CLINICAL ASSESSMENT (CA) - Revision history

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Patient’s history

Coecsa: /* Patient’s history Study Guide */

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Patient’s history Study Guide

Coecsa: /* Patient’s history */

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Patient’s history

Coecsa: /* Patient’s history */

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Patient’s history

Coecsa: /* IOP measurement using various tonometers */

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IOP measurement using various tonometers

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Coecsa: /* Vision assessment STUDY GUIDE */

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Vision assessment STUDY GUIDE

Coecsa: Created page with "==== Patient’s history ==== ===== Learning outcome OVERVIEW ===== {| class="wikitable" | colspan="2" |'''CLINICAL ASSESSMENT''' |- |'''Learning Outcome''' |'''Patient’s..."

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Created page with "==== Patient’s history ==== ===== Learning outcome OVERVIEW ===== {| class="wikitable" | colspan="2" |'''CLINICAL ASSESSMENT''' |- |'''Learning Outcome''' |'''Patient’s..."

New page

==== Patient’s history ====

===== Learning outcome OVERVIEW =====
{| class="wikitable"
| colspan="2" |'''CLINICAL ASSESSMENT'''
|-
|'''Learning Outcome'''
|'''Patient’s history'''
|-
|Code
|CA1
|-
|Description
|Trainees must be able to gather focussed information from patients or patient caretaker in an organised way and document the clinical situation based on the individual patient’s needs.
|-
|Assessment
|'''CRS1,portfolio/logbook and end of year review/ COECSA exams'''
|-
|Target Year of Achievement
|Year 1 and 2
|-
|Related Learning Outcomes
|CA1-CA12
|-
|Other Links
|Study Guide - 3.2.1.2 below
|}

===== Patient’s history Study Guide =====
'''Think:'''

· Many of your communication skills will have been acquired in your foundation training. How do these skills apply to an ophthalmic patient?

· How should I proceed when there is conflict between the history from the patient and that from relatives and careers?

· In what situations may it be helpful to revisit the history with the patient?

· What aids to history-taking can be used? (e.g. Questionnaires etc.?)

· How can I be sure that I have accurately identified the patient's concerns?

'''Activity:'''

· Observe senior colleagues and ask them to observe you

· With the patient's consent, video-record your consultation and discuss your performance with your trainer

'''Resources:'''

· Fred Wilson. Practical Ophthalmology; A Manual for Beginning Residents. 5th Edition. San Francisco. American Academy of Ophthalmology. 2005

'''Self Assessment:'''

· Clinical Rating Form. Ask a colleague to observe your technique, complete a clinical rating form and give you feedback

==== Vision assessment ====

===== Learning outcome OVERVIEW =====
{| class="wikitable"
| colspan="2" |'''CLINICAL ASSESSMENT'''
|-
|'''Learning Outcome'''
|'''Vision assessment'''
|-
|Code
|CA2
|-
|Description
|Trainees must be able: To assess visual acuity for both distance and near; to assess and interpret colour vision; to know the principles of contrast sensitivity assessment; to assess visual acuity in children and adults with barriers to communication; to assess vision outside the OPD environment and to perform and interpret confrontation visual fields.
|-
|Assessment
|'''CRS2, portfolio/logbook and end of year review/ COECSA exams'''
|-
|Target Year of Achievement
|Year 1 – 2
|-
|Related Learning Outcomes
|CA1-CA12
|-
|Other Links
|Study Guide 3.2.2.2 below
|}

===== Vision assessment STUDY GUIDE =====
'''Think:'''

· What is meant by 'visual acuity'?

· What are the various related tests done in assessment of vision?

· How do you assess vision in children or people with learning or communication difficulties?

· How do you assess vision away from the eye clinic?

· How can colour vision be assessed?

· When is it appropriate to test colour vision?

· Which test is best used for the different causes of impaired colour vision?

'''Knowledge:'''

· Understanding the underlying principles, benefits and pitfalls of visual acuity assessment methods including Snellen, logMAR Sheridan-Gardner etc.

