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INTERNAL MEDICINE

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INTERNAL MEDICINE Powered By Docstoc
					                                  INTERNAL MEDICINE

Programme Director -Professor Nugzar Narsia MD, PhD



         This program is to initiate structured medical residency program in Internal Medicine (Medicine)
for foreign medical graduates in Georgia, which may be a basic model for other programmers in different
subspecialties. It provides a three-year integrated training program at Tbilisi State Medical University
Hospitals. The program is designed to develop academically oriented General Medical Specialist, who
would serve as an Internist.


Goals and Objectives

         The Internal Medicine Program is a three- year structured training program, offering clinical
training in general medicine and medical subspecialties, according to the up-to-date requirement of the
Ministry of Health and Social Ensuring of Georgia. It is designed to provide academic environment,
formal teaching, and broad experience to the trainee, necessary to become excellent general medical
specialist/Internist. The residency program provides adequate opportunities for residents to gain skills in
the all the common and emergency procedures. The resident functions within the context of a team
approach to the patient care under the supervision of the curators. The residents are given provision of an
appropriate balance of inpatient, outpatient, critical care and ambulatory training experiences. Residents
have sufficient exposure to each of the recognized medical subspecialties so as to become fully familiar
with the role and contribution of each to effective patient care.

Duration of Training

        The duration of the training is three year.


Eligibility

              1. Diploma of TSMU(Medical Faculty, English Division)
              2. Diploma of other Medical Schools of Georgia, recognized by WHO
              3. Diploma of Medical Schools of foreign countries, recognized by WHO

              The selection process is based purely on merit.

At the end of training, the resident is able to:

    1. Acquire the ability to care for wide range of clinical problems.
    2. Diagnose and treat different disorders in a cost-effective manner.
    3. Be experienced in history taking, physical examination, and judicious use of laboratory
       investigations and their interpretation.
    4. Document patient’s history, physical examination and progress, clearly and concisely in the
       medical record.
    5. Present the relevant history and physical findings in coherent and precise manner.
    6. Formulate complete problem list from the initial data, and prepare an effective diagnostic and
       therapeutic plan.
   Didactics:The resident will prepare, present and discuss cases in morning and teaching conferences
   such as medical grand rounds, internal medicine conferences, mortality and morbidity conferences.
   He/she will be taught at the bedside and also in the form of formal lectures and seminars.
       Research:

       The resident will develop skills such as literature search, including computer-assisted literature
   search. At the completion of the training, he /she will have adequate clinical and/or basic research
   experience under the supervision of the faculty member. The trainee also actively participates in
   research conferences, where he/she is exposed to techniques and methodology used in research and
   participates in collective critical thinking. With this background, the resident will be able to carry out
   clinical research independently after the completion of his/her training.


        Core curriculum

       During the three years of residency training the core curriculum is covered through formal
   lectures, clinical rotations, tutorials, grand rounds, morning report, journal club, mortality and
   morbidity meetings, practice guidelines, bedside examinations and group discussions.



        Clinical Rotations

         First Year

   1.   Cardiology          -2months
   2.   Invasive Cardiology -2months
   3.   Rheumatology        -2months
   4.   Gastroenterology -3months
   5.   Hepatology         -2months
        Total                -11 months /1 month summer vocation/

        Resident will be trained in above mentioned subspecialties, according the special program
        prepared by coordinators.

General recommendations for teaching and training programme in
Cardiology and Invasive Cardiology
Clinical
Clinical work of Junior Resident guided and supervised by the Senior Resident and the Coordinator.

Ward: Duties include diagnostic case work up and day-to-day management of cases of
                  Cardiovascular diseases.
        Intensive Care Unit: Duration 2weeks. A resident should diagnose and manage acute
                                   myocardial infarction and its complications, arrhythmias etc.
               Out-patients: Work up and management of common ambulatory cases.
 Investigations
              The Junior Resident acquiring theoretical and practical knowledge about following
        investigations:
                   Electrocardiogram
                   Treadmill Test
                   Holter monitoring
                   Nuclear cardiology
                   Cardiac catheterization and Electro-physiological studies
                   Angiography
              Procedures
         The Junior Residents are trained to carry out the following common procedures:
                   Cardioversion
                   Defibrillation
                   Temporary pacemaker insertion
                   Pericardiocentesis
                   Central venous pressure monitoring
                   Pulmonary artery pressure monitoring by Swan-Ganz catheter
                   Cardiopulmonary resuscitation


                 Teaching
                    Bedside case presentation
                    Interpretation of investigations
                    Principles of haemodynamic changes
                    Procedures

 General recommendations for teaching and training programme in
     Rheumatology
             Clinical
           Clinical work of Junior Resident guided and supervised by the Senior Resident and the
        Coordinator.
            Ward: Duties include diagnostic case work up and day-to-day management of cases of
                     Rheumatology diseases.
             Out-patients: Work up and management of common ambulatory cases.

