UNIVERSITY OF THE WITWATERSRAND, JOHANNESBURG
DEPARTMENT OF MEDICINE
MEDICINE COURSE FOR GEMP IV STUDENTS
Table of Contents
1 INTRODUCTION 2
2 OBJECTIVES 2
3 CORE TOPICS AND CASE COMPETENCIES 3
4 A TYPICAL GEMP 4 WEEK IN THE WARDS (6 WEEK BLOCK) 4
5 STUDY, CLERKING TIME AND BEDSIDE TUTORIALS 6
6 PROBLEM BASED LEARNING (PBL) SESSIONS 6
7 THEME SESSIONS 8
8 SEMINARS 8
9 NEUROLOGY, DERMATOLOGY, RADIOLOGY, CHEMICAL PATHOLOGY AND CARDIOLOGY 8
10 PROCEDURES TO BE WITNESSED/PERFORMED 9
11 THREE WEEK BLOCK 10
12 LOG BOOK 10
13 ASSESSMENT AND EXAMINATION………………………………………………………………………….…….…………10
14. RECOMMENDED BOOKS 12
1 INTRODUCTION
Welcome to the Internal Medicine GEMP IV course, which is a formal qualifying course. A total of nine weeks is devoted to Internal Medicine. The nine weeks are split into a ‘stand-alone’ 6 week Medicine block and a further 3 week period which forms part of the Mixed block, in which Medicine is coupled with Orthopaedics. Students who fail the six week Medicine block will have to repeat the block immediately. This will also mean that they will graduate later than their peers.
· ATTENDANCE OF 90% OF WARD AND HOSPITAL ACTIVITIES (TUTORIALS, SEMINARS, PBLs etc) CONSTITUTE THE MINIMUM DP REQUIREMENTS. STUDENTS WHO DO NOT FULFIL ATTENDANCE AND LOGBOOK REQUIREMENTS WILL NOT BE PERMITTED TO WRITE THE EXAM.
· STUDENTS ARE REQUIRED TO BE IN THE WARDS ON THE MONDAY, WEDNESDAY AND FRIDAY OF THE FINAL WEEK OF THEIR BLOCK.
· AT THE END OF THE FIFTH WEEK OF THE BLOCK, UNIT HEADS WILL ADVISE THE ADMINISTRATION OFFICE IF A STUDENT HAS NOT FULFILLED THE DP REQUIREMENTS AND SHOULD NOT BE PERMITTED TO WRITE THE EXAMINATION.
Students who experience any difficulties in their clinical work or their teaching programme should approach the Academic Head of the Department of Internal Medicine, Professor P Manga, Area 553, Charlotte Maxeke Johannesburg Academic Hospital.
An introductory talk will be given at the start of each block. At Charlotte Maxeke Johannesburg Academic Hospital this will be given by Dr I Kalla at 12 noon on the first Thursday of the block in the Conference Room, Department of Internal Medicine, Area 553. At Chris Hani Baragwanath Academic Hospital Prof M Patel will give the introductory talk at 11:00am on the first Friday of the block before his Haematology tutorial.
2 OBJECTIVES
The objective of the GEMP 4 Internal Medicine rotation is to optimize the clinical skills learnt in GEMP 3, and to integrate the clinical and theoretical knowledge in the management of patients with common medical problems. GEMP 4 (particularly the 6 week block) could be regarded as an extension and expansion of GEMP 3 (including enhancing the level of competencies in core clinical topics to a 2T level, including 2E where relevant).
All the clinical skills taught and applied in GEMP 3 need to be consolidated.
The clinical skills include:
i) Communication with patients and the art of obtaining a concise, goal-directed medical history,
ii) Eliciting and demonstrating physical signs, and
iii) Formulating a clinical assessment.
In addition, GEMP 4 brings with it greater emphasis on clinical management (formulating a plan for appropriate investigation and treatment of the individual patient).
Knowledge of basic pharmacology and commonly used drugs is therefore essential.
