INTEGRATED MODULE FOR CARDIOVASCULAR SYSTEM. For MBBS First Professional (Session )

Transcription

1 INTEGRATED MODULE FOR CARDIOVASCULAR SYSTEM For MBBS First Professional (Session ) 1

2 INTEGRATED MODULE FOR CARDIOVASCULAR SYSTEM For First Year MBBS (Session ) Chairperson Coordinator Member Member Member MODULE PLANNING COMMITTEE Prof. Dr. Hashim Uddin Azam Khan Department of Medical Education, KMC Assoc. Prof Dr. Sadia Ashraf Department of Medical Education, KMU Assoc. Prof. Dr. Hamid Ali Department of Anatomy, KMC Assoc. Prof. Dr. Ubaid ur Rahman Department of Biochemistry, KMC Dr. Saleem Abbas (Lecturer) Department of Physiology, KMC LIST OF ABBREVIATIONS ACLS Adult Cardiac life Support JVP Jugular Venous Pulse Anat-L Anatomy Lecture MCQs Multiple Choice Questions BCLS Basic Cardiac Life Support Med-L Medicine Lecture Bio-L Biochemistry Lecture OSPE Objectively Structured Practical Examination Bio-P Biochemistry Practical Path-L Pathology Lecture BP Blood Pressure PBL Problem Based Learning CCF Congestive Cardiac Failure Phar-L Pharmacology Lecture CS Clinical Skills Phy-L Physiology Lecture CVS Cardio Vascular System Phy-P Physiology Practical ECG Electro Cardio Gram SA Sino atrial FDT Film/Demonstration/Tutorial SDL Self-Directed learning Histo-P Histology Practical SEQs Short Essay Questions IPS Islamiyat/Pak Studies SGD Small Group Discussion 2

3 MODULE SPECIFICATIONS Course Title Cardiovascular Module (Duration: 6weeks) Contact Hours (124 hrs.) Lectures/SDL Lab Work /Practical SGD Anatomy x2=06 Histology 03 2x2= Embryology Physiology 26 5x2=10 4x2=08 Biochemistry 07 1x2=02 1x2=02 Pharmacology Pathology Medicine Skill Lab x2=08 SDL IPS Behavioral Sc TOTAL= = 124 hrs. OBJECTIVES/OVERVIEW/FINAL COMPETENCIES A graduate of Khyber Medical College Peshawar should be able to manage (Diagnose, Investigate, Treat, Refer, Prevent and Counsel) the following common Cardiovascular diseases. 1. Common Arrhythmias-(Atrial Fibrillation, Ventricular Fibrillation, Ventricular Tachycardia, Supra-ventricular Tachycardia, Heart Block.) 2. Sudden Cardiac Arrest/BLS/ACLS 3. Ischemic Heart Disease. 4. Cardiac Failure/ Cardiogenic Shock/ Cardiomyopathies. 5. Common Valvular Heart Diseases. 6. Common Congenital Heart Diseases. 7. Hypertension (Essential/ Secondary). 8. Fever of Cardiac Origin (Rheumatic Heart Disease, Infective Endocarditis, Pericarditis). 9. Basics of Pulmonary Hypertension. 3

4 10. Peripheral Vascular Disease. In order to achieve these defined competencies, the CVS Module has been designed to define the scope of Knowledge/ Skills/ Attitudes of a first year medical student of the Basic Medical Sciences i.e. Anatomy, Physiology and Biochemistry with the introduction to the Clinical Sciences. Major contribution in this Module will be from departments of Anatomy, Physiology and Biochemistry while minor contribution will be from departments like Medicine, Pediatrics, Pathology and Pharmacology. The Basic Sciences Module in first year MBBS will be taught Theme Based so that the student can correlate the basic science Knowledge with Disease i.e. Symptoms and Signs. The duration of Module will be 6 weeks in first year MBBS. INTENDED LEARNING OUTCOMES KNOWLEDGE By the end of the Cardiovascular Module the student should be able to: 1. Explain the development of heart, major blood vessels, fetal circulation and the changes in circulation at birth. 2. Describe the gross anatomy of heart and major blood vessels and its neurovascular supply. 3. Describe the gross anatomy, development and histological features of lymph vessels, ducts & trunks. 4. Identify and describe the normal histological features of cardiac muscle and vessels (arteries, veins & capillaries). 5. Know the various developmental anomalies and valvular heart diseases 6. Describe the properties of cardiac muscle including genesis of impulse in the SA node and spread of excitation throughout the heart leading to its contraction. 7. Discuss the events of cardiac cycle including the functions of valves and origin of heart sounds. 8. Explain Frank Starling Law of the heart and nervous regulation of heart pumping. 9. Discuss the physiological basis of 12 Lead ECG and its analysis. 4

