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3. 2. Block I, Internal Medicine

 

First clinical year, 2x per year, winter and summerterm

duration: 14 weeks

ECTS-Credits: 30

Language of instruction: German

Kursverantwortliche/Lehrsekretariat

 

 

1. Course Content and Teaching Methods

 

1.1 General Introduction

The internal medicine block "HeiCuMed Innere" consists of a week long introduction (Propaedeutic week), 5 comprehensive modules, and the interdisciplinary seminars " Clinical Pharmacology" and "Geriatrics." Instruction time in the internal medicine block lasts 14 weeks. It begins with the Propaedeutic week and is followed by the two-week module in clinical chemistry. The modular course introduction follows in the next 10 weeks. The semester in internal medicine ends with a week-long exam period.

 

The various subdivisions of internal medicine will be introduced to the students during the propadeutic week, which consists of lectures and seminars.

 

The clinical chemistry module follows directly after the introduction week. The modules each last one to two weeks depending on the amount of material to be covered. In addition, one, two, or three other clinical subjects are integrated into each module. A lecture covering cardinal symptoms is offered in parallel to the modules.

 

The students rotate in groups from 30-35 participants through the internal medicine modules.

The students are divided into smaller groups of 6-12 individuals for bedside teaching, PBL (problem based learning), and the Medi-KIT (training in communication and interaction) seminars.

 

1.2. Propaedeutic Week

The propadeutic week serves as an introduction to the field of internal medicine. It consists of lectures and seminars. Each day, one or two subdivisons of internal medicine will be introduced. In addition, the essential issues of a doctor working in each area (for example, health economics and ethics) is covered.

 

Clinically relevant skills such as medical exams or interactive communicative skills are presented and practiced in the afternoon seminars. In addition, the students gain insight into the multifaceted specialty of geriatrics.

 

Clinically relevant skills that are not only crucial to internal medicine, but to all areas of medicine will be presented in the afternoon seminars.

 

1.3. Cardinal Symptoms Lecture

The cardinal symptoms lecture is an extremely important basis of internal medicine. Two lectures are offered daily from Tuesday to Friday over a period of 10 weeks. These lectures focus on a different cardinal symptom each week from an interdisciplinary standpoint. Knowledge of differential diagnosis is emphasized. Topics from the interdisciplinary areas of geriatrics, clinical pharmacology, family medicine, and clinical chemistry are handled in parallel to the module seminars.

 

A new topic is presented each week:

Week

Cardinal Symptom

1st week

Chest pain

2nd week

Abdominal pain

3rd week

Fever

4th week

Shortness of breath

5th week

Fatigue

6th weeke

Water retention

7th week

Jaundice

8th week

Dizziness/Syncope

9th week

Weight loss

10th week

Pain of the musculoskeletal system

 

The cardinal symptoms lecture is offered in parallel to the modules.

 

In addition, the topics of the PBL tutorials and the Communication/Interaction (Medi-KIT) Training are oriented after the topics presented in the cardinal symptom lectures.

 

 

1.4. Modules

Practical as well as theoretical knowledge of the various divisions of internal medicine are presented and expounded upon in the modules. Pathology, radiology, and ethics are also integrated into the modules. The modules last a total of 12 weeks. Clinical chemistry, cardiology, gastroenterology, and hematology/rheumatology each account for two weeks.

 

 

30.04.07 - 11.05.07

14.05.07 - 25.05.07

11.06.07 - 22.06.07

25.06.07 - 06.07.07

09.07.07 - 20.07.07

Cardiology, Angiology, Pulmonology

a

e

d

c

b

Gastroenterology

b

a

e

d

c

Hematology, Oncology, Rheumatology

c

b

a

d

c

1st week

Nephrology

2nd week

General Internal Medicine and Psychosomatics

d

c

b

a

e

Endocrinology

e

d

c

b

a

 

The smaller subjects like nephrology and internal psychosomatics are handled within a week. For example, in one of the modules, the main topic is internal psychosomatics, and ethics is directly integrated into this module. In the 14 day long endocrinology module, there is one day reserved for geriatrics and another day for sports medicine.

