The following are recommendations to be implemented depending on which competency(ies) are addressed in the student's plan. These standardized plans are meant to be a template for improvement. Please specify any additions or changes to the standard plans when completing the form.
In order to improve medical knowledge performance, the student should read daily and discuss readings with preceptor, practice multiple choice questions relevant to the clerkship, ask for suggestions on focused reading topics, and read about problems that have been seen in the patients s/he has followed. It is recommended that the student develop a study plan on the first day of the clerkship that lays out topics to be reviewed over the course of the clerkship. The CD should check in with the student to assure that the reading and questions are being covered at an appropriate pace.
In order to improve patient care, it is recommended that the student be given a time limit in which to see a patient. The student should take a history in a problem based format. Questions regarding each problem should reflect good medical knowledge of the complaint and it is suggested that an algorithmic approach such as that used in the CSI text be used. During history taking, ideally observed multiple times throughout a clerkship, the student should consider what aspects of the physical exam would confirm or refute the evidence gained in the history taking. Those aspects of the physical exam should be incorporated into the overall assessment. The student should be able to defend choices for the physical exam and the choice of questions asked during the history. The student should be able to use the history and physical findings to create a differential diagnosis. The differential diagnosis, if ordered correctly, should lead to the most appropriate next steps in management. When appropriate, the student should also know appropriate preventative medicine to incorporate into the visit. (i.e.pneumococcal vaccine in patient hospitalized with pneumonia or pap smear in a post-partum visit). The student should use decision tools to aid in discussion or write ups. Some examples of decision tools are Harrison’s, Uptodate, Cochran’s or pubmed.
In order to improve the student should continue to refine clinical questions; for example, by using the PICO format. The student should use decision support tools to learn about symptoms and diagnoses before and after history taking with the patient. (An example is UpToDate). Readings should pertain to the patient at hand and questions amiss should be readdressed with the patient if possible. The student should choose topics to read about in his/her free time. He/she should communicate the chosen topics to his/her direct supervisor so that expectations of knowledge in that subject area are high. The student should expect questioning and recognize it as a tool to improve learning.
In order to improve performance it is recommended that the student take a history in a problem based format. The details of each problem should be organized by problem. The appropriate physical exam should accompany each problem. The oral presentation should be organized in the same fashion. An assessment and plan should accompany each problem.
In order to improve performance it is recommended that the student use sample notes when constructing his/her notes. Time course and organization are very important in written communication. It is suggested that the HPI be organized by problem.
A student with difficulty on written notes should pay special attention to the assessment and plan. The assessment and plan is a reflection of his/her understanding of the patient and the processes of disease. The assessment should include a differential diagnosis, a persuasive statement as to why the evidence supports this assessment and the ordered differential diagnosis, and statements that refute other diagnoses. The plan should include a diagnostic plan, a therapeutic plan, and patient education. This should be referenced when needed.
Patient Communication and Relationship
In order to improve communication with the patient, the student should be observed and given feedback daily. The student should not use medical jargon. The body language of the student should be considered with proximity to the patient and eye contact as specific areas to focus on. The student should take responsibility for finding answers to patient’s questions and report back to the patient with accurate, researched, literacy appropriate answers. The student should use his in depth understanding of the patient to advocate for the patient to team members within and outside of the clinical environment in which he/she is working.
In order to improve, the student should be cognizant of his/her role as a confidant and advisor in patient care. Discussions should be sensitive to cultural or other needs. The language used should be respectful of the patient and his/her family.
Demonstrates honesty and integrity (3045, 3050)
In order to improve in this category, I recommend that the student have a one-on-one discussion with his/her preceptor regarding the expectations of honesty and integrity and review specific instances where these were not upheld. The student should be encouraged to review the core values of professionalism.
Sets personal learning objectives and seeks feedback (3055, 3056)
I recommend that the student meet with his/her next preceptor and set up learning objectives for the service which can be tied into a topic presentation at the mid-point. I also recommend that the student meet with his/her preceptor at the half-way point to receive direct and specific feedback. Additional check-ins should be scheduled in order to assess whether objectives were met.
Reflects on feedback and adjusts behavior (3057, 3058)
In order to improve, I recommend that the student meet with his preceptor to discuss his feedback and to outline ways to show adjustments in response to the feedback given.
Is punctual, dresses appropriately and demonstrates respect for others
In order to improve in this category, the student should take an online module directed towards cultural sensitivity. The student should review the core values of professionalism and the hospital dress code. The student should meet with his/her preceptor to discuss the specific instances cited by his/her team as points of improvement.
In order to improve in systems based care, the student should be asked to invoke systems in care and enunciate which systems have improved (or worsened) care. The student should be asked about ways that the system can be improved and how those improvements would enhance care. The student should not let deficiencies in the system result in poor care for the patient. Rather the student should look to use the patient’s case to advocate for better care.