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Integrating the Curriculum with Clinical Medicine

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Integrating the Curriculum with Clinical Medicine Presentation Transcript

  • 1. Integrating the Curriculum with Clinical Medicine Richard Usatine, MD
  • 2. Early introduction of Clinical Medicine
    • Teaching basic clinical skills – in physical exam courses
    • Preceptorships - early clinical experiences in the community
  • 3. Early introduction of Clinical Medicine
    • PBL or clinical case-based teaching in small groups
    • Clinical correlations in “Basic Science” Coursed
  • 4. Doctoring at FSU
    • Clinical case-based teaching in small groups
    • Teaching basic clinical skills – in our Clinical Learning Center
    • Preceptorship
    • Medical Informatics
  • 5. Doctoring Goals
    • Communication Skills
    • Physical Exam Skills
    • Clinical decision-making
    • EBM
    • Ethics
    • Humanism
    • Clinical application of sciences
  • 6. Horizontal Integration
    • Coordinated with
      • Pathology
      • Microbiology
      • Pharmacology
      • Health issues in medicine
      • Psychosocial aspects of medicine
  • 7. Vertical Integration
    • Doctoring 1 – Focus on basic interviewing, developmental psychology
    • Doctoring 2 – Cases based on common diseases
    • Doctoring 3 – Cases based on the 20 health priority areas of the IOM
    • Each year builds directly on the preceding year
  • 8. Doctoring
    • Simulate a clinical practice
    • Every student sees the same basic core cases
    • Patients return over time to simulate continuity and to see time course of various conditions – breast cancer, prostate disease, asthma, depression
  • 9. Doctoring 2 topics
    • Cellulitis
    • Pharyngitis
    • Smoking Cessation
    • Breast Cancer #1
    • Breast Cancer #2
    • Hypertension
    • Rape Case
    • Obesity, Nutrition, Exercise
    • Bioterrorism and Anxiety
    • Parkinson’s (Caregivers)
    • Cardiac Simulator
    • Healer’s Art
    • Formative OSCEs
    • Hip fractures
    • Prostate/BPH
    • Healer’s Art – Grief and Loss
  • 10. Doctoring 2 – cont.
    • Alcoholic Physician
    • Breast Cancer (metastatic)
    • Prostate Cancer
    • Diabetes (foot and eye exam)
    • Gastroenteritis (interpreters)
    • Asthma and adolescent depression
    • Asthma, suicide
    • Breast Cancer end of life
    • Back Pain
    • Dementia
    • Abortion
    • Tension HA vs Migraine
    • Dermatology cases
    • Malpractice
    • Domestic Violence
  • 11. Doctoring 3 - IOM
    • Asthma
    • Health care Coordination
    • Children with special health care requirements
    • Diabetes
    • End of life care for patients with advanced organ system failure
    • Evidence based cancer tests
    • Elder care
    • Hypertension
    • Immunization
    • Coronary Heart Disease
    • Major Depression
    • Medication Errors
    • Infections acquired in Hospitals
    • Obesity
    • Pain management
    • Pregnancy and Childbirth
    • Self management and health literacy (focus on arthritis case)
    • Mental Illness
    • Stroke
    • Addiction and Substance Abuse
  • 12. Prostate Module
    • By the completion of the module, students will be able to:
    • List the differential diagnosis of urinary symptoms
    • Describe aspects of benign prostatic hyperplasia including:
      • Evidence-based medicine (EBM) approach to treatment using lifestyle changes, medicine, phytotherapy, surgery
    • Critically appraise evidence on the risks and benefits of preventive services such as PSA
  • 13. Prostate Module Objectives
    • Discuss the value of the USPSTF and the Cochrane database for systematic reviews (EBM)
    • Describe the use and limitations of screening tests (using PSA as an example)
    • Describe the importance of “informed consent” surrounding issues of screening
    • Describe lead-time and length-time bias and their importance in evaluating the result of cancer screening studies
  • 14. Prostate Size 60+ can’t get finger over top severe enlargement 50 Plum Moderate enlargement 35-40 ping pong ball mild enlargement 15-20 Walnut Small GRAMS ANALOGY DESCRIPTION
  • 15. PSA
    • DVD on screening with PSA - includes interviews of 2 doctors considering having PSA screening
    • Informed consent
    • Students learn about uncertainty in medicine
  • 16. Surgery
    • TURP (transurethral resection of the prostate)
    • TUIP (transurethral incision of the prostate)
    • TUMT Transurethral microwave thermotherapy
    • TUVP Transurethral vaporization of the prostate
    • TUNA Transurethral needle ablation
    • Open Prostatectomy
  • 17. Prostate Case – Part 2
    • Patient returns with elevated PSA
    • Show students rectal ultrasound and biopsies
    • Get pathology results with Gleason Scores
    • Help patient decide on course of action
  • 18. Dermatology Cases
    • On the web at:
    • http://fm.mednet.ucla.edu/derm/search.cfm
  • 19. Breast Cancer Case
    • Patient presents with painful lump
    • Family History suggestive of genetic breast cancer
    • Normal mammogram
    • Suspicious ultrasound
    • Send for core needle biopsy
  • 20. Breast Cancer Case – Part 2
    • Core needle biopsy result shows invasive intraductal carcinoma
    • Counseling of patient to talk about where to go from here
    • Treatment options
    • Consider BRCA testing
  • 21. Questions?