General Surgery Clerkship

Faculty of Medicine Ain Shams University

Postgraduate Studies

Medical Doctorate in Rheumatology

درجة الدكتوراه في المراض الروماتيزمية

Program Code: GIM740

Program Guide and Logbook 2 3 C a n d i d a t e C u r r i c u l u m v i t a e

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TABLE OF CONTENTS: Page

6 I – Welcome Statement II - Mission Statement III – Senior supervisor and affiliated departments and Hospitals IV – Program specifications 1 - Basic Information 2 - Professional Information 3 – Academic standards 4 – Curriculum structure and contents 5 - Program courses: 6. Program admission requirements: 7. Regulation for progression and program completion 8. Appendix: course specifications Anatomy course specifications Pharmacology course specifications Molecular biology course specifications Basic immunology course specifications Rheumatology course specifications Genetics course specifications Physical medicine and rehabilitation course specifications Medical Statistics course specifications V - General information VI – Your log book 1 – Introduction 2 – Supervisors 3 - Tables for training records 4 – Log book preview VII - Head of department approval for the exam entry Detachable forms:

VIII – Thesis follow up IX - Evaluation forms

I – Welcome Statement:

7 The Department of Internal medicine Rheumatology division welcomes you to the Medical Doctorate in Rheumatology. As a department we are committed to medical student education and continuously strive to improve your educational experience. This handbook presents information guide and logbook activity of this degree administered by the General Internal Medicine department, Rheumatology division, Faculty of Medicine, Ain Shams University.

II - Mission Statement: The mission of the Faculty of Medicine, Ain Shams University is • The preparation of a competent graduate, who is able to compete on both national and regional levels, capable of life long learning, training and tutoring, while adhering to the codes of practice of medical health services and ethics.

• The college as well, seeks continuous development of programs and courses. It also enhances expansion of applied scientific research and health programs for community services and environmental development.

The mission of this degree is to provide practicing clinicians in in rheumatology with a comprehensive training program both at a basic science and clinical level. Furthermore, to provide extensive training in research design and methodology, to facilitate candidates’ career development in clinical and basic research of rheumatology.

III – Senior Supervisor and A ffilated Departments and Hospitals Senior Supervisor

Prof. ------E-mail:

A ffilated Departments and Hospitals Internal medicine Departments, Rheumatology division, Faculty of Medicine, Ain Shams University, Cairo University, Alexandria University, El- Mansoura University and Al-Azhar University. Rheumatology divisions of Internal medicine departments, in Military hospitals and educational ministry of health hospitals.

8 IV – Program Specifications A- Basic Information 1. Program title: Medical Doctorate in Rheumatology 2. Program type: Single Double Multiple 3. Faculty Ain Shams University – Faculty of medicine 4. Department General Internal Medicine department, Rheumatology division. 5. Assistant coordinator Prof Dahlia Abdel Mohsen 6. Coordinator Head of Rheumatology division, General Internal medicine department Prof Mohammad Salah Abdel Baky 7. Last date of program approval: ……………………………………………………………

B- Professional Information: 1. Program aims: This program should be able to: 1. Respond to the educational and research training needs of doctors with a special interest in rheumatology. 2. Meet the needs of Medical Doctorate candidates whilst they are completing their clinical training or working in clinical practice. 3. Provide study modules designed to give candidates a sound understanding of concepts and research in rheumatic diseases. 4. Provide trainees with additional advanced modules, this will allow them to undertake more indepth studies of specific areas in rheumatology according to individual interest. 5. Support evidence-based rheumatological practice. 6. Give trainees an opportunity to produce a detailed dissertation on a special topic of interest with respect to rheumatic diseases.

2. Intended learning outcomes (ILOs): a. Knowledge and understanding: By the end of this program the student should be able to: a1- Recognize anatomy, cellular and molecular biology, genetics and pharmacology relevant to the rheumatic diseases.

9 a2- Describe different types of Rheumatic Diseases and rheumatological emergencies in adult and pediatric age groups. a3- Identify the role of imaging techniques in the investigation of the rheumatic diseases. a4- Recognize different types laboratory investigations needed for the diagnosis of rheumatic diseases of Rheumatic Diseases. a5- Know the place of measurement techniques using imaging (bone densitometry and ultrasonography) in the investigation of the rheumatic diseases. a6- List the drugs used in the rheumatic diseases, their indications, actions and monitoring. a7- Outline the role of allied medical specialties (such as Orthopaedics, Anaesthetics and Rehabilitation) a8- Outline the role of patient education in rheumatic disorders. a9- Recognize the socioeconomic and legal aspects of rheumatic disorders. a10- Identify the role of non-conventional medicine in rheumatic disorders b. Intellectual capabilities: By the end of this program the student should be able to: b1- Classify rhematic disorders. b2 - Differentiate rheumatic disorders from each other. b3 - Assess multi-system disease. b4 - Select appropriate laboratory tests. b5 - Interpret appropriate laboratory tests. b6 - Select appropriate imaging technique for diagnosis of rheumatic diseases. b7 - Interpret radiological imaging. b8 - Select appropriate neurophysiological tests to diagnose and differentiate nerve and muscle diseases. b9 - Interpret neurophysiological test. b10 - Select the proper line of treatment. b11 - Support evidence-based rheumatological practice. c. Professional and practical skills: By the end of this program the student should be able to: c1- Examine different joints, periarticular and extraarticular structures. c2- Point out different joint, periarticular and extraarticular structures abnormalities. c3- Aspirate and inject synovial joints. c4- Analyse synovial fluids. c5 Perform soft tissue injections. c6- Perform as a either a consultant or a principal care provider when required c7-write and evaluate medical reports

10 c8- evaluate and develop methods of practice d. General and transferable skills: By the end of this program the student should be able to: d1- Consider communication skills with patients, peers and paramedical personnel. d2- Understand the importance of team working and peer teaching. d3- Use recent technology for practice development and update knowlwdge and self teaching d4- Teach and evaluate other trainees d6- Run scientific meetings and time management

3. Academic standards: (Benchmarks) Academic reference standards guided by ACR Core Curriculum Outline for Rheumatology Fellowship Programs Website: http://www.rheumatology.org/educ/training/CCO.pdf

4. Curriculum structure and contents:

4a- Program duration: three years (6 semesters) + thesis

4b- Program structure: المناهج المقررات الدراسية الكود الساعات المعتمدة متطلبات الكلية دورة اساسيات البحث العلمى الجزء الول تشريح GIM7401 2 الدوية GIM7402 2 البيولوجيا الجزيئية GIM7403 1 المناعة الساسية GIM7404 1 الرسالة 15 الجزء الثانى المراض الروماتيزمية GIM7405 22 المقررات الختيارية يتم اختيار مادة واحدة من: 1- علم الوراثة E7041 2 2- الطب الطبيعى والتاهيل E7042 3- الحصاء الطبية E7024 كراسة النشطة 15 المجموع 60 5. Program courses:

11 a. Compulsory Code Course title No. of actual hours L C F SDL GIM740 30 Anatomy 1 GIM740 Pharmacology 30 2 GIM740 Molecular biology 30 3 GIM740 Basic immunology 15 4 GIM750 15 57 Rheumatology 5 0 0 L: Lecture, C: Clinical, F: field and SDL: Self directed learning b. Elective Code Course title No. of actual hours L C F SDL E704 3 Genetics 1 0 E704 2 Physical medicine and rehabilitation 2 2 9 E702 2 2 Medical siatistics 4 0 0 6. Program admission requirements: المادة (7): يشترط لقيد الطالب للحصول على درجة الدكتوراه :- - أن يكون حاصل على درجة الماجستير في مادة التخصص من إحدى الجامعات المصرية أو على درجة معادلة لها أو دكتوراه المراض الباطنة أو دكتوراه طب الطفال. - موافقة جهة العمل على متطلبات الدراسة. - تسديد الرسوم ومصاريف التدريب سواستهلك الجهزة سواستيفاء المستندات المطلوبة في الملحق (2) 0 - التفرغ للدراسة لمدة خمس فصول دراسية على القل قبل دخول امتحان الجزء الثاني. ويمكن أن يتم التدريب لنفس المدة على القل فى احد المستشفيات أو المراكز العلمية المعتمدة من الكلية بعد أستيفاء الشروط التى تحددها القسام المختصة. 7. Regulation for progression and program completion مادة (8): يتم التسجيل لدرجات الدكتوراه مرتين فى العام : الولى من أول يوليو حتى آخر أغسطس والثانية من أول نوفمبر حتى آخر ديسمبر 0

