MINISTRY OF HEALTH OF REPUBLIC OF MOLDOVA
STATE MEDICAL AND PHARMACEUTICAL UNIVERSITY
„NICOLAE TESTEMIŢANU”
Summer Practical Training Program
for the students of the faculty of Medicine,4th year
______
Chişinău, 2011
PROGRAM
The practical training for the fourth year students of the General Medicine faculty, as a deputy of the ward physician
The practical training For the fourth year students of the General Medicine faculty is scheduled at the end of the VIII semester with a duration of 160 hours (20 work-days), as a deputy of the ward physician. Practical training is carried out in hospitals Republican, municipal and district - departments of internal diseases, surgery, obstetrics and pediatrics. In each department the student works for five days, during - 8 hours. In each section the student perform one night on-call service.
Responsible for the organization practical training are appointed lecturers from the departments of: Internal Medicine, Surgery, Pediatrics, Obstetrics and Gynecology.
The purpose of practical training is strengthening the knowledge gained by students during the study of the main clinical and theoretical disciplines, familiarization with medical practice and improvement of practical skills, study of the principles of health care organization, the accumulation of work experience working in the field of health prevention and education.
On the first day of practical training for students is organized a meeting with hospital management, during which students are introduced to the staff of the institution, circumstances and working conditions, working arrangements and traditions of the institution.
During practical training in hospital, the student is required to know the methods of clinical examination of patients, anti-epidemic hospital system, rules of admission and discharge of patients, to be actively involved in diagnostic and treatment procedures, to complete the necessary medical documentation, etc. Students must be familiar with the hospital staff, organization of curative work, the specific work of ancillary services, etc.
An obligatory condition during practical training course is to respect and fulfill the ethical norms, professional ethics, and interpersonal rules of conduct and discipline of work.
Working in the department students must participate in medical conferences, clinical and clinic-anatomical conferences. Students must perform, under the supervision of a medical specialist, manipulations necessary for diagnosis and treatment such as blood pressure, gastric and duodenal survey, intravenous and intramuscular injections, blood transfusions, pleural puncture, paracentesis, bladder catheterization, enemas (evacuees, medical , food enema - soda), blind survey, etc..
For participation in the application of different methods of diagnosis and treatment, the student must accompany the patient in the office of radiology, endoscopy, functional diagnostic departments and physio-therapy. Students should acquire practical skills in carrying out registration ECG, spirometry, pneumotachometry, etc. independently performing 3-4 record. They should also consider the results of laboratory investigations - blood count, urinalysis, sputum, gastric and duodenal ulcer, etc.
Students must participate actively and acquire practical skills in solving the critical state cases of emergency hospitalization of patients in hospital (stabilization of status asthmaticus, hypertonic crisis, emergency treatment in severe acute cardiovascular insufficiency, coma, diabetes or hypoglycemia, acute poisoning, etc.).
To acquire practical skills in assessing temporary or permanent incapacity, and fulfill the appropriate documentation the student must participate in the work of the Advisory Medical Committee and Medical expertise committee of working capacity.
In order to achieve the work of prevention and health education, students must prepare during practical training reports on infectious diseases in the various collective (obligatory course), participate in programs of local radio and TV stations, publishing articles in newspapers and magazines, etc. The theme is suggested by the person responsible for practical training.
Upon completion of practical training the student present the register, certificate confirming the achievement of health education work and sustain the exam in front of the Examination committee which is formed by: chiefs of department, and the head of practical stage from university. The mark obtained is fixed in the booklet of notes and in the examination list by the head of practical stage. Examination list is signed by all members of the examination committee.
SUBJECTS
For practical training for the fourth year students at the faculty of General medicine