'''Activity:'''

• Ask your orthoptist if you can participate in an orthoptist clinic assessing children’s vision

'''Resources:'''

• Fred Wilson. Practical Ophthalmology; A Manual for Beginning Residents. 5th Edition. San Francisco. American Academy of Ophthalmology. 2005

3.2.3 External eye examination

3.2.3.1 Learning outcome OVERVIEW
{| class="wikitable"
| colspan="2" |'''CLINICAL ASSESSMENT'''
|-
|'''Learning Outcome'''
|'''External eye examination'''
|-
|Code
|CA3
|-
|Description
|Trainees must be able to perform an examination of the external eye – (sclera & cornea), ocular adnexae, eyelids, and orbits and face using appropriate equipment/instruments. They must be able to carry out further examination utilizing other techniques as indicated.
|-
|Assessment
|'''CRS3, portfolio/logbook and end of year review/ COECSA exams'''
|-
|Target Year of Achievement
|Year 1 – 2
|-
|Related Learning Outcomes
|CA1-CA12
|-
|Other Links
|Study Guide -3.2.3.2 below
|}
3.2.3.2 external eye examination STUDY GUIDE

'''Resources:'''

·Fred Wilson. Practical Ophthalmology; A Manual for Beginning Residents. 5th Edition. San Francisco. American Academy of Ophthalmology. 2005

'''Self Assessment:'''

·Clinical Rating Form. Ask a colleague to observe your technique, complete a clinical rating form and give you feedback.

3.2.4 PUPIL EXAMINATION

3.2.4.1 LEARNING outcome OVERVIEW
{| class="wikitable"
| colspan="2" |'''CLINICAL ASSESSMENT'''
|-
|'''Learning Outcome'''
|'''Examine the pupil and perform appropriate diagnostic pharmacological tests'''
|-
|Code
|CA4
|-
|Description
|Trainees must be able to assess the pupil for abnormalities of shape, size and reactions and interpret their findings. They must know how to perform and interpret appropriate pharmacological tests for specific pupil abnormalities.
|-
|Assessment
|'''CRS4, portfolio/logbook and end of year review/ COECSA exams'''
|-
|Target Year of Achievement
|Year 1 – 2
|-
|Related Learning Outcomes
|CA1-CA12
|-
|Other Links
|Study Guide -3.2.4.2 below
|}
3.2.4.2 Examination of the pupils and perform diagnostic pharmacological tests STUDY GUIDE

'''Think:'''

·What are the pupillary pathways?

·What does a normal pupil look like?

·What are the causes of an abnormal pupil?

'''Resources:'''

·Kline LB, Bajandas FJ. The Pupil. ''Neuro-ophthalmology Review Manual. 5th ed. 2004''

·American Academy of Ophthalmology. Pupil. ''Neuro-ophthalmology. 1997.''

·Fred Wilson. Practical Ophthalmology; A Manual for Beginning Residents. 5th Edition. San Francisco. American Academy of Ophthalmology. 2005.

'''Self Assessment:'''

·Clinical Rating Form. Ask a colleague to observe your technique, complete a clinical rating form and give you feedback

3.2.5 Ocular Motility

3.2.5.1 Learning outcome OVERVIEW
{| class="wikitable"
| colspan="2" |'''CLINICAL ASSESSMENT'''
|-
|'''Learning Outcome'''
|

'''Ocular Motility'''
|-
|Code
|CA5
|-
|Description
|Trainees must be able: to perform and interpret cover tests; to assess and interpret ocular movements; to perform prism cover tests and to describe nystagmus if present.
|-
|Assessment
|'''CRS5, portfolio/logbook and end of year review/ COECSA exams'''
|-
|Target Year of Achievement
|Year 1 – 2
|-
|Related Learning Outcomes
|CA1-CA12
|-
|Other Links
|Study Guide -3.2.5.2 below
|}
Perform a cover test and assess ocular motility STUDY GUIDE

'''Think:'''

·What are the actions of the extraocular muscles?

·This is an examination technique that requires a lot of practice

·What are the implications of the different types of nystagmus?

'''Activity:'''

·Spend time with your orthoptist and ask to participate in their clinics or the strabismus clinics.

'''Resources:'''

·Rowe F. ''Clinical Orthoptics. Blackwell; 2004.''

·MacEwen CJ, Gregson RMC. ''Manual of Strabismus Surgery. 1st ed. Butterworth Heinemann; 2001.''

·''<nowiki>http://www.mrcophth.com/videosonclinicalexamination</nowiki>''

·Fred Wilson. Practical Ophthalmology; A Manual for Beginning Residents. 5th Edition. San Francisco. American Academy of Ophthalmology. 2005

'''Self Assessment:'''

·Clinical Rating Form. Ask a colleague to observe your technique, complete a clinical rating form and give you feedback.

