Clinical Skills Practice Sessions: Respiratory Exam

Part 1, Medical Foundation 1

These practice sessions are intended to improve standardization of teaching across groups and to provide tutorial groups with opportunities to focus on areas of particular concern to the group.

e-Learning Module: Integrated Pain and Opioid Curriculum Course 1 - Introduction

Part 1, Medical Foundation 1

A longitudinal integrated pain and opioid curriculum. Students must complete this learning path of 7 online courses throughout the program, in addition to other formal and experiential learning activities.

Tutorial: Luke Tomczak MF1 Respirology

Part 1, Medical Foundation 1, Respirology, Week 1

Luke, a 47 year old gentleman with a history of chronic alcoholism and poor eating habits, goes to the ER with a complaint of chest pain. He smokes two packs of cigarettes daily. He has not been feeling well for over one week due to an upper respiratory infection. Two days ago he developed a fever, chills and a sharp pain over his right chest that is worse when he breathes in. Luke had a dry cough initially, but today he has coughed up rusty sputum with some blood in it. Although Luke is not normally short of breath, he has had difficulty climbing the stairs to the office because of breathlessness.

Tutorial: Thomas Gagnon MF1 Respirology

Part 1, Medical Foundation 1, Respirology, Week 2

Thomas Gagnon, a 12 year old boy diagnosed with asthma 1 year ago, traditionally experienced minimal respiratory symptoms. In the past, he had used inhaled salbutamol sparingly, generally during soccer games, with excellent therapeutic effect. During a late September soccer game being held in a rural area, Thomas developed sudden onset dyspnea, wheeze, and chest discomfort. Earlier in the day he had visited with family members who smoke and have three pet cats. His symptoms were mostly relieved with repeated doses of salbutamol. He awakes the following night with ongoing symptoms that are not responsive to inhaled salbutamol, despite frequent dosing. His parents are alarmed and take him to the emergency department.

Tutorial: Pauli Emboli MF1 Cardiology

Part 1, Medical Foundation 1, Cardiology

Pauli is a 70 year old female, previously healthy, who presented with mild central pleuritic chest pain and a feeling of light-headedness with minimal activity. Past medical history is significant for systemic arterial hypertension (controlled with diet). Takes no medications other than occasional Tylenol. At baseline, patient is an active person who exercises regularly. Usual HR is in the 50-58 bpm and BP averages 130/85 mmhg. Examination reveals a woman in mild distress with the following vitals on presentation: HR 125 bpm, BP 105/60mmHg, O2 saturation 88% on room air, and respiratory rate of 25/min. Temperature was 37.5°C.

Clinical Skills Sessions: Introduction to the Cardiac Examination

Part 1, Medical Foundation 1, Cardiology, Week 1

To discuss and to practice the components of the Cardiac history and physical examination.

Clinical Skills Sessions: Cardiac Exam: Practice Case - Chest Pain

Part 1, Medical Foundation 1, Cardiology, Week 2

To practice the Cardiac history and physical exam. Pro Comp connection care for Adults with Intellectual and Developmental Disabilities (IDD).

Tutorial: Novak B. Part 3 MF1 Cardiovascular

Part 1, Medical Foundation 1, Cardiology, Week 3

Novak B. was discharged home following his myocardial infarction. He felt well for 4 days. He then developed an episode of dull retrosternal chest pain lasting for 2 hours. He felt this was somewhat different than the chest pain he had presented to hospital with during his MI. He felt unwell and was pale and diaphoretic on arrival at the ER. In the ER, his BP dropped to 85/55 mmHg, RR 32, HR 135 bpm, his JVP was elevated at 10 cm above the sternal angle. His lungs were clear to auscultation. Precordial examination demonstrated soft heart sounds. An EKG demonstrated sinus tachycardia with generalized low voltages and no new ST segment abnormalities. An echocardiogram was performed immediately and demonstrated a large pericardial effusion.

Tutorial: Novak B. Part 2 MF1 Cardiovascular

Part 1, Medical Foundation 1, Cardiology, Week 3

Three years have now gone by and Novak B. has done very well. He has used his Nitroglycerin only once since you prescribed it, when he had to run for a bus. One night, you happen to be working an ER night shift at the local hospital when Novak is brought in by an ambulance. He is complaining of severe retrosternal chest pain, which started one hour ago. An EKG is obtained immediately and confirms an acute myocardial infarction (AMI). A chest X-ray is normal, as is his first Troponin T. You give him 162 mg of aspirin to chew, along with 180 mg of ticagrelor and enoxaparin 80 mg subcutaneously every 12 hours, as a starting dose. On examination, he is in distress from the pain and looks dyspneic. His pulse is 90 bpm and his respiratory rate is 24. His blood pressure is 100/70 mmHg in both arms. His O2 saturation is 90% on 2L oxygen via nasal prongs. His JVP is 5 cm above the sternal angle. He has bibasilar inspiratory crackles. His heart sounds are obscured by the ambient noise in the ER, but no obvious murmurs are heard. He has no peripheral edema. You briefly discuss percutaneous coronary intervention (PCI) and thrombolytic therapy. Novak does not consent to thrombolysis, but agrees to PCI.

Tutorial: Novak B Part 1 MF1 Cardiovascular

Part 1, Medical Foundation 1, Cardiology, Week 3

Novak B. is a 55-year-old man with a history of type 2 diabetes mellitus, hypertension and hyperlipidemia. He presents himself at your office because he has been experiencing chest pain for several days, but has been reluctant to come to the office. He first noted it 6 weeks ago while shoveling snow. The discomfort was mid-sternal and radiated to his jaw. It resolved with rest. Since then, he has noted 3 similar episodes each occurring while climbing the 2 flights of stairs from his basement to the bedroom. Upon further questioning, he also tells you that he feels cramps in both of his calves whenever he walks for more than 500 meters. If he stops walking, his symptoms resolve within 2-3 minutes. On examination, he is mildly obese. His pedal artery and posterior tibial artery pulses are significantly decreased in volume bilaterally. The remainder of the examination is normal. You diagnose him with angina and prescribe aspirin, a beta-blocker, a statin and nitroglycerin. You also make a referral to a dietician.

Clinical Skills Sessions: Head and Neck Exam: Practice Case - Hearing Loss

Part 1, Medical Foundation 1, Cardiology, Week 3

Discuss and to practice the Head and Neck history and physical exam, with a focus on the ear and nose exam. Note: The ENT exam includes the Ear, Nose and Throat. We will not focus on the Thyroid exam as it is covered in MF3, nor the Lymph Node exam as it is explored in MF2.

Clinical Skills Sessions: Head and Neck Exam: Practice Case - Sore Throat

Part 1, Medical Foundation 1, Cardiology, Week 4

Objective: To discuss and to practice the Head and Neck history and physical exam, with a focus on the oropharyngeal exam. Pro-Comp Connection: Poverty - the disproportionate burden of Rheumatic Heart Disease on marginalized populations.

Tutorial: Teresa J Part 2 MF1 Cardiovascular

Part 1, Medical Foundation 1, Cardiology, Week 4

You are called to see a patient in the ER who has presented with shortness of breath. You immediately recognize Teresa J, the 65-year-old female who was previously admitted for several weeks with acute lung injury earlier in the year. A quick review of her chart reminds you that she also has a history of poorly controlled diabetes and premature CAD with a prior MI at age 62. She looks distressed and is only able to talk in short phrases. She describes chest pain on the left side that gets worse when she coughs or moves. She has been getting weaker over the last 3 days. Her sputum is yellow, but she denies hemoptysis. She stopped taking all of her medications a week ago (furosemide, ASA, antihyperglycemics, metoprolol).

Active Large Group Session: Introduction to Pain

Part 1, Medical Foundation 1, Cardiology, Week 4

This session is intended to generate a discussion towards formulating a basic early understanding of pain for future physicians. It is also intended to serve as a framework for future learning about how pain manifests in the context of health or disease, be it acute, chronic, or terminal, and to consider how it might be managed. Finally, this session is intended to begin illustrating how psychological, environmental and social factors can influence the experience of pain and its management thus resulting in the potential need for an interdisciplinary approach in that regard.

Tutorial: Terrance K. MF1 Cardiovascular

Part 1, Medical Foundation 1, Cardiology, Week 4

Terrance K. is a 60-year-old gentleman who comes to the emergency room after experiencing an episode of retrosternal chest discomfort. This occurred while he was walking on his treadmill at home. The pain was mid-sternal, non-radiating, and resolved approximately two minutes after he stopped his treadmill. He admits to several recent episodes of similar chest discomfort, each occurring during exercise. His first episode occurred 6 months ago, though they have become more frequent over the last month. He has noted these episodes only with exertion and never at rest. He became particularly alarmed with today's episode because he also felt quite lightheaded and thought he was going to faint. His past medical history is unremarkable, though he admits to not having been to a doctor in over 30 years. He is on no medications and denies any drug allergies. On examination, his heart rate is 76 bpm and regular, his BP is 110/70 mmHg, and his respiratory rate is 12. He is afebrile with a temperature of 36.8 degrees Celsius. His JVP is elevated at 5 cm above the sternal angle. His carotid pulse is somewhat delayed and with a diminished upstroke. There is a palpable thrill over both carotids. His chest reveals bibasilar crackles on auscultation. His cardiac exam reveals a sustained but not displaced point of maximal impulse. There is a palpable S4. The first heart sound is normal though the second heart sound is diminished in intensity. There is an easily heard fourth heart sound. There is also a harsh, grade 3/6, crescendo-decrescendo systolic murmur that peaks late in systole. The murmur radiates into both subclavian arteries as well as both carotids. It is also heard throughout the precordium.

Clinical Skills Sessions: Renal Exam Practice Case - Renal Colic

Part 2, Medical Foundation 2, Renal, Week 3

Practice the history and physical exam as it pertains to nephrolithiasis. Standardized case of 44 year old male with flank pain.

