Spring Quarter

Submitted by sypark on Thu, 03/12/2009 - 2:28pm

General Information

A.  Course Requirements

* -- these items should be in your portfolio

An unexcused or unexplained absence from a required sessions will result in a “Notice of Concern.”  These include: clinical tutorials, pediatrics tutorial, psychiatry tutorials, special skills interview sessions.  This is also the case for late work including required reflections or for incomplete work at the end of the year unless previously discussed with your College mentor.  If you have any questions about the any of the course requirements or any other aspect of the course, please contact Dr. Goldstein or Dr. McDonough to discuss them. 

B.  Overview of the Quarter

This quarter we will continue to build and work on the basic clinical skills of medical interviewing, physical examination, case presentation and documentation, and clinical reasoning in your clinical tutorials. You will continue on with your college group, at a new hospital, but with the same structure as in fall and winter quarters.  The last advanced physical examinations you will learn is the psychiatric exam.  You will do one write up of the complete mental status exam – the “advanced psychiatric exam”.

The final special topics of the course which are covered this quarter are human sexuality  and pediatrics.  Human sexuality will be taught in lectures and panel discussions, and as part of the special skills interviews (described below).  Pediatrics was introduced in winter quarter with an introductory lecture and is completed with a tutorial on your regular College morning.  “Wards Rounds” is an optional exercise during weeks 7-9 in which you can sign up to follow a medicine or pediatrics ward team for a morning.
Special skills interview sessions provide an opportunity to practice special skills related to interviewing patients in three areas covered this quarter and last quarter - human sexuality, alcohol and substance abuse, and interviewing patients with interpreters.  These will be brief, structured standardized patient interviews which will be described in detail later in the syllabus.  There are no write ups due for the special skills interviews.

You are asked to upload your reflections from the winter quarter seminar on “caring for patients with life threatening and terminal illness” by the end of the second week of classes, Friday, April 3.  There are no other required reflections in Spring quarter.

C.  Final Oral Case Presentation

Early in the quarter we will post sign up sheets for your final oral case presentations.  These will take place in the morning of April 28 – May 15. You will sign up for one twenty minute time slot and will present and discuss one of the patients on whom you have done a complete work up some time this year.  Please make sure that you don’t sign up to do your final presentation with your College mentor (or on your assigned College morning).

The oral case presentation you will do is similar to what you have been practicing in your clinical tutorials throughout the year including a brief discussion of the differential diagnosis.  It should consist of:

  • patient identification/chief complaint (be sure to include any relevant recent or chronic medical problems and the duration of the chief complaint)
  • a detailed HPI containing any elements of the past medical history, family history, social history relevant to the patient’s chief complaint - focus on chronology and details
  • briefly list the major additional categories of the database - past medical history (list major medical problems very briefly); medications, drug allergies, habits; family medical history, social history (2-3 sentences); ROS should not be included, but can be summarized as: “ROS: pertinent positives and negatives as noted in the HPI”.
  • physical exam, naming all of the major categories of the exam but describing in detail only the relevant positive and negative findings related to the patient’s chief complaint.
  • brief summary statement consisting of the identifying information and the chief complaint of the patient, the main points of the history and key physical exam findings, and the 2 or 3 most likely causes of the patient’s problem.
  • brief discussion of your differential diagnosis (the 2 or 3 most likely causes listed in  your summary statement)

Your presentation up to the summery statement should be limited to 5-7 minutes.  You should then briefly (3-5 minutes) present your different diagnosis, reviewing the 2-3 most likely causes of the patient’s problem outlining the evidence for or against each possibility with reference to the patient’s history and physical exam findings.

It is important to select a patient with a clear chief complaint which provides you with a good differential diagnosis to discuss, and one whose problems are neither too simple (a patient who fell and broke an ankle) nor too complex (one with 12 active problems and 12 inactive problems on their problem list).  You should not present more than 2-3 active problems in your case presentation. Also, always remember to start the story with the patient’s presentation to the hospital and give all symptoms and times in relation to that point, adding an “addendum” of the hospital course and the patient’s current condition if necessary at the end.

It is a good idea for you to use this framework and the time limits noted for all of your case presentations for this quarter.  It is also important to practice the presentation you plan to do for your final in your small group or with your clinical tutor to ensure that you make it as organized and concise as possible while at the same time including all of the relevant information.  If you have any questions about how to do the case presentation or what is expected don’t hesitate to ask your College mentor or contact Dr. Goldstein or Dr. McDonough.

D.  OSCEs

Spring quarter OSCEs are scheduled from March 31 – April 17.  To view your assigned date, please see the website to download the spring quarter assignment schedule as an Excel file.

For more information about the OSCEs, please go to http://uwosce.blogspot.com/

E.   Spring Quarter Goals

  • Interviewing – Special Skills Interview Session
    • substance abuse
    • working with interpreters
    • human sexuality
  • Advanced physical exams
    • psychiatric evaluation/mental status (lecture, tutorial)
  • Clinical tutorials - weekly
    • interview, physical exam, write up (each student 2 patients per quarter)
    • case presentation skills
    • clinical reasoning
    • professional issues
  • Special topics
    • human sexuality (lectures, panels, interviewing skills session)
    • pediatrics tutorial
  • Final Oral Case Presentation
  • [Clinical Skills Assessment (OSCEs)]