Principles of Clinical Medicine I

Revision February 20, 2021

This version will supersede any previous editions of this document. The university reserves the right to change or amend the rules and regulations at any time. The new rules and regulations will be applicable to all students registered on the course

* These activities are mandatory, and a score must be achieved for every assessment. Without scores in all of the listed examinations and assessments, a passing course grade cannot be assigned, and a course grade of F will be registered at the end of term. A score of zero will be retained for any exam that is missed and not subsequently completed on the scheduled completion date. 

# All activities must be fulfilled to the required performance, participation, and professionalism standards to earn these 18 points. Any single event activity must be remediated before a course grade can be earned. Participation in any element <80% may incur an additional professionalism penalty (up to 10% of the total course points per incidence). <70% participation in any of the multiple event activities subject to the 80% participation requirement will result in an incomplete grade that will be converted to an F at the end of term. For events where participation is recorded using the audience response system, all questions in the session must have a recorded response to earn credit for the session. 

** Maximum of 12 points available, 0.5 points per session, best 24 sessions count towards the course grade.

Note: For any activity in which the audience response system is used, participation credit is only awarded for full participation in all polled questions. Some activities (e.g., IMCQs) have an additional performance requirement standard (i.e.  all questions are answered with at least 50% accuracy) in order to earn points associated with the activity. 

† In addition to the lectures, ITI students need to participate in 80% of their scheduled ITI sessions. There is a total of 70 ITI Sessions. Participation for the entire 1-hour session is required for participation credit. 

The final course grade is calculated by converting the course points obtained by the student into a percentage. The student manual outlines the grading scales used in the SOM. Student Manual   

To pass this Term 4 course a minimum of 476.33 points is required, corresponding to a percentage score of 72.50%. In addition, all relevant assessment and participation criteria must be fulfilled.  

This course is delivered as a synchronous course using a live online platform for delivery. The live online platform is used for all lectures, small groups, IMCQ’s, ITI sessions and faculty office hours. It is important that you sign into the Zoom platform using the application (NOT the browser version) and sign in using the SGU SSO – see link below for instructions. 

ZOOM  

https://www.iorad.com/player/1657673/SGU-Zoom---How-to-Sign-in-with-SSO 

Additional guidance for online delivery of course requirements is given from IT/OIA in the following link: 

ONLINE DELIVERY   

https://mycourses.sgu.edu/access/content/group/7a7ac639-acc5-4f33-

b106ae0778aabff6/TeachingLearningRemotely/LearningRemotely.html  

For all technical support for course delivery at home please contact support@sgu.edu see link below https://www.sgu.edu/office-of-information-technology/it-support/ 

Computer requirements for the course and exams are outlined in the above link under Examplify guidelines from Examination Services.  

CLASS SCHEDULE  

Class schedules can be found on the Office of the University Registrar’s page.   https://mycampus.sgu.edu/office-of-the-university-registrar/Academic-Class-Schedules  

TIME ZONE:  

All live activities will follow the time zone in Grenada (Atlantic Standard Time GMT -4) with no summertime adjustment in Grenada. 

Any errors in participation data, or in scores for course assessments, that are displayed in the Sakai gradebook must be reported to the Course Director within 48 hours of their publication. Errors reported later than this will not be considered for correction.  

For all online proctored examinations, the published scores are preliminary at the time of publication; course penalties may apply if a subsequent investigation demonstrates a failure to comply with examination regulations or the online proctoring requirements.  

For Online Assessments, where results are immediately accessible upon submission, errors must be reported before the submission deadline.  

COURSE CONTACT   

Please direct all course-related queries to: 

sompcm1@sgu.edu

Content related questions

For all content-related questions, the most efficient way of interacting with faculty will be via email on the following:

• Clinical Skills – askcpd@sgu.edu
• Microbiology - askmicro@sgu.edu
• Pathology – askpathology@sgu.edu
• Pharmacology – askpharmacology@sgu.edu

The Principles of Clinical Medicine – 1 (PCM 500) is a 21-credit course taught over 18 weeks in Term 4 of the Doctor of Medicine (MD) program of St George’s University School of Medicine, Grenada.  It is a systems-based curriculum for the second academic year of the Basic Sciences program and is taught in four consecutive modules:

COURSE GOALS AND OBJECTIVES

Course Goals

1. Provide a foundational basis for subsequent courses and clinical medicine. 
2. Integrate the basic sciences and apply them for analysis and interpretation of clinical situations. 
3. Demonstrate commitment to excellence, honesty, respect for others, teamwork, integrity, and altruism in patient care.

