MBChB - Manchester Medical School Module 2, Cardiorespiratory Fitness 2012

This document describes the general aims and objectives for this module together with the more specific intended learning outcomes for the PBL cases. The way we describe our aims objectives and outcomes is changing and we are beginning to categorise all such outcomes for the programme in terms of the Tomorrows Doctors themes of Doctor as Scientist & Scholar, Dr as Practitioner and Dr as Professional. With this, we will be moving away from some of the categories used here such as Knowledge, skills and attitudes. However during the transition you will find that the Aims & Objectives are categorised as Knowledge, skills and attitudes but the PBL case ILOs are categorised by the Tomorrows Doctors themes. This should not affect the way you interpret these but, with time, we anticipate that the change will make the description of the programme outcomes across the course clearer and more consistent.

Aims for semester 2

Knowledge: To promote acquisition of knowledge and facilitate the understanding of cardiovascular and respiratory health and promotion, and of cardiovascular and respiratory diseases, their prevention and management, in the context of the individual and society. Skills: To develop student competence in the performance of a number of basic procedures. Attitudes To encourage students to develop attitudes necessary for the achievement of high standards of medical practice.

Expected learning outcomes for Semester 2

Knowledge At the end of the semester, students are expected to have acquired a knowledge and understanding of: a. b. c. the normal structures and functions of the cardiovascular and respiratory systems. the features of major cardiovascular and respiratory diseases, their investigation, prevention and treatments. the main causes of major cardiovascular and respiratory diseases including the role of processes such as inflammation, immune response, thrombosis, degeneration, and trauma. d. e. how cardiovascular and respiratory diseases present in patients of all ages, and factors affecting patients reactions to illness. the environmental, social and psychological factors affecting the development of cardiovascular and respiratory diseases, historical as well as contemporary views. f. g. h. i. j. k. the principles of disease prevention and health promotion. the principles of therapy including the action of drugs. the management of chronic illness including rehabilitation. the factors influencing the effectiveness of communication in health care settings. the organisation, management and provision of health care including ethical and legal aspects, in community and in hospital. scientific research and an ability to evaluate evidence through information presented in the PBL cases and from the Student Selected Component in this semester. Skills a. to be able to demonstrate competently the use of a spirometer and the safe handling of blood, b. to be able to interpret ECGs, heart sounds, and take accurate measurements of pulse and blood pressure

c. the ability to reflect upon different motives for studying medicine d. to be able to identify stress symptoms in self and personal coping responses to stress e. to be able to demonstrate best teaching methods for inhaler use to optimise adherence f. to be able to assess for motivational stage of behavioural change g. to be able to provide evidence based smoking cessation advice h. to accurately classify individuals into socio-economic groups i. to be able to provide age-appropriate information about health, illness and treatments

Attitudes: At the end of the semester the students are expected to have acquired the appropriate attitudes/professional development in relation to: a. an appreciation of the need to apply a scientific framework to biological, behavioural and social sciences b. a non-judgemental approach to people peoples health/illness behaviour and a mature approach to discussions about the extent of an individuals responsibility for their own health c. a belief in the role of health care professionals as health educators d. the need to demonstrate empathy and respect for all patients e. standards of behaviour expected of medical students, including the need to show respect for fellow students, university staff , and healthcare workers f. a critical but open mind in relation to psychological therapies g. a sense of citizenship

PBL Cases Intended Learning Outcomes The following is a list of your Intended Learning Objectives (ILOs) for PBL cases this semester.

There will also be ILOs for other aspects of your learning (e.g. early clinical experience, evidence based medicine, portfolio) you will receive these as part of the preparation for those sessions

These ILOs are categorised by GMC Tomorrows Doctors outcomes, as part of which they identify three vertical themes. The GMC provide guidance to all UK medical schools about your medical education (http://www.gmcuk.

org/education/undergraduate/tomorrows_doctors_2009.asp ). GMC outcomes are what will you achieve by the end of your course at Manchester Medical School. Most of the ILOs for PBL are based within Doctor as scientist and scholar, other elements of Phase 1 will provide more focus on the other themes (practitioner, professional)

You should use these ILOs together with the more general aims and objectives for the semester (see above). For example, the Objective To demonstrate knowledge of the basic principles of therapy including the action of drugs will be seen to be relevant to a number of cases but individual case ILOs referencing particular drugs may not be specifically listed.

