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PAC 5100 Physical Diagnosis II Syllabus

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  • 1. NOVA SOUTHEASTERN UNIVERSITY PHYSICIAN ASSISTANT PROGRAM Ft Lauderdale Course Syllabus I. Course Title: PAC 5100 Physical Diagnosis II II. Course Director: Steven J. Sager, MPAS, PA-C Terry Building, 2nd Floor, Room 1283 Office: 954-262-1236 ssager@nsu.nova.edu III. Meeting Times: Please refer to the online WebEvent calendar IV. Instructor’s Office Hours: By appointment. V. Pre-requisites: Successful completion of PAC 5000 Physical Diagnosis I VI. Course Description: This course will build upon the skills learned in PAC 5000, Physical Diagnosis I, and will concentrate on performing focused medical interviews and physical examinations. A combination of lectures, discussions, case studies, and performance skills labs will be used to present and practice the necessary concepts and skills. Lab sessions are used to optimize the teaching of these concepts. Students will learn to accurately record historical and physical findings in various formats. The student must demonstrate Competency Based Learning during the performance of the required procedures and skills. This course introduces the student to the concept of medical problem solving by incorporating normal and abnormal physical findings. During Clinical Problem Solving (CPS) sessions, a patient’s medical history, physical exam findings, and ancillary study results will be correlated into the process of formulating a differential diagnosis and management plan. Through case presentations and medical simulations, students will utilize knowledge acquired from previous and concurrent didactic courses to develop their problem solving skills. VII. Course Goals: A. Develop the skills necessary to obtain and properly document a clinically relevant medical history. B. Refine and improve the skills and techniques required to perform a comprehensive physical exam. C. Develop the skills necessary to perform a specialized, focused physical examination and to interpret the findings. D. Demonstrate competency of acquired skills through performance in simulated and actual patient contact and examination settings. E. Develop the skills necessary to correlate historical information and physical exam findings and begin to formulate a differential diagnosis and treatment plan. F. Develop and foster critical thinking as a tool to differentiate clinical scenarios of common diseases encountered in primary care. Updated September 18, 2008 1
  • 2. G. This course will teach students the skills necessary to obtain and document a comprehensive medical history and to perform and document a complete head-to-toe physical examination. Students will also develop the necessary skills to proficiently and comfortably handle medical equipment and instruments. H. Develop the skills necessary to present an organized, thorough case history in both written and oral form. VIII: Course Objectives: At the end of this course the student will be able to: A. Obtain a problem-oriented patient history. B. Perform a focused head-to-toe examination. C. Correctly document medical information in different formats. D. Provide a verbal report on a patient’s medical history and physical examination findings. IX: Course Format: Lectures and laboratory sessions will be scheduled weekly. Laboratory sessions will be divided into two-hour blocks and attended by assigned student lab groups and faculty. In addition to scheduled laboratory practice time, certain skills will require additional student participation, which may include evenings and/or weekends. Advanced notice will be given for those sessions as scheduled. These extra sessions will be mandatory. X: Learning Objectives: Individual instructors may provide you with additional objectives for their lectures. You are responsible for objectives in this syllabus as well as those provided to you throughout the semester. Given an adult patient and the necessary equipment, without assistance or reference, students will be able to obtain a problem-oriented medical history and perform a focused head-to-toe physical examination utilizing a logical, systematic sequence of steps. Each section will include the following: SOAP notes Discuss the components of the acronym SOAP Differentiate placement of information in the correct area of the SOAP note. Understand the purpose of documentation of SOAP notes. Understand what information is and is not included in a SOAP note. Construct and organize a detailed SOAP note. Define documenting guidelines as established by the Center for Medicare/ Medicaid Services (formerly HCFA) Clinical Problem Solving Describe the IDEAL problem solver. Define and utilize the Early Hypothesis Generation including problem identifications, formulating a differential diagnosis, collecting the clinical database, evaluating competing diagnoses and selecting a working diagnosis. Discuss the importance of disease categories in formulating a differential diagnosis. Discuss clinical problem solving is the setting of a nonspecific chief complaint. List a number of disease processes in which pattern recognition can aid in making a diagnosis. Advanced Skin Exam Identify the anatomy and function of the skin. Updated September 18, 2008 2
