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7/29/2019 Introduction Cluster Abdomen Bouvy 2009
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INTRODUCTIONcluster abdomen
1DE RUN
31-8-09Nicole Bouvy
surgeon
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Purpose
1. To gather knowledge about abdominalcomplaints
2. To get used to the abdominal complaintsquestions and the abdominal clinicalsurvey
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What drives learning?
Clinical presentations
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26 clinical presentations (p.17)and p28 Sheffield list
1. Dysphagia
2. Dyspepsia
3. Weight loss adult4. Child with bending growth
curve
5. Chronic abdominal pain adult
6. Chronic abdominal pain child7. Colic pain upper abdomen
8. Increase abdominalcircumference
9. jaundice10. Rectal blood loss
11. Chronic diarrhoea adult
12. Chronic diarrhoea child
13. Changed stool pattern
14. Faeces incontinence
15. Obstipation
16. Inguinal swelling17. Dysuria
18. Urine retention
19. Problems with sexual organs
20. Urine incontinence
21. Obstructive urination
22. Haematuria
23. Vaginal fluor24. Disturbance of menstruation
pattern
25. Problems with pelvic floor
26. Pregnancy
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Clinical presentations Basic medical sciences Clinical Sciences Common Index Conditions
Abdominal distention Knowledge of structures within
the abdomen and pelvis
Pathophysiology of bowel obstruction and
peritonitis
Ascites
Causes of enlarged organs in the abdomen
and pelvis
Bowel obstruction
Peritonitis
Enlarged intra abdominal
organs
Obesity
PregnancyAbdominal mass Structure and function of
internal abdominal organs
Pathophysiology of index conditions and their
cause
Hepatomegaly
Splenomegaly
Kidney enlargement
Bowel masses
Enlarged bladder
Aortic aneurysm
Uterine/ovarian masses
Abdominal wall hernias
Abdominal pain Knowledge of structures within
the abdomen and pelvis
Pathophysiology of index conditions and their
cause
Peptic ulcer disease
Mechanisms of abdominal pain Biliary tract diseasePrinciples of management of index conditions Pancreatic disease
Endometriosis
Aortic aneurism
Recurrent abdominal pain in
children
Ectopic pregnancy
Renal colic
Acute pyelonephritis
Diverticular disease
Appendicitis
Irritable bowel syndrome
Mesenteric ischemia
Intussusception
Bladder retention
Prostatitis
Adnexal torsion
Anorectal pain Structure and function of the
anal canal and the rectum
Pathophysiology of haemorrhoids Fissure in ano
Pathology and principles of management of
ano-rectal carcinoma
Thrombosed haemorrhoids
Knowledge of management of index
conditions
Carcinoma
Fistula
Pilonidal sinus abcessPerianal abcess
Rectal prolapse
Change in bowel habit Structure and function of the
large bowel
Pathophysiology of index conditions Carcinoma of large bowel
Knowledge of management of index
conditions
Diverticular disease
Inflammatory bowel disease
Toddlers diarrhoea
Irritable bowel syndrome
Constipation Structure and function of the
large bowel
Pathophysiology of index conditions Constipation
Pharmacology of laxatives and constipation
inducing drugs
Carcinoma
Laxative abuse
Drug related constipation
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Learning Methods Cluster Abdomen
Base group (Tuesday morning)
Outpatient clinic (Wednesday)
Training of skills (prostate, uterus) Anatomy, Physiology, pharmacology,
microbiology
Lectures Consulting experts
Self study
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Optional
Watching department of Endoscopy(Gastroscopy, colonoscopy, ERCP)
Watching operations department of
Surgery (phone Thursday morning 6-6883)
(laparoscopic cholecystectomy inguinalhernia repair etc)
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Esophyxrepair of Lower Esophageal Spincter
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Robot geassisteerdelittekenbreuk correctie na
opheffen stoma
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Example casus
Patient
vignettePrediscussion
on Tuesday
Vignette / casus
A 36-year old women
presents with rectal blood
los at the department ofsurgery
waarom een nieuwcurriculum?
