Internal Medicine 1 Syllabus
Virginia Campus: Peter J. Recupero, D.O. (firstname.lastname@example.org)
Carolinas Campus: Teresa Kilgore, D.O., FACOI (email@example.com)
Virginia Campus: Megan Cornwell Thomas, D.O. (firstname.lastname@example.org)
Rotation Credit Hours
4 credit hours. Corresponds to MED 8040
- To acquire the knowledge, skills and competencies that are required to evaluate and treat patients with acute and chronic medical conditions commonly found in the adult at a level consistent with a graduating generalist medical student.
- To develop the physical examination and clinical skills required of a graduate medical student in general internal medicine practice, including the ability interpret information relative to normal and abnormal structure, function and physiology.
- To apply historical and clinical information for problems solving to advance the health of the patient.
- To develop the psycho-social and communication skills and competencies that are required to communicate with, and treat a wide diversity of patients in acute, outpatient and institutional settings.
- To develop the ability to research medical literature and scientific resources for information that affects the patient’s condition, treatment and outcomes and the ability to evaluate and apply scientifically valid information to maximize the outcome of the patient.
- To develop knowledge, skill application and understanding of the indications, contra indications and application of medical procedures and therapies common to the specialty, including but not limited to ordering and interpretation of diagnostic studies, utilization of pharmacological agents, psychological and nutritional therapies, incorporation of osteopathic principles and practices into the patient’s care, and clinical procedures such as central line placement, lumbar punctures, intubation, management of ventilators, etc.
During the third year internal medicine rotations, students expand their knowledge of adult health and wellness, preventative, primary, secondary and tertiary care. They learn about the treatment of acute and chronic medical conditions, palliative and end of life care and gain the ability to apply this knowledge in the clinical setting. The curriculum is taught through on-line interactive SIMPLE cases, assigned readings, bedside and clinic teaching, journal clubs, tumor boards, grand rounds, and through one-on-one student-preceptor experience in caring for patients in the clinical setting. The Core Internal Medicine rotations include inpatient and outpatient exposure, as well as general internal medicine and medical sub-specialty exposure.
Clinical Setting in Which Rotation Occurs
The practice of internal medicine occurs in the private, public and governmental clinic settings, in long-term care facilities, in inpatient institutional settings and in the emergency departments of hospitals and institutions. Due to the variety of practice opportunities and formats in internal medicine rotations, students should review their specific site instructions for a more detailed description of their specific practice setting.
For more information on third year Internal Medicine clinical rotations, please review this PowerPoint presentation.
Requirements for Completion
- Internal Medicine Essentials for Students: A Companion to MKSAP for Students 5 (Available in electronic format on the VCOM Library in the Stat!Ref Section)
- American Osteopathic Association, and Anthony Chila. Foundations of Osteopathic Medicine, 3rd ed. Baltimore, MD: Lippincott Williams & Wilkins, 2011. ISBN: 978-0781766715
- Kuchera, M. & Kuchera, W. Osteopathic Considerations in Systemic Dysfunction, Revised 2nd Edition. Dayton, OH: Greyden Press, 1994. ISBN: 978-1570741548
The specific reading assignments in this textbook have been designed to correspond to the core clinical topics for the rotation and can be found on the web site along with the clinical cases found online in the SIMPLE section of the Med U website. Directions on how to access the SIMPLE cases follows.
The SIMPLE cases that are referred to in certain sections of the IM 1 and IM 2 Syllabus, can be accessed in the following way:
- Go to www.med-u.org
- Click on SIMPLE
- Click on Sign In
- If you are a first-time user, click on First Time User
- Fill out form, using your VCOM e-mail and password
- Read legal terms and click accept if you agree to them
- Type the “security” characters in the designated field
- Click send
- For future access to the cases:
- Repeat Steps 1, 2 and 3
- Log in using your VCOM e-mail and password
Requirements for Successful Completion of the Internal Medicine 1 Rotation:
Successful completion of the end-of-rotation written exam
- Attendance according to VCOM and preceptor requirements as defined in the College Catalog and Student Handbook
- Completion of a minimum of 10 SIMPLE cases from the Required Curriculum. Ten (10) cases must be completed during the IM 1 rotation and 10 cases must be completed during the IM 2 rotation, in addition to the Introductory case.
