MSc Clinical Medicine: Clinical Practice in Action Portfolio 2021

This portfolio documents a student's learning experience during cardiology and stroke placements within the NHS, as part of an MSc in Clinical Medicine. It includes reflections on initial expectations, daily observations in various departments like cardiology, radiology, and stroke units, and a final review comparing healthcare practices with those in Pakistan. The portfolio further explores teamwork, identifying strengths and weaknesses in communication, confidentiality, and resource availability. The student reflects on the advanced medical equipment, organized systems, and emphasis on hygiene within the NHS, contrasting it with the challenges faced in their home country's healthcare system. The experience enhanced the student's clinical knowledge, improved reflexes in emergency situations, and reinforced the importance of internationally guided medical practices.

MSc. Clinical Medicine
Clinical Practice in Action Module
Semester A 2021/22
Portfolio of learning
Cardiology and Stroke Placements
Student Name:
Student number:
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This portfolio of learning is the assessment for Clinical Practice in Action Module
7LM0156 It is divided into four parts:
Part 1: Reflection on Practice
During your time on placement you are required to keep a reflective diary. This should
consist of the following:
1.1. An Initial Statement: This should contain your concerns and expectations before the
start of the placement, includes targets for learning whilst on this placement; what do
you hope to experience and learn? (200 words)
Being a medical practitioner in Pakistan I have faced the patients suffering in cardiac illness or brain
stroke and i have learned from my seniors how to investigate and make an effective management
plan which is internationally guided but due to lack of medical facilities really could not have a
chance to learn the real internationally guided investigative or management plans.
By having a chance to study in the world’s best healthcare sector and work with NHS doctors I am
expecting to learn the professional doctor patient history taking plans ,how the doctors at outdoor
patient department interact with patients, an ideal way to approach the medical conditions and
conclude them in a short list, to improve my reflexes to life threatening medical emergencies,
enhance my examination taking skills, get familiar with the advance investigative procedures and go
through from the internationally guided management plans practically.
I am aiming to observe how the care team in the UK interact with each in order to provide the best
healthcare services to their patients.
Furthermore I am targeting to develop a clinical knowledge from the UK healthcare sector which
makes me understand the factors affecting clinical management of patients and amplify them in my
country’ healthcare system.
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1.2 Learning Log: You are required to record key aspects of your observational
placement experience. It is not necessary to describe what you did every minute of
each day. A brief description of your experience & first thoughts. DO NOT mention
any hospitals or clinics, staff or patients by name (confidentiality must be maintained at
all times)
Learning Log Details
Day 1 The day commenced with a morning ward round which was led by the
consultant. The unit was divided into three bays Purple, Green, and Yellow bay.
The consultant and the medicos' team went to visually perceive each patient
piecemeal. Asked about the presented complaints and discussed the further
management plans. In the afternoon I peregrinated to an outpatient clinic
where the patient came for a customary check-up the health system was very
advanced as the doctor was facilely able to access their all medical history by
utilizing their NHS number.
Day 2
It was the day when I was conclusively able to optically canvass the
procedures. I found myself fortuitous as there was a defibrillator
implantation procedure was appointed. The surgeon was very kind and
auxiliary because she invited me into the operation theatre. The procedure
last for three hours. In the afternoon I went to the pacing clinic where the
patients who were on ICD came for conventional check-up to visually
perceive if the pacemakers are working congruously or if the pacemaker
had detected any aberrant cardiac activity.
Day 3
The third day of my placement was spent in the radiology department where
I had a chance to get habituated with updated CT and MRI machines.
Came to magnetize with the system how it works at the reporting station.
Moreover, the consultant radiologist discussed with me the possible findings
and edified me how to report. In the afternoon I went to the stroke
department where the medicos on obligation welcomed me and availed me
to study the cases.