curriculumstructuur
onderwijsprocess basisgroep
coach
voorbespreking
vignette
praktijkbegeleider
voor / nabespreking
terugrapportage
specifieke taken
logistiek /ondersteuning
Focus op Mechanisme van Ziekte
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neoplasia
circulatory
traumatic
BLOEDBLOED
congenital
anatomical
inflammatory /
immunological
Infection
functional /psychosomatic
metabolic /
endocrine
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Anotherexample
Symptoms
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Anatomy of liver
and bile ductsystem
Physiology gall
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Outpatient Clinic
waarom een nieuwcurriculum?
curriculumstructuur
Learning processyear 3
basisgroep
coach
voorbespreking
casus / vignet
praktijkbegeleider
pre / post patint contact
terugrapportage
specifieke taken logistiek /
Outpatient clinic
08.30 08.35 prediscussion
08.35 08.50 Questions to patient
08.50 09.05 physical examination withspecialist
09.05 09.20 Discussion and learning objectives+ feedback
Structured individual feedback
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Self study
create a SOEPEL
Study learningtargets
create powerpointand word document
waarom een nieuwcurriculum?
curriculumstructuur
Learning processyear 3
basisgroep
coach
voorbespreking
casus / vignet
praktijkbegeleider
voor / nabespreking
terugrapportage
specifieke taken logistiek /
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Report back in base group
(Tuesday morning) Sunday evening worddocument en powerpointon eleum
Max20 minutes perclinical presentation
waarom een nieuwcurriculum?
curriculumstructuur
Learning processyear 3
basisgroep
coach
voorbespreking
casus / vignet
praktijkbegeleider
voor / nabespreking
specifieke taken logistiek /
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Onderwijsproces doorlopen
Voorbespreking
basisgroep
Voorbespreking
praktijkbegeleider
zelfstudie
Patinten
contactNabespreking
praktijkbegeleider
zelfstudie
Terugrapportage
basisgroep
Patinten
vignet/casus
activiteiten
rondom
patinten
contact
waarom een nieuwcurriculum?
curriculumstructuur
onderwijsproces jr 3 basisgroep
coach
voorbespreking
casus / vignet
praktijkbegeleider
voor / nabespreking
terugrapportage
specifieke taken
logistiek /ondersteuning
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Task coach
waarom een nieuwcurriculum?
curriculumstructuur
onderwijsproces jr 3 basisgroep
coach
voorbespreking
casus / vignet
praktijkbegeleider
voor / nabespreking
terugrapportage
task coach
logistiek /ondersteuning
coach giving feedback on
presentations
professional behaviour
stimulating discussion
preparing oral exam
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Lectures Cluster Abdomen Pathology
Physiology Radiology
Medical Microbiology
Pharmacotherapy
Genetics/cell biology
GP
Gastro-enterology
Pediatrics
Urology
Gynaecology enObstetrics
General Surgery
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Student is fully responsibel for
cluster file
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You have to be present to dowritten and oral exam
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Absence of studentsSanctionering : dit wordtmeegenomen in debeoordeling PG
Hetzij als onderdeel van de regulierebeoordeling, hetzij als incidentelemelding
NEE
Herkansing medisch- expert
ieder cluster biedt studententijdens de grote vakantie eenherkansingsperiode van eenweek aan (binnen een
vastgelegde periode van 3weken) week 29 is op zijnvroegst de eersteherkansingsweek.Niet toegelaten
tot
clustertoetsing
(Medisch Expert)Herhaling cluster
het volgende jaar
Exposure aan
klinische
presentaties1
Voldoet aanvoorwaardenreparatie(in totaal nietmeer gemist dannpraktijkcontact entwee
basisgroepen)
Voldoetniet aanvoorwaardenreparatie
(zie boven)
Coach
geeft
student
reparatie
opdracht
J A Studentvoldoet
aan
opdracht
(beoordelingdoor coach /examinator)
J A
NEE
Afwezigheidgerepareerd
(beoordeling doorcoach / examinator)
Hiermee wordt zowel bedoeld hetdaadwerkelijke patintencontactalsook de voorbereiding als denabespreking ervan in debasisgroep
overmacht(beoordeling doorexaminator / CCO)
geen
overmacht
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Conclusion
Good luck with your first real doctorexperience
Become a good doctor by constant
asking for feedback