SIU School of Medicine

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Office of Education and Curriculum

Doctoring Curriculum Director

Gary M. Rull, MD

Doctoring Curriculum Team

Susan T. Hingle, MD
David E. Steward, MD

Doctoring Curriculum Coordinator

Leslie Montgomery, RN, MS, CCRN, 217-545-2230

Doctoring Curriculum Objectives

The Doctoring Streamer runs through all four years and provides opportunities for students to acquire clinical skills via a documented system of procedures, skills and clinical experiences. Doctoring activities include peer and self-assessment skill building, physician'sattitudes and conduct sessions, clinical skills development and medical humanities issues (including physician/ patient relationship, ethics, death and dying, and practice management).

Students are assigned to mentors who work with students as they develop and build their clinical skills. In the first two years, students usually work with the same mentor for the year.  In the fourth year, students mentor second-year students as part of the Doctoring Curriculum.

In addition to the geriatric concepts integrated into all four years of the curriculum, special initiatives based on the program, “Aging Across the Curriculum,” have been developed to address significant issues germane to the older patient population.  Through experiences with older standardized patients, interactive sessions, and small group discussions, students address a myriad of topics critical for providing proficient health care services to an aging population.  Thanks to a grant from Arthur Vining Davis Foundations, focused geriatric sessions help students develop the caring attitudes needed to competently and compassionately care for this burgeoning older population.

 

dot Year One Objectives

1.  Professionalism
 

1.1.

Appearance (“Professional” look)
 

1.2.

Bedside Manner
  1.3. Compassion
 

1.4.

Empathy  
 

1.5.

Sensitivity  
 

1.6.

Concern  
 

1.7.

Attitude  
 

1.8.

Personal Values  
 

1.9.

Approaching patient’s values  
 

1.10.

Ethics  
 

1.11.

Historical perspectives
 

1.12.

Interaction with staff-nurses, ward clerks, receptionist
 

1.13.

Cadaver respect
   
2.  Patient-Physician relationship
 

2.1.

Creating a professional environment
   

2.1.1

 Doctor – patient space
    2.1.2

Modesty, undressing patient
    2.1.3 Chaperones
    2.1.4

Interview – exam settings
   

2.1.5

Clipboards and note taking
   

2.1.6

Family seating
   

2.1.7

Exam room essentials (mirror, sink, hangers, etc.)
   

2.1.8

Patient comfort
 

2.2

Boundaries
 

2.3

Patient confidentiality
 
3. 

Physician-centered interviewing and medical history acquisition skills
  3.1.

Greeting the patient
  3.2.

Exploring the chief complaint, searching the meaning (onset, location, duration, character, relieving and exacerbating factors)

  3.3.

Learning the standard/comprehensive medical history
  3.4.

Abstracting medical records for critical information
  3.5.

Obtaining information from non-patient sources
    3.5.1

Medical record
    3.5.2 Family
    3.5.3

Other care givers
  3.6

Giving information to the patient
  3.7

Bringing closure to patient encounter
  3.8

Learning the Review of Systems
 
4. 

Patient-centered interviewing skills
  4.1

Eliciting the patient’s story
  4.2

Active listening skills
    4.2.1

Connecting with the patient

    4.2.2

Body language

    4.2.3

Open ended questions

    4.2.4

Showing interest in and understanding the patient’s story

    4.2.5

Empathy

    4.2.6

Respecting the uniqueness of the patient

  4.3

Addressing patient’s concerns
  4.4

Non-judgmental
  4.5

Adjusting terminology to patient’s level
 
5.  Physical exam skills
  5.1.

Learning to use basic “tools”
   

5.1.1

Stethoscope
   

5.1.2

Otoscope
   

5.1.3

Ophthalmoscope
   

5.1.4

Sphygmomanometer
   

5.1.5

Reflex hammer
  5.2

Accurately eliciting common physical findings
  5.3

Learning the basic screening complete physical examination
  5.4

Applying basic anatomy and physiology to the physical exam
  5.5

Learning about infection control and universal precautions
 
6.

Medical writing and presentation skills
  6.1

Writing up a history and physical exam in standard format

  6.2

Oral presentation of patient history and physical to clinical mentor(s)
  6.3

Patient Problem List
 
7.

