CORE MEDICINE CLERKSHIP - Alliance for Academic Internal

254 Pages·2006·1.28 MB·English

CORE

MEDICINE

CLERKSHIP

CURRICULUM GUIDE

A R T L
ESOURCE FOR EACHERS AND EARNERS

Version 3.0
2006

CDIM SGIM

C D S G
LERKSHIP IRECTORS OCIETY OF ENERAL
I I M I M
N NTERNAL EDICINE NTERNAL EDICINE

CDIM/SGIM
CORE MEDICINE CLERKSHIP
CURRICULUM GUIDE VERSION 3.0 (2006)
UPDATE TASK FORCE

Task Force Leaders

Thomas M. De Fer, MD Sara B. Fazio, MD
Co-Director Co-Director
Clerkship Directors in Internal Medicine Society of General Internal Medicine
Clerkship Director Clerkship Director
Washington University School of Medicine Harvard Medical School Beth Israel Deaconess
Campus Box 8121 Medical Center
660 S. Euclid Avenue Shapiro Clinical Center 631 H
St. Louis, Missouri 63110 Sixth Floor
[phone] 330 Brookline Avenue
[email protected] Boston, Massachusetts 02215
[phone]
[email protected]

Special Advisor
Allan Goroll, MD
Chair, Clerkship Director’s Committee
Professor of Medicine
Harvard Medical School
Massachusetts General Hospital
Ambulatory Care Center suite 645
15 Parkman St.
Boston, MA 02114

Task Force Members

Erica Friedman, MD Dan A. Henry, MD
Associate Dean for Undergraduate Medical Course Director Multidisciplinary Ambulatory
Education Experiences and Advanced Inpatient
Mount Sinai School of Medicine Experiences
One Gustave L. Levy Place University of Connecticut
Box 1127 School of Medicine
New York, New York 10029 263 Farmington Avenue
[phone] Clinical Education AG 069
[email protected] Farmington, Connecticut 06030
[phone]
[email protected]
Task Force Members (continued)

Mary Ann Kuzma, MD James L. Sebastian, MD
Clerkship Director Director of Student Teaching Programs
Drexel University College of Medicine Department of Medicine
2900 Queen Lane Medical College of Wisconsin
Room 221 Froedtert Memorial Lutheran Hospital
Philadelphia, Pennsylvania 19129 Suite 4100
[phone] 9200 W. Wisconsin Avenue
[email protected] Milwaukee, Wisconsin 53226
[phone]
[email protected]
Cynthia H. Ledford, MD
Glenda Westmoreland, MD
Clerkship Director
Ohio State University College of Medicine Director of Geriatrics Education
201 Means Hall Director, Geriatric Medicine Fellowship
1654 Upham Drive Indiana University School of Medicine
Columbus, Ohio 43221 1001 W. 10th Street, OPW-M200
[phone] Indianapolis, Indiana 46202
[email protected] [phone]
[email protected]

Kathleen F. Ryan, MD
Terry M. Wolpaw, MD
Clerkship Director
Drexel University College of Medicine Associate Dean for Curricular Affairs
245 N. 15th Street Case School of Medicine
Mail Stop 427 10900 Euclid Avenue, T402
Philadelphia, Pennsylvania 19102 Cleveland, Ohio 44106-4924
[phone] [phone]
[email protected] [email protected]

Project Administrators

Nicole V. Baptista Charles P. Clayton
Policy Associate Vice President for Policy
Clerkship Directors in Internal Medicine Clerkship Directors in Internal Medicine
2501 M Street, NW 2501 M Street, NW
Suite 550 Suite 550
Washington, DC 20037 Washington, DC 20037
[phone] [phone]
[email protected] [email protected]
CDIM/SGIM
CORE MEDICINE CLERKSHIP
CURRICULUM GUIDE VERSION 3.0 (2006)
TABLE OF CONTENTS