5 10. Describe the Biophysics and Interrelationships of Pressure, Flow, and Resistance in terms of Ohm s law and Poiseuille s Law. 11. Discuss the functions of arteries, veins, capillaries and lymphatics. 12. Describe the factors affecting the local blood flow including auto-regulation. 13. Discuss the mechanisms for rapid and long term control of blood pressure. 14. Explain the factors regulating cardiac output and venous return. 15. Identify the enzymes that increase in myocardial infarction and to understand their behavior. 16. Describe the functions of different lipoproteins in the light of their metabolism. 17. Discuss the mechanism of atheromatous plaque formation. 18. Explain the significance of anaerobic glycolysis. 19. Identify the metabolic diseases leading to congestive cardiac failure. 20. Identify and describe the major causes, pathogenesis, morphological changes and complications of various disease processes which affect the cardiovascular system. 21. Identify the major risk factors which contribute to common diseases of the cardiovascular system and to understand their epidemiological pattern in the community. 22. Discuss the physiological basis of various drugs used in the diseases of cardiovascular system. Teaching strategies to be used to develop these OUTCOMES: Lectures Dissection Audiovisual Aids Practical sessions Tutorial Problem based learning (PBL) Self-directed learning (SDL) Discussions Multidisciplinary Lectures Methods of assessment of knowledge acquired: 1. End Of Module Assessment (MCQs, SEQs) 5

6 PSYCHOMOTOR SKILLS Description of the psychomotor skills to be developed and the level of performance required: A. By the end of Cardiovascular Module, the student should be able to: 1. Carry out practical work as instructed in an organized and safe manner 2. Identify mediastinum; its divisions and contents in cadaver/dissected specimen 3. Identify the heart & its coverings in the model / dissected specimen 4. Identify the heart and major blood vessels in cadaver/dissected specimen 5. Identify the chambers of the heart. 6. Identify the internal structures of various chambers of the heart. 7. Identify the Cardiac Muscle under the microscope 8. Identify salient features of a medium sized artery & vein in a cross-section under microscope. 9. Appreciate and describe the histological differences between medium size artery & vein. 10. Appreciate and describe the histological differences between large size artery & vein. 11. Identify normal cardiac shadow, borders and cardiomegaly on chest radiographs. 12. Identify various developmental anomalies of heart & blood vessels 13. Identify the position of borders and valves of the heart by surface marking 14. Palpate and find apex beat, and auscultatory areas in the chest of the subject provided and describe their significance. 15. Demonstrate the use of Stethoscope for Auscultation. 16. Demonstrate the normal characteristics of arterial pulse. 17. Describe the equipment needed for recording ECG. 18. Record an ECG on the subject provided. 19. Perform systematic analysis of ECG. 20. Recognize normal sinus rhythm from an ECG and other arrhythmias. 21. Determine blood pressure by palpatory and auscultatory methods. 22. Demonstrate the effect of posture on blood pressure in experiment. 23. Demonstrate the effect of gravity on BP. 24. Demonstrate different types of exercises and their effect on BP. 25. Determine the cholesterol level in the given sample of serum. 26. Interpret the results of lipid profile. 6

