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's attitudes 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.

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.

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