Program Overview

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Course Plan for Clinical Medicine 2: Internal Medicine Specialization and Broadening

Version History

• VT25
• HT25

Basic Data

• Course Code: 2LA012
• Course Name: Clinical Medicine 2: Internal Medicine Specialization and Broadening
• Higher Education Credits: 25.5
• Education Form: Higher Education, 2007 Study Ordinance
• Main Field of Study: Medicine
• Level: G2 - Basic Level 2
• Grading Scale: Failed (U) or Passed (G)
• Course Responsible Institution: Department of Medicine, Solna
• Decision-Making Body: Established by: Program Board for the Medical Program
• Date of Establishment:
• Course Plan Applies From: Autumn Semester 2025

Special Eligibility

• Passed grade on all courses in Basics 1-6 and Medical Diagnosis with Basic Integration (terms 1-4). Passed grade on a Clinical Placement (VFU) moment in the course Clinical Medicine 1: Internal Medicine Orientation (term 5).
• A student who has failed a clinical placement (VFU)/equivalent due to showing serious deficiencies in knowledge, skills, or attitude that have risked patient safety or patients' trust in healthcare is eligible for a new VFU opportunity only after completing the individual action plan.

Objectives

The course has the overall objective that the student should deepen their knowledge, skills, and attitudes within the internal medicine area and broaden their knowledge and skills in infection, skin and sexual diseases, clinical pharmacology, geriatrics, and general medicine. Based on patients' symptoms and findings, medical management is discussed. The student should be able to identify, diagnose, initially assess, and manage common, acute, serious, and more complex conditions and, if necessary, use drugs in a purposeful way within internal medicine and related specialties. Throughout the course, students are trained to apply basic scientific and pathophysiological explanatory models and to adopt scientific, global, health-promoting, and equal treatment perspectives on the course content. Knowledge, skills, and practical exercise of the doctor's role in the care team are based on evidence-based treatment and person-centered care and are trained under clinical supervision with feedback. Skill training takes place with progression according to the model for nationally agreed Entrustable Professional Activities (EPA).

Learning Objectives

The course's learning objectives relate to the national objectives for the medical degree in the ordinance on higher education (SFS 1993:100). Learning objectives for knowledge and understanding are level-divided according to the SOLO taxonomy (S2-S5), and learning objectives for skill and ability are divided according to Miller's pyramid (M3-M4).

Knowledge and Understanding To pass the course, the student should be able to:

• Reason about common, acute, serious, and complex disease conditions based on symptoms and findings (S4)
• Describe principles for triage (S4)
• Recommend management and reason about related risks and benefits based on common comorbidities (S4)
• Account for principles for clinical decision-making and differential diagnostic reasoning (S4)
• Explain the application of active expectation, person-centeredness, and situational adaptation in management and decision-making, including adaptation in home care or other environments outside healthcare (S4)
• Account for basic principles for assessing functional impairment and activity limitation and exemplify possible rehabilitative measures in different situations and preventive measures in areas such as undernutrition, oral health, pressure ulcers, and falls (S3)
• Motivate the choice of diagnostic methods and examination performance and interpret them with a scientific attitude, as well as evaluate the methods' possibilities and limitations (S4)
• Account for strategies regarding the choice of drugs, including environmental impact and drug interactions, factors that affect adherence, and how side effects should be reported (S3)
• Account for basic principles of pharmacokinetics and pharmacodynamics and sources of drug information, pharmacoepidemiology, and phases of clinical trials (S3)
• Describe the doctor's role and responsibility in teamwork and the importance of interprofessional collaboration in the care of patients with comorbidities and complex disease conditions (S4)
• Account for principles for prioritization in care and equal care related to ethical principles (S4)
• Account for healthcare organization regarding division into care levels and distribution of responsibility and resources between state, regions, and municipalities (S3)
• Account for principles for referral, tools to facilitate collaboration, coordinated individual plan, and rehabilitation in geriatric care and nursing (S3)
• Account for laws, guidelines, and practices in connection with sexually transmitted infections and specifically related to vaccination, infection control, and healthcare-associated infections in a local and global perspective (S4)
• Account for environmental and sustainability work in healthcare (S4)

