Semiology and Fisiopathology II

Code:

M321

Acronym:

SF2

Keywords
Classification	Keyword
OFICIAL	Medicine

Instance: 2024/2025 - 2S (of 17-02-2025 to 13-06-2025)

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	190	Official Study Plan	3	-	9	98	243

Teaching language

Portuguese

Objectives

-  To acquire autonomy, self-learning skills and continuing education purposes that guarantee the preservation of personal posture and professional competence, as well as the performance of the medical practice throughout life;

- To acquire postures and attributes, essential to medical profession, realizing the definitive importance of the doctor-patient relationship;

- To give clinical context to the basic scientific curriculum, integrating the knowledge previously acquired;

Learning outcomes and competences

Semiology and Pathophysiology II - Competencies to be acquired:

- Acquire basic clinical skills, that enable the student to collect a clinical history, perform a physical and mental examination and organize the data on a structured basis, according to the model adopted by the Unit;

- Understand the importance of communicational aspects in the establishment of a consistent, solidary and proficient doctor-patient relationship;

- Be aware of the importance of knowledge, skills and attitudes in promoting a healthy and constructive patient-doctor relationship.

- Be able to conduct, with reasonable ability and rigor, a clinical history by the rules and techniques of communication and inquiry;

- Perform a basic physical examination, excepting the techniques expressly excluded and / or not practiced in this stage;

- Recording, in a reflected and organized way, the clinical data according the model adopted;

- To know the relationships between the mechanisms underlying dysfunction and disease and its clinical expression, in relation to the various semiological areas included in the program;

- Using the pathophysiological and clinical knowledge acquired and applying the principles of clinical reasoning exercised, build an elementary physiopathological and clinical scenario, according to the capacity expected in this stage of learning;

- Based on the clinical setting, prepare a properly prioritized problems list;

- Elaboration of an elementary research plan, focusing on the clinical phase of research, for the most common problems addressed in the program;

- To acquired ability to oral presentation of clinical cases to their peers, in a synthetic and formal way;

- Read and interpret a hemogram blood test;

- Read and interpret the biochemical parameters in blood and urine, related to the topics covered in the program;

- Read and interpret a gasometry.

 

Learning outcomes and competences

- Autonomy and capacity for self-learning and motivation for continuous education through life

- Posture and communication suitable for the practice of medicine, including a good doctor-patient relationship;

- Integration of knowledge previously acquired in basic areas.

- Ability to conduct, with reasonable ability and rigor, a clinical history, observing the rules of communication and inquiry techniques.

- Ability to perform a physical and mental examination and to organize a database, structured clinical data, according to the model adopted by the Unit;

- Knowledge and understanding of the relationship between the underlying mechanisms of dysfunction and disease and its clinical expression, in the different areas addressed;

- Construction of an elementary physiopathological and clinical scenario, according to an expected capacity in the learning stage;

- Based on the clinical setting, prepare a properly prioritized problems list;

- Elaboration of an elementary research plan, focusing on the clinical phase of research, for the most common problems addressed in the program;

- Ability of oral presentation of clinical cases to their peers, in a synthetic and formal way;

- Be aware to the importance of the knowledge, the skills and the attitudes in the promotion of a productive and constructive doctor-patient relationship.

- Knowledge of basic principles and procedures for patient safety;

- Knowledge of the principles of electrocardiography and ability to read and interpret basic electrocardiographic traces;

- Knowledge of the principles of imaging and the ability to read a normal and recognizable thoracic radiograph as the most common anomalies;

- Knowledge of the principles and indications of spirometry and interpretation of its results.

Working method

Presencial

Program

Theoretical Course (42 h):

 

General module (2 hours): presentation of the Unit - program, methods, organization, evaluation; Clinical Record and List of Problems construction.

 

Specific modules:

- Neurological system (8 hours): Anatomy and physiology of the neurological system; Anamnesis, neurological examination and general examination; Neurological signs and symptoms - pathophysiology, characterization and etiologies. Vision, Strength, Sensibility, Consciousness and Commas, Language and Higher Functions. Great neurological syndromes.

- Hepatobiliary-digestive system (12 hours): Anatomy and physiology of the digestive system. Symptoms and signs of liver disease. - pathophysiology, characterization and etiologies. Symptoms and signs of digestive pathology. - pathophysiology, characterization and etiologies. Common pathologies.

- Renal System (12 hours): Renal Anatomy and Physiology; Laboratory evaluation and renal imaging; Hydro electrolytic balance; Acid-base balance; Pathophysiology of edema; Kidney and hypertension; Urinary tract infection; Pathophysiology of chronic renal failure and its clinical manifestations. Acute renal injury: pathophysiology, characterization and etiologies; Nephrotic syndrome. Nephritic syndrome. Pathogenesis and clinical manifestations of glomerular syndromes

- Hematopoietic System (8 hours): Physiology of hematopoiesis; Erythropoiesis; Approach of the patient with anemia; Leukocytes; The lymphatic system; Hemostasis and laboratory evaluation; Hemorrhagic syndromes; Thrombosis and thrombophilia.

 

Practical Course (4 hours / week):

- Practical classes (small groups accompanied by the teacher): Clinical Interview Training. Techniques of communication for the Clinical History collection with real patient; Clinical Record organization; Construction of Clinical History; Oral presentation of clinical cases. Basic physical examination with specific training stations for vital signs evaluation, physical examination of the chest and lungs, cardiovascular physical examination (role-playing model, in groups with 6 students maximum) and observation of the most common changes in simulators.

- Clinical cases discussion classes (based on real and / or simulated situations): Discussion and analysis of the actual clinical cases observed in the ward; Clinical Investigation / Clinical Reasoning; Pathophysiological approach of clinical cases and its semiological expression; Oral presentation of clinical cases.

