INTERNAL MEDICINE a Guide to the Four Year Specialty Training Program

DEPARTMENT OF MEDICAL EDUCATION

ACADEMIC AFFAIRS CENTRE

INTERNAL MEDICINE A Guide to the Four Year Specialty Training Program

DUBAI RESIDENCY TRAINING PROGRAM 

Last Updated :: November 2016

Contents

Introduction ...... 1

Program Administrators ...... 2

Competencies Of Residents ...... 3

Program Structure & Rotations ...... 6

Rotation Objectives ...... 7

Log Book ...... 17

Clinical Research ...... 18

References ...... 20

DRTP :: Internal Medicine Program Manual 2016 Page 0 | 20

Introduction

This document outlines the Internal Medicine Training Program under the Dubai Residency Training Program at Dubai Health Authority (DHA), Dubai — United Arab Emirates. Details includes descriptions of Residents’ knowledge & skills content, rotations & Curriculum in the specialty Internal Medicine.

The mission of the program is to train specialists in General Internal Medicine (Internists) who are capable of independent practice. An internist is a specialist trained in the diagnosis and treatment of a broad range of diseases involving all organ systems, and is especially skilled in the management of patients who have undifferentiated or multi-system disease processes. An internist cares for hospitalized and ambulatory patients and may play a major role in teaching or research.

The Program . The program provides organized education with guidance and supervision sufficient to facilitate the resident’s professional and personal development while ensuring safe and appropriate patient care. . Educational quality & patient care quality are conducted to enhance rather than interfere with each other . The balance of assignments and support are maintained so that the program does not rely on residents to meet patient care needs at the expense of effective and accountable education. . Focus is on the development of clinical skills, appropriate behavior and attitude, scholarship and professional competencies. . Hospital, ambulatory and community settings are utilized proportionately to reflect the importance of caring directly for adequate numbers and kinds of patients. . Residents are assigned progressively greater responsibility for patient care throughout the period of the residency, consistent with individual capabilities, maturity growth in clinical experiences, knowledge, skills & overall competence. . There are regular evaluations, feedback, and review of performances of resident, program and institution.

Objectives of the Program Upon completion of training, a resident in internal medicine is expected to be a competent specialist in internal medicine, capable of independent practice in the specialty.

Summarizing the goals and objectives, the residents must: . Acquire working knowledge of the theoretical basis of the specialty, including its foundations in the basic medical sciences and research. . Acquire the knowledge, attitudes, and skills common to all internal medicine practice. . Demonstrate knowledge of the pathophysiology, presentation of historical and clinical features, and appropriate investigation and medical management of acute and chronic disease processes. . Be able to identify, diagnose & treat single system or multi-system disease with appropriate prioritization of patient problems. . Demonstrate knowledge, skills & attitude relating to gender, culture & ethnicity pertinent to Internal Medicine. . Be able to incorporate gender, cultural & ethnic perspectives in research methodology, data presentation & analysis and contribute to research . Develop learning skills in the areas of problem-solving, evidence based medicine, and critical appraisal at a level to ensure that they remain effective clinicians, teachers and investigators throughout their career

DRTP :: Internal Medicine Program Manual 2016 Page 1 | 20

Program Administrators

Our Program Administrators in partnership with an expert team of supervisors & faculty steer the Internal Medicine Program towards the zenith of quality Residency training education offered in Dubai.

Under their expert care, your training journey is guaranteed to be an enlightening experience.

Dr. Jamila Mohammed Bin Adi PROGRAM DIRECTOR Head & Consultant, Rashid Hospital

Dr. Hussain Ali Hattawi Dr. Samra Omeir Shams Khan PROGRAM CO-DIRECTOR PROGRAM CO-DIRECTOR Head & Consultant, DH Specialist Senior Registrar, RH

DRTP :: Internal Medicine Program Manual 2016 Page 2 | 20 Competencies of Residents

MEDICAL EXPERT/CLINICAL DECISION-MAKER

Specialists possess a defined body of knowledge and procedural skills, which are used to collect and interpret data, make appropriate clinical decisions, and carry out diagnostic and therapeutic procedures within the boundaries of their discipline and expertise. Their care is characterized by up-to-date, ethical, and cost-effective clinical practice and effective communication in partnership with patients, other health care providers, and the community. The role of medical expert/clinical decision-maker is central to the function of specialist physicians & draws competencies included in the roles of scholar, communicator, health advocate, manager, collaborator & professional.

General Requirements  Demonstrate diagnostic and therapeutic skills for ethical & effective care using best available medical practices  Access and apply relevant information to clinical practice.  Demonstrate effective consultation services with respect to patient care and education.  Demonstrate an understanding of medico-legal issues as they apply to Internal Medicine. Specific Requirements  Elicit, present & document history that is relevant, concise, accurate & appropriate to the patient's problem(s).  Perform, interpret the findings of, present & document a physical examination that is relevant and appropriate.  Select medically appropriate investigative tools, interpret the results of common diagnostic tests and demonstrate an understanding of their cost effectiveness, limitations and complications.  Formulate a comprehensive patient problem list, synthesize an effective diagnostic and therapeutic plan and establish appropriate follow up.  Demonstrate effective consultation skills in presenting well-documented assessments and recommendations in written and/or verbal form.  Ability to assess, diagnose & manage patients with common/ uncommon diseases in the appropriate setting (emergency, in-patient & ambulatory) and demonstrate an understanding epidemiology of such conditions.  Demonstrate expertise in the management of: - Multi-system and/or undifferentiated disease; - Perioperative care; - Medical complications of pregnancy; - Issues related to health maintenance & disease prevention  Apply knowledge and technical expertise in performing the following procedures, interpreting the results and demonstrating an understanding of their limitations and complications: - Central venous catheter insertion; - Endotracheal intubation; - Lumbar puncture; - Thoracentesis; - Peripheral arterial catheter insertion; - Knee joint aspiration; and - Abdominal paracentesis; - Electrocardiographic interpretation.  Retrieve, critically appraise and apply relevant information to clinical practice.  Demonstrate an understanding of basic pharmacology and its application to clinical practice.

COMMUNICATOR

To provide humane, high-quality care, specialists establish effective relationships with patients, other physicians, and other health professionals. Communication skills are essential for the functioning of a specialist, and are necessary for obtaining information from, and conveying information to patients and their families. Furthermore, these abilities are critical in eliciting patients' beliefs, concerns, and expectations about their illnesses, and for assessing key factors impacting on patients' health.

General Requirements  Establish therapeutic relationships with patients/families.  Obtain and synthesize relevant history from patients/families/communities.  Listen effectively.  Discuss appropriate information with patients/families and the health care team. Specific Requirements  Recognize that being a good communicator is an essential function of a physician, and understand that effective patient- physician communication can foster patient satisfaction and compliance as well as influence the manifestations and outcome of a patient's illness.  Establish relationships with the patient characterized by understanding, trust, respect, empathy & confidentiality.  Demonstrate the ability to communicate professionally and compassionately, while considering the influence of factors such as the patient's age, gender, sexuality, and ethnic cultural and socio-economic background.

DRTP :: Internal Medicine Program Manual 2016 Page 3 | 20  Demonstrate skills in: - providing clear, concise and timely verbal and written communication as applied to consultation notes, sign over of patient care and discharge planning; - communication with patients and families regarding informed consent, the medical condition, plan of treatment, prognosis, primary and secondary prevention, adverse events, medical uncertainty, medical errors, end of life wishes, autopsy and organ donation; and - Communication with other health care professionals regarding all aspects of patient care.

