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Study Guide Studium Generale STUDIUM GENERALE AIMS To condition the students to the study and a carrier in medicine To introduce the students to the general skills and attitudes required to meet the demands of the new curriculum To recognize the relationships between professional competencies and the biomedical and allied sciences, clinical sciences, professional skills, and attitudes LEARNING OUTCOMES 1. Cognizance of the new paradigm of medical practice: science, clinical judgment, professionalism, communication, and team working 2. Awareness of the practical implications of developing basic skills in critical and associated thinking and scientific reasoning, and a habit of lifelong learning 3. Define medical and allied sciences, professional skills and attitudes. Clarify the relationships between professional competencies and the biomedical and allied sciences, clinical sciences, professional skills, and attitudes CONTENTS: items discussed 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 20. 21. 22. 23. 24. Overview of Studium Generale Independent Learning in Medical Education Philosophy of Science and Medicine History of Medicine Group dynamics in learning The new undergraduate competence-based University, Faculty of Medicine Basic Principles of Communication Information Acces Thinking skills and scientific reasoning Academic Reading Interprofesional Communication The Role of Biomedical Scienc Overview of Human Anatomy Overview of Human Physiology Overview of Hystology Basic Hystology Overview of Microbiology Overview of Parasitology Overview of Pharmacy Public Health Sciences General Pharmacology The Role of Clinical Science in Medical Practice The Role of Allied Science in Medical Practice Udayana University Faculty of Medicine, MEU, 2013 curriculum of Udayana 1 Study Guide Studium Generale KOMPETENSI YANG INGIN DICAPAI DOMAIN I. Profesionalisme IV. Pemulihan Fungsi Sistem Stomatognatik V. Kesehatan Gigi dan Mulut Masyarakat VI. Manajemen Praktik Kedokteran Gigi KOMPETENSI UTAMA 2.1 Menganalisis secara kritis kesahihan informasi 2.3 Berfikir kritis dan alternatif dalam mengambil keputusan. 13.9 Bekerja dalam tim secara efektif dan efisien untuk mencapai kesehatan gigi dan mulut yang prima. 14.3 Mengupayakan teknologi informasi untuk kepentingan pelayanan kesehatan masyarakat. 14.4 Bekerja dalam tim serta membuat jejaring kerja (networking) yang efektif dan efisien dalam usaha menuju kesehatan gigi dan mulut yang optimal. 16.1 Menata manajemen praktik serta tatalaksana lingkungan kerja praktik kedokteran gigi. 16.2 Menata lingkungan kerja kedokteran gigi secara ergonomik dan prinsip keselamatan kerja. 16.3 Menerapkan prinsip dasar pengelolaan praktik dan hubungannya dengan aspek sosial. KOMPETENSI PENUNJANG 14.4.1 Melakukan kerjasama dengan tenaga kesehatan dan masyarakat, dalam upaya mencapai kesehatan gigi dan mulut masyarakat yang optimal (C3,P3,A3). 2.3.1 Menyusun pemecahan masalah berdasarkan prioritas (C3, P3, A3). 2.3.2 Menilai kualitas produk dan teknologi kedokteran gigi (C4, P3, A3). 13.9.1 Bekerja sama secara terintegrasi diantara berbagai bidang ilmu kedokteran gigi dalam melakukan pelayanan kesehatan gigi dan mulut yang prima (C3,P3,A3). 13.9.2 Melaksanakan kerjasama dalam tim secara professional (C3,P3,A3). 13.9.3 Melakukan rujukan kepada sejawat yang lebih kompeten secara interdisiplin dan intradisiplin (C3,P3,A3). 14.3.1 Memahami penggunaan / pemanfaatan teknologi informasi untuk program kesehatan gigi dan mulut masyarakat (C2,P2,A2). Udayana University Faculty of Medicine, MEU, 2013 2 Study Guide Studium Generale 14.3.2 Memahami penggunaan teknologi informasi untuk penelusuran informasi dan sumber belajar di bidang kesehatan gigi masyarakat (C2,P2,A2). 14.3.3 Memahami penggunaan teknologi informasi untuk pengumpulan dan pengolahan data di bidang kesehatan gigi masyarakat (C2,P2,A2). 14.4.1 Melakukan kerjasama dengan tenaga kesehatan dan masyarakat, dalam upaya mencapai kesehatan gigi dan mulut masyarakat yang optimal (C3,P3,A3). 14.4.2 Melaksanakan jejaring kerja dalam pelaksanaan program kesehatan gigi dan mulut masyarakat (C3,P3,A3). 14.4.3 Melakukan kerjasama dan jejaring kerja dengan masyarakat, dan instansi terkait dalam upaya pemberdayaan masyarakat (C3,P3,A3). 16.1.1 Memahami manajemen praktik dan tatalaksana sesuai standar pelayanan kedokteran gigi (C2, P3, A3). 16.1.2 Membuat perencanaan praktek kedokteran gigi yang efektif dan efisien (C3, P3, A3). 16.1.3 Menjelaskan pengorganisasian dalam menjalankan praktek (C2,P3,A 3). 16.1.4 Menjelaskan cara memantau dan mengevaluasi praktek (C2, P3, A3). 16.1.4 Menjelaskan cara memantau dan mengevaluasi praktek (C2, P3, A3). 16.2.2 Menerapkan prinsip kesehatan dan keselamatan kerja (C3, P3, A3). 16.2.3 Mengelola dampak praktik terhadap lingkungan sekitar (C3, P3, A3). 16.3.1 Melakukan prosedur perawatan gigi yang tepat bersama-sama dengan tenaga medis lainnya (C3, P3, A3). 16.3.2 Melakukan komunikasi secara efektif dan bertanggung jawab secara lisan maupun tulisan dengan tenaga kesehatan, pasien dan masyarakat (C3, P3, A3). Udayana University Faculty of Medicine, MEU, 2013 3 Study Guide Studium Generale PLANERS TEAM No Name 1 dr. I Made Jawi, M.Kes (Leader) 2 dr. Agung Wiwiek Indrayani, M.Kes (Secretary) 3 Dr. dr. Dyah Paramita D., M.Si. (Member) 4 5 Dra. Ida Ayu Alit Widhiartini, Apt. MSi (Member) dr. I Wayan Sumardika, M.Med.Ed (Member) Department Phone Pharmacology Pharmacology 08179787972 Public Health 08886855027 0818357777 Pharmacy 0816572852 Pharmacology 08123619157 LECTURERS NO 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16.. 17. 18. 19 NAME Prof.Dr.dr. I Made Bakta, SpPD,KHOM Prof. dr. Putu Astawa, SpBO, M.Kes Prof. dr. N.A. Bagiada, Sp. Biok Prof. dr. I.G. M. Aman, SpFK Prof.dr. Ketut Tirtayasa, M.Sc Prof.Dr.dr. Mangku Karmaya, M.Repro Dr. dr. Dyah Paramita, M.Si Dr.dr. I Made Jawi, M.Kes Dr.dr. I Putu Gede Adiatmika, M.Kes Dr.dr. Sri Budayanti, SpMK Drs. I Nyoman Toya Wiartha, Apt dr. Made Sudarmaja, M.Kes dr. I.G.N. Mayun ,SpHK dr. Wayan Suarya dr.Ida Bagus Ngurah, M.For drg. Putu Lestari Sudirman dr. I Wayan Sumardika, M.Med.Ed dr.Agung Wiwiek Indrayani, M.Kes dr.I Gst Md Surya Candra Trapika, Msc Udayana University Faculty of Medicine, MEU, 2013 DEPT Internist Orthopedic Biochemistry Pharmacology Physiology Anatomy Public Health Pharmacology Physiology Microbiology Pharmacy Parasitology Hystology Anatomy Pharmacology Gigi Pharmacology Pharmacology Pharmacology PHONE 081338338611 081338770650 08123623422 0811387105 0818357777 08179787972 08123811019 08553711398 0811399886 08123953945 08155715359 0817355247 08123687288 081239885740 08123619157 08886855027 081337991177 4 Study Guide Studium Generale FACILITATORS (REGULAR CLASS) NO 1 2 NAME GROUP drg. Luh Wyn. Ayu Rahaswanti, Sp. KGA. drg. Mia Ayustina Prasetya, Sp. KGA. DEPT PHONE 1 Gigi 0818322169 VENUE 3nd floor: R.3.01 2 Gigi 08175053626 3nd floor: R.3.02 3 drg. Putu Lestari Sudirman 3 Gigi 081239885740 4 drg. I. G. A. Dyah Ambarawati 4 Gigi 081805598066 5 drg. Nym. Ayu 5 Gigi 08113853707 Anggayanti 3nd floor: R.3.03 3nd floor: R.3.04 3nd floor: R.3.05 ~ LEARNING SITUATIONS ~ 1. Independent Learning : Belajar mandiri dan mengerjakan tugas student project 2. Lecture : Kuliah yang diberikan oleh dosen 3. Plenary : Sesi tanya jawab pada akhir perkuliahan di ruang kelas 4. Small Group Discussion : Diskusi kelompok yang dipandu fasilitator di ruang diskusi kelompok Udayana University Faculty of Medicine, MEU, 2013 5 Study Guide Studium Generale TIME TABLE Studium Generale PSPDG 2013 (Gedung FK) Day/ Date Time 08.00 – 09.00 09.00 – 10.00 Sept 16th 10.00 – 11.00 11.00 –12.00 12.00 – 13.00 13.00 – 14.00 14.00 – 15.00 08.00-09.00 Sept 09.00-10.00 th 17 10.00-11.00 11.00-12.00 12.00-13.00 13.00-14.00 14.00-15.00 08.00 – 09.00 09.00 – 10.00 Sept 18th 10.00 – 11.00 11.00 –12.00 12.00 – 13.00 13.00 – 14.00 14.00 – 15.00 08.00 – 09.00 09.00 – 10.00 Sept th 19 10.00 – 11.00 11.00 –12.00 12.00 – 13.00 13.00 – 14.00 14.00 – 15.00 08.00-09.00 Sept 20th 09.00-10.00 10.00-11.00 11.00-12.00 Activity Overview ofStudiumGenerale Lecture 10 Information Acces Lecture 6Thinking Skill and Scientific Reasoning Independent learning Break PPKN Lecture 7 Academic Reading Independent Learning Lecture 5 The New Undergraduate Competence Based Curriculum of UdayanaUniversity, Faculty of Medicine Lecture 2 Philosophy of Science and Medicine Independent Learning Presentation Student Project Lecture 3History of Medicine Break Independent Learning Lecture 9 Interprofesional of Communication Lecture 8 Basic Principles of Communication Independent Learning Break Lecture PPKN Independent Learning Presentation Student Project Lecture 1 Independent Learning In Medical Education Lecture 4 Group Dynamics in Learning Independent Learning Break Presentation Student Project Simulation of SGD (Small Group Discussion) Plenary (Topic Group Dynamics in Learning) Lecture 21 Overview of Parasitology Lecture 22 Basic of Parasitology Independent Learning Break Udayana University Faculty of Medicine, MEU, 2013 Venue Class room Person-in-charge Lestari Sudirman Adiatmika Class room Class room Class room Adiatmika MKDU Wiwik Indrayani Class room Sumardika Class room Prof. Bakta Class room Prof. Mangku Class room Dr Purwa Class room Diah Paramita Class room MKDU Class room Class room Dr Jawi/Dr Purwa Jawi Class room Jawi Class room Discussion room Class room Jawi/Purwa Facilitators Class room Jawi, Lestari, Sumardika, Bakta, Mangku Made Sudarmaja Class room Kd. Suastika 6 Study Guide Studium Generale 12.00-13.00 13.00-14.00 14.00-15.00 Lecture PPKN Independent Learning Presentation student project Class Room MKDU Class room 08.00-09.00 Lecture 23 Overview of Pharmacy Lecture 24 Community Health Science Independent Learning Break Lecture PPKN Independent Learning Presentation student project Class room Made Sudarmaja/ Kd. Suastika Toya Wiartha Class room Dharmadi Class room MKDU Class room Lecture 25 General Pharmacology &Pharmacokinetika Lecture 26 Pharmacodynamics Independent Learning Break SGD Independent learning Plenary Class room Sudarmaja/Buday anti/Dharmadi IGM Aman Class room Surya Trapika 09.00-10.00 Sept 23th 10.00-11.00 11.00-12.00 12.00-13.00 13.00-14.00 14.00-15.00 08.00 – 09.00 Sept th 24 09.00 – 10.00 10.00 – 11.00 11.00 –12.00 12.00 – 13.00 13.00 – 14.00 14.00 – 15.00 08.00-09.00 Sept 25th Sept 26th 09.00-10.00 10.00-11.00 11.00-12.00 12.00-13.00 13.00-14.00 14.00-15.00 08.00 – 09.00 09.00 – 10.00 10.00 – 11.00 11.00 –12.00 12.00 – 13.00 13.00 – 14.00 14.00 – 15.00 08.00-09.00 Sept 27th Sept 30th 09.00-10.00 10.00-11.00 11.00-12.00 12.00-13.00 13.00-14.00 14.00-15.00 08.00 – 09.00 09.00 – 10.00 10.00-11.00 11.00-12.00 12.00-13.00 13.00-14.00 14.00-15.00 Lecture 13 Overview of Human Anatomy Lecture 14 Anatomy Independent Learning Break Lecture PPKN Independent Learning Presentation student project Lecture 15 Overview of Human Physiology Lecture 16 Physiology Independent Learning Break SGD Independent Learning Plenary ( Anatomy & Physiology) Lecture 11 The Role of Biomedical Sciences Lecture 12 Biochemical Processes Independent Learning SGD Lecture PPKN Break Plenary (Biochemistry) Lecture 27AutonomicNervous System Lecture 28 Drug Interaction Independent Learning Break Lecture PPKN Independent Learning Student Project Udayana University Faculty of Medicine, MEU, 2013 Discussion Room Class room Facilitators Class room Sudarmaja/Prof Aman/Surya Wayan Suarya Class room Wayan Suarya Class room MKDU Class room Class room Wayan Suarya Ketut Tirtayasa Class room Ketut Tirtayasa Discussion room Class room Facilitators Class room Wayan Suarya/ Ketut Tirtayasa N. A. Bagiada Class room N. A. Bagiada Discussion room Facilitators Class room Class room N. A. Bagiada Sumardika Class room I. B. Ngurah Class room MKDU Class room Prof. Aman/ Sumardika/ IB.Ngurah 7 Study Guide Studium Generale 08.00 – 09.00 09.00 – 10.00 Oct 1st 10.00 – 11.00 11.00 –12.00 12.00 – 13.00 13.00 – 14.00 14.00 – 15.00 08.00 – 09.00 Oct 2nd 09.00 –10.00 Lecture 17 Overview of Hystology Lecture 18 Hystology 10.00 11.00 12.00 13.00 14.00 Independent Learning Break Lecture PPKN Independent Learning Presentation student project -11.00 -12.00 -13.00 -14.00 -15.00 08.00 – 09.00 09.00 – 10.00 Oct 3rd 10.00 – 11.00 11.00 –12.00 12.00 – 13.00 13.00 – 14.00 14.00 – 15.00 Oct th 5 Lecture 19 Overview of Microbiology Lecture 20 Basic of Microbiology Independent Learning Break SGD Independent Learning Plenary (Hystology& Microbiology) Class room Prof. Astawa Class room Diah Paramita Discussion room Class room Class room Class room Fasilitators Prof. Astawa/Diah Paramita Gusti Ngurah Mayun Gusti Ngurah Mayun Class room MKDU Class Room Gusti Ngurah Mayun/Ketut Tirtayasa Class room Sri Budayanti Class room Sri Budayanti Discussion room Class room Facilitators Sri Budayanti/ Gusti