The Ministry of Health of the Republic of Uzbekistan Tashkent Medical Academy The department of internal diseases №3 of medical an Medical Pedagogical Faculty

The Ministry of Health of the Republic of Uzbekistan

Tashkent Medical Academy

The department of internal diseases № 3 of medical an

Medical Pedagogical Faculty

"APPROVED" Vice Rector for Academic Affairs, TMA, Professor Teshaev OR "_______" ______________ ' 2016 y.

Discipline: INTERNAL DISEASES
7 course
TECHNOLOGY TRAINING

Cycle: Gastroenterology

syndromes:

"Indigestion"

"The pain in the abdomen"

"Diarrhea"

"Constipation"

"Hepatomegaly"
Topics 1-10

_____________________________________________________________________
(teaching guidelines for teachers and medical students)

Tashkent REQUIREMENTS FOR KNOWLEDGE, SKILLS AND SKILLS TRAINING FOR STUDENTS ON THE BASIS OF SOLVING THE PROBLEM OF PATIENTS

With dyspepsia
Objective: To teach students posindromalnomu addressing patients with dyspepsia, as well as the principles of their management in primary health care as part of the qualifying characteristics of GPs
The main learning objectives:
• To teach students problem solving associated with dyspepsia.

• To train students in a timely diagnosis of the problems associated with dyspepsia.

• To teach students to differentiate the disease, accompanied with dyspepsia.

• Improve the knowledge, skills and practical skills in solving problems of patients with dyspepsia (gathering information, identifying problems and physical examination, as well as the ability to reasonably prescribe laboratory and instrumental methods of research);

• To teach students to reasonably choose the tactics;

• To teach students to exercise reasonable medical and preventive measures and monitoring in SAP and SP.
When parsing the problem of patients the key moments of assessing students must be:

• Ability to identify the underlying problem, which is reflected in the quality of life of patients.

• Ability to ask support questions rational history.

• Ability to identify risk factors.

• Ability to transfer a disease or condition that may be causing the problem.

• Ability to conduct reasonable physical examination.

• Ability to use sound laboratory and laboratory studies in a hovercraft or OP.

• Ability to identify the need for additional research outside of SVP or OP.

• Based on the information received ability to establish the root cause (diagnosis) of the problem.

• Ability to determine the tactics on the basis of qualifying characteristics of GPs.

• Ability to provide non-pharmacological advice.

• Ability to identify drug treatment based on evidence-based medicine

• Ability to identify preventive measures at the level of primary health care.

• Ability to define the principles of clinical examination and rehabilitation of patients in a hovercraft or a joint venture.
What the student needs to know to solve the problems of patients with dyspepsia:

№	The list of knowledge	The basic level
1	The list of diseases which occur with dyspepsia	The student should know at least 10 of the most common diseases
2	List of the most dangerous diseases which occur with dyspepsia	The student should know at least 5 diseases
3	The list of conditions that require management in SAP or SP (1 category)	According to the characteristics of the GP qualifying
4	The list of states that require a specialist consultation or hospitalization (category 2)	According to the characteristics of the GP qualifying
5	A list of studies requiring in SAP or SP (3.1 category)	According to the characteristics of the GP qualifying
6	The list of research areas requiring outside SVP or SP (3-2 category)	According to the characteristics of the GP qualifying
7	Key points (criteria) diagnosis, proceeding with abdominal pain	The student should know characteristics and manifestations of each disease, as well as criteria for diagnosis.
8	Signs of acute abdomen	The student must list the symptoms.
9	Симптомы поражения внутренних органов	Symptoms of internal organ
10	Indicators of results of laboratory and instrumental investigations	The student should know: - Normal values​​, as well as their changes in pathology.
11	therapeutic tactics	The student must know the techniques and principles of treatment (including non-drug).
12	The principles of primary, secondary and tertiary prevention	The student should know the basic activities required for the primary, secondary and tertiary prevention
13	The principles of clinical examination and rehabilitation of disorders that occur with dyspepsia in a hovercraft or a joint venture (category 4)	The student must list the main activities for clinical examination and rehabilitation

