Clinical Theory and Practice 5

The course is compulsary and positioned in semester 9 in the Programme in Medicine (360 credits).

Institute of Medicine
Institute of Neuroscience and Physiology
Institute of Biomedicine

A passing grade is required in Clinical theory and practice 3, 30 credits and in addition all courses placed before Semester 7, according to the programme curriculum of the medical programme, should be approved. 
Furthermore, a passing grade is required for the following course components in the course Clinical Theory and Practice 4: Clinical placement equivalent to a minimum of 8 credits.

The course consists of theoretical and practical elements within the subject areas of paediatrics (paediatric allergology, paediatric cardiology, paediatric gastroenterology, paediatric immunology and rheumatology, paediatric endocrinology and diabetes, paediatric nephrology, paediatric oncology, paediatric neurology and habilitation, and neonatology), paediatric surgery, paediatric orthopaedics, child psychiatry, gynecology, obstetrics, reproductive medicine, clinical genetics and dermatology. The course provides basic knowledge about the management of common, dangerous and acute conditions within the subject areas of the course. The course's connection to the list of clinical situations that a licensed physician should be able to handle independently is shown in Appendix 1.

The course aims to increase the ability to apply the laws that form the basis for the treatment of patients who may be harmed in close relationships. The course also deals with disease prevention in maternal, child and school health care.

During the course, the student will gain deeper understanding and skills for professional development (PU) in ethics, leadership skills and cooperation, human rights and gender perspectives.

The course provides an overview of global health issues from a multidisciplinary perspective. It addresses application areas in global health, disease burden, health determinants, context, crises, ethics and interventions.

Clinical placement (VFU) is included in the course, with placements within the clinical subject areas of the course.

Knowledge and understanding

After passing the course, the student should be able to, based on the central clinical situations:

• diagnose and manage common, serious and acute medical conditions within the subject areas of paediatrics (paediatric allergology, paediatric cardiology, paediatric gastroenterology, paediatric immunology and rheumatology, paediatric endocrinology and diabetes, paediatric nephrology, paediatric oncology, paediatric neurology and habilitation, and neonatology), paediatric surgery, paediatric orthopaedics, child and adolescent psychiatry, gynecology, obstetrics, reproductive medicine, clinical genetics and dermatology
• account for the epidemiology, etiology, pathogenesis and pathophysiology of common, serious and acute diseases and conditions within the subject areas of the course 

After passing the course, the student should be able to:

• account for the physiological changes in the woman during pregnancy, the phases of childbirth and the passage of the fetus during childbirth
• account for the child's physiological development from birth onwards
• describe how maternal, child, school health care and youth clinics are organized in Sweden, and describe strategies for health-oriented and preventive work including screening, information dissemination and equal access to health and medical care
• understand how preventive measures can prevent morbidity within the subject areas of the course
• discuss difficult situations linked to domestic violence, such as reporting concerns regarding children who are being harmed and securing traces and taking care of suspected sexual abuse
• account for how patients' gender, cultural, socioeconomic, religious and ethnic background can affect the occurrence of diseases and their treatment within the subject areas of the course
• account for regulations on human rights, the Convention on the Rights of the Child, as well as legislation regulating abortion activities, prenatal diagnosis, genetic integrity, sexual abuse, child abuse, infertility treatment, preimplantation genetic testing (PGT), care of minors and treatment of children as relatives
• account for sexual and reproductive health and rights
• describe the global burden of disease in maternal and child health, infectious diseases, non-communicable diseases and injuries
• discuss how local, national and international circumstances can affect the disease management practices of individuals and health systems
• discuss the concepts of "human rights" and "the right to health" from a global perspective 

Competence and skills

After passing the course, the student should be able to, based on the central clinical situations:

• apply a person-centred and age-appropriate approach to obtain a structured medical history and carry out a clinically relevant status adapted to the current situation, as well as compile and document the patient encounter in writing
• under supervision, carry out relevant sampling such as pap smears, sampling for sexually transmitted diseases and perform punch biopsy of the skin
• under supervision carry out skin suture
• based on anamnesis and status, prioritise work diagnosis among relevant differential diagnoses and, in consultation with the patient and/or guardian, draw up an initial investigation plan, design any referral, and provide a structured report to colleagues/other staff
• interpret the available investigation results based on the chosen investigation plan and, under supervision in consultation with the patient and/or guardian, carry out pharmacological and non-pharmacological treatment
• under supervision, identify patients in need of emergency care and carry out primary care, including establishing and initiating an initial treatment plan in consultation with the patient and/or relatives/guardians
• identify the need for and initiate preventive measures
• demonstrate the ability to search for information about diagnoses in relevant databases
• demonstrate the ability to interpret scientific results relevant to the professional role and included in a HTA
• issuing prescriptions
• write a report of concern according to the Social Services Act
• in a simulated environment, convey difficult information to the patient and/or guardian
• work in teams around the patient as a leader and as a co-worker
• in a simulated environment, analyse, document and communicate a health care injury or risk of health care injury in the organisation
• in a realistic simulated environment, handle patient cases related to all clinical situations defined by the medical program
• reflect on own development in terms of the ability to perform core physician tasks and present a plan for progression
• demonstrate the ability to integrate the approaches and skills required to be entrusted with the performance of core physician tasks under indirect action in practice-based training 

After passing the course, the student should be able to:

• analyse strengths and weaknesses in global health data on the prevalence of diseases and determinants of health
• argue for and against global health interventions from a multidisciplinary approach

