Medicine II and Medical Specialities

Code:

M5_BM03

Acronym:

M2EM

Keywords
Classification	Keyword
OFICIAL	Medicine

Instance: 2021/2022 - 1S (of 13-09-2021 to 07-01-2022)

Active?	Yes
Responsible unit:	Medical Teaching
Course/CS Responsible:	Integrated Masters Degree in Medicine

Cycles of Study/Courses

Acronym	No. of Students	Study Plan	Curricular Years	Credits UCN	Credits ECTS	Contact hours	Total Time
MIM	74	Official Study Plan	5	-	12	130	324

Teaching language

Portuguese

Objectives

The general objectives to be achieved by the students are divided into: knowledge, clinical skills and attitude & behaviour.

Knowledge: Students should understand the mechanisms and presentation of the main syndromes and pathologies that are included in the different modules of the class, as well as their diagnostic approach and the principles of the therapeutic plan, including the approach of acute situations and prediction of prognosis. The comprehension of the environmental, social and cultural contexts in which diseases occur is essential, as well as knowing the principles of preventive medicine and of a healthy lifestyle, the underlining epidemiology and community healthcare, and how all these principles should be individualized to each particular patient. The ethical and legal aspects inherent to the practice of medicine and the organization of healthcare will also be crucial when providing patient care and should be familiar to the students. 

Clinical skills: Students should communicate appropriately and efficiently with the patients, their relatives and with other healthcare professionals and should be able to work efficiently in a multidisciplinary team. Students should obtain and register a structured medical history, perform correctly a thourough physical examination, make an adequate list of problems, consider the differential diagnosis and propose an investigation plan. The ability to interpret and integrate the findings in the medical history, physical examination and exams will then be essential to reach a diagnosis, propose a therapeutic plan and define the prognosis. Students must also acquire execution skills in basic medical procedures and techniques, that will be specified in each module. 

Attitudes & behaviour: A professional attitude, focused on the best patient care and according to the highest standards of medical practice is fundamental. This includes the respect for cultural, social and linguistic diversity of the patients, colleagues and all healthcare professionals. Students must also acknowledge patient rights, including the confidentiality duty and informed consent; develop clinical investigation skills and critical analysis of scientific data. They should embrace the need to guarantee quality and safety of the care provided to the patient, according to the guidelines of scientific societies and state of the art. Students are also expected to be aware of personal and professional boundaries and should ask for help and provide their help whenever needed.

Learning outcomes and competences

Each student is expected to develop the ability to collect a medical history, perform the physical examination and formulate a list of problems, the investigation plan, a therapeutic approach, as well as a prediction of the prognosis. This should be complemented by the execution of basic clinical techniques.Besides the acquisition of clinical skills, the medical students should defend the quality and safety of patient care and must present a professional attitude, necessary to guarantee an adequate medical practice and respond to the current demands of the patients and the society. Students should acknowledge the importance of primary prevention, beware of healthcare costs and contribute to the appropriate use of available resources, avoiding waste and useless spending.All the students should acquire, at the end of each module, between 8 and 10 skills, distributed into actions, technical gestures or scientific knowledge (theoretical and practical) considered essential by the faculty. During the practical classes, the faculty should promote and evaluate the acquisition of these skills and, if they are not accomplished, the student will not have a positive continuous evaluation in the respective module and in the discipline.
The skills to be developed in each module are the following:

- Cardiology: Know the typical and atypical presentations of an acute myocardial infarction; Know how to investigate and manage a patient with atrial fibrillation; Execute a 12-lead ECG; Recognize different patterns in the ECG, namely: atrial fibrillation and flutter, ST elevation myocardial infarction, atrioventricular block, interventricular or bundle branch blocks, premature atrial and ventricular beats; Be familiar with transthoracic echocardiography; Known the indications and limitations of ischemia tests; Know the indications for temporary pacemaker; Watch an electrical cardioversion.