Internal medicine
1. Query (medical history) of the patient.
2. General inspection.
3. Palpation of peripheral lymph nodes.
4. Inspection of the respiratory system.
5. Chest palpation and percussion.
6. Lung auscultation.
7. Inspection of vessels and heart.
8. Determination of relative and absolute cardiac dullness limits.
9. Heart configuration. Vascular pedicle dimensions.
10. Auscultation of blood vessels and heart.
11. measurement of blood pressure
12. Pulse examination.
13. Determination of liver size (after Curlov)
14. Palpation of internal organs and kidney.
15. Preparing the patient for radiological investigation of the stomach, intestine, kidney, etc.
16. Gastric lavage.
17. Oil, healing and nutrition enemas.
18. Duodenal and stomach survey.
19. Thoracentesis, laparacentesis, pericardiocentesis and arthrocentesis.
20. Apply tourniquet on the extremities.
21. External cardiac massage, guided breathing (artificial).
22. Inhaled drug. Oxygen therapy Technique.
23. Administration (introduction) endobronchial, endotracheal, graft, intraarticular of drugs.
24. ECG, ECO-echocardiography, phonocardiographs. Heart radiography.
25. Description of lungs, gastrointestinal, joint, spine, and brain radiographs.
26. Elastic catheter bladder catheterization.
27. Injections i/c, s/c, i/m, iv and i/v infusions.
28. Transfusions of blood and blood substitutes.
29. Interpretation of blood count including platelets and reticulocytes in various diseases.
30. Duration of bleeding and clotting time.
31. Interpretation of General urine analysis in various pathologies.
32. Interpretation of urine analysis after Neciporenco.
33. Interpretation of urine analysis after Zimnitsky.
34. Blood glucose.
35. Analysis of gastric juice, pH.
36. Analysis of bile.
37. Hematocrit.
38. Stool analysis.
39. Gregersen's test (veder) in faeces.
40. Interpretation of general analysis of sputum.
41. Clinical analysis of pleural and ascitic fluid.
42. Blood typing.
43. Prothrombin index.
44. Transaminases
45. The plasma heparin tolerance.
46. Alkaline phosphatase in the blood.
47. Blood aldolase.
48. Isoenzymes, lactate dehydrogenase.
49. Indicators of inflammation in the acute phase (salicylic acid, protein C reactive, fibrinogen, etc.).
50. Samples of precipitation (with thymol and sublimated).
51. Summary of blood protein and proteinogram.
52. Cholesterol in the blood.
53. Triglycerides in blood.
54. Bilirubin in the blood.
55. Electrolytes in the blood.
56. Determination of bile pigments in urine.
57. Amylase in blood and urine diastase.
58. Immunological status indices: Ig, lymphocytes "B" and "T", immune complex.
59. Streptococcal antibody titers in blood.
60. Reading radiographs.
61. Read spirometry results, assess the degree and nature of respiratory failure.
62. lungs, liver, kidney, thyroid gland scanography.
63. Assessment of the isotopic radiography results.
64. Reading ECG. ECG Findings in different valvular changes,
pulmonary heart, coronary heart disease, etc.
65. Assessment of the veloergometry results.
SURGERY
1. The structure of surgical service in a hospital. The structure of surgical departments and operating block.
2. Learning of basic essentials of ethics and bioethics in the approach of surgical patients.
3. Learning of actual guidelines and regulations in the prevention of the nosocomial infection.
4. Completing the history form of a surgical patient.
5. Completing the consultation forms,
6. Examination of a patient with acute appendicitis: complaints, history, physical examination, the plan of necessary investigations, the analysis of the results.
7. The assistance and basic steps of appendicectomy.
8. Examination of a patient with peritonitis: complaints, history, physical examination, the plan of necessary investigations, the analysis of the results.
9. Examination of a patient with acute cholecystitis: complaints, history, physical examination, the plan of necessary investigations, the analysis of the results. The treatment of patients with acute cholecystitis.
10. The assistance and basic steps of cholecystectomy.
11. Examination of a patient with acute pancreatitis: complaints, history, physical examination, the plan of necessary investigations, the analysis of the results.
12. Completing the medication form of patients with acute pancreatitis.
13. Examination of a patient with perforated ulcer: complaints, history, physical examination, the plan of necessary investigations, the analysis of the results.
14. The assistance and basic steps of the surgical intervention in the case of a perforated ulcer.
15. Examination of a patient with bowel occlusion: complaints, history, physical examination, the plan of necessary investigations, the analysis of the results.
16. Conservative and surgical treatment of patients with bowel occlusion.
17. The assistance and basic steps of the surgical intervention in the case of bowel occlusion.
18. Examination of a patient with gastrointestinal bleeding: complaints, history, physical examination, the plan of necessary investigations, the analysis of the results.
19. Conservatory, endoscopic and surgical treatment of patients with gastrointestinal bleeding.
20. Examination of a patient with hernia (free and strangulated): complaints, history, physical examination, the plan of necessary investigations, the analysis of the results.
21. The assistance and basic steps of the surgical intervention in the case of free and strangulated hernia.
22. Examination of a patient with surgical pathology of pleura and the lung (pleural empyema, pulmonary abscess, pulmonary gangrena): complaints, history, physical examination, the plan of necessary investigations, the analysis of the results.