3.2.6 IOP measurement using various tonometers

3.2.6.1 Learning outcome OVERVIEW
{| class="wikitable"
| colspan="2" |'''CLINICAL ASSESSMENT'''
|-
|'''Learning Outcome'''
|'''IOP measurement using various Tonometers'''
|-
|Code
|CA6
|-
|Description
|Trainees must be able to measure IOP accurately using a variety of tonometers and understand the limitations of each. They must be able to check the calibration of the tonometer.
|-
|Assessment
|'''CRS6, portfolio/logbook and end of year review/ COECSA exams'''
|-
|Target Year of Achievement
|Year 1 – 2
|-
|Related Learning Outcomes
|CA1-CA12
|-
|Other Links
|Study Guide -3.2.6.2 below
|}
3.2.6.2 Measure intraocular pressure using applanation tonometry STUDY GUIDE

'''Think:'''

·How would I feel if I were the patient having applanation done for the first time, and how can I help them to relax appropriately?

·What can make the measurement of IOP less accurate? - How can I ensure the most accurate result possible?

·What factors should influence my interpretation of the result?

·In what situations should I be wary of performing applanation?

·What damage could applanation cause to the patient?

'''Activity:'''

·Watch senior colleagues and discuss the nuances of their technique

'''Resources:'''

·''<nowiki>http://www.opt.indiana.edu/riley/HomePage/new_Goldmann_tonometry/2Goldmann_Tonometry.html</nowiki>''

·Fred Wilson. Practical Ophthalmology; A Manual for Beginning Residents. 5th Edition. San Francisco. American Academy of Ophthalmology. 2005

3.2.7 Slit lamp examination

3.2.7.1 Learning outcome OVERVIEW
{| class="wikitable"
| colspan="2" |'''CLINICAL ASSESSMENT'''
|-
|'''Learning Outcome'''
|

'''Slit Lamp Examination'''
|-
|Code
|CA7
|-
|Description
|Trainees must be able to examine the eye and adnexae using the slit lamp and interpret their findings. They must know the indications for and uses of different kinds of illumination and filters. They must know the proper care and economical use of the instrument.
|-
|Assessment
|

'''CRS7, portfolio/logbook and end of year review/ COECSA exams'''
|-
|Target Year of Achievement
|Year 1 – 2
|-
|Related Learning Outcomes
|CA1-CA12
|-
|Other Links
|Study Guide -3.2.7.2 below
|}
3.2.7.2 slit lamp biomicroscopy EXAMINATION STUDY GUIDE

'''Think:'''

·It is important to know exactly how the slit lamp and its accessories work

'''Activity:'''

·Make sure that you can use the hand held and the table-mounted slit lamp microscope

·Ask a senior to observe and confirm your gonioscopic technique and findings

·Get a senior colleague to show you and the instruction manuals are a useful resource!

'''Resources:'''

·Fred Wilson. Practical Ophthalmology; A Manual for Beginning Residents. 5th Edition. San Francisco. American Academy of Ophthalmology. 2005

3.2.8 Fundoscopy

3.2.8.1 Learning outcome
{| class="wikitable"
| colspan="2" |'''CLINICAL ASSESSMENT'''
|-
|'''Learning Outcome'''
|'''Fundoscopy'''
|-
|Code
|CA8
|-
|Description
|Trainees must be able to examine the fundus using a direct and indirect ophthalmoscope, and slit lamp biomicroscopy (with contact and non-contact lenses). They must understand the optics of the techniques and the resulting images. They must be able to examine the peripheral retina with indentation
|-
|Assessment
|CRS8a CRS8b CRS8c CRS8d end of year exams, COECSA Exams
|-
|Target Year of Achievement
|Year 1 – 2 yr program/ Year 3/4 yr program
|-
|Related Learning Outcomes
|CA1-CA12
|-
|Other Links
|Study Guide -3.2.8.2 below
|}
3.2.8.2 FUNDOSCOPY STUDY GUIDE

'''Think:'''

·Is pupil dilation necessary to achieve adequate examination?

·Scleral indentation is a skill that takes a lot of practice

·When is it appropriate to use the different types of lenses that are available for fundus examination? How do all the techniques differ in magnification, orientation of the retinal image and field of view?

