The Department of Internal Medicine carries the responsibility for basic education at the Faculty of Medicine, University of Helsinki, in the disciplines of internal medicine, endocrinology, gastroenterology, geriatrics, haematology, infectious diseases, cardiology, pulmonary diseases, nephrology and rheumatology. The instruction provided by the department is primarily given in the third, fourth and sixth years of studies in the Degree Programme in Medicine.
Advanced studies are part of basic education in medicine. At the Department of Internal Medicine, advanced studies can be completed by participating in a research project. For many, advanced studies have been the start of research efforts that result in a doctoral dissertation.
Research topics and projects active at the Department of Internal Medicine are described under the department’s disciplines. Participation in a research project may be possible even before completing basic studies in the relevant discipline.
The discipline of internal medicine is a central medical specialisation. In Finland, there are more than 1,700 specialists in internal medicine, of whom a substantial share have further specialised in sub-fields belonging to the discipline (endocrinology, gastroenterology, haematology, infectious diseases, cardiology, nephrology, rheumatology). Specialists in internal medicine mainly work in hospitals and the private sector.
At the Faculty of Medicine of the University of Helsinki, the discipline of internal medicine is responsible for basic education and specialist training in internal medicine. In their secondary positions, professors and clinical instructors of the University contribute to hospital work at the departments and clinics of Helsinki University Hospital, as well as carry out consultation duties. All professors and instructors of internal medicine are also active in research, while many docents of the field also contribute to the provision of teaching.
Basic education in internal medicine is given in the third and fourth years of studies. The instruction is implemented as integrated block teaching in collaboration with the teachers of, among other fields, surgery, neurology, radiology and oncology. The blocks include the following: chest pain, dyspnea and vascular surgery; abdominal problems; endocrinology, diabetes and nutrition; and oncology, haematology and rheumatology. The teaching includes lectures, seminars, group teaching as well as clinical patient work and training. At the very beginning of teaching, a course on interviewing and clinically examining patients is organised.
A brief lecture-based refresher course in internal medicine is organised in the sixth year of studies. The discipline of internal medicine also provides opportunities to complete advanced studies and contributes to the provision of international instruction.
The specialist training in general internal medicine takes six years to complete, of which common trunk training constitutes three years and speciality training three years. The trunk training can be completed in a number of hospitals in the region, while the speciality training is primarily completed at the hospitals of Helsinki University Hospital. However, part of the speciality training can be completed, for example, in the central hospitals of Åland, Hyvinkää, Lohja and Kymenlaakso.
Research activities at the Department of Internal Medicine are conducted and supervised by the following groups:
Cardiology is a medical discipline focused on the treatment of cardiovascular diseases. Many diseases that fall under the discipline of cardiology are what are known as diseases of public health importance, something that every physician encounters in their work. The field also encompasses many rare diseases whose treatment is mainly centralised to Helsinki University Hospital for Finland as a whole. The urgency of treating cardiovascular diseases varies between hyperacute and chronic diseases, while forms of therapy range from conservative treatment to heart transplantations and demanding catheter procedures.
Cardiologists must be familiar not only with basic patient examination methods (taking a medical history, auscultation, palpation of the pulse and percussion) but also modern imaging techniques (ultrasonic cardiography, CT and MR imaging as well as isotope scanning) as well as examinations focused on the physiology of the body (ergometer exercise tests and measurements of internal cardiac pressure).
Basic education in the course Chest Pain, Dyspnea and Vascular Surgery offered by the Faculty of Medicine, University of Helsinki, is organised in the third and fourth years of studies at the cardiology department of the Helsinki University Hospital.
The specialist training in cardiology takes six years to complete. The speciality training, to be completed after the common trunk training in cardiology or internal medicine, is completed in central hospitals or regional hospitals approved by the University which have been accredited as a training unit (see the list on the University website). No less than 18 months of the speciality training must be completed at a central hospital and no less than 12 months at a university hospital.
The training is diverse and encompasses the entire field of cardiology. Progress in the training is monitored with the help of a log. As cardiology is a procedure-oriented field, the number of specific procedures carried out over the training is monitored.
