Universitat Internacional de Catalunya
Medical Practicums 2
Teaching staff
Dra. Sandra Díaz de Castellví sdiaz@uic.es
Introduction
The subject Medical Clinical Practice (PCM) looks for students to acquire and develop the knowledge, skills, attitudes and clinical judgment necessary to achieve an adequate professional practice. The goal is to help know how to perform what they have learned in theory and do so in a clinical and supervised environment.
Thus, medical clinical practice is within the plan of training of medical undergraduates an irreplaceable and essential part of learning.
The PCM1 are the first contact of students with patients – it is taught in 3rd year of grade- and PCM2 - taught in the 4th year of grade - progress in learning medical clinical skills. Both are performed in units of acute care hospital and emergency services.
In clinical practice, the student participates in clinical work with a medical team, applying theoretical knowledge in the care of patients and their pathologies. In this tutorial, the student performs a medical history, an essential tool of the medical act, records the information provided in the personal interview with the patient, known as anamnesis, perform physical examination, assess the complementary tests and develops a critical analysis of the information, it must lead to a process of reasoning and clinical judgment, the differential diagnosis and therapeutic plan.
During the days of the internship the student is integrated into the clinical team, keeps track of patients assigned and their care process and assists to clinical sessions and seminars.
With this experience, students develop clinical skills in an environment of teamwork and transversal skills and communication skills with patients and other professionals who will lead you to greater professional development.
Pre-course requirements
To have studied the subjects:
• Semiology
• Physiopathogenesis
• Cardiovascular system
• Respiratory system
• Neurology
• PCM1
Objectives
The main objective of the clinical practice is to obtain the knowledge, skills and attitudes of a general practitioner to practice autonomously learning from models: doctors and other healthcare professionals, guided by a professional who is responsible for the accompaniment and facilitates learning.
In relation to clinical history:
• Being able to perform a systematic anamnesis patient-centered, I tend its features.
• Being able to perform routine physical examination
• To recognize abnormalities on physical examination
• Conduct a concise and understandable for third of the registration data history and examination.
• Identify the needs of the patient and the family and social environment.
In relation to the diagnostic process:
• Distinguish acute and chronic symptoms and signs of serious pathology.
• Recognize the normality or abnormality of the findings of additional tests.
• Apply reasoning and clinical judgment to make a differential diagnosis from clinical information. Detect symptoms guide.
• Evaluate the prognosis of diseases.
• Knowing how to find information to supplement the study of cases attended and topics of interest.
Regarding the therapeutic plan:
• Recognize the most important aspects that require immediate treatment.
• Develop a treatment plan in the most prevalent pathologies.
Regarding the multidisciplinary work:
• Know continuity of care after discharge
Regarding the interprofessional communication:
• Integrate the dynamics of the health care team work
• To present clinical cases and participate in their clinical sessions.
With regard to prevention:
• Identify prevention measures based on the pathologies identified.
Competences/Learning outcomes of the degree programme
- 04 - Develop professional practice with respect for patient autonomy, beliefs and culture.
- 06 - Develop professional practice with other health professionals, acquiring teamwork skills.
- 09 - Understand and recognize the effects, mechanisms and manifestations of disease on the structure and function of the human body.
- 10 - To understand and recognise the agents and risk factors which determine health status, and learn how they determine the symptoms and natural development of acute or chronic diseases in individuals and populations.
- 13 - Obtain and develop a clinical history that contains all relevant information.
- 14 - Perform a physical examination and a mental assessment.
- 15 - Ability to formulate an initial diagnosis and establish a rationalised diagnostic strategy.
- 16 - Recognize and deal with situations that put life in immediate danger and those that require immediate attention.
- 17 - Establish the diagnosis, prognosis and treatment, applying principles based on the best information possible and safe clinical practice..
- 21 - Listen carefully, obtain and synthesize relevant information about the problems affecting the patient and understand the contents of this information.
- 22 - To write and maintain medical records and other medical documents which can be understood by third parties and are adapted to the protocols and information that is required.
- 23 - Communicate effectively and clearly, both orally and in writing with patients, family members, media and other professionals.
- 24 - Establish good interpersonal communication skills that enables efficient and empathetic communication with patients, relatives, media and other professionals.
- CTP-2 - To develop a perception and understanding of their own emotions and those of others, as well as the intelligence adjust answers.
- CTP-3 - To develop critical thinking and reasoning as well as self-assessment skills.
Learning outcomes of the subject
At the end of practice, students will have developed their skills and be able to:
- Develop a complete medical history with all sections: history, physical and mental state examination, evaluation of additional evidence
- if accurate, analyze and interpret information to reach a syndromic diagnostic orientation.
- Develop an admission hospital report .
- Perform a clinical reasoning from signs and symptoms guide anamnesis, findings of the physical examination and laboratory tests and differential diagnosis.
- Develop a treatment plan in the most prevalent pathologies.
- Establish the prognosis of the disease identified.
