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MINISTRY OF HEALTH OF UKRAINE DANYLO HALYTSKY LVIV NATIONAL MEDICAL UNIVERSITY "APPROVED" First Vice-Rector of Educational and Pedagogical work Danylo Halytsky LNMU prof. M.R. Gzhegotskyi ______________________ Minutes of the Meeting of CCM № ___ of "____" _________ 2012 Faculty of Postgraduate Studies Department of Oncology and Medical Radiology Hasheka 2a str., Lviv ONCOLOGY SUBJECT CURRICULUM for the students of higher medical institutions of Ukraine of the III – IV accreditation levels Specialty: 7.110106 “Dentistry” Lectures - 4 hours Practical lessons - 16 hours Self-training lessons – 10 hours Approved at the methodological meeting of Oncology and Medical Radiology Department "14" May 2014 Protocol №8 Head of Department___________ Prof. T.H. Fetsych Approved at the meetings of the Department of the Methodical Commission of the Surgical Disciplines " 16" May 2014 protocol №56 Head of the MC _________________ prof. V.P. Andryushchenko Lviv 2014 1. EXPLANATORY NOTE The program of Oncology for specialty 7.110106 « Dentistry» for higher medical education institutions of Ukraine of the III - IV accreditation levels is based on the program of the specialty 7.110101 - "General Medicine”. The Curriculum is made in accordance with the following existing regulation documents: Educational Qualification Characteristics (EQC), Educational and Occupational Programs (EOP) of specialists' training are approved by order of Ministry of Education and Science of Ukraine (MES) 16.04.03 №239 "Approval of the components of education standards of 110101 - "Medicine"; Experimental curriculum which is based on the principles of the European Credit Transfer System (ECTS) and approved by order of the Ministry of Public Health of Ukraine (MPH) №52, 31.01.2005 of "Approval and introduction of new curriculum of training of the educational-qualification level - " Specialist ", qualification - " Medical Doctor " at the high educational institutions of III-IV levels of accreditation of Ukraine of such specialties as "General Medicine" and "Dentistry"; The recommendations of development of the curriculum which are approved by the MPH of Ukraine March 24,2004, №152 "Approval of the recommendations of development of the curriculum of the educational subjects", are followed with changes and supplements which were introduced by the order of Ministry of Health of Ukraine from 12.10.2004, №492 "Changes and supplements to the recommendations of development of the curriculum of the educational subjects"; The order of MH of Ukraine, 31.01.2003, №148 "The implementation measures of the Bologna Declaration of the high education and science"; The instruction of evaluation system of learning activities of students in accordance with the credit-transfer system of education (Medical education in the world and in Ukraine which was approved by the Ministry of Health of Ukraine as a study guide for teachers, masters, graduate and postgraduate students. Kyiv. Book-plus., 2005); The order of MH of Ukraine, 17.05.2006, № 281 "The changes in the curriculum of training of the educational-qualification level - " Specialist ", qualification - " Medical Doctor " at the high educational institutions of III-IV levels of accreditation of Ukraine, approved by the Ministry of Health of Ukraine from 31.01.05 № 52. The educational process is carried out by the credit system in accordance with the requirements of the Bologna Declaration. The education program which is followed of the experimental curriculum for the 5th year graduate students consists of 20 hours of lectures, 50 hours of practical classes and 20 hours of self-training, total 90 hours (3 credits). These classes is devoted to the study of the basic questions of Clinical Oncology, Organization of the Oncology Care, clinics and diagnostic principles of the treatment of the most common malignancies (lung and mediastinum tumors, breast cancer, tumors of the thyroid gland, gastrointestinal cancer, urinary cancer, skin and soft tissues tumors, cancer of the reproductive system, malignant lymphoma and so on). The curriculum consists of one module, which is divided into 3 subject modules. The content of students’ training load is described in the ECTS credits – examination credits, which are awarded to students after successful passing of the corresponding module subject (examination credit). Oncology is managed by qualified scientific and pedagogical staff of the departments of oncology and the courses of oncology. The diagnostic and medical care institutions which are the headquarter of the oncology teaching should provide appropriate facilities such as quantity of oncology beds and patients with cancer, diagnostic and other equipment, perform whole amount of medical care of cancer. The curriculum «Oncology» consists of one module, which is divided of 3 subject modules. Module I «Oncology». Subject