /100 minimum /50 maximum /150

(5 credit points/hour) (1 credit points/hour)

5. Logbook Theoretical Education or Training

Theoretical Minimum 100 points Final MARK

Education

or Training /100

6. Logbook Core Practical Skills and Procedures – core 50 required by the CMSA

Practical Skills and Mark Allocated Core 50 completed Final MARK

Procedures

YES / NO 50/50

7. Observed Consultations (directly or video) – Calculate the average score for 10 best
consultations

Observed 1 2 3 4 5 6 Final
Ave
Consultations
MARK

/10
/10

8. Patient/Topic Presentations / Discussions with supervisor.

Presen 1 2 3 4 5 6 7 8 9 10 Final
t Ave
Patien Patien Patien Patien Patien Patien Patien Patien Patien Patien
t t t t t t t t t t MAR
 /10 Topic Topic Topic Topic Topic Topic Topic Topic Topic Topic K

/10

9. Global Portfolio Rating by supervisor of candidate’s Self-Reflection Evidence in portfolio:

1 2 3 4 5
Poor Barely adequate Average Good Excellent

Reflections 1:

Describes what Describes one’s Critical analysis of Critical analysis of Critical analysis of
happened: reactions: learning: learning and learning, learning
Only experiences or Writing shows self- Writing shows learning needs: needs and practical
clinical activities are awareness in terms critical analysis with Writing also shows planning:
described. of one’s thoughts, development of critical analysis of Writing also shows
feelings and more abstract what must still be how these new
context. conceptualization learnt or focused learning needs have
of new knowledge, on next. been translated
skills and personal into future plans.
growth.

1 2 3 4 5
Poor Barely adequate Average Good Excellent

Organization of portfolio:

Incomplete or Complete with a Complete and As before but As before but with
many areas few areas organized in a presented in an innovative
disorganized or disorganized but systematic way. exemplary way. additional evidence
filled in mostly at completed Completed such as photos,
the end of the year. throughout the throughout the videos, patient
year. year. reports.

*1Koole et al. BMC Medical Education 2011, 11:104 – Linkert Scale

Summary (candidate) & Assessment (supervisor) of self-reflection evidence MARK

/10

PORTFOLIO ASSESMENT TOOL (PAT) Score calculation

 TOTA
PORTFOLIO SECTION MARK TOTAL WEIGHTING SCORE %
L

1 Learning Plans
10 X5 50 /5

2 Learning Reflection Report

10 X5 50 /5

3 Patient Case Study

Assignments 100 X3 300 /30

4 Logbook Practical Training

Hours 150 X1 150 /15
(Min 100/150)

5 Logbook Theoretical
Education or Training
100 100 X1 100 100 10/10
(Min 100)

6 Logbook Core Practical Skills

and Procedures
50 50 X1 50 50 5/5
(Min 50)

7 Observed Consultations (6)

10 X10 100 /10

8 Patient Presentations /
Discussions (10) 10 X10 100 /10

9 Self-Reflection Evidence
10 X10 100 /10

1000 %
PAT SCORE / YEAR MARK

Candidate:

Signature College Number

Evaluation Feedback:

Recommendation: Qualify for Dip Allerg(SA) exam entrance YES / NO

Supervisor:

Signature: Date:

PAT Document and Logbook to be submitted to CMSA for Dip Allerg(SA) exam entrance.
 Appendix 1: Discussion Notes Sheet – as a guide to the consultation
These notes should be consulted and drawn on and applied to the context of an Allergy Consultation

Competence Proposed Questions Evidence Obtained

Practicing What do you think was the patient’s agenda (her I.C.E.)? How did you elicit this? Why Note: In general, when asking the registrar
present now? to present the case, ask them to also say:
holistically
What effect did the symptoms have on her work, family, and other parts of her life? 1. what issues they felt the case raised
(physical, psychological, (illness vs. disease)
socio-economic and 1. what issues they felt needed
cultural dimensions; How did the symptoms affect her psychosocially? What phrase(s) did you use? resolving
patient’s feelings and 2. what bits they found
thoughts) What prior knowledge of the patient did you have which affected the outcome of your challenging/difficult
consultation(s)? This will help you focus your questions.

