GMC Domains

• THE DOCTOR AS A SCHOLAR
  • TD 8: APPLICATION OF BIOMEDICAL SCIENTIFIC PRINCIPLES, METHOD AND KNOWLEDGE
    • Medical knowledge: ANATOMY (TD 8.1)
    • Medical knowledge: PHYSIOLOGY (TD 8.2)
    • Medical knowledge: BIOCHEMISTRY (inc. Metabolism) (TD 8.3)
    • Medical knowledge: CELL BIOLOGY (TD 8.4)
    • Medical knowledge: MOLECULAR BIOLOGY and GENETICS (TD 8.5, 8.6)
    • Medical knowledge: PATHOLOGY (TD 8.7)
    • Medical knowledge: CANCER
    • Medical knowledge: IMMUNOLOGY and INFLAMMATION (TD 8.8)
    • Medical knowledge: MICROBIOLOGY and INFECTION (TD 8.9)
    • Medical knowledge: PHARMACOLOGY (TD 8.10)
    • Medical knowledge: NUTRITION (TD 8.11)
    • Medical knowledge: CLINICAL FEATURES of DISEASE (TD 8 b)
  • TD 9: APPLICATION OF PSYCHOLOGICAL PRINCIPLES, METHOD AND KNOWLEDGE
    • Medical knowledge: PSYCHOLOGY (TD 9 a-g)
  • TD 10: APPLICATION OF SOCIAL SCIENCE PRINCIPLES, METHOD AND KNOWLEDGE
    • Medical knowledge: SOCIOLOGY (TD 10 a-e)
  • TD 11. PRINCIPLES, METHODS AND KNOWLEDGE OF POPULATION HEALTH
    • Medical knowledge: PUBLIC HEALTH and GLOBAL HEALTH (TD 11 a-j)
  • TD 12; APPLICATION OF SCIENTIFIC METHOD AND APPROACHES TO MEDICAL RESEARCH
    • Medical knowledge: EPIDEMIOLOGY
    • Medical Knowledge: SCIENTIFIC METHOD & RESEARCH
• THE DOCTOR AS A PRACTITIONER
  • TD 13: CARRY OUT A CONSULTATION WITH A PATIENT
    • Clinical skills: HISTORY (TD 13 a-b)
    • Clinical skills: PHYSICAL EXAMINATION (TD 13 c)
    • Clinical skills: MENTAL STATE EXAMINATION (TD 13 d)
  • TD 14: DIAGNOSE AND MANAGE CLINICAL PRESENTATIONS
    • Clinical skills: INTERPRETING FINDINGS AND INITIAL ASSESSMENT (TD 14 a-b)
    • Clinical skills: PLANNING AND INTERPRETING INVESTIGATIONS (TD 14 c-d)
    • Clinical skills: MAKING A DIAGNOSIS and CLINICAL JUDGEMENT (TD 14 e-f)
    • Clinical skills: FORMULATING A TREATMENT PLAN (TD 14 g)
    • Clinical skills: SURGERY and ANAESTHETICS (TD 14 g)
    • Clinical skills: SUPPORTING PATIENTS and IDENTIFYING ABUSE and NEGLECT (TD 14 h-i)
    • Clinical Skills: CARE OF PATIENTS AND RELATIVES AT END OF LIFE (TD 14 j)
  • TD 15: COMMUNICATE EFFECTIVELY WITH PATIENTS AND COLLEAGUES
    • Clinical skills: INTERACTION WITH PATIENTS (TD 15 a-b)
    • Clinical skills: MANAGING INFORMATION (TD 15 c)
  • TD 16: PROVIDE IMMEDIATE CARE IN MEDICAL EMERGENCIES
    • Emergency Management of Patients (TD 16 b-e)
  • TD 17: PRESCRIBE DRUGS SAFELY, EFFECTIVELY AND ECONOMICALLY
    • Clinical skills: PRESCRIBING DRUGS SAFELY AND EFFECTIVELY (TD 17 a-h)
  • TD 18: CARRY OUT PRACTICAL PROCEDURES SAFELY AND EFFECTIVELY
    • Clinical skills: DIAGNOSTIC PROCEDURES (TD 18 a)
    • Clinical skills: THERAPEUTIC PROCEDURES (TD 18 b)
  • TD 19: USE INFORMATION EFFECTIVELY IN A MEDICAL CONTEXT
    • Clinical skills: EVIDENCE BASED MEDICINE
• THE DOCTOR AS A PROFESSIONAL
  • TD 20: BEHAVE ACCORDING TO ETHICAL AND LEGAL PRINCIPLES
    • Professional issues: ETHICS and LAW (TD 20 a-g)
  • TD 21: REFLECT, LEARN AND TEACH OTHERS
    • Professional Issues: PERSONAL LIMITS OF CARE (TD 21e)
    • Professional issues: LEARNING (TD 21 a-d)
    • Professional issues: TEACHING AND MENTORING (TD 21 f)
  • TD 22: LEARN AND WORK EFFECTIVELY WITHIN A MULT-PROFESSIONAL TEAM
    • Professional issues: WORKING IN TEAMS (TD 22 a-c)
  • TD 23: PROTECT PATIENTS AND IMPROVE CARE
    • Professional issues: DUTIES OF A DOCTOR (TD 23 a-b)
    • Professional issues: MEDICAL FRAMEWORK IN THE UK (TD 23 c)
    • Professional issues: RISK MANAGEMENT and PATIENT SAFETY (TD 23 d)
    • Professional issues: GOVERNANCE, QUALITY MATTERS and AUDIT (TD 23 e)
    • Professional issues: PERSONAL ATTITUDES and SELF CARE (TD 23 f-j)

