Objectives for Outpatient Medicine

Objectives of the Outpatient Medicine Course:

The learning objectives for the UNC Outpatient Medicine Clerkships (Inpatient and Outpatient) are based on the UNC SOM Competency Milestones. The abbreviations in parentheses below identify the Year 3 Competency Milestones that correspond to the clerkship objectives. The objectives are grouped according to competency.

1. Medical Knowledge

a. Students will attain a basic working knowledge and understanding of the diagnostic and therapeutic processes of medical conditions commonly seen in the ambulatory clinic setting (MK3A1, MK3C1, MK3E1, MK3E2, MK3E3, MK3F2, MK3F3, MK3G1)

i. Students will demonstrate knowledge of common chronic medical conditions including:

Diabetes--hypertension--hyperlipidemia--atrial fibrillation--COPD--thyroid disease--tobacco abuse—chronic kidney disease--GERD

ii. Students will demonstrate knowledge of common acute medical conditions including:

Cough-upper respiratory illness—pneumonia--influenza--back pain—headache--vaginitis—fatigue—fever—urinary tract infection—chest pain

iii. Students will demonstrate knowledge of screening for common problems including:

osteoporosis--cancer screening--medication interactions—geriatric falls assessment—cognitive impairment—cardiovascular risk reduction

iv. Students will demonstrate knowledge and application of the following skills:

starting or changing the dose of insulin in a patient with diabetes—problem based presentation for patients with chronic illness—approach to the patient on multiple medications—cardiovascular risk reduction

2. Patient Care

a. Obtain an accurate, age-appropriate medical history. (PC3A1, PC3A2, PK3A3)

i. Logical, organized, thorough and reliable

ii. Student should be able to distinguish important information from unimportant information and focus data collection on central problems

b. Demonstrate proper technique in performing both a complete and a symptom-focused examination, addressing issues of patient modesty and comfort.  (PC3B1)

i. Assessment through preceptor observation, patient feedback and OSCE sessions.

c. Perform routine technical procedures and tests under supervision and with minimal discomfort to the patient

i. Include measurement of blood pressure

d. Apply clinical reasoning and critical thinking skills in developing a differential diagnosis and management plan. PC3E1, PC3E2, PC3E3)

i. Student should be able to formulate an initial diagnostic and therapeutic plan.

ii. Student should understand factors to consider when choosing among diagnostic and treatment options

e. Justify each diagnostic test ordered and management strategy proposed with regard to effectiveness, risks and complications, and the patient’s overall goals and values. (PC3D2, PC3D3)

i. Assessment through OSCE stations on shared decision making

f. Apply the principles of pharmacology, therapeutics, and therapeutic decision-making to the care of an individual patient. (PC3F1, PC3F2)

i. Students should be reviewing medications taken by patients

ii. Students should understand the side effects and indications for medications being prescribed.

iii. Assessment through computer problems about medication management of common problems and medication interactions

g. Identify and incorporate appropriate prevention strategies for common conditions into the care of patients (PC3G1, PC3G2)

i. Students will review age appropriate screening and prevention strategies and apply this to patient care

ii. Students will utilize shared decision making strategies

iii. Assessment through OSCE station on prevention strategies and shared decision making and computer problem on prevention

i. Sensitively address the care of patients reaching end of life, end-of-life issues, including do-not-resuscitate orders and pain management (PC3I1, PC3I2, PC3I3)

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3. Interpersonal and Communication Skills

a. Communicate effectively with patients, patients’ families, colleagues, and other health care professionals. (IC3A1, IC3A2, IC3A2)

i. Students should be able to communicate efficiently with a problem based format that demonstrates understanding of the medical condition.

ii. Students should be able to give a differential diagnosis for presenting symptoms

iii. Students should be able to develop with a rational plan based on the most likely items in the differential

g. Demonstrate collaborative teamwork skills and the ability to work effectively with other members of the health care team. (IC3B1)

i. Students will be exposed to caring for patients in an outpatient setting. They will work together with physician preceptors, nurses and other ancillary staff to provide care for patients.

ii. Students will demonstrate and acceptance of the premise that various physician styles of practice may be appropriate and that different valid approaches to patient care may coexist.

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4. Professionalism

a. Demonstrate honesty and integrity in all interactions with patients, patients’ families, and colleagues (PR3A1)

i. Students will be expected to be truthful and honest in all interactions.

ii. Students will be expected to attend all scheduled clinical and academic sessions

iii. Students are expected to be dependable and mature

iv. Students are expected to be respectful of patients and involve patients as participants in their care.

v. Students are expected to turn in all work on time


b. Actively seek and respond to feedback about professional performance (PR3K1, PR3K2, PR3K3). Identify gaps in medical knowledge, clinical skills and professionalism and develop a strategy for self-improvement (PR3J1)

i. Students will be given feedback from preceptors, patients as well as in the OSCE session.

ii. Students are responsible for asking for such feedback from preceptors.

iii. All students will complete a midclerkship feedback form in which they identify personal strengths and weaknesses and get feedback from the preceptor and course director.


c. Recognize unprofessional behaviors in peers and other health professionals with whom one interacts in professional life and address these in a constructive manner (PR3F1)

i. Students will complete evaluations of each of their peers in the Team Based Learning Session.

5. Practice Based Learning and Improvement

a. Demonstrate skills in retrieving, critically assessing, and integrating biomedical information into clinical decision-making (PB3A1)

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6. Systems Based Practice

a. Use electronic and other information tools [e.g., including electronic health records and computer order entry] for systems-based patient care (SB3A1)

i. Students should understand the medical record system whether paper or electronic

b. Identify necessary elements for coordinated care of patients with complex and chronic diseases (SB3B1)

i. Students should observe how patients with chronic illnesses are managed in their practices

c. Outline the roles of the various members of the healthcare team and describe how these roles can be integrated for optimal patient care (SB3E2)

i. students will observe and participate in the team caring for the patient in the clinic setting


7. Managing the Health of Populations

a. Identify factors that place populations at risk for disease or injury, and select appropriate strategies for risk reduction (HP3B1)

i. Students will learn about screening and cardiovascular risk and learn to counsel patients on options for screening and risk reduction.

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