Doctoring 201 BMS 6831

Curt Stine, M.D., Course Director curtis.stine@med.fsu.edu

(850) 644-0523

2003 – 2004 Course Syllabus x

Office Hours: “Doctoring Unplugged” Fridays 12:00 – 1:00 Rm. 407 Drs. Stine, Reyes, & Grossman will be available to answer questions, concerns, provide extra help, or chat about the Doctoring 2 experience. Stop by any time during the hour. Feel free to bring your lunch. Course Directors will also meet with individual students by appointment. Students are encouraged to stop by our offices anytime for extra help or chatting about the course. Course Coordinator: Candice Allbaugh Office: Administration Bldg Rm 130 644-7473 candice.allbaugh@med.fsu.edu

Doctoring Leadership:

Clinical Learning Center Sarah Sherraden, RN, MSN

Office: Clinical Learning Center 644- 9812 / 644-9800 (CLC Front Office)

Doctoring Precep r Coordinator toKaren Myers, ARNP

Office: Clinical Learning Center 644-1233 / 644-9800 (CLC Front Office)

Informatics Nancy Clark, MSEd

Office: Administration Bldg Rm 140 644-9706 nancy.clark@med.fsu.edu

Small Group and CLC Faculty:

Steve Grossman, M.D. Susanne Johnson, Ph.D.

Harold Bland, M.D. Jacquelyn Lloyd, M.D. Jerry Boland, M.D. Karen Myers, MS, ARNP Ken Brummel-Smith. M.D. Ed Shahady, M.D.

Tom Knobbe, Ph.D. Tom Serio, M.D.

Alma Littles, M.D. Robert Glueckhauf, Ph.D.

Elena Reyes, Ph.D. Curt Stine, M.D. Ellen Berkowitz, Ph.D. Jan Shepherd, M.D. Jeffrey Spike, Ph.D.

Introduction and Overview

The Doctoring 2 builds on the foundation established in Doctoring 1 to further the application of the basic biomedical, behavioral and clinical sciences to the practice of humane, compassionate, patient-centered medicine. The goal of the Doctoring 2 curriculum is to prepare students for their required third-year clinical experiences.

Doctoring 201 continues to emphasize medical history taking via the introduction of more advanced topics in clinical communication. Students will practice basic physical examination skills, but supplement these with more advanced and complete skills to assist the student in recognizing abnormal physical findings. In addition to focusing on gathering of clinical information, organizing, manipulating, processing and integrating that information are increasingly emphasized. Students are presented with opportunities to test their clinical reasoning and decision-making skills and to utilize medical informatics and decision support resources (e.g., practice guidelines and treatment protocols). Emphasis is placed on evidence based approaches. Woven throughout the curriculum is a continued emphasis on issues of professionalism, moral reasoning and medical ethics.

Portions of the Doctoring 201 curriculum are coordinated with topics covered in pathology, microbiology, pharmacology, health issues in medicine, and psychosocial aspects of medicine. This course utilizes a variety of educational methodologies, including: case-based discussion groups; encounters with simulated patients; supervised physical examination skills practice sessions; videotaping of student encounters; clinical role plays; lectures; discussions; and, community-based preceptor assignments to accomplish course objectives.

The Doctoring Curriculum—including Doctoring 1, 2, and 3--has been designed and is implemented by a multi-disciplinary team of medical, behavioral science, and humanities faculty. This longitudinal curriculum reflects the COM’s commitment to a broadly-based, integrated clinical approach that is the hallmark of the biopsychosocial model of medicine.

Course Objectives By the end of Doctoring 2, students will:

• Demonstrate the ability to conduct a focused medical history and targeted physical examination appropriate to the patient’s chief complaint(s).

• Demonstrate the ability to conduct a thorough medical history and complete physical examination, appropriate to the patient’s age and gender.

• Demonstrate the ability to organize information gathered via the medical interview and physical examination, recognize significant abnormal findings, understand the potential origins of those findings and construct appropriate differential diagnoses to explain those findings.

• Demonstrate the ability to synthesize clinical findings into a list of the patient’s problems and correctly title each identified problem.

• Demonstrate the ability to accurately document a clinical encounter, including the recording of subjective, objective and assessment components.

• Demonstrate the ability to apply the biopsychosocial model and patient-centered clinical method to understand patient presentations.

• Demonstrate the use of appropriate patient education techniques and the ability to assist patients who want to change health behaviors.

• Demonstrate the ability to use appropriate decision support resources (e.g., treatment guidelines) to assist in establishing the patient’s diagnosis and creating management strategies.

• Apply principles of Evidence Based Medicine (EBM) in making diagnostic and management decisions.

• Demonstrate knowledge of basic statistical concepts and ability to apply these concepts to provide evidence-based patient care.

• Demonstrate self-awareness in interactions with patients and discussions of clinical interactions with colleagues.

• Discuss ethical and legal issues related to clinical practice and medical decision-making.

• Demonstrate professional conduct in all educational and clinical settings.

These general course objectives reflect the knowledge, skills and attitudes of the overall COM objectives. Specific learning objectives are included with each course module.

Doctoring 201 Structure:

Doctoring 2 has several different coordinated components that facilitate the variety of teaching / learning experiences in the course. Student performance in each component is evaluated separately, and each evaluation contributes to the student’s final course grade.

