1. No category

Clinical Rotation Manual for
Faculty & Students
2012 – 2013
Class of 2014
Touro University-California
College of Osteopathic Medicine
Department of Clinical Education
JC Buller, MD
Walter Hartwig, PhD
Jennifer Weiss, DO
Greg Troll, MD
(PRELIMINARY DRAFT)
Copyright Touro University, California
All rights reserved.
This edition was first published in 2009.
This manual was revised in May 2012.
The information herein applies to the Academic Year 2012 - 2013
and is subject to change at the discretion of the University.
Touro University, California
1310 Johnson Lane
Mare Island, Vallejo, CA 94592
1-888-652-7580
www.tu.edu
Clinical Rotation Manual For Faculty and Students
Touro University-California
Clinical Rotation Manual for Faculty & Students
Editors:
JC Buller, M.D.
Associate Dean, Clinical Education
Associate Professor, Medicine
Touro University-CA, College of Osteopathic Medicine
Walter Hartwig, Ph.D.
Assistant Dean, Clinical Education
Professor, Basic Science
Touro University-CA, College of Osteopathic Medicine
Jennifer Weiss, D.O.
Director of Clinical Medicine Courses
Assistant Professor, Medicine
Touro University-CA, College of Osteopathic Medicine
Greg Troll, M.D.
Director of Clinical Faculty and Curricular Development
Professor, Medicine
Touro University-CA, College of Osteopathic Medicine
Clinical Rotation Manual For Faculty and Students
Touro University-California
Clinical Rotation Manual For Faculty and Students
Touro University-California
This manual is divided into three sections:
The first is information for faculty, attending, and rotation coordinators. If you are
faculty or a rotation site coordinator reading this, you may find it useful to also review the
third section, which contains learning objectives and requirements for your students. You
may also find it helpful to direct the students under your supervision to review this manual.
The second section is information for students. If you are a student reading this, you
may find it helpful to review the information in the first section. Sometimes providing this
information to your attending can improve the didactic environment and provide you with a
more rich experience.
The third section pertains to the clinical curriculum and contains the syllabi for the
clinical courses.
Clinical Rotation Manual For Faculty and Students
Touro University-California
Clinical Education Department & Contact Information
JC Buller, M.D., Associate Dean
707-638-5243
[email protected]
Walter Hartwig, Ph.D., Assistant Dean
707-638-5410
[email protected]
Greg Troll, M.D., Director of Clinical Faculty and Curricular Development
707-638-5292
[email protected]
Jennifer Weiss, D.O., Director of Clinical Courses
[email protected]
Irina Jones, Manager
707-638-5278
[email protected]
Mieshia Blackwell, Administrative Coordinator
707-638-5279 phone
[email protected]
Heather Page, Grades Coordinator
707-638-5274
[email protected]
Kaitlyn Jackson, Fourth Year Coordinator
707-638-5938
[email protected]
Andy Uchiyama, Interim Third Year Coordinator
707-638-5293
[email protected]
Clinical Rotation Manual For Faculty and Students
Touro University-California
Clinical Rotation Manual For Faculty and Students
Touro University-California
Table of Contents
Part I For Our Clinical Faculty
MessageStatement
from Clinical Education
Mission
Osteopathic Facts and Statistics
Osteopathic History Philosophy and application of Principles
Philosophy and General Goals of Clinical Training
Overview of the Clinical Training Program
Your participation in Curriculum Development
Administrative Guidelines for Clinical Sites
Overview
Orientation
Testing
Legal Issues
Guidelines for working with students
Objectives and Reading Assignments
Patient Interactions, Procedures and Documentation
Student Expectations and Evaluations
The Use of OMM during Rotations
Faculty Development Tools
Teaching Goals for Clinical Faculty
Types of Questions to Consider
Patient Chart Review Discussion
Reading Assignments
Tips for Efficient Instruction
Pearls for Faculty
Teaching Tips and Strategies for Preceptor
Image of Preceptor Evaluation
Part II for Students
Overview of Clinical Training
Policies and Procedures
Basic Graduation Requirements
How it Works: Clinical Education Department Guidelines
Clinical Rotation Procedures and Expectations
Overview of Year 4
Rank Order Lists and the Match Process
Frequent Issues That Have Simple Answers
2
2
2
3
3
3
4
4
4
6
6
6
6
7
7
8
9
9
9
9
10
10
11
13
23
25
26
27
32
35
47
56
58
Part III Clinical Curriculum
Core Clerkship Syllabus Internal Medicine
Pediatrics Core Clerkship Syllabus
Surgery Core Clerkship Syllabus
Clinical Rotation Manual For Faculty and Students
64
83
91
Touro University
OB/GYN Core Clerkship Syllabus
109
Psychiatry Core Clerkship Syllabus
119
Core Clerkship Syllabus Family Medicine
Appendixes
135
156
Clinical Rotation Manual For Faculty and Students
Touro University
Part I
Clinical Faculty
Clinical Rotation Manual For Faculty and Students
Touro University-California
1
One of the most important roles medical professionals can serve is that of mentor. While
there is much to be learned from classroom studies and written resources, nothing can
substitute for the opportunity to train under the supervision of an attending in a clinical setting.
Sir William Osler, the renowned Canadian physician, once said, ―To study the phenomenon of
disease without books is to sail an uncharted sea, while to study books without patients is not to
go to sea at all.‖
If you have any questions or concerns regarding the clinical training program at Touro
University College of Osteopathic Medicine, please contact the Department of Clinical
Education at (707) 638-5279.
MISSION STATEMENT
TUCOM prepares students to become outstanding osteopathic physicians who uphold
the values, philosophy and practice of osteopathic medicine and who are committed to primary
care and the holistic approach to the patient. The College advances the profession and serves its
students and society through innovative education, research and community service.
Touro University College of Osteopathic Medicine has revised our strategic plan to
meet the mission of the College. In 2005, greater than 60% of our graduates entered Primary
Care residencies. As the alumni grow, these graduates will serve our surrounding communities
and the communities of Northern California. Although we are a young institution, the College
enjoys a distinctive reputation of placing alumni in prestigious institutions holding leadership
roles within their training programs. Alumni have also distinguished themselves in the area of
research.
OSTEOPATHIC FACTS AND STATISTICS
There are about 64,000 active osteopathic physicians in the United States. The nearly 30
campuses with colleges of osteopathic medicine graduate approximately 4,000 osteopathic
physicians each year.
There are about six applicants for each student who matriculates; TUCOM-CA received
approximately 4000 applications for 135 available positions in 2010 - 2011.
OSTEOPATHIC HISTORY, PHILOSOPHY AND THE APPLICATION OF OSTEOPATHIC
PRINCIPLES
The Osteopathic Profession began in 1892 by Andrew Taylor Still, M.D., a practicing
physician in Missouri and Kansas. It developed during the pre-antibiotic era and massive flu
epidemics of the mid 1800’s as a drugless alternative to help reform the medical practices of the
day, and better treat suffering patients.
Osteopathic medicine has evolved along with medical science, and today’s Osteopathic
Physicians are fully trained in all modern medical practices, including manipulative medicine.
The next generation of DO’s is trained at Osteopathic medical colleges, in hospitals and medical
practices, both Osteopathic and Allopathic, across the United States.
Clinical Rotation Manual For Faculty and Students
Touro University-California
2
PHILOSOPHY AND GENERAL GOALS OF CLINICAL TRAINING
Primary care physicians are an integral factor in the functioning of the health care
system. At Touro University, College of Osteopathic Medicine, we focus our training on
primary care, while recognizing that some students will choose other specialties. As such, our
goals and objectives are designed to guide students to learn, through competency-based clinical
education, the myriad dimensions of primary care. This includes recognition of their role as
team leaders in providing comprehensive health care to the individual, to the family, and to the
community. Throughout their training, students will develop an understanding of the role of
the primary care physician while recognizing the need for consultation with other medical
specialists when appropriate.
•
•
•
•
•
•
•
•
•
•
•
The TUCOM-CA clinical curriculum is designed to ensure students:
Acquire basic clinical knowledge and essential clinical skills.
Foster analytic and problem-solving skills necessary for physicians involved in disease
prevention, diagnosis, and treatment in individual patients, families, and communities.
Deepen their understanding of Osteopathic Principles and their application to enriching
the health of their patients
Critically evaluate current and relevant research; and apply the results of the research to
medical practice.
Demonstrate the ability to integrate behavioral, emotional, social and environmental
factors of families in promoting health and managing disease.
Appreciate the differences in patient and physician backgrounds, ethnicity, beliefs and
expectations.
Cultivate compassionate, ethical, and respectful, physician-patient relationships.
Develop an understanding of contemporary health care delivery issues.
Share tasks and responsibilities with other health professionals, including recognition of
community resources as an integral part of the health care system.
Engage in reflection on his/her own practices and make changes as needed.
Develop the interest and skills necessary to continue lifelong learning.
OVERVIEW OF THE CLINICAL TRAINING PROGRAM
The Clinical Clerkship Program provides students with education and training in the
general areas of family medicine, internal medicine, obstetrics & gynecology, pediatrics,
psychiatry, and surgery; as well as exposure to additional specialty areas, such as critical care,
anesthesiology, emergency medicine, geriatrics, pathology, and radiology. Rotations take place
at a variety of clinical sites ranging from private, public and university based hospitals to
private and community based clinics. In order to give students the opportunity to pursue
individual interests, and to make decisions about options for residency training, flexibility is
provided in both the third and fourth year schedules.
YOUR PARTICIPATION IN CURRICULUM DEVELOPMENT
We at the clinical education department strive to produce didactic and practical
materials for the students which will support the training you are providing in the clinical
setting. The students participate in a standardized examination with simulated patients called
the OSCE (objective structural clinical examination). They have online reading materials,
objectives, quizzes and exams. All of these materials are updated continually and your
Clinical Rotation Manual For Faculty and Students
Touro University-California
3
participation is welcomed. If you have any interest in helping develop materials, including
submitting test questions, objectives, or lectures, or have other ideas, please contact The
Clinical Education Department.
ADMINISTRATIVE GUIDELINES FOR CLINICAL SITES
I. Overview
Our students rotate through a variety of clinical sites and have the challenge of being
new to their learning environment multiple times throughout their two years of clinical
education. Your assistance in helping them, as quickly as possible, get acquainted with
facilities, regulations, faculty and personnel is greatly appreciated. Below you will find some
general expectations of your site. Please contact us if any of these pose difficulties for you.
Clinical sites, in coordination with TUCOM-CA, will define the degree of student involvement
in their own institutions. While students are given general guidelines in terms of activities,
professional behavior and requirements, it is understood that they must comply with all
requirements related to patient care as established by the clinical site and that this supersedes
any guidance from Touro University.
II. Orientation
Students should be provided appropriate orientation to the clinical facilities. The
following should be included in the orientation:
1. Faculty and Personnel
a. Students should be introduced to the supervising physicians. Students should be informed
to whom they are responsible and how that person or persons may be reached when needed.
Additionally, if anyone other than the supervising physician will be evaluating or grading the
student, the student should be informed of this and introduced to these people.
b. Students should be introduced to staff, including nurses, technicians, and administrative
staff with whom they are expected to interact. Roles and types of interactions should be
explained.
2. Physical plant
Students should be shown the following:
a. Patient rooms
b. Safety procedures and announcements (fire, codes, etc)
c. Nurses’ stations
d. Ancillary services facilities (x-ray, laboratory, medical records, etc.)
e. Rest rooms and locker areas
f. Conference areas
g. Lounges, cafeteria or coffee shop
h. Library and Internet access if available
3. Patient Interaction, Scheduling, and Procedures
a. Patient interaction and Documentation
i. Interviewing and examining patients is one of the most critical parts of student
training. Whenever possible the student should be allowed to perform these tasks.
Clinical Rotation Manual For Faculty and Students
Touro University-California
4
When it is not appropriate to leave the student with the patient, they should be allowed
to observe the attending performing the H&P. Whenever possible, students should
document their findings in the medical records.
ii. It should be clearly defined initially whether students may document in the patient’s
medical record and, if so, what students are permitted to write (e.g. Progress notes and
H&P, orders etc) if your clinic or institution does not allow students to write in official
medical records, please have the student write notes outside of the official patient
charting system, understanding they will need to comply with HIPPA requirements.
c. No student may place orders in a chart that have not been countersigned by the
attending physician.
b. Procedures
Observing and attempting procedures is also a vital part of clinical training. It should be
clearly defined initially whether students may participate in procedures, and at what
level supervision is expected for all procedures.
c. Student Schedule
A schedule should be provided to the student at the start of the rotation.
i. Although patient care assignments take precedence over lectures and
conferences, the hospital and attending physicians are encouraged to allow the
students to attend scheduled lectures.
ii. Absences from clinical duty must be cleared in advance by the director of the
individual clinical service. If attendance at mandatory lectures and conferences is preempted by patient care assignments, this absence must be cleared by the DME.
iii. For more information about attendance expectations, see the student portion
of the manual page 26
iv. It is recommended that the following incorporated into the schedule for each
rotation. Details about these activities can be found in the next section of this manual.
o Meeting on the first day with attending to discuss expectations for rotation
o Mid rotation meeting with attending to discuss performance, give student a
written evaluation and make suggestions on where to focus during the rest of the
rotation. Attendings should take the opportunity not only to assess what the
student has done well, but to offer advice on how the student can improve.
o Anticipated time commitment.
o Any duties or responsibilities.
o Conferences and Educational Seminars: whenever possible students should
attend conferences and lectures if they are accessible, such as grand rounds,
M&M rounds, journal clubs and department meetings
o Suggested rounding times – such as pre-rounding in hospital if appropriate, as
well as times when student will make rounds or see patients with attending.
o Presentations or reports to be delivered by student, this includes case
presentations, case study analyses or critiques
o Date of Post rotation exam (see below for information about testing)
o Other possible activities
• Demonstrating or learning diagnostic techniques and procedures
• Doing medical audits with house staff members
• Working with adjunctive staff such as respiratory therapist,
ultrasound technician, vaccination nurse etc.
Clinical Rotation Manual For Faculty and Students
Touro University-California
5
III. Testing
Students must take a post rotation exam after the following rotations: Third year:
Family Practice (8 weeks), Internal Medicine ( 8 weeks) , Surgery ( 8 weeks) Psychiatry ( 4
weeks) Pediatrics ( 4 or six weeks) OB/GYN ( 4 or 6 weeks).
If you are the supervisor for any of the third year rotations and the rotation does not
occur at a site local to Touro, your assistance proctoring this exam is requested. These are high
stakes exams for the students. They are given two hours to take each exam online. They must
be logged on by an attending and if the internet service is unreliable it will affect the exam
environment. Please contact the Clinical Education department if you have difficulty providing
an adequate testing environment.
Students will need two hours to complete the exam. Information about logging them in
as well as passwords will be emailed monthly to the proctor at your site. Please contact the
Clinical Education department 3rd year coordinator if you are not receiving these emails or if
you need to change the email address to which they are sent. If there is a problem with
computer or connection speed you may need to assist the student in completing the exam by
logging them in again, or when appropriate giving them extra time.
The exams are high stakes for the students and should be taken seriously. As the exams are
offered throughout the year, students are not allowed to view the exam except when taking it or with a
proctor who can document that they are not copying the exam for future use.
IV. Legal Issues
1. OSHA/HIPPA
Student will arrive having completed training in both HIPPA and OSHA standards. A
certificate reflecting this is available from the Clinical Education Department.
2. Malpractice Insurance
All students on approved clinical rotations in the United States are covered by the
professional liability insurance of TUCOM during their OMS 3 and OMS 4 years. Copies of the
insurance binder are sent directly to rotation sites and cannot be provided to students directly,
as coverage applies only to school-approved activities.
GUIDELINES FOR WORKING WITH STUDENTS
I. Objectives and Reading Assignments
The specific objectives for each rotation are defined in the student portion of this
manual. In addition to active clinical hours students are expected to spend approximately 2
hours per day reading. However, the best teaching you can offer your students is that which is
focused on the patients you see together. It is not expected that as an attending you will teach
students about every topic. Students are given objectives as guidelines to ensure that they cover
a broad range of topics, spend time in didactic study and prepare for their board exams. They
will, however learn best from studying and reading about situations which they have had
experience with in your clinical site, and your guidance in this is often strong motivation for
students. Follow up after a recommended reading assignment ensures students take your
suggestions seriously.
As mentioned above, specific objectives for each rotation may be found in the student
section of this manual. We are constantly striving to improve the education of our students and
value your input. If you have any feedback regarding our goals and objectives, or would like to
participate in development of rotation materials, please contact the Clinical Education
Department.
Clinical Rotation Manual For Faculty and Students
Touro University-California
6
II. Patient Interactions, Procedures and Documentation
1. As much as possible the student should be occupied seeing patients. Ideally they should
be assigned to specific patients. Histories and physical examinations should be
completed on those patients and students should follow them for during as much of
their rotation as possible. If the rotation is inpatient, the student should perform ―prerounds‖ on patients or chart review, and accompany the attending on rounds, reporting
to you as appropriate. When it is not possible for the student to pre-round or see
patients on their own they should observe your patient interactions and consultations.
2. After seeing patients, students should document the interaction. Ideally, the student
should complete an average of at least one complete H&P per day and two SOAP notes
as a minimum. Your critical and careful feedback on these documents is extremely
useful to students. Please take time to review at least some of the students written
records with the student author. The student should have time and opportunity for
patient follow-up.
3. Please allow students to observe, assist and perform diagnostic procedures under
appropriate and proper supervision, in those areas where the training institution
regulations permit such instruction. As with all procedures, students should learn to
document them appropriately and your assistance and feedback with this are
invaluable.
4. Students should be encouraged to attend all educational conferences and seminars
offered at your institution while on rotation.
III. Student Expectations and Evaluations
One of the more challenging aspects of teaching medical students is creating clear
expectations and appropriately evaluating the student. Below are some general guidelines
that may facilitate this process.
1. On the first day of the student rotation, set aside some time to review your schedule
and the student schedule for the time you will be working together. Discuss with the
student your expectations of them, including time you expect them to spend with you, or
independently studying. If possible, suggest topics you feel are important for them to know
well.
2. Mid way through the rotation, set aside time to formally discuss performance, give
the student a written evaluation and make suggestions for what to focus on during the rest
of the rotation. Attendings should take the opportunity not only to assess what the student
has done, but to offer advice for how the student can do better. Every effort should be made
to counsel and assist those students having difficulty in a particular service. Students who
are particularly adept in a specific service should be given additional opportunities to learn
at the discretion of the appropriate supervising physicians and the DME in accordance with
hospital or clinical regulations. If you are having concerns about the students performance,
please do not hesitate to contact the Assistant Dean of Clinical Education at Touro
University.
3. On the last day of the student’s rotation, set aside time again to discuss and complete
the clinical performance assessment form. Give the student a copy of their assessment, but
please also send it to the department, via fax, email or regular mail.
Each of the 14 clinical competencies is evaluated on the form and have been applied to
the ClinEd course objectives A grade should be marked for each competency section, and an
overall recommendation for pass or fail for the rotation should be indicated. If the students
receive below 70% average, they will be required to remediate the rotation. Faculty should
add narrative comment to give the most specific guidance possible to the student. The
Clinical Rotation Manual For Faculty and Students
Touro University-California
7
overall narrative, positive and constructive comments will be included in the Medical
Student Performance Evaluation (MSPE; formerly the Dean’s letter).
It is important to note that students are evaluated against the standard of what should
be reasonably expected from a medical student at the same point in training.
These forms are the primary tool used to grade and rank third and fourth year students.
As such they will be most useful if they are completed based on your experience of the
students’ skill and knowledge. Additionally, timely submission via USPS is extremely
important as it affects students’ official transcripts, which in turn is critical for residency
application, financial aid check distribution and matriculation. Please submit the forms, no
later than 2 weeks from the end of the rotation, to:
Clinical Education Department, Touro University
c/o Grades and Evaluations Coordinator
1310 Club Drive, Building H-83
Mare Island
Vallejo, CA 94592
While we recognize and value the contributions made to student education by non-physician
staff, ultimate responsibility for students (and the signature on the evaluation form) must be the
province of a licensed physician (D.O. or M.D.).
IV. The Use of OMM during rotations
Overview: Your TUCOM-CA student has been carefully instructed in the use of OMM.
Your student is capable of providing OMM to your patients as an adjunct to your medical care,
the goal being to enhance your patient’s clinical outcomes. Your student may not apply OMM
without your permission. Students should be encouraged to do structural examinations, render
Osteopathic Manipulative Therapy (OMT), and document appropriately. OMM is generally
well tolerated and appreciated by patients. It is reliably safe, and effective in a broad variety of
clinical c on d it i o n s . Your TUCOM-CA student should be able to ease a wide variety
of musculoskeletal pains, as well as apply OMM to a variety of clinical circumstances such as,
but not limited to, easing the breathing of asthmatics, decongesting sinuses, decreasing
peripheral edema, treating common post surgical complications such as ileus, and preventing
atelectasis to name a few.
OMM RISKS: Osteopathic treatment is generally well tolerated, and has a low incidence
of adverse outcomes when carefully applied.
OMM Backup: You and your TUCOM-CA student are, should the need arise,
encouraged to consult with TUCOM faculty regarding the use of OMM in the various clinical
settings
OMM Procedure: We encourage you to ask your student: ―how would you utilize OMM
in this case?‖ Expect a rational answer that describes how the application of OMM might effect
a positive physiologic & clinical change in your patient. Your student should write a procedure
note that describes the OMM modality recommended OMM treatment time will vary,
depending on the complexity of the case, the severity of the illness, and the experience of the
student.
Clinical Rotation Manual For Faculty and Students
Touro University-California
8
FACULTY DEVELOPMENT TOOLS
I. Teaching Goals for Clinical Faculty
Clinical teaching faculty should be able to:
General
1. Clearly explain course objectives and directions to learners
2. Help learners organize their learning activities
3. Ask questions at various taxonomic levels to stimulate thinking
4. Respond to learners so that their interest and involvement in the learning
process and strengthened
5. Direct learners to the literature and other resources when they lack
prerequisite knowledge or have special interests Assign outside readings or tasks to
reinforce learning
Clinical Instruction
1. Describe differences between inpatient and outpatient teaching
2. Orient learners to each particular patient care setting
3. Help learners set realistic learning expectations by assigning responsibilities
appropriate to the developmental stage of each learner
4. Insert oneself into the clinical situation to model appropriate practices,
attitudes, and interpersonal skills
Small Group Instruction
1. Coordinate various types of small group instruction (e.g., seminars,
simulations, discussions)
2. Develop tasks and/or problems to be addressed by a group
3. Lead a discussion and delegate tasks to group members
4. Develop simulations to be used by a group
II. Types of Questions to Consider: Attempt to ask open-ended question
“What do you think is going on with this patient?”“What conclusions do you draw from the
data?”'What are the drug side effects?”“What evidence supports your conclusions?”“What is your
treatment plan for this patient?”“What is the next step in this patient's work-up?”“If your conclusions
are correct, what is the patient's prognosis?”“If the patient were a 17-year-old female instead of 52-yearold male, what would your differential diagnosis be?”'What are the implications of the diagnosis for the
patient's lifestyle?”
III. Patient Chart Review Discussion
Charting is an invaluable experience for our students – it provides them an opportunity
to learn about patients, disease systems and treatments as well as tools for effectively
communicating information regarding a patient’s health history. Reviewing chart notes and
H&P’s with your student can help them to learn effective succinct ways to summarize a
patient’s current condition, critical information that must be included in notes regarding care, as
well as how to manage disease processes.
Student documentation on patient charts can be used to assess student knowledge,
organization and problem solving. The student's written presentation of the patient's history
and physical and/or progress helps to document the student's clinical competency. Patient
charts can serve as a catalyst for teaching discussions. Medical students frequently report a lack
Clinical Rotation Manual For Faculty and Students
Touro University-California
9
of feedback on their written records. This gives rise to the perception that their work is not
valued, and that their write-ups are more ―busy work‖ than a learning experience. This lack of
recognition can sabotage the learning value of written patient assessments.
Furthermore, tracking student progress and response to feedback through review of their
written records facilitates completing evaluations at the end of the rotation and assists the
University and the students in assessing the adequacy of our training program.
V. Reading Assignments
After giving a mini-lecture or discussing a patient with a student, if they don’t have full
mastery over the topic, consider suggesting a reading assignment for that evening. If you have
resources you would choose (favorite text, journal or online source) suggest them. This gives
students guidance both for the immediate assignment and for the future as it models use of
good resources and lifelong learning skills. Also important in the case of giving a reading
assignment is to follow up. Simply asking the student the next day about it will reinforce your
expectations that they do the reading. Even better ask the student to tell you something they
read about or follow up on the patient that inspired the assignment. Please keep in mind that
the students are expected to follow our specific curriculum which includes online didactics,
recommended readings, and quizzes.
VI. Tips for Efficient Instruction
1. State clearly that your time is limited; set limits to encounters. For example, say to the
student, ―I can meet with you now for 10 minutes. You can have five minutes to ask me
questions, and then I need to give you some feedback on the patient we saw together this
afternoon.‖
2. Make assignments that are specific and time limited. ―Go in, get as much history as you
can in 10 minutes, and then come out and present it to me.‖ ―I have five minutes to discuss
this case. Please limit your presentation to three minutes.‖ ―I'd like you to examine this
gentleman's knee for 10 minutes, then I'll come in and we'll discuss your findings.‖
3. Have students carry a notebook to record their questions during the day. Follow up with
them at the end of each day for 15 to 20 minutes.
4. Honor your appointments with students and make them brief. If you say you'll discuss
patients with your student during the noon hour, be sure to do so.
5. Ask students to read about the problems of specific patients they've seen during the day.
Be specific about where they may be able locate this information (textbooks, journals, article
files, etc.). Set the expectation that the next morning you will check on this. You may ask
them to give you a 10-minute oral presentation about one of the problems they've prepared.
(This approach assures that they will do a wide range of reading but does not involve you in
listening to a long series of oral presentations. Be sure to follow up and check on one of the
problems you've assigned.)
6. Be realistic about how much you attempt to teach. You can't teach the whole discipline.
Teach what you judge the student needs and what she or he has expressed interest in.
7. Expose students to your busy schedule. Take your student with you as you attend noon
Clinical Rotation Manual For Faculty and Students
Touro University-California
10
conferences, hospital committees, boards, and civic activities.