COLLABORATOR

Specialists work in partnership with others who are appropriately involved in the care of individuals or specific groups of patients. It is therefore essential for specialists to be able to collaborate effectively with patients and a multidisciplinary team of expert health professionals for provision of optimal patient care, education, and research.

General Requirements  Consult effectively with other physicians and health care professionals.  Contribute effectively to other interdisciplinary team activities.

Specific Requirements  Identify & describe the role, expertise & limitations of members of an interdisciplinary team required to optimally achieve goals related to patient care, research problem, educational task or administrative responsibility.  Develop a care plan for a patient they have assessed, including investigation, treatment and continuity of care, in collaboration with members of the interdisciplinary team, the patient and the family.  Participate in an inter-physician or an interdisciplinary team meeting, demonstrating the ability to accept, consider and respect the opinions of other team members, while contributing specialty-specific expertise.

MANAGER

Specialists function as managers when they make everyday practice decisions involving resources, co-workers, tasks, policies, and their personal lives. They do this in the settings of individual patient care, practice organizations, and in the broader context of the health care system. Thus, specialists require the abilities to prioritize and effectively execute tasks through teamwork with colleagues, and make systematic decisions when allocating finite health care resources. As managers, specialists take on positions of leadership within the context of professional organizations and the Dubai health care system.

General Requirements  Utilize resources effectively to balance patient care, learning needs, and outside activities.  Allocate finite health care resources wisely.  Work effectively and efficiently in a health care organization.  Utilize information technology to optimize patient care, life-long learning and other activities. 4 Specific Requirements  Utilize appropriate time management for effective patient care, administrative duties and scholarly activities.  Recognize the business and financial skills needed for a successful medical practice and/or academic career.  Implement patient care practices considering available health care resources.  Understand population-based approach to healthcare services & recognize its implication on medical practice  Demonstrate conflict resolution skills.

HEALTH ADVOCATE

Specialists recognize the importance of advocacy activities in responding to the challenges represented by those social, environmental, and biological factors that determine the health of patients and society. They recognize advocacy as an essential and fundamental component of health promotion that occurs at the level of the individual patient, the practice population, and the broader community. Health advocacy is appropriately expressed both by the individual & collective responses of specialist physicians in influencing public health & policy.

General Requirements  Identify the important determinants of health affecting patients.  Contribute effectively to improved health of patients and communities.  Recognize and respond to those issues where advocacy is appropriate.

DRTP :: Internal Medicine Program Manual 2016 Page 4 | 20 Specific Requirements  Educate patients and families about and promote the importance of long-term healthy behaviors and preventive health care (e.g. smoking cessation, screening tests, vaccinations, exercise, and nutrition).  Respect and empower patient autonomy.  Promote equitable health care.  Apply the principles of quality improvement and quality assurance.  Appreciate the existence of global health advocacy and initiatives for elimination of poverty and disease, (e.g. tuberculosis, malaria, Acquired Immune Deficiency Syndrome).

SCHOLAR

Specialists engage in a lifelong pursuit of mastery of their domain of professional expertise. They recognize the need to be continually learning and model this for others. Through their scholarly activities, they contribute to the appraisal, collection, understanding of healthcare knowledge, and facilitate the education of their students, patients & others.

General Requirements  Develop, implement and monitor a personal continuing education strategy.  Critically appraise sources of medical information.  Facilitate learning of patients, house staff/students and other health professionals.  Contribute to development of new knowledge. Specific Requirements  Understand the principles of scientific research and how these principles apply to the development and implementation of a research proposal.  Understand how to search and critically appraise the medical literature.  Demonstrate the ability to teach medical students, residents, colleagues & other healthcare professionals  Develop lifelong learning skills.

PROFESSIONAL

Specialists, as professionals, have a unique societal role with a distinct body of knowledge, skills, and attitudes dedicated to improving the health and wellbeing of others. Specialists are committed to the highest standards of excellence in clinical care and ethical conduct, and to continually perfecting mastery of their discipline.

General Requirements  Deliver highest quality care with integrity, honesty and compassion.  Exhibit appropriate personal and interpersonal professional behaviors.  Practice medicine ethically consistent with obligations of a physician.

5 Specific Requirements  Discipline-based objectives: - Display attitudes commonly accepted as essential to professionalism. - Evaluate one's abilities, knowledge and skills, recognize one's limitations and use appropriate strategies to maintain and advance professional competence.  Personal/Professional Boundary Objectives: - Strive to heighten personal and professional awareness and explore and resolve interpersonal difficulties in professional relationships. - Strive to balance personal and professional roles and responsibilities. - Demonstrate ways of attempting to resolve conflict and role strain.  Objectives related to Ethics and Professional Bodies: - Know and understand the professional, legal and ethical codes to which physicians are bound. - Recognize, analyze and attempt to resolve in clinical practice ethical issues such as truth telling, consent, advanced directives, confidentiality, end-of-life care, conflict of interest, resource allocation, research ethics, interactions with the pharmaceutical industry. - Understand and apply relevant legislation that relates to the health care system in order to guide one's clinical practice. - Recognize and know how to deal with unprofessional behaviors in clinical practice, taking into account local and provincial regulations.

DRTP :: Internal Medicine Program Manual 2016 Page 5 | 20 Program Structure & Rotations

Residents will enter the program having received a broad foundation in several aspects of general medicine and surgery during their internship year. Fundamental to the program is a graded increase in responsibility for the resident as they proceed through the training. This level of responsibility will be dependent on their ability, experience and level of training. Appropriate levels of supervision for the trainee will be maintained throughout the program to maximize educational opportunities as well as to optimize patient care and satisfaction.

The internal medicine program comprises of four years of full-time supervised residency training. Training in each rotation shall be comprehensive, including inpatients, ambulatory care, and the emergency department. As trainees gain experience and competence, they shall assume progressive responsibilities and be actively involved in teaching juniors in addition to providing patient care.

The Program is divided into two levels, namely junior and senior, made up of 2 year each. The roadmap for rotations will be complied as stated below however the sequence of rotations may be customized within each level as determined by the Program Director.

Rotation Duration (weeks) General Internal Medicine 24 Emergency Medicine 8 Critical Care 8 Cardiology including the coronary care unit 8 Pulmonary Medicine 8 Gastroenterology 8 Nephrology 8 Endocrinology 4 Infectious Diseases 4 Rheumatology 4 JUNIOR LEVELJUNIOR (R1-R2) Neurology 4 ELECTIVE [Geriatrics/ Dermatology/ Allergy and immunology/Radiology/Research] 4 Annual Leave 8 104 General Internal Medicine 16 Cardiology 8 Gastroenterology 8 Endocrinology and metabolism 8 Hematology 8 Neurology 8 Infectious Diseases 8 6 Rheumatology 8 Neurology 4 Critical Care Unit 4 Pulmonary Medicine 4

SENIOR LEVEL LEVEL (R3-R4) SENIOR Nephrology 4 Oncology 4 ELECTIVE [Palliative care/Ambulatory care/Geriatrics/Dermatology/Allergy & 4 Immunology/ Clinical genetics/ Psychiatry/ Radiology] Annual Leave 8 104

Elective

The resident will be given the opportunity for additional experience in consultation with the Program Director in an area of interest that may be outside of the prescribed selective experiences.

