MedInTO Medicine and Surgery

Clinical Methodology and Semeiotics

Clinical Methodology and Semeiotics

Academic year 2023/2024

Sommario del corso

• Course objectives
• Results of learning outcomes
• Program
• Course delivery
• Learning assessment methods
• Suggested readings and bibliography
• Notes
• Teaching Modules
• Teaching tools
• Course card

Course objectives

This course will provide a foundation in knowledge and skills necessary for medical students to recognize the most important medical problems and to construct clinical reasoning models.

Students will be required to achieve a general understanding of the major subject areas of medical diseases, with a special focus on signs and symptoms, and the ability to build up a diagnosis and a differential diagnosis.

The same, as for surgical diseases, with a special focus on signs and symptoms of abdominal surgical diseases.

Interactive teaching: students will be skilled:

• To transform a patient's story into a meaningful clinical problem
• To perform a hypothesis-driven, focused history
• To perform a hypothesis-driven, focused physical examination

Results of learning outcomes

Students will be able to formulate a differential diagnosis, assessment and a prioritized plan for the standardized patient. They will be able to gather a focused history and physical examination in a timed simulated testing environment and to critically examine and reflect on most common laboratory tests, and radiological techniques.

Program

Clinical reasoning and critical thinking

• What is "a problem" in medicine: its perception and interpretation; discuss the definition of an illness script and why it is important to clinical reasoning when compared to "normal" picture;
• Initial concept and multiple diagnostic hypotheses, to be verified or falsified
• Probability, certainty and mistake in the diagnostic procedure; diagnostic errors and how to avoid them
• Measurable variables of clinical reasoning: the likelihood of illness, the diagnostic power of the tests
• Psychological aspects of clinical thinking
• The diagnosis as a correct selection among competing theories
• The steps of medical acting: diagnosis, prognosis, observation, therapy

Collecting clinical information and documents

• Anamnesis: aspects and techniques
• General physical examination
• Laboratory and radiology tools
• Medical record
• Cooperation with different healthcare givers
• Informed consent
• Professional confidentiality

Diagnostic methods in most important clinical problems

Internal Medicine

• Pain (thorax, abdomen, joints, lower limb ischemia)
• Fever
• Altered state of consciousness
• Paleness, cyanosis, jaundice
• Edema
• Dyspnea
• Cough
• Hemoptysis
• Hypertension
• Coronary artery disease
• Arrhythmias
• Cardiac failure
• Pre-syncope, syncope, shock
• Urinary tract diseases
• Acute renal failure and chronic kidney disease
• Nephritic and nephrotic syndrome
• Liver failure
• Portal vein hypertension
• Anaemia, polycythemia
• Hepatomegaly, splenomegaly
• Acid-base, water and electrolyte disorders

Surgery

• Four Abdominal Quadrants and nine Abdominal Regions
• Differential diagnosis in each Abdominal Region
• Clinical abdominal examination: inspection, palpation, percussion, and auscultation
• Main signs and symptoms of abdominal diseases and syndromes
  • Gastroesophageal reflux disease and achalasia
  • Gallstone disease
  • Peptic ulcer
  • Appendicitis
  • Pancreatitis
  • Splenic rupture
  • Inflammatory bowel diseases (Crohn’s disease and ulcerative colitis)
  • Colonic diverticulitis
  • Esophageal cancer
  • Gastric cancer
  • Colonic cancer
  • Rectal cancer
  • Cancer of the head of the pancreas

• Definition of most important abdominal clinical problems:
  • abdominal pain
  • bowel obstruction
  • gastrointestinal bleeding
  • gastrointestinal perforation
  • acute abdomen
  • portosystemic collateral pathways in portal vein hypertension

Psychiatry

The student learns what a mental disorder is and how a mental disorder is diagnosed. Particular attention will be given to learning the mental status examination; a systematic format for recording findings of mental status and behaviour will be provided.

Basics of Diagnostic Imaging

• Fundamentals of radiological techniques (conventional radiology, US, CT, MRI and nuclear medicine) in terms of equipment (including physical principles) and operating principles;
• Contrast agents;
• Radiological semiotics and anatomy, according to different imaging modalities.

Clinical Pathology

The course represents an introduction to Clinical Pathology and will provide key concepts in laboratory medicine, correlate them to the associated clinical or laboratory information, and apply them to the diagnosis and management of human disease. Laboratory testing key concepts will be covered, including variability, quality control, reference intervals, predictive value, decision levels.

