Department of Internal Diseases

 

 

Academic discipline – Therapy

 

MANUAL TO PREPARE FOR THE FINAL EXAM

EXAMINATION STATIONS.

PRACTICAL SKILLS DEMONSTRATION

                                                                                 

Orenburg - 2021

 

Orenburg State Medical University

 

Department of Internal Diseases

K.V. Korochina, T.V. Chernysheva, A.O. Mironchev,   

L.R. Tenchurina, G.E. Kuznetsov, I.E. Korochina

 

 

Academic discipline – Therapy

MANUAL TO PREPARE FOR THE FINAL EXAM

EXAMINATION STATIONS.

PRACTICAL SKILLS DEMONSTRATION

for 6^th year students

Foreign Faculty

Orenburg - 2021

UDC: 616-071.6

Authors:

1. Korochina Kristina Valerievna, PhD, assistant of the Department of Internal Diseases;

2. Chernysheva Tatiana Viktorovna, Doctor of Medical science, professor, Head of the Department of Internal Diseases;

3. Mironchev Anton Olegovich, PhD, associate professor of the Department of Internal Diseases, Dean of the Faculty of Foreign Students;

4. Tenchurina Lerida Ravilievna, PhD, associate professor of the Department of Internal Diseases;

5. Kuznetsov Grigory Eduardovich, Doctor of Medical science, professor of the Department of Internal Diseases.

6. Korochina Irina Eduardovna, PhD, associate professor of the Department of Polyclinic Therapy.

 

Reviewers:

1. Yudaeva Yulia Aleksandrovna, PhD, Associate Professor, Head of the Training Simulation Center;

2. Sayfutdinov Rustam Ilkhamovich, PhD, Professor, Head of the Department of Faculty Therapy and Endocrinology.

Bibliographic description: Examination stations – practical skill demonstration guide: Study and methodological guide for 6th-year students of Foreign Faculty / K.V. Korochina [et al.]. – Orenburg, 2021. –171 p.

 

Annotation. One of the steps of passing a final exam is the assessment of practical skills. For this, a course was developed on robots/manikins, simulating real patients, so that students could work out and show practical skills. Each specific algorithm of actions for examination of various clinical situations is called a Station. A total of 3 stations with different diagnoses are present in this guide. The aim was to provide students with information, explanations and recommendations about demonstrating practical skills on the final exam.

The guide contains a detailed description and clear algorithm of actions for the correct demonstration of each skill in Russian and English, with comments, as well as exemplary dialogues between simulated patient and student, depending on the clinical situation. Also, reference information with an abundance of explanatory pictures is provided for each station. Sample options for examination checklists with assessment criteria are also presented in the guide.

     Department of Internal Diseases and Training Simulation Centre wish all students successfully passing the final exam!