Please note: The Summary of Case Credit button must be clicked at the end of each case in order to receive credit for the case.
- Clinical Encounter Log
Your student encounter logs are to be submitted to the Internal Medicine Administrative Assistant below at the end of your rotation. Student Logs will be part of your evaluation for the clerkship and are required. Your log must be approved and signed by your preceptor.
The end-of-rotation exam questions will be derived directly from the specific objectives presented in each of the below modules.
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Clinical Modules - Required for Completion
The Internal Medicine curriculum is delivered through 19 on-line SIMPLE cases that accompany the 20 curriculum modules found below. Each module will cover the core topics, assigned readings and cases and will assist students in developing knowledge and competency in the clinical conditions most commonly encountered in the care of the adult patient. Each of the following topics has specific learning objectives and is accompanied by an assigned reading in the text as well as an online case. The end-of-rotation exam questions will be derived from the objectives presented in the modules and accompanying the reading assignments from Internal Medicine Essentials (except OMM specific readings which are found in Foundations and Kuchera's). Thus success on the exam will require that students complete a minimum of 10 SIMPLE cases and all reading assignments.
1. Acute Coronary Syndrome [+]
- Reading assignment: Chapters 1 & 3
- On-line SIMPLE case(s): Case 1 (49-year-old man with acute onset of chest pain - Mr. Monson)
- Create a differential diagnosis of acute chest pain and narrow the differential based on specific physical exam and history findings.
- Define and discuss the pathogenesis, signs, and symptoms of the acute coronary syndromes.
- List cardiovascular risk factors
- Predict the primary and secondary prevention of ischemic heart disease.
- Develop an appropriate diagnostic and treatment plan—including recommended lifestyle modifications—for a patient presenting with acute coronary syndrome
2. Ischemic heart disease [+]
- Reading assignment : Chapter 2
- On-line SIMPLE case(s): Case 2 (60-year-old woman with chest pain on exertion – Ms. Johnston)
- Identify the symptoms and signs of chest pain characteristic of angina pectoris.
- Categorize the patients’ symptoms as angina pectoris, atypical angina, or non-cardiac chest pain.
- Obtain, document, and present an appropriately complete medical history that differentiates among the common etiologies of chest pain.
- Obtain a history of a patient with chest pain that contains information about those clinical characteristics that are typical of angina pectoris and includes risk factors of coronary heart disease.
- Perform a physical exam that includes identifying the presence of dyspnea and anxiety, obtaining accurate vital signs, and performing heart, lung, and vascular exams.
- Order appropriate laboratory and diagnostic studies based on patient demographics and the most likely etiologies of chest pain.
- Recommend primary and secondary prevention of ischemic heart disease through the reduction of cardiovascular risk factors (e.g. controlling hypertension and dyslipidemia, aggressive diabetes management, avoiding tobacco, and aspirin prophylaxis).
- Prescribe appropriate anti-anginal medications when indicated and communicate potential adverse reactions.
3. Arrhythmias & disorders of cardiac output [+]
- Reading assignment : Chapters 4, 5, 6, 29
- On-line SIMPLE case(s): Case 3 (54-year-old woman with syncope - Mrs. Koda)
- List the common causes of syncope.
- Determine the important aspects of the history and physical exam in a patient with syncope.
- Discuss the approach to the evaluation and treatment of a patient with syncope.
- Identify atrial fibrillation on an electrocardiogram.
- List the common causes of atrial fibrillation.
- Discuss the approach to the evaluation and treatment of a patient with atrial fibrillation (including stroke risk scoring).
- Explain how atrial fibrillation and mitral stenosis may lead to syncope.
- List indications for permanent pacing.
- Identify a bundle branch block on electrocardiogram.
- Define SA node disease.
- Discuss management of a left bundle branch block
- Define Long QT syndrome and its risk factors
- Predict treatment regimens for ventricular tachycardia (including torsades de pointes)
4. Congestive heart failure [+]
- Reading assignment : Chapters 7, 8, 81
- On-line SIMPLE case(s): Case 4 (67-year-old woman with shortness of breath and leg swelling - Ms. Rivers)
- Interpret neck vein findings for jugular venous distention (JVD) and abdominal jugular reflux.
- Identify and translate auscultatory findings of the heart including rate, rhythm, S3/S4, and murmurs.
- List the major pathologic states that cause dyspnea.