Did you identify any ongoing problems which might have affected this particular
complaint?

How did you establish the patient’s point of view? What consultation skills did you
use to do this?
Needs develpmt. Comptnt
Other Qs Excllnt Not assessd

Data gathering Ask about the specifics of the case and diagnoses eg what biological features of
depression did she show? How long did she have it for? etc
and
What bits of information did you find helpful in this case? Why? How did you phrase
interpretation that?
(gathering and using
What other information did you use to help formulate your diagnosis/decision?
data for clinical
judgement, the choice Did you refer to any previous investigations to help you? What were they?
of examination and
investigations and their What skills did you use to obtain the history?
interpretation)
What examination did you make?
Needs develpmt. Comptnt
I see from the notes that there is no reference to examining her “chest”; Do you think Excllnt Not assessd
this might have been helpful? In what way?

Had you gathered any further information about this case from others?

Was there any other information you would have liked? How would that have helped
you?

Other Qs

Making DIAGNOSIS

diagnoses & What were you particularly worried about in this case?
decisions How did you come to your final diagnosis? Remind me which bits of the history and
examination were instrumental in this?
(conscious, structured
approach to decision- Did you use any tools or guidelines to help you?
making)
TREATMENT

What were your options? Which did you choose? Why this one? Convince me that
you made the right choice.
Needs develpmt. Comptnt
Did you consider any evidence in your final choice? Tell me about it?
Excllnt Not assessd
How did the patient feel about your choice of treatment? Did this influence your final
decision?

Did you consider the implications of your decision for the

relatives/doctor/practice/society? Tell me more about how they might feel? How did
this influence your final decision?

Did you use any framework or model to help justify your decision?

Other Qs
 Clinical What made you prescribe xxx? How did you come to choosing that? What does the
evidence say about it?
Management
Had you thought of any other options at the time? What were they? Tell me about
(recognition and some of the pros and cons of these options so I can get an idea of why you went for what
management of you did. Do you know the evidence behind any of these? What were your main priorities
common medical here?
conditions)
Why did you do those investigations? What were you looking for?
Needs develpmt. Comptnt
Why did you make that referral? What worried you that led to that referral? Did you
Excllnt Not assessd
speak to them? What were you hoping the referral might achieve? What did you actually
put in the referral letter?

Did you put into place any follow up/review? How long? Why do you want to see her
again?

Other Qs

Managing How did you generally FEEL about this case?

medical Do you think the patient kind of pushed you into investigation/referral/treatment with
abx? How do you feel about this? What have you learned from this case?
complexity
What did you do to alter her help seeking behaviour?
(beyond managing
straight-forward Was there a difference of agendas? How did you tackle this? (eg demanding patient,
problems, eg managing difficult angry patient, overbearing heartsinks etc). Tell me exactly how you managed to
co-morbidity, merge agendas. Needs develpmt. Comptnt
uncertainty & risk, Excllnt Not assessd
approach to health What made this case particularly difficult? How did you resolve that?
rather than just illness)
Were there any ongoing problems that added to the complexity of this case?

Other Qs

Primary care Look at the registrar’s electronic recording of information. Do you think it was
satisfactory? Ask what the registrar thinks on reflection- “Do you think what you have
admin and IMT documented is adequate?” Any important negatives left out? The patient’s narrative?
Concise yet thorough?
(effective recordkeeping
and online info to aid Did you use any online information to help you? What? How? Needs develpmt. Comptnt
patient care)
Other Qs Excllnt Not assessd

Working with Did you involve anyone else in this case? Why? How did they help?

colleagues and Did you involve any other organisations in this case? For what purpose?
in teams How did you ensure you had effective communication with others involved in this
particular case?
(working effectively;
sharing information Needs develpmt. Comptnt
If many people/organisations are involved in the case, ask: “What do you see as your
with colleagues) role considering loads of people are involved in this case?” Excllnt Not assessd

Other Qs

Community Did you think about the implications of your treatment/investigations/referral on the
individual patient and on society? Tell me more…OR
orientation
Is there a potential for harm in the way you approached this case? OR
(management of health
and social care of local Can you see any ethical dilemmas in this particular case? OR
community) Needs develpmt. Comptnt
Had you any ethical considerations when dealing with this case? Tell me more.
Excllnt Not assessd
Had you any thoughts at the time about the cost of treatment/investigation/referral?