· Large group class presentations / discussions o Meets in COM 407 o All students

· Small group exercises o Groups have 2 faculty and 6 –8 students. See group assignment

below o Groups meet in student community small group rooms – see

assignment below · Clinical Learning Center (CLC)

o See schedule for dates and times for your group o See description in “CLC” section

· Preceptorships o Occur in your assigned preceptor’s office every other week. o Preceptor assignments are for Fall and Spring semesters. o See description in “Preceptor” section

· OSCE Objective Structured Clinical Exam o See schedule for dates. All OSCE’s occur in the CLC.

Code of Conduct: Professional Dress:

Medical students, faculty and staff are all ambassadors and representatives of the College of Medicine. Your appearance and behavior reflect upon the College, the administration, the faculty and students.

Professional attire should be worn in all settings where patients are seen. This includes the Clinical Learning Center (CLC), a preceptor's office or clinic, a hospital or nursing facility or even when interacting with a standardized patient during a small group activity.

o For men, professional attire consists of slacks and collared shirts. In the CLC and other clinical settings, ties, lab coats, and name tags are also required.

o For women, professional attire consists of skirts or slacks and blouse. In the CLC and other clinical settings, lab coats, name tags, and closed heel and toe shoes are required.

o Closed toe shoes are required in all clinical settings.

Professional attire consists of clothes consistent with community norms. The established "norms" of certain clinical settings may modify these standards, but any variations in professional attire must be approved by the student's supervisor. At no time are jeans, seductive or revealing clothes or shorts considered professional attire.

Confidentiality:

You are expected to behave in a professional manner at ALL times, whether you are with patients, with faculty or among classmates. All patient material/information is to be treated as confidential. You are free to discuss this material with your classmates but not with others (including roommates, spouses, etc). When discussing clinical material among classmates, please be aware that others around you may hear (e.g. cafeteria line, elevators, halls, etc.).

Even when a specific patient name is not mentioned, clinical material may be specific enough to reveal patient’s identity. Furthermore, others around you may not realize

you are discussing a simulated patient case from class. Therefore, it is best to not discuss cases / patients in public.

Be careful to maintain confidentiality by protecting all patient notes, records and materials. Patient records--even those used by a simulated patient in class-- should be returned to faculty, destroyed or kept in a secure place.

Personal information revealed in class about classmates, faculty members or their families is also considered confidential. You should not disclose this information without the specific consent of the individual.

Students found in violation of the confidentiality agreement, may be referred to the Student Evaluation & Promotion Committee for breach of professionalism.

Attendance:

You are expected to attend all scheduled Doctoring activities. You are also expected to arrive on time and stay until the activity is scheduled to end. “Arriving on time” means being present and ready to start at the assigned time. If you have an emergency that prevents you from attending/or will delay your arrival for a scheduled Doctoring activity, you must notify the Office of Student Affairs and request that they inform your supervisors / professors for that activity. Additionally, contact one of the course directors, the front office of the CLC or your preceptor’s office (depending on the activity involved) to inform them of the emergency and your anticipated absence/delay.

It is important that you realize that your absence or tardiness negatively impacts a number of other people. Attendance, including tardiness, is part of your course evaluation for professionalism. Unexcused absences and repeated tardiness will negatively impact your evaluations and course grade, and may even result in failing Doctoring 210. In severe or repeated cases, students will also be referred to the Student Evaluation & Promotion Committee. The following is the absence policy for Doctoring lecture/small group. See the CLC and Preceptorship section of the syllabus for their respective attendance policies.

Unexcused Absences

v Missing an examination due to an unexcused absence will result in an automatic grade of “0” on that exam.

v Missing a small group session due to an unexcused absence will result in a grade of “0” for that session. This will reduce the semester grade for the small group portion of the course.

Excused Absences / Make-up

v Lecture/Small Group: Students are responsible for any material covered including presentations, readings and assignments. Any makeup work is due one week after the missed session or within one week of the student’s return to the COM.

v Exam: Make-up exams need to be completed within one week of returning to

the COM. Consistent with Curriculum Committee policy and FSUCOM Honor Code, the student will be administered the same exam administered to other students.

Doctoring 2 attendance requirements are consistent with the FSUCOM Attendance policy. For review of the attendance policy as approved by the Curriculum Committee and Advanced Notification of Absence form, see Appendix A.

Course Grading Scale

A = >90% B+ = 87 – 89.9% B = 80 – 86.9%

C+ = 77 – 79.9% C = 70 – 76.9% D = 65 – 69.9% F = < 64.9%

Exams (4 exams) 40%

OSCE (1 exam) 15%

CLC (see criteria in CLC section) 15%

Preceptor (see criteria in Preceptor section) 15%

Small Group (see criteria Appendix B) 15%

ADA Statement:

Students with disabilities needing academic accommodations should:

1. Register with and provide documentation to the Student Disability Resource Center (SDRC);

2. Bring a letter to the instructor from the SDRC indicating you need academic accommodations. This should be done within the first week of class.

Academic Honor Code:

Students are expected to uphold the Academic Honor Code published in the Florida State University Bulletin and the Student Handbook: The Academic Honor System of the Florida State University is based on the premise that each student has the responsibility (1) to uphold the highest standards of academic integrity in the student’s own work, (2) to refuse to tolerate violations of academic integrity in the University community, and (3) to foster a high sense of integrity and social responsibility on the part of the University community.

Required Texts:

Seidel, HM, Ball, JW, Dains, JE, Benedict, GW. Mosby’s Guide to Physical Examination. (5th Ed). St. Louis: Mosby, 2003.

