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Curricular alternative for the English syllabus for the South African students.

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Curricular alternative for the English syllabus for the South African students.

 

Authors:

  • Rafael Garcia Rodríguez, EFL Professor, MSc., UCM SS
  • Esperanza Alfonso Almeda, EFL Professor, MSc., UCM SS
  • Dora Aguila Morejón, EFL Professor, UCMH 
  • Sarah Lón López, EFL Professor, UCMH
  • Carlos M. Lleonart Cruz, EFL Professor, MSc., UCMH

2013

 

INTRODUCTION

 
The curricular alternative in the English syllabus is intended for South African students who are enrolled at Sancti Spíritus Medical University and in the course of years the staffs have noticed that their command of English in their professional performance is not the expected one to work in their country. South African medical authorities have also claimed about their English, the students still have difficulties in the English language as to negative transfers, spelling mistakes, fluency and accuracy in this language and, in general, their oral language is not enough to work as demanded by the South African Medical Council.  South African students speak more than one language; in most of the cases English is not well spoken and understood as the rest of the languages they speak. Sometimes the term native language is used to indicate a language that a person is as proficient in as a native individual of that language "base country", or as proficient as the average person who speaks no other language but that language. Sometimes the term mother tongue or mother language is used for the language that a person learned as a child at home (usually from their parents). Children growing up in bilingual homes can, according to this definition, have more than one mother tongue or native language (Chomsky, 2007). This is the case of the South African students who at home can learn different languages, being the other languages but English preferred by most of them. Most of our students have two or more native languages, thus being a native bilingual or indeed multilingual. The order in which these languages are learned is not necessarily the order of proficiency.  
The following is a proposal of contents and evaluation to be covered by the professors of English of the university and doctors who know some English from the different facilities South African students pass by in their curricular formation. 
 

MAIN BODY

 

3ER YEAR MEDICINE

 
Internal Medicine rotation
 
Main topics and procedures:
 
I. Cardiovascular system.
Rh fever and heart diseases.  Infective endocarditis. Cor pulmonale. EGC ultrasound. (Over load of the right part of the heart due to pulmonary hypertension)  Cardiomyopathy. (Ultrasound). Pericardial effusion. (Pericardial drainage) Angina pectoris and myocardial disorder (Read EGC) Hypertension and management. (BP measure) Pulmonary edema and ADRS. (Fundoscopy) Cardiac Congestive Failure CCF, Physiopathology and management. Arrhythmias.
 
II. Gastroenterology
Peptic ulcer diagnosis and management (Gastroscopy) Acute and chronic pancreatitis. Hepatitis, emphasis on hepatitis B. Jaundice, cause. (Liver ultrasound). Acute liver failure. Compensated chronic liver insufficiency. (Liver biopsy) Ascitis, cause. Malabsortion, (Paraceirosis)  Chronic inflammatory bowel disease. Gastrointestinal Bleeding (GIT)
 
III. Nephrology
Nephrotic symdrome. Glomerulonephritis (insertion of catheter) Acute renal failure dialysis (Peritoneal)(Urine stick testing). Chronic renal failure. (US of kidneys)
 
IV. Clinical haematology
Anaemias and management. (Bone marrow aspirations)Haemoglobinopathies.
Multiple myeloma, (Bone biopsy, X ray findings) Lymphomas Hodgkin and non-Hodgkin (Lymphonode biopsy) Leukemias. Classification. Diagnosis and management. Bleeding diathesis and approach. Hypersplenism and anemia of chronic disorders. Hemolytic anemias. Aplastic anemia. Haemophilias.
 
V. Central nervous system disorders.
Approach to patient in coma. (CT scan, lumbar puncture) Epilepsies and convulsive disorders. Parkinson’s disease and other extrapyramidal disorders. Multiple sclerosis and other demyelinating diseases. Myasthenia gravis and other motor and plate disorders. Ataxia, vertigo and dizziness. Meningitis viral, bacterial and cryotoccocal. Headaches. Cerebella disorders. Motor neuron disease. Paraplegia and quadriplegia.
 
VI. Endocrinology and metabolic disorders.  
Diabetes mellitus. Diagnosis, treatment and complications. Hypoglycemia, acute or recurrent, pathogenesis and management. Hypo and hyperthyroidism. Hypo and hyper adrenalism. Growth hormone abnormalities. Hyperparathyroidism and other hypercalcemic states. Panhypopituitarism. Gout and hyperurecemic states.
9. Obesity and hyperlipidemia. Porphiria. (Porphiria accumulation)
 
VII. Infections and infestations.
1Typhoid fever and cholera. Epidemiology, clinical manifestations and preventive measures.  Brucellosis. Tetanus.  Whooping cough.  Leptospirosis and borreliosis (transmitted by tick, garrapata). Rickettsial infection (provoca raquitismo), legionella and mycoplasma infections.  AIDS, manifestations and prevention.  Septicemia and septic shock.  Rabies.  Herpes virus infections, CMG virus, Coxsackie and enterovirus.   Food poisoning.  Viral hemorrhagic fevers in Africa. Malaria.  Intestinal amebiasis and amoebic liver abscess. Trypanosomiasis (dream disease) and toxoplasmosis. Schistosomiasis. Nematodes infestations. Actinomicosis and histoplasmosis. 
 
VIII. Connective tissue disorders. 
Systenmic lupus erithematosus. Rheumatoid arthritis. Sjogrens. Psoriasis. Dermatomyositis and polymyositis.  
 

Evaluation System

 Final examination
Class works
On – going assessment
In – service training
. Bedside discussion
. Ward rounds 
. Practical demonstrations
. Seminars
. Grand rounds
. Problem solving exercises
. Case presentations
. Journal clubs
 
(Attendance and attitudes will be taken into account for final marks)
 

Radiology  rotation.