Module 1: Tumors of the digestive tract. Subject Module 2: Tumors of the respiratory system, breast, thyroid gland and skin. Subject Module 3: Tumors of the genital and urinary organs. There are the several types of students’ training activity which are defined according to the curriculum: a) lectures; b) practical training; c) students' self-training work (SSW). All topics which are a part of subject module are implemented by the thematic plan of practical training and SSW in the educational process. Various teaching tools such as multimedia presentations, training films, slides, demonstration of patients' cases are maximum used throughout the lecture course. Practical training of clinical subjects is carried out by the rotation of clinical subject modules. Practical exercises consist of basic theoretical questions in oncology, organization of oncology medical care, methods of prevention, clinic, diagnostic methods, treatment principles of the most spread sites of cancers of such organs and systems as broncho-pulmonary and mediastinum, gastrointestinal, breast, thyroid gland, urinary, genitals, skin and soft tissues. Practical lessons which last 5 academic hours are provided in cancer hospital and consist of four parts: learning the theoretical part of the topic; demonstration of thematic patients; working on practical skills under the supervisor; solve the situation tasks and pass the test control. The students` ability such as the peculiarities of communication with patients, the capability to detect early signs of cancer as well as to know the factors which stimulate the growth of malignancies are in focus. The students' self-training work plays an important role in learning process of oncology. Besides the extracurricular theoretical training in oncology students being in the position as an observer spend some time in the theatres, hospital departments under supervision. The self-study includes the management of patients which is carried out by writing history of the cases. Although the Profile Departments of Oncology have the permission to make changes (15%) in the curriculum which depends on the organizational and technical capabilities, areas of scientific research, environmental characteristics of the region, students have done the all range of requirements of subjects according to the ultimate goals of EQC and EOP which are followed the training and curriculum. The regular students` training activities are supervised during practical lessons in accordance with specific goals. The interim control of the learning subject modules is checked at the last lesson of each module. The checking measures such as to solve situational tasks, tests, monitoring of practical skills of the methods of examination of the patients which is followed by interpretation of the data, analysis and assessment of instrumental and laboratory tests are recommended for the evaluation of the level of students` knowledge. Summing-up module control is carried out after the students’ activity finishing. Assessment of students’ achievements on the discipline is rating and defined as an arithmetic average mark of the corresponding modules learning according to multipoint scale. This mark is recognized by the ECTS system and traditional scale acceptable in Ukraine. Those students, who want to improve their achievement on the discipline according to the ECTS system can take their summing-up module control using the normative documents in extra time on schedule which are approved by the educational establishment. Structure of the discipline Total Module 1. Subjects modules - 3 Hours which include: Auditorium Total practical lectures lessons 30/3 4 16 30/3 4 16 SW Year of study Description of the curriculum of the Oncology discipline for students of medical faculties (7.110106 "Dentistry") 10 4 10 4 Type of control Regular and summing-up module control Comment: 1 ЕСТS credit corresponds to 30 hours. Auditorium load – 66,7%; SSW – 33%. 2. THE AIM OF STUDY THE SUBJECT (final objectives) The study objective of Oncology is based on the doctor training of the corresponding specialty to the subject module and is the background of the subject contents formation. Description of these objectives is formed as target assignments (skills). Specific objectives as certain assignments (skills), tasks and cases are formed based on the final objectives of each module or subject module and provide the final objective achievements during the subject study. The final goals of the subject: - To determine the tactic and examination of the patient in cases the malignancy is suspected; - To interpret the results of specific examination methods; - To formulate a preliminary clinical diagnosis of cancers; - To determine the tactics of treatment of patients with cancer; - To demonstrate the capability to manage medical issues and data in the oncological clinic; - To demonstrate the principles of the oncological ethics. Module. 