Day 4
An incipient day in the ward of stroke commenced with a morning round
where I and other doctors in the presence of consultant went to take a
history, examination of the patients suffering in ischemic or haemorrhagic
strokes. That was the time when I got exposure to the presenting complaint
which I just had read in the books. After the morning round the further
management plan was been discussed and followed by junior medicos. In
the afternoon I peregrinated to a stroke clinic where a patient with a history
of TIA was visited.
Day 5
After the morning round the consultant edified me and other medicos how to
make a diagnose utilizing the CT or MRI scans and discussed the peril
factors in detail that caused the patient's stroke.
Later on, I went to ER room with one of the doctors observed quick
examination taking method and how the patient is shifted to the ward for
further management withal had a chance to learn emergency treatment
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1. Final Review after the placement:
Record your overall thoughts about this placement and any differences between
organisation of care and patient services in the country where you practice and the
NHS.
Take into account the whole placement and the outcomes you wanted to achieve. (word
limit 500 words)
It was an indeed informative incentivized and adroit clinical placement that I ever had.
the staff was proved plenarily cooperative amicable and auxiliary. there was no
superiority and inferiority intricate among senior and junior doctors. This is what I
suffered in my country’s health system during my practice. There was a great example
of teamwork in order to provide the best healthcare to the patients. The hospital was
plenary of advanced medical equipment’s and highly adroit people were appointed to
control them. The professionalism was at its peak. There was none there to make me
feel mortified if I made any mistakes at the moment I was queried like the seniors
proved themselves as they were genuinely there to avail me. This posture enhanced
my confidence and I was so relaxed to ask any questions from the other medicos even
from the consultants The wards were so cleaned and hygiene was always the top
priority, which was minimizing the jeopardy of hospital-acquired infections.
The fundamental protective products such as gloves masks personal protective
equipment were facilely assessable which was minimizing the chances of needle prick
injuries The chances of making mistakes were very less as everyone was plenarily
responsible for the tasks they were assigned to do. Everything was well-mannered and
organized. The staff was highly active to provide the best care to their patients. The
investigative and management guidelines were felicitously followed. Everything there
was computerized. The patient’s folder was well organized and their privacy wasn’t
compromised.
Another thing that inspired me a lot as each NHS staff was uniformed congruously and
they were always wearing their ID cards to access any room they needed to visit. their
ID checks genuinely were a barrier for unauthorized people. On the other hand, in my
country where the unauthorized people can even facilely access any restricted areas
which are I feel is a solemn threat to any patient's health.
Belonging from a developing country caused me not to get habituated with advanced
and updated medical or surgical equipment due to the low medical budgets hospitals
aren’t taken care of felicitously. The patient’s files and folders are not well secured and
even in the wards, the caliber of hygiene is very low. The history-taking investigative
and management plans weren’t followed in accordance with the internationally guided
principles.
By granting a chance for this placement availed me in reviewing all the internationally
guiding principles which I studied in theories came virtually in my life and availed me to
memorize them. Optical discernment in the ER room enhanced my reflexes toward life-
threatening cardiac or stroke conditions I am now able to agnize the designation and
symptoms and can react felicitously in order to provide the best possible immediate
treatment to the patient to bring his life out of hazard as I visually perceived during my
clinical placement when the NHS medicos reacted when somebody brought to ER room
for treatment.
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Part 2:
Students are expected to undertake an:
2. Exploration of team work: observed during clinical placement. This might be
multidisciplinary teamworking, inter-professional team working or both. (1000w)
2.1. Identify the area(s) of team working you wish to explore and state why, giving some
observed examples?
During placement within cardiology department, I have observed that there are many
patients with having case of heart failure. In this, to tackle all the patient and to provide them there
is need for team working to deliver quality healthcare services. Teamwork techniques are generally
employed across all the organizations but it is quite specific in the care organization when the life of
the patients as well as their well-being are at stake. Every care provider on the care professional
team can specifically bring along with them several experiences as well as the skills which can
further results in the better outcomes of the patient’s health (Ahmad, Khalily and Hallahan, 2017).
the advantage of the teamwork in the care organization are generally undeniable and vast as well.