7 27. Interpret the results of cardiac enzymes. 28. Make and record observations accurately. B. Teaching strategies to be used to develop these skills: Practice on virtual models Laboratory sessions C. Methods of assessment of student s psychomotor skills: Evaluation of the activities in laboratories, homework assigned and Practical examination (OSPE) ATTITUDE AND BEHAVIOUR A. By the end of Cardiovascular Module the student shall gain the ability and carry responsibility to: 1. Demonstrate ability to give and receive feedback, respect for self and peers. 2. Demonstrate empathy and care to patients. 3. Develop respect for the individuality and values of others - (including having respect for oneself) patients, colleagues and other health professionals 4. Organize & distribute tasks 5. Exchange opinion & knowledge 6. Develop communication skills and etiquette with sense of responsibility. 7. To equip themselves for teamwork 8. Regularly attend the classes B. Teaching strategies to be used to develop attitude and behavior: 1. PBL 2. SDL 3. Assignment formation through team work C. Methods of assessment of students interpersonal skills and capacity to carry responsibility: 1. Class attendance should be recorded 2. Score for performance during PBL session using a designed Pro forma. 7

8 INSTRUCTIONAL METHODS Principles and concepts applicable to the structure and function of the Cardiovascular System will be studied by: Lectures on general aspects of the Cardiovascular system will be given for the purpose of conveying deeper understanding of the general concepts and principles underlying normal and abnormal structure and function during the module. Dissection of cadaver will be carried out to demonstrate the various anatomical structures related to cardiovascular system Practical sessions will be timetabled to enforce theoretical aspects of the subject but will be used for demonstrating skills/procedures and the use of electronic material will be encouraged. Tutorials, the small group sessions on special topics will be organized for the purposes of enriching the students' general knowledge and overall understanding of the cardiovascular system. It allows students to apply newly acquired knowledge and it is suitable for higher order cognitive objectives. Problem-Based Learning sessions will be encouraged and timetabled to facilitate higher cognitive objectives: problem solving and decision making; can incorporate objectives that cross domains. They will be organized into small groups and facilitated by a staff faculty member. Self-Directed Learning sessions will promote self-learning and thus, time will be available for further study by the students using all available learning resources including electronic learning materials. Small Group Discussion will engage the students in small groups of about 35 students which will help in Complementing knowledge in lectures Expanding on the concepts considered in lectures Encouraging student reflection Developing students' communication skills Encouraging active life-long learning 8

9 WEEKLY ACTIVITIES OF DIFFERENT DEPARTMENTS WEEK 1 Department of Anatomy Activity Code Anat-L1 Anat-L2 Anat-L3 Anat-L4 Anat-L5 Emb-L1 Emb-L2 Dissection-1 Dissection-2 Dissection-3 Dissection-4 Anat-SGD1 Topics Mediastinum: Its divisions and sub divisions Mediastinum: The structures present in each of its division & sub division Major arteries, veins, lymph vessels and lymph nodes in the mediastinum General overview of the heart: Pericardium: Gross Morphology, Neurovascular Supply Gross Morphology of Heart (Cardiac size, shape and external features) Development of heart Formation of heart tube: circulation through primordial heart Partitioning of common atrium Dissect and identify divisions and contents of the mediastinum in the cadaver/dissected specimen Dissect/Demonstrate the coverings and external features of the heart in the cadaver/ model/ dissected specimen Dissect/Demonstrate the heart: study the external and internal features of right heart Study the internal features of left heart Identify normal cardiac shadow, borders and cardiomegaly on chest radiographs: demonstrate the surface projection of cardiac valves Teacher/ Facilitator Phy-L1 Phy-L2 Phy-L3 Department of Physiology Overview of Cardiovascular System Cardiac Cycle (Phases) Cardiac Cycle: Physiology of the Heart Sounds and Functions of Valves 9

