Unit Code: IMD820

Unit Name: Internal Medicine II

Description: Internal medicine is the medical specialty concerned with the diagnosis and non-surgical management of diseases of the internal organs of the body in adults. Internal medicine is often subdivided into various subspecialty fields, usually centred on the major organ systems. These include, for example, subspecialties such as Cardiology (diseases of the cardiovascular system), Gastroenterology (diseases of the liver and digestive system), Neurology (diseases of the brain and nervous system), and Nephrology (diseases of the kidneys). IMD820 is the first year of the Master of Medicine in Internal Medicine programme developed to address the need for Specialist Physicians (internists) in the Pacific. It utilises the prior knowledge and skills attained during the study of the Postgraduate Diploma in Internal Medicine (IMD801) to enable the candidate to function as a trainee specialist. Practical Component For the duration of the Course, each candidate is employed as a medical registrar in a position approved by the College of Medicine, Nursing and Health Sciences (CMNHS) at either the Colonial War Memorial (CWM) Hospital or Lautoka Hospital. As candidates advance through the programme, and at the discretion of their supervising consultants, they will be given greater responsibilities, such as being on call without more senior registrar supervision. Registrars will participate in all the clinical activities of the Departments of Medicine at those hospitals, including on-call rosters, ward rounds, Outpatient clinics, grand rounds, radiology and pathology review meetings, and departmental continuing education activities such as journal clubs. A logbook must be kept for the recording of performance or observation of appropriate practical procedures. Necessary procedural competency for the requirements of IMD801 listed in that Course Outline should be maintained. In addition, for satisfactory completion of IMD820/830 candidates will be expected to have observed and/or performed the procedures listed below. Some of these procedures are performed in the ward (e.g., thoracocentesis, pleural biopsy) while others are performed in special clinics (e.g. bronchoscopy, gastroscopy). To facilitate this aspect of the course, an attachment schedule will be provided for all students to attend the special clinics as required. It is recognized that some procedures (e.g. renal biopsies) are currently not routinely performed at CWMH, but they are included so that students can record them should they have the opportunity to observe them. For all procedures, a criterion has been developed which all students should endeavour to meet (level A). This criterion is usually observation of, or participation in, a minimum number of procedures. For some procedures, criteria for a higher level of competence are also given which will enable the student to undertake the procedure unsupervised (level B). Although fulfilling a competency “level B” is not an absolute requirement, it is encouraged for students from other Pacific Island countries and also to interested candidates from Fiji. For each procedure, the criterion of competence for Level A is given in parentheses. Where relevant, the criteria for competence for Level B are also given. Note: The number of procedures indicated here are guides only Gastroscopy: Level B – performance of at least 50 procedures, and certified competent by the regular gastroscopists at CWMH. Abdominal ultrasound: Level A – observation of, or participation in, at least 10 procedures. Level B – performance of at least 30 procedures, and certified competent by the Dept. of Radiology at CWMH. Echocardiography: Level B – performance of at least 50 procedures, and certified competent by the regular echocardiographers at CWMH Treadmill exercise test: Level A – the performance of at least 15 tests, and certified competent by the physicians regularly undertaking these tests Pulmonary Function Testing: Level A – performance of at least 10 tests CT Scan: Level A – observation of at least 5 scans\" Myelogram: Level A – observation of at least 3 procedures Colonoscopy: Level A – observation of at least 3 procedures Barium Enema: Level A – observation of at last 3 procedures Venous cutdown/central venous line: Level A – performance of at least 10 procedures Pericardiocentesis: Level A – observation of at least 5 procedures, followed by the undertaking of at least 2 procedures Bronchoscopy: Level A – observation of, or participation in, at least 5 procedures. Level B – performance of at least 25 procedures and certified competent by the regular bronchoscopist at CWMH. Liver biopsy: Level A – observation of at least 5 biopsies. Level B - performance of at least 25 biopsies with a success rate of obtaining appropriate diagnostic material of at least 95%, and a major complication rate of less than 5%\" Cardioversion: Level A – observation of, or participation in, at least 5 procedures. Level B – performance of at least 10 cardioversions with a success rate of at least 90% Gastric Lavage: Level A – observation of, or participation in, at least 5 procedures Fine Needle Aspiration Cytology and Biopsy: Level A – observation of at least 5 procedures. Level B – performance of at least 20 procedures with a success rate of obtaining appropriate diagnostic material of at least 90%. Bone Marrow Biopsy and Aspiration: Level A – observation of, and participation in, at least 5 procedures. Level B –performance of at least 20 procedures with a success rate of obtaining appropriate diagnostic material of at least 90%. Renal Biopsy: Level A – observation of at least 5 biopsies. Level B – performance of at least 25 biopsies with a success rate of obtaining appropriate diagnostic material of at least 90% and a major complication rate of less than 5%. Pacemaker insertion: Level A – observation of at least 1 insertion.\" In addition to the core Course content discussed above, during IMD820/830 candidates must also successfully complete two of Public Health courses outlined in the PG Programme Guidelines i.e. MED811 and MED812 There are 5 levels of clinical supervision to help facilitate a conversation between the supervisor and the trainee needs when performing a task. And the level of supervision depends on the level of training. Below is from the Royal Australasian College of Physicians’ curriculum for physician training. Level 1: Be present and observe Trainee to be present and observe what is expected of him/her at the next stage. Level 2: Act with direct supervision The trainee may carry out the full activity by himself/herself. The supervisor is in the room watching and can intervene or take over at any time deemed necessary. Also known as “proactive supervision\"\" or” routine oversight” Level 3: Act with indirect supervision: The trainee may carry out full activity by himself /herself with a supervisor not present in the room but available within minutes. Also called” reactive supervision” or “responsive oversight. This includes the availability of supervision by telephone for advice. For example, a medical registrar sees a patient in special outpatient clinics with the consultant in another but nearby room for advice.\" Level 4: Act with supervision at a distance At this stage the learner may carry out the full activity by himself or herself with no supervisor available on short notice. The trainee reports post hoc the same or next day. This stage gradually extends into fully mature and unsupervised practice, but as long as he or she is in training, the learner acts under ‘clinical oversight’ or ‘backstage supervision’. This stage marks the degree of trust that would allow the learner to be entrusted with an activity e.g. When PG trainees go on-call, there is also an on-call consultant (either FNU staff or adjunct staff) with them as well. Level 5: Provide supervision This level is awarded when a senior trainee may act in a supervisory role for more junior trainees.\" Academic component: Teaching and learning within the IMD820 course is conducted both through formal structured tutorial sessions and through supervised clinical interactions as part of the performance of the candidate\'s practical duties as a medical registrar. The structured teaching is delivered in the form of a series of ten modules, each of three or four weeks\' duration. The learning modules run for about ten months. The first month of the Course is largely introductory and is used for familiarization with the School and the hospital system, learning standard protocols for management of various diseases and also for a compressed course on Emergency medicine that will prepare the MMED (IMD) for clinical work. The last month of the Course is used for revision and examinations. Full participation in and completion of all ten modules is compulsory, but in special circumstances (e.g. illness) at least eight of the modules must be completed to fulfil the course requirements. Each module will focus on one of the following medical subspecialties: · Endocrinology · Rheumatology · Renal Medicine · Haematology and Oncology · Clinical Pharmacology · Infectious Diseases · Gastroenterology · Respiratory Medicine · Neurology · Cardiology The details of the modules are outlined below, however these may vary slightly depending for example on the availability of visiting specialists who will be invited to present seminars and hold interactive discussions with candidates. The full curriculum for these modules for the complete MMED programme is further outlined in this IMD820 and IMD830 course outlines. The modules are conducted in small group tutorials presented in various formats including didactic sessions, case discussions and Medical Knowledge Self Assessment programme (MKSAP) questions. Where required, these may be conducted via teleconference. Appropriate resource material will be provided prior to the start of each module. In addition, each candidate is expected to undertake self-directed learning to expand their knowledge about the topics covered in the modules, and the clinical cases attended in their clinical work, by selecting additional information from textbooks, journals and on-line resources. For each module candidates will be expected to complete one written assignment based around a case relevant to that module\'s anticipated learning outcomes.

