Competencies for MSIII and MSIV Core Clinical Rotations

Unified Goals and Objectives

Medical Knowledge: Demonstrate knowledge about established and evolving biomedical, clinical, and cognate (e.g. epidemiological and social-behavioral) sciences and the application of this knowledge to patient care.

  • List the most common acute and chronic conditions seen during this rotation
  • For those problems seen during this rotation, apply the relevant genetics, physiology, embryology and development biology, anatomy, pharmacology, pathology, microbiology and imm
  • For the most common presenting symptoms and signs encountered during this rotation, explain the pathophysiological principles that underlie the manifestation of the symptoms and signs
  • Apply basic pharmacological principles to the most common conditions seen during this rotation
  • State the health promotion/disease prevention issues relevant to patients seen on this rotation
Family Practice
  • See link below for list of common problems for which students must become familiar during this rotation
Internal Medicine
  • See link below for list of common problems for which students must become familiar during this rotation
Pediatrics
  • See link below for list of common problems for which students must become familiar during this rotation
Obstetrics/Gynecology
  • See link below for list of common problems for which students must become familiar during this rotation
Surgery
  • See link below for list of common problems for which students must become familiar during this rotation
Behavioral Science/Psychiatry
  • See link below for list of common problems for which students must become familiar during this rotation
Emergency Medicine
  • See link below for list of common problems for which students must become familiar during this rotation

Patient Care: Provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health.

  • Demonstrate the ability to completely evaluate problems via appropriate medical history, physical examination, and laboratory/radiological and other modalities of evaluation
  • Balance proper use of investigations and treatment for patients with a social obligation to control health care costs
  • Formulate biopsychosocial hypotheses into a differential diagnosis, provisional diagnosis and working diagnosis
  • Identify patients at highest risk for serious morbidity and mortality
  • Present cases clearly and concisely to preceptors and others
  • Write legible, concise, accurate and timely notes
  • Perform skills and procedures relevant to the most common conditions seen during this rotation
  • Demonstrate an ability to involve other relevant caregivers into patient care decisions and plans
Family Practice
  • Demonstrate the importance of longitudinal care including growth and development assessments, health screenings and management of commonly seen chronic problems
  • Apply the principles of comprehensiveness and continuity to patient care encounters
Internal Medicine
  • Describe proper technique for a lumbar puncture, thoracentesis and central venous pressure line insertion
  • Conduct a pre-operative assessment
  • Manage post-operative patients with respect to their medical problems
Pediatrics
  • Demonstrate history and physical examination skills unique to newborns, infants and toddlers, children and adolescents
  • Demonstrate the appropriate involvement of parents and other caregivers in the assessment of the well and sick child
  • Plot growth and development charts for children
  • Conduct developmental assessments for children
  • Describe proper technique for beginning an intravenous line, phlebotomy, audiometry, tympanometry, testing for streptococcal pharyngitis, testing for hematocrit, administering immunizations
  • Effectively differentiate between the sick child who needs immediate attention and the sick child who can be managed less acutely

Patient Care: Provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health.

Obstetrics/Gynecology
  • Demonstrate proficiency in the unique aspects of the obstetrical and gynecological history and examination
  • Conduct a prenatal examination
  • Conduct a postnatal examination
  • Perform a pap smear and breast examination
Surgery
  • Write pertinent surgical notes
    • Operative
    • Post-operative
    • Progress notes
    • Effective consultation notes
  • Engage in effective surgical decision-making including timing, need for surgery, assessment of surgical risk/benefit ratios
  • Demonstrate basic surgical skills:
    • Nasogastric tube insertion
    • Venipuncture
    • Intravenous catheterization
    • Arterial puncture
    • Urinary catheterization
    • Suturing
    • Skin stapling
    • Drainage of abscesses
    • Effective surgical assisting
Behavioral

Science/Psychiatry

  • Conduct and record a psychiatric and mental status history and examination
  • Identify high risk patients who are dangerous to self and others
  • Make appropriate safety and legal decisions for patients determined to be high risk
  • Understand and describe the process of “commitment” including its indications, benefits, and risks
Emergency Medicine
  • Describe and perform the following procedures
    • Laceration repair
    • Regional anesthesia
    • Casting/splinting techniques
    • Reduction of uncomplicated dislocations
    • Removal foreign bodies
    • Interpretation of diagnostic imaging
    • Gastric lavage
    • Nasal packs/cautery
    • Legal and therapeutic indications for blood-alcohol testing
    • Incision and drainage of abscesses
    • Appropriate tetanus prophylaxis
    • Appropriate immunization procedures

Interpersonal and Communication Skills: Demonstrate interpersonal and communication skills that result in effective information exchange and teaming with patients, their patients families, and professional associates