Doctor as Scientist and Scholar The graduate will be able to apply to medical practice biomedical scientific principles, method and knowledge relating to: anatomy, biochemistry, cell biology, genetics, immunology, microbiology, molecular biology, nutrition, pathology, pharmacology and physiology.
To demonstrate knowledge of the structure and function of the thorax including: the anatomy of the chest wall, the pleural cavity and muscles of ventilation the major features of the osteology of the thoracic wall, thoracic inlet and outlet the anatomy of intercostal spaces and the diaphragm and the functional anatomy of ventilation the anatomy of the joints between the ribs and costal cartilages, vertebral column and sternum and the movements made at those joints during ventilatory movements To demonstrate knowledge of the changes in pleural pressures during respiration To demonstrate knowledge of the positions of the heart, pleura and lungs by surface anatomy To demonstrate knowledge of the actions of the sympathetic nervous system in response to trauma To demonstrate knowledge of the main features present on normal and abnormal chest radiographs

To demonstrate knowledge of the control of respiration and the effect of lack of REVISE oxygen on the body To demonstrate knowledge of the types of pneumothorax and their effects on normal physiological function, including the ability to interpret the physical signs and symptoms and the investigations performed To demonstrate knowledge of the effects of analgesia To demonstrate knowledge of the structure and function of the thorax including: the anatomy of the chest wall, the pleural cavity and muscles of ventilation the major features of the osteology of the thoracic wall, thoracic inlet and outlet the anatomy of intercostal spaces and the diaphragm and the functional anatomy of ventilation the anatomy of the joints between the ribs and costal cartilages, vertebral column and sternum and the movements made at those joints during ventilatory movements To demonstrate knowledge of the structure and function of the trachea, bronchi and lungs including: bronchopulmonary segments and their functional significance the lobes and fissures of the lungs the major anatomical relationships of the lungs to the ribs, heart, aorta and other major vessels of the thorax the structure and function of the respiratory epithelium, smooth muscle and lung parenchyma To demonstrate knowledge of the control of ventilation including the basic functional anatomy of the brain stem centres To demonstrate knowledge of the pathophysiology of asthma, including: aetiology and epidemiology inflammation the immune mechanisms of atopy hypersensitivity wheeziness bronchospasm To demonstrate knowledge of the therapeutic agents used in asthma, including the mechanisms of action and unwanted effects of Bronchodilators and antiinflammatory drugs To demonstrate knowledge of the basic concepts of agonism and antagonism as they relate to actions of molecules and/or drugs on their targets, and to outline different types of agonism/antagonism To demonstrate the ability to measure ventilation To demonstrate knowledge of gas exchange in the lung, including: the structure and function of the alveoli To demonstrate knowledge of the control of ventilation, including: the basic functional anatomy of the brain stem centres the peripheral and central detection of hypoxia

To demonstrate basic knowledge of the pathophysiology of pulmonary diseases, including: chronic obstructive pulmonary disorder pneumonia emphysema bronchitis asthma mesothelioma To demonstrate knowledge of the common bacterial respiratory infections and their effect on sputum To demonstrate knowledge of the action of antibiotics in the treatment of respiratory infections To demonstrate knowledge of the indications and limitations of the different therapies for chronic lung disease (bronchodilators, oxygen) To demonstrate knowledge of the assessment of lung function, including exercise tolerance To explain how to perform an exercise tolerance test To demonstrate the ability to assess lung function To demonstrate the ability to use statistical methods to predict lung function To demonstrate knowledge of the structure and function of the heart, including: Anatomy relationship to other structures in the thorax the structure and microanatomy of the auricles and ventricles the position and function of the heart valves the coronary blood supply (including the origin, course and name of the main branches of the main coronary arteries and be able to recognise them on angiograms) the nervous innervation Physiology the role of the cardiac pacemaker and the conduction of impulses through the heart cardiac events; the relationship to blood pressure and pulse of the heart and constituent parts the flow of blood through the heart the effects of the autonomic nervous system on the heart and peripheral circulation the effects of hormones on the heart and peripheral circulation cardiac output, venous return To demonstrate the ability to apply anatomical and physiological knowledge of the heart to basic clinical skills, including: auscultation of the heart valves anatomical basis of heart murmurs demonstration of the major thoracic structures on suitable radiographs and be able to recognise common abnormalities To demonstrate knowledge of the pathophysiology, signs and symptoms of cardiac failure

To demonstrate knowledge of the actions of drugs (including unwanted effects) on cardiac muscle and vascular smooth muscle To demonstrate knowledge of the circulatory system, including the anatomy and histology of arteries and veins To demonstrate knowledge of the pathophysiology of atheroma and the mechanisms leading to thrombosis To demonstrate the ability to apply anatomical and physiological knowledge of the heart to basic clinical skills, including: interpretation of ECG and chest radiograph differential diagnosis of a patient with chest pain To demonstrate knowledge of the route of referred pain from the heart To demonstrate knowledge of the pathophysiology of angina, including: signs and symptoms management options To demonstrate knowledge of the actions of drugs to treat angina and myocardial infarction To demonstrate knowledge of the effects of smoking on the cardiovascular system To demonstrate knowledge of the pathophysiology of hypercholesterolaemia in the cardiovascular system, including: signs and symptoms management options To demonstrate knowledge of the pathophysiology of inflammation in the cardiovascular system To demonstrate knowledge of the process of haematopoiesis, including: Changes occurring to the circulatory system and sites of haematopoiesis from the foetus to the adult Structure and function of erythrocytes (red blood cells) o Haemoglobin (the various subtypes and ability to carry oxygen) o Erythropoiesis o Recycling of damaged or old red blood cells and their constituents o The significance of blood groups and the immune response Structure and function of leukocytes (white blood cells) o Neutrophils o Eosinophils o Basophils o Monocytes o Lymphocytes o Platelets To demonstrate basic knowledge of the pathophysiology of anaemia, including: the symptoms of anaemia the causes of anaemia in different age groups inherited disorders of haemoglobin (such as sickle cell anaemia) the principles involved in the treatment of different types of anaemia