Academic Day

One half-day per week will be designated as protected academic time. This period will be utilized to bring all residents in the program together in order to undertake lectures, workshops and other learning experiences that are best delivered in this format. These sessions are meant to compliment and augment learning that is taking place in the clinical setting.

DRTP :: Internal Medicine Program Manual 2016 Page 6 | 20 Rotation Objectives

General Objective in relevance to all rotations: - Perform complete health assessment including a focused physical examination & patient’s mental state evaluation - Render immediate management to patients who are in need of such care - Perform the procedures in line with privileges, in a safe and competent manner including where appropriate: • Recognition of indications and contraindications control • Obtaining informed consent • Documentation • Ensuring patient comfort, privacy, and adequate pain • Post procedure follow up and handover - Document patient findings in medical records in a legible and timely manner - Communicate & liaise with patients & their families about patient’s condition, management plan & disposition - Respect the roles & responsibilities of other healthcare professionals including nurses, pharmacists & allied health - Promote prevention & health upkeep including dietary factors, lifestyle modification & smoking cessation in every consultation - Develop patient-centered care that values individual and family preferences and societal and religious norms

GENERAL INTERNAL MEDICINE ROTATION :: 24 weeks at the junior level (R1—2) :: 16-24 weeks at the senior level (R3—4) Specific rotation objectives: - Develop all seven CanMEDS core competencies while learning the basic skills required for the diagnosis and management of a broad range of general medical conditions affecting adolescents and adults - Demonstrate a thorough understanding of relevant basic sciences including pathophysiology, drug therapy, and microbial basis of diseases involving the key presenting problems and disease conditions shown in the table below - Order appropriate and selective investigations and interpret the findings in the context of the patient’s complaints - Formulate appropriate provisional & alternative diagnoses for key presenting problems and underlying conditions

Presenting Problem Underlying Key Condition Primary Focus in Learning Glucose metabolism Diabetes mellitus Hyperosmolar state Diagnosis & Screening Non-pharmacological disorders Diabetic ketoacidosis Metabolic syndrome & obesity Prevention of complications Management Dietary counseling Pharmacological management Lifestyle modification Prevention Hypertension Primary hypertension Hypertensive crisis Diagnosis Evidence-based management Secondary hypertension Classification Complications Hypertension in Pregnancy‐induced Pre-eclampsia Recognition Pregnancy hypertension HELLP syndrome Evidence-based management Chronic hypertension Lipid disorders Primary (familial) hyperlipidemia Etiology Evaluation Secondary (acquired) hyperlipidemia Screening Management Metabolic syndrome Clinical manifestation Breathlessness Heart Failure Bronchiectasis Etiology Pharmacological Management Asthma Pulmonary embolism Diagnosis Non-pharmacological COPD Pneumothorax Differential diagnosis management ILD Pleural effusion Assessment of severity Prevention 7 Coughs, colds & fever Community acquired pneumonia Aspiration pneumonia Diagnosis Treatment Hospital-acquired pneumonia Lung abscess Risk factors Prevention Complications Fever in ambulatory Urinary tract infection URTI Diagnosis settings Gastroenteritis Treatment Fever in specific Fever of unknown etiology Rift Valley fever Definition Complications geographical areas/ Malaria Dengue fever Risk factors Management Emerging infections Tuberculosis Swine flu Diagnosis Prevention Brucellosis Corona virus infection Identification Reporting to appropriate Visceral leishmaniasis authorities Chest pain Cardiac causes Gastrointestinal causes Etiology Differential diagnosis Ischemic heart disease GERD Classification Complications Pericardial disease Esophageal spasm Manifestation Management Aortic aneurism & dissection Others Diagnostic workup Prevention Pulmonary causes Musculoskeletal causes Pleurisy/ Pulmonary embolism Tietze’s syndrome Pneumothorax Others Heart valve disorders Tricuspid stenosis & regurgitation Acute rheumatic fever Risk factors Diagnosis Pulmonary stenosis & regurgitation Infective endocarditis Etiology Complications Mitral stenosis & Mitral regurgitation Valvular disorders Clinical features Evidence-based management Aortic stenosis & Aortic regurgitation Palpitations Supraventriculssar arrhythmias Ventricular arrhythmia Etiology & Mechanisms ECG recognition including atrial fibrillation, atrial Heart blocks Risk factors Acute/ chronic management flutter & atrial tachycardia Manifestation Prevention

Copyright © 2015 Saudi Commission for Health Specialties http://www.scfhs.org.sa/MESPS/TrainingProgs/TrainingProgsStatement/InternalMedicine Reproduced with permission DRTP :: Internal Medicine Program Manual 2016 Page 7 | 20 Presenting Problem Underlying Key Condition Primary Focus in Learning Skin, soft tissue & Cellulitis Definition Investigations bone infection Necrotizing fasciitis Clinical features Diagnosis Acute & chronic osteomyelitis Risk factors Management Infectious arthritis Causative organisms Evidence-based prophylaxis Jaundice Viral hepatitis Chronic liver disease and Investigation Treatment Nonviral hepatitis cirrhosis Prophylaxis Pallor (anemia) Iron deficiency anemia G6PD deficiency Presentation Hemolytic anemia Autoimmune hemolytic anemia Causes Sickle cell anemia Spherocytosis, elliptocytosis Investigation Thalassemia Megaloblastic anemia Complications & management Sexually transmitted Syphilis Gonorrhea Risk factors Reporting diseases HSV Chlamydia Diagnosis Prevention Acute kidney injury Acute pyelonephritis Contrast induced nephropathy Etiology Complications Acute glomerulonephritis Pigmented nephropathy Classifications Diagnosis Acute interstitial nephritis Thrombotic microangiopathy Pathophysiology Management Acute tubular necrosis Obstructive uropathy Manifestation Prevention Acid-base imbalance Anion & non-anion gap acidosis Alkalotic disorders Pathogenesis Associated conditions including renal tubular acidosis Recognition Water & electrolyte Hypo- and hypervolemia Hypo- and hyperkalemia Pathogenesis Immediate management disturbances Hypo- and hypernatremia Hypo- and hypercalcemia Recognition Diabetes in pregnancy Pre‐existent diabetes in pregnancy Screening Evidence-based management Gestational diabetes Complications Thrombotic disorders Deep vein thrombosis Recognition Evidence-based management during pregnancy Sagittal vein thrombosis Prophylaxis Medical disorders in Hypo- and hyperthyroidism Asthma Screening pregnancy (Misc.) SLE and similar disorders Epileptic disorders (medication Recognition Inflammatory bowel disease controlled) Evidence-based management Headaches Primary headache & related Secondary headaches Etiology syndromes Space occupying lesions Clinical manifestation Tension headache Pseudotumor - cerebri Diagnostic workup Migraine Thunderclap headache Differential diagnosis Cluster headache Trigeminal - neuralgia Management CNS infections Meningitis Focal CNS infections Etiology Management Viral meningitis Brain abscess Clinical manifestation Complication Bacterial meningitis Spinal epidural abscess Differential diagnosis Prevention Encephalitis Diagnostic workup Stroke Transient ischemic attack Etiology Diagnostic workup Ischemic stroke Risk factors Complications Hemorrhagic stroke Clinical manifestation Management Dural sinus venous thrombosis Lesion localization Prevention Mental & behavioral Depression Somatoform disorders Clinical manifestation Diagnosis disorders Anxiety & Bipolar disorders Eating disorders Differential diagnosis Management Toxicology & drug Common drug overdose Cyanide Recognition overdose Paracetamol overdose Carbon monoxide poisoning Initial stabilization 8 Antidepressants Organophosphate poisoning Management Benzodiazepines Heavy metal poisoning: Prevention Opiates Lead Alcohol Mercury Heroin Copper Cocaine Arsenic Perioperative Identify risk factors Assessment & Recognition management of common Patient monitoring Immediate management medical conditions