 

In order to master the relevant clinical knowledge of each area, practical skills are emphasized in each module every week. The purpose is to deepen clinical understanding and performance. For example, students will learn how to insert central venous lines and stomach tubes, set up, write, interpret EKGs, and practice bone marrow aspiration in the Skills Lab.

 

Students rotate in two-week cycles through the main topics of internal medicine according to the plan above.

 

The modules in general medicine are offered once a week with a new topic in each meeting and are offered as ten double seminar hours in parallel to the internal medicine modules. The methodology and functioning of general medicine should be imparted here. Actual cases from family practices stand in the foreground of this module.

 

The following topics will be handled in a weekly cycle: dizziness, diagnostic uncertainty, abdominal pain, leg pain, degenerative conditions/pharmaceutical therapy, back pain, afflicted skin, fever, naturopathic treatments, chest pain/house calls.

 

1.5. Integrated Clinical Pharmacology and Geriatrics

The major topics in clinical pharmacology will be handled via integration with internal medicine as well as the cardinal symptoms lecture.

 

After an introduction to geriatrics in the propaeudic week with the topics "Falling Accidents and the Elderly", "Special Features of Old Age", and "Water Balance and Incontinence in Old Age" presented in the Cardinal Symptoms lecture, each topic will be discussed and highlighted in the modules. In addition, further topics such as degenerative conditions, multiple medications, and psychosocial aspects with respect to typical geriatric situations will be examined in light of planning a proper therapy.

 

1.6. Learning on the Wards

Theoretical medical knowledge will be augmented on the wards as practical cases are handled. Students will be taught how to be responsible and competent. In addition, students will gain insight into daily routines on the wards.

 

Students will learn how to put together a medical history for patients and to evaluate and judge these medical histories. In addition, students will learn how to relay the most relevant facts of a patient history in a short presentation according to the SOAP-Scheme. During weekly patient visits lasting 3.5 minutes, the current state of each patient's health and therapy plan will be presented to the attending. Afterwards, the attending will hold a discussion session with the students. In addition, the students will write a longer letter about a patient twice in the semester. This patient letter is graded and the grade is part of the overall grade for internal medicine.

 

A further part of ward instruction consists of the collection of credit points. Each student will collect points by performing duties directly on patients(such as placing a central venous line) or assisting the attending with other duties.

 

The ward instruction time is divided into two portions during the semester, each lasting five weeks. Students can spend the first five weeks at the Heidelberg University hospital and the second five weeks at an academic teaching hospital of Heidelberg University, or vice versa.

 

1.7. Problem Based Learning (PBL) and Medi-KIT - Communication and Interaction Training for Medical Students

 

Clinical cases and the course goals will be handled in a concrete fashion in the PBL tutorials.

Course instruction takes place twice a week for one hour. The goal of PBL is for each student to develop his or her own problem-solving strategies, in addition to integrating the course content and the practically-oriented skills learned on the wards.

 

Concrete problems, cardinal symptoms, and patient histories will be discussed in small groups. The relevant information is considered and evaluated, and a therapy plan based is developed.

 

PBL represents an integrated learning strategy and is structured to emulate topics and problems found in each medical subject and the appropriate diagnoses. Working through a clinical case is handled after the seven classical steps of PBL methodology.

  1. Information collection and clarification of terms
  2. Defining the problem
  3. Brainstorming
  4. Recapitulation and systematic organisation
  5. Establishment of learning goals
  6. Individual evaluation of the problem
  7. Presentation

 

Medi-KIT - Communication and Interaction Training for Medical Students

 

Time and time again, current polls taken from patients show the high significance placed on the doctor's visit. The doctor should listen to the patient and try to truly understand his or her problems. Communication and interaction training enables students to learn and try out special communication skills in a private environment. The goal of the Medi-KIT training is to enable students to effectively and compassionately communicate with patients in difficult situations so that they feel accepted and understood. Patients who feel accepted and comfortable are usually more compliant.

 

The Medi-KIT instruction consists of two parts: holding a meeting with the standardized patient and the analysis of this conversation with the course instructor. The instruction takes place in small groups consisting of three students.

 

The student plays the role of the doctor in a videotaped role play and conducts a thematic discussion. Afterwards the student gets feedback from the standardized patient.

Feedback from the course instructor is crucial component of the videotape analysis. This is an important aspect of support that enables the students to further develop and fine-tune their interaction and communication skills. The feedback instruction takes place in a group of 12 students. Four videotaped discussions are analyzed and discussed in 90 minutes.