- Compare the differing etiologies and signs of left-sided vs. right-sided heart failure.
- Utilize the staging system for heart failure.
- Discuss the factors leading to symptomatic exacerbation of HF, including ischemia, arrhythmias, anemia, hypertension, thyroid disorders, non-compliance with medications and dietary restrictions, and use of non-steroidal anti-inflammatory drugs (NSAIDS).
- Interpret B-type natriuretic peptide (BNP) results.
- Recommend pharmacologic management of heart failure.
- Define grading of the intensity of cardiac murmurs.
- Describe the murmur, etiology and treatment of aortic stenosis
- Predict the etiology, diagnosis and therapy of mitral stenosis
5. Diabetes mellitus [+]
- Reading assignment: Chapters 9, 10
- On-line SIMPLE case(s): Case 7 (28-year-old woman with lightheadedness - Ms. Williams)
- Discuss the definition and differential diagnosis of hypotension, including how to use orthostatic signs and symptoms.
- Use the American Diabetes Association (ADA) and the U.S. Preventive Task Force (USPTF) recommendations to screen for diabetes, including recognizing risk factors for diabetes.
- Discuss the pathogenesis of Type 1 and Type 2 diabetes.
- Diagnose type 2 diabetes mellitus using the four accepted criteria, as well as know the diagnostic criteria for impaired fasting glucose and impaired glucose tolerance.
- Calculate anion gap, osmolar gap, and correct sodium to distinguish hyponatremia from pseudohyponatremia.
- Define hyperosmolar hyperglycemic state (HHS), including nonketotic coma.
- Recognize precipitants and presenting symptoms and signs of HHS and diabetic ketoacidosis (DKA), as well as discuss the pathophysiology for the abnormal laboratory values of each.
- Describe the basic management of diabetic ketoacidosis and nonketotic hyperglycemic states, including the similarities and differences in insulin therapy and fluid and electrolyte replacement.
- List the ADA-recommended targets for glycemic control for adults.
- Understand the differences between types of insulin and the indications for their use.
- Counsel diabetic patients appropriately on dietary measures and exercise.
- Recognize precipitants and presenting symptoms and signs of hypoglycemia, as well as basic management.
6. GI bleed [+]
- Reading assignment : Chapters 20, 21, 22, 23, 36, 74
- On-line SIMPLE case(s): Case 10 (48-year-old woman with diarrhea and dizziness - Ms. Blake) and Case 21 (78-year-old man with fever, lethargy, and anorexia – Mr. Ramirez)
- Perform medication reconciliation upon admission and discharge.
- Identify the common causes for and symptoms of upper and lower gastrointestinal blood loss, including recognizing the distinguishing features of each.
- Define hematemesis, melena, and hematochezia.
- Examine the role of contributing factors in gastrointestinal bleeding such as Helicobacter pylori infection, non-steroidal anti-inflammatory drugs, alcohol, coagulopathies, and chronic liver disease.
- Demonstrate the indications for, contraindications to, and complications of blood transfusion, including describing system errors that produce transfusion reactions.
- Identify and manage transfusion reactions.
- Describe the difference between adverse events and medical errors.
- Develop an appropriate evaluation and treatment plan for patients with a gastrointestinal bleed that includes:
- Establishing adequate venous access
- Administering crystalloid fluid resuscitation
- Ordering blood and blood product transfusion
- Determining when to obtain consultation from a gastroenterologist for upper endoscopy.
- Distinguish among the types of shock and their presentations.
- Discuss the common causes for and symptoms of lower gastrointestinal (GI) blood loss.
- List elements of physical exam in patient with suspected GI bleed.
- Recommend laboratory and diagnostic tests to evaluate GI bleeding.
- Understand the physician’s role when a patient is no longer capable of making medical decisions.
- Utilize clinical history and appropriate diagnostic tests to diagnose GERD
- Discuss treatment for GERD and indications for EGD
- Cite the strategy for diagnosis and treatment H. pylori
7. Abdominal pain [+]
- Reading assignment : Chapters 15, 16, 26
- On-line SIMPLE case(s): Case 12 (55-year-old male with lower abdominal pain - Mr. Wilson)
- List symptoms and signs indicative of an acute/surgical abdomen.
- Approximate a likelihood ratio of the common causes of abdominal pain based on pain pattern, the quadrant the pain is located and abdominal exam findings.