 
Main topics and procedures:
 
Medical students must be taught various imaging modalities and the use of different techniques to provide images of human internal organs and to demonstrate pathological lesions within them.
1. Radiological anatomy of the chest including axial with CT correlation.
2. Radiological anatomy of the head and neck, including axial anatomy of the brain with CT correlation. 
3. Upper limbs and shoulder, lower limbs and hips. 
4. The abdomen and pelvis, including the axial anatomy of the abdomen with CT correlation. 
5. The esophagus, the stomach, duodenum, large and small bowel, urinary tract, biliary tract, reproductive system.
6. The arteries and veins. 
 
Techniques and imaging modalities:
 
X rays techniques
Computed tomography (CT)
Ultra sound (US)
Magnetic resonance imaging (MRI)
Contrasted media (CM)
 

Evaluation System

 Final examination
Class works
On – going assessment
In – service training
. Bedside discussion
. Ward rounds 
. Practical demonstrations
. Seminars
. Grand rounds
. Problem solving exercises
. Case presentations
. Journal clubs
 
(Attendance and attitudes will be taken into account for final marks)
 

Pharmacology rotation

 
Main topics and procedures:
 
1. Basic principles of pharmacology and therapeutics. Pharmacodynamics. Pharmacokinetics. Drug metabolism and disposition. Drug interaction. Drug evaluation and regulation.  Drugs acting on the autonomic nervous system. Cholinergic receptor stimulants. Cholinergic receptor blockers. Adrenergic receptor stimulants. Adrenators  receptor blockers. Autocopids. Histamin, serotonin, ergot alkaloids. Vasoactive polypeptides. Eicosanoids.
 
2. Immunopharmacology. Immunosuppressants. Immunostimulants. Active-passive immunization. Immunologuical reactions to grugs and drug allergy. Non- steroidal and anti-inflammatory drugs (NSAID´s). Non-narcotic analgesics and drugs to gout. Antimicrobial and cancer chemotherapy. Principles of antimicrobial drug action. Principles of antimicrobial drug. Betalactams.Sulphonamides and trimethoprim. Aminoglycecosides. Other antibiotics. Anti mycobacterial agents. Antifungal agents. Antiviral agents. Antiseptics and disinfectants.Principles of antiparasitic chemotherapy. Antiprotozoal drugs. Antihelmintic drugs. Cancer chemotherapy. 
 
3.  Cardiovascular drugs. Drugs for the treatment of systemic hypertension. Antianginal agents. Drugs for CCF congestive cardiac failure. Antirrhythmic agents. Drugs used for coagulation disorders. Pharmacology of the respiratory system, Antilussives, expectorants, nasal descongestants. Drugs used in asthma. Drugs for seasonal allergic rhinitis (hay fever). Gastrointestinal pharmacology. Drugs used in pectic ulcer disease (PUD) . Drugs foe reflex oesophagitis and Zollinger – Ellison symdrome. Laxatives. Purgatives. Antiemetics Cytoprotective agents.  Renal pharmacology. Diuretic agents. 
 
4.  Pharmacology of the nervous system. Opioid analgesics, general and local anaesthetic agents. Sedative – hypnotics for drugs of abuse. Anticonvulsants. Skeletal muscle relaxants, drugs for movements disorders. Antipsychotic agents and lithium. Antidepressants.  Endocrine pharmacology. Hypothalamic and pituitary hormones. Thyroid hormones and antithyroid drugs. Corticosteroids and antagonists. Gonadal hormones and inhibitors/antagonists. Pancreatic hormones and antidiabetic agents, Bone and mineral homeostasis.  Toxicology. General principles of toxicology. Environmental and occupational toxicology. Household poisoning. Drug poisoning. 
 
5. Ethnopharmacology. Drugs from natural sopuerces. Traditional remedies (particularly herbal remedies).  Practical aspects. Risk-benefit assessment. Compliance. Drug monitoring. Drug dependance. 
 
Evaluation System
 
Final examination
Class works
On – going assessment
In – service training
. Seminars
. Problem solving exercises
. Journal clubs
 
(Attendance and attitudes will be taken into account for final marks)
 

4TH YEAR MEDICNE

 
Gynecology and Obstetrics rotation.
 
Main topics:
 
Topic I. As an introduction.
1. Obstetrical History Taking. OHT
- Presenting complaints if any history thereof
- Gravida
- Para gravida
- LNMP and menstrual history, contraceptive history
- Present Obstetric History: common symptoms, fetal movements, complications.
- POH: pregnancy, mode of delivery, outcome, complications.
- PGH
- Present and Past Medical and Surgical History.
- FH of HPN, Diabetes, twins.
- Dietary History.
- SH
- Drug History.
2. Obstetric examination of the antenatal patient.
- Symphysio-fundal height (SFH)
- The four maneuvers of Leopold
   . Fundal palpation
   . Lateral palpation
   . Pawlik grip
   . Pelvic palpation
- Fetal heart sounds.
 
3. Gynecological history taking.
- Complaints and history of presenting complaints.
- Parity
- Menstrual history: menarche, cycles, menstrual milimina.
- Contraceptive history.
- Sexual history.
- PGH
- POH
- Past Medical and Surgical History.
- FH: infertility, cancers, (ovary, breast, bowels)
- SH
 
4. Examination of the gynecological patient.
- Abdominal examination.
- Speculum examination and Pop smear-taking.
- Bimanual pelvic examination.
- Recto-vaginal examination.
 
Topic II. Normal pregnancy
 
1. Diagnosis of pregnancy.
- Clinical methods: history and physical examination.
- Lab methods: immunological and radioimmunoassay.
- Special methods: US examination.
 
2. Physiological adaptations in pregnancy.
- The placenta and its functions.
- Hormonal and metabolic changes.
- Hematological changes.
- CV and hematological changes.
- Renal changes.
- Pulmonary, GIT and other changes.
 
