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Integrating the Curriculum with Clinical Medicine


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Integrating the Curriculum with Clinical Medicine

  1. 1. Integrating the Curriculum withIntegrating the Curriculum with Clinical MedicineClinical Medicine Richard Usatine, MDRichard Usatine, MD
  2. 2. Early introduction of ClinicalEarly introduction of Clinical MedicineMedicine • Teaching basic clinical skills – in physicalTeaching basic clinical skills – in physical exam coursesexam courses • Preceptorships - early clinical experiencesPreceptorships - early clinical experiences in the communityin the community
  3. 3. Early introduction of ClinicalEarly introduction of Clinical MedicineMedicine • PBL or clinical case-based teaching inPBL or clinical case-based teaching in small groupssmall groups • Clinical correlations in “Basic Science”Clinical correlations in “Basic Science” CoursedCoursed
  4. 4. Doctoring at FSUDoctoring at FSU • Clinical case-based teaching in smallClinical case-based teaching in small groupsgroups • Teaching basic clinical skills – in ourTeaching basic clinical skills – in our Clinical Learning CenterClinical Learning Center • PreceptorshipPreceptorship • Medical InformaticsMedical Informatics
  5. 5. Doctoring GoalsDoctoring Goals • Communication SkillsCommunication Skills • Physical Exam SkillsPhysical Exam Skills • Clinical decision-makingClinical decision-making • EBMEBM • EthicsEthics • HumanismHumanism • Clinical application of sciencesClinical application of sciences
  6. 6. Horizontal IntegrationHorizontal Integration • Coordinated withCoordinated with – PathologyPathology – MicrobiologyMicrobiology – PharmacologyPharmacology – Health issues in medicineHealth issues in medicine – Psychosocial aspects of medicinePsychosocial aspects of medicine
  7. 7. Vertical IntegrationVertical Integration • Doctoring 1 – Focus on basic interviewing,Doctoring 1 – Focus on basic interviewing, developmental psychologydevelopmental psychology • Doctoring 2 – Cases based on commonDoctoring 2 – Cases based on common diseasesdiseases • Doctoring 3 – Cases based on the 20Doctoring 3 – Cases based on the 20 health priority areas of the IOMhealth priority areas of the IOM • Each year builds directly on the precedingEach year builds directly on the preceding yearyear
  8. 8. DoctoringDoctoring • Simulate a clinical practiceSimulate a clinical practice • Every student sees the same basic coreEvery student sees the same basic core casescases • Patients return over time to simulatePatients return over time to simulate continuity and to see time course ofcontinuity and to see time course of various conditions – breast cancer,various conditions – breast cancer, prostate disease, asthma, depressionprostate disease, asthma, depression
  9. 9. Doctoring 2 topicsDoctoring 2 topics • CellulitisCellulitis • PharyngitisPharyngitis • Smoking CessationSmoking Cessation • Breast Cancer #1Breast Cancer #1 • Breast Cancer #2Breast Cancer #2 • HypertensionHypertension • Rape CaseRape Case • Obesity, Nutrition,Obesity, Nutrition, ExerciseExercise • Bioterrorism and AnxietyBioterrorism and Anxiety • Parkinson’s (Caregivers)Parkinson’s (Caregivers) • Cardiac SimulatorCardiac Simulator • Healer’s ArtHealer’s Art • Formative OSCEsFormative OSCEs • Hip fracturesHip fractures • Prostate/BPHProstate/BPH • Healer’s Art – Grief andHealer’s Art – Grief and LossLoss
  10. 10. Doctoring 2 – cont.Doctoring 2 – cont. • Alcoholic PhysicianAlcoholic Physician • Breast CancerBreast Cancer (metastatic)(metastatic) • Prostate CancerProstate Cancer • Diabetes (foot and eyeDiabetes (foot and eye exam)exam) • GastroenteritisGastroenteritis (interpreters)(interpreters) • Asthma and adolescentAsthma and adolescent depressiondepression • Asthma, suicideAsthma, suicide • Breast Cancer end of lifeBreast Cancer end of life • Back PainBack Pain • DementiaDementia • AbortionAbortion • Tension HA vs MigraineTension HA vs Migraine • Dermatology casesDermatology cases • MalpracticeMalpractice • Domestic ViolenceDomestic Violence