Seidel, HM, Ball, JW, Dains, JE, Benedict, GW. Mosby’s Physical Examination Handbook (3rdEd). St. Louis; Mosby, 2003

Steele, DJ, Susman, JL, McCurdy, FA. Student Guide to Primary care: making the Most of Your Early Clinical Experience.Philadelphia: Hanley & Belfus, 2003.

Lo, Bernard. Resolving Ethical Dilemna.2nd Ed. Philadelphia: Lippincott, Williams, Wilkins, 2000.

Booklet: Steele, DJ. Basic Interviewing Skills

Doctoring II Fall 2003 Large Group Presentation / Small

Group CLC

Dates Topic Dates Comments

Topic Monday Wednesday

OSCE Prep Checklists and

Format 8/18/03 11:00

Group Orientation

8/21/03

Report to Rm 407

Clinical Reasoning/ Oral Presentation

8/28/03

Report to Rm 407

SP Case Formative OSCE 8/25/03

8/27/03

Electronic Resources/ Documentation 9/4/03

Report to Rm 407

Laptops and PDAs

9/5/2003 (Friday) 9/3/03

NO CLASS 9/11/0

3

Heart/Peripheral Vascular-adv.

Exam/ROS 9/8/03 9/10/03

SPECIAL CLC PREP CLASS Heart Sounds (Dr. Harris)

Friday, 9/12/03 1:00 Rm 407

EXAM # 1 9/12/0

3

Data collection/

Identifying Abnormal Findings

9/18/03

Report to SG Rooms

SP Case

Heart/Peripheral Vascular-murmurs

9/15/03 9/17/03

Bad News Delivery

9/25/03

Report to SG Rooms

SP Case 9/22/03 9/24/03

ADL Assessment

10/2/03

Report to Room 407

SP Case 9/29/03 10/1/03

NO CLASS 10/9/0

3

Lungs/Abdomen-Adv. Exam/ROS

10/6/03 10/8/03

Oral examination/ common oral pathology Room 407

Dr. Randy Huffines

10/10/03

12:00-1:30

EXAM # 2 10/10/

03

Pain Management

10/16/03

Report to Room 407

SP Case 10/13/03 10/15/03

Behavior Change/Nutrition

10/23/03

Report to Rm 407

SP Case

Shoulder/Knee/Ankle-ROS

10/20/03 10/22/03Travel Medicine / Patient Education

10/30/03

Report to Rm 407

SP Case OSCE Prep 10/27/03 10/29/03

NO CLASS 11/6/0

3

OSCE on Mon, Tues, Wed. before

3rd Exam 11/3-11/5/2003

EXAM # 3 11/7/0

3

Doctoring 2 Small Groups Fall and Spring 2003-2004 Shahady/Berkowitz (Room 501 A)

Lloyd/Spike (Room 501 B)

Shepherd/Knobbe (Room 501 C)

Mark Leyngold Aaron Nordgren Zach Elmir Manny Herrera Kim Spillman Danielle Stewart Shannon Price Bina Patel Paul Payne Kevin McLean Melissa Smith Reena Hemrajani Ferdi Schafer Stephano Bordoli Regan Rostorfer Kara Brooks Stelios Rekkas Jeffrey Davenport Chris Sunstrom Matt Henry Stephen Patrick

Stine/Glueckhauf (Room 501 D)

Bland/Johnson (Room 502 C)

Serio/Reyes (Room 502 D)

Daneille Bass Lindsey Scott Stephanie Cruz Sandy Ruiz Sandra Brafford Shellie Davis Matt Lee Esther Vildor Chad Krisel Phoung Nguyen Luis Izquierdo Jason Acosta David Drossner Nick Seeliiger Scott Brotherton Victor Hulstrand Brian Gibson Jason Buseman

Appendix A

FSU COM ATTENDANCE POLICY

COM Philosophy

We believe that: Professionalism is a major component of our medical curriculum. We believe students should conduct themselves appropriately in the various educational activities of the curriculum. This conduct includes coming to educational activities on-time, using the laptop computers only for course work during the educational activity, and not disrupting the class if late. The faculty should also demonstrate professionalism, by starting and ending all scheduled educational activities on time and providing a course schedule with clearly explained course policies in the course syllabus. Any changes in the schedule should be given to the students in a timely manner.

Students will be accountable and personally responsible for attending all educational activities (small groups, labs, clinical experiences, examinations, lectures, computer sessions, etc.).

Unexcused absences reflect negatively on the goals and objectives of the medical curriculum and demonstrate unprofessional behavior by the respective student.

We owe it to our state legislature and the citizens of the State of Florida to provide a quality educational program that meets the needs of our students in preparing them for the M. D. degree.

Attendance Policy: Students are expected to attend all scheduled activities. Students are expected to be on time. Being on time is defined as being ready to start at the assigned time. If a student has an emergency that prevents her/him from attending a scheduled activity, s/he is to call and notify the Office of Student Affairs and request that they inform the supervisors/professors/clerkship faculty for that activity. If at all possible, the student should also call and at a minimum, leave a message with one of the course/clerkship directors. It is important that students realize that their absence or tardiness negatively impacts a number of other people. Attendance, including tardiness, is part of the student’s evaluation for professionalism. Negative evaluations may result in decreased grades and in severe cases, referral to the Student Evaluation and Promotion Committee.

