Universitat Internacional de Catalunya
Medical Practicums 1
Other languages of instruction: Catalan
Teaching staff
Dr. Roger Malo rmalo@uic.es
Introduction
The Medical Clinical Practice (PCM) program allows students to acquire and develop the knowledge, skills, attitudes and clinical judgment necessary to achieve an adequate professional practice. This is accomplished by applying theoretical learning to clinical practice in a supervised setting. Thus PCM is a critical part of medical student training and an essential part of learning.
PCM1 takes place in the third year of medical school and is the first contact that students will have with patients. This continues into the fourth year with PCM2, where students will further develop and refine clinical skills. Both PCM1 and PCM2 take place in acute care and emergency services divisions of the hospital.
In PCM, the student participates in clinical work with a medical team, applying theoretical knowledge to patient care. The student will obtain and document patient medical histories, an essential tool of medical practice, known as anamnesis, perform physical examination and interpret relevant tests. By critically analyzing this information, using a process of reasoning and clinical judgment, the student will ultimately determine the differential diagnoses and develop a therapeutic plan of care for each patient.
During the days of the PCM internship the student is integrated into the clinical team and is responsible for the monitoring and care of assigned patients. The student is also expected to attend 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
It is essential that the student has completed the following subjects:
- Structure and Function of the Locomotor System
- Structures and Function Skin and Organs of the senses
- Structures and Function of integration systems: nervous and endocrine
- Structures and Function Cardiovascular, respiratory and renal system
- Structures and Function Digestive System and Metabolism
- Structures and Function of the Reproductive system
- Structures and Function of the Blood and Immune system.
- Semiology and Physiopathogenesis (having taken or be enrolled in the subject)
Objectives
The main objective of PCM is to develop the knowledge, skills and attitudes of a general practitioner critical to successful autonomous practice. This is accomplished by preceptorship by practicing physicians and other healthcare professionals.
During each PCM, the student will develop the following skills:
In relation to clinical history:
- Perform a systematic patient-centered anamnesis (real and simulated patient with a time limit), considering its features.
- Perform routine physical examination
- 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
- Communication with the patient, family and other professionals.
- Develop critical thinking and self-evaluation
In relation to the diagnostic process:
- Distinguish acute and chronic symptoms and signs of serious pathology.
- Interpret laboratory and diagnostic test results recognizing the normality and abnormalities.
- Know how to find information to supplement the study of cases attended and topics of interest
In relation to multidisciplinary work:
- Know and enable continuity of care after discharge by coordinating with other members of health care team, patient, and patient’s family as appropriate.
In relation to interprofessional communication:
- Understand and be a part of the dynamics of the health care team work
- Attend and participate if appropriate in clinical sessions
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.
- 13 - Obtain and develop a clinical history that contains all relevant information.
- 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.
- 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 be able to:
- Develop a complete medical history with all sections: history, physical examination, evaluation of additional evidence.
- Write medical history, reports, instructions and other records that are understandable to patients, families, and other professionals.
- If accurate, analyze and interpret information to reach a diagnosis.
- Interpretation of results derived from the different tests carried out.
- Develop a hospital admission report.
- Perform relevant literature search to complete the study patient.
- Communicate with the medical team.
- Work alongside clinicians and infirmary team and participate in the discussion of clinical cases.
- Communicate with patients and their families clearly and effectively.
-Assume different responsibilities in individual or collaborative work and evaluate the results obtained.
-Acquire and demonstrate knowledge of the theoretical and practical aspects and of the work methodology in the field of clinical practice.
-Move correctly in the general use of ICT and especially in the technological environments of the professional field.
Syllabus
- The medical history. Elements and elaboration.
- Development of physical examination.
- Differential diagnosis.
- Propose the diagnostic hypothesis.
- Complementary diagnostic tests.
- Clinical follow-up of assigned patients. Know the treatment and continuity of care at discharge.
- Digital tools and ICT. Search for information to complete the study of the pathological processes that affect patients.
- Join the work team (associate physician, resident, nurse and other health professionals) that provides patient care.
- Attend and participate if appropriate in the clinical sessions.
- Organization and operation of the unit.
Teaching and learning activities
In person
At the beginning of the rotation, the course will be presented, mentioning the new model of medical practices and evaluation system. During this session, students will be surveyed about their perception and expectations as well as their objectives regarding PCM1.
4 seminars will also be held to introduce the basics of the subject.
Seminars:
- Medical history
- Systematic of anamnesis and physical examination
- Neurological examination
- Rol play
The seminars are an important part of the subject. They will take place before starting the practices with the aim of facilitating some very useful aspects during them. For this reason, attendance is mandatory. The lack of assistance, not justified, will imply that the student could not be able to attend PCM1.
CISA
During the month of September, students will carry out, in the simulation environment (CISA), 8 hours of practice in a simulated environment to specifically work on two competencies, divided into 4 groups:
4 hours of Anamnesis
4 hours Physical Exploration
Anamnesis Skills (4 hours)
It includes conducting the interview with the patient and writing it in a way that faithfully, objectively and accurately reflects the signs observed and symptoms reported by the patient.
The date, affiliation of the patient, reason for consultation, personal, family and pharmacological history, environmental factors, socio-family situation and current illness must be recorded.
The students will carry out in groups of 2 doctor-patient “Role Play” an exhaustive medical history and later they will write up all the information collected. Subsequently, open feedback will be carried out on them to discuss strengths and points for improvement.