- Generate a prioritized differential of the most important and likely causes of a patient’s abdominal pain and recognize specific history, physical exam, and laboratory findings that distinguish between the various conditions.
- Recommend a basic management plan for diverticulitis.
- Define irritable bowel syndrome.
- Utilize history and clinical presentation to create a differential for infectious and non-infectious diarrhea
- Utilize common diagnostic tests for diarrhea to determine a diagnosis.
- Differentiate ulcerative colitis from Crohn’s disease.
8. Liver disease [+]
- Reading assignment : Chapters 17, 24, 25
- On-line SIMPLE case(s): Case11 (45-year-old man with abnormal LFTs - Mr. Chapman) and Case 36 (45-year-old man with ascites – Mr. Berlusconi)
- Understand pathophysiology of conjugated and unconjugated hyperbilirubinemia.
- Describe the common types of liver diseases and their risk factors (including inherited and acquired).
- Obtain an appropriate history to elicit risk factors for viral hepatitis.
- Know when to order laboratory tests for evaluation of liver disease and when a liver biopsy might be indicated.
- Know the signs, symptoms, and complications of portal hypertension.
- Describe the presenting signs and symptoms of spontaneous bacterial peritonitis (SBP).
- Complete an abdominal exam, including evaluation for presence of ascites.
- Understand the indications for paracentesis and how to analyze the ascitic fluid using the serum to ascites albumin gradient (SAAG).
- Describe the components of obtaining informed consent.
- Become familiar with the indications for hepatic transplantation referral in end stage liver disease.
- Utilize history and patterns in liver function tests to diagnose hepatitis.
- Utilize hepatitis B serologies to determine the stages of infection
- Utilize clinical history to create a differential for liver diseases, such as hemochromatosis, nonalcoholic fatty liver disease, alcoholic liver disease, autoimmune hepatitis, hepatitis A, hepatitis B, etc.
- List the goals of therapy for cirrhosis
9. Pancreatic disease [+]
- Reading assignment : Chapters 15, 17, 18, 19
- On-line SIMPLE case(s): Case 9 (55-year-old woman with upper abdominal pain and vomiting – Mrs. Turner)
- Describe the pathophysiology of the principle types of abdominal pain: parietal, visceral, vascular, and referred.
- Determine when to consult a surgeon regarding abdominal pain.
- Explain the indications and utility of hepatobiliary imaging studies including MRCP and ERCP.
- Utilize liver function tests and clinical history to create a differential for cholestatic liver disease.
- Discuss common etiologies of pancreatitis in the US.
- Predict general treatment plan for pancreatitis.
- Utilize clinical history such as painless jaundice and risk factors to diagnose pancreatic cancer.
10.Substance abuse [+]
- Reading assignment : Chapter 31
- On-line SIMPLE case(s): Case 9 (55-year-old woman with upper abdominal pain and vomiting – Mrs. Turner) and Case 11 (45-year-old man with abnormal LFTs - Mr. Chapman)
- Be familiar with the CAGE and AUDIT screening tools for alcohol abuse.
- Take a substance abuse history and provide counseling in a non-judgmental manner.
- Recognize the clinical presentations of substance abuse and recommend treatment.
- Apply diagnostic criteria for alcohol abuse, dependence, and addiction.
Recommend basic prevention and treatment for alcohol withdrawal.
11. Acute renal failure [+]
- Reading assignment : Chapters 60, 61
- On-line SIMPLE case(s): Case 33 (49-year-old woman with confusion - Mrs. Baxter)
- Compare the pathophysiology of major etiologies of acute renal failure including decreased renal perfusion (pre-renal), intrinsic renal disease, and acute renal obstruction (post renal).
- Utilize the fractional excretion of sodium and apply it to distinguish between pre-renal and intrinsic renal disease.
- Utilize common diagnostic tests, including UA, BMP to determine likely etiology of acute renal failure.
- Develop appropriate initial management plan for acute renal failure including volume management, dietary recommendations, drug dosage alterations, electrolyte monitoring, and indications for dialysis.
- Identify risk factors for contrast-induced nephropathy and recommend steps to prevent this complication.
- Interpret a urinalysis, including microscopic examination for casts, red blood cells, white blood cells, and crystals.
- Differentiate nephrotic syndrome and nephritic syndrome.