Procedure for Notification of Absence: If the student knows in advance of an upcoming legitimate absence, the “Advance Notification of Absence from Educational Activity(ies)” form should be completed with signatures from the student, the Assistant Dean for Student Affairs, the course or clerkship faculty member and the Course/Clerkship Director, and where appropriate, the Education Director for the Discipline. The form will be filed in the Office of Student Affairs. The implications for the absence (e.g., remediation, course grade adjustment, make-up exam, etc.) will be given to the student by the course/education director and final decisions regarding these actions shall rest with the course/education director.

If the absence occurs due to an unforeseen emergency, the student should contact the course/clerkship director and the Assistant Dean for Student Affairs immediately to report the absence including the reason for the absence. The implications for the absence (e.g., remediation, course grade adjustment, make-up exam, etc.) will be given to the student by the course/education director and final decisions regarding these actions shall rest with the course/education director.

Remediation Policy for Absences from Examinations, Quizzes, Small Group Sessions, Laboratory Sessions, Clinical Learning Center Sessions, Preceptor visits, and Clerkship Call: The remediation policies for absences from examinations, quizzes, small group sessions, laboratory sessions and clerkship call are:

1. POLICY ON MISSED EXAMINATIONS: Students are required to take major in-term and final examinations. According to the curriculum committee a student can only be excused from an examination by a course director decision based on the personal situation of the student. The course director will determine the time of the exam make-up session. Also, according to the curriculum committee decision and the existence of the FSU-COM honor code, the student will be given the same examination given to the other students.

2. POLICY ON MISSED QUIZZES: Students are required to take scheduled and unscheduled quizzes in the courses. A student can only be excused from a quiz by a course director decision based on the personal situation of the student. The student must make arrangements with the course director to make up a missed quiz. Also, according to the curriculum committee decision and the existence of the FSU-COM honor code, the student will be given the same quiz given to the other students.

3. POLICY ON MISSED SMALL GROUP SESSIONS, LABORATORY SESSIONS, CLINICAL LEARNING CENTER SESSIONS, PRECEPTOR VISITS, AND CLERKSHIP CALL: The student should contact the course director, small group leader or clerkship director for instructions on remediation of the missed session and material covered.

Remediation Policy for Students Who Fail a Course: Remediation of courses/clerkships will be planned and implemented by a combined decision of the Evaluation and Promotion Committee in collaboration with the course/education director.

Un-excused Absences: It will be the responsibility of the course/education directors to clearly state in their respective course/clerkship syllabi the implications

for having an un-excused absence from a scheduled education or examination activity in a course or clerkship.

Advance Notification of Absence from Educational Activity(ies)

Student’s Name: ________________________________________

Date of request: ________________________________________

Course or Clerkship Rotation: ________________________________________

Faculty Name(s): ________________________________________

Course Director: ________________________________________

Clerkship Director: ________________________________________

Education Director: ________________________________________

Faculty Name(s): ________________________________________

Date(s) of Requested Absence: From _____________ to _____________

Classes/Activities that will be missed: Date Time

______Classroom Lecture ____________________ ____________________

______Small Group ____________________ ____________________

______Laboratory session ____________________ ____________________

______CLC ____________________ ____________________

______Preceptor ____________________ ____________________

______Clerkship time ____________________ ____________________

______Clerkship Call ____________________ ____________________

Reason for Absence: ________________________________________

___________________________________________________________________________________ ___________________________________________________________________________________

____________________________ ____________________________

Student’s Signature/Date Associate Dean for Student Affairs/Date

____________________________ ____________________________

Faculty’s Signature/Date Course/Clerkship Director/Date

_____Approved _____Not approved

____________________________ ____________________________

Associate Dean for Student Affairs/ Regional Campus Dean/Date

Course/Education Director/Date

Form Filed in Student Affairs Office by: Date Filed

____________________________ ____________________________

Printed Name Date

____________________________ Signature

Appendix B

Doctoring 2 Small Group Student Evaluation Grid

2003-3004 Facilitators: Student: Instructions: After each small group session—and following consultation with your co-facilitator--have one facilitator complete the grid below for each student. Except for “+” and “-” responses in attendance/timeliness category, use the following scale for all student assessments: “3” = exceeds expectations; “2” = meets expectations; “1” below expectations; and, “0” not applicable. Attendance/Timeliness ( “+” = yes / “-” = no )

09/02

09/09

09/16

09/23

09/30

10/7

10/14

10/21

10/28

11/04

Did student attend? Did student arrive on time?

Knowledge/Skills/Behaviors

Familiar with

required readings.

Understands session goals. Regular contribution/participation.

Keep group on track.

Listens respectfully.

Demonstrates sensitivity/respect for other’s feelings.

Gives feedback effectively

Responds positively to feedback.

Accesses electronic resources.

Recognizes important facts.

Able to synthesize and organize clinical data.

Able to solve clinical problems.

Documents encounter appropriately.

Interactions with SP (when appropriate)

Interacts effectively with SP

Gathers complete data from SP

Comments:

Updated August 20, 2003

CLINICAL LEARNING CENTER Doctoring 201

Clinical Learning Center

Fall 2003

Clinical Learning Center Hours 8:00-5:00 Monday through Friday

During times when the CLC is not being used for scheduled activities, students are encouraged to use the CLC to practice their clinical skills. If the student desires faculty supervision for these independent practice sessions, he/she should contact one of the CLC faculty and arrange for the faculty member to supervise. Ms. Myers may be able to assist the student in arranging faculty supervision if the student is not able to make those arrangements by him/herself.

