Human Biology & Health…(“systems I”) 1

1. Introductory lecture (2hrs)

Course objectives

Overview of system/organ function

Overview of anatomy and relevant structures

Overview of Burden of illness

Patient illustration

2. Normal Development & Embryology

3. Gross Anatomy & Imaging

4. Microanatomy

5. Normal Processes including impact of aging

Physiology

Biochemistry & Molecular biology

Pharmacology

*All material ( where possible) will be presented as normal contrasting to illustrations of abnormal providing clinical relevance

Health & Disease….(“systems II” ) 2

1. Introductory lecture (2 hrs) • Course objectives • Review of Systems I • Burden of illness

Epidemiology and Social

• Patient illustration

2. Clinical Genetics • Review of embryology if relevant

3. *Life Cycle impacts: • Development--> pediatrics --> geriatrics

4. Abnormal Processes: • Specific Abnormality or Disease pathophysiology

*With each entity : 1) Epidemiology 2) Scientific Basis and Anatomy review 3) Prevention and Screening1

4) Cultural, Social and Ethical issues 5) Natural History & Prognosis

6) Diagnosis 2 7) Therapeutics and Disease Management 8) Translational Research & Evidence Based Medicine 9) Health Care System

*Either as part of unit or parallel longitudinal course

1 Includes amongst others nutrition, life style, exercise

2 Includes history, physical, labs, imaging and pathology

UGME CuRe 21stCentury: Module 1 & 2 Course Template DRAFT Mar2012

1

2

Asymptomatic Blood, Urine or Imaging

Abnormality or Mass

Symptomatic Relevant discomfort or mass; Blood, Urine or Imaging Abnormality

Person……Patient

-System:

-Learner:

Anatomy : Gross Microanatomy Embryology/Genetics

Physiology: Lower Urinary Tract Glomerular/Tubular

Pathophysiology: LUTS/ Incontinence Calculi UTI Cystic disease GU Tumors

Community:

Kidney Disease-Acute & Chronic Electrolyte (Na, K, Ca, P04, Mg)

Volume abnormalities Acid base abnormalities Glomerular Diseases

CONCEPT MAP : CuRe URINARY TRACT COURSE

Indigenous Health

Pediatrics Geriatrics Community

Health

Clinical Reasoning

Professionalism

Diagnostic Imaging

Genetics Health Psychology

CanMeds Objectives

• Medical Expert

• Scholar

• Communicator

• Health Advocate

• Collaborator

• Manager

• Professional

Urology Nephrology

Clinical Skills

InterProfessionalActivity/education

-Longitudinal Course or Theme:

Information Science

3

CuRe URINARY TRACT COURSE RENEWAL PROCESS

3

3

Course Leader: Keevin Bernstein kbernstein@hsc.mb.ca Education Coordinator : TBA

Anatomy: Sabine Hombach-Klonisch Hombach@cc.umanitoba.ca Biochemistry : TBA Community Health : TBA Diagnostic Imaging: Mark Vivian markvivian11@gmail.com Generalism : TBA Genetics : Alison Elliot aelliott@.hsc.mb.ca Immunology: Patricia Birk Pbirk@hsc.mb.ca Infectious Disease: Phillipe Lagace Wiens plagacewiens@sbgh.mb.ca Indigenous Health: Barry Lavallee blavalle@cc.umanitoba.ca Nephrology HSC: Martin Karpinski Mkarpinski@hsc.mb.ca Nephrology SBGH: Chris Sathianathan Csathianathan@sbgh.mb.ca Pharmacology: Don Smyth don.smyth@med.umanitoba.ca Pathology: Ian Gibson igibson@hsc.mb.ca Pediatrics: Patricia Birk Pbirk@hsc.mb.ca Urology: Brenda Hildebrand Brenda.hildebrand@gmail.com

