CC BY
0«шшэшшм-шгмаи тш / pedagogical sciences
25
УДК : 378.147.016:616.1/.4-07
Каньовська Л.В., Ляхович О.Д.
Буковинський державний медичний унгверситет DOI: 10.24412/2520-6990-2023-12171-25-29 ОСОБЛИВОСТ1 ВИКЛАДАННЯ ЕЛЕКТИВНОГО КУРСУ «КЛШ1КО-ЛАБОРАТОРНА Д1АГНОСТИКА В ПРАКТИЦ1 ВНУТР1ШНЬО1 МЕДИЦИНИ»
Kaniovska L. V., Liakhovych O.D.
Bukovinian State Medical University
FEATURES OF TEACHING THE ELECTIVE COURSE "CLINICAL AND LABORATORY DIAGNOSTICS IN THE PRACTICE OF INTERNAL MEDICINE"
Анотацш.
Елективний курс «КлШко-лабораторна дгагностика в практицi внутршньо'1 медицини» включае в себе основнi принципи ттерпретацИ результатiв клiнiко-лабораторних до^джень на основi базових те-оретичних знань та практичнихумiнь отриманих студентами при вивченнi окремих розджв внутршньо'1 медицини. Основними завданнями вивчення дисциплiни «КлШко-лабораторна дiагностика в практиц вну-трШньог медицини» е: обтрунтовування вибору лабораторних та iнструментальних до^джень для пiд-твердження клтчного дiагнозу, трактування результатiв.
Abstract.
The elective course "Clinical and laboratory diagnostics in the practice of internal medicine" includes the basic principles of interpreting the results of clinical and laboratory studies grounded on basic theoretical knowledge and practical skills acquired by students when studying individual sections of internal medicine. The main task of studying the discipline "Clinical-laboratory diagnostics in the practice of internal medicine" is to justify the choice of laboratory and instrumental studies to confirm the clinical diagnosis and interpretation of the results.
Ключовi слова: елективний курс, навчання, клШко- лабораторна дiагностика, студенти, мотивацiя.
Key words: elective course, training, clinical and laboratory diagnostics, students, motivation.
Main part. The transformation of the healthcare system affects everyone because its goal is to provide the citizens of Ukraine with equal access to quality medical services that meet the needs of the population. For instance, increasing the level and quality of life of the people based on increasing accessibility, improving the quality and safety of medical care, productive employment of personnel working in the field of health care, as well as increasing their level of social security, development and optimization of the social support system. All of the above leads to the fact that clinical practice and the training of students need significant changes [10].
A wide range of various pathological conditions, features of the course, and individual manifestations of the disease complicate the diagnostic process and require objective research methods, the most important role of which is played by clinical laboratory diagnostics. It is difficult to imagine an effective diagnostic and therapeutic process without the ability to interpret laboratory parameters. But the number of problems practicing doctors face after receiving the results of laboratory tests is increasing. Graduates of medical institutions quite often don't have enough information about the specificity and sensitivity of laboratory diagnostic methods, which are becoming more technologically advanced, so the need for highly qualified specialists who know how to navigate complex diagnostic situations and meet modern requirements remains high [15].
Making clinical decisions regarding the examination and subsequent tactics for patient treatment nowadays can only be done by considering the laboratory examination data. More than 70% of such decisions are made by doctors based on the results of diagnostics of laboratory medicine, which indicates its importance in modern realities. At the same time, the number, type, methods, and complexity of laboratory research have grown significantly over the past 50 years. Therefore, adequately used results of laboratory research by doctors contribute to optimizing the use of medical resources and reducing short-, medium- and long-term costs of medical care [1].
In order to eliminate deficiencies in knowledge, the elective course "Clinical and laboratory diagnostics in the practice of internal medicine" was introduced. Clinical laboratory diagnostics aims to provide scientifically based, reliable, maximally fast and least expensive laboratory support for the verification of pathological conditions. Nowadays, laboratory diagnostics is becoming increasingly important in practice and requires the training of relevant highly qualified specialists [2-6].
In addition, laboratory examination results allow medical workers to objectively assess the risk of the disease at an early stage, choose prophylactic or less invasive therapy, control appropriate treatment, and determine the course of disease progression. Nowadays, laboratory diagnostics has become not only
26
PEDAGOGICAL SCIENCES / «<g©LL©(MUM~J©U©MaL» #12(1713, 2©23
an independent field of medical science, but also an important element of evidence-based medicine [7, 9].
The syllabus of the elective course is structured into 1 module, which includes 1 structural module (90 hours) and topics in accordance with the requirements of the "Recommendations on the development of curricula of educational disciplines" (order of the Ministry of Health of Ukraine dated 12.10.2004 No. 492), among of which 20 hours are provided for practical classes and 70 hours are allocated for independent work [8, 10].