3. PROGRAMM CONTENT 1) Subject Module 1 tumors of the digestive tract. Specific objectives: - To conduct a survey and physical examination of patients with tumors of the digestive tract and analyze the results in the clinic; - To determine the tactics and examination of the patient in cases the malignancy of the digestive tract is suspected; - To interpret the results of specific research methods (esophagogastroscopy, sigmoidoscopy, colonoscopy, barium enema); - To formulate a preliminary clinical diagnosis in the case of cancer of the digestive tract (cancer of the lips, tongue, esophagus, stomach, pancreas, liver, colon and rectum); - To determine the treatment plan of patients with cancer of the digestive tract; - To demonstrate the capability to conduct medical issues and data in clinic; - To demonstrate the principles of the oncology ethics. Theme 1: Cancer of the lip, oral mucosa, tongue, salivary glands and sinuses. Malignant tumor of lips, oral mucosa, tongue, salivary glands and sinuses: morbidity, epidemiology, precancerous diseases; clinical manifestation, methods of diagnosis and early detection, morphological diagnostic methods (needle and incisional biopsy); classification by stages and TNM; treatment; surgical treatment, regional chemotherapy; principles of the combined and complex treatment; immediate and long-term outcomes; primary and secondary prevention of tumors of the lips, oral mucosa, tongue. Theme 2: Cancer of the esophagus and stomach, cancer of the pancreas and liver, Cancer of the colon and rectum. Cancer of the esophagus: morbidity, epidemiology, precancerous disease, clinical manifestation, diagnosis, early detection, differential diagnosis, diagnosis of Barrett's esophagus, the classification of the stages and TNM, cure, surgery (radical, palliative and symptomatic operation); general principles of the combined and complex treatment; immediate and long-term outcomes, methods of rehabilitation; prevention of esophageal cancer. Stomach cancer: morbidity, epidemiology, precancerous disease, clinical manifestation, diagnosis, early detection, diagnostic tool, methods of screening for gastric cancer; classification by stages and TNM; treatment: surgery (history, the role of local scholars, general principles), radical surgery, the role of lymphadenectomy; palliative and symptomatic operation; combined and complex treatment; immediate and long-term outcomes; methods of rehabilitation; primary and secondary prevention of gastric cancer. Pancreatic cancer: morbidity, epidemiology, precancerous disease, clinical manifestation, diagnosis, early detection, differential diagnosis, classification, general principles and methods of treatment; combined and complex treatment; immediate and long-term outcomes; prevention of pancreatic cancer. Liver cancer: morbidity, epidemiology, precancerous disease, clinical manifestation, diagnosis, early detection, classification, treatment, combined and complex treatment; prevention of liver cancer. Colon cancer: morbidity, epidemiology, precancerous disease, clinical manifestation, diagnosis, early detection, differential diagnosis, classification, treatment: surgery (general principles, the role of local scholars, radical, palliative and symptomatic operation), combined and complex treatment; immediate and long-term outcomes. Cancer of the rectum and anal canal: morbidity, epidemiology, precancerous disease, clinical manifestation, diagnosis, early detection, differential diagnosis, classification, treatment: surgery (the role of local scholars): radical, palliative and symptomatic transactions combined and complex treatment; immediate and long-term outcomes. Methods of screening for colon cancer. Methods of rehabilitation; primary and secondary prevention of colon tumors. 2) Subject Module 2: tumors of the respiratory system, breast, thyroid gland and skin. Specific objectives: - To conduct a survey and physical examination of patients with tumors of the respiratory system, breast and thyroid gland, skin and analyze the results in the clinic; - To determine the tactics and examination of the patient in cases the malignancy of the respiratory system, breast, thyroid gland and skin is suspected; - To interpret the results of specific research methods (bronchoscopy, needle biopsy of breast and thyroid cancer, skin cancer and lymph nodes); - To formulate a preliminary clinical diagnosis in the case of the cancer of the respiratory system, breast and thyroid gland, skin; - To determine the treatment plan of patients with cancer of the respiratory system, breast and thyroid gland, skin; - To demonstrate the capability to conduct medical issues and data in clinic; - To demonstrate the principles of the oncology ethics. Theme 3: Lung cancer, tumors of the mediastinum. Lung cancer: morbidity, epidemiology, precancerous disease, clinical