Skills

History and Physical Examination

Case Presentation

Goal:

To become highly skilled in presenting and communicating patient care data to health care professionals in an organized, concise and logical manner, in written and oral format for both new patients and follow-up visits, inpatients and outpatients.

Objectives:

Realize the importance of the appropriate case presentation of patient care information in an accurate and succinct manner in a well organized and legible manner in the patient record and in an organized and fluent manner orally.
Recognize and communicate the components of a complete history and physical case presentation including a well thought out problem list with a logical differential diagnosis, medical decision making and plan in a written and oral manner for inpatients and outpatients.
Recognize and communicate the components of a follow-up visit case presentation in an organized and legible progress note in the medical record and in an organized and fluent manner orally for both inpatients and outpatients.
Become accustom to the appropriate extent that patient care information should be communicated in different clinical scenarios.
Be cognizant and adherent to HIPAA regulations in the presentation of patient information. Avoid the use of unapproved abbreviations and properly title, date, time and sigh all record entries. To demonstrate the ability to present case presentations with clear and concise presentations about topics and learning points pertaining to that case.

Core Experiences:

Students will attend a mandatory didactic session early in their medicine clerkship given by the clerkship director. The learning objectives for this session will be the proper format for case presentations in the oral and written form.

Oral case presentation:

On the wards students will present their patients daily to the resident and attending including the presenting history and physical initially and then daily follow-up visits on subsequent inpatient days.
In the outpatient setting students will present cases as requested by their preceptor. Students should actively seek out their preceptors preferences in regards to presentations. During their emergency room rotation the student will orally present focused case presentations to either a resident or attending.
The student will receive feedback from the residents and faculty in regard to their performance and should actively seek out this feedback.

Written presentations:

On the wards students will document their patients initial history and physical in the chart and daily follow-up visits on subsequent inpatient days with a progress note.
In the outpatient setting students will document initial history and physical examinations and follow-up visit notes as requested by their outpatient preceptor. Students should actively seek instruction on the documentation of visits in the ambulatory setting.
The student will receive feedback from the residents and faculty in regard to their written presentations and should actively seek out this feedback.

Communication and Relationships with Patients and Colleagues

Goal:

To become proficient at using communication skills to effectively facilitate patient care and to function within the healthcare system and become skilled at developing highly functional, effective physician-doctor relationships as well as collaborative relationships with fellow colleagues and healthcare workers.

Objectives:

To understand how effective communication skills are required to increase patient trust, satisfaction, and compliance.
To recognize how effective communication and relationships with patients are central to the diagnostic and therapeutic process as well as coordination of care.
To appreciate how differences in socioeconomic class, race, culture, gender, age, and personality affect communication with patients, families and colleagues.
To become familiar with communicating with patients via an interpreter.
To become familiar with and observe techniques of communication with patients and families in regard to breaking bad news, discussing end-of-life issues and advanced directives.
To appreciate HIPAA standards and maintain confidentiality when communicating patient information to patients, families and health care providers.
To use communications skills in patient education.
To recognize and develop skills needed to develop effective patient-doctor relationships.
To appreciate how differences in socioeconomic class, race, culture, gender, age, personality, perceptions and preferences affect relationships with patients, families and colleagues.
To realize and demonstrate the physicians role as a patient advocate.
To develop an empathic relationships with patients and families and appreciate their emotional needs as well as their concerns and preferences.
To recognize barriers to effective patient care with difficult patients such as patients with limited resources, substance abuse, psychiatric co-morbidities, somatization or malingering.

Core Experiences:

The students will participate in direct patient care as an active member of the health care team rotating through seven to eight weeks of inpatient medicine in a university hospital and Veterans affairs or private hospital setting.
The students will actively interact with patients that they are following developing a patient-student doctor relationship and communicate with them as appropriate for their inpatient care.
The student will actively interact with residents and faculty in a collegial and functional capacity as a member of the healthcare team and with any physician or non-physician consultants as appropriate.
The student will participate in direct patient care as an active member of the health care team for two weeks in a variety of general internal medicine and subspecialty Internal Medicine outpatient sites.
The students will actively interact with patients that they see in the outpatient setting developing a patient-student doctor relationship and communicate with them as appropriate for their outpatient care.
The student will actively interact with their ambulatory faculty in a collegial and functional capacity as a member of the healthcare team and with any support staff as appropriate.
The student will participate in direct patient care as an active member of the health care team for one week in the ICU setting.
The students will actively interact with patients that they see in the ICU setting developing a patient student-doctor relationship and communicate with them as appropriate for their inpatient care.
The student will actively interact with residents and faculty in a collegial and functional capacity as a member of the ICU team and with any physician or non-physician members of the patients primary team as appropriate.
The student will participate in direct patient care as an active member of the health care team for one week in the Emergency Department.
The students will actively interact with patients that they see in the Emergency Department developing a patient-student doctor relationship and communicate with them as appropriate for their emergency care.
The student will actively interact with residents and faculty in a collegial and functional capacity as a member of an Emergency Department team and with any physician or non-physician consultants as appropriate.