Ngurah Mayun Presentation student project 4th Oct Lecture 29 The Role Of Clinical Science in Medical Practice Lecture 30 The Role Of Allied Science in Medical Practice Independent Learning Break SGD Independent Learning Plenary SILEN T DAY Oct 7th Oct 8th Udayana University Faculty of Medicine, MEU, 2013 ASSESSMENT HOLIDAY 8 Study Guide Studium Generale MEETING OF STUDENT REPRESENTATIVES In the middle of each block curriculum, a meeting is held among the student representatives, facilitators, and resource person of the block. The meeting is to discuss about the effectiveness of on going teaching and learning processes, facilitators and lectures as a feedback to improve process. This meeting is held on 30th September 2013. ASSESSMENT METHOD Formative assessment and written examination. Formative assessment: data on attendance, participation in lectures, group discussions and student projects will be used in determining students’ achievement. Written examination will be held on October 7th,2013. The passing composite score at 70. Udayana University Faculty of Medicine, MEU, 2013 9 Study Guide Studium Generale LEARNING PROGRAM Day 1st MODUL Monday, September 16th ,2013 Introduction To The Block Overview of Studium Generale Aims 1.To condition the students to the study and a carrier in medicine 2.To introduce the students to the general skills and attitudes required to meet the demands of the new curriculum 3.To recognize the relationships between professional competencies and the biomedical and allied sciences, clinical sciences, professional skills, and attitudes Learning outcomes 1. Cognizance of the new paradigm of medical practice: science, clinical judgment, professionalism, communication, and team working 2. Awareness of the practical implications of developing basic skills in critical and associated thinking and scientific reasoning, and a habit of lifelong learning 3. Define medical and allied sciences, professional skills and attitudes. Clarify the relationships between professional competencies and the biomedical and allied sciences, clinical sciences, professional skills, and attitudes Convensional curriculum Basic Science (Pre Clinic) Anatomy Hystology Biochemistry Physiology Pharmacology Parasitology Microbiology Clinical Pathology Pathology Anatomy Preventive Medicine Behavior Science Clinical Science (Clinic) Medical Pharmacy Radiology Interna Pediatric Obstetry and Gynaecology Neurology Psychiatry Surgery Ophtalmology Otorhinolaryngology Dermatology Forensic New paradigm of curriculum is integrated basic sciences and clinical sciences. Udayana University Faculty of Medicine, MEU, 2013 10 Study Guide Studium Generale CONTENTS: items discussed 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. Overview of Studium Generale Independent Learning in Medical Education Philosophy of Science and Medicine History of Medicine Group dynamics in learning The new undergraduate competence-based curriculum of Udayana University, Faculty of Medicine Basic Principles of Communication Information Acces Thinking skills and scientific reasoning Academic Reading Interprofesional Communication The Role of Biomedical Science Overview of Human Anatomy Overview of Human Physiology Overview of Hystology Overview of Microbiology Overview of Parasitology Overview of Pharmacy Public Health Sciences General Pharmacology The Role of Clinical Science in Medical Practice The Role of Allied Science in Medical Practice Learning Process 1. Lecture 2. Individual learning 3. Small Group Discussion (SGD) 4. Student Project 5. Plenary Session Assesment Method Multiple Choice Question (MCQ) with passing level 70 Formative assessment and written examination. Formative assessment: data on attendance, participation in lectures, group discussions and student projects will be used in determining students’ achievement. Lecture 1 Independent Learning in Medical Education I Made Jawi Teaching and learning activities at Faculty of Medicine, Udayana University can be in various forms, such as lecture, small group discussion, clinical skill session, bed side teaching, ambulatory care teaching, etc. Those scheduled teaching and learning activities are purposed to facilitate students’ acquisition of knowledge. Acquisition of knowledge can be done by two methods: formal and non-formal. The formal method commonly comprises attending lectures or seminars given by experts or “resource persons”; which is commonly Udayana University Faculty of Medicine, MEU, 2013 11 Study Guide Studium Generale “one-way” in terms of its intellectual interaction. Thus, the result of learning that can be gained through this method is usually relatively limited or little and also superficial in nature. The second and apparently better method is the non-formal one, called independent learning or self-directed learning, which can encourage greater and deeper learning. The term independent learning may imply several main features of learning process such as: learning by presetting individual objective(s), managing one’s own self, designing an individual learning direction and time-line, deciding individually the learning resources, etc. There are several basic features or concepts of independent learning: (1) learning according to individual need, (2) learning by deciding individually the learning process in terms of where, what, how and when to learn, including deciding learning objective and resources (3) developing individual preference for the learning program, (4) the learner/student individually knows his/her learning needs and how to accomplish them, (5) provision of adequate learning resources (6) a lecturer functions as a facilitator for learning. These prerequisites of independent learning should be well understood both by teaching staff and students in order to achieve optimal outcomes Lecture 2 Philosophy of Science and Medicine Prof. Bakta Philosophy comes from the Greek for "love of wisdom," giving us two important starting points: love (or passion) and wisdom (knowledge, understanding). Philosophy sometimes seems to be pursued without passion as if it were a technical subject like engineering or mathematics. The most effective way to integrate philosophy into medical education uses ethical, social, and conceptual problems arising in medical practice such as those about informed consent, confidentiality, competency, resource allocation, the doctor-patient relationship, and death and dying. Medical students become better physicians by learning salient views on these matters and by developing philosophical skills and attitudes to (1) examine key assumptions; (2) broaden their perspectives and gain self-knowledge; (3) develop critical thinking skills about: the kind of judgments they make, how bias affects their views, and the scope and limits of their knowledge claims; (4) generate tolerance, openness, and skepticism about: dogma; and (5) cultivate empathy. Learning these skills and disposition; using moral, conceptual, and social issues facing them will enable students to recognize these issues when they arise in their medical practices and learn how to respond to them in justifiable ways. It will also strengthen the health care profession and institutions overall by fostering the openness, the questioning mind, and the critical thinking essential to the practice of good medicine. Philosophy of science, branch of philosophy that attempts to elucidate the nature of scientific inquiry- observational procedures, patterns of argument, methods of representation and calculation, metaphysical presuppositions - and evaluate the grounds of their validity from the points of view of epistemology, formal logic, scientific method, and metaphysics. Historically, it has had two main preoccupations, ontological and epistemological. The ontological preoccupations (which frequently overlap with the sciences themselves) ask what kinds of entities can properly figure in scientific theories and what sort of existence such entities possess. Epistemologically, philosophers of science have analyzed and evaluated the concepts and methods employed in studying natural phenomena, both the general concepts and methods common to all scientific inquiries and the specific ones that distinguish special sciences. Udayana University Faculty of Medicine, MEU, 2013 12 Study Guide Studium Generale Philosophy of science is the study of assumptions, foundations, and implications of science, especially in the natural sciences and social sciences. The philosophy of science may be divided into two areas: Epistemology of science and Metaphysics of science. Philosophers of science are interested in: the history of concepts and terms and how they are currently used in science; the relation between propositions with arguments (Formal logic); the reasoning connecting hypotheses and conclusions (Scientific method); the manner in which science explains natural phenomena and predicts natural occurrences (observation); the types of reasoning that are used to arrive at scientific conclusions (deduction, induction, abduction); the formulation, scope, and limits of scientific understanding; the means that should be used for determining when scientific information has adequate support (objectivity); and the implications of scientific methods and models, along with the technology that arises from scientific knowledge for the larger society (applied science). Issues of ethics, such as bioethics and scientific misconduct, are not generally considered part of philosophy of science. Deductive reasoning is the kind of reasoning in which the conclusion is necessitated by, or reached from, previously known facts (the premises). If the premises are true, the conclusion must be true. This is distinguished from abductive and inductive reasoning, where the premises may predict a high probability of the conclusion, but do not ensure that the conclusion is true. Induction or inductive reasoning, is the process of reasoning in which the premises of an argument are believed to support the conclusion but do not ensure it. It is used to ascribe properties or relations to types based on tokens (i.e., on one or a small number of observations or experiences); or to formulate laws based on limited observations of recurring phenomenal patterns. Scientific method is a body of techniques for investigating phenomena and acquiring new knowledge, as well as for correcting and integrating previous knowledge. These steps must be repeatable in order to predict dependably any future results. Theories that encompass wider domains of inquiry may bind many hypotheses together in a coherent structure. This in turn may assist in the formation of new hypotheses, as well as in placing groups of hypotheses into a broader context of understanding. The general procedure of scientific method : 1. Identify a problem that you’re interested in studying. 2. Form a hypothesis – specify it exactly 3. Design a research project to address the hypothesis 4. Conduct the research project 5. Examine the data, statistical analyses, evaluate hypothesis 6. Communicate the results Philosophy of Medicine, though medicine and philosophy have been intertwined throughout their histories, systematic philosophical reflection on medicine began only in the 19th century. It was rekindled in the middle of this century and established as a distinct discipline within philosophy only around 1970, with the founding of several journals devoted exclusively to issues underlying the practice of medicine. The main stimulus for the creation of philosophy of medicine was a belief that there was a widening gulf between technology and human values, ironically most manifest in a field devoted to the study and care of individual human beings. Philosophy of medicine hoped that the new discipline would clarify medicine’s proper goals and, by redirecting attention to urgent issues of an increasingly powerful social force, help free current philosophy from an analytical scholasticism. As a result, philosophy of medicine in its earliest years focused largely on concrete ethical questions involving new medical technology, such as euthanasia, human cloning, artificial insemination, etc. Further impetus was given to those concrete concerns by criticism of current medical practice from many sources-feminists pointed to sexist traditions in the practice patterns, research and profession of medicine, ‘alternative’ medical practitioners advocated their own therapeutic approaches, and mainstream practitioners themselves complained of the impersonal drift of modern medicine in an era of high technology and cost controls. More recently, philosophy of medicine broadened its focus to address public policy issues on the distribution and financing of health care, epistemological issues about the attainment, growth and certainty of medical knowledge, and metaphysical issues about