EMERGENCY MEDICINE ROTATION :: 8 weeks at the junior level (R1—R2) Specific rotation objectives: Residents on rotation in emergency departments should improve their general knowledge and skills in preventing, diagnosing, and treating emergency medical conditions, as outlined below: - Develop all seven CanMEDS core competencies while learning the basic skills required for the diagnosis and management of a broad range of medical emergency conditions affecting adolescents and adults. - Complement internal medicine residents’ training in areas that are unique to emergency medicine but relevant to the internal medicine physician’s subsequent practice. - Develop competencies in the management of minor wound care; injury evaluation; and the assessment of common eye, ear, nose, and throat conditions. Develop competencies in the management of minor musculoskeletal injuries and application of clinical decision rules in management - Gain experience and competencies in the outpatient management of common gynecological disorders

DRTP :: Internal Medicine Program Manual 2016 Page 8 | 20 Topic Underlying Key Condition Primary Focus in Learning Chest Infections Acute coronary syndromes Costochondritis Etiology Pretest probability for IHD (STEMI, NSTEMI, & unstable Esophageal dysmotility Clinical features Diagnosis angina) Pulmonary embolism Classification Acute management Chronic stable angina Pneumothorax Pathophysiology Complications Acute pericarditis Chest infections Risk factors Aortic dissection Acute dyspnea Acute decompensated heart failure Pulmonary embolism Etiology Bronchial asthma Pneumothorax Diagnosis COPD Toxic inhalation Acute management Palpitations Supraventricular arrhythmias Ventricular arrhythmia Etiology Sinus node re-entrant tachycardia Ventricular tachycardia Diagnosis Atrial tachycardia Ventricular flutter Acute management Atrial fibrillation Ventricular fibrillation Atrial flutter Bradycardias AVRT Sick sinus syndrome AVNRT AV blocks Syncope and Neurally mediated syncope Etiology dizziness Cardiogenic syncope Diagnosis Unexplained syncope Acute management Hypertensive crisis Urgent hypertensive crisis Recognition Emergency hypertensive crisis Acute management Shock Hypovolemic shock Distributive shock Definition Pathophysiology Cardiogenic shock Combined shock Diagnosis Acute management Gastrointestinal Upper GI bleeding Recognition Acute management bleeding Lower GI bleeding Etiology Acute abdominal pain Peptic ulcer disease Ischemic bowel syndrome Etiology Peritonitis Ruptured viscus Diagnosis Pancreatitis Acute management Glucose metabolism Hypoglycemia Hyperosmolar nonketotic state Definitions Precipitating factors disorders Diabetic ketoacidosis Recognition Acute management Water & electrolyte Sodium disorders Calcium disorders Definition disorders Potassium disorders Recognition Acid-base imbalance Metabolic & respiratory acidosis Etiology Acute Management Metabolic & respiratory alkalosis Recognition Toxic ingestion & Drug overdose Alcohol Recognition exposure Paracetamol overdose Heroin Acute management Antidepressants Cocaine Benzodiazepines Cyanide Opiates Carbon monoxide poisoning Altered mental state Stroke Epilepsy Etiology Acute Management CNS infection Metabolic causes Diagnosis Headaches Tension Cluster Etiology Management Migraine Intracranial hypertension Diagnosis Environmental injury Cold & heat related injuries Recognition Acute Management Burns Fire burns Chemical burns Recognition Acute Management 9 Minor injuries Wounds & lacerations Sport injuries Recognition Extremities injuries Acute management ENT disorders Otitis media Pharyngitis & tonsillitis Diagnosis Otitis externa Management Gynecological & Essential hypertension Pregnancy-induced hypertension Diagnosis obstetric conditions Pelvic inflammatory disease (pre-eclampsia, eclampsia) Management

CRITICAL CARE MEDICINE ROTATION 8 weeks at the junior level (R1—R2) - 4 weeks at the senior level (R3—R4)

In addition to the general rotation objectives - Develop all seven CanMEDS core competencies while learning the basic skills required for the diagnosis and management of a broad range of critical conditions affecting adolescents and adults. - Develop competencies in the basic skills required for the diagnosis and management of a broad range of critical medical conditions that affect adolescents and adults and are sufficiently severe to require hospitalization and treatment in the medical ICU. - Learn to assess patients’ needs in line with ward v/s ICU admission during their responsibilities as admitting residents. - Learn and begin to practice lifelong learning behaviors and develop the attitudes and skills necessary to be a leader and coordinator of an increasingly complex health delivery team via demonstrated practice-based learning and systems-based practice. - Promote prevention and health maintenance, including dietary factors, lifestyle modification, and smoking cessation, during every consultation - Judiciously use common monitoring systems and techniques available in the ICU

CARDIOLOGY/CORONARY CARE UNIT ROTATION 8 weeks at the junior level (R1—R2) :: 8 weeks at the senior level (R3—R4)

Specific rotation objectives: - Develop all seven CanMEDS core competencies while learning the basic skills required for the diagnosis and management of a broad range of cardiovascular conditions affecting adolescents and adults - Demonstrate a thorough understanding of relevant basic sciences including pathophysiology, drug therapy, and microbial basis of diseases involving the key presenting problems and disease conditions shown in the table below - Order appropriate and selective investigations and interpret the findings in the context of the patient’s complaints - Formulate appropriate provisional & alternative diagnoses for key presenting problems and underlying conditions

Topic Underlying Key Condition Primary Focus in Learning Cardiopulmonary BLS and ACLS Perform BLS & ACLS as per protocol resuscitation Angina Chronic stable angina Definition Prevention Acute coronary syndromes Clinical features Understand the pharmacology of (STEMI, NSTEMI, and UA) Assessment of pretest probability inotropes, vasopressors, and Risk factors - Diagnosis vasodilators and demonstrate Risk stratification (TIMI scoring) appropriate selection of the use of Complications these agents in patients presenting with Acute management acute cardiac disease Understand the indications of List the indications & contra-indications invasive management including for intra-aortic balloon counter pulsation percutaneous coronary & understand the mode of action & intervention & coronary artery potential complications 1 bypass grafting List the driving restrictions for 0 Chronic management patients following ACS Myocardial Heart failure Definition Precipitating factors disorders Pathophysiology Complications Etiology Evidence-based acute and chronic Classification management Clinical features Device management Diagnosis Prevention Heart valve Aortic stenosis Medical management Etiology Diagnosis disorders Aortic regurgitation of prosthetic valves Clinical features Complications Mitral stenosis Pathophysiology Prevention and prophylaxis Mitral & tricuspid Regurgitation Acute v/s chronic valve regurg. Management

Cardiac rhythm Supraventricular arrhythmia Ventricular arrhythmia Recognition Classification & complications of disorders Atrial extrasystole Ventricular extrasystole Etiology antiarrhythmic medication Sinus node re-entrant Ventricular tachycardia Clinical features Understand the principles, indications tachycardia Ventricular flutter Risks & contra indications of active Atrial tachycardia Ventricular fibrillation Investigations hypothermia in patients with Atrial fibrillation Long QT syndrome Acute & chronic management resuscitated cardiac arrest Atrial flutter Short QT syndrome including device implantation AVRT Brugada syndrome AVNRT Bradycardias Sick sinus syndrome AV blocks