'''Activity:'''

·Take as many opportunities as you can to practice

·Watch senior colleagues and discuss the nuances of their technique, then practice again

'''Resources:'''

·Rosenthal ML. The Technique of Binocular Indirect Ophthalmoscopy. In: Hilton GF, McLean EB, Chuang EL, editors. ''Retinal Detachment. 5th ed. San Francisco: American Academy of Ophthalmology; 1989: 160-203.''

·Fred Wilson. Practical Ophthalmology; A Manual for Beginning Residents. 5th Edition. San Francisco. American Academy of Ophthalmology. 2005

'''Self Assessment:'''

·Clinical Rating Form. Ask a colleague to observe your technique, complete a clinical rating form and give you feedback.

3.2.9 General Medical examination

3.2.9.1 Learning outcome OVERVIEW
{| class="wikitable"
| colspan="2" |'''CLINICAL ASSESSMENT'''
|-
|'''Learning Outcome'''
|'''General Medical examination'''
|-
|Code
|CA9
|-
|Description
|Trainees must be able to perform a basic medical examination relevant to ophthalmic disease and understand the importance of their findings so as to be able to know when a patient requires appropriate referral.
|-
|Assessment
|'''Portfolio/logbook and end of year review/exams'''
|-
|Target Year of Achievement
|Year 1 – 2 yr program/ Year 3/4 yr program
|-
|Related Learning Outcomes
|CA1-CA12
|-
|Other Links
|Study Guide -3.2.9.2 below
|}

3.2.9.2 general medical examination STUDY GUIDE

'''Think:'''

·Many of your general medical examination skills will have been developed during your foundation years. Which ophthalmological problems would prompt you to use these skills as an ophthalmologist?

·When should I request a chaperone?

'''Activity:'''

·Offer to help a medical trainee with eye examination skills for postgraduate examinations if they will help you with your general medical examination skills (record this in your portfolio)

'''Resources:'''

·MacLeod's Clinical Examination 11th Edition. <nowiki>ISBN 0443074046</nowiki>. April 2005. Editors: Douglas,G. Nicol,F. Robertson,C.

3.2.10 Paediatric developmental examINATION

3.2.10.1 Learning outcome Overview
{| class="wikitable"
| colspan="2" |'''CLINICAL ASSESSMENT'''
|-
|'''Learning Outcome'''
|'''Paediatric developmental exam'''
|-
|Code
|CA10
|-
|Description
|The trainee should be able to perform an appropriate assessment of a child’s developmental milestones, understand the associations between systemic and ophthalmic diseases and recognise when it is appropriate to seek a paediatric opinion.
|-
|Assessment
|'''Portfolio/logbook and end of year review/exams'''
|-
|Target Year of Achievement
|Year 1 – 2 / Year 3-4
|-
|Related Learning Outcomes
|CA1-CA12
|-
|Other Links
|Study Guide -3.2.10.2 below
|}
3.2.10.2 paediatric and developmental examination STUDY GUIDE

'''Think:'''

·What developmental milestones would you expect a two year old have?

·What key areas should be examined in a child concerning their development?

·when should a paediatric specialist’s opinion be sought

'''Activity:'''

·Offer to help a paediatric trainee with eye examination skills for postgraduate examinations if they will help you with your paediatric examination skills (record this in your portfolio)

'''Resources:'''

·MacLeod's Clinical Examination 11th Edition. <nowiki>ISBN 0443074046</nowiki>. April 2005. Editors: Douglas,G. Nicol,F. Robertson,C.

3.2.11 neurological examination

3.2.11.1 Learning outcome Overview
{| class="wikitable"
| colspan="2" |'''CLINICAL ASSESSMENT'''
|-
|'''Learning Outcome'''
|'''Perform a focused neurological examination taking into account the associations between systemic and ophthalmic diseases'''
|-
|Code
|CA11
|-
|Description
|Trainees must be able to perform a basic neurological assessment with particular emphasis on the cranial nerves and conditions relevant to ophthalmic disease. They must be able to recognise when serious neurological problems are present that require the opinion of a neurologist. They must be able to recognise neurological emergencies.
|-
|Assessment
|'''Portfolio/logbook and end of year review/exams'''
|-
|Target Year of Achievement
|Year 1 – 2 yr program/ Year 3/4 yr program
|-
|Related Learning Outcomes
|CA1-CA12
|-
|Other Links
|Study Guide -3.2.11.2 below
|}
3.2.11.2 Perform a focused neurological examination STUDY GUIDE