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TD 12; APPLICATION OF SCIENTIFIC METHOD AND APPROACHES TO MEDICAL RESEARCH: Medical knowledge: EPIDEMIOLOGY

Introduction

Definition of Epidemiology

Epidemiology is the study of the incidence, distribution and determinants of diseases in human populations with a view to identifying their causes and bringing about their prevention.

 

Aims and Objectives of the Teaching

Aim:

To provide an introduction to epidemiology and public health showing how these areas of medicine are related to individual and population health sciences.

Objectives:

1.  An awareness of the burden of disease in the community, how it is measured, and the relative importance of different diseases as causes of morbidity and mortality.

2.  An appreciation and application of numerical methods in medicine. The importance of a quantitative approach.

3.  The basic academic discipline of epidemiology and its relationship with clinical medicine, pathology and the application of elementary statistics. The identification of the causes of major diseases, leading to preventive strategies. The relative importance of personal medical services and of environmental and lifestyle changes in the prevention of disease.

4.  The evaluation and interpretation of screening tests and diagnostic tests.

5.  An awareness of cost effectiveness in medicine, and of cost benefit analysis. The formulation of judgements on efficacy, safety and cost in medical care.

6.  An appreciation of the organisation and delivery of health care services.

7.  An appreciation of the epidemiological approach to a problem.

 

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Index

• General Topics in Epidemiology
• Statistics
• Cardiorespiratory Epidemiology
• Psychiatric epidemiology
• Gastrointestinal Epidemiology
• Musculoskeletal Epidemiology
• Obstetrics and Gynaecology Epidemiology
• Childhealth Epidemiology
• Sexually Transmitted Infections (inc HIV)
• Tropical Diseases
• Epidemiology of Endocrine Conditions

