2010-2011 academic year
Foundations of Diagnostic and Therapeutic Procedures (20551)
Qualification/course: bachelor's degree in Medicine
Year: third
Term: third
Number of ECTS credits: 4 credits
Student commitment: 100 hours (40 h face-to-face: 20 h of theory classes; 10 h of practical classes, 10 h of seminars and 60 h of virtual activities)
Teaching language or languages: Catalan and Spanish
Lecturers: Montserrat Andreu, Albert Goday
1. Introduction to the subject
The subject Foundations of Diagnostic and Therapeutic Procedures is is a complementary training subject in the degree in Medicine. It consists of 4 ECTS credits. It is taught during the third term of the third year.
It is a complementary subject to the two physiopathology subjects which acts as the foundations for the future development of medical/surgical disciplines. It provides students with information on complementary examinations, how, when and in what way they should be used, as well as a grounding in the knowledge of the various types of treatment of diseases.
The heads and coordinators of the subject are Montserrat Andreu García, temporary part-time lecturer at UPF, and Alberrt Goday, temporary part-time lecturer at the UAB. The subject also has two temporary part-time lecturers. Other lecturers, who are experts in specific areas from both universities, will occasionally also be involved in teaching the subject.
2. Competences to be acquired
Students will be given an introduction to clinical care, with an initial grounding in understanding the principles of the diagnostic and therapeutic process and the tools available for dealing with patients and diseases in medicine.
Specific objectives
• To understand the importance of anamnesis and physical examination in the diagnostic process.
• To understand the importance of the correct use of the arsenal of complementary examinations currently available as well as their risks and limitations.
• To learn the basic principles of interpreting the tests most frequently used in the diagnosis of the most common diseases.
• To learn the grounds for the use of pharmacological therapies and nutritional intervention.
• To learn the grounds for using the various non-pharmacological therapeutic alternatives.
Teaching arrangements for the subject are in line with the Faculty's general outlines. Based on the recommendations from the new European Higher Education Area (EHEA), the competences to be achieved by students have been clearly defined. There are therefore two specific aspects that are emphasised: one is students' active participation in their own teaching. In this respect, apart from the traditional lectures (20 in total), there are two other types of activities:
• Seminars: active learning spaces (2 hours/seminar). In seminars, students prepare a clinical history for thirty minutes, pertaining to part of the subject's conceptual content, under the supervision of a tutor. Each group subsequently gives a short presentation on the process of dealing with the clinical case. Each member of the group participates in part of the presentation and is assessed individually by the lecturer, with a specific form including content and formal aspects. The anticipated time for this activity is two hours face-to-face per student and per academic year.
• Practical sessions are another activity involving extensive participation by students. Attendance and participation will be assessed by means of a question sheet handed in at the end of every practical class (duration/practical class: 90 minutes).
3. Contents
Theory classes
Bloc A. Clinical methodology
1. Subject presentation. Justification: epistemological concept of diagnosis and therapeutics. Subject syllabus: objectives and competences to be acquired, sections of the syllabus, training activities (theory classes, seminars and practical classes), bibliography and support material and assessment methods. Lecturers in charge of the course and guest lecturers.
2. The principles and phases of the diagnostic process. Historical background. General principles. Concept and objectives of diagnostic reasoning. Phases of the diagnostic process: anamnesis (asking, listening and observing), physical examination, association of signs and symptoms. Arranging the information and hierarchy of semiological data. Formulation of the diagnostic hypothesis.
3. The other features of the diagnostic process: complementary examinations. Hierarchy in the diagnostic process. Selection of examinations and interpretation of tests individually and as a whole. Usefulness in diagnostic verification.
4. The principles and phases of the therapeutic process. The objective of all therapeutic procedures. Different types of therapies. The basic actions of drugs in living organisms. Factors to consider before deciding on treatment (safety, compliance, acceptability, costs, availability). The patient's participation in the selection of the therapeutic strategy.
5. Therapeutic strategies. Basis for the treatment, scientific evidence, expert consensus and empirical evidence. Treatment protocols. Clinical trials during treatment. Other considerations when taking therapeutic decisions: the general condition of the patient (assessment scales, physical condition), quality of life, and socio-cultural factors.
6. Health management of diagnostic and therapeutic procedures. Various types of healthcare: out-patient, hospitalisation, functional units, home hospitalisation, day hospitals. Factors in the decision to assign the process in each patient.
Bloc B. Diagnostic and therapeutic instruments
7. Introduction to diagnostic tests. General characteristics: types and criteria for selection. Basis for prioritisation. Obtaining, processing and preserving biological samples. Instructions to patients and informed consent.
8. Laboratory tests (I). Decision and selection of tests to be carried out. Interpreting results. Characteristics of normal basic analysis (hematology and clinical biochemistry).
9. Laboratory tests (II). Main techniques for microbiological and parasitological diagnosis. Indication for each test and samples collection procedures. Interpretation of microbiological tests. Toxicological tests: interest in general and emergency medicine.
10. Laboratory tests (III). Main immunology tests: indications and interpretation. Contribution of cytogenetics and molecular biology to the diagnostic process. Importance in the therapeutic decision.