12 مادة (9): توزع الدراسة فى كل عام جامعى على فصلين دراسيين مدة كل منهما خمسة عشر اسبوعا . يبدا الول فى أول أكتوبر ويبدا الثانى فى منصف فبراير. مع تنظيم فصل دراسى صيفى مكثف لمدة ستة اسابيع . و يتم التسجيل للفصل الدراسى قبل اسبوعين من بدايته على القل بعد إستيفاء الشروط حسب المقررات المسجلة. ولينبغى أن يزيد العبء الدراسى فى الفصل الواحد عن 6 ساعات معتمدة. ويجوز للطالب تعديل المقررات خلل اسبوعين من بداية الفصل الدراسى ( بالحذف او الضافة). كما يجوز له النسحاب خلل سته اسابيع من احد المقرارت دون احتسابه راسبا فيه. مادة (17): مدة الدراسة للحصول على الدكتوراه ستة وثلثون شهرا (ست فصول دراسية) يجتاز خللهم الطالب برنامجا تدريبيا متكامل بالقسم طبقا للساعات المعتمدة الموضحة بالباب الخامس ويستوفى خللها المطلوب منه فى كتيب متابعة النشطة ول يسمح له بدخول المتحان قبل إستيفاء ثلثة أرباع المطلوب منه من الساعات المعتمدة. مادة (18): مدة الدراسة في الجزء الول للدكتوراه إن وجد فصل دراسي واحد يجتاز بعده الطالب إمتحانا ول يشترط النجاح فيه بالكامل للنتقال للدراسة في الجزء الثاني ويشترط خللها التدريب بإحدى المستشفيات الجامعية أو المراكز المعتمدة من القسم ولجنة الدراسات العليا بالكلية سواء بالداخل أو الخارج على أن يتم إستكمال الدراسة طبقا للساعات المعتمدة. مادة (19): يقوم الدارس لدرجة الدكتوراه بتسجيل موضوع الرسالة مع القيد للدرجة ول تجوز مناقشة الرسالة قبل مرور عامين على التسجيل للدرجة ول يخصص لها درجات. مادة (20): يقوم الدارس لدرجة الدكتوراه بإستيفاء متطلبات الجامعة قبل التسجيل ومتطلبات الكلية ومناقشة الرسالة قبل دخول إمتحان الجزء الثاني. ومتطلبات الجامعة هي الحصول على شهادة التويفل في اللغة النجليزية (مجموع 550 درجة) ومتطلبات الكلية هى حضور دورات معتمدة من لجنة الدراسات العليا بالكلية فى مجال التخطيط والدراسات الطبية والحصاء الطبي أو إجتياز إختبارات خاصة تحددها اللجنة. مادة (21): الساعات المعتمدة لدراسة الدكتوراه ستون ساعة معتمدة على القل ويخصص منها خمس عشرة ساعة لكتيب متابعة النشطة وخمس عشرة ساعة للرسالة وست ساعات على القل للجزء الول إن وجد. مادة (22): مدة القيد لدرجة الدكتوراه خمس سنوات ويجوز لمجلس الجامعة بناءا على طلب مجلس الكلية وبعد موافقة لجنة الدراسات العليا بالكلية بعد طلب مجلس القسم سواستنادا إلى تقارير سنوية من جميع المشرفين على الطالب السماح بإضافة عام واحد وبحد أقصى ثمان سنوات من تاريخ القيد للحصول على درجة الدكتوراه. مادة (24): مجموع درجات المتحان النهائى للدكتوراه 1500 درجة منها 300 درجة للجزء الول إن وجد. ويضاف اليها المعدل الفصلى التراكمى بما يوازى 400 درجة للدكتوراه مادة (25): يعقد إمتحان الدور الول في أكتوبر ونوفمبر من كل عام ويعقد إمتحان الدور الثاني فى أبريل ومايو من كل عام.

13 مادة (26): يكون النجاح فى مواد الدكتوراه بعد الحصول على 60% من درجة التحريري والعملي والكلينيكى والشفوي كل على حدة. مادة (29): فى حالة إستنفاذ مدة القيد يمكن لطالب الدراسات العليا إعادة التسجيل مرة أخرى ول يعتد بالنجاح فى الجزء الول أو الرسالة ويجب إعادتهما.

Assessment Schedule and Weighing of Assessments حال ة ا ل ط e ا ل r s o t ب c n s i

Item Mark t o A a P t P s

G t n e d u t S During End of Total semester semester First semester (If present) 80 300 380 Second semester 80 80 Third semester 80 80 Fourth semester 80 80 Fifth semester 80 80 Sixth semester Written Final exam 1200 1200 Oral Practical /Clinical Total 400 1500 1900

:ملحوظة: تعادل درجات الطالب طبقا للنقاط على الوجه التالى 1- 90 % ررررر : A 4 نقا ر 2- ر ر 85% ر رر رر ر : A- 3.67 رر 90 % نقا ر 3 ر ر 80% ر رر رر ر : B+ 3.33 - رر 85% نقا 14 ر 4 ر ر 75% ر رر رر ر : B 3.00 - رر 80% نقا ر 5 ر ر 70% ر رر رر ر : B- 2.67 - رر 75% نقا ر 6 ر ر 65% ر رر رر ر : C+ 2.33 - رر 70% نقا ر 7- ر ر 62% ر رر رر ر : C 2.00 رر 65% نقا ر 8 ر ر 60% ر رر رر ر : C- 1.67 - رر 62% نقا ر 9 ررر رر 60% : صفر F -

ويتم حساب المعدل الفصلى (GPA) على أساس مجموع حاصل ضرب نقاط كل مقرر مضروبا فى عدد ساعاته المعتمدة مقسوما على الساعات المعتمدة للمقررات التى درسها الطالب فى الفصل الدراسى. كما يتم حساب المعدل التراكمى للطالب (CGPA) على أساس مجموع حاصل ضرب النقاط التى حصل عليها الطالب فى كل مقرر مضروبا فى عدد ساعاته المعتمدة مقسوما على مجموع الساعات المعتمدة الكلية. فى حالة الرسوب فى مادة أو مجموعة من المقررات فى الدبلوم أوالماجستير أو الدكتوراه يتم العادة فى المادة أو المجموعة فقط. ويتم حساب التقدير الفعلى الذى يحصل عليه فى أول إعادة فقط أما إذا تكرر رسوبة فيحسب له عند النجاح تقدير 60% فقط (اى 1.67 نقاط اى -C).

Anatomy course specification University: Ain Shams University Faculty: of Medicine

Course specifications Program on which the course is given: Medical Doctorate in Rheumatology Major or minor element of programs: Major Department offering the program: General Internal Medicine department, Rheumatology division. Department offering the course: Anatomy department. Academic Level: Medical Doctorate – 1st semester Date of specification approval: …………………………..

A- Basic Information Title: Anatomy course Code: GIM7401 15 Credit Hours: 2 hour Lecture: 2/week Total: 30 academic hours

Coordinator Anatomy department

B - Professional Information

1- Course Aims: At the completion of this course students will have an understanding of the functional anatomy of the human musculoskeletal system including major nerve and vascular trunks: 1. Anatomical terminology and the skeleton 2. Upper limb musculature, joint structure, vasculature and innervation 3. Lower limb, musculature, joint structure, vasculature and innervation 4. Axial musculature joint structure, vasculature and innervation

2- Intended Learning Outcomes (ILOs) from the Course: a- Knowledge and understanding By the end of the course the candidate will be able to: a1- Describe the basic principles of structure of the the musculoskeletal system of the human body. a2- Describe the surface landmarks of the underlying bones, muscles and tendons. a3- Outline major clinical applications of anatomical facts. b- Intellectual skills By the end of the course the candidate will be able to: b1) Apply the anatomical facts while examining the living subject in order to reach a proper diagnosis. b2) Identify the different surface markings and determine the position or course of internal structures. b3) Interpret the normal anatomical structures on radiographs and ultrasonography, CT scan and nuclear magnetic resonance images. c- Professional skills By the end of the course the candidate will be able to: c1- Differentiate anatomical structures of the musculoskeletal system. c2- Select the proper surface markings for an anatomical structure. c3- Differentiate between normal and abnormal anatomical structure of the upper limb. d- General and transferable skills By the end of the course the candidate will be able to:

16 d1) Maintain honesty and integrity in all interactions with teachers, colleagues, patients and others with whom physicians must interact in their professional lives. d2) Recognize the scope and limits of their role as students as well as the necessity to seek and apply collaboration with other workers. d3) Be responsible towards work. d4) Maintain a professional image concerning behavior, dress and speech. 3- Course content: Topics No of hours L SDL Bones and Skeleton – Overview 2 Joints and Muscles – Overview 2 Shoulder, Arm 2 Elbow, Forearm 2 Wrist, Hand 2 Upper Limb - Nerves & Vessels, surface anatomy 3 Hip, Thigh 2 Knee 2 Ankle and Foot 2 Lower Limb - Nerves & Vessels, surface anatomy 3 Neck 2 Vertebral Column 2 Spinal Muscles, surface anatomy of the back 2 Introduction to Biomechanics 2 L: Lectures and SDL: Self directed learning 4 - Student Assessment Methods 4.1 written exam to assess knowledge 4.2 oral exam to assess General and transferable skills Weighing of assessment 4.1 written exam 85 4.2 oral exam 15 Total 100 5 -- List of References 5.1- Course Notes (paper and / or electronic) None 5.2- Essential Books (Text Books) Gray's Anatomy, 39th edition, 2005 5.3- Recommended Books Moore, K.L. and A.F. Dalley, Clinically Oriented Anatomy, 5th edition, Lippincott, Williams & Wilkins, 2005.