3. Antenatal care.
- Pre-conceptional care.
- Initiation and antenatal care.
- History and Physical Examination at the first visit.
- Routine antenatal investigations: Blood Groud, Rh factor, Hb, urinalysis, and ¿HIV.
- Maternal monitoring: history and exam, weight, BP.
- Fetal surveillance: fetal movements, fetal heart sounds, symphysio-fundal height.
- Identification of risk of pregnancy: maternal age, stature, marital status, socio-economic status Parity.
- Obstetric conditions in present pregnancy:  HTN, PROM, Multiple pregnancy, abnormal presentation or lie.
-  POH: operative delivery, preterm delivery, blood transfusion required.
- Medical conditions: cardiac disease, DM, Chronic hypertension, anemia, Respiratory diseases (TB, asthma),STD´s HIV.
 
4. Normal labor and true labor.
- Definition and signs and symptoms of labor.
- Mechanism of normal labor.
- Obstetric exam in labor: S-F height, lie, presentation, position, attitude, descent.
- Evaluation of cervix: effacement, application to presenting part, dilatation, membranes and liquor.
- Presenting part: station, moulding, and caput.
- Pelvic assessment in primigravida: history of previous c/s assisted delivery.
- Stages of labor: fist, second, third and fourth stages of labour.
- Evaluation of normal progress of labor: use the partogram.
- Assessment of fetal well-being: fetal heart rate, moulding/caput, meconium.
 
5. The newborn baby.
- Apgar scoring.
- Examination of the newborn: sex, weight, gestational age, abnormalities.
- Physiological changes at birth.
 
6. The puerperium.
- Involution of uterus and other organs.
- Lochia
- Lactation or breastfeeding
 
Topic III. Abnormal pregnancy.
1. Spontaneous abortion, types, diagnosis and management.
- Threatened abortion.
- Inevitable abortion.
- Incomplete abortion.
- Missed abortion.
- Septic abortion.
- Recurrent abortion, habitual abortion.
 
2. Molar pregnancy, diagnosis, complications and management.
 
3. Ectopic pregnancy, types, complications and management.
- Acute rupture ectopic.
- Unruptured tubal ectopic.
- Leaking ectopic.
- Abdominal pregnancy.
 
4. Ante partum hemorrhage.
- Placenta previa: clinical features, diagnosis, management and complications. 
- Abruptio placentae: clinical features, diagnosis, management and complications. 
- Vasa previa.
- Local causes of bleeding.
- Unclassified
 
5. Multiple pregnancies.
- Monozigotic twin and placentation.
- Dizigotic twin.
- Placentations.
 
6. Abnormal presentations and abnormal lie.
- Breech presentation.
- Transverse lie.
- Oblique lie.
- Unstable lie.
 
7. Polyhydramnos and oligohydramnios.
 
8. Premature rupture of membrane and preterm labor.
- Causes, complications, diagnosis and management.
 
9. Intrauterine growth retardation and intrauterine fetal death.
- Causes, diagnosis and management.
 
10. Hypertensive disorders in pregnancy.
- Criteria, classification: Pregnancy-induced HT, gestational HT, pre-eclampsia, eclampsia, chronic HT, essential HT, renal HT, coartation of aorta.
- Complications: pulmonary edema, abruption, prematurity.
- Management: antenatal, intrapartum, postpartum.
- Prognosis
 
Topic IV. Abnormal Labour and delivery.
1. Prolonged labor and obstructed labor.
- Uterine inertia, cervical dystocia.
- Abnormal fetal presentation: breech, face, brow, shoulder presentation.
- Abnormal position: occipito-posterior position and mento-posterior position.
- Abnormal lie: transverse and oblique.
- Cephalopelvic disproportion, contracted baby, big baby, macrosomia, congenital anomalies, hydrocephalus, other congenital tumors.
 
2. Ruptured uterus.
- Spontaneous rupture, obstructive rupture previous scar on uterus, previous caesarian section scars, lower segment scars, classical scar.
 
3. Cord accidents. 
- Cord prolapse and cord presentation
 
4. Fetal distress.
- Placental insufficiency. Cord accidents and cord compression. Obstructed labor.
 
5. Premature labor. 
- Spontaneous and induced.
 
6. Operative obstetrics. 
- Caesarian section. Elective and emergency c/s. Assisted vaginal delivery. Vacuum extraction. Forceps  delivery. Assisted breech delivery. Manual removal of placenta for retained placenta.
 
7. Postpartum hemorrhages. 
- Uterine atomy. Retained placenta or placental parts. Infections at 24 hours.
 
8. Puerperal Pyrexia. 
- Puerperal sepsis. Endometritis.
 
Topic V. Other common disorders in pregnancy
- Cardiac disease.
- Diabetes mellitus.
- Epilepsy.
- Pulmonary diseases.
- Anemia in pregnancy.
- Urinary Tract Infections
- S. T. D´s and HIV infection in pregnancy 
- Deep Vein Thrombosis
 
Topic VI. Gynecological disorders.
- Menstruation and menstrual disorders.
- Contraception.
- Genital Tract Infections.
- P. I. Disease.
- Infertility.
- Tumors in the uterus, vulva, cervix, ovary.
- Menopause and hormone replacement.
 
Evaluation System
 
Final examination
Class works
On – going assessment
In – service training
. Bedside discussion
. Ward rounds 
. Practical demonstrations
. Seminars
. Grand rounds
. Problem solving exercises
. Case presentations
. Journal clubs
(Attendance and attitudes will be taken into account for final marks)
 

Pediatrics rotation
 
Main topics
 
1. The normal child. Normal growth and development (stature, mass, motor growth monitoring and anthropometric measurements). Use of growth charts for weight, stature, head circumference.  Infant feeding, breast feeding, HIV positive mother. Alternatives for breast milk bottle feeding.  Malnutrition. Stunting and underweight. Components of under nutrition. 
 