The 3 week period devoted to Medicine in the mixed block will be used to gain further clinical expertise and competence in the management of patients. The objective is to prepare the students to become competent junior interns who will manage patients under supervision.
3 CORE TOPICS AND CASE COMPETENCIES
The list of clinical topics covers a wide variety of conditions encountered in Internal Medicine. Each of these topics has been allocated a level of competence which the student should attain before graduation. Objectives have been written for each of these topics and they should be considered to be core knowledge for both written and clinical assessments. To maintain awareness of the level of competence required, a list of topics sorted by discipline and the associated levels of competence will be available to both students and staff in the Medicine department. The objectives are available on the CHSE website.
It is unlikely that students will be able to see all of the conditions listed during their GEMP 4 block. However, students who make full use of the wards and of the vast numbers of patients available to them should have little difficulty in seeing patients with most of these conditions. It is up to the students to seek out patients and to use their log books intelligently in order to cover the objectives. Good interpersonal relationships with the resident staff will make this task much easier.
Explanation of levels of competence;
1 = Be able to recognize or place:
The student does not have to be able to deal with this clinical picture, but he is supposed to have heard of it. This means that, when confronted with it in a patient or in the literature, he can place this clinical picture and knows how and where to acquire more information. This level indicates an overview of the condition.
2 = Be able to cope with clinically:
The student must be able to cope with this clinical picture in practice. This means, that in an actual situation he must be able to consider this clinical picture as a diagnosis. This assumes knowledge of the clinical picture. The extent of this knowledge varies according to the clinical picture, but contains at least knowledge of the presentations and complaints, and knowledge of diagnostic and therapeutic possibilities.
· 2 D = Able to diagnose:
For level 2D, able to diagnose means that the diagnosis must be made personally by means of physical examination, simple aids or additional investigation requested by the doctor himself (simple laboratory or x-ray investigation).
· 2 T = Able to treat:
For level 2T, able to treat means that the therapy must be carried out by the doctor personally, referring to the most common therapy for an uncomplicated illness.
· 2 E = Emergency management:
For level 2E, emergency management means that the student should be able to cope with the emergency situation at least. The student should be able to make the appropriate referral for more specialised care. The common emergencies in Medicine are covered in a booklet “A Guide to the Management of Common Medical Emergencies in Adults”, a copy of which was given to students in GEMP III. However, copies are obtainable from the Department of Medicine.
Levels of competence are intended only as a guide. Students must not feel restricted by the level as even the rarest condition will illustrate the basic principles of Clinical Medicine and may be used in a clinical examination for this purpose. For example, the signs of an upper motor neurone lesion are as valid in amyotrophic lateral sclerosis (level 1) as in a cerebrovascular accident (cerebral infarction level 2D).
4 A TYPICAL GEMP 4 WEEK IN THE WARDS (6 WEEK BLOCK)
THE TIMETABLE BELOW IS INTENDED AS A GUIDE. THE ACTUAL TIMETABLE IN USE IN EACH OF THE WARDS AND AT THE DIFFERENT HOSPITALS MAY DIFFER DEPENDING ON THE AVAILABILITY OF STAFF AT A PARTICULAR TIME AND THE FACILITIES AT THE RESPECTIVE HOSPITAL. HOWEVER, IRRESPECTIVE OF THIS, THE MEDICAL STAFF HAVE A COMMITMENT TO COMPLETE AND HONOUR ALL THE ACTIVITIES ALLOCATED TO THEM.
The general principles are as follows:
· Students are expected to spend the whole day in the hospital, except on Thursday afternoons from 12:30 hrs onwards.(Medical School Day – MSD).
· The wards are available to students at all times, including evenings and at week-ends.
· Most of the bedside teaching related to individual wards will take place in the mornings.
· Midmornings and afternoons will be used for hospital-based activities. Students allocated to the wards will form a single group for these activities (6 to 18 students).
· Attendance at INTAKE is compulsory including on MSD. Students will be excused for the time allocated to MSD.