The elective course "Clinical and Laboratory Diagnostics in the Practice of Internal Medicine" includes the basic principles of interpreting the results of clinical and laboratory tests based on the basic theoretical knowledge and practical skills students acquired in studying certain internal medicine sections. The main task of learning "Clinical and Laboratory Diagnostics in the Practice of Internal Medicine" is to justify the choice of laboratory and instrumental studies to confirm the clinical diagnosis and interpretation of the results [11-14].
The final goals of the educational discipline are established based on the academic and qualification characteristics (AQC) and the educational and professional program (EPP) of training a doctor by specialty, which are the basis for building the content of the academic discipline:
1. Formation of a complete system of theoretical foundations of clinical and laboratory diagnostics in the pathology of internal organs.
2. The ability to draw up a plan for clinical and laboratory diagnostics considering the patient's age, sex, stage, phase, course, degree of severity of the disease, the presence of complications and concomitant diseases.
3. Mastering practical techniques and methods of instrumental examination of patients.
4. Mastering the semiotics of clinical and laboratory studies of widespread diseases of internal organs.
As a result of studying this discipline, the student should know:
- modern terminology of clinical and laboratory diagnostics in the pathology of internal organs;
- protocols for managing patients with diseases of internal organs and a list of necessary examinations for various pathologies in patients of various ages with a comorbid course;
- manage to interpret the results of the patient's examination to justify the choice of rational pharmacotherapy;
Be able to:
- use the capabilities of laboratory diagnostics in a complex of diagnostic and treatment procedures;
- determine the diagnostic capabilities of a modern laboratory;
- interpret examination data in a comprehensive examination of the patient;
- prescribe a patient examination plan considerinh certain pathologies and comorbid course.
According to the requirements of the discipline standard, students acquire the following competencies:
- integral:
- the ability to solve typical and complex specialized tasks and practical problems in the learning process, which involves conducting research and/or implementing innovations and is characterized by the complexity and uncertainty of conditions and requirements.
- general:
GC1 Ability to abstract thinking, analysis and synthesis, ability to learn and be modernly trained
GC2 Ability to apply knowledge in practical situations
GC3 Knowledge and understanding of the subject area and understanding of professional activity
GC4 Ability to adapt and act in a new situation
GC5 Ability to make a reasoned decision; work in a team; interpersonal skills
GC6 Ability to communicate in the state language both orally and in writing; the ability to communicate in a foreign language
GC7 Skills in using information and communication technologies
GC8 Determination and perseverance in terms of tasks and responsibilities
GC9 The ability to act socially responsibly and consciously
GC10 The desire to preserve the environment
(GC - general competency) - special (professional, subject):
SC1 Skills of interviewing and clinical examination of the patient
SC2 Ability to determine the necessary list of laboratory and instrumental studies and evaluate their results
SC3 Ability to establish a preliminary and clinical diagnosis of the disease
SC4 Ability to determine the principles and nature of treatment of diseases
SC5 Skills of performing medical manipulations
SC6 The ability to determine the management tactics of persons subject to dispensary supervision
SC7 Ability to maintain medical records
SC8 The ability to carry out activities related to the organization and integration of the provision of medical care to the population and the marketing of medical services
(SC - special competency)
«COyyOMUM-JMTMaL» 2023 / PEDAGOGICAL SCIENCES
27
Clinical and laboratory diagnostics in the practice of internal medicine as a subject has as its goal the training of students who would possess a sufficient amount of theoretical knowledge and practical skills to carry out work to ensure the most rational drug therapy for a specific patient, identify early clinical signs and correct the negative impact of drugs on the patient's body, the methodology of the correct interpretation of the dynamics of the results of clinical and laboratory studies under the influence of various medications.
In the process of study, students must:
- form systematic knowledge about modern laboratory methods of research and the possibilities of their use in the practical activity of a doctor;
- learn the general principles of interpretation of the results of the clinical and laboratory examination of the patient;
- learn the basic principles and regularities of changes in clinical and laboratory indices under the influence of various drugs to control the effect of drugs in order to increase the effectiveness and safety of drug therapy;
- acquire the basic skills of conducting the most common clinical and laboratory analyzes of patients;
- get acquainted with the main clinical and laboratory signs of the most common diseases in the clinical course of internal diseases;
- acquire skills in working with modern diagnostic equipment;
- acquiring the skills of analysis and interpretation of the results of clinical and laboratory studies of the patient;
- study of typical changes in clinical and laboratory analyzes under the influence of medicines, which may indicate the development of side effects of drugs;
- master the principles of using data from clinical and laboratory studies in order to assess the effectiveness and safety of the use of medicinal products.