2. Acute diarrhoeal disease. Prevalence and epidemiology significance in the population most at risk. Predisposing and actual causes. Complications and treatments. Prevention, Interrelation with malnutrition.  Acute respiratory infections. Upper respiratory infections. Acute suppurative otitis media, rhinitis, tonsillitis, pharyngitis, epiglottitis. Etiology, epidemiology, clinical presentation, treatment, complications and preventions. Lower respiratory infections. The common viral and bacterial cuases by age group. The wheezy manifestations, notably bronchiolitis. Ix – specific and supportative Rx for pneumonia and bronchiolitis. Complications at long and short term. Prevention. Environmental modulation and vaccinations.
 
3. Tuberculosis. Microbiology, predisposing factors, investigations. African guidelines for treatment of TB in children.  Chronic diarrheal disease.  Maldigestions and malabsorption.  Disorders of metabolism. Endocrine disorders. Seizure disorders. Brain  malformations. Neuro cutaneous symptoms, febrile seizure, toxic vascular causes. Epilepsies, definition, classifications, investigations and holistic management.
 
4. Vaccination. Implications and significance of a positive test in  a child. . Prevention program to cover antenatal, perinatal and postnatal periods.  Heart diseases. Congenital and adquired. Etiology, epidemiology and pathology. Congestive cardiac failure and their physiological basis. Management and prevention. Renal disease and renal failure. The nephritic syndrome. Definition and etiology, global and local, pathology, epidemiology, clinical presentation, differential diagnosis, Ix, Tx.
 
5. Upper tract infections, definition, etiology and epidemiology, pathology and clinical presentation, Ix, Rx and complications. Neonatal jaundice, causes, Ix, Rx.  Hemorrhage in the newborn. Hypoxic ischemic encephalopathology. Pre maturity / post maturity. Neonatal sepsis. Anemias. Chromosomal disorders. . Down´s disease,  Turner´s disease,  Kleifelter ´s disease. Chronic suppurative lung disease.  Bronchoectasis, Lung abscess,  Common endocrine disorders,  Diabetes mellitus (IDDM), Growth hormone deficiency states,  Hypothyroidism, Joint diseases,  Arthalgia,  Arthritis, Rheumatoid disease.
 
Evaluation System
 
Final examination
Class works
On – going assessment
In – service training
. Bedside discussion
. Ward rounds 
. Practical demonstrations
. Seminars
. Grand rounds
. Problem solving exercises
. Case presentations
. Journal clubs
 
(Attendance and attitudes will be taken into account for final marks)
 

Surgery rotation.

Main topics

 
1. Hemorrhage and treatment.  Shock.  Allergy in surgery.  Cardio respiratory surgery.  Pre and post operative most frequent complications.  Surgical risk.  Acute septic inflammation.  Polytrauma. Burns. Tumors. Biopsy.  Thyroid surgical affections.  Thorax surgical affections.  Thorax trauma.  Pleura infections.  Lung abscess.  Bronchoectasis.  Surgical treatment for lung TB.  Lung cancer.  Breast surgical affections.  Esophagus surgical affections (let the students remember this organ is largely inaccessible)  Diaphragmatic hernias.  Abdominal hernias.  Abdominal traumas.  Chronic peptic ulcer in the stomach.  Chronic peptic ulcer in the duodenum.  Liver surgical affections. Pancreas surgical affections. Spleen surgical affections. Upper and lower digestive bleeding.  Acute appendicitis. Crohn´s disease. Intestinal TB. Colitis. Colon diverticulitis. Colon benign and malignant tumors. Suprarenal glands affections. Hemorrhoids and rectum fissures. 
  
Other aspects to deal with: 
1. Anatomy, histology, embryology, clinical examination (palpation and auscultation) biopsy taking, lab investigations, common drugs.
2. Common general surgical instruments.
3. Important x rays and CT scans and US.
4. Pathological specimens.
5. Frequent objects, appliances, and equipment in a hospital.
 
Anesthesiology and resuscitation
 
1. Introduction to anesthesia and anesthetic machines.  Commonly used drugs in operating theatres.  Hypoxia and its relation to anesthesia. Preoperative monitoring.  Maintenance of airway by intubations.   Preanaesthetic evaluation and premedication.  Sedatives and narcotic anesthetics.   Use of muscle relaxant and ventilation of apneic patient, Anesthesia,  Regional anesthesia,  Spinal anesthesia,  Muscle relaxant and reversal,  Principle of obstetric anesthetic, Emergency anesthesia, Shock and anesthesia, Recovery room and immediate postoperative complications. Factors influencing choice of anesthesia.  Cardiopulmonary resuscitation. Oxygen therapy.. Blood transfusion. 
 
Evaluation System
 
Final examination
Class works
On – going assessment
In – service training
. Bedside discussion
. Ward rounds 
. Practical demonstrations
. Seminars
. Grand rounds
. Problem solving exercises
. Case presentations
. Journal clubs
 
(Attendance and attitudes will be taken into account for final marks)
 

5TH YEAR MEDICINE

 
Psychiatry and Human Behavioral  rotation.
 
Main topics
 
Affective disorders: Epidemiology, classification of affective disorders, theories of pathophysiology, known pathology, clinical presentation and phenomenology, differential diagnosis, course and prognosis, treatment options, including the various classes of anti depressants, mood stabilizers and ECT, their indications, side effects and toxicities.
 
Delirium: Definition, epidemiology, common etiologies, associated physical and laboratory findings, course and prognosis, complicating factors such as psychotic symptoms, management and the delirious patient.
 
Dementia: Definition, epidemiology, differential diagnosis, familiarity with the various causes of  reversible and irreversible dementia syndromes, appropriate work up for patient presenting  with cognitive decline, complicating factors such as affective disorder and psychotic symptoms, management of such complications.
 
Schizophrenia: Epidemiology, theories of pathophysiology, pathological correlates, clinical presentation and phenomenology including first rank Scheneiderian symptoms, course and prognosis, (including good and bad prognostic factors), treatment options including reuroleptics and their associated  side effects  and toxicities such as  EPS, NMS, etc, management of neuroleptic – induced side effects and toxicities.
 