2021

TABLE OF CONTENTS

INTRODUCTION.. 7

THE GENERAL RULES FOR WORKING ON STATIONS: 8

I..... STATION DISPANSERISATION (ДИСПАНСЕРИЗАЦИЯ) 10

1.1.  OBJECTIVE.. 10

1.2.  DURATION OF WORK OF THE STATION.. 10

1.3.  BRIEFING (БРИФФИНГ) 10

1.4.  STUDENT WORKPLACE AT THE STATION.. 11

1.5.  MEDICAL DOCUMENTS. 12

1.6.  SAMPLE TEXT OF PATIENT-STUDENT DIALOGUE: 13

1.7.  SAMPLE TEXT OF EXAMINER-STUDENT DIALOGUE: 14

1.8.  ALGORITHM OF ACTIONS IN ENGLISH.. 14

1.9.  ALGORITHM OF ACTIONS IN RUSSIAN.. 22

1.10.    RESULTS OF EXAMINATION.. 28

1.11.    SAMPLE TEXT TO BE VOICED BY STUDENT WHILE WORKING AT STATION.. 29

1.12.    CHECK-LIST. 35

1.13.    BACKGROUND INFORMATION.. 37

1.13.1.    Cardiovascular system examination. 37

1.13.2.    Respiratory system examination. 48

II. STATION PHYSICAL EXAMINATION (ФИЗИКАЛЬНОЕ ОБСЛЕДОВАНИЕ) 76

2.1.  OBJECTIVE.. 76

2.2.  DURATION OF WORK OF THE STATION.. 76

2.3.  BRIEFING (БРИФФИНГ) 76

2.4.  SCENARIOS (DIAGNOSES) 77

2.5.  STUDENT WORKPLACE AT THE STATION.. 78

2.6.  MEDICAL DOCUMENTS. 79

2.7.  ALGORITHM OF ACTIONS IN ENGLISH.. 82

2.8.  ALGORITHM OF ACTIONS IN RUSSIAN.. 87

2.9.  SAMPLE TEXT OF DIALOGUE BETWEEN STUDENT AND EXAMINER, REGARDLESS OF SCENARIO.. 93

2.10.    SAMPLE TEXT OF DIALOGUE BETWEEN STUDENT AND EXAMINER, DEPEND ON SCENARIO.. 94

2.11.    SAMPLE TEXT TO BE VOICED BY STUDENT WHILE WORKING AT STATION.. 98

2.12.    CHECK-LIST. 100

2.13.    BACKGROUND INFORMATION.. 102

2.13.1.    Basic Cardiac Auscultation. 102

2.13.2.    Anatomical locations for listening. 104

2.13.3.    Patient Positioning. 105

2.13.4.    Listening technique. 105

2.13.5.    Frequency of heart sounds. 105

2.13.6.    Murmurs. 106

2.13.7.    Palpation of a Thrill 107

2.13.8.    Normal Heart Sounds. 108

2.13.9.    Aortic Stenosis Mild. 110

2.13.10. Aortic Regurgitation (Aortic Insufficiency) 115

2.13.11. Mitral Regurgitation. 119

2.13.12. Mitral Stenosis. 122

2.13.13. Ventricular Septal Defect (VSD) 126

2.13.14. Atrial Septal Defect (ASD) 128

2.13.15. Pulmonary Stenosis. 131

III. STATION EMERGENCY CARE (ЭКСТРЕННАЯ МЕДИЦИНСКАЯ ПОМОЩЬ) 134

3.1.  OBJECTIVE.. 134

3.2.  DURATION OF WORK OF THE STATION.. 134

3.3.  BRIEFING (БРИФФИНГ) 134

3.4.  SCENARIOS (DIAGNOSES) 135

3.5.  STUDENT WORKPLACE AT THE STATION.. 136

3.6.  ALGORITHM OF ACTIONS IN ENGLISH.. 138

3.7.  ALGORITHM OF ACTIONS IN RUSSIAN.. 140

3.8.  SAMPLE TEXT OF DIALOGUE BETWEEN STUDENT AND EXAMINER, REGARDLESS OF SCENARIO.. 143

3.9.  SAMPLE TEXT OF DIALOGUE BETWEEN STUDENT AND EXAMINER, DEPEND ON SCENARIO.. 144

3.10.    TREATMENT ACCORDING TO SCENARIO.. 149

3.11.    ESGS ACCORDING TO SCENARIO.. 152

3.12.    SAMPLE TEXT TO BE VOICED BY STUDENT WHILE WORKING AT STATION.. 154

3.13.    CHECK-LIST. 158

3.14.    BACKGROUND INFORMATION.. 160

3.14.1.    The ABCDE Approach - Underlying principles. 160

3.14.2.    First steps. 160

3.14.3.    Airway (A) 161

3.14.4.    Breathing (B) 162

3.14.5.    Circulation (C) 164

3.14.6.    Disability (D) 166

3.14.7.    Exposure (E) 167

CONCLUSION.. 168

REFERENCE.. 169

 

 

INTRODUCTION

One of the steps of passing the final exam is the assessment of practical skills. For this, a course was developed on simulation robots, simulating real patients, so that students could work out and show practical skills. The Department of Internal Diseases trains practical skills on 3 types of robots simulating various clinical situations. Each clinical situation is called a station (in Russ – Станция). The documents that contain information to prepare for a specific clinical situation are called Station Passport (In Russ.- Паспорт станции). A total of 3 Stations are present on the final exam, and 3 Station Passports are present in this study and methodological guide.

