e-Learning Module: Intro to Dermatology

Part 1, Medical Foundation 1

Approximately 7% of all adult outpatients have a primary skin complaint, and 60% of outpatient visits for skin disease are made to non-dermatologists. With dermatological conditions being so prevalent, it is important that medical students have a minimum core of dermatological knowledge at the time of graduation.

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: Matthew Clarke MF2 Renal

Part 2, Medical Foundation 2, Renal, Week 1

Matthew Clarke, a 4-year-old boy, developed periorbital edema for the first time three weeks ago, and despite being treated for allergies he showed increasing edema and weight gain. He now has ankle and leg edema, a distended abdomen, and can only sleep at night if propped up with three or four pillows.

Tutorial: Yong Mun Park MF2 Renal

Part 2, Medical Foundation 2, Renal, Week 3

Yong Mun Park is a 22 year old woman who has a 2 year history of recurrent urinary tract infections. These continue despite conservative measures and her family doctor elects to try her on a course of prophylactic antibiotics. She is allergic to sulpha medications, so she is prescribed cephalexin 250 mg daily. She is taking an oral contraceptive, but no other medications. Ten days after starting this antibiotic, she returns to her family doctor with a macular, red rash on her trunk and arms, general malaise, and nausea.

Tutorial: Martin Barratt MF2 Renal

Part 2, Medical Foundation 2, Renal, Week 3

Martin Barratt is a 40-year-old male with Autosomal Dominant Polycystic Kidney Disease (ADPKD). He was diagnosed at the age of 15 years when he was found to have bilateral cysts on renal MRI. The diagnosis was confirmed genetically (see attached result) and there is a strong family history of this condition. His mother is on dialysis and maternal grandfather had a kidney transplant and died from a ‘brain bleed’. Martin’s creatinine was elevated for a number of years and was measured at around 350 µmol/L (eGFR 18 ml/min/1.73m2) 3 years ago. Unfortunately, he was lost for nephrology follow up and was recently re-referred by his FD. He is seen by the nephrologist today and complains of fatigue and pruritus. Current medications include allopurinol 75 mg/daily. ROS was significant for erectile dysfunction and recent forearm fracture after a minor fall. He is also worried that his 15-year-old daughter could have the same condition and asks whether she needs to be tested. Physical examination shows a pale, malnourished male with BP of 169/92 mm Hg.

Active Large Group Session: Introduction to the Basic Skin Exam

Part 2, Medical Foundation 2, Renal, Week 3

Morphology in Dermatology. How to describe a lesion / rash.

Tutorial: Judy Patterson MF2 Hematology

Part 2, Medical Foundation 2, Hematology, Week 2

Judy Patterson is a 22 year-old university student who presented to the Student Health Clinic with a rash on her lower legs. Her past medical history is unremarkable except for a urinary tract infection diagnosed 6 days ago for which she is taking trimethoprim-sulfamethoxazole. The only other medication she takes is the occasional dose of ibuprofen for headaches. She has never had any dental extractions or surgeries. On examination, she has no lymphadenopathy or splenomegaly, but she does have petechiae on her lower legs. You ask to look inside her mouth and there you see a blood blister on the inside of her cheek. She says she must have bitten it by accident.

Tutorial: Mary Jane Morrison MF3 Reproduction

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

Mary Jane, a healthy 22-year-old woman, is seen in a walk-in clinic for abnormal vaginal discharge. She is otherwise healthy and not taking any medications. Her immunizations are up to date, though she is unsure if she received the HPV vaccination as a teen. Mary Jane has been sexually active for 2 years. She has never had a Pap smear. She tells you that she has tried the birth control pill in the past but is not taking it because it “makes her sad”. She uses condoms instead. Three months ago, she had unprotected sex one time with her current partner. She confides in you that she thinks her current partner "sleeps around" on her and she’s here today because she wants to get “checked”. When taking a detailed sexual history, you discover that she has intermittently experienced pain during sexual intercourse and some post-coital bleeding. Mary Jane minimizes these symptoms and tells you that this is normal for her. On examination she looks well but is very nervous. Vitals signs are within normal limits. Head and neck, respiratory and cardiac examinations are all normal. Abdominal exam does not reveal any masses or areas of tenderness. Skin and joints are all normal. Genital examination does not reveal any lesions. Pelvic examination reveals some purulent discharge from the cervical os. Swabs are collected from the cervical os and result in bleeding. Bimanual examination does not elicit any cervical or adnexal tenderness. You discuss the role of cervical cancer screening and how it relates to HPV, a sexually transmitted infection. Mary Jane agrees to return in 2 weeks for a Pap smear.

