CLERKSHIP OBJECTIVES
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PROFESSIONALISM, mORAL rEASONING, & eTHICAL jUDGMENT
Students will:
1. Care conscientiously for patients with the highest standard of
professional, ethical, and moral conduct in all circumstances arising in
association with the patients’ illnesses.
2. Display behaviors that foster and reward the patient’s trust in the
physician, such as appropriate dress, grooming, punctuality, honesty,
respect for patient’s confidentiality, and other norms of behavior in
professional relationships with patients.
3. Converse appropriately and behave with personal integrity in
interactions with peers, faculty, residents, and non-physician staff.
4. Recognize and accept own limitations in knowledge and clinical skills
and commit to continuous improvement in knowledge and ability.
5. Understand basic ethical concepts and apply them in moral reasoning in the educational and healthcare context. (SSOM #4)
(a) Describe basic principles of autonomy, paternalism, beneficence, and non-maleficence
(b)
Evaluate a clinical ethical situation using Loyola’s Ethical Work-up Guide Six Step Approach.
MEDICAL KNOWLEDGE
Students will be able to demonstrate knowledge of the following:
1. Etiology, epidemiology, clinical manifestations, differential
diagnosis, and treatment of the following:
acute mono and poly articular arthritis, acute renal failure, asthma,
atrial fibrillation, breast cancer, colon cancer/polyps, congestive
heart failure, chronic obstructive pulmonary disease, coronary artery
disease, type II diabetes mellitus, deep venous thrombosis/pulmonary
embolism, gastrointestinal bleeding, HIV infection,
hyper/hypothyroidism, hypertension, hyperlipidemia, viral hepatitis,
mental status changes, peptic ulcer disease, community acquired
pneumonia, pulmonary nodules/lung cancer, urinary tract infection/urosepsis.
2. Principles of preventive medicine for adults including vaccine
schedules, cancer screening, counseling for risk prevention and a
healthy lifestyle (especially smoking cessation).
3. Diagnostic approach to patients with cough, chest pain, dyspnea,
alcohol/cocaine addiction, hemoptysis, lymphadenopathy, sexually
transmitted diseases.
4. Evidence based medicine, especially the different types of study
designs and basics of test characteristics, including sensitivity,
specificity, positive/negative predictive values, and Bayes theorem.
CLINICAL SKILLS & PATIENT CARE
Students will be able to:
1. Assist in providing overall care for assigned patients under direct
supervision, including:
(a) Inpatient settings - constructing and presenting
admit notes (complete H&Ps, problem lists, assessments with prioritized
differential diagnoses, and diagnostic, therapeutic and patient education
plans); hospital orders and daily progress notes; interacting with family;
collaborating with other health care personnel
(b) Outpatient settings - constructing and presenting
complete H&Ps on new patients and follow-up notes on return patients,
including medication reviews, health maintenance and focused H&Ps for issues
requiring longitudinal care.
2. Work collaboratively as members of a healthcare team in a variety of
settings.
3. Perform, record, present and interpret a complete screening exam and
certain focused exams, including:
(a) heart - determine jugular venous pressure waves,
identify S4 and S3, certain murmurs, perform and describe the utility of
certain maneuvers, such as squatting, standing, hand grasp, and Valsalva.
(b) pulmonary - determine position of mediastinum,
asses chest expansion, percuss lung resonances, recognize abnormal lung
sounds, evaluate work of breathing and recognize clubbing.
(c) musculoskeletal - perform and interpret focused
exam of the shoulder, elbow, hip, knee and spine.
(d) endocrine - recognize eye findings of
hyper/hypothyroidism, palpate thyroid, observe and feel for tremors, and
elicit deep tendon reflexes.
4. Describe and utilize principles of advanced directives and
withholding/withdrawing life sustaining therapy.
5. Perform routine clinical procedures, including insertion of IV catheter,
arterial puncture, insertion of nasogastric tube, insertion of Foley
catheter.
6. Recognize, interpret, and assist in managing common EKG, laboratory, and
radiologic abnormalities, including:
(a) EKG – supra-ventricular, junctional, and
ventricular arrhythmias; intraventricular conduction defects; AV Blocks;
premature contractions; chamber enlargements; ischemia and infarctions,
drugs/metabolic effects.
(b) LABS - arterial blood gases/electrolyte panel;
liver tests (classification of jaundice, patterns of hepatocyte enzyme
elevation, markers of viral hepatitis, markers for immunologic liver
disease); hyponatremia (including treatment); common patterns of
autoantibody profiles, lymphocyte, phenotyping, measures of T cell function
and serum immunoglobulin abnormalities; common CBC abnormalities; pulmonary
tests (calculate Aa gradient and arterial/mixed venous O2 content, common
PFT patterns [obstructive vs. restrictive], exercise physiology and concept
of dead space); common laboratory measures of coagulation, hypercoagulation,
and anticoagulation from heparin/coumadin; urinary chemistry tests
(microscopic evaluation of urinary sediment, urinary protein
electrophoresis, creatinine clearance, fractional excretion of sodium, and
patterns of bun/creatinine ratios).
