The aim of the 9th semester curriculum is to prepare the students for work in disease prevention, as well as to give the students the necessary skills for assessing, maintaining and improving:
- health in children and adolescents
- the health of the male and female genital tract
- health in fertile individuals before, during and after pregnancy, including delivery and breast-feeding
- the health situation in the pre-, peri- and postmenopausal years
Medical personel face these challenges in various situations: at the mother-and-child health care centers (helsestasjoner), in schools, at work, in a doctor`s practice, on call and in society in general. The first step in achieving the required skills is to study the following areas: Anatomy and Physiology of the Reproduction Systems, Gynaecology, Obstetrics, Pediatrics and Child Psychiatry. The intention this semester is to provide a platform for continuous lifelong learning. Throughout the semester we hope to engage the students’ interest in the subjects taught and to inspire some students to do research on health and disease in these areas.
Learning goals
The genital system
Normal Anatomy and Physiology:
Macroscopically:
- The structure of the female and male genital tract and the important practical relations of the pelvic bones, joints and ligaments, pelvic floor and viscera.
- The abdominal cavity and the relation between the peritoneum and the pelvic structures in both genders.
- The superficial anatomy of the pelvis and its function as the birth canal.
- The main features of the organogenesis of the genital tract, especially the development of malformations.
- The blood supply, lymphatic drainage and innervation of the pelvis.
- The structure and function of the placenta.
Microscopic structure and function of:
- The testis, epididymis, ductus deferens, prostate, urethra, penis, vagina, vulva, ovaries, uterus and fallopian tubes.
- The endometrium and cervix, including hormonal changes during the menstrual cycle.
- The placenta: development, umbilical cord and membranes.
- The breasts and the changes during lactation.
Physiology and Biochemistry:
- physiological mechanisms related to the menstrual cycle, sexual activity, pregnancy, menopause and ageing (in both genders)
- the physiology, biochemistry, endocrinology and pharmacology of reproduction applied to clinical work: analytical endocrinology (pituitary gland/sex hormones/adrenal glands).
- To know and understand the different blood tests used in assessing the function of the gonads and pituitary gland.
Reproductive Pathology
- Knowledge of the most important defects and changes associated with male and female infertility
Obstetrics and Gynaecology
The student will learn to combine theoretical knowledge with practice in a primary care setting and to collaborate with the hospital based maternity units (both in- and out-patient units) in the management of patients. The objective is to gain a sense of reflection on ethical issues in obstetrics and gynaecology in order to:
- respect a patient’s choice in difficult ethical situations
- respect a woman’s right to self-determination
- treat women with compassion and respect regardless of background
- ensure empathy towards women with regards to a gynaecological examination
- understand the importance of objective information to a woman and her family
The student shall acquire knowledge about:
- the normal physiological changes in pregnancy and post partum
- complications in the pregnancy and what conditions require referral to a specialist unit
- the normal birth
- complicated/pathological birth
- pathological conditions after birth
- medication in pregnancy
- breast feeding
- medication in breast feeding
- oestrogen substitution in menopausal and elderly women
- vaginal bleeding disorders, diagnostic tests and treatment
- gynaecological infections, diagnostic tests and treatment
- benign tumors of the genital tract
- the different types of gynaecological cancers and their treatment
- causes of pelvic pain and problems related to sexual dysfunction
- causes of infertility and the main diagnostic tests and treatment
- diagnosing genital descent (uterovaginal prolapse)
- causes of urinary incontinence and various methods of treatment
- to know the most important morphological changes in the most usual gynecological diseases and diseases related to pregnancy and birth (infections, tumors, vaginal bleeding disorders, trophoblast diseases and placenta dysfunction, infertility pathology including relevant conditions in men)
- understand the causality between morphological changes and the characteristics of the symptoms, etiology, pathogenesis and prognosis of the disease
- to perform a critical review of an autopsy report, assess histopathological and cytological test results
- understand the different views and ethical issues in the debate on the Norwegian abortion law (abortion on request)
- know the ethical approaches tied to prenatal diagnostics and selective abortion
- know the ethical approaches tied to modern reproduction technology
Practical skills.
The student shall acquire practical skills to be able to:
- instruct patients on birth control and sterilization
- inform women who apply for abortion
- perform a gynaecological examination ( both inspection and exploration )
- identify signs of genital infections and perform relevant tests
- take a cytological sample from the cervix
- insert and remove an IUD
- perform a check-up on women using a pessary because of uterovaginal prolaps
- understand and use Helsekort for gravide
- perform pre and antenatal care
- judge the size of the pregnant woman’s uterus and measure from the symphysis to the fundus of the uterus (SF-m?l)
- palpate the fetal position (Leopolds/Pawliks h?ndgrep)
- count the fetal heart rate using a midwife stethoscope
- guide mothers who have problems breast feeding
- examine and estimate the cervical effacement and dilatation of a woman in labour
- be able to assist a normal birth
Pathology
- The student shall be able to: identify the organ manifestation of the most frequent genital diseases, using microscopic and macroscopic examination methods
- know and explain the most important morphological changes observed in the most commen diseases of the vulva, vagina, cervix uteri, endometrium, myometrium, Fallopian tubes, ovaries and placenta
- explain the connection between morphological changes and the symptomatology of different diseases, as well as know their etiology, pathogenesis and prognosis
- perform a critical review of an autopsy report and assess histopathological and cytological test results
- recognize and describe the morphological, macroscopic and histological changes in the most common pathological conditions in the female abdomen
Pediatrics and Child Psychiatry
The aim of this course is to aquire the skills and qualifications needed to work in the field of Children`s Health. This includes knowledge of physical and mental development in normal children as well as prevention, curative treatment and the social aspects of Pediatrics. Together with a respectful attitude, these skills will benefit the child, her/his family and society. We also hope this will encourage further studies, permanent interest and perhaps interest in doing research in this field.