Course Objectives

At the end of the course, a successful student should be able to:

1. Integrate basic sciences concepts from disciplines of Pathology, Pharmacology, Microbiology and Clinical Skills in a system-based format.
2. Apply basic sciences concepts to the analysis and interpretation of clinical situations.
3. Explain the functional basis behind various disease processes.
4. Conduct integrated patient interviewing and perform focused physical examinations to determine diagnosis and severity of disease.
5. Describe the mechanism of action, indications, contraindications, potential adverse effects, and interactions of major drug classes.
6. Select appropriate pharmacological therapies based on the current practice guidelines. 

MODULE OBJECTIVES

Foundation to Clinical Medicine (FTCM) Module

At the end of this module, a successful student should be able to:

1. Perform an integrated patient and clinician-centered medical interview.
2. Provide patient education with respect to health problems and maintenance.
3. Understand the components of the patient note using the SOAP format.
4. Understand analytic methods of clinical reasoning (hypothetico-deductive, forward-thinking, and the non-analytic methods (pattern recognition) in clinical decision making.
5. Identify key factors in the patient history and synthesize clinical syndromes/problem representations to formulate a differential diagnosis.
6. Understand the basic principles of physical examination (including general appearance, vital signs and maintaining patient privacy).
7. Appreciate element of uncertainty in diagnosis and need to incorporate the other health professionals in decision making and obtaining the patient perspective.
8. Describe the basic principles of pharmacodynamics, pharmacokinetics and toxicology.
9. Describe the mechanism of action, indications, contraindications, potential adverse effects, and interactions of drugs affecting the autonomic nervous system.
10. Describe the general principles of the common reactions of cells and tissues to injurious stimuli and explain the etiology, mechanisms and morphology of different types of inflammation, cell death and repair. Describe the pharmacologic properties of inflammatory mediators and their antagonists.
11. Describe the mechanism of action, indications, contraindications, potential adverse effects and interactions of drugs used for the management of pain and inflammation.
12. Develop a vocabulary of tumor biology and pathology and review the morphologic characteristics that define neoplasias. Discuss the tumor biology and the molecular basis of carcinogenesis.
13. Develop a vocabulary of the lesions over the skin and distinguish the disorders of the skin in terms of the etiopathogenesis, gross and microscopic appearances, clinical features, relevant investigations and complications.
14. Distinguish disorders of hemodynamic alterations.
15. Categorize skin, muscle and bone infections based on clinical presentation, microbial characteristics and diagnostic features and associate each with the most likely causal agent

Cardiovascular and Renal Systems (CRS) Module

At the end of this module, a successful student should be able to:

1. Practice communication skills and a hypothesis-driven approach for a patient presenting with a cardiovascular and peripheral vascular complaint.
2. Perform a comprehensive physical examination of the cardiovascular and peripheral vascular systems.
3. Practice and evaluate documentation of patient information in the SOAP note format.
4. Demonstrate the ability to provide and accept constructive feedback including self-evaluations.
5. Demonstrate respect, teamwork, professional behavior and ethical standards for patients and other health care professionals.
6. Identify and explain the etiology, pathogenesis, gross and microscopic appearances, clinical features, relevant laboratory investigations, complications and the outcomes of renal and cardiovascular diseases.
7. Describe the mechanism of action, indications, contraindications, potential adverse effects, and interactions of drugs affecting the renal and cardiovascular system and abnormal bleeding and clotting disorders.
8. Differentiate cardiovascular infections in terms of etiologies, microbial virulence factors, modes of pathogenesis, clinical features, body response to these microorganisms, epidemiological features and interpretation of common laboratory tests.
9. Differentiate urinary tract infections in terms of etiologies, microbial virulence factors, modes of pathogenesis, clinical features, body response to these microorganisms, epidemiological features and interpretation of common laboratory tests.