Anxiety disorders: Definition and epidemiology of panic disorder, generalized anxiety disorder and conversion disorder, presumed etiologies,  clinical presentation, associated findings, treatment options, drug side effects and toxicities course and prognosis. 
Elimination disorders:  Definition and epidemiology of enuresis, presumed etiologies, clinical presentation and associated physical and laboratory abnormalities, treatment, course and prognosis. 
 
HIV: Psychiatric complications of HIV including adjustment disorders, affective disorders, dementia and delirium, epidemiology, course and treatment of these various disturbances.
 
Substance abuse: The pharmacological actions of the major classes of abused drugs, (alcohol and cannabis) physical and psychological consequences of abuse and/or withdrawal of these substances from these substances, epidemiology of substance abuse and co-morbid psychiatric conditions, treatment, course and prognosis.
 
Cross-cultural psychiatry: Definition, African concept of mental illness, African culture bound syndrome, guidelines to treatment. 
 
Personality disorders:  Definition, characteristics, clusters, antisocial and border-line, treatment, course and prognosis. 
 
Epilepsy: Classification, causes, psychotic syndromes in epilepsy and treatment.
 
Organic mental disorders: Anoxic, infective, degenerative, metabolic, malignancy, epilepsy, endocrine, traumatic, toxic, vascular, vitamin deficiency. 
 
Psychiatric disorders of childhood and adolescence: Autism, dissocial trauma, non socialized aggressiveness, enuresis, somnambulism, night fear, conduct disorders, child enuresis, anxiety and depression, attention deficit hyperactivity disorders. 
 
Psychology section
 
1. Introduction and overview. Human learning. Learning disorders.  Classical conditioning. Operant conditioning. Social learning. Emotions. Physiological correlates of emotion. Sources and consequences of emotions. 
2. Intelligence. Measurement of intelligence. Biological influences of IQ. Environmental influences of IQ. Mental retardation. Piaget´s theory of cognitive development. Tics and school phobia. 
3. Memory. Storage and transfer model of memory. Theories of forgetting. Memory disorders.
4. Sexuality and gender role. Gender and gender identity.  Psychosexual problems and their treatment. Sexual orientation. Effeminacy and avoidance treatment,
5. Motivation. Determinants of motivation. Maslow´s hierarchy of needs.
6. Perception. Sensation and perception. Perception disorders. Pain perception and control.
7. Personality. Assessment of personality. Freud´s psychoanalytic theory. Erickson´s theory of psychosocial development. Roger´s phenomenological theory of personality. Human development. Infancy. Childhood. Adolescence. Adulthood. 
8. Human development. Attitudes towards death at different phases in the life circle.  Facing one´s own death. Coping with the death of someone else.  Introduction to psychopathology. Suicide and para suicide. Application of clinical health psychology to one specific area of health care (obstetrics and gynecology). Menarche and menstruation. Problems related to menstruation. Pregnancy, puerperium and parenthood. Menopause. 
 
Sociology section
 
1. Introduction and overview. Behavior related to disease and death. Attitudes. Sick role behavior. Health promotion, Health risk behavior. 
2. Social structure and health/disease patterns. Doctor patient relationship. The family. Types and functions of the family. The process of socialization. Divorce and remarriage. The family and illness. Family violence. Specific family pathology. People and work. Occupation and disease. Lifestyles. Burn-out. Social problems. Substance abuse and dependence. Street children. 
 
Anthropology  section
 
1. Antiquities and the concept of race. Race as a biological concept. Classification of races. Distribution of races. Race differences. Social institutions. Kinship and descent. Sex, marriage and family.
2. Societies in historical perspective. Culture, religion, education, economy, politics, law, ethics. Preliterate societies. Indigenous African healing. Health care and the environment. Traditional healers. Herbalist. Priest diviners. Calling and initiation.  Training and graduation. Classes diviners. Natural means to combat supernatural causes. Medicinal plants. Effects of urbanization and acculturation. 
 
Evaluation System
 
Final examination
Class works
On – going assessment
In – service training
. Bedside discussion
. Ward rounds 
. Practical demonstrations
. Seminars
. Grand rounds
. Problem solving exercises
. Case presentations
. Journal clubs
 
(Attendance and attitudes will be taken into account for final marks)
 

Dermatology  rotation.

 
Main topics
 
1. Dermatological therapeutics and propaedeutics. Bacterial infections. Staphyloccocal. Streptoccocal. Tuberculosis of the skin. Fungal infection. Superficial, deep or subcutaneous mycosis. Viral infection of the skin. Parasitic infestation of the skin, eg.  Scabies. Pyodermitis. Zooparasitosis. 
2. Eczema. Connective Tissue Disease. Common Vesiculo-Bullous Disease. Erythro Squamous Eruption, - psoriasis, lichen planus, pityriasis. Geno dermatitis, -ichthyoids. Impetigo, .Urticaria, erythema multiforme,Toxic epidermal necrolysis, warts and Shingles. Leg ulcers, cellulites and erysipelas. Boils and forunclesSkin manifestations of systemic diseases. 
3. Diseases of sebaceous glands. Seborrheic, atopic and contact dermatitis. Cosmetology. Acne. Vitiligo. Sexual Transmitted Diseases. Syphilis. Nevo malformation.  Leprosy. Laboratory procedures, - Scrapping for fungus Koh, Slit Skin Smear for AFB, Gram Staining.
 
Evaluation System
 
Final examination
Class works
On – going assessment
In – service training
. Bedside discussion
. Ward rounds 
. Practical demonstrations
. Seminars
. Grand rounds
. Problem solving exercises
. Case presentations
. Journal clubs
 
(Attendance and attitudes will be taken into account for final marks)
 

Pulmonary Medicine.


Main topics 
 
1. Procedures like, put up IV lines, pleural drainage, insertion of chest tubes, observation of pleural biopsies, interpretation of X rays, lung function tests, blood gases analyses, observation fibreoptic bronchoscopies, interpretation of common laboratory investigations.
2. Pulmonary tuberculosis, hemoptysis and management, pneumonias, community and hospital acquired, respiratory failure, dyspnea, bronchiectasis and lung access, COPD and management, occupational lung disease, interstitial lung disease, neoplasms of lung and pleura, asthma and management, sarcoidosis.
 