PULMONARY MEDICINE ROTATION :: 4-8 weeks at the junior level (R1—R2) :: 4 weeks at the senior level (R3—R4)

Specific rotation objectives: - Develop all seven CanMEDS core competencies while learning the basic skills required for the diagnosis and management of a broad range of pulmonary conditions affecting adolescents and adults - Demonstrate a thorough understanding of relevant basic sciences including pathophysiology, drug therapy, and microbial basis of diseases involving the key presenting problems and disease conditions shown in the table below - Order appropriate and selective investigations and interpret the findings in the context of the patient’s complaints - Formulate appropriate provisional & alternative diagnoses for key presenting problems and underlying conditions

Presenting Problem Underlying Key Condition Primary Focus in Learning Obstructive lung Bronchial asthma Etiology Complications diseases COPD Manifestation Acute & chronic management Emphysema Assessment of severity Prevention Diagnosis Restrictive lung Interstitial lung fibrosis Lymphangioleiomyomatosis Etiology Complications disease Hypersensitivity pneumonias Bronchiolitis Classifications Management Occupational lung diseases Shrug Strauss syndrome Manifestation Prevention 1 Sarcoidosis Diagnosis 1 Occupational Asbestosis Farmer’s lungs Etiology Diagnostic workup pulmonary diseases Silicosis Bird fancier’s lung Manifestation Management Berylliosis Bagassosis Differential diagnosis Prevention Byssinosis Others Complication Suppurative lung Bronchiectasis Etiology Complications diseases Lung abscess Manifestation Management Diagnosis Prevention Pleural effusion Heart failure Mesothelioma Etiology Manifestation Parapneumonic effusion Metastasis Classification Complications Empyema Pathophysiology Management Lung masses Solitary pulmonary nodule Etiology Management Bronchogenic carcinomas Manifestation Prevention Metastasis Diagnostic approach Sleep apnea Obstructive sleep apnea Etiology Diagnosis syndrome syndrome Screening Management Central sleep apnea syndrome Manifestation Prevention Pulmonary Primary pulmonary hypertension Thromboembolic pulmonary Etiology Risk factors vascular disorders Secondary pulmonary hypertension hypertension Pathophysiology Diagnosis Classification Management Manifestation Prevention Pulmonary Good Pasteur syndrome Etiology Manifestation vasculitis Wegener’s granulomatosis Classifications Diagnosis Pathophysiology Management

GASTROENTEROLOGY ROTATION :: 4 weeks at the junior level (R1—R2) :: 4-8 weeks at the senior level (R3—R4)

Specific Rotation Objectives: - Develop all seven CanMEDS core competencies while learning the basic skills required for the diagnosis and management of a broad range of gastroenterology conditions affecting adolescents and adults - Demonstrate a thorough understanding of relevant basic sciences including pathophysiology, drug therapy, and microbial basis of diseases involving the key presenting problems and disease conditions shown in the table below - Order appropriate and selective investigations and interpret the findings in the context of the patient’s complaints - Formulate appropriate provisional & alternative diagnoses for key presenting problems and underlying conditions

Presenting Problem Underlying Key Condition Primary Focus in Learning Upper GI bleeding Peptic ulcer disease Etiology Acute & chronic management Esophageal varices Pathophysiology Prevention Lower GI bleeding Diagnosis Epigastric Gastric ulcer Etiology Diagnosis pain/dysphagia Duodenal ulcer Pathophysiology Complications Gastroesophageal reflux Manifestation Management & Prevention Jaundice Acute hepatitis Nonalcoholic fatty liver Etiology Complications Chronic hepatitis Fatty liver in pregnancy Pathophysiology Management Autoimmune hepatitis Biliary obstruction Manifestation Prevention Cholestatic liver diseases Hepatoma Diagnosis Inflammatory Crohn’s disease Risk factors Management including surgical bowel diseases Ulcerative colitis Manifestation intervention Complication/Diagnosis Prevention of complication Malabsorption Coeliac disease Chronic pancreatitis Etiology Complications Tropical sprue HIV Pathophysiology Management Short bowel syndrome GI tuberculosis Manifestation Prevention Diagnosis Whipple’s syndrome Lactose, Sucrose & Fructose

Bacterial overgrowth intolerance Parasitic infestations Colonic and Irritable bowel syndrome Risk factors Screening anorectal diseases Colonic polyposis Manifestation Management Colonic cancer Diagnosis Prevention 1 Pancreatic and Acute and chronic pancreatitis Primary biliary cirrhosis Etiology Diagnosis 2 biliary tree disorders Gall stones Sclerosing cholangitis Pathophysiology Complications Ascending cholangitis Cholangiocarcinoma Manifestation Management

Complications of Portal hypertension Hepatic Encephalopathy Etiology Diagnosis Cirrhosis Ascites Hepatorenal, hepatopulmonary and Manifestation Management SBP porto-pulmonary syndrome Important diagnostic Abdominal paracentesis Liver biopsy Indications Interpretation tests Upper GI endoscopy Ultrasound of abdomen Precautions & Post-procedure instruction Lower GI endoscopy CT scan of abdomen contra-indications ERCP Barium studies

NEPHROLOGY ROTATION :: 4 weeks at the junior level (R1—R2) :: 4-8 weeks at the senior level (R3—R4)

Specific rotation objectives: - Develop all seven CanMEDS core competencies while learning the basic skills required for the diagnosis and management of a broad range of nephrology conditions affecting adolescents and adults - Demonstrate a thorough understanding of relevant basic sciences including pathophysiology, drug therapy, and microbial basis of diseases involving the key presenting problems and disease conditions shown in the table below - Order appropriate and selective investigations and interpret the findings in the context of the patient’s complaints - Formulate appropriate provisional & alternative diagnoses for key presenting problems and underlying conditions

DRTP :: Internal Medicine Program Manual 2016 Page 12 | 20 Presenting Problem Underlying Key Condition Primary Focus in Learning Hypertension Essential hypertension Etiology Diagnosis Secondary hypertension Classification Complications Pregnancy-induced hypertension Manifestation Evidence-based management Acute kidney Acute pyelonephritis Contrast-induced nephropathy Etiology Complications diseases Acute glomerulonephritis Pigmented nephropathy Classifications Diagnosis Acute interstitial nephritis Thrombotic microangiopathy Pathophysiology Management Acute tubular necrosis Obstructive uropathy Manifestation Prevention Chronic kidney Diabetes nephropathy Chronic interstitial nephritis Etiology Complications diseases Chronic pyelonephritis Polycystic kidney disease Classifications Diagnosis Chronic glomerulonephritis Pathophysiology Management Manifestation Prevention Renal colic Renal stones Etiology Management Diagnosis Prevention Complications Dialysis Hemodialysis & Peritoneal dialysis Indications & Contraindications Renal Types Complications transplantation Indications for referral Post-transplantation management Indications Management of rejection Contraindications Prevention of rejection Diagnostic tests Urine analysis & microscopy Ultrasound of kidneys Precautions Indications Biochemical renal functions Radioisotope renogram Complications Contraindications Estimation of GFR CT scan Interpretation Serology Kidney biopsy