Clinical Skills Sessions: Renal Exam Practice Case - Hematuria

Part 2, Medical Foundation 2, Renal, Hematology, Week 1, Week 4

Practice the Renal history and physical examination as it pertains to Hematuria. Pro Comp connection Indigenous Health - The case of Brian Sinclair is an important example of a fatal consequence of systemic racism in the Canadian Healthcare System. He was a 45-year-old First Nations man who died of a treatable bladder infection in 2008, after being ignored for 34 hours in the emergency.

Tutorial: Alexandria Vardalos MF2 Hematology

Part 2, Medical Foundation 2, Hematology, Week 1

You are on elective at a Health Clinic in downtown Hamilton with a multicultural patient population. Your supervisor asks you to see Alexandria Vardalos. Alexandria is an 8-month-old baby girl who is brought in by her parents. She was healthy at birth, but over the last 2 months, she has not been growing as fast as her sister did at the same age. She is frequently irritable and has difficulty feeding.

Tutorial: Shane Mosley MF2 Hematology

Part 2, Medical Foundation 2, Hematology, Week 2

Shane Mosley an 18-month-old boy was brought to the emergency room by the baby sitter for treatment of a swollen and tender right knee that had developed suddenly within the previous three hours. The knee began to swell soon after Shane tripped on the family room carpet. Physical examination reveals an apparently healthy child who is crying and favouring his right leg. The knee is swollen and held in partial flexion. Shane has a few old, superficial bruises over shins, chest wall and his back. The physician in the ER concludes that there is fluid in the knee and because of the sudden onset and absence of fever, thinks this is most likely due to a joint bleed. The physician wonders about an underlying systemic bleeding disorder as the cause of Shane's joint bleed. A complete blood count, "hemostasis screen" and an x-ray of the knee are ordered.

Clinical Skills Sessions: Introduction and Overview of the Lymph Node Examination

Part 2, Medical Foundation 2, Hematology, Week 2

To discuss and to practice the components of the Lymph Node history and physical examination.

Tutorial: Eva Foster MF2 Hematology

Part 2, Medical Foundation 2, Hematology, Week 3

Mrs. Foster is a 50-year-old female who comes to the ER complaining about some chest discomfort that seems worse when she takes a breath in and shortness of breath. She also feels like her heart is racing. Her past medical history is unremarkable except for mild hypertension. She usually takes an aspirin a day because she heard it was a good idea to take it, but she stopped taking it one week ago when she noticed some blood in her stool. She thinks her mother may have had a blood clot in her leg during one of her pregnancies. Mrs. Foster is married with no children. On physical examination in the emergency room, her HR is 110/min, RR 28/min, BP 122/70, oxygen saturation 86% on room air. Her chest and precordial exam are normal. Her left leg is normal in colour, slightly warm and edematous. The circumference of her left calf is 3 cm larger the circumference of her right calf. She complains of pain when you palpate behind her knee. Her pedal pulses are palpable. The ER staff person calculates her Wells Score and based on the result, orders a D-dimer blood test.

Active Large Group Session: Palliative Care: A Good Death

Part 2, Medical Foundation 2, Hematology, Week 4

Clinical Skills Sessions: Shortness of Breath: renal, cardiac, respiratory

Part 3, Medical Foundation 3

Observations of a student(s) taking a history from a patient with shortness of breath. Demonstration by preceptor of examination of a patient with shortness of breath. Discussion regarding shortness of breath. Etiology, differential diagnosis, investigations, etc.

e-Learning Module: Integrated Pain and Opioid Curriculum Course 2 - Pathophysiology of Pain and Pharmacology of Opioids

Part 3, Medical Foundation 3

In this module, you will review the types of pain and the basic mechanisms of pain signalling. You will also learn about the pharmacology of opioids, and how their primary effects are mediated by interactions with opioid receptors; and about the range of serious adverse effects associated with opioids. (c) AFMC, v. June 30 2023.

Tutorial: Shalini Mehta MF3 Reproduction

Part 3, Medical Foundation 3, Reproduction and Pregnancy, Week 1

Shalini Mehta is a successful 35-year-old lawyer who married five years ago. Her partner Varun is a 56-year-old judge who left his former wife to be with Shalini. He has three grown children and one grandchild. Varun was never as keen on starting a new family as Shalini, but he loves her and "wants what she wants". For the first three years of their marriage, Shalini continued on the birth control pill, as she wanted to focus on establishing her career further. She states that she had been on the pill since she was 18. Two years ago she stopped the pill and had hopes that she would be trying for her second baby by now.

Active Large Group Session: CisWoman's Sexual Health and Cervical Cancer Screening

Part 3, Medical Foundation 3, Reproduction and Pregnancy, Week 1

Active Large Group Session: GI-GU-Pelvic Imaging

Part 3, Medical Foundation 3, Reproduction and Pregnancy, Week 2

Essentials of gastrointestinal and gynecologic imaging.

Tutorial: Rachel Kowalski MF3 Reproduction

Part 3, Medical Foundation 3, Reproduction and Pregnancy, Week 2

Rachel is a 15-year-old grade 9 student who has come to the walk-in clinic requesting ‘the pill’. She has been dating John, who has not accompanied her, for 6 months and she feels that it is time for them to have sex. She has never had intercourse. John is 18 and will finish grade 12 this year. Rachel lives with her mother and two younger brothers. She has always been healthy and is on no medications. She states that she smokes occasionally and sometimes drinks. After a discussion regarding the implications of her decision and the issues of the options available, Rachel is given three months of oral contraceptives (OCP) and instructions. There is a plan to follow-up with her family doctor for a refill and a pap smear. Three months later, Rachel experiences heavy vaginal bleeding accompanied by suprapubic pain. She is very frightened and comes to the ER with her mother. She states that she thinks her last period was a month ago but it was not really normal and she has had spotting intermittently since starting the pill. She says that she is not on any other medications but two months ago she was on an antibiotic for 5 days for a bad cough. The antibiotic made her very nauseated.

Tutorial: Samira Shah 1 MF3 Reproduction

Part 3, Medical Foundation 3, Reproduction and Pregnancy, Week 3

Samira Shah is a 27 year old woman who works as a waitress in a local restaurant and is in her first pregnancy. She is slightly overweight (pre-pregnancy BMI 28.5). Her prenatal care has been unremarkable although she was found to be rubella non-immune and had a positive glucose challenge test (GCT) followed by a negative glucose tolerance test (GTT). Now at 38 weeks, she has abdominal cramping and slight bright red vaginal bleeding. Her husband, Sunny, informs Hanna’s midwife of this. Her midwife comes to their apartment to assess Samira.

Tutorial: Samira Shah 2 MF3 Reproduction

Part 3, Medical Foundation 3, Reproduction and Pregnancy, Week 3

One hour after giving birth to baby Varkey, Mrs. Shah states that she feels lightheaded as she sits upright for the first time. Her midwife who has been monitoring her closely following the delivery helps her to lay back down. She notes that Samira is somewhat pale and that her pulse is rapid and thready. She palpates the uterus and finds the fundus is above the umbilicus. As the midwife massages the fundus, a large grapefruit size blood clot is expressed followed by blood that soaks the bed sheets. As summoned help arrives, Samira’s BP is found to be 85/50 and her heart rate 120.

Clinical Skills Sessions: Obstetrical History: Practice Case – Intrapartum Care, Labour and Delivery Triage

Part 3, Medical Foundation 3, Reproduction and Pregnancy, Week 3

To discuss and to practice the components of the Obstetrical history as it pertains to Intrapartum Care. To apply key terminology appropriately in intrapartum care, including: Diagnosis and stages of labour, including differentiating term from preterm labour. Diagnosis of rupture of membranes (ROM), including differentiating spontaneous rupture of membranes (SROM), prelabour rupture of membranes (PROM) and preterm prelabour rupture of membranes (PPROM). Practice taking a focused history in an intrapartum care setting, with a focus on four essential triage visit questions (Contractions/labour; Fluid/rupture of membranes; Bleeding; and Fetal Movements). Demonstrate use of gender-inclusive perinatal language (e.g. parental leave, birthing parent, chest-feeding). Practice navigating key challenges in delivery of intrapartum care in rural and remote settings, including recognizing limitations of scope of practice to inform shared decision-making. Pro-Comp Connection – Indigenous Health and Prenatal / Intrapartum Care

Clinical Skills Practice Sessions: Abdominal Exam

Part 3, Medical Foundation 3, Gastroenterology and Nutrition

These practice sessions are intended to improve standardization of teaching across groups and to provide tutorial groups with opportunities to focus on areas of particular concern to the group.

Tutorial: Nick DeMarco MF3 Gastroenterology and Nutrition

Part 3, Medical Foundation 3, Gastroenterology and Nutrition, Week 1

Nick DeMarco is a 51 year old physical education teacher at a local elementary school. He has noticed increasing fatigue with exertion and complains about feeling exhausted at the end of the school day. He explains that he has been experiencing epigastric discomfort after eating and he has tried taking Advil for pain relief. He states the pain and regurgitation wakes him up at night. He reports that he is usually able to get back to sleep after taking antacids and a glass of milk.

Clinical Skills Sessions: Introduction and Overview of Abdominal Exam

Part 3, Medical Foundation 3, Gastroenterology and Nutrition, Week 1

Learn how to perform the abdominal history and physical examination.