8. Conduct discussions/tutorials as you commute with the student by car, by foot, etc.
9. Jot down patient care pearls that arise in conversation and on teaching rounds. Collect
these in a list and share with the student at the end of the clerkship and with the next
student(s).
10. Use other staff in your office to teach the student. Include partners, nurses, business
managers, receptionists, etc.
VII. Pearls For Faculty
1. Prior to the student’s arrival, make sure the office staff has been notified.
2. Early in the rotation, take time to get to know the student.
3. Take the student under your wing; make him or her feel welcome, and part of the team.
4. At the end of the day, have your staff photocopy the next days schedule. Then, take a
few minutes to review it with your student, highlighting those patients you feel would be
educationally beneficial for the student to see. The student can then direct reading activities
in anticipation of the next day’s patient-related medical concerns.
5. Often, you don't have time to answer the student's questions during a busy office
schedule. Have the student carry note cards at all times. When questions arise, the student
can write them down. Later in the day, or as time permits, review the student's questions.
6. Be educationally specific when you send the student in to see a patient. For example,
focus on just the student's ability to gather data, or perform a specific examination, or
present an adequate differential diagnosis. This minimizes trying to cram too much into the
teaching encounter and helps solve time-demand issues.
7. Save some feedback until the end of the day. Use the charts to jog your memory
regarding the student-patient encounter.
8. Have other learning activities available (5-10 minutes in length) for the times when
patients refuse student contact, i.e., slides, audiocassettes, an article, work with lab tech or
office staff, piggyback with another physician, etc.
9. The student does not have to see ALL the patients. It's more instructive for them to do
fewer but have time to learn from them, and really think about helping solve their problems.
3 or 4 per 1/2 day session in an outpatient setting is fine.
10. Don't be afraid of homework. Students can look things up and report back.
11. You don't have to know all the answers; in fact, it's helpful if you don't. Students need
to learn how to deal with uncertainty and how to work through problems.
12. Introduce the student to your family and other medical colleagues, attend a civic
Clinical Rotation Manual For Faculty and Students
Touro University-California
11
meeting or hospital staff meeting, etc. If the student was particularly interested in your
practice and demonstrated an aptitude for it, drop a short note to him or her one to three
months following the rotation, acknowledging the student's performance and encouraging
him or her to consider your discipline as a viable career choice.
Clinical Rotation Manual For Faculty and Students
Touro University-California
12
Teaching Tips and Strategies for Preceptors
By Tami Hendriksz
Why Teach Medical Students?
• Obligation to return some of the teaching you received in medical school
• Personal fulfillment as a good educator
• Being able to interact with medical students, the bright young minds of tomorrow
• Refining your own skills as a clinician and as a teacher
• Keeping abreast of the latest medical knowledge
• Recognition by colleagues and patients as an educator
• Academic acknowledgment
What Medical Students are Looking For:
• Adequate number and wide variety of patients
• Supervision by an enthusiastic preceptor who gives prompt feedback
• Preceptors who are willing to discuss their reasoning processes
• Preceptors who are willing to delegate responsibilities
• Having quality teaching rounds and conferences
Five Attributes of an Effective Preceptor:
• Demonstrates professional expertise
• Actively engages students in learning
• Creates a positive environment for teaching and learning
• Demonstrates collegiality and professionalism
• Discusses career-related topics and concerns
How Students Differ From Residents:
• Preceptor interaction is most important for students
• Residents most value issues pertaining to patient logistics
• Learning resources are less valued in early and late training
• Teaching and case review is less valued as learners advance in training
• Students desire more structure, more explanation, and more supervision. This desire
decreases as level of experience increases.
Clinical Rotation Manual For Faculty and Students
Touro University-California
13
Identify characteristics of a student / novice learner:
STAGES OF LEARNING:
Stage
Learner’s behavior
Teacher’s behavior
Unconscious incompetence
Lacks knowledge of even what it is that
cannot be done
Orients learner to skill; explains rationale
for learning skill, objective, and
performance outcome; demonstrates skill
(―see one‖); gives motivational feedback
Conscious incompetence
Cannot perform the skill but knows what
it is that cannot be done
Guides initial attempts of learner to perform
the skills; observes learner practice (―do
one‖) and gives frequent and ongoing
informational feedback
Conscious competence
Can perform the skill but has to work
(hard) to get through the skill (because of
demands of ―cognitive processing‖)
Allows more independent practice (―do
many more‖) and decreases learner’s
reliance on teacher feedback
Unconscious competence
Performs skill automatically and
confidently (on ―auto pilot‖)
Provides greater distance from the learner
and interferes less
EXPERT VERSUS NOVICE PROBLEM SOLVING SKILLS:
Novice
Tends to get mired in details and treats every detail as
equally important
Fact laden, but retrieves relevant facts slowly
Has no context for application
Expert
Easily discerns important features and patterns (―pattern
recognition‖)
Demonstrates content expertise that is organized in ways
that reflect deep understanding
Has conditional knowledge that demonstrates multiple
contexts of application
Exerts efforts to retrieve details
Effortlessly retrieves detailed knowledge
Focuses on surface features of problem
Focuses on source of problem
Jumps to conclusions and demonstrates flawed thinking
by faulty synthesis and ignoring key data
Avoids snap judgments and is willing to change mind;
pays attention to clinically significant details
Permission granted by and compliments of Judy L Paukert, PhD
Clinical Rotation Manual For Faculty and Students
Touro University-California
14
Qualities of an effective teacher:
• Personal
o Teach with enthusiasm
o Teaching is its own reward
o Treating students with respect
o Providing a role model
ƒ Clinical Competence
ƒ Professional Behavior
• Most common transgressions
o Derogatory language toward other services
o Derogatory language toward patients
o Disrespectful treatment of staff and patients
• Teaching Philosophy
o Intrinsic motivation is better than extrinsic motivation (test, grade)
o Aim for a higher level of cognition than accumulation of facts
ƒ Information learned should be filtered into a structured and organized
format for use in future clinical scenarios
o Learning complex concepts and then utilizing them takes time
• Teaching Behavior
o Inspiring confidence in medical skills
o Explaining the decision making process
o Actively involve students in the learning process
o Promote learner autonomy
o Communicate expectations for performance
o Focus on what they really need to know as practicing physicians
Barriers to effective clinical teaching:
• Hectic and unpredictable schedule of patients
• Patient privacy and confidentiality concerns
• Complex cases
• Administrative responsibilities
• Balancing the time available for teaching and patient care
• Inexperience with bedside teaching
• Lack of self confidence
• Lack of effective teaching skills
Techniques to Prevent Students from being overwhelmed or overwhelming you!
• Orientation
o Goals and objectives of the rotation
o Administrative details of the rotation
ƒ Patient flow
ƒ Computers / Charts / Paperwork
o Patient Selection
ƒ Preceptor directed
ƒ Autonomy based on abilities
• Reassurance
o Not alone in patient care
o Keep pace reasonable
o Priority is on learning
Clinical Rotation Manual For Faculty and Students
Touro University-California
15
o Responsibility is to primary patients
•
Structure the experience
o Patient Selection
o Presentation Format
o Evaluation / Feedback Format
Clinical Teaching:
• Administrative Aspects:
o Guide the student in their selection of patient to meet their level of ability
o Allow student time to complete directed H& P
o Allow time to review records and develop presentation
• Student Presentation
o The case presentation is the PRIME FOCUS of the preceptor-student interaction
o Inform the student what you expect from the presentation
o Allow student to finish without interruption
o Expect student to develop a differential diagnosis list and an evaluation and
treatment plan
ƒ Insight into their thought process
ƒ Identify their level of knowledge on subject
• Feedback is a crucial tool in effective teaching
o Identify areas of strengths and weaknesses
o Offer suggestions to aid improvement
• Generalize the learning
o Give Rules of Thumb or Clinical pearls not available by reading
o ―Do this‖ turns into ―do this every time‖ unless accompanied by an explanation.
• Promote reflection
o Encourage students to self evaluate
ƒ Knowledge
ƒ Skills
ƒ Experiences
• Observation of Students
o Can limit it to a portion of the history or physical
o Planned observation of specific portion
o ―Incidental‖ observation
ƒ Professionalism
ƒ H&P skills
• Interesting Patients / Findings
o Allows student to view a wide variety of disease without specific patient care
responsibilities
o Increases chance of seeing patients with less common disorders
o Can be presented as ―mystery‖ diagnosis
o Quick, directed teaching points
o Non-human encounters
ƒ ECGs
ƒ Radiographs
Old case presentations
Clinical Rotation Manual For Faculty and Students
Touro University-California
16
Motivating Students: Going Beyond Grades
While many students are naturally motivated, others are driven by grades and still others
expect their teachers to inspire and stimulate them. Of course, there are no magic bullets, but
here are some simple guides to help you keep students focused and motivated.
1. Help students feel they are active participants in the learning community, not just
recipients of your information. Treat them with respect.
2. Capitalize on students' existing needs. They will want to learn so they can accomplish a
task, improve skills, and meet challenges. Help them find personal meeting and value.
3. Hold students to a high standard. This tells the students you believe they can accomplish
much and also gives them a feeling of success when they meet those standards.
4. Rely on logic whenever possible. Tell student when something is a fact that must be
memorized and when the material or process is based on logic. Don't forget to lead them
through the "logic pathway."
5. Use visual aids, since many of today's students are visual learners.
6. Emphasize the most critical points continuously through exams, classroom activities,
clinical opportunities and other learning contexts.
7. Help students create a link to earlier learned information when teaching new concepts.
Remember these links can be to clerkships other than ob-gyn and to specific clinical
activities.
8. As a teacher, be enthusiastic, organized and involved.
9. Emphasize mastery and learning, rather than grades.
10. Provide feedback as soon as possible.
Reference
From http://www.apgo.org/getinfo/teaching-tips.cfm
Honolulu Community College. Faculty development teaching techniques: Core
abilities-Motivating students. Barbara Gross Davis. Motivating students; Lana Becker
and Kent N. Schneider, Motivating students: 8 simple rules for teachers.
http://honolulu.hawaii.edu/intranet/committees/FacDevCom/guidebk/teachtip/tea
chtip.htm
Thinking Out Loud
What is a proven way of helping learners develop good reasoning habits for making the
differential diagnosis or identifying treatment strategies? You can model these
reasoning skills by thinking out loud; that is, verbalizing your thoughts when you are
seeing patients together.
Start with a cue that tells the learner you are thinking aloud, like "let's see now…she has
right, lower quadrant pain that suddenly started six hours ago and has gotten worse.
Clinical Rotation Manual For Faculty and Students
Touro University-California
17
She's nauseous, but has no vomiting or fever. Her last menstrual period was six weeks
ago. At this point, I'm most concerned about ectopic pregnancy or appendicitis, as these
are potentially life threatening. I'm going to need more information to make the
diagnosis. My next step will be the physical examination."
Thinking out loud teaches reasoning steps, gives rationale to the plan, demystifies the
process, fosters open communication and sets the stage for asking questions of the
learner; e.g., "What should I be looking for in the physical examination of this patient?".
Source
Edwards JC, Marier RL. Clinical teaching of medical residents: roles, techniques, and
programs. Springer, New York, 1988.
Experience is the best teacher...
You are listening to a physician and you hear these words: "Let me tell you about a case that
happened to me." Suddenly your ears perk up and you are fully engaged. Chances are you
will remember this case better than the content of the talk, particularly if the physician uses
an example that is personal and has an emotional element, such as an unexpected outcome
("She nearly bled out and we had to transfuse her repeatedly to keep her alive.").
The often overlooked, but obvious, truth is that physicians, like everyone else, enjoy hearing
real-life stories. Physicians want to hear about other physicians' experiences, particularly the
near misses. They use their clinical reasoning skills to see if the patient's patterns fit with
what they know (scripts) or if they need to adjust their thinking.
When you ask medical learners to problem-solve on your case, you can learn a lot about
their clinical reasoning skills. A study of distinguished clinical teachers found that they use
scripts on teaching rounds to quickly diagnose the patient's problems and, simultaneously,
to diagnose the learner's level of understanding.1
Use your real-life case experiences to help others develop their clinical reasoning skills and
to potentially prevent a mishap. Real experiences are inherently attention-getting and can be
used in any number of ways to teach learners how to problem solve.2
Sources
From http://www.apgo.org/getinfo/teaching-tips.cfm:
1
Irby D. How attending physicians make instructional decisions when conducting
teaching rounds. Acad Med 1992; 67(10):630-638.
Edwards J, Marier R. Clinical teaching for medical residents. New York: Springer. 1988;
70-71.
2
Have the Learner Present in Front of the Patient
If you want to save time and enhance the educational experience in the clinic or at the
bedside, have the learner present his or her findings to you in front of the patient, rather than
in the hallway. Although this may be a little intimidating to the learner at first, patients
prefer this method, as they can hear what is being said about them, they can add to or correct
Clinical Rotation Manual For Faculty and Students
Touro University-California
18
the information and they value the time spent with the physician.
Learners also tend to make more concise presentations in front of the patient. It also gives
you an opportunity to role model the skills you want the learner to acquire as you involve
patients in the decision-making process. It teaches the learner the usefulness of a skillfully
taken history and focused physical exam.
Of course, this approach may not be appropriate for sensitive issues, or in cases where you are
assessing the learner's diagnostic skills. In most cases, however, this approach validates the
patient's issues and strengthens the learner's data collection and presentation skills.
Sources
Alguire P, DeWitt D, Pinsky L, Ferenchick G. Teaching in your office. A guide to instructing
medical students and residents. Philadelphia: American College of Physicians. 2001: 65-67.
Whitman N, Schwenk T. The physician as teacher, 2nd edition. Salt Lake City, Utah: Whitman
Associates. 1997: 185-187.
Clinical Rotation Manual For Faculty and Students
Touro University-California
19
One-Minute Preceptor
The One-Minute Preceptor emphasizes these learning and teaching concepts.6 The model
demonstrates how to teach effectively in short periods of time. By utilizing the One-Minute
Preceptor, the preceptor will be able to quickly evaluate the case then take the most
appropriate course of action for the patient and learner.7
Albert Schweitzer once said, "Example is not the main thing in influencing others. It is the only
thing."8 Learning from experience/example involves a cycle of having a concrete experience
(e.g., an encounter with a patient), reflecting on that experience as it unfolds, formulating
conceptualizations and generalizations from the experience, and testing them in new situations.
That is the basic idea of the One-Minute Preceptor.9 Five microskills form the basis of the OneMinute Preceptor.6 These skills enable the preceptor to analyze the case and the learner then
take appropriate action to teach the learner. The microskills are:
1. Get a commitment.
2. Probe for supporting evidence.
3. Teach general rules.
4. Reinforce what was done.
5. Correct mistakes.
Get a commitment: "What do you think is going on?"
When the learner presents the case, he/she may either wait for a response or ask for guidance
on how to proceed. At this time, ask the learner to state what he/she thinks about the case.
"What do you think is going on with this patient?" "What do you want to do?" Asking the
learners how they interpret the data is the first step in diagnosing the learner's needs. Without
adequate information on the learner's knowledge, teaching might be misdirected and not
beneficial.10
Probe for supporting evidence: "What led you to that conclusion?"
Once the learner has committed to a conclusion, he/she may ask for your confirmation or
suggestion to an alternative. Before offering your opinion, ask the learner for evidence that
supports their conclusion. "What were the major findings that led to your diagnosis?" "What
else did you consider?" By asking the learner to reveal their thought processes, both the
preceptor and learner can find out what the learner knows then determine the gaps in the
learner's knowledge.10 The preceptor should ask basic, obvious questions, and allow the
learner to answer, learn to wait. Ask only one question at a time, and ask open ended questions.
Teach general rules: "When this happens, do this."
Provide general rules, concepts or considerations, and target them to the learner's level of
understanding. Instruction is both more memorable and transferable if it is offered as a general
rule.6 For example, "The key features of this illness are…" "The natural progression of this
disease is…" "Patients with cystitis usually experience pain with urination, increased frequency,
and urgency. The urinalysis should show bacteria, white cells, and may also have some red
cells."
Clinical Rotation Manual For Faculty and Students
Touro University-California
20
Reinforce what was done: "Specifically, you did an excellent job of…"
Tell them what they did right. Take the first chance to comment on the specific good work and
the effect it had.10 Positive feedback helps build the learner's self-confidence. Both praise and
criticism need to be as specific as possible.2 With positive feedback, questions arise that allow
the student to seek answers. This self-directed learning is the most lasting of
all experiences. For example, "Your choice of medication was excellent. That antibiotic covers
most of the organisms that we are concerned about."
Correct mistakes: "Next time this happens, try this."
As soon after the mistake as possible, find an appropriate time and place to discuss what was
done wrong, and how to avoid or correct the error in the future. Correcting mistakes was placed
last because many people put this microskill first. Correcting mistakes is very important, but it is
only one part of the teaching encounter, and it requires tact to be effective.6 Unattended
mistakes have a good chance of being repeated. We learn best from our mistakes. For example,
"You could be right that the patient's symptoms are due to an
URI, but without looking at the ears you could easily overlook an otitis media."
Teaching general rules, reinforcing what was done correctly, and correcting mistakes can be
done in any order as long as correcting mistakes is done without embarrassing the learner (e.g.,
in front of the patient). Asking the learner to self-critique may decrease the tension in correcting
mistakes.10
Discussion
In order for the One-Minute Preceptor to work effectively, the preceptor must probe for a
commitment and supporting evidence. The preceptor must also reinforce what was done
correctly and teach according to the learner's needs following their presentation. The
preceptor should try not to lecture. He/she should give adequate feedback and most
importantly, ascertain what the learner knows about the case. We cannot do any form of
teaching without determining the learner's needs. The first two microskills are the most
effective tools in the preceptor's teaching experience. These microskills help determine the
learner's deficiencies and offer direction on how teaching should proceed.
Conclusion
As community-based teaching becomes a greater proportion of the undergraduate experience,
there has been a need for the development of newer teaching methods. Innovations such as the
One-Minute Preceptor model have provided new challenges for both the teacher and the learner
in promoting active learning and effective educational experience.11 Employing this model in
the ambulatory care setting will allow preceptors to satisfy those objectives. Students that
participate in office based experiences value learning the process of patient care as much as, or
possibly more than, mastering core content.12
Excellent one-on-one teaching in a clinical setting requires two major items. First, medical
educators must understand the special communication skills that create effective teaching.
Second, medical administrators must support the faculty development programs needed to
foster excellent teaching. Fortunately for the medical faculty here at UCLA, we have had full
support of the medical administration. William Osler and Albert Schweitzer would be proud.
REFERENCES
Clinical Rotation Manual For Faculty and Students
Touro University-California
21
From http://www.med.ucla.edu/modules/wfsection/article.php?articleid=98:
1.
Deutsch SL, Noble J, editors. Community-Based Teaching: a Guideto Developing Education Programs
for Medical Students andResidents in the Practitioner's Office. Philadelphia (PA): American College of
Physicians;
1997.
2.
Raskind HS. The 5 P's of effective teaching - a guide for the medical preceptor. Proc
UCLA Healthcare. 1999;3:14-16
3.
Elstein AS, Shulman LS, Sprafka SA, et al. Medical Problem Solving: an Analysis of Clinical
Reasoning. Cambridge (MA): Harvard University Press; 1978.
4.
Ferenchick G, Simpson D, Blackman J, DaRosa D, Dunnington G. Strategies for efficient
and effective teaching in the ambulatory care setting. Acad Med. 1997 Apr;72(4):277-280.
5.
Irby D. Plenary Session No. 2. Lecture. GIMGEL Cycle II National Meeting. Denver (CO). 2000
Jun 9.
6.
Neher JO, Gordon KC, Meyer B, Stevens N. A five-step "microskills" model of clinical teaching.
J Am Board Fam Pract. 1992 Jul-Aug;5(4):419-424
7.
The Expert Preceptor Interactive Curriculum. University of NorthCarolina, Dept of Medicine.
Accessed 2001 Sep. Available from: URL: http://www.med.unc.edu/epic/
8.
Schweitzer A. The World of Albert Schweitzer. New York: Harper & Brothers; 1995.
9.
Smith CS, Irby DM. The roles of experience and reflection in ambulatory care education. Acad
Med. 1997 Jan;72(1):32-35.
10.
Bowen J, Eckstrom E. Basic Precepting Skills. Workshop. GIMGEL Cycle II National Meeting.
Denver (CO). 2000 Jun 11.
11.
Hekelman FP, Blase JR. Excellence in clinical teaching: the core of the mission. Acad Med. 1996
Jul;71(7):738-742.
12.
Alguire P, DeWitt D, Pinsky L, Ferenchick G. Teaching in Your Office: a Guide to Instructing
Medical Students and Residents. Philadelphia (PA): American College of Physicians - American Society of
Internal Medicine; 2001.
Clinical Rotation Manual For Faculty and Students
Touro University-California
22
Clinical Rotation Manual For Faculty and Students
Touro University-California
23
Clinical Rotation Manual For Faculty and Students
Touro University-California
24
Part II
For Students
Clinical Rotation Manual For Faculty and Students
Touro University-California
25
OVERVIEW OF CLINICAL TRAINING
The clinical years of medical school will be extremely rewarding and offer a rich opportunity to explore
many aspects of the health care system – both in the United States and internationally. Outside of the
classroom, reality takes hold and you find yourself suddenly at the mercy of the random universe. No longer
able to rely on a syllabus and textbook to guide you to the right answers or even the right topics, you are given
the gift of true learning - one patient, one doctor, one nurse, one world in each moment. You may find on your
surgery rotation that you only see a few different surgeries, or that you see only strange and rare surgeries and
not a single appendectomy – such is the nature of medicine. You may be in a clinic filled with Spanish
speaking patients and no translator, or you may find yourself following a busy attending through a busier day
and never get to speak to a patient yourself. Undoubtedly you will see things that will linger with you for
years to come and you will learn.
Each new rotation brings with it many uncertainties‐ ― will I have time for lunch, will I get to see
patients myself, will I be able to find parking, will I get home in time to see my family….‖ And by the time
you find yourself oriented to one site, likely you will be moving on to another. Breathe deep, practice
mindfulness and trust that you will learn enough. Work hard, improve your discipline and find time for your
loved ones. Read, read, read and take on this vast body of knowledge – it is yours alone to conquer. Yes,
you have to take exams, yes you have to pass your boards, but it is yours to decide what kind of physician
you will be, what you will know, what service you will offer in this world.
Clinical Rotation Manual For Faculty and Students
Touro University-California
26
POLICIES AND PROCEDURES
The policies and procedures described below insure that you will meet the California state
requirements for satisfactory academic progress plus AOA accreditation standards for colleges of
osteopathic medicine. The CED staff work to maintain the record of your satisfactory academic
progress, and this is possible only if students remain within the policies. Current policies and
practices may differ from those in effect in the past; it is important for you to follow the guidelines in
this manual only. The standards that dictate the rotation guidelines are enforced by independent
agents such as licensing boards, the AOA, and our regional accreditors, and are not subject to change
or interpretation. To make your progress as timely as possible please remember these IMPORTANT
POINTS as you read this manual and prepare for clinical rotations:
IMPORTANT POINTS
1)
Read the manual. Refer to it before you query the CED.
2)
All emails from the CED to you individually or to the class as a whole must be read. We respect
your time and attention and will only contact you with actionable, binding, or useful opportunity
information. Prepare your electronic devices to receive emails sent to your tu.edu address, and to
send emails ONLY from your tu.edu address. The official means of communication are via the
tu.edu address domains. You are responsible for receipt of these communications no matter which
device you use to receive and send them. This policy is university-wide and relates to our FERPA
compliance. The Federal Educational Right to Privacy Act allows us to use only internally-secure
servers when we communicate information about your academic record. If your email address
includes a hyphen, multiple names, or a spousal name other than the one you enrolled under, please
remind us of this in your communications.
3)
If you change any contact information you must notify the Registrar and update your E*Value record
immediately.
Please include your contact phone number in every email or voicemail message. This helps us to
respond rapidly to your query from wherever we are.
4)
Remember that Student Services, Student Health, and the CED operate independently. Your
enrollment in the college must remain current and accurate as per the Student Services guidelines.
The CED cannot alter or correct your transcript for you. Currency and accuracy of your Registrar,
Financial Aid, and Student Health records insure that your grades and credentials will be ready
when you need them to be.
5)
The CED serves the needs and progress of second, third, and fourth year students. Each class has
priority issues at different times of the year. Be aware that our ability to move your priorities
forward depends upon how well everyone complies with the policies and procedures in this
manual.
6)
Securing your clinical clerkships is one of the most important functions of the CED. But we
depend upon other offices of the college, especially Student Health, to have current information in
your file. Please submit your protected personal health information (e.g., current immunization
Clinical Rotation Manual For Faculty and Students
Touro University-California
27
data) directly and only to Student Health.
Clinical Rotation Manual For Faculty and Students
Touro University-California
28
Basic Graduation Requirements
You need to be aware of the exclusive and separate requirements of the three organizations that govern your
academic progress: California State Requirements, the CED Guidelines, and the TU-C Registrar.
State of California Requirements
These are immutable and not subject to interpretation.
88 weeks of total clinical rotation
48 weeks of rotation in Year 3 in the following requirements:
8 weeks of General Surgery in two 4-week increments
8 weeks of Family Medicine in two 4-week increments
8 weeks of Internal Medicine in two 4-week increments
6 weeks of Obstetrics and Gynecology to include labor and delivery
6 weeks of Pediatrics
4 weeks of Psychiatry
8 weeks of elective subjects, in 2-week or 4-week increments
40 weeks of rotation in Year 4 in the following requirements:
8 weeks of subspecialty medicine in two 4-week increments
4 weeks of surgical subspecialty in one 4-week increment
4 weeks of critical care in one 4-week increment
4 weeks of emergency medicine in one 4-week increment
4 weeks of primary care medicine in one 4-week increment
16 weeks of elective subjects, in 2-week or 4-week increments
You must complete the 48 weeks of Year 3 before you proceed to the remaining 40 weeks. You do not
become a
4th year student on a specific date in 2012, but rather on the date at which you complete your last third-year
rotation.
