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Study-Unit Description
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CODE MDS3004

 
TITLE Medicine 2 (Gastroenterology, Endocrinology, Nephrology, Rheumatology)

 
LEVEL 03 - Years 2, 3, 4 in Modular Undergraduate Course

 
ECTS CREDITS 10

 
DEPARTMENT Faculty of Medicine and Surgery

 
DESCRIPTION The study-unit addresses nephrology, rheumatology, endocrinology and gastroenterology respectively, integrated with pathological and therapeutic correlates and is aimed at medical students in their early phase of clinical training.

The detailed lecture programme of the specialties in this teaching programme had its annual review and update in April 2011.

Structure of the programme: A. teaching methods, B. assessment.

A. Teaching methods.

1. Classroom-based integrated teaching sessions aimed at imparting basic principles of nephrology and rheumatology respectively in the context of general medicine. Whenever possible the sessions will be multidisciplinary and which form a theoretical underpinning for the acquisition of basic clinical skills. The programme of lecture/seminars is designed to address common clinical problems, disease processes and priorities in management. The lecture programme is not designed to be comprehensive but teaching sessions are structured as a basis and impetus for further study using up-to-date web-based information while encouraging clinical correlates observed in an actual teaching hospital setting.

2. Tutorials: aimed as acquisition of basic clinical, communication and examination skills using real patients and a simulator. The programme between is structured on the basis of a specific workbook that leads students along the small-group, interactive and hands-on teaching: it lists in detail the specific learning outcomes and skills required at the end of Year 3

3. Clinical attachments: specific consultant physicians.

4. Log-book. The Department of Medicine has a proforma electronic logbook that spans the last three years of the course of studies. The logbook, driven by learning objectives and expected competences, gives precise details for the acquisition of clinical skills. The logbook also gives direction for a voluntary summer project to be undertaken between Years 3 and 4.

B. Assessment
General aim: a test of both presence of knowledge and its practical application.

One two-hour paper with the twofold objective: to assess the ability to think critically about diagnosis, pathology and management, including pharmacological aspects and to ensure that the candidate has a satisfactory base of factual knowledge.

The examiners shall determine and document the correct answers to both sections at the time that the papers are set. Any multiple-choice questions shall be marked on the ‘negative-marking’ principle, awarding one mark for every correct answer and deducting one mark for every incorrect answer.

The clinical skills in Medicine and Surgery are assessed through a separate study unit, entitled Integrated Clinical Skills.

Study-unit Aims

1. To introduce nephrology, rheumatology, endocrinology and gastroenterology to students who would have already acquired proficiency in clinical anatomy, clinical physiology, biochemistry and general pathology/immunology.
2. To present an integrated approach involving the practice of clinical nephrology, rheumatology, endocrinology and gastroenterology respectively with pathology, surgery and clinical pharmacology as a mirror of actual day-to-day clinical practice.
3. To provide guidance for the acquisition of knowledge and its application.
4. To provide an order of priority and a theoretical complement to the acquisition of clinical skills.
5. To introduce clinical pharmacology and therapeutics.
6. To provide a sound understanding of the principles underlying the actions and uses of the various classes of drugs in the clinical setting in relation to nephrology, rheumatology, endocrinology and gastroenterology disorders.
7. To use formal lectures and tutorials to enhance case based learning and to provide an understanding of drug safety in relation to nephrology, rheumatology, endocrinology and gastroenterology disorders.
8. To provide details on the mode of action and clinical use of various classes of drugs specifically antimicrobial drugs in relation to nephrology, rheumatology, endocrinology and gastroenterology disorders.
9. To explain the clinical use of drugs used in nephrology, rheumatology, endocrinology and gastroenterology disorders.