Other Qs

Maintaining an What ethical principles did you use to inform your choice of treatment?

ethical How did you ensure the patient had an informed choice when it came to
 approach to management? What are patients’ rights? How did this influence your handling of the
case?
practice
Sick Notes – individual vs. society thing.
(ethical practice,
integrity, respect for Other Qs
diversity)
Needs develpmt. Comptnt
Excllnt Not assessd

Fitness to Excluding the serious stuff

practice eg What alarm features did you enquire about?; How did you carry out a suicidal risk
assessment?; How did you know her headaches are not a result of a brain tumour?; How
(awareness own did you exclude a brain tumour?
performance, conduct
or health, or of others; Safety Netting – How did you close the consultation? Did you advise on when to come
Needs develpmt. Comptnt
action taken to protect back? What did you say?
Excllnt Not assessd
patients)
Are there any other responsibilities you have to patients in general? How do they
apply to this case? How did you make sure you observed them? Why are they
important?

Did you use a chaperone?

Did you wear a glove before taking blood/doing a PV/PR/giving the injection?

Other Qs

* Developed by Dr. Ramesh Mehay, Programme Director Bradford VTS (Dec 2006)

Appendix 2: Dip Allerg(SA) Clinical Case Study Assignment - RUBRIC

 Student Name:________________________________________________________
CMSA candidate no: ____________________________

Date submitted:_______________________________________________________
Assignment Number:____________________________

Section A: The Patient

Below standard On standard Excellent Mar Comments

k

Marks 0-4 5-7 8-10

1. Introduction Lack of effort Comprehensive Multidimensional

Unclear Clear and logical . Various reasons
highlighted. /10
Clear and concise

2. Presenting Lack of effort. Comprehensive, Demonstrated

Problem List Incomplete/ logical and exceptional
Relevant incorrect format focused. clinical reasoning
subjective and used in Demonstrates and insight
objective data to documenting adequate Clear and concise
be used to findings clinical Exceptional /10
formulate a reasoning format used to
differential document
diagnosis and findings
management
plan
3. Patient Lack of effort. Comprehensive, Demonstrated
History Hard to follow logical and exceptional
Including Clinical, Incomplete/ focused. clinical reasoning
Individual (Ideas, incorrect format Some aspects and insight
Concerns, used in difficult to Clear and concise
Expectations, documenting follow Exceptional
Functioning, findings Adequate format used to
Psychological) format used in document
and Contextual documenting findings /10
History. findings.
Demonstrates
adequate
clinical
reasoning for
level of training

4. Physical Lack of effort. Comprehensive, Demonstrated

Examination Incomplete/ logical and exceptional
Vital signs, incorrect format focused. clinical reasoning
general survey used in Adequate and insight.
and relevant documenting format used in Clear and concise
systems involved findings documenting Exceptional
findings. format used to /10
Demonstrates document
adequate findings
clinical
reasoning for
level of training
5. Investigative Lack of effort. Comprehensive, Demonstrated
Data Incorrectly logical and exceptional
Any other documented with focused. clinical reasoning
relevant system information Adequate and insight
investigations missing format used in Exceptional
with results documenting format used to /10
available at 1st results. document results
contact with Demonstrates
patient adequate
clinical
reasoning

6. 3 Stage 3 stages unclear / 3 stages clear. Comprehensive

Assessment: incorrect. Not Linked to assessment.
Clinical (Bio) linked to evidence evidence Demonstrates
Individual exceptional
(Psychol) insight /10
Contextual
(Social)
(including
diff
diagnosis
and
substantiati
ve
reasoning)

7. 3 Stage Inappropriate Comprehensive. Excellent

Managemen management. Linked with management
t Plan – Not linked to assessment. plan. Addresses
including assessment Evidence based. all aspects of the /10
admission assessment as
plan if well as
relevant.
preventative
measures

