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Course Outline: Blood and Immunology

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Course Outline: Blood and Immunology Course Outline: Blood and Immunology DRAFT 14 May 2013 What we need to decide ●What do medical students need to learn about Hematology 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 ●Cell Biology: . Control of cellular proliferation and differentiation, including signal transduction (hematopoiesis); Neoplasia - oncogenes and tumour suppressor genes ●Biochemistry: . Enzymology and protein chemistry of coagulation and complement cascades; laboratory measurement (DNA vs. protein antigen vs. enzyme function) More Basic Sciences ●Immunology … all of it ●Genetics . clinical genetics of bleeding disorders, hemoglobinopathies, and hemochromatosis; issues of screening, prenatal testing, counseling, DNA diagnostic testing to be addressed; Gene therapy (hemophilia, SCIDS) ●Physiology – oxygen transport ●Pharmacology . Anticoagulants as models of targeted drugs, issues about monitoring; immunosuppressants Module 0 ●Inflammation… Module 1 Normal biology and health ●Laboratory analysis of Blood and immune system ●Transport function . Hematopoiesis: cell biology and biochemistry . Iron and heme and B12/folate metabolism . Oxygen transport: biochem/physiol . Blood groups and sero-compatibility ●Hemostatic function ●Defense function . Inflammation . Innate immunity: phagocytes / 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 . Anemias: marrow failure, hemolytic, nutritional . Transfusion practice ●Hemostasis . 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 . Vaccines . 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 . Anemia of chronic disease in endocarditis . Coagulopathy and thrombocytopenia in end-stage liver disease . Hematological disorders in pregnancy Clinical Reasoning ●More opportunity for multidisciplinary cases and examples that the students need to work through in steps Clinical Skills ●Examination of lymph nodes ●Examination of spleen & liver ●Examination of peripheral blood smear Integration with other subjects ●GI: iron deficiency ●CV: thrombosis 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: Leukemia/lymphoma/myeloma ●Med. Humanities: palliative & end of life care in heme malignancies; Other special topics ●Health economics: hemophilia care; cancer drugs; aspirin vs imatinib ●Preventive medicine: screening testing e.g. hemochromatosis ●Quality assurance / safety / health systems: transfusion medicine CCOMPOSITE CLINICAL PRESENTATIONS CP4* UGME DRAFT V6 SYMPTOMS/ SIGNS 34 hemoptysis 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 hemoglobin disorders 101 arthritis 4 Anxiety 38 incontinence 70 calcium/phosphate/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 Diabetes 8 Bleeding 42 lymphadenopathy 74 CXR abnormalities 106 Drug 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 hypertension 13 cyanosis 47 pruritus 79 platelet disorders 111 infertility 14 delirium 48 red eye 80 pulmonary function tests 112 kidney disease-chronic 15 dementia 49 paralysis 81 sodium abnormalities 113 lung disease-chronic • Symptoms or Signs 16 diarrhea- acute & chronic 50 pelvic pain/mass 82 urinalysis abnormalities 114 malnutrition 17 diplopia 51 seizures HEALTH FACTORS 115 menses/menopause • Lab abnormalities 18 dysphagia 52 skin 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 edema 56• sore States throat of Health87 WHO Determinants of Health 120 palliative care 23 extremity pain-acute & chronic 57 syncope 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 psychosis 26 fatigue 60 tinnitus 91 educational level 124 suicidal behavior 27 foot ulcers 61 vomiting 92 elderly/frail 125 shock/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 food and water 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 Venous thrombosis 16 .
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