- Develop a hospital discharge report.
- Identify prevention of diseases recorded.
- Define the continuity of care after discharge.
- Search information to complete the study patient.
- Communicate with the medical team and prepare a commentary income.
- Work - clinicians and infirmary- team and participate in the discussion of clinical cases.
- Communicate with patients and their families clearly and effectively.
At the end of the course the student must submit:
• Clinical history of a patient. (Patient A)
• Hospital discharge report of another patient (patient B)
• Reflective Report: to be provided to tutor two days before the end of your stay. In it will be discussed: "What have you learned?" "How did you learn?".
It would be desirable to discuss issues related to theoretical knowledge, the skills for conducting clinical history, performing the physical examination, assessment of evidence complementary, reasoning clinical, diagnosis or approach problems, integration into the care team, professional conduct etc ..
Perform a "Register of activitats" annotated with reflections on learning and skills acquired in connection with the activities.
Syllabus
To conduct a systematic anamnesis, oriented clinical syndrome:
Current illness
Allergies and intolerances
Family background
Personal history
Medical history - anamnesis by devices
Common drugs
Baseline patient status
To conduct a systematic exploration:
Overall rating
Mental State Evaluation
Interpretation of vital signs
Exploration skin and mucous membranes
Exploration lymphadenopathy
Scan head, neck and breast
Exploration cardiovascular system
Exploration breathing apparatus
Exploration digestive
Exploration nephrourologic
Exploration neurological system
Exploration locomotor - Osteoarticular
Nutritional status assessment
• Record medical history and commentary income, valuing the additional tests.
• Conduct a discharge report.
• Identify symptoms and signs guide. Perform clinical reasoning and differential diagnosis. Assess the prognosis of the disease / s.
• Planning treatment plan most prevalent pathologies.
• Clinical follow-up of patients assigned. Knowing treatment and continuity of care after discharge.
• Identify prevention measures related pathologies registered.
• Look for information to complete the study of the process / s pathological / s that affect patients.
• Integrate in the work team (attending physician, resident, nurse and other health professionals) providing patient care.
• Participate in clinical sessions and present clinical cases.
An explanatory and detailed on how to perform each of these tasks will be facilitated document.
Teaching and learning activities
In person
At the beginning of the course the course will be presented, mentioning the new model of medical practices and evaluation system. 4 seminars will also be held to introduce the basics of the subject.
Seminars:
- Mental State Evaluation
- Clinical reasoning and differential diagnosis of syndromes
- Treatment Plan
- Finding information
Each student will have a tutor assigned range. Both the PCM guide document where the objectives of the course and assessment methodology specified be provided.
Students were integrated medical care in acute inpatient teams over a period of 4 weeks.
The student will attend the center / service assigned in time 9:00 a.m. to 2:00 p.m. (see data centers to "host protocol" Moodle). It is agreed with the tutor distribution of working hours: Pass cards, conducting medical history, individual work time for study of clinical cases or search for information to delve into issues as directed by the tutor.
Absenteeism: Attendance at practices is mandatory every day. Any absence must be reported to the University (practicasmedicina@uic.es) 93504200 ext 5514, and the hospital / center through telephone contact identified in the specific space Moodle. You need excuse absences. Nonattendance, or repeated unexcused absences may prevent the final evaluation of the subject.
Evaluation systems and criteria
In person
The final evaluation will be conducted by the coordinator of the subject with the information and documentation available. The evaluation system will be multiple and consists of the following sections and proportions:
45% - Direct observation of collecting clinical tutor in the evaluation rubric.
30% - Clinical History. Delivered to the tutor of practices and incorporated into moodle two days before ending the clinical prectices.
10%- Discharge report. Delivered to the tutor of practices and incorporated into moodle two days before ending the clinical prectices.
10% - Follow-up report by the tutor.
5% - Thoughtful student report. Delivered to the tutor of practices and incorporated into moodle two days before ending the clinical prectices.
The final grade is the calculation of the weighted average of the different sections, provided they have obtained at least one 6 in the section of the tutor and the clinical history. If not reach 6, must repeat some or all periods depending on the sections requiring recovery.
PCM2 may not be evaluated because failure to submit the thoughtful, or exercise, or assessment of seminars, or lack of assistance not duly justified.
If any of the sections is not approved, it will be decided between the coordinator of the subject and tutor the need for do another complementary training activity: repetition of reports, preparation of summaries relating to seminars, redo the thoughtful document, ... as required in each case.
The note of the approved sections will be saved for the second call.
None item is not saved in case of repetition of the subject or successive calls.
Bibliography and resources
Farreras-Rozman: Medicina Interna, 17a edició
Harrison. Principis de Medicina Interna, 19a edició Dennis Kasper, Anthony Fauci, Stephen Hauser, Dan Longo, J. Larry Jameson, Joseph Loscalzo
Exploració clínica pràctica, 27ª edició Noguer-Balcells Prieto Valtueña, J.M