What the student should be able to solve the problems of patients with dyspepsia:

	The list of skills	The basic level
1	Ask the patient and his relatives	The student must be able to ask questions of management concise questions that really helps to set the probable diagnosis. • The student must be able to specifically identify and assess the patient's complaints. • The student must be able to analyze medical history: the beginning of the disease, the first symptoms, the causal relationship and the dynamics of their development. • The student must be able to analyze the history of life: the identification of risk factors, the health of the parents and close relatives.
2	Identify risc factors	The student must be able to identify the managed and unmanaged risk factors such as on questioning the patient, so on the basis of an objective approach
3	Calculate the index weight / body	The student must be able to identify signs: - Underweight - Increased weight.
4	general inspection	The student must be able to identify: - Liver palms, -gynecomastia - Cachexia.
5	Perform visual inspection of the skin	The student must be able to detect the presence of: pale- - Ikterichnost, -presence of lesions - seals - Telangioektazii.
6	inspection of the mouth	The student should be able to appreciate the language.
7	To conduct palpation, percussion and auscultation of the respiratory system.	The student must be able to assess: - A tour of the chest - Voice trembling   - Change in pulmonary sound and interpretation - The types of breathing - The presence of breath sounds and wheezing
8	To conduct palpation, percussion and auscultation of the cardiovascular system.	The student must be able to identify signs: - Hypertrophy of the heart The student must be able to assess: - Heart sounds; - If the heart murmur, be able to identify their epicenter, and relevant to the phase of cardiac (systolic or diastolic murmur); - To be able to differentiate functional cardiac noise from organic. - Noise pericardial friction
9	General inspection abdomen	The student must be able to detect the presence of: -ascites -flatulence -spider veins - Venous collaterals
10	Conduct a superficial abdominal palpation	The student should be able to: - To identify sensitive points - To evaluate the presence of tension in the muscles of the abdominal wall - To identify the presence of enlarged organs or tumor formation. - To carry out the test SHCHetkina-Blumberg
11	Conduct a deep abdominal palpation	The student should be able to: - To evaluate all available structures in the abdomen
12	Conduct percussion liver	The student should be able to: - Determine the limits of the liver Kurlov
13	To conduct palpation of the liver and gall bladder	The student should be able to: - To evaluate the properties of the liver and gall bladder.
14	Conduct percussion and palpation of the kidneys.	The student should be able to: - Test for tapping the lumbar region - Palpation evaluate the performance of the kidneys
15	Conduct a neurological examination.	The student must be able to assess the sensitive area, taking into account the principle of step by step and find the signs: - Sensory disturbances (analgesia hypalgesia, gipostezii, anesthesia, paresthesias, dysesthesia, etc.). 2. The student must be able to assess reflexes (using the neurological hammer) and identify signs: - hyperreflexia - hyporeflexia - arefleksiya 3. The student must be able to assess motor function and signs of 4. The student should be able to specify the symptoms of spinal cord lesions.
16	Conduct a gynecological examination	The student should be able to gynecological examination, taking into account the principle of step by step.
17	Interpret clinical, instrumental and biochemical analyzes	The student must be able to identify signs: - Increase or decrease in performance from the norm.
18	Remove the ECG and decrypt it	The student should be able to record the ECG with the incremental principle. The student must be able to decipher the results of the ECG
19	Differentiate between diseases accompanied with dyspepsia	The student must be able to differentiate the disease on the basis of the distinctive features (history, physical examination, laboratory and instrumental investigations)
20	Post a non-drug advice	The student should be able to: - Educate patients on self-monitoring - Advise on diet - Advise on healthy lifestyles
21	Rational use of medicines in the treatment of diseases that occur with dyspepsia	The student should be able to choose drugs with proven efficacy. When selecting a drug student should be able to evaluate: - Efficiency - Safety - Eligibility - Profitability.
22	Conduct monitoring and surveillance of patients	The student must be able to carry out monitoring and control status in SAP and SP.

