Introduction to Clinical Medicine II

Total Contact Hours:

123 hours

Course Director:

S. Bruce Binder, M.D., Ph.D., Associate Professor of Family Medicine and Pharmacology

Course Description:

Similar to ICM I, this year-long course prepares students for their first clinical year. Small group case discussions and tutorials are used to learn about common presenting signs and symptoms, interpretation of physical and laboratory findings, and the development of a differential diagnosis. Clinical skills exercises with standardized patients ensure the development of skills for the urogenital and rectal exams. Observed Structured Clinical Examinations are used at several points during the year to assess achievement of objectives and provide feedback.

Course Objectives & Integration with the Educational Objectives:

By the conclusion of this course, the student will demonstrate the ability to:

K1 Knowledge of common signs and symptoms with which a patient would present to a primary care physician's office, and the ability to suggest an approach to the diagnostic workup of such patients. Specific areas addressed are ENT, Ophthalmology, Neurology, and Genitourinary signs and symptoms.

K2 Knowledge of the presentation and pathophysiology of abnormal heart and lung physical findings commonly seen in a primary care office.

K3 Knowledge of the important facets of the history and physical examination in evaluating patients with the following presenting complaints/problems, as well as a general idea of the appropriate diagnostic workup of these patients:

• Abdominal pain
• Chest pain
• Dizziness
• Edema
• Fatigue
• Headache
• Musculoskeletal problems
• Nausea/vomiting
• Pediatric failure to thrive
• Shortness of breath
• Syncope
• Upper respiratory

K4 Knowledge of the clinical presentation and requirements for ongoing care of patients with the following common disease processes, as well as lifestyle issues typically faced by these patients:

• Allergic rhinitis
• Cancer
• Diabetes
• End stage renal failure

K5 During the Adult Examination Workshop, the ability to perform, under direct supervision, two or three complete history and physical examinations on adult patients, and to write up findings in the standard format for an admission history and physical.

K6 During the Pediatric Examination Workshop, knowledge of the basic aspects of the pediatric exam, and the ability to perform pediatric examination and newborn examination as part of a small group of students under direct supervision of a physician. The student will additionally build a patient history for an acutely ill child during a simulated patient encounter (with the child’s parent or grandparent).

K7 During the Female Breast and Pelvic Examination Workshop, the ability to:

• Elicit a gynecological and sexual history from a female patient
• Perform a thorough breast examination on a female patient
• Perform a pelvic examination, including speculum exam and bimanual exam, on plastic models and on a live patient
• Teach a patient self breast examination

K8 During the Male Genital/Rectal Examination Workshop, the ability to:

• Demonstrate appropriate communication skills in eliciting a urogenital history
• Perform a thorough male urogenital examination on plastic models and a live patient
• Perform a rectal examination on plastic models and a live patient
• Teach a patient self testicular examination

K9 During the Radiology Workshop, the ability to:

• Describe the basic principles of radiographic imaging
• Evaluate chest film quality
• Read chest x-rays using a consistent routine
• Recognize common or classic features of pneumonia, pulmonary edema, lobar atelectasis, COPD, pleural effusion, and cardiomegaly on chest x-rays
• Recognize common injuries, rheumatoid arthritis, DJD, joint effusions, and osteomyelitis on standard extremity x-rays
• Recognize bowel obstruction, ileus, pneumoperitoneum, and radiopaque stones on the standard plain abdominal films

K10 During the Simulated Patient Workshops, the ability to:

• Display appropriate skills of professional presence, including sensitivity to a patient’s gender, sexual orientation, ethnicity, and any potentially relevant cultural factors that may affect care
• Apply a working knowledge of the clinical approach to patients with common presenting problems (see K3 above), including appropriate focused history building, focused physical exam, and basic labs, EKG, and x-rays (where appropriate)
• Generate a limited differential diagnosis for patients presenting with the above complaints
• Use feedback received from a patient to modify behavior during an ensuing encounter

K11 During the Documentation Workshop, the ability to write:

• An acceptable SOAP note for an inpatient and ambulatory encounter
• Basic admission orders
• A standard medication prescription

K12 During the Abnormal heart Exam/Physical Exam Review Workshop, the ability to:

• Perform all components of the physical examination as previously outlined in ICM I
• Identify common abnormal heart sounds, as would be encountered during typical clerkship experiences
• Describe anticipated changes in these heart sounds with various common exam maneuvers

K13 During the EKG Workshop, the ability to:

• Read and interpret standard EKGs as listed above
• Identify his/her greatest weakness(es)
• Address identified weakness(es) with the faculty member

K14 During the Radiology Workshop, the ability to:

• Read standard radiographs as listed above
• Interpret standard radiographs as listed above
• Identify his/her greatest radiographic reading / interpretation weakness(es)
• Address identified weakness(es) with the faculty member

K15 During the Procedural Skills Workshop, the ability to:

• Describe the indications, contraindications, and potential complications of urinary catheter insertion and removal, nasogastric/orogastric and common enteral access tubes, various venipuncture techniques, peripheral venous access, arterial access, and various injection techniques (intramuscular, subcutaneous, intradermal)
• Successfully insert a urethral catheter in male and female patient models
• Successfully place, secure, and ascertain proper position of nasogastric/orogastric tubes
• Access the peripheral venous system via vacutainer and catheter or needle/syringe methods
• Access the femoral vein for emergent or difficult sampling
• Describe the fundamental techniques for proper insertion of venous access devices
• Describe basic knot tying and suturing techniques
• Tie basic surgical knots and utilize simple suturing techniques to close a wound or secure invasive catheters
• Use proper technique for obtaining arterial blood for analysis
• Administer an injection by each of the various techniques

K16 During the Joint Exam Workshop, the ability to:

• Perform an examination of the shoulder
• Perform an examination of the knee
• Identify basic orthopedic abnormalities as viewed on x-ray, as well as the terminology associated with them

K17 During the Case Presentation/ Problem List Generation Workshops, the ability to:

• Present cases for discussion
• Generate a problem list

K18 During the Delivery of Bad News Workshop, the ability to:

• Appreciate the importance and difficulty of delivering “bad news” appropriately to patients
• Empathize with patients who receive bad news
• Identify necessary elements of talking with patients or their families about serious threats to their health and treatment choices
• Improve their ability to deliver bad news effectively to a patient

C1 The ability to communicate effectively with colleagues in Team-Based Learning modules and other learning activities in the course that require collaboration.

P1 Professionalism, including the ability to:

• Be punctual and attend required events
• Complete assignments in a timely fashion
• Be truthful
• Be courteous to patients, patients’ families, staff, colleagues, and other health professionals
• Maintain confidentiality regarding patient care
• Demonstrate respect, empathy, responsiveness, and concern regardless of the patient’s problems, personal characteristics, or cultural background
• Demonstrate scholarship in the form of contributing to a positive learning environment, collaborating with colleagues, and performing self-assessment and self-directed learning

Syllabi:

• Schedule
• Course Materials

Learning Activities:

Presentations, small group work on physical examination and interviewing, teaching assistant sessions.

Assessment:

Small group participation, Objective Structured Clinical Examinations, written exams.