Tutorial: Hannah Rosen Part 1 MF3 Gastroenterology and Nutrition

Part 3, Medical Foundation 3, Gastroenterology and Nutrition, Week 1

Hannah, a 1-year-old girl, is brought to the clinic for a routine immunization by her mother. Mr. and Mrs. Rosen have a healthy 5-year-old boy at home. The pregnancy with Hannah was uneventful and a fetal ultrasound done at 16 weeks gestation was normal. The baby was born by spontaneous vaginal delivery, breathed immediately, and was placed on the breast for mom to nurse. Hannah's birth weight was 3.4 Kg. After seeming to feed normally for 24 hours, Hannah vomited bile and the abdomen was noted to be distended. An x-ray was interpreted as showing a distal small bowel obstruction. Further contrast x-rays of the colon showed a microcolon and inspissated meconium in the proximal colon, making a diagnosis of meconium ileus. Genetic testing confirmed cystic fibrosis. After a lengthy hospitalization to correct the bowel obstruction, Hannah was discharged home receiving exclusive breast milk. At 4 months of age, Hannah was switched to a cow's milk formula. Her mother noticed that she cried a lot. Hannah's mom attributed the symptoms to a milk allergy and progressed through a variety of cow's milk and soy formulae. At present Hannah is taking 1 litre of Rice milk and a small variety of foods daily. She has one small formed stool per day. She weighs 8.5 kg and is 74 cm tall.

Clinical Skills Sessions: Abdominal Exam Practice Case - Abdominal pain

Part 3, Medical Foundation 3, Gastroenterology and Nutrition, Week 2

Examples: Acute cholycystitis; Acute appendicitis; Traumatic acute abdomen. Observation of student taking a history from a patient with abdominal pain. Demonstration by preceptor of examination of a patient with abdominal pain. Observation of students examining a patient with abdominal pain. Discussion regarding abdominal pain.

Tutorial: Mike Bayuk MF3 Gastroenterology and Nutrition

Part 3, Medical Foundation 3, Gastroenterology and Nutrition, Week 2

Mike Bayuk, a 55 year old businessman, presents to the ER in Hagersville with severe abdominal pain. He indicates that the pain is located in the epigastric area and radiates into his back. He finds the pain is relieved when he sits up with his trunk flexed and his knees bent. He rates the pain as "11 out of 10".

Tutorial: Ted Mitchell MF3 Gastroenterology and Nutrition

Part 3, Medical Foundation 3, Gastroenterology and Nutrition, Week 2

Ted Mitchell is a 38 year old male who is homeless. He has been on and off the streets for the last 15 years. As a teenager, he started hanging out with "the wrong crowd" and his father, Dr. Ted Mitchell Sr. told him he could not return home till "you have cleaned up your act". Ted continues to abuse drugs, and any money he can get, has gone toward purchasing alcohol, his drug of choice.

Tutorial: Philip Cheung MF3 Gastroenterology and Nutrition

Part 3, Medical Foundation 3, Gastroenterology and Nutrition, Week 3

Mr. Cheung presents to the emergency department with a 2 day history of worsening pain in the right upper quadrant of his abdomen. He had been in the ER last year with pain in his right flank, but while that pain was colicky in nature, he currently describes a more constant pain. The right flank pain a year ago was accompanied by hematuria and he ended up passing a kidney stone. Currently, he has felt nauseated but has not vomited and he has been anorexic for over 24 hours. He finally came to ER after developing some fevers and chills.

Tutorial: Vivian Patel MF3 Gastroenterology and Nutrition

Part 3, Medical Foundation 3, Gastroenterology and Nutrition, Week 4

Vivian Patel is a 35-year-old computer programmer who presents to the ER with a 10- hour history of profuse vomiting, watery non-bloody diarrhea and abdominal cramps. She first tried to fight this illness on her own by drinking water, however her symptoms were persistent and her husband brought her to the emergency room. She was first seen by the triage nurse, who noted that she was febrile with a temperature of 38.6 C. Given her presentation, the nurse decided that she should be isolated with "enteric precautions” and she was subsequently seen by the ER physician. Vivian is an otherwise healthy woman with no known medical problems and only takes a multivitamin daily. The day prior to her presentation with these symptoms, she had attended her 5-year-old niece's birthday party. She cannot recall any sick contacts, although is unsure if anyone else from the party has developed similar symptoms. Additionally, she had recently returned from a trip to India 5 days ago. She went on a business trip for a week and stayed to travel the country for another 3 thereafter. She did not receive any pre-travel advice or prophylaxis.

Tutorial: Stephen Golding MF3 Endocrinology

Part 3, Medical Foundation 3, Endocrinology, Week 1

Stephen Golding, a 22 year old man presents to the emergency department with nausea, vomiting, abdominal pain and a 3-day history of polyuria, polydipsia, and weight loss. He states that he has "junvenille insulin-dependent" diabetes but stopped taking his insulin 5-days ago.

Tutorial: Adam Pajek MF3 Endocrinology

Part 3, Medical Foundation 3, Endocrinology, Week 2

A 40-year old man, Adam Pajek, was seen in a walk-in clinic complaining of palpitations, heat intolerance (felt hot when others were comfortable or cold), sweating, anxiety, weight loss, fatigue, and sleeplessness for two months. He reports that his sister has a hypothyroid problem for which she takes Eltroxin pills.

Clinical Skills Sessions: Thyroid Exam Practice Case - Thyroid disease

Part 3, Medical Foundation 3, Endocrinology, Week 2

Goiter (hypothyroidism and hyperthyroidism). Observations of a student(s) examining a patient with hyper or hypothyroidism. Discussions of examination of the thyroid by the preceptor. Example: the gland itself, lid lag, tremor. Observation of a student(s) examining a patient with thyroid disorder.

Clinical Skills Sessions: Adrenal Exam Practice Case - Adrenocortical disorders

Part 3, Medical Foundation 3, Endocrinology, Week 3

Examples: Cushing’s syndrome, Addison’s disease. Observations of a student(s) taking a history from a patient with adrenocortical disorder. Demonstration by preceptor of examination of a patient with adrenal disorder. Example: blood pressure, skin assessment, pigmentation, weight loss/gain, face and neck assessment. Observation of a student(s) examining a patient with adrenal disorder.

Tutorial: Julian Knight MF3 Endocrinology

Part 3, Medical Foundation 3, Endocrinology, Week 3

Mr. Knight is a 65-year-old obese male of African descent who works as a miner in Yellowknife, NWT. He smokes one pack of cigarettes per day. Outside of work he is generally sedentary and tends not to leave his home unless it is really necessary. He has a past medical history of type 2 diabetes mellitus, chronic kidney disease and COPD. His medications include metformin, sitagliptin and the inhalers ipratropium and fluticasone. He recently completed a course of prednisone for a COPD exacerbation, which he has a few times per year. He presented to the local Emergency Department after a fall at work. He tripped over a drill bit and fell on his outstretched hand. He felt a snap, followed by severe pain in the left wrist with noticeable swelling and bruising.

Tutorial: Riley Walker MF3 Endocrinology

Part 3, Medical Foundation 3, Endocrinology, Week 3

A healthy 3.6-kg baby boy, Riley, is born to a 25-year-old nulliparous mother in a community hospital. The family doctor notes that the boy's genital development is somewhat atypical. Her examination reveals that the infant has hypospadias, chordee and undescended testes. A plan is put in place for the infant to be seen by a pediatric urologist in 6 weeks with a view to eventual surgical correction. At one week of age, the infant is brought to the family physician's office for routine follow up. Riley's mother comments that he seems to be breastfeeding poorly. She describes him as increasingly uninterested in feeding and is concerned that he seems to be "spitting up" a lot. The infant now weighs 3.1 kg. A recommendation is made to begin some formula supplementation to help support weight gain. At 10 days of age, Riley's mother finds him in his crib, non-rousable, cool, mottled and covered in vomit. Riley is rushed to the emergency department via ambulance. In the emergency room, resuscitative measures are initiated. The airway is suctioned. He is intubated and hand-bagged to achieve ventilation. A 20 mL/kg bolus of normal saline is administered.

Tutorial: Pit Parapan MF3 Endocrinology

Part 3, Medical Foundation 3, Endocrinology, Week 4

A 32-year-old female was seen in emergency department for abdominal pain, nausea and diarrhea. Her serum calcium was found to be elevated at 2.94 mmol/L (normal 2.15-2.55 mmol/L). She was treated with intravenous fluids. Her calcium improved to 2.65 mmol/L and she was discharged home to care for her 6-year-old son. She was referred urgently to an outpatient clinic to investigate her elevated calcium. She was also prescribed pantoprazole for worsening heartburn. In the clinic, Ms. Parapan reported a 2-year history of abdominal pain that was getting worse over time. The pantoprazole she was prescribed was modestly helpful in easing her heartburn and abdominal pain. She denied symptoms of polyuria, polydipsia, confusion or mood changes. There is no history of kidney stones. She had a fracture of her humerus at age 15 due to a ski accident. She was taking pantoprazole and a multivitamin daily. Ms. Parapan’s family history is significant for a father who had a pancreatic tumour, though she does not know any more details about his condition. Both her sister and her paternal aunt had a parathyroidectomy. The same aunt had a pituitary tumour requiring surgery.

e-Learning Module: Integrated Pain and Opioid Curriculum Course 3 - Opioid Use Disorder: Principles of Assessment and Management

Part 4, Medical Foundation 4

Review the role of opioids in the brain and the signs and symptoms of withdrawal. Learn how to identify patients with opioid use disorder and review the various management options including how to manage patients in primary care with opioid agonist therapy with buprenorphine. Educate patients on strategies to prevent opioid overdose including the use of naloxone, a vital tool for overdose prevention. This should be completed by the end of MF4.

Active Large Group Session: Substance Use Disorders

Part 4, Medical Foundation 4, Brain and Behaviour

Active Large Group Session: Introduction to Psychiatry

Part 4, Medical Foundation 4, Brain and Behaviour, Week 1

Epidemiology. Nosology. Brain and behaviour. Medical Psychiatry. PBL cases. Five steps to differential diagnosis. Sub-unit overview.

