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  • These fields are subspecialties of internal medicine and thus require an additional fellowship of 2-3 years’ duration in order to practice.
  • Introduce the biomedical model as an extension of the biomedical definition of health given earlier. Modern medicine has looked to two explanations for disease: exposure to infectious agents, i.e. tuberculosis, and changes in physical systems, such as the changes to blood vessels that increase risk for heart disease. Move into thought experiment…..(next slide)
  • Imagine that I release a large quantity of cold virus into the ventilation system of the room, enough to guarantee that everyone in this room is exposed to the virus. Not everyone will develop symptoms – why not? Discuss each of these briefly, in terms of the their effects on the immune system in handling infections.
  • Use multiple languages in a room metaphor to compare biomedical and biopsychosocial models.
  • Use multiple languages in a room metaphor to compare biomedical and biopsychosocial models.
  • Case reports and below are considered clinically relevant but of lower quality that the above layers. So they make good background resources
  • 1 introduction

    1. 1. Introduction of Internal Medicine Professor of Cardiology The Second Affiliated Hospital Sun Yat-sen University Liu Pinming, M.D., Ph.D
    2. 2. Overview <ul><li>Concept </li></ul><ul><li>History </li></ul><ul><li>Progress in Internal medicine </li></ul><ul><li>Medical Education </li></ul><ul><li>The Way of Learning </li></ul><ul><ul><li>Establishing a high aim </li></ul></ul><ul><ul><li>Combining theories with Practices </li></ul></ul><ul><ul><li>Three basics: theories, knowledge, skills </li></ul></ul><ul><li>How to approach to a patient </li></ul>
    3. 3. What is Medicine <ul><li>Medicine is the art and science of healing. It encompasses range of health care practices evolved to maintain and restore health by prevention and treatment of illnesses </li></ul><ul><li>Internal medicine is the medical specialty concerned with the diagnosis, management and mainly nonsurgical treatment of illnesses </li></ul><ul><li>Internists/Physicians </li></ul>
    4. 4. Internal Medicine Subspecialties <ul><li>Respiratory Medicine </li></ul><ul><li>Cardiovascular Medicine </li></ul><ul><li>Endocrinology </li></ul><ul><li>Gastroenterology & Hepatology </li></ul><ul><li>Hematology </li></ul><ul><li>Nephrology </li></ul><ul><li>Rheumatology </li></ul><ul><li>Infectious Diseases </li></ul><ul><li>Oncology </li></ul><ul><li>Critical Care Medicine </li></ul><ul><li>Geruatrics </li></ul>
    5. 5. The Origins of Medicine <ul><li>Early records on medicine: Ayurvedic medicine in the Indian subcontinent , ancient Egyptian medicine , Traditional Chinese medicine, ancient Greek medicine, Islamic medicine </li></ul><ul><li>As science and technology developed, medicine became more reliant on medications </li></ul><ul><ul><li>Vaccines: Edward Jenner in 1796, Louis Pasteur in 1889 </li></ul></ul><ul><ul><li>Arsphenamine/Sulvarsan, Paul Ehilich, in 1908 </li></ul></ul><ul><ul><li>Insulin: discovered and isolated by Frederick Banting in 1921 </li></ul></ul><ul><ul><li>Penicillin : discovered by Alexander Fleming in 1928 </li></ul></ul><ul><ul><li>Sulfa drug: 1932 </li></ul></ul><ul><li>Shift from biomedical model to bio-psycho-social medical model </li></ul><ul><ul><li>Biological factors </li></ul></ul><ul><ul><li>Broadly environmental factors </li></ul></ul>
    6. 6. Why do people get sick? <ul><li>Biomedical Model: </li></ul><ul><li>Exposure to infectious agents or pathogens </li></ul><ul><li>Immune response either sufficient or insufficient </li></ul>
    7. 7. Why else do people get sick? <ul><li>Previous exposure to virus </li></ul><ul><li>Health behaviors (sleep, nutrition, etc.) </li></ul><ul><li>Stress/emotions </li></ul><ul><li>Social relationships (support, conflict) </li></ul>
    8. 8. The Biopsychosocial Model HEALTH BIO PSYCHO SOCIAL *
    9. 9. The Biopsychosocial Model HEALTH BIO PSYCHO SOCIAL *
    10. 10. The Biopsychosocial Model HEALTH BIO PSYCHO SOCIAL *
    11. 11. The Biopsychosocial Model: Why do college students get sick? HEALTH BIO PSYCHO SOCIAL personality emotions social conflict social support immune reaction to virus previous exposure to virus health behaviors
    12. 12. Shift from Experience-Based Medicine to EBM <ul><ul><li>“ E vidence- B ased M edicine is the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients. [In] practice, [this] means integrating individual clinical experience with the best available external evidence from systematic research.” </li></ul></ul><ul><ul><li>(Sackett et al., 1996. Evidence based medicine: what it is and what it isn't. BMJ , 312 : 71-2) </li></ul></ul>
    13. 13. Principles of EBM <ul><li>Highest quality  </li></ul><ul><li>Lowest quality  </li></ul>Clinical research aims to apply the best available evidence gained from the scientific method to medical decision making <ul><li>So what is “best evidence”? </li></ul>