17 Tank, P.W., Grant's Dissector, 13th edition, Lippincott, Williams and Wilkins, 2005 Agur, A.M.R. and Dalley, A.F. Grant's Atlas of Anatomy, 11th edition, Lippincott, Williams & Wilkins, 2005 5.4- Periodicals, Web Sites, etc http://www.med.mun.ca/anatomyts/msk/msktut.htm http://www.med.mun.ca/anatomyts/radioanat/radiology/msk/limbmsk.htm http://uwmsk.org/RadAnatomy.html http://www.rad.washington.edu/academics/academic-sections/msk/muscle-atlas/ http://www.medmatrix.org/_SPages/rheumatology.asp

Pharmacology course specification University: Ain Shams University Faculty: of Medicine

Course specifications Program on which the course is given: Medical Doctorate in Rheumatology Major or minor element of programs: Major Department offering the program: General Internal Medicine department, Rheumatology division Department offering the course: Pharmacology department Academic Level: Medical Doctorate – 1st semester Date of specification approval: …………………………..

A- Basic Information Title: Pharmacology course Code: GIM7402 Credit Hours: 2 hour Lecture: 2/week Total: 30 academic hours Coordinator Pharmacology department

B - Professional Information 1- Course Aims:

The aim of this course is to provide students with an understanding of the principles of pharmacology affecting the musculoskeletal system. For each medication, understand the dosing, pharmacokinetics, metabolism, mechanisms of action, side effects, drug interactions, compliance issues, costs, and use in specific patient populations, such as renal insufficiency and including fertile, lactating, pregnant women, pediatric and geriatrric populations.

2- Intended Learning Outcomes (ILOs) from the Course:

18 a- Knowledge and understanding By the end of the course the candidate will be able to: a1- Discuss the pharmacokinetic, pharmacodynamic and pharmacotherapeutic properties of different groups of drugs affecting musculoskeletal system. a2- Discuss the adverse and toxic effects, and their management of commonly used groups. a3- Give an account on limitations to the use of drugs such as contraindications and drug interactions. a4- Define clinically relevant age, sex and genetic related variations that affect response to drugs. a5- Define the principles, the indications, the relative advantages and disadvantages of various pharmacotherapy modalities. a6- Discuss the role, prevalence and limitations of alternative and complementary therapies commonly in use. a7- Recognize the rational and general guidelines of the use of drugs in the proper dose in special population such as pediatrics, geriatrics, pregnancy and lactation and in cases of liver and kidney impairment. b- Intellectual skills By the end of the course the candidate will be able to: b1- Calculate accurately drug’s dosage, bioavailability, plasma half life and volume of distribution in different patient populations. b2- Obtain and record a comprehensive drug history of the patient. b3- Document drug adverse reactions. b4- Observe, record and analyze the effect of drugs on biological tissues b5- Write prescriptions for musculoskeletal diseases. b6- Audit prescriptions citing multiple drugs. c- Professional skills By the end of the course the candidate will be able to: c1- Integrate, analyse and summarise information relating to practical aspects or current advances, issues and controversies within the pharmacological sciences from a wide range of sources and evaluate this information to draw reasoned conclusions or sustainable judgements; c2- Think independently, evaluate and reflect, set tasks and select appropriate and reasoned approaches to solve problems; c3- Use knowledge and understanding of the pharmacological sciences to formulate and apply theprinciples of scientific inquiry to address pharmacology- related problems;

19 c4- Apply the knowledge and understanding of the pharmacological sciences to plan and undertakehypothesis-driven pharmacological research. c5- Demonstrate confidence and competency in understanding, analysing and interpreting pharmacological data d- General and transferable skills By the end of the course the candidate will be able to: d1- Demonstrate respect to all patients irrespective of their socioeconomic levels, culture or religious beliefs and use language appropriate to the patient’s culture . d2- Provide appropriate basic drug education to the patient and his family. d3-Communicate effectively with other health care professionals to maximize patient benefits and minimize the risk of errors. d4 - Understand the importance of life-long self-learning and show a strong commitment to it. d5 - Use current IT for appropriate drug database to reach information about a specific medication. d6- Respect patient’s beliefs, values and privacy . d7- Respect ethics related to drug prescription and use specially to drugs liable to produce abuse. d8- Recognize and effectively deal with unethical behavior of other members of healthcare team.

3- Course content: Topics No of hours L SDL Nonsteroidal anti-inflammatory drugs 2 Glucocorticoids: topical, intraarticular, systemic 2 Systemic antirheumatic drugs: antimalarials, sulfasalazine, 2 gold compounds, methotrexate, D-penicillamine Cytotoxics: azathioprine, cyclophosphamide, chlorambucil 2 Immunomodulatory drugs: cyclosporine, mycophenolate 2 mofetil, tacrolimus Biologic agents 2 Hypouricemic drugs: allopurinol, sulfinpyrazone, probenecid 2 Antibiotic therapy for septic joints 2 Narcotic and non-narcotic analgesics 2 Tricyclics and other agents used for pain modulation 2 Anticholinergics and non pharmacologic agents used for the 2 treatment of sicca symptoms Skeletal muscle relaxants 2 Osteoporosis and osteomalacia 2 20 Others: anticoagulants with pregnancy and lactation, 4 complementary therapies, apheresis, ionizing radiation. L: Lectures and SDL: Self directed learning

4 - Student Assessment Methods 4.1 written exam to assess knowledge, skills 4.2 oral exam to assess General and transferable skills

Weighing of assessment 4.1 written exam 85 4.2 oral exam 15 Total 100 5 -- List of References

5.1- Course Notes (paper and / or electronic) None 5.2- Essential Books (Text Books)

5.3- Recommended Books Principles of Clinical Pharmacology

5.4- Periodicals, Web Sites, etc http://www.centerwatch.com/drug-information/fda-approvals/drug-areas.aspx? AreaID=8 http://www.medilexicon.com/drugsearch.php?a=19 http://www.chilanti.com/olbooks/medbooks/Cochrane_Musculoskeletal_Group.ht m

Molecular biology course specification University: Ain Shams University Faculty: of Medicine Course specifications Program on which the course is given: Medical Doctorate in Rheumatology Major or minor element of programs: Major Department offering the program: General Internal Medicine department, Rheumatology division Department offering the course: Medical biochemistry and Molecular biology department Academic Level: Medical Doctorate – 1st semester Date of specification approval: …………………………..

21 A- Basic Information Title: Molecular biology course Code: GIM7403 Credit Hours: 1 hour Lecture: 1/week Total: 15 Coordinator Medical biochemistry and Molecular biology department

B - Professional Information 1- Course Aims: By the end of the course the candidate will be able to: a) Understand the key features and operating principles of the organization of human genome, control of gene expression, DNA repair and molecular biology techniques. b) Read and interpret molecular biology containing scientific papers. c) Design approaches to addressing questions in molecular biology d) Apply molecular biology concepts in Rheumatology.

2- Intended Learning Outcomes (ILOs) from the Course: a- Knowledge and understanding By the end of the course the candidate will be able to: a1 - Describe the nucleotides, DNA and RNA structure. a2 - Understand the processes of replication, transcription and translation. a3 – Understand the basic principle of molecular biology techniques. a4 - Describe the pathway of uric acid formation and consequence of its alteration. a5 - Describe the pathway of collagen formation and consequence of its alteration. b- Intellectual skills By the end of the course the candidate will be able to: b1 - Select the proper investigation for rheumatic diseases. b2 - Read and evaluate scientific literature in the molecular biology sciences. c- Professional skills By the end of the course the candidate will be able to: c1 - Select the proper investigation for rheumatic diseases. c2 - Read and evaluate scientific literature in the molecular biology sciences. d- General and transferable skills By the end of the course the candidate will be able to: d1 - Work effectively in a group during preparation of seminars. d2- Respects the role of staff and co-staff members regardless of degree or occupation.

3- Course content:

22 No. of Topics hours L Basic DNA structure 1 DNA replication 1 DNA repair 1 Transcription and post transcriptional modification 2 Protein synthesis (Translation ) and genetic code 1 Post translation processing 1 Techniques PCR (Applications of polymerase chain reaction in 1 rheumatology) Blotting (western, southern and northen) 1 Recombinant technique 1 Special topics Role of Apoptosis in rheumatic diseases 1 Role of Angiogenesis in rheumatic diseases 1 Tolerance and rheumatic diseases 1 Uric acid formation pathway and consequence of its 1 alteration Collagen formation and consequence of its 1 alteration L: Lecture

4 - Student Assessment Methods 4.1written exam to assess knowledge and understanding

Weighing of assessment 4.1 written exam 50 Total 50

5 -- List of References 5.1- Course Notes (paper and / or electronic) Electronic lectures 5.2- Essential Books (Text Books) Lecture notes on molecular medicine 5.3- Recommended Books ……………………………………… 5.4- Periodicals, Web Sites, etc http://www.web-books.com/MoBio/ http://www.coe.uncc.edu/~hhilger/EB_I_F_06/web_links_on_basics_of_molecular _biology.htm