manifestation, diagnosis, early detection, differential diagnosis, classification, treatment: surgery (general principles, methods); combined and complex treatment; immediate and long-term outcomes; prevention of lung cancer. Metastatic lung tumors: diagnosis, differential diagnosis, treatment. Tumors of the mediastinum (thymoma, lymphoma, teratoma): morbidity, epidemiology, precancerous disease, clinical manifestation, diagnosis, early detection, differential diagnosis, classification, treatment: surgery; combined and complex treatment; immediate and long-term outcomes. Theme 4: Breast cancer, thyroid cancer. Breast cancer: morbidity, epidemiology, precancerous disease, clinical manifestation, diagnosis, early detection, differential diagnosis, classification, screening for breast cancer, TNM classification and the stages of treatment: surgery, combined and complex treatment; immediate and long-term outcomes; methods of rehabilitation; primary and secondary prevention. Thyroid cancer: morbidity, epidemiology, precancerous disease, clinical manifestation, diagnosis, early detection, differential diagnosis, classification and TNM stage for treatment: surgery, combined and complex treatment; immediate and long-term outcomes; prevention. Theme 5: Skin cancer, melanoma, Hodgkin's disease. Skin cancer, melanoma: morbidity, epidemiology, precancerous disease, clinical manifestation, diagnosis, early detection, differential diagnosis, classification and TNM stage for treatment: surgery; combined and complex treatment; immediate and long-term outcomes; primary and secondary prevention. Hodgkin's disease: morbidity, epidemiology, precancerous disease, clinical manifestation, diagnosis, early detection, differential diagnosis, classification, combined and complex treatment. 3) Subject Module 3: tumors genital and urinary organs. Specific objectives: - To conduct a survey and physical examination of patients with tumors of the genital and urinary organs and analyze their results in oncology clinic; - To determine the tactics and examination of the patient in cases the malignancy of genital and urinary organs is suspected; - To interpret the results of specific research methods (bimanual examination, cystoscopy); - To formulate a preliminary clinical diagnosis in the case of the cancer of the genital and urinary organs; - To determine the treatment plan of patients with cancer of the genital and urinary organs; - To demonstrate the capability to conduct medical issues and data in clinic; - To demonstrate the principles of the oncology ethics. Theme 6: Cancer of the body and cervix, ovarian cancer. Cancer of the body and cervix: morbidity, epidemiology, precancerous disease, clinical manifestation, diagnosis, early detection, differential diagnosis, classification and TNM stage for treatment, methods of screening for cervical cancer; treatment: surgery, combined and complex treatment; immediate and long-term outcomes; prevention of cervical cancer. Ovarian cancer: morbidity, epidemiology, precancerous disease, clinical manifestation, diagnosis, early detection, differential diagnosis, classification and TNM stage for treatment, combined and complex treatment; immediate and long-term outcomes. Theme 7: Cancer Kidney, ureter, urinary bladder, prostate cancer. Cancer of the kidney, ureter, urinary bladder: morbidity, epidemiology, precancerous disease, clinical manifestation, diagnosis, early detection, differential diagnosis, classification and TNM stage for treatment: surgery; combined and complex treatment; immediate and long-term outcomes, prevention of kidney cancer and bladder. Prostate cancer: morbidity, epidemiology, precancerous disease, clinical manifestation, diagnosis, early detection, differential diagnosis, classification and TNM stage for treatment; immediate and long-term outcomes. 4) Summing-up module control. Individual SSW SSW Lectures Topic Practical lessons Approximate structure of examination credit – MODULE Subject Module 1: tumors of the digestive tract. Theme 1: Cancer of the lip, oral mucosa, tongue, salivary glands and sinuses. Theme 2: Cancer of the esophagus and stomach. Cancer of the pancreas and liver. Cancer of the colon and rectum. 2 1 2 1 Examination of patients in hospital and clinic departments; Work in the theatre; Participation in the instrumental studies; Observation of patients and writing history of cases. Subject Module 2: tumors of the respiratory system, breast, thyroid gland and skin. 2 2 Theme 3: Lung cancer, tumors of Examination of the mediastinum. patients in hospital 2 2 Theme 4: Breast cancer, thyroid and clinic cancer. departments; Work Theme 5: Skin cancer, melanoma, in the theatre; 2 1 Hodgkin's disease. Participation in the instrumental studies; Observation of patients and writing history of cases. Subject Module 3: tumors genital and urinary organs. Theme 6: Cancer of the body and cervix, ovarian cancer. Theme 7: Cancer Kidney, ureter, urinary bladder. Prostate cancer. 