Active Large Group Session: Skin Cancer and Common Dermatology Procedures

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

Tutorial: Savita Singh MF3 Reproduction

Part 3, Medical Foundation 3, Reproduction and Pregnancy, Week 4

Savita Singh, a 33-year-old married woman, is seeing her physician for amenorrhea. She was suspected of having diabetes mellitus 6 months ago after a round of routine blood tests. The diagnosis of diabetes mellitus was confirmed with repeat testing soon thereafter. Savita was immediately counselled on the importance of lifestyle modification, with special attention to weight loss and exercise at least 3 times per week. Since then, Savita has found it very challenging to integrate these recommendations into her busy lifestyle and says she has “only lost 3 pounds.” Savita has always had irregular menstrual cycles since menarche at age 11, generally having periods once every 1-3 months on average. She could not reliably predict when a period would start or end. Her menses were sometimes very light and sometimes extremely heavy. For the past 6 months, however, she has had no period whatsoever. Savita has never been on any medications. Her family history is significant for type 2 diabetes and premature coronary artery disease, with her father having had a myocardial infarction at the age of 45. On physical examination, Savita has a weight of 77 kg and height of 153 cm. Her abdominal circumference is measured at 93 cm at the umbilicus. There are small skin tags and hyperpigmentation noted at the back of her neck and in both axillae. Her abdomen has some striae but they are pale, thin and not depressed. She has excessive hair growth on the upper arms, upper chest, abdomen, lower back and face with a Ferriman-Gallwey score of 16/36. There is mild acne and her hairline appears to be receding. There are no virilizing signs on exam. Fundoscopic examination reveals changes consistent with early non-proliferative diabetic retinopathy. Examination of the feet does not show any signs of neuropathy.

Tutorial: Li Chin and Baby Albini MF3 Reproduction

Part 3, Medical Foundation 3, Reproduction and Pregnancy, Week 4

Li Chin is a 19-year-old woman from Hong Kong who has been in Canada for one year studying Computer Science at McMaster University. She is a known carrier of Hepatitis B, but is otherwise healthy and on no medication. You are a family physician working at Student Health Services at the university. Li came to see you today for a routine prenatal appointment at 28 weeks gestational age. You inquire as to Li's plans for feeding her baby after birth. She is uncertain and has not yet considered this. When you recommend that she breastfeed her baby, she asks why. She doesn’t know anyone who has breastfed. She is uncertain as to whether or not she would be able to do it.

Tutorial: Jane Deglutinato MF3 Gastroenterology and Nutrition

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

Jane Deglutinato is a 50-year-old female with a 4-month history of progressive dysphagia, symptomatic heartburn and regurgitation that has not responded to the use of regular non-prescription oral antacid medications. She has also noticed some general joint discomfort and painful swelling of her fingers with occasional pain and discoloration of the fingertips. She also reports having lost approximately 9 lbs of weight over that period of time related to a reduction in her appetite. Her bowel movements continue to be formed with no evidence of blood or fatty stool. On examination, her vitals are within normal limits and she is afebrile. Her weight is 55 kg. You notice that she has some tightening of the skin around her mouth as well as her fingers and toes, with pitting and some ulceration of the fingertips on both hands and toes of both feet. You also note several telangiectasias over her chest and upper torso. Cardiac and respiratory as well as abdominal examinations are unremarkable.