Respiratory and Hematopoietic Systems (RHS) Module

At the end of this module, a successful student should be able to:

1. Practice communication skills and a hypothesis-driven approach for a patient presenting with a Head, Neck and Respiratory complaint.
2. Perform a comprehensive physical examination of the head and neck region and the respiratory system.
3. Practice and evaluate documentation of patient information in the SOAP note format.
4. Demonstrate the ability to provide and accept constructive feedback including self-evaluations.
5. Demonstrate respect, teamwork, professional behavior and ethical standards for patients and other health care professionals.
6. Identify and explain the etiology, pathogenesis, gross and microscopic appearances, relevant laboratory investigations, complications and the usual outcomes of respiratory diseases.
7. Identify and explain the etiology, pathogenesis, gross and microscopic appearances, clinical features, relevant laboratory investigations, complications and the outcomes of environmental diseases.
8. Select the appropriate pharmacological therapies for respiratory diseases.
9. Differentiate respiratory infections in terms of etiologies, microbial virulence factors, modes of pathogenesis, clinical features, body response to these microorganisms, epidemiological features and interpretation of common laboratory tests.
10. Distinguish the hematological abnormalities in terms of etiology, pathogenesis, morphology, clinical features, laboratory investigations, complications and relevant outcomes.
11. Distinguish the pharmacological basis of anti-cancer therapies.
12. Differentiate infections of blood and lymphatic systems in terms of etiologies, microbial virulence factors, modes of pathogenesis, clinical features, body response to these microorganisms, epidemiological features and interpretation of common laboratory tests. Describe malaria prophylaxis and treatment.
13. Describe the pharmacological agents used for anemias.

Digestive, Endocrine and Reproductive Systems (DERS) Module At the end of this module, a successful student should be able to:

1. Practice communication skills and a hypothesis-driven approach for a patient presenting with an abdominal, obstetric or endocrine complaint.
2. Perform a comprehensive physical examination of the pelvic, breast and abdominal region.
3. Practice and evaluate documentation of patient information in the SOAP note format.
4. Demonstrate the ability to provide and accept constructive feedback including self-evaluations.
5. Demonstrate respect, teamwork, professional behavior and ethical standards for patients and other health care professionals.
6. Differentiate gastrointestinal tract infections in terms of etiologies, microbial virulence factors, modes of pathogenesis, clinical features, body response to these microorganisms, epidemiological features and interpretation of common laboratory tests.
7. Explain the diseases of the gastrointestinal tract in terms of etiology, pathogenesis, clinical features, laboratory investigations, complications, outcomes and the appropriate pharmacological therapies. 
8. Explain the diseases of the endocrine system in terms of etiology, pathogenesis, clinical features, laboratory investigations, complications, outcomes and the appropriate pharmacological therapies. 
9. Differentiate urogenital tract infections in terms of etiologies, microbial virulence factors, modes of pathogenesis, clinical features, body response to these microorganisms, epidemiological features and interpretation of common laboratory tests and the appropriate pharmacological therapies. 
10. Explain the pathologies affecting the breast, ovaries, female and male genital tract in terms of etiology, pathogenesis, clinical features, laboratory investigations, complications and outcomes.
11. Explain the pharmacological basis of contraceptives and drugs acting on the uterus.

Course Leadership team

Course Secretaries

Support Staff

Teaching Faculty

A full list including a biography of the teaching faculty will be provided on SAKAI. 

Clinical Tutors and Teaching Fellows

A group of physicians responsible for facilitating small group sessions and other educational activities. See SAKAI for further information.

Standardized Patient (SPs)

Individuals of various backgrounds who are trained to portray, in a consistent and standardized manner, a patient in a medical situation, allowing students to practice their communication, history taking and physical examination skills. 

Required textbook, lecture slides, small group material and additional resources are provided on My Courses.  

Copyright 2021 St. George's University.  All rights reserved. 