23 Basics http://plato.acadiau.ca/courses/biol/Microbiology/Basics.htm Cell structure http://www.wiley.com/legacy/college/boyer/0470003790/animations/cell_structure /cell_structure.htm http://www.cellsalive.com/cells/3dcell.htm DNA http://www.pbs.org/wgbh/nova/genome/dna.html# http://www.johnkyrk.com/DNAanatomy.html good link http://www.pwc.k12.nf.ca/wadey/biotech/dna1.swf Replication http://www.johnkyrk.com/DNAreplication.html http://highered.mcgraw- hill.com/sites/0072437316/student_view0/chapter14/animations.html# http://www.wiley.com/college/pratt/0471393878/student/animations/dna_replicatio n/index.html Transcription http://www.johnkyrk.com/DNAtranscription.html very good link Protein synthesis http://www.johnkyrk.com/DNAtranslation.html very good link http://www.wisc-online.com/objects/index_tj.asp?objid=AP1302 http://highered.mcgraw- hill.com/sites/0072437316/student_view0/chapter15/animations.html http://learn.genetics.utah.edu/units/basics/transcribe/ http://library.thinkquest.org/20465/g_DNATranscription.html http://www.brookscole.com/chemistry_d/templates/student_resources/shared_reso urces/animations/protein_synthesis/protein_synthesis.html http://www.biostudio.com/demo_freeman_protein_synthesis.htm Beginner’s guide to molecular biology http://www.rothamsted.ac.uk/notebook/courses/guide/ http://publications.nigms.nih.gov/insidethecell/chapter1.html http://www.cs.washington.edu/homes/tompa/papers/molbio.pdf http://en.wikipedia.org/wiki/Central_dogma_of_molecular_biology http://en.wikipedia.org/wiki/Molecular_biology PCR http://www.escience.ws/b572/L3/L3.htm http://www.bio.com/protocolstools/protocol.jhtml?id=p1242 http://users.ugent.be/~avierstr/principles/pcr.html http://depts.washington.edu/genetics/courses/genet371b-aut99/PCR_contents.html [animation] http://www.sumanasinc.com/webcontent/anisamples/molecularbiology/pcr.html

24 [animation] Southern blot http://www.accessexcellence.org/RC/VL/GG/southBlotg.html http://highered.mcgraw-hill.com/olcweb/cgi/pluginpop.cgi? it=swf::535::535::/sites/dl/free/0072437316/120078/bio_g.swf::Southern%20Blot Northern blot http://www.ambion.com/techlib/basics/northerns/index.html http://homepages.strath.ac.uk/~dfs99109/BB211/RecombDNAtechlect2.html#sout herns Western blot http://www.bme.gatech.edu/vcl/WesternBlotting/Background/Introduction.htm http://www.bio.davidson.edu/courses/genomics/method/Westernblot.html http://www.westernblotting.org/ Animated Techniques: http://www.sumanasinc.com/webcontent/anisamples/molecularbiology/molecularbi ology.html

Basic Immunology course specification University: Ain Shams University Faculty: of Medicine

Course specifications Program on which the course is given: Medical Doctorate in Internal Medicine Major or minor element of programs: Major Department offering the program: Internal Medicine department Rheumatology Division Department offering the course: Clinical pathology department Academic Level: Medical Doctorate - 1st semester Date of specification approval: …………………………..

A- Basic Information Title: Basic Immunology course Code: GIM7404 Credit Hours: 1 hour Lecture: 15 Total: 15

Coordinator Head of immunology unit clinical pathology dept. B - Professional Information 1- Course Aims: The aims of the course are to provide postgraduate students with an advanced academic and laboratory research training in modern cellular and molecular immunology, with emphasis on the interface between the basic and clinical aspects of the subject.

25 By the end of the course the candidate will be able to: a) Have a good understanding of the molecular and cellular mechanisms involved in the development and regulation of the immune response. b) Understand the way in which the immune system can be manipulated in the treatment of disease, in particular transplantation and cancer. c) Understand the ways in which defects in the immune system can lead to disease such as allergy and auto-immunity. d) Understand the basis of major immunological laboratory investigations and their clinical use. 2- Intended Learning Outcomes (ILOs) from the Course: a- Knowledge and understanding By the end of the course the candidate will be able to: a1. Identify major mechanisms involved in the immune response. a2. Recognize how the immune system can 'go wrong' to cause disease. a3. Recognize how the immune system can be manipulated to prevent or treat disease learning' a4. Know the latest research techniques and approaches, including molecular and cellular immunology and data handling, data storage and manipulation. b- Intellectual skills By the end of the course the candidate will be able to: b1 - Analyze & solve immunological problems. b2 - Integrate and evaluate information from a variety of sources c- Professional skills By the end of the course the candidate will be able to: c1- Analyse experimental results and determine their strength and validity c2 - Prepare research reports c3 - Give research presentations Use the scientific literature effectively c4- Use computational tools and packages d- General and transferable skills By the end of the course the candidate will be able to: d1 - Work effectively in a group during preparation of seminars. d2- Respects the role of staff and co-staff members regardless of degree or occupation. d3 - Communicate effectively through oral computer processing and written reports. d4 - Use of computer data bases and other computer skills. d5 - Handle data Appropriately and analyze them through: decision processes, objective criteria, problem definition, project design and evaluation, risk management, teamwork and coordination. d6 - Learn independently with open-mindedness and critical enquiry.

26 3- Course content: No. of hours L T C S Topics /P D L A. Anatomy and  Anatomy of the immune system 1 cellular elements of  Cells of myelomonocytic the immune system lineage, NK cells and non- specific defence  Ontogeny, structure, phenotype, function and activation  Organisation of the lymphoid system  Primary and secondary lymphoid organs 1  Lymphocyte migration  Mucosal and other compartments of the lymphoid system  Complement  structure, function, control in defence and in disease  Complement and Fc receptors, adhesion molecules  Deficiencies B. Immune and  Natural or innate immune 1 inflammatory response 1 mechanisms  Antigens and antigen processing and presentation  Antigens: types, structures, processing and presentation 1  Macrophage & Dendritic Cell Function 1  APC Regulation of the Immune Response  Major Histocompatibility Complexes:  structure, function and regulation

27  T Lymphocytes and cell mediated immunity 1  Ontogeny, phenotype, subpopulations  T cell receptors: structure, function and antigen binding  Receptor/ligand interactions and cell activation  T cell mediated immune 1 responses - participating cells  T cell subsets  Regulatory T cells and memory cells 1  Effector functions  B Lymphocytes and humoral immunity  B cell receptors; structure, function and antigen binding  Immunogenetics: polymorphisms, generation of diversity and rearranging gene families  Immunoglobulins: structure, function and antigen binding  Idiotype networks: inhibition and stimulation  Effector functions  Cytokines, chemokines and immunomodulators  Cytokines and Chemokines: origin, structure, effect, site(s) of action  receptors, metabolism, and regulation  The acute phase response and inflammation  Inflammatory mediators (e.g. leukotrienes, prostaglandins and platelet- activating factor): origin, structure, effect, site(s) of

28 action (receptor), metabolism and regulation 3. Cellular 1. Cellular activation and regulation: for 1 interactions and each cell type, understand mechanisms of immunomodulation activation and suppression of function (e.g. T cell:B cell interactions via CD28:CD80/86).. 3. Immune cell trafficking; adhesion molecules, chemokines

4.  Immunoregulation 1 Immunoregulation  Tolerance: clonal selection, suppression and antigen paralysis  Oral tolerance  Cell-cell interactions; help and suppression

5. Immune response  Hypersensitivity 1 mediated tissue mechanisms damage  IgE-mediated; acute and late phase reactions  IgA-,IgG and IgM-mediated: opsonization, complement fixation, antibody dependent, cell-mediated cytotoxicity, stimulation and blocking  Immune complex mediated: 1 physicochemical properties and clearance  Cell-mediated: participating cells, effector mechanisms and granuloma formation

 Immune Mechanisms of Autoimmunity and Autoimmune Disease  What is autoimmunity?  Factors [breakdown of functional T cell anergy, genetics, infection, exposure to normally hidden

29 antigens, new epitopes] which give rise to autoimmune disorders  Mechanisms of tissue damage in autoimmunity

6-Autoimune Laboratory diagnosis of autoimmune 1 Diseases: (connective tissue) diseases

 Clinical relevance of autoantibodies, diagnostic specificity and sensitivity for autoimmune disorders  SLE  Diagnosis of rheumatoid arthritis and seronegative arthropathies  Differential diagnosis of rheumatic diseases  Rare Rheumatic Disorders: diagnosis  Systemic vasculitis including Cryoglobulinaemia

7- Scientific basis of immunosuppressive 1 Immunomodulatory and immunomodulatory therapy therapy  Drugs  Antibodies  Recombinan molecules  Others

L: Lecture, T: Tutorial, C/P: Clinical or Practical and SDL: Self directed learning

4 - Student Assessment Methods 4.1written exam to assess knowledge and understanding Weighing of assessment 4.1 written exam 50 Total 50 30 5 -- List of References 5.1- Course Notes (paper and / or electronic) Lectures 5.2- Essential Books (Text Books) Kuby Immunology. Richard A. Goldsby, Thomas J. Kindt, Barbara A. Osborne, Jani Kuby. W H Freeman 5.3- Recommended Books Immunology. Roitt, Ivan M. (ed), Jonathan Brostoff (ed), David K. Male (ed). Mosby, Inc 5.4- Periodicals, Web Sites, etc http://www.bio.davidson.edu/courses/immunology/Bio307.html#anchor24514174 - (Graphics) Descriptions of aspects of immunity with fantastic graphics (and sound effects!) to accompany. Covers MHC antigen loading, second messengers, B cell maturation / activation, B/T cell selection, etc. http://www.biology.arizona.edu/immunology/tutorials/immunology/main.html - (Student Help) Variety of immunology questions with multiple choice answers. Correct answers are reinforced with a brief explanation. Incorrect answers are linked to tutorials to help solve the problem. http://gsbs.utmb.edu/microbook/ch001a.htm -Immunology overview; description of immune system components and systems, evolution of immune system, functions of components, mechanisms. Pictures very helpful. Text somewhat more advanced.