Judgement and approach

After passing the course, the student should be able to:

• demonstrate understanding and be able to discuss challenges regarding the implementation of scientific studies in pediatrics, gynecology/obstetrics and clinical genetics with a particular focus on the ethical aspects in each area
• demonstrate a professional approach towards patients of different ages, relatives and co-workers within the subject area of the course
• reflect on strategies that promote a professional way of working, independently as well as in teams, and give examples of how to establish confident relationships with patients of different ages, relatives and co-workers within the subject areas of the course
• identify, analyse and evaluate ethical and medical aspects regarding limitations in diagnostics and treatment within the subject areas of the course
• identify, analyse and discuss situations where, for example, gender, age or ethnicity can play a role in access to care, treatment, diagnosis and treatment within the subject areas of the course
• demonstrate the ability to relate in a professional manner to the experience of illness and symptoms as well as social consequences in patients within the subject area of the course
• analyse how attitudes towards ethics, human rights and social justice affect health at the individual and population level, health care systems and research, globally
• describe the importance of an interdisciplinary perspective in addressing global health issues

Forms of teaching:

• lecture
• seminar
• group work
• peer-learning
• group exercise
• role play
• case study/discussion
• simulation
• auscultation
• clinical placement

During clinical placement, the student practice his/her skills to perform for physicians central professionals activities and receive feedback on these elements according to the model of "Entrustable" Professional Activites" (EPA).

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

The course is examined through the following components:

• Seminars: Pediatrics, Pediatric Surgery, Pediatric Orthopedics and Child and Adolescent Psychiatry (2.5 credits)
• Seminars: Gynecology, Obstetrics, Reproductive Medicine and Dermatology (3.1 credits)
• Seminars: Professional Development, Clinical Genetics and Global Health (3 credits)
• Written exam (2.1 credits)
• Web tests (0.9 credits)
• Oral exam in Gynecology, Obstetrics and Reproductive Medicine (0.2 credits)
• Portfolio Examination in Professional Development (0.2 credits)
• Clinical placement
  - Clinical placement Pediatrics (7 credits)
  - Clinical Placement in Obstetrics and Gynecology (7 credits)
  - Clinical placement dermatology (1.5 credits)
  - Clinical placement overall assessment (0.5 credits)
  - OSCE (2 credits) 

Objective Structured Clinical Examination
Level examination with a focus on skills that the students have acquired during semesters 5-9. The examination takes place in the form of an Objective Structured Clinical Examination (OSCE), and includes 10-13 stations. During the exam, clinical skills are examined, such as anamnesis, status and interpretation of investigation findings, but also communication with patients of different ages, relatives and with healthcare employees. Particular emphasis is placed on clinical decision-making.

The following subjects may be included in the examination:
Internal Medicine, Surgery, Psychiatry, General Medicine, Professional Development, Urology, Orthopedics, Hand Surgery, Anesthesia/ICU, Emergency Medicine, Cardiology, Pulmonary Medicine, Rheumatology, Infection, Neurology, Radiology, Dermatology, Obstetrics and Gynecology, Pediatrics, Ear, Nose and Throat, Eye and Oncology.

To pass clinical placement, compulsory attendance and completed elements according to an e-portfolio for professional activities (EPA) are required.

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 examination occasions at clinical placements (VFU) is limited to two 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 one opportunity is used, 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 checks 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).

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 result and any changes in the course structure must be communicated to both the students who completed the evaluation and to the students who will start 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.

Aggressiveness and irritability
Acute crisis response
Breathing
Loss of appetite
Abnormal diagnostic and accident findings
Deviations from normal development of children
Child abuse
Assessment of functional variation
Blood in stool
Blood in urine/proteinuria
Blood pressure changes
Bleeding propensity
Abdominal pain
Shock
Diarrhoea
Fever
Discharge (women/men)
Prenatal diagnosis
Fractures
Foreign body
Confusion
Altered skin color
Altered fluid and electrolyte balance
Changed bowel habits
Changes in disease panorama
Genetic disease in the family
Heartburn/acid reflux
Palpitations/abnormal heart rhythm
Cardiac arrest
Cough
Skin disorders
Headache/facial pain
Hair and nail problems
Health promotion
Hearing loss/ringing in the ears
Nausea and vomiting
Itch
Impairment of strength
Cramps
Sensory change
Susceptibility to infections
Long-term pain/aches
Disturbance of consciousness
Menstrual problems
Normal childbirth/lactation
Involuntary movements
Worry/anxiety/panic disorder
Palpable resistances
Person who opposes care that is deemed necessary
Personality change
Pigment changes
Contraceptive
Mental illness
Psychological effects of trauma
Reproduction/pregnancy
Risk of violence against others
Movement disorders
Screening
Sexual discomfort/dysfunction
Pain when defecating
Painful and/or swollen joint(s)
Language and speech disorder
Mood influence
Substance use and withdrawal
Suicide risk/suicide attempt/ and/or self-harm
Burning/sores/itching in the genital area
Sweating/hot flashes
Fainting
Swollen abdomen
Swollen extremities
Swallowing difficulties
Syndrome
Wounds/wounds
Rare diagnoses
Testicular pain/testicular swelling
Obsessions and actions
Thirst/dehydration
Vaginal bleeding
Delusions/hallucinations
Urination/anuria
Weight loss
Domestic violence
Violence/assault
Eating disorder
Overweight/obesity