  • 3. Demonstrate proficiency in performing a skin exam. Define the elements of the medical history that aid in identifying abnormal conditions of the skin. Define the elements and physical exam findings that aid in identifying the abnormal conditions of the skin. Define and be able to identify common abnormal conditions of the skin. Define common dermatologic terminology. Identify common skin lesions based on an accurate description and/or photograph. Advanced Examination of the Eye Identify and define the anatomical landmarks of the eye. Demonstrate proficiency in performing a complete ocular exam Define the elements in the medical history that aid in identifying abnormal conditions of the eye. Define the elements and physical exam findings that aid in identifying abnormal conditions of the eye. Define and be able to identify common abnormal conditions of eye and related disease states Discuss how a lesion in various places along the visual pathway affects vision. Describe the function of the cranial nerves and muscles that control movement of the eye. Define and be able to identify common visual defects of the eye. Define and identify fundoscopic changes that occur with hypertensive and diabetic retinopathy. Advanced HENT Examination Identify and define the anatomical landmarks of the head, ear, nose and throat (HENT). Demonstrate proficiency in performing an HENT exam. Define the elements of the medical history that aid in identifying abnormal conditions of the head, ears, nose and throat. Define the elements and physical exam findings that aid in identifying the abnormal conditions of the head, ears, nose and throat. Define and be able to identify common abnormal conditions of the head, ear, nose and throat. Discuss physical exam findings that aid in differentiating conductive and sensorineural hearing loss. Documentation of the Yearly Physical Define the elements of the medical history need to be addressed during a routine annual physical. Define the elements and physical exam findings that aid in identifying any abnormalities during a routine annual physical. Discuss the purpose and order of an annual physical exam. Demonstrate proficiency in performing an annual physical. Identify the necessity of documenting the annual exam with objectivity and clarity. Be able to document an annual physical. Oral Presentations Describe the purpose of patient presentations. Updated September 18, 2008 3
  • 4. Define the parts of the patient history, physical exam, assessment and plan that need to be detailed in patient presentations. Discuss what parts of the patient information needs to be omitted from patient presentations. Be able to present patient cases in an organized and concise fashion. Advanced Cardiac Exam Identify and define the anatomical landmarks of cardiovascular system. Demonstrate proficiency in performing a cardiovascular exam. Define the elements of the medical history that aid in identifying abnormal conditions of the heart. Define the elements and physical exam findings that aid in identifying the abnormal conditions of heart. Define and be able to identify common abnormal conditions of the heart. Define the character of the apical impulse with reference to anatomy and ventricular function. Describe the events of systole and diastole as they pertain to the cardiac cycle and heart sounds. Define and compare the differences of heart murmurs in systole and diastole and the maneuvers to evaluate these murmurs. Define extra heart sounds in systole and diastole and causes of split heart sounds. Advanced Peripheral Vascular Exam Identify and define the anatomical landmarks of the peripheral vascular system. Demonstrate proficiency in performing a peripheral vascular exam. Define the elements of the medical history that aid in identifying abnormal conditions of the peripheral vascular system. Define the elements and physical exam findings that aid in identifying the abnormal conditions of the peripheral vascular system Define and be able to identify common abnormal conditions of the peripheral vascular system. Differentiate between chronic arterial and venous insufficiency. Define the different mechanisms and patterns of edema. Advanced Pulmonary Exam Identify and define the anatomical landmarks of the thorax and lungs. Demonstrate proficiency in performing a pulmonary exam. Define the elements of the medical history that aid in identifying abnormal conditions of the lungs. Define the elements and physical exam findings that aid in identifying the abnormal conditions of the lungs Define and be able to identify common abnormal conditions of the pulmonary system Differentiate and discuss significance of percussion notes and adventitious breath sounds. Differentiate diseases that may present with sudden onset versus gradual or intermittent shortness of breath. Identify from a given list the disease process that may be associated with clubbing and hemoptysis. Updated September 18, 2008 4
  • 5. Assessment of Anemia Define the elements of the medical history that aid in identifying anemia. Define the elements and physical exam findings that aid in identifying anemia. List presenting symptoms of anemia associated with each of the following organ systems: Cardiovascular Nervous Gastrointestinal Musculoskeletal Characterize the symptoms of anemia with regard to severity of anemia and specificity. Identify physical exam findings which are characteristic of the following anemias: Iron deficiency anemia Folate and Vitamin B-12 deficiency Hemolytic anemia Sickle Cell Disease XI. Texts: Required: 1) Seidel HM, Ball JW, Dains JE, Benedict GW. Mosby’s Guide to Physical Examination. 6th ed. St. Louis, MO: Mosby; 2006. (ISBN 13: 978-0-3230-2888-2) 2) Coulehan JL, Block MR. The Medical Interview: Mastering Skills for Clinical Practice. 5th ed. F.A. Davis; 2006 (ISBN 13: 978-0-8036-1246-4) Recommended: 1) Seidel HM, Ball JW, Dains JE, Benedict GW. Student Laboratory Manual for Mosby’s Guide to Physical Examination. 