Learning Outcomes

1. Knowledge & Understanding:

By the end of the study-unit the student will be able to:
1. apply scientifically reliable evidence to clinical practice.
2. access information sources and carry out an appropriate literature search.
3. critically appraise published medical literature.
4. use information technology including hospital based electronic sources such as iSoft, PACS and census databases.
5. show an understanding of basic principles involved in clinical pharmacology and therapeutics specific classes of drugs specifically antimicrobial drugs and drugs used in nephrology, rheumatology, endocrinology and gastroenterology disorders.
6. describe the various scientific principles underlying the actions and uses of these specific classes of drugs in the clinical setting in relation to nephrology, rheumatology, endocrinology and gastroenterology disorders.
7. recognise the importance of understanding the mode of action and clinical use of these classes of drugs in relation to nephrology, rheumatology, endocrinology and gastroenterology disorders.
8. list the clinical principles involved in the selection of these classes of drugs to the individual patient in relation to nephrology, rheumatology, endocrinology and gastroenterology disorders.
9. predict the effects of these classes of drugs in specific patients in relation to nephrology, rheumatology, endocrinology and gastroenterology disorders.
10. outline the concept of individualised drug therapy in use of these classes of drugs in relation to nephrology, rheumatology, endocrinology and gastroenterology disorders.
11. describe the aetiology, risk factors, pathogenesis and morphology of bone and renal diseases, inflammatory and malignant diseases of the oesophagus, stomach and small and large bowel, viral hepatitis, pancreatic and biliary diseases, posterior pituitary disorders, diabetes mellitus and metabolic syndrome.
12. outline the clinical consequences and complications of bone and renal diseases, inflammatory and malignant diseases of the oesophagus, stomach and small and large bowel, viral hepatitis, pancreatic and biliary diseases, posterior pituitary disorders, diabetes mellitus and metabolic syndrome.
13. describe the types of laboratory tests available for clinical diagnosis of bone diseases, acute and chronic renal failure, gastritis, viral hepatitis, malabsorption, pancreatic and biliary diseases, posterior pituitary disorders, diabetes mellitus, and metabolic syndrome.

2. Skills:

By the end of the study-unit the student will be able to:
1. carry out a basic consultation with a patient.
2. seek appropriate additional information and advice, to arrive at a working diagnosis.
3. devise and discuss the rationale and practicalities of a basic management plan.
4. discuss the theoretical aspects of diagnosis, possible complications and management options.
5. show an understanding of the knowledge of the mode of action of drugs to specific clinical scenarios in the use of specific classes of drugs specifically antimicrobial drugs and drugs used in nephrology, rheumatology, endocrinology and gastroenterology disorders.
6. show an understanding of the basic pharmacological principles in prescribing decisions for these classes of drugs in relation to nephrology, rheumatology, endocrinology and gastroenterology disorders
7. predict inter-patient variability with respect to drug response in these classes of drugs in relation to renal, rheumatological and haematological disorders nephrology, rheumatology, endocrinology and gastroenterology
8. explain the selection of differing drug therapies in these drug classes for the individual patient in relation to nephrology, rheumatology, endocrinology and gastroenterology disorders.
9. interpret common symptoms and signs in terms of possible underlying pathology in bone and renal diseases and in inflammatory and malignant diseases of the oesophagus, stomach and small and large bowel, viral hepatitis, pancreatic and biliary diseases, posterior pituitary disorders, diabetes mellitus and metabolic syndrome and to outline a differential diagnosis.
10. choose the appropriate management for posterior pituitary disorders, diabetes mellitus and metabolic syndrome;
11. correlate the use of simple diagnostic laboratory tests with clinical and morphological features of disease.
12. choose the appropriate laboratory tests to confirm diagnosis and interpret the result.
13. choose the best antibiotic therapy for microbiological infections.

It is expected that the student will have following specific clinical competences:

1. Communicate with a patient by taking a focused and structured medical history.
2. Carry out a basic physical examination.
3. Assess a patient’s mental status.
4. Match appropriate drugs to a specific clinical context.
5. Communicate with colleagues in a medical context.
6. Assess psychological and social factors and the impact of illness.

More specific details of learning outcomes are found in the proforma logbook of the Department of Medicine.

Main Text/s and any supplementary readings

Textbooks as suggested for the whole three-year teaching programme in medicine:

1. Clinical Medicine. Parveen Kumar & Michael Clark, Saunders, 8th Edition, 2012.
2. Macleod's Clinical Examination. Graham Douglas, Fiona Nicol, Colin Robertson. Churchill Livingstone. 12th Edition, 2009.
3. Oxford Handbook of Clinical Medicine. Murray Longmore, Ian Wilkinson, Edward Davidson, Alexander Foulkes, OUP. 8th Edition, 2010.

Pathology Text Books as suggested for All Pathology teaching Year 1-5.

Recommended:

Systematic Pathology (and Haematology)

1. Muir’s Textbook of Pathology, Ed by DA Levison, R Reid, AD Burt, DJ Harrison, S Fleming, 14th Edition, ISBN 9780340740620, Hodder Arnold, 2008.
and
2. General and Systematic Pathology, P Bass, S Burroughs, N Carr, C Way, 3erd Ed, Master Medicine, ISBN-10: 0080451292, ISBN-13: 978-0080451299, Churchill Livingstone, 2008.