Skill and Ability To pass the course, the student should be able to:

• Take spontaneous anamnesis and targeted anamnesis and perform relevant status examinations, adapted to the current situation (M4)
• Investigate signs in anamnesis and status that may raise suspicion of violence in close relationships (M3)
• Compare normal findings, disease changes, and injuries on the skin and mucous membranes at different ages or pigmentation degrees (M3)
• Prioritize and motivate a working diagnosis among relevant differential diagnoses (M3)
• Draw up an initial investigation plan for common, acute, serious, and complex disease conditions (M3)
• Formulate an initial action plan, including discussing investigation results' reliability in relation to the method's properties and limitations (M3)
• Discuss investigation results with the patient, convey difficult news, formulate an action plan and follow-up, and perform pharmacological or non-pharmacological treatment in consultation with the patient (M3)
• Identify the need for and formulate preventive and health-promoting measures at the individual level (M3)
• Prescribe drugs based on the patient's conditions and needs (M3)
• Perform common medical procedures within the course's areas and interpret results (M3)
• Identify and prioritize patients with serious conditions in need of emergency care and perform primary care (M3)
• Independently, under supervision, use digital tools to gather information and correctly document patient-related information in electronic patient records, certificates, and referrals, as well as prescribe and dispense drugs (M3)
• Use digital tools, taking into account basic legal and ethical aspects when in direct or indirect contact with patients and relatives, using digital systems (M3)
• Work in interprofessional teams around patients and communicate patient information in a patient-safe manner within healthcare and with professions in social care and other parts of society (M3)
• Contribute to a safety culture in care by applying patient-safe communication (M3)
• Perform a drug review, write a drug report (M4), and formulate a report on drug side effects (M3)
• Collaborate in groups and contribute to other students' learning by being well-prepared, actively participating in discussions related to the course content, and using peer feedback as a tool for competence development (M4)
• Consider the patient's autonomy in investigation and treatment (M3)
• Treat patients, relatives, other students, teachers, and staff in a respectful and professional manner (M4)

Attitude and Judgment To pass the course, the student should be able to:

• Consider principles for equal treatment and equal care regarding, for example, disability, gender, and geographic and cultural background in encounters with patients, relatives, and staff
• Consider ethical principles and cost-effectiveness in relation to patient interventions in healthcare
• Problematicize one's own values, empathy, and a professional attitude in interaction with patients, relatives, and staff
• Evaluate one's knowledge needs in relation to the course's learning objectives and future professional role and be able to formulate goals for further competence development
• Act and behave judiciously and professionally in clinical and other learning situations

Content

Basic scientific and clinical knowledge, as well as clinical skills from previous courses, are applied and deepened both theoretically and in structured training in simulated clinical environments and during Clinical Placement (VFU). The focus is on deepening within internal medicine and rheumatology, in parallel with broadening within geriatrics and general medicine, clinical pharmacology, infectious diseases, and skin and sexual diseases, including sexual medicine. The focus is on clinical practical training within the course's clinical areas. Patient cases with symptoms and findings illustrate complex problem areas and comorbidities. In all areas, imaging diagnostics and clinical physiological examinations are included, and a general medical perspective is applied. The principle of person-centered good and equal care is permeating the course. The student should be able to reflect on how gender, age, psychosocial factors, functional variations, LGBTQI, geographic and cultural background can affect health and healthcare, as well as equal treatment and equal care. Decision-making and management are related to an introduction to the organization of care and reimbursement and control models with the support of basic health economic concepts. Reasoning about one's own stress reactions and their impact on care collaboration is also included. Integration also takes place by involving experts in adjacent medical areas and behavioral sciences, as well as in basic scientific subjects, such as physiology, pathology, and microbiology, when relevant. Interprofessional learning takes place through collaboration in multiprofessional care environments.

