Course Specification oF Internal Medicine for the 5^th year Undergraduates

Sohag University                  Faculty of Medicine

Course Specifications

1.      Program(s) on which the course is given: MBBCh

1. Major element of program                                                  
2. Department offering the program: the whole faculty                               
3. Department offering the course:     Departments of Internal Medicine, neurology, tropical medicine, chest diseases, dermatology, radiology, and clinical pathology                                                                                                                                                    
4. Academic year / Level: Fifth and sixth years / undergraduate level for old bylaw and fifth year only for new bylaw
5. Date of specification approval: 17/11/2008, 27/9/2010
6. Last date of specification approval: 16/1/2012.

1. Basic Information

Title:  Internal Medicine for undergraduate students     

Code: IMED500 (IMED510, IMED520, IMED530, IMED540, IMED550, IMED560,IMED570,  IMED580, IMED590, IMED591, IMED592, IMED593, IMED594)

Hours:

1. Professional Information
2. Overall Aims of Course

By the end of the course of Internal Medicine, the student should be qualified as a general practitioner, who is able to:

• Make a proper diagnosis of common medical conditions accurately and independently based on adequate history taking, physical examination and interpretation of relevant supportive investigations.
• Deal with acute medical emergencies safely and effectively with the aid of the assistant lecturers.
• Identify the indications and logistics of referring patients to higher levels of experience or specialization.
• Perceive and integrate accurately the progress in medical knowledge and technology.
• Maintain and improve his standards of knowledge and training by clinical self-education.

2. Intended Learning Outcomes of Course (ILOs)
3. Knowledge and Understanding:

By the end of the course, students should he able to:

• Grasp the spectrum of clinical symptomatology related to different body systems.
• Appreciate the clinical spectrum of common medical conditions with multisystem reflections.
• Describe the concept of emergency management of acute medical disorders.

1. Intellectual Skills:

By the end of the course, students should he able to:

• Interpret the most important symptoms and signs of disease in Internal Medicine patients.
• Formulate appropriate management plans for individual patients presenting with the most common medical disorders.
• Make decisions regarding common clinical situations using appropriate problem solving skills.
• Interpret X-ray and CT films, blood gas and blood picture reports covering the most important medical conditions.
• Demonstrate appropriate professional attitudes and behaviors in different practice situations.

1. Professional and Practical Skills:

By the end of the course, students should he able to:

• Take a good medical history.
• Measure vital signs adequately.
• Conduct a proper general examination and identify normal and major abnormal physical signs.
• Conduct proper regional examination of the thorax and abdomen by inspection, palpation, percussion and auscultation to identify:
• Surface anatomy of internal organs.
• Normal physical signs.
• Major abnormal physical signs.
• Develop and present a comprehensive medical sheet including history and physical examination.
• Develop the clinical skills of eliciting abnormal physical signs.
• Interpret the significance and relevance of abnormal physical signs.
• Identify the appropriate supportive investigations relevant to a particular patient and adequately interpret the results.
• Integrate the patient’s symptomatology, historic data, abnormal physical signs and investigations into a comprehensive differential diagnosis.
• Identify adequate logistics for further patient assessment and management.
• Become acquainted with special approach to the diagnosis of common medical conditions related to the specialty.
• Get exposed to less common medical disorders within the domain of specialty.
• Get updated information about and demonstrations on modern diagnostic tools within the specialty.
• Get acquainted with special therapeutic and interventional techniques related to the specialty.
• Perform basic nursing procedures as injections, infusions, transfusion, introduction of urinary catheter, gastric and rectal tubes, etc.
• Adequately interpret the results of common laboratory investigations as urine analysis, blood picture, liver and kidney function tests, etc.
• Properly read X-ray, CT and ultrasonic images of common diseases.
• Properly interpret ECG recordings of common conditions as ventricular hypertrophy, myocardial infarction, common arrhythmias, etc.
• Get acquainted with the methods of patient clinical assessment and monitoring, their significance and inter-relations.
• Adequately evaluate the patient’s acute morbidity score and need for urgent intervention.
• Identify a clear priority plan in the patient’s management.
• Recognize the indications for consulting higher levels or reference to other disciplines.