- Create a differential diagnosis for acute kidney injury based on clinical history and basic diagnostic studies.
12. Chronic kidney disease [+]
- Reading assignment : Chapters 41, 60, 62, 65
- On-line SIMPLE case(s): Case 23 (54-year-old Hispanic woman with fatigue – Ms. Torres)
- List the most common causes of chronic kidney disease (CKD).
- Utilize clinical history and diagnostic tests to diagnose etiologies of chronic kidney disease.
- Describe pathophysiology and clinical signs of uremia.
- Tell about the pathophysiology of hyperkalemia, hypocalcemia, and hyperphosphatemia in the setting of CKD.
- Educate patients about the significance of proteinuria in CKD.
- Appropriately recommend the use of angiotensin converting enzyme (ACE)-inhibitors and angiotensin receptor blockers (ARBs) in the management of CKD.
- Outline treatment with phosphate binders and calcium replacement.
- Summarize the staging of CKD based on glomerular filtration rate (GFR).
- Define hypertension, hypertensive emergency, and hypertensive urgency.
- List indications for antihypertensive drug classes.
- Define the stages of chronic kidney disease.
- List the indications for dialysis.
13. Acid-Base Disorders [+]
- Reading assignment : Chapter 63
- On-line SIMPLE case(s): Case 26 (58-year-old man with altered mental status - Mr. Johnson), Case 33 (49-year-old woman with confusion - Mrs. Baxter)
- Calculate anion gap, osmolar gap, and correct sodium to distinguish hyponatremia from pseudohyponatremia.
- Discuss the pathophysiology of simple and mixed acid- base disorders.
- Calculate the anion gap and explain its relevance to determining the cause of a metabolic acidosis.
- List the differential of anion-gap metabolic acidosis.
- Calculate the anion gap and generate a differential diagnosis for metabolic acidosis
14. Pneumonia [+]
- Reading assignment : Chapters 33, 55, 57, 81
- On-line SIMPLE case(s): Case 22 (71-year-old male with cough and fatigue – Mr. Groszek)
- Suggested on-line resources: Infectious Disease Society of American Community-Acquired Pneumonia and Hospital-Acquired Pneumonia guideline
- http://www.idsociety.org/Organ_System/#Lower/Upper Respiratory
- Discuss the common causes of acute dyspnea, their pathophysiology, symptoms, and signs.
- List the common pneumonia pathogens (viral, bacterial, mycobacterial, and fungal) in immunocompetent and immunocompromised hosts.
- Describe radiographic findings associated with specific pathogens.
- Identify bronchial breath sounds, rales (crackles), rhonchi, and wheezes, signs of pulmonary consolidation, and pleural effusion on physical exam.
- Recognize the most common complications of pneumonia.
- Recommend when to order diagnostic laboratory tests—including complete blood counts, sputum gram stain and culture, blood cultures, and arterial blood gases—how to interpret those tests, and how to recommend treatment based on these interpretations.
- Select an appropriate empiric antibiotic regimen for community-acquired, nosocomial, immunocompromised-host, and aspiration pneumonia, taking into account pertinent patient features.
- Discuss the Centers for Medicare and Medicaid Services (CMS) and Joint Commission’s quality measures for smoking cessation advice and vaccination against pneumonia and influenza in patients with pneumonia and other pulmonary disorders.
- Create a differential diagnosis for chronic cough.
- Define hospital-acquired and ventilator-associated pneumonia.
- Predict empiric antibiotic treatment for HAP and VAP.
- Discuss risk factor modification for the prevention of HAP and VAP.
- Create a differential diagnosis for acute and chronic dyspnea.
15. Chronic lung disease [+]
- Reading assignment : Chapters 75, 80, 81, 83, 84, 86
- On-line SIMPLE case(s): Case 28 (70-year-old man with shortness of breath and leg swelling - Mr. Honig)
- Accurately interpret arterial blood gas.
- Explain pulmonary function test (PFT) results and use them to recommend appropriate therapy.
- List major pathologic states causing dyspnea.
- Relate the utility of supplemental oxygen and the potential dangers of overly aggressive oxygen supplementation.
- Describe the indications for, benefits of, and side effects of therapies for chronic obstructive pulmonary disease (COPD) including: beta-agonists, anticholinergics, methylxanthines, and inhaled and systemic corticosteroids.