2 1 2 1 1 Final control module. 2 Examination of patients in hospital and clinic departments; Work in the theatre; Participation in the instrumental studies; Observation of patients and writing history of cases. 4 26 10 Total: 90 Credits ECTS - 3, practical lessons - 66.7%, SSW - 33.3% 4. The lecture course schedule of MODULE 1. 2. TOPICS Introduction to oncology. Epidemiology. Organization of oncology care in Ukraine. Related diseases and associated tumors. TNM classification. Anti-cancer measures. Preventive measures to cancer. Modern methods of diagnostics and treatment of cancer of digestive tract, lungs, tumors of mediastinum, breast, urinary system. Total Hours 2 2 4 5. The practical lessons course schedule of MODULE PRACTICAL CLASSES Subject module 1. Cancer of the lip and oral cavity. Clinical presentation, diagnostics, methods of 1. treatment Esophageal and stomach tumors, liver and pancreas cancer, colon and rectum 2. cancer. Clinical presentation, diagnostics, methods of treatment Subject module 2. Lung cancer. Mediastinum tumors. Clinical presentation, diagnostics, methods 3. of treatment Breast and thyroid gland tumors. Clinical presentation, diagnostics, methods of 4. treatment Skin cancer and melanoma, Hodgkin's disease. Clinical presentation, 5. diagnostics, methods of treatment. AIDS, related diseases and associated tumors Subject module 3. Female genital organ tumors. Clinical presentation, diagnostics, methods of 6. treatment Male genital organ tumors. Prostate cancer. Urinary tract tumors. Clinical 7. presentation, diagnostics, methods of treatment 8. Final module checking. Total Hours 2 2 2 2 2 2 2 2 16 6. The student self-training work course schedule (SSW) on MODULE №1 1. 2. 3. 4. 5. 6. 7. 8. Self-training work Cancer of the lip, tongue, oral cavity. Find out complaints, medical history; inspection of the patient, palpation of lymph nodes. Cancer of the esophagus and stomach. Cancer of the pancreas and liver. Cancer of the colon and rectum. Find out complaints, medical history; inspection of the patient, palpation of lymph nodes, superficial and deep palpation of the abdomen, revealing the presence of free fluid in the abdominal cavity, method of esophagogastroscopy. Lung cancer. Mediastinum tumors. Find out complaints, medical history; inspection of the patient, palpation of the chest and regional lymph nodes, lung auscultation and percussion to detect violations of bronchial obstruction and the presence of free fluid in the pleural cavity; method bronchoscopy and puncture of the pleura cavity. Breast and thyroid gland cancer. Find out of complaints, medical history; inspection of the patient, palpation of breast and thyroid and regional lymph nodes; fine-needle aspiration biopsy of tumors of the breast and thyroid gland. Skin cancer and melanoma, Hodgkin's disease. Find out of complaints, medical history; examination of the patient, palpation of regional lymph nodes, scraping biopsy of the tumor. Female genital organ tumors. Find out of complaints, medical history; examination of the patient, palpation of regional lymph nodes, bimanual examination. Male genital organ tumors. Find out of complaints, medical history; examination of the patient, bimanual examination, taking flush from the genitals, cystoscopy . Observe and curation of patients, filling in medical history. Total Hours 1 1 2 2 1 1 1 1 10 7. FORMS OF CONTROL. Forms of control and assessment system are carried out in accordance with the requirements of the discipline curriculum and instruction on the assessment system of the student education activity in credit-module system of the education organization, which was approved by the Ministry of Public Health of Ukraine in 2005. Score on the module is defined as a sum of scores on regular education activity in points and score on summing-up module control in points as well, which are awarded during assessment of the theoretical knowledge and practical skills according to lists determined within the subject curriculum. Maximum point score which is awarded to students during the each module mastering (examination credit) equals to 200 including on regular education activity – 120 points (60%), results of the summing-up module control – 80points (40%). Regular control is carried out at each practical lesson in accordance to the learning objectives on each topic. Standardized methods of control such as tests, structural writing works, practical skills structural by control procedure in conditions which is similar to real are preferred during the assessment of the student education. Assessment of the regular training activity: Part of each topic in the module has to be equal, but can be different for another modules of the same discipline and is determined by the topic quantity in the module. The student receives the score for his regular training according