California measures weeks, not days. A four week rotation must have a start date and an end date
that are 28 days apart. You are expected to be in clinical rotation on 20 of those 28 days (and more if your
preceptor requests, up to
any 12 days in a 14-day period). Even if you complete the minimum of 20 days of rotation before four calendar
Clinical Rotation Manual For Faculty and Students
Touro University-California
29
weeks have elapsed, you must be scheduled for a rotation of 28 calendar days. Thus, it is not possible to
perform a 3-week elective rotation at a hospital that offers only 3-week rotations, work for 20 days, and ask
that it count as a four-week elective. The only increments are 2-week and 4-week, so you will be credited for a
2-week elective.
Registrar Requirements
YEAR 3
Your 52-week third year will include 4 weeks of vacation, 8 weeks of elective courses, and 40 weeks of
the following required courses:
700A
Internal Medicine 1
4wks
700B
Internal Medicine 2
4wks
701A
General Surgery 1
4wks
701B
General Surgery 2
4wks
702A
Family Medicine 1
4wks
702B
Family Medicine 2
4wks
705
Psychiatry
4wks
706
OB/GYN
6wks
707
Pediatrics
6wks
If you rotate in a state that does not offer a 6-week option for obstetrics or pediatrics, you must register for the
course that fits your time, and then perform the remaining two weeks of each in separate rotations, either in
that state or in California,
BEFORE proceeding to Year 4. The pertinent courses are:
703
OB/GYN
4 wks
704
Pediatrics
4 wks
712
Pediatrics
2 wks
714
OB/GYN
2 wks
Elective course numbers reflect the length of the elective experience.
715
Elective
2 wks
716
Elective
4 wks
Clinical Rotation Manual For Faculty and Students
Touro University-California
30
YEAR 4
Your fourth year begins when you have finished your 48 weeks of required third-year courses. Your
course distribution is as follows:
808A
Medicine Subspecialty
4 wks
808B
Medicine Subspecialty
4 wks
809
Surgical Subspecialty
4 wks
810
Critical Care Medicine
4 wks
811
Emergency Medicine
4 wks
813
Elective Rotation
4 wks
814
Elective Rotation
2 wks
819
Primary Care
4 wks
Your 813 and 814 courses must add up to a total of 16 weeks.
Current and accurate registration records are essential. Financial aid depends upon accurate
registration. Your transcript is the historical record of your registration. The CED cannot interfere with
the operations of Financial Aid or the Registrar. Please be aware of their policies and adhere to them.
Questions regarding your financial aid status and transcript record should be directed to their offices,
respectively. ALWAYS correct your registration immediately upon receipt of new information.
CED Requirements
Your internal requirements for Year 3 are aligned with the state and Registrar requirements.
Because Year 4 state requirements can be met in a variety of different rotation settings and topics, each
school must define what ―counts‖ or does not ―count‖ for credit in the requirements.
The intent of Year 4 subject requirements is to expose you to advanced disease processes,
acutely ill patients, emergency medicine, and the environments of secondary and tertiary care. You can
choose the location of all of these required and elective rotations within the general guidelines of the
CED. Indeed, as per the instructions for preparing for your fourth year, you will schedule every week
of your fourth year very carefully. As such, you will seek, instinctively, to interpret what the subjects
mean in a way that best fits your interest and your approach to residency. This may lead to some
confusion about what qualifies as a required course subject.
The CED sets the approval for what qualifies as ―Medicine Subspecialty‖, ―Primary Care‖, etc, for
the core fourth-year required subjects. The approval is binding. The experience of students in prior years
is not relevant. The following lists define our expectations. Additions and substitutions are not allowed.
808A-B Medicine Subspecialty
The 8 weeks of rotation in subspecialty medicine should be performed with an organ-
Clinical Rotation Manual For Faculty and Students
Touro University-California
31
system specialist in an inpatient setting. Examples include, but are not limited to:
Internal Medicine: Inpatient
Allergy/Immunology
Cardiology
Endocrinology
Gastroenterology
Hematology / Oncology
Infectious Disease
Nephrology
Neurology
Rheumatology
Pulmonary Medicine
Dermatology
Radiology
Pathology
Pediatric Medical Sub-Specialty
Medicine Sub-Internship
Medical Genetics
Psychiatry
Emergency Ultrasound
HIV/AIDS
Pediatrics Inpatient
Family Medicine Inpatient
Radiation Oncology
Geriatrics
The 808 course specifically excludes Physical Medicine and Rehabilitation, Urology, Gynecology,
Ophthalmology, and Otolaryngology (ENT).
809
Surgical Subspecialty
The 4-week surgical subspecialty requirement should be performed in one of the
following services:
Anesthesiology
Clinical Rotation Manual For Faculty and Students
Touro University-California
32
Ophthalmology
Orthopedic surgery
Urology
Otolaryngology (ENT)
Gynecological oncology
Plastic surgery Trauma
surgery Obstetrics
Neurosurgery
General Surgery
Colorectal Surgery
Surgical Sub-Internship
810
Critical Care Medicine
You should perform this rotation in an inpatient setting of acutely ill patients.
Options include:
Intensive Care
Pediatric Intensive Care
Neonatal Intensive Care Surgical
Intensive Care
Inpatient Pulmonary Medicine
Inpatient Cardiology CCU only
Inpatient Critical Care
Trauma Surgery
811
Emergency Medicine
Emergency Medicine
Pediatric Emergency Medicine
819
Primary Care
You must perform this rotation within the following areas, strictly interpreted, and to include
direct patient contact:
Outpatient Internal Medicine
Clinical Rotation Manual For Faculty and Students
Touro University-California
33
O
ily Medicine
u
Gynecology
t
p
a
t
i
e
n
t
P
e
d
i
a
t
r
i
c
s
O
u
t
p
a
t
i
e
n
t
F
a
m
Clinical Rotation Manual For Faculty and Students
Touro University-California
34
You are not allowed to perform a clinical rotation for academic credit with a preceptor who
is a family member.
You can perform a maximum of eight weeks of clinical rotations under the same preceptor.
CED Guidelines
Rotation Requests
For your core third-year requirements we submit all necessary information to your core program site(s)
for you.
For your elective rotations, and for all Year 4 rotations, you must submit a Rotation Request Form to
the CED so that we will know your schedule and insure that the sites receive the proper credential
information about you. The Rotation Request Form is available on the website and from the Year 3
Coordinator. For elective rotations please indicate the name of the clinical service so that your letter of good
standing will be accurate.
You must complete all sections of the Rotation Request Form, and the information must be accurate.
The Rotation Request Form initiates every other related function of your experience, from your schedule to
grades to acceptability by the hospital and through to your final graduation audit. Two CED staff work fulltime on rotation requests. They can process your request only if the information on it is complete and accurate.
Be sure to include all contact information for any hospital at which your precepting physician has privileges.
Rotation request forms must be submitted for all elective rotations, even if you are performing them at a Year 3
core site.
Remember, you do not submit anything to the clinical site yourself. You submit everything to the CED and we bundle it
together with your credential packet and send it to the site.
The places where you request to go for an elective or for a fourth-year rotation need to know you are
coming at least 60 days in advance of the start date of the rotation. Many facilities, particularly those at which
you need to rotate in your fourth year, will be in great demand and so will insist that you submit an
application to them through a formal Visiting Student Application Service (VSAS). The VSAS deadlines will
be even earlier than our department 60-day rule. All of this means that you need to be thinking ahead about
your rotations. For the CED to honor your ability to plan ahead we must abide strict policies about submitting
the rotation request forms. Forms submitted with incomplete information, or submitted after the stated
deadline, will be returned.
Clinical Rotation Manual For Faculty and Students
Touro University-California
35
Thus, if you are within 60 days of an unassigned rotation period you will be assigned to
a clinical rotation in the BayArea or in Northern California by the Clinical Education
Department.
If you are scheduled for a rotation and that rotation is canceled by the host facility, every effort will be
made to credential you into a replacement rotation with minimal disruption to the rest of your schedule.
Clinical Rotation Manual For Faculty and Students
Touro University-California
36
Electives and Vacation
You can elect a rotation in an inpatient or outpatient setting with any willing physician who is licensed to
practice medicine. If that physician is not in our system already you must allow for 60 days prior to the start date
of the rotation in order for them to be credentialed properly. All students are encouraged to consult our network
of credentialed physicians, which can be found by searching E*Value, our rotations software database.
Several area hospitals and facilities regularly provide elective and fourth-year core rotation opportunities
to our students. But these facilities are not residency hospitals and thus are not staffed with a full-service
education office that can handle individual student contacts about physician availability. Instead, they have
provided the CED with an advance schedule of their availability, and the CED acts as their rotation schedule
center. At the time of this writing the following hospitals and facilities rely upon the CED to schedule you:
Doctors Hospital, San Pablo
NorthBay Medical Center, Fairfield
Kaiser Permanente Santa Rosa Medical Center
Tahoe Forest Hospital
Sutter Medical Foundation East Bay Neurology Associates
DO NOT CONTACT THESE FACILITIES OR ANY PHYSICIANS ASSOCIATED WITH THESE FACILITIES.
ASK THE CED FOR CURRENT AVAILABILITY OF ELECTIVE AND FOURTH YEAR ROTATIONS.
Clinical Education Documentation
You must be credentialed to begin clinical rotations. The CED prepares your credentials for each
rotation and submits them to your rotation site on your behalf. The credentials are:
1. Immunizations
All students must have current immunizations. Records are kept by Student Health, not by the
CED, and can only be updated or altered by Student Health as per HIPAA regulations. Be
aware of the expiration dates of your annual immunizations. Resolve errors or discrepancies in
your health record with Student Health. Part of representing yourself professionally means
keeping your immunizations current, even if doing so incurs extra time or financial expense.
Regulations prohibit the CED from endorsing your letter of good standing in the absence of
current immunizations. You will be removed from rotation without credit until your
Clinical Rotation Manual For Faculty and Students
Touro University-California
37
immunization record is current.
2. ACLS / BLS
You receive your certification during Capstone. Keep the original certification cards with
you at all times. Until you are able to get the originals keep copies in their place. You will
need to update this certification in advance of residency, but will not be able to do this
through the annual course offered to second-year students at Capstone. Because your initial
certification occurs in May it will expire in May, well before you commence residency. You
must secure your own recertification in or before May of your graduating year.
3. Insurance
TU-C carries malpractice and liability insurance for you during your clinical rotations, but only
under very strict conditions. Your insurance covers you for the specific rotation you are on, for
the specific dates only, and only for the specific locations in the letter of good standing. You
secure this coverage by submitting a rotation request as per CED policy.
If a physician on
another service invites to you see or treat a patient outside of these parameters you are not
covered by insurance unless your rotation request form indicates that information.
4. OHSA and HIPAA Compliance
Your certificates of completion are included in the CED documentation to sites. As with
ACLS/BLS, you must keep originals or copies of these completion certificates with you at all
times.
5. Letter of Good Standing
The CED prepares a standard Letter of Good Standing for each rotation that you perform
until you graduate. Beyond your core rotations you may need to apply to a hospital or
university for permission to perform a rotation, and this application may ask for such a letter.
Please follow all instructions for Rotation Requests (above).
Clinical Rotation Manual For Faculty and Students
Touro University-California
38
CLINICAL ROTATION PROCEDURES AND EXPECTATIONS
1. Reporting for Service
Confirm your upcoming rotation with the specific site two weeks in advance. Unless otherwise arranged,
on the first day of each rotation students should report to the DME or a designee by 8:00 a.m. Understand the
importance of first impressions. Clinical services and physicians expect students to be on time. If you are traveling
a new route into unknown traffic patterns, anticipate accordingly. Student-physicians are expected to be
prepared and ready.
2. First Day
Represent yourself professionally in appropriate dress, and equipped with your credentials and
evaluation forms. Preview and review the dates and expected hours of the rotation with the site coordinator or
physician. Present the site coordinator or physician with your evaluation form. The top of the evaluation form
must be filled out in its entirety. This point is absolutely critical. Do not expect the site coordinator or
physician to complete this section on your behalf. Incomplete evaluations interrupt the CED’s ability to manage
your academic progress. Keep blank copies of the evaluation on hand in case the site coordinator or physician
have new information to include on it.
You are giving your complete effort at all times to each rotation, on each day. For this you should
expect that physicians will step out of their busy routine to write a letter of recommendation or endorsement
for you. Represent yourself to them on this first day with a one-page personal statement of your interests
and a current resume/CV.
Inform your physician of your desire to learn under their guidance. Make sure they know why you are
there (i.e.,
is this a core third-year rotation, an elective of your interest, a sub-internship, etc). Communicate to them that
you respect the time and effort necessary to teach clinical skills to medical students, and that you look forward to
any opportunities that they have to meet with you for feedback during the rotation.
Thank the site coordinator or physician for hosting you on this rotation and refer them to your CED deans
(including specific contact information) with any questions or concerns they have regarding your participation.
3. Learning Objectives
Each core rotation includes specific learning objectives. Third-year core rotation objectives are assessed
on post- rotation examinations (COMAT) and COMLEX Level 2 / USMLE Step 2 national exams. Your clinical
rotation experience will enrich your understanding of these objectives according to the patients you see and the
relationships you have with your preceptors. But you are responsible for mastering all of the objectives. And to
do that you must study beyond the range of patients and procedures that you experience in rotation.
You may have reading assignments given to you by your attending or you may choose to read about a
patient you treated. In addition, reading assignments are listed in Blackboard for each core rotation and some of
Clinical Rotation Manual For Faculty and Students
Touro University-California
39
the electives. Finally please carefully review the objectives – which match the reading assignments – as there are
materials to be read specific to each rotation as well as material that can be read during any rotation. As you
have already experienced, there is always more to read and learn than there is time to do it in. The objectives are
designed to help you appropriate your time and guide you in your studies for your career and your exams. You
may find that carrying around electronic access to reading materials or a journal useful, as medical students
invariably find themselves waiting for preceptors at some point in the course of most days.
4. Last Day
Before you leave your rotation please ask your preceptors to meet with you for an exit evaluation. Have
an additional copy of a completed preceptor evaluation form at the ready in case they want to fill it out as part of
the exit meeting. Some physicians will be too busy to commit to this meeting, but it is a professional expectation
that you seek it. You are responsible for your preceptor’s evaluation of you, so having this meeting is one way to
ensure that this is done in a timely manner, as well as ensuring that the last impression you leave is a positive
one.
5. Authority on Rotation
When you are on clinical rotation you are considered, for all intents and purposes, an employee of the
host site. Your host site sets the hours of expected service, regulations, dress and conduct codes. If you
experience an interpersonal problem on rotation your recourse lies with the chain of command and human
resources organization of the host site. You must report your concerns to the CED so that we can be aware of
your experience, but, like any third party, we have no authority to resolve the dispute.
Be aware that many problems arise because of simple misunderstandings or miscommunications. For
example,
if you are unsure how to report that you will be absent from rotation, report it widely. If you are unsure whether
or not you should pre-round on patients before morning round, ask widely. Each rotation will have its own
standard of ―how things work‖. The more you communicate about what, how and why you are doing
something, the less likely it is that you will experience a misunderstanding.
6. Rotation Duration
California state requirements are measured in calendar weeks, not in days served. You are required to
perform four weeks of psychiatry in your third year, for example. A typical work week would be 5 days, and
thus you would typically work 20 days as part of a four-week clinical rotation. You might experience a rotation
in which you work more
than 20 days over the four-week period, and thus seek to end the rotation early because you have worked the
equivalent length of time. This is not allowed.
Likewise, you might want to alter your forward schedule, or become aware of a great rotation
Clinical Rotation Manual For Faculty and Students
Touro University-California
40
opportunity that conflicts with the last week of your rotation. You might offer to work weekends in advance of
that so that you can clear 20 days of service in three weeks of calendar time. This is not allowed.
All rotations must be two calendar weeks, or four calendar weeks, as reported on your CED schedule and
on the
preceptor evaluation form. There are no exceptions to this rule under any circumstances, even as your
graduation date becomes threatened because of a late fourth-year incident.
If a site schedules only three-week rotations you will receive credit for a two week rotation only. If you
complete one or three weeks of rotation but have to leave the rotation, you cannot resume it at a later date. You
lose the odd week of time spent. The California requirements, and TU-C graduation requirements, are met only
through two-week, four-week, or six-week rotation durations.
7. Attendance and Absences
Under typical circumstances, students are expected to be present at their clinical rotation sites for the
entirety of all scheduled shifts. 100% attendance is expected. Current California regulations allow for up to 60
hours of on-site clinical service time in a calendar week, averaged over four weeks, and up to 12 days of service in
any 14 day period. Most rotations will expect you to perform 40 hours of service Monday – Friday not including
call periods.
Students are allowed up to three days of excused absences per four weeks of rotation. If your site
requires approval for such absences please contact the Assistant Dean of Clinical Education. In all cases of
absence the host site may request that the student make up the missed time on alternate dates during the rotation.
In keeping with the normative standards of a working environment, widely communicate your
anticipation of, need for, or unexpected incident causing your absence. For the benefit of those who have not been
in a workplace environment prior to now, be aware that most workplaces expect your attendance unless you are
physically unable to attend or may communicate an infectious disease.
During the course of your third and fourth year you will need to be away from a scheduled rotation for
other
required events such as Callback, Convocation, national board exams, and residency interviews. Each of these
events will be scheduled well in advance of your rotation schedule. Anticipate your need to be away and
communicate these priority events on your first day of the rotation. Refer your site coordinators to the CED
deans if they need more information, and DO NOT ask for excused absences at the last minute.
School Holiday procedures
Students may obtain an excused absence for observance of official school holidays. Request an excused
absence PRIOR to the start of the rotation so that you will have the excused absence document with you when
you report on your first day. Host sites may require that students make up the missed time on alternate dates
during the rotation. Be aware that while host institutions are expected to honor your excused absence, your
Clinical Rotation Manual For Faculty and Students
Touro University-California
41
preceptors are under no expectation to understand why you prioritize the holiday observance over their clinical
service. That is, be aware that your preceptor evaluation form is an exercise in how your mentor/preceptor
perceives you. Be ahead of any potential misunderstandings
between you and your preceptor if you plan to be absent from your rotation in order to observe an official school
holiday.
Excessive Absences
Your host site has discretion over the extent of absences, excused or not, that they will accept and still
credit you for a rotation. This is a risk primarily during residency interview season, so when that time comes
please plan your rotations accordingly and please communicate your interview schedule widely.
Unfortunately, unexpected life circumstances occur without regard to your rotation schedule. Most host
sites will do everything they can to enable you to attend to these critical family circumstances and still complete
the rotation, but others will not. If the site says that it cannot continue you in their rotation because you have
missed or will miss too many days, you must replace that rotation with a different one at loss of time to your
progress.
8. Rotation Schedule Changes
Any request for rotation change must have prior approval by Clinical Education. Schedule changes are
not possible for third-year core rotations. On-site coordinators and physicians may ―agree‖ to your request, but
they are not responsible for our outside compliances and they cannot see the impact of such changes on other
students. Do not ask site coordinators or physicians about their availabilities, and do not ask the CED for
permission to change your core third-year rotations. If your personal circumstances are such that an upcoming
rotation presents a significant challenge, cancel the rotation and re-schedule it for the end of your third year.
TUCOM maintains a Leave of Absence policy for this purpose. The CED acknowledges that unexpected
circumstances arise and that a Leave of Absence seems like a negative choice. At the same time, our affiliations
with hospitals and preceptors preclude us from adding students to their services within 60 days of the start date
of a rotation.
Elective and fourth-year rotations are also subject to the 60-day advance rule for both scheduling and
changing. You have a better opportunity to control for upcoming personal conflicts in the scheduling of these
rotations, however, because they are not reserved as far in advance.
GRADE REMEDIATION ISSUES
All components of each core course must be completed to receive a passing grade on your transcript.
This includes the preceptor evaluation, one or two site evaluations, all quizzes, and all assignments. Please
verify that you have completed the site evaluation.
Any late component cannot be ―remediated‖ but it must be completed. This means you will still
Clinical Rotation Manual For Faculty and Students
Touro University-California
42
receive decreased points once it is completed (0 for site eval, quizzes and assignments, 70% for the COMAT
post rotation exam).
The COMAT post-rotation examination must be passed in order to pass the rotation. You will be allowed
to remediate the examination one time. A second failed attempt will prompt the CED to determine the course of
action. Options include a third attempt, a different examination, repeating all or some portion of the rotation,
being removed from rotations until the situation is resolved, failing the rotation, and/or meeting with the Student
Promotions Committee.
You must receive 70% or higher on each Clinical Performance Evaluation you receive in order to pass a
rotation. A score of less than 70% on any Clinical Performance Evaluation will prompt the CED to determine the
course of action. Options include but are not limited to repeating all or some portion of the rotation, being
removed from rotations until the situation is resolved, failing the rotation, and/or meeting with the Student
Promotions Committee. In all cases successful remediation of a failed rotation results in an overall rotation grade
of U/70.
A student who fails any two clinical rotations will be referred to the Student Promotions Committee
and is a candidate for dismissal from the college. Please refer to the Student Handbook for details on dismissal.
Disputes Regarding the Preceptor Evaluation
If a student disagrees with the Preceptor Evaluation, he or she should first set up a meeting with the
Preceptor to discuss the matter. Please note that this is more in the nature of requesting an explanation of
the grading than a request for a grade change, and that attendings are under no obligation to change grades.
If the disagreement persists, the student should provide to the Assistant Dean of Clinical Education a letter
describing the area(s) of dispute along with a copy of the evaluation. The Assistant Dean will contact the
attending and/or DME to discuss it, and will then respond to the student with a decision regarding the dispute.
COMLEX Policy
In keeping with institutional policy for Class of 2013 and Class of 2014, you are required to take
COMLEX Level 1 prior to 1 October of your third year. Some rotation sites and some precepting physicians
require that you have taken and/or passed COMLEX Level 1 prior to participating in their service. If you fail
COMLEX Level 1 you will be allowed to finish a rotation that you began prior to receipt of your score, and then
will be removed from rotation for a minimum of four weeks. Other aspects of the COMLEX policy as detailed in
the Student Handbook also apply.
You are allowed to resume rotation after you have taken COMLEX Level 1 for a second time. In the event
that the next available Level 1 examination date falls within a week of your rotation start date, your ability to
begin the rotation will be determined by the CED. If you fail the exam for a second time you will be removed
Clinical Rotation Manual For Faculty and Students
Touro University-California
43
from rotation immediately upon receipt of the score. You will not be allowed to complete the rotation, no matter
how many days remain on it. Pending resolution of your academic progress by the Student Promotion
Committee and the Office of the Dean, you will be allowed to resume rotation after receipt of a passing score.
at the
Rotations that you miss as a result of a COMLEX failure or other Leave of Absence must be re-scheduled
end of your third year. Remember that all 700-series rotations must be completed before any 800-series credits
can be taken. Because a new class of students will commence their third year rotation program at the same time
that you would need to complete a missing rotation, you will not be able to complete missing rotations at your
core site. The CED will assign you to a rotation location based upon availability at the time that you finish your
other 700-series rotations.
Call Backs
Call Backs occur in late May or early June of your third year. This one week curriculum is designed to help
you
integrate the material you have learned over your first clinical year. You will take examinations which help
prepare you for Step 2 Board examinations both written and practical. You will participate in workshops
designed to refresh your skills in OMM and to help you further your career in medicine. Call Backs are required
and if you miss them, for any reason, excused or not, you will be required to remediate, most likely by returning
to campus at another time. Touro University recognizes that returning to campus can be difficult both to
schedule and to finance. However, it has been determined that this part of your training is extremely important
and as such it is mandatory for advancement.
Clinical Rotation Manual For Faculty and Students
Touro University-California
44
The Path to Residency
Overview of Year 4
From July – November of your 4th year you will perform a series of critical clerkships at prestigious
residency programs in the field of medicine you wish to practice. From July (AOA) to September (ACGME) you
will submit your applications to residency programs. You will need to research desirable programs prior to that
time, write a moving personal statement, and garner a handful of powerful letters of recommendation from
physicians of standing in the world of residency.
From November – January you will travel to numerous residency programs to interview for a possible
match. In early 2014 you will submit a rank order list of your preferred residencies to the National Matching
Service (DO) and/or the National Residency Matching Program (MD). At that point the result is out of your
control. You will busy yourself with completing the rest of your required rotations and completing the steps for
graduating on time.
You will take COMLEX Level 2 CE prior to 1 March 2014 and you will take COMLEX Level 2 PE prior to 1
January 2014.
Along the way you will find that fortune favors the ready. This section is all about being ready for Year 4.
Step 1: Choose a direction for your career.
Much of the strategy involved in getting the most out of your fourth year and the residency match is
driven by which type of medicine you seek to practice. While it is not essential that you know – right now –
your career direction, it is also true that advanced and organized planning will boost your momentum toward
residency. Planning Year 4 rotation schedules begins in February of your third year, so the sooner you can
decide your career direction, the better.
Step 2: Choose where you will develop your skills.
You will choose where you perform each of your fourth year clerkships. There is no requirement to
perform core rotations in a particular place or in a particular sequence. Once you have identified a site for a
given rotation you will submit the Rotation Request Form to the CED via FAX (707-638-5252) or email.
If you perform a clerkship in the subject of your residency discipline and at a facility where you hope to
be a resident then such a clerkship could be described as an audition rotation. If you perform a clerkship in
which you expect to be treated like an intern/first-year resident, with all of the attendant expectations and
recognition for your performance, then you are performing a sub-internship. High marks in a sub-internship
rotation carry more weight than do high marks in a regular rotation.
Clinical Rotation Manual For Faculty and Students
Touro University-California
45
Plan to perform three to five clerkships of Year 4 in different residency program facilities that
are high on your personal preference list for your own residency. There is no substitute for being on site for a
month showing your skills to a potential future residency director. But you can only do this during the
application season (fall of Year 4), and thus at far fewer than the ultimate number of programs to which you will
apply.
Step 3: Optimize the path to internship and residency.
Each of you is on your own, individual path. General advice is just that. The CED is committed to
advising you specifically and individually. To be available to you for that level of service we need to be
working with complete, timely and error-free files. Put yourself in the best position to be advised by following
the policies and instructions closely. To provide the best service to students the CED will be enforcing all policies
for your rotation assignments, deadlines, and graduation audit.