Physical Exploration Skills (4 hours)
It includes a thorough and complete physical examination.
The students will carry out in groups of 2 doctor-patient “Role Play” an exhaustive physical examination and later there will be an open “feedback” of one of them to discuss strengths and points for improvement.
In both cases, the verbal communication skills will also be worked, assessing the presentation, consent, empathy, open questions and transmission of information and non-verbal (greeting, eye contact, active listening, empathy, etc.). During these internships at CISA, other aspects such as professional behavior can also be worked on in parallel: respect, integrity in different situations or patients or interpersonal relationships.
Finally, self-learning and self-evaluation will also be promoted so that students understand the importance of interest in improving, recognizing their qualities and limitations.
Problem-based learning
After having carried out the practices in CISA, the students will receive two "theoretical-practical pills" . Two videos will be posted on the moodle.
In the first pill, a clinical case of Anamnesis will be presented with "gaps" in it and then the students will be asked a some questions about the methodology and other aspects of the medical history. The students will also have to reason about the diagnostic possibilities. The entire video will then be shown to them and they will be asked again a series of complementary questions to reason as well as their diagnostic orientation after viewing the entire video.
In the second pill, a clinical case of Physical Examination will be presented following the same methodology as in the previous one.
Practices in a healthcare setting
Each student will have an assigned practical tutor.
The students will be integrated into acute hospitalization medical assistance teams in a period of 4 consecutive weeks. These practices will be evaluated, by the tutor, by means of a rubric (see rubric annex).
Personal growth and structuring workshops
In addition to attending the training centers and the seminars that are given at the beginning of practices, the student will attend in a scheduled way within his rotation 4 workshops given by the "academic tutors of the practices". These workshops are aimed at personal development and growth to promote professional excellence. They will mainly work cross-disciplinary skills focused on personal values and the profession, the strengths to face decisions, the management of their own emotions and personal and interpersonal communication. Each workshop lasts two hours and are compulsory attendance. Once completed, students have the opportunity to schedule, recommended but voluntarily, a personal tutoring to deepen the experience. The workshops represent 10% of the grade of each subject of clinical practices. The note takes into consideration: attendance at the workshops, participation in them and the preparation of a reflective report of each workshop, which will be incorporated into the Moodle of the subject.
Practices
Each student will have an assigned tutor. Both of them will be provided with the PCM1 guidance document that specifies the objectives of the subject and the evaluation methodology.
The practice schedule will be determined by the hospital in which the practices are done. The reference schedule is from 09.00h to 14.00h. (see data centers to "host protocol" Moodle). Details of working hours are to be determined in conjunction with the preceptor. Daily medical visit, conducting medical history, individual work time for study of clinical cases or search for information to delve into issues as directed by the preceptor.
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. Absences must be excused. Nonattendance or repeated unexcused absences may prevent the final evaluation of the student.
At the end of the practices, a survey will be carried out to the students on the perception, expectations as well as the objectives that they consider that they have achieved on PCM1.
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 is multi-faceted, consisting of the following:
35% - Direct observation by the preceptor collecting clinical tutor using an evaluation rubric.
25% - Simulated Minic CEX . The student will have to carry out a clinical history to a simulated patient.
20% - Exercise incorporated into Moodle (clinical history to simulated patient) which must include:
- Current Illness
- Physical examination
10% - Problem-based learning (PBL)
In order to be able to apply the percentages of the detailed assessment instruments, it is essential that thestudent has completed all the seminars and obtained a score=or higher than 5 in the tutor’s rubric, and hiher than 5 the MiniCEX assessment. The clinical history posted in Moodle will serve to round off the note in case of doubt.
In addition, a knowledge integration exam will be held at the end of the academic year, in which the contents of all the subjects taught during the course will be included. This exam will be mandatory and will have an impact on the grade of the clinical practice subject, as long as the student obtains a grade = or > 4 in said exam; In this case, you will see your final practice grade increased, and the increase may range between 0.2 (if the grade is 4) and 1.5 (if the grade is 10). This increase will not apply in the event that the student has not passed the subject.
Second call
In the second call, the marks obtained in the sections passed in the first call will be kept but the assessment of the new rubric will be taken into account for the final score:
- If the failure is for a tutor's rubric less than 5 or Mini CEX less than 5 or both of them, a stay of one week in a hospital center will be scheduled and the student at the end of it must pass a Mini CEX.
-If the student has not attended the seminars in the first call, they will have an NS (not submitted) and must complete the mini CEX and the Moodle exercise and send a complete clinical history in the second call. In case of having any of the other elements of the evaluation suspended, they must also be carried out in this second call.
Third and fourth call
No section will be saved in case of repetition of the subject or successive calls.
Bibliography and resources
McGee, S (2017). Evidence-Based Physical Diagnosis (4 ed.). Philadelphia: Elsevier.
Farreras, V., Rozman, C., Cardellach López, F. (2020). Medicina Interna (19 ed.). Elsevier.
Jameson, JL., Fauci, A.S., Kasper, D.L., Hauser, S.L., Longo, D.L., Loscalzo, J. (2019). Harrison's Principles of Internal Medicine (20 ed.). New York: McGraw-Hill Medical.
Swartz, M (2015). Tratado de semiología: Anamnesis y exploración física. (7 ed.).
Noguer-Balcells P, Prieto Valtueña JM. (2016). Exploración clínica práctica. (28 ed.).