1. General and Transferable Skills:

By the end of the course, students should he able to:

• Gaining of professional behavior, team work capabilities and skills of communications with fellows .
• Communication effectively with patients and their families.
• Dealing perfectly with the computer and gaining informations through the internet

3. Contents

        I- Lectures:

II-Practical: (Total 432 hrs)

• Internal medicine branches (cardiology, hematology,hepatology, endocrine, nephrology, gastroenterology, rheumatology and general):. 3 (hrs) × 6 (days) × 12 (weeks)= 216 hrs.
• Chest, neurology, dermatology and tropical med. :.3 (hrs) × 6 (days) ×12 (weeks)=216 hrs

DETAILED CONTENTS

1 -Cardiology Teaching

The cardiology curriculum is designed so that at the end of the course the student will be able to:

• Know the principles of cardiovascular anatomy and physiology which are relevant to cardiovascular diseases.
• Know the basic patho-physiological and structural alteration that occur in cardiovascular diseases.
• Know the important causes, presenting features (symptoms, signs and alteration in specific investigations) that may occur in each of the following conditions:

-Heart failure (acute, chronic, systolic, diastolic)

-Rheumatic fever, rheumatic heart disease including the affection of the pericardium and cardiac valves.

-Major congenital heart diseases occurring in older children and in adults such as ASD, VSD, PDA, pulmonary stenosis, aortic stenosis, Fallot's tetraology, triology, coarcitation of the aorta and Eisenmeniger's syndrome

-Major dysrhythmias especially the followings: sinus tachycardia, bradycardia, atrial fibrillation, ventricular tachycardia, fibrillation and heart block.

-Causes and management of syncope.

-Causes features and management of infective endocarditis.

-Coronary artery diseases (pathogenesis, risk factors, clinical features, complications and detail of both prophylactic and curative treatment)

-The problem of hypertension in Egypt and the importance of all grades of elevated blood pressure also causes and features of essential and secondry hypertension,, also methods of treatment and the problem attending the use of antihypertensive drugs.

-Causes, clinical picture and management of pericardial and myocardial diseases.

-The interaction between the lung and the heart and causes Clinical                                                                                  presentation and manegment of pulmonary hea diseases (pulmonary

                hypertension, embolism and cor pulmonale)                           .

-Elements of management of cardiac patients undergoing surgery,  pregnancy, labour and treatment of other general diseases.

-Cardiovascular manifestations of systemic diseases.

-Properties, uses, and side effects of important cardiovascular drugs used in treatment of common diseases.

4-Skills: The graduate should be able to:

• Elicit normal and abnormal cardiovascular signs such as general features, attitude, facies, BP arterial and venous pulse
• Elicit normal and abnormal physical signs in chest and abdominal examination that may cause or accompany or result from cardiac disease such as hepatomegaly, splenomegaly, ascites
• Can perform successfully basic life support and cardiac resuscitation (cardiac message, mouth to mouth breath) either alone or with a team.
• He should be able to interpret normal and abnormal cardiac shadows in chest Xray.
• He should recognize the normal ECG and diagnose the following abnormalities in ECG:
• Ventricular hypertrophy (Rt, Lt)
• Atrial dilataion (Rt, Lt)
• Bundle branch block (Lt, Rt)
• Myocardial infarction
• Major dyrhthmias

Cardiology teaching (Methodology):

A combination of strategies are used to reach the above mentioned objects, this include lectures, clinical word rounds, practical classes and self teaching.

1-Lectures : 24 lectures each is one hour are given to accompany the clinical and the practical teaching. They are designed to cover the sailent features, difficult aspects, recent advances not usually incorporated in students text books and specific personal practices of the following subjects:

A-Lectures (24 hours)

B- Practical teaching (cardiology)  

Practical Topics:

1-Cardiovascular history taking

2-Cardiac examination (including pulse BP, and Jugular venous pressure comment)

3-Cardiac valve lesions

4-Rheumatic heart disease

5-Infective endocarditis

6-Heart failure

7-Cardiomyopathy

8-Adult congenital heart diseases

 9-Pericardial effusion

10-Atrial fibrillation

11-Interpretation of certain ECG abnormalities:. Acute myocardial infarction, ischemic heart disease, atrial fibrillation, ventricular tachycardia.,…     

3-Self learning: This include:

• Personal or group ward responsibilities including follow up of inpatients in the department.
• Cardiology outpatient sessions in which the student examine the patients with the assistant lecturer to recognize the presenting

2-Endocrinology teaching

The curriculum consisits of an integrated  theortical, clinical and practical training courses.

Terminal objectives are:

1-To know the principles of the physiology of endocrinal system

2-To know the basic pathophysiological and structural alteration changes that occur in common endocrinal diseases.

     3-To know important presenting features  of endocrinal diseases

     4-To be able to elicit skeletal disproportions and to identify body mass index

5-To diagnose various endocrinal emergencies

6-To know  the basics of various investigations of endocrinal diseases

7-To interpret endocrinal imagings such as X-ray , CT and MRI of different endocrinal organs.

Endocrinology teaching (Methodology)

A combination of stratiegies are used to reach the above mentioned objectives. This include:

A- lectures (16 hours)

B-Practical teaching in endocrinology

Practical topics:.

