Phase 2 (Year 3) Curriculum

1. Explain the pathophysiology of each of the diagnoses or clinical conditions as outlined by the AAIM Core Medicine Clerkship Curriculum Guide
2. Describe how biomedical, ethical, and psychosocial-behavioral factors apply to the clinical presentation of the disease in their patients
3. List the indications, contraindications and benefits of the following common procedures: ABGs, thoracentesis, paracentesis, and lumbar puncture
4. Describe the indications for the following tests: complete blood count, comprehensive metabolic panel, coagulation studies, chest x-ray, abdominal x-rays, EKG, PFTs, and interpret results of these tests for their patients
5. Obtain an accurate, pertinent history from all appropriate available sources, and record it in a complete and concise manner
6. Perform and record a thorough physical examination, and review the physical findings with the faculty
7. Based on history and physical examination findings as well as any laboratory or diagnostic tests done, develop an appropriately prioritized and detailed problem list for each patient
8. Utilize clinical reasoning to develop appropriate differential diagnoses to assess the patients’ problems
9. Select a working diagnosis and formulate a diagnostic and therapeutic plan for their patient based on gathered clinical information and laboratory data
10. Document and deliver oral case presentations on new admissions (full H&P) and document and present daily progress notes (SOAP notes) that are generally accurate, concise, organized, and complete.
11. Communicate with patients and their families in a clear, respectful manner, responding to verbal and non-verbal cues.
12. Demonstrate respect and courtesy when communicating with all members of the health care team, including staff, nurses, residents and faculty
13. Demonstrate ability to actively engage with patients, families and other members of the health care team to coordinate care.
14. Demonstrate ability to discuss management plan with their patient and explain pathophysiology to them without using medical jargon
15. Discuss how psychosocial, educational, economic and religious backgrounds of patients may underlie their diverse belief systems, and demonstrate this understanding in the approach to the management of individual patients
16. Demonstrate sensitivity to, and an understanding of, the ethical dimensions of patient care, and demonstrate this sensitivity in the approach to the management of individual patients
17. Develop professional relationship based on trust, mutual-respect, empathy and conscientiousness with patients, peers and other health care members at all times
18. Demonstrate ability to work hard, accept patient responsibility and respond appropriately to feedback provided
19. Demonstrate respect, compassion, integrity, and honesty at all times
20. Develop and research clinical questions that arise during patient care and management, using evidence-based resources.
21. Demonstrate critical reading skills by analyzing selected journal articles, and identify characteristics of effective medical articles.
22. Choose pertinent issues related to the care of their patients and research them independently.
23. Describe the roles of other health care professionals in the care of patients in internal medicine.
24. Collaborate with other health professionals to establish and maintain a climate of mutual respect, dignity, diversity, ethical integrity, and trust
25. Develop the ability to use self-awareness of knowledge, skills, and emotional limitations to engage in appropriate help-seeking behaviors
26. Demonstrate healthy coping mechanisms to respond to stress
27. Manage conflict between personal and professional responsibilities
28. Practice flexibility and maturity in adjusting to change, with the capacity to alter one’s behavior
29. Demonstrate trustworthiness that makes colleagues feel secure when one is responsible for the care of patients
30. Recognize that ambiguity is part of clinical health care and respond by utilizing appropriate resources in dealing with uncertainty

1. Obtain an accurate clinical history focused on area of surgical concern
2. Perform an accurate clinical physical exam focused on area of surgical concern
3. Present and discuss patients with the need for surgical intervention
4. Explain various circumstances when an operation is, and is not, indicated and the importance of the timing of the intervention
5. Discuss rational indications for ordering imaging studies, and laboratory tests
6. Describe the limited benefit of non-operative therapy
7. Explain the pathophysiology and the prevention strategies of the most common diseases presenting for surgical intervention
8. Describe the course of the management and perioperative care of patients undergoing surgical intervention
9. Develop treatment plans for patients with surgical illnesses, while incorporating knowledge of cultural diversity and experience into all patient care activities
10. Develop decision-making skills in the ambulatory surgical setting, with the goal of being able to select best practices for the ambulatory surgical patients
11. Discuss the risk/benefit issues (e.g., the goals and risks, indications and contraindications of surgical operations, cost concerns) in the decision making of surgical intervention.
12. Incorporate feedback and demonstrate improvement on surgical patient history taking skills
13. Incorporate feedback and demonstrate improvement on assessment and physical examination performance skills
14. Demonstrate the use of evidence-based medicine to fill knowledge gaps for the delivery of inpatient and ambulatory surgical care delivery
15. Describe the concepts of and observe obtaining informed consent for surgical interventions
16. Communicate effectively and compassionately with patients and families
17. Participate as an effective member of a multidisciplinary team, adding value to the care of the surgical patient
18. Actively participate in the clerkship learning activities, as the student knowing their own learning is the active process for which the student is responsible
19. Demonstrate compassion, respect and dignity directed to the patient, family and colleagues
20. Practice punctuality, honesty, confidentiality and respect for patients’ privacy concerns
21. Adhere to ethical practices and demonstrate respect and sensitivity to all patient populations
22. Describe interdisciplinary health care services, techniques, and resources for the surgical patient
23. Define and identify individualized discharge plans, utilizing interdisciplinary services and resources within the healthcare system for continued patient care