- The course is a standardized basic education for all doctors regardless of what specialization they choose later.
Required skills:
- to evaluate the growth and development of the normal child, both physically and mentally.
- to contribute to the prevention of diseases, malnutrition, injuries, child abuse and neglect.
- to diagnose disease, anomalies and deviations from the expected development.
- to recognize symptoms and signs of serious illness and to initialize intervention and treatment
- to stabilize a child`s vital functions on the scene and during transport
- to start and follow up medical treatment in the most common diseases in the child and adolescent years
- to organize and coordinate intervention and health services for children and adolescents with chronic illnesses, conditions and disabilities in the community, while maintaining a holistic and familiar perspective
Content:
To aquire and develop an attitude that:
- ensures empathy with ill children and their life situation.
- shows the child and family respect regardless of the type of disease or problem.
- considers the child and family as active collaborators in the treatment and problem solving process.
- makes the student able to pass on medical information in a open minded and reflective way.
- whenever help is needed it is actively sought out.
Knowledge
Growth and development.
Objectives: The students should be qualified in these areas:
- basic knowledge about normal growth and development
- collecting and selecting data about a child`s development and independently draw conclusions from this information
- assessing a child`s state of nutrition
- estimating nutrition requirements in different age groups as well as with special childrens` diseases and this need is to be dealt with
Prophylactic Pediatrics.
Objectives: The students should know:
- the importance of preventive health care for children, families and the society
- how preventative health work oriented towards children is organized
- the most important physical, psychological and social risk factors for the child`s and family`s health
- the vaccination program, contraindications and side effects of vaccines
Curative Pediatrics
Objectives: The students should know:
- how to detect, examine and treat children in life-threatening situations(emergency Pediatrics) (see special course in the 12. semester)
- how to examine a newborn
- the main principles in Adolescence Medicine
- the pathogenesis and pathophysioogy of common and important diseases in children
- how to diagnose and ananage common and important diseases in children
The students should recognize the symptoms and signs as well as knowing the treatment guidelines for:
- diseases and injuries in the CNS
- upper and lower respiratory tract diseases
- gastrointestinal diseases
- diseases in the kidneys, urinary tract and genital tract
- heart and circulatory failure
- diseases of the blood, blood-forming organs and the coagulation system
- immunological diseases
- cancer in children
- hormonal and metabolic diseases
- bone, muscle and skeletal diseases
Pathology
The students should:
- know and be able to explain the most important morphological changes observed in the most important diseases in the infant, toddler and child years.
- be concerned with the reasons for perinatal diseases and death, tumors, inflammations, degeneration and congenital malformations.
- be able to explain the connection between morphological changes and the symptomatology of different diseases, ethiology, patogenese and prognosis (if possible).
- know how to perform a critical review of an autopsy report, assess histopathological and cytological test results.
- recognize and describe the morphological, macroscopical and histological changes in the most common pathological conditions in the infant, toddler and the older child.
Child Psychiatry
The student should know:
- the psychological and social aspects of chronic illness in childhood.
- age specific difficulties and psychiatric disorders.
- emotional disturbances with childhood-onset (F93 in ICD-10), such as separation anxiety, social phobia and sibling rivalry.
- disturbance of social functions (F94) with childhood-onset, specially the reactive or unspecific attachment disorders.
- tics disorders (F95)
- signs of abuse and neglect in children and adolescents.
- available offers from Barnevernet and other initiatives for chronic ill and disabled children and adolescents.
Clinical skills
The student must develop skills in:
- cooperating with the child and family.
- obtaining a problem oriented medical history.
- performing a physical and psychomotorical examination at different ages.
- assessing a child`s general condition.
- assessing a child`s fluid balance.
- judging fontanels and sutures.
- judging the red reflex using a ophtalmoscope.
- using an otoscopye.
- inspecting the oral cavity and throat using a spatula and lamp.
- using percussion in examining the thorax.
- using the stethoscope in examining the lunges (assisted stethoscopy).
- using a stethoscope and palpation in examining the heart.
- palpating peripheral pulses and measuring the bloodpressure.
- examining the abdomen using palpation, percussion and stethoscope.
- examining the genital organs.
- triggering primitive reflexes.
- testing the muscle tonus and traction.
- testing sight and hearing as well as assess speech development.
- testing fine and gross motor skills.
- triggering deep tendon reflexes.
- measuring head circumference, plot growth curves, and assess puberty.
- estimating hip abduction, columna and foot deformities.
- capillar blood drawing.
- vaccination.
- administration of intravenous injections, spinal punction.
- measurement of the body temperature.
- how to administer medication at various ages.
Pharmacology and related areas:
- pharmacology and endocrinology of reproduction and their application in clinical situations.
- sex-hormones and contraceptives
- drugs affecting uterine motility
- antihypertensive drugs used in pregnancy
- drugs in pregnancy
- drugs during breastfeeding
- hormonal replacement therapy
- drug treatment of infections in gynaecology
- cytotoxic drugs for gynaecologic cancers
- pharmacological aspects of urinary incontinence
The fundamentals and principles of the drug treatment of disease in children and adolescents:
- in the central nervous system
- in the respiratory tract
- in gastrointestinal tract
- in the kidneys, urinary tract and genital organs
- in the cardiovascular system
- in the blood and hemopoieticorgans
- related to hormones and metabolism
Drug prescription
The student must know:
- the regulations that concern drug prescriptions and the different prescription classes (A, B, C).
- how to fill out the different types of prescriptions.
- the most important regulations on repayment of expenses for vital medication (“bl? resept”).
- where to find information on the prescription group a medication belongs to and if it can be prescribed on “bl? resept”.