1-History taking of  various endocrinal disorders

2-Anthropometric measurements, Body mass index

3- Obesity, morbid obesity

4-Short stature

5-Thyrotoxicosis

6-Myxedema

7-Cushing syndrome

8-Acromegally

9-Pheochromocytoma

10-Diabetic commas                                            

• Hematology Teaching

The curriculum consists of theortical practical and training courses.

Terminal objectives in teaching hematology are:

1. To review their informations about the physiology of blood cells (RBCs, WBCs and platelets) and homeostasis.
2. To review their informations about the anatomy of the lymphatic and hematopiotic organs.
3. To know the important causes, presentation and management of various types of anemias.
4. To examine lymph nodes, liver and spleen and to know causes and management of lymphadenopathy, hepatomegaly, and splenomegaly.
5. To know causes, manifestation and management of bleeding and coagulation disorders.
6. To know causes presentation and management of various hematological malignancies (Leukaemias, lymphomas, plasma cell tumours).
7. To interpret lab investigations as blood picture, bone marrow examination, results of lymph node, spleen biopsy …and tests for coagulation disorders.
8. To know recent advances in treatment of various hematological disorders as bone marrow transplantation, immunological treatment,

Hematology teaching (Methodology) :

A combination of stratiegies are used to reach the above mentioned objectives. This include:

A- lectures (16 hours):.

B- Practical hematology:    Topics

1.      History taking in hematological disorders

2.      pallor

3.      Differntial diagnosis of Lymphadenopathy

4.      differential diagnosis of Hepatospleenomegaly

5.      Acute leukemias

6.      Chronic leukemias

7.      Purpura

8.      Bleeding tendency

1. Cases who need blood transfusion (Observation of the technique, and follow up)                     

4-Rheumatology teaching

The curriculum consisits of integrated theortical, clinical and practical training courses

Terminal objectives are:

1-To know the basic pathophysiological and structural alteration in common musculoskletal and connective tissue diseases

2-To do systemic examination (face, skin, eye cardiac, chest abdominal nervous system examination and understanding their relation to common connective tissue diseases

3-To know the important causes, presenting features (symptoms, signs and alteration in specific investigations) that may occur in each of the following conditions:

-Rheumatoid arthritis, Systemic lupus erythematosis

-Seronegative arthropathies -Gout

-Osteoporosis-Systemic sclerosis -Systemic vasculitis

Rheumatology teaching (methodology)

A- Lectures (8 hours)

B-Practical rheumatology

Topics:.

1-      History taking in collagen diseases

2-      Joint examination

3-      Rheumatoid arthritis

4-      Systemic lupus erythematosus

5-      Scleroderma

6-      Gout

7-      Polyarteritis nodosa

8-      Reach interpretation of X ray, laboratory markers that occur with autoimmune dieases  

5-Nephrology teaching

A-Lectures (9 hours):.

B-Practical nephrology

Topics:.

1-      History taking in renal disorders

2-      Nephrotic syndrome

3-      Generalized oedema

4-      cute nephritis

5-      Chronic renal failure

6-      Acute renal failure

7-      DD of Renal mass                           

6-Gastroenterology and hepatology teaching

 Terminal objectives in teaching gastroenterology are:

1. To know the basic physiology of the digestive system (oesphagus, stomach, small, large intestine and the pancreas)
2. To know the anatomy and the basic pathophysiological and structural changes that occur in the gastrointestinal tract in various GIT diseases.
3. To know the gastrointestinal symptoms such as vomiting , diarrhea, constipation,…… and how to elicit important findings through abdominal examination, examination of the buccal cavity and PR examination.
4. To know the important causes, presentation and management of the following disorders affecting the gastrointestinal tract:

• .Salivary gland disorders
• oesphageal diseases (GERD, oesphagitis, cancer)
• Peptic ulcer , gastritis, gastric malignancies.
• Acute and chronic GIT bleeding
• Malabsorption syndromes, vascular occlusion of the intestinal vessels and malignancies affecting the intestine
• Inflammatory bowel diseases
• Functional GIT disorders
• Causes and management of medical causes of acute abdomen
• To acquire the basic knowledge for the following investigations done for GIT diseases as:

-Abdominal  sonography           -Barium studies

        -Endoscopies                                 -abdominal CT

        -Motility studies                            -ERCP

The Hepatology curriculum is designed so that at the end of the course the student is able to:

1. Know the principles of hepatobiliary system anatomy and physiology which are relevant to hepatobiliary diseases.
2. Know the basic pathophysiological and structural alteration that occur in hepatobiliary diseases.
3. Know the important causes, presenting features (symptoms, signs and alteration in specific investigations) that may occur in each of the following conditions:

