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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
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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
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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
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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
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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
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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
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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)
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The Second Affiliated Hospital of Sun Yat-Sen University
The Biopsychosocial Model
HEALTH
BIO PSYCHO
SOCIAL
*
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The Second Affiliated Hospital of Sun Yat-Sen University
The Biopsychosocial Model
HEALTH
BIO PSYCHO
SOCIAL
*
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The Second Affiliated Hospital of Sun Yat-Sen University
The Biopsychosocial Model
HEALTH
BIO PSYCHO
SOCIAL
*
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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
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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)
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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”?
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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The Second Affiliated Hospital of Sun Yat-Sen University
谢谢!