  •       Communicate effectively with patients, their families and other members of the health care team
    • Adhere to the principles of openness, honesty, completeness and responsibility in communication
    • Demonstrate an ability to effectively communicate difficult/bad news
  •       Provide effective patient education and anticipatory guidance
  •       Respect confidentiality
  •       Demonstrate willingness and ability to receive and act upon feedback from colleagues, other health care workers and their families and caregivers
  •       Demonstrate empathy with patients
  •       Utilize touch when appropriate and within the boundaries of an appropriate doctor-patient relationship
Family Practice
  • Provide anticipatory guidance relative to the various stages of the family life cycle
Internal Medicine
  • Utilize interpersonal and communication skills necessary to care for dying patients and their families
Pediatrics
  • Recognize and address the needs of both the child and the parent or caretaker
  • Assure comprehension when discussing medical issues with children
  • Provide effective education that will enable parents and caregivers to provide care to sick children both in person and over the telephone
  • Provide anticipatory guidance on
    • Normal growth and development concerns
    • Normal psychological developmental issues
    • Issues related to puberty and adolescence
    • Issues related to family dynamics as the child grows and matures
  • Educate parents and children or caretakers on safety issues specific to:
    • Recreational activities
    • Exercise
    • Diet
    • Drugs and alcohol
    • Sexual activity
    • Sexually transmitted diseases
    • Pregnancy
  • Consider and acknowledge issues related to the rights of parents, caretakers and minor children
Obstetrics/Gynecology
  • Gain a sympathetic understanding of the problems encountered by females of all ages
  • Demonstrate comfort with the sexual history and examination and conduct such inquiry and examination in a manner that instills confidence and the experience of care within the patient
  • Demonstrate counseling skills with respect to problems such as contraception, antepartum care and gynecological malignancy
Surgery
  • Demonstrate an ability to combine speed, compassion, clarity and precision in communicating surgical issues for acute and urgent problems
  • Demonstrate an ability to combine respect, compassion and empathy when communicating surgical issues for unexpected, serious, life-threatening diagnoses
  • Consider the psychological ramifications of surgical diagnoses on patient and their families when communicating
  • Avoid use of surgical jargon
Behavioral

Science/Psychiatry

  • Demonstrate the ability to convey bad news to patients and their families in a flexible, understanding and balanced manner
Emergency Medicine

Practice-Based Learning and Improvement: Investigate and evaluate their patient care practices, appraise and assimilate scientific evidence, and improve their patient care practices.

  • Practice and apply the principles of evidence-based medicine to all patient care encounters
  • Collect and analyze patterns of practice and compare/contrast these individual patterns with established clinical guidelines and norms (best practices)
  • Access, in a disciplined way, sources of new information pertaining to the practice of medicine
  • Apply the basic principles of continuous quality improvement to the practice setting
  • Recognize and accept one’s own limitations in the practice of medicine
Family Practice
  • Differentiate between evidence that is applicable to primary care versus evidence that is applicable to specialty care and demonstrate an application of these distinctions
Internal Medicine
Pediatrics
Obstetrics/Gynecology
Surgery
  • Utilize surgical complications, post-operative pathological findings and other sources of feedback to continuously hone one’s diagnostic and therapeutic skills
  • Develop means for practicing and refining surgical skills that will be needed over time, especially those that may be infrequently utilized
  • Accept that surgery involves extreme outcomes, both positive and negative, and that the nature of these outcomes is not always predictable
Behavioral Science/Psychiatry
Emergency Medicine

Systems-Based Practice: Demonstrate an awareness of and responsiveness to the larger context and system of health care and the ability to effectively call on system resources to provide care that is of optimal value.

  • For the problems most commonly encountered on the rotation, list the indications for referral, consultation and transfer (to others and from others)
  • Demonstrate respect and honor for the roles of the many health care professionals required for collaborative care
  • Utilize the network of health care facilities, providers, agencies and institutions available for the diagnosis, management and support of patients and their families
  • Acknowledge and act in accord with payment issues involved in medical care
  • Advocate for patient and family issues
  • Take into consideration issues related to the cost and supply of pharmaceuticals in medical decision-making
Family Practice
  • Apply the principles of “gate keeping” when dealing with managed care populations
Internal Medicine
Pediatrics
  • Utilize the myriad community agencies that exist on behalf of the care of children and the support of parents and caregivers
Obstetrics/Gynecology
Surgery
  • Develop and demonstrate respect and honor for the roles of the many health care professionals required for collaborative surgical care
    • Primary care, emergency and attending physicians
    • Medical and other consultants
    • Operative and nursing personnel
    • Social workers and discharge planning personnel
    • Pain management specialists
    • Nutritionists
    • Therapists – physical and occupational
    • Hospice
    • Clergy
  • Develop an awareness of unique payment issues in surgical care
    • Managed care requirements for pre-operative clearance
    • Issues regarding length of stay
    • Issues regarding decision to admit to hospital or utilize same-day surgical approaches
    • Cost of surgical supplies and their impact on hospital operating budgets
Behavioral Science/Psychiatry
  • Utilize the special expertise of psychiatrists, psychologists and social workers with respect to indications for referral and coordination of care with primary care physicians
  • Explain the overall mental health and social service delivery systems in the community
Emergency Medicine
  • Describe and identify emergency medical services for pre-hospital care within the community, i.e., paramedics, ambulance services, communications systems, first-aid programs, poison control, public education programs, abuse/homeless shelters, and disaster planning
  • Discuss the myriad relationships between the emergency room physician and primary care physician on the one hand and the consultant specialists on the other hand

Professionalism:     Demonstrate a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population.