General Advice
Your end goal determines what will make your residency application strong. For patient-based careers
(primary care), the emphasis will be on your interpersonal skills, passion for helping others, how well your
MSPE (dean’s letter) aligns with your values, and what your mentors say about you. For procedural careers
(sub-specialties), the emphasis will be on board scores, your MSPE and what your mentors say about you. For
cognitive careers (one of the ―-ologies‖), the emphasis will be on evidence of your problem-solving skills, your
MSPE and what your mentors say about you.
You can see that no matter which career direction you are pursuing, having a strong MSPE and strong
letters of recommendation are relevant. Working with the CED (i.e., following procedures and timelines) will
result in a strong MSPE. You control the inspiration you provide to clinicians for them to step out of the box and
write a serious letter. Board scores are what they are. If yours are above-average let them lead the way. If yours
are below average, bury them in the heap of brilliance that you display in everything else that you do.
Clinical Rotation Manual For Faculty and Students
Touro University-California
46
Managing Your 4th Year Requirements
Timeline for completing 4th year
In your fourth year you are required to complete 40 weeks of clinical rotation. To be safe about it all,
graduate on time and be available for a 1 July residency you should plan to end rotations on or before 1 June 2014.
This is a conservative date but conservation is preferred to procrastination, obviously. Plus, it gives you some
flexibility if a rotation gets cancelled unexpectedly.
Count the 52 weeks of Year 4 from 1 June 2013, whether or not you have finished your third year
rotations at that time. From 1 June 2012 you have 104 weeks to complete 88 weeks of clinical clerkships, and
safely pass the graduation audit to receive a diploma on the first Sunday of June 2014.
Although it seems that the unassigned time in Year 4 is a large chunk, in truth you will need it in order to:
Pay back the part of June 2013 (or more) in which you are still completing Year 3.
Fit between your 800-series rotations because they will not articulate back-to-back as did your core
rotations in Year 3. From July – November you should be in a different teaching hospital for each 4-week
rotation. Each hospital sets its rotation start and end dates, so you will find yourself with a few days here and a
few days there between rotations. Those few days begin to add up.
Secure travel time to complete your residency interviews and COMLEX PE pilgrimage to
Pennsylvania.
Insure that you have two or three weeks to spare so that you can go to Commencement, relax with
your family, move to your residency and be fresh for a July 2013 start.
Required clerkships
A basic educational intent of Year 4 is to experience the medical environment of the acutely ill. You will
satisfy
California state requirements to perform the following:
8 weeks of intensive inpatient medicine (808)
4 weeks of a sub-specialty surgical practice (809)
4 weeks of acute care / critical care medicine (810)
4 weeks of emergency medicine (811)
4 weeks of primary care (819)
16 weeks of electives (813, 814)
The Clinical Rotation Manual explains the types of rotations that qualify as your requirements (see above).
If you have a question about whether or not what you want to do can be counted as one of the required rotations,
please ask the Assistant Dean directly. We support your curiosity for unique learning experiences, but we must
Clinical Rotation Manual For Faculty and Students
Touro University-California
47
remain within the California statute.
Be aware of subtle dynamics. You must get your whole 4th year scheduled as soon as possible once you have
decided on a career path. If you have not decided on a career path until late in the spring, or early summer, you
still need to have a complete schedule. And this is why:
Many facilities close their rotations to 4th year students after Match Day.
The logic of this is simple. Chances are you will schedule your 4th year such that the things you like to do
are packed into the summer and fall, as auditions and sub-internships prior to residency interviews. That leaves
the things you do not like to do for later in the spring. Couple that with the general euphoria and ―coasting‖
mindset that students acquire after they have matched for a residency, and the result is that hospitals fear that if
you come to rotate there during April and May that you will be distracted at best, and a liability at worst.
Nobody likes to feel as though they are being used just to fill a requirement. Emergency medicine is the most
restrictive. It tends to be the discipline that has the strongest ―avoidance factor‖ among people for whom it is not
a career direction. California statute prohibits most programs from offering EM in Year 3, so there are many
students aiming for it at the same time. And the nature of the discipline is such that a strong ability to learn
quickly with minimal guidance is required. EM program directors have been burned in the spring by disinterested clerks, and there is too much on the line.
Another reason to get your whole 4th year scheduled as soon as you can is because the ability of the CED to
serve your best outcome depends upon our efficiency in getting you those key early-4th-year rotations. It is hard
for us to do that if we have to prioritize the students in the class ahead of you who are at risk for not graduating.
As a class you will submit >700 separate 4th-year rotation requests between January – May of 2013. Every Class of
2013 student who is out there unassigned and having trouble finding acute care or EM in that time period will
displace your request, because in a crisis we have to graduate those students before we optimize your audition
rotations.
SUBMITTING YEAR 4 ROTATION REQUESTS
You will be seeking rotations at facilities that are exactly where you want to be a resident, and/or where
many other students also seek training to gain the same expertise you seek. In response to this the facilities
construct their own application service. Some will ask that you apply to them directly using their forms only.
Others will require that you apply through the Visiting Student Application Service (VSAS). Each application
will require proof on their custom forms that your immunizations are current. Please provide Student Health
Clinical Rotation Manual For Faculty and Students
Touro University-California
48
with current immunization information at every point in your progress.
The CED must complete all of your Year 4 applications, either through VSAS or through individual paper
applications. The CED must process a very large number of these applications in a very short period of time.
Please read below to understand how this happens.
The Hospital Application
According to 2010 data, 80% of university teaching hospitals use the centralized Visiting Student
Application Service (VSAS) for all 4th year rotations. But some of these hospitals will ask that DO students submit
applications through a separate, paper, route. All VSAS applications come with a fee, which varies by institution.
Institutions also may charge a separate fee based on the clinical department.
VSAS (https://www.aamc.org/students/medstudents/vsas/) will be open to graduating students in
February of Year 3. At the time VSAS opens the CED will upload your transcript and other credentials that are in
your file. Once student information is uploaded, any missing information or other requirements must be
uploaded by the student. Please ensure that your credential files (background check, immunizations, mask-fit,
ACLS/BLS, HIPAA, OHSA, etc.) are complete and current as of 1 February 2013. Please be aware that the
application may require that your immunizations and or drug screens / background checks are current to within
a year of when you will perform the clerkship (not when you apply for the clerkship). We advise you to update
your credentials ahead of their expiration dates accordingly, and preferably in January of Year 3.
VSAS will ask that you state the dates of your core Year 3 clerkships. Please complete only the information
that is requested (do not include Year 4 rotations or electives).
Each hospital requires its own set of health information and immunization data. Be aware that your
information must be complete, accurate, and verified by an appropriate health professional, and sometimes by
you as well. The breadth and depth of personal health documentation that hospitals require increase each year.
The CED does not have HIPAA clearance to help you with these steps. Please avoid delay in the processing of
your VSAS application by reviewing each application in its entirety and by maintaining complete, accurate and
current personal health information with Student Health and/or your primary care physician at all times.
Incomplete personal health forms in VSAS applications are the main reason for application delays.
All hospital applications, whether they are through VSAS or not, ask for the same basic information.
They want to know that you are insured, that you are not carrying a communicable disease, that you can save a
life, have passed board exams, etc. The CED provides this documentation based on the information in your file,
except for your COMLEX/USMLE transcript and personal health insurance.
If you are applying for a rotation at a hospital that does not use VSAS, you will need to submit a
Clinical Rotation Manual For Faculty and Students
Touro University-California
49
Rotation Request form with all information that the form requires. You need to submit the Rotation Request
form at the same time as the application, and at least 60 days in advance of the application deadline or date on
which you want the application to be submitted. Other items, such as a photograph, clerkship payment,
and/or official transcript may be required. Because your application moves along as a single entity, all of these
materials must be submitted at the same time.
Some hospitals will want to pre-approve you for a rotation based on your academic record, such as
Kern Medical Center and UCSF – Fresno. This pre-approval, if required, takes place between you and the
hospital clerkship coordinator. You will learn which facilities require pre-approval by researching clerkship
programs on the internet.
Important things to remember:
The CED submits all official hospital applications. Students do not submit parts of or whole applications to a
hospital.
Submit the fully completed hospital applications and rotation request forms to the CED 60 days prior to the
deadline for the application. Not 60 days prior to the start date of the rotation.
Complete the application in all sections that you can answer. And we mean ALL SECTIONS. SIGN IT. We fill
in and sign the rest.
The CED processes all applications in the order in which they are received. Because of the volume of applications
and the requirements of the hospitals, the CED must prioritize complete and accurate applications over
incomplete ones regardless of position in the queue.
You can obtain an official transcript at www.getmytranscript.com.
GRADES
Year 4 clerkship grades are 95% from your preceptor evaluation and 5% from your evaluation of the
preceptor and site. Keeping your grades current will be difficult because you must rely on busy physicians to
complete paperwork. Fortune favors the ready.
In mid-August of 2013 medical schools upload official transcripts of graduating students to the
Electronic Residency Application Service (ERAS). It is imperative that all of your 3rd year grades be complete at
that time. Gaps in your official transcript are unappealing. So please make every effort to acquire preceptor
evaluations as you go. The CED Grade Coordinator records all received evaluations in Blackboard. Please do
not query the Grade Coordinator about a missing evaluation until you have confirmed your proper enrollment
for the clerkship and have allowed two weeks to elapse after the end of the clerkship.
Medical schools are obliged to report your rank in class as of the end of Year 3 to the Electronic Residency
Application Service. We will benchmark that calculation in mid-August of 2013. Rank in class is calculated
from your total number of units taken as a weighted average of all of your existing course grade percentages.
It is not calculated from the GPA total that you will see on your transcripts. Your Year 3 grades cover 72
Clinical Rotation Manual For Faculty and Students
Touro University-California
50
units, many more than a single year of pre-clinical curriculum. Your rank in class will move more than you
might expect as a result of your third-year clinical rotation performance.
International Clerkships
International rotations are available for elective credit only. Your core subject requirements must be
performed in domestic, nationally accredited facilities. The COM’s Global Health faculty (Drs. Mahmoud, Lin,
Elul, Garcia-Russell, and others) have established ongoing relationships with sites in Tanzania, Ethiopia, Taiwan,
Israel and Bolivia. Our program is at a level in which we can make long-term plans to develop our presence in
the communities of those sites. This is the expectation of meaningful international health outreach. We greatly
value your interest in global health and your desire for an international health experience in your fourth year. At
the same time, we are not able to exercise our due diligence of oversight for every international rotation request
that we receive. We ask that you apply your interests to one of our established sites. If you and a current
TUCOM faculty member would like to develop a long-term plan for a new site, please consult with Dr.
Mahmoud. As of July 2011 we will not be able to approve an international rotation request for a site experience
that does not involve TU-C faculty sponsorship. Even though established NGO and non-profit entities may be
involved, for you to receive curricular credit toward graduation the experience must be at one of our sites. You
are of course welcome to participate in any international activities during unassigned time in your fourth year.
Research Clerkships
You may receive elective credit for a research clerkship. You must submit an abstract of your proposed
project and the CV of your preceptor with your Rotation Request form. If you have created the project, and/or
are extending the original project of your preceptor to include new data, you need to have your project approved
for human subjects research through the TUCOM Instiitutional Review Board
(http://tws.tu.edu/webdocs/IRB/IRB_Review_form_.pdf). Your preceptor must submit the same evaluation
form that is used for clinical clerkships.
Rank Order Lists and the Match Process
Introduction
You have completed your interview circuit and now must complete the final step of your residency
application process – submitting a rank order list of programs. If you are participating in the DO match you
will need to finalize your rank order list now (28 January). If you are participating in the MD match you will
have approximately one more month. Please read below for some general information and advice. If you are
seeking a residency in ophthalmology or in urology, please contact the CED directly.
The MD and DO matches are coordinated to the extent that you must decide whether or not to
Clinical Rotation Manual For Faculty and Students
Touro University-California
51
participate in the DO match before you make any other decisions. If you participate in the DO match by
submitting a rank order list, you must accept the resulting match. You cannot participate in the later MD match.
If you participate in the DO match but do not match, you still have time to participate in the MD match
(provided you have applied to and been interviewed at MD programs). If you are seeking only an MD residency
you should not submit a rank order list to the DO match. If you do not match an MD program you then can join
the DO scramble (which is then 30 days elapsed) and/or the MD scramble.
Deadlines
DO Match Rank Order Lists are due in late January (refer to National Matching Service website).
MD Match Rank Order Lists are due in late February (refer to National Residency Matching Program
website).
Golden Rule of Rank Order Lists
Rank your programs by TRUE PREFERENCE only.
The algorithm that matches you is driven by your list, not by program rankings. It will seek to match you
to each program on your list in descending order. As soon as it links a program on your list to your name on that
program’s list it will hold you in a ―pending‖ or ―temporary‖ match. This is because the algorithm assumes that
your #1 program is where you would prefer to match. If your #1 program ranks you #1, the algorithm skips the
―pending‖ assignment and creates a TRUE MATCH for you. If your #1 program does not list you,
the algorithm will seek your #2 program, etc. It will settle on the best outcome FOR YOU. After it finds the
best ―pending‖ match for each APPLICANT, it then drives the program list. If more applicants with
―pending‖ matches are above you on the program list, and your name is below the program’s quota line, the
algorithm will cancel your ―pending‖ match and seek another one at the next lower program on YOUR list. At
the end of the algorithm your pending match becomes a TRUE match.
Rank your programs by TRUE PREFERENCE only.
Match Rules
Match rules in their entirety are available on the National Matching Service and National Residency
Matching Program websites, respectively. The fundamental principle of match rules and violation is that your
actions do not affect the outcome of someone else. The easiest match violation to commit is if you enter the DO
match, match to a program, then submit a rank order list to the NRMP. Your name will spin in the MD match
algorithm and will affect how other applicants are matched. Your match is a binding legal agreement. So you
cannot ―test the waters‖ in the DO match, ignore your match result, and then see ―how you fare‖ in the MD
match.
If you are thinking about participating in both matches (on the logic that if you do not get a DO
Clinical Rotation Manual For Faculty and Students
Touro University-California
52
position then you can at least try for an MD position), then do not submit an MD rank order list until AFTER
the DO match results are released on 14 February.
In the time preceding your rank order list deadline you should be careful about how you communicate
to residency program directors. It is natural and instinctive to have conversations during and after your
interviews. Information and feelings are shared in good faith and with no direct intent to commit a violation.
The Match rules are designed in order to prevent programs from putting you in a leveraged position regarding
your rank list, and to prevent you from manipulating programs in order for you to preview your likely match
outcome. The official language of your limitations is copied below:
6.0 Restrictions on Persuasion
One of the purposes of the Matching Program is to allow both applicants and programs to
make selection decisions on a uniform schedule and without coercion or undue or
unwarranted pressure. Both applicants and programs may express their interest in each
other; however, they shall not solicit verbal or written statements implying a commitment.
Applicants shall at all times be free to keep confidential the names or identities of programs
to which they have or may apply. In addition, it is a breach of the applicable Match
Participation Agreement for:
(a) a program to request applicants to reveal ranking preferences; or
(b) an applicant or program to suggest or inform the other that placement on a rank
order list is contingent upon submission of a verbal or written statement indicating
ranking preferences; or
(c) a program to require applicants to reveal the names or identities of programs to
which they have or may apply; or
(d) a program and an applicant in the Matching Program to make any verbal or written
contract for appointment to a concurrent year residency or fellowship position
prior to the release of the List of Unfilled Programs.
The last part of the excerpt above refers to what happens in the time period between a
program knowing that it has an unfilled position and the time when that position is
openly listed for all unmatched applicants.
DO, MD, or Both? What Should I Do?
For some students this is an agonizing question. Your interests are well-served in both matches. You are
uncertain of your prospects in the MD match, but aware that if you commit to the DO match that you will get a
program and therefore never know how you would have fared in the MD match. You do not want to turn away
from the programs you worked so hard to match, but you also do not want to be left with nothing and have to
Clinical Rotation Manual For Faculty and Students
Touro University-California
53
scramble. We have some general advice, and we encourage all students who are in this dilemma and who seek
specific advice from the CED to call one or more of the deans.
In general, consider the TRUE PREFERENCE of your interview experience. If your major concern is that
you might not be competitive enough for the list of your MD programs, review the data with one of the deans. If
your major concern is that you only had a few MD interviews, review those program websites for the presence of
DO residents. If you do not see any, carefully consider whether or not you should stay in only the MD match. If
your major concern is that your DO (or MD) programs are in better locations for you (and thus contribute to the
non-academic aspect of your true preference), and given that you will match whatever you
put at the top of your list, then you should follow your true preference.
Clinical Rotation Manual For Faculty and Students
Touro University-California
54
THINGS TO REMEMBER
•
The length of a four-week rotation is, actually, four weeks. Some hospitals, such as Harbor UCLA, provide
three-week clerkship experiences. Because you must accrue four weeks in a core rotation, if you do a
rotation for three weeks it will not count as a full core rotation. It will count as a two-week elective. We are
audited by the state on this issue and so there can be no exceptions.
•
A four-week rotation must take place over four consecutive weeks. Aside from the rule, this is also good
educational practice. You are not able to combine a two-week experience with a separate two-week
experience and call it a four-week rotation. As per above, there can be no exceptions.
•
Your CED includes competent staff who can facilitate your path to graduation. And deans that are
committed to your success. Use these resources efficiently, not dependently. If we have to pay attention to
solving problems that could have been avoided, or re-informing a student about something in this document
or on Blackboard, then we are not spending time advancing your mission.
Give your preceptor a copy of the evaluation form on the first day of each rotation. Fill in the top portion
•
completely (know your course numbers!). When we receive an evaluation from a physician and there are
no
dates and/or no course number, your grade posting is delayed.
•
Include your cell phone number in your email signature line or in all emails to the CED. A phone
conversation with one of the deans or staff can resolve a problem much more quickly than an email exchange,
so by having your number on the screen you will expedite that opportunity.
•
Fill out ALL ITEMS on the Rotation Request Form prior to submitting it. This form triggers paperwork on
our part that must be submitted to your clerkship site, and establishes the record upon which your grade is
based. Because Year 4 rotation requests will exceed several hundred each month, we must return incomplete
requests to you.
•
Keep your personal immunizations and other credentials (drug screen, background check, etc.) well ahead of
their update schedules.
•
Practice SITUATIONAL AWARENESS. For the CED, situational awareness means being cognizant of the
information that has been provided to you. We are committed to your success, on nights, weekends, and
holidays, too. We trust that you are aware of our policies and procedures, and our covenant with you is to
Clinical Rotation Manual For Faculty and Students
Touro University-California
55
champion your individual path to residency and beyond.
ALWAYS CARRY THESE ITEMS WITH YOU
This reflects how you represent yourself. You are entering a profession that cannot defer responsibility. You
have earned credentials that enable you to do things that no one else can do. Own those credentials and have
them as near to your person as you hold your driver’s license, credit cards, cell phone, ID badge and car keys:
•
Immunization record
•
ACLS/BLS cards or copies
•
Drug Screen (current, 10-panel preferred)
•
Background Check
•
Clinical Rotation Manual
•
Mask-Fit Test reading
•
Access to your tu.edu email account
•
CED contact information and FAX number (707-638-5252)
•
Rotation Request Forms
•
Preceptor Evaluation Forms
•
ERAS LOR Cover Sheets
•
AOA ID number
•
AAMC ID number (if applying to MD residencies)
•
Official Transcripts (current to end of 3rd year rotations)
•
Passport-size pictures of yourself
Clinical Rotation Manual For Faculty and Students
Touro University-California
56
Part III
Clinical
Curriculum
Clinical Rotation Manual For Faculty and Students
Touro University-California
57
Overview Of Core Courses
Introduction
During your third year you will spend the majority of your time in Core rotations. During these rotations, in
addition to attending clinical activities you have a didactic curriculum to complete. The purpose of this curriculum
is to moderate the variety of experiences that you will have and to ensure that you have a general outline of what
material is important to learn during your third year. Ultimately we are trying to prepare you for your rotations in
both third and fourth year, your post rotation examinations and Board examinations and your residency.
Assignments are geared towards each of these different goals. If you are most concerned with your multiple-choice
examinations you may be frustrated by the materials that are designed to make you a better physician. The reverse
is true as well. However, ultimately you are responsible for determining where your strengths and weaknesses are
and what study is most critical at any given time.
Core courses are designed to teach you, as an Osteopathic Physician the critical components of being a general
physician. In the pages that follow you will find guidelines, competencies, objectives and assignments all of which
are designed to be in line with Touro’s mission to help you become an outstanding physician, committed to primary
care, and a holistic approach to your patients. That means whether your rotation is surgery or family medicine,
pediatrics, internal medicine, ob or psychiatry, your primary goal is to understand Osteopathic principles and a
general approach to all issues and concerns your patient might have. For example, while on surgery, consider how
important it is for the primary care physician know in detail about a surgery, so that they can assist their patient by
being able to discuss the surgery, explain risks and benefits and refer them to the appropriate surgeon.
For each core course you will find, in the following pages, a syllabus, objectives and assignments. These materials
are also posted on Blackboard in organizations for each Core Course.
Competencies
The competencies are developed by multiple organizations and details regarding the specifics of what each
competency entails are available. Please contact Dr. Weiss if you are interested in more background or specifics.
These competencies drive the development of learning outcomes and specific course objectives. In most cases, the
specific competency addressed by each course learning outcome is listed by number after the learning outcomes in
the syllabi.
Summary of AOA Competencies
1. Osteopathic Philosophy/Osteopathic Manipulative Medicine
2. Medical Knowledge
3. Patient Care
4. Professionalism
5. Interpersonal and Communication Skills
6. Practice-based Learning and Improvement
7. Systems Based Practice
Clinical Rotation Manual For Faculty and Students
Touro University-California
58
Learning Domains
Learning Domains are useful to understand why particular areas are assessed and what the assessment means.
While the learning domains are not graded as separate entities, your performance in each of the domains is reflected
in the following components of your overall rotation grade.
1. Professionalism
The following components of your rotation are considered as part of your professional behavior:
a.
b.
c.
Behaviors in your rotation including attire, attendance, punctuality, communication, taking
initiative when appropriate, HIPPA compliance, taking responsibility for your schedule and
assigned tasks.
Behaviors relating to your rotation include scheduling, paper work and completion of respiratory
testing, PPD placement and vaccinations and other necessary logistics for site placement including
communication with the CED department and administrative staff at your rotation site.
Behaviors relating to the didactic components of your rotation include completion of all
components of your grade in a timely fashion and communication regarding scheduling problems
and errors in performance. You will not receive reminders or additional emails regarding your
requirements and reading through all materials and using them as references is part of professional
behavior.
The above components are assessed in the following formats: Grade on Self Test, Med-U cases, post rotation
examination, grades for site evaluation and CPE and Deans Letter.
2.
Medical Knowledge
a. Medical knowledge is to be obtained through your didactic study and your clinical interactions
b. Medical knowledge is assessed in your post rotation examination and your CPE as well as in your
Board examination.
c. Formative assessment of medical knowledge is available through use of the Self Test, Med-U cases
and mid rotation evaluation.
3.
Clinical Skills
a. Clinical skills are primarily taught through your clinical rotation experience
b. Clinical skills are assessed through your CPE and your COMLEX PE
Logistics
1. Courses and Rotations
Understanding the structure of Core Courses and the difference between a Course and a Rotation is critical.
Core courses consist of the following time allocations:
Surgery Course: 8 weeks of General Surgery in two 4-week increments/rotations
Clinical Rotation Manual For Faculty and Students
Touro University-California
59
Family Medicine Course: 8 weeks of Family Medicine in two 4-week increments/rotations
Internal Medicine Course: 8 weeks of Internal Medicine in two 4-week increments/rotations
OB/Gyn Course: 6 weeks of Obstetrics and Gynecology to include labor and delivery usually in one 6 week
increment/rotation but may be divide
Pediatrics Course: 6 weeks of Pediatrics usually in one 6 week increment/rotation but may be divided
Psychiatry Course: 4 weeks of Psychiatry in one 4-week increment/rotation
* The 4 week increments may be back to back or separated in time.
Each Rotation or increment is given a CLIN number:
700A
Internal Medicine 1
700B
Internal Medicine 2
701A
General Surgery 1
701B
General Surgery 2
702A
Family Medicine 1
702B
Family Medicine 2
705
Psychiatry
706
OB/GYN
707
Pediatrics
4wk
4 wk
4wk
4wk
ss
4wk
s4wk
4 wk
4wk
4wk
ss
6wk
s6wk
s
If you rotate in a state that does not offer a 6-week option for obstetrics or pediatrics, your CLIN numbers and
time increments for these rotations will be different.
The pertinent courses on your REGISTRATION FORM are:
703
OB/GYN
4wks
704
Pediatrics
4 wks
712
Pediatrics
2 wks
714
OB/GYN
2 wks
2. Why This Information Is Important
Your grade is affected by multiple actions, input by multiple people and is processed by in three-four
different software programs.
The two most important for you to understand are Blackboard and Evalue.
The critical piece of information is that a core course is made up of up to two rotations. If it is made up of
more than one rotation you have to complete two evaluations and the first one must be completed on the
last day of the first rotation. IF YOU WAIT UNTIL THE END OF THE COURSE TO COMPLETE THE
EVALUATION FOR BOTH ROTATIONS YOU WILL NOT GET CREDIT FOR THE EVALUATION OF
THE FIRST ROTATION.
Also, if your rotation is made up of more than one rotation and the time increments are separated by a
different rotation or course, your assignments for the Core course will be due at a different time. For
Clinical Rotation Manual For Faculty and Students
Touro University-California
60
example, if you complete Internal Medicine Block I in June and Internal Medicine Block II in October, your
COMAT exam and assignments will be in October. Your first evaluation will be due in June.
3. What Happens in Evalue
You may view your course schedule based on CLIN number as well as location and dates.
You will enter your evaluations of your rotation – required for you to receive credit for your evaluations.
The single most frequently lost credit item is the first evaluation.
You must fill out an evaluation in evalue based on the rotation block or clin number as you have registered. IF
YOU WAIT UNTIL THE END OF THE COURSE YOU WILL NOT GET CREDIT FOR THE FIRST
EVALUATION. Even if the rotations are scheduled back to back at the same location you must fill out an
evaluation at the end of the first four weeks. You will need to complete a site evaluation for every rotation block
– put another way for every CLIN number for which you are registered you must complete a site evaluation
whether it is 4 weeks, 8 weeks, 2 weeks or 6 weeks, Even if it is 8 weeks with one preceptor if it is listed as two
CLIN numbers it will require two site evaluations. If your FP, IM or Surgery rotations are apart from each other
in sequence you still must complete the site evaluation of each one on the last day of the rotation.