• Jaundice (classification, causes and manegment)
• Portal hypertension, oesphageal varices.
• Ascites including causes rather than portal hypertension
• Liver cirrhosis (causes, presentation and complications).
• Liver cell failure ( acute and chronic)
• Hepatomegaly (causes and manegment)
• Splenomegaly (including causes and manegment of huge splenomegaly)
• Hepatitis (acute and chronic)
• Liver tummours
• liver diseases in relation to drugs and other medical situations.
• Different investigations which are performed for liver diseases as biochemical tests, abdominal imaging (sonography, CT,……..) endoscopies.
• Liver transplantation

A-Lectures (29 hours)

Practical GIT and Hepatology

Topics:.

1. History taking of gastroenterology and hepatobilliary disorders
2. Abdominal masses including malignancies
3. 3-Hepatomegally                                           
4. Spleenomegally
5. Vitamine deficiencies manifestations   
6. Ascites
7. Weight loss causes and detection             
8. Hepatocellular failure
9. Gastrointestinal bleeding evaluation      
10. Acute and chronic hepatitis
11. Gastroenteritis                                         
12. Jaundice
13. Pancreatitis

-Self teaching: This include:

• Personal or group word responsibilities including follow up of inpatients in the department.
• Hepatology outpatient sessions in which the student examine the patients with the assistant lecturer to recognize the presenting manifestations of the diseased and non diseased person

 7-General teaching : 8 hours lectures

8-Respiratory disease teaching

A-Lectures (22 hours)

 B- Practical respiratory disease:. (3 hrs × 6days ×3weeks=54 hrs)

Topics:

1-History taking of chest diseases

2-Chest examination

3-Cyanosis tremors

4-Bronchial asthma,

5-Chronic obstructive airway diseases

6-Pleural effusion

7-Tuberclosis

8-Cancer lung

9-Mediastinal syndrome

10 Chest infection

11-Chronic suppurative lung diseases

12-Interstial lung fibrosis

13-Interpretation of X-ray chest

9-Neuropsychiatry teaching

A –Lectures (22 hours)

B-Practical neuropsychiatry (65 hours);. (3 hrs × 6days ×3weeks=54 hrs)

Topics:.

1-History taking in neurology

2-Neurological examination

3-Cerebrovascular stroke

4-Hemiplegia

5-Paraplegia

6-Ataxia

7-Parkinsonism

8-Chorea

9-Cranial nerve palsy

10 -Myopathy

11- Prepheral neuropathy

12- Psychatric history and mental state examination

13- Mood disorders

14- Anxiety disorders

15- Psychotic disorders

 9- Teaching of Tropical Medicine

Lectures: 22 hs

Clinical teaching: (3 hrs × 6days ×3weeks=54 hrs)

10-Radiology teaching

10 hours practical

11-Teaching in Laboratory Medicine (16 hours)

 12- Dermatology teaching

  24 hours lectures

Clinical teaching: (3 hrs × 6days ×3weeks=54 hrs)

4. Teaching and Learning Methods

4.1- Self-learning

4.2- Cooperative Learning

4.3- Lecture

4.4- Group Discussion

4.5- case study

4.6- Problem Solving

4.7- Brainstorming

4.8- Role-playing

4.9- Cognitive maps

4.10-Presentations

4.11- Learning cycle

5. Student Assessment Methods

Assessment Schedule

I- for the students following old bylaw:.

"Assessment 1": at the end of each clinical rounds for the 5^th year.

"Assessment 2": at the end of each clinical round for the 6^th year.

"Assessment 3": Final exam for the 6^th year.

Weight of Assessments

II- for the students following new bylaw:. (Only fifth year)

"Assessment 1": at the end of each clinical round.

"Assessment 2": Final exam.

Weight of Assessments

6. List of References

6.1- Essential Books (Text Books)

- Kumar and Clarke Textbook of Medicine; Parveen Kumar and Richard Clark; Blackwell Science; 14^th edition, 2005

-Hutchison's Clinical Methods; Robert Hutchison; Harry Rainy; 21^st edition;2003

6.2- Recommended Books

- Cecil Textbook of Medicine; McGraw Hill; 16^th edition, 2004.

- Harrisson’s Textbook of Medicine, McGraw Hill, 2005.

6.3- Periodicals, Web Sites, … etc

7. Facilities Required for Teaching and Learning

- Lecture rooms

- Rooms for practical teaching

- Accessibility to hospital wards, clinics and emergency department

- Audio-visual teaching equipments (computers, data show projector, video, etc.)

- Models and mannequins

- Video tapes and scientific pictures archives.

- Radiology collections and archives.

-Library for the department.