Ateneo - UPO

The course on Methodology and Clinical Semiotics represents, for students in the Master's Degree program in Medicine and Surgery, their first exposure to clinical subjects and prepares them for interactions with patients. As such, the course is foundational in nature with respect to the practice of professional activities, while simultaneously highlighting the practical applications of theoretical knowledge acquired in the first years of study, through subjects such as anatomy, physiology, physics, and biochemistry. In this context, the course will cover the methodology for approaching medical patients, whether hospitalized or outpatient, offering, whenever possible, an analysis of the diagnostic value of various symptoms and signs, which is particularly important in relation to the use and misuse of medical technology.

Particular emphasis will be placed on the practical methods of how to correctly gather patient history, accurately perform physical examinations, identify and solve patient problems, and, in general, how to approach the main signs and symptoms of diseases of medical interest. In addition to demonstrating a classic "head-to-toe" physical examination, detailed information and instructions will be provided on how to conduct focused patient history and physical examinations. The knowledge thus acquired will be instrumental in the practical application of these skills during clinical rotations.

Macleod. Manuale di semeiotica e metodologia medica. 13° Ed. Edra-Masson (2014).
Talley and O'Connor's Clinical Examination - 2-Volume Set, 8e Elsevier (2017).
Harrison's Principles of Internal Medicine. 21°Ed. McGraw-Hill (2022).

The student must know and understand the principles that govern the doctor-patient relationship, the fundamentals of diagnostic reasoning, and the value and limitations of physical semiotics applied to various organs and systems. They must also acquire a methodological approach to common instrumental investigations, such as electrocardiographic tracings and chest X-rays. During this initial exposure to clinical practice, the development of clinical acumen will be encouraged through the discussion of clinical cases and consultation of relevant scientific literature. It is expected that, by the end of the course, the student will have developed—albeit in an initial form—sufficient autonomy of judgment and adequate communication skills to establish a productive relationship with patients, their families, and the healthcare staff. In interaction with peers and tutors, it is also expected that they will develop the ability to refine what they have learned in lectures and wards through further individual study.

Knowledge of normal human anatomy, physics, human physiology and biochemistry, as per the curriculum of the previous years in the medical school.

The course includes lectures during the second semester of the third year of the degree program. Approximately 20% of the lectures will be conducted in a seminar and interactive format, with discussions of simple clinical cases or practical aspects of patient approach. A significant portion of the lectures will be available as podcasts only on the course website through the Online Education Portal (DIR).

The practical internship, which will be conducted in hospital facilities under the responsibility and supervision of tutors, is fundamental for achieving the educational objectives. For this internship, students will be divided into small groups and assigned a clinical supervisor who will guide them throughout the entire activity. Further details can be found in the Syllabus dedicated to the internship.

The teacher will be available for any clarification or request for clarification from the students, both in person and via email (mario.pirisi@uniupo.it).

The final exam consists of a quiz of N.=75 multiple choice questions, with four possible answers of which only one is correct. The test is offered using the DIR platform. The grade is derived from the number of correct answers, normalized for the best result and is modulated according to the judgment provided by the tutors during the hospital internship.

Medical Semiology Overview:

Understanding Semiology:

Definition: Medical semiology involves studying symptoms, somatic signs, and laboratory signs through history-taking and physical examination (bedside diagnostic examination).
Documentation: Writing a problem-oriented medical record is key to accurately capturing patient information.
Medical History:

Components: Chief complaint, history of present illness, past medical history, medication history, childhood diseases, family history.
Review of Systems: Systematic evaluation of symptoms across all body systems.
Symptom Description: Use the acronym SOCRATES (Site, Onset, Character, Radiation, Associations, Time course, Exacerbating/Relieving factors, Severity) for a thorough description.
Physical Examination:

Phases: Inspection, palpation, percussion, auscultation.
Documentation: Create a problem list and plan, progress notes, and a discharge letter.
Doctor-Patient Relationship:

Improving Relationships: Practical suggestions for fostering a positive doctor-patient relationship.
Calgary-Cambridge Method: Structured approach to medical consultation involving starting the session, gathering information, performing physical examinations, explaining and planning, and concluding the session.
Communication and Presentation:

First Impressions: Setting, dress code, and listening modes can improve first impressions.
Active Listening: Techniques to enhance active listening abilities.
Clinical Reasoning:

Rational Basis: Understanding the importance of shared terminology.
Statistical Concepts: Pre-test probability, sensitivity and specificity, positive and negative predictive values, likelihood ratio, Bayes theorem.
Kappa Statistics: Understanding inter-observer variability, reproducibility, and accuracy.
Physical Examination Techniques:

Comprehensive Examination: Perform a "head-to-toe" physical examination smoothly and efficiently.
Symptoms and Signs by System:

Vital Parameters: Body temperature, heart rate, respiratory rate, blood pressure, pulse oximetry.
Skin: Symptoms of skin diseases, examination, and lesion description.
Head and Neck: Headaches, epistaxis, otalgia, pharyngodynia, thyroid dysfunction.
Respiratory: Cough, hemoptysis, wheezing, dyspnea, chest pain; examination techniques.
Cardiovascular: Dyspnea, orthopnea, edema, syncope, palpitations; heart sounds and murmurs.
Gastrointestinal: Abdominal pain, nausea, vomiting, diarrhea, constipation, bleeding; liver disease signs and rectal examination.
Genitourinary: Examination of the male and female systems; approach to sexual history.
Musculoskeletal: Screening, focused evaluation, clinical examination of joints and spine.
Neurological: Gait, cranial nerves, motor/sensory systems, cerebellar tests.
Instrumental Tests:

Key Tests: Electrocardiogram, chest X-ray, blood gas analysis, and pulse oximetry.
Evidence-Based Physical Diagnosis in Clinical Conditions:

Conditions: Cushing's syndrome, "red eye," pneumonia, COPD, pulmonary embolism, pleural effusion, aortic stenosis, heart failure, deep vein thrombosis, diplopia.

At the end of the course, the student will have learned to recognize the main symptoms and signs of disease, understanding how to use their diagnostic skills at the patient's bedside to manage the patient's problems. This knowledge will be applied concretely in conducting medical history and physical examinations and will be instrumental in establishing a differential diagnosis once they are more thoroughly introduced to the complexity of systematic medical pathology.