Tutorial: Desta Ayo MF4 Brain and Behaviour

Part 4, Medical Foundation 4, Brain and Behaviour, Week 2

Desta Ayo is a 42 year old woman, on disability pension and married to a disabled man. She was brought to the hospital by ambulance after she called 911 to report she was dying. After running a few tests, the ER physician could not find anything wrong with her. He referred her to psychiatry because the problem was obviously "all in her head." On interview, Desta sits motionless in the chair, opening her eyes and speaking with dramatic effort. She believes she is again suffering with another kidney infection, like the one that almost killed her 10 years ago. She describes "passing out" almost every day for the last 2 weeks, feeling too weak to walk, and experiencing crippling back pain. She denies anxiety and depression but continues to take paroxetine for chronic pain and Trazodone for sleep. She says she has arthritis throughout her back, frequent migraines, temperomandibular joint pain, chronic fatigue, and recurrent sinusitis that eats away at her nasal bones. She also reports a history of gynaecological problems since age 22, with breast cyst and ovarian cyst surgery, endometriosis, and uterine fibroids. She reports an early childhood history of sexual and physical abuse. She remembers her mother as an alcoholic, a distant and cruel woman. Inquiries about current stress in her life reveal major financial problems and an argument with her mother on the phone 2 weeks ago. She says that she doesn't think her mother will ever talk to her again.

Tutorial: Benjamin Nuri MF4 Brain and Behaviour

Part 4, Medical Foundation 4, Brain and Behaviour, Week 2

Benjamin Nuri is a 45 year old Caucasian male who presents at the emergency room accompanied by his wife. He has been to the emergency room on two occasions prior to today . He reports that for the past year and a half he has experienced transient episodes of chest pain, shortness of breath, sweating nausea, numbess in the left side of his face and left arm as well as dizziness.

Tutorial: Beau Chandler MF4 Brain and Behaviour

Part 4, Medical Foundation 4, Brain and Behaviour, Week 3

Beau is a 3-year-old boy, the youngest of three children. His father manages a local bank and his mother is a stay-at-home mom. He has two older sisters, Theresa age 7 and Gracie age 9. His parents are in their late 30s. Beau is the focus of the entire family's attention and the apple of everyone's eye. His sisters behave like 2 additional mothers, to the point that they anticipate his every need. His parents have even noted that his language development seemed slightly slower than his sisters' as he did not need to use language to have his needs met. He now speaks well but it just seemed to be slower than his sisters (who his mother described as early talkers). Beau's mother's pregnancy was unexpected but welcomed. The pregnancy was uneventful with no history of substance use. Beau was full term and the delivery was uneventful. Beau was a cute and cuddly infant. He breastfed well and developed predictable routines for both sleeping and feeding. He appears quite adaptable. For instance, when family visits other family or friends, Beau smiles, plays and amiably engages children and adults alike. He has even slept well at these homes if needed. He needed only his favourite blanket in those situations to assist him with settling down to sleep.

Active Large Group Session: Personality Disorders

Part 4, Medical Foundation 4, Brain and Behaviour, Week 3

Tutorial: Malcolm Lowry MF4 Brain and Behaviour

Part 4, Medical Foundation 4, Brain and Behaviour, Week 3

Malcolm Lowry presents to the ED of the Hamilton General Hospital accompanied by his wife, Vita. He is seen by a second-year resident in Emergency Medicine and a clinical clerk. Mr. Lowry is a 47-year-old businessman. This afternoon, he collapsed in front of his wife, who observed that both arms and legs were shaking and that his eyes were rolled back. After 30-60 seconds the shaking stopped, but he was unresponsive for several minutes and remained drowsy and confused for half an hour. Vita called 911 and Malcolm was taken to the Emergency Department. The patient states that this has never happened to him before. He had no warning symptoms prior to collapsing. He does not remember collapsing. He did not soil himself or bite his tongue, but his muscles are sore. His past health has been good. He does not have hypertension, diabetes or other chronic health problems. He has never been hospitalized and he is not on any medications. He denies recent head trauma, febrile illness, headache or neurological symptoms. He has no family history of epilepsy. Vita states that Malcolm has been drinking alcohol heavily for a number of months but stopped two days ago after she removed all the alcohol from the house. Today he was so tremulous that he could hardly button his shirt. Malcolm points out that he has stopped alcohol for a day or two several times in the past few months, and although he has felt shaky he has never had a seizure.

Clinical Skills Sessions: Hip and Knee Pain

Part 4, Medical Foundation 4, Musculoskeletal Medicine, Week 1

Discuss and practice the components of the history and physical exam for the Hip and Knee.

Tutorial: Joshua Song MF4 MSK

Part 4, Medical Foundation 4, Musculoskeletal Medicine, Week 1

Joshua is a 48-year-old man who suffered a motor vehicle accident while riding his motorcycle. Joshua was unable to stop in time at a red light and rear-ended into an SUV, causing him to be thrown from his motorcycle, landing on his right side. He has a large laceration to the lateral thigh. He also notices some weakness to certain movements of his right lower extremity. He is taken to the trauma centre and the physical exam reveals that he is unable to dorsiflex his ankle, evert the foot, and extend the toes on the right side. All other muscles are normal. On sensory examination, it is noted that sensation is slightly impaired over the front of the leg and foot. An x-ray reveals that he has sustained a mid-femur shaft non-displaced fracture.

Tutorial: Ronnie Olchuk MF4 MSK

Part 4, Medical Foundation 4, Musculoskeletal Medicine, Week 1

Ronnie Olchuk is a 6-year-old boy who was hit by a car while crossing the street. A witness at the scene said he was hit on the left side and thrown approximately 20 m. He is healthy, has no allergies, and has never had surgery. He last ate eight hours ago. He has been stabilized by the trauma team, is alert and oriented, and has no injuries except to his right forearm and left thigh. His distal right forearm is badly deformed. His left thigh has a 2 cm laceration located medially and is also badly deformed. He is in excruciating pain, especially in the right forearm.

Tutorial: Ann Green MF4 MSK

Part 4, Medical Foundation 4, Musculoskeletal Medicine, Week 2

Ann Green is a 66-year-old woman who was referred to the rheumatology outpatient clinic by her family physician, Dr. Mac Grad. In his referral note, Dr. Grad states that Mrs. Green has been experiencing joint achiness for the past several years, involving mostly her hands and knees. From time to time, she has also reported low back pain. Her symptoms have always been relatively mild and have never stopped her from carrying on with her general daily activities or her charitable work in the community. What currently concerns Dr. Grad is that Mrs. Green's symptoms have progressed. Usually a rather stoic person, she is now complaining of increased pain in her fingers and both knees. Because of her knee pain, she is having increasing difficulty walking. Whereas previously her pain would always settle after she took some Tylenol, this is no longer the case. On physical examination, Dr. Grad elicits tenderness at several of the proximal (PIP) and distal interphalangeal (DIP) joints of both hands and at the carpometacarpal joint of the left thumb. Heberden's nodes are evident at the DIP joints bilaterally. Tenderness is also present at the joint lines of both knees; and there is (chronic) puffiness on both sides, but more pronounced on the left. Knee flexion is reduced and there is bony crepitus. Radiographs demonstrate osteoarthritic changes at the wrists, the PIP and DIP articulations of the fingers, and moderately severe (tri-compartmental) degenerative changes at both knees.

Clinical Skills Sessions: Shoulder and Elbow Pain

Part 4, Medical Foundation 4, Musculoskeletal Medicine, Week 2

Discuss and practice the components of the history and physical exam for the Shoulder and Elbow.

Tutorial: Diane Bainbridge MF4 MSK

Part 4, Medical Foundation 4, Musculoskeletal Medicine, Week 2

Diane Bainbridge, a 32 year old woman, complains of fatigue and weakness, lower back, and hip pain which she describes as a gnawing ache. She has noticed that this has become progressively worse over the past few months and she finds that getting up from a chair is difficult. She has noticed that her gait has changed. She has known celiac disease and has had associated weight loss and intermittent diarrhea

Tutorial: Amy Field MF4 MSK

Part 4, Medical Foundation 4, Musculoskeletal Medicine, Week 2

Part One: A thin 65-year-old woman presents complaining of back pain that began 5 days ago while lifting her wash. The pain becomes worse when she rolls over in bed or when she stands up. She has noticed that the hems of her skirts seem longer and on measurement she appears to have lost 6 cm in height. Part Two: The patient reports she got over that last "attack" after around 3 months. She was commenced on a bisphosphonate, calcium, and vitamin D. She now returns 2 years later because of another attack of acute back pain after falling on the ground.

Active Large Group Session: Introduction to Adult and Pediatric Orthopedics

Part 4, Medical Foundation 4, Musculoskeletal Medicine, Week 2

Opportunity to consolidate knowledge acquired through PBL cases. Review of high yield orthopedic clinical pearls. Opportunity to actively practice relevant clinical skills such as reading imaging (within the confines of virtual learning).

Tutorial: Daniel Gatto MF4 MSK

Part 4, Medical Foundation 4, Musculoskeletal Medicine, Week 2

Daniel Gatto is a 41-year-old stockbroker. Once a top level soccer player, he now plays the game only over weekends, though he is sometimes able to get out for his club's midweek practice session. He enters your walk-in clinic on a Tuesday morning, limping slightly and reporting that he has been having increasing problems with his right knee over the past month. The knee has been intermittently painful and has seemed swollen from time to time. He has also been concerned about what he describes as "a feeling of weakness" of the knee, as though it was about to "give way"

Tutorial: Richard Strang MF4 MSK

Part 4, Medical Foundation 4, Musculoskeletal Medicine, Week 3

Richard Strang, a 50-year-old male with a two-day history of sudden onset of acute pain and swelling of the left great toe, is seen at his family physician's office. It seemed to suddenly start when he awoke two days ago. It is so painful that he could not even tolerate the bed-sheet touching it. Richard works in construction, and routinely enjoys a few beers at the end of the day with his buddies. He had a similar attack in the right knee about 3 months ago, and right 1st MTP about 6 months. He was told that he had "the gout".

