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 (314) 747-4366 330 Brookline Avenue [email protected] Boston, Massachusetts 02215 (617) 667-1338 [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 (212) 241-8572 Clinical Education AG 069 [email protected] Farmington, Connecticut 06030 (860) 679-3821 [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 (215) 991-8526 9200 W. Wisconsin Avenue [email protected] Milwaukee, Wisconsin 53226 (414) 456-6793 [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 (614) 293-8589 Indianapolis, Indiana 46202 [email protected] (317) 630-6906 [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 (215) 762-7296 (216) 368-6986 [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 (202) 861-8600 (202) 861-8600 [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.