Read T2Clinical-Diagnosis_Syllabus2010-2011final_rev_Oct-272010.pdf text version

SYLLABUS: Clinical Diagnosis 2010-2011 Academic Year DeBakey Classroom, SP and SIM Centers, Campus Clinics and Hospitals CONTACT INFORMATION: Course Director: Elma I. LeDoux, MD, FACP, FACC 1555 Poydras St. New Orleans, LA 70112 SP Center, 22nd Floor, room 2276 Office phone: (504) 988-3710 Office Fax: (504) 988-4596 Cell: (504) 289-3610 Email: [email protected]

Coordinator: Ms. Kari Goforth 1555 Poydras St. SP Center, 22nd Floor Office Phone: (504) 988-3710 Office Fax: (504) 988-4596 Email: [email protected] COURSE MATERIALS: Texts Bickley L and Szilagyi P. Bates' Guide to the Physical Exam and History Taking 10th ed., 2008 Lippincott, Williams, and Wilkins ISBN 0-7817-1655-1 LeBlond R, Brown D, and DeGowin R. DeGowin's Diagnostic Examination. 9th ed., 2008 McGraw-Hill ISBN: 978-0-07-160574-8 Silen W. Cope's Early Diagnosis of the Acute Abdomen. 22nd ed. 2010 Oxford University Press. ISBN 978-0-19-973045-2 Other Resources: ­ case of the week and photo quizzes American College of Physicians: Heartsongs ________________________________________________________________ Tulane University School of Medicine Syllabus


Day to day course information will be posted on TMedWeb; group assignments will be posted on Blackboard and TMedWeb. Please check daily for suggested reading, assignments, etc.

COURSE DESCRIPTION: Introduction to Clinical Diagnosis is a required, year-long course for sophomore medical students. It is designed to enhance history-taking skills while introducing the student to both normal and abnormal exam findings. The course is interdigitated with the mechanisms of disease course and is, therefore, organ systemsbased. This allows the student to approach the patient's exam with an understanding of the underlying pathophysiology, thus reinforcing the principles of basic science at the bedside. In addition to the history and physical exam sessions with the preceptor, the student will be introduced to statistics and evidence-based medicine, clinical reasoning sessions, SP FEX sessions, and SIM Center activities. There are also ward preparation sessions which present and allow for group discussion of ethical issues which the students may face as clinical clerks.

COURSE OBJECTIVES: At the conclusion of this course, the student should be able to 1) demonstrate proficiency in the performance of a history and physical exam and its oral and written presentation 2) integrate the clinical information with the underlying pathophysiology 3) apply clinical reasoning to develop a differential diagnosis 4) incorporate biostatistics and evidence-based medicine into clinical reasoning and review of the literature 5) identify and appreciate cultural differences and factor these into the overall patient assessment 6) demonstrate a conscious commitment to professionalism, medical ethics, and patient advocacy

TEACHING PHILOSOPHY The student should read as much as possible. This consists of required reading, but also should include reading about the illnesses of each patient seen with the preceptor immediately after the session. The patient is your best teacher and embodies the ultimate expression of the art and science of medicine. These patient interactions remind us that our ultimate goal is the treatment of human beings, not just the appreciation of their underlying pathophysiology. Your instructors will serve as guides and mentors in this experience, but ultimately the learning occurs within the context of the doctor-patient relationship.

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COURSE POLICIES It is expected that the student will attend all required activities (to include, but not limited to: FEX sessions, TBLs, preceptor sessions, and required seminars). All excused absences must be approved by the Office of Student Affairs. Make up FEX sessions and exams are available for those who have obtained an excused absence. It is also expected that students will be punctual, and professionally attired for activities that involve patient contact. Deficiencies in these areas will affect the professionalism component of the course grade. COPY STATEMENT: Some of the materials in this course are possibly copyrighted. They are intended for use only by the students registered and enrolled in this course and only for instructional activities associated with and for the duration of the course. They may not be retained in another medium or disseminated further. They are provided in compliance with the provisions of the Teach Act (Section 110(1) of the Copyright Act. GRADING/EVALUATION: Block Exams (Clinical Diagnosis questions only) average: Custom Shelf Exam (Clinical Diagnosis questions): Attendance and Participation at all Preceptor/FEX sessions: SCOPE exam (counts for FIM II, also) Professionalism (includes punctuality, preceptor comments, SP comments, TBL peer evaluation) 25% 25% 30% 10% 10%