              Investigations
               The Junior Resident acquiring theoretical and practical knowledge about following
        investigations:
             Laboratory
             X-ray
             Arthroscopy
             Ultrasound

                Teaching
                Bedside case presentation
                Interpretation of investigations


   General recommendations for teaching and training program in
        Gastroenterology and Hepatology
             Clinical
          Clinical work of Junior Resident guided and supervised by the Senior Resident and the
Coordinator.
   Ward: Duties include diagnostic case work up and day-to-day management of cases of
         Gastrointestinal, Liver and Gallbladder diseases.
   Out-patients: Work up and management of common ambulatory cases.

           Investigations
         The Junior Resident acquiring theoretical and practical knowledge about following
   investigations:
                       Plain X-ray of the abdomen
                       Oral cholecystography
                       Barium swallow
                       Barium meal
                       Barium enema
                       Abdominal ultrasound
                       Nuclear scan
                       CT scan of the abdomen
                       Interpretation of liver biopsy


                Procedures
             The Junior Residents are trained to carry out the following common procedures:

                        Per rectal examination and sigmoidoscopy
                        Nasogastric intubation
                        Gastrointestinal Endoscopy
                        Sigmoidoscopy and Colonoscopy
                        Ultrasound examination of the abdomen
                        Laparoscopy
                        Endoscopic retrograde cholangiopancreatography (ERCP)

                    Teaching
                       Bedside case presentation
                       Interpretation of investigations
                       Procedures

   Second Year

   6. Endocrinology         -2months
   7. Hematology           - 1months
   8. Nephrology           -2months
   9. Pulmonology           -2months
   10. Infectious Diseases - 1 month
   11. Pharmacotherapy       - 1 month
   12. Radiology             -1 month
   13. Neurology             -1 month
       Total                  -11 months/1 month summer vocation/

         Resident will be trained in above mentioned subspecialties, according the special program
        prepared by coordinators.

       General recommendations for teaching and training program in
         Endocrinology
             Clinical
          Clinical work of Junior Resident guided and supervised by the Senior Resident and the
Coordinator.
      Ward: Duties include diagnostic case work up and day-to-day management of cases of
       .      common endocrine disorders.
       Out-patients: Work up and management of common ambulatory cases

        Investigations

                   Laboratory
                 X-ray
                 Ultrasound
                 CT scan



                    Procedures
                  Daily glucose monitoring with glucometer
                  Stimulation tests
                  Suppression tests
                  Other – Prolonged fasting test, water deprivation test etc.

                  Teaching
                     Bedside case presentation
                     Interpretation of investigations
                     Procedures


       General recommendations for teaching and training program in
               Hematology

             Clinical
          Clinical work of Junior Resident guided and supervised by the Senior Resident and the
Coordinator.
      Ward: Duties include diagnostic case work up and day-to-day management of cases of
       .      Common Hematology disorders.
       Out-patients: Work up and management of common ambulatory cases

              Investigations and Procedures
               Laboratory
               Bone marrow aspiration
               Lymph node biopsy


                  Teaching
                     Bedside case presentation
                     Interpretation of investigations
                     Procedures

General recommendations for teaching and training program in
          Nephrology

             Clinical
          Clinical work of Junior Resident guided and supervised by the Senior Resident and the
Coordinator.
      Ward: Duties include diagnostic case work up and day-to-day management of cases of
       .       Urinary tract disorders.
       Out-patients: Work up and management of common ambulatory cases

              Investigations
               Urine examination
               Serum and urine osmolality
               Glomerular and renal function tests
             Urinary tract ultrasound
             Intravenous urography
             Immunological tests



         Procedures
             Renal biopsy
             Peritoneal and Haemodialysis


                Teaching
                   Bedside case presentation
                   Interpretation of investigations
                   Theoretical and practical aspects of peritoneal and hemodialysis
                   Fluid and electrolyte management
                   Dialysis – Transplantation

General recommendations for teaching and training program in
         Pulmonology
          Clinical
          Clinical work of Junior Resident guided and supervised by the Senior Resident and the
Coordinator.
      Ward: Duties include diagnostic case work up and day-to-day management of cases of
       .       Respiratory tract disorders.
       Out-patients: Work up and management of common ambulatory cases

           Investigations
      Examination of the sputum
      X-ray
      CT scan
      MRI
      Bronchoscopy
      Bronchography
      Pulmonary Function Tests
      Arterial and Venous Gases
      Analysis and Interpretation of Pleural Fluid
      Interpretation of the results of Pulmonary and Pleural Biopsy

