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The First Case Debate Competition among Internal Medicine Residents Successfully Held at PUMCH
CopyFrom: PUMCH UpdateTime: 2023-04-03 Hits: 39 Font Size: SmallBig

On the afternoon of March 15, 2023, the final of the First Case Debate Competition among Internal Medicine Residents was held at PUMCH. Two teams entering the final were supervised by Professor Li Jian and Professor Fan Hongwei, and each team sent three residents to analyze, cross-examine and debate on the diagnosis and treatment of one case. During this process of heated debate and quick thinking, contestants broadened their horizon, enhanced their abilities, and worked together to find the best solution to treat patients with intractable and critical diseases.



The team “I Love the Internal Medicine” came first and they narrated a story about how a 17-year-old senior high school student finally received proper treatment. Initially, the patient only felt pain in his left wrist, but in the following six months, he gradually developed multiple lesions in his spine, which made him unable to walk. He even fell to the floor whenever he sneezed. Fortunately, after several rounds of pathological tests, the medical team confirmed the presence of Mycobacterium tuberculosis, and eventually achieved a definitive diagnosis of disseminated bone tuberculosis. Thanks to the anti-tuberculosis medication and the timely surgery, the patient was able to walk again when discharged from the hospital.

The “Best Talker” team demonstrated a case on the complex diagnosis and differential diagnosis of vascular lesions. The patient’s initial symptoms were pain at the lower edges of both ribs, and the aneurysmal dilation was later discovered in the thoracic aorta through enhanced CT. The aortic stent implantation surgery did not alleviate those symptoms at all. As indicated by PET/CT results, the patient was very likely to suffer from vasculitis, but even after applying steroids for anti-inflammatory treatment, the symptoms did not improve. The diagnosis and treatment team at PUMCH repeatedly compared the patient’s imaging results and found that the soft-tissue shadow beside the aorta was gradually growing and eroding the thoracic spine. The team performed a puncture biopsy of the patient’s lesion through multi-disciplinary collaboration, and the culture result was negative. By metagenomics next generation sequencing for pathogen the medical team confirmed that the infection was unexpectedly caused by the bacteria Coxiella burnetii (also known as “Q fever”), which doesn’t grow in conventional culture. After receiving targeted anti-infection treatment, the patient’s condition gradually improved.




“Don’t ignore the possibility of rare diseases for patients with common symptoms, but also pay more attention to common and frequently re-occurring diseases before suggesting rare ones”; “always keep the possibility of TB in mind”; “the devil is in the details”; and “a fool with a tool is still a fool”. Those are all the lessons learnt in this competition. This competition also offers a great opportunity for teaching and learning. The explanations of experts from the observer panel, the summary by Professor Shen Ti, the former head of the Department of Internal Medicine, and the insightful comments by Vice President Du Bin all helped the participants to learn and benefit tremendously. After several rounds of fierce competition, “the Best Talker” won the contest by a narrow margin.

   




▲Speeches and comments from guests on site

Shi Jingjing, the Science and Education Section Chief of Beijing Municipal Health Commission, said, “I hope that PUMCH will continue to set an example in the training of young doctors in Beijing, as well as in other educational and teaching areas.”

This activity also provoked a lot of discussions in the hospital about clinical thinking. Vice President Wu Peixin said: “I hope that everyone will focus on the clinical practice, the problems encountered, and the clinical science, immerse yourselves in and enjoy this process, build your character and hone your skills, and facilitate the development of medicine as you pursue your dreams.”

President Zhang Shuyang made her comments: “Medical records is a vivid narration, a medical archive of the patient’s fight against illness and the doctor’s empathy for the patient.” She encouraged the young physicians to be great doctors and learn from the heavyweight predecessors such as Zhang Xiaoqian, Lin Qiaozhi and Zeng Xianjiu, to write every medical record with a compassionate heart and a professional mind. She also ask them toinherit the spirit of PUMCH, take over the baton from the predecessors, fully carry forward the scientist spirit “daring to be the first and fearless of difficulties”, set great ambitions and further improve the service quality of PUMCH, to write a new and glorious chapter of PUMCH.


Written by Yan Xiaobo, Zou Linfeng, and Jiao Yuhao

Photographed by Yan Xiaobo and Chen Jialin

Edited by Yan Xiaobo, Chen Xiao and Wang Yao

Translated by Liu Haiyan