Aim: to provide 6th-year students with 3 passports of examinational stations, adapted to Foreign faculty, for Final Exam and to give explanations and recommendations about demonstrating practical skills.

Student must know: The basis of palpation, percussion, auscultation of internal organs of chest and abdomen, blood pressure measurement methodic, normal ranges of these parameters and abnormal changes in different pathologies, basis of emergency course.

Student must be able: To perform a visual examination of the patient, to palpate chest and abdomen, to percuss and auscultate heart, lungs, to measure blood pressure, to realize emergency care in cases of acute coronary syndrome, anaphylactic shock, gastrointestinal bleeding, broncho-obstructive syndrome, pulmonary embolism, spontaneous pneumothorax, hyper- and hypoglycemia, stroke.

For successful studying of material, the student must revise:

Propaedeutic, Therapy, Cardiology, Pulmonology, Pharmacology, Emergency course, Russian language.

This manual will help the student to develop general cultural competences, general professional competencies.

 

 

THE GENERAL RULES FOR WORKING ON STATIONS:

This exam is taken in the Russian language! This guide has Russian, English and bilingual fragments for the most effective studying.

Each station is given 10 minutes, of which the first 30 seconds are needed to familiarize themselves with the task, then 8.5 minutes are given to demonstrate practical skills, then 1 minute to prepare for the next station.

All 3 stations are located in adjacent rooms, which are interconnected by doors. After completing the first station, the student goes to the second room, after completing the manipulations in it, he goes to the next. Thus, each student completes all 3 stations in 30 minutes (strictly 10 minutes are given for each station).

Each room is equipped with microphones, cameras and speakers. To maintain timing, a voice command system has been developed. They will automatically sound:

- «внимательно прочтите задание на двери экзаменационной станции» ("carefully read the task on the exam station door") - the countdown starts from this phrase, you stand in front of the door and read the assignment for 30 seconds

- «войдите на экзаменационную станцию» ("enter the examination station") - only after this phrase you enter

- «предъявите свой уникальный номер» ("present your unique number") - this phrase is required for students who pass Russian accreditation. You are doing nothing at this moment.

-«приступайте» ("proceed") - you start work at the station.

-«осталась одна минута» ("one minute left") - it's just informing, do not stop working at the station.

-«спасибо, переходите дальше» ("Thank you, move on") - this phrase sounds at the ninth minute. You finish work at any current stage, go to the door of the next station and wait one more minute.

- after this minute the phrase «Подойдите к двери своей следующей станции» (“Go to the door of your next station”) sounds, which you have already done.

- then «внимательно прочтите задание на двери экзаменационной станции» (“read the task on the exam station door”) sounds again and the next station starts counting down.

To know which station will be next, there is a task on the door in front of the entrance, which is called Briefing (in Russ- Бриффинг) in the station passport. The student reads it for 30 seconds before entering the next station, so that he knows what skills need to be shown at the next station.

For each station, there is a fixed sequence of actions that the student must follow. To do this, he must know the station passport well. The student performs various diagnostic manipulations on the robot and learns specific parameters (for example, murmurs and heart sound on auscultation). If the robot cannot display the required parameter (for example, swelling in the legs), then the examiner himself says this indicator when the student asks for it. For this, the rooms are equipped with speakers and microphones). Some stations have different diagnoses for patients, which are called scenarios (in Russ – Сценарий). This means that the student must, after carrying out the skills, understand for himself what is the diagnosis of the patient and prescribe the correct treatment for him. The number of scenarios for each station is fixed in the corresponding station passport. All parameters for each scenario are present in tables, and all replicas of the examiner are also present there. Carefully read all tables in the station passport.

In each room where the exam takes place, there is an opaque glass through which the Examiner observes the student's skills. To assess his actions, checklists (in Russ -Чек-лист) have been developed at each station. They are also presented in every passport. The general station scoring system is as follows: if 71-80% of the checklist is correctly and completely completed, this corresponds to score 3, if 81-90%, this is 4, if 91% or more, this is 5.

The team of Simulating Centre asks you to treat the equipment carefully, use gloves when working with robots and do not enter class without a teacher.

Departments of Internal Diseases and Simulating Centre wish all students successful passing of the exam!