8. Continuity No or inadequate Adequate Insightful,

of care information continuity of comprehensive
Patient Incompletely or care continuity of care
follow-up incorrectly demonstrated described
consultation documented /10
,
communica
tion or in-
hospital
clinical
progression
till discharge

Section A Mark /80

Section B: Learning Needs

Below standard On standard Excellent Mar Comments

k

Marks 0-4 5-7 8-10

1. Critique No critical Most negatives Excellent critique.
Reflection by comments. and positives Evidence of lateral
candidate on the Serious or obvious identified. Up to thinking or change of
care of the patient. errors not date protocols practice (show how
How could this identified used. Sense of self things can be done /10
patient have been awareness. better)
helped better?

2. Reflection & Disconnected Connected to Depth and

Introspection from patient’s patient’s comprehensive
Reflection mark will presentation. No presentation.
be awarded based self-awareness. Focused
on the candidate’s
ability to:
 Identify learning needs
and important
incidents regarding the
problem solving and
critical thinking
process. 0-8 10-14 16-20
 Identify learning needs
and important
incidents regarding the
individual, ethical and
professional issues.
 Self-awareness:
academic and social.
Deal with weaknesses
– self and others;
confront own
strengths, uncertainties /20
and weaknesses
 Understanding:
translate an experience
into learning
 Show change of
practice

3. Discussion of Inadequately Addressing the Wide range of

learning needs / identifies learning learning need. resources. Include
clinical subjects needs. Not Appropriate self and community
& Conclusion addressing the resources aspects
Plagiarism or Word- learning need. Exhibits clear
for-word content Lack of effort. understanding of
copying submitted Inappropriate identified learning
MUST result in a resources. needs /40
candidate receiving 16-21
zero for this section. 0-16
Evidence based 22-40
referencing
required.
Conclusion.
4. References No or little All relevant All relevant
information on information of information of each
the sources used each source source reported in
Inappropriate reported the correct
resources used Adequate and Vancouver format
Incorrect appropriate Min 8 references /10
referencing resources used
format used. Adequate format
Min 4 references Min 6 references

Section B Mark /80

 Section C: Pharmacotherapy Component

Criteria Possib Marks Comments

le
Points

1. The reasons (indications) and effectivity 10

of each medication prescribed.
Alternatives discussed.

2. The common adverse effects or possible 10

drug interactions that could be expected
from medications applicable. Critically
comment on the prescription.

3. Describe the education that you would 10

give to the patient regarding each of the
medicines prescribed.

4. References. 10

Section C Mark 40

Marks Allocated: Section A+B+C _________________________/200

Percentage:_________________/100

Global Feedback:

____________________________________________________________________________________
__________________________________________

____________________________________________________________________________________
__________________________________________

Evaluator (Supervisor): _______________________________________________________

Signature: ______________________________________
 Appendix 3: Discharge Summary OR Transfer Summary
Date of Admission:
Date of Discharge:
Admitting Diagnosis: This should be your working diagnosis at the time of admission (not the
chief complaint/presenting symptoms)
Discharge Diagnosis: Make sure this is a diagnosis and not a sign or symptom.
Secondary Diagnoses: Include all active medical problems regardless of whether or not they
were diagnosed this admission. (Active medical problems include any condition for which the
patient may be receiving treatment).

Procedures: List all the procedures with the date of occurrence and outcomes.
Consultations: List all consultations if relevant
History of Present Illness: Typically this is a brief snapshot of how they presented. A good way
to think about this is it is basically the same thing you would write as your 1 – 2 sentence
summary statement under the assessment before you go into more details of your thought
process, differential, and plan. It should include the relevant physical examination findings and
investigative data that prompted admission.