Integrative final program learning outcomes, the formation of which is facilitated by the educational discipline:
- to carry out professional activities in social interaction based on humanistic and ethical principles; to identify future professional training as socially significant for human health;
- to apply knowledge of general and professional disciplines in professional activity;
- to comply with the norms of the sanitary and hygienic regime and the requirements of safety equipment during professional activities;
-to use the results of independent search, analysis and synthesis of information from various sources to solve typical tasks of professional activity;
- to argue information for decision-making, bear responsibility for them in standard and non-standard professional situations; adhere to the principles of deontology and ethics in professional activity;
- to carry out professional communication in the modern Ukrainian language, use oral communication skills in a foreign language when analyzing specialized
texts and translating foreign language information sources;
- to observe the norms of communication in professional interaction with colleagues, management, work effectively in a team;
- to analyze information obtained from scientific research, generalize, systematize and use it in professional activities.
For the successful provision of the educational process, the department's employees have prepared the necessary materials for the methodical provision of classes. Methodical instructions are created for each practical lesson, considering the essential points that ensure a pedagogically competent organization of the educational process at all stages. A high level of student motivation for the topic is an important condition for perception, memorization, understanding of educational material and its further use in professional situations. Therefore, the teacher must have convincing data that testify to the importance of the topic, its role, and place in future professional activity. Each methodical development begins with the actuality of the topic. An important methodical point is the setting of educational goals of the lesson, which should be inextricably linked with positive motivation.
The syllabus provides for the study of the following topics:
1. Clinical and laboratory hematology
2. Clinical and laboratory cardiology and rheumatology
3. Clinical and laboratory gastroenterology
4. Clinical and laboratory pulmonology.
Assessment of discipline
The results are evaluated on a two-point scale: "passed", "failed".
At the last thematic training session in the discipline after the discussion of the topic, the teacher of the group announces the sum of points scored by each student based on the results of the current control and the completion of individual tasks (if such tasks are available).
A student receives a grade of "passed" if he has completed all types of work provided by the syllabus for the discipline, attended all training sessions -lectures, practical sessions, determined by the thematic plan for the discipline (if there are gaps - completed them in a timely manner), scored the total number of points when studying an academic discipline, not less than 120.
A student receives a grade of "failed" if he has unworked absences from educational classes (practical, seminar and lectures) and the number of points for the current control is less than the minimum.
The grades "passed" and "failed" are entered by the teacher into the grade sheet (Form No. H-5.03-3), the Student's Individual Academic Plan, the Student Attendance and Progress Record, and the Gradebook.
Forms of control and the evaluation system are carried out in accordance with the requirements of the discipline program and the Instruction on the
diagnostics in diagnostics in
diagnostics in
diagnostics in
28
PEDAGOGICAL SCIENCES / «ШУУЮШШ-ЛЭУГМак» #ЩШ)), 2©H
evaluation system of students' educational activities under the credit-module system of the organization of the educational process, approved by the Ministry of Health of Ukraine (2005).
The maximum number of points assigned to students for mastering module (credit) is 200, including 120 points (60%) for the current educational activity, 80 points (40%) based on the results of the final module control.
Current control is carried out in accordance with specific goals in each practical session. For control, it is recommended to use the following means of diagnosing the level of students' training: computer tests, situational tasks of the III level, control of the implementation of practical skills with further interpretation of the obtained data: analysis of appointment sheets, selection of the optimal means in a specific situation.
Evaluation of current educational activities:
The number of points for one topic within the module is the same and is determined by the number of topics in the module.
The grade in the discipline "Clinical-laboratory diagnostics in the practice of internal medicine" is rating and is determined taking into account the current educational activity of the student and the assessment of his mastery of the modules provided by the program. The current evaluation of students on the relevant topics is carried out according to the traditional 4-point system ("excellent", "good", "satisfactory", "unsatisfactory") with subsequent conversion into a multi-point (rating) scale.
The grade "excellent" is given in the case when the student knows the content of the lesson in full, illustrating the answers with various examples; gives exhaustively accurate and clear answers without any leading questions; teaches the material without errors and inaccuracies; freely solves problems and performs practical tasks of varying degrees of complexity.
The grade "good" is given on the condition that the student knows the content of the lesson and understands it well, answers the questions correctly, consistently and systematically, but they are not exhaustive, although the student answers additional questions without mistakes; solves all problems and performs practical tasks. experiencing difficulties only in the most challenging cases.
The grade "satisfactory" is given to the student based on knowledge of the entire content of the lesson and at a satisfactory level of understanding. The student is able to solve modified (simplified) tasks with the help of leading questions; solves problems and performs practical skills, experiencing difficulties in simple cases; is not able to give a systematic answer on his own, but answers directly to directly asked questions correctly.
The grade "unsatisfactory" is given in cases where the student's knowledge and skills do not meet the requirements for a "satisfactory" grade.
