Ateneo - UPO

The Clinical Methodology and Semeiotics course represents the first approach to clinical topics for students of the Master's Degree in Medicine and Surgery and prepares them for meeting the patient. As such, the course has a truly foundation nature with respect to the ways of practicing medicine, at the same time making evident the practical applications of the theoretical knowledge acquired in the first years of study with teachings such as anatomy, physiology, physics and biochemistry. With this in mind, the course will address the methodology of approaching the medical patient, whether inpatient or outpatient, offering whenever possible the analysis of the diagnostic value of the various symptoms and signs, particularly relevant in relation to the use and misuse of medical technology. Particular emphasis will be given in the course to the practical modalities of how to correctly collect the anamnesis, how to accurately perform the physical examination, how to identify and solve the patient's problems, and in general how to approach the main signs / symptoms of the diseases of interest. In addition to demonstrating a classic head-to-toe physical examination, detailed information and instructions on how to perform a focused history and physical examination will be provided. The knowledge thus acquired will be instrumental to the concrete application of the same in clinical rotations. This methodological approach will be useful for the study and practice of subsequent clinical courses, both general and specialistic.

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 foundations of diagnostic reasoning, the value and limits of physical diagnosis applied to various organs and systems. He/she must also acquire a method of approach to common instrumental investigations, such as electrocardiogram and chest X-ray. During this initial exposure to clinical practice, the development of a clinical spirit will be fostered through discussion of clinical cases and consultation of relevant scientific literature. At the end of the course, the student is expected to have developed - albeit in an initial form - sufficient autonomy of judgment and adequate communication skills to allow him/her to establish a fruitful relationship with the patient, family and health staff. In comparison with his/her peers and tutors, he/she is also expected to develop the ability to perfect what learned in class and in the ward with 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 2nd semester of the 3rd year of the Degree Course. About 20% of the lessons will be held in a seminar and interactive form, with the discussion of simple clinical cases or practical aspects of the approach to the patient. A significant part of the lessons will be available, in the form of podcasts, only on the course website through the Online Didactics portal (DIR).
The practical training, which will be carried out in hospitals and at the Simulation Center, under the responsibility and supervision of a tutor, is fundamental for the achievement of the educational objectives. To carry out this internship, students will be divided into small groups and entrusted to a clinical contact, who will follow them throughout the activity. Further details on these activities are provided in the dedicated Syllabus.

In the case of students with specific learning disabilities (DSA), the Teacher will be available, in synergy with the DSA Help Desk Service, to meet the specific needs that will be presented, with the aim of maintaining maximum autonomy of the person, enhancing personal skills. To start this process, it will be sufficient to send an email to the Course Coordinator (luigi.castello@med.uniupo.it). The methods of learning assessment will also be adapted to specific needs, as provided for by the University system.
The teacher will be available for any clarification or request for clarification from the students, both in person and via email (luigi.castello@uniupo.it).

The final exam consists of a quiz of 60 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 and is modulated according to the judgment provided by the tutors during the hospital internship.
In the presence of a limited number of students, teachers may propose oral examination.

The meaning of medical semiology; how symptoms, somatic signs and laboratory signs, history taking and physical examination (Bedside diagnostic examination) are studied. Writing a problem-oriented medical record. The medical history, step by step: chief complaint, history of the present illness, past medical history, medication history, childhood diseases, family history. Review of systems. Thorough description of a symptom: the acronym SOCRATES. Phases of physical examination: inspection, palpation, percussion, auscultation. Problem list and plan. Progress notes. The discharge letter.
The doctor-patient relationship and practical suggestions to make it good. The Calgary-Cambridge method for the medical consultation: starting the session, gathering information, performing physical examination, explanation and planning, concluding the session.
Setting, dress code, listening modes. How to improve the possibility of making a good first impression and the abilities of active listening. Introduction to Narrative Medicine and Medical Humanities.
The rational basis of clinical reasoning. The importance of speaking the same language. Pre-test probability, definition of sensitivity and specificity, positive and negative predictive value, likelihood ratio. Bayes theorem. Inter-observer variability, reproducibility and accuracy: what is the meaning of kappa statistics.
How to perform smoothly and efficiently a "head-to-toe" physical examination.
Symptoms and signs of organs and systems:
1) Vital parameters: body temperature, heart rate, respiratory rate, blood pressure, pulsioxymetry. General physical exam, constitutional symptoms (fever, anorexia, unintentional weight loss, night sweats, generalized pruritus) Evaluation of nutritional status. Hypovolemia;
2) Symptoms of skin diseases. Examination of the skin and description of elementary lesions.
3) Headaches, epistaxis, otalgia, pharyngodynia. Examination of head and neck, facies, fundus examination. Symptoms and signs of thyroid dysfunction;
4) Symptoms of respiratory diseases: cough, hemoptysis, wheezing, dyspnea, chest pain. Examination of the chest: inspection, palpation, percussion and auscultation of the chest. Symptoms of heart disease: (dyspnea and orthpnea; chest pain), edema, syncope, palpitations. Apical impulse, fremitus, normal heart sounds, cardiac murmurs.
5) Symptoms of gastrointestinal diseases: abdominal pain, nausea and vomiting, diarrhea and constipation gastrointestinal bleeding. Examination of the abdomen, symptoms and symptoms and signs of liver disease; the rectal examination;
6) Examination of the male and female genitourinary system and relevant symptoms. How to approach sexual history;
7) Musculoskeletal examination: screening and focused evaluation, clinical examination of the shoulder and of the knee; examination of hands and feet; examination of the spine and stretch tests;
8) Neurological examination: gaits, cranial nerves, motor and sensory systems, cerebellar tests.

Main instrumental tests: approach to electrocardiogram, chest X-ray, blood gas analysis and pulse oximetry.

At the end of the course, the student will have learned to recognize the main symptoms and signs of many common human diseases, understanding how to use their bedside diagnostic skills to manage the problems that the patient presents. This knowledge will be concretely applied in history taking and physical examination and will be instrumental to the construction of a differential diagnosis once better introduced to the complexity of systematic medical pathology.