6th ed. St. Louis, MO: Mosby; 2006. (ISBN 13: 978-0-3230-3573-6) 2) LeBlond RF, DeGowin RL, Brown DD. DeGowin’s Diagnostic Examination. McGraw- Hill; 2008 (ISBN 13: 978-0-0714-7898-4) XII. Evaluation Procedures: Quizzes – will be administered using audience response devices (“clickers”) and will be given prior to each lecture for each system discussed. Advanced reading of the material prior to the lecture is required. (Responding to questions asked during the lectures will be counted as part of the class participation grade.) Written examinations for PAC 5100 will be held at the times designated on the WebEvent calendar. The comprehensive midterm written examination will cover lecture material from the first half of the course. The comprehensive final written examination will cover lecture material presented in the second half of the course. Practical Examinations – Faculty will use standardized checklists to evaluate each student’s physical examination skills. A minimum score of B- (80%) must be achieved to pass each practical exam. Failure of a practical exam requires mandatory attendance and participation in a remedial exercise (tutorial), which consists of practicing the failed material under direct faculty supervision. Although the remedial exercise is mandatory, your original grade will not change after the exercise is complete. Updated September 18, 2008 5
  • 6. Classroom and laboratory preparation and performance will be evaluated based on student’s attendance and participation. This includes: punctuality preparation and successful completion of assignments classroom responses using the audience response device (“clicker”) proper lab attire functional diagnostic equipment familiarity with material The final course grade will be calculated based on the following distribution: Quizzes 10% Classroom & laboratory preparation and performance 10% Midterm written exam 15% Final written exam 15% Practical exams 30% Written Assignments 20% In order to pass this course, all students must achieve a cumulative average of C (75%) or greater on the written exams, a cumulative average of B- (80%) or better on the practical examinations, and a score of B- (80%) or better on the final skills demonstration. NOTE: all evaluation components of this course must be passed to pass the course. The student will be offered one remedial exam for each component that is not passed. Failure to pass any of the remedial exams will result in course failure without the option of additional remediation and the student will be referred to the Committee on Student Progress. This course is a prerequisite for PAC 5200 Physical Diagnosis III. Failure to pass the course may result in dismissal, prohibition from enrolling in PAC 5200 Physical Diagnosis III, or may extend the student’s course of study. XIII. COURSE POLICIES: Student attendance at all lectures, labs, and exams is mandatory and essential to achieve the course objectives! It is expected that all students will engage in critical thinking and problem solving during this course. Reading assignments must be completed prior to the lecture. All written assignments must be in MS Word document format and they must be submitted electronically as an e-mail attachment. All written assignments must also be formatted using the following parameters: Margins: 1” on all sides Font: Times New Roman 12-pitch Spacing: single-space Title: LastnameFirstinitial_Assignment (SmithA_SOAP1) Updated September 18, 2008 6
  • 7. Participation is essential insure learning of interviewing and physical examination techniques and is expected of every student throughout the course. While in the classroom or lab, students will be selected at random to answer questions concerning the reading material. Students should bring their textbook to all lecture and lab sessions throughout the semester. Assigned readings must be completed prior to lectures and laboratory practicums. Students will be randomly called upon to answer questions and will be expected to critique their own and other students' thinking. The required textbooks will serve as the authoritative answer to a clinical problem if not addressed in lecture or written handout. Mandatory lab attire and equipment: If a student is not properly attired or does not have their diagnostic equipment, they will be asked to leave, which will be counted as an unexcused absence. Only tennis shoes or crocs-like footwear is authorized. Slippers, sandals, and flip-flops are not acceptable. Men: program T-shirt and exercise shorts Women: sports top (bra), program T-shirt, and exercise shorts All: student lab coat with PA program logo Please refer to the Academic Year Handbook on the policies and procedure for missed exams and the procedure for documenting and reporting all absences. Immediately notify the course director via phone call of any missed lectures, exams, or labs. Tardiness will not be tolerated. Tardy students will not be permitted to enter the classroom. However, if the student is denied entry into the lecture because of tardiness, he/she will be permitted to enter the classroom during the next class break. XIV. Classroom Behavior and Conduct Professional behavior and decorum is a requirement for successful completion of this course. This will be evaluated in the classroom, labs, and all associated encounters with the instructor and/or staff. Failure to adhere to this standard, regardless of academic achievement in the course, will subject the individual to referral to the Committee on Student Progress for possible disciplinary action and/or dismissal. THE COURSE DIRECTOR RESERVES THE RIGHT TO MAKE REVISIONS TO THIS SYLLABUS AT ANY TIME. Updated September 18, 2008 7