პეტრე შოთაძის სახელობის თბილისის სამედიცინო აკადემია

Petre Shotadze Tbilisi Medical Academy

SYLLABUS

INTRODUCTION TO CLINICAL MEDICINE IV(ICM IV) WITH INTEGRATION WEEKS

1. BASIC INFORMATION ON THE LEARNING COURSE

Course Name Introduction to Clinical Medicine IV (ICM IV) with Integration Weeks

Course Code M03IG030 Semester IV

Author(s) of the Syllabus Manana Kutkhashvili, MD, assistant professor

Status of the Learning Course Mandatory course for the one-step educational programme - Medicine

Language of Instruction English

Prerequisite Learning Courses for Enrolment Introduction to Clinical Medicine III (ICM III) with TBL

Formats and Volume of the Learning Course Formats Volume in Hours

Lectures -

Group Work 21

Exams Mid-Term Exam -

Final Exam 2

Contact 23

Student’s Independent Work 7

Total 30

ECTS Equivalent Credits 1

Consultation Hours The Students’ Dean coordinates the scheduling of consultation hours based on the students’ needs and in agreement with

the teaching staff. Teachers should be available for at least 2 consultation meetings (1-2 hours per meeting) throughout the

learning course.

Teaching Staff Position at TMA Contact Information

Berika Kiknadze MD Invited lecturer [email protected]

2. LEARNING GOALS AND OBJECTIVES OF THE COURSE

To ensure that students learn/develop:

 Clinical skills in assessment of GI, GU, endocrine and integumentary systems to facilitate integration of basic courses with clinical ones
 Clinical thinking ability
 Skills for working in a team

3. COURSE LEARNING OUTCOMES

The course learning outcomes are closely interlinked with the defined goals and objectives of the course (see Section 2) and the TMA Program Outcomes and Competencies.

Section 3.1 presents the course learning outcomes based on the National Qualification Framework (level 7) that are in turn aligned to the European Qualification Framework

(level 7). Section 3.2. presents course learning outcomes based on the TMA Program Outcomes and Competencies.
 3.1. LEARNING OUTCOMES OF THE COURSE ACCORDING TO THE NATIONAL QUALIFICATION FRAMEWORK

Knowledge and Understanding the student:

 has basic knowledge of physical examination principles of GI, GU, Endocrine and integumentary system

Skills The student:

 examines GI system, GU, endocrine and integumentary system at the very basic level: observation, palpation,

percussion, auscultation.

 makes clinical judgements related to disscused clinical case

 has ability of critical thinking: links presented clinical presentations to problems, linking one problem to several issues

and trying to identify the cause of the problem, makes analysis and synthesis of facts and makes final deduction

 communicates with team members, real patient and teacher, communicate with teacher and SP patient in

accordance with ethics, shares information

Responsibility and Autonomy The student:

 Plans and manages own learning process, identifies problems, uses appropriate sources, teachs teammates when

presenting clinical case, and performs the role of leader

 is polite and disciplined, acts in accordance with ethical principles

3.2. COURSE LEARNING OUTCOMES BASED ON TMA PROGRAM OUTCOMES AND COMPETENCIES
Level of Competencies relevant to the Learning Course defined in accordance with Miller’s pyramid

CanMed Roles Outcomes/Competencies

I Medical Expert As a medical expert, the student integrates the 6 roles of physician – II (1) assessed by OSPE, portfolio

the student applies the knowledge of Biomedical and Clinical Sciences in clinical problem solving and decision making - II (2) assessed

by MCQ, OSPE

The student:

 analyses pathogenesis of disease and links it with clinical manifestations, diagnosis, treatment, monitoring and prevention

in the process of clinical reasoning and decision-making

The student provides consultation of the patient and assesses his/her clinical case - II (3) - assessed by OSPE

The student:

 is aware and can apply at primitive level basic principles of communication with patient

II Communicator The student effectively communicates with patient and their family members – II (6)-assessed by OSCE

The student documents medical records - II (7)- assessed by OSCE

The student demonstrates interpersonal communication skills – II (9) assessed by TBL

III Collaborator The student effectively engages in team work and collaborates with colleagues /other healthcare providers - II (12)- assessed by

TBL

The student:

 gives and recieives colleague’s feedback

 shares the workload and responsibilities with other memebers of the team

The student manages the patient’s case and demonstrates leadership skills - II (13)- assessed by OSCE

The student:

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  sets priorities

 teachs other team members, performs the role of leader

The student manages his/her personal issues - II (14)- assessed by portfolio

VI Scholar The student is engaged in continuous personal learning and development - II (17)- assessed by TBL

The student applies evidence-based medicine principles in clinical practice – II (19)- assessed by TBL

The student:

 demonstrates the ability of critical thinking

 formulates questions

 searchs for relevant information and uses acquired knowledge in clinical case review

VII Professional The student applies the knowledge of Biomedical Ethics, Medical Laws and regulations in clinical practice – II (21)- assessed by

OSCE, MCQs

The student:

 acts in accordance with ethical principles when communicating with the patients

 acts in compliance to the principles of the Medical Law when communicate with patient and colleagues

 respects patient's rights and dignity, keeps confidentiality and privacy

The student demonstrates professional attitude and general moral values of physician - II (22)- assessed by OSCE, portfolio

The student:

 demonstrates kindness, respect, compassion, honesty, altruism and empathy.

 is oriented to acknowledge and correct his/her mistakes

The student critically evaluates his/her own work and the practice of colleagues - II (23)- assessed by TBL

The student:

 acknowledges his/her own autonomy limits and calls for help

 performs peer review

The student demonstrates critical thinking, vreativity and decision-making skills - II (24)- assessed by TBL

The student:

 adapts to new and changing /uncertain environment, analyses complex situation, makes appropriate decision and

solves the problem – demonstrates creativity and leadership skills

The student demonstrates the ability to act in international context - II (25) - assessed by TBL, MCQs

The student:

 knows English language

 is up-to-date with modern international demands and standards of patient care and principles of structure and

organization of healthcare system

4. TEACHING FORMATS AND METHODS FOR ACHIEVING

THE LEARNING GOALS AND OBJECTIVES

Please check (X) as relevant to the Course. For more information please see Annex A

Interactive Lectures Early Clinical Exposure

Seminars X Clinical Case Study (CBCR, CBL, Clinical Correlations) X

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 Audio-Visual (Posters, Slides, Atlases, etc.) Bed-Side Teaching

Laboratory Work Clinical Clerkship

Team-Based Learning (TBL) X Basic and Clinical Skills training, with simulation methods (SP, manikins, X

etc.)

Role Play Virtual Simulation Methods (VR Room, Anatomage, Body Interact, other)

Flipped Classroom Mandatory Portfolio Assignments

Methods of Scientific Communication (presentation, essay, scientific Other, please specify

report, research project, clinical case report)

5. LITERATURE AND RESOURCES FOR LEARNING THE COURSE

Core Literature  Lynn S. Bickley. (2016). Bates' guide to Physical Examination and history taking. 12 th ed.

Supplementary Resources

6. PRINCIPLES OF ETHICS AND ACADEMIC INTEGRITY

TMA strives for achieving academic and research excellence based on its institutional mission, corporate culture and code of ethics.

Every member of the TMA community – students, teachers, administrative staff and researchers - should read and promote the implementation of the following 3 policy documents:

1. Mission Statement

2. Code of Ethics, and

3. The Policy of Academic Integrity

The documents can be found on TMA’s website and the Library. At the same time, the Students’ Dean and the Students Association will distribute and discuss the document with

students on the first week of each academic year.

7. CONTENT OF THE LEARNING COURSE

ICM IV WITH TBL

Learning Course
Weeks Contact Hours Topic Core and Supplementary Literature
Format

The presentation of the Syllabus

Introduction of integration week format

Group Meeting with portfolio mentors

4 1
Working Assignments for integration weeks

Meeting with real patient with endokrine system disease and his/her clinical case

discussion – history taking, discussion of clinical symptoms, laboratory and

1
Group instrumental examination data and treatment
5 1
Working Clinical case discussion of a virtual patient using CP (Cyber patient) or Clinical
2
reasoning sesion

TBL

Group 1 Meeting with real patient with GI system disease –and his/her clinical case
11
Working 1

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 discussion – history taking, discussion of clinical symptoms, laboratory and

instrumental examination data and treatment

2 Clinical case discussion of a virtual patient using CP (Cyber patient) or Clinical

reasoning sesion

TBL

Seminar: GI; common and concerning symptoms; Techniques of

examination: inspection, palpation; percussion;

Group Practical work: Demonstartion of

12 2
Working Examination techniques on manikins and SP patient

Seminar: consideration of theoretical issues related to GI examination

Practical work: Practicing examination techniques on manikins and SP patient

Group
13 2
Working

Seminar: GU; Endocrine system; Integumentary system. Common and

concerning symptoms, Techniques of examination: inspection, palpation;

Group percussion;
14 2
Working Practical work: Demonstartion of examination techniques on manikins and SP

patient,

practicing examination

Seminar: consideration of theoretical issues related to GU, Endocrine and

Integumentary system.

