| Overview: Proposed Advanced Core Curriculum
(Total 16 Weeks but can be taken as 4 Week blocks)
Skeleton Draft
Goals:
(1) Enhance student skills in clinical reasoning by developing the student’s clinical skills to acquire, organize and analyze clinical data to justify a diagnostic evaluation, therapy or management plan; improve sophistication in oral and written communication. (All Components, particularly A,B, C and D)
(2) Create an opportunity for students to build on core skills and knowledge developed during the Core Blocks by experiencing the depth and breath of patient’s presenting signs and symptoms and specific chronic diseases. (Components A, B and C)
(3) Develop skills in the care of the aging patient and the medical care of surgical patients undergoing surgery and pain. (Components C and D)
(4) Expand knowledge of the health care system and various physician roles in the health care system through clinical experience in specific clinical areas including perioperative medicine, aging, chronic disease management and the approach to the undifferentiated patient.
(5) Recognize the involvement of the overall health care process including costs associated with chronic disease management.
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Learning
Objectives |
1. Demonstrate the ability to take and corroborate history from a reliable informant.
2. Learn how to elicit the basic activities of daily living (BADL) and instrumental activities of daily living (IADL)
3. Be able to perform a functional assessment in the elderly
4. Demonstrate the ability to conduct a quick test to elicit gait
5. Evaluate Psychosocial issues such as Depression, alcoholism, Elder abuse, self neglect, Non-compliance with medication and ability to afford medications in the elderly
6. Demonstrate the ability to perform and conduct a mini-mental status exam
7. Describe the understanding of the general principles of prescribing medications for older adults.
8. Review the Importance of disease prevention In the elderly
9. Exhibit an understanding of the Importance of preventing Iatragenic disease In the hosptialized elderly
10. Recognize the clinical features and differences between depression, delirium and dementia.
11. Demonstrate how to determine the etiology of falls in the Elderly
12. Assess and identify the patient in need of palliative care
13. Describe the normal physiological changes of aging for the cardiovascular system.
14. Compare and contrast the premenopausal vs. the post menopausal hormonal milieu.
15. List the changes that occur with aging in the ophthalmologic system.
16. Review the status of the urological system in the elderly, for both male and female.
17. Assess the disability encountered with aging of the musculo-skeletal system.
18. Evaluate how nutritional needs change with aging.
19. Identify the signs of frailty in the elderly.
20. Assess the likelihood of falls in a specific patient.
21. Choose pharmacologic therapy based on an understanding of the changes in metabolism and drug excretion.
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1. Focus the physical examination to areas pertinent to the patient’s primary complaint.
2. Construct a comprehensive problem list in descending order of importance.
3. Elaborate a diagnostic testing plan to eliminate less likely possibilities.
4. Interpret the diagnostic testing in light of the patient’s presentation.
5. Remain aware of contributing factors to the patient’s presentation.
6. Order further diagnostic testing as needed to focus on likely etiologies of the presentation.
7. Create a short term treatment plan focused on the patient’s current chief complaint.
8. Choose a long term plan to address the close and more remote contributing factors to the patient’s presentation.
9. Recognize and evaluate vitals signs rapidly to identify the acutely ill vs. the chronically ill patient
10. Describe the characteristics of acutely ill patients requiring ICU support and disposition.
11. Demonstrate the ABC’s of resuscitation
12. Demonstrate the ability to approach the interpretation of commonly used radiographic tests (CXR, extremity films, CT, ultrasound, MRI)
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1. Evaluate the patient’s signs and symptoms related to the chronic disease being evaluated
2. Learn how to take a focused history and perform a physical exam related to the chronic disease in question
3. Recognize the various laboratory and radiologic tests used to evaluate the chronic disease in question
4. Appreciate the cost-effectiveness of performing certain tests for the disease in question
5. Demonstrate the ability to work as part of a multidisciplinary team in caring for patients with chronic diseases
6. Recognize and be able to use disease specific evidence-based guidelines
7. Appreciate the health care costs associated with chronic disease care
8. Learn how to present and apply the evidence d-based approach to clinical practice
9. Evaluate the functional capacity of patient being treated for chronic disease.
10. Recommend a rehabilitation plan for patients with chronic disease.
11. Identify the level of disability encountered by a patient with chronic disease.
12. Identify the patient as a partner in chronic disease management.
13. Evaluate a chronic disease patient with a recognition of genetic risk factors.
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1. Outline the various elements of a preoperative evaluation for non-cardiac surgery
2. Assess perioperative risk using the history and exam
3. Integrate cost-effective preoperative testing and published guidelines into practice
4. Understand the basics of intraoperative stressors and physiology
5. Appreciate disease processes relevant to Perioperative care and implement evidence-based therapies for Perioperative risk reduction
6. Manage common post-operative medical complication
7. Evaluate and treat both acute and chronic pain
8. Understand the requirements for perioperative blood transfusions and common transfusion reactions
9. Review the nutritional needs of a post operative patient.
10. Calculate volume requirements for a patient who is “npo”.
11. Review the pharmacology of vasoactive agents.
12. Calculate renal function using the serum creatinine. |
Required
Didactics
(Noon to 2 pm) |
1. Dementia / Delirium
2. Medical Ethics 1
3. Managing the Hospitalized Elderly
4. Medical Ethics 2
5. Palliative Care / End of life issues
6. Falls
7. Menopause
8. Osteoporosis
9. Frailty
10. Changes in drug metabolism and excretion.
11. Drugs to avoid in the elderly. |
1. Shock
2. Chest pain
3. Abdominal Pain
4. ABC's of resuscitation
5. Chest Imaging
6. Common pediatric diseases
7. Abdominal Imaging
8. Upper respiratory tract infections
9. Dyspnea |
1. EBM 1
2. Use of evidence based guidelines in Medicine
3. Laboratory testing
4. EBM 2
5. Chronic disease management
6. EBM 3
7. Role of the patient partner and the role of the provider
8. EBM 4
9. Assessment of volume. |
1. The Preoperative evaluation and testing
2. Cardiac risk assessment and risk reduction
3. Anesthesia techniques and effects on perioperative management
4. Common Postoperative complications
5. Acute Pain
6. Quality and safety in perioperative Care
7. Chronic Pain
8. Transfusion medicine
9. Nutritutional requirements
10. Volume assessment |
Procedure
Skills Lab
every week
(Wednesday
afternoon
1-5 pm) |
-0- |
Procedural
Skills Lab
-Develop psychomotor ability and demonstrate procedural competencies (through clinical oversight or simulation evaluation) of the following procedures: Central venous catheterization, venopuncture, IV catheter insertion, ABG, NG tube insertion, foley catheter insertion, lumbar puncture, splinting, suturing, intubation, and defibrillation |
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Procedural
Skills lab
-Develop psychomotor ability and demonstrate procedural competencies (through clinical oversight or simulation evaluation) of the following procedures: Central venous catheterization, venopuncture, IV catheter insertion, ABG, NG tube insertion, foley catheter insertion, lumbar puncture, splinting, suturing, intubation, and defibrillation |