· Additional tutorials in disciplines not mentioned e.g. Respiratory, rheumatology, haematology etc. can be arranged by the groups at the relevant hospitals.
· It is compulsory that students wear white coats in the wards and name tags at all times. They should be familiar with the Faculty Dress Code which appears on the GEMP website.
· Before students approach a patient, permission should be sought from the Sister in charge or from the respective Medical Staff.
A TYPICAL WEEK IN A MEDICAL WARD IN GEMP 4
THIS IS INTENDED ONLY AS A GUIDE. INDIVIDUAL UNITS AND GROUPS WILL DETERMINE THEIR OWN TIME-TABLE WITHIN THESE PARAMETERS.
08:0008:30
09:00
09:30
10:00
10:30
11:00
11:30
12:00
12:30
13:00
13:30
14:00
14:30
15:00
15:30
16:00
16:30
17:00 / Monday / Tuesday / Wednesday / Thursday / Friday / Sat/Sun
Bed-side Tutorial / Bed-side Tutorial / Bed-side Tutorial / Bed-side Tutorial / Study and Clerking Time / Intakes / Post-intake Rounds
and
Ward Access
Time
if
Required.
Study and Clerking Time / Study and Clerking Time / Study and Clerking Time / Study and Clerking Time / Cardiology
Neurology / Chemical Pathology / Bed-side Tutorial / Dermatology / Haematology
LUNCH / MEDICAL
SCHOOL
DAY
(MSD) / TIME
Seminar / Bedside tutorial / Seminar / Radiology
PBL 1 &
Theme / PBL 2
Study and clerking time / Study and clerking time
MEDICAL INTAKES AND WARD ACCESS TIME
Hours per Week / Time
Monday / Tuesday / Wednesday / Thursday / Friday
Neurology / 1.5 / - / - / - / - / 1.5
Chemical Pathology / - / 1.5 / - / - / - / 1.5
Cardiology / - / - / - / - / 1.5 / 1.5
Dermatology / - / - / - / 1.5 / - / 1.5
HAEMATOLOGY / - / - / - / - / 1.5 / 1.5
Radiology / - / - / - / - / 1.5 / 1.5
Bed-side Tutorials / 1.5 / 3.0 / 3.0 / 3.0 / - / 10.5
Study and Clerking Time / 1.5 / 3 / 1.5 / 1.5 / 3.0 / 10.5
Seminars / 1.0 / - / 1.0 / - / 1.0 / 2.0
PBL’s / 2.0 / - / 2.0 / - / 1.5 / 4.0
Intakes / Weekdays: Minimum of 4 Hours after 17:00 hrs
Weekends: Minimum of 10 Hours
5 STUDY, CLERKING TIME AND BEDSIDE TUTORIALS
The major emphasis will be on learning Medicine at the bedside. Students will be expected to take histories from, examine patients and formulate an assessment and management plan on a wide range of diseases. The patients will be discussed with tutors at daily bedside teaching rounds. Since the course relies on the availability of clinical material, students cannot expect a systematic exposure to each of the organ systems. The students themselves will be responsible for seeking out patients who exhibit features of different diseases, thereby ensuring that every student sees the full spectrum of pathology. To facilitate this, each student will be required to keep a Log Book, recording the details of each patient clerked and presented as well as procedures witnessed and performed during the block. Details on how to use the Log Book appear on the first page of the Log Book.
6 PROBLEM BASED LEARNING (PBL) SESSIONS
Students already have a working knowledge of PBL sessions, based on their experience in GEMP III. PBLs should be based on real patients identified in the wards, and will work as follows:
1. The PBLs will be run by facilitators in each of the three hospitals.
2. Each week of the block is devoted to a different Division/discipline, and this will be the same for each hospital. In general, disciplines covered in GEMP 3 will not be repeated in GEMP 4.
3. On the Monday, the facilitator will choose a topic from the list provided by the Division (see attached time table). Part of this session must incorporate a theme session the content of which will be available in a pack provided by the theme coordinators (see Theme sessions below)
4. The choice of topic will depend on which patients are available in the hospital at that time.
5. The PBL must be based on the problem or problems presented by a real patient who is presently in the hospital. The patient should be clerked and seen by all the students.