Practical lesson number 1

Theme: "Dyspepsia (indigestion, nausea, vomiting). Differential diagnosis of biliary dyskinesia and cholecystitis. Tactics GPs. Indications for referral to a specialist or hospital in the profile department. The principles of treatment, monitoring, control and rehabilitation in a hovercraft or a joint venture. The principles of prevention. The principles of teaching about "

Learning technology

Study time: 6.4 hours
The structure of the training session	- Training thematic study clinic. - Office of the GP in the clinic.
The purpose of the training session: Teach GP diagnosis and differential diagnosis, conducting best option treatment strategy for dyspepsia caused by various diseases, as well as the principles of management of patients in primary care, provided the requirements of the "Qualification characteristics of the GP"
Pedagogical objectives: 1. Consider dyspepsia diagnosis. 2. Demonstrate patients with dyspepsia. 3. Discuss the results of clinical, laboratory and instrumental investigations under dyspepsia. 4. Make a differential diagnosis of dyspepsia. 5. Discuss questions about the tactics of management of patients with dyspepsia in the qualifying characteristics of GPs 6. The principles of treatment (medication and non-medication). 7. Principles of management, follow-up and monitoring of patients with dyspepsia in a hovercraft or a joint venture. 8. The principles of primary, secondary and tertiary prevention of diseases involving dyspepsia.		Learning outcomes: GPs should be aware of: 1. The mechanism and causes of dyspepsia. 2. Clinical manifestations of dyspepsia. 3. Diagnosis of dyspepsia. 4. Differential diagnosis of dyspepsia. 5. The principles of treatment (medication and non-medication) in these diseases, accompanied by dyspepsia. 6. Principles of follow-up and monitoring of patients in a hovercraft or a joint venture. 7. The principles of primary, secondary and tertiary prevention of diseases involving dyspepsia. GPs should be able to: 1. Analyze the data and history of complaints for the diagnosis of dyspepsia. 2. Diagnose, differentiated by clinical and laboratory-instrumental investigations different types of dyspepsia. 3. Choose the right treatment strategy for specific dyspepsia. 4. Choose drugs with proven efficacy 5. Advise on non-drug therapies. 6. To monitor in a hovercraft or a joint venture ..
training Methods		Method * Handle middle of the table; * graphic organizer - a conceptual table
Forms of organization of learning activities		Individual work, small group work, teamwork
learning Tools		Training manuals, training materials, ECG patients, slides, video and audio recordings, medical history
Methods and feedback means		Quiz, test, presentation of the results of the learning task, filling medical records implementation of practical skill "professional debriefing"

Flow chart classes

Theme: "Dyspepsia (indigestion, nausea, vomiting). Differential diagnosis of biliary dyskinesia and cholecystitis. Tactics GPs. Indications for referral to a specialist or hospital in the profile department. The principles of treatment, monitoring, control and rehabilitation in a hovercraft or a joint venture. The principles of prevention. The principles of teaching about "

№	Stages of the practice session	Form classes Venue	Duration classes 225
1	Intoduction (justification themes)		10
2	The discussion on the practical lessons with the use of new educational technologies (method "* Handle on the middle of the table; *"), as well as demonstration material (sets of medical charts, tables, posters, x-ray), define the initial level.	The survey, discussion Classroom, GP surgeries	40
3	conclusion discussion		10
4	Definition of tasks to perform the practical part - professional questioning. Explanation of the provisions and recommendations for the job by filling in medical charts.	discussion GP doctor's office	20
5	Mastering the practical part of the training under the guidance of a teacher.	Prof. questioning. A conversation with patients and honey filling cards, situational problems. Admission of patients in the clinic, examination at home	20
6	Interpretation of the survey data of patients, complaints, inspection, palpation, percussion, auscultation of patients, as well as research OAM KLA and biochemical analysis and diagnosis	Medical history,   laboratory data situational problems	25
7	Discussion of theoretical and practical knowledge of the students, securing the material to determine the level of assimilation of knowledge assessment.	Oral questioning, tests, discussion, identification of practical skills Classroom in a clinic	75
8	Defining output on practical sessions on a 100-point rating system and ad evaluations. Homework next practice session (a collection of questions).	Information, questions for homework. Classroom in a clinic	25