COURSE CONTENT AND OUTLINE: Didactic sessions (DeBakey) 1-2/block- provide an overview of the normal and commonly seen abnormal physical findings associated with that organ system, and introduce students to essential terminology used to describe these findings. All sessions are recorded on Tegrity and specific objectives are included at the beginning of each session. These large group sessions are led by a faculty member. FEX sessions (one per block, in the SP Center)) with standardized patients introduce the student to the normal physical exam under the guidance of a trained standardized patient facilitator. Students become comfortable with the patient encounter while also enhancing their skills with a normal exam. Objectives specific to each FEX session are presented prior to each session. Students work in groups of four with a standardized patient. Clinician-facilitated sessions at the bedside (nine per academic year at campus- based clinics and hospitals). Students practice their history taking and physical exam skills under the guidance of a physician. Students focus their attention each session on the particular organ system being studied in MOD while also integrating previously studied pathology. The students learn the art and science of ________________________________________________________________ Tulane University School of Medicine Syllabus 3

medicine and have the opportunity to develop a differential diagnosis and present the patient to the facilitator. Specific objectives for each session are provided to the students and the facilitators at the beginning of each year. The students are assigned to groups of four per clinician at various clinics and hospitals within the Health Sciences Center. Biostatistics and Evidence-based Medicine (DeBakey, eight contact hours)- the students are exposed to EBM through reading and discussion of journal articles led by a faculty facilitator. Students are exposed to biostatistical terms, types of clinical trials and common flaws found in research results. Students work in small groups. Specific objectives of the course are provided to the students at the beginning of the course. Ward Prep and Clinical Reasoning (Debakey, four contact hours)- students are introduced to the concept of team-based medicine, issues in patient safety, critical thinking, and scenarios involving ethical issues to which the students may be exposed while on their clerkships. These sessions are led by faculty facilitators. Cultural Sensitivity Training- consists of two hours of didactic sessions followed by a small group encounter with a standardized patient at the SP Center. These sessions will enhance awareness of cultural differences, bias, and communication issues in patient care. TBL sessions (DeBakey; one per block; integrated with MOD and Pharmacology) These are small group sessions during which the students work in teams to discuss and answer questions related to a journal article pertinent to that particular organ system. Students also evaluate each other's level of participation in this activity as part of the professionalism component of the course. The objectives for each TBL are provided at the time the student is given the reading assignment and the IRAT questions. Harvey Simulator and other SIM Center Activities- students are given the opportunity to have hands on experience related to heart sounds and management of an unstable angina case. Specific objectives are provided to the students prior to each session. Sessions are led by faculty and senior medical student facilitators. Lagniappe Room (in the SP Center) - this is an optional enhanced learning activity whereby students are exposed to clinical cases, Xrays, EKGs, etc. for interpretation in the context of their evolving knowledge of pathophysiology. This activity is designed to expose the student to the clinical presentation and integration of information from several sources in the development of a differential diagnosis. SCOPE exam (SP Center)- an OSCE-type examination taken at the end of the second year which is designed to assess the students' ability to interview, perform a systematic exam, and develop a differential diagnosis for patients presenting with complaints across various specialties. Communication skills, professionalism, and regard for patient comfort are an integral aspect of this activity,

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RESOURCES Office of Medical Education- assistance with test-taking and study skills Medical Library ­journal searches, proficiency in on-line searches Harvey Lab- by arrangement with course director

TULANE UNIVERSITY HONOR POLICY: The Tulane School of medicine Honor Policy outlines the School of Medicine expectations for the integrity of the students' academic work, the procedures for resolving alleged violations of those expectations, and the rights and responsibilities of students and faculty members throughout that process. Students are responsible for reading the Honor Policy and for living up to their pledge not to violate the Honor Code. The Honor Policy can be found at:

AMERICANS WITH DISABILITIES ACT: Students with disabilities needing accommodation should 1) register with and provide documentation to the Student Disability Resource Center; 2) bring a letter to the instructor indicating the need for accommodation and what type. This should be done during the first week of class. This syllabus and other class materials are available in alternative format upon request.


