MED403 — Introduction to Clinical Medicine II: Lecture Note

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Course code: MED 403 Course title: Introduction to Clinical Medicine II Course credit load: 2 Units Series 1: Health Workers, Their Functions, and the Multidisciplinary Team • Part 1.1: Categories of Health Workers in Clinical Medicine o Sub Part 1.1.1: Medical doctors and their roles o Sub Part 1.1.2: Nursing and allied health professionals o Sub Part 1.1.3: Paramedical and support staff • Part 1.2: Functions and Responsibilities of Key Health Workers o Sub Part 1.2.1: Diagnostic roles in the health team o Sub Part 1.2.2: Therapeutic roles in the health team o Sub Part 1.2.3: Supportive and administrative roles • Part 1.3: The Multidisciplinary Team Approach to Patient Care o Sub Part 1.3.1: Concept and rationale of the multidisciplinary team o Sub Part 1.3.2: How the multidisciplinary team functions in practice o Sub Part 1.3.3: Benefits and challenges of the multidisciplinary approach • Part 1.4: Intersections and Collaboration in Health Team Practice o Sub Part 1.4.1: Where health team roles intersect o Sub Part 1.4.2: Communication and coordination in the health team

o Sub Part 1.4.3: The student doctor's place in the health team Introduction Modern clinical medicine is not practised by any single professional working in isolation. The complexity of human illness, the breadth of knowledge and skill required to investigate and manage patients effectively, and the recognised importance of holistic, patient-centred care have made the collaborative health team the fundamental unit of clinical practice. Understanding who the various health workers are, what functions each performs, and how they work together is foundational knowledge for any student beginning clinical medicine. This Series introduces the categories of health workers encountered in Nigerian clinical settings, from medical doctors and nurses to laboratory scientists, pharmacists, physiotherapists, radiographers, and the many support and administrative staff whose work sustains the clinical environment. It examines the distinct yet overlapping functions these workers perform in patient diagnosis, treatment, and support, and explores the multidisciplinary team model through which their contributions are coordinated around individual patient needs. A clear appreciation of how the health team is composed and how it functions prepares the clinical student not only to work effectively within it but to understand the patient's experience of healthcare as a journey through multiple professional contacts, each contributing a distinct and necessary dimension to their care. Series Learning Outcomes Upon completing this Series, you should be able to: • SLO 1.1 identify and describe the major categories of health workers encountered in clinical medicine and the training background of each (Linked to Part 1.1),

• SLO 1.2 describe the diagnostic, therapeutic, and supportive functions performed by key members of the health team (Linked to Part 1.2), • SLO 1.3 explain the concept of the multidisciplinary team, describe how it functions in practice, and identify its benefits and challenges (Linked to Part 1.3), • SLO 1.4 describe the intersections between health team roles and explain how communication and coordination are managed in the clinical team (Linked to Part 1.4), and • SLO 1.5 explain the place of the student doctor in the health team and describe the appropriate conduct expected of a student in clinical settings (Linked to Part 1.4). 1.1 Categories of Health Workers in Clinical Medicine 1.1.1 Medical doctors and their roles Medical doctors are the clinicians with primary responsibility for diagnosis, prescription of treatment, and overall medical management of patients. In Nigeria, a medical doctor holds a Bachelor of Medicine and Bachelor of Surgery (MBBS or MBChB) degree obtained after a minimum of six years of undergraduate medical education, followed by a period of housemanship. Doctors practise across a wide range of settings, from primary care to highly specialised hospital departments, and at various levels of seniority from house officer to consultant. The medical profession is structured through a hierarchy of roles: house officers are newly qualified doctors completing mandatory post-graduate training; medical officers or senior registrars are doctors in supervised practice or specialist training; and consultants are fully qualified specialists with the authority to admit patients, lead clinical teams, and bear ultimate clinical responsibility for patient care. Medical doctors in Nigeria are regulated by the Medical and Dental Council of Nigeria (MDCN).