11. Imaging techniques. Use in the morphological study of diseases. Characteristics and principles of the various techniques: radiology, endoscopic procedures, ultrasound scanning, nuclear magnetic resonance (NMR), positron emission tomography (PET) and computed axial tomography (CAT). General selection criteria. Morbimortality associated with imaging examinations.
12. Function tests. Principles, usefulness and importance within the diagnostic process. Main electrophysiological techniques (ECG, EEG, EMG). Main respiratory function tests.
13. Study of tissues. Macroscopic and microscopic study. Normal and pathological situations (inflammation, proliferation, neoformation) Concept of benign and malign neoformation.
14. Diagnostic methods in psychology and psychiatry. Main instruments for assessment in normal practice. Importance of psychological assessment throughout the diagnostic process.
15. Therapeutic procedures. General concepts regarding the main procedures. The primary measures: changes in hygiene habits, changes to diet, abstaining from toxic substances and risk conducts. Establishment of healthy habits. The treatments themselves: medicines, diets, psychotherapy, physiotherapy and rehabilitation.
16. Surgery as therapy. The principles of surgical treatment. Types of surgery: radical and curative, palliative and reparative. Surgery combined with other treatments.
17. Physical means. The main physical means than can be used in therapy. Heat and cold, hydrotherapy, radiotherapy and radiofrequency.
18. The economy and the diagnostic process. Concept of effectiveness and efficiency in processes. Prioritisation of resources in health. Healthcare and financial considerations. Treatment of the same patient depending on the country of residence.
19. Health education among the population. Personal and social behaviour habits: impact on health. Tools for changing and rechannelling behaviour that determine disease (smoking, alcohol, obesity, sedentarism).
20. Ethics in the diagnostic and therapeutic process. The principlist ethic and its application to the diagnostic process. Main considerations with regard to patients. Therapeutic process and shared decision making. Projection and debate on the film XXY.
Practical sessions (90 minutes/each practical session)
Practical session 1. Initial assessment of the patient. Anamnesis, basic vital constants, inspection, physical examination. Assessment of health and illness (seriousness of the process)
Practical session 2. Analytical tests. Biological profiles according to the disease (diabetes mellitus, acute and chronic hepatitis, renal insufficiency, dyslipidemia).
Practical session 3. Microbiological tests. Gram staining, basic cultures, antibiogram. Parasite analysis (thick blood film).
Practical session 4. Imaging tests. Digestive endoscopy.
Practical session 5. Function tests. Cardiac and respiratory function tests.
An active attitude and the answers to the final survey will be assessed in each practical session.
Seminars
Seminar 1. Consultation due to excess weight.
Seminar 2. Consultation due to thoracic pain.
Seminar 3. Consultation due to red blood in stools and abdominal pain
Seminar 4. Consultation due to loss of strength in the arm and right leg
Seminar 5. Consultation due to coughing, expectoration and shortness of breath for months
Each seminar will consider the following points:
• Questions to be asked during the anamnesis
• What needs to be observed during the clinical visit?
• Physical examination
• Which examinations need to be requested?
• Which results we expect to obtain?
• What treatment we consider?
4. Assessment
Assessment will be carried out based on various concepts. In specific terms:
(1) Multiple choice test (MCT), assessed on 5 points (40% of the mark). The threshold necessary to pass this part is 50%.
Suggested: 40 questions.
(2) Test with short questions, which is assessed on 3 points (30% of the grade). The necessary threshold to pass this part is 50% of the knowledge.
Suggested: 5 questions.
(3) Seminar: assessed up to 1 point (assessment sheet) (10% of the grade).
(4)Practical Sessions: active participation in the practical classes will also be assessed up to 1 point (attendance sheet + active participation in the practical sessions + final survey).
Among the subjects assessed in 1 (the MCT) and 2 (the test) are those taught in lectures, seminars and practical classes. This material will be available on the subject's website (Campus Global).
Attendance at practical classes classes is essential in order to be able to be assessed in the final examination (essay and MCT).
Finally, there will be a formative evaluation in essay test format when approximately 50% of the syllabus has been completed. This evaluation enables the teaching staff to assess the progress made on the course, as as well as the grade obtained providing added value in the student's final mark.
5. Bibliography and teaching resources
5.1. Basic bibliography
1. ROZMAN, C.; FARRERAS - ROZMAN. Medicina interna, 2 vols. 16th ed. 2009 [+ CD-ROM - PREMIUM EDITION].
2. HARRISON. Principios de medicina interna. 17th ed.
3. DÍAZ PORTILLO, J.; PAREDES, F.; FERNÁNDEZ, Mª T. 770 preguntas y respuestas: determinaciones bioquímicas. 1st ed. Elsevier-Masson, 2004. 536 pp. ISBN13: 978844581368-3.
4. NATH, S.; REVANKAR, S. Microbiología basada en la resolución de problemas. 1st ed. 2007.
5. Albert R. JONSEN; Mark SIEGLER; William J. WINSLADE. Ética clínica. 1st ed. Ariel, 2005. ISBN: 8434437198 ISBN-13: 9788434437197.
6. H. H. Manual de diagnóstico médico Friedman. 5th ed. 2004.
7. RODRÍGUEZ, M. Desigualdades sociales en salud. 1st ed. 2008. [Latest reprint: 2009].
6. Methodology
7. Programme of activities