Hospital Course: This is the most difficult part to write as you need to balance appropriate
details with conciseness. A day-by-day account of the course is too detailed. For example,
instead of “he appeared to have pneumonia at the time of admission so we empirically covered
him for community-acquired pneumonia with ceftriaxone and azithromycin until day 2 when his
cultures grew S. pneumoniae that was Sensitive to all antibiotics commonly used for CAP so we
stopped the ceftriaxone and completed a 5 day course of azithromycin. But on day 4 he
developed diarrhea so we added flagyl to cover for C. difficile which did come back positive on
day 6 so he needs 3 more days of that......” this can be summarized more concisely as follows:
“Completed 5 day course of azithromycin for pan sensitive S. pneumoniae pneumonia
complicated by C. difficile colitis. Currently on day 7/10 of flagyl and C. difficile positive .”
Self-limited electrolyte abnormalities, minor medication adjustments, routine fluid administration
are too detailed. Focus on major interventions with the rationale, including all complications.
Condition: For discharges, this should always be stable
Disposition: This is where the patient is going (home, daughter’s house, etc,)
Discharge Medications: List all medications the patient needs to take at home including doses,
route, frequency, and date of last dose when applicable. Do not list all of the prn medications
you wrote for them in the hospital unless there is something they really need. If you have
changed any of the patient’s admission medications this should be noted along with the
rationale.

Discharge Instructions: Be specific about activity level, diet, wound care, symptoms and signs
to report or seek care for. Try to anticipate specific needs related to your patient’s problems.
This is also another good place to include statements like “patient counselled to avoid all
tobacco and alcohol products”.

Follow up: Name of clinic/doctor/hospital, location, date and time. If the patient is to schedule
the appointment, make sure you include the time frame by which the patient should schedule
the appointment.

C. Self-Reflection - Dip Allerg (SA)

Background

Self-reflection allows us to examine our own professional practice and clinical actions, and compare
them with current best-practice recommendations or standards.Self-reflection and a sense of inquiry
can also be beneficial as you develop your short- and long-term educational goals.One of the
mechanisms in achieving good reflective outcomes is the use of the Gibbs Reflective cycle model

The process is essentially a cycle or loop, containing the following six elements:

• Description: This element requires a factual description of the learning activity . At this stage, no
conclusion is drawn, the focus is on the information; that too which is relevant. Some prompt questions
are: What happened? How did it happen? Where? When? Who else was there? Did someone react?
How did they react? Why were you there? What did you do? What happened at the end? This builds up
the background and a better understanding of the activity

• Feelings: Here any emotion felt during the activity is discussed. Questions like, what did you feel
before the activity? During it? After it was all over? What do you think other people felt? What do you
feel about the activity now?

• Evaluation: Objectively evaluate the situation. What went well? What did not? What were the
negatives and the positives of the activity? How did you and the others contribute to it (positively or
negatively)?.
• Analysis: Think about what might have hindered or helped the situation. This part can be
improved by reference to a literary article or a previous experience if needed. Link the theory and
experience together.

• Conclusion: Consider what did you learn from the activity. What else could you have done in
that situation? What skills will help you cope with it better next time? How differently would you react if
you face a similar situation again? If the outcomes were negative, how would you avoid that? If the
outcomes were positive, how could you improve it for yourself and everyone else.

• Action Plan: This area deals with the plan of how to effectively handle and improve the activity
next time. Any training, skill, or habit that can equip you with handling the situation better if it occurs
again? Is there something more to be learned for a better outcome? Work out the areas that need work
and thrive to improve in them.

As part of Dip Allerg (SA) we ask that you:

1. Write a general essay of 500 words on your reflections of your engagement with the subject
matter of the Diploma.

2. Reflect on 3 cases specifically. Guidelines for this question are given below.

Clinical Question Analysis (guide for Question 2)

This sheet should be with you during your practice and act as a guide to ask questions in a moment of
reflection alone after the patient consultation. It can also be used to reflect on other challenges or
situations that arise in clinical practice.

a. The Situation and/or Patient Actually Met Needs (PAN) at time of consultation
.......................................................................................................................................
.......................................................................................................................................
.......................................................................................................................................
b. The Situational Difficulty and/or Patient Unmet Need (PUN) (on Reflection)
.......................................................................................................................................
.......................................................................................................................................
.......................................................................................................................................
c. MY Problem, difficulty, questions or observations (including my emotional reactions on reflection)
....................................................................................................................................... ................................
....................................................................................................... ................................................................
.......................................................................

d. MY (Doctor) Educational Need (DEN) (Which aspects of this encounter or situation do I need to find
out more about to improve?)
.......................................................................................................................................
.......................................................................................................................................
.......................................................................................................................................

e. How did I close the learning loop i.e. what did I do in my practice differently or implement what I
learnt?
..........................................................................................................................................
........................................................................................................................................................................
.................................................................................................................