         Procedures
             Thoracentesis
             Bronchoscopy
             Ventilation –Perfusion Matching
             Thoracostomy Tube Insertion

                       Teaching
                      Bedside case presentation
                      Interpretation of investigations
                      Cardiopulmonary resuscitation


             General recommendations for teaching and training program in
             Infectious Diseases
          Clinical
          Clinical work of Junior Resident guided and supervised by the Senior Resident and the
Coordinator.
      Ward: Duties include diagnostic case work up and day-to-day management of cases of
       .       Infectious diseases
       Out-patients: Work up and management of common ambulatory cases

            Investigations
       Laboratory Investigations
       Direct Detection
        Microscopy, Staining, Macroscopic Antigen Detection
       Detection of pathogenic agents by culture
       Identification methods
       Susceptibility testing
       Automation of microbial detection in blood
       Detection of Pathogenic Agents by Serologoc Methods


          Procedures
              Immunization and Vaccination

                        Teaching
                       Bedside case presentation
                       Interpretation of investigations
                       Immunization and Vaccination


General recommendations for teaching and training program in
          Pharmacotherapy

Junior Resident guided and supervised by the Senior Resident and the Coordinator.
Goal of the course is to teach the residents of different aspects of clinical pharmacology:
    1. Scientific bases of drug therapy
             Practical Pharmacokinetics
             Fundamental issues of Pharmacodynamics of the drugs
             Adverse Drug reactions
             Drug induced disease
             Drug interactions
    2. Clinical use of different drugs
         All appropriate class of drugs


General recommendations for teaching and training program in
          Radiology

        Junior Resident guided and supervised by the Senior Resident and the Coordinator
        Goal of the course is to train the residents on different aspects of diagnostic and inteventional
radiology in the diseases of various organ system of human body.

        Course content
    1. Basic sciences related to radiology
           Radiation physics and Radio-Biology
            Radiological anatomy and pathology of various organ system
            Imaging Techniques
            Radiography
   2.   Respiratory System
         CT scan
         MRI
   3.   Gastrointestinal and Hepato-Biliary-Pancreatic System
         Ultrasound
         CT scan
         MRI
         Angiography
   4.   Genito-Urinary System
         Ultrasound
         Radiography
   5.   Masculoskeletal System
         Ultrasound
         CT scan
         MRI
   6.   Cardio-Vascular System
         Echocardiography
         Color-Doppler
         Angiography
         Radionuclide Imaging
         CT scan
         MRI
   7.   Nervous system
         CT scan
         MRI

General recommendations for teaching and training programme in
         Neurology


             Clinical
          Clinical work of Junior Resident guided and supervised by the Senior Resident and the
Coordinator.
      Ward: Duties include diagnostic case work up and day-to-day management of cases of
       .       Nervous system disorders.
       Out-patients: Work up and management of common ambulatory cases

        Investigations and Procedures
          Interpretation of plain x-ray-skull, CT scan and MRI
          Interpretation EEG
          Lumbar Puncture and Interpretation of CSF examination
          Nerve conduction studies
          Evoked potential studies
          Muscle biopsy
          Nerve biopsy

                       Teaching
                      Bedside case presentation
                      Interpretation of investigations
                      Managements of neurological emergencies
     Third Year

     Resident will work as a senior resident at Internal Medicine department and supervise and teach first
and second year residents, medical students on clinic and hospitalized patients and consultations. He/she
will mediate in cases where confusion or conflict exists in patient care (along with faculty members when
necessary).He/she will help doctors with other departments (Radiology, Surgery, Pathology, Blood Bank
etc.).


       Teaching and Learning Strategies

    Core Lectures                    Weekly
    Grand Rounds                     Weekly
    Morning Reports                  Twice a week
    Journal Club                     Twice a month
    Residents Bedside Teaching       Twice a week
    Clinicopathological Conference    Monthly
    Mortality And Morbidity           Monthly
    Residents Hour                    Weekly
    PGME Lectures                     Twice a month
    Clinical Practice Guidelines      Monthly
    Teaching Ward Rounds              Daily

        Evaluation and Feedback

        The trainees will be almost daily contact with one or more faculty members. The faculty member
will have opportunity to discuss with the residents their progress in the Programme on a day-to-day basis.
The faculty members will give regular feedback to the residents and to the Programme Director or
Coordinator.
        The Program Director or coordinator will discuss the performance with each trainee every three
months. When necessary, the Program Director/Coordinator will discuss the performance of the trainee
with him/her more frequently than the above schedule.
            Monthly Continuous In Training Evaluation.
            Annual In-training exam
            MCQs at the conclusion of each subspecialties
            OSCE-were it is possible
            Annual residents’ appreciation

      External Rotation

        This activity will be encouraged if there are no specialized departments (Hematology, Infectious
diseases etc.) in the main hospital.