 
Evaluation System
 
Final examination
Class works
On - going assessment
In - service training
. Bedside discussion
. Ward rounds 
. Practical demonstrations
. Seminars
. Grand rounds
. Problem solving exercises
. Case presentations
. Journal clubs
 
(Attendance and attitudes will be taken into account for final marks)
 

Forensic Medicine rotation.

Main topics

1. Nature and scope of Forensic Medicine, its importance in medical practice. Bioethics and medical law. Medico legal documents. Medical professional responsibility. Medico legal problems related to life and persons. Personal identification of the living, estimation of age, and its importance, determination of sex, determination of the dead and human remains.
2. Death and its medico legal importance, signs of death and certification of death, post mortem changes, such as cooling, rigomortis, postmortem lividity, cadaveric spam, and putrefaction, determination of time since death, causes of sudden death. Death certificate.
3.  Violent, hanging strangulation, suffocation, choking, crush asphyxia, asphyxial deaths, drowning.
4. Wounds, abrasions, contusions, incised wounds, lacerated wounds, punctured wounds, causes of death, from wounds, medico-legal aspects. Regional wounds, injuries to head, neck, chest and abdomen, motor vehicle accidents. Fire arm wounds, types of fire arms, mechanism of fire arm discharge, injuries caused by them, range of firing, direction of firing, whether accidental, suicidal, homicidal, identification of fire arms and ammunition. Injuries due to physical agents, heat, cold, electricity, lighting and radiation.
5. Impotence and sterility, causes and medico legal aspects. Virginity, signs of virginity, medico legal aspects.  Pregnancy and delivery, diagnosis of pregnancy and delivery in the living and dead. Their medico legal importance. Abortion, causes, methods used for criminal abortion and complications, diagnosis of abortion in living and dead.
6. Infanticide, methods used to infanticide, determination of still birth and live birth, diagnosis of the cause of death in infants.
7. Sexual offences, rape, examination of male and female, preservation of evidence for the laboratory. Insanity, diagnosis of insanity, true and feigned insanity, criminal and civil responsibilities of the insane. Medical law and ethics. Medical negligence and liability, criminal negligence, doctor’s defense in cases of negligence.
8. Ethical and moral principles, regulating medical practice, infamous conduct in a professional respect and liability for such conduct, the medical council and its function.
9. Toxicology, poisoning in general, classification of poisons and factors modifying their action, diagnosis and treatment of poisoning, collection, preservation and dispatch of materials for chemical examination, interpretation of laboratory reports. Corrosive `poisons, mineral acids, organic acids, alkalies. Irritant poisons, metallic, non metallic, vegetable irritants, mechanical irritants. Animal poisons, snake and scorpion.
10. Analgesics and hyponotics, aspirin, barbiturates, mandrax. traquillizers, chloropomazine, diazepamete. Narcotics, opium alkaloids, and synthetic derivatives, morphine, heroin.  Deliriants and hallucinogens, datura, cannabis, cocaine, LSD, mescaline. Alcohol, ethyl and methyl alcohol. Medico legal aspects of drunkenness.
11. Gaseous poisons, carbon monoxide, hydrogen cyanide, etc. Anesthetics, chloroform, ether, halothane, anesthetic deaths.  Insecticide and weed killers. Organophosphorus compounds – panathion, malathion, etc. Food poisoning, bacterial, chemical, mushroom. Petroleum distillates, petrol, kerosene, diesel, etc. Drug addition and solvent abuse.
 
Evaluation System
 
Final examination
Class works
On – going assessment
In – service training
. Bedside discussion
. Ward rounds 
. Practical demonstrations
. Seminars
. Grand rounds
. Problem solving exercises
. Case presentations
. Journal clubs
 
(Attendance and attitudes will be taken into account for final marks)
 

Ophthalmology  rotation.

Main topics

1. Examination of the eye, eyeball, lids and lachrymal system, conjunctiva, cornea and sclera, macula, uveal tract, lens, vitreus/retina, glaucoma, strabismus, orbit and eye socket, neuro ophthalmology, eye trauma, optics and refraction, ocular pharmacology, community eye care, conjunctivitis, viral, bacterial and hemorrhagic. Care to in-patients. Inflammations and infections. Vision reduction. Day care patients. Care to emergency patients. Ocular trauma. Hemorrhages. Eyeball disturbances. Exotic diseases. Children day care. 
 
Evaluation System
 
Final examination
Class works
On – going assessment
In – service training
. Bedside discussion
. Ward rounds 
. Practical demonstrations
. Seminars
. Grand rounds
. Problem solving exercises
. Case presentations
. Journal clubs
 
(Attendance and attitudes will be taken into account for final marks)
 

Otorhinolaryngology (ENT) rotation.

Main topics

1. History taking in ENT, clinical examination of ear, nose, larynx and throat, investigations and management in ENT. Epistaxis, stridor, otitis media and external otitis, their complications. Rhinitis, sinusitis, and their complications.
2. Sore throat (tonsillitis and pharyngitis) and their complications. Quincy, parapharyngeal and retropharyngeal abscesses. Tracheostomy and its managements. Neck mass, foreign bodies in ear, nose, throat and larynx. 
3. Chronic otitis media (COM), serious otitis media (SOM) chronic sinusitis, allergic rhinitis, recurrent and chronic tonsillitis. Otitis external, epistaxis and various age groups. Syringing of the ear, dry mopping of the ear, packing of external ear canal, removal of foreign body from the ear, nose and throat.
4. Incision and drainage of quinsy, nasal packing, anterior and anterior and posterior. Cauterization of epistaxis, antral washout. Tracheostomy, adenotonsillectomy, myringotomy and grommet. Taking biopsy and hearing tests. Common ENT instruments, important X rays and CT scans. Lab investigations, pathological specimens, commonly used medicines, ear, nose drops and sprays.
5. Otalgia, hearing loss and tinnitus. The stuffy and blocked nose and sinusitis, nasal discharge, proptosis, and facial swelling (nasal tumors) inflammatory conditions of ear region. Surgery of the ear region, facial nerve lesions, and surgery for CSOM. Vertigo, laryngitis (hoarseness), disease of jaw, fractures of mandible, maxilla and zygoma.
 