causality, personal identity and spirituality in medicine. The Udayana University Faculty of Medicine, MEU, 2013 13 Study Guide Studium Generale emphasis at times also reflects my belief that medicine can only provide ‘treatment,’ while ‘healing’ must come from within the patient. As a result, ‘philosophy of medicine’ here means ‘philosophy of healing’ more than ‘professional ethics’ or ‘phenomenological analysis’ of medical practice or patient experience. Those other pursuits may benefit from exercises of this sort, though even the most subtle of metaphysical insights is bound to leave value judgments in medicine a matter of drawing well-educated, well-intentioned lines through painfully gray areas of human lives. Medical humanities is an interdisciplinary field of medicine which includes the humanities (literature, philosophy, ethics, history and religion), social science (anthropology, cultural studies, psychology, sociology), and the arts (literature, theater, film, and visual arts) and their application to medical education and practice. The humanities and arts provide insight into the human condition, suffering, personhood, our responsibility to each other, and offer a historical perspective on medical practice. Attention to literature and the arts helps to develop and nurture skills of observation, analysis, empathy, and self-reflection -- skills that are essential for humane medical care. The social sciences help us to understand how bioscience and medicine take place within cultural and social contexts and how culture interacts with the individual experience of illness and the way medicine is practiced. Day 2nd MODUL Tuesday, September 17th ,2013 Lecture 3 History of Medicine Mangku Karmaya Abstract We have a look at some discoveries , especially in medicine, that has led to a better life for the citizens of the world. For example. Try to imagine life without antibiotics. We wouldn’t live nearly as long as we do without them. But all innovations/discoveries require the prepared mind Each scientific discovery is made possible by the arrangement of neurons in the brain of one individual and as such is idiosyncratic. In looking back on centuries of scientific discoveries, however, a pattern emerges which suggests that they fall into three categories—Charge, Challenge, and Chance—that combine into a “Cha-Cha-Cha” Theory of Scientific Discovery Udayana University Faculty of Medicine, MEU, 2013 14 Study Guide Studium Generale Lecture 4 Group Dynamics in Learning I Made Jawi A human being need someone else in his life. Through life in group human being can achieve their personal and group goals. Because of character of each member then the interaction become dynamic. It should be distinguished the working group from working team. The goal of interaction in working group is to distribute information for making decision by each member according to their responsibility. Interaction in team group result in greater impact than the individual contribution. Development of the team group proceed through many steps. The effective group is the group that succeed achieving the goal, sustain and can develop according to the changeable situation. Small group dynamic (SGD) is a method to reach learning objectives because of its benefit. Lecture 5 The New Undergraduate Competence-Based Curriculum Of Udayana University, Faculty of Medicine Wayan Sumardika In the context of medical practice, a physician usually has a direct contact with the individual patient, the family and sometimes the community at large. Thus a physician should provide the best possible health services to the patient to help them to regain health, and to protect the family and the community. To ensure the provision of optimal health services for every patient, the Medical Council acting on behalf of the Government, has been bestowed with the responsibilities “to protect, promote and maintain the health and safety of the general public by ensuring proper standards in medical practice”. The Medical Council requires every physician practicing in Indonesia to be fully competent. During the initial stage professional competence is developed and gained during the formal medical education, but later after graduation every physician is required to be capable of maintaining their levels or standards of professional competence in keeping with new developments in medical science and technology and changing needs of the clients and the profession. Thus lifelong learning is mandatory. National Certificate of Competency is issued by the Medical Council to all Indonesian medical schools’ graduates who have successfully completed the National Competency Examination. A license for medical practice is only issued to those who have successfully passed the National Competency Examination. In response to these new challenges, Udayana University Medical Faculty has recently introduced a new competency-based undergraduate curriculum with seven areas or domains of exit competencies A. New Paradigm of Medical Education Introduction to the New Undergraduate Competency-Based Curriculum The word profession is derived from the word ‘profess’ which literally means “to claim to do something”. Physicians profess two things: “to be competent to help the patient and to have the patient’s best interest always in mind”. With the growing globalization of medicine and the emerging concept of a ‘global profession of physicians’, the minimum essential competences of all physicians must be Udayana University Faculty of Medicine, MEU, 2013 15 Study Guide Studium Generale vigorously defined. Since 2003 Udayana University Medical School has started to formulate and later formally defined and adopted seven exit competencies to be achieved by its graduates at the time of graduation. These general core competencies and the associated competency-based undergraduate curriculum can be perceived as Udayana’s response to the new needs and demands of ‘global physicians’. Very simply, competency-based education or curriculum, means that we focus primarily on the attaining the specific outcomes (or competencies) of the education, rather than the process of education. This is not to say that the process of education in not important – certainly it is. But the process(es) of education should be planned and carried out with the outcomes (or competencies) always kept in mind. So all students, without exception, should have attained the seven competencies by the time of their graduation The exit competencies cover seven areas or domains of competency. Aspects of medical practice Domains of general core competency Health care……………………. (1) Patient care Scientific foundation…………. (2) Biomedical, clinical and allied sciences base Clinical skill…………………… (3) Basic clinical skills Communication……………… (4) Professional communication Informatics……………………. (5) Information management Professional behaviors……… (6) Medical professionalism Population health…………….. (7)Community-and-health system-based practice The inter-relationships between the seven competencies can be seen in Fig. 1 The seven exit competencies are further elaborated in the lecture and discussion to convey clear messages of what are to be achieved by all students at the time of their graduation and to the faculty members and assessors on how and what to assess. 2 7 6 1 5 3 4 Figure 1. The relationships between the exit competencies, the primary competency on patient care occupying the central position and the other competencies help to strengthen it. Context of patient care includes individual, family and community health services. B. Professional Competence in Medical Practice Epstein and Hundert have defined professional competence as “the habitual and judicious use of communication, knowledge, technical skills, clinical reasoning, emotions, values, and reflection in daily practice for the benefit of the individual and community being served.” Udayana University Faculty of Medicine, MEU, 2013 16 Study Guide Studium Generale Professional competence builds on three educational domains as basic foundation: knowledge (biomedical and allied sciences and clinical sciences), skills (professional skills: clinical, intellectual and clinical) and attitudes or behaviors. The three domains are integrated and applied together holistically. Professional competence is neither a theory nor science, but it refers mainly to performance and must be developed and built during the formal or structured training programs and applied in daily practice. Day 3rd MODUL Wednesday, September 18th ,2013 Lecture 6 Thinking Skills and Scientific Reasoning Putu Adiatmika The essence of scientific reasoning is deduction and induction. Deductive reasoning starts with a general statement and leads to particular or specific instances; inductive process starts with particular instances or observations and leads to a general conclusion. Valid and true deductive reasoning leads to infallible inferences or proof; whereas inductive inference is not watertight, because inductive reasoning is based on the assumption of uniformity of nature. Deductive reasoning only aims to make particular instances more explicit, and inductive reasoning leads to new or tentative knowledge or information called evidence. Thinking skill as defined in this course is not identical to scientific reasoning skill or logical thinking; this implies a good scientific thinking may not reflect a good thinking skill. Simply defined, thinking skill is related to the ability to broaden one’s perception by exploration of past experience. Lecture 7 Academic Reading Wiwiek Indrayani Reading is a visual and active process and is probably one of the most important study skills a medical student should develop. There is not enough time to read everything line by line. As a medical student you need to be able to read efficiently. General efficient reading strategies such as scanning to find the book or chapter, skimming to get the gist and careful reading of important passages are necessary as well as vocabulary building exercises in your own area. Learning about how texts are structured can also help you to read more efficiently. Reading effectiveness can be greatly improved by one’s own interest Udayana University Faculty of Medicine, MEU, 2013 17 Study Guide Studium Generale and motivation in achieving it. The SQR4 approach is probably the most recommended reading strategy, with reflection on what has been read as the most important vehicle to long-term memory. In skimming a piece of writing, the conventional structure of a paragraph should be kept in mind. In the context of medical education, a working vocabulary of about 3000 words and recognition vocabulary of about 2000 words seem to be required by the average medical students. The SQR4 approach to academic reading 1) Scan through the chapter to see what the subheadings are. 2) If there is a summary, read it through, identifying the main points and arguments that have been covered. 3) Ask yourself what you want to get from your reading. 4) Read the sections and subsections, actively identifying the main ideas in each. These ideas are often contained in the first (or rarely last) sentence of the section or paragraphs. 5) Look at any example. Make sure that you understand how it is related to the idea in that section. 6) Summarize periodically. Pause and list the main ideas in the section you have just read. Check that you have missed nothing out and that you understand the ideas. 7) Review the whole topic when you have finished it by scanning through your notes. 8) Relate what you have read to other areas of knowledge. Day 4th MODULE Thursday, September 19th ,2013 Lecture 8 Basic Principles of Communication Dyah Paramita Foundations of Communication The course objectives After completing the course the students are expected to be able 1. To define communication and its essential components. 2. To explain the principles of human communication. 3. To describes the role of verbal and non verbal communication. 4. To describes various factors influencing communication process. 5. To explain the special role of culture to human communication. 