Skip to main content

Rationale

The growing appreciation for the contributions of screening, prevention, and health promotion to health outcomes necessitates that basic clinical education incorporate advances made in this area. Especially important are those interventions that relate to prevention of cardiovascular disease and early detection and treatment of potentially curable cancers

Prerequisites

Prior knowledge, skills and attitudes acquired during the pre-clinical (basic science) years
Should include:

  1. ability to:
    1. take a blood pressure
    2. perform a breast examination and recognize the signs of malignancy
    3. perform a pelvic examination and participate in obtaining a PAP smear
    4. perform a rectal examination, including prostate examination
    5. perform a testicular examination
    6. identify the warning signs of melanoma and other skin cancers
  2. knowledge of:
    1. basic criteria and principles of screening
    2. clinical epidemiologic concepts as they pertain to estimation of health risk
    3. and quantitative rationale for screening
    4. ethical, biomedical, and economic reasons for screening
    5. major environmental and occupational hazards
    6. communicable infectious diseases and modes of transmission
    7. mechanisms of immunization
    8. the aging process and its effects on functional capacity
    9. intermediate metabolism and nutrition

Specific Learning Objectives

  1. Knowledge: Students should be able to describe and define:
    1. the epidemiology and definitions of hypertension, its contribution to cardiovascular risk, the impact of treatment on risk, and current recommendations for screening
    2. the epidemiology of hyperlipidemia, its contribution to cardiovascular risk, the reliability of testing modalities, the impact of treatment on cardiovascular risk, and current recommendations for screening
    3. the epidemiology of common cancers, including:
      1. breast cancer, the efficacy of available screening modalities, impact of early treatment on survival, and current recommendations for screening.
      2. common skin cancers, including the warning signs of melanoma and basal and squamous cell carcinoma
      3. cervical cancer, the utility of the PAP smear, impact of early treatment on outcome, and current recommendations for screening
      4. colorectal cancer, the utility of available screening methodologies, the impact of early treatment on outcome, and current screening recommendations
      5. testicular cancer, the early clinical presentation, impact of early treatment on outcome, and current screening recommendations
      6. prostate cancer, the utility of available screening modalities, impact of early treatment on outcome, and current screening recommendations
    4. the risks, benefits, methods, and recommendations for immunizing adults against hepatitis B, influenza, pneumococcal infection, tetanus/diphtheria, and mumps/ measles/rubella
    5. safe sexual practices and risks, benefits, and efficacy of common methods of contraception
    6. efficacy of seat belt use and proper belt application
    7. efficacy of exercise in prevention of cardiovascular disease and recommended exercise programs
    8. the clinical presentations of substance abuse and basic approaches to prevention and treatment (see more detailed recommendations in segment on substance abuse)
    9. the impact of smoking on cardiovascular and cancer risk and basic approaches to smoking cessation (see also specific recommendations in segment on smoking)
    10. daily caloric, fat, carbohydrate, protein, mineral, and vitamin requirements; adequacy of diets in providing such requirements; evidence of need for supplements (e.g. calcium, antioxidants)
    11. methods of stress reduction and their efficacy
    12. the functional status assessment in the geriatric patient and its impact on assuring the best possible functional state
    13. common environmental and occupational hazards
  2. Skills: Students should demonstrate specific skills including:
    1. history-taking skills: Students should be able to obtain, document and present an age-appropriate medical history, that includes:
      1. dietary intake of fats and cholesterol
      2. exercise and activity levels
      3. substance use and its effects
      4. psychosocial stresses and environmental risks
      5. specific cancer risks (e.g. family history, exposures, warning symptoms, preventive efforts)
      6. any high-risk sexual practices
      7. immunization status appropriate for adults including:
      8. DT for all adults
      9. fluvax and pneumovax for the elderly and those with underlying cardiopulmonary disease and other indications for immunization
      10. rubella for sero-negative women of child-bearing age
      11. hepatitis B vaccine for medical personnel and other at-risk populations
    2. physical exam skills: Students should be able to perform a physical exam specifically doing, when appropriate, depending on age/sex/race and medical history of an individual:
      1. screening skin examination for signs of malignancy
      2. screening breast examination for a dominant nodule and secondary signs of malignancy
      3. participate in obtaining a PAP smear
      4. testicular examination (including transillumination) and differentiation of testicular from extratesticular lesions
      5. screening rectal examination that includes palpation of the prostate gland, identification of any nodules, and performance of a stool test for occult blood
      6. ordering of proper screening tests for hyperlipidemia, colorectal cancer, prostate cancer, and breast cancer (see specific sections in other training conditions)
      7. performance of a functional status examination in the geriatric patient
    3. differential diagnosis: Students should be able to generate a prioritized differential diagnosis recognizing specific history and physical exam findings identified during the screening examination.
    4. laboratory interpretation: Students should be able to recommend and interpret diagnostic laboratory tests, both prior to and after initiating treatment based on the differential diagnosis, including consideration of test cost and performance characteristics as well as patient preferences.
      1. CBC and differential
      2. electrolyte panel (SMA-12; SMA-20)
      3. lipid screening (fasting if possible)
      4. urinalysis
      5. stool guaiac
    5. communication skills: Students should be able to explain results of the evaluation and counsel for disease prevention.
    6. basic procedural skills: Students should be able to perform, when appropriate:
      1. stool guaiac
      2. functional status examination of the elderly
      3. administration of intramuscular injection of a vaccine
      4. Participating in obtaining a PAP smear
    7. management skills: Students should develop an appropriate evaluation and treatment plan for healthy patients including:
      1. design
      2. an appropriate work-up for any abnormalities noted on the screening exam
      3. counseling for safe sexual practices
      4. teaching of breast and testicular self-examinations
      5. design of a practical exercise program appropriate to the patient’s age, sex, physical condition, and preferences
      6. counseling for stress management and limiting risks of occupational and environmental hazards
      7. design of a balanced dietary program
      8. accessing and utilizing appropriate information systems and resources to help delineate issues related to healthy patients
  3. Attitudes and Professional Behavior: Students should be able to:
    1. recognize the importance of regularly screening all patients followed
    2. recognize the importance of teaching all patients preventive measures
    3. recognize the importance of reviewing diet and exercise with all patients on a regular basis
    4. recognize the importance of keeping detailed records of screening and health maintenance measures and statuses
    5. recognize the importance of addressing community sources of health risk