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Office of Education and Curriculum

 

Objectives For Graduation


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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.

I. 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, literacy level, 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.

II. 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, literacy level, 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, electronic health records, 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.

III. 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 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.
  5. Participate in the education of patients, families, students, trainees, peers and other health professionals.

IV. 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 identify, address, and/or report incidents of domestic violence including: child, elder, and intimate partner abuse.
  8. Describe other legal and regulatory reporting responsibilities.

V. 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).

VI. 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. Recognition of the primacy of patient welfare, including the 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, electronic etiquette, 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 or conflicts of interest 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/STI 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 dying patients/delivering bad news

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.     pelvic relaxation/pelvic organ prolapse

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