Clinical Skills Sessions: Wrist, Hand and Ankle, Foot Pain

Part 4, Medical Foundation 4, Musculoskeletal Medicine, Week 3

Discuss and practice the components of the history and physical exam for the Wrist / Hand and Ankle / Foot.

Tutorial: Joan Spaulding MF4 MSK

Part 4, Medical Foundation 4, Musculoskeletal Medicine, Week 3

Joan Spaulding is a 32 year old lady who arrives at your clinic with a history of joint pains in the hand. The pain in her hands was predated by a viral flu that manifested itself as generalized arthralgias and fatigue. The pain has been ongoing for 10 weeks and transformed itself from generalized arthralgias to symptoms in the hands and feet associated with morning stiffness that lasts approximately 1 hour.

Active Large Group Session: Inflammatory Arthritis

Part 4, Medical Foundation 4, Musculoskeletal Medicine, Week 3

Tutorial: Cindy Edsworth MF4 MSK

Part 4, Medical Foundation 4, Musculoskeletal Medicine, Week 3

Mrs. Cindy Edsworth is a 30 year old African Canadian lady who describes the onset of joint pains which have been on going for 3 months. She describes that the small joints of her hands are constantly aching and over the past 4 weeks she describes having swelling in the PIP and DIP joints of both hands. Over the past week she points out that she is having significant swelling affecting the feet that reaches the ankles. With the onset of the joint pains she developed alopecia and a scarring type rash over the scalp. She has been quite fatigued. She finds she is exhausted when she awakens in the morning and by 6:00 pm she has to go to bed because of persistent fatigue. Cindy also finds that she has become quite irritable. Her temper is easily disturbed and she is also becoming quite argumentative with her husband. Her husband is disturbed by her recent change in mood.

Tutorial: Joseph Collins MF4 MSK

Part 4, Medical Foundation 4, Musculoskeletal Medicine, Week 3

Joseph is a 34-year-old man who arrives at the emergency room having returned from a vacation to Cuba 3 weeks ago. He had profuse diarrhea for about 5 days while he was in Cuba. The diarrhea settled by the time he returned to Canada. His primary concern now is swelling and pain in his right knee, left ankle, and left elbow. He is worried that infection from the diarrhea has somehow gotten into his joints. He asked whether he should have received antibiotics while in Cuba, and whether he needs any right now.

Tutorial: Jane Young MF4 MSK

Part 4, Medical Foundation 4, Musculoskeletal Medicine, Week 3

Jane Young is a 3 1/2 year-old girl, brought to the Pediatric Medicine Clinic by her mother. For the past 10 days, her right knee has been swollen and stiff. There was no preceding trauma. She seems to have most symptoms in the morning, getting better when she is up and about playing. She seems to have less energy since the swelling was first noted. Her mother has been giving her children's Tylenol but has not noticed any improvement in her symptoms. Her mother thinks her ankles are also "puffy" at times. On examination, Jane appears well, afebrile and is on the 50th percentile for height and weight. No fever or skin rashes. Cardiovascular, respiratory and abdominal examinations unremarkable. Right knee is swollen, warm and effused and Jane stands with this knee slightly flexed. There are mild effusions of both ankles which are also slightly swollen. The pediatrician decides to order a few investigations. Baseline CBC, renal and liver function is unremarkable. ESR moderately elevated at 30. Rheumatoid Factor is negative, but Antinuclear Antibody (ANA) is positive at 1:160.

Tutorial: Fred Newman MF4 MSK

Part 4, Medical Foundation 4, Musculoskeletal Medicine, Week 4

Fred Newman, a 32-year-old man, complains of severe low back pain of gradual onset over the past few years. The pain is much worse in the morning and gradually decreases during the day. He denies fever or weight loss but does feel fatigued.

Tutorial: Giuseppe Carnivale MF4 MSK

Part 4, Medical Foundation 4, Musculoskeletal Medicine, Week 4

Giuseppe Carnivale is a 42 year old construction worker who presents with the complaint of gradually increasing weakness in his legs. He has noted difficulty climbing stairs. He feels the strength in his arms is normal, except when working over his head. He admits to mild aching in his muscles, but has no muscle pain or tenderness. The weakness has been insidious. A rash has been present on his face and upper chest for several months.

Tutorial: Theodore McIntyre MF4 MSK

Part 4, Medical Foundation 4, Musculoskeletal Medicine, Week 4

Mr. McIntyre, a 69 year old man, has developed a new onset right-sided headache for the last 5 days. He has some pain when he chews his food and has been feeling increasingly fatigued. He has had stiffness in his shoulders and his hips so much so that it takes him at least an hour to get up and move around first thing in the morning. He has started to develop some double vision. He has tenderness when he combs his hair on the right side of his temple. Physical exam reveals a BP of 120/70 (right arm) and 126/68 (left arm), HR 75/min, temp 37. He has tenderness along his R temporal region and the R temporal artery feels thickened.

Clinical Skills Sessions: Back Pain, GALS Exam

Part 4, Medical Foundation 4, Musculoskeletal Medicine, Week 4

Discuss and practice the components of the history and physical exam for the Back and GALS Exam. Demonstrate a focused musculoskeletal examination.

Tutorial: Jake Gamble MF4 MSK

Part 4, Medical Foundation 4, Musculoskeletal Medicine, Week 4

Part One: Jake Gamble, an obese 65-year-old man, presents complaining of back pain that began 5 days ago while shovelling snow. The pain becomes worse when he stands. Part Two: The patient reports he got over that last "attack" in less than a week but has had low back pain ever since. He now returns 2 years later because of another attack of acute back pain after chopping wood. Part Three: The patient returns in 6 weeks because the pain has not decreased. His legs feel "heavy," and he has had some incontinence in the last week.

Active Large Group Session: MSK Radiology

Part 4, Medical Foundation 4, Musculoskeletal Medicine, Week 4

Compare and contrast how various imaging modalities can be best utilized to image the different components of the musculoskeletal system. Develop an approach to the interpretation of MSK radiographs. Develop an approach to the interpretation of the cervical spine radiograph. Compare and contrast the appropriate use of various imaging modalities in the work up of the following cases: Scaphoid fracture; Acute knee pain; Ankle trauma; C-spine trauma.

Tutorial: Mandy Wallsmith (Part 1) MF4 Neurology

Part 4, Medical Foundation 4, Neuroscience, Week 1

Mandy Wallsmith is a 19-year-old young lady who has been brought to the Emergency Department because of problems walking. Approximately one week ago, she noticed some numbness in her left leg. She thought she had slept on it the wrong way initially, but then the numbness persisted. The next day she fell while skating and landed on her backside. Over the next few days, she reports feeling significant pain in her lower back and progressive “heaviness” in her left leg. She began having difficulty lifting her left leg. She also noticed that her right leg seemed to feel cold when she showered. After speaking to her parents about her symptoms, she was brought to a walk-in clinic where an x-ray of the spine was ordered. This reported no fractures, and Mandy was advised to follow-up with her family doctor if her symptoms did not improve in the next few days. When she started to have episodes of urinary incontinence, her parents became very concerned, and decided to bring her to the Emergency Department.

Tutorial: Ivan Nettar MF4 Neurology

Part 4, Medical Foundation 4, Neuroscience, Week 2

Ivan is a 68 year old man who has enjoyed excellent health in the past. His only medication is hydrochlorothiazide for mild hypertension. For the past few weeks he noticed that by the end of the day he had difficulty focusing his eyes and keeping them open. He decided to see his family physician when the other day his vision became double. On the day of the visit, Ivan was feeling even worse. His double vision was present shortly after lunch and he felt generally weak. On observation, it was clear that Ivan had a right-sided ptosis. He kept closing one eye and then the other, complaining that otherwise his vision was double. His voice seemed mildly hoarse. Blood pressure was normal at 135/80. General physical examination of the heart, lungs, and abdomen was normal. Neurological examination showed that the pupils were equal and reactive. A prominent ptosis was present on the right. The extra ocular movements were abnormal with dysconjugate gaze present intermittently and not consistently on lateral, upward, and downward gaze. The other cranial nerves were normal. Tone was normal in the limbs. He had some difficulty holding up his arms in the air for more than a couple of minutes. He had some difficulty doing more that 5 deep knee bends. Sensation was normal and the reflexes were all present and symmetric. The plantar responses were down going. You ask Ivan to close his eyes and rest them for a few minutes while you make some notes. You ask him then to open his eyes and temporarily the double vision is much better and the ptosis is almost gone! A referral is made to the neurologist on call. She asks that you send Ivan to the emergency room so that she can perform a tensilon test to confirm the diagnosis.

Large Group Session: Neuro Toolbox - Muscle/nerve histology, physiology and EMG-NCS

Part 4, Medical Foundation 4, Neuroscience, Week 2

Muscle and nerve neuropathology basics. Clinical examination. Muscle enzymes CPK. Electrophysiology EMG. Muscle biopsy. Type 1 and 2 muscle fibers. Muscular Dystrophies. Inflammatory Myopathies. Congenital myopathies. Metabolic muscle disease. Mitochondrial disease. Peripheral nerve and motor unit. Electromyogram (EMG) and Nerve Conduction Studies (NCS).

Tutorial: Carmen Shellinger MF4 Neurology

Part 4, Medical Foundation 4, Neuroscience, Week 3

Carmen Shellinger is a 32-year-old office manager at a local law firm. Her regular office duties include transcription for the senior partner. Over the past few weeks she has noticed pain in the right wrist at the end of the day. On some occasions she has been awakened at night by pain, tingling and numbness in the right hand. After shaking the hand, the symptoms seem to settle down and she has been able to fall asleep. Her symptoms have become more persistent and she decides to seek her doctor's help. Carmen is otherwise healthy and general inquiry identifies only occasional neck and shoulder pain. The results from the neurological examination are normal. Phalen's manoeuvre reproduces her symptoms in the right hand that she has experienced at night. Tinel's sign provokes numbness into the lateral 3 fingers of the right hand.

