Integration Foundation

• Upon completion of this problem, the student should be able to describe chronic pain in a biopsychosocial framework which recognizes nociceptive, neuropathic, cognitive-perceptual, brain and behaviour and socio-environmental factors.
• Explain the assessment and management of cardiovascular complications in patients with chronic kidney disease including management of hypertension and dyslipidemia.
• Recognize the different modalities of renal replacement and the psychosocial impact of dialysis on patients.
• Describe the epidemiology of chronic pain and social and economic burden it places on society.
• Identify and characterize the risk factors for developing chronic pain and explore how chronic pain may develop using the biopsychosocial model.
• Compare and contrast nociceptive and neuropathic pain and describe how pain signalling might evolve in chronic pain.
• Discuss how the disease model approach may not apply to patients with chronic pain and explain when investigations are appropriate in chronic pain.
• Describe the interdisciplinary approach to chronic pain management including physical, psychological, and pharmacological modalities including opioids and cannabinoids.
• Discuss the physician role in the potential development of opioid addiction and how it might be recognized and avoided using the Canadian Opioid Guidelines.
• Upon completion of this problem, students should be able to identify key features of a polytrauma patient and discuss primary management utilizing the ATLS algorithm. Students should be able to demonstrate compassionate, culturally safe, relationship centered care for First Nations, Inuit, Métis patients, their families and communities.
• Identify ATLS primary survey principles.
• Outline key treatment principles and associated investigations in the management of the polytrauma patient.
• Review the common findings seen on trauma-associated radiographs: chest x-ray, pelvis x-ray, and long bone x-rays.
• Identify risk factors in the trauma patient requiring DVT prophylaxis.
• Review the initial management of an open fracture treatment in the ER setting.
• Review risk factors for, and the management of, alcohol withdrawal in a hospital setting.
• Identify treatment resource issues within urban vs rural geographical regions in Canada.
• Review risk factors for suicidality and associated management including the use of the Form I of the Mental Health Act criteria and its implementation.
• Upon completion of this problem, the student should be able to develop an approach to congestive heart failure and atrial fibrillation in patients with chronic kidney disease and diabetes and recognize the burden of polypharmacy in the elderly.
• Review the pathophysiology of ischemic heart disease.
• Review the long-term complications of myocardial infarction.
• Review the anatomy of the coronary circulation and conducting system.
• Describe atrial fibrillation in relation to ischemic cardiomyopathy.
• Explain the effect of arrhythmia on cardiac function.
• Compare and contrast atrial fibrillation with 2 other common types of arrhythmias: nodal reentry, ventricular tachycardia.
• Explain the risk of thrombosis associated with irregular cardiac rhythm.
• Describe an approach to anticoagulation with attention to renal function.
• Describe various risk factors that influence the choice of anticoagulation (Bleeding vs Thrombosis).
• Develop an approach to multiple medications/polypharmacy (prescription and OTC), in the elderly and the concept of de-prescribing.
• Upon completion of this problem, students should be able to describe an approach to the management of chronic illness in a child with severe neurologic disease. Students should be able to describe an approach to the assessment of quality of life, goals of care and advanced care planning.
• Describe the classification, clinical features and common complications of cerebral palsy.
• Review the anatomy of each part of the alimentary tract from the mouth to the colon.
• Review the innervation and functions of the upper esophageal, lower esophageal (LES) and pyloric sphincters and describe the factors that might hinder motility.
• Explain gastrointestinal problems caused by delayed gastric emptying, abnormal autonomic control of gastrointestinal mobility, immobilization, inadequate oral intake, and prolonged colonic transit.
• Review the classification of seizures.
• Review the mechanism of action for the drugs that are frequently used in the treatment of seizures.
• Describe standard genetic tests for a person with developmental delay and the role of whole exome sequencing in complex cases.
• Upon completion of this problem, students should be able to discuss the assessment and management of the microvascular and macrovascular complications of diabetes. Students should be able to recognize the importance of an interdisciplinary team to manage complications of diabetes.
• Review the microvascular complications of diabetes including chronic kidney disease, retinopathy, and polyneuropathy.
• Review screening and management approaches for microvascular complications.
• Describe the nutritional and metabolic recommendations for chronic kidney disease patients, including diet to manage complications such as vascular disease, renal mineral and bone disorder and diabetic nephropathy.
• Identify the need to modify choice and/or dosage of medications in the face of declining renal function.
• Review the neuroanatomy of the lower limb.
• Describe the pathophysiology and inflammatory pathways resulting from chronic venous insufficiency.
• Identify peripheral vascular disease as a common complication of diabetes and describe the impact on healing potential for wound issues.
• Recognize how an interdisciplinary team can help manage a patient with complex chronic disease.
• Identify common barriers to resources and services to marginalized populations and isolated communities.
• Upon completion of this problem, students should be able to describe the pathophysiology of chronic respiratory failure and associated clinical decision-making with regard to organ transplantation and donation.
• Review the impact of chronic hypoxia on the cardiopulmonary circulation.
• Compare the pathophysiology of chronic respiratory insufficiency in cystic fibrosis and COPD.
• Describe the effect of hypoxemia on acid-base disturbance.
• Discuss how CF leads to susceptibility to lung infections by breaking down host defenses.
• Discuss interventions used to support individuals with acute and chronic respiratory failure including home O2, BiPAP, high flow O2, and intubation.
• Identify common types of organ transplantation.
• Describe the immunology of transplant rejection.
• Discuss pharmacology of anti-rejection medications, discussing their effects on the immune system.
• Outline how death is defined for the purposes of harvesting organs.
• Describe how to approach family members with a discussion regarding organ donation.
• Recognize ethical concerns surrounding consent for organ donation and different approaches to organ donation consent in Canada and around the world.
• Describe the various health care services that are delivered to First Nations peoples, and the historical basis for the systems as they pertain to these communities.
• Articulate how the medical, social and spiritual determinants of health and well-being for First Nations peoples impact their health.