Using medical learning resources and approaching the medical literature
  7.1

Textbooks
  7.2

Medical Journals
  7.3 Library
  7.4

Audiovisual material
  7.5

CD ROM
  7.6

Internet
  7.7

Faculty and colleagues
 
8. 

Physician-self care and personal development
  8.1

Recognizing personal limits
  8.2

Maintaining life balance
  8.3

Avoiding substance abuse

  8.4

Measuring, monitoring and managing stress

  8.5

Engaging in wellness behavior and modeling a healthy life style
  8.6

Maintaining a personal and/or family life
  8.7

Undergoing TB testing and Hepatitis immunizations
 
9. 

Societal context of the practice of medicine including preventive medicine
  9.1.

Human growth and development
  9.2.

Clinical ethics

  9.3.

Role of other healthcare professionals
  9.4.

Introduction to human sexuality (including safe and unsafe sexual practice)
  9.5.

Understanding healthy and unhealthy life styles (e.g. exercise, diet, seat belts, drugs, guns)
 
10.

Integrating information to solve clinical problems
  10.1

Understanding and applying basic pathophysiology
  10.2

Knowing the cardinal manifestations and presentation of diseases
 
11.  Continuity of Care
  11.1

Learning and practicing principles of continuing care of patients
 
12. 

Complimentary Alternative Medicine
  12.1.

Knowledge
    12.1.1

Students will understand how to elicit a history from a patient about their use of these therapies
    12.1.2

Students will understand how to search available medical resources to determine the safety and efficacy of such therapies.
  12.2. Attitudes
    12.2.1

Students will understand and respect cultural/ethnic influences on health beliefs and health care choices
    12.2.2

Students will be able to discuss with patients their use of such therapies as a necessary part of finding a common ground when practicing patient-centered integrative medicine.
  12.3 Skills
    12.3.1

Students will develop the ability to inquire into patients’ use of these therapies in a non-threatening, non-judgmental manner
    12.3.2

Students will develop the ability to provide complete and balanced patient education to those patients inquiring about these complementary/alternative therapies.

       

 

dot Year Two Objectives

1.  Professionalism
  1.1

Accepting responsibility for patient care (under supervision)
  1.2 Accepting responsibility for medical errors
     
2.  Physician/patient relationship
  2.1

Giving patients directions, patient education, basics of information giving
       
3. 

Physician-centered interviewing and medical history acquisition skills
  3.1

Searching for associated complaints
  3.2

Prioritizing elements of the history
  3.3

Sexual history
  3.4

Obtaining history from someone, other than patient:
    3.4.1

Unable to speak English by appropriately using Interpreters
    3.4.2

Deaf and hearing impaired patients
    3.4.3

Confused, obtunded patients
    3.4.4

Hostile patients
    3.4.5

Withdrawn patients
    3.4.6

Mentally impaired patients
    3.4.7

From a different ethnic, racial, or cultural background
    3.4.8

A very young or pre-verbal child
    3.4.9

A geriatric patient presenting communication difficulties

    3.4.10

Recognizing a difficult patient
      3.4.10.1

How to recognize
      3.4.10.2

How to reroute the interview

  3.5

Special interviewing (e.g., Psychiatry, Pediatrics)

  3.6

Abstracting medical records for critical information
       
4. 

Patient-centered interviewing skills
  4.1

Advanced Interviewing Skills (non-directive, etc)

  4.2

Sensitivity to female issues and “common” challenges (sensitive body awareness, etc.),
  4.3

Sensitivity to male issues and “common” challenges (rage, sensitive body awareness, etc.)
  4.4

Recognizing patient anxiety, stress and depression and adjusting interviewing techniques appropriately.
  4.5 Sensitivity to issues faced by adolescents
  4.6 Sensitivity to issues faced by patients with chronic illnesses
       
5. 

Physical exam skills
  5.1

Applying universal precautions and practicing sterile procedures
  5.2

Focused, Targeted and Comprehensive Examinations by System
  5.3

Examples include:
    5.3.1 Ophthalmologic
    5.3.2 Otolaryngologic
    5.3.3 Oral
    5.3.4 Vascular
    5.3.5 Respiratory
    5.3.6 Breast
    5.3.7 Cardiac
    5.3.8

Abdominal, GI
    5.3.9

Musculoskeletal
    5.3.10 Neurologic
    5.3.11 Psychiatric
    5.3.12

Male, genitourinary
    5.3.13 Rectal
    5.3.14

Gyne, including breast, pelvic
       
6. 

