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Clinical Competence Skills

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  • 1. Windsor University School of Medicine has made it mandatory for all its students to learn History taking skills on a patient with physical diagnosis. These sessions will be scheduled once a week from the first semester and will be introduced in the master class schedule. it is mandatory that all students will be required to attend the session. History and physical diagnosis sample is presented below
  • 2. Clinical Competence Skills capacity = requirement “ the habitual and judicious use of communication, knowledge, technical skills, clinical reasoning, emotions, values, and reflection in daily practice for the benefit of the individuals and communities being served”.
  • 3. Competencies
    • Effective Communication (asking, listening & responding)
    • Basic clinical skills
    • Using science to guide DMTP
    • Life-long learning
    • Self awareness, self-care & personal growth
    • Social & community context of health care
    • Moral reasoning &Ethical judgement
    • Problem-solving
    • Professionalism
  • 4. Components
    • Identify: able to relate to people in distress
    • Empathy: make them comfortable
    • Active listening
    • Communication skills
    • Patient safety
    • Knowledge & Clinical reasoning
    • Technical or procedural skills
  • 5. Diagnostic Skill
    • First Impressions: Experienced clinicians make a short list of differential diagnosis within the first few minutes of history-taking.
    • Keep an open mind
    • Open-ended questions
    • Detail oriented
  • 6. Scenarios
    • Emergency room
    • Inpatient unit
    • Outpatient clinic
    • Ambulatory care
    • Intensive care unit (CICU, NICU, PICU, NSICU etc.)
    • End-of-life care
  • 7. Residencies
    • Internal medicine:
    • Transitional year: Radiology, Neurology, Anesthesiology
    • Family practice
    • Surgery
    • Orthopedics
    • Ophthalmology
    • Otolaryngology
    • Obstetrics & Gynecology
    • Psychiatry
    • Pediatrics
  • 8. Specialities: Fellowships
    • Cardiology, Gastroenterology, Nephrology, Pulmonology, Hematology & Oncology, Dermatology, Allergy & Immunology, Rheumatology, Toxicology, Endocrinology, Infectious diseases, Genetics, Geriatrics
    • Cardiothoracic, Vascular, Plastic, Urology
    • Neonatology
    • Sleep medicine
  • 9. Phrases of wisdom
    • “ we are humans, we are not perfect”
    • “ accidents do happen”
    • ““ Listen to the parents – They may know best” ”
    • “ We have two ears and one tongue so we may listen twice as long as we talk”!
    • Observe, absorb, and apply
    • Good humor is kind and compassionate
    • Beware of medicalization!
    • Change is a process
  • 10. Family meetings
    • V aluing and appreciating what the family members have to say
    • A cknowledging the emotions expressed by the family members
    • L ISTENing
    • U nderstanding who the patient was as a person, by listening to family members
    • E liciting questions from the family members.
  • 11. Take home points
    • Focus has to be on the patient
    • Physician must know the big picture
    • Pay close attention to what the patients (and parents in pediatrics) have to say
    • Describe what you see (not impressions and interpretations)
    • Be clear and precise with the words you use to describe (no euphemisms, vague remarks)
    • Use the correct words to show the urgency of the situation
  • 12. Sentinel events:
    • surgery at wrong sites
    • perinatal injuries
    • deaths
  • 13. Gossip
    • Genug syndrome: enough
    • “ Zahl Kam Rauf”: “number came up”
    • “ I have the ticket. The train has’nt arrived”.
    • Beware of medicalization
      • Fatigue = c f s/anemia
      • Shy = schizoid
      • Race
      • HIV treatment
    • The Lancet (Vol 369: Number 9562: February 24-March 2, 2007)
  • 14. Healthy Habits
    • A recent study from England examined the effects of four specific health related behaviors – moderation in drinking, not smoking, regular exercise and plenty of fruits and vegetables in the diet. These health behaviors added 14 more years to the life span of the individuals.
  • 15. Electronic medical records: Drs.Pamela Hartzband and Jerome Groopman (N Engl J Med 358: 1656-1658, 2008).
    • The habit of cutting and pasting passages from other physician’s notes, instead of taking one’s own history, may lead to errors in diagnosis and management.
    • Notes written on templates may be insufficient to document some of the unique features of individual patients and may interfere with critical thinking.
    • Automatic reproduction of ALL laboratory results may lead to errors and delay in identifying critically important data.
    • New developments in the condition of the patient and sequences in change of status get buried in the mass of data.
    • Physicians keep looking at the computer screen when the patient is talking thus missing important non-verbal cues.
    • Filling in boxes may help obtain and record important and critical data consistently, but does not allow entry of free texts on observations other than what the “pigeon-holes” require. (This is not the problem of the computer).
  • 16. Physicians and Pharmaceutical Industry
    • How drug reps make friends and influence doctors: Fugh-Berman A, Ahari S. PloS Medicine April 2007; 4 (4): e 150 )
    • www.polsmedicine.org .
    • A national survey of physician-industry relationship. Campbell EC, Gruen RL, Mountford J, Miller LG, Cleary PD, Blumenthal D. N Engl J Med 2007: 356: 1742-50)
  • 17.
    • Resources for 3rd Year OSCE & USMLE Step 2 CS Websites:
    • USMLE
    • AAMC
    • Prep4USMLE
    • Studentdoc.com
    • MDLinks.net  
  • 18. Publications:
    • First Aid for the USMLE Step 2 CS, by Vikas Bhushan, Tae Le, L. David Martin, Fadi Abu Shahin, Mae Sheikh-Ali. ISBN: 007142184X
    • CS Checklists: Portable Review for the USMLE 2 CS, by Jennifer K. Rooney. ISBN: 0071445153
    • Blueprints USMLE Step 2 CS, Carter E. Wahl. ISBN: 1405104384
    • Mastering the Objective Structured Clinical Examination and the Clinical Skills Assessment, by Jo-Ann Reteguiz and Beverly Cornel-Avendano. ISBN: 0071318135X