INTERNAL MEDICINE PAPER XVI

General Objectives

Students will be able to:

  • diagnose and manage common life threatening medical emergencies
  • diagnose and manage common medical conditions prevalent in Nepal
  • refer complicated and uncommon cases to appropriate referral hospital/consultants.
  • communicate skillfully in interaction with patients, relatives or attendant
  • take appropriate history of illness from the patient, relative or attendant.
  • perform thorough general physical examination and interpret findings.
  • perform thorough clinical examination of body systems in a systematic manner and interpret findings.
  • order relevant investigations, justify and interpret them.
  • describe common medical emergencies and outline appropriate strategies to reach an accurate diagnosis.
  • describe and recognize clinical manifestations of common life threatening emergencies.
  • prescribe appropriate medications in medical emergencies and monitor their effects.
  • undertake life saving measures:
  • cardiopulmonary resuscitation
  • insertion of chest drainage tube
  • venesection
  • putting up a drip
  • perform procedures:
  • catheterization of urinary bladder
  • thoracic paracentesis
  • abdominal paracentesis
  • lumbar puncture.
  • counsel the patient and the family on disease process, management and follow up care.
  • counsel the patient, family and the community on health promotion and prevention of diseases.

First year: History taking skill exercise

Students will develop clinical history taking and communication skills and become able to integrate general medicine with community medicine with focus on building up a good student-patient rapport and epidemiological approach to diseases. This is achieved through the Teaching Learning activity’ once a week in a block encompassing all departments.

Second year: Clinical examination skill I

Students will develop clinical history taking and communication skills.

The clinical course I consists of general physical examination and systemic examination of respiratory, cardiovascular, and gastrointestinal systems. It is learnt concurrently with the related basic medical sciences. This is achieved through once a week Teaching

Learning session in a block encompassing all departments.

The students are required to correlate the knowledge and skills, acquired during sources on the basic sciences, to clinical medicine by undertaking clinical examination of patients and correlate with surface anatomy, radiological anatomy and applied physiology and pathology.

The clinical course II consists of physical examination of nervous, locomotor and genito- urinary systems with emphasis on application of knowledge of applied basic medical sciences (anatomy, clinical physiology, pathology, radiology and pharmacology) to finical medicine.

Third year

In the first half of the third year, a systematic approach to general medicine theory begins that includes respiratory, cardiovascular, gastrointestinal, hepatobiliary, nematological and lymphoreticular systems and tropical diseases.

In the second half of the third year, the systematic approach in general medicine theory continues with the nervous, endocrine, metabolic, locomotor and musculoskeletal, renal and electrolyte systems.

Clinical examination of different cases belonging to different body systems is learnt concurrently during three months bed side teaching placement in different wards.

Fourth year

The students continue to develop their skills in clinical examination, diagnosis and management by examining patients in one zonal hospital (3 weeks) and two district hospitals (3 weeks each) during field practice under supervision and guidance from their teachers during the second half of the fourth year.

Fifth year

The students are attached to different medical units for a total of one month with the aim of further refining their clinical reasoning and therapeutic skills during Junior Internship before appearing for the final qualifying examination.

Internship

The students will do a compulsory rotation for 3 months in internal medicine. The aim of this rotation is to enhance their clinical reasoning skills learnt previously and to learn therapeutic procedures so as to prepare them for independent practice and management in the future.

The students are allocated a number of beds for which they are responsible to clerk, order investigations and manage cases under supervision. They will also complete a log book of 20 cases which has to be submitted to the designated preceptor. They will also learn common diagnostic and therapeutic procedures as specified in the curriculum and maintain a log book of them.

The competencies to be achieved are defined