1. Interviewing to obtain a complete and reliable neurologic history
2. Performing a reliable neurologic examination
3. Examining patients with altered level of consciousness or abnormal mental status
4. Delivering a clear, concise, and thorough oral presentation of a patient’s neurologic history and examination
5. Preparing clear, concise, and thorough documentation of a patient’s neurologic history and examination
6. Communicating empathically with patients and families
7. Recognizing symptoms that may signify neurologic disease
8. Identifying symptoms that may represent neurologic emergencies
9. Distinguishing normal from abnormal findings on a neurologic examination
10. Localizing the likely sites in the nervous system where a lesion may produce a patient’s symptoms and signs
11. Formulating a differential diagnosis based on lesion localization, time course, and relevant historical and epidemiologic features
12. Explaining the indication, potential complications, and interpretation of common tests used in diagnosing neurologic disease
13. Describe a systematic approach to the management of common neurologic diseases
14. Reviewing, interpreting, and applying pertinent medical literature to patient care

1. Gather information, formulate differential diagnoses, and propose plans for the initial evaluation and management of patients with common presentations.
2. Manage follow-up visits with patients having one or more common chronic diseases.
3. Develop evidence-based health promotion/disease prevention plans for patients of any age or gender.
4. Demonstrate competency in advanced elicitation of history, communication, physical examination, and critical thinking skills.

At the end of the clerkship, for each symptom listed above, students should be able to:

1. Differentiate among common etiologies that present with that symptoms.
2. Recognize dangerous conditions that may present with that symptom.
3. Perform a focused history and physical examination.
4. Proposed an evidence-based approach to the diagnostic work-up.
5. Describe the initial management of common and dangerous diagnoses that present with that symptom.

For each core chronic disease listed above, students should be able to:

1. Find and apply diagnostic criteria.
2. Find and apply surveillance strategies.
3. Elicit a focused history that includes information about adherence, self-management, and barriers to care.
4. Perform a focused physical examination that includes identification of complications.
5. Assess improvement or progression of the chronic disease.
6. Describe major treatment modalities.
7. Propose an evidence-based management plan that includes pharmacologic and non-pharmacologic treatments, and appropriate surveillance and tertiary prevention.
8. Communicate appropriately with other health professionals (e.g., physical therapists, nutritionists, counselors).
9. Document a chronic care visit.
10. Communicate respectfully with patients who do not fully adhere to their treatment plan.
11. Educate a patient about an aspect of his/her disease respectfully, using language that the patient understands. When appropriate, ask the patient to explain any new understanding gained during the discussion.

Adult

For each health maintenance condition in Table 1, students should be able to:

1. Identify risks for specific illnesses that affect screening and treatment strategies.
2. Identify issues and risks related to sexual health
3. Apply the stages of change model and use motivational interviewing to encourage lifestyle changes to support wellness (weight loss, smoking cessation, safe sexual practices, exercise / activity / nutrition / diet).
4. Provide counseling related to health promotion and disease prevention.
5. Find and apply the current guidelines for adult immunizations.
6. Develop a health maintenance plan for a patient of any age or gender that addresses the core health maintenance conditions.

Child and Adolescent

For each health maintenance condition in Table 1, students should be able to:

1. Identify and perform the core components of child preventive care—health history, physical examination, immunizations, screening / diagnostic tests, and anticipatory guidance.
2. Identify health risks, including accidental and non-accidental injuries and abuse or neglect.
3. Conduct a physical examination on a child. Recognize normal and abnormal physical findings in the various age groups.
4. Identify developmental stages and detect deviations from anticipated growth and developmental levels.

At the end of the family medicine clerkship, students should be able to:

1. Discuss the relationship of access to primary care and health disparities.

1. Develop competence in the medical interview and physical examination of women
2. Incorporate ethical, social, and diversity perspectives to provide culturally competent health care to patients seeing obstetric and gynecological care
3. Apply recommended prevention strategies to women throughout the lifespan
4. Demonstrate knowledge of preconception care, including the impact of genetics, medical conditions and environmental factors on maternal health and fetal development
5. Explain the normal physiologic changes of pregnancy, including interpretation of common diagnostic studies
6. Describe common problems in obstetrics
7. Demonstrate knowledge of intrapartum care of the mother and newborn
8. Demonstrate knowledge of postpartum care
9. Describe menstrual cycle physiology, discuss puberty and menopause and explain normal and abnormal bleeding
10. Describe the etiology and evaluation of infertility
11. List family planning options and describe risks and benefits of each
12. Demonstrate knowledge of common benign gynecological conditions
13. Formulate a differential diagnosis of the acute abdomen and chronic pelvic pain
14. Describe common breast conditions and outline the evaluation of breast complaints
15. Demonstrate knowledge of perioperative care and familiarity with gynecological procedures
16. Describe gynecological malignancies, including risk factors, signs and symptoms and initial evaluation
17. Provide a preliminary assessment of patients with concerns about sexuality and sexual health
18. Demonstrate professional behaviors with the healthcare team and with patients seeking obstetric and gynecological care