• General Topics in Epidemiology
  • The Epidemiological Approach
    1. Understand how epidemiology and clinical medicine are related (HSPH2)
    2. Explain briefly the two main methods of investigation in epidemiology: the cohort study and the case-control study. (HSPH2)
    3. Describe the complementary roles of nature and nurture. (HSPH2)
    4. Describe how different methods of prevention and treatment can be combined (HSPH2)
    5. Be able to describe the epidemiology of pancreatitis (MET3A)
  • Malnutrition and other Nutritional Deficiencies
    1. Outline the prevalence and significance of protein-energy malnutrition
    2. Understand the importance of different nutrients in disease causation. (PH3)
    3. Define wasting and stunting
    4. Understand the factors influencing the development of public health policy in relation to nutrition. (PH3)
    5. Recognise the key factors that influence nutrition policy (advocates,individuals and government). (PH3)
  • Mortality and Morbidity
    1. Locate and access national mortality and morbidity statistics.
    2. Define perinatal, neonatal and infant mortality. (GEP/HD, HD2)
    3. Discuss the main causes of mortality in the perinatal, neonatal and infancy periods. (GEP/HD, HD2)
  • Hepatitis
    1. Know that the two major liver killers are alcohol consumption and the Hepatitis C virus. (PH3)
    2. Describe the epidemiology and natural history of Hepatitis A, B, C and D (I&I 4)
    3. Understand how to calculate alcohol units. (PH3)
    4. Know the different types of public health interventions. (PH3)
    5. Know that the two major liver killers can be eliminated by public health interventions but that there are political challenges. (PH3)
  • Rheumatic Fever
    1. Discuss the epidemiology of rheumatic fever in the UK and worldwide (CR3)
  • Routes of Spread
    1. Define the terms: incidence; prevalence; endemic; epidemic; pandemic (FM1)
    2. Discuss how pathogens are transmitted (FM1)
    3. Discuss methods of controlling infectious diseases (prevention, immunisation, treatment) and the significance of herd immunity. (FM1)
  • Drugs, Medicine and Safety
    1. Understand the outline history of drug development in the UK throughout the twentieth and into the twenty-first century.
    2. Describe efforts to standardise and regulate medicines in the UK, including the Therapeutic Substances Act (1925), the Penicillin Act (1942), and the Medicines Act (1968) which remain the basis of contemporary legislation.
  • Hearing and Visual Impairment
    1. Describe the prevalence and pattern of hearing impairment in the population
  • Prevalence of Disease
    1. To appreciate the prevalence of skin disease seen by GPs in the community (CC4)
  • Trauma
    1. Know the scale of trauma in the UK
  • Pandemics
    1. Pandemic Influenza: 1918 pandemic; virology of infectious disease; emerging viral infections; pandemics past and future
  • Health Screening
  • Obesity
    1. Understand how several screening methods can be combined into a single screening test. (PH3)
    2. Consider obesity and diabetes as both an individual and a public health problem. (PH3)
    3. Assess the screening performance of a multi-marker screening test (e.g. the Quadruple test). (PH3)
    4. Recognise the major determinants of obesity and diabetes. (PH3)
    5. Understand why cholesterol and blood pressure measurement are poor screening tests for cardiovascular disease. (PH3)
    6. Understand approaches in the prevention of obesity and diabetes, and appropriate public health policy. (PH3)
    7. Describe the prevalence of obesity in the UK and its relationship with the populations' intake of fat and carbohydrate and trends in physical exercise
  • HRT
  • Ageing Population
    1. Describe changes in the demographics of ageing.
    2. Outline the differences between biological and social ageing.
    3. Describe typical health experiences in later life.
    4. Discuss key features of the health and health care needs of older people.
  • Cancer epidemiology
    1. Recognise that risk of cancer generally becomes high only after prolonged (decades) exposure to a carcinogen but falls within a few years of removing the exposure. (PH3)
    2. Understand why some cancers do well (high 5 year survival) and others do not. (PH3)
    3. Understand why "debulking" cancers does not materially prolong survival. (PH3)
    4. Recognise that cancer is monoclonal and is a multistage process and hence has many causes. (PH3)
    5. Recognise that carcinogens have no threshold. (PH3)
    6. Know the major causes of cancer. (PH3)
    7. Understand the concept of over-diagnosis. (PH3)
    8. Appreciate why some cancers are becoming less common and others more so. (PH3)
  • Trials & Research
    1. To know the strengths and weaknesses of different study designs, and choose the most appropriate to answer specific questions. (PH3)
    2. Interpret ‘means’, ‘standard deviations’ and ‘standard errors’.
    3. Understand the properties of the Gaussian distribution. (GEP/HSPH, GEP/HSPH, HSPH2)
    4. Describe the essential structure of cohort and case-control studies.
    5. Explain the importance of the following features of clinical trials: randomisation, controls, blinding, placebo. (GEP/HSPH)
    6. Be able to describe the importance of the critical evaluation of standard / accepted and new treatment approaches
    7. Understand what p-values are.
    8. Explain the Bradford Hill criteria for causality and give examples of each.
    9. Recognise the link between epidemiological research and determination of causal mechanisms of disease. (PH3)