Anatomy Lectures: Sensory Systems

Part 4, Medical Foundation 4, Neuroscience, Week 3

Sensory pathways of the somatosensory system. Reflexes. Cross extensor reflex and central pattern generators. Parts of the Central Nervous system: cerebral cortex, diencephalon, brainstem, cerebellum, spinal cord. Peripheral nerves. Skin. Cutaneous nerve receptors. Testing the 5 sensory modalities (pain, temperature, pressure, touch, vibration). Cutaneous receptors. Deep receptors. Sensory Homunculus. Dorsal columns quantitative sensations (touch, pressure and proprioception (position)). Spino-thalamic tract qualitative sensations (pain and temperature). Gate control of pain. Reflex descending control of pain. Role of enkephalins and endorphins. Neuropathic pain. Romberg Test. Olfactory pathways.

PC Session: Ethical Issues in End-of-Life Care

Part 4, Professional Competencies 4, Week 7

Probably some of the most discussed issues in health ethics are raised in the context of end-of-life care. Questions around when to provide or stop treatment and how best to respect individuals' wishes have been debated publicly and personally for generations. In this session you will have a chance to explore some debates around withholding and withdrawing treatment, decision-making and advanced directives and notions of futility or burdensome treatment.

e-Learning Module: Integrated Pain and Opioid Curriculum Course 4 - Strategies for Managing Chronic Pain: Moving Beyond Opioids

Part 5, Integration Foundation

Explore how to optimize non-opioid medications for the management of chronic non-cancer pain. Learn how to collaborate with patients to use non-pharmacologic strategies such as physical activity, physical therapies, self-management programs, and psychological therapies for pain self-management. Discover available resources to assist you in helping your patients manage their chronic pain. You should complete this course along with the Henry Baker tutorial from the Integration Foundation.

Tutorial: Adrian Scholtz Part 1

Part 5, Integration Foundation

Adrian Scholtz is a 33 yr old male patient presenting at the Shelter Medical Outreach centre. He complains of a dry cough, fever, shortness of breath and worsening fatigue. He was seen at a walk-in clinic a few days ago for similar symptoms. He states he underwent testing for influenza A and COVID, but did not stay around to see what the results were. Adrian was encouraged to take Tylenol and rest, but did not receive any antibiotics or other treatment. Past medical history includes intravenous drug use, mechanical valve replacement (3 years ago), and is a current smoker. Concerned that Adrian appears quite sick, the medical clinic staff arranges for Adrian to be sent to the local ER department for evaluation.

Tutorial: Ethel MacConkey IF Host Defence and Neoplasia

Integration Foundation, Host Defense and Neoplasia, Week 1

Ethel is a 76 year old widow. She has a history of hypertension (treated with a thiazide diuretic and a calcium channel blocker), hyperlipidemia (treated with an HMGCoA reductase inhibitor), and obesity. Apart from this, she has been relatively healthy, and plays an active role with her 3 grandchildren as well as her church. Unfortunately, over the past few years, she has had increasing difficulty walking because of pain from osteoarthritis in her hips (especially her right hip) and, to a lesser extent, her knees. She therefore undergoes a right total hip arthroplasty. After 6 days in hospital, she is transferred to the rehab ward for further physiotherapy to improve her mobility. Five weeks into her rehab stay she develops a fever of 38.7 C. Additionally her physiotherapist has noticed that over the past 7-8 days Ethel has been less willing to participate in her exercises due to complaints of pain in her right hip. Concerned about Ethel's fever, the nurses give her acetaminophen and call the attending physiatrist to assess the patient for a potential infectious source.

Clinical Skills Sessions: Knee Pain in the ER

Part 5, Integration Foundation, Host Defense and Neoplasia, Week 1

To practice a history and physical exam for acute mono-arthritis, with focus on knee joint examination. To review can’t miss diagnoses for acute inflammatory monoarthritis. To review NEJM Clinical Video on Knee Arthrocentesis: https://www.nejm.org/doi/full/10.1056/NEJMvcm051914. To practice using likelihood ratios from the JAMA Rational Clinical Exam Article Does This Adult Patient Have Septic Arthritis to formulate a post-test probability of septic arthritis in this case. To discuss initial next steps in management including investigations in workup for acute inflammatory monoarthritis, and empiric antibiotics for septic arthritis

Tutorial: Albert Johnson IF Host Defence and Neoplasia

Part 5, Integration Foundation, Host Defense and Neoplasia, Week 4

Mr. Johnson is a previously fit, retired 70-year old Afro-Canadian gentleman. His son and daughter-in-law live several hundred miles away in another city and maintain contact with him by telephone. They return home on a Friday evening to surprise him for his birthday and find his apartment in disarray and Mr. Johnson in bed, in too much pain to move. He seems unable to stand independently, though it is hard to tell if this is a result of his overall weakness, or the pain. They call an ambulance and he is taken to the Emergency Department of the local community hospital.

Active Large Group Session: End-of-Life Care

Part 5, Integration Foundation, Host Defense and Neoplasia, Week 4

Clinical Skills Sessions: Palliative Care

Part 5, Integration Foundation, Host Defense and Neoplasia, Week 4

Describe and Identify patients who would benefit from a palliative care approach early in their illness trajectory. Systematically assess symptoms in patients with palliative care needs and participate in the evidence-based holistic and interprofessional management of these symptoms. Identify the components of a holistic, interprofessional management plan for a patient with palliative care needs. Describe the hierarchy for Substitute Decision Making for a patient who lacks Capacity. Describe the role of POAs or SDMs in palliative and end-of-life care planning.

PC Session: From White Coat to Blue Gown

Part 5, Professional Competencies IF, Week 2

This session highlights concepts and competencies covering end of life care, professionalism/self-awareness and self-care/compassion in Barbara Tatham’s journey from a physician to patient through to her final stages of comfort measures and palliative care.

PC Session: Serious Illness Conversations

Part 5, Professional Competencies IF, Week 5

Students will be introduced to the SPIKES protocol. During tutorial students will practice the application of the SPIKES protocol using role plays .

PC Session: Addictions

Part 5, Professional Competencies IF, Week 6

This session focuses on the complex psychosocial issues that underlie addictions and is designed to complement your knowledge of the neurophysiological mechanisms of addiction. This session builds on your understanding of trauma as there is a strong connection between trauma and addiction. It also builds on your understanding of the relationship between gender and health outcomes as gender is an important variable in addiction.

PC Session: Being Human in Medicine

Part 5, Professional Competencies IF, Week 11

The learning objectives for this session are for students to: 1) recognize physician vulnerability and relate to personal vulnerability; 2) list personal, local, provincial and web-based resources for self care; 3) recognize and practice reaching out to colleague in need.

Tutorial: Adrian Scholtz Part 2

Part 5, Integration Foundation, Maternal Health Risks/Aging-Related Care, Week 4

Adrian was admitted to the ICU 24 hours ago. Since that time, additional investigations and bloodwork has been ordered. Adrian underwent a CT chest to rule out pulmonary pathology and septic embolic in the lungs are confirmed. Blood cultures are positive for Methicillin-resistant Staphylococcus aureus (MSSA). After an infectious disease consult, Adrian is started on IV Ancef. The Cardiology team led by Dr. Sibbald and the Cardiac Surgery team led by Dr. Semelhago agrees that the patient requires a repeat heart valve replacement. In addition, the nurses observe Adrian to appear to be volume overloaded with worsening swelling. Despite copious IV fluids, Adrian is not making much urine (<200mL/day). A nasogastric tube was inserted for methadone administration. The nurse and dietician are requesting consideration for total parenteral nutrition based on recent laboratory results demonstrating malnutrition and hypoproteinemia. Ophthalmology is consulted for concerns of septic emboli following completion of an MRI of the brain. Nephrology consulted and believes dialysis may help the patient, but it is not the definitive treatment. They will only start dialysis if the patient is under consideration for repeat heart valve surgery.

e-Learning Module: Integration Foundation Rapid Fire Cases: Medical decision making in the acute care setting

Part 5, Integration Foundation, Maternal Health Risks/Aging-Related Care, Week 4

12-15 cases of rapid action required or immediate clinical decision making. Content of these modules: Internal Medicine, Surgery, Obstetrics, Paediatrics, Geriatrics and Radiology.

Tutorial: Claire McFadden Part 2 IF Maternal and Child Health Risks

Part 5, Integration Foundation, Maternal Health Risks/Aging-Related Care, Week 1

Claire is a 35-year-old G1 with Type 1 DM. She had an episode of pyelonephritis at 26 weeks gestation and did well following this, and was last seen at 30 weeks. At 32 weeks Claire presents in St. Catharines with a headache and RUQ pain. Her husband says that Claire’s swelling, especially in her face, has worsened over the past 2 days. BP is 160/105. FH is normal. She has 4+ urine protein. Hb 142 g/L, platelets 152, AST 67, ALT 75, INR/PTT normal, fibrinogen 5.8 g/L, glucose 6.5 mM/L, creatinine 100 uM, urea 4.2 mM. Urinary ketones are negative. She is given morphine and oral labetalol. Her symptoms settle and BP is 145/95. Ultrasound shows a cephalic fetus with normal head and femur measurements but the abdominal measurement lags by 3 weeks. There is marked oligohydramnios. Doppler studies are abnormal. MUMC is called and a decision is made to transfer Claire. On arrival, she complains of severe RUQ pain. BP is 170/110. She has made very little urine and it is dark tea coloured. Hb 137 g/L, platelets 100, AST 265, ALT 310. Her urinary protein to creatinine ratio is 500 mg/mmol. She is given a dose of nifedipine and MgSO4 is started. A decision is made to do an immediate C/S with spinal.

Active Large Group Session: Addiction Medication

Part 5, Integration Foundation, Maternal Health Risks/Aging-Related Care, Week 3

Understand what addiction is. Gain appreciation of different Substance Use Disorders. Gain familiarity for principles of treatment of SUDs.

