1 introduction

The Second Affiliated Hospital of Sun Yat-Sen University

Introduction ofInternal Medicine

Professor of CardiologyThe Second Affiliated HospitalSun Yat-sen University

Liu Pinming, M.D., Ph.D

Overview

• Concept• History• Progress in Internal medicine • Medical Education• The Way of Learning

– Establishing a high aim– Combining theories with Practices– Three basics: theories, knowledge, skills

• How to approach to a patient

What is Medicine

• Medicine is the art and science of healing. It encompasses range of health care practices evolved to maintain and restore health by prevention and treatment of illnesses

• Internal medicine is the medical specialty concerned with the diagnosis, management and mainly nonsurgical treatment of illnesses

• Internists/Physicians

Internal Medicine Subspecialties

• Respiratory Medicine• Cardiovascular

Medicine• Endocrinology• Gastroenterology &

Hepatology

• Hematology• Nephrology• Rheumatology

•Infectious Diseases•Oncology•Critical Care Medicine•Geruatrics

The Origins of Medicine • Early records on medicine: Ayurvedic medicine in the Indian

subcontinent ， ancient Egyptian medicine ， Traditional Chinese medicine, ancient Greek medicine, Islamic medicine

• As science and technology developed, medicine became more reliant on medications – Vaccines: Edward Jenner in 1796, Louis Pasteur in 1889 – Arsphenamine/Sulvarsan, Paul Ehilich, in 1908 – Insulin: discovered and isolated by Frederick Banting in

1921 – Penicillin ： discovered by Alexander Fleming in 1928 – Sulfa drug: 1932

• Shift from biomedical model to bio-psycho-social medical model– Biological factors – Broadly environmental factors

Why do people get sick?

Biomedical Model: • Exposure to infectious agents or pathogens• Immune response either sufficient or insufficient

Why else do people get sick?

• Previous exposure to virus• Health behaviors (sleep, nutrition, etc.)• Stress/emotions• Social relationships (support, conflict)

The Biopsychosocial Model

HEALTH

BIO PSYCHO

SOCIAL

HEALTH

BIO PSYCHO

SOCIAL

HEALTH

BIO PSYCHO

SOCIAL

The Biopsychosocial Model: Why do college students get sick?

HEALTH

BIO PSYCHO

SOCIAL

personality

emotions

social conflictsocial support

immune reaction to virus

previous exposure to virus

health behaviors

Shift from Experience-Based Medicine to EBM

“Evidence-Based Medicine is the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients. [In] practice, [this] means integrating individual clinical experience with the best available external evidence from systematic research.”

(Sackett et al., 1996. Evidence based medicine: what it is and what it isn't.BMJ, 312: 71-2)

Principles of EBM

Highest quality

Lowest quality

aims to apply the best available evidence gained from the

scientific method to medical decision making • So what is “best evidence”?

Evidence Based Medicine

• Best practice based on current knowledge– Formulate of the problem– Find the evidence– Critical evaluation of the evidence– Practical application– Evaluation of the results

• Evidence based and creative medicine

Progress in Internal Medicine

With the development of techniques in molecular

biology, cellular biology, genetics and immunology, etc

Etiology & Pathogenesis

Diagnostic

Management & Treatment

Timeline of Medicine (Technology)

• 1895 - medical use of X-rays in medical imaging • 1901 - the existence of different human blood types • 1903- Willem Einthoven, the invention of String galvanometer ECG• 1921 - Frederick Banting, the discover of insulin - the treatment of diabetes • 1927 - First vaccine for Tuberculosis • 1928 - Alexander Fleming discovers penicillin • 1929 - Hans Berger discovers human electroencephalography • 1943 - Willem Kolff build the first dialysis machine • 1958- an implantable pacemakerinvented at the Karolinska Institute, Sweden• 1960 - Invention of Cardiopulmonary resuscitation (CPR) • 1965 - Frank Pantridge installs the first portable defibrillator • 1965 - First commercial ultrasound • 1967 - Christiaan Barnard performs first human heart transplant • 1971 - Sir Godfrey Hounsfield invents the first commercial CT scanner • 1976 - First commercial PET scanner • 1877 – First PTCA for coronary artery disease perfromrd by Andreas Gruentzig• 1978 - Last fatal case of smallpox • 1980 - Raymond Damadian builds first commercial MRI scanner • 1981 - First vaccine for Hepatitis B • 1992 - First vaccine for Hepatitis A available

Internal Medicine

• Internal Medicine plays a vital role in clinical medicine

• Not only fundamentals to other clinical medicine subjects, but also closely related to them

• Mastering Internal Medicine well & laying a solid foundation

The Way of Studying Medicine

• Establishing a high aim

• Combining theories with Practices

• Three basics: theories, knowledge, skillsEverything you want to know about Internal Medicine-

and dare to ask

Learning Skills throughout Lectures

Diseased-Centered, Learner-Driven Focused on:• Etiology & Pathogenesis• Pathophysiology• Clinical Manifestations: symptoms, signs• Laboratory Findings & other Additional

testing• Diagnosis & Differential Diagnosis• Management Principles

Problem-based Learning

Characteristics:• Learning: driven by challenging, open-ended

problems • Students: in small collaborative groups • Teachers: the role as "facilitators" of

learning.

student-centered instructional strategy in which students collaboratively solve problems and reflect on their experiences

Problem-based Learning

Advocates of PBL claim it can be used to enhance content knowledge and foster the development of communication, problem-solving, and self-directed learning skill

Students are encouraged to take responsibility for their group and organize and direct the learning process with support from a tutor or instructor

Problem-based learning is widely used in many medical universities world wide

Doctoring Skills Rotation

Patient-Centered, Learner-Driven Focused on:• History taking and communications skills• Physical diagnosis• Real patients and patient simulation

technology• Decision-making skills• Life-long learning skills• Clinical teaching skills• Direct Feedback from Specially Trained

Teaching Faculty

SUMMARY

• The key to study internal medicine:– Care about what you are learning– Try your hardest at all that you do– Think and reason through things– Learn every day– Work as a team– Have fun

谢谢！

1 introduction

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