VERSION 3.0 TASK FORCE MEMBERS 3
INTRODUCTION 9
APPENDIX I: ACGME OUTCOME PROJECT GENERAL COMPETENCIES 19
APPENDIX II: END OF LIFE CARE OBJECTIVES ACROSS THE CURRICULUM 21
APPENDIX III: GENETICS OBJECTIVES ACROSS THE CURRICULUM 23
APPENDIX IV: PROFESSIONALISM ACROSS THE CURRICULUM 27
APPENDIX V: ABBREVIATIONS USED IN THIS DOCUMENT 28
APPENDIX VI: COMPETENCY/TRAINING PROBLEM TEMPLATE 30
APPENDIX VII: VERSION 2.0 UPDATE COMMITTEE MEMBERS 33
APPENDIX VIII: VERSION 1.0 PROJECT PARTICIPANTS 35
GENERAL CLINICAL CORE COMPETENCIES 38
CATEGORY 1
DIAGNOSTIC DECISION MAKING 38
CASE PRESENTATION 40
HISTORY AND PHYSICAL EXAMINATION 44
COMMUNICATION AND
RELATIONSHIPS WITH PATIENTS AND COLLEAGUES 48
INTERPRETATION OF CLINICAL INFORMATION 52
THERAPEUTIC DECISION MAKING 56
BIOETHICS OF CARE 60
SELF-DIRECTED LEARNING 64
PREVENTION 68
CATEGORY 2
COORDINATION OF CARE AND TEAM WORK 72
GERIATRIC CARE 76
BASIC PROCEDURES 80
NUTRITION 82
COMMUNITY HEALTH CARE 86
CATEGORY 3
CONTINUOUS IMPROVEMENT IN SYSTEMS OF MEDICAL CARE 90
OCCUPATIONAL AND ENVIRONMENTAL HEALTH CARE 94
ADVANCED PROCEDURES 96
TRAINING PROBLEMS: HEALTHY PATIENTS
HEALTHY PROMOTION, DISEASE PREVENTION, AND SCREENING 98
TRAINING PROBLEMS: PATIENTS WITH A
SYMPTOM, SIGN, OR ABNORMAL LABORATORY VALUE
ABDOMINAL PAIN 104
ALTERED MENTAL STATUS 110
ANEMIA 114
BACK PAIN 118
CHEST PAIN 122
COUGH 128
DYSPNEA 132
DYSURIA 136
FEVER 140
FLUID, ELECTROLYTE, AND ACID-BASE DISORDERS 144
GASTROINTESTINAL BLEEDING 148
KNEE PAIN 152
RASH 156
UPPER RESPIRATORY COMPLAINTS 162
TRAINING PROBLEMS: PATIENTS PRESENTING WITH A KNOWN CONDITION
ACUTE MYOCARDIAL INFARCTION 166
ACUTE RENAL FAILURE AND CHRONIC KIDNEY DISEASE 170
COMMON CANCERS 174
COPD/OBSTRUCTIVE AIRWAYS DISEASE 180
DIABETES MELLITUS 184
DYSLIPIDEMIAS 189
HEART FAILURE 193
HIV INFECTION 199
HYPERTENSION 205
LIVER DISEASE 211
MAJOR DEPRESSION 217
NOSOCOMIAL INFECTIONS 223
OBESITY 229
PNEUMONIA 233
RHEUMATOLOGIC PROBLEMS 237
SMOKING CESSATION 243
SUBSTANCE ABUSE 247
VENOUS THROMBOEMBOLISM 251

INTRODUCTION

We are pleased to introduce version 3.0 of the CDIM/SGIM Core Medicine Clerkship
Curriculum Guide: A Resource for Teachers and Learners. The guide is a
cooperative project of the Clerkship Directors in Internal Medicine (CDIM) and the
Society of General Internal Medicine (SGIM) and was originally created in 1995 under a
contract with the Division of Medicine of the Health Resources and Services
Administration’s Bureau of Health Professions. Version 2.0 was released in 1998. The
editors are indebted to all of the individuals who contributed to these earlier “editions” of
the guide, in particular Allan Goroll, MD, and Gail Morrison. MD. Version 3.0 is merely
an extension of their initial vision. Most of the original authors will continue to
recognize the essence of their work throughout the guide. The ongoing encouragement,
consultation, and advice of Dr. Goroll have been invaluable to the project.

