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: 2LA014
• 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 Department: Department of Clinical Science and Education, Södersjukhuset
• 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 the entire courses Basics 1-6 and Medical Diagnosis with Basic Science 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 such serious deficiencies in knowledge, skills, or attitude that patient safety or patients' trust in healthcare is at risk is eligible for a new VFU opportunity only when the individual action plan has been completed.

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, as well as to apply 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 degree ordinance within the Higher Education Ordinance (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
For a passed 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 situation adaptation in management and decision-making, including adaptation in home care or other environments outside healthcare (S4)
• Account for basic principles for assessing disability and activity limitation and exemplify possible rehabilitative measures in different situations and preventive measures in terms of 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 possibilities and limitations of the methods (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 for pharmacokinetics and pharmacodynamics and sources of drug information, drug epidemiology, 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 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 diseases 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
For a passed course, the student should be able to:

• Take spontaneous anamnesis and targeted anamnesis and perform relevant status examination, 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 levels (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 reasoning about the reliability of investigation results 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 obtain information and correctly document patient-related information in electronic patient records, certificates, and prescriptions, as well as prescribe and prescribe 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
For a passed 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 meeting with patients, relatives, and staff
• Consider ethical principles and cost-effectiveness in relation to patient interventions in healthcare
• Problematic own values, empathy, and a professional attitude in interaction with patients, relatives, and staff
• Evaluate their own need for knowledge in relation to the course's learning objectives and future professional role and be able to formulate goals for their continued 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 a simulated clinical environment 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 diagnostic and clinical physiological examinations are included, and a general medical perspective is applied. Exercising the medical profession based on the principles of person-centered good and equal care is a recurring theme throughout the course. The student should be able to reflect on how gender and gender, age, psychosocial factors, functional variations, hbtqi, 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 the impact of stress 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 Patient 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, with a focus 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, also skill training, e.g., complex scenarios in a simulated clinical environment. General medical perspectives are integrated, and practical interpretation of imaging diagnostic 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 care and nursing of patients is highlighted. The student should also develop an understanding of the importance 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 limitation of infection spread, 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 and practical exercises, as well as 1.5 hp integrated Virtual Patient Learning (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, leg 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 care levels and international and sexual medicine aspects and hbtqi perspectives. The teaching includes theory and practical exercises, as well as 1.5 hp integrated Virtual Patient Learning (VIL).

Geriatrics and Clinical Pharmacology, 1.5 hp

The geriatrics submoment 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 care levels in interaction with various professions (geriatric teams). Furthermore, what distinguishes many elderly or biologically aged patients from younger ones, especially frailty, multimorbidity, undernutrition, and cognitive impairment, particularly dementia, is covered. This submoment includes an introduction to the management of the patient in the end-of-life and the principles of palliative care and basic palliative care. The clinical pharmacology submoment covers central principles for evidence-based and individualized pharmacotherapy. Being able to prescribe and prescribe 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 submoments. 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 care unit in inpatient care, in an outpatient/ daytime unit in regular open specialist care, or in student-adapted activities within the clinical internal medicine area or in adjacent specialties. Shorter auscultations/case presentations at another unit or simulation in a clinical environment can be included. Students train to exercise their doctor's role in patient care and clinical diagnostic examinations of common, serious, acute, and more complex conditions within the area that 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 professional exercise of the doctor's role in the care team.

Clinical Placement (VFU) 2, 4.5 hp

Placement under supervision at a care unit in inpatient care, in an outpatient/ daytime unit in regular open specialist care, or in student-adapted activities within the clinical internal medicine area or in adjacent specialties. Shorter auscultations/case presentations at another unit or simulation in a clinical environment can be included. Students train to exercise their doctor's role in patient care and clinical diagnostic examinations of common, serious, acute, and more complex conditions within the area that 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 professional exercise of the doctor's role in the care team.

Application and Integration, 2.0 hp

The moment includes 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.

Professional Attitude, Responsibility, and Learning, 1.0 hp

Teaching, training, and assessment of a professional attitude, responsibility, and learning take place continuously throughout the course and specifically in connection with Team-Based Learning (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 takes place in this moment, through continuous assessment, based on the program's criteria.

Work Forms

The course includes work-integrated learning (WIL) 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 (see Other Regulations) and reflects on their performances in relation to performances on previous courses.

Examination

Complexity and Multimorbidity in Internal Medicine, 3 hp

• Mandatory participation
  • Team-Based Learning (TBL)
  • Seminars
  • Teacher-led skill training
  • Case-based teaching (in care or clinic-like environment)
  • Simulation

Infection, 4.5 hp

• Mandatory participation
  • Team-Based Learning (TBL)
  • Seminars
  • Teacher-led skill training
  • Case-based teaching (in care or clinic-like environment)
  • Simulations
  • Diagnostic test

Skin and Sexual Diseases, 4.5 hp

• Mandatory participation
  • Team-Based Learning (TBL)
  • Seminars
  • Teacher-led skill training
  • Case-based teaching (in care or clinic-like environment)
  • Simulations
  • Skill training (diagnostics based on images)

Geriatrics and Clinical Pharmacology, 1.5 hp

• Mandatory participation
  • Team-Based Learning (TBL)
  • Seminars
  • Case-based teaching (in care or clinic-like environment)

Clinical Placement (VFU) 1, 4.5 hp

• Mandatory participation
  • Clinical Placement (VFU)
  • Case-based oral presentations in groups
• Mandatory formative assessments
  • Ongoing assessment in VFU

Clinical Placement (VFU) 2, 4.5 hp

• Mandatory participation
  • Clinical Placement (VFU)
  • Case-based oral presentations in groups
• Mandatory formative assessments
  • Ongoing assessment in VFU

Application and Integration, 2 hp

• Objective Structured Clinical Examination (OSCE)
• Written examination
• Oral presentation (at least one case-based oral presentation in groups)

To participate in the written examination, at least 50% of VFU must be completed.

