Objectives for graduation have a number of important functions.  They provide:

1. A description of the basic skills, knowledge, and behavior expected of graduates of the School of Medicine;

2. A basis for evaluation of student performance;

3. A guideline for developing and implementing the curriculum (see also Curriculum Guidelines);

4. A basis for evaluation of the curriculum;

5. A framework for life-long learning.

The Patient Encounter – Clinical Skills

When the student encounters a patient with any presenting complaint or complaints as defined by the objectives for each curricular segment and as outlined in Appendices A and B, the student should be able to:

1. Obtain an accurate medical history.
2. Perform a complete and appropriately focused organ system specific examination.
3. Accurately interpret patient responses and physical findings.
4. Develop a problem list that includes the consideration of all psychosocial and social variables.  The differential diagnosis should emphasize all likely causes of each problem.
5. Develop a plan for any necessary further investigations to confirm the diagnosis.  The following should be considered:
   1.  Availability, reliability, and validity of the requested tests or procedures.  In doing so, students must:
      1. Appropriately use sensitivity, specificity, and predictive values of the test.
      2. Understand the importance of the prevalence of disease in interpretation of tests.
      3. Estimate pre-test and post-test probability of disease.
   2. Risks and complications;
   3.  Discomfort and inconvenience to the patient;
   4. Cost and its impact on the patient and society;
   5. The patient’s wishes and values.

6. Accurately interpret the results of all tests ordered and modify the problem list and the differential diagnoses accordingly. 

7. Design and implement a comprehensive management plan for the patient.  The following should be considered:

   1. Therapeutic goals;

   2. Informed consent, including benefits, risks, and treatment alternatives of the proposed interventions;

   3. Discomfort and inconvenience to the patient;

   4. The patient’s goals, expectations, and ability to adhere to treatment proposals;

   5. The patient’s cultural and religious values;

   6. The indications, contraindications, and side effects of therapies involved;

   7. Available resources (including patient, family, health care system and community);

   8. Legal and ethical requirements;

   9. The structure and function of health care delivery and payment systems, and how payments for medical care affect decision making and care provision.

8. Consult other physicians and/or other health care professionals to enhance the quality of care.

9. Arrange for follow-up on all problems identified.

10. Monitor the effectiveness of therapy and modify when indicated.

11. Recognize patients with immediate life-threatening conditions and institute initial therapy.

12. Identify and design plans to manage situations that require on-going support: chronic, complex illness; chronic pain; permanent disability; death and dying.

13. Provide appropriate health maintenance, health counseling, and disease-prevention strategies.

14. Comply with infection control guidelines and the use of universal precautions.

15. Perform common technical procedures.

Knowledge

Students should be highly knowledgeable about medicine to provide the best possible care for patients; they should demonstrate:

1. An understanding of the importance of the scientific foundation upon which medicine is based and a recognition of the need for lifelong learning and the scholarly practice of medicine.
2. Knowledge of the normal structure and function of the body and each of its major organ systems.
3. Knowledge of the molecular, biochemical, and cellular mechanisms that are important in maintaining the body’s homeostasis.
4. Knowledge of the altered structure and function of the body and its major organ systems that are seen in various diseases and conditions and patient presentations (Appendices A and B).
5. Knowledge of the social and behavioral factors that influence patients’ responses to health and disease.  Such factors include:
   1.  Specific cultural, ethnic, and societal beliefs and behaviors;
   2. Patients’ age, education, finances, and family resources;
   3.  Alternative or complementary medical practices within patients’ communities.
6. Knowledge of contemporary health care policy and practice issues.
7. Knowledge of the capabilities and limitations of information technology and the management of knowledge, including:
   1. Searching, collecting, organizing, and interpreting health and biomedical information from different databases and sources;
   2. Retrieving patient-specific information from a clinical data system;
   3. Using information and communication technology to assist in diagnostic, therapeutic, and preventive measures, and for surveillance and monitoring health status;
   4. Maintaining practice records for analysis and improvement.
8. Knowledge of the rational use, risks, and benefits of medical therapies, including pharmacotherapeutic agents.

