Area of Concentration
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Objectives
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Methods
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I. Clinical Skills
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History Taking:
Student is able to obtain:
a)Comprehensive/initial
b)focused/sick (emphasizes #4-#7 in the next column)
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- Introduce self/ Set Environment
- Establish rapport
- Assure patient of confidentiality
- Elicit CC
- Direct HPI
- Organize pertinent background information
- Elicit level of illness
- Elicit patients perspective
- Assure mutual understanding/Agreement/
- Provide closure/ Identify next steps
- Perform these in a fluid and organized manner that generally
follows the Atchley format
- Deal with language issues with appropriate use of translator
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Physical examination:
Student is able to perform:
a)Comprehensive/initial
b)focused: relevant, pertinent to symptoms (#8,#9) specifically)
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- Demonstrate sensitivity to patients modesty
- Ensure proper draping of patient to maximize comfort and privacy
- Wash hands
- Obtain vital signs
- Progress in organized fashion from head to toe
- Elicit complaint specific findings
- Utilize appropriate developmental/cultural/ gender specific
strategies (for example: uses chaperone when appropriate)
- Identify the physical findings that are pertinent to the individual
patient
- Perform specialized aspects of the exam correctly. (pelvic
exam/neuro exam/etc.)
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Written Notes and Summaries:
Student is able to perform:
a) Hospitalized patient
b) Ambulatory patient
- comprehensive/new
- interval/follow-up
- sick
c) Procedures
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- Apply Atchley format for comprehensive notes
- Apply S.O.A.P. format for follow-up notes
- Document procedures and patient understanding and consent
- Document patient education and counselling
- Document date/time/
- Write legibly
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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
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- Present pertinent information in a distilled Atchley format
for new patients
- Present succinct problem-oriented format for follow-up or sick
patients
- Distill presentation to 3-5 sentences for bullet summary
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Clinical reasoning:
Student is able to identify:
a)differential diagnosis
b)level of urgency
c)problem list
Problem Solving:
Student is able to:
- synthesize patient data
- prioritize problems
- anticipate problems
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- Articulate urgency of situation
- Articulate initial management
- Articulate most serious diagnoses
- Articulate most common diagnoses
- Articulate problem list
- Describe a prioritized management algorithm
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Organization of daily work:
Student can prioritize and perform daily work for:
a)Hospitalized patients
b)Ambulatory patients
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- Review charts prior to seeing patients
- Retrieve and interpret labs
- Report interval findings on patients histories and physical
examinations
- Prioritize work and learning agendas for the day
- Arrange for daily activities and tests when appropriate
if instructed to do so.
- Describe indications for consults
- Describe how to communicate to a consultant
- Communicate effectively and regularly with other staff members
as necessary including nurses, social workers and other
staff.
- Communicate at appropriate intervals with other members of
the team
- Anticipate potential problems
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Procedures:
Students will be able to participate in:
- Preparation of patients
- Mechanics of procedure (for basic procedures)
- Rationale for procedure
- Comfort of procedure
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- Articulate risks (complications) and benefits
- Identify equipment and steps of procedure (for basic procedures)
- Discuss diagnostic or therapeutic utility of procedure
- Identify potential for pain control
- Document procedure
- Act under appropriate supervision
- Stay within limits of expertise
- Stay within limits of number of attempts
- Log procedures in Student Log (Blue Book)
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II. Knowledge
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Core Knowledge
Students will articulate basic principles of::
- Common diseases
- Common problems
- Emergencies
- Disease prevention
- Wellness
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- Discuss presentation of disease
- Discuss clinical course of disease
- Discuss basic pathophysiology of disease
- Discuss principles and basic science of basic management (Pharmacology)
- Discuss pertinent differential diagnoses of common problems
- Identify emergent conditions
- Describe management algorithm for common conditions and complaints
- Discuss underlying mechanism of common problems
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Depth of Understanding
Student is able to identify different levels of understanding:
- Handbook level
- Textbook level General and Subspecialty
- Literature level
- Web level
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- Use handbook level when on the fly
- Prepare textbook level for formal discussions
- Understand use of literature to guide specific decisions
- Perform literature searches when appropriate.
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III. Professional/Humane Behavior
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Humanism
Students will be able to convey:
- Compassion for patients needs
- Competence
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- Put aside own pressures/perspective
- Respect patients needs/perspective
- Resolve/Avoid conflicts by performing "1 and 2" above
- Honest portrayal of capabilities and limitations
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Decorum/ Professionalism
Students behavior will be characterized by:
- Neat attire
- Timeliness
- Respectful language
- Appropriate manners
- Confidentiality
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- Students will adhere to dress code
- Will keep to time commitments
- Speak in a cordial manner
- Respect other peoples rights and opinions
- Adhere to code of conduct (University and School wide)
- Adhere to strict rules of confidentiality - including access
to patient records and discussion of patient issues
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Initiative
Students will demonstrate:
- Responsibility for patients
- Responsibility for own education
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- Identify patient needs as paramount.
- Identify own learning needs
- Elicit feedback
- Maintain open posture to feedback
- Negotiate learning as a result of patient care
- Act with energy/interest
- Identify patient needs independently
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Ethics
Students will perform all actions with:
- Patients interests as paramount
- Honesty
- Humility
- Flexibility
- Awareness of ethical dilemmas
Students will identify:
- Common ethical dilemmas
- Resources for resolving ethical dilemmas
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- Elicit patients wishes
- Articulate role and limitations
- Acknowledge errors
- Acknowledge contributions of others
- Respect other points of view
- Identify conflicts among legitimate competing interests
- Identify conflicts of interest, such as drug company influence.
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IV. Interpersonal Skills
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Patients/ Families
Students will identify how to convey a sense of:
- Physical comfort
- Privacy
- Confidentiality
- Caring
- Clarity
- Follow up
- Shared decision making
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- Elicit physical needs
- Assure privacy
- Explicitly acknowledge confidentiality
- Meet even small needs
- Assure full understanding of situation
- Keep patient informed of all aspects of situation; including
future steps
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Colleagues
Students will demonstrate respect for classmates by:
- Acknowledge others contributions
- Share learning opportunities
- Take responsibility for everyones success
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- Give others appropriate credit
- Share materials/ideas
- Help others in any way possible
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Nurses/ Other Staff/ Faculty/ House Staff/Institution
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V. Formal Course Work
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