Students : Jesse Marantz (2015) marantzj@cc.umanitoba.ca Patrick Jung (2015) jungp@cc.umanitoba.ca Resident: Alissa Lloyd (PGY4) alloyd@exchange.hsc.mb.ca

M1/M2 URINARY TRACT UT Course Committee

4

CuRe URINARY TRACT Jan 20, 2014

4

M1 and M2 Urinary Tract course covers:

UPPER and LOWER URINARY TRACT and MALE GENITALIA:

• Normal urinary tract and male sexual function • Abnormalities that are either

Urology : anatomical abnormalities of the urinary tract and male genitalia

Nephrology : abnormalities of kidney parenchymal function

5

At the completion of M1 UT1 , the Learner should be able to:

1. Describe the burden of illness that pertains to the urinary tract, specifically acute and chronic kidney disease, urinary tract infections, benign and malignant conditions involving the upper and lower urinary tract.

2. Describe normal anatomy, microanatomy and (development) of the urinary tract, and male genitalia.

3. Describe normal urinary tract physiology as it pertains to assessment of urologic or renal function and solute homeostasis.

4. Describe the impact of age and aging on the normal urinary tract physiology.

5. Describe the genetic and developmental disorders associated with cystic kidneys

6. Solve various clinical problems that involve solute abnormalities based upon the understanding of renal physiology & interpretation of lab tests.

CuRe URINARY TRACT COURSE OBJECTIVES

6

At the completion of M2 UT2 , the Learner should be able to:

1. Describe the etiology, pathophysiology, clinical presentation, treatment and prognosis of a variety of diseases of the urinary tract, either urological or nephrological.

2. Using case illustrations differentiate potential urologic from nephrologic diseases based upon random & timed urinary tests (urinalysis, urinary indices, timed urine collection) and diagnostic imaging.

3. Using case illustrations differentiate acute from chronic kidney disease including potential causes, prognosis and treatments.

4. Demonstrate the roles of professionalism and health advocacy in managing or preventing various diseases of the urinary tract.

5. Appreciate cultural and ethnic impact on diseases of the urinary tract.

6. Appreciate the roles of all health care professionals in the management of individuals with diseases of the urinary tract.

CuRe URINARY TRACT COURSE OBJECTIVES

7

CuRe URINARY TRACT COURSE RENEWAL PROCESS

7

7

Build upon existing Kidney course strengths ie nephrology section:

Use compilation of integrated assigned studies and small groups sessions

Strategic WGS for introductory topics, reviews or illustrating integration with

other specialities or disciplines

Enhance Urology section: Include male genitalia

Establish troika – Anatomy, Urology and Diagnostic Imaging - collaborating to create and present Anatomy content in M1, and Urology in M2.

Sabine Hombach-Klonisch, Brenda Hildebrand or Mark Vivian designated as session leader

Integrate Themes Burden of disease- ie aboriginal influences

Geriatrics and pediatrics - effects of aging added to renal physiology at both extremes

