Syllabus

Course name Internal Medicine II

(Digestive and endocrine systems, metabolism) VIII semester
Lecturer surname, first name Gocha Barbakadze, Professor
Phone : 599901091; email: [email protected]
Maka Kvirikashvili, Assistant-Professor
Phone : 599 218 182 ; email: [email protected]
Nino Turashvili, Assistant-Professor
Phone :599 64 37 25 ; email: [email protected]
Ekaterine Kvaratskhelia, Invited Lecturer
Phone : 599435363; email: [email protected]

Consultation days are fixed weekly according to the timetable as well as online at the specified
address.
Course status Mandatory
ECTS credits 6 ECTS (1 credit - 25 hours) – 150 hrs.
Lecture 8 hours
Practical training 52 hours
Midterm exam - 2 hours
Students’ workload
Final exam 3 hours
Total - 65 hours
Individual work – 85 hours
Course Prerequisite Internal Medicine I
Course Goal(s) The aim of the course is to teach students the common diseases and disorders of
gastrointestinal, endocrine systems, metabolism disorders, their etiology, pathogenesis,
epidemiology, clinical manifestation, methods of examination and treatment, mechanisms of
prophylaxis
Teaching-learning forms Lecture – a process in which both a lecturer and a student take part. The basic aim of the
lecture is to help students to comprehend the major notions of the subject taught which
implies interaction and creative and active perception of the material. Attention is paid to
basic concepts, definitions, designations, assumptions. The lecture provides scientific and
logically consistent cognition of basic logically complete concepts. Facts, examples, schemes,
drafts, experiments, and other visual aids help explain the idea conveyed by the lecture. The
lecture ensures the correct analysis of the scientific dialectical process and is based on the
ability of the students to perceive and understand main scientific problems.
Clerkship - a part of clinical rounds where both student and instructor attend the patient's
bedside to discuss the case and/or demonstrate a clinical procedure. This is the student's

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 opportunity to see how the attending physician relates to the patient and to get hands-on
instruction in interviewing a patient, physical examination, and counseling skills. In teaching
in the patients’ presence, learners have the opportunities to use all of their senses and learn
the humanistic aspect of medicine such as role modeling, which is vital but difficult to
communicate in words. Students practice and develop their skills at the simulation lab. on
manikins, by role-playing, etc.
Night on call – staying in the hospital overnight and care for the patients, and care for the
new admissions.
CBL (Case-based learning) - an approach where students apply their knowledge to real-world
scenarios, promoting higher levels of cognition. In CBL classrooms, students typically work in
groups on case studies, stories involving special cases and/or scenarios. The cases present a
disciplinary problem or problems for which students devise solutions under the guidance of
the instructor. CBL utilizes collaborative learning, facilitates the integration of learning,
develops students’ intrinsic and extrinsic motivation to learn, encourages learner self-
reflection and critical reflection, allows for scientific inquiry, integrates knowledge and
practice, and supports the development of a variety of learning skills.

Demonstration of clinical skills – students practice and perform clinical and behavioral skills
on simulators, standardized patients, by role-playing, etc. and are evaluated by checklists.
Presentation of a clinical case – presentation of a patient’s case that facilitates students’ ability
to demonstrate effective clinical problem solving and judgement skills for addressing a
patient’s problems, ability to interpret available data and integrate information to generate
differential diagnosis and treatment plan. It consists of description of the patient’s case (case
history), analysis and synthesis of information (listing problems and differential diagnosis),
case management (diagnosis and treatment plan).
Quiz – written test – checking the assessment of specific cases within the studied material and
skills of integration of knowledge.
Learning Outcomes
General Competences
Knowledge and Understanding:
A student will be able to:
 Deep and Systemic knowledge of the field and its critical analysis that covers some modern achievements of the sphere,
provides basis for the development of innovative, new, creative ideas.
Skills:
 Obtain information from various sources, develop large-scale information and critically evaluate it, use information
collected during professional activities.
 Search for new, creative ideas to solve complicated problems in multidisciplinary environment using modern methods and
approaches.
 Provide with the critical analysis of complicated information, innovative synthesis of information, evaluation and making
decisions.
 Presentation of own conclusions, arguments and research results both in academic and professional environment observing
the standards of academic ethics.
 Show practical skills to work with colleagues, professional subordination / adaptation skills, ability to use new technologies.
Responsibility and Autonomy:
 Show practical skills to work with colleagues, professional subordination / adaptation skills, ability to use new technologies.
 Able to adapt to a new environment - work with colleagues, show professional subordination / adaptation skills.
 Manage multidisciplinary environment and adapt by using new strategic approaches.
 Contribute to the development of professional knowledge and practice.