Carrying out ultrasonic cardiography belongs to the basic skills of today’s cardiologists. Learning the skill begins no later than during the speciality training, and the goal is to make the skill routine by the time the specialising physician arrives at a university hospital. Over the final year, this skill will be honed to perfection, aiming to ensure broad-based skills.
Advanced studies are part of basic education in medicine. At the cardiology department, advanced studies can be completed by participating in a research project. For many, advanced studies have been the start of research efforts that result in a doctoral dissertation.
Enquiries on the research topics and projects of the cardiology department can be directed at the professor of the relevant field or by directly contacting research group leaders. Participation in research projects may be possible even before completing the Chest Pain, Dyspnea and Vascular Surgery course.
The department of cardiology conducts active research, with more than 30 ongoing doctoral dissertation projects and more than 120 international scientific articles written at the department published every year. The research activities are diverse, and the areas of active research cover myocardial infarctions, cardiomyopathies, heart failure, genetics, imaging, heart transplantations and inflammatory heart diseases. Research approaches range between epidemiology and molecular biology. Among the large research avenues currently active are extensive studies focused on cardiomyopathies, sarcoidosis, heart failure and the aortic valve. A project focused on hydroxychloroquine aims to prevent the recurrence of myocardial infarctions.
Endocrinology focuses on the function and diseases of hormones and the glands that secrete them. In practice, the problems falling under the field of endocrinology are common, and all physicians need to give their opinion on them on a daily basis.
Diabetes and obesity are public diseases that have reached the proportions of global pandemics, and the most common of endocrine and metabolic diseases. Other common endocrine diseases include various problems with the thyroid (e.g., hypothyroidism, hyperthyroidism and thyroid nodules), hyperparathyroidism and osteoporosis. Electrolyte disturbances, such as hyponatraemia, hypokalaemia and hypercalcaemia, are very common clinical problems.
Basic education in endocrinology in the clinical stage at the Faculty of Medicine is taught in the block for endocrinology, diabetes and nutrition.
At the Department of Internal Medicine, several research groups are actively conducting research in the field of endocrinology and diabetology.
Gastroenterology (European Section and Board of Gastroenterology and Hepatology ESBGH) is a specialist field in medicine that studies the normal function and diseases of the digestive tract, including the organs of the entire digestive tract from the mouth to the anus, as well as the liver, bile ducts, gallbladder and pancreas. Other focus areas include nutrition and nutritional deficiencies, the oncology of the digestive tract as well as disease prevention and screening, especially for colorectal cancer.
Gastroenterology requires increasingly complex decisions as well as the capacity to master a growing number of endoscopic and interventional techniques, both diagnostic and therapeutic. Gastroenterology is a procedure-oriented field that often requires manual dexterity, knowledge in the basic sciences as well as clinical skills and the capacity for analytical problem-solving.
The discipline of gastroenterology is responsible for basic education in gastroenterology and hepatology, the speciality training in gastroenterology (three years) belonging to the specialist training in the field, as well as the relevant questions and assessment of the national specialist examination in medicine. The discipline of gastroenterology also organises national professional continuing education together with various operators, including specialist and other associations, the University and businesses. In cooperation with national and international research units, the discipline contributes to multicentre studies focused especially on cholestatic liver diseases and inflammatory bowel diseases.
Basic education in gastroenterology is organised in the fourth year of studies, integrated with gastric surgery. The teaching includes seminars, lectures and group instruction, as well as clinic instruction at the Meilahti, Jorvi and Peijas hospitals.
The specialist training in gastroenterology takes six years to complete, including three years of common trunk training in internal medicine and three years of speciality training in gastroenterology, of which no less than half (18 months) must be completed at the training unit of a university hospital. The education in gastroenterology must meet the minimum requirements in the recommendations by the ESBGH to facilitate the employment of gastroenterologists educated in Finland in EU countries. After obtaining the qualifications of a specialist in gastroenterology, specialists can apply for a European certificate from the ESBGH, awarded on the basis of the recommendations of the organisation. The certificate will be awarded automatically to specialists trained at the training units accredited by the ESBGH (Helsinki University Hospital and Tampere University Hospital). The rules pertaining to the completion of the specialist education have been compiled into standing orders (Degree Regulations) confirmed by the Faculty Council. Specialising physicians must familiarise themselves with the standing orders. Additionally, the gastroenterology unit of the University of Helsinki is part of the Visiting Fellowship Programme of the United European Gastroenterology organisation, which provides opportunities to work for a month-long period in selected European university level gastroenterology clinics with a scholarship awarded by the UEG.