It is quite important for a care organization to have an effective team work (Anjum and Ming,
2018). In this, the areas of team working which has been identified here is the lack of
confidentiality, lack of well qualified equipment’s. in this it also includes the lack of effective
communication among the care professionals, lack of maintenance of records, lack of proper sanity
or hygiene, lack of an effective clinical management and many more. It is quite important in a care
organization to have all these things as it can directly impact on the well-being of the patients to
provide them a better treatment. In context with the confidentiality, it is quite crucial for building
the trust among the patients as well as the care professionals. The patients are more likely to
disclose their private information regarding their health if they fully trust their care professionals or
the nurses.
In this, the trust based relationship among the patients and care professionals can
ultimately lead towards an effective interaction as well as the elevated quality visits regarding the
health conditions. This particular confidentiality is not present or followed in the care organization
of Pakistan and this is highly recommended to the care organization to strictly adhere the such
rules so that the trust among the patients with their care professionals will remains increased. In
contrast with effective communication, it is also an important point or component in a care
organization to have an effective communication with the patients and the team workers. I have
observed that there is lack of communication that can lead to create quality healthcare services
delivery to patient and impact their health. Lack of an effective communication can directly impact
on the health of the patients and its decreased well-being outcome. An effective communication
among the co-workers or the care providers can effectively work on the treatment towards the
outcomes of the patients. Here, it is lack in the care organization as the care providers did not
communicate well with each other. This can result in providing the double dose of medications or
not providing the proper treatment to the patients which can further results in decrease the
outcomes of the patient’s health. Having a well-qualified equipment’s are quite necessary in a care
organization as it an effectively save the lives of the patients. The equipment’s such as highly
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qualified electronic machines or any other machinery which is specifically used to treat the serious
illness. The care organization of the Pakistan is totally lack in having the highly qualified
equipment’s. in this, if the confidentiality ruptures or breached then the patient will be reluctant to
divulge the data and therefore the care of the patients may be affected by this (Anjum and Ming,
2018).
2.2. Identify the strengths and weakness of your chosen areas of team working.
Effective communication is needed to deliver quality services and health care treatment to patient
with heart failure. In this, information should be shared with each other through effective
communication. The weakness of the team working care organization is that they have lack of
patient’s confidentiality, they did not contain an effective communication skill. The Multidisciplinary
teamwork on the failure of heart can rationally as well as effectively integrate the medical
resources as well as provide the full play to the benefits of various professional staff. This can also
enhances the treatment effects of a particular illness, the quality of medical services as well as the
satisfaction of the patients. The weakness also includes that the care organization also lack the well
qualified equipment’s. The care organization did not effectively manage the health of the patients
as they have poor sanitization or hygiene which can also make effect over the health of the
patients. The care organization of Pakistan generally lack in concentrating on the safety of the
patients. While considering the necessity of having a communication in the care organization, the
safety of the patients is one of the top priority to create an effective communication structure
among the care organization. An inadequate communication is often an elevated cause of deaths in
the care organizations. With the help of communication in a care organization, the care
professionals can effectively discuss a particular case with the other care providers so that they can
provide the best care to reduce their illness. All these such things are lack in the care organization
of Pakistan. They have to work on these particular things so that they can provide an effective care
towards their patients (Bashir, 2018).