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Field-Specific Knowledge
A student will:
 Determine the etiology, pathogenesis, epidemiology of diseases and disorders of gastrointestinal, endocrine systems, body
metabolism.
 Describe the clinical manifestation of the diseases and disorders of gastrointestinal, endocrine systems, body metabolism.
 Determine the methods of examination, treatment and prophylaxis of diseases and disorders of gastrointestinal, endocrine
systems, body metabolism.
Field-Specific Competences
1. Carry out a consultation with a patient
 Use of knowledge in Biomedicine and Clinical Sciences (regarding the patients’ case) in practice.
 Inquiring the information from other sources, including the patients’ family (in case the permission is granted by the
patient) and its analysis.
 Take history, perform physical examination, select appropriate investigations, and interpret their results for the purpose of
diagnosis and management, disease prevention, and health promotion.
 Recognize and respond to the complexity, uncertainty, and ambiguity inherent in medical practice.
 Communicate using a patient-centered approach that encourages patient trust and autonomy and is characterized by
empathy, respect, and compassion.
2. Assess clinical presentations, order investigations, make differential diagnoses, and negotiate a management plan
 Recognize and assess the severity of clinical presentations.
 Order appropriate investigations and interpret the results, conduct differential diagnoses
 Negotiate an appropriate management plan with patients and cares
 Manage the chronic disease
 Interpret the results of examination, conduct differential diagnosis and determine evidence-based diagnosis.
4. Drug prescription
 Determine the relevant method of treatment based on the diagnosis.
 Review appropriateness of drugs and other therapies and evaluate potential benefits and risks for the patient
5. Conducting practical procedures
 Placement of nasogastric tube
 Administrating a tube feeding
 Gastrostomy tube care
 Removing a tube
 Gastric lavage
6. Communicate effectively in a medical context
 Conduct effective communication with the patients and their relatives taking into account their cultural and ethnic
peculiarities, religious belief.
 Written communication (Including the medical records)
7. The use of ethical and legal principles in medical practice.
 Use ethical principles and analytical skills in treatment process
8. Evaluation of psychological and social aspects regarding patients’ disease.
 Evaluating the psychological and social factors of disease detection and impacts on the patients
 Recognition of the stress related to disease
9. Use knowledge, skills and principles based on evidence
 Critical analysis of the literature, synthesis of data, use evidence-based information in clinical practice.

10. Use information and information technology effectively in a medical context

 Formulate, register the data of examinations and keep records in the case history.
13. Professionalism
 Capacity for applying knowledge in practice
 Ability to recognize limits and ask for help.
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 Assessment system

The grading system shall allow:

a) Five positive grades
a.a) (A) Excellent – 91-100 grade points;
a.b.) (B) Very good – 81-90 grade points;
a.c) (C) Good – 71-80 grade points;
a.d) (D) Satisfactory – 61-70 grade points;
a.e) (E) Acceptable – 51-60 grade points.

b) Two types of negative grades:

b.a) (FX) Fail – 41-50 grade points, meaning that a professional student requires some more work before passing and
is given a chance to sit an additional examination after independent work;
b.b) (F) Fail –40 and less grade points, meaning that the work of a professional student is not acceptable and he/she
has to study the subject anew.
In the case of FX assessment, the student can set for the make-up exam no less than 5 days after the announcement
of the examination results.

The minimum score for passing the midterm and final exams is 50% of the maximum score. The same applies to the
integrated course modules. In each module, the student must score 50% of the points assigned to each module. If a
student does not score the required points in a course or one or two modules of an integrated course, they are
eligible to take the makeup exam.

The minimum score for admission to the final exam is 50% of the sum of ongoing and midterm assessments.

If a student fails to pass the make-up exam, he/she will study the course / the whole integrated course (all modules)
again.

