Clinical Skills and Professionalism Benchmarks

Medical school is only one part of your journey in becoming a physician. It is, however, that vital part which should enable each and every one of you to attain the basic proficiencies that are essential to ensure your clinical competence and excellence in whichever specialty you choose. These proficiencies are skills, knowledge, and professionalism that build on the skills and knowledge mastered the previous year.

Your College mentors will be supporting you and monitoring your progress as you establish goals for yourself throughout your medical school experience. The goals you set will help you attain the developmental benchmarks of a four-year integrated curriculum of clinical skills and professionalism.

The integrated curriculum includes the following five domains:

Communication skills
Clinical reasoning and interpretation skills
Diagnostic and physical exam skills
Professionalism and ethics
Use of informatics

The developmental objectives for each domain are listed on the attached tables. The skills and information to attain these milestones will be offered and taught in a variety of venues throughout your four years: in the classroom, small groups, workshops, clerkships, and interactions with patients and families and through independent study, service, and reflection.

As you begin your first year, you will want to start by reviewing the benchmarks for year one and developing learning goals for the fall. Many of these learning goals will be accomplished in your Introduction to Clinical Medicine I course or in preceptorships with the help of the faculty you are working with. You will also want to reflect on your skill level in each of these domains as you plan your one-on-one session with your College mentor to clarify and refine your goals as you progress through the year.

Professionalism and Ethics

Year	Developmental objectives
1	Recognize the concept and task of developing professionalism. Recognize ethical issues in medicine and develop a framework for addressing ethical issues. Begin to develop a professional identity: Integrity Responsibility Teamwork Life long learning Self reflection
2	Demonstrate ability to address advanced ethical issues: Uncertainty End of life care/serious illness Delivering bad news Physician impairment Demonstrate advancement in professional skills: Teamwork & collaborative learning Personal responsibility Integrity Peer evaluation Continued development of professional identity
	Transition to the wards – anticipating issues in clinical training
3 / 4	Process professional & ethical issues arising in clinical training: Mistakes/uncertainty Truth telling/withholding End of life care/DNR Informed consent/advanced directives Teamwork Honesty & integrity Personal responsibility Learning from positive and negative role models Discipline-based topics Continued development of professional identity
Transition to residency – anticipating issues in residency training

Communication Skills

Year	Developmental objectives
1	Learn the principles of Doctor/Patient communication: Learn and practice basic interviewing skills: Patient-centered interviewing Function & structure of the medical interview Identify specific topics in the medical interview: Human sexuality/HIV/sexual minorities Alcohol & substance abuse Diversity Special populations (elderly, adolescent, pediatrics, etc.) Peer communication – giving and receiving feedback
2	Demonstrate advancement in interviewing skills: Patient-centered interviewing Specific topics Special skills (interpreters, motivational interviewing, difficult patients) Peer communication – giving and receiving feedback
Transition to the wards – anticipating issues in clinical training
3 / 4	Demonstrate advancement in interviewing skills: Patient-centered interviewing Motivational interviewing Patient education Shared decision-making Discipline-based application: Special topics (informed consent, advanced directives, delivering bad news, etc.) Special populations (children, disabled, etc.) Peer communication Giving and receiving feedback Active role as a teacher
Transition to residency – anticipating issues in residency training

Clinical Reasoning and Interpretation Skills

Year	Developmental objectives
1	Recognize the iterative system of clinical reasoning. Practice formulating hypothesis. Practice organizing data (written). Recognize issues related to uncertainty & ambiguity.
2	Practice clinical reasoning – generating and testing hypotheses (clinical problem-solving and branching diagrams). Understand the role of uncertainty in clinical practice. Practice and demonstrate progress in organizing and presenting data (written and oral).
Transition to the wards – anticipating issues in clinical training
3 / 4	Discipline-based application – observed within each clerkship, including feedback and evaluation. Clinical reasoning Data organization & presentation
Transition to residency – anticipating issues in residency training

Diagnostic and Physical Exam Skills

Year	Developmental objectives
1	Learn basic interview skills (see Communication): Patient-centered interviewing Basic listening skills – biopsychosocial content Basic questioning skills – including difficult questions/special topics Understand intersection with clinical reasoning Learn basic physical exam skills – learn the flow and elements of the basic (non-problem based) physical exam. Begin to consider uses of lab and other diagnostic tests.
2	Learn advanced interview – organ system or problem-based interview Learn advanced physical exam skills: Organ system or problem-based physical exam Relationship to pathophysiology Appreciate relationship between advanced interview, physical exam, and clinical reasoning process Learn the use of lab and other diagnostic tests: Organ system based Link to clinical reasoning Use these skills in generating and testing hypotheses.
Transition to the wards – anticipating issues in clinical training
3 / 4	Discipline-based application - observed within each clerkship, including feedback and evaluation: Physical exam Interview skills Lab/diagnostic testing
Transition to residency – anticipating issues in residency training

Use of Informatics

Year	Developmental objectives
1	Basic computer literacy including e-mail, word processing, and internet access (desirable at entry). Understand principles of clinical epidemiology. Practice evaluation of resources (Identifying evidence for the content being taught). Understand importance of examining clinical outcomes. Learn the basics of literature searching.
2	Application of clinical epidemiology. Application of clinical outcomes considerations. Learn the principles of evidence-based medicine: Ability to form an clinical question, search for and retrieve current literature, critically analyze the literature, apply to question and determine appropriate medical course from this information; Understanding of clinically relevant basic epidemiological terms including benefits and shortcomings of types of studies and statistical outcome measures
Transition to the wards – anticipating issues in clinical training.
3 / 4	Discipline-based application - observed within each clerkship, including feedback and evaluation: Evidence-based medicine: Critically appraise topic of interest and report results in structure CAT format including RRR, ARR, number needed to treat/harm. Clinical epidemiology: Weighted differential diagnosis Technology assessment Accepting uncertainty Outcomes-based practice
Transition to residency – anticipating issues in residency training.