Knowledge

Interpretation of clinical information

Goal:

To appropriately incorporate diagnostic tests and procedures in clinical practice including the appropriate interpretation of results and application to clinical problems. To be able to effectively communicate the indication, method of obtaining, risks and benefits and results of a test and how this test result could change the diagnostic and/or therapeutic management.

Objectives:

  • To understand the indication for and be able to interpret the results of common tests to work-up common problems in internal medicine. Including but not limited to:
    • Laboratory tests: Basic metabolic panel, magnesium, phosphorus, complete blood count with differential, blood smear, hepatic function panel, urinalysis, thyroid function tests, cardiac injury panel, coagulation profile, arterial blood gas, basic rheumatologic panel, hepatitis series, pleural fluid, peritoneal fluid and joint aspiration fluid cell counts and chemistries.
    • Medical tests: Electrocardiogram, echocardiogram, cardiac stress tests, pulmonary function tests, esphagogastroduodenoscopy, and colonoscopy.
    • Imaging: Chest X-ray. Abdominal X-ray, abdominal ultrasound, CT Chest, and CT abdomen and pelvis.
  • To understand variations of normal results for these tests and be able to identify critical values.
  • To become familiar with the performance characteristics of these tests (sensitivity, specificity, etc.) and use this in clinical probabilistic reasoning (likelihood ratios, etc).
  • To consider patient preferences in choosing tests
  • To understand risk-benefit, cost-benefit and evidence based considerations in regards to diagnostics tests and procedures.

Core Experiences:

  • The student will be active student learner directly involved in patient care under the direct instruction of an attending, resident and intern physician in the care of inpatients on an academic healthcare team for seven to eight weeks.
  • The student will be active student learner directly involved in patient care under the direct instruction of an attending in the care of outpatients in a variety of ambulatory settings for two weeks.
  • The student will be active student learner directly involved in patient care under the direct instruction of an attending and resident physician in the care of Emergency room patients for one week.
  • The student will be active student learner directly involved in patient care under the direct instruction of an attending, fellow, and resident physician in the care of ICU patients for one week.
  • The student will receive didactic instruction in the proper interpretation of a chest x-ray.
  • The student will receive didactic instruction in the proper interpretation of electrocardiograms.

Diagnostic decision making

Goal:

To effectively and efficiently conduct and direct the diagnostic work-up of patients who are presenting in the inpatient or outpatient setting with simple or complex, acute or chronic illnesses per the standard of care.

Objectives:

  • To understand the importance of a thorough history and physical in the proper, effective and efficient diagnostic work-up of a patient.
  • To realize the key findings in the history and physical important to a particular problem
  • To synthesize symptoms and signs from a history and physical into a logical clinical syndrome or illness.
  • To become familiar with critical pathways and practice guidelines in performing diagnostics work-ups.
  • To become familiar with and improve deductive reasoning skills, forward thinking, pattern recognition.
  • To be able to construct an appropriate differential diagnosis based on the history and physical findings, use this to guide diagnostic testing and their sequence and be able to communicate this to the patient and family.
  • To become familiar with information resources available to help determine diagnostic options for working-up common medical problems.
  • To use probability based thinking in diagnostic reasoning. Recognize the importance of utilizing other health care professionals in the diagnostic decision making.

Core Experiences:

  • The student will be active student learner directly involved in patient care under the direct supervision and instruction of an attending, resident and intern physician in the care of inpatients on an academic healthcare team for seven to eight weeks.
  • The student will be active student learner directly involved in patient care under the direct supervision and instruction of an attending in the care of outpatients in a variety of ambulatory settings for two weeks.
  • The student will be active student learner directly involved in patient care under the direct supervision and instruction of an attending and resident physician in the care of Emergency room patients for one week.
  • The student will be active student learner directly involved in patient care under the direct supervision and instruction of an attending, fellow, and resident physician in the care of ICU patients for one week.

Therapeutic decision making

Goal:

To effectively and efficiently conduct and direct the therapeutic management of patients who are presenting in the inpatient or outpatient setting with simple or complex, acute or chronic illnesses per the standard of care.

Objectives:

  • To become familiar with the process of formulating an initial therapeutic plan and modifying this plan based on patient response, compliance, and adverse reactions.
  • To become familiar with resources available to determine therapeutic options available for common medical problems.
  • To gain experience in monitoring patients response to therapy including effectiveness and adverse responses.
  • To gain experience in communicating therapeutic options to patients and their families including risks, benefits and clinical effectiveness.
  • To consider patient factors and preferences in choosing between therapeutic options.
  • To begin to understand factors to consider in choosing among treatment plans.
  • To understand and to begin to demonstrate using risk-benefit, cost-benefit and evidence-based considerations in selecting and maintaining therapeutic interventions.
  • To understand when and how to use critical pathways and clinical practice guidelines in therapeutic decision making.
  • To gain experience in the counseling of patients in regards to the proper administration of their medications and other aspects of their treatment plan and common and serious adverse reactions.

Core Experiences:

  • The student will be active student learner directly involved in patient care under the direct supervision and instruction of an attending, resident and intern physician in the care of inpatients on an academic healthcare team for seven to eight weeks.
  • The student will be active student learner directly involved in patient care under the direct supervision and instruction of an attending in the care of outpatients in a variety of ambulatory settings for two weeks.
  • The student will be active student learner directly involved in patient care under the direct supervision and instruction of an attending and resident physician in the care of Emergency room patients for one week.
  • The student will be active student learner directly involved in patient care under the direct supervision and instruction of an attending, fellow, and resident physician in the care of ICU patients for one week.

Geriatric Care

Goal:

To become skilled in effective geriatric patient care understanding their possible atypical presenting symptoms and signs, complex co-morbid disease, differing response to diagnostic tests, and atypical reactions to treatments and medications.