    10. Identify potential biases in case-control and cohort studies.
    11. To know the reasons for randomisation and blindness in trials. (PH3)
    12. Be able to calculate and interpret risks, odds, rates and their ratios and differences. (HSPH2)
    13. Define ‘risk’, ‘odds’, ‘relative risk’ and ‘odds ratio’.
    14. Appreciate the need for clinical trials
    15. Interpet ‘medians’ and ‘interquartile ranges’.
    16. Know the deductive and inferential process of discovering the causes of disease. (PH3)
    17. Understand the difference between standard deviation and standard error. (GEP/HSPH, GEP/HSPH, HSPH2)
    18. Be able to interpret statistical significance.
    19. Define ‘intention to treat’ analysis, ‘loss to follow-up’ and ‘compliance’. (GEP/HSPH)
    20. Understand the nature of bias.
    21. Apply these to breast cancer epidemiology and aetiology and thence to its prevention. (PH3)
    22. Be able to describe and interpret confidence intervals for relative risks and odds ratios (HSPH2)
    23. Interpret Standardised Mortality Ratios. (SMRs)
    24. To distinguish intention-to-treat and on-treatment analyses. (PH3)
    25. Explain how confounding occurs.
    26. Detail when each of case-control, cohort and randomised controlled trials are appropriate research studies.
    27. Explain the basic characteristics of a Normal Distribution.
    28. Have practical experience of calculating ranges and confidence intervals for data with a Gaussian distribution. (GEP/HSPH)
    29. To appreciate the superiority of crossover trials when feasible. (PH3)
    30. Be aware of the impact of sample size on uncertainty. (GEP/HSPH, HSPH2)
    31. Define a reference range.
    32. Interpret confidence intervals for all of the above statistical measures.
    33. Interpret unadjusted and adjusted results and be able to explain when each is valid.
    34. Be able to give examples of important case-control and cohort studies.
    35. Be able to interpret calculated ranges and confidence intervals. (GEP/HSPH)
    36. To recognise that P<5% is statistically significant only when testing a prior hypothesis. (PH3)
    37. Be aware of the relationship between P values and confidence intervals. (GEP/HSPH, HSPH2)
    38. To know that different causes of a disease usually interact multiplicatively. (PH3)
    39. Have practical experience of calculating risks, odds, rates and their ratios. (HSPH2)
• Statistics
  • Statistical Principles
    1. Appreciate how observational studies are designed
    2. Appreciate how observational studies are designed (HSPH2)
    3. Appreciate their limitations (HSPH2)
    4. Understand the properties of the Gaussian distribution
    5. Understand the difference between standard deviation and standard error
    6. Have practical experience of calculating and interpreting ranges and confidence intervals for data with a Gaussian distribution.
    7. Understand what p-values are and be able to interpret statistical significance
    8. Be able to describe and interpret confidence intervals for relative risks and odds ratios.
    9. Be aware of the relationship between P values and confidence intervals.
    10. Be aware of the impact of sample size on uncertainty
    11. Have practical experience of calculating risks, odds, rates and their ratios.
    12. Be able to calculate and interpret risks, odds, rates and their ratios and differences.
    13. Define the terms : Randomised , primary outcome, intention to treat analysis, data and safety monitoring committee , hazard ratio, Current Controlled Trials number, ST-segment elevation myocardial infarction (STEMI), percutaneous coronary intervention (PCI), refractory Angina (HSPH2)
    14. What is a confidence interval and P value? (HSPH2)
    15. Why is a critical appraisal of a trial performed and why do we ask the questions that we do? (HSPH2)
    16. Perform a critical appraisal on this paper and interpret its results. (HSPH2)
    17. Evaluate if this intervention should be adopted. (HSPH2)
  • Evaluating Clinical Data
    1. Interpret means, standard deviations and standard errors.
    2. Interpret medians and interquartile ranges
    3. Explain the basic characteristics of a normal distribution
    4. Define a reference range.
    5. Define and interpret p-values and confidence intervals and understand their relationship
  • Randomised Controlled Trials
    1. Explain the importance of the following features of clinical trials: randomisation, controls, blinding, and placebo.
    2. Define intention to treat analysis, loss to follow-up and compliance.
    3. Explain why intention to treat analysis is often used.
    4. Interpret the results from a clinical trial and assess how applicable they are to a patient you may be treating.
    5. Explain numbers needed to treat (NNT)
    6. Explain why meta-analyses are undertaken.
  • Cohort Studies
    1. Describe the essential structure of cohort studies (HSPH2)
    2. Identify potential biases in cohort studies (HSPH2)
    3. Be able to calculate and distinguish between relative risks, absolute excess risks and attributable proportions.
    4. Interpret the results from cohort studies including survival analysis (HSPH2)
    5. Explain how confounding occurs.
  • Case-Control Studies
    1. Describe the essential structure of case-control studies including nested case-control studies. (HSPH2)
    2. Identify potential biases in case-control studies (HSPH2)
    3. Detail when each of cross-sectional, case-control, cohort and randomised controlled trials are appropriate research studies. (HSPH2)
