Core Objectives: Third Year Clerkships

For a printable copy of these goals, click here. (PDF format)

Area of Concentration

Objectives

Methods

I. Clinical Skills

History Taking:

Student is able to obtain:

a)Comprehensive/initial

b)focused/sick (emphasizes #4-#7 in the next column)

  1. Introduce self/ Set Environment
  2. Establish rapport
  3. Assure patient of confidentiality
  4. Elicit CC
  5. Direct HPI
  6. Organize pertinent background information
  7. Elicit level of illness
  8. Elicit patient’s perspective
  9. Assure mutual understanding/Agreement/
  10. Provide closure/ Identify next steps
  11. Perform these in a fluid and organized manner — that generally follows the Atchley format
  12. Deal with language issues with appropriate use of translator
 

Physical examination:

Student is able to perform:

a)Comprehensive/initial

b)focused: relevant, pertinent to symptoms (#8,#9) specifically)

  1. Demonstrate sensitivity to patient’s modesty
  2. Ensure proper draping of patient to maximize comfort and privacy
  3. Wash hands
  4. Obtain vital signs
  5. Progress in organized fashion from head to toe
  6. Elicit complaint specific findings
  7. Utilize appropriate developmental/cultural/ gender specific strategies (for example: uses chaperone when appropriate)
  8. Identify the physical findings that are pertinent to the individual patient
  9. Perform specialized aspects of the exam correctly. (pelvic exam/neuro exam/etc.)
 

Written Notes and Summaries:

Student is able to perform:

a) Hospitalized patient

  • Admission
  • Progress/follow-up

b) Ambulatory patient

  • comprehensive/new
  • interval/follow-up
  • sick

c) Procedures

  1. Apply Atchley format for comprehensive notes
  2. Apply S.O.A.P. format for follow-up notes
  3. Document procedures and patient understanding and consent
  4. Document patient education and counselling
  5. Document date/time/
  6. Write legibly
 

Oral Presentations:

Student is able to perform:

a) Hospitalized patient

    • Attending rounds
    • Work rounds
    • Bullet summaries

b) Ambulatory patient

  • New/intake
  • focused follow-up
  • sick/walk-in
  1. Present pertinent information in a distilled Atchley format for new patients
  2. Present succinct problem-oriented format for follow-up or sick patients
  3. Distill presentation to 3-5 sentences for bullet summary
 

Clinical reasoning:

Student is able to identify:

a)differential diagnosis

b)level of urgency

c)problem list

Problem Solving:

Student is able to:

  1. synthesize patient data
  2. prioritize problems
  3. anticipate problems

 

 

  1. Articulate urgency of situation
  2. Articulate initial management
  3. Articulate most serious diagnoses
  4. Articulate most common diagnoses
  5. Articulate problem list
  6. Describe a prioritized management algorithm
 

Organization of daily work:

Student can prioritize and perform daily work for:

a)Hospitalized patients

b)Ambulatory patients

  1. Review charts prior to seeing patients
  2. Retrieve and interpret labs
  3. Report interval findings on patients’ histories and physical examinations
  4. Prioritize work and learning agendas for the day
  5. Arrange for daily activities and tests — when appropriate — if instructed to do so.
  6. Describe indications for consults
  7. Describe how to communicate to a consultant
  8. Communicate effectively and regularly with other staff members as necessary — including nurses, social workers and other staff.
  9. Communicate at appropriate intervals with other members of the team
  10. Anticipate potential problems
 

Procedures:

Students will be able to participate in:

  1. Preparation of patients
  2. Mechanics of procedure (for basic procedures)
  3. Rationale for procedure
  4. Comfort of procedure
  1. Articulate risks (complications) and benefits
  2. Identify equipment and steps of procedure (for basic procedures)
  3. Discuss diagnostic or therapeutic utility of procedure
  4. Identify potential for pain control
  5. Document procedure
  6. Act under appropriate supervision
  7. Stay within limits of expertise
  8. Stay within limits of number of attempts
  9. Log procedures in Student Log (Blue Book)

II. Knowledge

Core Knowledge

Students will articulate basic principles of::

  1. Common diseases
  2. Common problems
  3. Emergencies
  4. Disease prevention
  5. Wellness
  1. Discuss presentation of disease
  2. Discuss clinical course of disease
  3. Discuss basic pathophysiology of disease
  4. Discuss principles and basic science of basic management (Pharmacology)
  5. Discuss pertinent differential diagnoses of common problems
  6. Identify emergent conditions
  7. Describe management algorithm for common conditions and complaints
  8. Discuss underlying mechanism of common problems
 

Depth of Understanding

Student is able to identify different levels of understanding:

  1. Handbook level
  2. Textbook level — General and Subspecialty
  3. Literature level
  4. Web level
  1. Use handbook level when on the fly
  2. Prepare textbook level for formal discussions
  3. Understand use of literature to guide specific decisions
  4. Perform literature searches — when appropriate.

III. Professional/Humane Behavior

Humanism

Students will be able to convey:

  1. Compassion for patient’s needs
  2. Competence
  1. Put aside own pressures/perspective
  2. Respect patient’s needs/perspective
  3. Resolve/Avoid conflicts by performing "1 and 2" above
  4. Honest portrayal of capabilities and limitations
 

Decorum/ Professionalism

Students behavior will be characterized by:

  1. Neat attire
  2. Timeliness
  3. Respectful language
  4. Appropriate manners
  5. Confidentiality
  1. Students will adhere to dress code
  2. Will keep to time commitments
  3. Speak in a cordial manner
  4. Respect other people’s rights and opinions
  5. Adhere to code of conduct — (University and School wide)
  6. Adhere to strict rules of confidentiality - including access to patient records and discussion of patient issues
 

Initiative

Students will demonstrate:

  1. Responsibility for patients
  2. Responsibility for own education
  1. Identify patient needs as paramount.
  2. Identify own learning needs
  3. Elicit feedback
  4. Maintain open posture to feedback
  5. Negotiate learning as a result of patient care
  6. Act with energy/interest
  7. Identify patient needs independently
 

Ethics

Students will perform all actions with:

  1. Patient’s interests as paramount
  2. Honesty
  3. Humility
  4. Flexibility
  5. Awareness of ethical dilemmas

Students will identify:

  1. Common ethical dilemmas
  2. Resources for resolving ethical dilemmas
  1. Elicit patient’s wishes
  2. Articulate role and limitations
  3. Acknowledge errors
  4. Acknowledge contributions of others
  5. Respect other points of view
  6. Identify conflicts among legitimate competing interests
  7. Identify conflicts of interest, such as drug company influence.

IV. Interpersonal Skills

Patients/ Families

Students will identify how to convey a sense of:

  1. Physical comfort
  2. Privacy
  3. Confidentiality
  4. Caring
  5. Clarity
  6. Follow up
  7. Shared decision making
  1. Elicit physical needs
  2. Assure privacy
  3. Explicitly acknowledge confidentiality
  4. Meet even small needs
  5. Assure full understanding of situation
  6. Keep patient informed of all aspects of situation; including future steps
 

Colleagues

Students will demonstrate respect for classmates by:

  1. Acknowledge others contributions
  2. Share learning opportunities
  3. Take responsibility for everyone’s success
  1. Give others appropriate credit
  2. Share materials/ideas
  3. Help others in any way possible
 

Nurses/ Other Staff/ Faculty/ House Staff/Institution

 

V. Formal Course Work