6. To identify possible barriers during communication process The course outline The ultimate goal of studying human communication is to foster the development of practical skills in interpersonal communication including interviewing, small group communication and public speaking based on its theoretical foundation. It also covers the importance of cultural awareness and ethical issues, active and effective listening, critical thinking and the unique role of power in communication process. The course is initiated with Udayana University Faculty of Medicine, MEU, 2013 18 Study Guide Studium Generale introduction to Human Communication covering basic principles of communication and the role of culture during the communication process. Lecture 9 Interprofesional Communication Purwa Samatra Lecture 10 Information Acces Komang Januartha P Nowadays, internet becomes a popular communication tool used by people all over the world. With internet, people can instantly communicate themselves with others or gather information from every place in the world. Many things now become easier, simpler and cheaper to be done. For instance, a letter that is sent by conventional system, which usually used airplane as the carrier, takes few days or weeks to be done. But through the internet, an electronic mail or e-mail can be sent just within a few seconds. Online transaction now become more popular than ever. For example someone who lives in Indonesia doesn’t need to go to United States to buy things that they want. They can find lots of online-shops in the internet, and then transaction and payment can be done through the internet. Things that they bought will be sent within few days. This is more easier, simpler and cheaper than conventional transaction. Conferences, for business or scientific purposes, now can be done more easier. With web-conferences, people from different countries don’t need to come and gather themselves in a room. By using a web camera, they can communicate with others face to face. Despite of those advantages, lots of negative effects can be seen from the use of internet. On-line transaction using illegal credit card is one of some examples. Hundreds of computer viruses are created everyday. These viruses spread from one computer to another within seconds, and will destroy data from the infected-computer. The change in orientation of medical education into a ‘ student centered’ paradigm make the students to active in searching information required to support the process of learning. Infrastructures facilities (library and its collections) possessed by our institution is still limited in number. This limitation can be overcome by the provision of easy accessed internet, which nowadays getting simpler and cheaper. Development of information technology enables us to obtain information provided in the web fast and unrestrictedly. Unfortunately, not all information is valid and reliable. Today, many sites not only general sites such as Yahoo or Google, but also particular sites in medicine such as Pub med give chance to the users to access their databases using the available search engines. Each sites normally has its own regulation that should be followed in order to access the information within. Therefore, a special skills is needed to do more efficient search, so information we gained is valid and trustworthy. Udayana University Faculty of Medicine, MEU, 2013 19 Study Guide Studium Generale Day 5th MODULE Friday, September 20th ,2013 Lecture 11 The Role of Biomedical Science N.A Bagiada A. The Role of Biomedical Sciences Learning outcomes Define medical sciences Clarify the relationship between professional competencies and the contribution of biomedical sciences in supporting medical sciences (professional skills and attitude) Enabling outcomes Be able to knows what is Biomedical Science Be able to describe that Biomedical Science is concerned to integration of a wide range of subject to understand the biology of disease. Be able to describe the role of Biomedical Science as science of causes, diagnoses and treatment of disease. Abstract Biomedical sciences is a science which is concerned with integration of wide range of subject to understand the biology of disease. Biology in this sense means predominantly anatomy, histology, physiology, biochemistry, genetic, immunology, microbiology, pharmacy, pharmacology, and molecular biology. More specific knowledge of human disease process come form the study of specialized biology such as cellular pathology, clinical biochemistry, clinical immunology, medical microbiology, hematology and transfusion sciences. With the sciences the graduates will understand the physiology of normal condition of human being, and how the disorder happened. The graduate will have an ability to analyze the cause, diagnose, treating the disease scientifically. The advantage of learning biomedical sciences include an increasing the competency using multidisciplinary approach to study human diseases, how disease develop and how its affect the normal function of the human body. It is also will increase the awareness of graduates to the development of new methods for diagnosis, treatment and prevention of disease. The characteristic of which biomedical sciences are always changes depend on the development of medical science and technology, tight relationship one another and are always in the forefront of modern sciences, will make graduates rapidly involving subject and highly relevant to investigating and understanding current controversies. Lecture 12 The Role And Value of Biochemistry Udayana University Faculty of Medicine, MEU, 2013 20 Study Guide Studium Generale The study of human Biochemistry will open your eyes to how the body works as a chemical system. From a physician’s point of view, biochemistry not only describes how the system works, but also provides a foundation for understanding how to improve its operation (eg, by appropriate nutrition and exercise), how to diagnose problem and where possible, how to remedy them. Knowing biochemistry helps to understand current therapies, which include recombinant protein, such as human insulin or erythropoietin synthesized by bacteria. Its help to understand the action of new drugs, such as thizolidinediones used in type 2 diabetes, which act through cell signaling system. In the future, therapies will possibly involve gene rather than organ transplantation. Pharmacogenomic and nutritional genomics will create a basis for designer treatments, customized to an individual’s genetic makeup. To understand all this, it is essential to know something not only about the ”nuts and bolts” but to appreciate functional interaction between metabolic pathway, organ and tissues. One of the important characteristic of living organism including humanist is its ability to communicates with its environment. We regularly consume water, oxygen and fuels from environment (such as carbohydrate, lipids and proteins) and metabolized to produce energy (heat and ATP). We use these energy to perform works (such as muscle contraction, nerve conduction, active transport and synthesis reactions) and maintain body temperature. The amount and composition of food we consume is important for our health and forms a background for a wide range of treatment and preventive actions. To understand link between nutrient, metabolism and health and disease is one of the most important reason to study biochemistry. Most of metabolism occurs in the cell, in sub cellular organelles such as nucleus, cell membrane, rough and smooth endoplasmic reticulum, mitochondria, golgi apparatus and lysosomes or peroxisome. Metabolism consist of two component that is contrary one another, synthesis (anabolism) and degradation (catabolism). The main pathway of carbohydrate and lipid metabolism are routes of access to other processes in biochemistry. In other to know an abnormal apafasa93xapafasa93xapafasa93 of body chemical constituent in diseases, we have to know the normal value of all the chemical substances in our body (in blood), in urine, cerebrospinal fluid, bone, nerve, and other tissues). Understanding in these normal value will lead and help you to diagnose the disease or organs affected Udayana University Faculty of Medicine, MEU, 2013 21 Study Guide Studium Generale Day 6th MODULE Monday, September 23rd ,2013 Lecture 13 & 14 Overview of Human Anatomy I Wayan Suarya Enabling outcomes 1. To know the history of anatomy 2. To know approaches to studying anatomy, systems of body, anatomical variations and medical terminology anatomical positions and planes terms of relationship and comparison terms of laterality and movements and others Anatomy: Anatomy is a science of the structure of the body. Anatomy (English) in Greek anatome, from an etymological point of view, the term “dissection” (dis-, meaning asunder, and scare, meaning to cut) is the Latin equivalent of the Greek anatome. Greek anatomy had its origins in Egypt, by Alemaeon of Croton (500 B.C.) provided the earliest records of actual (animal) anatomical observations. Anatomy is one of biosciences and as a foundation of the building of medical sciences. There are three main approaches to studying of anatomy, systemic, regional and clinical anatomy. In medical sciences and anatomy has terminology. Anatomy has an international vocabulary that is the foundation of medical terminology. It is important that physicians, dentists, and others health professionals. The eponyms trend no used now, for example: tuba Eustachius tuba auditiva or tuba pharyngotympanica. In anatomy we have three planes : sagital, frontal and horizontal planes. So that we have some terms direction, for example: left/sinister; right/dexter, upper/superior, lower/inferior, etc. Terms of movement: flexion/flexio/flexi means bending of a part or decreasing the angle between body parts. Extention/extentio/extenti means straightening a part or increasing the angle between body parts, etc. Heart & Pancreas The heart, slightly larger than a clenched fist, has four chambers, be located in the middle of mediastinum, and has three layers from superficial to deep (profundus) : epicardium, myocardium, endocardium. The main function of the heart is to pump the blood to entire of the body (systemic circulation), and to the lung as pulmonary circulation. The innervation of the heart from vagal nerve as parasympathetic, and from the upper segments thoracic part of spinal cord as sympathetic nerves. The pancreas as a gland in retroperitoneal of abdominal cavity, has four parts: caput, collum, corpus, and cauda. The pancreas as endocrine gland secrete to blood and exocrine gland secrete to duodenum. Udayana University Faculty of Medicine, MEU, 2013 22 Study Guide Studium Generale Day 7th MODULE Tuesday, September 24th ,2013 Lecture 15 & 16 Overview of Human Physiology Adiartha Griadhi Homeostasis and regulation of internal environment are central precepts of physiology. Although the human body as a whole is adapted to cope with a variables external environment, its individual cells are much less tolerant of change. Only a small minority of cells in a multi cellular organism are actually in direct contact with the external environment. The vast majorities of the cells are sheltered from the outside world by buffer zone of extra cellular fluid, the body fluid that surrounds the cells and make up one-third of body’s total volume. The bulk of the body’s water is found in the intracellular fluid inside cell. Extra cellular fluid is the body’s internal environment and serves as the interface between the external environment and the cells. When conditions outside the body change the changes are reflected in the composition of the extra cellular fluid, which in turn affect the cells. But our cells are not very tolerant of changes in their surroundings. As a result, a variety of mechanisms have evolved that maintain the composition of the extra cellular fluid within a narrow range of values. The body’s ability to maintain internal stability is known as homeostasis. Failure to maintain homeostasis disrupts normal function and results in a disease state or pathological condition. Diseases generally can be divided into two groups according to their origin: those in which the problem arise from internal failure of some normal physiological process and those in which the problem arise from internal failure of some normal physiological process and those that originate from some outside source. In the both internally and externally cause of disease include the abnormal growth of the cells which may cause cancer or benign tumors the production of antibodies by the body against its own tissues (autoimmune diseases) and the premature death of cells or the failure of cells process. Inherited disorders are also considered to have internal causes. External causes of disease physical trauma, toxic chemicals, and foreign invaders such as viruses and bacteria. In both internally and externally caused disease, when homeostasis is disturbed the body attempt to compensate through the integration of function of the organs in the body. If compensation is successful, homeostasis is restored. If compensation fails, disease results. Udayana University Faculty of Medicine, MEU, 2013 23 Study Guide Studium Generale Day 8th MODULE Wednesday, September 25th ,2013 Lecture 17&18 Overview of Histology Gusti Ngurah Mayun Branch of anatomy that studies tissues of animals and plants. In text book, however discusses only animal and more specifically human tissues. In its broader aspect, the word histology is