Communication/Team Skills

Students should be able to communicate effectively with individuals and health care teams to ensure delivery of high quality patient care.  In all health care settings, the students should be able to:

1. Communicate with patients, families, caregivers, and medical translators with respect, sensitivity, and compassion in a culturally sensitive and jargon-free manner.
2. Provide a well-organized, concise, and thorough oral presentation of a patient’s problem.
3. Produce proper written documentation to facilitate patient care, including initial history and physical examination, follow-up notes, physician orders, and prescriptions.
4. Function as an effective member of a health care team through cooperative interactions with health and social service professionals, families, and other caregivers.

Community/Public Health/Preventive Medicine

Students should be highly knowledgeable about community and public health to provide the best possible care for populations.  Students should be able to:

1. Articulate the importance of public health measures in promoting health and wellness and preventing disease.
2. Describe the health status of a defined population and identify subgroups whose health status differs significantly from the population at large.
3. Define specific public health problems in terms of incidence, prevalence, risk factors, and socioeconomic impact.
4. Define the roles for the physician in relation to other service providers and community agencies in addressing the health problem.
5. Apply the principles of preventive medicine, including screening and case findings, for individual patients and populations.
6. Treat patients of all races and cultures with respect, striving to understand how spirituality and cultural beliefs impact the encounter, treatment, and health care in general.
7. Know when and how to report incidents of domestic violence including: child, elder, and spousal abuse.
8. Describe other legal and regulatory reporting responsibilities.

Self-Assessment/Professional Development Skills

Students should be able to assess their own skills, those of their peers, and those of the programs in which they participate.  This assessment should provide thoughtful, appropriate, and constructive feedback for professional development.  To enhance life-long learning, continuous improvement, and professional development, students should be able to:

1. Evaluate their own skills, practice patterns, fund of knowledge and communication abilities.  In areas that are lacking, the student should have the ability to commit him or herself to making a change and seeking appropriate resources and guidance to do so.
2. Evaluate the practice patterns and communication skills of their peers and offer meaningful formative feedback.
3. Participate in continuing educational programs and activities to improve skills and be able to evaluate program effectiveness with meaningful feedback.
4. Access information related to practice and professional development, critically analyze their own practice habits and outcomes, and learn and incorporate new skills.
5.  Critically analyze the medical literature using the principles of evidence-based medicine, including:
   1.  Understanding the statistical methods basic to clinical trials (relative risk, relative risk reduction, absolute risk, absolute risk reduction, and number needed to treat or harm).
   2. Understanding the statistical methods basic to case control and observational studies (2 x 2 tables, odds ratio and confidence intervals).

Professional And Ethical Behavior

The student should accept the responsibilities of the profession of medicine, which expects the highest level of competence with regard to knowledge, skills, attitudes, and behavior in the care of patients and/or the generation and dissemination of knowledge.  The student should be able to demonstrate in daily activities:

1. Treatment of the patient as a person, not a disease, and understanding that the patient is a person with values, goals, and concerns which must be respected and which may influence how the patient responds to his or her disease and its management.
2. Respect of the patient’s rights and privacy and maintaining confidentiality of patient information.
3. Interaction with the patient in a way that will allow the patient to feel he/she has received medical care in a caring, compassionate, and humane manner.
4. Self-motivation; self-discipline; and personal integrity, including both honesty and reliability.
5.  A professional image in manner, dress, grooming, speech, and interpersonal relationships that is consistent with the medical profession’s accepted contemporary standards in the community.
6.  Recognition of personal limitations, whether they are intellectual, physical, or emotional, and work with or adapt to them.
7. Recognition of the importance of personal and family roles and the need to balance them with professional demands.
8. Provision of patient care without allowing personal biases to interfere.
9. Caring for individuals who are members of underserved populations.
10. Application of principles that govern critical decision-making to common ethical dilemmas faced by physicians.