Rheumatology course specification University: Ain Shams University Faculty: of Medicine

Course specifications Program on which the course is given: Medical Doctorate in Rheumatology Major or minor element of programs: Major Department offering the program: General Internal Medicine department Rheumatolgy Division. Department offering the course: General Internal Medicine department, Rheumatology division Academic Level: Medical Doctorate – from 2nd to 6th semester Date of specification approval: …………………………..

A- Basic Information Title: Rheumatology course Code: GIM7405 Credit Hours: 22 hour Lecture: 150 Clinical: 570

31 Coordinator …………………………………………………………

B - Professional Information 1- Course Aims: a) Respond to the educational and research training needs of doctors with a special interest in rheumatology. b) Meet the needs of MSc candidates whilst they are completing their clinical training or working in clinical practice. c) Provide study modules designed to give candidates a sound understanding of concepts and research in rheumatic diseases. d) Provide trainees with additional advanced modules, this will allow them to undertake more in-depth studies of specific areas in rheumatology according to individual interest. e) Support evidence-based rheumatological practice.

2- Intended Learning Outcomes (ILOs) from the Course: a- Knowledge and understanding By the end of the course the candidate will be able to: By the end of this course the student should be able to: a1- Describe different types of Rheumatic Diseases and rheumatological emergencies and pediatric age groups. a2 - Identify the role of imaging techniques in the investigation of the rheumatic diseases a3- Recognize different types laboratory investigations needed for the diagnosis of rheumatic diseases of Rheumatic Diseases. a4 - Know of the place of measurement techniques using imaging (bone densitometry and ultrasonography) in the investigation of the rheumatic diseases. a5- List the drugs used in the rheumatic diseases, their indications, actions and monitoring. a6- Outline the role of allied medical specialties (such as Orthopaedics, Anaesthetics and Rehabilitation) a7- Outline the role of patient education in rheumatic disorders a8- Identify the role of non-conventional medicine in rheumatic disorders b- Intellectual skills By the end of the course the candidate will be able to: b1- Interpret the most important symptoms and signs of disease. b2- Select appropriate investigations and interpret the results.

32 b3- Formulate appropriate management plan for individual patients presenting with the most common diseases. b4- Make decisions regarding the common clinical situations using appropriate problem solving skills. b2 - To know the indications for and limitations of the laboratory and imaging techniques used in the diagnosis and management of rheumatic diseases c- Professional skills By the end of the course the candidate will be able to: c1- Elicit and correctly interpret a history of: - the presenting symptoms of rheumatic disease, - the disability and handicap caused by rheumatic disease , - the psychosocial problems associated with rheumatic disease and other general medical problems. c2- Undertake a physical examination - the normal musculoskeletal system and its’ variations eg at extremes of age - the clinical signs associated with inflammation or structural damage of joints & periarticular structures - non-articular, systemic and other features of rheumatic disease - general medical complications of rheumatic disease - diffuse or regional pain disorders or somatisation disorders. c3- Use the clinical findings to formulate a differential diagnosis and plan of investigation for patients presenting with - monoarthropathy - oligoarthropathy - polyarthropathy - axial arthropathy - multisystem disorder - muscle weakness - regional limb & spinal musculoskeletal pain disorders - unexplained musculoskeletal pain - rheumatological and patient emergencies. c4- Identify the correct indications for: joint injection/aspiration - soft tissue injection. c5- Aspirate and inject joints competently using the appropriate techniques c6- Recognise the macroscopic appearance of normal and abnormal synovial fluid (non-inflammatory, inflammatory, haemorrhagic and septic) c7- Inject soft tissue lesions competently using the appropriate techniques (tennis/golfer’s elbow, carpal tunnel, tenosynovitis/flexor tendon nodules, bursitis, tendinitis and plantar fasciitis). d- General and transferable skills By the end of the course the candidate will be able to: d1 - Inculcate the habit of life long learning. d2 - Communicate, explain and discuss with the patient, the diagnosis, the need for further investigations, the evidence-based management options, their risks and benefits and need for clinical monitoring. the need for orthopaedic/surgical intervention, and the main risks and benefits, the patient’s views on causation,

33 management and the risks and benefits of complementary or non-conventional approaches d3- Identify the need for - paramedical intervention, and aids to assist self care, mobility or driving - intervention by other relevant specialists including the neurologist, neurosurgeon, renal physician or rehabilitationist. - referral of children to specialist paediatric colleague - education and self management techniques - disability benefits or re-training to reduce the socioeconomic impact of rheumatic disease on the patient. d4- Communicate effectively with members of the multidisciplinary team (physiotherapist, occupational therapist, nurse specialist, orthotist, podiatrist or clinical psychologist) - with other clinical colleagues - with relevant support workers including medical social worker and voluntary agencies.

3- Course content: 2nd semester Title: Module 1 Code: GIM7405a Credit Hours: 6 Lecture: 2/w Total: 30 Clinical: 8/w Total: 120 Topics L C 1. Physical Examination of the Musculoskeletal System. 4 2. Joint Aspiration & Injection 2 3. Laboratory Diagnosis. 2 4. Approach to the Patient with Arthritis 2 5. Approach to the Adolescent with Arthritis 2 6. The Patient with Hand, Wrist, or Elbow Pain. 2 7. Approach to the Patient with Ankle & Foot Pain. 2 8. Approach to the Painful Shoulder. 2 9. Approach to the Patient with Neck Pain. 2 10. Approach to the Patient with Low Back Pain. 2 11. The Patient with Hip Pain. 2 12. Approach to the Patient with Knee Pain 2 13. The Patient with Diffuse Pain. 2 14. Pregnancy & Rheumatic Diseases 2

3rd semester Title: Module 2 Code: GIM7405b Credit Hours: 6 Lecture: 2/w Total: 30 Clinical: 8/w Total: 120 Topics L C 15. Rheumatoid Arthritis: The Disease-Diagnosis and Clinical 2

34 Features. 16. Treatment of Rheumatoid Arthritis. 2 17. Ankylosing Spondylitis and the Arthritis of Inflammatory Bowel 2 Disease. 18. Reactive Arthritis. 2 19. Psoriatic ArthritiS 2 20. Adult Still Disease. 2 21. Juvenile Idiopathic Arthritis 2 22. Systemic Lupus Erythematosus 2 23. Treatment of Systemic Lupus Erythematosus 2 24. Antiphospholipid Antibody Syndrome. 2 25. Raynaud Phenomenon. 2 26. Scleroderma. 2 27. Primary Sjogren Syndrome. 2 28. Polymyositis & Dermatomyositis. 2 29. Relapsing Polychondritis 2

4th semester Title: Module 3 Code: GIM7405c Credit Hours: 6 Lecture: 2/w Total: 30 Clinical: 8/w Total: 120 Topics L C 30. Introduction to Vasculitis: Classification & Clinical Clues. 2 31. Giant Cell Arteritis & Polymyalgia Rheumatica. 2 32. Takayasu Arteritis 2 33. Wegener Granulomatosis 3 34. Microscopic Polyangiitis 2 35. Churg-Strauss Syndrome 2 36. Polyarteritis Nodosa 2 37. Mixed Cryoglobulinemia 2 38. Hypersensitivity Vasculitis 2 39. Behcet Disease 2 40. Henoch-Schonlein Purpura 2 41. Vasculitis of the Central Nervous System 3 42. Buerger Disease 2 43. Miscellaneous Forms of Vasculitis 2

5th semester Title: Module 4 Code: GIM7405 d Credit Hours: 6 Lecture: 2/w Total: 30

35 Clinical: 8/w Total: 120

Topics L C 44. Osteoarthritis 2 45. Gout. 2 46. Pseudogout: Calcium Pyrophosphate Dihydrate Crystal Deposition 3 Disease 47. Septic Arthritis & Disseminated Gonococcal Infection 2 48. Lyme Disease 2 49. Mychobacterial & Fungal Infections of Bone & Joints 2 50. Rheumatic Manifestations of Acute & Chronic Viral Arthritis 2 51. Evaluation of Rheumatic Complaints in Patients with HIV 2 52. Rheumatic Fever 2 53. Sarcoidosis 2 54. Endocrine & Metabolic Disorders 3 55. Rheumatic Manifestations of Malignancy 2 56. Amyloidosis 2

6th semester Title: Module 5 Code: GIM7405b Credit Hours: 5 Lecture: 2/w Total: 30 Clinical: 6/w Total: 90 Topics L C 57. Osteoporosis & Glucocorticoid-Induced Osteoporosis. 2 58. Osteonecrosis 2 59. Common Rheumatologic Problems Encountered by the Hospitalist: 2 Pearls and Myths 60. Approach to the Patient with a Painful Prosthetic Joint 2 61. The Patient with a Red eye 2 62. Common Injuries from Running 2 63. Complex Regional Pain Syndromes: Reflex Sympathetic 2 Dystrophy & causalgia . 64. Sensorineural Hearing Loss (Immune-mediated Inner Ear Disease) 2 65. Legal Issues 2 66. Complementary & Alternative 2 67. Medications 4 68. Neurophysiology in the investigation of the rheumatic diseases (eg. 4 Nerve conduction studies and electromyography) 69. Rheumatological emergencies 2 L: Lecture, T: Tutorial, C: Clinical and SDL: Self directed learning

