Clinical Theory and Practice 2

The course is compulsory in The Study Programme in Medicine, 360 credits and constitutes semester 6.

Institute of Neuroscience and Physiology

Passed grade in course Basic science and clinical introduction 2, 30 credits, and furthermore all courses placed before Semester 4, according to the programme curriculum of the medical programme, should be approved. Furthermore, a pass grade on the following course components on course Clinical theory and practice 1 is required: half of the clinical placement including practical components.

Subjects that are included in the course are general medicine, emergency medicine, endocrinology and diabetology, gastroenterology and hepatology, hematology, cardiology, lung medicine, nephrology, clinical pharmacology, clinical chemistry, clinical physiology, radiology/radiation protection and its connection to the list over clinical situations that a registered physician should be able to process independently (appendix 1). The course also contains components of professional development, and emphasis is placed on interprofessional learning.

The learning is focused on identification, investigation, differential diagnosis and treatment of common, serious or acute internal medicine conditions. The different subject areas are integrated in one another and are included in several joint components. Throughout the course, communicative ability, leadership, ethical skills, scientific approach and understanding of various cultures, equally right perspective and self-knowledge are developed.

The course introduces ordinances that are of importance for drug prescription. The course furthermore provides knowledge in health care organisation and priorities and the principles of safe care/patient safety. Clinical placement is included with placements in open- and in-patient care and primary care.

Knowledge and understanding

After passed course the student on the basis of the central clinical situations should be able to:

• give an account of common internal medicine diseases regarding aetiology, pathophysiology, investigation, diagnostics and treatment of these
• give an account of symptoms and clinical findings that indicate that the patient should go through investigation to exclude serious or common internal medicine disease
• give an account of symptoms and clinical findings that indicate that a patient has been affected by a seriously acute internal medicine disease
• give an account of and evaluate rational and safe drug treatment, drug life cycles and suggest appropriate pharmacological treatment for common internal medicine diseases
• give an account of and discuss the use of diagnostic examinations and analyses regarding internal medicine issues
• discuss appropriate procedure to inform patients that have been affected by a chronic disease or disease with very bad prognosis

On successful completion of the course the student will be able to:

• account for the importance of primary and secondary preventions for internal medicine diseases
• evaluate epidemiological and randomised clinical scientific studies relevant for the subject areas of the semester
• give an account of ordinances that are of importance for drug prescription
• discuss ethical and legal aspects on questions that concern life-sustaining treatment
• describe the connection between society, lifestyle and illness as well as methods fo rintervention
• give an account of theories of leadership and employee ownership
• give an account of basic radiation biology and radiation protection

Competence and skills

On successful completion of the course, the student on the basis of the central clinicalsituations should be able to:

• in a simulated environment carry out A-Cardiopulmonary resuscitation and ascertaining death
• independently connect electrocardiogram (ECG), systematically analyse ECG and identify clearly abnormal findings
• under supervision carry out arterial punction for the analysis of blood gas
• carry out a simple drug review together with patient
• follow up patients with chronic internal medicine disease in the primary care and suggest relevant investigations and medicine changes
• orally and in writing communicate findings, measures and treatment results with e.g. patients, relatives and health care personnel

In the subject areas of the course:

• on the basis of the patient's needs and together with supervisor cooperate around the patient with colleagues and other staff in health care and when necessary refer to and interact with other instances/professions
• apply a person-centered working method to acquire a structured medical historyand carry out a clinically relevant status on the basis of the current situation, and compile and in writing document the patient meeting
• on the basis of medical history and status prioritise work diagnosis among relevant differential diagnoses and in consultation with the patient establish an initial investigation plan
• identify risk factors for future disease of a patient, initiate preventive measures and plan for follow up
• discuss the result of the investigation with the patient and together with supervisor formulate a remedial plan and carry out pharmacological and/or non-pharmacological treatment in consultation with the patient
• together with supervisor identify patients in need of acute care and carry out a primary care including to establish and start an initial treatment plan in consultation with patient and/or the relative

Judgement and approach

• take responsibility for their own learning and contribute to others' learning identifyand discuss ethical issues in relation to the patient's autonomy
• identify and discuss situations where factors that sex, age and ethnicity can affect the availability to care, treatment, diagnostics and treatment
• discuss the meaning of a professional attitude both in the role as a medical student and as a future physician
• reflect on in which fields the need of own skills improvement in the internal medicine field is particularly urgent
• demonstrate the ability to self-reflection and empathy in the meeting with the patient and with other personnel categories
• demonstrate a professional attitude vis-à-vis patients, the relative and co-workers

The teaching activities will consist of:

• seminars
• case presentations/discussions
• lectures
• case presentation according to case methodology
• simulations
• skills training
• peer-learning: student feedback
• self-studies
• clinical placement

During the clinical placement, the student trains their proficiency to carry out for physician central professional activities and are given continous feedback on these components according to the models for "Entrustable Professional Activities" (EPA) and sit-in.

