| CO-INSTRUCTORS |
Dalekos George, Rigopoulou Eirini, Makaritsis Konstantinos, Zachou Kalliopi, Gatselis Nikolaos, Ntaios George: (Daily ward round with students’ training by the patients’ bed and lectures performance during the 11-week period at the University Internal Medicine Clinic).
Stefanidis Ioannis, Eleftheriadis Theodoros, Vassilopoulos George Yannakoulas Nikolaos, Gourgoulianis Κonstantinos, Daniel Zoe, Katsiari Christina, Bogdanos Demetrios, Bargiota Alexandra, Efremidis Gregory, Skoularigkis John, Giamouzis Gregory, Kapsoritakis Andreas, Manolakis Anastasios, Roussaki Angelica, Zafiriou Euterpi, Zakynthinos Epaminondas, Makris Dimosthenis, Dardiotis Efthimios, Xeromerisiou Georgia, Kotsakis Athanasios, Saloustros Emmanuel, Koinis Filippos, Kotsi P., Pantazopoulos I.
(The above tutors participate in training with certain lectures and during the 3 weeks of elective training in the Internal Medicine related specialties and in the Neurology Clinic).
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| Objective Objectives/Desired Results: |
The Internal Medicine Clinical Clerkship course is one of the core courses (along with Surgery, Pediatrics, Gynecology and Psychiatry) of the Medical School and carries the highest requirements by the students. The course is offered in the 6th year (12th Semester) of the Medical School. Because of this, the Internal Medicine Clinical Clerkship course has the highest grading of all courses of the Medical School and is the only course that has been graded with nineteen (19) ECTS credits. During the 14-week course, students must acquire and be able to apply the clinical skills necessary to evaluate and care for adult patients with various disorders. In addition, students need to improve their knowledge of Internal Medicine focusing on differential diagnosis, and treatment of common and urgent pathological situations. Treatment of patients suffering from various diseases is a primary objective of the course. Finally, students need to understand and become familiar with the principles necessary to provide proper medical care, while respecting the patient’s personal data and rights. The 14-week clinical practice course aims to acquire the clinical skills, knowledge and professional behavior necessary for the care and management of adult patients with the careful supervision of the medical staff and faculty of the Internal Medicine Clinic.
Clinical Practice is done in groups under the supervision of a tutor supervisor (faculty member). Usually each group consists of 4-8 students. Each student attends at least 4-6 patients.
Objectives
The 14-week Internal Medicine Clinical Clerkship course aims to acquire the clinical skills, knowledge and professional behavior required in the study and care of adult patients with the close supervision of the medical staff and faculty of the Internal Medicine Clinic.
The Objectives of the course can be categorized in clinical skills, knowledge and professional behavior.
CLINICAL SKILLS: During the course, students will acquire and be able to apply the clinical skills needed to evaluate and care for adult patients with common pathological problems (with the appropriate supervision).
Specifically, students should acquire the following skills:
- Obtain accurate, complete and focused medical history from the patient based on the symptoms presented by the patient.
- Perform accurate, complete and focused medical examination.
- Be able to evaluate simple laboratory tests, such as blood tests, urine tests, routine biochemical laboratory findings, and chest X-rays.
- Identify the major problems of the patient and formulate differential diagnostic possibilities accordingly.
- Design the necessary laboratory, imaging, and other clinical examinations needed for differential diagnosis, diagnosis establishment, and patient management.
- Be able to record the history, findings of the physical examination, the natural course of the disease, the findings of the lab tests and treatment in the appropriate medical records (in parallel with, but also independently of the official records kept by the attending physicians).
- Communicate with other team members and in particular report incidents during the ward round and communicate with the nursing staff of the clinic.
- Become familiar with the ways to communicate about the diagnosis, prognosis and treatment approach with the patients and their families, learning from the procedures followed by the attending physicians.
- Become familiar with and be able to perform simple medical procedures, such as venipuncture, arterial blood catheterization, venous catheter placement, ECG execution, nasogastric tube placement and urinary catheterization.
- Become familiar with the use of sterilization and the application of general rules for the prevention of transmission of infectious agents.
- Become acquainted in assisting attending physicians performing more complex medical procedures such as obtaining peritoneal fluid, synovial fluid, pleuritic fluid, lumbar puncture for cerebrospinal fluid collection and marrow smear and bone marrow biopsy.
PROFESSIONAL BEHAVIOR: Students need to understand and become familiar with the behaviors necessary to provide proper care. Particularly:
- Independent and self-driven learning
- Reliability
- Integrity, honesty, altruism
- Respect the patient’s personal data and rights
- Professional look and dress code
- Recognition by the student of gaps and limitations in knowledge and skills and a constant willing to improve
- Providing medical care without personal bias
- Respect the role of other health professionals
Requirements
In order for the student to attend the 6th year Internal Medicine Clinical Clerkship course effectively, he / she must have significant knowledge of many previous courses offered in the curriculum. Of particular importance are the knowledge of preclinical courses like: Anatomy, Histology, Physiology, Biology, Biochemistry, Pharmacology and Microbiology. Additionally, vast knowledge in Pathology, Pathophysiology, Radiology, Clinical Examination and Diagnosis in Internal Medicine, Internal Medicine I & II is required.