Urinary continence

Pharmacology

Add pediatric cases to nephrology small group sessions

Enhanced content on genetics including developing link to cystic disease

8

Course

IDSESSION TOPIC-TITLE Dept Date Time Hrs Format Session Leader Notes

UT101 Introduction: Urinary Tract IM/CHS 17-Feb 9:00 2 WGS Keevin Bernstein

UT102Histology of the Kidney and Male

Reproductive Tract Ana 19-Feb 9:00

1 AS Sabine Hombach spermatogenesis

UT103Development of Genito-Urinary

System Ana 19-Feb 10:00

1 WGS Mark Torchia

UT104Anatomy of Lower UT and male

reproductive tract

Ana/

Uro/DI19-Feb 16:00

1 WGS Sabine Hombach

Mark Vivian

Brenda Hildebrand

gross anatomy with radiologic

images dissection

UT105GFR & RBF: Control and

Clinical Assessment IM 20-Feb 9:00

2 AS Keevin Bernstein age effects; young & old.

Hyperfiltration and energy

UT106Bladder & Male Sexual

Function/DysfunctionUro 20-Feb 11:00

1 WGS Rob Bard continence;age effects

UT107 GU Heredity/Cystic Disease IGen/

Peds20-Feb 12:00

1 WGS Alison Elliot

Patricia Birk

UT108 Tubular Secretion & Reabsorption IM 24-Feb 9:00 1 AS Keevin Bernstein

UT109 Renal Hormones IM 24-Feb 10:00 1 AS Keevin Bernstein

UT110 GU Heredity/Cystic Disease II Genet 24-Feb 11:001 SGS/T Alison Elliot

Patricia Birk

UT111 Renal Hemodynamics IM/Peds 25-Feb 9:00 2 SGS/T Keevin Bernstein

UT112 Salt & Water Handling by Kidney IM 02-Mar 11:00 2 AS Keevin Bernstein

UT113Anatomy of Upper UT-Kidneys &

ureters

Ana/

Uro/DI04-Mar 9:00

2 SGS/LP Sabine Hombach

Mark Vivian

Brenda Hildebrand

gross anatomy with radiologic

images dissection

UT114 Control of Salt & Water Balance IM/Peds 05-Mar 9:00 2 SGS/T Keevin Bernstein augment diuretc effects

UT115 Review of Salt Balance (IT1) IM 0 T (O) Keevin Bernstein

UT116 Potassium Homeostasis IM/Peds 06-Mar 9:00 2 SGS/T Martin Karpinski

UT117 Acid Base Balance IM/Peds 09-Mar 11:00 2 SGS/T Martin Karpinski

UT118 Overview of Renal Tubular Function IM 10-Mar 9:001 L Keevin Bernstein

UT119 Volume & Osmolality Control I IM/Peds 10-Mar 10:00 2 SGS/T Keevin Bernstein

UT120 Volume & Osmolarity II IM/Peds 11-Mar 9:00 1 SGS/T Keevin Bernstein

UT121 Instructional Test II 12-Mar 9:00 IT Keevin Bernstein

CuRe URINARY TRACT M1 2015

Course objectives

Overview:

1.system/organ function

2.anatomy& relevant structures

3.Burden of illness

4.ESRD Patient

9

SESSION TOPIC-TITLE Depart. Date Time Hrs Format Session Leaders

Bold point person

Notes:Includes

UT201 IM/CHS Mon.Jan 25 9:00

AM

2 WGS Keevin Bernstein

Renal Pathophysiology physiology & Intro case patho

physiology;burden of illness

UT202 Salt and Water I IM/Peds 2 SGS/T Keevin Bernstein

UT203 Salt and Water II IM/Peds 2 SGS/T Keevin Bernstein

UT204 Clinical Acid Base & Potassium

I

IM/Peds 2 SGS/T Martin Karpinski

UT205 Clinical Acid Base & Potassium

II

IM/Peds 2 SGS/T Martin Karpinski

UT206 Renal Pharmacology Pha 1 WGS Don Smyth Diuretics,ACE/ARB,BPH

UT207 Urinalysis IM 1 WGS Keevin Bernstein

UT208 LUTS &

Male Reproductive Abnormalities

Uro/

Ana/DI

2

WGS

Brenda Hildebrand

Sabine Hombach

Mark Vivian

Presentation, imaging, path.,

management includes

Incontinence & Infertility

UT209 GU tumors Uro/

Ana/DI

1

WGS

Brenda Hildebrand

Sabine Hombach

Mark Vivian

Presentation, imaging,

pathology, management

UT210 Calculi URO/DI/ 2WGS

Brenda Hildebrand

Mark Vivian

Presentation, imaging,

management

UT211 Urinary Tract Infection I ID/ 1 WGS Philipe Legace Weins add Ped UTI

UT212 Urinary Tract Infection II ID/Ped/ 1 SGS/TPhilipe LegaceWiens

Patricia Birk

UT213 Urology:Abnormal U/A & GU

Tumours

URO 2 SGS/T Brenda Hildebrand

UT214 Instructional Test I IM 1 IT Keevin Bernstein

UT215 Abnormal Urinalysis IM 1 WGS Keevin Bernstein

UT216 Glomerulonephritis - GN - I IM/

Ped/Pa

2

WGS

Keevin Bernstein

Patricia Birk

Ian Gibson

Approach

Immunology

Case presentations/pathology

UT217 Glomerulonephritis - GN - II IM/PA 1WGS

Keevin Bernstein

Ian Gibson

Case presentations/pathology

UT218 Nephrology: Abnormal

Urinalysis

IM/Peds 2 SGS/T Keevin Bernstein

UT219 Acute Kidney Disease IM 1 AS Keevin Bernstein

UT220 Chronic Kidney Disease IM 1 AS Keevin Bernstein

UT221 Urinary Tract Obstruction URO 1 AS Brenda Hildebrand add Ped VUR

UT222 Kidney Disease Management I IM/CHS1 WGS

Keevin Bernstein Augment Bone & BP mgmt

Burden illness

UT223 Kidney Disease Management II IM/Peds 2WGS

Keevin Bernstein

Patricia Birk

Approach and RRT

UT224 Kidney Disease Management III IM/

NU/Nu

1WGS

Keevin Bernstein Prevention

Multidisciplinary care

UT225 Kidney Disease Management IV IM/Peds 2 SGS/T Keevin Bernstein

UT226 Kidney Disease Management V IM/Peds 2 SGS/T Keevin Bernstein Includes Ped age

UT227 Kidney Disease Management VI IM/Peds 1 SGS/T Keevin Bernstein

UT228 Clinical Potpourri I - Adults IM/Peds 2 SGS/T Keevin Bernstein

UT229 Clinical Potpourri II -Peds Peds 1 SGS/T Patricia Birk

UT230 Instructional Test II IM 2 IT Keevin Bernstein

CuRe URINARY TRACT M2 2016Course

ID

Introduction: Case:Review M1 UT clinical

10

CuRe URINARY TRACT COURSE RENEWAL PROCESS

10

10

M1/M2 URINARY TRACT Course Breakdown

74 Hours

% M1 M2 TOTAL

33 7 18 25

47 14 21 35

3 2 0 2

11 5 3 8

6 1 3 4

100 29 45 74

11 11

11

M1/M2 URINARY TRACT Student Evaluation

All MCQ – 50 % case based:

Instructional Tests 2 per course 4 % if achieved 60 %;

indefinite attempts

Mid term 26 %

Final 70 %

12 12

12

CuRe URINARY TRACT M3 topics

Complex diabetes with CKD and CHF

Multi-organ failure- PCKD – liver and kidney; genetics/ ethics/ clinical management

Multiple myeloma – integrating approach to anemia and kidney disease;

therapy including immunosuppressive therapy, dialysis and BMT

Multisystem disease ie SLE with lupus nephritis and immunosuppressive therapy

Pediatric kidney disease with salt and water management

Multi-organ donation – national system, organ allocations, immunosupressive

therapies, resource allocation based age and co-morbidities

Complex co-morbid disease in either pediatric and adult incorporating fluid,

electrolyte and acid base abnormalities

Elderly patient- lower tract symptoms, mild dementia and other medical

comorbidities addressing therapies

Male Fertility – male/ sperm donation/reproductive technology/ethics

13

Composite Clinical Presentations CP4* UGME Sept 2012 DRAFTV6 HEALTH CONDITIONS

SYMPTOMS & SIGNS 34 hemoptysis ABNORMAL LABS 99 ADHD spectrum

1 abdominal mass 35 hirsutism 66 acidosis 100 adrenal disorders

2 abd pain: acute & chronic 36 hoarse voice 67 alkalosis 101 arthritis

3 allergic reactions 37 impotence 68 hemoglobin disorders 102 CVD

4 anxiety 38 incontinence 69 calcium/phopshate/magnesium 103 cirrhosis

5 ascites 39 jaundice 70 cardiac markers/EKG 104 CNS infections

6 blunt trauma 40 joint pain-acute & chronic 71 coagulation abnormalities 105 diabetes