Clinical Learning Center Faculty

Harold Bland, M.D. Jacquelyn Lloyd, M.D.

Jerry Boland, M.D. Karen Myers, MS, ARNP

Ken Brummel-Smith. M.D. Ed Shahady, M.D. Steve Grossman, M.D. Curtis Stine, M.D. Anne Gunderson, MSN, RN, APN, CRRN-A Alma Littles, M.D.

During Doctoring 201, students are scheduled in the Clinical Learning Center (CLC) every other week to practice advanced physical examination skills. (These scheduled CLC sessions alternate weeks with preceptorship experiences.) In the CLC, students will work in groups of 2 to 4 students. Using the appropriate checklist, CLC faculty will observe and assess student performance, answer questions and provide individualized feedback. In addition to the interviewing practice students will obtain during the preceptorship, students will periodically have the opportunity to interview standardized patients (SPs) in the CLC. Students are expected to have read the assigned readings and viewed assigned videos before arriving in the CLC. Additionally, students are expected to arrive on time and to be properly attired.

Objective Structured Clinical Examination

At the end of Doctoring 201, students will take an Objective Structured Clinical Examination (OSCE). OSCEs are skills-based examinations conducted in the CLC and are the primary evaluation method for assessing clinical skills. OSCEs typically consist of several “stations” (patient exam rooms). At each station, students are asked to perform a particular task (e. g. take a history of a patient’s present illness). Students are observed during the OSCE by a faculty member and assessed against a standard set of observable, behavioral criteria.

Attire in the CLC

Professional attire should be worn in all settings where patients are seen. This includes the Clinical Learning Center (CLC) when students are interacting with a standardized patient.

o For men, professional attire consists of slacks, shirt and tie, and lab coat.

o For women, professional attire consists of skirt or slacks, blouse, and lab coat.

Note: Although standards for professional attire may vary in community settings, jeans, seductive or revealing clothing, shoes with open toes or heels or shorts do not constitute professional attire.

When patients are not included as part of the CLC session, students will be practicing examination maneuvers on each other. Sometimes this will necessitate wearing clothing that allows access to the body parts being examined. Appropriate attire for these sessions can be found with the CLC assignments.

Equipment in the CLC

Students are also expected to bring the following to each CLC session:

§ A stethoscope (or other diagnostic equipment), § a watch with sweep second hand § a pen for writing, and § the student’s PDA.

Attendance

Students are expected to attend all scheduled CLC activities. Students are also expected to arrive on time. Arriving on time is defined as being ready to start at the assigned time. If you have an emergency that prevents you from attending a scheduled CLC activity, notify the Office of Student Affairs and, if possible, the CLC at 644-9800. See the policy on CLC absences below.

If you know in advance that you will be unable to attend a scheduled CLC session, it is your responsibility to find a classmate with whom you can switch CLC sessions. In the event you plan to switch a session, notify the CLC at 644-9800 or wanda.gaines@med.fsu.edu.

A student’s absence or tardiness negatively impacts a number of other people. The student’s CLC evaluation includes measures of both attendance and tardiness—both markers of professionalism. Repeated absence and tardiness will cause your Doctoring 201 grade to be lowered. In severe cases, students will be referred to the Student Evaluation & Promotion Committee.

CLC Absences

Planned absences require students to complete the proper forms and obtain the required permissions prior to the absence. Schedule changes or session remediation for planned CLC absences is negotiated in advance. Students arranging for a schedule change or completing a remediation session will be evaluated by a CLC faculty and scored using the same criteria used in a regular CLC session. In the case of an approved, planned absence where the session is completed by a schedule change or via remediation session, the student will not incur a grading penalty.

Unplanned, but excused, CLC absences: Unplanned but excused absences are student absences due to circumstances beyond the student’s control. Examples of unplanned, but excused absences include student illness and/or family death. The Doctoring Course Directors will decide whether or not an unplanned student absence qualifies as an excused absence. In the case of any unplanned absence, students are expected to contact the CLC, and inform the CLC Director (or, if the director is unavailable, a CLC staff member) that the student will not be in the CLC and the reason for the unplanned absence.

Impact of excused absence on the student’s grade: If the CLC absence qualifies as an “excused” absence, a remediation plan will be developed by the student and the CLC Director. In most situations, remediation of the missed CLC session must occur within one week. These remediation sessions will be evaluated by a CLC faculty and scored using the same criteria as regular CLC sessions. In the case of an unplanned, but excused absence, the student will not incur a grading penalty.

Unplanned and unexcused CLC absences: Unplanned and unexcused absences are any unplanned student absences that do not qualify as an excused CLC absence. These generally are due to circumstances within the student’s control. Examples of unplanned and unexcused absences include the student who forgets about a CLC session, the student who skips CLC to study for an exam and/or any absence where an able student fails to contact the CLC director (or, if the director is unavailable, a CLC staff member) to inform them that the student will not be in the CLC.