To demonstrate basic knowledge of blood transfusion, including: the process of compatibility testing the adverse effects of blood transfusion and consequences to the body of haemolysis, anaphylaxis or iron overload infectious conditions transmitted by blood transfusion and measures taken to prevent this To demonstrate knowledge of haemostasis, including: Vasospasm Platelet aggregation Coagulation processes Blood clots To demonstrate knowledge of the effect of obesity on the cardiovascular system To demonstrate knowledge of the pathophysiology of clotting disorders, including: triggers for, and causes of deep vein thrombosis and pulmonary embolism signs, symptoms and causes of deep vein thrombosis and pulmonary embolism To demonstrate basic knowledge and understanding of the detection and treatment of clotting disorders, including: clinical investigations (the basis of ventilation-perfusion scans, blood tests and clotting screens) anti-coagulant therapies (mechanisms of action and unwanted effects) effects of self-medication on anti-coagulant therapies To demonstrate knowledge of: how blood is returned to the heart from the legs and the consequences of the failure of this mechanism the causes and consequences of embolism in the lower limb the causes and consequences of compartment syndrome, common locations and possible causes of deep vein thromboses To describe the regional circulation: muscular and cutaneous. To describe the origins, course and relationships of: the jugular and subclavian venous systems subclavian and carotid arteries vagus and phrenic nerves sympathetic chains as they pass from neck to thorax To demonstrate knowledge of the physiological effects of shock and trauma on the cardiovascular system and how to monitor them To demonstrate an understanding of the nature of fluid replacement therapy including blood and other infusions To demonstrate a basic understanding of the signs of closed and open fractures To describe the effects of acidosis, hydrogen ions, pH and buffers on the blood To demonstrate a basic understanding of the concepts of consciousness

Apply psychological principles, method and knowledge to medical practice.

To demonstrate knowledge of the psychological and physiological features of the stress response To demonstrate knowledge of the main components of Cognitive Behavioural Therapy as applied to Post Traumatic Stress Disorder To demonstrate an understanding of bystander apathy and factors affecting the likelihood of receiving help To demonstrate understanding of the concept of psychosomatic illness To demonstrate knowledge of health protective and health threatening behaviours To demonstrate knowledge of adherence, including theories and strategies used to enhance adherence to treatment and health advice To demonstrate knowledge of the approach to control smoking related disease, including: individual and social factors associated with the initiation and maintenance of smoking Tobacco control To demonstrate knowledge of the role of illness beliefs and mood in cardiac disease To demonstrate knowledge of heart disease, including the evidence base for cardiac rehabilitation To demonstrate knowledge of the psychological and social factors in the development, detection and treatment of coronary heart disease To demonstrate knowledge and understanding of altruism and altruistic acts, including appropriate ethical and psychological terms To demonstrate knowledge of health promotion concepts in relation to weight reduction, and disease prevention To demonstrate a basic knowledge of patients experiences of sensory disturbance in ICU (Intensive Care Units)

Apply social science principles, method and knowledge to medical practice.

To demonstrate knowledge of the classification of social groups in terms of socio economic status To demonstrate knowledge of inequalities in health and health care for smoking and cardiovascular disease To demonstrate knowledge of the psychological and social factors in the development, detection and treatment of coronary heart disease

Apply to medical practice the principles, method and knowledge of population health and the improvement of health and healthcare.
To demonstrate knowledge of the pathophysiology of asthma, including aetiology and epidemiology To demonstrate knowledge of the approach to control smoking related disease,

including Public health promotional campaigns describing the health risk from tobacco smoking for the individual and the population To demonstrate knowledge of heart disease, including: epidemiology historical and population trends in mortality (esp. sex differences and ethnicity) the main types of analytical and interventional epidemiological study designs used in obtaining this data the use of statistical methods to predict risk factors in coronary heart disease public health strategies for education on healthy lifestyles

The Doctor as a Practitioner

To demonstrate knowledge of the role of interpreters in health care To demonstrate a basic understanding of the main ways in which language differences may act as a barrier to communication and access to health care To demonstrate a basic understanding of the barriers to communication with unconscious or confused patients

The Doctor as a Professional The graduate will be able to behave according to ethical and legal principles.
To demonstrate knowledge of the ethical reasons for acting paternalistically To demonstrate knowledge and understanding of altruism and altruistic acts, including: appropriate ethical and psychological terms altruism in current health care practice To be able to outline the principles of informed consent To demonstrate a basic knowledge of the legal position in relation to the treatment of unconscious patients