Clinical Practice II

Coordination

• Domingo Ruiz Hidalgo

Sustainable Development Goals (SDG)

• 3. Good health and well-being

Objectives

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

These practices are developed in two ways:

General practices

They correspond to intensive periods of clinical stay of 6 consecutive weeks. They mean the continued stay in one or more services or equipment, medical or surgical.

Objective: The student must achieve the defined learning outcomes and at the same time integrate into the dynamics of the healthcare center.

As a general criterion, in general practices the knowledge and skills worked on are deployed. Exploration II (which have to do with general clinical practice) and the fundamental aspects of the rest of the subjects of the course.

Specific practices

They are carried out in each subject of the clinical cycle, usually in short periods (2-4 days), during the teaching of the subject's classes and before starting the next one.

Objective: acquire specific practical learning related to the topic being taught at any given time.

Therefore, the Clinical Practice II subject allows the student to put into practice everything they have worked on in the fourth-year subjects and becomes the space in which the student can check their level of competence as a "learner", since they are already able to feel how they progress and acquire 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.

The competency objectives are:

• Make progress in the preparation of the clinical history and in the physical examination adjusted to the reason for the consultation and the area of care.
• Interpret any complementary exploration related to the core subjects of the 3rd and 4th years of the degree.
• Make basic diagnostic and therapeutic decisions.
• Be comfortable communicating with patients, family members and healthcare professionals.
• Develop clinical judgment.
• Acquire professional values and ethical attitudes.

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.
• Carry out 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 II the student achieves the following learning outcomes:

• Demonstrates that he knows 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 a reason for consultation or reason for admission, preferably from the pulmonological and endocrinological 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 pulmonological and endocrinological fields.
• Takes a clinical history and writes it up in accordance with the main reasons for consultation related to the pulmonology and endocrinology fields, as well as those acquired in Clinical Practice I.
• In addition to the examination of Clinical Practice I, he does the systematic pneumological physical examination.
• Explore the thyroid gland.
• In addition to the syndromic orientation of Clinical Practice I, he does a syndromic orientation of pneumological and endocrine 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 manner.
• 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. Physical examination practice
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 assessed is attendance at a minimum of 80% of the time allocated to general practices and 80% of the specific planned practices.

Once this percentage is reached, the evaluation is carried out by applying the following evaluation instruments:

• Section A [15%]: skills in anamnesis, physical examination, communication, clinical judgment and professionalism assessed through the miniCEX tests.
• Section B [35%]: collection of evidence on skills in anamnesis, physical examination, communication, clinical judgement, decision-making and critical reflection, assessed through portfolio exercises and structured assessment rubrics.
  • The teaching collaborating doctors of the practices can help the student in the process of preparing the portfolio, but it is the academic tutors who carry out the evaluation. Only one portfolio is prepared (there is no option for a second portfolio as was done in previous years).
• Section C [50%]: Competencies in anamnesis, physical examination, communication, clinical judgement, decision-making and psychomotor skills in simulated practice environments. It is assessed using an ACOE test and also includes the acquisition of the practical skills worked on in the simulation of the subject Exploration II.

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 in 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 an academic tutor (subject professor) and a teaching collaborator (doctor from the healthcare center where the internships are carried out who ensures the achievement of the learning outcomes).

Bibliography

Further reading

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