CuRe PreClerkship Presentation. CARDIOVASCULAR COURSE Anita Soni MD FRCP (C) January 23, 2014

Transcription

1 CuRe PreClerkship Presentation CARDIOVASCULAR COURSE Anita Soni MD FRCP (C) January 23, 2014

2 DRAFT 5 Nov 1, 2013 Y1 M1 Y2 M2 CuRe Preclerkship M0, 1/2: Human Biology, Health and Human Disease Biology and Health wks.days ( w. 2 days eval ) FOUNDATION 1.Blood & Immunology I (+ Skin I) 2.CV I & Resp (+ ET) I 3.NeuroScience I(Psych, Neuro + Opth) 4.Musculoskeletal I 5.Endocrine I & Woman s Reproduction I 6.GI/ Nutrition I & Urinary system I Health and Disease 1. Intro to week Infectious Disease and Therapeutics 2. CV II 3. Resp (+ ET) II 4. Introduction to Oncology 5. Blood & Immunology (+ autoimmune diseases) II 6. NeuroScience II (Psych, Neuro, Opth) 7. WRP II 8. Endocrine II 9. GI & Nutrition II 10. Urinary system II 11. Musculoskeletal II & Skin II Aug 25 - Sept Sept 22 - Oct Oct 14 - Nov Nov 24 - Dec 19 Dec break Jan 5 - Jan Jan 19 - Feb Feb 17 - Mar 13 TOTAL 27.Mar Reading Mar 23 - April 2 ( Friday April 4 ) April 7 - May 22 (Easter Monday April 6) May Rural week Aug 24 - Sept Sept 21 - Nov 6 3. Nov 9- Nov Nov 30 Dec 18 break Jan 4 - Jan Jan 25 - Feb 12 M3 2 Consolidation Feb Mar Mar May Dec

3 CV Course Objectives- Module I 1. Describe the scope and burden of cardiovascular disease in our community 2. Describe the normal anatomy of the heart and great vessels 3. Describe the normal development and embryology of the cardiac system 4. Describe normal cardiovascular physiology including: (1) properties of the vascular system, (1) the cardiac cycle, (3) the autonomic nervous system, (4) blood pressure regulation, (5) hemodynamics, (5) cardiac indices and (6) cardiac performance. Contrast normal physiology to abnormal. 5. Describe basic cardiac electrophysiology including normal and abnormal 6. Understand the basis of the electrocardiogram (ECG). Have an approach to ECG interpretation. 7. Understand the physiologic basis and pharmacology of cardiovascular drugs including (1) inotropic drugs & vasopressors, (2) vasodilator drugs (3) diuretics(4) antiadrenergic drugs, and (5) antiarrhythmic drugs. 8. Have a basic introduction to cardiac imaging including (1) cardiac radiography (2) echocardiography (3) cardiac catheterization (4) nuclear imaging and (5) computed tomography & magnetic resonance imaging. 9. Have an introductory approach to the cardiovascular patient- basic history skills, and physical exam skills including (1) blood pressure, (2) JVP, (3) precordial exam and (4) peripheral exam.

4 M0 and M1 Course Hour Allocation June 25, 2013 M CuRe 90% Available Surplus Allocated FLEX 1st Iteration HOURS HOURS Avail-90% HOURS HOURS HOURS MO MO M1 B/I CV RESP ET COMBO NS MS EM1/ WRP COMBO GI1/ UT COMBO

5 Module 1-45 hours Introduction to Cardiovascular Anatomy Development of the heart Physiology Cardiovascular Physiology The Cardiac Cycle (include heart/valves background) Autonomic Nervous System CV Hemodynamics BP Regulation- ANS/RAAS Pressure Volume Loops Cardiac Performance Cardiac Indices Introduction to Shock Pathology: abnormal hemodynamics Pharmacology: Vascular and Autonomic Drugs (inotropic, vasopressors, antiadrenergic) Vasodilators, Diuretics Electrophysiology Basic Cardiac Electrophysiology Mechanism of Arrhythmia Pharmacology: Antiarrhythmic drugs ECG Cardiac Imaging- CXR, echo, catheterization, nuclear, CT, MRI Introduction to investigations, incorporating anatomy/physiology. Review Mid Instructional test Anatomy Review Course Review