In addition, you may have the opportunity to use electronic log software. For this, however, use of electronic
softwared for logs will be optional.
4. What Happens in Blackboard
A. Blackboard is where you can find forms and rotation information, view your syllabus, your learning
objectives, your assignments and your rotation grades. The grades in black board are a breakdown of each
of the components for each Core Course. Additionally you will see an unofficial record of your course
grade. Until all components are completed a final grade cannot be sent to the registrar.
B. All of the information you need will be available on BB in the following organizations:
Class of 2014 Family Medicine Core Rotation
Class of 2014 Internal Medicine Core Rotation
Class of 2014 Mindfulness in Medicine Elective
Class of 2014 OB/GYN Core Rotation
Class of 2014 Pediatric Core Rotation
Class of 2014 Psychiatry Core Rotation
TUC 2014 Surgery Core Rotation Clerkship
Additional information may be found on Blackboard in the organizations:
Clinical Education Resources
OMM/OPP Materials
C. Grades in BB for each component are entered by different people. For example, the grade coordinator
enters the grade for your preceptor evaluation and for your site evaluation as well as your COMAT
Clinical Rotation Manual For Faculty and Students
Touro University-California
61
examination. Completion of self tests automatically generates a grade. Completion and grade entry of
other assignments varies depending on the assignment and rotation.
In general it takes a minimum of two weeks from the last day of the COURSE for all components to be
entered. A variety of factors can cause delay for example; if a preceptor evaluation has not been received
then your site evaluation and the preceptor evaluation will not be entered. If an assignment is partially or
poorly completed it may take longer to evaluate and grade. Occasionally issues like other deadlines or sick
leave within the department cause delays as well.
D. As mentioned above, the components of your rotation grade arrive at separate times and from unrelated
sources. The activity for each component is dependent on you as well as a variety of other staff and faculty.
Preceptor Evaluations are submitted directly to the Clinical Education Department by mail, fax
or through Evalue.
Site evaluations are completed by you in Evalue.
Med-U cases are completed by you via the Med-U website. A grade for the completion of all cases on
time is entered in Blackboard by staff or faculty.
The online self tests are completed in Blackboard. The self test is graded automatically by Blackboard
when you complete it. If there is an error or problem with this it will be corrected manually by Dr. Weiss.
Logs for pediatrics are completed by hand and faxed or mailed to the Grade Coordinator by you.
Your preceptor must sign logs before they are turned in and they will be reviewed by Drs.
Hendriksz and Malouf, the clerkship directors.
Post-Rotation Examinations are administered through COMAT, a national osteopathic board shelf exam
service. The grade you receive is entered in Blackboard by the grade coordinator.
Other Assignments and attendance at webinars are recorded in Blackboard by faculty or staff.
Please refer to the syllabus for each core rotation for more information. All graded components are recorded in
Blackboard once they are completed or received and you may review your grades there. The CED Grade
Coordinator reviews each of the components of your rotation grade and submits a final grade to the Registrar. This
final grade then appears on your official transcript and is visible to you on TC Web. This process may take a period
of weeks following completion of all of the grade requirements. In the meantime you can follow the progress of
your grade through each rotation’s Blackboard posting.
The CED Grade Coordinator manages rotation grades for both OMS III and OMS IV students, and each class
experiences different critical dates for keeping grades current. The most efficient way for the Grades Coordinator to
calculate your rotation grade, submit it to the Registrar, and post it for you to see, is to process the information in
cycles. We call this a Grade Audit, and it takes place for each class approximately six times per calendar year. This
means that your rotation grade could be posted within 24 hours of its components arriving in the CED, if that
moment happened to be within the current Grade Audit for your class. But it also means that your rotation grade
may not be posted for up to two months if the information arrived just as the Grade Audit switched from your class
to the other class.
It is natural for students to query the Grade Coordinator individually about the status of a rotation grade,
particularly if the grade information was submitted just after a Grade Audit and the student expects to see the grade
posted. Please recognize that individual queries are counter-productive and actually make it more difficult for the
Grade Coordinator to perform the audit on time. You will receive an email from the Grade Coordinator if there is
Clinical Rotation Manual For Faculty and Students
Touro University-California
62
missing information in your file that should have arrived by the time of the current Grade Audit. (In other words,
don’t call us, we’ll call you.)
This is another reason that you should prioritize meeting with your preceptor at the end of your rotation. It is
the best way to secure a copy of your evaluation and thus not have to wonder whether or not it was submitted,
nor whether or not it was positive or critical.
Grade Components and Valuation for Third Year Core Courses
Each Core course has somewhat different requirements. The most important thing is that you are responsible for
knowing what is due when it is due and completing it. There are steep grade deductions for late materials and
any single incomplete component will prevent your grade from being recorded (in other words you cannot
pass the rotation without completing all components.) This means that even if you are late and will get 0
points you have to complete each component.
Each core course requires the following elements be completed:
1. Preceptor evaluation of your performance
2. Student evaluation of each rotation block
3. Post rotation examination
4. Assignments which consist of some or all of the following elements:
a. Med-u cases
b. Logs
c. Self Test
d. Reading assignments
e. Webinars or lectures
While assignments vary based on the Course, the following three components are part of every Core Course
grade; post rotation examination, preceptor evaluation and your evaluation of the site.
POST ROTATION EXAMINATIONS: NBOME’s COMAT SUBJECT EXAMINATION
For all six core rotations you will need to complete an Exit Exam. Your exam will be scheduled for the last
Friday of each Core Course. If you are taking your Core course in two blocks or rotations separated by time, the
exam will occur on the last Friday of the second block. The exam is worth 20% of your clerkship grade AND
must be passed.
Clinical Rotation Manual For Faculty and Students
Touro University-California
63
The exam is developed by the NBOME – the same national board who creates your board examination.
Information about these exams can be found on the NBOME website. Regardless of the specific topics covered in
your clinical rotation and by the syllabus, you are responsible for preparing for these examinations in the same
way that you are expected to prepare for the Boards. Review the material on the NBOME website before you
begin your rotation. http://www.nbome.org/comatmain.asp?m=coll
SITE EVALUATIONS
For all six core required courses you will need to complete at least one and usually two Site Evaluations. The
number of Site Evaluations you must complete is dependent on what you are registered for. Errors in
registration do not change the number of site evaluations you must complete and when there are
administrative errors it is your responsibility to complete your corrected site evaluations in a timely manner.
Site evaluations must be completed on EMS and will be worth 2 or 2.5% of your course grade and must be
completed to pass the clerkship.
PRECEPTOR EVALUATIONS
70% of your Clerkship grade is derived from one or two Preceptor Evaluations completed by your clerkship
director or attending physician.
It is highly recommended that you seek out a mid rotation feedback encounter in order to avoid losing points on
this large portion of your grade and to allow you to improve your performance before it is too late. DO NOT rely
on your preceptor to initiate this conversation. Additionally it is useful to schedule a time to review your
Preceptor Evaluation at the end of the rotation – with your attending. This facilitates timely completion of the
form as well as giving you the opportunity to get vital feedback on your clinical performance.
The weighted percentages of all course components are as follows:
OB/GYN, Psychiatry and Surgery and Family Medicine and Internal Medicine
Clinical Performance Evaluation
70%
Student Site Evaluation(s)
2.5 %
Med U cases
2.5%
Self Test
5%
Post Rotation Examination
20%
Course total
100.0%
Pediatrics
Clinical Rotation Manual For Faculty and Students
Touro University-California
64
Clinical Performance Evaluation
70%
Student Site Evaluation(s)
2%
Self Test
2%
Webinars
4%
Logs
2%
Post Rotation Examination
20%
Course total
100.0%
The Non core courses (ELECTIVES) have the following grade distribution and components which differs from
the Core rotations.
Electives
Clinical Performance Evaluation
95%
Student Site Evaluation
5%
Course total
100.0%
ANY ONE INCOMPLETE COMPONENT CAN KEEP YOU FROM PASSING THE ROTATION.
SITE EVALUATIONS TESTS AND ASSIGNMENTS MUST BE COMPLETED ON TIME TO GET ANY
CREDIT.
ALL COMPONENTS ARE DUE ON THE LAST FRIDAY OF THE COURSE. IF A COURSE IS TWO
ROTATIONS SEPARATED BY TIME, THE COMPONENTS ARE DUE ON THE LAST DAY OF THE
SECOND ROTATION EXCEPT FOR THE FIRST SITE EVALUATION.
Core Course Materials
Important course materials include:
Blackboard
Syllabus
Objective and Learning Assignment document
Online Self tests
Links and Powerpoint lectures
Med U cases (link in BB to external website)
Logs
Web X webinars
Email
BLACKBOARD
Clinical Rotation Manual For Faculty and Students
Touro University-California
65
At some point in the weeks before your rotations start (early June) check Black Board and log into each of
the core rotation sites to confirm you are enrolled and can access the materials. The sites are as simple as
possible to ensure that you will access ALL of the materials.
a. The SYLLABUS, is a CRITICAL document. It will include specific grade break down and required
assignments or reference to documents detailing assignments also available on Black Board. It will also have
useful information, like course learning outcomes and required texts and materials. YOU MUST READ THE
SYLLABUS CAREFULLY FOR EACH ROTATION. You are responsible for the information in these documents
and on each BB site. Download the syllabus for each rotation and determine if there are any books you need to
purchase before your rotation begins. In almost every case resources are chosen which are available online
through the Touro Library or another Link. This is so you will not need to purchase texts. Exceptions include
reading for Psychiatry and OB/Gyn.
b. The Document ―Objective and Learning Assignments‖ is also a CRITICAL document. It can be
downloaded from BB. It contains all of the learning objectives for the course, by week, all of the reading
assignments and case assignments and a time management section. In the case of the Surgery Core course this
material is integrated into the syllabus.
c. Med-U Cases
Each course has a different number of Cases that are required. Case based assignments must be completed to
pass the clerkship. Med-U cases are at the Med-U site. You will be issued a password and the link will be
available in Blackboard. Although the Med-U site divides courses by subject, for example, FM cases are for
Family Medicine and Clipp Cases are for pediatrics, your assigned cases for any core rotation may come from
the entire bank of Med U cases. For example, Clipp case 4 is required during psychiatry although it is a
pediatrics case. Use the syllabus as your guide to determine what is required.
Assignments are spot-checked. That means that they are randomly reviewed to determine adequate effort is
made. If an assignment is not completed or is completed in a way which clearly indicates no effort was made you
will receive 0.
In addition to this random check of content, grade is based on completion, which is assessed through
visualization of the icon exclamation mark in BB and through reports generated by Med-U. These reports
show time spent on each case and the icon indicates that you have accessed the assignment or self test and that
you have submitted it as complete. At least 15 minutes must be spent on all required Med-U cases and the
Med-U report must show a completed check mark icon. Please review your own Med-U report to ensure this
is happening.
Med-U cases are accessed through the med-U website. Ensure early that you have access to Med-U.
d. Reading Assignments and Didactic Materials
A variety of carefully selected links, reading assignments and Med-U materials are assigned. These are
Clinical Rotation Manual For Faculty and Students
Touro University-California
66
considered required unless they are listed specifically as optional. In some cases you will have preceptors who
inquire about your use of the materials specifically or generally. Some preceptors will request that you cover
particular materials for discussion. In other cases you will find it useful or necessary to complete the reading in
order to fully utilize the Self-Test. However, overall these assignments are not a component of your grade.
They serve several purposes listed here so that you might be motivated to use these resources:
1.
Select texts, articles and resources are chosen because they are used by physicians extensively, considered
gold standards and/or referenced regularly by clinicians in practice. Examples include Up-to-date,
Harrison’s Internal medicine, Harriet Lane, and the Red Book. In many cases only a few assignments come
from these sources so that you simply have an opportunity to gain some insight into its utility. In other cases
the resources are so rich that they are recommended extensively.
2.
In some cases the choice is designed to help you narrow down the extensive amount of information available
on a subject so that you can focus on the depth and quantity of information appropriate to your level and
your examinations. Though many students find Harrison’s to be intimidating, each chapter has been
carefully constructed to cover an appropriate but not extensive amount of each pertinent area, for example
the physiology or pathophysiology, testing and physical findings, treatment options and so on. It is a large
text because it covers so many diagnoses, not because it covers them in excessive detail. It will serve you to
get comfortable with this resource.
3.
In some cases the choice is designed to expose you to a critical resource – for example the JNC 7 Guidelines to
HTN , ATPIII guidelines to Lipid management, USPSTF, and the ASCCP guidelines to management of
Abnormal Pap Smears.
4.
In most cases the textbooks chosen are also the texts chosen by the NBOME as resources for preparation
for the COMAT examination.
5.
Finally, for most rotations the assignments are aligned with the objectives and designed with a Time
Management Plan which will allow you to cover all the material during your rotation and help you to
better prepare for your clerkship, sub-I’s of fourth year, exit examinations and the boards.
SELF TESTS
The Self tests for each Core Course are multiple choice tests in Blackboard which may be taken as many times as the
you like. It must be completed by the last Friday of your rotation. It will cover the material in the Med-U cases and
in the OMM powerpoints available via links in the respective BB organizations. The test is self-grading so the first
time you complete it and click submit you will see your grade. If you are not happy with your grade, you may take
the test again as many times as you like. You may find it useful to take this test at the beginning and end of your
rotation. Because these tests are taken throughout the year, answers are not provided however if you would like to
discuss any question in particular you may email Dr. Weiss at [email protected].
Clinical Rotation Manual For Faculty and Students
Touro University-California
67
Challenges to any questions may be submitted by the last day of your rotation. Any challenges received after the
last Friday of your rotation will not be considered.
Challenges must be submitted in writing via email to Dr. Weiss by the last day of your rotation.
They must include the information listed below. If any of the information is missing the challenge will simply be
dismissed. You will not be notified that there is missing information. If you have not reached the deadline you
may resubmit. If the deadline has passed you may not resubmit.
1.
Your Name and Email
2.
Your rotation location and the name of the Core Course ( ie Family Medicine or Internal medicine)
3.
The start and end date of your rotation
4.
The name of your primary attending/preceptor
5.
The question number
6.
The first line of the question
7.
The answer/s you think should be given credit and the reason, in your own words why you think this. If
you think none of the answers are correct, explain your reasoning.
8.
An online source which supports your explanation. This must be accessible via a link, which should be
included in the email. It is not enough to say, according to uptodate. Copy and past the quote which
supports your explanation AND provide the link. The best resource, the one most likely to support your
explanation is MED-U or the OMM powerpoint since these questions are based on the resources provided
and assigned, however, most credible medical sources will be accepted. Wikipedia and e-medicine will not
be accepted but any resource from the Touro Library or other approved medical journal will be. If you are
concerned your resource is not credible, please email me in advance to confirm. A note from your
preceptor is insufficient - you must have a published resource.
LOGS
Logs for your pediatric rotation are required. You must download the forms from Blackboard or Evalue, fill
them out, have your preceptor sign them and fax them to the grade coordinator. Logs for other rotations may be
made available to you either as optional or extra credit assignments. See Blackboard for details.
WEB X WEBINARS
Webinars are required for Pediatrics. See the Black board organization and syllabi for details. Other webinars
may be made available to you and you are encouraged to take advantage of these opportunities.
EMAIL
Communications will be sent via the tu.edu email and you are responsible for receiving these communications.
Please respond to all emails requiring a response within 5 business days. If you will be out of the country or unable
Clinical Rotation Manual For Faculty and Students
Touro University-California
68
to respond for other reason, please set up an automatic response indicating when you will be able to respond.
Clinical Rotation Manual For Faculty and Students
Touro University-California
69
Core Clerkship Syllabus Internal Medicine
Core Rotations 702A and 702B Internal Medicine I and II
Six units per block = four weeks each total of 8 weeks
2012-2013 Academic Year
Materials for TUCOM Class of 2014
Course Director
Jennifer Weiss, DO
Assistant Professor
Department of Clinical Education
Phone: available upon request.
Please email me to arrange phone appointment if needed.
Office hours: upon request, available for instant messaging
Email: [email protected]
Course Philosophy
The most important concept in your training is that you are an Osteopathic Physician. The primary tenet of this
concept is that you are treating whole people within their environment. The other essential tenet of Osteopathic
Medicine is that you use your knowledge of the human body in health to ―dig on‖ and figure out both the cause
and the treatment for each condition. As a third year medical student your strongest tools should be your recent
training in basic science and especially anatomy as well as your attention to detail in history taking and physical
examination. Using the knowledge of normal, approach each patient that you meet taking on the challenge of
understanding what the physiologic process is that is causing their dysfunction and what the anatomy, physiology
and chemistry is that will effect a cure. In this way you will be reasoning like an Osteopathic Physician and you
will find you are integrating the material rather than learning lists and procedures by rote.
Course Description
Core clinical sites for the Internal Medicine rotation offer a range of experiences. The overall goal of the didactic
portion of the rotation is to create a forum in which a consistent set of objectives can be learned. Students will rotate
in assigned clinical settings in order to complete the required third year clerkship. Internal Medicine attendings will
specify site requirements for the clerkship and will see that students are provided with an appropriate level of
clinical and didactic experience. To provide more consistency among Internal Medicine clerkship experiences, the
standardized online curriculum is provided. In order to successfully complete the required third year rotation, all
students must fulfill requirements specified by their preceptor AND complete the required elements of the
standardized curriculum as outlined in the Clinical Education Handbook and this syllabus.
Clinical Rotation Manual For Faculty and Students
Touro University-California
70
Summary of the AOA Competencies
1. Osteopathic Philosophy/Osteopathic Manipulative Medicine
2. Medical Knowledge
3. Patient Care
4. Professionalism
5. Interpersonal and Communication Skills
6. Practice-based Learning and Improvement
7. Systems Based Practice
Each AOA competency that can be improved by achieving Course Learning Outcomes is referenced after the
learning outcome. In the excel file posted in BB there is a comparison of Course Learning Outcomes, Program and
University Learning outcomes and AOA competencies.
Course Learning Outcomes*
At the end of the Internal Medicine clerkship, each student should be able to:
1. Demonstrate the ability to determine and monitor the nature of a patient’s concern or problem using a
patient-centered approach that is appropriate to the age of the patient and that is culturally sensitive.
(AOA;1,2,3,4,5,)
2. Provide patient care that incorporates a strong fund of applied osteopathic medical knowledge and b est
m e d i c a l e v i d e n c e , o s t e o p a t h i c p r i n c i p l e s and p r a c t i c e s , s o u n d c l i n i c a l judgment, and
patient and family preferences. (AOA;1,2,3,4,5)
3. Demonstrate the ability to effectively perform a medical interview, gather data from patients, family
members, and other sources, while establishing, maintaining, and concluding the therapeutic
r e l a t i o n s h i p and in doing so, s h o w e f f e c t i v e i n t e r p e r s o n a l a n d communication skills, empathy for
the patient, awareness of biopsychosocial issues, and scrupulous protection of patient privacy.
(AOA;1,2,3,4,5)
4. Demonstrate the ability to perform a p h y s i c a l e x a m i n a t i o n , i n c l u d i n g o s t e o p a t h i c s t r u c t u r a l
a n d palpatory components, as well as the ability to perform basic clinical procedures important for
generalist practice. (AOA;1,2,3,4,5)
5. Demonstrate analytical thinking in clinical situations and the ability to formulate a differential diagnosis
based on the patient evaluation and epidemiologic data, to prioritize diagnoses appropriately, and to
determine the nature of the concern or problem, in the context of the life cycle and the widest variability of
clinical environments. (AOA;1,2)
6. Demonstrate the ability to develop a n d i n i t i a t e an appropriate evidence-based, cost-effective, patientcentered management plan including monitoring of the problem, which takes into account the motivation,
willingness, and ability of the patient to provide diagnostic information and relief of the patient’s physical
and psychological distress. Include patient counseling and education. Management should be consistent
with osteopathic principles and practices including an emphasis on preventive medicine and health
promotion that is based on best medical evidence. (AOA;1,2,3,4,5,6,)
7. Demonstrate the ability to work effectively with other members of the health c a r e team i n p r o v i d i n g
p a t i e n t -centered c a r e , i n c l u d i n g s y n t h e s i z i n g a n d documenting clinical findings, impressions,
and plans, and using information technology to support diagnostic and therapeutic decisions. This should
include interpersonal and communication skills that enable them to establish and maintain professional
Clinical Rotation Manual For Faculty and Students
Touro University-California
71
relationships with patients, families, and other members of health care teams by applying related
osteopathic principles and practices. (AOA;1,2,3,4,5)
8. Demonstrate the ability to describe and apply fundamental epidemiologic concepts, c l i n i c a l
d e c i s i o n -making s k i l l s , e v i d e n c e -based m e d i c i n e principles and practices, fundamental
information mastery skills, methods to evaluate relevance a n d v a l i d i t y o f r e s e a r c h i n f o r m a t i o n ,
a n d t h e c l i n i c a l s i g n i f i c a n c e o f research evidence. (AOA; 2,6)
9. Demonstrate effective written and electronic communication in dealing with patients and other
health care professionals. Maintain accurate, comprehensive, timely, and legible medical records.
(AOA;1,2,4,5)
10. Demonstrate knowledge of the behavioral and social sciences that underpin the professionalism
competency; humanistic behavior; responsiveness to the needs of patients that supersedes self-interest;
accountability to patients, society, and the profession; a respect for the patient as a person; knowledge and
application of ethical principles in practice and research; and awareness and proper attention to the issues
within cultural competency. (AOA;1,3,4)
11. Demonstrate milestones that indicate a commitment to excellence with ongoing professional
development as evidence of a commitment to continuous learning behaviors. (AOA; 4)
12. Demonstrate an understanding of the important physician interventions required to evaluate,
manage, and treat the clinical presentations that will or may be experienced in the course of practicing
osteopathic medicine by properly applying competencies and physician tasks, incorporating applied
medical sciences, osteopathic principles, and best available medical evidence. This would also include, but
not be limited to, incorporating the following physician tasks:
a. Health promotion and disease prevention
b. History and physical examination
c. Appropriate use and prioritization of diagnostic technologies
d. An understanding of the mechanisms of disease and the normal processes of health
e. Health care delivery
f. Osteopathic principles, practices and manipulative treatment as related to the appropriate clinical
encounters (AOA;1,2,3,4,)
13. Using all of the outcomes listed above as a framework for gathering and integrating knowledge, demonstrate
competency in the area of medical knowledge in the disease states listed in the course specific objectives.
(AOA;1,2)
14. Systems-based practice is an awareness of and responsiveness to the larger context and systems of health
care, and it is the ability to effectively identify and integrate system resources to provide osteopathic
medical care that is of optimal value to individuals and society at large. Students are simply expected to
obtain a beginning understanding and awareness of the larger context and systems of health care, and
effectively identify systems’ resources to maximize the health of the individual and the community at large.
(AOA; 7)
*Adapted from the NBOME Fundamental Osteopathic Medical Competencies. This document is posted in the CED
Resources organization in BB.
Clinical Rotation Manual For Faculty and Students
Touro University-California
72
Objectives and Reading Assignments
The Internal Medicine core clerkship objectives are divided into clinical knowledge and clinical skills objectives.
The clinical knowledge and clinical skill objectives and recommended assignments are available on the blackboard
organization: Class of 2014 TUCA Internal Medicine Core Rotation
Learning Resources
The primary resource is your clinical experience during your rotation. The most valuable teaching tools are your
patients, adjunctive staff at your site, and supervising physicians. However, as clinical training can vary based on
site, all of the topics listed in the objectives should be reviewed independently. It is highly recommended that you
read about your patients’ condition that day in order to solidify the knowledge. Recommended reading
assignments for each learning objective are provided and you should expect to spend two to four hours per day
reading. Lectures and other learning tools will be made available on the Blackboard site.
Assignments
Reading assignments and MedU cases are required unless noted otherwise.
Your reading requirements are from the following resources accessible Online through the library:
Up-to-Date
Harrison’s Internal medicine
Current Medical Diagnosis & Treatment - 48th Ed. (2009)
BlackBoard Materials in Class of 2014 Internal Medicine Core Rotation Site
Med-U Lecture and Case Presentations*
OMM Links on BlackBoard
Additional Reading Assignments and Med-U
There are a multitude of resources at your disposal in your preparation for your exit examination. It is
recommended that you review the blueprint for the examination found on the NBOME website
(http://www.nbome.org/comatmain.asp?m=coll) and study any topics on which you feel you need additional
review.
Communication
Announcements and emails will be provided on or sent through Blackboard (http://blackboard.touro.edu).
Additionally email may be sent to your tu.edu account, which should be checked frequently. See this site for a more
information regarding the course including suggested and required resources.
Mid-clerkship Evaluation
Clinical Rotation Manual For Faculty and Students
Touro University-California
73
At the mid-way point of the clerkship, students are expected to meet with their preceptors to discuss their progress.
Students should elicit feedback on possible areas of improvement for the second half of the rotation. It is often
necessary for you to request this meeting, as preceptors may not initiate it.
Clinical Performance Evaluations (CPE)
At the end of the clerkship experience, attendings and other instructors who have supervised the student during the
clerkship complete CPE forms. CPE forms are included in the clinical rotations manual accessible online and copies
should be provided by the student to the preceptors that he/she worked with during the clerkship. Completion of
the clerkship is dependent upon submission of a completed CPE. Obtaining a passing grade on the CPE is required
in order to pass the clerkship.
COMAT Clinical Exam in Internal Medicine
The purpose of the COMAT Internal Medicine subject examination is to assess the scope of knowledge and
cognitive skills for clinical problem-solving of osteopathic medical school students at the end of the Internal
Medicine rotation and/or to provide a summative assessment of their scope of knowledge and cognitive skills for
clinical problem-solving. It is presented in a style and format comparable to the COMLEX licensure series. All
students are expected to take the web-based exam at the end of the clerkship. The exam consists of a 10-minute
tutorial followed by two hours allotted for the 100-item examination. Time will not be extended beyond the close of
the examination. The COMAT performance accounts for 20% of the final clerkship grade and must be passed in
order to pass the rotation.
