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 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.

Procedures and Competency Levels

• Gastroscopy: Level B – performance of at least 50 procedures, certified competent by regular gastroscopists at CWMH
• Abdominal ultrasound: Level A – observation or participation in at least 10 procedures; Level B – performance of at least 30 procedures, certified competent by Dept. of Radiology at CWMH
• Echocardiography: Level B – performance of at least 50 procedures, certified competent by regular echocardiographers at CWMH
• Treadmill exercise test: Level A – performance of at least 15 tests, certified competent by 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 least 3 procedures
• Venous cutdown or central venous line: Level A – performance of at least 10 procedures
• Pericardiocentesis: Level A – observation of at least 5 procedures, followed by at least 2 procedures
• Bronchoscopy: Level A – observation or participation in at least 5 procedures; Level B – performance of at least 25 procedures, 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 ?95% success rate, <5% major complication rate
• Cardioversion: Level A – observation or participation in at least 5 procedures; Level B – performance of at least 10 cardioversions with ?90% success
• Gastric Lavage: Level A – observation 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 ?90% success rate
• Bone Marrow Biopsy and Aspiration: Level A – observation and participation in at least 5 procedures; Level B – performance of at least 20 procedures with ?90% success rate
• Renal Biopsy: Level A – observation of at least 5 biopsies; Level B – performance of at least 25 biopsies with ?90% success rate and <5% major complication rate
• Pacemaker insertion: Level A – observation of at least 1 insertion

• Endocrinology
• Rheumatology
• Renal Medicine
• Haematology and Oncology
• Clinical Pharmacology
• Infectious Diseases
• Gastroenterology
• Respiratory Medicine
• Neurology
• Cardiology

• Participation with clinical faculty in the hospital practice
• Shares the emergency and night duties on rotation in the larger and small animal hospitals including Sundays or holidays
• Participation with a staff of the place of posting in Veterinary Practice (production or technology)
• The intern responsibilities include hands-on diagnostic and treatment procedures for hospitalized cases under the supervision of the attending veterinarian
• Participation in the tutorial instructional program of the Veterinary College
• The intern will administer primary care to emergency cases and participate in services such as anaesthesia, radiology, ultrasonography, endoscopy, laboratory and diagnostic procedures
• Medicine and Surgery rounds are held periodically allowing the interns to present cases and participate in topic discussion

Learning Target Outcomes:

Prerequisite: Minimum Entry Requirement.

Prerequisite Sentence: N/A

Credit Point: 120

Offered In: Semester 1,2