Structure of Educational Process
Internal Medicine Clinical Clerkship course is offered in the 6th year according to the Medical School Study Guide. Clinical Practice lasts 14 weeks (11 weeks in the University Internal Medicine Clinic and 3 weeks in the Internal Medicine Subspecialty Clinics). One of the 3 weeks is held at the Respiratory Diseases Clinic.
During the course the students are trained as follows:
1) Attend the clinic on weekdays from 08.00 to 15.00.
- Each student personally attends weekly at least 4-6 patients. He/she records the history, the findings of the physical examination on a daily basis, the results of the lab tests, the course of the disease and the patient’s treatment. The student attends 70 patients approximately during the total course period of time. On discharge, a critique with a summary of the history, physical examination findings and an analysis of the rationale for differential diagnosis, establishment of diagnosis and treatment are recorded.
- Performs and attends the performance of clinical interventions described in “CLINICAL SKILLS”.
- Follows medical instructions given to him by the medical staff of the clinic.
2) Every student during the course is present at the hospital from 16.00 to 23.00 for at least 20 days. There he has the opportunity to familiarize himself with problems that arise frequently in hospitalized patients.
3) Each student during the course is present at the hospital from 08.00 to 23.00 for at least 10 days. During these days he becomes familiar with acute situations and especially abdominal pain, precordial pain, fever, coma, gastrointestinal bleeding, acute renal failure, asthma, acute heart failure, seizures, acute neoplastic syndromes, venous thrombosis and pulmonary embolism and other acute conditions.
4) During the course, the student attends the whole educational processes of the Internal Medicine Clinic according to the annual postgraduate program:
– Analysis of patient cases and lectures on medical entities
– Lectures by invited speakers
– Conferences and Seminars organized by the Clinic or other Clinics of the Department of Medicine
– Bibliography information
– Interclinic scientific meetings
– Lecture Attend (see below)
LECTURES IN THE INTERNAL MEDICINE CLINICAL CLERKSHIP COURSE
- Coma: Definitions, Causes, Diagnostic Approaches and Management.
- Perception disorders: Confusion, delirium and acute confusion, amnesia, dementia: Definitions, etiology and diagnostic approach.
- Febrile states: Diagnostic approach for fever in the first week and fever of unknown etiology.
- Chemotherapy of Infections: Medication Groups, Mode of Action, Common Side Effects by Group and Therapy of Common Bacterial Infections
- Arterial Hypertension: Definition of arterial hypertension and treatment (antihypertensive drug groups, mode of action, side effects) and treatment strategy of hypertension.
- Bronchial asthma: Groups of anti-asthma drugs, mode of action, side effects in groups. Treatment of acute episodes and chronic treatment.
- Pneumonia: Community pneumonia, hospital pneumonia, pneumonia in immunosuppressed patients, pulmonary abscess. Diagnostic approach and treatment.
- Abdominal Pain: Types of abdominal pain, possible causes and diagnostic approach.
- Gastric ulcer: Clinical manifestations, importance of Helicobacter pylori and treatment.
- Upper Gastrointestinal Bleeding: Definition, Reason, Investigation and Treatment.
- Interpretation of laboratory findings of liver disease
- Anemia: Differential diagnosis of the main types of anemia (iron deficiency anemia, chronic anemia, megaloblastic anemia, hemolytic anemia).
- Anticoagulant treatment: Heparin therapy (heparin formulations, mechanisms of action, indications for their administration, modes of administration and monitoring, major side effects). Coumarine derivatives (mechanism of action, modes of administration, monitoring and major side effects). Newer oral anticoagulants (Dabigatran, Rivaroxaban, Apixaban – mechanism of action, modes of administration, monitoring and major side effects).
- Blood transfusions and blood derivatives.
- Acute & Chronic Kidney Failure: Definition, Categorization, Diagnosis and Treatment.
- Electrolyte disorders (Sodium, Potassium, Calcium etc.): Main pathophysiological groups, etiology, investigation and treatment.
- Acid-base balance disorders
- Arthritis Syndromes: Clinical syndromes, differential diagnosis based on clinical and laboratory data.
- Autoantibodies: Classification and clinical applications in diagnostics.
- Non-steroidal anti-inflammatory drugs: Mode of action, clinical applications and adverse reactions.
- Hyperthyroidism and hypothyroidism: Definition, etiology, clinical-laboratory manifestations and treatment.
- Diabetes mellitus: Definition, major complications and treatment with antidiabetic tablets and insulin.
- Dyslipidaemia: Major lipid disorders, clinical implications and management.
- Paraneoplastic syndromes: Endocrine, neurological, dermatological and hematological.
- Acute neoplastic syndromes: Superior vena cava syndrome, spinal cord compression, gastrointestinal tract obstruction, urological emergencies.
- Investigation of ascites
- Emergencies in Internal Medicine: Airway obstruction-Pneumothorax-Cold and Heat injuries-Poisoning-Bites-Rhabdomyolysis-Anaphylactic shock-Cardiopulmonary resuscitation
General Abilities
The course aims to:
- Search, analyze and synthesize data and information, using the necessary technologies
- Decision making
- Independent work
- Teamwork
- Working in an international environment
- Working in an interdisciplinary environment
- Promoting the production of new research ideas
- Exercising criticism and self-criticism
- Promoting free, creative and inductive thinking
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