Training program for clinical master of Internal Medicine 2 Training program for clinical master of Surgery 26



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        1. Basic skills requirements:

Skill

Case no. (≥)

Abdominal paracentesis

5

Sengstaken-Blakemore tube compression

3

Digestive system roentgenography (interpretation)

20

Endoscopy (interpretation)

20




      1. Further requirements

        1. Diseases to be learned

Disease

Abdominal tuberculosis (intestinal TB & tuberculous peritonitis)

Chronic diarrhea

Others




        1. Clinical knowledge and skills requirements:

Skill

Skill

Gastroscopy

Liver puncture biopsy

ERCP

Gastric juice analysis & duodenal drainage

Colonoscopy

Concentrated ascites reinfusion therapy




    1. Hematology

2 months (1 week in hematological clinic)

      1. Aim of rotation

Master:

        1. Etiology, clinical manifestation, basis of diagnosis, differential diagnosis, and essence of treatment of various kinds of anemia;

        2. Normal mechanism of hemostasis and coagulation; classification, characteristics and principle management of hemorrhagic diseases;

        3. The clinical manifestation, laboratory examinations, basis of diagnosis, common therapeutic medications and treatment strategies of acute and chronic leukemia;

        4. classification, staging, basis of diagnosis and treatment of lymphoma;

        5. Indications and contraindications of bone marrow aspiration and biopsy.

Understand:

        1. Classification and treatment principle for myelodysplastic syndrome (MDS);

        2. Laboratory examination and rescue of disseminated intravascular coagulation;

        3. Indication of component blood transfusion and management of various transfusion reactions;

        4. Clinical presentations, diagnosis and differential diagnosis of myeloproliferative neoplasms and common coagulopathy disorders;

        5. Application of immnophenotypic, cytogenetic and molecular biology in blood disorders;

        6. Principles of examination methods and clinical significance for various hemolytic, bleeding and coagulation laboratory studies;

        7. Other blood disorders.

      1. Basic requirements

        1. Disease to be learned and case number requirements: At least 10 in-patients and 20 out-patients.

Disease

Case no. ()

Disease

Case no. ()

Iron deficiency anemia

8

Megaloblastic anemia

1

Aplastic anemia

1

Hemolytic anemia

1

Idiopathic autoimmune thrombocytopenia

2

Allergic purpura

2

Acute leukemia

2

Chronic leukemia

3

Lymphoma

4

Leukopenia and agranulocytosis

6




        1. Basic skill requirements:

Skill

Case no.(≥)

Bone marrow aspiration

10

Bone marrow biopsy

10




      1. Further requirements:

        1. Diseases to be learned

Disease

Congenital coagulation factor deficiency

Myelodysplastic syndrome (MDS)

Myeloproliferative neoplasms (polycythemia vera, primary myelofibrosis, primary thrombocytosis)

Multiple myeloma

Disseminated intravascular coagulopathy (DIC)

Component blood transfusion and transfusion reaction




        1. Clinical knowledge and skills requirements: blood and bone marrow smear techniques and general skill for interpretation.




    1. Nephrology

2 months (including 1 week in nephrology clinic, 1 week in hemodialysis)

      1. Aim of rotation

Master: Physiology of nephron and kidney; etiology, pathogenesis, clinical classification, clinical presentation, diagnosis, differential diagnosis and treatment of glomerular disease; application of corticosteroids, immunosuppressant and anticoagulants; diagnosis, differential diagnosis and management of acute and chronic pyelonephritis; etiology, pathogenesis, diagnosis and treatment of acute and chronic renal failure; the purpose and demand of nutritional treatment in non-dialysis therapy; indications for hemodialysis and peritoneal dialysis; application of renal function tests and results interpretation.

Understand: Pathologic classification of glomerular disease; indications for renal biopsy; etiology, pathogenesis and treatment principle of renal tubular disease and interstitial nephritis; anti-rejection therapy for kidney transplant; Other clinical diagnoses and treatment techniques.



      1. Basic requirements

        1. Diseases to be learned and case number requirements: At least 20 cases.

Disease

Case no.(≥)

Nephrotic syndrome

1

IgA nephropathy

1

Secondary glomerulonephritis (lupus nephritis, anaphylactoid purpura nephritis)

1

Urinary tract infection

6

Acute renal failure

1

Chronic renal failure

10

Primary glomerulonephritis (acute nephritis, rapidly progressive glomerulonephritis, chronic nephritis, latent nephritis)

2

Renal tubular interstitial disease (acute interstitial nephritis, chronic interstitial tubular disease)

1

Diabetic nephropathy

10




        1. Basic skills requirements: Urine sediment microscopic examination: 10 cases.

      1. Further requirements

        1. Diseases to be learned: Rapidly progressive glomerulonephritis

        2. Skill requirement: Renal puncture.




    1. Endocrinology and metabolism

2 months (including 1 week in endocrinology clinic)

      1. Aim of rotation

Master: Etiology, clinical manifestation, laboratory examination and treatment of hyperthyroidism; classification, etiology, diagnostic criteria, clinical presentation, and treatment of diabetic mellitus, principle of diet control, food calorie calculation and application essentials; chronic complications of diabetes; diagnosis and rescue of diabetic ketoacidosis and hyperosmolar coma; methods and significance of oral glucose tolerance test.