The course includes Clinical Placement (VFU) of varying scope and content, divided into two VFU moments. During these VFU moments, students deepen and apply knowledge and skills acquired earlier, mainly during the course Clinical Medicine 1, and broaden their knowledge within adjacent specialties. All students complete one week of VFU in emergency care, one week of VFU in rheumatology, one week of VFU in geriatrics, and one week of VFU in primary care, as well as two weeks of VFU in internal medicine care. The VFU periods include recurring case-based oral presentations in groups. Furthermore, the course includes Virtual Intercultural Learning (VIL) within moment 2 (infection) and moment 3 (skin and sexual diseases).

The course is divided into eight moments:

Complexity and Multimorbidity in Internal Medicine, 3.0 hp

The student acquires a deepened and broadened competence regarding the management of internal medicine conditions, focusing on differential diagnostic thinking and clinical decision-making in more complex conditions. The moment builds on knowledge and skills from previous courses, mainly from the course Clinical Medicine 1: Internal Medicine Orientation, and integrates basic scientific and pathophysiological explanatory models. The student should, during the moment, train and reflect on the management of unselected, complex, and/or multimorbid patients within internal medicine areas. Primary care is discussed based on care context, e.g., primary care, emergency department, and geriatric care. The teaching includes, in addition to theory, skill training, e.g., complex scenarios in simulated clinical environments. General medical perspectives are integrated, and practical interpretation of imaging diagnostics and clinical physiological examinations is included. The student should develop a solid background for understanding pathophysiology and a basic scientific attitude towards diagnostic methods, including how cognitive biases can lead to diagnostic errors. Furthermore, collaboration with other professions involved in patient care and nursing is highlighted. The student should also develop an understanding of the significance of the psychosocial situation.

Infection, 4.5 hp

The moment covers knowledge and skills relevant to the management of individuals with symptoms and findings that raise suspicion of or are due to acute and/or chronic infectious diseases. Particular emphasis is placed on knowledge of antibiotic resistance and limiting the spread of infection, both locally and globally. The moment includes infectious diseases from both specialist, general medical, national, and global perspectives, including infection epidemiology, where students should learn to identify and interpret risk factors at individual, group, and population levels. Differential diagnostic reasoning, choice of examinations, and measures are based on current evidence and explained based on basic scientific and pathophysiological explanatory models. The content is integrated with basic science but also with other specialties, such as surgery, orthopedics, and microbiology. The teaching includes theory, practical exercises, and 1.5 hp integrated VIL.

Skin and Sexual Diseases, 4.5 hp

The moment includes the areas of dermatology and venereology, including sexual medicine. Based on symptoms and findings, the student trains to conduct differential diagnostic reasoning, choose examinations, and measures based on current evidence and be able to explain their choices based on basic scientific and pathophysiological explanatory models. This area includes, among other things, inflammatory and autoimmune skin diseases, itching, cutaneous drug reactions, microbial and parasitic skin diseases, bone and pressure ulcers, benign and malignant skin tumors, global dermatology, including disease presentations at different skin colors, as well as sexually transmitted infections. The moment includes the management of skin and venereological conditions at different levels of care and international and sexual medicine aspects and LGBTQI perspectives. The teaching includes theory, practical exercises, and 1.5 hp integrated VIL.

Geriatrics and Clinical Pharmacology, 1.5 hp

The geriatrics part covers knowledge about biological aging, its impact on symptomatology, course, and effects of treatment of various diseases, as well as the value of a comprehensive assessment of the elderly patient, where medical, functional, psychological, social, and existential aspects are considered. This includes the elderly patient's diseases, complexity, treatment, and rehabilitation at different levels of care in interaction with various professions (geriatric teams). Furthermore, it covers what distinguishes many elderly or biologically aged patients from younger ones, particularly frailty, multimorbidity, undernutrition, and cognitive impairment, especially dementia. This moment includes an introduction to the management of the patient in the end-of-life phase and the principles of palliative care and basic palliative care. The clinical pharmacology part covers central principles for evidence-based and individualized pharmacotherapy. Being able to prescribe and dispense drugs to the greatest benefit for the patient and follow up on drug treatment is included. Clinical pharmacological principles, drug-related problems, critical evaluation of drug studies, and prescription rules are important sub-moments. General medical perspectives on aging and clinical pharmacology are included. The teaching includes both theory and practical exercises.