used as if it were a synonym for microscopic anatomy, because its subject matter encompasses not only the microscopic structure of tissues but also that of cell, organ and organ system Histology (gr.Histos = tissue; logia = a branch of learning ) means the science of the tissues in normal structures. Microscopic observations confirmed that the body is made up of different tissues and revealed that cells are the ultimate living units from which animals and plats are constructed. The important purpose of learning histology is to gain some understanding of the relation between the normal body structure and function at the cellular level. The body is composed of cells, intercellular matrix and a fluid substance, extra cellular fluid (tissue fluid), which bathes these components. Extra cellular fluid, which is derived from plasma of blood, carries nutrients, oxygen and signaling molecules to cells of the body. The cells are organized together to constitute the tissue, and some tissues organized together to form the organ in the body. In fact, histology has a direct relationship to other disciplines and is essential for their understanding. Based on it structure and function our body composed of four primary tissues; epithelial, connective, muscle and nerve tissues. To learn these tissues we use light microscope and for more details ultra structures of the tissues we use electron microscope. Specification of each of the tissues are: The epithelial tissue covers and protects our body surface, glands, the connective tissue supports and fills the spaces in our body; the muscle tissue will contracts, and the nerve tissue transmits and conducts the impulse in our body How to learn the microscopic study of cells and tissues? Cells can be observed directly in the living state. Valuable information can generally be obtained by encouraging cells to grow in culture systems amenable to study by microscopy and related methods. To preserve the structural relationship between cells in tissues, it is necessary to cut very thin slices of tissue, called sections, that are suitable for light and electron microscopy. Sections cut to light microscopy must be thin enough to transmit sufficient light to avoid visual superimposition of their various components. For light microscopy, sections are generally prepared by the paraffin technique, which is described in the following discussion. The apparatus for cut the tissue very thin slices called microtome, and the sections will follow the process for preparation until it able to observe by light microscope. Udayana University Faculty of Medicine, MEU, 2013 24 Study Guide Studium Generale Day 9th MODULE Thursday, September 26th ,2013 Lecture 19 & 20 Overview of Microbiology Sri Budayanti Udayana University Faculty of Medicine, MEU, 2013 25 Study Guide Studium Generale Day 10th MODULE Friday, September 27th ,2013 Lecture 21& 22 Overview of Parasitology Made Sudarmaja Day 11 MODULE Monday, September 30th ,2013 Lecture 23 Overview of Pharmacy Toya Wiartha Learning outcome: Understand : 1. Drug dosage forms (solid, semisolid, liquid and gas) and route of administration (intravascular and extra vascular) 2. Biopharmaceutical aspects which affect drug absorption (biological, physicochemical and dosage form) The role of drugs in human body: Pharmacology Drug dosage forms and route administration Biopharmaceutics and pharmacokinetics Bioavailability Udayana University Faculty of Medicine, MEU, 2013 26 Study Guide Studium Generale Drugs interaction Pharmacodynamics Physicians treat their patient with or without drugs based on clinical diagnosis. The treatment done by physician using certain drugs is known as pharmacotherapy In order to give the most effective medication treatment for patients, physicians must have a good knowledge of the drugs that they might use, together with its mechanism of action, its combination and dosage forms, availability and its bioavailabilty and activity within the human body. Furthermore, they have to know how age, sex, and secondary disease status might influence the course of treatment as well as how other drugs, foods, and any diagnostic procedures might modify the clinical activity of drugs. Biopharmaceutics is a scientific discipline concerns with the relationship between drug’s physic- chemical properties in a particular dosage form and the biologic responses observed after its administration The development of pharmacokinetics or the study of absorption, distribution, metabolism and elimination (ADME) of drugs as it relates to their therapeutic and toxicological effects has led to a better understanding of quantitative aspects of biopharmaceutics. The knowledge of biopharmaceutics and pharmacokinetics principles is fundamental to the rational selection of drug product, the determination of its appropriate dose and dosing schedules, and its monitoring of therapy. Bioavailability is the relative amount of administrated dose of a particular drug that reaches systemic circulation. Bioavailability is therefore defined as the rate and extent of drug absorption which very important in determining whether a therapeutically effective concentration will be achieved at the site of action. Pharmacodynamics is interaction between active drug with receptor on receptor site in target tissue which resulting biological response. The success of pharmacotherapy depends on how drug move from the site of administration to the site of action. The 3 steps of drug kinetics in human body includes: 1. Pharmaceutical phase 2. Pharmacokinetic phase 3. Pharmacodynamic phase Lecture 24: Overview of Public Health IB Wirakusuma Objectives 1. 2. 3. 4. : Describe definition and areas of Public Health Describe Understanding Population Health and Its Determinants. Describe health problem in the community. Describe Treatment and Prevention for Health Problem in the Community ABSTRACT Public health is art and science of diseases prevention method, increasing of physic and mental health. In discussion, public health covers sanitation and environmental health, epidemiology, occupancy health, mother and child health, nutrition and administration of health services. Udayana University Faculty of Medicine, MEU, 2013 27 Study Guide Studium Generale Reference: 1. Charles du V. Florey, Peter Burney, Michael D’Souza, Ellie Scrivens, Peter West. 1983. An Introduction to community medicine. Eidinburgh London 2. Bord on Health Promotion and Disease Prevention. 2003. The Future of The Public’s Health in the 21st Century. The National Academic Press. Wasington DC 3. Daniar. 1995. Materi-materi Pokok Ilmu Kesehatan Masyarakat. Widya Merdeka. Jakarta. Day 12 MODULE Tuesday, October 1st ,2013 Lecture 25 General Pharmacology & Pharmacokinetika I Gusti Made Aman Learning outcome: Understand: 1. pharmacology 2. pharmacokinetic (absorption, distribution, biotransformation and excretion of drugs) The role of pharmacology in the treatment of patient (Medicine is an ever changing science) After diagnose the patient, there are 2 kind of treatments, non pharmacological treatment and pharmacological treatment. A non pharmacological treatments mean treatment without drugs intervention, such as diet therapy, modification of life style, massage etc. A pharmacological treatment is the treatment with drugs intervention. In pharmacological treatment, pharmacology knowledge plays an important role, especially in choosing the right drug. Drugs are an agents that are used for diagnosed diseases, prevent diseases, treat disease, rehabilitation and prevent pregnant. There are abundance of drug marketed in the world that can be grouped as essential drugs, generic drug and patent drugs. Drugs can be differentiated in efficacy, safety, and cost. Nearly all of drugs have side effect and toxic effect. The doctor should be afford to choose the right drugs, in the right amount, at the right interval dosage, at the right route of administration, right the period of time (length of treatment) for the right patient. The doctor should be used the drugs rationally. At least 4 considerations to choose drugs rationally such as efficacy, safety, suitability and cost of the drugs. In addition to the safety and efficacy of the drug, the doctor should be considered about potential side effects or adverse reactions, and the possibility of drug interactions. Pharmacokinetics Udayana University Faculty of Medicine, MEU, 2013 28 Study Guide Studium Generale The aim of studying pharmacokinetic is to understand the term that commonly used in pharmacology and the fate of drug in the body. The action of the body to drug is called pharmacokinetics, that are including absorption, distribution, metabolism and excretion of drug. If the drug is given to patient, the first reaction of the body is absorption of the drug. The drug is absorbed from the site of administration, pass through the cell membrane. In blood or plasma part of drug will bound to protein especially albumin and orosomucoid, and the others are free. So in plasma there are two kind of drugs, free drug (unbound drug) and bound drug. Each drug have its specific protein bound (eg.warfarin, only 2 % in the form of free, while penicilline 50 % are bound). Only free drug will be distributed, produce effects, metabolized and excreted. The very common route of administration is oral route, although absorption may be slower and less complete. Ingested drugs are subject to the first pass effect, in which a significant amount of drug is metabolized in the gut wall and the liver before the drug reaches the systemic circulation. The drug then distributed to all part of the body and reaches its receptor to produce its effects. An important pharmacokinetic parameter that reflect of dug distribution is apparent volume of distribution (Vd). The bigger the value of Vd, the greatest amount of drugs distributed to body organ. After distribution process the drug will be metabolized. Metabolism of drug sometimes terminate its action. The action of many drugs (eg.phenothiazine) is terminated before they are excreted, but prodrugs (eg.Levodopa) are inactive as administered and must be metabolized in the body to become active. The other drugs (eg.benzodiazepine) are active as administered and have active metabolites as well. On the other hand lithium is not metabolized by the body, so lithium still active in the body until it is excreted. Elimination is not the same with excretion of drug. Elimination means that an active drugs are metabolized to become inactive, although it metabolites are still in the body, and excreted means that molecules of drugs are excreted from the body. But for drugs that are not metabolized, excretion is the mode of elimination. For most drugs and it’s metabolites, excretion is primarily by kidney and intestine. Anesthetic gases are excreted primarily by the lungs. Lecture 26 General Pharmacology & Pharmacokinetika Surya Chandra Trapika Day 13 MODULE Wednesday, October 2 nd ,2013 Lecture 27 Autonomic Nervous System Udayana University Faculty of Medicine, MEU, 2013 29 Study Guide Studium Generale Wayan Sumardika Lecture 28 Drug Interaction IB Ngurah Day 14 MODULE Thursday, October 3nd ,2013 Lecture 29 The Relationships between the Basic Sciences and Clinical Practice Putu Astawa A good doctor can better treat a patient if he or she is thoroughly familiar with the processes leading to an illness in the patient’s body, i.e. he or she is familiar with the pathophysiologic processes involved. Usually we can recognize four important aspects of disease process: the etiology, pathophysiology, morphological changes and clinical significance, all of which should be well understood before a doctor could properly manage the patient’s problem. The clinical picture of the patient represents a manifestation of the underlying pathologic processes in the cells, so we must always remember the often-heard adage: “treat what the cells say”. For mastering the various aspects of basic mechanisms leading to an illness, we need the services of the basic sciences: anatomy, physiology, biochemistry, molecular biology, etc. Usually, we need to learn the normal processes first before being able to understand the abnormal mechanisms. We can imagine the cell as a miniature of human being; it needs energy produced by the energy metabolic processes in the body, it secretes some active chemical substances, and excretes some waste products, it produces important substances for maintaining life and tissue regeneration. The earliest clinical manifestation of an illness always starts at the cell level, but sometimes during the early stages the clinical evidence is not apparent as yet and this condition is often referred to a stage of cell imbalance resulting from micro environmental changes. Changes in the cellular microenvironment can caused by any cause or etiology (e.g. injury) and make the cells in a