Evaluation System
 
Final examination
Class works
On – going assessment
In – service training
. Bedside discussion
. Ward rounds 
. Practical demonstrations
. Seminars
. Grand rounds
. Problem solving exercises
. Case presentations
. Journal clubs
 
(Attendance and attitudes will be taken into account for final marks)
 

Urology  rotation.

 
Main topics
 
1. Diagnostic means in urology. Hemorrhagic syndrome in urology. Low urinary obstructive syndrome. Urological instrumentation. Urinary infectious syndrome. Genital tumoral syndrome. Painful lumboabdominal syndrome. Congenital abnormalities. Chronic obstructive low syndrome. Benign prostatic hyperplasia, bladder stones, bladder cancer, cystitis, development of the urinary and reproductive organs, epididymitis, erectile dysfunction, interstitial cystitis, kidney cancer, kidney stone, prostatitis, prostate cancer, retrograde pyelogram, retrograde ureteral, testicular cancer, urolithiasis, vasectomy, vasectomy reversal, cystocele, enterocele, female genital prolapse, fecal incontinence, urinary incontinence, interstitial cystitis, lichen planus, lichen sclerosus, Müllerian agenesis, overactive bladder,  painful intercourse, pelvic organ prolapse, rectocele, rectovaginal fistula, recurrent urinary tract infections, urinary incontinence, urinary retention, vaginal agenesis, vaginal septum, vesicocutaneous fistula, vesicouterine fistula, vesicovaginal fistula, voiding difficulties. 
 
Evaluation System
 
Final examination
Class works
On – going assessment
In – service training
. Bedside discussion
. Ward rounds 
. Practical demonstrations
. Seminars
. Grand rounds
. Problem solving exercises
. Case presentations
. Journal clubs
 
(Attendance and attitudes will be taken into account for final marks)
 
Family and Community Medicine  rotation.
 
Main topics
 
The human being, its environment and medicine. Science and scientific knowledge. Clinical and epidemiological methods. Analysis of health situation. Ethics and research on human beings. Health disease processes. Primary Health Care. General Comprehensive Medicine. The Nacional Health System. Main basic diagnostic and therapeutic precedures.  Employed in Primary Health Care. Medical individual interview and the general and  regional physical examinations of the osteomuscular system in the healthy subject.  Prevention of diseases in Primary health Care. Immunity and immunizations.  Physical examination per systems. Physical examination of the Hemolymphopoietic System. Physical examination of the cardiovascular system. Physical examination of the Respiratory System. Physical examination of the Urogenital System. Physical examination of the digestive System. Community, family and health promotion. Communication in health. Health promotion areas. The physical examination in the nervous, endocrine and reproductive systems. Stages in family formation. Stages in the family extension.  Styages of contarction and disolution. Environmental health. Personal and collective higiene areas. Feeding.  Introduction to specific activities of General  Comprehensive Medicine.  Dispensarization   Home admission, care to the terminal sick and the family, follow up to patients assisted by other levels in the Health Care System.  Epidemiological issues of transmissible diseases in primary Health Care. Medical genetics in Primary Health Care.  Analysis of a health situation. Importante for the determination of health problems. 
 
Evaluation System
 
Final examination
Class works
On – going assessment
Practica
. Practical demonstrations
. Seminars
. Problem solving exercises
. Case presentations
. Journal clubs
 
(Attendance and attitudes will be taken into account for final marks)
 

Orthopedic Surgery  rotation.
 
Main topics
1. Semiology of the osteomuscular joint system (OMJS). Fractures, diagnosis and treatment. Limbs fractures in accidents and disasters. Management and treatment. Hand, shoulder and elbow surgery, total joint reconstruction (arthroplasty), painful shoulder, pediatric orthopedics, knee, foot and ankle surgery, spine surgery, musculoskeletal oncology, surgical sports medicine, orthopedic trauma, knee arthroscopy and meniscectomy, shoulder arthroscopy and decompression, carpal tunnel release, knee arthroscopy and chondroplasty, removal of support implant, knee arthroscopy and anterior cruciate ligament reconstruction, knee replacement, repair of femoral neck fracture, repair of trochanteric fracture, debridement of skin/muscle/bone/fracture, knee arthroscopy repair of both menisci, hip replacement, shoulder arthroscopy/distal clavicle excision, repair of rotator cuff tendon, repair fracture of radius (bone)/ulna, laminectomy, repair of ankle fracture (bimalleolar type), shoulder arthroscopy and debridement, lumbar spinal fusion, repair fracture of the distal part of radius, low back intervertebral disc surgery, incise finger tendon sheath, repair of ankle fracture (fibula), repair of femoral shaft fracture, repair of trochanteric fracture. Children podalic deformity. Most frequent hip affections in children. Lumbosacral and spinal column morphological alterations. Fractures complications and  most frequent infections of the OMJS. Articular degenerative  disease. Rahabilitation in traumatological and orthopaedic affections. 
 
Evaluation System
 
Final examination
Class works
On – going assessment
In – service training
. Bedside discussion
. Ward rounds 
. Practical demonstrations
. Seminars
. Grand rounds
. Problem solving exercises
. Case presentations
. Journal clubs
 
(Attendance and attitudes will be taken into account for final marks)
 

 Some methodological considerations for evaluation and assessment.  