The central research projects in gastroenterology are related to inflammatory bowel disease, autoimmune liver diseases and cholestatic liver diseases, with a particular focus on primary sclerosing cholangitis (PSC) as well as the gut microbiota and changes to it in conjunction with various diseases.
The Department of Gastroenterology of Helsinki University Hospital employs a BCB treatment register for treating IBD and establishing related prognoses, which offers an excellent opportunity to analyse the effectiveness of therapeutic interventions in patient care.
The ProsIBD and RetroIBD clinical trials are investigating immunologic, genetic and microbiomic factors as predictors of the treatment response for TNF α blocking drugs, focusing on a prospective follow-up cohort of patients with Crohn’s disease or ulcerative colitis.
We are also investigating the functionality and effectiveness of home monitoring in conjunction with IBD by utilising calprotectin measurements and symptom monitoring carried out at home.
The effect of the microbiome on the progress of IBD is being investigated in controlled faecal transplantation trials on the maintenance of remission in ulcerative colitis and IBS.
Efforts focused on investigating the factors affecting the onset, progress and prognosis of primary sclerosing cholangitis constitute an extensive research project under which two doctoral dissertations have already been completed. Currently ongoing sub-projects under the main project include those with the following topics: the role of metabolomics, lipodomics and proteomics in the disease progression and development of biliary dysplasia and cholangiocarcinoma in PSC; bile and serum calprotectin and IL-8 as indicators for disease progression and risk for biliary dysplasia in PSC; and the characteristics of inflammatory bowel disease associated with primary sclerosing cholangitis (PSC).
Geriatrics (Geriatric Medicine, definition by the Geriatric Medicine section of the European Union of Medical Specialists UEMS) is a specialist field of medicine focusing on the physical, mental, functional and social conditions related to the acute and long-term illnesses of elderly patients as well as their rehabilitation, preventive care and end-of-life care.
This patient group is characterised by fragility and multiple illnesses, requiring a comprehensive approach. In old age, illnesses may not only be manifested differently than in younger patients but are also harder to diagnose, the response to treatment is often delayed, and frequently the patient requires social support.
Therefore, geriatrics has a wider scope than other fields of medicine that focus on individual organs. Geriatrics provides care within the framework of a multiprofessional team with the aim of optimising the functional condition of the patients as well as improving their quality of life and ability to function independently.
Although geriatrics is not an age-specific field, it usually deals with the treatment of illnesses typically encountered in elderly patients. Most patients are over 65, but the expertise of geriatrics most clearly meets the needs of patients of over 80.
Understandably, the organisation of geriatric operations in Europe can vary by country due to historical and structural differences.
The discipline of geriatrics is responsible for basic education in geriatrics and speciality training in geriatrics, in addition to which it organises national professional continuing education for physicians together with various parties (universities, associations, businesses). In cooperation with other national and international clinical units and municipal healthcare units, the discipline carries out a number of clinical and epidemiological follow-up studies, as well as randomised clinical trials.
Basic education in geriatrics is organised in the fifth year of studies jointly with palliative medicine. The teaching includes seminars and a clinical training period implemented in the hospitals located in Helsinki.
The specialist training in geriatrics takes five years to complete. In addition to geriatrics, the three-year speciality training must include internal medicine, neurology and (geriatric) psychiatry. The number of physicians specialising in geriatrics has ranged from 35 to 45.
The aim of clinical and epidemiological follow-up studies (e.g., Helsinki Businessmen Study HBS, DEBATE study) has been to determine the predictive significance of abnormal observations made in old age.