Appendix A (Must be seen and documented by students)
A1.        abdominal mass A2.        abdominal pain A3.        abnormal ECG A4.        abnormal serum lipids A5.        acid Base disorders A6.        acute illness in an infant/child A7.        allergic reactions A8.        anemia/pallor A9.        back pain A10.     breast disorders A11.     chest discomfort/angina pectoris A12.     contraception A13.     dementia/memory disturbances A14.     diarrhea/constipation A15.     dizziness/vertigo A16.     difficulty swallowing A17.     domestic violence A18.     dyspnea/breathlessness A19.     ear pain A20.     electrolyte disorders A21.     eye redness/pain A22.     falls A23.     fatigue A24.     fever/chills A25.     fractures/dislocations/joint injuries A26.     gait disturbances A27.     gastrointestinal bleeding A28.     genetic/hereditary concerns A29.     headache A30.     hearing loss/deafness A31.     hemoptysis A32.     hyperglycemia/diabetes mellitus A33.     hypertension A34.     immunocompromise/immunodeficiency A35.     impaired consciousness A36.     jaundice (adult & infant) A37.     joint pain, non-traumatic A38.     leukocytosis/leukopenia A39.     lymphadenopathy A40.     menstrual cycle – abnormal	A41.     mood disorders A42.     murmur/abnormal heart sounds A43.     numbness/tingling/paresthesias A44.     painful limb A45.     panic/anxiety A46.     pap abnormality A47.     pelvic mass A48.     pelvic pain/dysmenorrhea A49.     periodic health examination/growth & development A50.     pregnancy/delivery A51.     Preventive Health Care/Cancer screening/STD screening A52.     psychotic patient/disordered thought A53.     renal failure: acute or chronic A54.     rhinosinusitis (rhinorrhea/sneezing/nasal congestion/sinus congestion) A55.     scrotal mass/pain A56.     seizures (epilepsy) A57.     sexual dysfunction A58.     shock/hypotension A59.     Skin lesions A60.     sleep disturbances A61.     sore throat A62.     speech and language abnormalities/ dysphonia/hoarseness A63.     substance abuse/drug addiction/withdrawal A64.     suicidal behavior/prevention A65.     syncope/pre-syncope/loss of consciousness A66.     thromboembolic disorders A67.     trauma A68.     urinary disorder/incontinence/incomplete emptying/frequency A69.     vaginal bleeding-abnormal A70.     vaginal/penile discharge A71.     visual disturbance/loss A72.     vomiting/nausea A73.     weakness/paralysis A74.     weight gain/obesity A75.     weight loss A76.     wheezing/cough
Appendix B (Must be known by students)
B1.  abdominal distention B2.  abnormal liver function tests B3.  abnormalities of white blood cells B4.  attention deficit/learning disorder/school failure B5.  behavior disorder B6.  bleeding tendency/bruising B7.  burns B8.  cardiac arrest/respiratory arrest B9.  cyanosis/hypoxia B10.     depressed newborn B11.     development disorder/development delay B12.     diplopia B13.     eating disorders B14.     edema/anasarca/ascites B15.     failure to thrive B16.     fetal distress/non-reassuring fetal status B17.     hair and nail disorders B18.     head injuries/brain death/transplant donation B19.     hematemesis B20.     hematuria B21.     hirsutism and virilization B22.     infertility B23.     involuntary movement disorders/tic disorders	B24.     issues of bad news/dying patients B25.     limp/pain in lower extremity in children B26.     menopause B27.     mouth/oral disorders B28.     neck mass/goiter B29.     personality disorders B30.     poisoning B31.     polycythemia/elevated hemoglobin B32.     pregnancy loss B33.     prematurity B34.     prolapse/pelvic relaxation B35.     proteinuria B36.     pruritus B37.     pupil abnormalities B38.     sexual maturation B39.     sexually concerned patient, gender identity disorder B40.     sudden infant death syndrome B41.     spinal injuries B42.     splenomegaly B43.     strabismus and/or amblyopia B44.     tall stature, short stature B45.     tinnitus B46.     torticollis