Group Practical work: Practicing examination teqniques on manikins and SP patient, on

15 2
Working each other

Meeting with real patient with GI system disease –and his/her clinical case

discussion – history taking, discussion of clinical symptoms, laboratory and

instrumental examination data and treatment

Clinical case discussion of a virtual patient using CP (Cyber patient) or Clinical

1 reasoning sesion
Group
16 1 TBL
Working
2

8. STUDENT ASSESSMENT SYSTEM

The student’s performance is assessed based on a scoring system of 0-100 points, including 0-60 points for the Intermediate Assessment and 0-40 points for the Final Exam. The student

is allowed to proceed to the Final Exam if he/she obtains at least 31 points through the Intermediate Assessment. The student is awarded ECTS credit if he/she obtains at least 51 points

in the Final Assessment, including at least 31 points in Intermediate Assessment and a minimum of 20 points in the Final Exam. Please see Sections 8.3 and 8.4 for more details.

8.1. INTERMEDIATE ASSESSMENT

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Intermediate Assessment Components for the Intermediate Assessment for ICM IV with TBL consists of 3 components and is assessed based on a scoring system of 0-60 points,

Course including:

1. Class Activity assessed with a 55-point scale

2. Attendance assessed with 0 or 5 points

3. Portfolio assignments, assessed based on a Pass/Fail system

Component 1. The Class Activity includes 2 physical examinations on SP, with related theoretical issues and 3 TBL sessions as proof that

Class Activity the learning has taken place. The student can obtain a maximum of 55 points from the 5 assessments.

For physical examination student can obtain 0-10 points (assessed based on cheklists) and 0-10 points for theoretical part as de-

scribed bellow

10 points has a detailed, more exhaustive understanding of the question, answers to additional questions without

errors and has the ability of creative thinking;

Performs physical assessment without any fault

8 points has a good understanding of the issue, has some defects, answers to the additional questions;

6 points answers to the questions satisfactorily, but some fragmentations are noted, answers partially to the

questions;

4 points does not reveal the systematic knowledge and can answer the questions by means of additional,

referential questions

2 points shows a minimal knowledge and it is hard to answer additional, referential questions for him/her;

0 point he/she has no knowledge or refuses to answer. The student is not able to perform physical assessment

Prerequisites for admission of students to the TBL sessions are attendance activities planned within the framework of the

integration week: 1.Meeting with a real patient. 2. Clinical case discussion of a virtual patient using CP or CR session

TBL sessions are assessed by 0-5 points based on the following table, Students’ Evaluation Forms and the Peer Assessment Scales

(see Annex B).

Assessment Criteria for the TBL session Points

Peer assessment (10 criteria, 0.1 points for each) 0-1

5 MCQs, each assessed by 0.2 points - individual score 0-1

Interpersonal Skills 0-1

Completing the Peer Assessment Form 0-1

Application of evidence-based medicine principles - 5 open-ended questions, each assessed by 0-1

0.2 points. The same general score applies both to the TBL group and individual members of

the team.

Total Points 0-5

Component 2 If the student attends > 80% of the class activity during the course, he/she is granted 10 points for Attendance; if the attendance is

Attendance < 80%, no (0) points are given

Component3 Mandatory Portfolio Assignment for the course includes development of Personal Development Plan (PDP) or self-reflection.

Portfolio assignments Completion of the portfolio assignment is pre-requisite for the student’s admission to the Final Exam.

Mentors and the teaching staff of the learning course assess students’ portolio assignments by Pass or Fail based on Annex D. For

more information, please refer to the TMA Portfolio Concept.

8.2. FINAL EXAM

Final Exam Components for the Course The Final Exam for ICM IV with TBL is assessed based on a scoring system of 0-40 points and includes 2 components:

1. MCQ - based Test assessed with a 20-point scale, and

2. Objective Structured Practical Exam (OSPE)

The student should pass a minimum of 50% threshold for each component of the Final Exam. If the student fails one of the

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 components of the Final Exam, he/she must retake it. The Final Exam is considered as passed if the student obtains at least 20 out

of 40 points.