6 CV Module 1 See Excel Spreadsheet

7 CV Course Objectives- Module 2 1. Know the following learned previously: Objectives from CV Module 1 Antithrombotic drugs- covered in the Blood Course Lipids- covered in the Endocrinology Course. 2. Describe the pathophysiology and clinical approach (diagnosis, investigations and management (both non-pharmacologic and pharmacologic) for various cardiovascular diseases including: (1) valvular heart disease, (2) atherosclerosis & ischemic heart disease, (3) heart failure, (4) cardiomyopathies, (5) arrhythmias, (6) pericardial disease, (7) hypertension, (8) diseases of the peripheral vasculature, (9) acquired pediatric heart disease, and (10) congenital heart disease. 3. Describe primary prevention, risk factors and risk factor modification for cardiovascular diseases. 4. Describe physiologic and pathologic changes of the cardiovascular system that occur with aging. 5. Be aware of genetic and molecular aspects of cardiac disease 6. Evaluate the clinical presentations of cardiovascular diseases including the workup of chest pain syndromes, shortness of breath, palpitations, and syncope. 7. Have an approach to the cardiovascular patient- be able to perform a pertinent history and physical examination.

8 M2 Course Hour Allocation June 25, 2013 M CuRe 90% Available Surplus Allocated FLEX 1st Iteration HOURS HOURS Avail-90% HOURS HOURS HOURS M2 ID ONC BI COMBO CV Decrease by 3 hours YEAR 2 RS ET 8 RS EM WRP GI UT NS MSK skin MSK

9 Module 2 ~61 hours Introduction to Cardiovascular- Valvular heart disease- Includes review of the cardiac cycle, valvular disease, diagnostics, treatment Pathology ID and surgery Atherosclerosis/Ischemic heart disease- Pathophysiology: atherosclerosis (including risk factors), chronic IHD, and ACS. Diagnostics: exercise physiology, stress testing, ECG (tutorial), treatment/drugs Pathology Instructional and Mid-Term Exam- CV/RS Hypertension Heart Failure and Cardiomyopathies Pathophysiology of heart failure, including review of hemodynamics Diagnostics, treatment/drugs Pathology Arrhythmias- Bradyarrhythmia and tachyarrhythmia Includes review of mechanism, treatment/drugs, and ECG Pericardial Diseases Diseases of the Peripheral Vasculature Diseases of the aorta Peripheral artery disease Congenital and Pediatric Heart Disease Includes acquired conditions (ie. rheumatic fever, Kawasaki) and congenital disease Genetics/Molecular Aspects Aging Course Review Unknown Patient Cases CV/RS- 3 hours combined with RS Exam

10 CV Module 2 See Excel Spreadsheet

11 Common Topics Lipids- moved to Endocrine course Antithrombotic drugs- moved to Blood course Volume Regulation/RAAS/Diuretics/ARB/ACE- overlap with Urinary Course HTN exclusive to CV Not to Forget: pulmonary HTN/ path- consider integrate in unknown patient cases) Ensure pregnancy and cardiac issues covered (not in CV course right now)

12 Skills INTRO SESSION CV- 2 hours (students rotate through 5 demonstration stations) RS- 2 hours (WGS) SMALL GROUP SESSIONS 5-6 students per group Run by Cardiologists/Respirologists Real patients Total of 6 hours exposure to CV (3 sessions of 2 hours each) Total of 6 hours exposure to RS (3 sessions of 2 hours each)

13 Skills small group sessions 110 students Divide class into ¼ (A, B, C, D) A subdivides into 5 small groups, each with 5-6 students A1, A2, A3, A4, A5 B subdivides into 5 small groups, each with 5-6 students B1, B2, B3, B4, B5 C subdivides into 5 small groups, each with 5-6 students C1, C2, C3, C4, C5 D subdivides into 5 small groups, each with 5-6 students

14 Skills small group sessions For CV and RS: each group gets 3 sessions of 2 hours each SESSION 1: Group A- CV Group B- RS Group C- free time or other CS activity Group D- free time or other CS activity SESSION 2: Group A- RS Group B- CV Group C- free time or other CS activity Group D- free time or other CS activity etc

15 Skills small group sessions For CV and RS: each group gets 3 sessions of 2 hours each Total: 12 sessions needed to accommodate all students to get: 3 CV sessions 3 RS sessions & 6 free time/other CS activities.