NEW TO VERSION 3.0:

1.Each learning objective coded by Accreditation Council for Graduate Medical Education
(ACGME) General Competencies: Patient Care (PC), Medical Knowledge (MK),
Practice-Based Learning and Improvement (PLI), Interpersonal and Communication
Skills (CS), Professionalism (P), and Systems-Based Practice (SBP) (Appendix I).
2. Addition of learning objectives regarding End-of Life Care (Appendix II).
3. Addition of learning objectives regarding Genetics (Appendix III).
4. The addition of five new Training Problems: Knee Pain, Obesity, Fever, Rash, and
Upper Respiratory Complaints.
5. Conversion of the Training Problem Joint Pain to Rheumatologic Problems.
6. Conversion of the Training Problem Acute Renal Failure to Acute Renal Failure and
Chronic Kidney Disease.
7. Expansion of learning objectives regarding Professionalism (Appendix IV).
8. All General clinical core competencies and training problems updated for progress in
medical knowledge, trends in health care, and developments in medical education.
9. Addition of references that will be particularly useful to students.
10. Simultaneous release of the updated Pocket Guide.

This update maintains the same structure of the earlier versions, namely:

1. General Clinical Core Competencies
2. Training Problems: Healthy Patients
3. Training Problems: Patients With a Symptom, Sign, or Abnormal
Laboratory Value
4. Training Problems: Patients Presenting with a Known Condition
5. Knowledge, Skills, and Attitudes model
Version 3.0 was inspired by ongoing progress in medical knowledge, trends in health
care, and developments in medical education. Most notable since the release of version
2.0 has been the development and broad application of the ACGME General
Competencies (www.acgme.org/outcome/): Patient Care, Medical Knowledge,
Practice-Based Learning and Improvement, Interpersonal and Communication
Skills, Professionalism, and Systems-Based Practice. Refer to Appendix I for a
detailed account of the ACGME General Competencies. These competencies apply to all
facets of graduate medical education, including residency and fellowship. They have
been quite influential as a “new paradigm” for medical education as a whole. In fact, it
has been suggested that the learning goals of the core medicine curriculum be framed in
the context of the ACGME competencies to facilitate the transition from student to
resident and to emphasize the continuum of medical education.1

Clearly, a unified approach to medical education encompassing medical school through
residency, fellowship, and perhaps continuing medical education, has strong face validity
and growing support. The ACGME General Competencies across the continuum of
education and sites have been conceptualized as the Association of American Medical
Colleges “cube” (www.cbil.vcu.edu/cube/), which has subsequently evolved into the
MedEdPORTAL, Providing Online Resources to Advance Learning in Medical
Education (http://services.aamc.org/jsp/mededportal/). This online repository of
educational materials focuses on the continuum of medical education and uses the
ACGME General Competencies as one of the primary indexing tools.

Precedence exists for framing a medical student curriculum in the context of the ACGME
General Competencies, namely the Family Medicine Curriculum Resource (FMCR)
released by the Society of Teachers of Family Medicine in 2004 and funded by the
Health Resources and Services Administration.2 Citing the congruency of the broad-
based calls for medical education reform with the ACGME competency structure, the
advisory committee of the FMCR Project made the conspicuous decision to use this
framework for the project from the beginning. The resource includes goals for medical
student education during the preclerkship, family medicine clerkship, and postclerkship
periods organized by the ACGME General Competencies. Members of CDIM served in
a consultative role during the FMCR Project and that process proved informative
regarding the planned curriculum update. In fact, the first discussion of version 3.0
occurred at one of the first FMCR project meetings.

1 Whelan A, Appel J, Alper EJ, De Fer TM, Dickenson TA, Fazio SB, Friedman E, Kuzma MA, Reddy S.
The future of medical student education in internal medicine. Am J Med. 2004; 116:576-80.
2 Family Medicine Curriculum Resource (FMCR) Project. HRSA Contract (Contract No. 240-00-0107) to
the Society of Teachers of Family Medicine. October, 2004.