Universitat Internacional de Catalunya
Appropriate Use of Diagnostic Tests
Teaching staff
Students may ask lecturers questions at the end of each class. For enquiries outside of class time, students must make an appointment by email:
Dr. Esteve Largués ellargues@uic.es
Dra Elena Vargas Vilardosa: evargas@uic.es
Dr Juan José Sánchez Fernández: jjsanchez@uic.es
Dra María Dolores Cocho Calderón: dcocho@uic.es
Dra Paloma Puyalto De Pablo: ppuyalto@uic.es
Dr Emilio Miguel Gené Tous: emgene@uic.es
Introduction
The course will provide the student with the knowledge for the correct indication and use of diagnostic tests (DT) in clinical practice.
The DT have contributed to great advances in medicine by making available to the physician sensitive and specific information of great help in the diagnosis. The imaging tests provide a very precise degree of anatomical detail, fundamental for clinical and therapeutic decisions.
The indication of the DT should be made based on the clinical reasoning generated by the careful study of the patient, observation and physical examination. The doctor must know how to use the DT with criteria and moderation and assess whether the results will modify the treatment or benefit the patient.
You have to know the information provided by each of the DT, as well as their limitations and possible harm to the patient.
Pre-course requirements
To have passed the following subjects:
- Semiology and Physiopathogenesis
- Biochemistry
Objectives
To learn the indication and assessment of DT in clinical practice.
Specific objectives:
1. To know the theoretical foundations of the tests / complementary explorations.
2. To know the indications of the DT. Place the DT as a support tool in the diagnostic and therapeutic aspects of the clinical history and patient care.
- To know the indications of the different DT.
- To know the information that can contribute and the limitations of the exploration.
- To evaluate the efficiency of each exploration.
- To recognize the importance of searching for the best evidence.
- To know sensitivity and specificity of each exploration.
- To know how to interpret the results of the tests and the correlation with the clinic.
3. To know how to inform the patient.
- To offer information to patients about the explorations to be performed.
- To obtain written informed consent.
4. To know the conditions of the tests.
- To assess the suitability of the treatment according to the patient's situation.
- To assess the limitation of the diagnostic - therapeutic effort.
- To know the limitations and contraindications of the DT.
- To know adverse and secondary effects of DT.
Learning outcomes of the subject
The student plans the study of DT (indication, priority and staging by complexity) based on clinical reasoning and differential diagnosis.
The student knows the DT, informs the patient of the risk - benefit that they entail, and asks for informed consent.
The student values the information provided by the test and makes a critical contrast with the clinic.
Syllabus
The focus of the subject will be directed to the following areas of knowledge:
- The study and therapeutic approach of systems
Cardiovascular
Respiratory
Digestive - hepatobiliary
Neurological
Nephro - urological
Endocrinology - metabolism
Haematological and coagulation disorders
Infections
Locomotor
- The study of symptoms and syndromes
Sdr. Febrile. Fever of unknown origin
Chest pain
Abdominal pain
Headache
Dorsal and neck pain. Low back pain
Arthralgia and arthritis
Sdr. Constitutional
Sdr. Polyadenopathic
Sdr. Confusional
|
Modalitat |
Tema |
Professor/a |
|
CM |
El procés diagnòstic i l’elecció de PD- I. |
E. Llargués |
|
CM |
El procés diagnòstic i l’elecció de PD - II. |
E. Llargués |
|
CM |
Estudi en infeccions i de l’aparell locomotor: aportació de les PD |
E. Vargas |
|
MC |
Sdr. Febril. Febre d’origen desconegut. Sdr. Constitucional. |
E. Vargas |
|
MC |
Lumbàlgia. Artràlgies. Artritis. |
E. Vargas |
|
CM |
Estudi de l’aparell cardiovascular: aportació de les PD. |
E. Llargués |
|
CM |
Estudi de l’aparell respiratori: aportació de les PD |
E. Llargués |
|
MC |
Hipòxia i cianosi. Tos. Hemoptisi. Dolor en punta de costat. |
M. Rodríguez |
|
MC |
Diagnòstic per la imatge en el tòrax.- |
L. Esteba |
|
LH |
Estudi de dolor toràcic. |
E. Llargués |
|
ABP |
Dolor toràcic. Dispnea. |
C. Tolosa |
|
CM |
Estudi de trastorns hematològics i de coagulació: aportació de les PD. |
E. Llargués |
|
MC |
Sdr. Anèmica. Policitèmia. Adenopaties. |
C. Tolosa |
|
MC |