Impact of unexcused absence on the student’s grade: If the CLC absence does not qualify as an “excused” absence, the student will not be allowed to remediate the missed session. This will result in the student receiving a “0” for the session. This will reduce the student’s grade for the CLC portion of the Doctoring Course, and may result in an overall reduction in his/her overall Doctoring grade. Students with an unplanned and unexcused absence, will still be responsible for the missed material in future OSCE’s and written examinations. Students with multiple unplanned and unexcused absences will be referred to the Student Evaluation and Promotions Committee

OSCE absences:

Planned absences require students to complete the proper forms and obtain the required permissions prior to the absence. OSCE schedule changes (a student scheduled to complete the OSCE arranges to swap testing times with another student) to accommodate planned absences are negotiated in advance. Students arranging for an OSCE schedule change will be scored using the same criteria used for other students completing the OSCE. Students arranging a schedule change to accommodate an approved planned absence will not incur a grading penalty.

Only schedule changes are permitted. Because of the expense involved in recruiting and using standardized patients, remediation for a missed OSCE is not an available option for planned absences. If a student misses an OSCE and is unable to arrange for a schedule change in advance, the student will receive a “0” for the OSCE. This will reduce the student’s grade for the OSCE portion of the Doctoring Course, and may result in an overall reduction in his/her Doctoring grade.

Unplanned, but excused, OSCE absences: Unplanned but excused absences are student absences due to circumstances beyond the student control. Examples of unplanned, but excused absences include student illness and/or family death. The Doctoring Course Directors will decide whether or not an unplanned student absence qualifies as an excused absence. In the case of any unplanned absence, students are expected to contact the CLC, and inform the CLC Director (or, if the director is unavailable, a CLC staff member) that the student will not be able to participate in the OSCE and the reason for the unplanned absence.

Impact of excused absence on the student’s grade: If the OSCE absence qualifies as an “excused” absence, an attempt will be made to identify another student with whom the student can change testing schedules. If a schedule change is not possible, an attempt will be made to schedule a remediation for the missed OSCE before the end of the semester. If this is not possible, the student will receive an “I” for the Doctoring course until plans for remediation can be made the following semester.

Unplanned and unexcused OSCE absences: Unplanned and unexcused absences are any unplanned student absences that do not qualify as an excused absence. These generally are due to circumstances within the student’s control. Examples of unplanned and unexcused absences include the student who forgets about an OSCE session, the student who skips an OSCE to study for an exam and/or any absence where an able student fails to contact the CLC director (or, if the director is unavailable, a CLC staff member) to inform them that the student will not be able to participate in the OSCE.

Impact of unexcused absence on the student’s grade: If the CLC absence does not qualify as an “excused” absence, the student will receive a “0” for the OSCE. This will reduce the student’s grade for the OSCE portion of the Doctoring Course, and may result in an overall reduction in his/her Doctoring grade.

Required Texts:

Seidel, HM, Ball, JW, Dains, JE, Benedict, GW. Mosby’s Guide to Physical Examination. (5th Ed). St. Louis: Mosby, 2003.

Seidel, HM, Ball, JW, Dains, JE, Benedict, GW. Mosby’s Physical Examination Handbook (3rdEd). St. Louis; Mosby, 2003

Additional Learning Resources:

Mosby’s Video

CLC Grading:

CLC activities comprise 30% of the overall Doctoring 201 course grade. Grading in this component will be based on the following:

• OSCE (Physical Exam and History) o Scheduled November 3-5 15%

• Clinical Learning Center (CLC) Sessions

o Attendance, participation and preparation, response to feedback

15%

*See Appendix C for the CLC student assessment form.

Doctoring 201 CLC Sessions, Fall 2003

CLC Activity (Topic)

Session Goal/Focus Dates

(Mon & Wed PM)

CLC Assignments

Formative OSCE OSCE Aug. 25-27

Heart/Peripheral Vascular Advanced Exam and ROS

Demonstrate and narrate a thorough examination of the heart and peripheral vasculature.

Demonstrate the ability to perform a review of symptoms appropriate for the bodily system(s) being examined.

Memorize the meanings of key vocabulary words appropriate for the bodily system(s) being examined.

Sept. 3, 5*

Sept. 8, 10

* Monday 9/1 group will meet on Fri. 9/5 due to holiday

Mosby’s text

pps. 414-421; 423-427; 429-438; 445-446; 462-485.

Mosby Handbook chaps. 10 & 11.

Mosby Video

Overview of Heart Sounds

Overview of Heart Sounds Using SAM-the Student Auscultation Model.

Fri., Sept. 12

1:00-2:30

ATTENDANCE REQUIRED

Heart Murmurs

(Student Auscultation Model)

Demonstrate and narrate an approach to characterizing and diagnosing a heart murmur.

Demonstrate the ability to perform a review of symptoms appropriate for the bodily system(s) being examined.

Memorize the meanings of key vocabulary words

Sept. 15, 17

Sept. 22, 24

Mosby’s text pps. 439-443; 447-456.

Mosby Handbook (see above)

Mosby Video

appropriate for the bodily system(s) being examined.

Lungs/Abdomen Advanced Exam and ROS

Demonstrate and narrate a thorough examination of the chest and lungs.

Demonstrate and narrate a thorough examination of the abdomen.

Demonstrate the ability to perform a review of symptoms appropriate for the bodily system(s) being examined.

Memorize the meanings of key vocabulary words appropriate for the bodily system(s) being examined.

Sept. 29, Oct. 1

Oct. 6, 8

Mosby’s text pps. 356-363; 364-389; 395-413. 525-530; 531-535; 536-561.

Mosby Handbook chaps. 12 & 16

Mosby Video

Shoulder/Knee/ Ankle Exam and ROS

Demonstrate and narrate a thorough examination of the shoulder, knee and ankle.