Active Large Group Session: Acute and Chronic Pain

Part 5, Integration Foundation, Complexity and Chronicity

Large Group Session: Clinical Skills Male Sensitive Exam

Part 5, Integration Foundation, Complexity and Chronicity, Week 1

Genital exam in pubic area, penis, testicle and the surrounding region.

Tutorial: Henry Baker IF Chronicity and Complexity

Part 5, Integration Foundation, Complexity and Chronicity, Week 1

Henry is a 57 year old man whom you have seen four times in the past ten years because of back pain episodes initially diagnosed as lumbar strain. With each episode, there has been a period of work disability ranging from two to six months. Henry now attends at your office again complaining of longstanding generalized back pain and stiffness. He has pain across the lumbar area, radiating down the lateral aspect of the left thigh, calf and foot and to a lesser extent, the lateral aspect of the right leg. He also has some pain in the shoulder blades, neck, and headaches. He complains of constipation, can't sleep, and spends most of his day lying down, because all activity aggravates his pain.

Clinical Skills Sessions: Dyspnea in Adult Palliative Care

Part 5, Integration Foundation, Complexity and Chronicity, Week 2

To practice a palliative care assessment, including symptom assessment, detailed social and functional history, and practice a goals of care discussion using the Serious Illness Conversation Guide (Click for link) as a template. To practice using likelihood ratios from the JAMA Rational Clinical Exam Article Does this patient have a pleural effusion? to formulate a post-test probability of pleural effusion in this case. To discuss common clinical tools helpful in a palliative care assessment, including the Edmonton Symptom Assessment Scale (ESAS – Click for link), and Palliative Performance Scale (PPS). To discuss core principles of primary palliative approach to care. Pro Comp Connection – Palliative care for marginalized populations.

Clinical Skills Sessions: Opioid Use Disorder, Chronic Non-Cancer Pain

Part 5, Integration Foundation, Complexity and Chronicity, Week 4

To practice a history and physical exam for low back pain including a focus on red flags and yellow flags (re. CORE Back tool). To recognize symptoms and signs of opioid withdrawal using the Clinical Opioid Withdrawal Scale (COWS). To discuss non-pharmacologic approaches for treatment of chronic non-cancer pain. To discuss the watchful dose for opioids in chronic non-cancer pain, and practice an opioid conversion to determine morphine equivalent daily dose (MEDD). To review risk factors for opioid use disorder using the Opioid Risk Tool (ORT). To review core principles of diagnosis and initial management of opioid use disorder in primary care. Pro Comp Connection – Patients with Addictions.

Tutorial: Hannah Rosen Part 2 IF Chronicity and Complexity

Part 5, Integration Foundation, Complexity and Chronicity, Week 4

Hannah Rosen is 18-year-old female who presents to the outpatient clinic after a frantic call to the receptionist earlier during the day. Hannah has been coming to the clinic for the past 16 years for treatment and monitoring of her cystic fibrosis. Her parents, who have been supportive, are out of town on an anniversary cruise and Hannah didn’t know who to call. Hannah states she has been having increased sputum production, low grade fever and difficulty catching her breath over the past few days. She took the action plan of ciprofloxacin she has at home. She takes this when her respiratory symptoms worsen. Hannah states she has been compliant with her antibiotics, but her symptoms suddenly got worse overnight. Hannah does not want her parents to know about this and asks that they not be contacted about her hospital visit. On examination, Hannah appears in distress. She is using her intercostal muscles to help her breathe and appears cyanotic and diaphoretic. Her vitals are taken by the clinic nurse while they are waiting for her pediatric respirologist to finish with the previous patient. Hannah’s temperature is 39.1, oxygen saturation is 91 percent, heart rate is 115 and her blood pressure is 100/60. The nurse calls for immediate help and Hannah is taken to the ICU where she is placed on oxygen. Chest x-ray and additional blood work including ABGs are ordered.

Clinical Skills Sessions: Exertional Nausea and Dyspnea x 2 weeks

Transition to Clerkship, Week 1

You are on a family medicine clerkship rotation at a clinic in Stoney Creek. The clinic has access to interdisciplinary supports (e.g. social work, dietitian, physiotherapy, nursing), bedside 12-lead Electrocardiogram (ECG) and Oxygen by Nasal Prongs, an AED (Automated External Defibrillator), X-Ray and bloodwork next door. Your nearest tertiary care hospital is <30 minutes away. Your first patient is Casey Brady, a 60 year-old from home alone in a townhouse in Stoney Creek. Casey’s reason for visit is listed as “new onset exertional nausea and dyspnea x 2 weeks”.

Clinical Skills Practice Sessions: Clerkship Hands-On Practical Skills

Transition to Clerkship, Week 1

Introduction to core clerkship hands-on skills. Stations are: Defib and EKG, IV, Airway, Pediatric emergencies, NG tube insertion, Foley insertion, Casting and splinting, Suturing

Small Group Session: Women's Sexual Health

Transition to Clerkship, Week 3

Menopause. Pregnancy symptoms. Normal delivery. OB complications. Shoulder dystocia.

Clinical Exposure: Pain Management

Clerkship, Anesthesia Rotation

e-Learning Module: Pain Overview

Clerkship, Anesthesia Rotation

In this module, you will be presented with information regarding pain, including: What is pain? Classification of pain. Acute pain and chronic pain

Essential Clinical Experience: Pregnancy Problems - SA, ectopic

Emergency Medicine Rotation

Large Group Session: Approach to Trauma and Burns

Clerkship, Emergency Medicine Rotation

Describe the roles of the trauma team members. Describe the ABCDE approach to the trauma patient. Know 5 diagnoses not to miss in the primary survey. Know the types of IV fluid to use in a trauma resuscitation. Describe the utility and limitations of investigations used in the primary survey. Use the “rule of 9’s” to calculate burn area percentage. Use the Parkland formula to estimate IV fluid requirements of a burn patient.

Clerkship Teaching Session: Abdominal Pain

Clerkship, Emergency Medicine Rotation

Develop an approach to undifferentiated abdominal pain. Describe early management of abdominal pain.

Clerkship Teaching Session: Chest pain

Clerkship, Emergency Medicine Rotation

By the end of the session you should be able to: Develop a differential diagnosis and choose appropriate initial tests and list early management strategies for: Adult Chest Pain; Pediatric SOB (shortness of breath) and wheeze.

Essential Clinical Experience: Injury, lower extremity

Emergency Medicine Rotation

Clinical Exposure: EM Medical Expert (presenting problems)

Clerkship, Emergency Medicine Rotation

Demonstrate an approach to patients presenting to the ED with the following problems listed below (including basic differential diagnosis, initial investigations, and initial treatments)

Clinical Exposure: Examination: Trauma and burn

Clerkship, Emergency Medicine Rotation

Tutorial: Musculoskeletal presentations

Clerkship, Family Medicine Rotation

Tutorial: Counseling

Clerkship, Family Medicine Rotation

Tutorial: Genitourinary presentations

Clerkship, Family Medicine Rotation

Tutorial: General presentations

Clerkship, Family Medicine Rotation

Tutorial: ENT presentations

Clerkship, Family Medicine Rotation

Essential Clinical Experience: Pelvic examination, complete

Clerkship, Family Medicine Rotation

Essential Clinical Experience: Palliative Care (Disease Management)

Clerkship, Family Medicine Rotation

Tutorial: Cardiovascular presentations

Clerkship, Family Medicine Rotation

Tutorial: Women's Health

Clerkship, Family Medicine Rotation

e-Learning Module: Family Medicine Adolescent Case

Clerkship, Family Medicine Rotation

Understand when you have to report relationships to the child protection authorities. Understand issues around consent and confidentiality for adolescent patients in Canada. STI Screening and Treatment. Create a plan of how you would counsel an adolescent patient on STI prevention and treatment. What are the risks associated with STIs during pregnancy, and how would your education on STI Prevention and treatment change if your patient is pregnant? Prenatal Care. Know the safest pain medications to use during pregnancy (e.g. for headache). Headache: Differentiate the symptoms into mild versus severe in your approach. What are other important components of prenatal care, especially suited to primary care? (Immunizations, STI screening, etc.) Develop an approach to screening for substance use in pregnant patients, and how to explain risks specific to the substance being used. Mood Disorders in Adolescents. Understand the use of the Edinburgh Postnatal Depression Scale in detecting depression and anxiety in the antenatal and postnatal period. What risk factors in adolescent pregnancy make pre-term labour more likely? What validated tools exist for screening for depression and anxiety screening in adolescents? How would this differ if the patient were pregnant?

Clinical Exposure: Cardiovascular Presentations

Clerkship, Family Medicine Rotation

Clinical Exposure: Continuity of care/chronic disease management

Clerkship, Family Medicine Rotation

Clinical Exposure: General Presentations

Clerkship, Family Medicine Rotation

Undifferentiated problem (unwell, fatigue, pain). Falls.

Clinical Exposure: ENT

Clerkship, Family Medicine Rotation

e-Learning Module: Family Medicine Palliative Case

Clerkship, Family Medicine Rotation

Describe the palliative care approach to care, and who may benefit from it. Assess and manage pain and other common symptoms in palliative care. Understand the interprofessional approach to providing palliative care. Organize care for the actively dying patient and family. Describe an approach to responding to grief, bereavement, and suffering

Clinical Exposure: Counseling

Clerkship, Family Medicine Rotation

Clinical Exposure: Gastrointestinal Presentations

Clerkship, Family Medicine Rotation

Abdominal pain. Pelvic pain. AnalAbdominal paracentesisrectal symptoms. Blood in stool. Changes in bowel habits. Decreased appetite. Heartburn. Nausea and vomiting. Weight loss.