Edema. Rash cutani. Sdr confusional, deliri. |
E. Vargas |
|
CM |
Estudi del sistema neurològic: aportació de les PD. |
G. Figueras |
|
MC |
Cefalea. Meningisme. Alteracions motores i sensitives. Mareig. Vertigen. |
G. Figueras |
|
MC |
Diagnòstic per la imatge en el crani. |
L. Esteba |
|
CM |
Estudi de l’aparell digestiu - hepatobiliar: aportació de les PD |
E. Gené |
|
MC |
Dolor abdominal. Sdr. Ictèrica. Ascites. Hemorràgia digestiva baixa i alta |
E. Gené |
|
MC |
Disfàgia. Dispèpsia. Nàusea – vòmits. Sdr. Diarreica. Restrenyiment. |
E. Gené |
|
MC |
Diagnòstic per la imatge en l’abdomen |
L. Esteba |
|
CM |
Estudi de l’aparell nefro – urològic i reproductor: aportació de les PD. |
E. Vargas |
|
CM |
Estudi de endocrinològic: aportació de les PD |
E. Llargués |
- Laboratory of skills
- Study of chest pain
Dr. Esteve Llargués
- Virtual Lesson
Dr. Esteve Llargués, Dra. Paloma Puyalto
Teaching and learning activities
In person
The master class is the scenario in which a teacher transmits knowledge in a classroom to the whole group of students. The format, however, allows the introduction of activities in small groups within the classroom and the development of strategies that encourage the active participation of students.
Script:
Approach to the major clinical syndromes of the system (reason for study)
• List of complementary tests that are used for the study of the organ / system
- Structural study tests - Structure of the apparatus - system
- Functional study tests - Function of the device - system
- Structural and functional study tests
- Other diagnostic tests.
• List of the main syndromes that are presented for study and that will be presented in the class, is part of the script of the class.
• Study process based on the differential diagnosis of a specific clinical / syndromic situation.
• What tests do we use and in what order / priority ?. Argumentation, to what the priority obeys.
• Expected results of the tests. Contrast results of complementary tests with the patient's clinic: interpretation of results in the clinical context, false positives, false negatives, ...
The case method consists of the process of solving clinical cases or those specific to the profession. They are activities in groups that are resolved with the active participation of the teacher after the students' deliberation.
The teacher defines the learning objectives he wants the students to achieve.
Clinical cases. Process of analysis of the clinical information of the case. Development of the differential diagnosis. Development of the study process of a specific clinical - syndromic situation through diagnostic tests
Problem-based learning has similarities to the case method but differs in that students are held responsible for finding the solution to the problem. The teacher acts as a tutor that facilitates the learning process based on their metacognitive abilities. It is developed in small groups.
The skills laboratory is an area in which the student can basically develop communication and physical examination skills based on mannequins and clinical cases. They are developed with small groups.
Evaluation systems and criteria
In person
Evaluation, Academic Integrity, and Exam Conduct Regulations
Applicable to any evaluable activity.
Conduct contrary to academic integrity, electronic devices, recording, use of AI, etc.
Conduct contrary to academic integrity may lead to the cancellation of the test, a failing grade in the activity or subject, and the impossibility of retaking the test. Furthermore, the facts may result in the opening of the corresponding disciplinary procedure. The conduct provided for in these regulations will be sanctioned in accordance with the current regulations on co-existence and disciplinary regime of the Universitat Internacional de Catalunya.
Final Course Grade
To pass the subject:
FIRST EXAM SESSION (MAY / JUNE)
To pass the subject, the student must pass the exam (minimum grade of 5) and reach a minimum grade of 5 in Formative Activities* (Skills Lab, PBL, Midterm Exams, Lesson).
MIR-style multiple-choice exam. 4 options to choose from:
Correct answer: +1 point
Incorrect answer: -0.33 points
Formative Activities Grade (Weighting of grades):
Skills Lab - PBL and faculty assessment
Midterm exams grade
Lesson
Absent / Non-attendance = 0
Attending PBL or Skills Lab having changed groups without a swap with another student will be penalized, resulting in a maximum grade of 5. The group change must have been communicated to and accepted by the course coordinator.
