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The Second Affiliated Hospital of Sun Yat-Sen University
Introduction ofInternal Medicine
Professor of CardiologyThe Second Affiliated HospitalSun Yat-sen University
Liu Pinming, M.D., Ph.D
The Second Affiliated Hospital of Sun Yat-Sen University
Overview
• Concept• History• Progress in Internal medicine • Medical Education• The Way of Learning
– Establishing a high aim– Combining theories with Practices– Three basics: theories, knowledge, skills
• How to approach to a patient
The Second Affiliated Hospital of Sun Yat-Sen University
What is Medicine
• Medicine is the art and science of healing. It encompasses range of health care practices evolved to maintain and restore health by prevention and treatment of illnesses
• Internal medicine is the medical specialty concerned with the diagnosis, management and mainly nonsurgical treatment of illnesses
• Internists/Physicians
The Second Affiliated Hospital of Sun Yat-Sen University
Internal Medicine Subspecialties
• Respiratory Medicine• Cardiovascular
Medicine• Endocrinology• Gastroenterology &
Hepatology
• Hematology• Nephrology• Rheumatology
•Infectious Diseases•Oncology•Critical Care Medicine•Geruatrics
The Second Affiliated Hospital of Sun Yat-Sen University
The Origins of Medicine • Early records on medicine: Ayurvedic medicine in the Indian
subcontinent , ancient Egyptian medicine , Traditional Chinese medicine, ancient Greek medicine, Islamic medicine
• As science and technology developed, medicine became more reliant on medications – Vaccines: Edward Jenner in 1796, Louis Pasteur in 1889 – Arsphenamine/Sulvarsan, Paul Ehilich, in 1908 – Insulin: discovered and isolated by Frederick Banting in
1921 – Penicillin : discovered by Alexander Fleming in 1928 – Sulfa drug: 1932
• Shift from biomedical model to bio-psycho-social medical model– Biological factors – Broadly environmental factors
The Second Affiliated Hospital of Sun Yat-Sen University
Why do people get sick?
Biomedical Model: • Exposure to infectious agents or pathogens• Immune response either sufficient or insufficient
The Second Affiliated Hospital of Sun Yat-Sen University
Why else do people get sick?
• Previous exposure to virus• Health behaviors (sleep, nutrition, etc.)• Stress/emotions• Social relationships (support, conflict)
The Second Affiliated Hospital of Sun Yat-Sen University
The Biopsychosocial Model
HEALTH
BIO PSYCHO
SOCIAL
*
The Second Affiliated Hospital of Sun Yat-Sen University
The Biopsychosocial Model
HEALTH
BIO PSYCHO
SOCIAL
*
The Second Affiliated Hospital of Sun Yat-Sen University
The Biopsychosocial Model
HEALTH
BIO PSYCHO
SOCIAL
*
The Second Affiliated Hospital of Sun Yat-Sen University
The Biopsychosocial Model: Why do college students get sick?
HEALTH
BIO PSYCHO
SOCIAL
personality
emotions
social conflictsocial support
immune reaction to virus
previous exposure to virus
health behaviors
The Second Affiliated Hospital of Sun Yat-Sen University
Shift from Experience-Based Medicine to EBM
“Evidence-Based Medicine is the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients. [In] practice, [this] means integrating individual clinical experience with the best available external evidence from systematic research.”
(Sackett et al., 1996. Evidence based medicine: what it is and what it isn't.BMJ, 312: 71-2)
The Second Affiliated Hospital of Sun Yat-Sen University
Principles of EBM
Highest quality
Lowest quality
aims to apply the best available evidence gained from the
scientific method to medical decision making • So what is “best evidence”?
The Second Affiliated Hospital of Sun Yat-Sen University
Evidence Based Medicine
• Best practice based on current knowledge– Formulate of the problem– Find the evidence– Critical evaluation of the evidence– Practical application– Evaluation of the results
• Evidence based and creative medicine
The Second Affiliated Hospital of Sun Yat-Sen University
Progress in Internal Medicine
With the development of techniques in molecular
biology, cellular biology, genetics and immunology, etc
at
Etiology & Pathogenesis
Diagnostic
Management & Treatment
The Second Affiliated Hospital of Sun Yat-Sen University
Timeline of Medicine (Technology)
• 1895 - medical use of X-rays in medical imaging • 1901 - the existence of different human blood types • 1903- Willem Einthoven, the invention of String galvanometer ECG• 1921 - Frederick Banting, the discover of insulin - the treatment of diabetes • 1927 - First vaccine for Tuberculosis • 1928 - Alexander Fleming discovers penicillin • 1929 - Hans Berger discovers human electroencephalography • 1943 - Willem Kolff build the first dialysis machine • 1958- an implantable pacemakerinvented at the Karolinska Institute, Sweden• 1960 - Invention of Cardiopulmonary resuscitation (CPR) • 1965 - Frank Pantridge installs the first portable defibrillator • 1965 - First commercial ultrasound • 1967 - Christiaan Barnard performs first human heart transplant • 1971 - Sir Godfrey Hounsfield invents the first commercial CT scanner • 1976 - First commercial PET scanner • 1877 – First PTCA for coronary artery disease perfromrd by Andreas Gruentzig• 1978 - Last fatal case of smallpox • 1980 - Raymond Damadian builds first commercial MRI scanner • 1981 - First vaccine for Hepatitis B • 1992 - First vaccine for Hepatitis A available
The Second Affiliated Hospital of Sun Yat-Sen University
Internal Medicine
• Internal Medicine plays a vital role in clinical medicine
• Not only fundamentals to other clinical medicine subjects, but also closely related to them
• Mastering Internal Medicine well & laying a solid foundation
The Second Affiliated Hospital of Sun Yat-Sen University
The Way of Studying Medicine
• Establishing a high aim
• Combining theories with Practices
• Three basics: theories, knowledge, skillsEverything you want to know about Internal Medicine-
and dare to ask
The Second Affiliated Hospital of Sun Yat-Sen University
Learning Skills throughout Lectures
Diseased-Centered, Learner-Driven Focused on:• Etiology & Pathogenesis• Pathophysiology• Clinical Manifestations: symptoms, signs• Laboratory Findings & other Additional
testing• Diagnosis & Differential Diagnosis• Management Principles
The Second Affiliated Hospital of Sun Yat-Sen University
Problem-based Learning
Characteristics:• Learning: driven by challenging, open-ended
problems • Students: in small collaborative groups • Teachers: the role as "facilitators" of
learning.
student-centered instructional strategy in which students collaboratively solve problems and reflect on their experiences
The Second Affiliated Hospital of Sun Yat-Sen University
Problem-based Learning
Advocates of PBL claim it can be used to enhance content knowledge and foster the development of communication, problem-solving, and self-directed learning skill
Students are encouraged to take responsibility for their group and organize and direct the learning process with support from a tutor or instructor
Problem-based learning is widely used in many medical universities world wide
The Second Affiliated Hospital of Sun Yat-Sen University
Doctoring Skills Rotation
Patient-Centered, Learner-Driven Focused on:• History taking and communications skills• Physical diagnosis• Real patients and patient simulation
technology• Decision-making skills• Life-long learning skills• Clinical teaching skills• Direct Feedback from Specially Trained
Teaching Faculty
The Second Affiliated Hospital of Sun Yat-Sen University
SUMMARY
• The key to study internal medicine:– Care about what you are learning– Try your hardest at all that you do– Think and reason through things– Learn every day– Work as a team– Have fun
The Second Affiliated Hospital of Sun Yat-Sen University
谢谢!