16 Week 1 April 7-10, 2015 TIME MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY 8-9 CV INTRO LECTURE 9-10 CV INTRO PATIENT ILLUS RS INTRO LECTURE CV VHD LECTURE REVIEW CARDIAC CYCLE/MURMURS CV VHD LECTURE AORTIC VALVE RS INTRO PATIENT ILLUS CV VHD LECTURE MITRAL VALVE CV VHD CSA (T1) CASES BREAK BREAK BREAK BREAK CV VHD ASSIGNEDSTUDY CV/ID VHD LECT. ENDOCARDITIS

17 Week 2 April 13-17, 2015 TIME MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY 8-9 CLINICAL SKILLS CV INTRO CLINICAL SKILLS RS INTRO 9-10 STATION DEMO SESSIONS SESSION IHD CV VHD TUTORIAL IHD CV VHD TUTORIAL ATHEROSCLEROSIS AND RISK FACTORS BREAK BREAK BREAK BREAK BREAK CV PATHOLOGY ATHEROSCLEROSIS CV PATHOLOGY IHD TUTORIAL 15-16

18 Week 3 April 20-24, 2015 TIME MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY 8-9 CV ACS ASSIGNED STUDY CV TUTORIAL IHD 9-10 ACS CV TUTORIAL IHD ACS & 2 PREVENTION BREAK BREAK BREAK BREAK BREAK CV TUTORIAL ECG IN IHD CV HTN ASSIGNED STUDY

19 Week 4 April 27-30, 2015 TIME MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY 8-9 CV/ RESP/ENT INSTRUCTIONAL CV TUTORIAL HF/CM 9-10 CV/ RESP/ENT INSTRUCTIONAL CV TUTORIAL HF/CM HTN HEART FAILURE HTN REVIEW HEMODYNAMICS/ HEART FAILURE HEART FAILURE BREAK BREAK BREAK BREAK BREAK CV CSA HTN CASES CARDIOMYPATHIES CARDIOMYOPATHIES PATHOLOGY TUTORIALHF/CM

20 Week 5 May 4- May 8, 2015 TIME MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY 8-9 CV PERICARDIUM ASSIGNED STUDY CV TUTORIAL ARRHYTHMIA 9-10 CV PERICARDIUM CSA (T1) CASES CV TUTORIAL ARRHYTHMIA BRADYARRHYTHMIA CV ASSIGNED STUDY ARRHYTHMIA CV TUTORIAL ECG ARRHYTHMIA BREAK BREAK BREAK BREAK BREAK REVIEW EP TACHYARRHYTHMIA TACHYARRHYTHMIA

21 Week 6 May 11- May 15, 2015 TIME MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY 8-9 THORACIC AORTA CV TUTORIAL PEDS CARDIO 9-10 CV TUTORIAL PEDS CARDIO PERIPHERAL VASCULAR CV TUTORIAL AGING CV REVIEW CV TUTORIAL PVD ACQUIRED PEDS RESP REVIEW BREAK BREAK BREAK BREAK BREAK CONGENITAL CONGENITAL CV -GENETICS & MOLECULAR?ASSIGNED STUDY

22 Week 7 May 18- May 22, 2015 TIME MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY CLINICAL SKILLS E CLINICAL SKILLS X CV/ RESP CV/ RESP A UNKNOWN PATIENT CASES UNKNOWN PATIENT CASES BREAK BREAK BREAK M

23 Community Health Community Health topics- moved to Epidemiology of Heart Disease Prevention of Vascular Disease Community Health Concepts (CV/Resp)

24 Indiginous Health Need to coordinate sessions to CV topics

25 Other Themes to consider: Professionalism/ethics Multidisciplinary care- ie post MI rehab

26 Meeting next week (CR/CV/RS)

27 CP4 topics SYMPTOMS & SIGNS 9- cardiac murmurs 10- chest pain 13- cyanosis 22- edema 23- extremity pain- acute and chronic 45- palpitations 56- syncope

28 CP4 topics ABNORMAL LABS 70- cardiac markers and ECG 74- lipid abnormalities (with endo) FACTORS AFFECTING HEALTH 83- chronic disease

29 CP4 topics HEALTH CONDITIONS 102-CVD 110-hypertension 120- palliative care 125- shock/ rescucitation

30 Consolidation Topics (M3) To be considered - Chest pain, dyspnea, palpitations, syncope