7 burns 41 low back pain 72 creatinine:acute & chronic 106 Drug OD

8 bleeding 42 lymphadenopathy 73 CXR abnormalities 107 eating disorders

9 cardiac murmurs 43 neck mass/thyroid 74 lipd abnormality 108 fungal infections

10 chest pain 44 pain syndrome 75 leukocyte disorders 109 HIV/AIDS

11 constipation 45 palpitations 76 liver enzymes/function 110 hypertension

12 cough- acute & chronic 46 pruritus 77 potassium abnormalities 111 infertiltiy

13 cyanosis 47 red eye 78 platelet disorders 112 kidney disease-chronic

14 delirium 48 paralysis 79 pulmonary function tests 113 lung disease-chronic

15 dementia 49 pelvic pain/mass 80 sodium abnormalities 114 malnutrition

16 diarrhea- acute & chronic 50 seizures 81 urinalysis abnormalities 115 menses/menopause

17 diplopia 51 skin growths FACTORS EFFECTING HEALTH 116 mood disorders

18 dysphagia 52 skin rashes 82 adverse drug reactions 117 multiple sclerosis

19 dyspnea-acute & chronic 53 sleep disorders 83 chronic disease 118 osteoprosis

20 dysuria/UTI 54 somnolence 84 Contraception 119 pediatric emergencies

21 ear pain 55 sore throat 85 Culture 120 palliative care

22 edema 56 syncope 86 WHO Determinants of Health 121 pituitary disorders

23 extremity pain-acute&chronic 57 tendon rupture 87 developmental pediatric delay 122 pregnancy/complications

24 eye trauma 58 testicular swelling/pain/mass 88 Disabilities 123 psychosis

25 fever 59 tinnitus 89 neglect/abusive relationship or behavior 124 suicidal behavior

26 fatigue 60 vomiting 90 educational level 125 shock/resuscitation

27 foot ulcers 61 vision loss acute&chronic 91 elderly/frail 126 sports injuries

28 fracture/dislocation 62 weakness 92 environmental health 127 STI

29 GI bleed 63 wheezing- acute & chronic 93 infectious epidemic/prevention 128 suicidal behavior

30 head injury 64 UT obstruction symptoms-lower 94 food and water security 129 systemic autoimmune disorders

31 headache 65 vertigo/dizziness 95 body weight disturbances 130 surgical infections