Understand: Diagnosis and principles of treatment for other endocrine diseases; principles, procedures and clinical significance of hormone immunoassays; endocrine function tests (including the principles, steps and significance of excitement and inhabitation tests).



      1. Basic requirements

        1. Diseases to be learned and case number requirements: At least 30 cases.

Disease

Case no.(≥)

Diabetes mellitus

20

Hyperthyroidism (Graves’ disease, etc.)

1

Diabetic ketoacidosis and diabetic hyperosmolar coma

2

Nodular goiter

10

Various types of thyroiditis

2




        1. Basic skills requirements:

Skill

Case no.(≥)

Oral glucose tolerance test

6

Blood and urine specimen collection for various hormones’ concentration determination

3

Measurement of waist and hip circumferences

10

Prescription of nutrition diet for patients of diabetes

5




      1. Further requirements

        1. Diseases to be learned:

Disease

Disease

Cushing’s syndrome

Pheochromocytoma

Diabetes Insipidus

Hyperlipidemia and hyperproteinemia

Prolactinoma

Primary adrenal insufficiency (Addison’s disease)

Gout

Other types of hyperthyroidism

Primary aldosteronism







        1. Clinical knowledge and skills requirements: Dexamethasone suppression test; water deprivation test.




    1. Rheumatology

1 month (1 week in clinic)

      1. Aim of rotation

Master: The clinical presentation, basis of diagnosis, differential diagnosis and treatment principles for common rheumatic diseases; the clinical significance of rheumatic related laboratory examinations; action mechanism, usage and adverse reaction of common anti-rheumatic medications.

Understand: The principle of autoantibodies and related subjects’ detection in common rheumatic diseases; normal joint structure and imaging manifestations of common joint diseases; understanding of rheumatic diseases in interaction with other disciplines, and establishment of anoverall concept for diagnosis and treatment of diseases.



      1. Basic requirements

        1. Diseases to be learned and case number requirements: At least 20 cases.

Disease

Case no.(≥)

Systemic lupus erythematosus

3

Rheumatoid arthritis

3

Osteoarthritis

5

Ankylosing spondylitis

5

Sjogren's syndrome

2

Gout

2




        1. Basic skills requirements: To master the detection theory of various rheumatic related antibodies, results interpretation and clinical significance; basic examinations of joints.

      1. Further requirements

        1. Diseases to be learned:

Disease

Adult-onset Still’s disease

Inflammatory myopathy

Systemic sclerosis

Reactive arthritis

Psoriatic arthritis

Behcet’s disease

Systemic vasculitis




        1. Clinical knowledge and skills requirements: Pathologic characteristics of various arthritis,joint aspiration, synovial fluid analysis and its clinical significance, accurate identification of the image characteristics of rheumatoid arthritis, osteoarthritis, ankylosing spondylitis, and other rheumatic diseases.




    1. Infectious disease

One month (including 2 weeks in hepatitis ward, 2 weeks in other wards of infectious diseases)

      1. Aim of rotation

Master: Pathogenesis, clinical presentation, basis of diagnosis, differential diagnosis and treatment of viral hepatitis; knowing the identical transmission route of intestinal infectious diseases such as typhoid fever, dysentery, amoebiasis, bacterial food poison, etc., and their diagnostic basis, differential diagnosis and specific management; pathogenesis and anti-shock therapy for septicemia and septic shock; antibiotic selection, evolution and clinical application of antibacterial drugs; treatment of parasitic diseases; diagnosis and differential diagnosis of prolonged fever of unknown origin, its diagnostic thinking process and strategy of treatment; indications for lumbar puncture; etiology, clinical presentations, diagnostic basis, differential diagnosis and management of acquired immunodeficiency syndrome (AIDS); procedures for disinfection and isolation.

Understand: The general situation of anaerobic bacteria infection and the selection of therapeutic drugs; clinical epidemiology and prevention of nosocomial infection; action mechanism and selection of antiviral drugs; indications and contraindications of liver puncture.



      1. Basic requirements

        1. Diseases to be learned and case number requirements: At least 20 cases.

Disease

Case no.

Disease

Case no.

Viral hepatitis

5

Epidemic hemorrhagic fever

1

Measles

2

Typhoid fever

1

Bacillary dysentery

3

Septicemia, septic shock

3

Viral encephalitis

2

Tuberculosis

2

Bacterial food poisoning

3

AIDS




Optional according to region differences:

Encephalitis B

Leptospirosis

Cholera

Epidemic mumps

Amoebiasis

Epidemic cerebrospinal meningitis

Liver abscess

Schistosomiasis

Malaria







        1. Basic skills requirements: Procedures for disinfection and isolation.

      1. Further requirements

        1. Diseases to be learned and case number requirements:

Disease

Disease

Infectious mononucleosis

Nosocomial infection

Toxoplasmosis

Rabies

Brucellosis







        1. Clinical knowledge and skills requirements: Liver puncture, artificial liver.





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