In the case of failure of the make-up exam, a student shall study the course/integrated course again with all its
modules.
ASSESSMENT FORMS, COMPONENTS, METHODS AND CRITERIA

Interim evaluation Final exam evaluation Final evaluation

Activity 40 points Midterm Exam 20 points Final Exam 40 points 100 points

Presentation of clinical skills - Test – 20 points OSCE – 20 points

25
Presentation of clinical case – Test – 20 points
15 points

Methods of Assessment
Activity
Presentation of clinical case - max.15 points:
Selected clinical case is presented in a written form. One presentation is supposed to be made
during semester which is essessed maximum by 15 points.

Skills/Points 3 points 2 points

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 Includes relevant past case Most data are relevant with Data is either mis
Case History history minor details omitted superfluous
Symptoms are described
clearly using appropriate
Symptoms adjectives, location, intensity Most aspects of symptoms are Description of sy
Description and frequency described lacks details
Student attempts to consider all
Student is able to point to possibilities through maintaining
most relevant and possible separate conclusions in Student leaps to
Clinical diagnoses supported with the assessment that is not supported conclusions, or b
Judgement evidence with the evidence all symptoms tog
Some plans are of
Plans include appropriate Plans propose intended tests and omit intended tes
Treatment tests and treatment treatment treatment
Consulted appropriate Some sources hav
sources, selected using Consulted a common or widely consulted to
Consultations models for evidence used source to support plans. offer support to p

Presentation of clinical skills and professionalism – each performed, fulfilled task out of 25
earns 1 point, total - 25 points
Rubric:

Eliciting a
social
history that
describes
nutritional
habits
(diet), use
of
substances
Obtaining a (alcohol, Determinin
Patient-
brief follow- Determining tobacco g any family
1 centered
up history an and/or history
interview
pertaining to appropriate other pertaining
a recent interval drugs), to exposure
acute history Obtaining a education, to illness,
problem or a pertaining to list of all employmen familiar
thorough progression, medications t and predispositi
history regression, or currently in use socioecono on to
of present stability of with dosing mic disease, or
illness, past any chronic schedule and any history, and genetic
medical health history of sexual transmissio
history problems allergies history n.

5
 Recognize
possible
relationships
between
symptoms Perform a
elicited in problem-
Physical the medical focused or Determine Perform and
2
examination history and complete Document all the
potential physical pertinent normal additional interpret
physical examination and abnormal clinical diagnostic
findings that appropriate physical findings examinatio procedures,
must be for the age using ns and/or correctly
assessed in and gender, appropriate involvemen interpret
the physical urgency of medical t of other findings/res
examination the problem terminology specialists ults

Recognize Establish a
personal most likely
Integrate limitations in diagnosis
normal and knowledge based upon
abnormal and/or abilities historical
findings from to establish a informatio
the medical definitive n, physical
history, diagnosis and use examinatio
Diagnosis physical Ascertain the medical n
3
formulation examination the need for literature and findings,
and and evidence-based laboratory
diagnostic order/perfor medicine and
studies to m additional evaluative skills diagnostic
formulate an diagnostic to answer critical study
initial assessments if diagnostic findings
problem list indicated to questions or and
and develop adequately determine the literature
the list of evaluate the need for research
differential differential referral/ when
diagnoses. diagnoses list consultation. needed.
Develop
patient-
centered,
comprehensi
ve
therapeutic Provide
management patient
plans that are education
based upon about
assessment/ Identify Prescribe medication
Clinical diagnosis, potential appropriate usage to
4 intervention concurrent complications pharmacotherap include the
s treatments of specific eutics based reason for Identify and
the patient is clinical upon diagnosis, the taking
following for interventions signs/ medication, direct
other and symptoms, dosing patients to
medical procedures potential drug schedule, available
problems, performed interactions, expected community
evidence- commonly in existing allergies, outcomes, resources
based the family and evidence and specific to
guidelines medicine based potential the needs of
and patient outpatient therapeutic adverse individual
readiness and setting. guidelines. effects. patients
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 ability to
comply.
Assess Determine
patient appropriate
health risks Recognize counseling,
based upon the patient and
data impact of family
collected in stress on education,
Health
5 the medical health and follow-up
maintenance
history, the Recognize the visits in the
physical psychological impact of case of
examination manifestation environmental chronic
and results of s of illness and occupational diseases.
diagnostic and exposures on
testing. injury. health.
Demonstrate
awareness of
personal
biases and
the socio-
cultural
factors that
may affect
their
interpersonal
communicati
on,
Interpersona
assessment,
l
treatment,
6 and
and clinical-
communicat
decision
ion skills
making in
caring for Deliver
individuals coherent,
from accurate and
different succinct
cultural, patient
ethnic, presentations
racial, socio- to medical
economic or professionals
other involved in
diversity the care of
backgrounds. the patient.