Clinical Placement (VFU) 1, 4.5 hp

Placement under supervision at a healthcare unit in inpatient care, in an outpatient/day care unit in regular open specialist care, or in student-adapted activities within the clinical internal medicine area or in adjacent specialties. Shorter observations/presentations on another unit or simulation in a clinical environment can be included. Students train to exercise their role as doctors in patient care and clinical diagnostic examinations of common, serious, acute, and more complex conditions within the area the unit focuses on. Emphasis is placed on anamnesis, status, differential diagnosis, decision-making, and prioritization of tasks, where students train to deepen their competence and ability to act more independently and on activities necessary for the professional exercise of the doctor's role in the care team. Examination (grading) of professional attitude in VFU takes place in this moment, through ongoing assessment based on the program's criteria.

Clinical Placement (VFU) 2, 4.5 hp

Placement under supervision at a healthcare unit in inpatient care, in an outpatient/day care unit in regular open specialist care, or in student-adapted activities within the clinical internal medicine area or in adjacent specialties. Shorter observations/presentations on another unit or simulation in a clinical environment can be included. Students train to exercise their role as doctors in patient care and clinical diagnostic examinations of common, serious, acute, and more complex conditions within the area the unit focuses on. Emphasis is placed on anamnesis, status, differential diagnosis, decision-making, and prioritization of tasks, where students train to deepen their competence and ability to act more independently and on activities necessary for the professional exercise of the doctor's role in the care team. Examination (grading) of professional attitude in VFU takes place in this moment, through ongoing assessment based on the program's criteria.

Application and Integration, 2.0 hp

The moment contains repetition and integration through self-study and reflection, a recurring group assignment with a case-based oral presentation that includes sustainability aspects in clinical activities, a summative OSCE, and a written examination. To participate in the written examination, at least 50% of the VFU must be completed.

Professional Attitude, Responsibility, and Learning, 1.0 hp

Teaching, training, and assessment of a professional attitude, responsibility, and learning take place throughout the course and specifically in connection with TBL, the Mentor Program, and the final submission with reflection on the student's own learning in relation to the course's learning objectives. Examination (grading) of professional attitude outside of VFU takes place in this moment, through ongoing assessment based on the program's criteria. Professional attitude in authentic clinical situations is assessed and graded in the VFU moments.

Work Forms

The course includes work-integrated learning (VIL) where theoretical education and clinical placement (VFU) are combined. Theoretical course content is taught mainly through team-based learning (TBL). In addition, the course includes lectures, seminars, simulations, skill training, case-based teaching, interprofessional learning, study visits, and group work, as well as reflection groups. During the course, the student collects material in their individual learning portfolio and reflects on their performances in relation to performances on previous courses.

Examination

• Complexity and Multimorbidity in Internal Medicine, 3 hp: Obligatory participation in team-based learning (TBL), seminars, teacher-led skill training, case-based teaching, and simulation.
• Infection, 4.5 hp: Obligatory participation in team-based learning (TBL), seminars, teacher-led skill training, case-based teaching, simulation, and diagnostic tests.
• Skin and Sexual Diseases, 4.5 hp: Obligatory participation in team-based learning (TBL), seminars, teacher-led skill training, case-based teaching, simulation, and skill training (diagnostics based on images).
• Geriatrics and Clinical Pharmacology, 1.5 hp: Obligatory participation in team-based learning (TBL), seminars, and case-based teaching.
• Clinical Placement (VFU) 1, 4.5 hp: Obligatory participation in clinical placement (VFU) and case-based oral presentations in groups. Ongoing assessment in VFU.
• Clinical Placement (VFU) 2, 4.5 hp: Obligatory participation in clinical placement (VFU) and case-based oral presentations in groups. Ongoing assessment in VFU.
• Application and Integration, 2 hp: Objective Structured Clinical Examination (OSCE), written examination, and oral presentation.
• Professional Attitude, Responsibility, and Learning, 1 hp: Obligatory participation in the Mentor Program and reflection groups. Ongoing assessment based on the program's criteria.

