Clinical analysis of patients as a form of practical training with internship doctors at surgical dentistry.

State Institution “Dnipropetrovsk Medical Academy of Health Ministry of Ukraine”.

Department of Dentistry. Faculty of Postgraduate Education.

Boiko G.G.

Abstract. Clinical analysis of patients causes interest and activity of internship doctors during practical sessions, encourages their work with literature, develops their skill of disease management as well as expressing their views and opinions, helps to learn knowledge and skills.

Keywords: dental patient, internship doctor, clinical analysis, examination, diagnosis, treatment.

Modern system of education is a holistic system in which all types, forms and methods of teaching are reasonably combined, and in which the thinking of internship doctor, his ability to make an independent decision should have a prevailing and a definite role.

Educational process is an informational process, but the process of learning involves not only receiving the information, but also its processing, as well as checking its acquisition in practice. Yet, the issue of knowledge transferring remains less urgent than the ability to learn, the ability to receive knowledge.

Much emphasis in surgical dentistry is placed to problem-based teaching, which is based on creation of problem situations and tasks, which contain known and unknown material and require analytical and synthetic activities of internship doctors in the process of study. Problem-based teaching allows to individualize teaching process significantly, rendering it in the required amount and pace to each postgraduate student.

The role of problem-based teaching in surgical dentistry is particularly big because the majority of situations at the bedside always mean problems and tasks which sometimes involve missing information. However, despite this, they always require to be solved, because health or lives of patients depend on it. By teaching doctors how to solve specific problems we form their methods of thinking, practical skills and common ways to approach any task, as well as the ability to look for solutions in any kind of situation; not only do we try to deepen the knowledge of internship doctors in a theoretical plane, but we also provide them with necessary practical skills. Practical skills are acquired and reinforced through their active participation in the treatment of patients under constant supervision and participation of their teacher.

One of the forms of training the internship doctors to solve problem tasks, to learn how to think and then make decisions is a clinical analysis of patients during patient consultations and visiting hospitalized patients at profile department. The main objectives of clinical analysis are:

1. Identifying the main (primary cause) of disease.

2. A detailed study of pathogenesis, clinical picture and state of disease.

3. Introduction to methodology of diagnosis.

4. Understanding principles of treatment and prevention of disease.

Clinical analyses help to form doctors’ mentality and broaden their horizons. They require a more thorough study of patients, the analysis and synthesis of all clinical and laboratory investigations, work with literature on the subject.

In our department very much attention is paid to clinical analyses of the patients. They are one of the main forms of teachers work with internship doctors and masters. Particularly careful clinical analysis is carried out with patients who are admitted for planned and urgent surgical interventions. Methodology of the clinical analysis is as follows: internship doctor (or a group of internship doctors), responsible for the patient who is selected for analysis, under supervision of a teacher, gets carefully prepared for the clinical analysis, i.e. reads the latest literature on the subject, works on clinical history description, checks additional examinations for their completeness, prepares visual material.

Analysis begins with opening words of a teacher, who emphasizes the object and purpose of analysis in such a way that it should cause interest and activity of internship doctors. Then an internship doctor gives a detailed description of the patient’s medical history (the main points which could be relevant to the progression of disease), followed by a medical history of the very disease, trying to draw a parallel between them. For example, in cases of temporomandibular joint diseases great significance is attached to previous life situations that caused stress or a long period of depression.

After presenting a set of published data, a detailed medical history of the patient and the disease in progress, the teacher clarifies particular facts and invites the patient, or visit the patient in a ward, depending on the patient’s general condition.

Particular attention with internship doctors should be paid to the patient’s complaints, and these complaints should not only be heard by them but also sent to the right track. During such procedure the internship doctor must be very tactful, should not rudely interrupt the patient’s speech, and ask only probing questions, aiming at the basic facts of the complaints and clinical symptoms.

After clarifying the patient’s complaints, the clinical analysis supervisor and internship doctors carry out a thorough analysis of not only the local dental pathology, but the whole facial area: the parotid and submandibular areas, neck area, supraclavicular and subclavicular fosses in order to identify lymph nodes, presence of infiltrates etc. In case of presence of tumours or other changes, lymph node status must be checked also in the axillary, inguinal and other areas.

Then the doctors carry out inspection, palpation, instrumental examination of the face and the mouth cavity, interpretation of the results of analysis of the patient’s examination, if any. Based on the complaints of the patient, the collected medical history of the patient, progression of the disease and the objective data, the doctors form their initial vision of the patient; the internship doctors express their opinions, actively discuss the situation, but the main conclusion is made by their teacher. At this stage the alleged primary diagnosis is established.

At this stage internship doctors should name the list of diseases for which a differential diagnosis should be carried out.

At this very same stage, further tests are planned and basic stages of treatment are discussed.

Additional information from radiological, laboratory, biochemical and ultrasound examinations shall be addressed after the initial presentation of the patient. If examination data are available, after the speech of internship doctor the teacher carries out a thorough analysis of the available examination data.

The results of examinations are compared by internship doctors with clinical data; on the basis of this comparison they make correction in the preliminary diagnosis and establish the primary diagnosis, as well as the secondary one along with possible complications.

Taking into account the diversity of pathology in the maxillofacial area, especially presence of tumours of initially unknown aetiology, sometimes primary and final diagnoses are established during surgery or in the post-surgery period after obtaining histological conclusions.

Clinical analysis of patients who have tumours in maxillofacial area should be carried out taking into account the rules of ethics and deontology during discussion, consultation and in clinic. We prepare internship doctors for such situations prior to clinical analysis.

Internship doctors as well actively discuss the issues of patient treatment, which is based on a thorough and comprehensive analysis of pathogenesis of the disease. Internship doctors offer a specific treatment regimen, and each prescription is justified by a pathogenetic mechanism of the disease.

Once a treatment regimen is prescribed the doctors discuss prognosis of the disease, possible complications and the ways to prevent such complications. Issues of medical and labour examination are also discussed.

At the end of analysis (in absence of the patient), the teacher sums up, gives the final wording of diagnosis, emphasises the peculiarity of the given clinical case, clarifies treatment regimen and possible prognosis for the disease.

Thus, the main substance of clinical analysis is that the internship doctor learns to carry out a thorough analysis of the disease, logically establish the diagnosis, carry out differential diagnosis and prescribe reasonable pathogenetic treatment.

List of References

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