Learning Target Outcomes: On successful completion of this course, the students will be able to: 1. Synthesise and appropriately rank provisional diagnoses/problem list by integrating information obtained from comprehensive history and thorough examination of moderately complex conditions accounting for interactions and impacts of comorbid conditions in inpatient, outpatient and emergency care setting. 2. Prioritize, organize and interpret investigations of moderately complex conditions. 3. Formulate comprehensive acute and long -term management plans of moderately complex conditions incorporating sound prescribing practices in collaboration with patient, families or careers and the attending medical team. 4. Assess and manage the acutely and critically unwell moderately complex medical patients at a level 4 clinical supervision. 5. Practice effective verbal, non-verbal and written communication skills when dealing with patients, families, carers, colleagues and other health professionals. 6. Write summaries of patient care, comprehensive medical reports and correspondences to coordinate patient care. 7. Demonstrate level B (unassisted) competence in performing the following procedural skills: lumbar puncture, pleural aspiration/biopsy, nasogastric (NG) tube insertion, bone marrow aspiration and biopsy, knee joint aspiration, cardioversion; and level A (assisted) competence in pericardiocentesis intra-articular injections, urinalysis, electroencephalogram (EEG), diagnostic gastroscopy, colonoscopy, Treadmill exercise test, echocardiography, Abdominal Ultrasound, and renal biopsy. 8. Demonstrate safe and ethical practice. 9. Show professional conduct, compassion, and cultural sensitivity in daily practice. 10. Integrate evidence based medicine in own practice. 11. Demonstrate critical thinking and the ability to be a life- long learner. 12. Appraise one’s own practice and setting in which practicing with the intent of professional development and enhancing health care delivery.

Prerequisite: Minimum Entry Requirement.

Prerequisite Sentence: N/A

Credit Point: 120

Offered In: Semester 1,2