Professional Attitude, Responsibility, and Learning, 1 hp

• Mandatory participation
  • Mentor Program
  • Reflection group meetings
• Mandatory formative assessments
  • Self-assessment and peer feedback (TBL)
  • Self-assessment and individual action plan (Mentor Program)
• Examination of professional attitude

• Objectives for professional attitude are assessed continuously, based on assessment criteria, in all contexts where the student appears in their role as a student or related to the university's or healthcare's activities within the education. In case of insufficient objectives, which are then identified, the examiner can fail the student on the moment PFAL or the moment VFU (if insufficient objectives occur in VFU). In such cases, an individual action plan should be drawn up.

Other Regulations

Language of Instruction

The language of instruction is Swedish, but teaching in English may occur. Swedish and English literature is used in the course.

Learning Portfolio

Support for the student's development in various areas of competence is collected continuously throughout the education in the student's individual learning portfolio. The course-responsible department provides information on which documents should be saved for the course occasion.

Scheduling

Scheduling during evenings and weekends may occur.

Course Evaluation

Course evaluation is carried out according to Karolinska Institutet's guidelines.

Literature List and Other Teaching Materials

Compulsory Course Literature

• Internal Medicine , Dahlström, Ulf; Kechagias, Stergios; Stenke, Leif, Sixth edition: Stockholm: Liber, 2018 - 1046 pages ISBN: 6-2, LIBRIS-ID:
• Infectious Diseases: Clinical Situations , Christensson, Bertil, Second edition: Lund: Studentlitteratur, [2022] - 370 pages ISBN: , LIBRIS-ID: zd7jn8dcwm76535q
• Rorsman, Hans, Rorsman's Dermatology, Venereology , Wahlgren, Carl-Fredrik, Tenth edition: Lund: Studentlitteratur, [2022] - 442 pages ISBN: , LIBRIS-ID: v9x1h2pfsvbhptd5
• Jern, Sverker; Jern, Helene, Clinical ECG Diagnosis 2.0 , Second edition of version 2.0: Ljungskile: Sverker Jern Education, 2017 - 264 pages LIBRIS-ID:
• Treatment Program for Region Stockholm: Acute Internal Medicine , Region Stockholm, 2024
• Treatment Program for Region Stockholm: Acute Cardiac Care , 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 ISBN: , LIBRIS-ID: 194c8kpvzs349ksd
• 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 pages, pages , 4, 64 pages ISBN: , LIBRIS-ID: 9nlwf5c57q1w3b9v
• General Medicine , Hunskår, Steinar; Hovelius, Birgitta; Andersson, Christer, Berndtsson, Margareta Brandin, 2nd edition: Lund: Studentlitteratur, 2015 - 1102 pages ISBN: , LIBRIS-ID:
• Böttiger, Ylva; Eliasson, Erik; Lindh, Jonatan, Succeeding with Drugs , 1st edition: Stockholm: Studentlitteratur, 2014 - 156 pages ISBN: , LIBRIS-ID:
• Geriatric Book , Wahlund, Lars-Olof, First edition: Stockholm: Liber, [2020] - 407 pages ISBN: , LIBRIS-ID: bnqvmh8r8r12klcj
• Acute Geriatrics , Wisten, Aase; Brännström, Ingrid, Third edition, 2013 (revised 2024), Studentlitteratur, ISBN
• Gastroenterology and Hepatology , Lindberg, Greger; Nyhlin, Henry, 1st edition: Lund: Studentlitteratur, 2016 - 331 pages ISBN: , LIBRIS-ID:
• Rheumatology , Klareskog, Lars; Saxne, Tore; Rudin, Anna; Rönnblom, Lars; Enman, Yvonne, Third edition: Lund: Studentlitteratur, [2017] - 481 pages ISBN: , LIBRIS-ID:
• Endocrinology , Werner, Sigbritt, 3rd revised and updated edition: Stockholm: Liber, 2015 - 528 pages ISBN: , LIBRIS-ID:
• Weller, Richard P. J. B.; Hunter, Hamish J.A.; Mann, Margaret W., Clinical Dermatology , Fifth edition: Chichester, West Sussex: Wiley Blackwell, 2015 - xi, 438 pages ISBN: (pbk.), LIBRIS-ID:
• Ritter, James, Rang and Dale's Pharmacology , Tenth edition: Amsterdam: Elsevier, 2023 - 808 pages ISBN: , LIBRIS-ID: wcqts6v5twkn31tb

In addition, course material is provided, including references to current scientific publications, on the learning platform.