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Core Clinical Conditions and Skills


MEDICAL KNOWLEDGE AND CLINCAL CARE:

    • Every student should understand the etiology, clinical manifestations and pathophysiology of common illnesses encountered during this rotation and as outlined below
    • Every student should be able to demonstrate consistent, complete and adequate data collection during history taking on the common illnesses encountered during this rotation and as outlined below
    • Every student should be able to develop the differential diagnosis for, an appropriate assessment of and basic treatment plan for the following:

    • CORE SIGNS AND SYMPTOMS:
      • Chest pain
      • Dyspnea
      • Edema
      • Jaundice

    • CORE CLINICAL ISSUES:
      • Anemia
      • Cancer
      • COPD
      • Coronary artery disease
      • Congestive Heart Failure
      • GI bleed
      • DVT/ Pulmonary Embolism
      • Liver disease
      • Pneumonia
      • Renal failure
      • Substance abuse (tobacco, alcohol, illicit drug use)

    • SECONDARY CLINICAL ISSUES (NOT REQUIRED BUT OFTEN COVERED AND MAY BE TESTED ON THE EXAMS)
      • General Care of the Hospitalized Patient—Nutrition/diet, bowel care, sleep issues, activity levels, fluids and electrolytes, skin care, etc.
      • Pain Management
      • Infections
      • Cardiac Rhythm Disturbances
      • Sepsis/DIC/Shock
      • Hypertensive Crisis
      • Common Endocrine Problems
      • Delirium/Dementia

    • Every student should be able to complete a comprehensive and focused history and physical examination for each of the clinical entities above.
    • Every student should be able to correctly and thoroughly perform the following physical examination skills:
    • PHYSICAL EXAM SKILLS:
      • Cardiovascular Examination
      • Pulmonary Examination
      • Every student should be able to interpret the results of the following diagnostic tests, identify appropriate times for ordering such tests, and apply them to the clinical care of a patient:

    • DIAGNOSTIC TESTS:
      • Basic chemistries including renal function and hepatic function studies
      • ABG
      • Cardiac Enzymes
      • Cultures/Gram Stains
      • EKG
      • Radiology (chest and abdominal plain films, abdominal ultrasound, basic chest and abdominal CT)

COMMUNICATION:

    • Every student should be able to obtain and convey medical information with patients, their families and professional colleagues including but not limited to:
      • Complete written communications that are organized, accurate, complete, concise, and incorporate prioritization and analysis of medical issues
      • Perform oral presentations that are organized, accurate, complete, concise, and include prioritization and analysis of medical issues
      • Create rapport with patients/families through active listening, use of open-ended questions, limited interrupting and use of words that demonstrate compassion and caring
      • Discuss advanced directives and DNAR orders with patients and families in the inpatient setting
      • Deliver difficult news including information regarding diagnosis and prognosis in life-threatening conditions
      • Demonstrate collaborative decision making
      • Obtain a medical consultation from subspecialty colleagues; communicate effectively with consultants
      • Perform peri-discharge education for a patient including indications for admission, red flags to watch for, use of medications and indications, appropriate necessary follow-up

PROFESSIONALISM:

    • Every student should be able to:
      • Demonstrate a commitment to carrying out professional responsibilities in a timely and efficient manner
      • Interact respectfully with ALL members of the health care team, consultants and fellow physician providers
      • Adhere to ethical principles at all times
      • Demonstrate sensitivity to a diverse patient population and culturally competent care by being sensitive to patient differences (race, culture, gender, socioeconomic status) and preferences

SYSTEMS-BASED PRACTICE:

    • Every student should be able to:
      • Demonstrate understanding of the importance of interdisciplinary team members, consultants and health care resources for the benefit of the patient
      • Develop skills in team-based care, including an understanding of the skills and knowledge provided by consultants, nurses, PT, RT, OT, lab staff, discharge planners, etc through active participation in multidisciplinary rounds
      • Understand some of the costs of an inpatient hospitalization and the role that physicians play in incurring these costs
      • Understand the resources available to patients upon discharge from the hospital as they continue to recover form their illness and how insurance and financial constraints may impact the care you provide/ recommend on discharge
      • Understand the common pitfalls associated with transitions in medical care from one setting to another
      • Understand and educate patients on the 4 pillars necessary for successful transition to an outpatient environment including:
        1. Patient activation (education on reasons for hospitalization; understanding of medical illness)
        2. Medication self-management
        3. Red flags regarding their condition
        4. Follow up needs
      • Complete a medication reconciliation

PRACTICE-BASED IMPROVEMENT:

    • Every student should be able to:
      • Assess the quality of care provided to one or more of their patients as determined by core quality measures for pneumonia
      • Discuss their findings regarding the team’s performance on the quality core measures with the housestaff and faculty
      • Understand their own limitations and seek help when needed
      • Review the literature to find answers to questions that occur in the course of patient care and educate the team to benefit both the team and the patient