Demonstrate the ability to perform a review of symptoms appropriate for the bodily system(s) being examined.

Memorize the meanings of key vocabulary words appropriate for the bodily system(s) being examined.

Oct. 13, 15

Oct. 20, 22

Mosby’s text pps. 694-708; 717-718; Figs. 20-24, 20-25.

pps. 728-733; Figs. 20-37, 20-38, 20-39, 20-41. pps. 737-739; Figs. 20-46, 20-47, 20-48, 20-49, 20-50, 20-51.

Mosby Handbook chap. 16.

Mosby Video OSCE Prep Individual practice in CLC

for OSCEs Oct. 27, 29

OSCE Nov. 3-5

Appendix C

The Florida State University College of Medicine Clinical Learning Center

Instructor Evaluation of Student

Date

Student’s Name

Class of

2006

Faculty’s Name

Instructions: Please fill out completely. If “uncertain” or “no” answer is

given, explanatory comment must follow.

1. Arrived on time. ¨ Yes ¨ No

2. Dressed Appropriately.

¨ Yes ¨ Uncertain ¨ No Comments on Dressed appropriately.

3. Demonstrated preparation. ¨ Yes ¨ Uncertain ¨ No

Comments on Demonstrated preparation.

4. Respectful of staff, faculty, patients, facility, and equipment. ¨ Yes ¨ Uncertain ¨ No

Comments on Respectful of staff, faculty, patients, facility, and equipment.

5. Gave feedback effectively.

¨ Yes ¨ Uncertain ¨ No Comments on Gave feedback effectively.

6. Responsive to feedback. ¨ Yes ¨ Uncertain ¨ No

Comments on Responsive to feedback.

7. Participated actively.

¨ Yes ¨ Uncertain ¨ No

Comments on Participated actively.

8. Summary comments on professional behavior.

Communication Skills and Empathy

9. Very sensitive to patient needs. Excellent pace. Listens and follows extremely well. Crystal clear communication-including questions and

explanations. Avoids using medical jargon. Shows genuine rapport with patient. Appropriate use of empathic responses.

¨ Most of the time

¨ Some of the time

¨ Rarely ¨ Never ¨ Not applicable

History Taking

10. History is thorough, logical and predictable. Collects all significant

pieces of data. Expands information by consistently following up patient responses. Uses reflection, clarification and summarization well.

¨ Most of the

time ¨ Some of the

time ¨ Rarely ¨ Never ¨ Not

applicable

Physical Examination

11. Able to perform expected exam maneuvers well. Demonstrates superior techniques. Very organized and systematic. Clear and correct

instructions to patients. Concerned with patient privacy/modesty. Appropriately confident approach to exam.

¨ Most of the

time ¨ Some of the

time ¨ Rarely ¨ Never ¨ Not

applicable

Oral Case Presentation

12. Organized and complete presentations. Includes all important data-including patient responses and student perceptions. Knows and uses

template. Concludes presentation appropriately.

¨ Most of the ¨ Some of the ¨ Rarely ¨ Never ¨ Not

time time applicable

Knowledge Acquisition

13. Exceptional fund of medical knowledge. Outstanding ability to access new information. Is developing critical appraisal skills.

¨ Most of the

time ¨ Some of the

time ¨ Rarely ¨ Never ¨ Not

applicable

14. Summary comments on clinical skills performance.

Doctoring 2 CLC Groups X1 Monday (9/5 1st session is on a Friday

due to Labor day holiday)

Y1 Wednesday (9/3)

Shannon Price Kim Spillman Stephanie Cruz Sandra Brafford

Reena Hemrajani Brian Gibson Mark Leyngold Zach Elmir Stelios Rekkas Chris Sunstrom

Regan Rostorfer Phoung Nguyen Luis Izquierdo Jason Acosta Ferdi Schafer Stephen Patrick

Scott Brotherton Kevin McLean Paul Payne

David Drossner Sandy Ruiz

X2 Monday (9/8) Y2 Wednesday

(9/10) Danielle Stewart Nick Seeliiger

Kara Brooks Daneille Bass Esther Vildor Shellie Davis Melissa Smith Victor Hulstrand

Aaron Nordgren Chad Krisel Matt Lee Jeffrey Davenport

Stephano Bordoli Matt Henry

Lindsey Scott Jason Buseman

Manny Herrera Bina Patel

PRECEPTORSHIP

Preceptorship within the Doctoring 2 Curriculum

Doctoring students will each be assigned to a primary care (family practice, general internal medicine, or general pediatrics) physician in the community. Students will remain with this preceptor for the entire year. The purpose of the preceptorship is to provide the student with the opportunity to practice the interview, history taking, physical examination skills, clinical reasoning skills and to observe patient care being delivered in a community-based setting. Students will be scheduled to spend 3-4 hours with the preceptor every other week. During alternate weeks students will be learning and practicing clinical skills in the CLC.