You pass the subject if both grades (exam + formative activities) are at least 5. They will be weighted as follows:
|
Evaluation and Weighting |
Percentage |
|
Multiple-choice exam (1st session) |
65% |
|
Skills Lab - PBL and faculty assessment |
20% |
|
Midterm exams grade |
10% |
|
Lesson |
5% |
|
Total |
100% |
|
Summative Assessment: OPTIONAL (See corresponding section below. This score will only be obtained in the 1st session if the exam grade and formative activities grade, separately, are both at least 5) |
+10% |
Honors (Matrícula de Honor): The final grade of the subject will be assessed (always minimum 9), along with the results of the formative activities and the summative assessment.
Any other situation (exam grade below 5 and/or Formative Activities below 5) goes to the second exam session.
SPECIAL SITUATIONS:
Failing the Exam or Formative Activities in the 1st Session:
1. EXAM – First Session (May / June)
If the exam grade in the 1st session is between 4.5 and 4.99, it will be averaged with the Formative Activities grade if the Formative Activities grade is at least 7.5.
If the exam grade in the 1st session is between 4.5 and 4.99, and the Formative Activities grade is below 7.5, the student goes to the 2nd session.
If the exam grade in the 1st session is below 4.5, the student goes to the 2nd session.
2. FORMATIVE ACTIVITIES – First Session (May / June)
If the Formative Activities grade is below 5 and the exam grade is at least 7, the weighting in the 1st session will be:
|
Evaluation and Weighting |
Percentage |
|
Multiple-choice exam (1st session) |
40% |
|
Formative Activities |
60% |
|
Total |
100% |
To pass, the "Total" must be at least 5; otherwise, the student goes to the second session.
If the Formative Activities grade is below 5 and the exam grade is below 7, the student must take the 2nd session exam.
If the Formative Activities grade is below 3, see the second exam session rules.
Any personal situation of a student that prevents them from attending classes and formative activities will be taken into account if it is an isolated situation and the professor in charge is notified.
SECOND EXAM SESSION
If the Formative Activities (Skills Lab, PBL, Midterm Exams, Lesson) have a grade equal to or greater than 5, to pass the subject, the exam grade (2nd session) must be a minimum of 5.
Weighting:
|
Evaluation and Weighting |
Percentage |
|
Multiple-choice exam (2nd session) |
65% |
|
Skills Lab - PBL and faculty assessment |
20% |
|
Midterm exams grade |
10% |
|
Lesson |
5% |
|
Total |
100% |
If the Formative Activities grade in the 1st session is below 5, the student must complete the Summative Assessment assignment (if the assignment meets all requirements, oral exam will be taken, the Formative Activities grade will be maximum 5) and pass the 2nd session exam (with a minimum grade of 5).
If the Formative Activities grade in the 1st session is below 3, the student must complete the Summative Assessment assignment(if the assignment meets all requirements, oral exam will be taken, the Formative Activities grade will be maximum 5) and pass the 2nd session exam with a minimum grade of 8.
If the Formative Activities grade in the 1st session is below 2, the student must complete the Summative Assessment assignment (if the assignment meets all requirements, oral exam will be taken, the Formative Activities grade will be maximum 5) and pass the 2nd session exam with a minimum grade of 8.5.
Weighting when Formative Activities in the 1st session is under 5:
|
Evaluation and Weighting |
Percentage |
|
Multiple-choice exam (2nd session) |
50% |
|
Formative Activities (Maximum grade: 5) |
50% |
|
Total |
100% |
If the exam grade in the 2nd session is between 4.5 and 4.99, it will be averaged with the Formative Activities grade if the Formative Activities grade is at least 7.5.
If the exam grade in the 2nd session is between 4.5 and 4.99 and the Formative Activities grade is below 7.5, the student fails the session.
Maximum grade in the 2nd session: 7
Maximum grade in the 2nd session if Formative Activities are between 3 and 4: 6
Maximum grade in the 2nd session if Formative Activities under 3: 5
Repeating students must contact the professor in charge of the subject at the beginning of the semester to evaluate possible credit transfers/convalidations for Formative Activities from the previous academic year.
Any personal situation of a student that prevents them from attending classes and formative activities will be taken into account if it is an isolated situation and the professor in charge is notified.
Sumative Assessment - VOLUNTARY - : Moodle query
Bibliography and resources
Longo, Fauci, Kasper, Hauser, Jameson, and Loscalzo, Eds. HARRISON’S PRINCIPLES OF INTERNAL MEDICINE INTERNA. 18th Ed. McGraw Hill, 2011.
Rozman C., Cardellach F. Farreras: MEDICINA INTERNA 16º edición. ELSEVIER ESPAÑA, S.A. 2008.