D. Learning Plan

Preparing a Learning Plan for the Postgraduate Diploma in Allergology of the College of Family
Medicine of South Africa.

You must meet with your local supervisor at the beginning and end of every clinical allocation, or as
arranged between you and your supervisor to review your learning plan as required.

With your logbook at hand, list the learning objectives you have set for yourself for the duration of any
given allocated period. These should be updated as your allocation progresses.

On completion of the allocation, you must reflect on the progress you made in meeting your objectives
and identify areas in which further learning is needed.

Some tools are useful to help you reflect, e.g. the Case-based discussion, Chart stimulated recall, and
Clinical question analysis tools.

Note that this is not an assessment by the supervisor of the student’s work during the allocation. It is an
exploration of the student’s insight into the learning appropriate to that allocation and the extent to
which it has been achieved.

The Learning Plan includes the following objectives:

- Identification of prior learning

- Identification of current learning needs (objectives)

- Planning of activities to meet these needs

- Timelines and support required to enable these activities

- How learning will be evaluated (with the suggested tools)

You need to be able to adjust your learning plan with each allocation and as you progress in the
programme to develop the skill of lifelong learning and personal growth. Learning is best when it is
learner-centered and very individual!

You need to keep in mind:

1. The CMSA training outcomes for Diploma in Allergology.

2. The CMSA Diploma in allergology curriculum and its outcomes.

3. Your personal learning needs.

4. The relation of your planned allocations with the health service platform.

When you develop your learning plan you need to simultaneously consider what you will be doing in
your academic programme (e.g., assignments), what practical experience you will be receiving in your
clinical setting (e.g., your allocations), what your personal learning needs are, and what the health issues
with respect to allergic conditions in the local community are. Ultimately all of this must contribute
towards achieving the outcomes of the programme, your own personal growth, and improving the
health of people in families in the local community.

Some tips to help you write your learning plan:

1. Use the CMSA postgraduate diploma in allergology outcomes as framework.

2. Read your local (Sub) District Health plan, to align your learning plan.

3. Look at your progress overall - you should get to everything over the allocated period.

4. Have at least 2 learning plans at any given period according to your immediate allocation.

5. Be SMART, flexible, and adapt your learning to the working environment.

6. Discuss your draft learning plan with your supervisor and the clinical manager.

7. Regularly revisit and update your plan with your supervisor - Contract to meet at least twice to
review the plan at a fixed time and day of the week.

8. Consider the local team - make visible your plan within the team.

9. Ensure your plan is graded and revisit it together with your reflections and supervisor report,
before you draw up your next plan.

10. Transfer your unmet learning needs from the previous allocated time to your first learning plan
in the following allocated time.

The discussions you have with your local supervisor or mentor and the feedback you get are of much
greater value than simply a grade.

Please ensure that your supervisor has assessed and signed every learning plan.

Acknowledgement of source:

College of Family Medicine of South Africa , Residency training program.

 LOGBOOK FOR DIP ALLERG (SA)
TOTAL POINTS = 300

NAME:………………………………………………………………………........................………………..

ADDRESS:…………………………………………………………………………………….......................

…………………………………………………………………………………………………........................

TEL NO: WORK:……………………………………TEL NO: HOME:..………………….........................

HPCSA REG NO:……………………………………………………………………………........................

GENERAL PRACTITIONER / FAMILY PRACTITIONER / PAEDIATRICIAN / OTHER SPECIALIST (please

indicate)........................................................................................................................................
 A. PRACTICAL TRAINING (Minimum 100 points, maximum 150
points)

Record supervised training at a College-accredited unit or practice. A minimum of 100

points is required at 5 points per hour. The maximum amount of points that may be
claimed is 150. Unsupervised training may be claimed by affidavit at 1 point per hour up
to a maximum of 50 points.