The blueprint provided by the NBOME is as follows:
Clinical Rotation Manual For Faculty and Students
Touro University-California
74
You should go to the NBOME COMAT site and review the Objectives for the examination as well.
http://www.nbome.org/comat3.asp?m=coll
It is recommended that you supplement the assigned reading with reading from the required materials on these
topics. You may also wish to use a board review book to determine which topics you need to spend more time
reviewing.
Course Units
The Core Internal Medicine Clerkship Rotation consists of 8 weeks, which is equivalent to 12 units. It is divided
into two four-week rotation blocks, which may be consecutive or divided in time.
Grading and Remediation
A cumulative score of 70% or higher is required to pass the rotation. A cumulative score lower than 70% will result
in failure and will require action as directed by the TUCOM Student Promotions Committee, and as explained in
the Clinical Rotations-Manual in section II. In order to pass the rotation ALL components must be completed on
time, even if not completing one results in a score of 70% or greater. If any individual component is completed late
points will be deducted as follows: Post rotation examination – no greater than 70% may be scored; Self tests, site
Clinical Rotation Manual For Faculty and Students
Touro University-California
75
evaluations and Med-U cases which are completed late will be given 0%. Again, if they are not completed, you will
not pass the rotation, so even if they are late, they must be completed.
1. Preceptor Performance Assessment
70%
Two will be averaged
2. Student Site Evaluation
2.5 %
3. Med –U Cases
2.5%
3. Self Test
5%
4. Post Rotation Examination
20%
Course total
100.0%
All components are due by the last Friday of your rotation. Your examination will be scheduled on the last Friday of
your rotation.
If you pass your overall rotation with a grade of 70% or higher, but fail your preceptor performance assessment you
will need to remediate the rotation. Please see the Clinical Rotations Handbook for more details.
If you fail your examination you must retake it. The make up examination will be pass/fail and your score - if
passing - will be recorded as 70% and averaged in to your total for the 20% that the post examination is worth. The
score on the failed exam will not be recorded in your transcript or averaged into your final grade.
In the event of a failed make – up examination the CED will review the situation and both examinations and one of
the following actions will be required of you: 1. remediate the rotation or some portion of it, 2. Take a third written
assessment 3. submit the matter to the student promotions committee.
You may view your progress in the grade book in BB in the co2014 Internal Medicine Core Rotation Organization.
Items with an exclamation have not been graded but have been submitted as completed. Items with a dash have not
been accessed or recorded. Items with a paper and pencil icon are in progress and cannot be graded. For questions
regarding Med-U cases and Self Test contact Dr. Weiss. For Site Evaluations, Exam scores and CPE contact the
grade coordinator.
Course Map
Learning Outcome
Learning Opportunities
1. Determine and monitor patient concern,
patient-centered, appropriate to age, culturally
sensitive. (AOA;1,2,3,4,5,)
2. Patient care that applies osteopathic
knowledge, b est e v i d e n c e , O P P , patient and
Family preferences. (AOA;1,2,3,4,5)
Clinical rotation
experiences, Reading
assignments, Med U cases
Clinical rotation
experiences, Reading
assignments, Self Test,
Clinical Rotation Manual For Faculty and Students
Direct
Assessments
COMAT, CPE,
COMAT, CPE,
Self-Test
Touro University-California
Indirect
Assessments
COMLEX II,
COMLEX PE
MATCH
COMLEX II,
COMLEX PE
OCSE
76
6. Management Include patient counseling and
education consistent with OPP , preventive
medicine and, health (AOA;1,2,3,4,5,6)
Med U cases
Clinical rotation
experiences, Reading
assignments, Self Test,
Med U cases
Clinical rotation
experiences, Reading
assignments, Self Test,
MED-U cases,
Clinical rotation
experiences, Reading
assignments, Self-Test
(FM case
Clinical rotation
experiences, Reading
assignments, Self-Test
7. work with health c a r e team i n i n c l u d i n g
s y n t h e s i z i n g a n d documenting clinical
findings, and using IT (AOA;1,2,3,4,5)
Clinical rotation
experiences, Reading
assignments, Self-Test
COMAT, CPE,
Self-Test
8. Epidemiologic concepts, c l i n i c a l
d e c i s i o n -making s k i l l s , E B M to evaluate
relevance a n d v a l i d i t y a n d t h e c l i n i c a l
s i g n i f i c a n c e o f research (AOA; 2,6)
Reading assignments, SelfTest,
COMAT, CPE,
Self-Test
9. written a nd electronic communication
and medical records. (AOA;1,2,4,5)
Clinical rotation
experiences, Reading
assignments
COMAT, CPE,
COMLEX II,
COMLEX PE
MATCH
10. Professionalism responsiveness to the needs
of patients that supersedes self-interest; respect
ethical principles awareness of cultural
differences. (AOA;1,3,4)
Clinical rotation
experiences, Reading
assignments
CPE
COMLEX II,
COMLEX PE
MATCH
11. Commitment to ongoing professional
development (AOA; 4)
Clinical rotation
experiences, Reading
assignments
CPE
COMLEX II,
COMLEX PE
MATCH
12. Physician interventions competencies and
tasks
Clinical rotation
experiences, Reading
assignments
COMAT, CPE,
Self-Test
COMLEX II,
COMLEX PE
MATCH
13. Medical knowledge in the disease states listed
in the course specific objectives
Clinical rotation
experiences, Reading
assignments, Self-Test
COMAT, CPE,
Self-Test
COMLEX II,
COMLEX PE
OCSE
MATCH
14. Systems-based practice awareness
Clinical rotation
experiences, Reading
assignments, Self-Test,
Med U cases
CPE
COMLEX II,
COMLEX PE
OCSE
MATCH
3. Medical interview, establishing, the
therapeutic r e l a t i o n s h i p communication skills,
scrupulous protection of patient privacy.
(AOA;1,2,3,4,5)
4. P h y s i c a l e x a m i n a t i o n , i n c l u d i n g
o s t e o p a t h i c s t r u c t u r a l a n d palpatory and
basic clinical procedures (AOA;1,2,3,4,5)
5. Analytical thinking, formulate a differential
diagnosis prioritize diagnoses (AOA;1,2)
Clinical Rotation Manual For Faculty and Students
COMAT, CPE,
Self-Test
COMAT, CPE,
Self-Test
COMAT, CPE,
Self-Test
COMAT, CPE,
Self-Test
Touro University-California
MATCH
COMLEX II,
COMLEX PE
OCSE
MATCH
COMLEX II,
COMLEX PE
OCSE
MATCH
COMLEX II,
COMLEX PE
OCSE
MATCH
COMLEX II,
COMLEX PE
OCSE
MATCH
COMLEX II,
COMLEX PE
OCSE
MATCH
COMLEX II,
COMLEX PE
OCSE
MATCH
77
INTERNAL MEDICINE CORE COURSE OBJECTIVES
Please review the following objectives carefully at the start of your rotation. The level of detail you are responsible
for is dictated by the reading assignments. Contact Dr. Weiss at any time to discuss these objectives or assignments
if you have questions.
Your knowledge and understanding should be evident in your patient interactions, SOAP notes and written history
and physicals, didactic interactions with your preceptors and your performance on Self-Tests and examinations and
at the call back OSCE
Week 1
Carefully use the following approach:
Be able to demonstrate your knowledge of the following components of each listed disease entity:
Presentation
o History
o Physical to include
 Examination
 Lab and imaging findings
Diagnosis to include
o basic pathophysiology of diagnosis and complications of the disease process
o clinical reasoning process in determining the diagnosis
o Basic Epidemiology including risk factors for each diagnosis
Differential Diagnosis to include:
o important things to rule out
o most common alternative diagnoses
Management to include:
o Tests or studies needed to confirm or rule out diagnoses
o Medications - interactions/side effects dosing compliance issues, etc
o Non pharmacologic medical treatment options including, osteopathic approach, nutrition, behavior
modification and so on.
o Consultations and interdisciplinary team management.
o Management of psychosocial issues, and rehabilitation.
o Patient education and follow up
As always, your information gathering, clinical reasoning and assessment and plan should include
osteopathic signs, symptoms, principles, management options and techniques.
Week 1 and 2
Cardiovascular:
Congestive Heart Failure
Atrial fibrillation
Endocarditis
Pericarditis
Myocarditis
Acute Coronary Syndrome
Clinical Rotation Manual For Faculty and Students
Touro University-California
78
Respiratory:
COPD/Emphysema
Pulmonary Embolism
Bronchitis
Pneumonia
Interstitial lung disease
Lung Cancer
Week 3 and 4
Renal:
Fluid and Electrolyte imbalances and management
CKD: Chronic Kidney Disease
ARD: Acute Renal disease
Anemia
Glomerular Disease:
Nephritis/Nephrosis
Proteinuria
GI:
Diseases of the liver
Hepatitis
Cirrhosis
Alcoholic Liver Disease and systemic complications
Non Alcoholic Fatty Liver
Cholangitis and cholecystitis
Pancreatitis
Diverticulosis, and diverticulitis
Inflammatory Bowel Disease and Irritable Bowel Disease
Week 5 and 6
Disorders of the thyroid
Hypo/Hyperthyroid
Grave’s Disease
Thyroiditis and Subclinical Thyroiditis
Thyroid Cancer
Autoimmune and Rheumatic Diseases
Systemic Lupus Erythematosus
Rheumatoid Arthritis
Osteoarthritis
Systemic Sclerosis (Scleroderma)
The Spondyloarthritides
The Vasculitis Syndromes
Sarcoidosis
Week 7 and 8
Other Common Inpatient Issues:
Chronic Alcohol Abuse – medical consequences
DKA
Guillan Barre
AMS: Delirium and Dementia, confusion, disorientation
Clinical Rotation Manual For Faculty and Students
Touro University-California
79
Dyspnea
Chest Pain
Other Infectious Disease:
HIV/AIDS
Cellulitis
Osteomyelitis
Tuberculosis
INTERNAL MEDICINE CORE COURSE ASSIGNMENTS
Unless listed otherwise, all readings are from the assigned text, Harrison’s and all articles are from UptoDate. (all
titles in quotes- copy and paste the names of the articles into the search feature of UptoDate.)
Week 1 and 2 Cardiovascular and Respiratory
Cardiovascular
Med U Cases
FM case 22, 31 required
Simple Cases 1, 2, required
Optional Simple case 4
Reading Assignments
1.
2.
3.
4.
5.
6.
Congestive Heart Failure
a. Chapter 227 Heart Failure and Cor Pulmonale
Atrial fibrillation
a. Chapter 226 intro and section on atrial fibrillation The Tachyarrhythmias
Endocarditis
a. Chapter 118, Infective Endocarditis,
b. Chapter 157 Infections Due to Mixed Anaerobic Organisms (sections on Endocarditis)
Pericarditis
a. Chapters 232, Pericardial Disease,
b. Chapter 157 Infections Due to Mixed Anaerobic Organisms (section on pericarditis)
Myocarditis
a. Chapter 231 Cardiomyopathy and Myocarditis
Acute Coronary Syndrome
a. Chapter 237 Ischemic Heart Disease
b. Chapter 238 Unstable Angina and Non-ST-Elevation Myocardial Infarction
c. Chapter 239 ST-Segment Elevation Myocardial Infarction
d. Chapter 240 Percutaneous Coronary Intervention
Respiratory
Med U Case: FM case 28, 7 , 21 required
Clinical Rotation Manual For Faculty and Students
Touro University-California
80
Reading Assignments
1.
COPD/Emphysema
a. Chapter 254 Chronic Obstructive Pulmonary Disease
b. Article: “Diagnosis and treatment of infection in acute exacerbations of chronic obstructive pulmonary
disease”
c. Article: “Management of acute exacerbations of chronic obstructive pulmonary disease”
2. Pulmonary Embolism
a. Chapter 256 Deep Venous Thrombosis and Pulmonary Thromboembolism
3. Bronchitis
a. Article: “Acute bronchitis”
4. Pneumonia
a. Chapter 251 Pneumonia
b. Article: “Community-acquired pneumonia in adults: Risk stratification and the decision to admit”
c. Article: “Treatment of community-acquired pneumonia in adults who require hospitalization”
d. Article: “Treatment of community-acquired pneumonia in adults in the outpatient setting”
5. Interstitial lung disease
a. Chapter 255 Interstitial Lung Diseases‖
6. Lung Cancer
a. Chapter 85 Neoplasms of the Lung
Week 3 and 4 Renal and Gastrointestinal
Renal:
Med U Cases: Simple Cases 19, 23, 33 - required
Reading Assignments
The books for this section are both, Current Medical Diagnosis & Treatment - 48th Ed. (2009) ( see
the STAT REF books online) for topic 1 and 2, and Harrison’s for topics 3 -7
There will be some overlap between the two books and assignments.
1.
2.
3.
4.
5.
6.
Fluid and Electrolyte imbalances and management
a. Chapter 21, ―Fluid and Electrolyte disorders‖ from Current Medical Diagnosis and Treatment (Stat
ref)
CKD
a. Chapter 22. ―Kidney Disease‖ (from Current Medical Diagnosis & Treatment - 48th Ed. (2009)
ARD
a. Chapter 22. ―Kidney Disease‖ (from Current Medical Diagnosis & Treatment - 48th Ed. (2009)
Anemia (from Harrison’s)
a. Chapter 58 Anemia and Polycythemia (exclude section on polycythemia)
b. Chapter 98 Iron Deficiency and other Hypoproliferative Anemias
c. Chapter 100 Megaloblastic Anemias
d. Chapter 101 Hemolytic Anemias and Anemia Due to Acute Blood Loss
Nephritis/Nephrosis
a. Chapter 277 Glomerular Diseases ( Harrison’s)
Proteinuria
a. Chapter 277 Glomerular Diseases ( Harrison’s)
Clinical Rotation Manual For Faculty and Students
Touro University-California
81
GI:
Med U Cases:
Simple Case 11, 36
(FM case 9, Case 12) optional
Reading Assignments
All of these chapters are from Harrison’s
1.
Diseases of the liver
a. Chapter 295 Approach to the Patient with Liver Disease
b. Chapter 296 Evaluation of Liver Function
2.
Hepatitis
a. Chapter 298 Acute Viral Hepatitis
b. Chapter 299 Toxic and Drug-Induced Hepatitis
c. Chapter 300 Chronic Hepatitis
3.
Cholangitis and cholecystitis
a. Chapter 305 Diseases of the Gallbladder and Ducts
This chapter is also assigned in surgery – focus here is on the non surgical diagnosis, but you
really have to understand all of the chapter to differentiate
4.
Alcoholic Liver Disease
a. Chapter 301 Alcoholic Liver Disease
b. Chapter 302 Cirrhosis and Its Complications
c. Article: “Treatment of alcoholic liver disease”
5. Non Alcoholic Fatty Liver
a. Chapter 303 Genetic, Metabolic, and Infiltrative Diseases Affecting the Liver (only the section on
Nonalcoholic Fatty Liver Disease)
6. Pancreatitis
a. Chapter 306 Approach to the Patient with Pancreatitis
b. Chapter 307 Acute and Chronic Pancreatitis
c. Article: “Predicting the severity of acute pancreatitis”
d. Article: “Treatment of acute pancreatitis”
7. Diverticulosis, and Diverticulitis
Chapter 291. Diverticular Disease and Common Anorectal Disorders
Section on Diverticular Disease only
8. Inflammatory Bowel Disease and Irritable Bowel Disease
b.
c.
Chapter 289 Inflammatory Bowel Disease
Chapter 290 Irritable Bowel Disease
d. Article: “Clinical manifestations and diagnosis of irritable bowel syndrome”
e. Article: “Treatment of irritable bowel syndrome”
Week 5 and 6 Thyroid, Autoimmune and Rheumatic
Clinical Rotation Manual For Faculty and Students
Touro University-California
82
Med U Case: FM case 5 - required
Reading Assignments
For all of the following thyroid topics:
Chapter 335 Disorders of the Thyroid
1.
2.
3.
4.
Hypo/Hyperthyroid
Grave’s Disease
Thyroiditis and Subclinical Thyroiditis
Thyroid Cancer
Autoimmune and Rheumatic Diseases
Med U Cases
Simple case 31, - required
Simple case 32 optional
Reading Assignments
For all topics read the listed chapter and the overview chapter :
Chapter 312: Autoimmunity and Autoimmune Diseases
1.
Systemic Lupus Erythematosus
Chapter 313 Systemic Lupus Erythematosus
2. Rheumatoid Arthritis
Chapter 314 Rheumatoid Arthritis
3. Osteoarthritis
Chapter 326 Osteoarthritis
4. Systemic Sclerosis (Scleroderma)
Chapter 316 Systemic Sclerosis (Scleroderma)
5. The Spondyloarthritides
Chapter 318 The Spondyloarthritides
6. The Vasculitis Syndromes
Chapter 319 The Vasculitis Syndromes
7. Sarcoidosis
Chapter 322 Sarcoidosis
Article: “Clinical manifestations and diagnosis of sarcoidosis”
Week 7 and 8 Other Common Inpatient issues and Other Infectious disease
Other Common Inpatient Issues:
Med U Cases: Simple Case 7 - required
Reading Assignments
Clinical Rotation Manual For Faculty and Students
Touro University-California
83
1.
2.
3.
4.
5.
6.
Chronic Alcohol Abuse – medical consequences
a. Article: “Overview of the chronic neurologic complications of alcohol”
b. Article: “Clinical manifestations and diagnosis of alcoholic liver disease”
c. Article: “Alcohol abuse and hematologic disorders”
d. Article: “Management of moderate and severe alcohol withdrawal syndromes”
DKA
a. Chapter 338 Diabetes Mellitus
b. Article: “Clinical features and diagnosis of diabetic ketoacidosis and hyperosmolar hyperglycemic state in
adults”
c. Article: “Treatment of diabetic ketoacidosis and hyperosmolar hyperglycemic state in adults”
Guillain Barre Syndrome
a. Chapter 370 - Disorders of the Autonomic Nervous System - corresponding sections
b. Chapter 380 - Guillain-Barré Syndrome and Other Immune-Mediated Neuropathies– corresponding
sections
AMS: Delirium and Dementia, confusion, disorientation
a. Chapter 26 Confusion and Delirium
b. Article: “Prevention and treatment of delirium and Confusional states”
c. Article: “Diagnosis of delirium and confusional states”
Dyspnea
a. Chapter 33 Dyspnea and Pulmonary Edema
b. Article: “Approach to the patient with dyspnea”
Chest Pain ( all articles from UptoDate)
a. ―Diagnostic approach to chest pain in adults‖
b. ―Differential diagnosis of chest pain in adults‖
c. ―Evaluation of chest pain in the emergency department‖
d. ―Patient information: Chest pain‖
Other Infectious Disease:
Med U Cases: Simple case 20 – required
Reading Assignments
1.
2.
3.
4.
HIV/AIDS
a. Chapter 181The Human Retroviruses
b. Chapter 182 Human Immunodeficiency Virus Disease: AIDS and Related Disorders
Cellulitis
a. Article: “Cellulitis and Erysipelas”
b. Article “Treatment of skin and soft tissue infections due to methicillin-resistant Staphylococcus aureus in
adults”
c. Article “Preseptal (periorbital) and orbital cellulitis”
Osteomyelitis
a. Chapter 120 Osteomyelitis
Tuberculosis
a. Chapter 158 Tuberculosis
Time Management
Clinical Rotation Manual For Faculty and Students
Touro University-California
84
8 weeks = 40 weekdays
Cases – 16 required over 8 weeks = 2 cases per week (About 3 hours per week)
Reading assignments
UptoDate – 27 articles – weekdays read one per day – done with a couple weeks to spare.
Chapters from Harrisons or Current Diagnosis; 48 full chapters, 6 partial chapters
Read 1.5 chapters per day on weekdays = and you’ll be done by the beginning of the last week.
Still overwhelmed?
Do the assigned case first – do it well, then if you also saw a patient with this condition, for example CHF, skim the
reading for any details you might be missing after seeing a patient and going carefully through the interactive case.
Here’s an example. You see a patient with pneumonia. While you are still at the hospital, maybe on your lunch
break, you read the uptodate article on the topic. You do the case that night on pneumonia. It takes you about an
hour. Than you review the reading assignments on Pneumonia which only takes you about 30 minutes because
now you feel pretty confident with the material. You spent about 1.5 hours after work studying and you still have
30 minutes to make some notes about what you learned to reinforce the materials.
I admit this is a lot of work. You may find that during this intense rotations where there is so much to learn you
have to study all weekend too. Remember, you’ve studied all of this material in first and second year. Now you are
going deeper into the material, getting a more clinical perspective and improving your clinical skills and clinical
reasoning capacity.
After you’ve used the cases some and done some practice test questions you may decide that some of the assigned
reading can be skipped by a more detailed review of the cases and links associated with the cases. Especially in the
situation where optional cases are listed, if you choose to use these you may find you can learn the material without
the required chapter.
This is not permission to skip the required reading, just an acknowledgement that you may learn differently and
ultimately you are simply responsible for completing the assignments and passing the exam.
Questions? [email protected]
Clinical Rotation Manual For Faculty and Students
Touro University-California
85
Surgery Core Clerkship Syllabus
Surgery Core Rotations
General Surgery I CLIN 701A and General Surgery II CLIN701B
2012-2013 Academic Year
Materials for TUCOM Class of 2014
Course Director
Jennifer Weiss, DO
Assistant Professor
Department of Clinical Education
Phone: available upon request.
Please email me to arrange phone appointment if needed.
Office hours: upon request, available for instant messaging
Email: [email protected]
Course Philosophy
The most important concept in your training is that you are an Osteopathic Physician. The primary tenet of this
concept is that you are treating whole people within their environment. In surgery while the most novel and
exciting part of your rotation may be in the operating room, the most important pieces for you to learn are not.
While on this rotation it is important for you to learn about the conditions that necessitate surgery. You should
know the presentation of each condition, when a patient needs to be referred for surgery and how to manage a
patient before and after surgery. It is helpful to participate in surgeries so that when your patients have questions
you are able to answer them. As a primary care physician you will find your role is to confirm patients are in need
of surgery, confirm they are well enough to withstand the stress of surgery and answer questions they have before
they consent to surgery. You may also find yourself in the position of managing their health after surgery. As a
primary care medical student and resident, though you may assist in surgeries and learn essential skills, such as
suturing and stapling, you will be called upon primarily to manage pre and post operative care.
Finally, enjoy the phenomenal experience of first hand viewing of human anatomy inside a living being. This is an
invaluable gift of your training, which will serve you as you pursue the tenets set forth by A.T. Still.
Course Description
Core clinical sites for the General Surgery rotation offer a range of experiences. In one four week block you will be
rotating with a general surgery service. In your second four-week block your experience will depend on your site
and may be more specialized. The topics you will cover for the online portion of this 8-week rotation are all general
surgery topics. The overall goal of the didactic portion of the rotation is to create a forum in which a consistent set
of objectives can be learned. Students will rotate in assigned clinical settings in order to complete the required third
year clerkship. Surgery attendings will specify site requirements for the clerkship and will see that students are
provided with an appropriate level of clinical and didactic experience. To ensure consistency among surgery
Clinical Rotation Manual For Faculty and Students
Touro University-California
86
clerkship experiences, the standardized online curriculum is provided. In order to successfully complete the
required third year rotation, all students must fulfill requirements specified by their preceptor AND complete the
required elements of the standardized curriculum as outlined in the Clinical Education Handbook and this syllabus.
Course Learning Outcomes
On completion of this course students will









1. Have a basic knowledge of Pre and Postoperative care (including risk stratification, wound care,
physiology of wound healing, inpatient and outpatient work ups, both pre and post op and common post
operative complications). Be able to apply that knowledge in clinical scenarios in which patients require
surgery. (AOA:1, 2, 3, 4)
2. Be able to diagnosis and initiate management of common surgical illnesses and differentiate acute
surgical illnesses from those that can be managed conservatively. (AOA: 2, 3)
3. Have developed communication skills that will facilitate the clinical interaction with patients who may
require surgery, including risk benefit counseling and describing basic surgical procedures and postoperative self-care. (AOA: 1, 2, 3, 4, 5)
4. Be able to differentiate an acute from a non acute abdomen, have a thorough knowledge of the
differential diagnosis of abdominal pain including epidemiologic risk factors and be able to take
appropriate steps to arrive at the most likely diagnoses. (AOA: 2,3)
5. Be able to work up a breast mass and manage the patient with a breast mass from discovery to diagnosis.
Include team collaboration, communication and professional behavior. Use evidence based medicine to
make choices about appropriate diagnostic tools. (AOA: 2,3,4,5,6)
6. Have developed basics of clinical problem-solving ad clinical reasoning. skills(AOA: 2, 6)
7. Have developed attitudes and professional behaviors appropriate for clinical practice. (AOA: 4)
8. Have developed knowledge of presentation, work up and management of general surgical conditions
such as Biliary tract disease, Hernia, abdominal masses, colo-rectal disease and scrotal swelling and thyroid
nodules. ( AOA: 1,2,3,5,6)
9. Begin to develop an approach to management of trauma and differentiating surgical vs. non-surgical
traumatic situations. (AOA: 2,6)
Program Learning Outcomes
University Learning Outcomes
AOA Competencies
See Blackboard for a comparison of Program Learning Outcomes, University Learning outcomes, AOA
competencies and Course Learning Outcomes.
Summary of the AOA Competencies
1. Osteopathic Philosophy/Osteopathic Manipulative Medicine
2. Medical Knowledge
3. Patient Care
4. Professionalism
5. Interpersonal and Communication Skills
6. Practice-based Learning and Improvement
7. Systems Based Practice
Objectives and Reading Assignments
Clinical Rotation Manual For Faculty and Students
Touro University-California
87
The Surgery core clerkship objectives are divided into clinical knowledge and clinical skills objectives.
The clinical knowledge and clinical skill objectives and recommended assignments are available on the
blackboard organization: Class of 2014 TUCA Surgery Core Rotation
Learning Resources
The primary resource is your clinical experience during your rotation. The most valuable teaching tools are your
patients, adjunctive staff at your site, and supervising physicians. However, as clinical training can vary based on
site, all of the topics listed in the objectives should be reviewed independently. It is highly recommended that you
read about your patients’ condition that day in order to solidify the knowledge. Recommended reading
assignments for each learning objective are provided and you should expect to spend two to four hours per day
reading. Lectures and other learning tools will be made available on the Blackboard site.