Medical writing and presentation skills
  6.1

Generating a problem list
  6.2

Writing SOAP Notes and complete H&Ps
  6.3

Oral presentation of patient history and physical to faculty and clinical mentor(s)
    6.3.1 Short
    6.3.2

Medium
    6.3.3 Long
    6.3.4 Formal
  6.4

Describing Basic Management Plan
  6.5 Prescription  Writing
       
7. 

Basic ward and operative skills
  7.1

Injections SQ & IM
  7.2

Patient transfer and log rolling
  7.3

Blood Pressure Monitoring
  7.4

IV insertion & removal, IV fluid line set-up, Venipuncture
  7.5

Urinary catheter insertion and removal (male and female)
  7.6

Suture and staple removal
  7.7

Dressing changes
  7.8

Swab specimen collection:  throat, nasopharyngel, wound, rectal and eye
  7.9 N/G insertion and removal
       
8. 

Physician-self care and personal development

  8.1

Monitoring and controlling personal stress during patient encounters
     
9. 

Societal context of the practice of medicine including preventive medicine
  9.1

Recognizing patients’ cultural beliefs and incorporating them into patient care plan
  9.2

Human growth and development
  9.3

Principles of disease prevention
  9.4

Screening for illness
    9.4.1 Cancer
    9.4.2 Diabetes
    9.4.3 Lipids
  9.5

Recognizing domestic violence
     
10. 

Integrating information to solve clinical problems
  10.1

Recognizing severity of illness and initiating assistance (Basic Life Support)
  10.3

Developing a differential diagnoses while obtaining a history
  10.4

Using medical history and physical to solve diagnostic problems
  10.5

Using laboratory and diagnostic imaging to solve clinical problems
    10.5.1

Understanding sensitivity and specificity

    10.5.2

Mechanism of test
    10.5.3

Indication for test
    10.5.4

Non-indications for test
    10.5.5

Contraindications for test
    10.5.6

Interpretation of results
    10.5.7

Practical aspects and costs
  10.6

Applying pathophysiology to differential diagnosis
  10.7

Developing a diagnostic strategy
     
11. 

Complimentary Alternative Medicine
  11.1 Knowledge
    11.1.1

Students will understand how to elicit a history from a patient about their use of these therapies
  11.2 Attitudes
    11.2.1

Students will understand and respect cultural/ethnic influences on health beliefs and health care choices
    11.2.2 Students will be able to discuss with patients their use of such therapies as a necessary part of finding a common ground when practicing patient-centered integrative medicine.
  11.3 Skills
    11.3.1

Students will develop the ability to inquire into patients’ use of these therapies in a nonthreatening, nonjudgmental manner
    11.3.2

Students will develop the ability to provide complete and balanced patient education to those patients inquiring about these complementary/alterative therapies.

       
12. End of Life Issues
  12.1 Sensitivity to end of life issues
 
13.

Basic Clinical Skills Sessions
  13.1

Hematology, Immunology & Infection Unit (HII)
    13.1.1 Orientation to PDL rooms
    13.1.2  Injections SQ & IM
    13.1.3 Patient transfer and log rolling
    13.1.4 Blood Pressure Monitoring
    13.1.5 Orientation to inpatient charts
  13.2

CV/Renal/Respiratory Unit (CRR)
    13.2.1  IV insertion & removal, IV fluid line set up, Venipuncture
    13.2.2 Urinary catheter insertion and removal - Male and Female
  13.3

Neuromuscular/Behavior Unit (NMB)
    13.3.1  Suture and staple removal
    13.3.2 Dressing changes
    13.3.3 Swab specimen collection: throat, nasopharyngeal, wound, rectal and eye
  13.4

Endocrine/Reproduction/Gastrointestinal Unit (ERG) 
    13.4.1  N/G insertion and removal

dot Year Three Objectives

1.

Students will be able to discuss important ethical, historical, and legal perspectives on the physician-patient relationship.

2.

Students will be able to identify legal rights and responsibilities within the physician- patient relationship, with emphasis on the standard of care and professional liability in the context of medical malpractice litigation.

3.

Students will be able to describe ethical and legal principles that give rise to and shape the doctrine of informed consent as well as the informed consent interchange between physician and patient.

4.