Objective 1: Medical Knowledge

1. Describe the typical psychological development throughout the lifespan
2. Describe biological and psychological theories related to psychiatric disorders, including substance use disorders
3. Describe pharmacological and psychotherapeutic approaches used in treating psychiatric disorders
4. Identify the components of a mental status examination and cognitive screening exam

Objective 2: Patient Care (clinical skills)

1. Conduct patient interviews proficiently
2. Use emotional response of patient and clinician as diagnostic information
3. Accurately diagnose psychiatric disorders in patients
4. Recommend evidence-based therapeutic interventions
5. Evaluate risk factors for potential dangerousness and violence in patients, whether directed towards themselves (e.g., suicidal ideation or self-injurious behavior) or others (e.g., homicidal thoughts or aggression)

Objective 3: Systems-Based Practice

1. Utilize the biopsychosocial model when conducting psychiatric assessments
2. Advocate for the equitable, just, compassionate, safe, and prudent care of patients with psychiatric disorders
3. Describe the foundational framework for mental health care in this country

Objective 4: Interpersonal Skills and Communication

1. Deliver clear and comprehensive (yet concise) patient presentations
2. Accurately document information in the electronic medical record
3. Communicate and collaborate effectively with patients, families, colleagues, and the treatment team while maintaining professional boundaries

Objective 5: Professionalism

1. Demonstrate respect, empathy, and concern for all patients, irrespective of their cultural backgrounds, socioeconomic status, personal attributes, or reason for presentation
2. Maintain courtesy towards patients, families, colleagues, and the treatment team
3. Uphold the highest ethical standards of the profession, including confidentiality, honesty, integrity, respect for persons, autonomy, beneficence, non-maleficence, and justice

Objective 6: Practice-Based Learning

1. Commit to a practice of personal growth through self-reflection
2. Embrace, reflect upon, and apply feedback to improve clinical competency
3. Utilize evidence-based resources to address personal gaps in medical knowledge skills

Fluid and Electrolyte Management

1. Calculate intravenous or oral maintenance fluids for a child, considering daily water and electrolyte requirements
2. Assist in the writing of IV fluid orders for a child requiring acute fluid resuscitation

Therapeutics

1. Demonstrate the appropriate use of medications for common chronic pediatric conditions (see Common Illness table)

Common Acute illness in Children

1. Obtain a history pertinent to the presenting concerns
2. List the differential diagnosis and identify the clinical and laboratory features of an acutely ill infant for common problems that may occur (see common illnesses table)
3. Perform a physical examination and interpret pertinent findings (Common Physical Exam Findings)
4. Interpret common laboratory tests (Common laboratory findings)
5. Generate an age-appropriate differential diagnosis
6. Describe an initial diagnostic and therapeutic plan for children with common pediatric concerns (see Common Illnesses table)

Pediatric Emergencies

1. Describe the clinical manifestations and initial management of emergent pediatric conditions such as sepsis, shock, etc
2. Discuss presentations concerning for child maltreatment, and the physician’s role in reporting to Child Welfare

Newborn Care

1. List the differential diagnosis and identify the clinical and laboratory features of an acutely ill infant for common problems that may occur (see common illnesses table)
2. Propose the evaluation and management of the acutely ill infant with conditions such jaundice, etc

Growth and Nutrition

1. Obtain a dietary history in children of different ages with chronic conditions, including type of feeding, amount, frequency, restrictions, and supplements

Common Chronic Illnesses

1. Describe the clinical features associated with common pediatric chronic medical conditions (see chronic illnesses table)
2. Describe how chronic illness can influence a child’s growth and development, educational achievement, and psychosocial functioning.
3. Identify basic management strategies for common chronic illnesses seen in children (see Common Illness table)
4. Participate as an engaged team member on multidisciplinary team in the care of children

Growth and Nutrition

1. Identify abnormal growth patterns on standard growth chart

Development

1. Describe the major developmental domains (e.g. gross motor, fine motor, language, and social development) and how development is routinely assessed
2. Recognize developmental delays based on history, physical exam, and results of screening tools

Behavior

1. Describe the range of typical behavior across the developmental spectrum
2. Recognize the clinical manifestations of common pediatric behavioral and developmental conditions including anxiety, depression, ADHD, autism, and concerns for self-harm

Adolescence

1. Interview an adolescent patient using a standard structured interview technique to address sensitive issues that affect health and safety
2. Describe the unique features of the physician-patient relationship during adolescence

Prevention

1. Describe the rationale behind the pediatric immunization guidelines and the vaccine preventable diseases they aim to prevent
2. Describe age-appropriate anticipatory guidance for injury prevention across the developmental spectrum
3. Recognize the use of screening tools in the assessment of growth, development, behavior, social determinants of health, and family violence

Newborn

1. Describe the common concerns to be reviewed during well newborn visits, including newborn feeding, sleep, safety, and parental self-care
2. Describe the advantages of breastfeeding and describe common difficulties experienced by breastfeeding mothers