Medicine / Pedagogy
BOIKO H.H., ANISIMOVA L.A.
The State Establishment “
of the Ministry of Health of
Department
of Dentistry, Faculty of Postgraduate Education.
SPECIFICS OF PRACTICAL CLASSES IN
SURGICAL DENTISTRY
FOR MEDICAL INTERNS.
Specifics of training
specialists in surgical dentistry define a number of tasks to be faced by the
collective of the department, because there are not so many hours devoted to
surgical dentistry according to the program. Therefore, during this period it
is necessary to train medical interns, who have only basic knowledge, to
develop and improve their clinical thinking, first of all, and to be able to make
their own independent decisions as well.
Educational process is an
informational process; however, the process of learning includes not only
obtaining information, but also its processing, as well as checking the learned
material in practice. And yet, the topical issue is not the transferring of
knowledge, but rather the ability to learn, the ability to receive knowledge.
In surgical dentistry we
pay a lot of attention to problem-based learning, which is based on the
creation of problem situations, tasks that contain known and unknown material
requiring synthetic-analytical activity from medical interns, in the course of
a practical lesson. Problem-based learning makes it possible for us to
significantly individualize the training process, carry it out in the volume
and pace required for each medical intern. During a practical lesson in
surgical dentistry most situations occur at the patient’s bedside, and these
are always real problems, always real tasks which sometimes contain information
which is quite far from being called complete. However, despite this, they
always require solutions, because health or even life of patients depends upon
them. Therefore, by teaching a doctor to solve specific problems, we form their
way of thinking, their skills in practical activity and ways to approach any
problem, the ability to seek solutions in any situations; we try to deepen
their knowledge not only theoretically, but also to teach them necessary
practical skills. Practical skills are acquired and get fixed due to the active
work of medical interns in the treatment of patients under constant supervision
and with participation of their teacher.
One of the forms of training of medical interns during practical classes
in surgical dentistry is a clinical analysis of patients at a consultation
session or the patients hospitalized by a specialized department of surgical
dentistry. The main tasks of clinical analysis, which we set for a medical
intern, include the following:
1.
Identification of the main and
underlying cause of the disease;
2.
Detailed study of pathogenesis, clinical
picture of the disease;
3.
Acquaintance with the method of
diagnosis;
4.
Clarification of the principles of
treatment and prevention of the disease.
Clinical analysis helps to form medical thinking, broaden their horizons
and is one
of the main forms of the teacher’s work in the practical work with medical
interns. Especially careful attention is paid to analysis of a patient who was
admitted to routine or urgent surgery. Methodology for conducting clinical
analysis is as follows: an intern who supervises the patient, under the
guidance of a teacher, works on a detailed description of the patient’s medical
history, checks the availability of all the necessary laboratory and
biochemical test results, interprets them and expresses his (her) opinion on
which way of treatment to choose: conservative or surgical one. The analysis
begins with the introductory words of the teacher, which emphasizes the task
and purpose of analysis, in such manner that it should arouse the interest and
activity of medical interns. Then a medical intern presents a detailed anamnesis
of the patient’s life (basic moments, which would be relevant to the
development of the disease), then the anamnesis of the disease, trying to draw
a parallel between them. For example, in case of development of diseases of the
temporomandibular joint it is very important to reveal the situations that
happened in the patient’s life and caused stress or long-term depressive condition.
After the above literary
data, detailed anamnesis of life and disease, the teacher clarifies certain
facts and invites the patient or visit the patient’s ward if it is required by
the patient’s general condition.
Particular attention of
medical interns should be drawn to the patient’s complaints and the listeners
should not just listen to the patient, but rather guide him (her) in the right
direction. Medical interns should be very tactful: they do not abruptly
interrupt the patient’s speech, but rather make him (her) focus on the main
facts on clinical symptoms and complaints, by asking him (her) only guiding
questions.
After clarifying the
complaints, the supervisor of analysis together with medical intern conduct a
thorough analysis of not only local dental pathology, but also the entire face,
parotid, submaxillary and submandibular areas, neck area, over- and subclavian
pits in order to identify lymph nodes, the presence of infiltrates etc. In the
presence of tumors or other changes, the condition of the lymph nodes should be
also checked in the axillary, inguinal and other areas.
Then the examination, palpation, facial and oral tool examination,
examination of the results of the patient previous survey, if any, is performed.
Based on the patient’s complaints, collected anamnesis of his (her) life and
development of the disease and objective data the primary idea about the
patient is getting formed; medical interns express their opinions, actively
discuss the situation, but the main conclusion is made by the teacher. At this
stage, the suspected underlying diagnosis gets established.
At this stage, medical
interns should name the diseases, for which differential diagnostics is
required to be carried out. Additional data from X-ray, laboratory, biochemical
test and ultrasound survey should be named after the initial presentation of
the patient. If the patient does have the examination results, after a speech
of a medical intern, the teacher performs a thorough analysis of such available
survey data.
