Clinical Practice I

Coordination

• Domingo Ruiz Hidalgo

Sustainable Development Goals (SDG)

• 3. Good health and well-being

Objectives

The Clinical Practice I subject is equivalent to 13 ECTS in which practical activities are developed that are adjusted to the student's training and curricular itinerary and that maintain a direct link with the subjects taught throughout the course.

These practices are developed in two ways:

• General practices: They correspond to intensive periods of clinical stay of approximately 6 consecutive weeks. They involve a continuous stay in one or more medical or surgical services or teams, which must allow the student to achieve the defined learning outcomes and at the same time integrate into the dynamics of the center.
  As a general criterion, general practices develop the knowledge and skills worked on in Exploration I (which have to do with general clinical practice), and the fundamental aspects of the rest of the subjects in the course.
• Specific practices (extensive): They are carried out in each subject of the clinical cycle, usually in short periods, during the teaching of the subject's classes and before starting the next one. Specific practices include concrete practical learning, related to the topic being taught at any given time.

Therefore, this subject allows the student to put into practice everything they have worked on in the other third-year subjects.

The competency objectives that must be achieved are:

• Learn how to write a clinical history adjusted to the reason for the consultation and the area of care.
• Know how to do a basic physical examination.
• Know how to interpret basic complementary examinations (analysis, ECG, simple X-rays, etc.).
• Know how to apply basic life support procedures.
• Develop communication skills with patients, family members and healthcare professionals.

Clinical practices are the moment in which the student can verify his or her level of competence as a "learner", since he or she can already feel how he or she progresses and acquires confidence in the exercise of the applied part of the degree in Medicine at UVic-UCC.

In this process, he has the support of various professionals, both from the Faculty itself and from the healthcare centers where he does his practical stays.

Therefore, it is a process of verifying your vocation to be a doctor.

Learning outcomes

In supervised internships, the student:

• Acquire the necessary skills to carry out the tasks arising from the clinical stay.
• Demonstrates skills in communicating bad news.
• Writes histories, reports, instructions and other records in a way that is understandable to patients, family members and other professionals.
• Assumes different responsibilities in individual or collaborative work and evaluates the results obtained.
• Recognizes the care environment and the internal and external relationships that are established within it.
• Acquires and demonstrates advanced knowledge of theoretical and practical aspects and work methodology in the field of clinical practice.
• Correctly prepares a clinical history and anamnesis.
• Performs a complete and adequate physical examination.
• Develops accurate and consistent differential diagnoses.
• It defines hypotheses that take into account several variables.
• Determine the necessary diagnostic tests according to each case.
• Correctly interprets results derived from the different tests carried out.
• Shows skills in determining and arguing intervention proposals.
• It moves with desymboltura in the general use of ICT and, in particular, in the technological environments specific to the professional field.

Specifically, in Clinical Practice I the student achieves the following learning outcomes:

• Demonstrate that you know how to determine vital signs (blood pressure, temperature, heart and respiratory rates and oxygen saturation).
• Conducts at least 5 complete clinical interviews (in a structured, orderly and reliable manner) with patients with reasons for consultation or admission, preferably from the cardiovascular, oncohematological, nephrourological and digestive fields.
• Performs a physical examination in a structured, orderly and technically correct manner on at least 5 patients with a reason for consultation or reason for admission, preferably from the cardiovascular, oncohematological, nephrourological and digestive fields.
• Takes a clinical history and writes it according to the main reasons for consultation related to the cardiovascular, oncohematological, nephrourological and digestive fields.
• Performs systematic cardiovascular, nephrourological and digestive physical examination.
• Explore the ganglionic chains.
• It provides a syndromic orientation, especially for cardiovascular, oncohematological, nephrourological and digestive pathology.
• It indicates the initial complementary examinations adjusted to the syndromic orientation and interprets them appropriately.
• Acquires and demonstrates advanced knowledge of theoretical and practical aspects and work methodology in the field of clinical practice.
• Adopt appropriate attitudes and skills for self-learning and critical reflection.
• Evaluates the contents of the practical stay and the portfolio in an argumentative way.
• Communicates effectively in different contexts of clinical practice, both orally and in writing.

Competencies

General skills

• Develop professional practice with due respect for other health professionals and acquire teamwork skills.
• In professional activity, bring to bear a critical, creative, constructively skeptical and research-oriented outlook.