ENDOCRINOLOGY AND METABOLISM :: 4 weeks at the junior level (R1—R2) :: 4-8 weeks at the senior level (R3—R4)

Specific rotation objectives: - Develop all seven CanMEDS core competencies while learning the basic skills required for the diagnosis and management of a broad range of endocrinology and metabolic conditions affecting adolescents and adults - Demonstrate a thorough understanding of relevant basic sciences including pathophysiology, drug therapy & the microbial basis of diseases involving the key presenting problems and disease conditions shown in the table below - Order appropriate and selective investigations and interpret the findings in the context of the patient’s problems - Formulate appropriate provisional & alternative diagnoses for key presenting problems and underlying conditions

Topic Underlying Key Condition Primary Focus in Learning Glucose Diabetes mellitus Diagnosis Dietary counseling metabolism Diabetic ketoacidosis Screening Non-pharmacological Management disorders Hyperosmolar state Prevention of complications Pharmacological management Metabolic syndrome & obesity Lifestyle modification Prevention Thyroid gland Hyperthyroidism & thyroid storm Goiters Etiology Manifestation disorders Hypothyroidism & myxedema Thyroid cancers Pathophysiology Diagnosis & Management coma Classification Complications 1 Hyperlipidemia Familial Classification Complications 3 Secondary Manifestation Management Diagnosis Prevention Calcium Hypo- & hyperparathyroidism Osteoporosis Etiology Diagnosis & Management metabolism Vitamin D deficiency Classification Complications disorders Pituitary Anterior pituitary disorders Etiology Diagnosis disorders Posterior pituitary disorders Clinical syndromes Principles of the water deprivation Incidental adenomas Manifestation test Pathophysiology Complications Diagnosis Management Adrenal gland Adrenal insufficiency Etiology Screening disorders Cushing’s syndrome Manifestation Management Hyperaldosteronism Diagnosis Poly-glandular MEN Classifications Manifestation disorders Pathophysiology Management Hirsutism Polycystic ovary syndrome Acromegaly Etiology Diagnosis Congenital adrenal hyperplasia Von Hippel-Lindau syndrome Pathophysiology Management Cushing’s syndrome Drugs Manifestation Prevention Important Fasting blood sugar Hormonal assays Indications diagnostic Random blood sugar Ultrasound of thyroid, parathyroid Contraindications tests HgA1C & adrenal glands Utility Serum and urine for ketones CT of pituitary & adrenal glands Interpretations Serum osmolality Dynamic endocrine tests

DRTP :: Internal Medicine Program Manual 2016 Page 13 | 20 HEMATOLOGY ROTATION :: 8 weeks at the senior level (R3—4)

Topic Underlying Key Condition Primary Focus in Learning Bleeding Congenital bleeding disorders Disseminated intravascular coagulopathy Overview of normal Complications disorders Hemophilia A and B Vitamin K deficiency hemostasis Diagnosis Von Willebrand disease Thrombocytopenia Classification Acute & chronic management Acquired bleeding disorders Thrombocytosis Etiology Coagulopathy due to liver disease Thrombasthenia Manifestation Thrombosis Venous thrombosis (DVT and Congenital Risk factors Workup for thrombophilia pulmonary embolism) Acquired Manifestation Management Thrombophilia Lymphoma Hodgkin’s lymphoma Classification Diagnosis Non-Hodgkin’s lymphoma Manifestation Management Staging Leukemia Acute lymphocytic leukemia Chronic myeloid leukemia Etiology Prognosis Acute myeloplastic leukemia Hairy cell leukemia Classification Management Chronic lymphocytic leukemia T-cell prolymphocytic leukemia Manifestation Complications of therapy Diagnosis Myelomas Multiple myeloma Solitary plasmacytoma Manifestation Prognosis Waldenström macroglobulinemia Amyloidosis Diagnosis Management

Transfusion Types of transfusion Indications Contraindications Preparation Complications Bone marrow Types Indications Post-transplantation transplantation Contraindications management Complications Management of complications Diagnostic Complete blood count Hemoglobin electrophoresis Basic principles tests Peripheral smears Bone marrow aspiration Interpretations Serum iron-TIBC-ferritin-Vit B12-folate Bone marrow biopsy Coagulation profiles Lymph node biopsy Coagulation factor assays Immunocytochemistry Thrombophilia assays Flow cytometry

ONCOLOGY ROTATION DURATION: 4 weeks at the senior level (R3—4)

Specific rotation objectives: 1 4 - Develop all seven CanMEDS core competencies while learning the basic skills required for the diagnosis and management of a broad range of endocrinology and metabolic conditions affecting adolescents and adults - Demonstrate a thorough understanding of relevant basic sciences including pathophysiology, drug therapy & the microbial basis of diseases involving the key presenting problems and disease conditions shown in the table below - Order appropriate and selective investigations and interpret the findings in the context of the patient’s problems - Formulate appropriate provisional & alternative diagnoses for key presenting problems and underlying conditions

Topic Underlying Key Condition Primary Focus in Learning Lymphoma Hodgkin’s lymphoma - Classification Diagnosis Non-Hodgkin’s lymphoma Manifestation Management Staging

Oncology Breast cancer Lung cancer Manifestation Prognosis Prostate cancer Colon cancer Risk factors Management of the disease & its complications Hepatoma Oncological emergencies Diagnosis Prevention Oncological Superior vena cava syndrome Tumor lysis syndrome Manifestation Management urgencies and Spinal cord compression Hypercalcemia Risk factors Prevention emergencies Malignant pleural effusion Diagnosis Complications of Hematopoietic complications Sexual complications Manifestation Management cancer therapy Cardiac complications Renal complications Risk factors Prevention Pulmonary complications Secondary malignancies Diagnosis Genitourinary complications Others

DRTP :: Internal Medicine Program Manual 2016 Page 14 | 20 INFECTIOUS DISEASES ROTATION :: 4 weeks at the junior level (R1—R2) :: 4-8 weeks at the senior level (R3—R4)

Presenting Problem Underlying Key Condition Primary Focus in Learning Fever Fever of unknown origin Definition Diagnostic workup Etiology Management Hospital acquired Clostridium difficile VRE Etiology Diagnosis & Management infection MRSA ESBL Manifestation Prevention Antimicrobial agents Antibiotics Rational use Interactions Antiviral agents Mechanism of actions Principles of imperative initiation Antifungal agents Pharmacokinetics Monitoring Antiprotozoal agents Dosage & Side effects Prophylaxis Precautions Emergence of drug resistance Emergency infections Septicemia and septic shock Brain abscess Etiology Diagnosis Meningitis Febrile neutropenia Pathophysiology Management Encephalitis Postsplenectomy infection Manifestation Prevention Complications

Fever in patients with Infective endocarditis Definition Diagnosis cardiac murmur Pathophysiology Complication Etiology Medical & surgical management Manifestation Prophylaxis HIV infection AIDS Risk factors Complication Pathophysiology Management Manifestation Prophylaxis Infection in Bacterial Protozoan Etiology Management immunocompromised Viral Mycobacterial Manifestation Complications patients Fungal Opportunistic infections Diagnosis Prevention Fever in diabetes Diagnosis Prevention Management Tuberculosis Pulmonary Primary vs. secondary Etiology Complication Extra pulmonary Multidrug resistance Risk factors Management Active vs. latent Pathophysiology Prevention Manifestation 1 Fungal infection Histoplasmosis Cryptococcus Pathophysiology Complication 5 Blastocytosis Mucormycosis Manifestation Management Diagnosis Prevention World health issues Emerging infections Bioterrorism Epidemiology Public health infection control Notification Geographic infections Pandemic preparation Transmission Management Prevention Infection control Principles of infection control Epidemiology Prevention Transmission Public health infection control Notification Diagnostic tests Gram stain Biopsy & Aspirations Knowledge of technique Acid fast stain Serological tests Interpretations Body fluid cultures Imaging Reliability