36 4 - Student Assessment Methods 4.1 written exam to assess knowledge, skills 4.2 Clinical exam to assess practical and professional skills 4.3 oral exam to assess General and transferable skills Weighing of assessment 4.1 written exam 530 4.2 Clinical exam 450 4.3 Oral exam 120 Total 1100 End semester exams 400 5 -- List of References 5.1- Course Notes (paper and / or electronic) 5.2- Essential Books (Text Books) CURRENT Rheumatology: Diagnosis & Treatment Primer of rheumatic diseas 5.3- Recommended Books Kelley's Textbook of Rheumatology Oxford Handbook of Rheumatology Harrison's Clinical Immunology and Rheumatology 5.4- Periodicals, Web Sites, etc http://www.amazon.com/CURRENT-Rheumatology-Diagnosis-Treatment- LANGE/dp/0071410279#reader http://www.worldortho.com/dev/index.php? option=com_content&view=article&catid=&id=411:musculoskeletal-examination http://www.medmatrix.org/_SPages/rheumatology.asp http://courses.washington.edu/colleges/vids/injection.shtml www.qub.ac.uk/cskills/hipexamination.htm Rheumatology journals http://www.epodiatry.com/resource/rheumatology-journals.htm Journal of Clinical Rheumatology Annals of the Rheumatic Diseases Journal of Rheumatology Arthritis Care & Research Lupus Arthritis & Rheumatism. Musculoskeletal Care Arthritis Research and Therapy Osteoarthritis and Cartilage Best Practice & Research Clinical Osteoporosis International Rheumatology Seminars in Arthritis & Rheumatism Clinical and Experimental Scandinavian Journal of Rheumatology Rheumatology Rheumatology International Clinical Rheumatology Rheumatology Current Opinion in Rheumatology

37 Rheumatic Disease Clinics of North Arthritis Today America Current Rheumatology Reports Medical Genetics course specification University: Ain Shams University Faculty: of Medicine

Course specifications Program on which the course is given: Medical Doctorate in Rheumatology Major or minor element of programs: Minor Department offering the program: Internal Medicine department Rheumatolgy Division Department offering the course: General Internal Medicine department, Rheumatology division Academic Level: Medical Doctorate – 2nd or 3rd or 4th or 5th or 6th semester Date of specification approval: …………………………..

A- Basic Information Title: Medical Genetics Code: E7041 Credit Hours: 1 hour Lecture: 2/week Total: 30 Coordinator Pediatrics department, Genetic Division

B - Professional Information 1- Course Aims: This course is designed to give students a working knowledge of the principles and practice of Medical Genetics which will allow them to evaluate, choose and interpret appropriate genetic investigations for individuals, families and populations with genetic disease. Students will also learn to recognize role of genetics in rheumatic diseases. It also enable students to work with family information and diagnostic data in order to provide genetic risk assessment and best genetic advice to individuals and their families in an ethical way;

2- Intended Learning Outcomes (ILOs) from the Course: a- Knowledge and understanding By the end of the course the candidate will be able to: a1 – Understand the molecular basis of inherited disease and the molecular diagnostic methods which are used to identify the causative mutations in patients or carriers. a2 - Understand the chromosomal disorders and the cytogenetic and molecular cytogenetic diagnostic methods which are used to characterize the underlying chromosomal abnormality.

38 a3 - Understand the treatments and therapy for inherited disease and gene therapy for rheumatic diseases. b- Intellectual skills By the end of the course the candidate will be able to: b1- Interpret the data foem examination and investigation to reach a diagnosis b2 – Plan for proper genet ic counseling disability. b3 – Use gene therapy for rheumatic diseases. c- Professional skills By the end of the course the candidate will be able to: c1- Demonstrate application of their knowledge base in Medical Genetics in using cues from pedigree, family history and other information to suggest likely inheritance patterns and / or diagnoses; c2- Demonstrate critical use of online molecular and genetics databases to select possible diagnoses; c3- Select diagnostic or screening methods which will be most appropriate and informative in a given clinical situation· c4- Identify appropriate information to be given to patients and their families or their referring clinicians; c5- Evaluate and interpretat data; c6- Apply critical analysis, evaluation and synthesis in producing an investigative report on a selected aspect of Medical Genetics. d- General and transferable skills By the end of the course the candidate will be able to: d1- Be responsible for one’s own work in independent tasks and as part of a team effort; d2- Have time management skills to accomplish individual designated tasks by a given date; d3- Plan tasks fairly within a team and set dates for review or feedback; d4- Demonstrate effective interpersonal group skills with particular reference to educational, cultural and religious diversity; · team leadership; constructively critical self- and peer-evaluation; d5- Write scientific report, poster presentation and oral presentation skills; d6- Use of online databases and e-journals;

3- Course content: Topics L Chromosomal basis of inheritance: cell division 2 Chemical basis of inheritance: structures of genes – function of genes- 2

39 anatomy of gene Manipulating and tracking genes: tools of gene tracking- application of gene 2 tracking- genetic linkage Single gene disorders: autosomal dominant inheritance-autosomal recessive 2 inheritance- sexlinked inheritance-mitichondrial inheritance Chromosomal disorders: numerical chromoseome aberrations-structural 2 chromosome aberrations-genomic imprinting Immunogenetics: HLA system 2 Genetics of the rheumatic diseases 14 Potential impact of pharmacogenomics on the future 2 gene therapy in rheumatic diseases 2 L: Lecture, T: Tutorial, C/P: Clinical or Practical and SDL: Self directed learning

4 - Student Assessment Methods 4.1written exam to assess knowledge and understanding

Weighing of assessment 4.1 written exam 50 Total 50

5 -- List of References 5.1- Course Notes (paper and / or electronic) Lectures (handouts – electronic) 5.2- Essential Books (Text Books) Davidson’s principle and practice of Medicine Primer of rheumatic diseases 5.3- Recommended Books ………………………………………… 5.4- Periodicals, Web Sites, etc http://books.google.com/books? id=dMIFiNR0I7YC&pg=PA5&lpg=PP1&ots=ptiuYq7bNq&dq=genetics+in+rheu matology Rehabilitation of rheumatic diseases course specification University: Ain Shams University Faculty: of Medicine

Course specifications Program on which the course is given: Medical Doctorate in Rheumatology Major or minor element of programs: Minor Department offering the program: Internal Medicine department Rheumatolgy Division

40 Department offering the course: Physical medicine rheumatology and rehabilitation department Academic Level: Medical Doctorate – 1st or 2nd or 3rd semester Date of specification approval: …………………………..

A- Basic Information Title: Rehabilitation of rheumatic diseases Code: E6089 Credit Hours: 2 hour Lecture: Total: 29 Practical: Total: 2 Coordinator Physical medicine, rheumatology and rehabilitation department.

B - Professional Information 1- Course Aims: a) knowledge of Methods of rehabilitation: for each method, understand principles, mechanism of action, indications, precautions and contraindications, potential side effects, and costs. b) Importance of multidisciplinary approaches to rehabilitation and pain control. Appropriate use of and referral/prescription to rehabilitation specialists and pain clinics. 2- Intended Learning Outcomes (ILOs) from the Course: a- Knowledge and understanding By the end of the course the candidate will be able to: a1 - know when is Rehabilitation appropriate a2 - know When is physiotherapy appropriate a3 - know What is the role of the occupational therapist a4 - know When to refer to a pain clinic a5 - estimate value of physical therapies a6 - recognize Rehabilitation Modalities b- Intellectual skills By the end of the course the candidate will be able to: b1- master the musculoskeletal examination b2 – plan for physiotherapy for the patient b3 – assess the disability. c- Professional skills By the end of the course the candidate will be able to: c1- tell when Rehabilitation is appropriate c2 - refer When physiotherapy is appropriate c3- refer to the occupational therapist when indicated c4 - refer to a pain clinic c5 –select proper Rehabilitation Modalities

41 d- General and transferable skills By the end of the course the candidate will be able to: d1) have the ability to explore both disease and illness with patients, and meet their communication needs and those of their relatives through the acquisition of effective Comprehensive Clinical Method; d2) be able to work within the organisational, interpersonal and inter-professional dynamics of the clinical team; d3) be able to make judgements about their strengths and weaknesses and take responsibility for continuing learning, personal support and professional development 3- Course content: No. of hours Topics L T C/P SDL Patient education 1 when is Rehabilitation appropriate 1 When is physiotherapy appropriate 1 How to take rehabilitation sheet (including 2 relevant drug history) Musculoskeletal examination with clinical 1 1 assessment of rheumatologic diseases (activity, deformities and severity) What is the role of the occupational therapist 1 When to refer to a pain clinic 1 Value of physical therapy and exercise 1 Rehabilitation Modalities (1) Rest and splinting 1 (2) Different physical modalities and hydrotherapy 3 (3) Joint protection and energy conservation 1 techniques 1 1 (4) Adaptive equipment and assistive devices 1 (5) Job site/home evaluation and adaptation 2 (6) Footwear and orthotics 1 (7) Acupuncture and other alternative modalities Rehabilitation of shoulder and upper limb pain 2 Rehabilitation of neck and back pain 2 Rehabilitation of lower limb pain 2 Rehabilitation of pain syndromes generalized like 2 fibromyalgia & localized L: Lecture, T: Tutorial, C/P: Clinical or Practical and SDL: Self directed learning 4 - Student Assessment Methods 4.1written exam to assess knowledge and understanding 42 Weighing of assessment 4.1 written exam 100 Total 100 5 -- List of References 5.1- Course Notes (paper and / or electronic) ………………………………………… 5.2- Essential Books (Text Books) Physical medicine and rehabilitation review 5.3- Recommended Books ………………………………………… 5.4- Periodicals, Web Sites, etc

Medical statistics course specification University: Ain Shams University Faculty: of Medicine

Course specifications Program on which the course is given: Medical Doctorate in Rheumatology Major or minor element of programs: Minor Department offering the program: General Internal Medicine department - Rheumatology Division Department offering the course: Community, Environmental and Occupational Medicine Academic Level: Medical Doctorate – 2nd or 3rd or 4th or 5th or 6th semester Date of specification approval: …………………………..