to the 4-point traditional scale which consequently is converted into points depending on the topic quantity in each module during the mastering of each topic of the module. The following system of conversion of the traditional scores into points is applied in the curriculum: Traditional score «5» «4» «3» «2» Conversion in points: Module 1 17 14 10 0 Maximum score which can be awarded to the student during the module mastering equals 120 points. This score is calculated as multiplication of points corresponding to the mark «5» by the topic quantity in the module and points which are earned by the student during his individual work are added. Minimum score which can be awarded to the student during the module mastering is calculated as multiplication of points corresponding to the mark «3» by the topic quantity in the module and points which are earned by the student during his individual work are added (8x10=80). Assessment of the self-training individual work (individual tasks): Quantity of points of different types of the student self-training individual work (SSIW) depends on the volume and significance but cannot be more than 10-18 points. These points are added to the sum of points which are awarded to the student for his regular training activity. Assessment of the self-training work: Assessment of the student self-training work which is provided in the topic together with auditorium work is carried out during regular control of the topic on the corresponding practical (auditorium) lesson. Assessment of the topics which are for self-training and excluded from the topics of auditorium practical lessons are controlled at the summing-up module control. Summing-up module control: Summing-up module control takes place after finishing of all topic mastering at the last control lesson on the module. The students, who performed all types of activity provided by the curriculum and received scores not less than minimum are allowed to pass the summing-up module control. Form of the summing-up module control must be standardized and include the control of theoretical knowledge and practical skills. Specific forms of control of oncology are determined in the working curriculum. Maximum point score for the summing-up module control equals 80. Summing-up module control is passed if the student has received not less than 50 points. Assessment of the subject: Score on oncology is awarded to those students who sat off all modules on the subject. Score on the subject is defined of all scores on the modules which are included in the subject. Conversion of the point score on the subject into the ECTS marks and 4-point (traditional) scale: The students who study the same specialty taking into account the point score which have been received after the subject mastering are converted according to the following table: ECTS mark А В С D Е Statistical index The best 10% of students Next 25% of students Nest 30% of students Next 25% of students The last 10% of students Percentage of students is defined on the access for the students of this year of study of the corresponding specialty. Point score on the discipline, which has been accounted to the students is converted into the 4-point scale by the following: ECTS mark А В, С D, Е FX, F Mark according to the 4point scale «5» «4» «3» «2» Mark on the discipline FX, F («2») is assigned to those students who fail to pass at least one module on the subject after mastering has completed. Mark FX («2») is assigned to those students who have received the minimum point score on their regular training activity, but have not passed the summing-up module control. They may pass the summing-up module control consequently not more than 2 (two) times according to the schedule which is approved by the University administration. Students who are awarded the mark F after finishing the subject mastering (failed to perform the curriculum of at least one of the modules or did not receive the minimum point score on their regular training activity on the module) can pass repeated training of the corresponding module. Solution must be approved by the director of the higher medical institution in accordance to normative documents which are approved in the established order. 8. REFERENCES. Principal. 1. DeVita V. T. CANCER: Principles and practice of oncology, 9 th edition / Vincent T. DeVita, Theodore S. Lawrence, Steven A. Rosenberg // Publisher: LWW, 2011, 2800 p. 2. Bland K.I. Surgical Oncology. Contemporary principles and practice / K.I. Bland, J.M Daly., C.P. Karakousis - New York et al.: McGraw-Hill , 2001. - XVI; 1223 p. 3. Sorkin V.M., Perehod I.A. Clinical oncology (Lectures for medical students). Simferopol. 2007.- 136p. Additional. 1. NCCN Clinical practice guidelines in oncology / NCCN guidelines for treatment of cancer by site //. – 2014. -V.3.: available at: http://www.nccn.org/professionals/physician_gls/f_guidelines.asp