state of functional imbalance; the degree of imbalance must a certain level before the cells become really sick. The presence of sick cells can be clinically recognized or detected by supporting investigations, such as X-ray study, laboratory investigations, etc. The relationship between the presence of sick cells and clinical manifestations must be hypothesized based on the pathogenesis of the disease. The sequence used for teaching in the block system always starts with the study of the basic sciences: anatomy-histology, physiology, biochemistry, pathology, pharmacology, microbiology, parasitology, and followed by diseases or disease entities related or relevant to the particular curriculum block. In summary, we may conclude that to become a good and competent doctor we must first master the basic sciences foundation of disease, and then we must combine the basic science knowledge with the real cases through our clinical experiences (called an Udayana University Faculty of Medicine, MEU, 2013 30 Study Guide Studium Generale illness script) and finally we must use the experience with the illness script to deal with a new case. Lecture 30 The Role of Allied Science in Medical Practice Diah Pradnya Paramita PSYCHO-SOCIAL PERSPECTIVE Learning outcome: To be able to understand that determinant factor of health is complex (not only bio and physical aspect but also pshyco-social perspective). To be able thinking holistically in order to overcome such cases in societies. Abstract: One important question from Albrecht and Higginbotham in Health Social Science, is “What is the best way to begin the journey towards understanding the complexity of human health and incorporating the knowledge into more effective health policy and practice?” It is a transdisciplinary and complexity perspective. The need for a transdisciplinary approach grows more obvious as the disease profiles of all countries become increasingly complicated. As stated by WHO, the definition of health is a state of complete physical, mental and social well-being, and not merely the absence of disease and infirmity. That means WHO recognise health as a state of complete bio-psycho-social well-being. Nowadays, as a health provider in order to overcome a case we must think holistically. We all understand that the determinant factor of health is not only bio and physical aspect but it is complex. It is influenced by psychological and social aspect too. For example heart disease, stroke, diabetes, etc. in industrialised societies and developed countries have a substansial burden. It is called lifestyle disease- Then, in the rural societies and developing countries, the diseases almost influenced by physical and non physical environtmental such as social values and norms, clean water, air, housing and others physical environmental aspect. Friday, October 3st ,2013 Presentation Project Udayana University Faculty of Medicine, MEU, 2013 31 Study Guide Studium Generale Learning Tasks for Independent Learning Task 1. Independent Learning in Medical Education Day:1st Group Dynamics in Learning Scenario Consuming natural food is one of many efforts to maintain our health, so the government, especially the Ministry of Health, always promote the consumption of natural food and avoidance of fast food. Natural food coloring is considered better than artificial food coloring (which contain dangerous chemical substances). Until nowadays, the governmental efforts still not achieve the health promotion target to encourage Indonesian people to eat healthy foods. Specific measures should be done to overcome the problems of fast food consumption and usage of artificial food coloring which are prevalent in this country. Based on that problems, a group of students are given tasks to develop community-suitable method to overcome the problems. Learning Tasks 1. If you become a member of that group, what are your attitudes toward the tasks so that your group can work under the appropriate dynamics? 2. If one of the group members is getting stubborn, and want to use his own ways to deal with the tasks, is that student compatible with the concept of group dynamics? If not, please give your reason and explain it! 3. Please explain the steps which are needed to better overcome the problems if you are a physician! Day:2nd Information Acces 1. Describe in your own words, what should be mentioned when putting the keywords into the search box ! 2. What is Boolean operator? What kind of operators usually used ? 3. Describe the punctuation marks commonly used to help us in searching over the internet ! 4. Explain the similarity in function of Boolean operator and those punctuation marks ! 5. What are the advantages and disadvantages of html and pdf file format ? 6. Please try to find one or more articles with the topic: * Smoking and cancer * The role of vitamin C in influenza Udayana University Faculty of Medicine, MEU, 2013 32 Study Guide Studium Generale * Risk factors in breast cancer Day:3rd . Independent Learning in Medical Education Scenario Smoking is one of the established risk factors of lung cancer. The government, especially Health Department, always campaign about the danger of smoking. Unfortunately, until today , the government’s target to decrease smoking in community still not achieve its target. Based on that problem, the lecturer gives tasks to medical faculty student to find out the mechanism to stop smoking in the community. They get this tasks for final assessment in the end of semester. The student have to consult with the cigarette expert that also own a famous cigarette factory in Indonesia. Learning task Please discuss the step to achieve the goal with this cycle : Udayana University Faculty of Medicine, MEU, 2013 33 Study Guide Studium Generale Day:4th The New Undergraduate Competence-Based Curriculum Of Udayana University, Faculty of Medicine Scenario Teaching and learning activities at Faculty of Medicine, Udayana University can be in various forms as explained in the lecture. Those teaching and learning activities might be differ with your experiences during senior high school. Learning task Please discuss the following issues that related to your professional competence development : 1. Experience is the best teacher. In your opinion, what kind of experiences from your previous education that can be useful during your study at Faculty of Medicine, Udayana University? Please explain why? 2. In your opinion, what difficulties that you might be encounter to adapt with the teaching and learning activities at Faculty of Medicine, Udayana University? Please explain why? 3. Collaboration (team working) is one of skill that physician/health practitioner should have. Please mention and explain some factors that can determine the quality of collaboration among health practitioners. 4. Explain the reasons and benefits of requiring every practicing physician to be fully competent. 5. Explain the general strategy (or strategies) to maintain one’s professional competence. 6. Describe the actions to be taken by students in order to achieve the required competencies as stipulated by the Institution (Medical Faculty). Day:5th Philosophy of Science and Medicine Scenario Udayana University Faculty of Medicine, MEU, 2013 34 Study Guide Studium Generale Philosophy of medicine seeks to understand what it is to be human. The primary tool medicine has developed for obtaining this knowledge has been science, which has been spectacularly successful in many respects. "The human" is very complex, however, and perhaps there are aspects of us that science cannot easily reach. Medical humanities seek to bring other sources of human knowledge to medicine, particularly medical education. Subjects such as philosophy, literature, and history provide a distinct and complementary vision of the human, while philosophy of science and the social sciences provide a broader understanding of science itself. Learning Task 1. Epistemology is a branch of philosophy that deal with knowledge, especially the method or way to attain knowledge. The method to attain scientific knowledge is called scientific method. Please discuss the scientific method, especially the philosophical basic and its procedure 2. Medical (biomedical science) is a part of science. In point of view of philosophy of science a knowledge could be classified as true science if it fulfill three aspects, i.e : ontological, epistemological and axiological aspect. Please give reason that medicine is a true science 3. Philosophy of medicine seek s to understand what it is to be human. The primary tool medicine has developed for obtaining this knowledge has been science, which has been spectacularly successful in many respects. “The human” is very complex, however and perhaps there are aspects of us that science cannot easily reach. Medical humanities seek to bring other sources of human knowledge to medicine, particularly medical education. Subjects such as philosophy, literature, and history provide a distinct and complementary vision of the human, while philosophy of science and the social sciences provide a broader understanding of science itself. Please discuss the role of philosophy of medicine in connection in disease, health care, medical humanity and biomedical ethic. Day:6th Thinking Skill and Scientific Reasoning Instruction : Answer the following questions either in Indonesia or English. 1. What is meant by scientific reasoning ? What is scientific inference ? Are these two terms meaning the same thing? 2. What is a “proof “ (very solid conclusion ) and what is “ evidence “? 3. What is the main limitation of deductive reasoning ? Give an example where deductive reasoning is applied in scientific investigation ? 4. What is the main advantage and limitation of inductive reasoning ? Provide an example where you can apply inductive reasoning in scientific investigation ? 5. Explain briefly Karl popper’s falsification theory. What is its main weakness ? 6. What is meant by David Hume’s problem ? What is the main problem of inductive reasoning according to David Hume ? Udayana University Faculty of Medicine, MEU, 2013 35 Study Guide Studium Generale 7. Identify the type of reasoning applied in composing the following paragraph. Use (A) for deductive reasoning, (B) for inductive reasoning, and (C) When it is deductive-inductive Day:7th Basic Principles of Communication Please completing in the independent learning! Each student should be able to describe and to answer the following aspects of communication: 1. The definition of communication 2. The purpose of communication 3. The scheme of communication process 4. The component of communication 5. The possible sources of problem during communication process 6. Types of statements during communication process and selection of the most common statement being used by a good speaker or listener 7. The important role of communication in medicine. Scenario During small group discussion each participant is requested to share their strengths and weaknesses in communication. The results should be summarized and be presented during plenary session. Learning Task The following statements should also be discussed in small group discussion. 1. Good communicators are born. 2. The more you are communicating the better you are in communication. 3. Unlike effective speaking, effective listening can not be taught. 4. Opening communication with formal statements is not necessary, 5. The best way to communicate with someone from a different culture is exactly as you would with someone from your own culture. 6. When verbal and non verbal messages are contradict each other, people believe the verbal ones. 7. Interpersonal conflict is a reliable sign of your relationship is in trouble. 8. Like good communicators, leaders are born. 9. To be an effective speaker, one must learn to eliminate fear of speaking. 10. Complete openness should be the goal of meaningful interpersonal relation ship. Day:8th Great Discovery in Medicine Udayana University Faculty of Medicine, MEU, 2013 36 Study Guide Studium Generale Scenario 1 A number of scientists discover ribonucleic acid, or RNA, a chemical found in the nucleus and cytoplasm of cells with a structure similar to DNA. They find that RNA plays an important role in protein synthesis and other chemical activities in the cell. Question 1. According to the “cha cha cha” theory, were the scientists making process of charge, challange or chance? 2. Discuss the charge, challange and chance in a discovery process Scenario 2 Andreas Vesalius dissects human corpses, revealing detailed information about human anatomy and correcting earlier views. Vesalius believes that understanding anatomy is crucial to performing surgery, so he dissects human corpses himself (unusual for the time). His anatomical charts detailing the blood and nervous systems, produced as a reference aid for his students, are copied so often that he is forced to publish them to protect their accuracy. In 1543 he publishes De Humani Corporis Fabrica, transforming the subject of anatomy. Question 1. Why Vesalius was known as a great discoverer? 