10 Phy-L4 Phy-L5 Phy-P1 Valvular Heart Diseases Action Potential in the Cardiac Muscle Examination of the Apex Beat and Heart Sounds Department of Biochemistry Bio-L1 Fatty Acid Chemistry WEEK 2 Department of Anatomy Anat-L6 Anat-L7 Histo-L1 Emb-L3 Emb-L4 Histo-P2 Anat-SGD2 Structural Differences in the Heart Valves and Surface Anatomy of the Valves Conducting system and Autonomic Nerve supply of the Heart Microscopic Structure of Cardiac Muscle and Conductive System of the Heart Partitioning of ventricles Development of outflow tracts of the heart Identify the cardiac muscle under the microscope Structural & functional characteristic of CVS (Different types of blood circulation/ types of anastomosis in the body) Department of Physiology Phy-L6 Phy-L7 Phy-L8 Phy-L9 Phy-L10 Phy-P2 Phy-SGD1 Excitation Contraction Coupling in the Cardiac Muscles and Concept of the Refractory Period Conductive System of the Heart, Genesis of Impulses in SA Node Physiological Basis of ECG Components of a Normal ECG and Normal Sinus Rhythm 12 Leads of ECG and Concept of Cardiac Axis Recording of 12 Lead ECG Extrinsic/ Nervous Regulation of the Heart 10

11 Department of Biochemistry Bio-L2 Bio-L3 Simple Lipids Complex Lipids I Department of Pathology Path-L1 Diseases of the Pericardium: Pericardial Effusion, Pericarditis WEEK 3 Department of Anatomy Anat-L8 Histo-L2 Histo-L3 Emb-L5 Emb-L6 Histo-P3 Anat-SGD3 Blood supply of the heart General Structure of the Vessels & their Types (Arteries, Veins & capillaries) Differential microscopic features of Veins & Arteries Development of arterial system I Development of arterial system II Study the histological features of elastic arteries Study the blood supply of heart Department of Physiology Phy-L11 Phy-L12 Phy-L13 Phy-L14 Phy-P3 Phy-SGD2 Mechanisms of Cardiac Arrhythmias and Concept of Artificial Pacemaker Arteries and their Function, Veins and Their Functions Microcirculation: Arterioles and Capillaries Local and Humoral Control of Tissue Blood Flow Interpretation and Analysis of ECG Physical Principles of Circulation Department of Biochemistry Bio-L4 Bio-L5 Complex Lipids II Complex Lipids III 11

12 Bio-L6 Derived Lipids Department of Pharmacology Phar-L1 Introduction to Anti-Arrhythmic Drugs WEEK 4 Department of Anatomy Anat-L9 Emb-L7 Emb-L8 Emb-L9 Emb-L10 Gross and microscopic anatomy of lymph vascular system Development of lymph vascular system Development of Venous System-1 Development of Venous System-2 Developmental anomalies of arterial & venous system Department of Physiology Phy-L15 Phy-P16 Phy-P17 Phy-P18 Phy-P4 Phy-SGD3 Features of Coronary Circulation Cardiac Cycle: Pressure Volume Loop and Concepts of SV, EDV, ESV, EF, Work Output of Heart Intrinsic Regulation of Heart Pumping, Factors affecting the Stroke Volume. Concept of Preload and Afterload Functions of Lymphatic System Recording of Arterial Blood Pressure Electrocardiographic changes in IHD. Current of Injury, and J point Department of Biochemistry Bio-L7 Bio-P4 Bio-SGD3 Associated Lipids Interpretation of the results of serum cardiac enzymes by students Cardiac Enzymes/Markers: Their Role in the 12

13 Diagnosis and follow up of Myocardial Infarction Department of Pharmacology Phar-L2 Introduction to Drugs used in IHD Department of Pathology Path-L2 Hyperlipidemia: Mechanisms involved in the Development of Atherosclerosis and the Risk Factor Department of Medicine Med-L1 Coronary Heart Disease: Introduction to Clinical Features, Counseling a patient with IHD WEEK 5 Department of Anatomy Emb-L11 Emb-L12 Foetal circulation Congenital heart defects (CHD) Department of Physiology Phy-L19 Phy-L20 Phy-L21 Phy-L22 Phy-L23 Phy-L24 Phy-L25 Phy-L26 Phy-P5 Nervous Regulation Of The Circulation Rapid Control of Blood Pressure Long Term Control of Blood Pressure Cardiovascular Changes During Exercise Cardiac Output, Venous Return and their Regulation Quantitative Analysis and Measurement of the Cardiac Output Heart Failure: Types and Compensatory Mechanisms Circulatory Shocks Demonstrate the Effect of Posture and Exercise 13