- Recommend appropriate laboratory evaluation for suspected COPD exacerbation.
- Describe the benefits of immunizing adults with COPD against influenza and pneumococcal infection.
- Identify paraneoplastic syndromes associated with lung cancer.
- Recognize basic treatment protocols for lung cancer based on stage.
- Differentiate obstructive and restrictive lung disease using pulmonary function tests.
- Utilize history and clinical examination to diagnose diffuse parenchymal lung diseases.
- Utilize diagnostic tests (imaging and laboratory) in a work-up of acute and chronic dyspnea.
- Diagnose asthma and initiate treatment based on asthma severity.
- Classify COPD by stages and predict treatment based on severity.
- Create a differential diagnosis for diffuse parenchymal lung diseases.
16. Altered mental status [+]
- Reading assignment : Chapters 29, 64, 66
- On-line SIMPLE case(s): Case 3 (54-year-old woman with syncope - Mrs. Koda), Case 25 (75-year-old woman with altered mental status - Mrs. Kohn), and Case 26 (58-year-old man with altered mental status - Mr. Johnson)
- List the common causes of syncope.
- Determine the important aspects of the history and physical exam in a patient with syncope.
- Discuss the approach to the evaluation and treatment of a patient with syncope.
- Recognize that altered mental status in an older inpatient is a medical emergency and requires that the patient be evaluated immediately.
- Differentiate among delirium, dementia, and depression.
- Identify the risk factors for developing altered mental status, including:
- Advanced age
- Substance abuse
- Comorbid physical problems such as sleep deprivation, immobility, dehydration, pain, and sensory impairment
- ICU admission
- Thoroughly review prescription medications, over-the-counter drugs, and supplements, and inquire about substance abuse when evaluating delirium.
- Recognize the symptoms and signs of the most common and most serious causes of altered mental status, including metabolic causes, such as hyponatremia.
- Perform a thorough diagnostic evaluation of altered mental status.
- Manage the most common causes of altered mental status.
- Describe the pathophysiology, presenting signs and symptoms, laboratory interpretation, and the management of hyponatremia, including the risk of too rapid or too delayed therapy of hyponatremia.
- Write appropriate fluid and replacement orders for patients with common electrolyte and metabolic disturbances.
- Identify the presenting signs and symptoms of intoxication and overdose of common substances of abuse.
- Recognize the presenting signs and symptoms and list the differential diagnosis of hypernatremia.
- Understand how homelessness can influence patient’s access to illicit substances and interfere with ability to enable effective treatment.
- Describe the pathophysiology of ethylene glycol toxicity.
- Evaluate for calcium oxalate crystalluria and relate the presence to ethylene glycol toxicity and other disorders.
- List the differential of hypernatremia.
- Manage ethylene glycol toxicity, including the use of the antidote fomepizole.
- Describe how to correct hypernatremia.
17. Sepsis [+]
- Reading assignment : Chapters 50, 52, 67, 70
- On-line SIMPLE case(s): Case 21 (78-year-old man with fever, lethargy, and anorexia – Mr. Ramirez) and Case 24 (52-year-old female with headache, vomiting, and fever - Mrs. Cole)
- Interpret a urinalysis.
- Recommend appropriate empiric therapy for urosepsis based on an understanding of urinary tract infection pathogenesis and resistance patterns.
- Discuss types of patient isolation precautions and their indications.
- Describe indications for and contraindications and complications of lumbar puncture.
- Demonstrate knowledge of cerebrospinal fluid analysis and its interpretation.
- Define systemic inflammatory response syndrome, sepsis, severe sepsis, and septic shock.
- Predict treatment principles of sepsis including early recognition, appropriate laboratory, aggressive fluid resuscitation, early broad-spectrum antibiotic administration and vasopressor administration
- Predict treatment of urinary tract infections based on clinical history and risk factors.
- Recognize “red flag” headache signs.
- Differentiate headaches based on clinical history and physical exam findings.
- Differentiate bacterial from viral meningitis based off typical cerebrospinal fluid findings.
- Predict empiric antibiotic treatment for meningitis based on age and clinical risk factors.