Doctoring Preceptor Coordinator:

Karen Myers, ARNP-C Office: CLC 644-1233 karen.myers@med.fsu.edu

Goals of the Doctoring 2 Preceptorship Experience

The educational goals of the Doctoring Preceptorship Experience include:

• Demonstrate the patient-centered clinical method and the biopsychosocial approach to patient care by applying the principles of effective doctor-patient communication in history taking, patient education, negotiation and shared decision-making

• Collect appropriate and complete clinical information from patients using a structured and organized history taking approach

• Perform the appropriate physical examination maneuvers in identified organ systems and regions

• Organize and effectively communicate patient data to other health professionals, including the community preceptor

• Begin to recognize common patterns of disease presentation and be able to construct simple differential diagnoses

• Document clinical encounters using the CDCS system • Access and utilize “point of care” electronic medical resources

In addition, students will begin to learn important clinical processes, including: 1) the process of formulating clinical questions; 2) the process of applying the principles of evidence based medicine (EBM) in clinical settings; and, 3) the life-long process of developing approaches for dealing with medical uncertainty. Students will also have the opportunity to practice two important skills--documentation of clinical findings and oral presentation techniques.

If a preceptor is not providing the opportunity to interview and examine patients, students are encouraged to discuss this situation with the preceptor. If the preceptor still does not provide opportunities for the student to interact with his/her patients, please contact Karen Myers at 644–1233.

Grading

The Doctoring preceptor will evaluate the student’s performance in these areas: professional behavior, empathy/communication skills, history taking skills, physical examination skills, oral presentation skills, clinical reasoning skills and documentation skills. The preceptor portion of Doctoring 2 accounts for 15% of the total Doctoring 2 grade and is comprised of 2 separate components--CDCS documentation activities (5%) and student performance in the aforementioned areas (10%).

Clinical Activities at Preceptorship Sites:

Interviewing/history taking/patient education/counseling

Student will be given opportunities to:

• Elicit patient’s chief complaint • Conduct a focused history of the present illness • Conduct a focused review of systems (ROS) • Conduct an extended interview including

o Past medical history o Social history o Family medical history and risk factor assessment

• Conduct a sexual history • Counsel patients re: behavior change strategies

Physical Examination

Students will be given opportunities to:

• Take and properly record vital signs (BP, pulse, respiration) • Inspect skin for rashes, lesions • Perform eye exams, including examination of the ocular fundi • Perform ear exams, including otoscopy • Examine the oropharynx • Examine thyroid and neck • Auscultate and percuss lungs • Perform cardiac auscultation and examination of the peripheral vascular

system • Perform the abdominal examination (auscultation, percussion, palpation) • Perform the musculoskeletal examination (upper and lower extremities) • Perform screening neurological examination • Perform male and female genitourinary examinations—including pelvic and

rectal examinations on consenting patients • Perform examinations of the female breast on consenting patients

Professional Communication

Students will be given opportunities to:

• organize and present clinical information to the preceptor • document appropriate portions of the patient visit into a medical record

Student Conduct

Prior to the student’s first preceptorship session, each student is expected to contact the preceptor and arrange a time to meet with his/her preceptor. Prior to this meeting, the student will read: Steele, D. (2003) Student Guide to Primary Care Making the Most of Your Early Clinical Experience, (chap 1)

Attendance/hours

• Attendance at all scheduled preceptorship sessions is mandatory. • In case of an unexpected absence, the student will call the preceptor to notify

him/her of the absence and the student’s situation. The student is also to notify if possible, the Office of student affairs and Karen Myers.

• In cases of excused absences, it is the student’s responsibility to arrange for a make-up session within one week of returning to FSUCOM and to notify Karen Myers of the date the session was completed.

• For unexcused absences, no remediation is available. Student will receive a “0” for that session which will result in a decrease in the overall final grade.

• Students are expected to spend a minimum of 3 contact hours in the preceptorship every other week.

• Any changes in the preceptor schedule must be approved by the Doctoring Preceptor Coordinator. It is not acceptable for the student to change the assigned preceptor time without receiving advance approval.

Dress/equipment

• Students will dress professionally, and will always bring white coats and FSU ID badges with them to each preceptor session.

• Students will bring all necessary examination equipment with them to each preceptor session.

• Students will bring their PDA’s/laptop computers with them to each preceptor session.

• Students will provide the preceptor with a copy of the clinical skill checklist from their most recent CLC class.

Professional behavior

• Students must arrive in the preceptor’s office on time. • Students will treat the preceptor, his/her staff and all patients with respect

and courtesy. • Students will maintain patient confidentiality and will avoid non-professional

relationships with patients.

Documentation/Evaluation

• Following each interaction with a patient, students will enter information on that patient encounter into the CDCS system.

• Students will complete an evaluation of the clinical preceptorship at the end of each semester. This information will be provided to the preceptors and used to assist in planning faculty development activities for preceptors.

Doctoring 2 Preceptor Groups

Group A1 Group B1 Group C1 Monday

September 15 Tuesday

September 16 Wednesday

September 17

Jeffery Davenport Jason Buseman Stephano Bordoli

Lensey Scott Bina Patel Manny Herrera Shellie Marks Danielle Bass Matt Henry Aaron Nordgren Victor Hulstand Daniella Steart Melissa Smith Chad Krisel Nick Seelinger Esther Vildor Matt Lee Kara Brooks

Group A2 Group B2 Group C2 Monday

September 22 Tuesday

September 23 Wednesday

September 24 Ferdinand Schafer Shannon Price Luis Izquierdo Reena Hemrajani Stelio Rekkas Sandy Ruiz

David Drossner Chris Sundstrom Kevin McLean

Phuong Nguyen Brian Gibson Jason Acosta Mark Leyngold Kim Spillman Stephanie Cruz Regan Rostorfer Stephen Patrick Scott Brotherton Paul Payne Sandy Brafford Zach Elmir