Clinical practice 6th year

A.Y. 2019/2020
10
Max ECTS
80
Overall hours
SSD
M-PSI/01 MED/01 MED/09 MED/18
Language
English
Learning objectives
The clinical practice course is organized along 3 semesters (1st and 2nd sem 5° year and 1st sem 6° year) and integrates several disciplines to provide the students with conceptual tools to properly manage major clinical presenting problems. The 6° year module integrates Internal medicine and General surgery with Exercise and Sport Medicine, General psychology and Medical statistics. Coherently with the first module of the course held in the 5th year,in the 6 year
Starting from a complex cases the differential diagnosis and the therapeutic aspects are addressed. By integrating the different discipines students are trained to identify the most appropriate clinical and diagnostic tests to formulate a correct diagnosis and start planning the appropriate treatment. The Exercise and Sport Medicine Module provides the students with conceptual tools to introduce lifestyle intervention programs (with particular focus on physical exercise and nutrition) to foster health/wellbeing and to prevent/treat major chronic non communicable diseases. Medical Statistic introduces the students to Methodology of clinical research: how to write and present a clinical research protocol. The General Psychology module focuses on the concept of patients' adherence, cultural and gender differences in patients management and care givers in health management.
Expected learning outcomes
At the end of the 5th and 6th year module fo the course students are expected to:
- use appropriately the clinical judgment in the evaluation of patients with complex presenting problem and complex diseases
- use the appropriate use of clinical, laboratory, tests and exams findings
- know the predictors, barriers and facilitators of adherence, know the methods for improving patient's adherence
- be aware of the cultural factors impacting on patients choices
- know the principal etiopathogenetic mechanisms of chronic non communicable diseases are modified by lifestyle interventions
- know the basic clinical competencies in order to define cardio-metabolic risk and behaviors
- be able to prescribe lifestyle intervention programs, physical exercise and nutrition, in order to foster health/wellbeing and to prevent/treat major chronic non communicable diseases.
- know how to motivate subjects/patients to modify their lifestyle
- Be able to write and present a clinical research protocol
- set up of a proper patient's treatment
Course syllabus and organization