Knowledge (K=KNOWLEDGE)

K2: normal structure, function and pathophysiology of all organ systems K4: all components of the medical interview and physical examination K5: fundamental issues of environmental health K6: principles and application of scientific literature K7: foundations of evidence-based medicine K8: use of modern information technology K9: basic principles and practice of medical ethics K11: apply the basic science principles of normal and abnormal structure and function to clinical medicine K12: apply the principles of clinical reasoning K13: recognize and manage common medical problems K16: apply the principles of evidence-based medicine

Aligned with Course Learning Objective 1, 2 1,3 2,3 4 4 4 5,6 2 3, 4 1,2,3 4

Assessment Method

Block exams; SCOPE exam; preceptor evaluation; shelf exam SCOPE exam, preceptor evaluation SCOPE exam; block exams; preceptor evaluation; shelf exam EBM- small group assignments EBM- small group assignments EBM-small group assignments SP and preceptor evaluation; Shelf exam Block exams; shelf exams; FEX sessions; preceptor evaluations EBM-small group assignments; bedside preceptor evaluation Block exams; bedside preceptor eval.; shelf exam EBM-small group assignments

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K20: provide patient care with regard for psychosocial issues K21: apply the principles of clinical epidemiology, medical ethics, and alternative medicine in clinical medicine Attitude/Behavioral (AB=ATTITUDES/BEHAVIORS) AB1: act with integrity, honesty and candor AB2: treat the patient as a person AB3: view medicine as a service profession AB4: maintain confidentiality about patients, colleagues, faculty, etc. AB5: practice humanism, courtesy, and social decorum AB6: exhibit teamwork and collegiality AB7: respect diversity AB8: promote equity AB9: work through ambiguity and uncertainty AB10: altruism, honesty, ethical behavior, caring and compassion AB11: use of adaptive mechanisms for dealing with stress AB12: commitment to excellence in patient care AB13: commitment to the patient's welfare and advocacy AB14: respect for and cooperation with all participants of the health care system AB15: sensitivity to diversity AB16: appreciation of medicine as a service profession AB17: commitment to equity AB18: responsibility for preventive care AB19: participation in providing public health education AB20: engagement in life-long learning and adaptability to the changing health care environment AB21: commitment to civic responsibilities Skills (S=SKILLS) S1: apply basic knowledge in a clinical setting S2: establish rapport with patients S3: perform a reliable history and physical exam S4: generate a basic "problem list" based on the history and physical exam S5: communicate effectively in oral and written form S6: work collaboratively in problem-solving S7: navigate biomedical information resources S8: use critical thinking

5,6 4,5,6 Aligned with Course Learning Objective 5,6 5,6 5,6 5,6 5,6 5,6 5,6 5,6 5,6 5,6 5,6 5,6 5,6 5,6 5,6 5,6 5,6 5,6 5,6 4,5 5,6 Aligned with Course Learning Objective 2,3 5,6 1 3 2,3 2,3,4 4 2,3,4

SCOPE exam; bedside preceptor evaluation EBM-small group assignments; Shelf exam Assessment Method SCOPE exam; bedside preceptor evaluations " " " " " " " " " " " " " " " " " " " " Assessment Method SCOPE exam, block exams, shelf exam, preceptor evaluation SCOPE exam; preceptor evaluation SCOPE exam; preceptor evaluation SCOPE exam; preceptor evaluation SCOPE exam; preceptor evaluation Preceptor evaluation EBM small group assignments SCOPE exam; block exams; shelf exam; EBM small group assignments; preceptor evaluation EBM small group assignments; SCOPE exam; block exams; shelf exam EBM small group assignments; preceptor evaluation SCOPE exam; block exams; shelf exam; preceptor evaluation SCOPE exam; block exams; shelf exam SCOPE exam; preceptor evaluation SCOPE exam; preceptor evaluation SCOPE exam; preceptor evaluation

