WR2 Curriculum

Overall Goals  ▪  Block A  ▪  Block B  ▪  Block C  ▪  Block D

Overall Goals

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■  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)

■  Create an opportunity for students to build on core skills and knowledge developed during the Core Blocks

■  Acquire and Develop cognitive and technical skills in patient care

■  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 undifferentiated and emergent care.

Block A Clinical Discipline

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Care of the Older Adult:  Aging of Men and Women

Learning Objectives:

At the end of this advanced rotation the medical student should be able to:

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 bedside test to test 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 preventative care in the elderly

9. Describe and exhibit a key measure of preventing disease in the elderly patient

10. Recognize the clinical features and differences between depression, delirium and dementia.

11. Recognize the various types of dementia

12. Demonstrate an ability to perform a fall assessment in the Elderly

13. Assess and identify the patient in need of palliative care

14. Recognize, assess and manage gender specific diseases such as osteoporosis, benign and malignant breast diseases, benign and malignant prostate disease and urinary incontinence.

15. Describe the normal physiological changes of aging with a focus on the cardiovascular system.

16. Compare and contrast the premenopausal vs. the post menopausal hormonal milieu.

17. List the changes that occur with aging in the ophthalmologic and auditory system.

18. Assess the disability encountered with aging of the musculoskeletal system.

19. Evaluate how nutritional needs change with aging 

20. Identify the signs of frailty in the elderly 

21. Recognize and understand issues in the elderly related to post-acute care, home-health and health care delivery for the elderly

Block B Clinical Discipline 

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Undifferentiated and Emergent Care

Learning Objectives:

At the end of this advanced rotation the medical student should be able to:

1. Perform a focused history and physical examination pertinent to the patient’s chief complaint.
    
2. Recognize characteristics of critically ill patients requiring emergent management. 
    
3. Developing and prioritizing a differential diagnosis
    
4. Develop, prioritize and interpret a diagnostic plan to evaluate the differential diagnosis.
    
5. Know the indications for obtaining diagnostic testing, including laboratories, radiographs, computer tomography, ultrasound, and procedural testing within an evidence based medicine framework.
    
6. Recognize and manage common emergency room presentations
    
7. Understand the appropriate use of consultants
    
8. Develop and carry out a management plan, based on the patient’s current physical condition.
    
9. Determine appropriate disposition for patients based on the patient’s response to therapy and the availability of social support systems.
    
10. Communicate appropriately with the PCP, consultants and the family
     
11. Understand resources and options for disposition within the health care system
     
12. Understand the costs of emergency care for themselves and implications of the health care costs on systems
     
13. Understand health insurance coverage options

Block C Clinical Discipline   

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Chronic Disease Management

Learning Objectives:

At the end of this advanced rotation the medical student should be able to:

1. Assess and prioritize the patient’s signs and symptoms as they relate 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 and manage the patient with chronic disease.
    
4. Understand and review the basic pathophysiology of the chronic disease.
    
5. Understand and perform education of the patient and the family
    
6. Demonstrate the ability to work as part of a multidisciplinary team in caring for patients with chronic diseases.
    
7. Evaluate the functional capacity of patient being treated for chronic disease.
    
8. Review the principles of Evidence-based medicine
    
9. Demonstrate the application of an appropriate evidence-based guideline to the evaluation/management of the disease.
    
10. Describe the general principles, strengths and pitfalls of using evidence-based guidelines.
     
11. Understand the concept of cost-effectiveness in medical decision-making, and demonstrate the application of cost-effectiveness analysis to the disease.
     
12. Describe the general principles of quality of life indices, including their construction, validation, and roles in medical research or patient care.
     
13. Appraise at least one study that evaluates QOL for the disease in question, and summarize the implications for care of this chronic disease.
     
14. Understand the concept of quality improvement process and disease specific quality indicators

Block D Clinical Discipline     

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Perioperative Medicine and Pain

Learning Objectives:

At the end of this advanced rotation the medical student should be able to:

1. Understand the role of the consultant and the principles and ethics surrounding medical consultation

2. Write up a preoperative assessment and outline the various components of this  evaluation including patient specific risk, surgery specific risk and anesthesia related risk
    
3. Compare and contrast the various options for anesthesia.
    
4. Create a basic anesthesia plan for the patient
    
5. Identify and select evidence-based preoperative laboratory testing.
    
6. Interpret preoperative testing and implement risk reduction strategies and therapies
    
7. Understand the elements of airway management.
    
8. Recognize and Understand the various intraoperative stressors
    
9. Be able to interpret hemodynamic monitoring.
    
10. Understand fluid management and blood resuscitation.
     
11. Evaluate and admit post-operative patients to the post-anesthesia care unit (PACU) and the Intensive care unit (ICU)
     
12. Understand the role of the ICU
     
13. Describe and manage common post-op complications such as post-operative MI, pneumonia, VTE, delirium and fever.
     
14. Perform a basic assessment of acute post-operative/ procedural pain and develop an analgesic plan.
     
15. Recognize and differentiate between acute, chronic, malignant and non-malignant pain
     
16. Recognize and understand safe prescription of drugs