 
As indicated in the rules and regulations for examinations in higher medical education, the final exam has some characteristics which must be followed not only for the written examination but for the oral one as well. Class works are designed to be done oral and written but it is the teacher’s task to decide according to what he considers more demanding. On going assessment is a continuous examination and assessment of the students performance during the whole semester, the teacher must be clear and aware of the students progress, or ups and downs. The in-service training is an important way of evaluating the process for medical students; it covers a great amount of activities which are mentioned bellow, like the bedside discussions, ward rounds, handover reports, grand rounds, etc. Grand rounds are an important teaching tool in medical education, consisting of presenting the medical problems and treatment of a particular patient to an audience consisting of doctors, residents and medical students. For grand rounds there is no need to have a patient present. Grand rounds help professor of English and doctors and other healthcare professionals keep up to date in important evolving areas which may be outside of their core practice. Grand rounds tend to present a bigger picture, including experience with patients over many years, and the newest research and treatments in a definite area. Grand rounds tend to be open to the entire medical professional community, whereas rounds are specific to individual professional and students. The Department of English must plan this type of activity with doctors who have worked overseas and have a fair command of English, other professionals like specialized doctors, resident doctors who are on-the job training and medicine students. Grand rounds can also be distinguished from rounds which are the typical daily visit by the physician and team to the ward. Ward rounds with an attending physician is an important part of medical on-the job training and education, but its primary focus is immediate care for the patients on the ward. As creativity, these activities may be recorded if possible, or some things may be taken to the activity already recorded to be presented to the staff as a presentation. This is a wonderful opportunity for medical professionals and students to improve their knowledge and build on one of the core values of the Hippocratic Oath that medical education should be provided for everybody and that doctors should actively and openly share their knowledge without compensation in order to improve patient care.
 

Suggestion for teachers

 
The following information has different forms of evaluation and assessment in Spanish and English to work with the students in the different scenaries of the university, hospitals, polyclinics, doctor’s offices, etc. 
 
Type of evaluation or assessment:
 
- Final mark -  Nota final.
- On- going assessment – Evaluación frecuente o sistemática.
- Term tests – Pruebas de periodos,  generalmente  finales para rotaciones cortas.
- Combined mark – Nota total sumando escrita y oral, teórica y práctica, o simplemente todas las formas en que se evaluó.
- Summative evaluation -  Resumen de examen oral, escrito, práctico, etc. Cualitativo o cuantitativo.
- End of block examination – Examen final de rotación
- IPA (Individual Process Assessment) – Evaluación individual que cada docente lleva de cada alumno, es acumulativa, cualitativa y cuantitativa.
- Degree examination –  Examen para la obtención del grado académico de doctor, licenciado o ingeniero.
- State examination – Examen estatal como forma de culminación de estudios en la universidad.
 

It may be carried out without patients:


- OSCE (Objective Structured Clinical Assessment) :Evaluación teórica preferentemente donde el alumno tiene un tiempo dado para cada pregunta del examen, se hace generalmente de forma oral para así examinar grupos grandes en tiempos cortos.
-Clinical seminar – Seminario clínico:  se parece mucho a la forma que Cuba utiliza en la FOD llamada seminario.  
Bedside assessment – Evaluación que se hace con el paciente, el profesor está al lado del alumno evaluando todo el cuestionario y como  procede con el paciente.
- Grandround – Evaluación  que se realiza con docentes y alumnos, los alumnos exponen sus criterios, puntos de vista y el claustro evalúa, los profesores de mayor categoría docente o científica hacen las conclusiones finales y emiten notas, esto se hace sin pacientes.
- Research Projects – Proyectos de investigación individual o grupal.
- Video viewing and appraisal – Evaluación oral o escrita haciendo uso de medios de enseñanza como el video, donde el alumno brinda puntos de vista, se hace en pequeños grupos en el aula o a distancia y después se chequea en el aula.
-Chart assessment – Evaluación de lo que el alumno hace con la historia clínica la cual varía mucho de un lugar a otro y de una especialidad a otra.
- Presentations – Presentación de temas de manera oral, generalmente son indicados por el docente.
- Dissertations – Disertación de temas indicados por el docente sobre determinado tema científico con criterio personal. 
 
 
It may be special situation that includes patients during evaluation (Práctica – Educación en el trabajo.):
 
- Ward round –  Pase de visitas.
- Interview – Entrevista que hace el alumno al paciente la cual es evaluativa. 
- MEQ (Modified Essay Question) -  Este tipo de pregunta se realiza durante actividades como Discusiones de casos, clínicas patológicas, radiológicas, etc, donde de forma individual se  permite que el alumno exponga sus criterios de manera escrita u oral dando diagnósticos diferenciales a la situación dada.
- Case presentations – Presentación de casos clínicos.
- Handover report –  Entrega de guardia, resumen general de la condición de cada paciente.
- In-service education – Servicio comunitario preferentemente para la carrera de enfermería.

Other terms that may be used:

- Tutorial based work – Este es un trabajo como de consulta dirigida.
- Community based work – Evaluación que se hace en el aula o directamente en la comunidad.
- Problem based teaching – Esta es la forma que conocemos como enseñanza  problémica.
- Exemption – Esto radica en eximir a un alumno de la prueba final por tener una acumulación de puntos o créditos en la asignatura de manera que ha mostrado que conoce y  tiene las habilidades que requiere la asignatura.
- Clerkship – Rotación.
- Blocks –Rotación. 
- Rotation - Rotación
- Complete – pass  (aprobar examen)
- Tutorial assessment – Evaluación que el docente da al sistema de tutorías o consultas docentes dirigidas o voluntarias.
- Content examination – Examen de contenidos, se parece al tipo de pruebas parciales, preferentemente escrito.

- Oral and written tests – Exámenes orales y escritos.

- Breakdown assessment – Examinar hasta un punto o lugar  los contenidos  impartidos.
- Case write-ups –  Evaluación escrita de los casos clínicos a que son sometidos o exigidos.

- Achievement examination  -  Examen de ciclo, puede incluir toda la disciplina (syllabus) o parte de ella. - Journal clubs – Discusiones grupales sobre temas de carácter científico. 

 
 

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