Unique edition

Prerequisites for admission
To attend the Clinical Practice course, students must have already passed all the exams of the first and second year (Fundamentals of Basic Sciences, Cells, Molecules and Genes 1 and 2, Human Body, Functions and Mechanisms of Diseases).
Assessment methods and Criteria
The Clinical Practice exam is organized as a combination of written, practical and oral examinations. Final formal examination may be preceded by an intermediate evaluation test of General Surgery at the end of the 5th year. Also reviews and discussion on medical literature and/or specific clinical research topics could concur to the evaluation either at intermediate or final stage.
· Written test: it is a multiple choice test, and focuses all the discipline of the 5th and 6th year courses of Clinical Practice, but Internal Medicine. Surgery and Biostatistics. Multiple choices Q&A questionnaire will be used. The questionnaire is prepared on the slides presented at the frontal lessons (uploaded in the University website for student access) and on the official textbooks.
Each question has 4 answers, and each answer can be true or false. The passing threshold is the 75% of all answers, with at least one correct question (all answers in the question) in each module. Once passed, the written test is valid for the next three years. Either the teaching staff and/or the IMS office will inform the students about the results of the written test.
Biostatistics assessment is based on the evaluation of a presentation of the work conducted during the practical activities.
Practical test: it evaluates the practical skills acquired by the students, and consists in a circuit of stations, in which students are examined on a simulated patient. Once passed, the practical test is valid for the next three years.
Oral test: When students pass both the written and the practical tests, they are allowed to take the oral examination of Internal Medicine and General Surgery. The final mark is the average of the two marks obtained in Internal Medicine and in General Surgery, weighted by the number of credits of each discipline.
The exam is deemed to be passed successfully if the final grade is equal to or higher than 18/30. In the event of a full grade (30/30) honors (lode) may be granted with the consent of all the professors.
Registration to the exam through SIFA is mandatory.
Internal medicine
Course syllabus
TOPIC 1. Transition-of -Care
TOPIC 2. Innovative treatments
TOPIC 3. How to treat: pain (Recall different types of pain , Describe the general approach to pain treatment, Pain in the oncology setting , Treatment of oncological pain , Chronic pain in fibromyalgia , Drugs for fibromyalgic pain)
TOPIC 4. How to treat: Hypertension and Hypotension
TOPIC 5. Treatment of complex clinical cases
TOPIC 6. How to treat infection
Teaching methods
Interactive lectures, Clinical cases, Seminars, Discussion on clinical cases. Clerkship attendance and sufficient exposure to practice (i.e. simulation lab, formal patients examination at bedside, training of basic medical-surgical techniques etc.) will be registered, as clinical teaching will be based also on direct participation of the students to different aspects of the hospital life.
Teaching Resources
· Harrison's Principles of Internal Medicine, 20th Edition, McGraw Hill, 2018 (also available as ebook in the digital library of the University of Milano http://www.sba.unimi.it/)
· UP To Date - Evidence Based Clinical Decision Support resource
· ACSM's Guidelines for Exercise Testing and Prescription. 2018, 10th ed
· Up to Date-Evidence based clinical decision support resources
General surgery
Course syllabus
Lecture 1 - SURGICAL PRINCIPLES AND INDICATION IN GENERAL PRACTICE (SUM-UP)
Lecture 2 - SEMINAR: SURGERY IN THE ELDERLY (PROS AND CONS)
Lecture 3 - SEMINAR: ENDOCRINE SURGERY AND NEUROENDOCRINE TUMORS
Lecture 4 - SURGERY FOR MORBID OBESITY
Lecture 5 - SEMINAR: SURGERY AND INFECTIONS (PRINCIPLES, GUIDELINES)
Lecture 6 - TRANSPLANTATION AND IMMUNOLOGY
Teaching methods
Interactive lectures, Clinical cases, Seminars, Discussion on clinical cases. Clerkship attendance and sufficient exposure to practice (i.e. simulation lab, formal patients examination at bedside, training of basic medical-surgical techniques etc.) will be registered, as clinical teaching will be based also on direct participation of the students to different aspects of the hospital life.
Teaching Resources
Significant material and all slides used during frontal lessons and seminars are uploaded in the Ariel platform for student access.
· Sabiston Textbook of Surgery. The Biological Basis of Modern Surgical Practice. 20th Edition Elsevier 2017
Medical statistic
Course syllabus
PART 1 - Methodology of clinical research
Introductory Lecture. Statistical Inference
Lecture: How to write a research protocol
PART 2 - Write and present your research protocol
Small group work.
Presentation
Teaching methods
Interactive lectures, Clinical cases, Seminars, Discussion on clinical cases. Clerkship attendance and sufficient exposure to practice (i.e. simulation lab, formal patients examination at bedside, training of basic medical-surgical techniques etc.) will be registered, as clinical teaching will be based also on direct participation of the students to different aspects of the hospital life.
Teaching Resources
· J. Mark Elwood, "Critical Appraisal of Epidemiological Studies and Clinical Trials", 3rd Edition, Oxford University Press
· CONSORT Statement (www.consort-statement.org)
General psychology
Course syllabus
Lecture 1 - Patients' Adherence I
Lecture 2 - Patients' Adherence II
Lecture 3 - Cultural and gender differences in patients management
Lecture 4 - Care givers in health management
Teaching methods
Interactive lectures, Clinical cases, Seminars, Discussion on clinical cases. Clerkship attendance and sufficient exposure to practice (i.e. simulation lab, formal patients examination at bedside, training of basic medical-surgical techniques etc.) will be registered, as clinical teaching will be based also on direct participation of the students to different aspects of the hospital life.
Teaching Resources
· Papers provided during lessons.
General psychology
M-PSI/01 - GENERAL PSYCHOLOGY - University credits: 1
Lessons: 8 hours
Professor: Mazzocco Ketti
General surgery
MED/18 - GENERAL SURGERY - University credits: 3
Lessons: 24 hours
Internal medicine
MED/09 - INTERNAL MEDICINE - University credits: 4
Lessons: 32 hours
Medical statistic
MED/01 - MEDICAL STATISTICS - University credits: 2
Lessons: 16 hours
Professor: Ambrogi Federico