All course material, whether in print or online, is protected by copyright. Course materials, in part or in their entirety, may not be copied, distributed or published in any form, printed, electronic or otherwise. As an exception, students enrolled in the course are permitted to make electronic or print copies of all downloadable files for personal and classroom use only, provided that no alterations to the documents are made and that the copyright statement is maintained in all copies. 

Lecture recordings are explicitly excluded from download and creating copies of these recordings by students and other users is strictly prohibited.

Course Website

The Principles of Clinical Medicine one (PCM1) course offers a website through Sakai, our learning management system. This site is used for COMMUNICATION (including Announcements, Calendar and Discussion Forums) and COURSE TOOLS (including Syllabus, Resources, Tests & Quizzes, Gradebook, a link to Lecture Recordings and a web link to the student resources of the Required Books).

To login, go to myCampus Secure Login (formerly Carenage), type in your user ID and password, and click on MyCourses. 

Electronic Resources

Distribution of course material will be in electronic format. The Resources folder contains multiple subfolders arranged by module and teaching week, which contain all relevant course materials. In accordance with the Committee for Technology based Teaching and Learning (CTTL) recommendations, students are provided with unlocked PDF files, which may be annotated for personal use. This format facilitates active learning, as it allows highlighting and annotations, using a variety of platforms, operating systems and annotation software. Copyright restrictions regarding the duplication of materials apply (see copyright statement above).

Required textbooks

• Robbins Basic Pathology (10^th ed.) – Kumar, Cotran, WB Saunders Co. 
• Robins Essential Pathology (1^st ed.) - Kumar, Abbas, Aster & Deyrup. [for sample questions]
• Basic & Clinical Pharmacology (14^th ed.) Katzung, BG, Trevor, AJ & Masters, SB. McGraw-Hill.  
• Lippincott’s Illustrated Reviews: Pharmacology (7^th ed.) Whalen, K. Lippincott Williams and Wilkins.  
• Katzung & Trevor's Pharmacology Examination and Board Review (12^th ed.) Trevor, AJ, Katzung, Knuidering-Hall, M. McGraw-Hill Medical. [for sample questions]
• Jawetz, Melnick, & Adelberg’s Medical Microbiology, 28th Edition by Karen C. Carroll, Stephen A. Morse, Timothy Mietzner and Steve Miller.
• Medical Microbiology (9^th ed.) – Patrick R. Murray, Ken S. Rosenthal and Michael A. Pfaller. Elsevier.
• Bickley, L. S., Szilagyi, P. G., & Hoffman, R. M. Bates' Guide to Physical Examination and History Taking (12^th ed.). Philadelphia: Wolters Kluwer. 2017. Lippincott.
• Bates Visual Guide [available only through the library site] https://batesvisualguide.com.periodicals.sgu.edu/multimedia.aspx?categoryID=21787  

Reference textbooks, Additional study and Sample questions (optional)

• Bickley, L. S. Bates' Pocket Guide to Physical Examination and History Taking (8^th ed.). Philadelphia: Wolters Kluwer, 2017. Lippincott.
• Henderson, Mark C. The patient history: an evidence-based approach to differential diagnosis (2^nd ed.). Stamford, CT: Appleton & Lange, 2013. McGraw Hill.
• Stern, Scott D. C. Symptom to Diagnosis: an evidence-based guide (4^th ed.). New York: McGrawHill Education/Medical, 2015.
• McGee, Steven R. Evidence-based physical diagnosis (4^th ed.). Philadelphia, PA: Elsevier, 2018.

Online resources

List of all online medical textbooks available through SGU library: https://mycampus.sgu.edu/group/library/databases-and-ebooks AccessMedicine https://accessmedicine.mhmedical.com.periodicals.sgu.edu/

This resource contains searchable medical textbooks and is highly recommended. It has a search function to look up concepts relevant to medical student education.

Free online access for SGU students (requires log-in with SGU credentials)

Additionally, many reliable websites offer free access. The use of online resources is particularly recommended to prepare for the Small Group Sessions or additional reading. 