(c) RADIOLOGY - chest (normal x-ray and common
abnormalities, including pneumonia, atelectasis, pneumothorax, pleural
effusion, pulmonary edema and pulmonary nodules); GI (normal upper and lower
GI studies and common abnormalities); GU (normal IVP, renal tumors and
stones); nuclear medicine (basic principles and commonly used scans,
including breast, heart, thyroid, and pulmonary).
7. Perform data base retrievals and retrieve patient-specific information.
8. Construct appropriate management strategies (diagnostic and therapeutic)
for the following conditions:
acute mono and poly articular arthritis, acute renal failure, asthma, atrial
fibrillation, breast cancer, colon cancer/polyps, congestive heart failure,
chronic obstructive pulmonary disease, coronary artery disease, type II
diabetes mellitus, deep venous thrombosis/pulmonary embolism,
gastrointestinal bleeding, HIV infection, hyper/hypothyroidism,
hypertension, hyperlipidemia, viral hepatitis, mental status changes, peptic
ulcer disease, community acquired pneumonia, pulmonary nodules/lung cancer,
urinary tract infection/urosepsis, cough, chest pain, dyspnea,
alcohol/cocaine addiction, hemoptysis, lymphadenopathy, sexually transmitted
diseases.
INTERPERSONAL & COMMUNICATION SKILLS
Students will be able to:
1. Elicit, record, and present a complete history, with emphasis on the
history of present illness, as:
(a) a clear, chronological narrative of the patient’s
problems, and
(b) a description of the patient’s understanding of his
or her illness, fears and concerns, and the impact of the illness and its
treatment on the patient and the patient’s family.
2. Explain to a patient and the patient’s family the findings of a clinical
investigation, plans for follow-up or possible courses of therapy.
3. Record and present a hospital admit note (including a complete H&P and
problem list with assessment and plans), hospital orders and progress notes.
4. Demonstrate an understanding of how cultural beliefs and spirituality can
affect healthcare outcomes, including obtaining a cultural and/or spiritual
history when appropriate.
5. Demonstrate skills/strategies for dealing with difficult situations.
6. Participate in rounds, including presenting assigned patients and
demonstrating changes in patients’ status and plans.
7. Demonstrate evidence of reading around patients’ problems.
8. Elicit, record and present follow-up histories for longitudinal patient
care, including review of medications, preventive medicine needs, and
focused histories and physicals for specific problems.
LIFE LONG LEARNING, PROBLEM SOLVING & PERSONAL GROWTH
Students should be able to:
1. Demonstrate an investigatory and analytic thinking approach to course work and clinical situations
(a) Pursue resources necessary to understand and solve diagnostic and therapeutic problems
(b) Demonstrate ability to use multiple sources of information
(c) Demonstrate openness to adopting new methods of acquiring information.
2. Search, evaluate and critically review scientific evidence appropriate to the care of individual patients or, as an approach to clinical problem.
3. Use information technology learning resources to manage information, access online medical information and support own education.
SOCIAL & COMMUNITY CONTEXT OF HEALTH CARE
1. Appreciate the importance of the many non-biologic factors that influence health, disease, disability, and access to care.
(a) Demonstrate understanding of how the patient’s family, culture, age, gender, disabilities, and religious beliefs can influence healthcare decisions and outcomes.
(b) Engage the familial, cultural and spiritual supports of the patient in the care of the patient,
(c) Avoid stereotypical language (e.g. racist, sexist, homophobic, etc.)
(d) Recognize the barriers to health care that non-biologic (socio-economic) factors impose
(e) Demonstrate knowledge of non-biological determinants of child abuse and domestic violence and the economic, psychological, social, and cultural factors that impact their development and continuation.
(f) Demonstrate an understanding that some individuals in our society are at risk for inadequate healthcare, including the poor, uninsured, underinsured, children, unborn, single parents, elderly, racial minorities, immigrants, refugees, physically disabled, mentally disabled, chemically dependent, and those with incurable diseases.
2. Begin to partner with health care managers and health care providers to assess, coordinate, and improve health care, and how these activities can promote health, prevent disease and manage illness.
(a) Demonstrate knowledge of the role of and services provided by community resources
(b) Arrange referrals to community resources for patients and their families
(c) Work cooperatively with social/human service providers valuing their input and incorporating appropriate input into the treatment plan.
© Loyola University Chicago Stritch School of Medicine. All rights reserved.
Please send questions or comments to: Matthew Fitz, M.D.
Updated: 6/28/05