 

2. Course Aims in Internal Medicine

 

Course goals of each seminar and meeting can be read on the following website:

athena-med.uni-heidelberg.de/dotlrn/clubs/medizin/file-storage/index?folder%5fid=3079296

 

3. Exams in Internal Medicine

 

The end of semester exam in internal medicine consist of a written and an oral/practical examination.

 

Prerequisites for taking the internal medicine exam:

  1. timely submission of the patient charts with a minimum grade of 4
  2. consistent, documented attendance
  3. 50 credit points

The grades in internal medicine are broken down into the following areas:

 

10% Written Exam I (clinical chemistry and hematology)

30% Written Exam II (internal medicine, general medicine and clinical chemistry)

10% patient charts in internal medicine

45% OSCE (objective structured clinical examination)

5 % MiniCex

 

The content of the exam reflects the course content. The content of clinical chemistry and hematology will be examined directly after the end of these modules in Exam I.

Exam II contains the course material from internal medicine, general medicine, and clinical chemistry and is given after the 14th week of the semester as an end of semester exam.

 

Students will get the certificate for internal medicine, general medicine, and clinical chemistry with a passing grade on both of these exams. The integrated pharmacology and geriatrics courses will also be examined as part of internal medicine. The grades in geriatrics consist of a geriatric assessment and an exam. A minimum grade of 4 in clinical pharmacology is required to get the certification.

 

 

Useful Literature

Clinical Chemistry

  • Lab Manuel (available in the central lab for 2,50 Euro)
  • Dörner K, Klinische Chemie. Enke-Verlag
  • Greiling, Gressner, Klinische Chemie und Pathobiochemie. Schattauer-Verlag (available to read in the central lab)
  • Nawroth P, Ziegler R, Klinische Endokrinologie & Stoffwechsel. Heidelberg, Berlin: Springer Verlag
  • Neumeister, Besenthal, Liebich, Klinikleitfaden Labordiagnostik
  • Thomas L, Labor & Diagnose. TH-Verlag (im Zentrallabor einzusehen)
  • Müller-Berghaus, Pötzsch, Hämostaseologie. Heidelberg, Berlin: Springer Verlag (available to read in the central lab)

Internal Medicine

  • Baenkler HW, Duale Reihe-Innere Medizin. Stuttgart: Hippokrates
  • Braun J, Renz-Polster H, Basislehrbuch Innere Medizin. München, Jena: Urban & Fischer Verlag
  • Hahn JM, Checkliste Innere Medizin. Stuttgart: Georg Thieme Verlag
  • Herold G, Innere Medizin-eine vorlesungsorientierte Darstellung. Köln: Gerd Herold
  • Hellnich B, Fallbuch Innere Medizin. Stuttgart, New York: Georg Thieme Verlag
  • Checkliste: Anamnese und klinische Untersuchung. Stuttgart, New York: Georg Thieme Verlag
  • Medical Skills. Stuttgart, New York: Georg Thieme Verlag (Neuerscheinung November 2004 (voraussichtl.))

General Medicine

  • Kochen MM (Hrsg.), Allgemein- und Familienmedizin. Stuttgart: Hippokrates Verlag (Neuaufl. in Vorb.)
  • Roger J, Oxford Textbook of Primary Medical Care - Band 1-2. Oxford University Press; 2004
  • Dörner K, Der gute Arzt. Stuttgart. New York: Schattauer Verlag (2001)
  • Fischer G, Komplikationen in der Allgemeinmedizin. Wien: Springer (2004)

Clinical Pharmacology

  • Lemmer B, Brune K (Hrsg.), Pharmakotherapie-klinische Pharmakologie. Heidelberg, Berlin: Springer Verlag; 2004
  • Ruß A, Arzneimittelpocket. Grünwald: Bröm Bruckmeier Verlag; Current edition.

 

At this time we would like to inform you about the AID database, which is accessible from the internal medicine clinic via Intranet. The database contains a wealth of information about various medications on the market. There are many useful options available, such as searching by name, active ingredient, expert commentary, and additional information about dosage (in conjunction with kidney failure, for example). We invite you to take a look inside.