A- Basic Information Title: Medical statistics course Code: E7024 Credit Hours: 2 hour Lecture: 1.3 /w. Total: 20 Practical: 1.2/2w. Total: 20 A credit hour = one hour lecture or practical weekly for 15 weeks Coordinator Community, Environmental and Occupational Medicine Department

B - Professional Information Course Aim: To enable the doctorate candidate to plan, conduct, analyze and interpret the results of a research in his specific field. This course unit introduces the application of statistical ideas and methodology to medical research.

2- Intended Learning Outcomes (ILOs) from the Course: a- Knowledge and understanding

43 By the end of the course the candidate will be able to: a1 - Define medical statistics and identify uses and importance of medical statistics in medical research a2 – Define:  Types of variables.  Descriptive statistics.  Presentation and summarization of data.  Measures of central tendency and scatter.  Principles of probability and probability distributions.  Concepts of inferential statistics: confidence interval and hypothesis testing.  Different tests of statistical significance.  Difference between parametric and nonparametric tests of significance.  Correlation and regression  Concept of statistical modeling using multivariable and multivariate statistical methods.  Combining evidence from different studies and meta-analysis  Importance and methods of sampling and how to determinate the suitable sample size.  Different types of research methodology:  Observational and intervention studies and the different statistical issues related to the design, conduct, analysis and interpretation of the results of each study type.  Ethical aspects of medical research including those specifically applied to clinical trials. b- Intellectual skills By the end of the course the candidate will be able to: b1 - Interpret correctly the results of statistical analyses and critically evaluate the use of statistics in the medical literature. b2 - Integrate and evaluate information from a variety of sources. c- Professional skills By the end of the course the candidate will be able to: c1- Select appropriate study designs to address questions of medical relevance c2 - Select and apply appropriate statistical methods for analyzing data typically encountered in medical applications. c3- Use selected software packages for statistical analysis and data management. d- General and transferable skills By the end of the course the candidate will be able to:

44 d1 - Work effectively in a group from different backgrounds. d2 - Respects the role of staff and co-staff members regardless of degree or occupation. d3 - Communicate effectively with professional statisticians and the wider medical community, including the ability to present results of statistical analyses through written and oral presentations d4 - Use of computer data bases and other computer skills. d5 - Handle data appropriately and analyze them through: decision processes, objective criteria, problem definition, project design and evaluation, risk management, teamwork and coordination. d6 - Learn independently with open-mindedness and critical enquiry. 3- Course content: Topics T C/P Introduction to medical statistics and its uses x x Types of variables and Descriptive statistics x x Graphic presentation of data x x Introduction to probability theory and rules x x Sample and population: sampling distribution of mean and proportion x x Confidence interval of a mean and a proportion x x Confidence interval of a difference between two mean /proportion x x Testing a hypothesis about population mean/proportion x x Testing a hypothesis about the difference between two x x means/proportion Comparing between more than two means-Introduction to factorial x x analysis Cross-tabulation and introduction to categorical data analysis x x Simple correlation and simple regression x x Introduction to multivariable and multivariate analysis x x Study designs: observational studies x x Study designs: Intervention studies: clinical trials x x Study designs: Experimental animal studies x x Study designs: Bias and Confounding x x Ethical issues in medical research x x Sample size estimation for continuous and binary outcome measures. x x Meta-analysis and publication bias. x x T: Tutorial and C/P: Clinical or Practical and SDL: Self directed learning

4 - Student Assessment Methods

45 4-1 Written exam to assess knowledge and understanding and will concentrate on problem solving questions

4-2 Weighing of assessment Written exam 100 Total 100

5 - List of References 5.1- Course Notes (paper and / or electronic) Student Notes on Medical Statistics and Research Methods. Prof. Mohsen Abdel Hamid and Dr Moustafa El Houssinie. Department of Community, Environmental and Occupational Medicine. 5.2- Essential Books (Text Books) Statistics in Clinical Practice. avid Coggon. BMJ Books. 2nd edition 2003 5.3- Recommended Books Handbook of Epidemiology. Springer 2005 5.4- Periodicals, Web Sites, etc www.brettscaife.net/statistics/introstat/ onlinestatbook.com/rvls/ www. Epidemiolog.net http://www.shef.ac.uk/

Semesters’ map

Semester Courses and topics 1st semester Anatomy Pharmacology Molecular biology Basic immunology 2nd semester Module 1: Rheumatology 3rd semester Module 2: Rheumatology 4th semester Module 3: Rheumatology 5th semester Module 4: Rheumatology Module 5: Rheumatology 6th semester One of the elective courses

Elective Course title Genetics Physical medicine and rehabilitation Medical siatistics

46 V- General Information 1 – Monitoring Of Training and Submission Of Training Reports You must keep proper and updated records in your logbook to reflect the activities encountered in your training. Your logbook must be duly endorsed by an authorized signatory at the end of each semester. You will be continuously assessed by your supervisors, in consultation with head of department. An assessment will be submitted within 2 weeks of completion of each semester.

2 - Miscellaneous Information: Injury and/or Blood or Body Fluid Exposure: During regular working hours, you should immediately report an exposure incident to infection control unit. If exposure occurs after regular working hours or during a weekend or holiday; please report to the Emergency Department. Please also be sure to inform the supervisors of an exposure incident and/or injury.

3 - Action Completion Of Clinical Training Once all training sessions are completed the log book should be signed by the senior supervisor and the head of the department and then should be submitted to post graduate Secretariat.

4- Reference The Training Guide is available at the post graduate Secretariat and could be downloaded from the following website is

------

47 Your log book

1- Introduction The aim of this book is to give you a guide to the expectations for each item. It will be a guide for both you and your teachers to what you should be seeing and doing.

It will give you a list of the important topics that you should think about and should be covered in: 1. Clinical or practical sessions or 2. Lectures or 3. Self-directed learning (SDL) For each item there is also a list of 1. Clinical conditions or Practical sessions to be seen or attended (According to each degree) 2. Practical procedures to be seen and done Remember

This document is only a guide. It is not an exhaustive list. It is not just a checklist to score points. It is a guide to encourage you to read and learn more. This book is for your benefit. It will form a record of your clinical training and experience.

2 - Supervisors

Professors and Assisstant professors of the Rheumatology departments are delegated for the signature in the logbook. ……………………………………………………………………………………… ……………………………………………………………………………………… ……………………………………………………………………………………… ……………………………………………………………………………………… ………………………………………………………………………………………

48 ……………………………………………………………………………………… ………………………………………………………………………………………

3–Tables for Training Records Requirements

Candidates are required to fulfill 75% of the listed activities in order to be eligible for the exam entry. The minimum number required for each activity = 75%. You are free to attend more and record your extra attendance. Weekly Rheumatology Department Plan (Rheumatology Division) Day /time Saturday Sunday Monday Tuesday Wednesday Thursday Grand round 8am- 9-10 9-11 11am Rheumatolog 9am-1pm 9am- 9am- 9am- 9am-1pm 9am-1pm y clinics 1pm 1pm 1pm GIM clinics 9am- 9am- 1pm 1pm Rheumatolog 10am-11am y conference GIM 11am-12pm conference Journal club 12-2pm Every other week: Emergency (Thursday) Monthly activity: Radiology conference (Wednesday) Three monthly activities: Grand Rheumatology meeting

Rheumatology Conferences attendance (NB. Minimum number required is 24) e e

c t Supervisor o a a

l Topics N D

P signature

1 2 3 4 5 6 7 8 49 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24

General internal medicine Conferences attendance (NB. Minimum number required is 24) e e

l Topics N D

P signature

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

50 16 17 18 19 20 21 22 23 24

Thesis attendance (NB. Minimum number required is 10) N Supervisor Date Place Name of the thesis o signature 1 2 3 4 5 6 7 8 9 10

Journal club attendance (NB. Minimum number required is 15) e e

l Topics N D

P signature

1 2 3 4 5 6

51 7 8 9 10 11 12 13 14 15 radiology Conferences attendance (NB. Minimum number required is 15) e e

l Topics N D

P signature

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

Case presentation with review article (NB. Minimum number required is 9) Supervisor No Date Place Diagnosis signature 1 2

52 3 4 5 6 7 8 9

Rheumatology Clinics attendance (NB. Minimum number required is 60)

Supervisor No Date Place Name of the Clinic signature 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 53 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60

General medicine Clinics attendance (NB. Minimum number required is 45) No Date Place Name of the Clinic Supervisor 54 signature 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38

