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Course Outline: and Immunology

DRAFT 14 May 2013 What we need to decide ●What do medical students need to learn about and Immunology? . What knowledge/skills does an ‘undifferentiated physician’ require? ●What should go in Module 1 and Module 2? ●What can go elsewhere? . Clinical reasoning . Consolidation (integration) block . Clerkship . Other System courses ●What other subjects (esp. those without courses) or themes should be presented in our block? Foundational Principles: Blood & Immunology Course We will design our course to: ●Integrate basic biological principles into a clinical context ●Equip students with a core of knowledge and conceptual understanding to allow them to . Diagnose and manage common hematological, immunological, and autoimmune disorders, and recognize less common but serious disorders . Build on this framework in their continuing professional development ●Engage a range of learning methods to suite different learning styles ●Integrate horizontally with other disciplines to eliminate duplication and gaps and reinforce learning

First and Foremost Relocation from the end of Med II (where BL currently resides) to the beginning of Module 1 and Module 2: ●Allows better integration of basic sciences from Foundations (Module 0) – well suited to a clinical subject with strong laboratory component ●Equips students with foundational information to proceed through following blocks Basic Science emphasis

● Contraction of 12 weeks of SF into 4 weeks of Foundations means that a lot of basic sciences must be carried into System blocks ● : . Control of cellular proliferation and differentiation, including signal transduction (hematopoiesis); Neoplasia - oncogenes and tumour suppressor genes ●Biochemistry: . Enzymology and chemistry of and complement cascades; laboratory measurement (DNA vs. protein antigen vs. enzyme function) More Basic Sciences ●Immunology … all of it ●Genetics . clinical genetics of disorders, hemoglobinopathies, and hemochromatosis; issues of screening, prenatal testing, counseling, DNA diagnostic testing to be addressed; Gene therapy (hemophilia, SCIDS) ●Physiology – transport ● . as models of targeted , issues about ; immunosuppressants

Module 0 ●Inflammation… Module 1 Normal biology and health ●Laboratory analysis of Blood and ●Transport function . Hematopoiesis: cell biology and biochemistry . and and B12/ . Oxygen transport: biochem/physiol . Blood groups and sero-compatibility ●Hemostatic function ●Defense function . Inflammation . Innate immunity: / RE . Humoral immunity . Cellular immunity

Module 2 Health and Disease (?or Disease and ●Therapy)Hematological oncology . Molecular pathobiology of neoplasia . Principles of care . Lymphoid and myeloid malignancies ●Transport . : marrow failure, hemolytic, nutritional . Transfusion practice ● . Thrombotic disorders and management; pharmacology of anticoagulants . Bleeding disorders and management Module 2 Disease and Therapy … continued ●Defense . Immunodeficiencies . Hypersensitivity disorders . Autoimmune disorders . Immunosuppression – pharmacology . . Transplantation ●Autoimmune disorders . SLE . Vasculitis . Note: Rest of autoimmune disorders will go to respective blocks e.g MSK for rheumatoid arthritis Module 3 Integration / consolidation Potential for many interdisciplinary topics and multisystem cases … e.g. . Lupus . Immunodeficiency e.g. HIV . of chronic disease in endocarditis . and in end-stage disease . Hematological disorders in Clinical Reasoning ●More opportunity for multidisciplinary cases and examples that the students need to work through in steps Clinical Skills ●Examination of nodes ●Examination of & liver ●Examination of peripheral blood smear Integration with other subjects ●GI: iron deficiency ●CV: and vascular disease, AFib ●Resp: oxygen transport; PE ●ID: infection in the immune compromised host; blood borne infection ●Repro: anemia, thrombocytopenia, thrombosis in pregnancy; bleeding disorders in women ●Oncology: /lymphoma/myeloma ●Med. Humanities: palliative & end of life care in heme malignancies; Other special topics ●Health economics: hemophilia care; drugs; aspirin vs imatinib ●Preventive medicine: screening testing e.g. hemochromatosis ●Quality assurance / safety / health systems:

CCOMPOSITE CLINICAL PRESENTATIONS CP4* UGME DRAFT V6

SYMPTOMS/ SIGNS 34 ABNORMAL LABS CONDITIONS 1 abdominal mass 35 hirsutism 67 acidosis 99 ADHD spectrum 2 abd pain: acuteComposite & chronic 36 hoarse voice Clinical68 Presentationsalkalosis 100 adrenal(CP disorders4) 3 allergic reactions 37 impotence 69 disorders 101 arthritis 4 Anxiety 38 incontinence 70 calcium//magnesium 102 CVD 5 Ascites 39 jaundice 71 cardiac markers/EKG 103 cirrhosis 6 blunt trauma 40 joint pain-acute & chronic 72 coagulation abnormalities 104 CNS infections 7 Burns Goals41 low backto pain be achieved73 creatinine: acute upon & chronic 105 8 Bleeding 42 lymphadenopathy 74 CXR abnormalities 106 OD 9 cardiac murmurs graduation43 neck mass/thyroid 75 lipid abnormality 107 eating disorders 10 Chest pain “Composite”44 pain syndrome Clinical76 leukocyte Presentations: disorders 108 fungal infections 11 constipation 45 palpitations 77 liver enzymes/function 109 HIV/AIDS 12 cough- acute & chronic 46 prostatism 78 potassium abnormalities 110 13 47 pruritus 79 disorders 111 infertility 14 delirium 48 red eye 80 pulmonary function tests 112 disease-chronic 15 dementia 49• paralysis Symptoms or81 Signs abnormalities 113 disease-chronic 16 diarrhea- acute & chronic 50 pelvic pain/mass 82 urinalysis abnormalities 114 17 diplopia 51• seizures Lab abnormalitiesHEALTH FACTORS 115 menses/menopause 18 dysphagia 52 growths 83 Adverse drug reactions 116 mood disorders 19 dyspnea-acute & chronic 53 skin rashes 84 Chronic disease 117 multiple sclerosis 20 dysuria/UTI 54• sleep Determinants disorders 85 ofContraception Health 118 osteoporosis 21 ear pain 55 somnolence 86 Culture 119 pediatric emergencies 22 56• sore States throat of Health87 WHO Determinants of Health 120 palliative care 23 extremity pain-acute & chronic 57 88 developmental pediatric delay 121 pituitary disorders 24 eye trauma 58 tendon rupture 89 Disabilities 122 pregnancy/ complications 25 fever 59 testicular swelling/pain/mass 90 neglect/abusive relationship or behavior 123 26 fatigue 60 tinnitus 91 educational level 124 suicidal behavior 27 foot ulcers 61 92 elderly/frail 125 /resuscitation 28 fracture/dislocation 62Spiral vision loss acute & chronic Curriculum 93 environmental health 126 sports injuries 29 GI bleed 63 weakness 94 infectious epidemic/prevention 127 STI 30 head injury 64 wheezing- acute & chronic 95 and security 128 suicidal behavior Clinical31 headache PresentationsFramework65 UT obstruction “must symptoms represent -lower a 96common Body weight disorderor important way129 insystemic which autoimmune a disorders patient,32 hearing loss group of patients,66 vertigo/dizziness community or 97population substance abuse/addiction/alcoholism actually presents 130 surgical to the infections 98 131 33 hematuria Povertyhttp://www.ucalgary.ca/mdprogram/node/622TB physician and which a graduate would be expectedSmoking to handle” UC 2009132 thyroid disorders 133 16