This document provides an overview of internal medicine and discusses key aspects of studying it. It outlines internal medicine subspecialties and the origins and history of medicine. It emphasizes establishing high aims, combining theory with practice, and developing skills through problem-based learning and doctoring skills rotations. The document stresses taking a biopsychosocial approach and using evidence-based medicine to integrate experience with best research evidence for patient care.

1. Introduction of Internal Medicine Professor of Cardiology The Second Affiliated Hospital Sun Yat-sen University Liu Pinming, M.D., Ph.D

2. Overview Concept History Progress in Internal medicine Medical Education The Way of Learning Establishing a high aim Combining theories with Practices Three basics: theories, knowledge, skills How to approach to a patient

3. What is Medicine 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 Internal medicine is the medical specialty concerned with the diagnosis, management and mainly nonsurgical treatment of illnesses Internists/Physicians

4. Internal Medicine Subspecialties Respiratory Medicine Cardiovascular Medicine Endocrinology Gastroenterology & Hepatology Hematology Nephrology Rheumatology Infectious Diseases Oncology Critical Care Medicine Geruatrics

5. The Origins of Medicine Early records on medicine: Ayurvedic medicine in the Indian subcontinent ， ancient Egyptian medicine ， Traditional Chinese medicine, ancient Greek medicine, Islamic medicine As science and technology developed, medicine became more reliant on medications Vaccines: Edward Jenner in 1796, Louis Pasteur in 1889 Arsphenamine/Sulvarsan, Paul Ehilich, in 1908 Insulin: discovered and isolated by Frederick Banting in 1921 Penicillin ： discovered by Alexander Fleming in 1928 Sulfa drug: 1932 Shift from biomedical model to bio-psycho-social medical model Biological factors Broadly environmental factors

6. Why do people get sick? Biomedical Model: Exposure to infectious agents or pathogens Immune response either sufficient or insufficient

7. Why else do people get sick? Previous exposure to virus Health behaviors (sleep, nutrition, etc.) Stress/emotions Social relationships (support, conflict)

8. The Biopsychosocial Model HEALTH BIO PSYCHO SOCIAL *

9. The Biopsychosocial Model HEALTH BIO PSYCHO SOCIAL *

10. The Biopsychosocial Model HEALTH BIO PSYCHO SOCIAL *

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. Shift from Experience-Based Medicine to EBM “ 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.” (Sackett et al., 1996. Evidence based medicine: what it is and what it isn't. BMJ , 312 : 71-2)

13. Principles of EBM Highest quality  Lowest quality  Clinical research aims to apply the best available evidence gained from the scientific method to medical decision making So what is “best evidence”?

14. Evidence B ased M edicine Best practice based on current knowledge Formul ate of the probl e m Find the evidence Critical evaluation of the evidence Practical application Evaluation of the results Evidence based and creative medicine

15. Progress in Internal Medicine With the development of techniques in molecular biology, cellular biology, genetics and immunology, etc at Etiology & Pathogenesis Diagnostic Management & Treatment

16. Timeline of Medicine (Technology) 1895 - medical use of X-rays in medical imaging 1901 - the existence of different human blood types 1903- Willem Einthoven , the invention of String galvanometer ECG 1921 - Frederick Banting , the discover of insulin - the treatment of diabetes 1927 - First vaccine for Tuberculosis 1928 - Alexander Fleming discovers penicillin 1929 - Hans Berger discovers human electroencephalography 1943 - Willem Kolff build the first dialysis machine 1958- an implantable pacemakerinvented at the Karolinska Institute , Sweden 1960 - Invention of Cardiopulmonary resuscitation ( CPR ) 1965 - Frank Pantridge installs the first portable defibrillator 1965 - First commercial ultrasound 1967 - Christiaan Barnard performs first human heart transplant 1971 - Sir Godfrey Hounsfield invents the first commercial CT scanner 1976 - First commercial PET scanner 1877 – First PTCA for coronary artery disease perfromrd by Andreas Gruentzig 1978 - Last fatal case of smallpox 1980 - Raymond Damadian builds first commercial MRI scanner 1981 - First vaccine for Hepatitis B 1992 - First vaccine for Hepatitis A available

17. Internal Medicine Internal Medicine plays a vital role in clinical medicine Not only fundamentals to other clinical medicine subjects, but also closely related to them Mastering Internal Medicine well & laying a solid foundation

18. The Way of Studying Medicine Establishing a high aim Combining theories with Practices Three basics: theories, knowledge, skills Everything you want to know about Internal Medicine-and dare to ask

19. Learning Skills throughout Lectures Diseased-Centered, Learner-Driven Focused on: Etiology & Pathogenesis Pathophysiology Clinical Manifestations: symptoms, signs Laboratory Findings & other Additional testing Diagnosis & Differential Diagnosis Management Principles

20. Problem-based Learning Characteristics: Learning: driven by challenging, open-ended problems Students: in small collaborative groups Teachers: the role as "facilitators" of learning. student-centered instructional strategy in which students collaboratively solve problems and reflect on their experiences

21. Problem-based Learning 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 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. Doctoring Skills Rotation Patient-Centered, Learner-Driven Focused on: History taking and communications skills Physical diagnosis Real patients and patient simulation technology Decision-making skills Life-long learning skills Clinical teaching skills Direct Feedback from Specially Trained Teaching Faculty

23. SUMMARY The key to study internal medicine: Care about what you are learning Try your hardest at all that you do Think and reason through things Learn every day Work as a team Have fun

24. 谢谢！