Coordination of Care and Teamwork

Goal:

To appreciate and become familiar with the professional responsibility the physician has in coordinating the patients care during an office visit or hospitalization and thereafter to ensure that the patient receives optimal care. To become skilled at the communication and collaboration with the healthcare team, including colleagues, consultants, nurses, social workers, case managers and other community based agencies, as well with the patient and family in order to provide smooth and effective patient care within the inpatient and outpatient healthcare system.

Objectives:

To understand to role of the primary care physician in coordinating the longitudinal and comprehensive patient care plan and to become familiar with the means to accomplish this.
To recognize the role of the consultant in the patient care plan and their relationship within the health care team.
To appreciate the process of medical or surgical consultation including when and how to ask for a consult and how to utilize the subsequent recommendations.
To become cognizant of personnel, services and agencies in the inpatient and outpatient setting who can contribute to the care of the patient longitudinally.
To appreciate the importance of an accurate and safe patient transition or hand-off within the health care system between providers and different levels of care and home.
To appreciate the importance of and become familiar with the accurate reconciliation of a patient medications at every transition point within the hearth care system.
To learn and demonstrate proper prescription writing and inpatient order writing in a safe, accurate and effective manner.
To become familiar with the roles of ancillary staff, nurses, nurse practitioners, physician assistants, residents and other health care workers within the inpatient and outpatient health care team.
To function and collaborate within the healthcare team in a professional and effective manner showing respect for all members of the team and demonstrating effective teamwork in setting forth the patient care plan.
Become familiar with and participate in the many aspects of discharge planning and recognize the importance of a safe and effective discharge plan.
To encourage patient and family participation in the health care plan when possible.

Core Experiences:

The student will follow Internal Medicine patients in all aspects of care. As a member of the healthcare team active in the care of patients in the inpatient, outpatient, Emergency Department and ICU setting the student will be familiar with the continuum of care and help coordinate this care through the complex healthcare system.
The student will actively seek participation in the coordination of patient care interacting with the healthcare team, including colleagues, consultants, nurses, social workers, case managers and other community based agencies, as well with the patient and family.
The student will be an active member of several healthcare teams during the clerkship in the inpatient, outpatient, Emergency Department and ICU setting.
The student will become familiar with the functions and roles of members of the primary team including attending, resident and intern physicians and the role and proper interaction with consultant physicians.
The student will become familiar with the functions and roles of the extended healthcare team including pharmacists, nurses, social workers, case managers, dietitians, respiratory, physical and occupational therapist, community based agencies and all other ancillary and support staff.

Basic Procedures

Goal:

To become familiar with the indications, contraindications, technique and complications of basic medical procedures. To be discuss these aspects of medical procedures in common terms to patients and/or their family.

Objectives:

To understand the indications, contraindications, risks, benefits, technique and complications of the following basic procedures:
- Venipuncture
- Arterial puncture for ABG determination
- ECG
- nasogastric tube placement
- urethral catheter placement
- peripheral IV placement
- throat culture
- PAP smear
- subcutaneous injection
- intramuscular injection
- PPD placement.
To be familiar with which procedures need informed consent and how to obtain this consent.
To be able to discuss the indications, contraindications, risks, benefits, steps and complications of these procedures with the patient and/or family in a manner in which they will understand.
To understand that a patient can refuse any procedure at any time.
To become familiar with when sterile measures are required and be able to demonstrate proper sterile technique and body substance isolation.
To become familiar with the documentation required for basic procedures.
To understand and help patients deal with the anxiety and fear they may have for basic 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, resident and intern physician in the care of ICU patients on an academic healthcare team for one week.
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 actively seek out opportunities to participate in, perform or learn about basic procedures.
The student will learn advanced life support procedures during their ACLS class.
The student will learn a variety of procedures during a simulation experience during their Emergency Department experience.