- E-learning contents: respiratory function, thoracic imaging; basic electrocardiography 

Mandatory literature

Bickley Lynn S.;Bates.; Guide to physical examination and history taking. ISBN: ISBN: 0-7817-6718-0
Kasper Dennis L. ed.;; Harrison's principles of internal medicine.. ISBN: ISBN: 0-07-140235-7
Gary D. Hammer, Stephen J. McPhee:; Pathophysiology of Disease. ISBN: ISBN: 0071806008

Complementary Bibliography

Greenberg Arthur. Ed.; ; Primer of Kidney Diseases. ISBN: ISBN: 0-12-299100-1
J. L. Ducla Soares.; Semiologia Médica, Edições Lidel, 2017

Teaching methods and learning activities

The teaching of semiology and physiopathology encompasses several teaching / learning methodologies. In addition to passive, teacher-centered learning, active student-centered methodologies are used, where the student actively participates in his / her learning and receives feedback relative to his / her performance. The introduction of e-learning content, the use of simulation and the implementation of a reflective portfolio aim to increase the student accountability, instill self-learning habits and allow to repeat maneuvers in an environment free of risk.

Theoretical Course: plenary sessions lasting 50 minutes, using audiovisual media and other technologies that favor interactivity.

Practical Course (4 hours / week): students distributed by "classes" (20 to 27 students), subdivided into small groups (4-5 students). Pedagogical orientation of the class by a Senior Teacher, to which are associated three junior teachers, each of whom guides a small group of students. The teaching objectives of the practical course focus on the development of a productive and supportive doctor-patient relationship and the acquisition of basic clinical skills. The creation of a "small group dynamics" and the determined commitment of each student are essential conditions for the pedagogical success of this model of education. In this model, teachers have the functions of coordinating and guiding more than teaching, leaving to each student and the group the major responsibility for researching and solving clinical problems. To raise problems, to open the topics to the discussion, to make points of situation and conceptual syntheses, are the pedagogical coordinates for the success of the practical teaching, along with the demonstration of the technical gestures and the creation of opportunities for its training. The practical teaching methodology is thus focused on the PBL.

Practical classes (2 hours / week): practical classes (small group / Junior Assistant) using simulations or real patients, are intended for the acquisition of the "clinical method" (data collection, clinical record, oral presentation) and clinical reasoning skills. The data collected are recorded according to the clinical record model of the Unit by all the students of the group individually and presented in the theoretical-practical class. Each student has a notebook where he records the clinical histories of the patients observed, all the cases discussed in the Discussion classes as well as the abilities acquired in performing the physical examination.

Training stations: training the effective execution of physical examination procedures. They use audiovisual support (videos), electronic teaching and model-oriented execution (real, role-playing or simulator). They apply "three-level pedagogy" (observes, comments, executes), conducted by the Junior Assistant.

Clinical cases discussion classes (2 hours / week), under the responsibility of the Senior Assistant. They pursue objectives of integrating knowledge and developing research capacities and clinical reasoning. Analysis and discussion of actual clinical cases observed by the various groups of students. Pathophysiological approach and systems integration in more complex clinical cases.

Workshops about hemogram and acid-base regulation (e-learning mode).


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.

Evaluation Type

Distributed evaluation with final exam

Assessment Components

Designation	Weight (%)
Exame	25,00
Participação presencial	45,00
Teste	30,00
Total:	100,00

Amount of time allocated to each course unit

Designation	Time (hours)
Estudo autónomo	145,00
Frequência das aulas	98,00
Total:	243,00

Eligibility for exams

Assessment Components: Continuous assessment; Multiple choice test; Structured physical examination evaluation; Practical Test with clinical case discussion (Long Clinical Case)

Continuous assessment (CA) (45% of final grade) + Multiple Choice Test (MCT -30% of final grade)

Continuous assessment (CA) (45% of the final grade): evaluates the acquisition of technical skills and non-cognitive aspects of learning: methodologies, postures, behaviors, motivation, interest, collaboration and communication skills (40% of final grade) and e-learning contents (5% of final grade).

Cognitive Assessment: Multiple Choice Test (MCT -30% of final grade): Multiple Response Test approval is a necessary condition for access to the final exam. This test consisting of 75 multiple-choice questions addresses the content taught in the theoretical lessons and that are part of the UC program. The test will be subdivided into two partial tests, the first in the Week of Intercalary Assessments and the second test at the end of the semester. It is considered as approved the student who has more than 37 correct answers in the set of the two tests. Students who did not obtain approval have a second chance by performing a rescue test with 75 questions.

Calculation formula of final grade

Final Exam (25% of the final grade): Admission to the Final Exam (FE) is allowed after approval in the CA and MCT. The final exam consists of a clinical examination of a previously selected patient and the clinical record, performed under predefined conditions, followed by the formal oral presentation and discussion with a jury with at least 2 teachers. The evaluation of this test is quantitative (scale 0 -20 values).

 

Final classification (0-20 scale):

Continuous Assessment: 45%

Multiple Choice Tests : 30%

Final Practical Exam: 25%

Classification improvement

Oral assessment

Observations

The assessment methodology described above is applied to the classroom method (scenario A) and semi-classroom teaching plan (scenario B).

If teaching is totally remote using digital platforms (scenario C),  the evaluation will be carried out as follows:


Continuous assessment (AC) (30% of the final grade): continuous assessment - 25% + assessment of e-learning content - 5%

Final written exam - Multiple choice test with clinical vignettes - 70% of the final grade.
Admission to the Final Exam (PF) is dependent on the positive evaluation in the AC.

Approval in final written exam requires a minimum of  37 correct answers of a total of 75 questions