RHEUMATOLOGY ROTATION :: 4 weeks at the junior level (R1—R2) :: 4- 8 weeks at the senior level (R3—R4)

DRTP :: Internal Medicine Program Manual 2016 Page 15 | 20 Topic Underlying Key Condition Primary Focus in Learning Arthritis - Rheumatoid arthritis - Crystal-induced arthropathy Classification Complications - Septic arthritis - Spondyloarthropathies Manifestation Management Diagnosis Systemic Systemic lupus erythematosus Antiphospholipid antibody syndrome Classification autoimmune Progressive systemic sclerosis Idiopathic inflammatory myopathies (PM, DM, Manifestation disorders (scleroderma) inclusion body myositis, and myopathy Diagnosis Scleroderma visceral involvement associated with malignancy) Complications with renal crisis and/or cardio- Sjögren’s and sicca syndromes Management pulmonary involvement Vasculitis Small vessel vasculitis Medium vessel vasculitis Etiology Diagnosis Good pasture syndrome Polyarteritis nodosa Pathophysiology Complications Henoch-Schönlein purpura Large-vessel vasculitis Manifestation Acute and chronic Churg-Strauss syndrome Giant cell arteritis management Wegener's granulomatosis - Takayasu's disease Uncommon Behçet’s syndrome Osteomalacia Etiology Manifestation rheumatology Cogan’s syndrome Sarcoidosis Classification Complications conditions Relapsing polychondritis Eosinophilic fasciitis Pathophysiology Management Isolated CNS vasculitis Diagnostic tests Hematological serology Imaging Synovial fluid analysis Principles – Interpretation - Reliability

NEUROLOGY ROTATION :: 4 weeks at the junior level (R1—R2):: 8 weeks rotation at the senior level (R3—R4) Specific rotation objectives: - Develop all seven CanMEDS core competencies while learning the basic skills required for the diagnosis and management of a broad range of endocrinology and metabolic conditions affecting adolescents and adults - Demonstrate a thorough understanding of relevant basic sciences including pathophysiology, drug therapy & the microbial basis of diseases involving the key presenting problems and disease conditions shown in the table below - Order appropriate and selective investigations and interpret the findings in the context of the patient’s problems - Formulate appropriate provisional & alternative diagnoses for key presenting problems and underlying conditions

Topic Underlying Key Condition Primary Focus in Learning Consciousness Delirium Etiology Examination for brain death disorders Dementia Assessment-reduced conscious level Investigation Coma Application of Glasgow Coma Scale Management Neurological Diabetes Malignancy Recognition manifestation of Renal failure Respiratory disorders Diagnosis other diseases Hepatic disease Fluid and electrolyte disorders Management Headaches Tension headache High intracranial hypertension Manifestation Complication Migraine Trigeminal neuralgia Diagnosis Prevention Cluster headache Thunderclap headache Management Stroke and Cerebral infarction Subarachnoid hemorrhage Etiology Complications intracranial Cerebral hemorrhage Subdural hemorrhage Risk factors Diagnosis & Management hemorrhage Dural thrombosis Extradural hemorrhage Manifestation Prevention Movement Parkinson’s disease Tardive dyskinesia Etiology 1 disorders Parkinson plus syndrome Myoclonus Manifestation and assessment 6 Ataxia / Tremor Wilson’s disease Diagnosis Chorea Neuroleptic malignant syndrome Management Dystonia Restless leg syndrome Seizures and Generalized epilepsy Etiology Diagnosis & Complications epilepsy Localized epilepsy Manifestation Acute & chronic management Paraplegia Spinal cord injury Transverse myelitis Etiology Diagnosis Spinal cord compression Manifestation Management Neuromuscular Myasthenia gravis Etiology Diagnosis disorders Lambert-Eaton syndrome Classification Management Myopathies Manifestation Neuropathy Mononeuropathy Etiology Classification Polyneuropathy Diagnosis & Management Differential diagnosis Demyelinating Multiple sclerosis Pathophysiology Manifestation disorders Diagnosis & Management Differential diagnosis Neuro-oncology Intracranial tumors Metastasis Etiology Manifestation Primary CNS tumors Paraneoplastic syndrome Classification Special Oculocephalic reflex Dix–Hallpike maneuver/ Indications Utility neurological tests Caloric test Tensilon test Contraindications Interpretation Diagnostic tests CT scan & MRI Nerve conduction study Indications Electroencephalography Muscle biopsy Contraindications Electromyography Visually evoked potential Utility Lumbar puncture Auditory evoked potential Interpretation Lumbar puncture

Objectives of the log book: - Maintain records of all academic activities (e.g., procedures, lectures, journal clubs, meetings, training courses, workshops, symposia & case presentations) undertaken during the training program - Assist the resident in identifying his or her deficiencies in specific areas - Assist the program director/evaluator in documenting the contribution and evaluation of trainees - Provide the evaluator with guidance regarding appropriate and fair assessment of trainees - Provide the program director with guidance regarding deficiencies in training

Guidelines for residents: - Residents are required to maintain log books during the entire training period - Log book entries concerning recorded activities should be completed on the day on which activities occur - All entries must be signed by a mentor within one week - Residents should discuss their training progress as indicated in the log book, with the program director every month - Residents should submit their completed log books to the program director at the end of rotations and training, for subsequent submission to the regional supervisory committee - If a log book is not signed by the program director, the resident will be ineligible for end-of-training certification and final examination

List of Procedures

Observation Under supervision Independently Echocardiography Central venous line insertion Venipuncture Exercise ECG testing Thoracocentesis Nasogastric tube insertion Flexible and rigid bronchoscopy Bone marrow aspiration and biopsy Performing 12-lead ECG Upper GI endoscopy Mechanical ventilation (invasive & noninvasive) Cardiopulmonary resuscitation Lower GI endoscopy Knee joint aspiration and injection Arterial access including blood gas sampling Electroencephalography Intercostal tube insertion Spirometry Electromyography Pericardiocentesis Blood films for malaria Visual & auditory evoked potentials & CNS imaging Under supervision Gram stain Kidney biopsy Acid fast stain Plasmapheresis Peripheral blood smear Principles of endocrine dynamic tests Urine analysis and microscopy Insulin tolerance test Abdominal paracentesis Oral glucose tolerance test with growth hormone level Fundoscopy Low-dose dexamethasone suppression test Lumbar puncture Synacthen test External cardioversion/defibrillator Metyrapone suppression test Water deprivation test 1 7

DRTP :: Internal Medicine Program Manual 2016 Page 17 | 20

Clinical Research

Residents are required to present a research through final year thesis and for this purpose, workshops are held as follows: - Research methodology (3 days) - Literature review & Refworks (1 day) - SPSS (Basic Statistics)