- Endocrinology: Thyroid palpation; Pemberton’s sign; Chvostek and Trosseau signs; Screening for diabetic sensory and motor neuropathy; Arterial pulse evaluation in the inferior limbs; Orthostatic hypotension evaluation; waist circumference measurement; capillary glycemia measurement; technical of subcutaneous infusion of drugs used in Endocrinology; technical administration of glucagon.

- Clinical Immunology: Basic osteoarticular physical examination; Knowledge of the activity/ lesion indices and classification criteria of the different autoimmune diseases; Differentiate between inflammatory and non-inflammatory disease; Measuring the dermal skin thickness (modified Rodnan score); Evaluation of muscular strength; Characterization of the most common autoimmune diseases; Know the intra and peri-articular infiltration technique in the perspective of a general medicine clinician.

- Medical Oncology: Know which exams to request to stage a patient with breast, prostate, colon or lung cancer; Know how to interpret an anatomopathological examination of a patient with breast, prostate, colon or lung cancer; Give general counselling to patients when they are about to start chemotherapy (diet, exercise, usual medication); Know how to discuss with a patient the potential general side effects of chemotherapy and radiotherapy; Know how to manage cancer pain, acute and chronic; Perform the physical examination of breast cancer patients who underwent tumorectomy, mastectomy or/ and radiotherapy; Identify and provide general guidance in oncologic emergencies, such as febrile neutropenia, thrombocytopenia, superior vena cava syndrome, spinal cord compression, hypercalcemia, hyponatremia; Evaluate the prognosis of a patient with breast, prostate, colon or lung cancer; Attend one session of the Oncology Multidisciplinary Team Clinic.

- Infectious Diseases: Knowledge about the diseases discussed in the lectures and pratical lessons; Watch a lumbar pucture, paracentesis and thoracocentesis; Know how to perform an arterial blood gas analysis (ABG); Know how to perform a tuberculin skin test; Know the epidemiology of the infectious diseases taught in class; Basic reading of lung imagiology; Formulate a clinical algorithm and reasoning for a febrile syndrome; Basic interpretation of laboratory tests in Infectious Diseases: complete blood count, biochemistry, urinalysis, serologies, microbiological tests and serous fluid analysis.

Working method

Presencial

Program

The following contents will be addressed in the theoretical and practical classes:

CARDIOLOGY: Coronary Artery Disease – atherosclerosis, acute coronary syndromes; Arrhythmias – rhythm disturbances, pharmacologic treatment, invasive treatment; Conduction Disturbances – blocks, indications for pacemaker implantation; Hypertension – diagnosis, epidemiology, prognosis, therapeutics; Syncope – epidemiology, physiopathology, prognosis, initial work-up, diagnosis, risk stratification and treatment.

ENDOCRINOLOGY: Diabetes mellitus; Obesity, changes of eating behaviour;  Dyslipidemia; Healthy eating for type 1 and type 2  diabetes, for dyslipidemia and obesity;  Pituitary pathology – acromegaly, prolactinoma and  panhypopituitarism ; Cushing Syndrome; Adrenal pathology - endocrine hypertension - hyperaldosteronism, pheochromocytoma and primary adrenal insufficiency. Thyroid pathology - hyperthyroidism, hypothyroidism and thyroid nodular pathology; primary hyperparathyroidism and hypocalcemia.

CLINICAL IMMUNOLOGY: Introduction to autoimmune diseases- Systemic Sclerosis, Inflammatory Myopathies, Sjogren Syndrome, Behçet disease, Overlap syndromes, Rheumatoid Arthritis and Senonegative Arthropathies, Systemic Lupus Erithematosus and Antiphospholipid Syndrome.

ONCOLOGY: Epidemiology, biology and genetics of cancer; Cancer Prevention and Screening; Diagnosis, staging and cancer prognosis; The importance of multidisciplinary decision; Treatment of Cancer Principles; The 4 main tumors: breast, prostate, lung and colorectal; Handling the toxicity of cancer treatment; Emergencies in oncology; Oncology research

INFECTIOUS DISEASES: Prolonged or undetermined febrile syndrome, SIRS/ sepsis; malaria and main zoonosis; tuberculosis and emerging infectious; HIV infection/ AIDS; Meningitis.