In this, another weakness of the care organization here includes is having lack of the
medical instruments or equipment as these are quite essential to diagnose, prevent as well as treat
a particular illness in a very safe and effective manner as well. Having the lack of such equipment’s
can potentially impact over the access to medical services in a healthcare. The potential well-being
effects of the low well-being care access can involve the low management of the chronic illness. It
can also involve the elevated burden due to the very preventable illness and its disability and the
premature death of the patients as well. The strengths of the chosen area of the team working
includes that having a restriction over the confidentiality regarding the patients records or
information is quite taken in a positive way. In this, it is quite essential and can build a trust as well
that the patients information is not being shared with anyone other than patients. The confidential
information of the patients generally includes the medical records, their current illness, their
ongoing treatment, the visual recordings and so on. Furthermore, confidentiality is one of the most
shared risk factor in the care organizations or any other organizations. In context with effective
communication, sometimes in the care organization having an effective communication can also
lead to negative acknowledgement. Not always the good communications be much enough to
make others be heard. The surrounding circumstances can influence all this process in other ways
which directly impact the well-being of the patients.
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Part 3: Critical Review
3.1. Retrospective Review: You are required to undertake a reflective analysis of an
observed patient consultation during your placement. This review should consider
what could be learnt from this patient interaction and how it could be applied in your
own workplace. (Total this section ; 1000w)
You may wish to discuss with placement staff or academic staff several patient
interactions so that you make an informed choice.
3.1. 1. Describe the patient interaction and why it was important to you?
During taking consideration of patient needs I have consulted with patient who are in the
cardiology unit. Where I have interacted with the patient and get better communication for the
effective service delivery. Here, patient has explained his issues and healthcare needs which is
regarding treatment and recovery process. Here, it is important that can help to communicate the
healthcare needs and ensure about getting recover. The patient-centred interaction generally
supports the patients to enlarge their roles in making the decisions. The interactions can also aid
the patients to expand their role in modifications in the health related behaviours as well as its self-
management. The patients centred practices particularly respects the preferences as well as the
values of the patients and this is generally reflected in the way in which the practice has been
designed. It is quite crucial to interact with the patients with the help of an effective
communication. An effective communication among the care professionals and the patients can
effectively aid the patients to attain the high quality care services. During the ward round with a
care professional in the specific cardiology department, I saw a 39 year female patients who are
generally admitted to A to E due to atrial fibrillation and being transferred to the ward. She was
particularly diagnosed with this particular issue ten year ago. In this, according to the condition of
the patients, the healthcare professionals recommended the ill people to perform the computed
tomography angiogram next Monday to check the situations of the of the coronary arteries. Then
the ill people generally asked for the opinion and he generally express the resistance to the CT scan
as well as showed her desires towards be discharged directly. In this the attitudes of both the care
professionals or the patients are quite essential. Having a positive interaction among them can aid
to build a relationship, can establish the trust as well as can encourage the exchange of accurate as
well as the relevant data or information. In this, an effective communication among the care
professionals as well as the patients is generally a central clinical function and the resultant of such
communication is the heart and an art of the medicines. It is also a central component while
delivering the health care to the patients. It can involve the very three main objectives of the
patient and care professional communication that creates some good interpersonal relationships,
and can facilitating the exchange of information’s and including the patients in making decisions
(Compton-Phillips and Mohta, 2019).
3.1. 2. What have you learnt from this experience?
I have some experience about the effective communication which is necessary for
cardiology related service delivery. Effective communication can allow to sharing of information for
achieving better health. In this, it has been learned that there is need to implement effective
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equipment and should arrange the management which can be more effective and allow to get
better deal with patient health. There is also need to get sure about the confidentiality of patient
and should ensure about the proper maintaining about the patient health recorded. It is also need
to ensure that it is effective to get the patient consent regarding any treatment. It has also learned
how to manage the healthcare premises that can help to get better interaction with patient for
their better delivery of healthcare services. The care professionals as well as the patients must
communicate with each other so that they can reach a consensus instead of a relationship of
command as well as obedience. It has been learned that what is the benefits of getting proper
management and proper security that can have high impact on the safety and security of patient
health and there confidentially. It has been learned that with maintaining proper sensitisation and
cleanliness, patient care can be managing more effective to avoid any risk of contamination of
disease that can may cause due to infection and dirt. I have also learned that how to manage
difficult situation and to deal with other healthcare professional to deliver quality care to patient.