S10: use effective learning techniques


S11: use learning resources, including mentors, effectively S12: evaluate and remedy personal deficiencies S13: develop effective test-taking skills S16: perform a comprehensive or focused history and physical examination, and recognize the appropriateness of when to perform each of these exams. S17: order and interpret appropriate laboratory and diagnostic studies S18: integrate history, physical examination and laboratory results

2,4 5,6 2 1,2,3 3,4 3

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S19: perform routine and simple procedures necessary for patient care S21: recognize normal and abnormal findings across the life cycle S22: generate appropriate differential and working diagnoses S23: use information and knowledge seeking skills necessary for lifelong learning S24: cope with ambiguity and uncertainty S25: recognize and differentiate between emergent, urgent, and routine health conditions S27: interact in a confidence-inspiring manner with patients and their families S29: recognize and manage personal limitations in treating patients, evaluate and remediate personal deficiencies S30: listen to and communicate information effectively to patients, families, and colleagues S34: apply population knowledge to patient management

1 1,2 3 4 3,4,5 2,3 5,6

SCOPE exam; preceptor evaluation SCOPE exam; preceptor evaluation SCOPE exam; preceptor evaluation; block exams; shelf exam EBM small group assignments SCOPE exam; preceptor evaluation SCOPE exam; preceptor evaluation SCOPE exam; preceptor evaluation SCOPE exam; preceptor eval EBM small group assignments; SCOPE exam; preceptor evaluation

1,2,5,6 4,5,6


PC=Patient Care

PC1: Communicate effectively and demonstrate caring and respectful behaviors when interacting with patients and their families. PC2: Gather essential and accurate information about their patients. PC3: Make informed decisions about diagnostic and therapeutic interventions based on patient information and preferences, up-todate scientific evidence, and clinical judgment. PC5: Counsel and educate patients and their families. PC6: Use information technology to support patient care decisions and patient education.

Aligned with Course Learning Objectives 1,5,6 1 2,3,4,5,6

Assessment Method SCOPE exam; preceptor evaluation SCOPE exam; preceptor evaluation EBM small group assignments; SCOPE exam; preceptor evaluation SCOPE exam; preceptor evaluation EBM small group assignments

5,6 4

MK=Medical Knowledge

MK1: Demonstrate an investigatory and analytic thinking approach to clinical situations. 2,3,4 EBM small group assignments; SCOPE exam; preceptor evaluation

PBL=Practice-based Learning and Improvement

PBL2: Practice-based Learning and Improvement: Locate, appraise, and assimilate evidence from scientific studies related to their patients' health problems. PBL4: Practice-based Learning and Improvement: Apply knowledge of study designs and statistical methods to the appraisal of clinical studies and other information on diagnostic and therapeutic effectiveness. PBL5: Practice-based Learning and Improvement: Use information technology to manage information, access on-line medical information; and support their own education. 3,4 4 EBM small group assignments; preceptor evaluation EBM small group assignments EBM small groups assignments


ICS=Interpersonal and Communication Skills

________________________________________________________________ Tulane University School of Medicine Syllabus


ICS1: Create and sustain a therapeutic and ethically sound relationship with patients. ICS2: Use effective listening skills and elicit and provide information using effective nonverbal, explanatory, questioning, and writing skills. ICS3: Work effectively with others as a member or leader of a health care team or other professional group.

5,6 1,5 5,6

SCOPE exam; preceptor evaluation SCOPE exam; preceptor evaluation Preceptor evaluation


P1: Professionalism: Demonstrate respect, compassion, and integrity; a responsiveness to the needs of patients and society that supercedes self-interest; accountability to patients, society, and the profession; and a commitment to excellence and on-going professional development. P2: Professionalism: Demonstrate a commitment to ethical principles pertaining to provision or withholding of clinical care, confidentiality of patient information, informed consent, and business practices. P3: Professionalism: Demonstrate sensitivity and responsiveness to patients' culture, age, gender, and disabilities. 5,6 SCOPE exam; preceptor evaluation

5,6 5,6

SCOPE exam; preceptor evaluation SCOPE exam; preceptor evaluation


Except for changes that substantially affect implementation of the evaluation (grading) statement, this syllabus is a guide for the course and is subject to change with advanced notice.

________________________________________________________________ Tulane University School of Medicine Syllabus



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