Medical interns compare these
data with clinical data and on the basis of this comparison introduce
corrections into the preliminary diagnosis and establish the main diagnosis, as
well the concomitant diagnosis and possible complications.
Taking into account the
variety of pathology in the maxillofacial area, especially the presence of
tumors of primarily unknown etiology, sometimes the main and final diagnosis
get established during a surgery period or in the post-surgery period after
histological conclusion.
It is necessary to perform
clinical analysis of patients who have neoplasms in the maxillofacial area,
taking into account the rules of ethics and deontology, no matter where it
takes place: in the classroom, during consultation or in the hospital. We
prepare our medical interns for this in advance, before the clinical analysis
is done.
Medical interns also
actively discuss the issues of patients’ treatment, which is based on a deep
and multifaceted analysis of the pathogenesis of the disease. Medical interns suggest
a specific treatment regimen, and each prescription should be substantiated by
a pathogenetic mechanism of a specific disease.
After the scheme of
treatment gets developed, medical interns discuss the prognosis of the disease,
possible complications as well as prevention of these complications. The issues
of medical and labor expertise also get discussed.
At the end of the analysis (no
longer in the presence of the patient), the teacher summarizes all the
information, gives the final formulation of the diagnosis, highlights the
peculiarity of the given clinical case, clarifies the scheme of treatment and a
possible prognosis of the disease.
Thus, the main content of a
clinical analysis is that a medical intern learns how to conduct a thorough
analysis of information about disease, logically establish the diagnosis and
prescribe evidence-based pathogenetic treatment.
The task of a teacher,
who knows his discipline perfectly, as a true expert, is to be able to teach a
young doctor the art of being a good clinician. Each particular patient is a
particular situation, and having theoretical knowledge medical interns will try
to use them in the treatment of the patient. Under the conditions of
independent work, along with the need to repeat the previously studied material,
medical interns come to a certain psychological state that makes them require
discovery and learning new knowledge and skills.
The teacher should require the medical interns to perform assignments, bring
up a humane attitude to the patients in them, and at the same time show respect
for the patients’ personality, help, open the prospect of growth, learn to
rejoice in successes, develop their positive features as doctors. During a
practical class the teacher should be a real mentor for his students, act in
such a way that a young doctor would not hesitate to ask questions in order to
get practical advice on examination and treatment of patients, and as well
personal questions, when making first steps as an assistant in surgical
interventions.
During practical classes
in surgical dentistry, medical interns study not only in a hospital
environment, but also in a polyclinic. The teacher should take into account
that patients at polyclinic not always willingly trust the young medical
interns, therefore it is necessary to show tactful, attentive and sensitive
attitude. Independent work with patients
under the guidance of a teacher calls for a young doctor’s sense of
responsibility, enhancing his (her) desire to learn and use his (her) skills in
synthetic-analytical thinking.
Under the conditions of
independent work, along with the need to repeat the previously studied
material, medical interns come to a certain psychological state that makes them
require discovery and learning new knowledge and skills.
The teacher should require the medical interns to perform assignments,
bring up a humane attitude to the patients in them, and at the same time show
respect for the patients’ personality, help, open the prospect of growth, learn
to rejoice in successes, develop their positive features.
Under the conditions of independent work, along with the need to repeat
the previously studied material, medical interns come to a certain
psychological state that makes them require discovery and learning new
knowledge and skills.
The teacher should require the medical interns to perform assignments,
bring up a humane attitude to the patients in them, and at the same time show
respect for the patients’ personality, help, open the prospect of growth, learn
to rejoice in successes, develop their positive features as doctors.
LIST OF REFERENCES
1. Glazunov O.A.
Principles of the Bologna Process in Integrated Teaching Dental disciplines at
the Department of Dentistry, Faculty of Postgraduate Education, Dnipropetrovsk
State Medical Academy / O.A. Glazunov // In the book “Achievements and
Prospects in Postgraduate Education”, devoted to the 35th
anniversary of the Faculty of Postgraduate Education of Dnipropetrovsk State
Medical Academy. – 2008. – P.24.
2. Gordiiuk M.Ì.
Organization of educational process with medical interns at the Department of
Dentistry of the Faculty of Postgraduate Education / M.Ì. Gordiiuk, H.H. Boiko // Materials
of the scientific and practical
conference “Theoretical and clinical aspects of medical-social examination and
rehabilitation”, devoted to the 30th anniversary of the Department of Medical and Social
Expertise.
3. Timofeev A.
A. Independent work of students /
A. A. Timofeev,
S.V. Vitkovskaya, S.V. Maksimcha // Modern
dentistry. – 2009. - No 1. – P. 143-145.
4. Gromov O.V.
Information technologies in the educational process: Problems, prospects of
development (invitation to discussion) / O.V. Gromov, R.A. Kotelevsky // Modern
dentistry. -2010. – No.5.-P. 108-110.