Clinical Exposure: Women's Health

Clerkship, Family Medicine Rotation

Essential Clinical Experience: Abdominal pain (> 48 hrs)

Clerkship, Family Medicine Rotation

Clinical Exposure: Musculoskeletal Presentations

Clerkship, Family Medicine Rotation

Clinical Exposure: Acute coronary syndrome

Clerkship, Internal Medicine Rotation

Clinical Exposure: Urinary tract infection

Clerkship, Internal Medicine Rotation

Clinical Exposure: Peptic ulcer disease

Clerkship, Internal Medicine Rotation

Clinical Exposure: Substance abuse

Clerkship, Internal Medicine Rotation

Clinical Exposure: Rheumatoid arthritis

Clerkship, Internal Medicine Rotation

Clinical Exposure: Septic arthritis/osteomyelitis

Clerkship, Internal Medicine Rotation

Essential Clinical Experience: Urinary tract infection

Internal Medicine Rotation

Clinical Exposure: Connective tissue diseases

Clerkship, Internal Medicine Rotation

Essential Clinical Experience: Participate in a discussion on end-of-life care.

Clerkship, Family Medicine Rotation, Internal Medicine Rotation

Clinical Exposure: Spinal cord compression

Clerkship, Internal Medicine Rotation

Essential Clinical Experience: Joint pain

Internal Medicine Rotation

Essential Clinical Experience: Acute coronary syndrome

Internal Medicine Rotation

Clinical Exposure: Osteoporosis

Clerkship, Internal Medicine Rotation

Clinical Exposure: Osteoarthritis

Clerkship, Internal Medicine Rotation

Essential Clinical Experience: Alcoholism, tobacco and other substance Abuse

Internal Medicine Rotation

Essential Clinical Experience: EKG abnormalities

Internal Medicine Rotation

Clinical Exposure: Inflammatory bowel disease

Clerkship, Internal Medicine Rotation

Clinical Exposure: Hypo/hyperthyroidism

Clerkship, Internal Medicine Rotation

Essential Clinical Experience: Chest Pain

Clerkship, Emergency Medicine Rotation, Family Medicine Rotation, Internal Medicine Rotation

Preceptor: Postpartum Care

Clerkship, Obstetrics and Gynecology Rotation

Preceptor: Premature Rupture of Membranes (PROM)

Clerkship, Obstetrics and Gynecology Rotation

Preceptor: Intrapartum Care

Clerkship, Obstetrics and Gynecology Rotation

Clinical Exposure: Endometriosis

Clerkship, Obstetrics and Gynecology Rotation

e-Learning Module: Intrapartum Fetal Surveillance

Clerkship, Obstetrics and Gynecology Rotation

Preceptor: Abnormal Labour

Clerkship, Obstetrics and Gynecology Rotation

Self-Assessment Quiz: Intrapartum Fetal Surveillance

Clerkship, Obstetrics and Gynecology Rotation

Clinical Exposure: Chronic Pelvic Pain

Clerkship, Obstetrics and Gynecology Rotation

Self-Assessment Quiz: Dysmenorrhea

Clerkship, Obstetrics and Gynecology Rotation

Self-Assessment Quiz: Isoimmunization

Clerkship, Obstetrics and Gynecology Rotation

Self-Assessment Quiz: Post-Term Pregnancy

Clerkship, Obstetrics and Gynecology Rotation

Self-Assessment Quiz: Postpartum Care

Clerkship, Obstetrics and Gynecology Rotation

Simulations: Fetal Bradicardia

Clerkship, Obstetrics and Gynecology Rotation

Simulations: Postpartum Hemorrhage

Clerkship, Obstetrics and Gynecology Rotation

Simulations: Shoulder Dystocia

Clerkship, Obstetrics and Gynecology Rotation

e-Learning Module: Endometriosis

Clerkship, Obstetrics and Gynecology Rotation

e-Learning Module: Ectopic Pregnancy

Clerkship, Obstetrics and Gynecology Rotation

e-Learning Module: Dysmenorrhea

Clerkship, Obstetrics and Gynecology Rotation

e-Learning Module: Isoimmunization

Clerkship, Obstetrics and Gynecology Rotation

Simulations: Intrapartum Care

Clerkship, Obstetrics and Gynecology Rotation

e-Learning Module: Pelvic Inflammatory Disease

Clerkship, Obstetrics and Gynecology Rotation

Large Group Session: Sexually Transmitted Infections

Clerkship, Obstetrics and Gynecology Rotation

Most common reportable infectious diseases (gonorrhea, pelvic inflammatory disease, chlamydia, syphilis, herpes, human papilloma virus (hpv), genital warts). 'Syndromic' approach to treatment. Sequelae: infertility, cancer, chronic pain, psychiatric illness. Synergistic nature, HIV and other STIs. Economic issues: correlation with poverty, high cost to society.

Essential Clinical Experience: Cesarean section, assist (2nd assist)

Obstetrics and Gynecology Rotation

Essential Clinical Experience: Emergency gynecologic assessment

Obstetrics and Gynecology Rotation

Clinical Exposure: Intrapartum Care

Clerkship, Obstetrics and Gynecology Rotation

Clinical Exposure: Intrapartum Fetal Suveillance

Clerkship, Obstetrics and Gynecology Rotation

Essential Clinical Experience: Intra-partum cervical examination

Obstetrics and Gynecology Rotation

Essential Clinical Experience: Intrapartum fetal health surveillance

Obstetrics and Gynecology Rotation

Essential Clinical Experience: Labour determination

Obstetrics and Gynecology Rotation

Essential Clinical Experience: Labour induction, augmentation

Obstetrics and Gynecology Rotation

Clinical Exposure: Abnormal Labour

Clerkship, Obstetrics and Gynecology Rotation

Clinical Exposure: Postpartum Care

Clerkship, Obstetrics and Gynecology Rotation

Clinical Exposure: Premature Rupture of Membranes (PROM)

Clerkship, Obstetrics and Gynecology Rotation

Essential Clinical Experience: Postpartum Care

Obstetrics and Gynecology Rotation

Essential Clinical Experience: Postpartum hemorrhage

Obstetrics and Gynecology Rotation

Essential Clinical Experience: Ruptured membranes

Obstetrics and Gynecology Rotation

Essential Clinical Experience: Shoulder dystocia

Obstetrics and Gynecology Rotation

Essential Clinical Experience: Vaginal delivery (normal)

Obstetrics and Gynecology Rotation

Large Group Session: Abnormal Labour

Clerkship, Obstetrics and Gynecology Rotation

Stages of labour. Cardinal movements of labour. Causes of Abnormal labour: Inadequate contractions, inadequate pelvis, baby too big or malpositioned. Induction/augmentation of labour.

Large Group Session: Chronic Pelvic Pain

Clerkship, Obstetrics and Gynecology Rotation

Chronic pelvic pain (CPP): definition; significance; prevalence; etiology; history; physical exam. Characteristics of pain. Laboratory investigations of chronic pelvic pain. Pharmacologic approach to CPP. Endometriosis. Role of hysterectomy for treatment of CPP.

Tutorial: Intrapartum Care

Clerkship, Obstetrics and Gynecology Rotation

Large Group Session: Fetal Health Surveillance

Clerkship, Obstetrics and Gynecology Rotation

Factors to consider when interpreting fetal heart patterns. How should the fetus be monitored in labour? Intermittent auscultation (IA) vs. Electronic fetal monitoring (EFM).

Large Group Session: Low Risk Obstetrics

Clerkship, Obstetrics and Gynecology Rotation

Diagnosis of pregnancy. Risk assessment in pregnancy. Counseling issues in pregnancy. Components of routine antenatal care. Diagnosis of labour: Latent vs active. Assessment of the labouring patient. Stages of labour: Definintions, Normal Labour Management of 1st, 2nd and 3rd stages.

e-Learning Module: Postpartum Care

Clerkship, Obstetrics and Gynecology Rotation

Large Group Session: OB Labour and Pain Relief

Clerkship, Obstetrics and Gynecology Rotation

Obstetrical Anesthesia and Analgesia. Understand the principles of applied anatomy in labor analgesia. To understand epidurals more in depth.To understand the physiology changes due to an epidural/spinal block in pregnant women.to understand the patophysiology of PDPH (post-dural puncture headaches).

Large Group Session: Obstetrical Emergencies

Clerkship, Obstetrics and Gynecology Rotation

Shoulder Dystocia. Post Partum Hemorrhage. Cord Prolapse.

Tutorial: Postpartum Care

Clerkship, Obstetrics and Gynecology Rotation

Tutorial: Child with a Limp

Clerkship, Pediatrics Rotation

Identify key history and physical examination findings pertinent to the differential diagnosis of acute limp in a child. Review common causes of acute limp in children and formulate an approach for initial diagnostic work-up.

e-Learning Module: CLIPP Cases: Common Pediatric Conditions

Clerkship, Pediatrics Rotation

Computer simulated pediatric cases will be used to supplement direct patient encounters. A series of 31 e-learning modules is made available to each student. Students are required to complete 15 cases by the end of the rotation.

e-Learning Module: CLIPP Cases: Chronic Childhood Illness

Clerkship, Pediatrics Rotation

Computer simulated pediatric cases will be used to supplement direct patient encounters. A series of 31 e-learning modules is made available to each student. Students are required to complete 15 cases by the end of the rotation.

Tutorial: Pediatrics Peer to Peer teaching session

Clerkship, Pediatrics Rotation

At the end of the third week of your rotation, you are asked to present a brief overview of one of these key topics: Fever (differential, focus on UTI); Headache in children/teens; Neonatal jaundice; Approach to Lymphadenopathy; Abdominal pain (differential, focus on constipation); Growth problems in children

e-Learning Module: CLIPP Cases: Critical and Acute Pediatric Conditions

Clerkship, Pediatrics Rotation

Computer simulated pediatric cases will be used to supplement direct patient encounters. A series of 31 e-learning modules is made available to each student. Students are required to complete 15 cases by the end of the rotation.