Mandatory literature

Harrison´s ; Principles of INTERNAL MEDICINE , McGraw-Hill
Edition, Michael T. McDermott. ; Endocrine Secrets 6ª Standards of Medical Care in Diabetesd2018 Diabetes Care 2018;41(Suppl. 1):S3 | https://doi.org/10.2337/dc18-SPPC01. ISBN: 978-1-4557-4975-1

Complementary Bibliography

J. Larry Jameson - 3rd Edition; Harrison´s Endocrinology

Teaching methods and learning activities

Theoretical-practical and practical lessons

Evaluation Type

Distributed evaluation with final exam

Assessment Components

Designation	Weight (%)
Participação presencial	20,00
Teste	50,00
Trabalho de campo	30,00
Total:	100,00

Amount of time allocated to each course unit

Designation	Time (hours)
Estudo autónomo	196,00
Frequência das aulas	130,00
Total:	326,00

Eligibility for exams

Attendance to a minimum of three quarters of practical and theoretical classes is mandatory. All the components of the evaluation will be classified between 0 and 20 points, and it is mandatory to get a positive grade (minimum of 10 points) in each one of them.

Test - It will have 50 multiple-choice questions to select the most correct answer. Each module of the discipline will have 10 questions.
Students will have 75 minutes for completing the test.

Continuous evaluation - The following parameters will be considered: Punctuality and attendance: 2 points; Interest and participation: 6 points; Clinical Aptitude: 6 points; Theoretical knowledge: 6 points. The final classification will be the average obtained in all the modules.

Practical test - Will be conducted by two faculty members who were not responsible for the practical classes of that student, who will have to prepare the medical history of a previously selected patient. The following parameters will be considered: medical history and physical examination 4 points; diagnostic hypotheses and investigation plan: 4 points; interpretation and appreciation of diagnostic tests: 4 points; definitive diagnosis, therapeutic plan and prognosis: 4 points; theoretical knowledge: 4 points. The final classification will be expressed in whole units.

Calculation formula of final grade

Assessments components and weight in final grade (%) - Continuous evaluation (20%), Practical test (30%) and Written test (50%)
The final grade will result from the weighted-average of the classifications obtained in the continuous evaluation, practical test and written test. It is mandatory to get a positive classification (minimum of 10 points) in each one of them.
The final grade will be expressed in whole units, within a range from 0 to 20 points, rounded up in cases when the decimal part is equal or superior to 0,5 and rounded down if inferior to 0,5.

Special assessment (TE, DA, ...)

Written test.

Classification improvement

In order to improve the final classification the student should undertake an oral examination; in this case, the previous classifications as well as theoretical and practical knowledge will be taken into consideration.

Observations

In the context of the COVID-19 pandemic, teaching / learning methodologies will depend on the existing epidemiological situation and we can have one of the 3 scenarios:
A. Face-to-face - classes will take place in the usual manner

B. Blended format for contact hours: 
Theoretical classes will be held with presence of some students or totally remotely via Zoom in a synchronous way. 
TP classes will be held with presence of some students or totally remotely via Zoom in a synchronous way with discussion of clinical cases. .
Practical classes: the groups will be divided into two parts, half should have contact with the real patient and the other half with the virtual patient or perform another activity indicated by the teacher, alternating the following week.

C. Distance learning - this model will only be applied if the conditions for semi-face-to-face teaching are impossible due to pandemic and will be done entirely with the use of virtual patients and digital platforms.

Moodle platform written test - On site or distance test


Erasmus Student Evaluation

Assessements components and weight in final grade (%): continous evaluation (50%) and theoretical-pratical oral examination (50%).
The theoretical-pratical examination, on site or at a distance, will be conducted by two faculty members, one of them will be the responsible for the pratical classes of the student