MedInTO Medicine and Surgery

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.

Upon successful completion of this course, 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.

Students will be required to achieve a general understanding of all the major subject areas of clinical pathology testing, including clinical chemistry, full blood count interpretation, coagulation,  immunology, transfusion medicine and basic concept of molecular diagnostics.

Students will be required to achieve a general understanding of all the major subject areas of intervention in surgical diseases, with a special focus on signs and symptoms of abdominal surgical diseases.

Interactive teaching: students will be skilled a) to transform a patient's story into a meaningful clinical problem, b)  to perform a hypothesis driven, focused history,   c) to perform a hypothesis driven, focused physical examination.

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

WRITTEN

Number and type of questions:

                                              long essay     multiple choice

Internal medicine           (CFU 6)           4                      4

Surgery                      (CFU 1)           2                      2

Clinical pathology           (CFU 1)            0                      8

Clinical research             (CFU 1)            0                      8

Diagnostic imaging         (CFU 1)            0                      8

Psychiatry                  (CFU 1)            0                      8

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 at least the 25% of each discipline's score threshold (2 out of 8), and the 50% of the overall score threshold in the written test (50 out of 100) to have granted access to the oral part of the exam.

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

Critically examine and reflect on the outcomes of written tests.

Demonstrate understanding of all the disciplines part of the integrated course.

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; List several classic diagnostic errors and how to avoid them.

- measurable variables of clinical reasoning: likelihood of illness, 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

Pain (thorax, abdomen, joints, lower limb ischemia); bowel occlusion; gastrointestinal bleeding and perforation; fever; altered state of consciousness; paleness, cyanosis, icterus/ jaundice; oedema; 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; portal vein hypertension; anemia, polycythemia; hepatomegaly, splenomegaly; acid-base and electrolyte (Na/K) disorders; nutrients deficiency or excess, the medical use of diets and the concept of dietary goals and guidelines.

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 about mental status and behavior 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 anatomy and semiotics, 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.

MED/05 - clinical pathology - 1 CFU
MED/09 - internal medicine - 6 CFU
MED/18 - surgery - 1 CFU
MED/25 - psychiatry - 1 CFU
MED/36 - diagnostic imaging and radiotherapy - 1 CFU