Evaluation of independent work:
Assessment of independent work of students, which is provided along with classroom work, is carried out during the current control of the topic in the
corresponding classroom lesson. Assessment of individual independent work of students is controlled on the final module control.
Students' individual independent work includes writing a pharmacotherapy scheme with justification for each appointment and filling out a prescription sheet.
Independent work is submitted on the last day of the module and is evaluated separately.
Recalculation of the students' current performance when studying the module "Clinical and laboratory diagnostics in the practice of internal medicine
The grade "excellent" is 50 points
The grade "good" is 40 points
The grade "satisfactory" is 30 points
The rating "unsatisfactory" is 0 points.
Thus, conducting the elective course "Clinical and laboratory diagnostics in the practice of internal medicine" is necessary and logical for the training of students. The student develops the basics of clinical thinking: he must master the ability to interview and examine a patient, evaluate laboratory and instrumental examination data, integrate his knowledge about a person, his organs and systems, carry out differential diagnoses of diseases and, acting according to a certain algorithm, make a reasoned decision.
References
1. Михайловська НС, Лкова ОО. Основи кль ншо-лабораторно! дiагностики захворювань внут-ршшх оргатв. Запорiжжя; 2017. 293 с.
2. Virchow JC. Diagnostic challenges of adult asthma. Curr Opin Pulm Med. 2016;22(1):38-45. doi: 10.1097/mcp.0000000000000232
3. Денисюк В1, Денисюк ОВ. Пневмони: су-част стандарта дiагностики та лшування. Украш-ський медичний часопис. 2010;3:75-80.
4. Фещенко Ю1, Яшина ЛО, Дзюблик ОЯ. Хро-тчне обструктивне захворювання легень: етюло-пя, патогенез, класифшацш, дiагностика, терапiя. Украшський пульмонолопчний журнал. 2013;3:7-12.
5. Кривенко В1, Федорова ОП, Непрядюна 1В, Пахомова СП, Колесник МЮ, Качан 1С, та in. Ос-новт ревматичт захворювання в практищ лжаря загально! практики - амейно! медицини. Запорь жжя; 2020. 142 с.
6. Visseren FLJ, Mach F, Smulders YM, Carballo D, Koskinas KC, Bäck M, et al. 2021 ESC Guidelines on cardiovascular disease prevention in clinical practice. Eur Heart J. 2021;42(34):3227-3337. doi: 10.1093/eurheartj/ehab484
7. Дзяк ГВ, Бшьченко ОВ. Тактика сшейного лшаря у веденш хворих з найбшьш поширеними се-рцево-судинними захворюваннями. Ки!в; 2014. 116с.
8. Ршко МВ, Прилипко ЛБ, Кедик АВ, Лазур ЯВ. Дiагностичнi критерп ревматичних захворювань. Ужгород; 2022. 40 с.
9. Катеренчук 1П. Клшчна оцшка, дiагности-чне та прогностичне значення результата лабора-торних дослвджень. Кшв: Медкнига; 2019. Частина 3, Нефролопя; 168 с.
«шшэшшм-шгмаи зшшя тш / реблооогсль ясшмсея
29
10. Курята ОВ, Карапетян КГ, Фiлiппова ОЮ, Бардаченко Н1. Аналiз досввду використання прото-колш надання медично! допомоги у навчальному процесi при викладаннi внутршньо! медицини у студент 5 курсу медичного факультету. Медична освiта. 2015;3:100-104. ао1: 10.11603/ше.у013.3606
11. Вишнивецький II, Холопов ЛС, Баташова-Галинська ВО. Клшчна характеристика дихально! та серцево-судинно! систем при поеднанш хрошч-ного обструктивного захворювання легень i серце-во! недостатностi. Запорiзький медичний журнал. 2017;19(3):250-256. ао1: 10.14739/23101210.2017.3.100572
12. Колесник ЮМ, Авраменко МО, Моргун-цова СА, Рижов ОА. Досвщ впровадження онлайн-
технологш у систему подготовки фах1вц1в галузi знань 22 «Охорона здоров'я». Медична освiта. 2018;2:69-73. ао1: 10.11603/ше.2414-
5998.2018.2.8962
13. Авдеев ОВ. Використання дистанцшно! си-стеми MOODLE для ошгашзацп навчального про-цесу у вищш школi. Медична освгга. 2015;1:6-8. ао1: 10.11603/ше.у0И.4156
14. Приступа ЛН, редактор. Невiдкладнi стани в клшщ внутрiшнiх хвороб. Суми; 2017. Частина 2, Пульмонология, нефрология, алерголот, гематология та гастроентеролот; 219 с.
15. Свшцщький АС. Методи дiагностики в кль нiцi внутршньо! медицини. Ки!в: Медицина; 2019. 1008 с.