2. What is the future impacts of Vesalius discovery in medicine ? Learning task 1. Describe all the medical discoveries and their influnces to the future medicine. 2. Describe the medical discoveries and catagorise them into the “cha cha cha” group 3. All innovations/discoveries require “the prepared mind”. What does it mean? Day:9th Academic Reading Udayana University Faculty of Medicine, MEU, 2013 37 Study Guide Studium Generale Scenario Many students still rely on painstakingly slow word by word reading. It soon becomes clear to them, however, that they cannot read every word in the library. Try this exercise : please read the journal carefully and you must do this steps : 1. Understanding meaning : deducing the meaning of unfamiliar words and word groups; relations within the sentence/complex sentences; implicationsinformation not explicitly stated, conceptual meaning. 2. Understanding relationships in the text :-text structure ; the communicative value of sentences; relations between the parts of a text through lexical and grammatical cohesion devices and indicators in discourse. 3. Understanding important points; distinguishing the main ideas from supporting detail; recognizing unsupported claims and claims supported by evidence-fact from opinion; reading critically/evaluating the text 4. Reading efficiently : surveying the text, chapter/article, paragraphs, skimming for gist/ general impression, scanning to locate specifically required information, reading quickly 5. Make notes on what you read Day:10th The role of Biomedical Science Scenario: 55 years woman visited her family physician, complaining chest pain. More deeper anamnesis the pain is located in the left part of his chest and sprain out to the left arm. Its comes especially when he is exercised physically and psychologically. She is also complained lost his weight more than 8 kg in a mount while he eat and drink more than usual. On laboratory examination : Blood sugar (fasting blood sugar) 150 mg%, cholesterol total 240 mg%, LDL cholesterol 200 mg, HDL cholesterol 40 mg% and triglyceride 300 Udayana University Faculty of Medicine, MEU, 2013 38 Study Guide Studium Generale mg%. Blood pressure examination 160/100 mmHg. Chest X-ray examination showed enlargement of left heart, prominent of aorta knob. Occupational and social history found that he is weight barber athlete and like to eat sweet candy and weight smoker. His family doctor diagnosed him as DM, hypertension and dyslipidemia with transient ischemic attack. His doctor treat him with glicasid for his Diabetes Mellitus, captopril for high blood pressure and statin for dylipidemia. Learning task: 1. Find some term in this task which lead you to find diagnose ! 2. In your opinion which department in Biomedical Science can help you to support your diagnosis 3. Do you also need allied science to help you. What department you must have contact ? 4. What is the normal value of fasting blood sugar ? 5. What is dyslipidemia means ? 6. Generally what kind of advice must you give to this patient ? Day:11st Overview of Human Anatomy Learning Task 1 : 1. What is the meaning of anatomy. Word analog/equivalent to anatomy is…. 2. Greek anatomy (anatomy) had its origins in….. 3. What do you know about Vesalius ? 4. What do you know about the nomina anatomica ? 5. Who is the founders of the science of anatomy ? 6. Who is the founders of comparative anatomy ? 7. Who is the father of physiology ? 8. What do you know about anatomical position ? 9. Mentions three main approaches to studying anatomy ? 10. Mention 10 systems of body! 11. Mention 3 anatomical planes! And mentions term directions from each planes! 12. Please mentions the others term directions 13. Please mention some terms of movement 14. What do you know about cavity in body ? 15. Mention 4 the most commonly used diagnostic imaging techniques. Learning Task 2 : 1. Where is the location of the heart ? 2. What are left and right sides of the heart ? 3. What is the organ inferior of the heart ? 4. How many chambers the heart have ? 5. Where are the base and apex of the heart ? 6. What is the name of the muscle of the heart? 7. The blood stream out from the heart pass through….. Udayana University Faculty of Medicine, MEU, 2013 39 Study Guide Studium Generale 8. 9. The blood fill in the heart pass through……… When we heard mitral sound the stethoscope put on…….. Learning Task 3 : 1. Where is the location of the pancreas ? 2. The organ left side of the pancreas is……. 3. The organ right side of the pancreas is…….. 4. Mention 4 parts of the pancreas 5. What are the hormones secrete from pancreas ? 6. What do you know about rupture of the pancreas on traffic accident ? Udayana University Faculty of Medicine, MEU, 2013 40 Study Guide Studium Generale Day:12nd Overview of Histology Scenario Mr. Anton 45 years old is a worker at Histology Department Laboratory do sectioning for histology preparation. He uses mice for this experiment and take the liver organ of the mice to observe it microscopic structure . Learning Task : 1. Describe the steps must be done to find the histology preparation. 2. Describe the kind of fixative substances , explain the purpose of the fixation 3. How do you use the light microscope for observe the histology preparation, and describe the components of the light microscope 4. Describe about staining in the histology preparation 5. Describe the components of the tissue and explain the kind of the tissues in our body Day:13rd Overview of Human Physiology Scenario A street paving worker usually work in the outdoor, under the exposure of sun light and dry air. He often get thirsty, so he bring bottled water. He often rehydrates himself with the bottled water, but rarely get the time to urinate. Although the work time is relatively the same everyday, the amount or volume of the water consumed is not same. Why he often get thirsty Learning Task 1. Please explain the physiologic mechanism of thirst! 2. Please explain the association between thirst and drinking in relation with internal environment of the human body! 3. Describe the cell as the living unit of body 4. Describe the extra cellular fluid as the internal environment ! 5. Internal environment of the body contains some elements or substances in a specific amount. Why can this happened? Please give some examples! 6. What are the differences between extra and intracellular fluid ? 7. Describe homeostasis and give an example ! Udayana University Faculty of Medicine, MEU, 2013 41 Study Guide Studium Generale 8. Describe the function of circulatory system as extra cellular fluid transport system ! 9. What are the function of pancreas as one of the organs in the body for regulation of blood glucose? Day:14th Biomedical Process Scenario A male 30 years old visited his family doctor complaining lost of weight since 2 months ago. On anamnesis and laboratory test found that he eats and drink a lot and frequent pass urine especially on night.His fasting blood sugar found 175 %. Learning Task Discuss on your SGD which kind nutrition metabolism are disturbed and explain how such symtoms appear. Scenario A male 20 years old visiting his family physician complaining difficult to pass urine. On anamnesis and laboratory examinations found symptoms of dysurie, hematurie, proteinurie, polakisurie. Doctor diagnosed him suffer from urolithiasis. Learning Task Please try to find out the term you don’t now in this case and explain how can its happened Udayana University Faculty of Medicine, MEU, 2013 42 Study Guide Studium Generale Day:15th Pharmacotherapy 1 Scenario A lady is taking her 2 years old son to a clinic. The boy has 39◦C fever and is going to have a medical assessment, but suddenly during the assessment, the boy gets a febrile convulsion. His mother is panic and finally the doctor gives him Diazepam rectal solution through his rectal. In a few minutes later, the boy has stopped suffering and the doctor later on prescribes him : 1. Mixture of analgesic – antipyretic, antihistamine, and muscle relaxant, in pulverous dosage form (in separate preparation) 2. A dry syrup antibiotic Learning Task 1. Why does the doctor give a rectal solution dosage form in order to over come the boy’s convulsion ? Why does not the doctor use an injection instead? Which one from these two dosage forms are the most rational in giving effect ? 2. For additional therapy a form of mixture and dry syrup were given by the doctor. Why does these two become a chosen dosage form? What are the advantages & disadvantages of these two forms compared with other dosage forms such as capsule, tablet and solutions? 3. Explain how to use dry syrup form properly and why some medicines are made into this form? 4. What is the requirement for powder mixture form? Instead of used as systemic purpose, is it possible to use to local site or topical? 5. Name an oral dosage form that is comfortably can be used for baby under 1 year old! 6. Which one of antibiotic’s dosage form between dry syrup and tablet that give a faster effect? 7. Explain the impact of food existence in GI tract to medicine absorption! Day:16th Pharmacotherapy 2 Scenario Udayana University Faculty of Medicine, MEU, 2013 43 Study Guide Studium Generale A patient come to the clinic. Her chief complain was breath difficulty. The doctor then diagnosed as Bronchial Asthma. The doctor will give her Salbutamol, a short acting B2 agonist as bronchodilator. Learning Task The dose that given to the patient is 4 mg. With this dose, the concentration of salbutamol in blood is 0.25 mg/L. Please calculate the value of Vd. Half life (t ½ ) of salbutamol is about 4 hours. Calculate the concentration of Salbutamol in blood after 12 hours Salbutamol is a weak acid drug. If this drug is given to nursing mother, where is the drug concentrated, in breast milk or in the plasma (the pH of breast milk 1s 7.0, the pH of plasma is 7.4). Describe it briefly . If given orally, 20% of salbutamol eliminated pre systemically (first pass effect). Calculate their bioavailability. The excretion of salbutamol through urine will accelerated by Amonium Chloride (an acid diuretic). Is that true? Differentiate between drug elimination and drug excretion, first order kinetic and zero order kinetic. Day:17th The Role of Clinical Sciences in Medical Practice The following items or topics should be discussed in small group. 1) From the study of physic we learn about pressure of air (pressure of gas), what do you know about the relationships between that air pressure and respiration mechanism (changes of air pressure during inspiration and expiration)(relation of physic and physiology). 2) Yesterday your friend fell down from a height and now suffered from pain on the right elbow. If a bone fracture was diagnosed, do you know which bone or bones could possibly be involved? (physiology and anatomy) 3) Do you know about diabetes mellitus? In diabetes, there is a disorder of the glucose metabolism. Do you know about the chemical configuration of glucose molecule? 4) What do you know about glucose metabolism? (physiology and biochemistry) 5) What is the primary defect in diabetes mellitus? (endocrinology) Day:18th The Role of Allied Sciences in Medical Practice Independent Learning Udayana University Faculty of Medicine, MEU, 2013 44 Study Guide Studium Generale Please completing in independent learning! Each student should be able to describe and answer the following question: 1. What is the definition of allied sciences? 2. Why we talk about allied sciences in medical practice? 3. What the purpose to learn allied sciences? 4. Where you can implement your ability in allied sciences? Scenario: 55 years woman visited her family physician, complaining chest pain. More deeper anamnesis the pain is located in the left part of his chest and sprain out to the left arm. Its comes especially when he is exercised physically and psychologically. She is also complained lost his weight more than 8 kg in a mount while he eat and drink more than usual. On laboratory examination : Blood sugar (fasting blood sugar) 150 mg%, cholesterol total 240 mg%, LDL cholesterol 200 mg, HDL cholesterol 40 mg% and triglyceride 300 mg%. Blood pressure examination 160/100 mmHg. Chest X-ray examination showed enlargement of left heart, prominent of aorta knob. Occupational and social history found that he is weight barber athlete and like to eat sweet candy and weight smoker. His family doctor diagnosed him as DM, hypertension and dyslipidemia with transient ischemic attack. His doctor treat him with glicasid for his Diabetes Mellitus, captopril for high blood pressure and statin for dylipidemia. Learning Task 1. Based on the scenario above, please mention the determinant factor of the psychological aspect. 