  • Exemplify those behaviors that comprise professionalism:
    • Altruism: the best interest of the patient must come before the interests of the doctor
    • Accountability: accountability to patients, their families, colleagues and to society
    • Excellence: an effort to exceed ordinary expectations; scientific and humanitarian curiosity
    • Duty: a commitment to service
    • Honor and Integrity: a commitment to the highest standards of personal and professional behavior
    • Respect for Others: the essence of humanism; includes respect for patients, their families, colleagues, nurses, students, residents, other medical and administrative personnel.
  • Respect privacy, confidentiality and autonomy
  • Demonstrate caring and compassionate actions at all times
  • Dress appropriately when working with patients
    • Appropriate dress is defined as that dress which serves the interest of the healthcare needs of patients, their families and the staff
    • Acknowledge and accommodate concerns related to cultural diversity
Family Practice
  • Address the unique confidentiality issues that arise when caring for more than one member of a family
Internal Medicine
Pediatrics
  • Demonstrate tolerance of family attitudes, beliefs (religious and otherwise), cultural and socioeconomic influences
Obstetrics/Gynecology
  • Acknowledge the unique privacy, autonomy and comfort issues of the female patient paying special attention to issues involving the patients personal relationships
Surgery
  • Apply ethical and legal standards to surgical decision making:
    • Differentiate between the ability to do a surgical procedure and the appropriateness of choosing to actually schedule that procedure for a specific patient
    • Apply principles from end-of-life care to surgical decision making
    • Attend to unique compassionate issues within surgical practice:
    • Giving unexpected bad news for, perhaps, the first time in a patient or families life
    • Acting in accord with unique surgical issues raised by groups such as Jehovah’s Witnesses
  • Describe the legal issues that arise through conflict of interest when, for example, physician ownership issues come into play regarding surgical centers and specialty hospitals
Behavioral Science/Psychiatry
Emergency Medicine

Osteopathic Philosophy and Osteopathic Manipulative Medicine: Integrate Osteopathic Concepts and OMT into the medical care provided to patients as appropriate. Understand and integrate Osteopathic Principles and Philosophy into all clinical and patient care activities.

  • Apply osteopathic medical concepts in the diagnosis and treatment of patients
    • Holistic approach
    • OMT
Family Practice
Internal Medicine
Pediatrics
  • Recognize the differences in osteopathic approaches to the child versus the adult
  • Perform osteopathic evaluation and treatment to newborns, children and adolescents
    • Condylar assessment and decompression
    • Occipital to sacral fascial evaluation and fascial unwinding
    • Leg length discrepancy
    • Scoliosis
Obstetrics/Gynecology
  • Identify those obstetrical and gynecological conditions that are most effectively managed by OMT (e.g postural discomforts of pregnancy, pelvic pain, pre-menstrual syndrome, dysmennorrhea)
Surgery
  • Utilize OMT skills as appropriate in presurgical diagnosis such as appendicitis, ovarian disease, obstructive colonic disease
  • Utilize OMT skills as appropriate in the management of surgical diseases such as otitis media and myringotomy, tonsillitis, thyroid disease, torticollis, carpal tunnel syndrome, sternotomy, post-CABG sympathectomy, mastectomy, ileus, urolithiasis, appendicitis, herniated nucleus pulposus, caesarian section, episiotomy, CABG/saphenous vein graft, knee internal derangement, hip replacement
  • Utilize OMT skills as appropriate in the management of surgical complications such as wound infections, peritonitis, subphrenic and subhepatic abscess, empyema, mediastinitis, pneumonia, ARDS, renal failure, post-operative jaundice, post-operative ileus, bowel obstruction, acute gastric hemorrhage, multiple organ failure, myocardial infarction, edema, atelectasis, nausea and vomiting, gastectasia, post-operative back ache, apprehension and tenseness, headache, hypertension, dumping syndrome, embolic phenomena, laminectomy, fixed nerve pathway (post-cholecystectomy syndrome), lumbar myospasm, radiculopathy following epidural anesthesia
Behavioral Science/Psychiatry
  • Assess for and administer adjuvant osteopathic manipulative techniques to aid in the lessening of suffering caused by concomitant medical illnesses that may be impacting, or are impacted by, mental health issues
Emergency Medicine
  • Identify and treat those emergency medical conditions that may be effectively managed by OMT (e.g. spinal muscle strains, tension headaches, upper and lower respiratory tract infections, pre-menstrual syndrome, dysmenorrhea, etc.)
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