14 Phy-SGD4 on Blood Pressure Changes at Birth in Pulmonary Circulation Department of Pathology Path-L3 Introduction to Cardiomyopathies Department of Medicine Med-L2 Clinical Presentation Of Heart Failure and Counseling a Patient with HF Department of Pharmacology Phar-L3 Introduction to Drugs used in CCF and Ionotropic agents 14

15 WEEK 6: END OF MODULE ASSESSMENT It will consist of MCQs, SEQs and skill assessment (OSPE). Formative: This form of assessment is designed to help the students to identify areas for improvement. It includes a multiple choice questions, problems-solving exercises and independent learning activities in all subjects. These will be given during tutorial and practical sessions. The Answers are presented and discussed immediately with you after the assessment. The results will be made available to the students. Summative This type of assessment is used for judgment or decisions to be made about the students performance. It serves as: 1. Verification of achievement for the student satisfying requirement 2. Motivation of the student to maintain or improve performance 3. Certification of performance 4. Grades All the three basic sciences i.e. Anatomy, Physiology and Biochemistry should be made compulsory so that the students do not ignore one subject as an option. The theory paper should consist of three sections such as: Section A: This section will deal with the Anatomical aspects of cardiovascular module. Section B: This section will deal with the Physiological aspects of cardiovascular module. Section C: This section will deal with the Biochemical aspects of cardiovascular module FEEDBACK: From the students and faculty to further improve the module. 15

16 LEARNING RESOURCES Textbooks: 1. The Developing Human: Clinically Oriented Embryology, by Dr. Keith L. Moore, T.V.N. Persaud, and Mark G. Torchia, 9th edition,elsevier Saunders; Clinical Anatomy by Regions. by Richard S. Snell MD.PhD 9th edition ; Lippincott Williams and Wilkins; Clinical Neuroanatomy by Richard S. Snell MD.PhD 7th edition ; Lippincott Williams and Wilkins; Last s Anatomy, Regional and Applied by Chummy S. Sinnatamby FRCS Twelfth Edition Churchill Livingstone; Langman's Medical Embryology, by T.W.Sadler 13th edition; Lippincott Williams and Wilkins; Junqueira's Basic Histology, Text and Atlas by Anthony L. Mescher, Ph.D...13th edition... McGraw Hill ; Gray's Anatomy, the Anatomical Basis of Clinical Practice, by Susan Standring PhD,DSc 41st edition, Elsevier USA; Color Textbook of Histology; 3rd ed.; Gartner LP & Hiatt JL; WB Saunders Company; Textbook of Medical Physiology; 13 th ed.; Guyton AC and Hall JE; Saunders / Elsevier Co.; Human Physiology from Cell to System; 9 th ed.; Lauralee Sherwood; Brooks/Cole Pub. Co.; Harper s Illustrated Biochemistry; 30 th ed.; Robert K Murray; Textbook Medical Biochemistry, 8th ed.; Chatterjea MN, Shinde Rana, JAYPEE, Robbins Basic Pathology; 9 th ed.; Cotran RS, Robbins SL and Kumar V; WB Saunders Company; Lippincott s Illustrated Review of Pharmacology; 6 th ed.; Richard A Harvey & Pamela C Champe; Lippincott s Williams & Wilkins; ABC of Learning and Teaching in Medicine; Cantillon P, Hutchinson L and Wood D; BMJ Publishing Groups Books; Davidson s Principles and Practice of Medicine; 22th ed; Katzung Basic and Clinical Pharmacology; 12 th ed.; Katzung B; McGraw Hill Medical Company; Kumar & Clerk Internal Medicine; 8 th ed.; Saunders;