32 hearing loss 96 substance abuse/addiction/alcoholism 131 TB

33 hematuria 97 poverty 132 thyroid disorders

98 smoking 133 Venous thrombosis

Directly 16 Indirectly 3

14

CuRe M1 Urinary Tract and GI plus LC 2015

Monday Tuesday Wednesday Thursday Friday

February 16 February 17 February 18 February 19 February 20

9:00

10:00

11:00

12:00

13:00

14:00

15:00

16:00

UT and GI

M1 Week 20

Lunch Lunch

GI103 WGS

Anatomy I

GI101 WGS

Introduction to GI

and Nutrition

UT 101 WGS

Introduction to

Urinary Tract

UT102 AS

Histology: Kidney

and Male

Reproductive Tract

GI 105 SGS/LP

Anatomy:Oral

GI106 SGS/LP

Anatomy: Abdomen

Louis Riel Day

Clinical Reasoning

GI102 WGS GI

Embryology and

Congenital

Disorders

UT103 WGS

Development of

Urinary Tract

Clinical Skills

Clinical Reasoning

PR-HM5 AS

History of Medicine

video project

PR-PW3 WGS

Determining Skills

and Values

Clinical Skills

UT104 WGS

Anatomy Lower

Urinary Tract

GI104 WGS

Histology I

LunchLunch

UT105 AS

Renal

Hemodynamics

and GFR

UT106 WGS

Bladder and Male

Sexual Function

UT107 WGS

Heredity/Cystic

Disease

GU Tract I

15

CuRe M1 Urinary Tract and GI plus LC 2015

Monday Tuesday Wednesday Thursday Friday

February 23 February 24 February 25 February 26 February 27

9:00

10:00

11:00

12:00

13:00

14:00

15:00

16:00

G1113 AS

Biliary Physiology

G1114 AS

Pancreas

Physiology

GI 115 WGS

Anatomy Small and

Large Intestine

Lunch

UT and GI

M1 Week 21

GI109 WGS

Anatomy II Liver Lunch Lunch

UT108 AS

Renal Tubular

Reabsorption &

Secretion

UT109 AS

Renal Hormones

GI108 WGS

Gastric Physiology

UT110 SGS/T

Heredity/Cystic

Disease

GU Tract II

GI111 WGS

Histology II LiverGI107 WGS

Oral and

Esophageal

Physiology

UT111 SGS/T

Renal

Hemodynamics

GI110 SGS/LP

Anatomy: Liver,

Gall bladder and

Pancreas

GI112 SGS/T

Liver Physiology

Lunch Clinical Reasoning Lunch

Clinical Reasoning

PR-PW4 SGS

Self Awareness-

Managing Stress

Clinical Skills

Clinical Skills

PR-PW5 WGS

Managing Your

Finances

PR-PW6 WGS

Career Planning

CHS-Pop7

Nutrition Public

Health Perpsective

PR-PW7 WGS

Introduction to

CaRMS

16

CuRe M1 Urinary Tract and GI plus LC 2015

Monday Tuesday Wednesday Thursday Friday

March 2 March 3 March 4 March 5 March 6

9:00

10:00

11:00

12:00

13:00

14:00

15:00

16:00

UT and GI

M1 Week 22

Lunch Lunch

Mid Term Exam

UT112 AS

Salt and Water

Handling

GI117SGS/LP

Anatomy: Smal and

large Intestine

GI118 SGS/T

Small

Bowel/Nutrition

Physiology

UT113 SGS/LP

Anatomy Upper

Urinary Tract

UT114 SGS/T

Salt and Water

Handling

Lunch Clinical Reasoning Lunch

Clinical Reasoning

Clinical Skills

Clinical Skills

CHS-SP7

Infant Nutrition /

Breastfeeding

CHS-HD12 SGS

Food Security &

Health

GI120 WGS

Salt & Water

Absorption

GI 116 WGS

Histology: Small &

Large Intestine

GI119 SGS/T

Physiology: Water

soluble vitamins

UT116 SGS/T

Potassium

Lunch

17

Monday Tuesday Wednesday Thursday Friday

March 9 March 10 March 11 March 12 March 13

9:00

10:00

11:00

12:00

13:00

14:00

15:00

16:00

UT and GI

M1 Week23

LunchGI 123 WGS

Gut MotilityLunch

GI 120 SGS/T

Lipid Soluble

Vitamins

UT117 SGS/T

Acid Base

UT 118 WGS

Renal Tubular

Review

UT119 SGS/T

Volume &

Osmolarity I

UT120 SGS/T

Volume &

Osmolarity II

GI 121 WGS

Diet & Nutrition 1

GI 122 WGS

Diet & Nutrition II

UT 121 WGS/A

Instructional Test

GI 124 WGS

Instructional Test

GI 125 SGS/LP

Anatomy Review

Final Exam

Lunch Clinical Reasoning Lunch

Clinical

Reasoning

Clinical Skills

Lunch

Information Science:

Secondary literature

Clinical Skills

CuRe M1 Urinary Tract and GI plus LC 2015