6. The group of students must be divided up and each sub-group given a different task (e.g. If the topic is lymphoma, and the patient has NHL, the patient must be clerked and his/her problems identified. One group could look at the epidemiology and aetiopathogenesis; another at the clinical spectrum, diagnosis and staging; another at the treatment options etc. A conscious attempt must be made to incorporate the GEMP themes into the presentation.
7. On Wednesday afternoon, the students will present their findings to the facilitator.
8. Student attendance and performance at PBL sessions will be recorded in the student’s Log Book.
PROBLEM BASED LEARNING (PBL) & SEMINAR TOPICS - 2015
Dates / Discipline / Problem Based Learning Topics / Seminar TopicsWeek 1
Block 1: 19 – 23 Jan
Block 2: 02 – 06 March
Block 3: 13 – 17 April
Block 4: 25 – 29 May
Block 5: 20 - 24 July
Block 6: 31 Aug–04Sept
Block 7: 12 – 16 Oct / Nephrology / 1. Acute Renal Failure
2. Diabetes and the Kidney
3. Hypertension and the Kidney
4. Proteinuria and Glomerular Disease
5. Acid-Base and Electrolyte Disorders
6. Infections of the Urinary Tract / 1. Chronic Kidney Disease
2. HIV and the Kidney
Week 2
Block 1: 26 – 30 Jan
Block 2: 09 – 13 March
Block 3: 20- 24 April
Block 4: 01 – 05 June
Block 5: 27 - 31 July
Block 6: 07 – 11 Sept
Block 7: 19 – 23 Oct / Gastroenterology / 1. Approach to Dysphagia
2. Cirrhosis and its complications
3. HIV and GIT
4. Dyspepsia
5. Hepatitis
6. Inflammatory Bowel Disease / 1. Approach to Jaundice
2. Functional Bowel Disorders (Diarrhoea, Constipation, Irritable Bowel Syndrome, Malabsorption)
Week 3
Block 1: 02 Feb – 06 Feb
Block 2: 16 – 20 March
Block 3: 27 April –01 May
Block 4: 08 – 12 June
Block 5: 03 – 07 Aug
Block 6: 14 – 18 Sept
Block 7: 26 – 30 Oct / Neurology / 1. Disorders of the Spinal Cord
2. Meningitis
3. Neuropathy
4. Myopathy / Neuromuscular Junction Disorders
5. Headache
6. Abnormal Movements/ Movement Disorders / 1. Stroke
2. Coma
Week 4
Block 1: 09 – 13 Feb
Block 2: 23 – 27 March
Block 3: 04 – 08 May
Block 4: 15 – 19 June
Block 5: 10 – 14 Aug
Block 6: 21 - 25 Sept
Block 7: 02 – 06 Nov / Infectious
Diseases / 1. Malaria
2. The Febrile Patient
3. Infectious Diseases of the Skin
4. Emerging Infectious Diseases
5. Infectious Diseases of the Lung
6. Infectious Diseases of the Brain, GIT and Liver / 1. Tuberculosis
2. HIV / AIDS
Week 5
Block 1: 16 – 20 Feb
Block 2: 30 Mar – 03 Apr
Block 3: 11 – 15 May
Block 4: 22 – 26 June
Block 5: 17 – 21 Aug
Block 6: 28 Sept – 02 Oct
Block 7: 09 – 13 Nov / Mixed Week / 1. Approach to cardiac examination / 1. Hypertension
2. Diabetic Emergencies
Week 6
Block 1: 23 – 27 Feb
Block 2: 06 - 10 April
Block 3: 18 – 22 May
Block 4: 29 Jun – 03 July
Block 5: 24 - 28 Aug
Block 6: 05 – 09 Oct
Block 7: 16 – 20 Nov / Dermatology / No PBL sessions in the last week / 1. An Approach to common disorders of the skin
7 THEME SESSIONS