2. Is there any social aspects in the scenario above?What are they? Why do you think those things are included in the social aspect? Please explain! 3. Please give some advices to solve the psychological aspect! Why do you think it suitable for the psychological? Do you need support from the member of the family? Why? What are their role? 4. Please give some advices to solve the social aspect! Why do you think it suitable for the social aspect? 5. Why we must think holistically for all cases we faced? Udayana University Faculty of Medicine, MEU, 2013 45 Study Guide Studium Generale STUDENT PROJECT Each small group discussion must do this student project and presentation at additional lecture schedule. All student project must be writen and than collect it to the secretary of the block Studium Generale. Student project will be contribute 15 % in to the final report Day:1st Group Dynamics in Learning Case 1 While you are in a serious discussion, there are three students constantly refrain from taking part in the discussion, what will you do? Case 2 There are about 2 students seriously talking each other in your group. What is your opinion in this case? Case 3 Udayana University Faculty of Medicine, MEU, 2013 46 Study Guide Studium Generale You are leading a discussion. Trying to solve a problem there are 2 members take most of the time in arguing. What is your opinion? Day:2nd Information Acces Try to find some scientific article from the internet that have correlation with hypertension or diabetes mellitus Day:3rd Independent Learning in Medical Education Please read the article PRINCIPLE OF ADULT LEARNING. a. Make summary of that article in your own words after reading the article. b. If you learn with “deep approach and self-directed” method, consider the aspects of the article that you must search or discuss with your group members. Day:4th The New Undergraduate Competence-Based Curriculum Of Udayana University, Faculty of Medicine Udayana University Faculty of Medicine, MEU, 2013 47 Study Guide Studium Generale Until very recently, prevailing assessment methods for physicians’ competence have mainly focused on core knowledge, while under emphasizing some other important domains such as interpersonal skills, lifelong learning, professionalism, and integration of core knowledge into the clinical practice. Epstein and Hundert have thought fully identified 7 dimensions or domains of professional competence (JAMA 2002;287:226-235), i.e. cognitive, technical, integrative, context, relationship, affective/moral and habits of mind. Each small group of students should discus at least three of the seven dimensions of competence, and submits a written report on emerging ideas and comments on the chosen dimensions. Wish you success! Day:5th Philosophy of Science and Medicine Project 1 Medical sciences is a branch of science. In point of view of philosophy of science a knowledge could be classified as true science if it fulfill three aspects, i.e. ontologycal, epistemiological and axiological aspects. Please give reasons that medicine is a true science Project 2 Epistemology is branch of philosophy of science that deal with knowledge, especially the methods or way to acquire scientific knowledge. The methods to acquire scientific knowledge is called scientific methods Please discuss the scientific methods, especially the philosophical basic and its procedure. Day:6th Thinking Skill & Scientific Reasoning, A Instruction Udayana University Faculty of Medicine, MEU, 2013 48 Study Guide Studium Generale Find the correct answer and provide your argument(s) for your choice of answer to each of the following items of questions. Scientific Reasoning (1) The essence (basic and most important characteristics or features) of scientific reasoning is: (A) Logics (B) Critical thinking (C) Creative thinking (D) Deduction-induction (E) General thinking skills (2) What is the type of reasoning used in the following sequence of statements? Sugar causes tooth decay or caries Ali likes sugar very much Ali has rotten teeth or caries (A) Induction (B) Logical reasoning (C) Deduction (D) Scientific inference (E) Critical thinking (3) What is the nature of reasoning cited in question item number (2) above? (A) True (B) Valid (C) Valid and true (D) Valid but not true (E) Neither valid nor true (4) What is the type of inference implied (indicated indirectly) by the following short narrative? “Down syndrome (DS) is a genetic disease. Geneticists tell us that DS sufferers have an additional chromosome-they have 47 instead of the normal 46. How do they know this? They examined a large number of DS sufferers and found that each had an additional chromosome. They then reason and conclude that all DS sufferers, including the ones they hadn’t examined, have an additional chromosome.” (A) Deductive-inductive (B) Inductive-deductive (C) Deductive (D) Inductive (E) Inductive-deductive-inductive (5) What is the essence of David Hume’s problem or challenge in relation to the reliability of inductive inference? (A) The uniformity of nature (UN) is true phenomenon (B) The UN is probably untrue (C) The UN is only a basic assumption considered to be true (D) The UN is only a basic assumption considered to be untrue (E) Sientific inference should not be based on induction Critical thinking (1) Which of the following statement or response indicate strong disposition or tendency to critical thinking? Udayana University Faculty of Medicine, MEU, 2013 49 Study Guide Studium Generale (A) “ I prefer to learn under condition where the facilitators in general instruct me to study or learn as they have indicated previously.” (B) “ I often think it is a waste of time looking things up what I don’t fully comprehend” (C) “Selling an idea is like selling cars, you say whatever works for your audience” (D) “In general I dislike lectures where the teachers state their opinions but rarely or never try to give any reasons at all” (E) “No matter how complex the problem, you can often expect there will be a simple solution.” (2) What are the two main components of critical thinking? A. Logical and creative thinking B. General and straight thinking C. Cognitive and affective abilities D. General reasoning and deductive-inductive reasoning E. Rational and scientific thinking (3) The mental or intellectual skill related to explaining and summarizing material or comprehending and expressing the meaning and significance of something is called: A. Interpretation B. Inference C. Analysis D. Explanation E. Evaluation (4) The mental or intellectual ability related to breaking down a concept or idea or thought into its parts, elements, or components, including identifying their interrelationship and organizational principles is called: A. Interpretation B. Inference C. Analysis D. Explanation E. Evaluation (5) The intellectual skill related to judge or appraises the merit or worth of some statement or idea by using a definite internal or external criterion is called A. Interpretation B. Inference C. Analysis D. Explanation E. Evaluation Day:7th Basic Principles of Communication : Udayana University Faculty of Medicine, MEU, 2013 50 Study Guide Studium Generale After completing the class session, each student should be able to describe or to answer the following aspects of communication: 1.The purpose of communication 2.The component of communication 3.The scheme of communication process 4.The possible sources of problem during communication process 5.Types of statements during communication process and selection of the most common statement being used by a good speaker or a good listener 6.The important role of communication in medicine Day:9h Academic Reading Please find 1 journal about medicine and try using the SQ3R method. Every group will present the result in front of the class at additional lecture . Day:10th-14th The role of Biomedical Science: Case 1 A 45 years, male patient with body weight 80 kg and height 165 cm come to family physician with loss of body weight since 3 months with necrotic wound on his toe. On history taking, he also has a frequent urination, eating and drinking. Laboratory test revealed his fasting and post prandial blood sugar are 130 mg% and 250 mg% respectively. He was diagnosed by the doctor and treated with oral anti-diabetic, metformin 500 mg twice daily. He was recommended to do moderate exercise regularly. Discuss case above (about which departments are involved in the management of this patient) ! Case 2 20 years woman come to her family physician complaining squeezing pain on his lower abdomen and vaginal bleeding since yesterday. On history taking found that she still single Udayana University Faculty of Medicine, MEU, 2013 51 Study Guide Studium Generale and had treated by traditional massager. On examination, her blood pressure are 90/70 mmHg with anemia, Hb 7 gr%. She diagnosed with provocated abortion. What are medical sciences needed to safe the patient (which biomedical sciences and departments) Case 3 A mother with 2 children found unconscious in the bath room by her husband. A container of mosquitoes repellant was found by her side. She was brought to the primary care centre by her husband. On history taking revealed that she was accusing her husband had another woman and they were fighting about it. On physical examination found she was unconscious, bubbling from her mouth that smell like mosquito repellant. She was diagnosed with intoxication and suicide attempt. Gastric lavage procedure was performed and antidote was given. She was survived and subsequently consulted to psychiatry department. Discuss about case above ( associated with biomedical, clinical and allied sciences ) Anatomy Anatomy (English) : Greek :………………..equivalent to :…………………. 1. Please mentions 4 or 5 limitations of anatomical positions. 2. Please fill in the synonym of the terms : ( on human body) : Superior = Anterior = Posterior= Inferior = 3. Please fill in the opposite of the terms : Superior >< Flexion >< Anterior >< Pronation >< Dorsal >< Elevation >< Cranial >< Eversion >< Lateral >< Retrusion >< Sinister >< Apposition >< Proximal >< Profundus >< Contralateral >< Unilateral >< Dorsal/ Dorsum >< Pharmacotherapy 1. Mention/name any drugs delivery system which is proper for systemic and non systemic purpose! 2. Describe the drug’s routed from it is firstly given until it causes effect! 3. Explain the definition of : - Biopharmaceutic. - Pharmacokinetic - Bioavailability - Pharmacodynamic 4. Explain with example, each of Biopharmaceutic’s factor that influence drug’s absorption ! Udayana University Faculty of Medicine, MEU, 2013 52 Study Guide Studium Generale 5. Explain any drug interactions that possible to happen/ ever happened! Day:15th The Role of Allied Sciences in Medical Practice Why we must think holistically for all cases we faced? According to allied science, what do you want to know more about this patient ( the case on biomedical sciences) ? Please write down your discussion with your group ? Udayana University Faculty of Medicine, MEU, 2013 53 Study Guide Studium Generale ~ REFERENCES ~ 1. Amin,Z., and Eng, K. .2003. Basics in Medical Education 2. Bandaranayake, R.C., Study skills, in Dent JA and Harden RM (eds) A Practical Guide for Medical Teachers. London: Elsevier 2005 p382-389 3. Barry, G., Routledge, 1997. Scientific Method 4. Chalmers, A.F., 1999. What is This Thing Called Science? 3rd ed, 5. DeVito,,J.A., 1999. Essential of Human Communication .3rd edition, Longman. 3-29 6. Edward, D.B, 1976. Teaching Thinking 7. Evans, M., Louhiala, P., Puustinen ,R,. 2004. Philosophy for Medicine 8. Epstein, R.M, Hundert, E,M, Dreyfus, H. Defining and Assessing Professional Competence. JAMA 2002;287:226-235 9. Grant ,V.J. 2007 Making Room for Medical Humanity. Mh. Bmj. 45-48 10. Guyton,C.A, Hall, J.E. 2000. Textbook of Medical Physiology.10th Edition.WB. Saunders Company 11. Judy ,C. P. Interpersonal Communication, 1983 12. B.G. Katzung &Trevor . Pharmacology 7th edition 2005 Lange Medical Book/Mc Graw- Hill, New York. 13. B.G.Katzung. Basic & Clinical Pharmacology 9th edition 2004. Lange Medical Book/Mc Graw- Hill, New York 14. Leach,D.C. Competency is a Habit. JAMA 2002;287:243-244 15.Leung, W.C. Competency-Based Medical Training: review. BMJ 2002;325:693-696 16. Lieb ,S. 1991. Principles of Adult Learning 17. Rudnick, A. 2007. An Introduction Curse in Phylosophy of Medicine 18. Salmon, W 1967.The Foundations of Scientific Inference 19. Silverthorn: Human Physiology 20. Sinitsa, K. 2000. Learning Individually : A Life- Long Perspective Introduction to the Special Issue Udayana University Faculty of Medicine, MEU, 2013 54
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