Here, it also helps to learn about partnership working with other healthcare service provider that
can help to get better interaction and take care of patient better health. With proper guidance
allow to learn different learning which can be applied to improve the service quality of healthcare
within premises (Dahm and Yates, 2020).
3.1.3. How could this learning be applied to your own workplace setting? Consider do you face
similar issues or are they different, please explain why?
As a healthcare student in need to ensure about the precious experience that can help to
apply in future. These learning are effective and can be applied effectively but due to lack of proper
funding and individual behaviour can create difficulty in applying these learning within own
workplace. In this, one of the main issues is approval of resources, then arrangement of proper
funding and then providing appropriate training to healthcare professional to use those equipment
and resource to deliver quality service to patient for their improved health and to improve the
quality of healthcare services. There can be different issues which are like risk of privacy bleach,
unauthorised entry of people and not proper management and effective equipment are some of
the issues within the workplace which should be taken care after improving and applying the
learning within workplace. I should maintain a very positive attitude, as well as listen patiently
towards the demand of the patients and can analyse the disadvantages and the advantages one by
one. This need to take some time and managing effectively through communication with the higher
authority that can apply the effectiveness and help to get proper and effective management. Due to
proper funding within NHS, there is taken care of each and every equipment and management
which needs funding for their maintenance. Whereas, in Pakistan, it is not possible to apply those
application and learning due to poor management system and less funding. It is difficult to apply
those learning in area of getting resources which are higher level in the NHS but are not possible to
get there in the Pakistan healthcare premises (Dreger and Bains, 2020).
3.1. 4. Consider the wider implications for practice and organization of specialist services and
make firm recommendations to improve this.
In this, through making management system more effective, there is need to first arrange
some meeting where learning can be shared with the higher authority and higher management that
can help to adopt and approve the changes within system. In there, there is need to make some
presentation with communicating effectively. It need to ensure that they should take action and
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allow to apply the change within workplace. This can be helpful and allow to get better
management for providing better facilities within organization. Through arranging meeting and
providing ideas about the implication for specialist services, there is need to ensure that they
should be effective and possible to implement for the better outcomes. They should improve the
quality of services over time. To improving service quality, it is recommended that there is also
need to implement some changes that can be effective and allow to get better interaction with
other to provide improvement within healthcare setting and management system. There is also
need to take care about the restriction for unnecessary access or involvement of person within
restricted area or surgical area. It is also recommended to take care about the patient
confidentiality that should not be breached for any cause and take care of patient safety while
delivering treatment and care services. There is recommended to ensure about the implication of
updates technology which can be effective to deal with better outcomes in treatment and other
healthcare services. Through this, workplace can improve themselves in delivery of quality services
to their patient. This is effective and allow them to get better impact on treatment and care
services. It also saves time with better outcomes (Gondal and Shaukat, 2020).
Part 4:
Please write a critical review using the following questions as triggers: (2300 words).
You are expected to critically reflect on differences / similarities between clinical
practice in your placement and clinical practice in your own working environment
1. What were the key factors influencing clinical decision making in your observed
placement?
It has been observed in the placement which may include different key factor for the decision
making. There is various key factor which can influence the clinical decision making within
workplace or care setting in comparison to the observed placement. The CDM is specifically a
process of choosing among the options in an action plan. The plan can be fast, intuitive, evidence
based as well as analytical. In this, some of the key factors are highly important and have high
impact during making decision within clinical practices. There are some of the key factors are going
to be discussed further.
Working environment- There is high difference in the working environment in the Pakistan
and NHS. Within NHS, there is better environment within healthcare. In this, there is main role of
management which is effective and allow to operate the decision making more smoothly due to its
operations. There is better guidance of healthcare professional who are experienced, they help
other to perform well and shore their experience that can allow to get better deal with the
situation for improved care services. In workplace, there is not good working environment which
can have impact on the working environment and impact the clinical decision making (Lynch, 2018).
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