'''Think:'''

·Many neurological problems present to the ophthalmologist and a competent neurological assessment of patients is required

'''Activity:'''

·Arrange sessions with your local neurology/neurosurgical department in their clinics or ward rounds to develop your examination skills

·Offer to help a medical trainee with eye examination skills for postgraduate examinations if they will help you with your neurological examination skills (record this in your portfolio)

'''Resources:'''

·MacLeod's Clinical Examination 11th Edition. <nowiki>ISBN 0443074046</nowiki>. April 2005. Editors: Douglas,G. Nicol,F. Robertson,C.

3.2.12 differential diagnosis

3.2.12.1 Learning outcome Overview
{| class="wikitable"
| colspan="2" |'''CLINICAL ASSESSMENT'''
|-
|'''Learning Outcome'''
|

'''Formulate a differential diagnosis'''
|-
|Code
|CA12
|-
|Description
|Trainees must be able to formulate and justify an appropriate differential diagnosis for a patient as part of the management plan. They must be able to identify the most likely diagnosis and initiate management. They must consider the common conditions as well as the rare but important ones in the differential diagnosis.
|-
|Assessment
|'''CbD, Portfolio/logbook and end of year review/exams'''
|-
|Target Year of Achievement
|Year 1 – 2 yr program/ Year 3/4 yr program
|-
|Related Learning Outcomes
|CA1-CA12
|-
|Other Links
|Study Guide -3.2.12.2 below
|}
3.2.12.2 DIFFERENTIAL DIAGNOSIS STUDY GUIDE

'''Activity:'''

·Make it routine at the end of a consultation to document a differential diagnosis.

·Make sure that you discuss your differential diagnosis during CbD

'''Resources:'''

* The Wills Eye Manual: Office and Emergency Room Diagnosis and treatment of Eye Disease. Kunimoto et al. Lippincott Williams and Wilkins (2004)
* Oxford Textbook of Ophthalmology. Easty and Sparrow. Oxford Medical Publications (1999)

'''Assessments:'''

·Case based discussions

·Part 1 COECSA

·Part 2 COECSA. OSCE

3.2.13 Gonioscopy

3.2.13.1 Learning outcome OVERVIEW
{| class="wikitable"
| colspan="2" |'''CLINICAL ASSESSMENT'''
|-
|'''Learning Outcome'''
|'''Gonioscopy'''
|-
|Code
|CA13
|-
|Description
|Trainees must be able to perform gonioscopy with an indirect gonioscopy lens, identify anterior chamber angle anatomy and interpret the clinical significance of their findings. They should be able to use the major angle grading systems clinically.
|-
|Assessment
|'''CRS13, portfolio/logbook and end of year review/ COECSA exams'''
|-
|Target Year of Achievement
|Year 1 – 2
|-
|Related Learning Outcomes
|CA1 - CA12
|-
|Other Links
|Study Guide -3.2.13.2 below
|}
3.2.13.2 Gonioscopy Study Guide

'''Think:'''

·Why is gonioscopy physically required to see the angle and why is it needed clinically?

·How would I feel if I were the patient having gonioscopy done for the first time, and how can I help them to relax appropriately?

·What are the major classes of gonioscopy lenses and how do their uses differ?

·What are the anatomic landmarks of the angle?

·What landmark can be identified using the corneal light wedge technique?

·How can one distinguish an open angle from a closed angle?

·What is dynamic gonioscopy and when does it help you assess the angle?

·What are the major grading systems used in evaluating/reporting the angle?

·In what situations should I be wary of performing gonioscopy?

·What damage could gonioscopy cause to the patient?

'''Activity:'''

·Watch senior colleagues and discuss the nuances of their technique.

·Perform gonioscopy on all glaucoma patients.

·Perform the corneal light wedge technique to identify Schwalbe’s line.

·Perform dynamic gonioscopy with an indirect Posner, Sussman or Zeiss style lens.

'''Resources:'''

·''Alward, W. L. M. (2007) Atlas of Gonioscopy. gonioscopy.org''

·''eyewiki.aao.org/Gonioscopy''

·''American Academy of Ophthalmology, Glaucoma, Section 10. Basic and Clinical Science Course. San Francisco: American Academy of Ophthalmology; 2014:38-42.''