55 39 40 41 42 43 44 45

Web Cme rheumatology certificates (NB. Minimum number required is 40) Supervisor No Date Place Name of the Clinic signature 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 31 32 33 34 35 36 56 37 38 39 40

Examination and Diagnosis of Patients with Each of the Following Problems: Low back pain Neck pain Shoulder pain or immobility Hip pain or immobility Knee pain, restricted mobility, or instability Foot pain or deformity Hand pain or restricted function Polyarthritis Monoarthritis

Diagnosis and Management of Each of the Following Diseases : Osteoarthritis Spinal Disc and Joint Diseases Osteoporosis Fibromyalgia Rheumatoid Arthritis Systemic Lupus Erythematosus Juvenile rheumatoid arthritis Scleroderma, limited and diffuse Polymyositis/Dermatomyositis Systemic vasculitis Infectious Arthritis Reactive Arthritis Psoriatic Arthritis Ankylosing Spondylitis Microcrystalline arthropathies - gout, pseudogout, arthropathies related to dialysis Sarcoidosis Anti-phospholipid syndromes Others

57 Patients seen / with any of the listed problems (NB. Minimum number required for each diagnosis is 20) (Write the diagnosis)

y n n n i i r r r y i i t d t t o t i y o o o

i i a a i i l e

t l i r t r r t i p p y i n n n c

o c b t i i i h h

i b i m t t n k k a a a a l r n o r t r r i c c u t i p p p s o f a a e a b s a

m f t n r y o e o p b i N p e l d i o

e o d o i m r , d d o t w H l P o F n c o n

m i u i , M i a r L a o y t t p h H s i

l S e e i r e b n o K m 1 2 3 4 5 6 7 8 9 10 Patients seen / with any of the above problems (NB. Minimum number required for each diagnosis is 20) (Write the diagnosis PT initials, AGE/SEX)

s s e a d s i i i d s d i s s t i e s s u i g n u s o e l u i l , o i r o t i p s f t s a t t r

a i a f a h i n a u o a i r t c o t r y e e r m L s d m h a p h s

m i v t r a t i m u o r c e d u r u o m i e o D e a J D e d

n e r e t

h A l t a t h s m o r b h s a r i t e n R O t d n i e y F O i l s e r o t c p y J i E S S S m i l 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20

Patients seen / with any of the above problems (NB. Minimum number required for each diagnosis is 20)

/ s s s s s s s s s i s i i i i i r e i t t t t t s e e t i i i i i i i l l r r r o m h

h s t y u h h h d o t o t t t i o

r o c t d a r r r ,

s o y d t n p d a c A A A n u o o r

e m v r t y o p

s a e c y s i a h l g c u S

v S t l t i

i o o r s o d a e t g i i i i r d a P m c t

n p s u e a c s i i i e y o t e l t e s l e e s s n i s i f a o i o s R y P i l l p h n h l

t o I S d y , p a a t y t k s p u s n o m o o y h r o r A g t p

h c a t - - o i r t r m a c n r i e A M D 1 60 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20

61 Practical skills Full musculoskeletal examnation (NB. Minimum number required is 40) PT initials, Supervisor No Date Diagnosis AGE/SEX signature 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40

Capillary microscopy performance and interpretation (NB. Minimum number required is 10) e e

l Topics N D

P signature

1 2 3 4 5 6 7 8 9 10

Full comment on musculoskeletal radiollogy (NB. Minimum number required is 40) PT initials, Supervisor No Date Diagnosis AGE/SEX signature 1 2 3 4 5 6 7

63 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40

Joint injection and aspiration (NB. Minimum number required is 15) PT Supervisor No Date initials, Indication signature AGE/SEX 64 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

soft tissue injection (NB. Minimum number required is 15) PT Supervisor No Date initials, Indication signature AGE/SEX 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

65 Nerve conduction interpretation (NB. Minimum number required is 9) PT Supervisor No Date initials, Indication signature AGE/SEX 1 2 3 4 5 6 7 8 9

electromyography interpretation (NB. Minimum number required is 9) PT Supervisor No Date initials, Indication signature AGE/SEX 1 2 3 4 5 6

Pulmonary function tests (NB. Minimum number required is 20) PT initials, Supervisor No Date Diagnosis AGE/SEX signature 1 2 3 4 5

66 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20

5 - Log book preview The candidate logbook will be reviewed and patients seen/ skills performed summarized by diagnosis groups during the semester evaluation and at the end of the course in the table below. The results of this review will be totaled in the summary chart below. Semester 1st 2nd 3rd 4th 5th 6th Total Activity (Minimum number No No No No No No required) Rheumatology Conferences attendance General internal medicine Conferences attendance Thesis attendance Journal club attendance radiology Conferences attendance Case presentation with review article Rheumatology Clinics attendance General medicine Clinics attendance Web Cme rheumatology certificates

67 Examination and Diagnosis of Patients with Each of the Following Problems: Low back pain (10) Neck pain (10) Shoulder pain or immobility (10) Hip pain or immobility (10) Knee pain, restricted mobility, or instability (10) Foot pain or deformity (10) Hand pain or restricted function (10) Polyarthritis (10) Monoarthritis (10) Diagnosis and Management of Each of the Following Diseases : Osteoarthritis (10) Spinal Disc and Joint Diseases (10) Osteoporosis (10) Fibromyalgia (10) Rheumatoid Arthritis (10) Systemic Lupus Erythematosus (10) Juvenile rheumatoid arthritis (10) Scleroderma, limited and diffuse (10) Polymyositis/Dermatomyositis (10) Systemic vasculitis (10) Infectious Arthritis (10) Reactive Arthritis (10) Psoriatic Arthritis (10) Ankylosing Spondylitis (10) Microcrystalline arthropathies - gout, pseudogout, arthropathies

68 related to dialysis (10) Sarcoidosis (10) Anti-phospholipid syndromes (10) Full musculoskeletal examnation (40) Capillary microscopy performance and interpretation (10) Full comment on musculoskeletal radiology (40) Joint injection and aspiration (10) soft tissue injection (10) Nerve conduction interpretation (6) electromyography interpretation (6) Pulmonary function tests (20) Full musculoskeletal examnation (40) Capillary microscopy performance and interpretation (10) Supervisor signiture

VII - Head Of Department Approval For The Exam Entry ______69 ______

70 VIII – Thesis Follow up

التقرير النصف السنوى لعام / التاريخ/ عن الطالب / المقيد لدرجة ( دكتوراه ) بقسم / تقرير السادة الساتذة المشرفين

جمع المادة العلمية و كتابة المقدمة بدأ قطع شوطا محدودا أوشك على النتهاء إنتهى من الجمع

الجزء العملى بدأ قطع شوطا محدودا أوشك على النتهاء إنتهى من التحليل

مناقشة النتائج بدأ قطع شوطا محدودا أوشك على النتهاء إنتهى من التحرير

المراجعة النهائية مع المشرف بدأ قطع شوطا محدودا أوشك على النتهاء إنتهت تماما

رأى السادة المشرفين إستمرار قيد الطالب مد القيد شطب قيد الطالب

تم تشكيل لجنة المناقشة نعم تاريخ التشكيل / / ل مد / شطب القيد توقيع السادة المشرفين وكيل الكلية

71 72 التقرير النصف السنوى لعام / التاريخ/ عن الطالب / المقيد لدرجة (دكتوراه) بقسم / تقرير السادة الساتذة المشرفين

81 82 VIII – Evaluation Forms

To be completed at ------

Candidate Supervisor Location

Aim of training ______

Agreed educational objectives and timescale in which objectives should be achieved. ______

Comments by Candidate ______

Comments by Supervisor ______

Date of next meeting Signed by candidate

83 Signed by Supervisor Date

84 VIII – Evaluation Forms

94 Degree Program Evaluation Form by The Candidate To be completed at the end of your degree.

Please consider each pair of statements and decide which most clearly reflects your view and tick one box or answer the question.

I. Individual Information 1. Are you a graduate of ASU?

yes no to some degree 2. Year and semester when studies began:

II. General Questions 1. What are the advantages/disadvantages of the general study environment at the University ASU?

2. What were your expectations when you applied to the degree?

3. Do you feel that the degree program prepares you well for your future studies or employment according to the demands and expectations of those institutions?

yes no to some degree

4. Has the time limit of the program (two or three academic years) caused you any difficulties or inconveniences?

III. Structure of Degree Program 1. Did you receive enough guidance in planning your study schedule in the beginning of the program?

2. What were the main difficulties in the planning of your study schedule?

3. What is your general opinion on the structure of the degree program?

95 4. In your opinion, does the degree program offer a good balance of lectures, seminars, conferences, and book exams?

yes no to some degree a) General Studies i) Do you feel that you have received enough guidance on academic writing?

yes no to some degree ii) Do you feel that you have acquired sufficient knowledge on research skills (eg. quantitative and qualitative research methods)?

yes no to some degree b) Courses i) Have you had some special difficulties in completing some of the courses? Please specify. ii) Has there been a sufficient variety of courses offered for your optional studies?

yes no to some degree iii) Have you received enough guidance for the preparation of your thesis?

IV. Concluding Points 1. Did the degree program meet your expectations?

yes no to some degree 2. What aspects of the degree program do you particularly like?

3. What aspects of the degree program do you particularly dislike?

4. What are your suggestions on how to improve the program?

Thank you!