Language of instruction: Swedish
Some parts may be given in English

The course is examined through the following components:

• Seminars (3 credits)
• Webtests (1,5 credits)
• Written assignments (1 credit)
• Clinical placement (15 credits in total)
- Clinical placement, portfolio examination in patient care (6 credits)
- Clinical placement, portfolio examination, special weeks (4 credits)
- Clinical placement, portfolio examination, Primary Care (3 credits)
- Clinical placement, simulation exercises (1 credit)
- Clinical placement, overall assessment (1 credit)
• Examination Portfolio in Professional Development (0,5 credit)
• A written exam (6 credits)
• An oral exam (3 credits)

For approved VFU, attendance and completed components are required according tothe examination portfolio for Entrustable Professional Activities (EPA).

All compulsory elements must be completed in order to pass the course and, if missed, should be retaken as soon as possible by agreement with the course coordinator.

The number of clinical placement opportunities is limited to two (2) occasions.

If a student has received a recommendation from the University of Gothenburg for special support in learning when compatible with the learning outcomes of the course and provided that unreasonable resources are not required, the examiner may decide to allow the student adjusted conditions for exam or alternative form of assessment.

The examiner may, with immediate effect, suspend a student from his/her clinical placement or equivalent if the student shows a deficiencies in knowledge, skills or attitudes to the degree that there is significant risk for self-injury or physically or mentally injury of another person or that patient safety or the patients' confidence in healthcare is at risk. When the clinical placement is interrupted in this way it means that the student has failed the current course component, and that he/she may not continuethe same clinical placement at a later stage. The reason for the interruption should be documented and an individual plan be established that states which activities and knowledge checks are required before the student can be offered a new occasion. A student who fails clinical placement has the possibility to retake the course once more.

If a student who has been failed twice for the same examination element wishes to change examiner before the next examination session, such a request is to be granted unless there are specific reasons to the contrary (Chapter 6 Section 22 HF).

If a student has received a certificate of disability study support from the University of Gothenburg with a recommendation of adapted examination and/or adapted forms of assessment, an examiner may decide, if this is consistent with the course’s intended learning outcomes and provided that no unreasonable resources would be needed, to grant the student adapted examination and/or adapted forms of assessment.

If a course has been discontinued or undergone major changes, the student must be offered at least two examination sessions in addition to ordinary examination sessions. These sessions are to be spread over a period of at least one year but no more than two years after the course has been discontinued/changed. The same applies to placement and clinical placement (VFU) except that this is restricted to only one further examination session.

If a student has been notified that they fulfil the requirements for being a student at Riksidrottsuniversitetet (RIU student), to combine elite sports activities with studies, the examiner is entitled to decide on adaptation of examinations if this is done in accordance with the Local rules regarding RIU students at the University of Gothenburg.

The grading scale comprises: Pass (G) and Fail (U).

Course evaluation takes place during an on-going course in the form of a Course Board, where the elected representatives of the course discuss with the course management representatives. The protocol from the course board will be published on the university's learning platform. Written course evaluation takes place after the first half of the course and again after the end of the course with the help of a course evaluation survey. A compilation of the course evaluation is published in the virtual learning environment and forms the basis for development of the course.

The results of and possible changes to the course will be shared with students who participated in the evaluation and students who are starting the course.

Clinical placements may be carried out outside the Gothenburg region and may involve travel costs for students.

Clinical placements may be carried out in the evenings, at night and at weekends.

At clinical placements, certain units may require the student to be able to present extract from the criminal record. It is therefore important that the student always has a valid extract that can be shown upon request. For some activities, ID checks of students may also occur.

At clinical placements, the Västra Götaland region and Region Halland's regulations for professional secrecy and confidentiality apply.

At clinical placements, the hospital hygienic routines of respective activities are followed.

Elements of distance/net teaching assume access to computer, web camera and connection.

Appendix 1 - Clinical situations

The Medical Programme has defined a number (about 100) clinical situations that are cently licensed physician will encounter and therefore is expected to be able to process. Below situations are a selection that is commonly occurring in the subject areas of the course. The clinical situations are defined because the student should know in which fields the examination takes place. The student should for below clinical situations be able to pathophysiological mechanisms and clinical image, and describe and justify treatment, including investigation, treatment and essential differential diagnoses.
Observe that apart from the course, the central clinical situations include the majority other clinical situations according to the programme curriculum as associated clinical situations in this course.

The central clinical situations of the course are:

Difficulties in respiration
Inappetence
Abnormal diagnostic and accidental findings
Blood in faeces
Blood in the urine/proteinuria
Hematemesis/vomiting of blood
Hemoptysis/coughing up of blood
Blood pressure changes
Hemorrhagic disorder
Abdominal pain
Shock
Diarrhea
Fever
Poisonings
Confusion
Changed skin colour
Changed fluid and electrolyte balance
Changed faeces habits
Heartburn/acid eructations
Arrhythmia/abnormal cardiac rythm
Heart arrest
Cough
Health promotion measures
Sickness and vomitings
Itching
Longlasting pain/ache
Consciousness disorder
Chest pain
Palpable masses
Pain when defecating
Substance use and abstinence
Faint
Swollen abdomen
Swollen extremities
Deglutition disorders
Sleep disorders
Tiredness
Thirst/drying
Urination problems/anuria
Weight loss
Terminal care
Dizziness/balance disturbances
Overweight/obesity