18. Hospital acquired infections [+]
- Reading assignment : Chapter 55
- On-line SIMPLE case(s): Case 24 (52-year-old female with headache, vomiting, and fever – Mrs. Cole)
- Suggested on-line resources: Infectious Disease Society of America (IDSA) guideline on Prevention of Healthcare-Associated Infections in Acute Care Hospitals and Clostridium difficile
- http://www.idsociety.org/Organ_System/#Gastrointestinal (GI)
- List risk factors for and precautions against the acquisition of nosocomial infection.
- Utilize system-based practices to prevent health care-associated infections such as catheter-related bloodstream infections, urinary tract infections and ventilator-associated pneumonia
- Diagnose Clostridium difficile infection and predict treatment based on severity of the illness.
19. Venous thromboembolism [+]
- Reading assignment : Chapters 46, 87
- On-line SIMPLE case(s): Case 30 (55-year-old with leg pain - Ms. Bond)
- Describe indications for and methods of deep vein thrombosis prophylaxis.
- List risk factors for the development of a deep vein thrombosis (DVT).
- Recognize the signs and symptoms of DVT and pulmonary embolism (PE).
- Generate a prioritized differential diagnosis of DVT/PE based on specific physical findings using pre-test probability tools.
- Understand the indications for and utility of various diagnostic tests and describe their interpretation.
- Develop an appropriate management plan for DVT/PE, including appropriate use and monitoring of heparin and warfarin
- Diagnose congenital and acquired thrombophilia disorders utilizing clinical history and diagnostic testing
20. OMM for Internal Medicine [+]
- Kuchera, M. & Kuchera, W. Lower Respiratory Disorders Disorders. Osteopathic Considerations in Systemic Dysfunction, Revised 2nd Edition. Dayton, OH: Greyden Press, 1994, pp. 33-52.
- American Osteopathic Association, and Anthony Chila. Chapter 59: Difficulty Breathing. Foundations of Osteopathic Medicine, 3rd ed. Baltimore, MD: Lippincott Williams & Wilkins, 2011, pp. 931-938.
- Identify the structural areas affected by sympathetic viscerosomatic reflex
- Define “Work of Breathing” as it pertains to the pulmonary system
- Recognize the Osteopathic “Models” of treatment
- Identify the structural areas which may play a role in Vagal nerve facilitation
- Identify the common rib dysfunctions found as a result of paroxysmal coughing
- Describe the pulmonary effects of increased parasympathetic tone
- Describe the pulmonary effects of increased acute sympathetic activation
- Describe the pulmonary effects of increased chronic sympathetic activation
- Identify the spinal segments most likely to become facilitated with lung dysfunction
- Identify the anterior Chapman’s points for lung dysfunction
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Clinical Performance Objectives
While the end-of-rotation exam is derived from the didactic curriculum, reading assignments and objectives described in the Curriculum section, the end-of-rotation evaluation completed by your internal medicine preceptor is based on clinical competencies, demonstrated professionalism and demonstrated knowledge of the discipline and the ability to apply that knowledge to the care of the patient. These core competencies reflect student performance in 6 key areas: communication, problem solving, clinical skills, medical knowledge, osteopathic medicine and professional and ethical considerations. Your end-of-rotation evaluation from your preceptor will be based directly on your performance in these 6 core competencies as described below.
- Communication - the student should demonstrate the following clinical communication skills:
- Effective listening to patient, family, faculty, peers, and other members of the healthcare team
- Demonstrates respect, compassion and respect in patient communications and interactions
- Demonstrate the ability to conduct both a focused and comprehensive patient interview, obtain historical and current information that is pertinent to the care of the patient and demonstrate accuracy and effectiveness in their investigation of medical complaints, medical, social and psychosocial history specific to the rotation.
- Considers whole patient: social, spiritual & cultural concerns
- Efficiently gathers, interoperates and prioritizes essential from non-essential information
- Skill in educating and motivating patient compliance and understanding of condition, treatment instructions, consents & medications
- Demonstrated ability to present patient cases and medical information in an accurate, concise, well organized manner in both “written” documents and oral formats.
- Problem Solving – the student should demonstrate the following problem solving skills:
- Identify important questions, identify and sort data in organized fashion organizing and prioritizing positives & negatives
- Discern major from minor patient problems
- Formulate an appropriate differential diagnosis while identifying the most common and probable diagnoses
- Identify indications for, interoperate and apply findings from the most appropriate diagnostic or clinical tests for the patient and the condition
- Identify correct treatment and management plans considering contraindications & interactions based on scientifically valid, outcome proven information from research of literature
- Incorporate patient’s and family perspectives and values into the diagnostic and therapeutic decision making.