23. Examination of a patient with surgical pathology of breast (benign and malignant): complaints, history, physical examination, the plan of necessary investigations, the analysis of the results.
24. Examination of a patient with surgical pathology of colon and rectum (ulcerative non-specific colitis, colonic diverticular disease, colorectal cancer, anal fissure, anal polyps, hemorrhoids): complaints, history, physical examination, the plan of necessary investigations, the analysis of the results. The rectoscopy: technique, the competence of the method. The fibrocolonoscopy. The digital rectal examination.
25. The assistance and basic steps of hemorrhoidectomy.
26. Examination of a patient with chronic arterial insufficiency of the extremities: complaints, history, physical examination, the plan of necessary investigations, the analysis of the results.
27. Examination of a patient with acute arterial insufficiency of the extremities: complaints, history, physical examination, the plan of necessary investigations, the analysis of the results.
28. Examination of a patient with chronic venous insufficiency of the inferior extremities: complaints, history, physical examination, the plan of necessary investigations, the analysis of the results.
29. Examination of a patient with acute venous thrombosis of the extremities: complaints, history, physical examination, the plan of necessary investigations, the analysis of the results.
30. Examination of a patient with acute purulent surgical infection of soft tissue (furuncle, carbuncle, abscess, phlegmon, erysipelas, mastitis, paraproctitis): complaints, history, physical examination, the plan of necessary investigations, the analysis of the results.
31. The technique of surgical treatment of acute purulent infection of soft tissue. The application of immediate primary sutures, delayed primary sutures, secondary sutures.
32. Examination of a patient with sepsis: complaints, history, physical examination, the plan of necessary investigations, the analysis of the results. The general principles of treatment of a patient with sepsis.
33. Examination of a patient with gas gangrene: complaints, history, physical examination, the plan of necessary investigations, the analysis of the results. The plan of treatment.
34. Examination of a patient with acute trauma of the superior extremities: complaints, history, physical examination, the plan of necessary investigations, the analysis of the results. The plan of treatment. The immobilization during pre-hospital transport. Methods of casting.
35. Examination of a patient with acute trauma of the inferior extremities: complaints, history, physical examination, the plan of necessary investigations, the analysis of the results. The plan of treatment. The immobilization during pre-hospital transport. Methods of casting.
36. Examination of a patient with trauma of the vertebral column: complaints, history, physical examination, the plan of necessary investigations, the analysis of the results. The plan of treatment. The immobilization during pre-hospital transport in case of vertebral column.
37. Examination of a patient with acute head trauma: complaints, history, physical examination, the plan of necessary investigations, the analysis of the results. The plan of treatment.
38. Examination of a patient with acute trauma of the chest: complaints, history, physical examination, the plan of necessary investigations, the analysis of the results. The plan of treatment. The principles of pleural puncture.
39. Examination of a patient with acute trauma of the abdomen: complaints, history, physical examination, the plan of necessary investigations, the analysis of the results. The plan of treatment. The principles of laparocentesis, laparoscopy.
40. The medical aid in critically ill patients (traumatic shock, asphyxia, electric injury, cardiac arrest): external cardiac massage, artificial breathing.
41. Principles of blood transfusion.
42. Methods of local anesthesia. Novocain blockages.
OBSTETRICS
1. Medical history in pregnancy, calving and confinement.
2. The obstetric physical examination, the pelvimetry.
3. The pelvic examination in pregnant women and parturients.
4. The auscultation of fetal heart tones.
5. The determination of gestational age and probable date of birth.
6. The determination of the probable weight of the fetus.
7. The preliminary physiologic and pathologic period. The differential diagnosis.
8. The management and supervision of normal labour. The partography.
9. The amniotomy.
10. The determination of the signs of placenta delivery.
11. The active management of the third stage of labour.
12. The determination of the integrity of placenta, the appreciation of the volume of hemorrhage in labour.
13. The speculum examination of the birth canal.
14. The principles of perineotomy and episiotomy.
15. The assistance in uterine neck and vagina tear repair.
16. The assistance in perineal tear repair.
17. Birth partnership
18. The assessment of newborn health using the Apgar score.
19. The assessment and simple resuscitation at birth. The asphyxia of newborn.
20. The manual control of uterine cavity. The technique.
21. The instrumental control of uterine cavity. The technique.
22. The analgesia in labour. Methods, indications, used drugs.
23. The determination of blood groups and probe of individual compatibility in pregnant women and newborns.
24. The technique of blood transfusion.
25. Completing the history form of labour and the partogram.