Randomised controlled clinical trials test the effectiveness of various treatments and interventions in elderly patients. Research topics have included a range of vascular diseases, cognitive disturbances, confusional states and psychosocial problems, such as loneliness. Cooperation is conducted with the Department of General Medical Practice and Primary Health Care (e.g., the FINALEX study) and the Department of Public Health at the University of Helsinki, the Research Council of Finland, the Finnish Social Insurance Institution KELA and the Finnish Association for the Welfare of Older People, as well as the Center for Life Course Health Research at the University of Oulu. Through the professor in charge of the discipline, the unit is participating in the European IMI project SPRINTT and the Finnish FINGER study
Basic education in haematology provided by the University of Helsinki is organised at the haematology clinic of Helsinki University Hospital as part of the integrated teaching in oncology, haematology and rheumatology (OHERA) in the third and fourth years of studies. The instruction is given on inpatient wards 7 A and B of the Meilahti Triangle Hospital, at the Hematology Outpatient Clinic and the Day Hospital in Meilahti.
Clinical haematologists investigate and treat diseases of the blood and the organs that produce blood (bone marrow, spleen and lymphatic tissues), as well as diseases associated with blood coagulation. Most of the diseases examined and treated by haematologists are various malignant blood diseases, such as leukaemias, plasma cell diseases as well as chronic lymphoproliferative and myeloproliferative diseases. The most common non-malignant haematological diseases include various autoimmune cytopenias, hereditary haematological diseases and diseases associated with blood coagulation.
Haematology is a rapidly advancing specialist field where the latest methods in modern cellular and molecular biology can be effectively employed. As subjects of research, blood and blood cells are easily accessible, which boosts haematological biobank operations, research and drug development to the forefront in many fields. Personalised medicine has also advanced quite far in the treatment of haematological diseases.
In Finland, the work of clinical haematologists does not involve haematological laboratory diagnostics; that sector is covered by specialists in clinical chemistry and pathology. From among coagulation disorders, haematologists primarily focus on haemorrhagic diseases and certain types of severe susceptibility to occlusions. Certain physicians specialised in coagulation disorders are trained as haematologists.
Clinical haematologists mainly work in public university hospitals and central hospitals, in duties that vary to a certain degree. In Finland, acute leukaemias, stem cell transplantations and rare blood diseases are treated centrally in university hospitals, while central hospitals may treat lymphomas which elsewhere fall primarily under the field of oncology. Cooperation is conducted especially with laboratories specialised in haematology, pathology and clinical genetics, as well as specialists in oncology and infectious diseases.
The specialist training in haematology takes six years to complete. The speciality training, to be completed after the three-year common trunk training in clinical haematology or internal medicine, is completed primarily at the haematology clinic of a university hospital. No more than six months of service completed in the following units can be accepted as part of the training: the haematological laboratory of a university hospital, the infectious diseases department of a university hospital and the oncology clinic of a university hospital. A training agreement has been concluded with the Päijät-Häme Central Hospital and the Kymenlaakso Central Hospital under which six months of service can be included in the speciality training in haematology.
The training is diverse, encompassing the field of haematology in its entirety, including stem cell transplantation. At the University of Helsinki, the training includes a three-month period completed at the Comprehensive Cancer Center, focusing primarily on the diagnostics and treatment of lymphomas. The training period completed at the Coagulation Disorder Unit takes two to three months to complete. The progress in the training is monitored with the help of a log and annual meetings with the administrative coordinating physician, as well as with development discussions held with the supervising professor. We are also using the Curriculum Passport self-assessment tool of the European Hematology Association (EHA).
Bone marrow sampling and intrathecal therapies are haematological procedures that are taught in conjunction with daily clinical work. The microscopic examination and interpretation of peripheral blood smears and morphological samples of bone marrow aspirates are taught at the laboratory specialised in haematology.
Research at the haematology clinic is active and part of good patient care and everyday operations. The Finnish Hematology Registry and Clinical Biobank is an important proponent of research. In recent years, substantial investments have been made in early phase clinical trials, with a number of trials focused on first-line therapies and relapse stages ongoing in all large disease groups. Furthermore, active cooperation is conducted with international research groups and those operating under the auspices of the University of Helsinki, with a focus on the personalised treatment of acute leukaemia and multiple myeloma, hereditary blood diseases and coagulation disorders.
professor Perttu Arkkila
perttu.arkkila@helsinki.fi
PO BOX 22 (Haartmaninkatu 4)
00014 University of Helsinki
PO BOX 22 (Meilahti Hospital, Haartmaninkatu 4)
00014 University of Helsinki