- Be knowledgeable of socioeconomic considerations in design of diagnostic and treatment plans for the patient.
- Clinical Skills - the student should demonstrate the following skills:
- Demonstrate the ability to utilize inductive and deductive reasoning to problem solve patient complaints and conditions.
- Demonstrate the ability to apply the clinical knowledge and skills they were instructed on during PPC and OMM education throughout the OMS-I and OMS-II years.
- Assesses vital signs & triage patient according to degree of illness
- Demonstrate good observational, auscultory, palpatory and visual skills to gather clinical information and the ability to apply the findings to the treatment of the patient.
- Perform a thorough physical exam pertinent to the patient and the systems involved with the patient’s condition or complaints.
- Demonstrate the ability to incorporate the clinical findings with osteopathic treatment of abnormalities discovered in structure or function.
- Osteopathic Manipulative Medicine - the student should demonstrate the following skills in regards to osteopathic manipulative medicine
- Apply osteopathic principles to all patient encounters and osteopathic manipulative medicine successfully when appropriate
- Perform and document a thorough musculoskeletal exam
- Utilize palpatory skills to accurately discern physical changes that occur with various clinical disorders
- Apply osteopathic manipulative treatments successfully
- Medical Knowledge – the student should demonstrate the following in regards to medical knowledge
- Identify & correlate the anatomical, physiological, pathological, psychological and socio-economic conditions that are related to patients condition and the disease processes
- Demonstrate characteristics of a motivated, life-long learner including demonstrating intellectual curiosity, academic and clinical interest and enthusiasm about patient care and the ability to review and research the literature
- Thoroughness and Competency in researching evidence based literature and the ability to apply scientifically valid, outcome based information for the treatment of patient populations as well as the individual patient.
- Correlate symptoms and signs with most common diseases with underlying pathophysiological conditions.
- Demonstrated ability to different normal from abnormal physiology, behavior, structure and function in the patient.
- Ability to perform a comprehensive and accurate history and physical examination and correlate the history, clinical signs, symptoms and findings with the clinical condition, its management and underlying pathology.
- Ability to utilize, evaluate and apply diagnostic processes for common adult medical conditions.
- Professional and Ethical Behaviors - the student should demonstrate the following professional and ethical behaviors and skills:
- Is dutiful, punctual, reliable, and responsible regarding obligations of the rotation and patient care needs.
- Prepares for each day by performing assigned and required reading, self-study, documentation, review and completing individual responsibilities.
- Consistently completes all patient care, call and documentation responsibilities to ensure that they contribute to high quality patient care and outcomes.
- Accepts and appropriately responds to feedback, evaluation, praise as well as criticism without resistance or obstinacy.
- Displays professionalism in relationships with patients, staff, & peers
- Displays integrity and honesty in assessment of their medical competency and documentation
- Acknowledges errors, seeks to correct errors appropriately
- Identifies the importance to care for diverse, disadvantaged, underserved populations in a culturally competent, non-judgmental and altruistic manner.
- Demonstrated ability to work professionally, collaboratively and cooperatively in a team environment.
- Demonstrates awareness of and respect for patient’s rights, including need for informed consent, patient involvement in medical care and treatment decisions and end of life issues.
- Demonstrate respect for and complies with the rules and obligations that are established by the educational, regulatory, legislative and professional organizations that regulate, supervise and govern the profession of osteopathic medicine
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Osteopathic Manipulative Medicine Components
The student should demonstrate competencies inherent to the principle, practice and philosophy of osteopathic medicine including:
- Demonstrate a “whole patient” approach to the assessment and management of each patient including consideration and incorporation of cultural, social, spiritual, family, and behavioral considerations.
- Demonstrate the ability to perform a comprehensive osteopathic examination of the patient with attention to the visual and palpatory findings of the neurological and musculoskeletal systems.
- Demonstrate knowledge of and the ability to utilize Chapmans points, changes in somatovisceral and viscerosomatic reflexes and dermatome nerve distribution in the evaluation and treatment of the patient.
- Demonstrate the ability to utilize OMM techniques to treat the patient’s complaints or abnormalities.
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