Component 1. MCQ-based Test includes 20 questions, each assessed by 1.0 point. The student can obtain a maximum of 20 points.

MCQ-based Test

Component 2. OSPE exam consists of 2 stations, each assessed by 10 points (checklists), total 20 points:

OSCE Station 1 – examination of GI system

Station 2 – examination of GU, endocrine and integumentary systems

8.3. FINAL ASSESSMENT

As noted in Section 8, the student is awarded ECTS credit if he/she obtains at least 51 points in the Final Assessment, including at least 31 points in Intermediate Assessment and a

minimum of 20 points in the Final Exam. If the student has 41-50 points in the Final Assessment, he/she is allowed to retake the Final Exam no earlier than 5 days from the initial

exam. If the student obtains less than 41 points in the Final Assessment, he/she has to retake the learning course.

8.4. GRADING SYSTEM AND CRITERIA

The table below summarizes the grading system and specific grading criteria based on the total number of points (0-100) obtained by the student in the Final Assessment, including the

results of the Intermediate Assessment (0-60 points) and the Final Exam (0-40 points).

Points Grade

91-100 (A) Excellent

81-90 (B) Very good

71-80 (C) Good

61-70 (D) Satisfactory

51-60 (E) Sufficient

41-50 (FX) Failed, with the right to retake the Final Exam

0-40 (F) Failed. The student must retake the learning course to obtain the ECTS credit

9. ACADEMIC APPEAL AND FEEDBACK MECHANISMS

Every student has the right to Academic Appeal, a formal request to the University to review a decision relating to the assessment of his/her academic performance based on

intermediate assessments or final exams.

As part of the academic appeal process, the students may also be provided with individual reviews and feedback from respective teaching staff as an Assessment-for-Learning exercise.

For more information please refer to the Student Appeal Procedure.

The document can be found on TMA’s website and the Library. At the same time, the Students’ Dean and the Students Association will distribute and discuss the document with

students in the first week of each academic year.

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 ANNEX A

DESCRIPTION OF TEACHING FORMATS AND METHODS APPLIED IN MEDICAL EDUCATION PROGRAMMES OF TMA

Seminars Seminars are used for review and interactive discussion of topics and theoretical issues covered by lectures and/or independent

studies.

Audio-Visual The Audio-Visual method is applied for teaching the majority of basic and clinical disciplines by using posters, atlases, computer

programs, animations, video clips and other resources. Audio-visual methods also include the use of PowerPoint Presentations,

slides, white/blackboard, etc.

Team Based Learning (TBL) TBL is a problem-oriented teaching method adopted at TMA as alternative to Problem-Based Learning (PBL). TBL sessions are

integral part of ICM modules (Introduction to Clinical Medicine) in semesters I-V and is also actively applied in teaching of clinical

disciplines.

Basic and Clinical Skills training, TMA at its Clinical Skills and OSCE Center offers a virtual clinic, where students acquire, enhance and master their basic and

with simulation methods (SP, advanced clinical skills (communication, practical procedures, physical examination and clinical reasoning) by using manikins and

manikins, etc.) other simulators.

The students also practice communication and physical examination skills with Standardized/Simulated Patients (SP) under

supervision and guidance of trained staff at the Clinical Skills and OSCE Center.

In addition, TMA provides special spaces for teaching Anatomy, Histology and Pathology equipped with manikins, posters,

microscopical slides and microscopes.

Finally, students attend and participate in dissection of animal organs at the Anatomical Theater

Clinical Case Study (CBCR, CBL, Case Studies at the Basic level of medical education includes discussion of clinical cases, clinical correlations and situational scenarios

Clinical Correlations) under the guidance and supervision of the teaching staff. In Clinical Courses, Case Studies consider demonstration and application of

theoretical knowledge in biomedical, social and clinical sciences, clinical reasoning and practical skills while assessing, analyzing,

making diagnoses, and elaborating a management plan for the given case.
rd
Case-Based Clinical Reasoning (CBCR) sessions are implemented in the 3 academic year as part of integrated Modules –

Diagnostics of Internal Diseases I and II.

Case-Based Learning (CBL) is implemented in teaching of clinical disciplines and implies detailed consideration of real patient cases,

as well as use of evidence-based principles (e.g. searching for new knowledge through e-resources) and its practical application by

the student.

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