Fill in the blank: Medical doctors in Nigeria hold the MBBS or MBChB degree; the clinical hierarchy progresses from house officer through medical officer and registrar to ________, who bears ultimate clinical responsibility for patient care. 1.1.2 Nursing and allied health professionals Nurses are the largest professional group in most clinical settings and provide the most continuous patient contact of any health profession. Registered nurses in Nigeria hold a Bachelor of Nursing Science (BNSc) or a nursing diploma from an approved school of nursing, and are registered with the Nursing and Midwifery Council of Nigeria (NMCN). Nurses assess patient condition, administer prescribed medications, perform clinical procedures, educate patients and families, and coordinate care between the patient and other members of the team. Allied health professionals encompass a broad range of disciplines that support diagnosis, treatment, and rehabilitation. Key allied health professionals include pharmacists (who dispense medicines, counsel patients on drug use, and provide pharmaceutical care), physiotherapists (who assess and treat physical impairment and disability through movement and exercise), occupational therapists (who help patients regain the ability to perform daily activities), and medical laboratory scientists (who perform the diagnostic tests that guide clinical decision-making). Fill in the blank: Nurses provide the most continuous patient contact; allied health professionals include pharmacists, physiotherapists, occupational therapists, and medical laboratory scientists who support diagnosis, treatment, and ________. 1.1.3 Paramedical and support staff Paramedical staff include radiographers, who perform imaging investigations including X-rays, ultrasound, CT, and MRI scans and whose images are interpreted by radiologists; medical records officers, who manage patient documentation and health information systems; dietitians and nutritionists, who assess nutritional status and provide medical nutrition therapy; and speech and language therapists, who assess and treat disorders of communication and swallowing.

Support staff are essential to the safe and effective functioning of clinical environments but may not hold professional health qualifications. They include healthcare assistants and ward orderlies who provide personal care, transport patients, and assist with basic clinical tasks under nurse supervision; hospital porters and domestic staff who maintain the physical environment; and administrative and clerical staff who manage appointments, admissions, discharge records, and the administrative systems that underpin clinical operations. Fill in the blank: Paramedical staff include radiographers, medical records officers, dietitians, and speech therapists; support staff including healthcare assistants, porters, and ________ staff are essential to safe clinical operation though they may not hold professional health qualifications. Medical Professionals Allied and Paramedical Staff Support Staff Medical Doctors (MBBS or MBChB, house officer to consultant) Pharmacists Healthcare Assistants Nurses (BNSc or diploma, continuous patient contact) Physiotherapists Ward Orderlies Occupational Therapists Porters Medical Laboratory Scientists Administrative Staff Radiographers Dietitians Medical Records Officers Speech Therapists Figure 1.1: Categories of health workers in clinical medicine, their professional background, and key roles

Pilot questions 1.1 1. Describe the educational background and regulatory body of medical doctors in Nigeria. (Linked to SLO 1.1) 2. Describe the clinical hierarchy of medical doctors from entry level to consultant. (Linked to SLO 1.1) 3. Describe the role of nurses in the clinical team and identify their regulatory body in Nigeria. (Linked to SLO 1.1) 4. Identify four allied health professionals and state the primary function of each. (Linked to SLO 1.1) 5. Explain the contribution of support staff to safe clinical operation. (Linked to SLO 1.1) 1.2 Functions and Responsibilities of Key Health Workers 1.2.1 Diagnostic roles in the health team Diagnosis in clinical medicine is not the exclusive function of the medical doctor but a distributed responsibility shared across the health team, with each professional contributing a distinct dimension to the overall diagnostic picture. Medical doctors take the clinical history, perform physical examination, formulate a differential diagnosis, and decide which investigations to request. Medical laboratory scientists perform the haematological, biochemical, microbiological, and histological tests whose results confirm or refute the diagnostic hypotheses generated by the clinician. Radiographers produce the imaging investigations (plain X-rays, ultrasound, CT, and MRI) whose interpretation by radiologists provides critical diagnostic information, particularly in trauma, oncology, and complex internal medicine cases. Nurses contribute to diagnosis by performing bedside assessments and side-room tests, monitoring vital signs and reporting changes, and recognising clinical deterioration that prompts urgent medical review. Each professional's diagnostic contribution is most valuable when effectively communicated to the rest of the team.

Fill in the blank: Diagnosis is a distributed responsibility: doctors formulate the differential and request investigations; laboratory scientists perform tests; radiographers produce imaging; and nurses perform bedside assessments, monitor vital signs, and report ________. 1.2.2 Therapeutic roles in the health team Medical doctors have the primary authority to prescribe pharmacological treatment and order therapeutic procedures, bearing responsibility for the appropriateness, dosing, and potential interactions of prescribed medicines. Pharmacists perform a critical safety and therapeutic function by reviewing prescriptions for errors, checking for drug interactions and contraindications, dispensing medicines with counselling on correct use, and managing ward drug supplies in hospital settings. Nurses administer prescribed

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