    4. Interpret results from case-control studies and distinguish between the terms odds ratio, absolute excess risk and attributable proportion. (HSPH2)
  • Bias, Confounding and Causality
    1. Explain the Bradford Hill criteria for causality and give examples of each. (HSPH2)
    2. Understand the nature of bias. (HSPH2)
    3. Explain how confounding occurs. (HSPH2)
    4. Interpret unadjusted and adjusted results and be able to explain when each is valid. (HSPH2)
• Cardiorespiratory Epidemiology
  • Respiratory Disease (inc. Tuberculosis)
    1. Describe the epidemiology of tuberculosis; global, UK and risk factors (CR3)
    2. Outline the causes and social impact (in terms of mortality and morbidity) of a) airways disease; and b) respiratory infection (GEP/CO2)
    3. Outline the causes and social impact (in terms of mortality and morbidity) of a) airways disease; and b) respiratory infection (CR1)
    4. Comment on the major social, environmental and occupational factors associated with pulmonary disease. (GEP/CO2)
    5. Comment on the major social, environmental and occupational factors associated with pulmonary disease. (CR1)
    6. Discuss epidemiological factors associated with tuberculosis, and differentiate between primary and post-primary disease.
  • Respiratory Tract Cancer
    1. Describe the mortality associated with lung cancer and how this has changed over time.
  • Asthma
  • Coronary Heart Disease (CHD)
    1. Know the risk of IHD and stroke in the UK now and why IHD mortality increased and then decreased over the past century. (PH3)
    2. Discuss the burden of cardiovascular disease worldwide and in the UK.
    3. Recognise the important modifiable and non-modifiable risk factors. (PH3)
    4. Be aware of key epidemiological studies of risk factors for cardiovascular disease
    5. Understand the relationship with serum cholesterol and blood pressure, and which risk factors make good screening tests. (PH3)
    6. Understand the basis for a healthy diet preventing future IHD and stroke. (PH3)
    7. Know the important drugs used to prevent IHD and stroke, their efficacy alone and in combination, and the polypill concept. (PH3)
    8. Understand the clinical management of acute myocardial infarction and acute ischaemic stroke in an epidemiological context. (PH3)
• Psychiatric epidemiology
  • Anorexia Nervosa
    1. Summarise current knowledge of the aetiology, clinical features, epidemiology, course, co-morbidities, complications and treatment for anorexia nervosa
  • Bulimia Nervosa
    1. Summarise current knowledge of the aetiology, clinical features, epidemiology, course, co-morbid disorders, complications and treatment for bulimia nervosa
  • Mood Disorders
  • Accidents and Suicide
    1. To understand the epidemiology of the psychiatric index conditions (PSYCH4)
    2. To appreciate that suicide is often impulsive (spur of the moment) and can be prevented by removing the means. (PH3)
    3. To appreciate that death and disease are often better prevented by "changing the environment" rather than telling people not to do things. (PH3)
    4. To recognise the high morbidity associated with hip fracture and the ways of preventing it. (PH3)
    5. Anxiety Disorders: To summarise current knowledge of the aetiology, pathophysiology and epidemiology of generalized anxiety disorder, panic disorder, social phobia, agoraphobia and other specific phobias (PSYCH4, PSYCH4)
    6. Obsessive-Compulsive Disorder: To summarise current knowledge of the aetiology, pathophysiology and epidemiology of obsessive-compulsive disorder. (PSYCH4)
    7. To summarise the current knowledge concerning aetiology, pathogenesis and epidemiology of schizophrenia. (PSYCH4, PSYCH4)
• Gastrointestinal Epidemiology
  • Gastric Ulceration
    1. Be able to describe the epidemiology of duodenal and gastric ulceration (MET3A)
  • GI Cancer
    1. Understand the incidence and prevalence of colorectal cancer (MET3A)
    2. Know the risk factors for colorectal cancer (MET3A)
    3. Know the genetic groups at risk of colorectal cancer (MET3A)
• Musculoskeletal Epidemiology
  • General Outcomes for Musculoskeletal Epidemiology
• Obstetrics and Gynaecology Epidemiology
  • General Outcomes for Obstetrics and Gynaecology Epidemiology
• Childhealth Epidemiology
  • Epidemiology of Childhealth
    1. Describe common congenital malformations, their prevalence and reasons for high prevalence in some communities. (PH3)
    2. Explain what a teratogen is, some common teratogens and their action. (PH3)
  • Infant and Childhood Death (inc. Sudden Infant Death Syndrome)
    1. Discuss the epidemiology and risk factors of sudden infant death (SIDS) (GEP/HD, HD2)
• Sexually Transmitted Infections (inc HIV)
  • Sexually Transmitted and HIV Infections - General
    1. Epidemiology HIV worldwide
    2. To outline national screening programs relevant to sexual and reproductive health and HIV (currently cervical screening, Chlamydia screening and antenatal HIV testing)
    3. To understand the basic epidemiology of STIs and HIV and public health issues for control of spread of infection locally and globally (I&I 4)
• Tropical Diseases
  • Epidemiology of Tropical Diseases - General
    1. Have basic knowledge of the epidemiology and pathogenesis of malaria and of the parasite life cycle
• Epidemiology of Endocrine Conditions
  • Diabetes
    1. Describe the incidence and prevalence of Type 1 and Type 2 diabetes and the impact of diabetes on the general practice workload (MedSoc1)

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