Objectives:

  • To become familiar with the diagnostic and therapeutic management of the elderly in regards to common medical problems that they may be afflicted with focusing in on their atypical presentations and response to therapy. Common medical syndromes include but are not limited to: Cardiovascular and cerebrovascular disease, diabetes and its complications, urinary tract infections, pneumonia, substance abuse, depression, thyroid disease, fluid and electrolyte disturbances, arthritis, abdominal pain, constipation, anxiety and depression
  • To become familiar with the diagnostic and therapeutic management of common geriatric syndromes. Common geriatric syndromes include but are not limited to: Decreased mobility, falls, gait disturbances and balance problems, dizziness, incontinence, malnutrition, sleep disturbances, dementia, delirium, osteoporosis and is complications, hearing and visual impairment, decubitus ulcers.
  • To become familiar with nutritional needs and problems of the elderly.
  • To become familiar with the pharmacologic treatment of the elderly including pharmacokinetic and pharmacodynamic changes associated with aging.
  • To understand the clinical significance of polypharmacy in the elderly and strategies to limit this in patients.
  • To be able to adjust ones history and physical exam skills to adapt to the mental and physical constraints of the elderly patient.
  • To perform a thorough and accurate mental status examination and understand the results of the test.
  • To be able to identify patients at high risk for falling.
  • To understand the increased risk geriatric patients have for iatrogenic complications and to work at understanding means to monitor for these complications and limit them.
  • To always respect geriatric patients, especially elderly patients with dementia or decreased capacity working to preserve their dignity and modesty at all times.

Core Experiences:

  • The student will participate in, LinkAges, a didactic and patient interactive experience consisting of two, day sessions at to local skilled nursing facilities under the instruction of a gerontologist.
  • The student will be active student learner directly involved in patient care under the direct supervision and instruction of an attending, resident and intern physician in the care of inpatients on an academic healthcare team for six weeks.
  • The student will be active student learner directly involved in patient care under the direct supervision and instruction of an attending in the care of outpatients in a variety of ambulatory settings for two weeks.
  • The student will complete a geriatric curriculum provided below and be evaluated via a geriatric test. The geriatric curriculum will address the Minimum geriatric competencies for medical students. The minimum geriatric competencies for medical students is as follows:

Prevention

Goal:

To be able to effectively and efficiently perform health maintenance and prevention for patients in an evidence based manner.

Objectives:

  • To understand the concepts of primary, secondary and tertiary prevention.
  • To be familiar with the general preventive health issues and screening that should be address on a routine basis for both male and female patients.
  • To be familiar with the indications, contraindications, evidence supporting or opposing, and complications or common screening tests.
  • To be familiar with the sensitivity, specificity, positive and negative predictive value of common screening tests.
  • To be familiar with the commonly available vaccines and their indications, contraindications and administration. Indications for and means of providing infective endocarditis prophalaxis.
  • To understand and identify high-risk behaviors and methods of counseling patients on behavior modification.
  • To be familiar with the stages of change and their clinical implication in behavior modification.
  • To be able to identify patients at high risk for developing diabetes, dyslipidemia, cardiovascular disease, cancer, osteoporosis, influenza, community acquired pneumonia, hepatitis, substance abuse, depression, HIV, other sexually transmitted diseases, tuberculosis and being a victim of domestic or sexual abuse.
  • To be able to find and critically appraise recommendations on disease screening and health maintenance practices.
  • To be able to encourage patients to be active participants in their health maintenance.
  • To use risk-benefit, cost-benefit and evidence based approaches to health maintenance and screening.

Core Experiences:

The student will be active student learner directly involved in patient care under the direct supervision and instruction of an attending in the care of outpatients in a variety of ambulatory settings for two weeks.

Nutrition

Goal:

To assess the nutritional status of patients and to understand how nutrition plays a role in acute, chronic and terminal medical illness and in health maintenance. To assess patient factors involved their malnutrition or obesity and to be able to council patients on proper diet modification to overcome these barriers. To manage the nutritional needs of patients while hospitalized.

Objectives:

  • To understand the contribution diet has to common medical problems such as diabetes, hypertension, dyslipidemia, obesity and cardiovascular disease.
  • To understand the co-morbidity that obesity contributes to many medical illnesses and medical and surgical procedures.
  • To understand the consequences of poor nutrition in medical illness and hospitalized patients such as poor wound healing, decreased immunity and increased morbidity and mortality. The indications, contraindications and means of enteral and parenteral nutrition.
  • To understand the indications for and means of dietary supplementation.
  • To learn to assess a patients nutritional status and provide counseling in regards to diet modification.
  • To become familiar with common medical illnesses that can cause nutritional deficiencies.
  • To learn how to calculate an patients body mass index (BMI) and understand the result.
  • To be able to identify physical exam finding suggesting malnutrition or other inappropriate diet behaviors.
  • To be able to obtain a thorough and accurate dietary history. To be familiar with the diagnostic work-up of malnutrition and obesity.
  • To understand the importance and influence patient preferences and/or culture play in dietary behaviors.

Core Experiences:

  • The student will be active student learner directly involved in patient care under the direct supervision and instruction of an attending, resident and intern physician in the care of inpatients on an academic healthcare team for seven to eight weeks.
  • The student is encouraged to interact with dietitian consultants and the care of their patients in regards to nutrition therapy.
  • The student will be active student learner directly involved in patient care under the direct supervision and instruction of an attending in the care of outpatients in a variety of ambulatory settings for two weeks.
  • The student will be active student learner directly involved in patient care under the direct supervision and instruction of an attending, fellow, and resident physician in the care of ICU patients for one week.
  • The student is encouraged to interact with dietitian consultants and the care of their patients in regards to nutrition therapy.