ADDITIONAL REQUIREMENTS DURING PRACTICAL TRAINING (50 points) 10 lung

functions (spirometry) observed and interpreted; 5 skin prick tests (SPT) observed; 5 SPT
done and interpreted; 4 subcutaneous immunotherapy observed; 1 subcutaneous
immunotherapy administered; 5 teaching of spacer technique demonstrated; 5
performance of peak flow tests; 5 demonstration of epipen ® training; 5 food challenges
observed; 2 food challenged performed; 2 wet wraps observed / administered; 1
sublingual immunotherapy observed / administered. 1 Point per procedure.

SUPERVISED CLINICAL TRAINING

SUPERVISOR
INSTITUTION DATE NO POIN CANDIDATE
SIGNATURE
HOU TS SIGNATURE/
RS NAME
SUB TOTAL

UNSUPERVISED PRACTICAL EXPERIENCE (Cross out unutilised rows)

DATE PLACE HOURS SIGNATURE
 SUB TOTAL

AFFIDAVIT

I …………………………………………………. of …………………...........……………….....

(residential address) ………………………………………………………………….........................…………………

……………………………………………….........................………………………………………………………………

declare that the details entered in “Unsupervised Practical Experience” above are true and accurate.

…..…………………………………… (signature)…………………………………….(place) ………………(date)

LUNG FUNCTION TESTING

NO INSTITUTION DATE SUPERVISOR CANDIDATE SIGNATURE

SIGNATURE/NAME

6
7

10

SKIN PRICK TESTING OBSERVED

NO INSTITUTION DATE SUPERVISOR CANDIDATE SIGNATURE

SIGNATURE/NAME

SKIN PRICK TESTING PERFORMED

NO INSTITUTION DATE SUPERVISOR CANDIDATE SIGNATURE

SIGNATURE/NAME

SUBCUTANEOUS IMMUNOTHERAPY OBSERVED

NO INSTITUTION TYPE DATE SUPERVISOR CANDIDATE
SIGNATURE
 SIGNATURE/NAME

SUBCUTANEOUS IMMUNOTHERAPY ADMINISTERED

NO INSTITUTION TYPE DATE SUPERVISOR CANDIDATE
SIGNATURE
SIGNATURE/NAME

SPACER TECHNIQUE
NO INSTITUTION DATE SUPERVISOR CANDIDATE SIGNATURE

SIGNATURE/NAME

PEAK FLOW TESTS

NO INSTITUTION DATE SUPERVISOR CANDIDATE SIGNATURE

SIGNATURE/NAME
1

EPIPEN ® TRAINING
NO INSTITUTION TYPE DATE SUPERVISOR CANDIDATE
SIGNATURE
SIGNATURE/NAME

ORAL FOOD CHALLENGES OBSERVED

NO INSTITUTION DATE SUPERVISOR CANDIDATE SIGNATURE

SIGNATURE/NAME

ORAL FOOD CHALLENGES PERFORMED

NO INSTITUTION DATE SUPERVISOR CANDIDATE SIGNATURE

SIGNATURE/NAME
1

WET WRAPPING
NO INSTITUTION DATE SUPERVISOR CANDIDATE SIGNATURE

SIGNATURE/NAME

SUBLINGUAL IMMUNOTHERAPY
NO INSTITUTION TYPE DATE SUPERVISOR CANDIDATE
SIGNATURE
SIGNATURE/NAME

1
B. THEORETICAL EDUCATION / TRAINING (Minimum 100 points) (20 hours)

Congresses, postgraduate courses, CME meetings, journal club attendance: 5 points per
hour.
Presentations at congresses and writing journal articles: 20 points per presentation or
article.
TYPE OF DATE PLACE ORGANISING NAME & SIGNATURE HOURS CREDITS
ACTIVITY BODY OF REPRESENTATIVE OF
ORGANISING BODY

SUB-
TOTA
L

TOTAL
A+B