Tutorial: Michel Dupois MF3 Endocrinology

Part 3, Medical Foundation 3, Endocrinology, Week 3

Mr. Dupois is a 35-year-old French-Canadian man born in rural Quebec who moved to Hamilton with his wife a few years ago. His family physician noted a persistent rash around his eyes that he identified as xanthelasma. This prompted some blood tests and a referral to the Lipid Clinic. He is rather reluctant to see you at the Lipid Clinic because he is completely asymptomatic. He denies any significant medical history and is taking no medications. He is a lifelong non-smoker who faithfully walks to work for 1 km with no problems. A family history indicates that Mr. Dupois’ father died suddenly at the age of 46 with no clear explanation. He has multiple family members on his father’s side had a history of heart attacks, some at an unusually young age. His mother is healthy. On physical exam he has soft, velvety, yellowish, non-tender plaques in the palpebral area. Thickening of the Achilles tendons bilaterally were also noted. His blood pressure was 145/90 and waist circumference 98 cm.

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: 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: 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: 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: 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.

Tutorial: P.J. Peters (Part 2) IF Host Defence and Neoplasia

Part 5, Integration Foundation, Host Defense and Neoplasia, Week 2

When you see Mr. Peters next, you learn that he had continued to take his HAART faithfully an additional 6 months after he last saw you. He had been feeling physically well and figured his virus was under control (as he recalled it had last been "non-detectable") and so began questioning the need to continue his medications. He was concerned about long-term side effects of therapy and figured he could diminish his risk by reducing his exposure to HAART. Moreover he had started a new job around that time and did not want anyone to inadvertently find out about his diagnosis of HIV. He therefore elected to stop taking his anti-retrovirals. Mr. Peters was reluctant to tell his physicians about his decision and so he had not come back for his follow ups. He returns today complaining of a new painful rash on his chest that appeared 2 days prior. Additionally he notes a 3-month history of increasing fatigue as well as intermittent fevers, night sweats and a 20 lb weight loss. On examination his temperature is 37.2º C, blood pressure 135/80, pulse 79. There are 2 cm nodes palpable in the cervical and axillary areas bilaterally. His throat is clear. When you examine his chest you notice a vesicular rash over the right side of his chest extending from the midline towards his right axilla at the level of his nipple. Examination of his respiratory and cardiovascular system are unremarkable. His abdomen is soft with no palpable masses or organomegaly. Examination of his extremities is unremarkable.

e-Learning Module: Integration Foundation Pathology Cases

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

Normal Histology and Disease. Integrating Pathology Into the Clinical Picture. The frozen section (intraoperative consultation).

Tutorial: Susanna Green Part 2 IF Chronicity and Complexity

Part 5, Integration Foundation, Complexity and Chronicity, Week 3

Susanna is an Indigenous woman who lives in the Six Nations of the Grand River Reserve. She is well-known to you. She first met you in the outpatient setting during your day in family medicine rotation two years ago at the beginning of medical school. At that time, Susanna had several issues with the management of diabetes, including regular blood glucose monitoring and appropriate medical management. Susanna has a complex medical history including type 2 diabetes, hypertension, obstructive sleep apnea, and a previous myocardial infarction and subsequent triple coronary bypass graft. After a lengthy stay in ICU six months ago due to pneumonia and septic shock, she developed end stage renal disease and is currently receiving in centre hemodialysis through a tunneled internal jugular catheter twice weekly. You are currently on your clerkship selective on nephrology with Susanna assigned to your team. Susanna has been admitted for a worsening chronic wound on her right heel. Susanna states she was attending the Grand River dialysis outpatient clinic on the Six Nations reserve 2 days ago, when one of the nurses there noticed increasing drainage from her right heel wound. Susanna’s vital signs there revealed she was febrile at 38.1 degrees and tachycardiac at 110 beats per minute with blood pressure 90/50 mmHg, respiratory rate 17 breaths per minute, and oxygen 100% on room air. Bloodwork was then taken, and a septic workup was also ordered.

Active Large Group Session: Dermatology Papulosquamous Disorders and Drug Reactions

Part 5, Integration Foundation, Complexity and Chronicity, Week 3

To introduce an approach to the assessment of patients presenting with red scaly patches or plaques on the body. Introduce an approach to the assessment and initial management of common papulosquamous disorders (e.g. psoriasis, seborrheic dermatitis, atopic dermatitis, contact dermatitis). To introduce an approach to the assessment and initial management of patients presenting with drug reactions, including severe drug eruptions such as Angioedema, Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS), Steven Johnson Syndrome (SJS) and Toxic Epidural Necrolysis (TEN).

e-Learning Module: Anaphylaxis

Clerkship, Emergency Medicine Rotation

Be able to identify and define anaphylaxis. Know how to manage a patient with an acute anaphylactic reaction in the Emergency Depatment.