Specific skills

• Be able to make an initial diagnosis and establish a rational diagnostic strategy.
• Carry out professional tasks with due respect for patient autonomy, beliefs and culture.
• Indicate the most appropriate treatment for the most common acute and chronic conditions, and for the terminally ill.
• Obtain and make medical records that contain all relevant information.
• Perform a physical examination and a mental assessment.
• Understand the basic components of the medical profession, including ethical principles, legal responsibilities and patient-centered professional practice.
• Understand the principles of action, indications and efficacy of therapeutic interventions, based on the available scientific evidence.

Basic skills

• Students can communicate information, ideas, problems and solutions to both specialists and non-specialists.
• Students have demonstrated knowledge and understanding in a field of study that builds on general secondary education with the support of advanced textbooks and knowledge of the latest advances in this field of study.

Core skills

• Become the protagonist of one's own learning process in order to achieve personal and professional growth and acquire all-round training for living and learning in a context of respect for linguistic, social, cultural, gender and economic diversity.
• Display professional skills in complex multidisciplinary contexts, working in networked teams, whether face-to-face or online, through use of information and communication technology.
• Exercise active citizenship and individual responsibility with a commitment to the values of democracy, sustainability and universal design, through practice based on learning, service and social inclusion.
• Interact in international and worldwide contexts to identify needs and and new contexts for knowledge transfer to current and emerging fields of professional development, with the ability to adapt to and independently manage professional and research processes.
• Project the values of entrepreneurship and innovation in one's academic and professional career, through contact with a variety of practical contexts and motivation for professional development.
• Use oral, written and audiovisual forms of communication, in one's own language and in foreign languages, with a high standard of use, form and content.

Content

1. The clinical history. Elements and elaboration
2. Development of physical exploration
3. The differential diagnosis
4. Determination of the diagnostic hypothesis
5. Diagnostic tests
6. Clinical intervention according to different cases and situations
7. Effective communication
8. Digital tools and ICT
9. Organization and operation of the unit
10. Interprofessional relationship

Evaluation

The previous criterion that every student must meet to be eligible to be evaluated is attendance at a minimum of 80% of ACC sessions.

Once this percentage is reached, the evaluation is carried out applying the general criteria of the Faculty of Medicine. This criterion is applied based on the following evaluation instruments and in the percentages indicated below:

• Section A [15%]: skills in anamnesis, physical examination, communication and professionalism assessed through the miniCEX tests.
• Section B [35%]: collection of evidence on skills in history taking, physical examination, communication, clinical judgement, decision-making and critical thinking, assessed through designed portfolio exercises and structured evaluation rubrics shared between academic tutors and collaborating doctors teaching the practices.
• Section C [50%]: skills in anamnesis, physical examination, communication, clinical judgement, decision-making and psychomotor skills in simulated practice environments. It is evaluated using an ACOE test and also includes the acquisition of the practical skills worked on in the simulation of the subject Exploration I.

None of the three sections can be made up and, to be eligible to pass the subject, you must have obtained at least a 4 in each of the sections. The grade obtained is the weighted average of the grade obtained in each section.

Methodology

Clinical practices are carried out through stays at the different healthcare centers collaborating with the degree and linked to the territorial teaching units of Vic and Manresa.

During their stay, students have as their main references a academic tutor (teacher of the subject) and one teaching collaborator (doctor from the healthcare center where the internships are carried out), who ensures the achievement of the learning outcomes.

Bibliography

Key references

• McGee, S (2017). Evidence-Based Physical Diagnosis (4 ed.). Elsevier.
• Farreras, V., Rozman, C., Cardellach López, F. (2016). Medicina Interna. Retrieved from https://www-clinicalkey-com.biblioremot.uvic.cat/student/content/toc/3-s2.0-C20151017483
• Jameson, JL., Fauci, A.S., Kasper, D.L., Hauser, S.L., Longo, D.L., Loscalzo, J. (2018). Harrison's Principles of Internal Medicine (20 ed.). McGraw-Hill Medical.
• Swartz, M (2015). Tratado de semiología: Anamnesis y exploración física. Retrieved from https://www-clinicalkey-com.biblioremot.uvic.cat/student/content/toc/3-s2.0-C2014000514X

Further reading

Teachers will provide complementary bibliography and compulsory reading throughout the course via the Virtual Campus.