Basic concepts in Clinical Research Methodology 

• Introduction to clinical research
• Classification of clinical studies
• Concept of primary sources, observational and experimental studies, secondary sources, systematic reviews
• Concept of guidelines and randomized clinical trials
• Method for evaluating a guideline
• Principles for setting up an experimental clinical study

Course delivery

 Formal authority.

Lectures' keynote slides, and other learning material will be made available through the Campusnet page of each module.

Semeiotics exercises will be organized in the Advanced Medical Simulation Center.

They will be given to small groups (10-12 students), during the semester. Each group will participate in a four-day exercise, in the afternoon (16:00-18:00), as follows:

1. General approach to the physical examination, vital parameters

2. Physical examination of the lungs

3. Physical examination of the heart and of the circulatory system

4. Physical examination of the abdomen

Learning assessment methods

The exam test covers all the disciplines included in the course and the final score proportionally takes into account results of each module.

EXAMINATION ARRANGEMENTS: written and oral

EXAM IN ATTENDANCE: WRITTEN + ORAL (optional)

WRITTEN EXAM

Number and type of questions:

Scores:

• Long Essay Questions:
  • 0 to 10 points for each answer
• Multiple-choice questions (1 out of 4):
  • +1 point for each right answer
  • 0 point for each missing answer
  • -0.25 point for each wrong answer

Students must reach the sufficiency (18/30) in each discipline in the written test to pass the exam and/or to have access to the oral part of the exam (optional, see below). 

The result of the written test may be valid, at the student's discretion, until the next exam session.
If a student fails the oral exam, the written test has to be taken again.

ORAL EXAM

Internal Medicine only. It is possible on request, but optional, to critically examine and reflect on the outcomes of the written test, and demonstrate understanding of all the disciplines part of the integrated course. At the end of the oral, the Internal Medicine grade (written) can increase or decrease by not more than 3/30.

FINAL GRADE

The final grade will be given with a weighted average of the results obtained in each module and expressed in thirtieths.

• J. Larry Jameson et al., Harrison's Principles of Internal Medicine, ISBN: 9788808185389, New York: McGraw Hill Education
• L. Goldman, A. Schafer, Goldman-Cecil Medicine, ISBN: 9781455750177, Philadelphia, PA: Elsevier
• L. S. Bickley et al., Bate's Guide to Physical Examination and History Taking, ISBN: 9781975109912, Philadelphia, Pa: Wolters Kluwer Health
• M. W. Mulholland et al., Greenfield's Surgery: Scientific Principles and Practice, 6th ed. ISBN: 9781469890012, Philadelphia, Pa: Wolters Kluwer Health, 2016
• J. M. Boone et al., The Essential Physics of the Medical Imaging, 3rd ed., ISBN: 9781975167660, Philadelphia, Pa: Lippincott Williams & Wilkins, 2012
• M. Y. M. Chen et al., Basic Radiology, 2e, Part 1. The McGraw-Hill Companies, Inc, 2011 (available at https://accessmedicine-mhmedical-com.bibliopass.unito.it/book.aspx?bookid=360#39669006)
• K. M. Elsayes et al., Introduction to Diagnostic Radiology, Chapter 1 and 2. McGraw-Hill Education, 2014 (available at https://accessmedicine-mhmedical-com.bibliopass.unito.it/book.aspx?bookid=1562)

Notes

Please be aware that the teaching materials for the course in Clinical Methodology and Semeiotics is divided into various teaching modules. The teaching materials are available for download on the specific pages of each teaching module at the following links:

• Clinical Pathology
• Diagnostic Imaging
• Internal Medicine
• Psychiatry 
• Clinical and Analytical Methodology
• Surgery

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• MED/09 - Internal medicine - 6 CFU
• MED/09 - Clinical and Analytical Methodology - 1 CFU
• MED/05 - Clinical pathology - 1 CFU
• MED/18 - Surgery - 1 CFU
• MED/25 - Psychiatry - 1 CFU
• MED/36 - Diagnostic imaging - 1 CFU

Students with DSA or disabilities are kindly requested to take note of the reception services and support services offered by the University of Turin, and in particular of the procedures required for exam support.

Teaching Modules

• Clinical methodology - Module of Clinical and Analytical Methodology (SCB0426B)
• Clinical methodology - Module of Clinical Pathology (SCB0426E)
• Clinical methodology - Module of Diagnostic Imaging (SCB0426D)
• Clinical methodology - Module of Internal Medicine (SCB0426A)
• Clinical methodology - Module of Psychiatry (SCB0426C)
• Clinical methodology - Module of Surgery (SCB0426F)

• Teaching material
• Exams and finals
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