Clinical Exposure: Procedural Skills in the ER

Clerkship, Emergency Medicine Rotation

Demonstrate competency in performing the following procedural skills (including indications, contraindications).

Simulations: Suture workshop

Clerkship, Emergency Medicine Rotation

Wound care procedural skills. Wound assessment, focused history and physical. Geography of the wound. Wound preparation. Local anaesthetics. Infiltration technique. Cleansing. Wound closure. Sutures.

Clinical Exposure: Dermatology

Clerkship, Family Medicine Rotation

Tutorial: Dermatology

Clerkship, Family Medicine Rotation

e-Learning Module: Family Medicine Pediatric Case

Clerkship, Family Medicine Rotation

Be familiar with Growth and Development Milestones and know how to determine if the child needs early interventions (Rourke, Nippissing). Nippissing has a new name Looksee. Describe the impact the social determinants of health have on health outcomes (young, single mother with little money and time to raise child). Appreciate the role of the Family Physician as an advocate for health - what resources can you leverage in the community to help optimize life for both Ashley and her mother? Be able to discuss contraception planning to prevent another unplanned pregnancy. Be familiar with common skin rashes in children

Clinical Exposure: Cellulitis

Clerkship, Internal Medicine Rotation

Clinical Exposure: Anaphylaxis/angioedema

Clerkship, Internal Medicine Rotation

Large Group Session: Knot tying and Perineal Trauma

Clerkship, Obstetrics and Gynecology Rotation

To review wound healing. Provide basic information on commonly used suture materials. Review general principles of wound closure. Provide a general overview of basic surgical knot tying and suturing.

Essential Clinical Experience: Rash, Pediatric

Pediatrics Rotation

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: Adrenal adenoma

Clerkship, Surgery Rotation

This module reviews how to work up an adrenal adenoma and gain comprehension of the complex physiology of the adrenal gland.

Essential Clinical Experience: Wound cleansing / dressing

Emergency Medicine Rotation, Surgery Rotation

Clinical Exposure: Closure of wound (skin)

Clerkship, Surgery Rotation

Clinical Exposure: Benign/Malignant skin lesions

Clerkship, Surgery Rotation

e-Learning Module: Skin cancer

Clerkship, Surgery Rotation

This module reviews the presentation, diagnosis, and management of skin cancer, specifically melanoma.

Large Group Session: Plastic Surgery

Clerkship, Surgery Rotation

Stages and phases of wound healing. The acute wound healing cascade. Burns. Benign and malignant skin conditions.

Essential Clinical Experience: Closure of wound (skin)

Emergency Medicine Rotation, Surgery Rotation, Orthopedic Surgery Rotation

Concept Integration and Review: Dermatology

Post-clerkship, Concept Integration and Review

Acne, Rosacea, Seborrheic Dermatitis; Acne, Perioral Dermatitis ; Psoriasis, Atopic Dermatitis; Warts, Molluscum ; Vitiligo, Tinea Versicolour, Progressive Macular Hypomelanosis; Urticaria, Urticarial

Concept Integration and Review: General Pediatrics

Post-clerkship, Concept Integration and Review

Rashes, growth issues, genetic syndromes, newborn issues, neurodevelopment, school / learning issues, respiratory conditions.

Concept Integration and Review: Pediatric Communicable Diseases

Post-clerkship, Concept Integration and Review

How do you decide what antibiotics to use? Is there an infection? Where is the infection? What pathogens are probably causing the infection? Are there antibiotics that can get to where the pathogens are? kill the pathogens?

Concept Integration and Review: Gynecology

Post-clerkship, Concept Integration and Review, Week 3

Understanding the menstrual cycle. Disorders of menstruation. Contraception. Infertility. Understanding pelvic pain. Urinary incontenence. Dysmenorrhea. Abnormal Uterine Bleeding. PMS / PMDD. Menopause and hormone therapy. Pregnancy Loss (Spontaneous Abortion, Recurrent Pregnancy Loss, Ectopic Pregnancy). Pelvic Organ Prolapse. Vulvovaginitis, Cervicitis, PID. PAP.