The goal of these workshops is to understand and able to apply the following: - Using electronic databases such as Medline & Internet to conduct literature searches and to locate information - Critically appraise/evaluate relevant literature, reviews and new techniques/technologies - Use word processors, databases, spreadsheets and statistical packages to produce statistical analysis & research papers - Conduct a literature review - Develop an hypothesis to be tested - Choose an appropriate research methodology and design a research study - Write a grant application to fund a research project. - Apply for ethics committee approval for a clinical or laboratory based study - Collect, collate and interpret data - Apply basic statistical analysis to clinical data - Develop an outline structure for a research paper - Write a literature review for a research paper - Apply the developed outline to write a research paper - Searching the literature and data-bases purposefully - Appraising critically relevant articles and reports - Interpreting findings and consider their applications to other contexts - Know how to select and draw on clinical evidence to inform practice - Be able to define the following terms  Clinical significance  Laboratory variability  Statistically significant / insignificant  Observer variability  Variability  Data types: categorical, continuous, qualitative,  Biological variability quantitative, discrete - Understand the following methods of and terms associated with data collection:  Epidemiological studies  Observational studies  Randomized controlled & crossover clinical trials  Discrete and continuous variables  Randomized controlled laboratory study  Sample size determination - Recognize and understand the following concepts of problems associated with data:  Bias: confounding - measurement - sampling  Understand the significance & limitations of measures of  Randomization central tendency:  Stratification o Mean, median, mode o Variance  Blindness (masking) o Co-variance  Relevance of sample size to the ultimate o Standard deviation  Outcome of the statistical analysis o Confidence interval - Understand and apply the following statistical terms:  Probability & probability distribution models  Meta-analysis  Regression and correlation analysis  Absolute risk  Risk — sensitivity analysis, particularly: o Absolute risk difference  Exposure odds ratio o Absolute risk reduction o Attributable risk  Number needed to treat o Etiologic fraction  Significance testing o Relative Risk - Getting Research skills:  Choosing a topic for research  Having a detailed literature review for this purpose  Designing a research as per standard methodology  Choosing a mentor on the related field  Finalize the research proposal and get both scientific and ethical approval  The research proposal will consist of at least of Title page, Specific Aims  Introduction/Background and Significance  Objectives and Hypothesis  Research Design and Methodology  References / Bibliography  Conduct the research through data gathering, survey, or any standard tool  Analyze the data  Present the data on a thesis as per DRTP thesis guidelines.

DRTP :: Internal Medicine Program Manual 2016 Page 18 | 20 Each thesis must be arranged in the following order: - Title Page (Sample A). Do not place a page number on this page. - Dedication. Do not place a page number on this page. - Acknowledgements and/or Preface. Do not place a page number on this page. - Abstract (Sample B). Do not place a page number on this page. - Table of Contents. Do not place a page number on this page. - List of Tables, Figures, Illustrations/Maps/Slides, List of Supplemental Files such as multimedia files. - List of abbreviations - Text of the Thesis. All pages from the first page of text through the bibliography or Vita, if included, are numbered consecutively in Arabic numerals, beginning with Arabic numeral “1” on the first page of the thesis text. - Introduction - Material and Methods - Results - Discussion - Limitations - Conclusion - Appendix or Appendices. Continue text numbering with Arabic numerals. - References. Vancouver or Harvard standard style. - Publications (please insert the full text of your published paper if you have any) - Curriculum Vita. Continue text numbering with Arabic numerals.

Thesis Formatting and Layout Requirements:

Page Size Page size should be standard A4 size (8.50 x 11.00). Margins 1 inch on all sides, including page numbers. Page Nos. Should be at least 1" from the below margins edges of the page, as appears in this document. Spacing Preliminary pages and text must be double-spaced or 1.5-spaced. Under certain conditions, quotations may be single spaced. Table of Contents and lists with lengthy entries may be single spaced with a double space between entries. References may be single spaced, with a double space between entries. Page Alignment Each new chapter/ major section (i.e. Chapter 1 - 2, Appendix, Bibliography, Vita) must begin on a new page. Pagination All text page in the thesis is numbered. All text page numbers in the thesis must be centered under the text in the same location on each page and located at least one inch from the bottom of the page. Word Your final thesis must be correct in spelling and punctuation and presented in a consistent, structured format. A Processing single, legible font must be used throughout the thesis, the only exceptions being in tables, figures, graphs, appendices, foot notes, and supplemental files. The font size should be 12-pt. Accuracy and consistency is required in format of the thesis. Tables & Pages carrying illustrative material must be given page numbers appropriate to their place in the document. Illustrations Illustrative material may not be inserted after the document has been numbered and given numbers such as “10a.” All tables, figures, illustrations, and other types of examples included and referenced in the text of the thesis should be numbered for identification. There should be no duplication of these numbers; i.e., no two tables should be assigned the same number. Figures may be numbered in one of two ways: consecutively throughout the document (Table 1, Table 2, Table 3, etc.), or double-numbered so that illustrations’ numbers reflect their locations in the document (Fig. 9.3 is the third figure in Chapter 9, or Fig. A2 is the second figure in Appendix A.) Captions & To be placed on the same page with the figure, graph, table or illustration they describe. In order to fit both figure legends and caption on the same page, captions may be single-spaced, margins may be decreased to one inch, and figures may be reduced in size to fit. If the figures are reduced from their original size, then the page number must be added after the reduction so as not to alter its size. If there is no other way to manage the amount of material to be shown, the caption and figures should be side-by-side in continuous view. This method should only be used in the rare instance where all of the pertinent material will not fit on the same page. Figures, captions, and page numbers must be easily readable when the electronic document is viewed at 100 percent. Copies Residents upload a single pdf file of their thesis to Research website (e.g. thesis submission site). The electronic Required pdf file serves as the DHA archival copy of the thesis. As an extra measure of security, students are strongly encouraged to keep a copy of their approved thesis and to provide an additional copy to their thesis supervisor or department/program library, if applicable. By keeping an electronic backup on hand, students can easily provide scholars with a copy of the thesis during the time between submission and publication, if necessary. A paper copy of the thesis is required by the AAC Footnote Each thesis must include a reference, or bibliography section,. This section may be called “Bibliography” or Citations, “References”. The bibliography is the last required section of the thesis and the last section heading listed on the References & Table of Contents unless an optional Vita page is included. When a Vita page is included, the bibliography Bibliography immediately precedes the Vita at the end of the thesis. The bibliography must indicate materials actually used, such as articles, chapters of books, websites, etc

DRTP :: Internal Medicine Program Manual 2016 Page 19 | 20

References

• Policies and Procedures for Certification and Fellowship, Royal College of Physicians and Surgeons of Canada, January 2001 • Internal Medicine Curriculum 2015, © 2015 Saudi Commission for Health Specialties (SCFHS) • General Standards of Accreditation, Royal College of Physicians and Surgeons of Canada, September 2006 • General Information Concerning Accreditation of Residency Programs, Royal College of Physicians & Surgeons of Canada, 2006 • Specific Standards of Accreditation for Residency Programs in Internal Medicine Royal College of Physicians and Surgeons of Canada 2006 • Objectives of Training and Training Requirements in Internal Medicine, Royal College of Physicians & Surgeons of Canada, 2006 • Residency Training in Internal Medicine; A Collaborative Program of the Faculty of Medicine and Health Sciences and the General Authority of Health Services. Departments of Medicine at Al-Ain, Tawam Hospitals and Faculty of Medicine and Health Sciences. January 2006. by Professor Michael Ellis

DRTP :: Internal Medicine Program Manual 2016 Page 20 | 20