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 •        Fred Wilson. Practical Ophthalmology; A Manual for Beginning Residents. 5<sup>th</sup> Edition. San Francisco.  American Academy of Ophthalmology. 2005
+===== Learning outcome OVERVIEW =====
 {| class="wikitable"
 | colspan="2" |'''CLINICAL ASSESSMENT'''
@@ Line 137: / Line 135: @@
 |CA1-CA12
 |-
-|Other Links
 |}
 '''Resources:'''
@@ Line 150: / Line 147: @@
 ·Clinical Rating Form. Ask a colleague to observe your technique, complete a clinical rating form and give you feedback.
-.2.4 PUPIL EXAMINATION
+=====  LEARNING outcome OVERVIEW =====
 {| class="wikitable"
 | colspan="2" |'''CLINICAL ASSESSMENT'''
@@ Line 178: / Line 174: @@
 |Study Guide -3.2.4.2 below
 |}
 '''Think:'''
-·What are the pupillary pathways?
+* ·What are the pupillary pathways?
+* ·What does a normal pupil look like?
-·What does a normal pupil look like?
+* ·What are the causes of an abnormal pupil?
 '''Resources:'''
-·Kline LB, Bajandas FJ. The Pupil. ''Neuro-ophthalmology Review Manual. 5th ed. 2004''
+* ·Kline LB, Bajandas FJ. The Pupil. ''Neuro-ophthalmology Review Manual. 5th ed. 2004''
+* ·American Academy of Ophthalmology. Pupil. ''Neuro-ophthalmology. 1997.''
-·American Academy of Ophthalmology. Pupil. ''Neuro-ophthalmology. 1997.''
+* ·Fred Wilson. Practical Ophthalmology; A Manual for Beginning Residents. 5<sup>th</sup> Edition. San Francisco. American Academy of Ophthalmology. 2005.
 '''Self Assessment:'''
@@ Line 202: / Line 193: @@
 ·Clinical Rating Form. Ask a colleague to observe your technique, complete a clinical rating form and give you feedback
-.2.5 Ocular Motility
+===== Learning outcome OVERVIEW =====
 {| class="wikitable"
 | colspan="2" |'''CLINICAL ASSESSMENT'''
@@ Line 232: / Line 222: @@
 |Study Guide -3.2.5.2 below
 |}
 '''Think:'''
@@ Line 260: / Line 250: @@
 ·Clinical Rating Form. Ask a colleague to observe your technique, complete a clinical rating form and give you feedback.
-.2.6 IOP measurement using various tonometers
+===== Learning outcome OVERVIEW =====
 {| class="wikitable"
 | colspan="2" |'''CLINICAL ASSESSMENT'''
@@ Line 285: / Line 274: @@
 |CA1-CA12
 |-
-|Other Links
 |}
 '''Think:'''
@@ Line 312: / Line 300: @@
 ·Fred Wilson. Practical Ophthalmology; A Manual for Beginning Residents. 5<sup>th</sup> Edition. San Francisco. American Academy of Ophthalmology. 2005
-.2.7 Slit lamp examination
+===== Learning outcome OVERVIEW =====
 {| class="wikitable"
 | colspan="2" |'''CLINICAL ASSESSMENT'''
@@ Line 344: / Line 331: @@
 |Study Guide -3.2.7.2 below
 |}
 '''Think:'''

CLINICAL ASSESSMENT (CA) - Revision history

Coecsa: /* Patient’s history */

Coecsa: /* Patient’s history Study Guide */

Coecsa: /* Patient’s history */

Coecsa: /* Patient’s history */

Coecsa: /* IOP measurement using various tonometers */

Coecsa: /* Vision assessment STUDY GUIDE */

Coecsa: Created page with "==== Patient’s history ==== ===== Learning outcome OVERVIEW ===== {| class="wikitable" | colspan="2" |'''CLINICAL ASSESSMENT­''' |- |'''Learning Outcome''' |'''Patient’s..."

Coecsa: Created page with "==== Patient’s history ==== ===== Learning outcome OVERVIEW ===== {| class="wikitable" | colspan="2" |'''CLINICAL ASSESSMENT''' |- |'''Learning Outcome''' |'''Patient’s..."