    14. 14. Evidence B ased M edicine <ul><li>Best practice based on current knowledge </li></ul><ul><ul><li>Formul ate of the probl e m </li></ul></ul><ul><ul><li>Find the evidence </li></ul></ul><ul><ul><li>Critical evaluation of the evidence </li></ul></ul><ul><ul><li>Practical application </li></ul></ul><ul><ul><li>Evaluation of the results </li></ul></ul><ul><li>Evidence based and creative medicine </li></ul>
    15. 15. Progress in Internal Medicine With the development of techniques in molecular biology, cellular biology, genetics and immunology, etc at <ul><li>Etiology & Pathogenesis </li></ul><ul><li>Diagnostic </li></ul><ul><li>Management & Treatment </li></ul>
    16. 16. Timeline of Medicine (Technology) <ul><li>1895 - medical use of X-rays in medical imaging </li></ul><ul><li>1901 - the existence of different human blood types </li></ul><ul><li>1903- Willem Einthoven , the invention of String galvanometer ECG </li></ul><ul><li>1921 - Frederick Banting , the discover of insulin - the treatment of diabetes </li></ul><ul><li>1927 - First vaccine for Tuberculosis </li></ul><ul><li>1928 - Alexander Fleming discovers penicillin </li></ul><ul><li>1929 - Hans Berger discovers human electroencephalography </li></ul><ul><li>1943 - Willem Kolff build the first dialysis machine </li></ul><ul><li>1958- an implantable pacemakerinvented at the Karolinska Institute , Sweden </li></ul><ul><li>1960 - Invention of Cardiopulmonary resuscitation ( CPR ) </li></ul><ul><li>1965 - Frank Pantridge installs the first portable defibrillator </li></ul><ul><li>1965 - First commercial ultrasound </li></ul><ul><li>1967 - Christiaan Barnard performs first human heart transplant </li></ul><ul><li>1971 - Sir Godfrey Hounsfield invents the first commercial CT scanner </li></ul><ul><li>1976 - First commercial PET scanner </li></ul><ul><li>1877 – First PTCA for coronary artery disease perfromrd by Andreas Gruentzig </li></ul><ul><li>1978 - Last fatal case of smallpox </li></ul><ul><li>1980 - Raymond Damadian builds first commercial MRI scanner </li></ul><ul><li>1981 - First vaccine for Hepatitis B </li></ul><ul><li>1992 - First vaccine for Hepatitis A available </li></ul>
    17. 17. Internal Medicine <ul><li>Internal Medicine plays a vital role in clinical medicine </li></ul><ul><li>Not only fundamentals to other clinical medicine subjects, but also closely related to them </li></ul><ul><li>Mastering Internal Medicine well & laying a solid foundation </li></ul>
    18. 18. The Way of Studying Medicine <ul><li>Establishing a high aim </li></ul><ul><li>Combining theories </li></ul><ul><li>with Practices </li></ul><ul><li>Three basics: </li></ul><ul><li>theories, knowledge, skills </li></ul>Everything you want to know about Internal Medicine-and dare to ask
    19. 19. Learning Skills throughout Lectures <ul><li>Diseased-Centered, Learner-Driven </li></ul><ul><li>Focused on: </li></ul><ul><li>Etiology & Pathogenesis </li></ul><ul><li>Pathophysiology </li></ul><ul><li>Clinical Manifestations: symptoms, signs </li></ul><ul><li>Laboratory Findings & other Additional testing </li></ul><ul><li>Diagnosis & Differential Diagnosis </li></ul><ul><li>Management Principles </li></ul>
    20. 20. Problem-based Learning <ul><li>Characteristics: </li></ul><ul><li>Learning: driven by challenging, open-ended problems </li></ul><ul><li>Students: in small collaborative groups </li></ul><ul><li>Teachers: the role as &quot;facilitators&quot; of learning. </li></ul>student-centered instructional strategy in which students collaboratively solve problems and reflect on their experiences
    21. 21. Problem-based Learning <ul><li>Advocates of PBL claim it can be used to enhance content knowledge and foster the development of communication, problem-solving, and self-directed learning skill </li></ul>Students are encouraged to take responsibility for their group and organize and direct the learning process with support from a tutor or instructor Problem-based learning is widely used in many medical universities world wide
    22. 22. Doctoring Skills Rotation <ul><li>Patient-Centered, Learner-Driven </li></ul><ul><li>Focused on: </li></ul><ul><li>History taking and communications skills </li></ul><ul><li>Physical diagnosis </li></ul><ul><li>Real patients and patient simulation technology </li></ul><ul><li>Decision-making skills </li></ul><ul><li>Life-long learning skills </li></ul><ul><li>Clinical teaching skills </li></ul><ul><li>Direct Feedback from Specially Trained Teaching Faculty </li></ul>
    23. 23. SUMMARY <ul><li>The key to study internal medicine: </li></ul><ul><ul><li>Care about what you are learning </li></ul></ul><ul><ul><li>Try your hardest at all that you do </li></ul></ul><ul><ul><li>Think and reason through things </li></ul></ul><ul><ul><li>Learn every day </li></ul></ul><ul><ul><li>Work as a team </li></ul></ul><ul><ul><li>Have fun </li></ul></ul>
    24. 24. 谢谢!