Students will be able to discuss ethical and legal considerations that bear upon privacy and confidentiality within the physician-patient relationship.

5.

Students will be able to describe the value of meaningful communication between physicians and patients in the clinical setting and its importance in strengthening the physician-patient relationship.

6.

Students will be able to identify and discuss issues of bias that affect the physician-patient relationship.

7.

Students will be able to discuss the clinical, ethical, legal, and psychosocial aspects of decision-making relative to withholding/withdrawing life-sustaining treatment from patients who are terminally ill or permanently comatose.

8.

Students will be able to describe clinical, ethical, and psychosocial considerations that bear upon assessment and treatment of pain in situations where patients are terminally ill, with emphasis on palliative care and hospice care.

9.

Students will be able to discuss ethical and legal issues arising out of the controversy surrounding physician participation in assisted death.

10.

Students will be able to describe ethical, legal, and policy considerations relating to organ donation and transplantation as an aspect of the physician-patient relationship.

11.

Students will be able to discuss the effects of an impaired physician-patient relationship and describe available legal and professional responses.
   

dot Year Four Objectives

1.   

Students will be able to discuss the physician’s role in the administration of justice, with emphasis on describing an overview of the judicial process, including physician involvement as an expert witness in civil and criminal litigation.

2.   

Students will be able to describe various systems of medical-legal investigation and the manner in which these systems affect public health.

3.   

Students will be able to explain the legal and professional structures that regulate the conduct of physicians as expert witnesses.

4.   

Students will be able to evaluate how physicians participate in civil litigation through an evidence deposition.

5.   

Students will be able to describe the health care system in the United States, discussing its strengths and inadequacies, and comparing it with other health care systems.

6.   

Students will be able to describe the economics, financing, and cost of health care in the United States.

7.   

Students will be able to discuss policy issues of access to and availability of health care for vulnerable populations in the United States.

8.   

Students will be able to explain the concept of parity for mental health care services and describe social and economic barriers to achieving parity.

9.   

Students will be able to discuss issues in ensuring quality in medical practice and patient-centered clinical decision-making in the context of the current health care environment.

10.   

Students will be able to compare ethical, legal, and policy issues arising in fee-for-service medicine and in managed care.

 

dot All Years

1. Professionalism
  1.1

Recognize the following issues that could affect a patient's management and modify management as appropriate:
    1.1.1

Legal issues (such as informed consent, malpractice)
    1.1.2

Ethical issues (such as confidentiality, truth-telling)
    1.1.3

Conflict of values between the patient and the community
    1.1.4

Psychosocial issues
    1.1.5

Religious issues
  1.2

Project 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
   
2.

Physician/patient relationship
  2.1.

Treat the patient as a person, not a disease; and understand 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.
  2.2.

Respect the patient's rights and privacy and maintain confidentiality of patient information
  2.3.

Interact with the patient in a way that will allow the patient to feel he/she has received medical care that was provided in a caring, compassionate, and humane manner.
       
3.

Physician-self care and personal development
  3.1

Behave in a self-motivated, responsible, reliable, and dependable manner.
  3.2

Demonstrate personal integrity, honesty, and self-discipline.
  3.3

Recognize personal limitations, whether they are intellectual, physical, or emotional, and work with or adapt to them.
  3.4

Demonstrate the professional and emotional maturity to take appropriate steps to resolve tensions and conflicts that occur among professional, personal, and family responsibilities, seeking professional help if necessary.
  3.5

Demonstrate the ability to think critically and exercise sound judgment.
  3.6

Provide patient care without allowing personal biases to interfere.
       
4.

Complimentary Alternative Medicine
  4.1. Knowledge
    4.1.1

Students will understand how to elicit a history from a patient about their use of these therapies
    4.1.2

Students will understand how to search available medical resources to determine the safety and efficacy of such therapies.
  4.2. Attitudes
    4.2.1

Students will understand and respect cultural/ethnic influences on health beliefs and health care choices
    4.2.2

Students will be able to discuss with patients their use of such therapies as a necessary part of finding a common ground when practicing patient-centered integrative medicine.
  4.3

Skills
    4.3.1

Students will develop the ability to inquire into patients' use of these therapies in a non-threatening, nonjudgmental manner
    4.3.2

Students will develop the ability to provide complete and balanced patient education to those patients inquiring about these complementary/alternative therapies.