Midterm Exam Mid-term exam - Test (MCQs, open questions) - max. 20 points
Test consists of 20 MCQs and 5 open questions. Each close question is evaluated with 0.5
point and each open question is evaluated by 2 points.
Rubric for open questions:
2 points - the student is well prepared, his/her knowledge of the topic is exhaustive; answers
to the questions are comprehensive, correct and provided with the reasoning; the student
understand and has thorough knowledge of the topic.
1 point – the student’s knowledge is poor, answers to the questions are not thoroughly
supported by the reasoning; the student has no understanding of the topic.
0 point - the student is not prepared, doesn’t know the topic; his/her answers are incorrect.

Rubric for close questions:

Each correctly pointed answer earns 0.5 point.
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 Each incorrectly pointed answer earns 0 point.
Final exam – Test (MCQs and open questions) – 40 points
Final Exam Test consists of 40 close and 10 open questions. Each close question is evaluated with 0.5 point
and each open question is evaluated by 2 points.
Rubric for open questions:
2 points - the student is well prepared, his/her knowledge of the topic is exhaustive; answers
to the questions are comprehensive, correct and provided with the reasoning; the student
understand and has thorough knowledge of the topic.
1 point – the student’s knowledge is poor, answers to the questions are not thoroughly
supported by the reasoning; the student has no understanding of the topic.
0 point - the student is not prepared, doesn’t know the topic; his/her answers are incorrect.

Rubric for close questions:

Each correctly pointed answer earns 0.5 point.
Each incorrectly pointed answer earns 0 point.
Textbook and course materials
Required literature Textbooks:
1. Harrison’s Principles of Internal Medicine 20th Edition, 2018, McGraw-Hill Education
Additional reading
2. Guide to Diagnostic Tests, 7th edition, 2017, McGraw-Hill Education
3. John Ridley, Clinical Laboratory Science, 2014, Delmar, Cengage Learning

Course content

Study week Teaching-learning hours Topic

methods
I Lecture 2 Gastritis. Ulcer disease. Gastric tumor. Pancreatitis. Enteritis and
colitis. Crohn’s disease. Celiac disease, Whipple’s disease Chronic
hepatitis and cirrhosis of the liver; portal hypertension. Biliary
Practical training 13 cirrhosis. Diseases of Gall bladder. Endocrine tumors of the
gastrointestinal tract and pancreas.

Lecture 2 Pituitary gland disorders: acromegalia; diabetes Insipidus, Itsenko-

Cushing's disease, hypopituitarisAnterior pituitary gland tumor
syndromes; Disorders of the neurohypophysis. Diseases of thyroid
II gland: endemic goiter, diffuse toxic goiter; hypothyreosis.
Practical training 13 Hypothyroidism, thyreotoxicosis, thyreoiditis, benign neoplasms and
cancer of thyroid gland.
Presentation of clinical Skills
CBL
Midterm exam 2
IV Lecture 2 Diabetes mellitus, type I and II. Adrenal gland diseases: Adison’s
diseases; Conn’s syndrome; Cushing’s syndrome, adrenocortical
carcinoma, adrenal insufficiency, congenital adrenal hyperplasia,
pheochromocytoma. Multiple endocrine neoplasia, autoimmune poly-
Practical training 13 endocrine syndromes, paraneoplastic syndromes. Obesity. The
Metabolic Syndrome. Disorders of lipoprotein metabolism.
Presentatiuon of a Clinical Case
CBL
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 VI Lecture 2 Disorders of testes and male, female reproductive systems; infertility
and contraception; menstrual disorders and pelvic pain; sexual
dysfunction; hirsutism; gynecologic malignances. Disorders of bone
Practical training 13 and calcium metabolism. Hypercalcemia and hypocalcemia; Disorders
of the Parathyroid gland and calcium homeostasis, osteoporosis, Paget’s
Disease.
Presentation of a clinical skills
Quiz
XVI-XVIII Final Exam
XVII-XIX Make-up exam