Assignments
Reading assignments and Med-U cases are required unless noted otherwise.
Your reading requirements are from the following resources accessible through the library:
1.
2.
3.
4.
5.
6.
Current Diagnosis and Treatment Surgery – 13th Edition, 2010 ( Stat Ref and Access Medicine)
Schwartz’s Principles of Surgery – 9th Edition, 2010 ( Access Medicine)
Townsend: Sabiston 18th Edition – Access via MD Consult
Up-to-Date
Blackboard Materials in Class of 2014 Surgery Core Rotation Site
Med-U Lecture and Case Presentations*
Additional Reading Assignments and Med-U
There are a multitude of resources at your disposal in your preparation for your exit examination. It is
recommended that you review the material on the NBOME website including the blueprint for the examination and
the content outline (http://www.nbome.org/comatmain.asp?m=coll) and study any topics on which you feel you
need additional review. Some recommended and optional materials are listed in your reading assignments
document.
Mid-clerkship Evaluation
At the mid-way point of the clerkship, students are expected to meet with their preceptors to discuss their progress
so far. Students should elicit feedback on possible areas of improvement for the second half of the rotation. It is
often necessary for you to request this meeting as preceptors may not initiate it.
Clinical Performance Evaluations (CPE)
At the end of the clerkship experience, attendings and other instructors who have supervised the student during the
clerkship complete CPE forms. CPE forms are included in the clinical rotations manual accessible online and copies
should be provided by the student to the preceptors that he/she worked with during the clerkship. Completion of
the clerkship is dependent upon submission of a completed CPE. Obtaining a passing grade on the CPE is required
in order to pass the clerkship.
Clinical Rotation Manual For Faculty and Students
Touro University-California
88
COMAT Clinical Exam in General Surgery
The purpose of the COMAT Surgery subject examination is to assess the scope of knowledge and cognitive skills for
clinical problem solving of osteopathic medical school students at the end of the Surgery rotation and/or to provide
a summative assessment of their Surgery scope of knowledge and cognitive skills for clinical problem-solving. It is
presented in a style and format comparable to the COMLEX licensure series. All students are expected to take the
web-based exam at the end of the clerkship. The exam consists of a 10-minute tutorial followed by two hours
allotted for the 100-item examination. Time will not be extended beyond the close of the examination. The COMAT
performance accounts for 20% of the final clerkship grade and must be passed in order to pass the rotation.
Preparing for the Examination:
The blueprint provided by the NBOME is as follows:
Topic %
Fluids 5-13%
Skin and Subcutaneous Tissues 2-7%
Infections 2-8%
Gastrointestinal 30-37%
Hepato/Biliary 13-20%
Hernias 5-13%
Trauma 5-13%
Endocrine/Breast 5-13%
Anesthesia 2%
Most but not items are covered by assigned reading and Med-U materials. Additionally on your General Surgery
rotation you are likely to see many of cases which cover these topics.
Items not specifically addressed as objectives are covered in part by assigned reading, and by additional Surgery
modules from Med-U or optional reading assignments (unassigned). For example, Skin and Subcutaneous Tissues
in part will be covered by wound care management but you may want to review the Med-U case on Skin Cancer.
Similarly Infections will be covered to some degree in your study of Biliary disease, Abdominal pain, post operative
complications and wound care, but again, you may need to supplement these materials depending on your clinical
experience. As you will find on the COMAT website, the texts from which your assigned reading is derived are
also the recommended texts – these include Sabiston, Schwartz and UptoDate – you may choose to read additional
material from these sources to prepare for the examination. You may also wish to use a board review book to
determine which topics you need to spend more time reviewing.
Course Units
The Core Surgery Clerkship Rotation consists of 8 weeks, which is equivalent to 12 units.
Grading and Remediation
A cumulative score of 70% or higher is required to pass the rotation. A cumulative score lower than 70% will result
in failure and will require action as directed by the TUCOM Student Promotions Committee, and as explained in
the Clinical Rotations-Manual Section II. In order to pass the rotation each component must be completed, even if
not completing it results in a score of 70% or greater. If any individual component is completed late points will be
deducted as follows: Post rotation examination – no greater than 70% may be scored, the self -test, site evaluations
Clinical Rotation Manual For Faculty and Students
Touro University-California
89
and Med-U cases which are completed late will be given 0%. Again, if they are not completed you will not pass the
rotation so even if they are late, they must be completed.
1. Preceptor Performance Assessment
70%
Two will be averaged
2. Student Site Evaluation
2.5 %
3. Med –U Cases
2.5%
4. Self Test
5%
5. Post Rotation Examination
20%
Course total
100.0%
The self-test is self grading. Any challenges must be submitted according to the guidelines presented in the
overview to the curriculum and this must happen by the last day of your rotation.
All components must be completed by the last Friday of your rotation.
If you pass your overall rotation with a grade of 70% or higher, but fail your preceptor performance assessment you
will need to remediate the rotation. Please see the Part II of the Clinical Rotations Handbook for more details.
If you fail your examination you must retake it. The make up examination will be pass-fail and your score - if
passing - will be recorded as 70% and averaged in to your total for the 20% that the post examination is worth. The
score on the failed exam will not be recorded in your transcript or averaged into your final grade.
In the event of a failed make – up examination the CED will review the situation and both examinations and one of
the following actions will be required of you: 1. remediate the rotation or some portion of it, 2. Take a third written
assessment 3. submit the matter to the student promotions committee.
Policies and Logistics
Communication to students for the surgery course will be provided on Blackboard (http://blackboard.touro.edu).
You are responsible for all material posted on BB. Email may be sent to your tu.edu account, which should be
checked frequently. You are responsible for reading all emails. See the BB site for a more information regarding the
course including suggested and required resources.
Clinical Rotation Manual For Faculty and Students
Touro University-California
90
Course Map
Course Outcome
1. Have a basic knowledge of
Pre and Postoperative care
(including risk stratification,
wound care, physiology of
wound healing, inpatient
and outpatient work ups pre
and post op and common
post operative
complications) and be able to
apply that knowledge in
clinical scenarios in which
patients require surgery.
2. Be able to diagnosis and
initiate management of
common surgical illnesses
and differentiate acute
surgical illnesses from those
that can be managed
conservatively.
3. Have developed
communication skills that
will facilitate the clinical
interaction with patients
who may require surgery,
including risk benefit
counseling and describing
basic surgical procedures
and post-operative self-care.
4. Be able to differentiate an
acute from a non acute
abdomen, have a thorough
knowledge of the differential
diagnosis of abdominal pain
including epidemiologic risk
factors and be able to take
appropriate steps to arrive at
the most likely diagnoses
5. Be able to work up a
breast mass and manage the
Learning Opportunities Direct Assessments
Indirect
Assessments
Clinical rotation
experiences, Reading
assignments, Self-Test
COMLEX II,
COMLEX PE
OCSE
MATCH
Clinical rotation
experiences, Reading
assignments, Self-Test
Clinical rotation
experiences, Reading
assignments, Self-Test
Clinical rotation
experiences, Reading
assignments,SelfTest,SIMPLE case 9,
surgery appendicitis
module, bowel
obstruction module,
diverticulitis module
Clinical rotation
experiences, Reading
Clinical Rotation Manual For Faculty and Students
COMAT, CPE, SelfTest
COMAT, CPE, SelfTest
COMLEX II,
COMLEX PE
OCSE
MATCH
COMAT, CPE, SelfTest
COMLEX II,
COMLEX PE
OCSE
MATCH
COMAT, CPE, SelfTest
COMLEX II,
COMLEX PE
OCSE
MATCH
COMAT, CPE, SelfTest
COMLEX II,
COMLEX PE
Touro University-California
91
patient with a breast mass
from discovery to diagnosis.
Include team collaboration,
communication and
professional behavior. Use
evidence based medicine to
make choices about
appropriate diagnostic tools.
6. Have developed basic of
clinical problem-solving
skills that apply to managing
surgical patients.
7. Development of the
attitudes and professional
behaviors appropriate for
clinical practice.
8. Develop knowledge of
presentation, work up and
management of general
surgical conditions such as
Biliary tract disease, Hernia,
abdominal masses, colorectal disease and scrotal
swelling and thyroid
nodules.
9. Begin to develop an
approach to management of
trauma and differentiating
surgical vs. non-surgical
traumatic situations.
assignments, Self-Test
OCSE
MATCH
(FM case 26?)
Clinical rotation
experiences, Reading
assignments, Self-Test
Clinical rotation
experiences, Reading
assignments, Self-Test
COMAT, CPE, SelfTest
COMLEX II,
COMLEX PE
OCSE
MATCH
COMAT, CPE, SelfTest
COMLEX II,
COMLEX PE
OCSE
MATCH
COMAT, CPE, SelfTest
COMLEX II,
COMLEX PE
OCSE
MATCH
COMAT, CPE, SelfTest
COMLEX II,
COMLEX PE
OCSE
MATCH
Clinical rotation
experiences, Reading
assignments, Self-Test
FM case 15, 27, 10,12 ,
surgery module –
diverticulitis,
cholecystitis, Hernia
Reading assignments,
Self-Test, Surgery
trauma , module
Clinical Rotation Manual For Faculty and Students
Touro University-California
92
SURGERY CORE COURSE LEARNING OBJECTIVES AND ASSIGNMENTS
Please review the following objectives carefully at the start of your rotation. Do not be diverted
into thinking the listed topics are important and the rest of the information given below is not.
The level of detail you are responsible for is dictated by the guidelines to the objectives and the
reading assignments. Contact Dr. Weiss at any time to discuss these objectives or assignments if
you have questions.
These topics are divided into four weeks based on the assumption that you are doing one general
surgery rotation block followed by 4 weeks of a subspecialty surgery. You may however use all 8
weeks to cover the topics. Having said that, you will find that the above topics are the bread and
butter of general surgery and you may need all of the information right away during your
general surgery block. Self Tests are based only on the material and reading assignments
dictated by this syllabus.
Covering these topics well will prepare you for COMAT, however, it is recommended that you
approach your study for COMAT as you would any Board exam and review additional
materials. You may find that consulting a board review book is helpful to determine in which
topics you are deficient.
The Assignments are from the following resources:
1. Up-to-date
2. Current Diagnosis and Treatment Surgery13th Edition, Eds; Lawrence W. Way and
Gerard M. Doherty, Lange Medical Books/McGraw-Hill, New York, 2003 ($59.95 at
Barnes & Noble.com).
3. Sabiston Textbook of Surgery, Townsend, 18th edition 2008
4. Schwart’z Principles of Surgery
5. An Osteopathic Approach to Diagnosis and Treatment
6. Med U: surgery modules****, Family medicine and Internal Medicine cases
**** Due to the slow loading time of the surgery modules only a few are required, while
all are highly recommended. You may find that having a supplemental reading
assignment available to review while waiting for the video’s to load allows you to persist
in viewing these great lectures and case presentations.
The FM and IM cases are not a problem.
Week 1
The topics for this first week are critical to your success in all surgery rotations and in many other
rotations. As a general practitioner – in pediatrics, family medicine, internal medicine and
obstetrics, you will find yourself in need of understanding general wound healing and nutrition
and you will also find you are called on for both pre-operative and post operative care by your
patients and by your surgical colleagues.
Note that week 1 has two sections – the one that follows here and the one after the general
guidelines for the rest of the rotation.
Part I Clinical Skills
History and Physical examination of the surgical patient
Labs, Imaging and Special Tests
Suturing and knot tying
Clinical Rotation Manual For Faculty and Students
Touro University-California
93
Assignments:
1. Current Diagnosis and treatment Chapter 1 and 2
2. Ethicon Wound Healing and suture manual Link:
Suturingwww.pilonidal.org/_assets/pdf/wound_closure.pdf
Part II Clinical Knowledge
A. Pre- and peri-operative care and assessment of surgical patients, including anesthesia Risk,
and Goldman’s index
When you finish your study of these topics you should be able to:
A. Assess a patient and determine if they are healthy enough to withstand surgery and if
not what they need to do to improve their health.
i. You should know which examination and tests need to be completed prior to
surgery and what tests are unnecessary.
ii. based on the data you gather from your history examination and tests evaluate
the health of the patient and their readiness for surgery.
iii. Recommend surgery or not, and lifestyle or medical changes necessary for a
successful procedure.
B. Be able to explain to your patients what the risks are of surgery – based on their
current state of health.
Assignments:
1. Current Diagnosis and Treatment Chapter 3,4
2. Optional Chapter 11 Anesthesia
3. From Up-to-date Required: Estimation of cardiac risk prior to noncardiac surgery and
Preoperative medical evaluation of the healthy patient
B. Wound healing
Describe the normal physiology of wound healing and how it can be complicated by
poor immune function and chronic disease, poor nutrition and toxic substances such as tobacco
and alcohol or prescription drugs.
Assignments:
1. Ethicon Wound Healing and suture manual Link:
Suturingwww.pilonidal.org/_assets/pdf/wound_closure.pdf
2. Current Diagnosis and Treatment Chapter 6 and 8
C. Body Fluids and Fluid and Electrolyte Therapy
i. Refresh your knowledge of Body Fluids, and normal control of volume, pH and
electrolytes
ii. Differentiate the types and uses of parenteral solutions
iii. Prescribe preoperative and postoperative fluid solutions and and explain your
calculations and determinations.
iv. Diagnose and correct electrolyte abnormalities in the surgical patient.
Assignments:
1. Current Diagnosis and Treatment Chapter 9
2. From Up-to-date: Maintenance and replacement fluid therapy in adults
3. Townsend: Sabiston Textbook of Surgery, 18th ed. Chapter 5 – Shock, Electrolytes, and
Fluid ( shock is covered later, so you will need to read the whole chapter)
Clinical Rotation Manual For Faculty and Students
Touro University-California
94
For the rest of the topics, carefully use the following approach:
Your knowledge and understanding should be evident in your patient interactions, SOAP notes,
written history and physicals, didactic interactions with your preceptors and your performance
on your Self-Test and examinations and at the call back OSCE
Be able to demonstrate your knowledge of the following components of each listed disease entity:
Presentation
o History
o Physical to include
 Examination
 Lab and imaging findings
Diagnosis to include
o basic pathophysiology of diagnosis and complications of the disease process
o clinical reasoning process in determining the diagnosis
o Basic Epidemiology including risk factors for each diagnosis
Differential Diagnosis to include:
o important things to rule out
o most common alternative diagnoses
Management to include:
o Tests or studies needed to confirm or rule out diagnoses
o Medications - interactions/side effects dosing compliance issues, etc
o Non pharmacologic medical treatment options including, osteopathic approach,
nutrition, behavior modification and so on.
o Consultations and interdisciplinary team management.
o Management of psychosocial issues, and rehabilitation.
o Patient education and follow up
As always, your information gathering, clinical reasoning and assessment and plan should include
osteopathic signs, symptoms, principles, management options and techniques.
Week 1
Post-operative complications:
Fever
Chest pain
Disorientation and coma
Urinary problems
Ileus
Mechanical obstruction
Wound: dehiscence, evisceration and infection
Shock and Acute Pulmonary Failure
Assignments:
Current Diagnosis and Treatment Chapter 4, 5,8,12
Optional Reading: Surgical metabolism and Nutrition
Required Med-U case Family Medicine cases #26 - this case covers a range of pertinent
and advanced issues that will help you with clinical reasoning and some of the topics
that follow as well as post operative care.
Clinical Rotation Manual For Faculty and Students
Touro University-California
95
Week 2
For this week you may either do the SIMPLE cases or the reading or both – These cases will not
be part of your Med U grade.
These topics are so common and make up such a large portion of your general surgery rotation
that you should determine what the best study tools are – either to read, do the med-u cases or
other research on these topics. If you do not see some of these as part of your clinical experience
it is a good idea to do the cases. If you see them frequently you may find the reading a more
useful tool.
GI/GU:
Bleeding (include hematemesis, hematochezia/,melena)
Acute Abdominal Pain
Abdominal mass
Assignments:
Current Diagnosis and Treatment Chapter 21/
Townsend: Sabiston's Textbook of Surgery. Section X, Chapter 45 and 46
Uptodate articles:
Approach to the adult patient with upper gastrointestinal bleeding
Major causes of upper gastrointestinal bleeding in adult
Approach to the adult patient with lower gastrointestinal bleeding
Etiology of lower gastrointestinal bleeding in adults
Evaluation of occult gastrointestinal bleeding
History and physical examination in adults with abdominal pain
Diagnostic approach to abdominal pain in adults
Differential diagnosis of abdominal pain in adults
And/ OR ( Highly recommended)
Med U case – from SIMPLE cases 9, 10, 12
And Med-U surgery module on Abdominal Aortic Aneurysm
Week 3
Hernia
Intestinal obstruction
Biliary Tract Disease
Appendicitis
Assignments:
Current Diagnosis and Treatment Chapters: 28, 30
Required reading Schwartz’s Principles of surgery
Chapter 37 Inguinal Hernias, Chapter 28 Small Intestine
Chapter 32 Gallbladder and Extrahepatic Biliary System
Required Med U case – from Family Medicine: case 15
Highly Recommended: Surgery Modules diverticulitis, cholecystitis, Hernia
Clinical Rotation Manual For Faculty and Students
Touro University-California
96
Week 4
Breast Masses and Breast Cancer (benign and malignant findings)
Rectum and colon diseases, including neoplasia
Scrotal swelling
Thyroid Nodule
Trauma
Assignments:
Current Diagnosis and Treatment Chapters 13, 17, 30, 31 and appropriate section from
chapter 38
Schwartz Chapter 38 Thyroid, Parathyroid, and Adrenal
Articles from Uptodate
Screening for breast cancer
Primary care evaluation of breast lumps
Diagnostic evaluation of women with suspected breast cancer
Patient information: Breast cancer guide to diagnosis and treatment
Clinical manifestations and diagnosis of colonic diverticular disease
Clinical manifestations and diagnosis of irritable bowel syndrome
Tests for screening for colorectal cancer: Stool tests, radiologic imaging and endoscopy
Approach to the patient with colonic polyps
Required Med U Cases
Family Medicine: case 27
Surgery Module on Breast Cancer
Surgery Module on Appendicitis
Highly Recommended: Surgery Modules on bowel obstruction, colon cancer and thyroid
nodule and Trauma Resuscitation
Summary of reading and cases for the rotation
Current Diagnosis and treatment Chapter 1 - 6 and 8, 9, 12, 13, 17, 21, 25, 28 - appropriate section
from chapter 38
(14 chapters)
Townsend: Sabiston Textbook of Surgery, 18th ed. Chapter 5 . Section X, Chapter 45 and 46 (2
chapters)
Schwartz’s Principles of surgery Chapter 37 Inguinal Hernias, Chapter 28 Small Intestine,
Chapter 32 Gallbladder and Extrahepatic Biliary System
Schwartz Chapter 38 Thyroid, Parathyroid, and Adrenal
Shock chapter 5, Trauma chapter 7 ( 6 chapters)
Ethicon Wound Healing and suture manual Link:
Suturingwww.pilonidal.org/_assets/pdf/wound_closure.pdf
From UptoDate:
1. Estimation of cardiac risk prior to noncardiac surgery
2. Preoperative medical evaluation of the healthy patient
3. Maintenance and replacement fluid therapy in adults
4. Approach to the adult patient with upper gastrointestinal bleeding
Clinical Rotation Manual For Faculty and Students
Touro University-California
97
5. Major causes of upper gastrointestinal bleeding in adult
6. Approach to the adult patient with lower gastrointestinal bleeding
7. Etiology of lower gastrointestinal bleeding in adults
8. Evaluation of occult gastrointestinal bleeding
9. History and physical examination in adults with abdominal pain
10. Diagnostic approach to abdominal pain in adults
11. Differential diagnosis of abdominal pain in adults
12. Screening for breast cancer
13. Primary care evaluation of breast lumps
14. Diagnostic evaluation of women with suspected breast cancer
15. Patient information: Breast cancer guide to diagnosis and treatment
16. Clinical manifestations and diagnosis of colonic diverticular disease
17. Clinical manifestations and diagnosis of irritable bowel syndrome
18. Tests for screening for colorectal cancer: Stool tests, radiologic imaging and endoscopy
19. Approach to the patient with colonic polyps
Required Med-U case Family Medicine cases #15, 26, 27
Optional
Med U cases
from SIMPLE cases 9, 10, 12
Surgery Module on Breast Cancer
Surgery Module on Appendicitis
Time Management
You have 8 weeks to complete these requirements, however you will find most of this
information critical to general surgery, which may only be four weeks of your 8-week rotation. If
this is the case I highly recommend you use the 4 week plan below so that you may do reading
during your subspecialty rotation.
Note that these plans are five day a week study plans. You can use weekends to prepare for the
exit exam by taking practice board review tests.
An 8-Week Plan
One Med-U case or module per week
1 articles from UptoDate per week day (finished with all articles in three weeks)
1 chapter from Current Diagnosis and Management per every two week days.
Self Test – take it at the beginning and the end of the rotation ( if you want to see what you
learned) take it only once if you are feeling pressed for time. Take it a whole bunch of times till
you get 100% if you are worried about your grade.
*** you’ll be done with the reading before the 8 weeks are over.
Clinical Rotation Manual For Faculty and Students
Touro University-California
98
A Four-Week Plan
Two cases or modules per week
1 articles from UptoDate per week day (finished with all articles in three weeks)
1 chapter from Current Diagnosis and Management, Schwarz or Sabiston every day.
Self Test: take it at the beginning and the end of the rotation ( if you want to see what you
learned) take it only once if you are feeling pressed for time. Take it a whole bunch of times till
you get 100% if you are worried about your grade.
Clinical Rotation Manual For Faculty and Students
Touro University-California
99
OB/GYN Core Clerkship Syllabus
Core Rotation OB/GYN CLIN 706 (6 weeks, nine units) OR CLIN 714 (4 weeks) and CLIN 703
(two weeks)
2012-2013 Academic Year
Materials for TUCOM Class of 2014
Course Director
Jennifer Weiss, DO
Assistant Professor
Department of Clinical Education
Phone: available upon request.
Please email me to arrange phone appointment if needed.
Office hours: upon request, available for instant messaging
Email: [email protected]
Course Philosophy
Obstetrics and Gynecology or Women’s Health is a rich field of study. During your rotation you
may have a narrow or a broad experience, but you should be aware of the opportunities available
in this field. All demographic populations have issues related to sexuality and reproduction and
these issues, time and again, offer abundant opportunities to grapple with ethical and
professional issues such as confidentiality, religion, social justice, alternative care, natural care,
use or lack of use of evidence, sexism, ageism, and parenting concerns to name just a few of the
issues you may encounter in your training and career. Open your mind and your eyes and take
in each experience as an opportunity to expand and grow. In addition, the intensity of labor and
delivery is unique. Each birth is different in as many ways as it is the same, and the level of
emotion and bonding, between parents, newborns, nurses and physicians is also unique to this
particular branch of medicine. Also, working with young people who are at the beginning of this
phase of their lives is a privilege and a responsibility. You may be the only adult they are able to
talk with about STI’s, sex and pregnancy. Gathering the medical knowledge to talk to your
patients is just one small aspect of what is required of you as a physician in Obstetrics and
Gynecology.
While most of your reading assignments are designed to help you gather the knowledge
you need to excel, you should take every opportunity to explore the complex issues that arise
Clinical Rotation Manual For Faculty and Students
Touro University-California
100
during your rotation with your preceptors and those further ahead in their training. Please don’t
hesitate to contact me if you are confused or stuck in any way during this exciting rotation.
Course Description
Core clinical sites for the OB/GYN rotation offer a range of experiences. The overall goal of the
didactic portion of the rotation is to create a forum in which a consistent set of objectives can be
learned. Students will rotate in assigned clinical settings in order to complete the required third
year clerkship. OB/GYN attendings will specify site requirements for the clerkship and will see
that students are provided with an appropriate level of clinical and didactic experience. To
ensure consistency among obstetric/gynecologic clerkship experiences, this standardized
curriculum is provided. In order to successfully complete the required third year rotation, all
students must fulfill requirements specified by their preceptor AND complete the required
elements of the standardized curriculum as outlined in the Clinical Education Handbook and this
syllabus.
Summary of AOA Competencies
1. Osteopathic Philosophy/Osteopathic Manipulative Medicine
2. Medical Knowledge
3. Patient Care
4. Professionalism
5. Interpersonal and Communication Skills
6. Practice-based Learning and Improvement
7. Systems Based Practice
See Excel spread sheet, posted in the BB organization for alignment of course learning outcomes
with Program and University Learning Outcomes as well as AOA competencies. Please contact
Dr. Weiss directly if you have questions about this or would like more information. The AOA
competencies are listed following each Course Learning Outcome with which they are aligned.
Course Learning Outcomes
1.
2.
3.
4.
5.
Have a basic knowledge of normal female reproductive physiology and endocrinology
including the menstrual cycle, changes in pregnancy and puberty and menopause.
(AOA: 2)
Develop competence in obtaining a history and physical examination of women,
including a sexual history, incorporating social, ethical, and culturally diverse
perspectives. (AOA; 1,2,3,4,5)
Be able to diagnose and initiate management of common gynecologic concerns. (AOA: 1,
2, 3)
Be able to diagnose, communicate about and initiate management of STI’s including
HPV. (AOA; 1,2,3,4,5)
Demonstrate knowledge of contraception options, including sterilization and abortion.
(AOA; 2,3,4)
Clinical Rotation Manual For Faculty and Students
Touro University-California
101
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
Demonstrate the ability to counsel patients regarding contraception options (AOA;
1,2,3,4,5)
Describe the etiology and evaluation of infertility
Demonstrate knowledge of prenatal and preconception counseling and care. (AOA;
1,2,3,4,5)
Develop communication skills that facilitate the clinical interaction with patients in
potentially sensitive situations such as dealing with sexually transmitted infections,
infertility and other issues pertaining to women’s health. (AOA: 1, 2, 3, 4, 5)
Demonstrate knowledge of normal intrapartum and delivery care. (AOA; 1,2,3,4,5)
Demonstrate knowledge of common complications of pregnancy and intrapartum care
and how to initiate management of them. (AOA; 1,2,3,5)
Demonstrate knowledge of perioperative care and familiarity with common obstetric and
gynecologic procedures. (1,2,3)
Demonstrate the ability to communicate with colleagues and support staff through
traditional oral presentations, and standard formatted notes, such as SOAP, H&P, pre
and post operative, admit and so on. (1,2,3,4)
Be able to offer prenatal, and post partum counseling and care, and breast feeding
counseling and support. (AOA; 1,2,3,4,5)
Have developed of the attitudes and professional behaviors appropriate for clinical
practice. (AOA: 1, 3,4,5)
Recognize one’s role as a leader and advocate for women
Objectives and Reading Assignments
The OB/GYN core clerkship objectives are divided into clinical knowledge and clinical
skills objectives. These objectives as well as the reading assignments and assigned Med-U cases
are in a separate document which can be found in the BB organization co2014 OB Core Rotation.