  11. 11. Doctoring 3 - IOMDoctoring 3 - IOM • AsthmaAsthma • Health care CoordinationHealth care Coordination • Children with special healthChildren with special health care requirementscare requirements • DiabetesDiabetes • End of life care for patientsEnd of life care for patients with advanced organ systemwith advanced organ system failurefailure • Evidence based cancer testsEvidence based cancer tests • Elder careElder care • HypertensionHypertension • ImmunizationImmunization • Coronary Heart DiseaseCoronary Heart Disease • Major DepressionMajor Depression • Medication ErrorsMedication Errors • Infections acquired inInfections acquired in HospitalsHospitals • ObesityObesity • Pain managementPain management • Pregnancy and ChildbirthPregnancy and Childbirth • Self management and healthSelf management and health literacy (focus on arthritisliteracy (focus on arthritis case)case) • Mental IllnessMental Illness • StrokeStroke • Addiction and SubstanceAddiction and Substance AbuseAbuse
  12. 12. Prostate ModuleProstate Module • By the completion of the module,By the completion of the module, students will be able to:students will be able to: • List the differential diagnosis of urinaryList the differential diagnosis of urinary symptomssymptoms • Describe aspects of benign prostatic hyperplasiaDescribe aspects of benign prostatic hyperplasia including:including: – Evidence-based medicine (EBM) approach toEvidence-based medicine (EBM) approach to treatment using lifestyle changes, medicine,treatment using lifestyle changes, medicine, phytotherapy, surgeryphytotherapy, surgery • Critically appraise evidence on the risks andCritically appraise evidence on the risks and benefits of preventive services such as PSAbenefits of preventive services such as PSA
  13. 13. Prostate Module ObjectivesProstate Module Objectives • Discuss the value of the USPSTF and theDiscuss the value of the USPSTF and the Cochrane database for systematic reviewsCochrane database for systematic reviews (EBM)(EBM) • Describe the use and limitations of screeningDescribe the use and limitations of screening tests (using PSA as an example)tests (using PSA as an example) • Describe the importance of “informed consent”Describe the importance of “informed consent” surrounding issues of screeningsurrounding issues of screening • Describe lead-time and length-time bias andDescribe lead-time and length-time bias and their importance in evaluating the result oftheir importance in evaluating the result of cancer screening studiescancer screening studies
  14. 14. Prostate SizeProstate Size DESCRIPTION ANALOGY GRAMS Small Walnut 15-20 mild enlargement ping pong ball 35-40 Moderate enlargement Plum 50 severe enlargement can’t get finger over top 60+
  15. 15. PSAPSA • DVD on screening with PSA - includesDVD on screening with PSA - includes interviews of 2 doctors considering havinginterviews of 2 doctors considering having PSA screeningPSA screening • Informed consentInformed consent • Students learn about uncertainty inStudents learn about uncertainty in medicinemedicine
  16. 16. SurgerySurgery • TURPTURP (transurethral resection of the prostate)(transurethral resection of the prostate) • TUIPTUIP (transurethral incision of the prostate)(transurethral incision of the prostate) • TUMTTUMT Transurethral microwave thermotherapyTransurethral microwave thermotherapy • TUVPTUVP Transurethral vaporization of the prostateTransurethral vaporization of the prostate • TUNATUNA Transurethral needle ablationTransurethral needle ablation • Open ProstatectomyOpen Prostatectomy
  17. 17. Prostate Case – Part 2Prostate Case – Part 2 • Patient returns with elevated PSAPatient returns with elevated PSA • Show students rectal ultrasound andShow students rectal ultrasound and biopsiesbiopsies • Get pathology results with Gleason ScoresGet pathology results with Gleason Scores • Help patient decide on course of actionHelp patient decide on course of action
  18. 18. Dermatology CasesDermatology Cases • On the web at:On the web at:
  19. 19. Breast Cancer CaseBreast Cancer Case • Patient presents with painful lumpPatient presents with painful lump • Family History suggestive of geneticFamily History suggestive of genetic breast cancerbreast cancer • Normal mammogramNormal mammogram • Suspicious ultrasoundSuspicious ultrasound • Send for core needle biopsySend for core needle biopsy
  20. 20. Breast Cancer Case – Part 2Breast Cancer Case – Part 2 • Core needle biopsy result shows invasiveCore needle biopsy result shows invasive intraductal carcinomaintraductal carcinoma • Counseling of patient to talk about whereCounseling of patient to talk about where to go from hereto go from here • Treatment optionsTreatment options • Consider BRCA testingConsider BRCA testing
  21. 21. Questions?Questions?