Especially useful sites are:

• http://meded.lwwhealthlibrary.com.periodicals.sgu.edu/   
• http://www.dynamed.com/   
• https://www.clinicalkey.com
• https://library.med.utah.edu/WebPath/webpath.html   
• http://peir.path.uab.edu/library/   
• http://www.path.uiowa.edu/virtualslidebox/
• http://www.rxlist.com  
• http://www.merck.com/mmpe/index.html  
• http://www.cdc.gov  
• http://www.medscape.com  

Required Readings

The content of each Required Reading is integrated into course activities including lectures, Small Groups, and Directed Learning Activities. Each required reading should be previewed before the relevant lecture and/or Small Group and read closely afterwards to reinforce knowledge and understanding. Some readings are referred to repeatedly during different parts of the course. 

Required Electronic Equipment 

Laptop 

Students need a personal laptop that meets the specifications outlined by SGU Examination Services (access to a webcam and a stable internet connection is also required for online course delivery and assessments;     https://mycourses.sgu.edu/access/content/group/7a7ac639-acc5-4f33b106ae0778aabff6/TeachingLearningRemotely/LearningRemotely.html  See section on Examplify guidelines from Examination Services). 

It is the responsibility of each student to ensure his/her laptop is in full working condition, as specified by Examination Services, and keep it up to date. For those students in ITI on campus an ethernet cable and USB ethernet dongle will be required. In ITI venues no Wi-Fi streaming of content is allowed and all students must be equipped to have wired access to the internet. Ethernet cables and wireless dongles are available for purchase from the University bookstore. 

Turning Point 

Turning Point is the audience response system utilized in all basic sciences courses. Its use is assumed to reflect the participation and performance of the student to whom the device is registered. Misrepresentation of participation and/or performance through the misuse of the audience response system constitutes academic dishonesty and may result in loss of points, additional course penalties and/or referral to the Office of Judicial Affairs. Participation in online activities is monitored through Turning Point (Turning Technologies). Dedicated Clicker devices are normally used in a physical lecture.  

For online live lectures, there are two options for submitting a response to a clicker question: 

1. Turning Point App from Google Play or Apple Stores: This must be accessed with the students SGU turning point account. 
2. Browser based TTPoll.com can also be used for the audience response system. 

For any on campus live sessions, a student may use only a single clicker, which has been registered to their name. Clicker devices are not to be shared with any another student, temporarily re-registered under a different name, or used on behalf of any other student. Each student is responsible for the registration of their individual clicker and responsible for keeping it in full working condition at all times during the course. Any problems with the device should be reported to the course e-mail (SOMPCM1@sgu.edu) on the day the problem occurs, and adequate steps should be taken to resolve the issue immediately (e.g., battery replacement, or repair or replacement of device). 

Students are required to participate with the audience response system in scheduled teaching sessions, and it is the students’ responsibility to ensure that they are able to do so. Any technical failures fall within the normal 80% participation requirement.  

If there is any problem with the clicker, app or browser, ensure adequate steps are taken to resolve the issue (e.g., battery replacement, repair or replacement of device, download of new app, seek assistance from IT, etc.). A new device or batteries can be obtained at the bookstore. On campus, clicker functioning can be checked at the Charter Hall print room. 

Students MUST participate in all components of the course with their assigned cohort. No switching is permitted. Any student who fails to participate in a session with their assigned cohort will lose the participation for that particular course activity.  

Ensure that you review the Learning Pathway document on SAKAI for further details on the expectations for each course component  

Please be advised that all course activities will be subject to video recording for educational and other purposes and your participation in this course is deemed to constitute consent to the recording and use of your image and voice. 

COURSE ASSESSMENTS  

Course assessments may be summative (a high-stakes assessment that counts towards points in the gradebook), formative (a low stakes assessment that provides valuable feedback to students to optimize their learning strategies), or both.  

The total summative assessment points that can be earned in the course are listed in the table below: 

STUDENT SUPPORT  

Office Hours 

Office hours will be provided by the teaching faculty through a live online delivery platform as open office hours (log in) or by appointment. The available hours (open or appointments) for the different faculty members will be posted on Sakai. Appointments should be made through the module secretaries or individual faculty.   

Open Hours 

Clinical Tutors and Teaching Fellows will be made available to provide additional assistance to student’s outside of scheduled coursed activities. Details regarding these sessions will be posted on SAKAI.