Other Regulations

• Language of Instruction: The language of instruction is Swedish, but teaching in English may occur.
• Learning Portfolio: Support for the student's development in various areas of competence is collected throughout the education in the student's individual learning portfolio.
• Scheduling: Scheduling during evenings and weekends may occur.
• Course Evaluation: Course evaluation is conducted according to Karolinska Institutet's guidelines.

Literature List and Other Teaching Materials

Mandatory Course Literature

• Internal Medicine, Dahlström, Ulf; Kechagias, Stergios; Stenke, Leif, Sixth edition: Stockholm: Liber, 2018 - 1046 pages
• Infection Medicine: Clinical Situations, Christensson, Bertil, Second edition: Lund: Studentlitteratur, [2022] - 370 pages
• Rorsman's Dermatology, Venereology, Rorsman, Hans, Tenth edition: Lund: Studentlitteratur, [2022] - 442 pages
• Clinical EKG Diagnostics 2.0, Jern, Sverker; Jern, Helene, Second edition of version 2.0: Ljungskile: Sverker Jern Education, 2017 - 264 pages
• Treatment Program for Region Stockholm: Acute Internal Medicine, Region Stockholm, 2024
• Treatment Program for Region Stockholm: Acute Heart Disease, Region Stockholm, 2022
• Janusinfo, Region Stockholm
• Wise List, Region Stockholm

Recommended Literature and Other Teaching Materials

• Harrison's Principles of Internal Medicine, Kasper, Dennis L.; Longo, Dan L.; Fauci, Anthony S.; Hauser, Stephen L.; Loscalzo, Joseph; Jameson, J. Larry, Twentieth edition: New York: McGraw-Hill Education, [2018] - 3528 pages
• Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine, Zipes, Douglas P.; Libby, Peter; Bonow, Robert O.; Mann, Douglas L.; Tomaselli, Gordon F.; Braunwald, Eugene, Eleventh edition: Philadelphia, PA: Elsevier, [2019] - xxviii, 2112 pages
• General Medicine, Hunskår, Steinar; Hovelius, Birgitta; Andersson, Christer, Second edition: Lund: Studentlitteratur, 2015 - 1102 pages
• Succeeding with Medicines, Böttiger, Ylva; Eliasson, Erik; Lindh, Jonatan, First edition: Stockholm: Studentlitteratur, 2014 - 156 pages
• The Geriatrics Book, Wahlund, Lars-Olof, First edition: Stockholm: Liber, [2020] - 407 pages
• Acute Geriatrics, Wisten, Aase; Brännström, Ingrid, Third edition, 2013 (revised 2024), Studentlitteratur
• Gastroenterology and Hepatology, Lindberg, Greger; Nyhlin, Henry, First edition: Lund: Studentlitteratur, 2016 - 331 pages
• Rheumatology, Klareskog, Lars; Saxne, Tore; Rudin, Anna; Rönnblom, Lars; Enman, Yvonne, Third edition: Lund: Studentlitteratur, [2017] - 481 pages
• Endocrinology, Werner, Sigbritt, Third revised and updated edition: Stockholm: Liber, 2015 - 528 pages
• Clinical Dermatology, Weller, Richard P. J. B.; Hunter, Hamish J.A.; Mann, Margaret W., Fifth edition: Chichester, West Sussex: Wiley Blackwell, 2015 - xi, 438 pages
• Rang and Dale's Pharmacology, Ritter, James, Tenth edition: Amsterdam: Elsevier, 2023 - 808 pages

In addition, course materials are provided, including references to current scientific publications and regional, national, and international guidelines, on the learning platform.