Clinical Theory and Practice 3

The course is compulsory and positioned in semester 7 in Programme in Medicine, 360 credits.

Institute of Medicine
Institute of Neuroscience and Physiology

A passed grade in course Clinical theory and practice 1, 30 credits, and furthermore all courses placed before Semester 5, 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 2 is required: clinical placement (8 credits).

The course consists of theoretical and practical exercises in below stated subject areas:
surgery (gastrointestinal, breast, endocrine, hand, vessels, plastic surgery) includingtrauma and parts of gastroenterology, hepatology, orthopaedics, urology, anaesthetics with intensive care, radiology/radiation protection and oncology.

The connection of the course to the list of clinical situations that a registered physician should be able to process independently is listed in appendix 1.

The course contains professional development components such as identification of power relations and norms in health care and violence in close relationships. The course contains continued training of leadership and interprofessional collaboration around acute ill patient in a simulated environment and progression in science such as the relevance and applicability in clinical work of clinical studies.

The course consists of clinical placements in surgical areas as well as primary care.

Knowledge and understanding

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

• give an account of surgical diseases and injuries regarding epidemiology, aetiology, pathogenesis, pathophysiology, diagnostics and treatment
• give an account of the diseases and injuries of the musculoskeletal organs regarding epidemiology, aetiology, pathogenesis, pathophysiology, diagnostics and treatment
• give an account of pathophysiology and treatment principles of failure in vital functions and the principles of types of anaesthesia, its suitability at different anaesthesia forms and its suitability at different clinical situations, perioperative treatment and stabilisation of the patient's vital functions
• give an account of and discuss use of radiological/diagnostic imaging methods for diagnostics and treatment for the most common symptoms and disease groups in the surgical disciplines
• give an account of principles of pharmacological treatment and radiotherapy in cancer disease in both curative and palliative phase
• give an account of the pathophysiology and treatment principles of acute and chronic pain
• give an account of how preventive measures can influence the risk for disease in the subject areas of the course
• give an account of the possibilities with palliative care at incurable, progressive, critical disease
• on a general level describe and explain basic concepts regarding violence and violent crimes, risk factors for violence and violent crimes and violence against particularly exposed groups including how the health of the one exposed to violence may be affected

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

• give an account of epidemiological aspects for the most common cancer diseases in Sweden and backgrounds to differences in the incidence of cancer globally and overtime
• give an account of application of screening programme for surgical and oncological disease
• give an account of various types of clinical studies
• give an account of basic concepts for assessing clinical studies such as different types of bias, internal validity, external validity and clinical relevance
• give an account of the concepts evidence and recommendation

Competence and skills

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

• independently reassess work diagnoses at new relevant information together with supervisor in a simulated environment lead an interprofessional collaboration around an acute severely ill patient and in a professional way communicate difficult information to patient
• independently carry out intravenous, subcutaneous injection, put venous access, apply bandage and gypsum and preform joint puncture in a simulated environment
• under supervision; carry out local anaesthesia in the skin, put and remove skinsuture, establish free airway and in clinical setting or simulation carry outprocto-/rectoscopy and apply urinary tract catheter
• under supervision; cooperate around a patient with colleagues and other staff inhealth care
• initially handle patients with smaller and larger trauma
• initially assess patients with common and non-serious diseases in locomotive organsin the primary care
• make a preliminary assessment of the nursing level in investigation and treatment of patients with common and non-serious diseases in the locomotive organs in the primary care
• carry out systematic review and preliminary assessment of the most common basic and acute radiological studies
• independently process an uncomplicated wound with professional skill

In the subject areas of the course:

• apply a person-centered working method to acquire a structured medical history and 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
• discuss the result of the investigation with the patient and together with supervisor formulate a remedial plan and carry out pharmacological 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 establishing and start an initial treatment plan in consultation with patient and/or the relative

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

• critically review a clinical study

Judgement and approach

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

• reflect on the basic principles to assess the relevance and applicability in clinical work of clinical studies
• reflect on strategies that promote a professional working method independent as well as in teams, and give examples of how one establishes trustful relationships with patients, relatives and co-workers
• identify, analyse and evaluate ethical and medical aspects regarding limitations in diagnostics and treatment
• identify, analyse and discuss situations where gender, age and ethnicity can affect the availability to care, personal treatment, diagnostics and treatment in the subject areas of the course
• identify and discuss power relations and norms in health care, including own current and future power and influence possibilities
• reflect on which challenges non-normative patients, relatives, physician and other health-care personnel can experience in healthcare
• demonstrate a professional attitude vis-à-vis patients, relatives and co-workers in the subject area of the course

The teaching activities will consist of:

• lectures
• team-based learning (TBL)
• seminars
• case studies/discussions
• group exercise
• skills training (in clinical and simulated environment)
• simulations
• self-studies
• clinical placement

During clinical placement, the student practice proficiency to carry out for physicians central professional activities and receives feedback on these components according to the model for "Entrustable Professional Activites" (EPA).

Language of instruction: Swedish
Teaching elements in English can occur.

The course is examined through the following components:

• seminars (1.5 credits)
• web test (1.5 credits)
• Clinical placement including simulation exercises (in total 18 credits)
  - Clinical placement block 1 Surgery (3.5 credits)
  - Clinical placement block 2 Anaesthesia and acute simulation (3.5 credits)
  - Clinical placement block 3 Urology, hand-, plastic-, vessels- and endocrinesurgery (3.5 credits)
  - Clinical placement block 4 Ortopaedics, general medicine, oncology andradiology (6.5 credits)
  - Clinical placement overall assessment (1 credit)
• seminars and examination portfolio in professional development (1 credit)
• a practical examination in a simulated environment (1.5 credits)
• a written examination (6.5 credits)

For approved clinical placement, attendance and completed components are required according to the 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 placements opportunities is limited to two (2) occasions.

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 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 continue the 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 are required before the student can be offered a new clinical placement. A student who fails clinical placement has the possibility to retake the course once more.

If a student who has twice received a failing grade for the same examination component 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). In instances of when an evaluation is limited to two occasions,the student may request change of examiner after the first evaluation.

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 three 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 internship (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/digital teaching requires access to computer, web camera and connection.

Appendix 1 - Clinical situations

The Medical Programme has defined a number (about 100) clinical situations that a recently 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 give an account of pathophysiological mechanisms and clinical image and describe and justify treatment, including investigation, treatment and relevant differential diagnoses.

Difficulties in respiration
Differing diagnostic and findings
Blood in faeces
Blood in the urine/proteinuria
Bloody vomitings
Burn- and frostbites
Abdominal pain
Shock
Diarrhea
Drowning incident/drowning
Electricity accidents
Fever
Discharges (women/men)
Fractures
Foreign body
Poisonings
Changed liquid and electrolyte balance
Changed faeces habits
Heartburn/acid eructations
Sickness and vomitings
Sensitivity for infections
Long pain/ache
Back pain/neck/shoulder
Palpable resistants
Mental effects of trauma
Screening
Sexual uneasiness/dysfunction
Pain at faeces
Painful and/or swollen joint/lead
Sting and bites
Burn/sows/itching in the abdomen
Faint
Swollen abdomen
Deglutition disorders
Wound/wounds
Testicle pain/testicle swelling
Trauma (high energy)
Trauma (low energy)
Tiredness
Thirst/drying
Urination problem/anuri
Weight loss
Violence/assault
Terminal care
Overweight/obesity