Microbiology

1. Medical Microbiology and Infection, T Elliott, H Osman, M Gill, T Warthington, 4th Edition, ISBN-10: 1405129328, ISBN-13: 978-1405129329, Blackwell, 2007. [also a Kindle edition, 2012]
and
2. Clinical Oriented Cases in Microbiology, Hilary Humphreys & William Irving, 2nd Ed, ISBN 0198515855, Oxford University Press, 2004.
and
3. Basic Concepts of Infection Control
www.theific.org.

Alternative texts:

1. General and Systematic Pathology, JCE Underwood, 5eth Edition, ISBN-10: 0443068887, ISBN-13: 0443068881, Churchill Livingstone, 2009.
or
2. Robbins Basic Pathology, V Kumar, A K Abbas, N Fausto, JC Aster, 9eth Edition ISBN-10: 1437717810, ISBN-13: 978-1437717815, Saunders, 2012.
and
3. Notes on Medical Microbiology (Paperback), MC Timbury, C McCartney, B Thakker, KN Ward, ISBN 0443071640 or latest edition, Churchill Livingstone.

Additional Resources:

1. Pathology Illustrated, R Reid, F Roberts, E MacDuff, 7eth Edition, ISBN-10: 0702033766, ISBN-13: 978-0702033766, Churchill Livingstone, 2011.
2. Robbins and Cotran Review of Pathology, EC Klatt, V Kumar, 3rd Edition, ISBN9781416049302, Saunders, Elsevier, 2010.

Reference Texts:

1. Robbins and Cotran Pathologic Basis of Disease, V Kumar, A K Abbas, N Fausto, J C Aster, 8eth Edition ISBN-10 1416031219, ISBN-A3 1416031215, Saunders, Elsevier, 2009.
and
2. Medical Microbiology, Greenwood D, Slack RCB, Peutherer JF, Barer MR, 17eth Edition, ISBN-10: 0443102090, ISBN-13: 978-0443102097, Churchill Livingstone, 2007.

Online resources:

1. http://emedicine.medscape.com/
2. http://www.medicalstudent.com/
3. http://library.med.utah.edu/WebPath/webpath.html

Recommended Clinical Pharmacology text books:

1. Humphrey P. Rang HP, Dale MM, Ritter JM, Flower R. Rang & Dale's Pharmacology. Churchill Livingstone. 6th Ed.
2. Grahame-Smith D, Aronson J. Oxford Textbook of Clinical Pharmacology and Drug Therapy. Oxford University Press. 3rd Ed.
3. Bennett PN, Brown MJ. Clinical Pharmacology. Churchill Livingstone. 10th Ed.
4. British National Formulary. Pharmaceutical Press.

Reference/Additional

1. Brunton L, Lazo J, Parker K. Goodman & Gilman's The Pharmacological Basis of Therapeutics. McGraw-Hill Medical. 11th Ed.
2. Waller DG, Renwick AG, Hillier K. Medical Pharmacology and Therapeutics. Saunders. 3rd Ed.

Lecture notes

1. Reid JL, Rubin PC, Walters MW. Clinical Pharmacology and Therapeutics (Lecture Notes). Blackwell. 7th Ed.
2. Neal MJ. Medical Pharmacology at a Glance. Wiley-Blackwell. 6th Ed.

 
STUDY-UNIT TYPE Lecture, Independent Study & Placement

 
METHOD OF ASSESSMENT
Assessment Component/s Resit Availability Weighting
MCQ & Examination (2 Hours) Yes 100%

 
LECTURER/S Simon Attard Montalto
Christopher Barbara
Andrew A. Borg
Stephen Brincat
Gerald C. Buhagiar
Mario J. Cachia
Roberta Callus
Franco Camilleri
Paul John Cassar
Bernard Coleiro
James Degaetano
Bridget Ellul
Roger Ellul Micallef
Pierre Ellul
Joseph Farrugia Agius
Emmanuel Farrugia
Stephen Fava (Co-ord.)
Christopher Fearne
Jurgen Gerada
Carmel P. Mallia
Claire Marantidis Cordina
James Pocock
Josanne Vassallo
Mario John Vassallo

 
The University makes every effort to ensure that the published Courses Plans, Programmes of Study and Study-Unit information are complete and up-to-date at the time of publication. The University reserves the right to make changes in case errors are detected after publication.
The availability of optional units may be subject to timetabling constraints.
Units not attracting a sufficient number of registrations may be withdrawn without notice.
It should be noted that all the information in the study-unit description above applies to the academic year 2017/8, if study-unit is available during this academic year, and may be subject to change in subsequent years.
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