In addition to the reading assignments and Med-U cases, be sure to review the materials
referenced on the BB site in the Didactic Materials section.
The amount of material to cover and read in this 6 week rotation is quite large. Review
the Time Management Section of the Reading Assignment Document for assistance.
It is recommended that you complete the Med-U cases prior to attempting the reading
assignments, as the reading will have more relevance once you have had some clinical
experience. These cases offer a rich source of clinical and interactive learning opportunities if
utilized properly. If you learn from the cases you will find the reading much quicker to cover as
it will be either a review or complimentary to the learning from the cases. The cases, however, do
not cover all of the objectives.
The clinical knowledge and clinical skill objectives and recommended assignments are available
on the blackboard organization: Class of 2014 OB/GYN Core Rotation
Learning Resources
Clinical Rotation Manual For Faculty and Students
Touro University-California
102
The primary resource is your clinical experience during your rotation. The most valuable
teaching tools are your patients, adjunctive staff at your site, and supervising physicians.
However, as clinical training can vary based on site, all of the topics listed in the objectives
should be reviewed independently. It is highly recommended that you read about your patients’
condition that day in order to solidify the knowledge. Recommended reading assignments for
each learning objective are provided and you should expect to spend two to four hours per day
reading. Lectures and other learning tools will be made available on the Blackboard site.
Reading assignments and MedU cases are required unless noted otherwise.
Your reading requirements are from the following resources accessible through the library:
1. Katz: Comprehensive Gynecology, 5th ed. Chapter 7 – History, Physical Examination, and
Preventive Health Care : General, Gynecologic, and Psychosocial History and Examination,
Health Care Maintenance, Disease Prevention
2. Gabbe: Obstetrics: Normal and Problem Pregnancies, 5th ed.
3. ―Current Obstetric and Gynecologic Diagnosis and Treatment‖ by DeCherney, Alan H.
(Author) Nathan, Lauren (Author).‖
4. Up-to-Date
5. BlackBoard Materials in Class of 2014 OB/GYNCore Rotation Site
6. Pocket Guide to Contraception
7. OMM Power Point Presentations
8. Med-U Lecture and Case Presentations*
The topics covered in this rotation require an understanding of the menstrual cycle, sexual reproduction,
and hormone synthesis and function. Please review this basic science material.
Additional Reading Assignments and Med-U
There are a multitude of resources at your disposal in your preparation for you’ your exit
examination. It is recommended that you review the blueprint for the examination found on the
NBOME website (http://www.nbome.org/comatmain.asp?m=coll) and study any topics on
which you feel you need additional review.
Communication
Communication to students for the course will be provided on Blackboard
(http://blackboard.touro.edu). Additionally email may be sent to your tu.edu account, which
Clinical Rotation Manual For Faculty and Students
Touro University-California
103
should be checked frequently. See this site for a more information regarding the course including
suggested and required resources.
Mid-clerkship Evaluation
At the mid-way point of the clerkship, students are expected to meet with their preceptors to
discuss their progress so far. Students should elicit feedback on possible areas of improvement
for the second half of the rotation. It is often necessary for you to request this meeting, as
preceptors may not initiate it.
Clinical Performance Evaluations (CPE)
At the end of the clerkship experience, CPE forms are completed by attendings and other
instructors who have supervised the student during the clerkship. CPE forms are included in the
clinical rotations manual accessible online and copies should be provided by the student to the
preceptors that he/she worked with during the clerkship. Completion of the clerkship is
dependent upon submission of a completed CPE. Obtaining a passing grade on the CPE is
required in order to pass the clerkship.
COMAT Clinical Exam
The purpose of the COMAT subject examination is to assess the scope of knowledge and
cognitive skills for clinical problem solving of osteopathic medical school students at the end of
the OB/Gyn rotation and/or to provide a summative assessment of their scope of knowledge
and cognitive skills for clinical problem-solving. It is presented in a style and format comparable
to the COMLEX licensure series. All students are expected to take the web-based exam at the end
of the clerkship. The exam consists of a 10 minute tutorial followed by two hours allotted for
the 100 item examination. Time will not be extended beyond the close of the examination. The
COMAT performance accounts for 20% of the final clerkship grade and must be passed in order
to pass the rotation.
Preparing for the Examination
The blueprint provided by the NBOME is as follows:
Topic / %
Dimension I Patient Presentation
Normal OB 15-25%
Abnormal OB 20-30%
General Gynecology 25-35%
Reproductive Endocrinology 10-20%
Gynecologic Oncology 5-15%
Dimension II Physician Tasks
History Examination Communication Interaction 40-50%
Diagnosis Management- Pap Smear/DNA testing 35-45%
HPDP 10-15%
Clinical Rotation Manual For Faculty and Students
Touro University-California
104
Secondary overarching topics 1-5%
You should visit the web page for the OB COMAT exam to review the objectives listed there.
http://www.nbome.org/comat3.asp?m=coll
It is recommended that you supplement the assigned reading with reading from the required
materials on topics as needed to do well on your COMAT examination. You may also wish to
use a board review book to determine which topics you need to spend more time reviewing.
Grading and Remediation
A cumulative score of 70% or higher is required to pass the rotation. A cumulative score lower
than 70% will result in failure and will require action as directed by the TUCOM Student
Promotions Committee, and as explained in the Clinical Rotations-handbook. In order to pass
the rotation each component may be completed, even if not completing it results in a score of 70%
or greater. If any individual component is completed late points will be deducted as follows:
Post rotation examination – no greater than 70% may be scored, the self Test, site evaluations and
Med-U cases which are completed late will be given 0%. Again, if they are not completed you
will not pass the rotation so even if they are late, they must be completed.
1. Preceptor Performance Assessment
70%
Two will be averaged
2. Student Site Evaluation
2.5 %
3. Med –U Cases
2.5%
3. Self Test
5%
4. Post Rotation Examination
20%
Course total
100.0%
All requirements are due the last Friday of your Core Course
If you pass your overall rotation with a grade of 70% or higher, but fail your preceptor
performance assessment you will need to remediate the rotation. Please see the Clinical
Rotations Manual Section II for more details.
If you fail your examination you must retake it. The make up examination will be pass-fail and
your score - if passing - will be recorded as 70% and averaged in to your total for the 20% that the
post examination is worth. The score on the failed exam will not be recorded in your transcript
or averaged into your final grade.
Clinical Rotation Manual For Faculty and Students
Touro University-California
105
In the event of a failed make – up examination the CED will review the situation and both
examinations and one of the following actions will be required of you: 1. remediate the rotation
or some portion of it, 2. Take a third written assessment 3. submit the matter to the student
promotions committee.
Course Map
Course Outcome
1.
2.
3.
4.
5.
6.
Have a basic knowledge of
normal female
reproductive physiology
and endocrinology
including the menstrual
cycle, changes in
pregnancy and puberty
and menopause. (AOA: 2)
Develop competence in
obtaining a history and
physical examination of
women, including a sexual
history, incorporating
social, ethical, and
culturally diverse
perspectives. (AOA;
1,2,3,4,5)
Be able to diagnose and
initiate management of
common gynecologic
concerns. (AOA: 1, 2, 3)
Be able to diagnose,
communicate about and
initiate management of
STI’s including HPV.
(AOA; 1,2,3,4,5)
Demonstrate knowledge of
contraception options,
including sterilization and
abortion. (AOA; 2,3,4)
Demonstrate the ability to
counsel patients regarding
Clinical Rotation Manual For Faculty and Students
Learning
Opportunities
Direct
Assessments
Indirect
Assessments
Clinical rotation
experiences,
Reading
assignments, SelfTest
COMAT,
CPE, SelfTest
COMLEX II,
COMLEX
PE
OCSE
MATCH
COMLEX II,
COMLEX
PE
OCSE
MATCH
Clinical rotation
experiences,
Reading
assignments, SelfTest
Clinical rotation
experiences,
Reading
assignments, SelfTest
Clinical rotation
experiences,
Reading
assignments, SelfTest, cases
Clinical rotation
experiences,
Reading
assignments, SelfTest
(FM case
Clinical rotation
experiences,
Reading
COMAT,
CPE, SelfTest
COMAT,
CPE, SelfTest
COMAT,
CPE, SelfTest
COMAT,
CPE, SelfTest
COMAT,
CPE, SelfTest
COMLEX II,
COMLEX
PE
OCSE
MATCH
COMLEX II,
COMLEX
PE
OCSE
MATCH
COMLEX II,
COMLEX
PE
OCSE
MATCH
COMLEX II,
COMLEX
PE
Touro University-California
106
7.
8.
9.
contraception options
(AOA; 1,2,3,4,5)
assignments, SelfTest
OCSE
MATCH
Describe the etiology and
evaluation of infertility
Clinical rotation
experiences,
Reading
assignments, SelfTest
COMLEX II,
COMLEX
PE
OCSE
MATCH
Demonstrate knowledge of
prenatal and preconception
counseling and care.
(AOA; 1,2,3,4,5)
Develop communication
skills that facilitate the
clinical interaction with
patients in potentially
sensitive situations such as
dealing with sexually
transmitted infections,
infertility and other issues
pertaining to women’s
health. (AOA: 1, 2, 3, 4, 5)
10. Demonstrate knowledge of
normal intrapartum and
delivery care. (AOA;
1,2,3,4,5)
11. Demonstrate knowledge of
common complications of
pregnancy and
intrapartum care and how
to initiate management of
them. (AOA; 1,2,3,5)
12. Demonstrate knowledge of
perioperative care and
familiarity with common
obstetric and gynecologic
procedures. (1,2,3)
13. Demonstrate the ability to
communicate with
colleagues and support
staff through traditional
Clinical Rotation Manual For Faculty and Students
Clinical rotation
experiences,
Reading
assignments, SelfTest
FM case
COMAT,
CPE, SelfTest
COMAT,
CPE, SelfTest
COMLEX II,
COMLEX
PE
OCSE
MATCH
COMLEX II,
COMLEX
PE
OCSE
MATCH
Reading
assignments, SelfTest,
COMAT,
CPE, SelfTest
Clinical rotation
experiences,
Reading
assignments, SelfTest
COMAT,
CPE, SelfTest
Clinical rotation
experiences,
Reading
assignments, SelfTest
Clinical rotation
experiences,
Reading
assignments, SelfTest
Clinical rotation
experiences,
Reading
assignments,SelfTest, case, ____
COMAT,
CPE, SelfTest
COMAT,
CPE, SelfTest
COMAT,
CPE, SelfTest
COMLEX II,
COMLEX
PE
OCSE
MATCH
COMLEX II,
COMLEX
PE
OCSE
MATCH
COMLEX II,
COMLEX
PE
OCSE
MATCH
COMLEX II,
COMLEX
PE
OCSE
MATCH
Touro University-California
107
oral presentations, and
standard formatted notes,
such as SOAP, H&P, pre
and post operative, admit
and so on. (1,2,3,4)
14. Be able to offer prenatal,
and post partum
counseling and care, and
breast feeding counseling
and support. (AOA;
1,2,3,4,5)
Clinical rotation
experiences,
Reading
assignments, SelfTest
(FM case
COMAT,
CPE, SelfTest
COMLEX II,
COMLEX
PE
OCSE
MATCH
Reading Assignments and Learning Objectives for OB/Gyn Rotation
I. Required Texts
1. Gabbe: Obstetrics: Normal and Problem Pregnancies, 5th ed.
2. Katz: Comprehensive Gynecology, 5th ed.
3. ―Current Obstetric and Gynecologic Diagnosis and Treatment‖ by DeCherney, Alan H.
(Author) Nathan, Lauren (Author).‖
4. ―Managing Contraception‖
5. UptoDate
6. OMM Cases
7. Med u Family Medicine cases
1, 12, 14, 17, 24, 30, 32,
SIMPLE case 14
8. Links online
Required Texts are all available online through the Touro University Library Website with the
exception of the pocket book ―Managing Contraception.‖
It is recommended that you review all of the reading assignments ahead of time as some weeks
require much more reading than others and you may want to shift when you do the assignments.
The required texts are the same texts recommended by the NBOME for your preparation for your
shelf examination.
Clinical Rotation Manual For Faculty and Students
Touro University-California
108
II. Guide to Objectives
Guidelines each topic below should be explored using the following guidelines unless there are
other details. In some cases objectives listed below have other details but ALSO indicate that you
should use these guidelines.
Be able to demonstrate your knowledge of the following components of each listed topic:
Presentation
o History
o Physical to include
 Examination
 Lab and imaging findings
Diagnosis to include
o Basic pathophysiology of diagnosis and complications of the disease process
o Clinical reasoning process in determining the diagnosis
o Basic Epidemiology including risk factors for each diagnosis
Differential Diagnosis to include:
o Important things to rule out
o Most common alternative diagnoses
Management to include:
o Tests or studies needed to confirm or rule out diagnoses
o Medications - interactions/side effects dosing compliance issues, etc
o Non-pharmacologic medical treatment options including, osteopathic approach,
nutrition, behavior modification and so on.
o Consultations and interdisciplinary team management.
o Management of psychosocial issues, and rehabilitation.
o Patient education and follow up
As always, your information gathering, clinical reasoning and assessment and plan should
include osteopathic signs, symptoms, principles, management options and techniques.
III. Objectives by Topic and Week with Required Med-U cases
Week 1
MED U Case from Family Medicine section: 32
Topics
For each of these menstrual problems, in addition to the listed guidelines, define the terms or
diagnostic criteria as appropriate.
1. Oligomenorrhea
2. Amenorrhea
3. Dysmenorrhea
4. Abnormal Uterine Bleeding (describe normal menses)
5. Premenstrual Syndrome and PMDD
6. Contraception
Clinical Rotation Manual For Faculty and Students
Touro University-California
109
―Managing Contraception For Your Pocket‖ is the recommended resource for this topic.
Read the whole book. In your first day be sure to review the headers of each section so
you know what information is in your pocket.
Be able to discuss the risks and benefits and efficacy and of each type of contraception
(including emergency contraception) with your attending and with your patient. Be able
to determine the best options based on the patient demographics. Be able to speak with
your patient about each type of contraception and answer their questions including how
each is used and what to do in the case of misuse. Be sensitive and informed about issues
such as prevention of conception vs. implantation, and religious implications.
Understand what testing, if any is needed prior to and during use of each form of
contraception.
SKILL – observe insertion of IUD and string check
Week 2
Med U case from Family Medicine #1 and from SIMPLE # 14
Topics
1. Vaginitis- use the general guidelines to the objectives listed above
SKILL – perform and interpret a wet mount
2. STI’s
Be able to counsel a patient regarding each STI that may be contracted through sexual
intercourse. Be able to explain how each is contracted, what the signs and symptoms are
and what the treatment and prognosis is of each. In addition to the above guidelines,
know when informing and testing of partners and informing the state is mandated.
Understand the sensitive nature and develop skill for having counseling and educating
patients, both preventively and once they have been diagnosed.
3. PID - use the general guidelines to the objectives listed above
4. Cervical Cancer
In addition to the above guidelines, using the most current guidelines (ASCCP 2006
consensus) know when to screen for cervical cancer and how to manage abnormal pap
smear results. Be able to counsel patients regarding the need for screening and the
results of abnormal pap smears
SKILLS
1. Perform an adequate pap smear
2. Observe colposcopy and be able to describe the procedure to a patient
3. Obtain specimens to detect sexually transmitted infections
Week 3
Med U case from Family Medicine # 12 and # 17
Topics
1. Endometriosis and Chronic Pelvic Pain
In addition to the above guidelines, list the common sites of implants, understanding
they may be found as distant as the lungs or other places.
2. Menopause
Be able to identify the signs and symptoms of menopause and perimenopause
Clinical Rotation Manual For Faculty and Students
Touro University-California
110
Be able to counsel a patient on the use of HRT
Be able to prescribe HRT according to ACOG guidelines
Be able to treat symptoms of Menopause using non-hormonal methods including
Osteopathic treatment.
3. Abortion- induced
Explain surgical and non-surgical methods of pregnancy termination, including risks,
potential complications, and benefits and indications and gestational limits
Be able to manage normal patient care after pregnancy termination.
Be able to diagnose complications of surgical and non-surgical pregnancy termination.
Describe appropriate management of each potential complication.
Provide non-directive, non-judgmental, compassionate counseling to patients
surrounding pregnancy options.
Provide resources for more information regarding each option.
Reflect on your personal feelings and understand how they influence you in your
interaction with patients.
4. Spontaneous Abortion
Develop a differential diagnosis for first trimester bleeding.
Differentiate the types of spontaneous abortion
List the complications of spontaneous abortion
Identify the causes and complications of septic abortion
Counsel a patient following a spontaneous abortion.
Week 4
Med U case from Family Medicine # 14 and # 30
Topics
1. Normal pregnancy, labor and birth
Be able to offer preconception counseling including appropriate doses of supplements,
diet and other issues.
Be able to recognize and describe signs and symptoms of pregnancy.
Determine if a woman is pregnant and determine EDD/EGA. Know the accuracy of
different methods and timing of determination of EGA.
Know appropriate schedule of antepartum visits and what labs and counseling should
happen at each visit.
Be able to explain the use of normal prenatal labs to your patient.
Counsel a patient in each trimester regarding healthy lifestyle issues, including nutrition,
medications, activity and treatment of common pregnancy concerns such as nausea,
fatigue, mild edema, weight gain, reflux.
Recognize signs and symptoms of labor and be able to counsel your patient in
management of these signs.
Define and describe the three stages of labor.
Describe the steps of a normal vaginal delivery
Clinical Rotation Manual For Faculty and Students
Touro University-California
111
2. Be able to recognize and manage common pregnancy complications such as Hyperemesis, UTI,
cholestasis, pica
6. Fetal monitoring – Describe the use and indications of fetal monitoring including risks and
benefits.
SKILLS
1. Determine EGA using a wheel and LMP (Nagle’s rule)
2. Become confident in performing prenatal care visits, including:
a. Routine assessments; patient counseling about pregnancy, labor and delivery
that will support and educate a woman throughout her gestation
b. Routine testing; Be able to order appropriate tests at appropriate times,
interpret the results, and explain them to your attending or patients
c. Perform a routine first and follow up prenatal visit and complete a written
prenatal visit SOAP note Testing done in special circumstances during
pregnancy, for example, advanced maternal age, or late to care pregnancies.
d. Determine G and P status
3. Perform and document an admission note for a patient in labor
4. Perform and document Labor progress check and note
5. Perform Leopold’s maneuvers
6. Observe normal vaginal delivery
7. Present a patient to an attending or your colleagues
8. Read and interpret a fetal monitor strip
Week 5
Topics
1. Pain management in labor and delivery
Understand available options including non pharmacologic and be able to counsel a
patient regarding the risks, benefits and indications.
2. Complications of early onset labor or contractions
3. Failure to progress (define recognize, counsel and manage)
4. Puerpel Fever and infection – diagnosis and management
5. Induction – indications and methods, risks, benefits
6. Surgical Vaginal Deliveries: forceps and vacuum and C-Sections – describe the use of each and
indications risks and benefits
SKILLS
Observation of vacuum and surgical deliveries
For each of the above topics (1-6) recognize the need for non-routine intervention in labor
and delivery and be able to explain these to the patient. Begin to develop the skills and
knowledge required to perform these non-routine interventions.
7. Dystocia – define and describe management, know management options
8. Third trimester bleeding – as applicable, use the guidelines listed above in addition to the
following:
Develop a list of the causes and know which are most likely given the presentation
When possible diagnose the etiology based on presentation and examination
Clinical Rotation Manual For Faculty and Students
Touro University-California
112
Know what the initial evaluation should be
Understand potential complications
Know the initial management plan for shock secondary to acute blood loss
Week 6
Med U case from Family Medicine # 24
Topics
1. Preeclampsia and HTN in pregnancy
2. Gestational Diabetes
3. Preterm labor – Use the general guidelines in addition to the following:
Describe adverse events associated with PTL, counsel a patient who has experienced PTL
and birth
SKILLS:
Distinguish PTL from Braxton hicks
Counsel patient regarding signs and symptoms of PTL
4. Perinatal Psychiatric issues –
Postpartum blues, postpartum depression and postpartum psychosis
In Addition to the general guideline know the diagnostic criteria for each of the above
issues.
5. Postpartum Care
Manage normal and abnormal post partum care both in the hospital and follow up visits
recommended
SKILLS
Be able to offer counseling regarding common post partum issues – maternal infant
bonding, perinatal- sex, breastfeeding, pain, dealing with lacerations, normal bleeding
postpartum
In-patient postpartum rounding and SOAP note documenting
Discharge orders and counseling for post partum patient
IV. Reading assignments and Med-U cases with correlated Objectives repeated
This section repeats the objectives listed above with the corresponding reading assignments
and Med-U cases
Week 1
The first two reading assignments for this week cover general topics that are important for your gyn/ob
rotation. After that the chapters follow the required topics from the syllabus
1. Katz: Comprehensive Gynecology, 5th ed.
Chapter 7 – History, Physical Examination, and Preventive Health Care: General, Gynecologic,
and Psychosocial History and Examination, Health Care Maintenance, Disease Prevention
2. UptoDate: ―The normal menstrual cycle‖
3. Katz: Comprehensive Gynecology, 5th ed.
Clinical Rotation Manual For Faculty and Students
Touro University-California
113
Chapter 36
Primary and Secondary Dysmenorrhea, Premenstrual Syndrome, and Premenstrual
Dysphoric Disorder: Etiology, Diagnosis, Management
Chapter 37
Abnormal Uterine Bleeding: Ovulatory and Anovulatory Dysfunctional Uterine
Bleeding, Management of Acute and Chronic Excessive Bleeding
Chapter 38
Primary and Secondary Amenorrhea and Precocious Puberty: Etiology, Diagnostic
Evaluation, Management
Chapter 14
Family Planning: Contraception, Sterilization, and Pregnancy Termination (section on
Abortion is for week 3)
4. Managing Contraception – Read the whole thing!
5. OMM cases – see Links on BB
Week 2
1. Katz: Comprehensive Gynecology, 5th ed.
Chapter 22: (skip sections on acute bacterial cystitis, infections of Bartholin’s Glands, Pediculosis Pubis
and Scabies and Molluscum Contagiosum)
Infections of the Lower Genital Tract: Vulva, Vagina, Cervix, Toxic Shock Syndrome,
and HIV Infections
Chapter 28
Intraepithelial Neoplasia of the Lower Genital Tract (Cervix, Vulva): Etiology, Screening,
Diagnostic Techniques, Management from the beginning through the section
―EVALUATION OF ABNORMAL CYTOLOGY: COLPOSCOPY
2. Current Obstetric and Gynecologic Diagnosis and Treatment
Chapter 41
Sexually Transmitted Diseases & Pelvic Infections
3. See links to ASCCP and other materials as they are posted to the BB site in the Didactic
materials section – you are responsible for the most up to date guidelines regarding Cervical
screening.
Week 3
1. Katz: Comprehensive Gynecology, 5th ed.
Chapter 19
Endometriosis: Etiology, Pathology, Diagnosis, and Management
Chapter 42
Menopause: Endocrinology, Consequences of Estrogen Deficiency, Effects of Hormone
Replacement Therapy, Treatment Regimens
Chapter 14: (for this week section on Induced Abortion)
Clinical Rotation Manual For Faculty and Students
Touro University-California
114
Family Planning: Contraception, Sterilization, and Pregnancy Termination (section on
Abortion for week 3)
Chapter 16
Spontaneous and Recurrent Abortion: Etiology, Diagnosis, and Treatment
Week 4 and 5
Due to the organization of the textbook it was simpler to combine the reading from weeks 4 and 5. Some of
the chapters cover topics from both weeks so the order of the reading assignments is not necessarily the
same as the order of the topics in the syllabus. All chapters from the textbook are listed first followed by
required articles from UptoDate.
1. Gabbe: Obstetrics: Normal and Problem Pregnancies, 5th ed.Section II Prenatal Care
Chapter 5
Preconception and Prenatal Care: Part of the Continuum
Chapter 6: Optional but recommended if studying for USMLE
Genetic Counseling and Genetic Screening
Chapter 7
Prenatal Genetic Diagnosis
Only read the following pages/sections:
Diagnostic Procedures for Prenatal Genetic Diagnosis 153
Amniocentesis 153
Early Amniocentesis 155
Chorionic Villus Sampling 155
Fetal Blood Sampling 158
Indications for Prenatal Genetic Studies 160
Noninvasive Screening Followed by an Invasive Procedure for High-Risk Pregnancies
Noninvasive Maternal Serum Alpha-Fetoprotein Screening for Neural Tube Defects 168
Noninvasive Screening for Aneuploidy 169
Second-Trimester Serum Screening for Trisomy 21 169
Second-Trimester Screening in Multiple Gestations 171
Second-Trimester Screening for Trisomy 18 171
First-Trimester Screening for Trisomy 21 171
First-Trimester Versus Second-Trimester Screening 173
Chapter 9
Ultrasound for Pregnancy Dating, Growth, and the Diagnosis of Fetal Malformations
Only the following sections
a. Introduction 215
b. Ultrasound for Determining Gestational Age 216
c. Standard Measurements 216
Clinical Rotation Manual For Faculty and Students
Touro University-California
115
d. Determination of Gestational Age 217
e. When to Use Ultrasound Dating 218
Chapter 11 – Antepartum Fetal Evaluation
Section on Assessment of Fetal Pulmonary Maturation is optional but recommended for board
review – especially the USMLE. Note - this is not the last section in the chapter and the rest of
the chapter is required reading.
3. Gabbe: Obstetrics: Normal and Problem Pregnancies, 5th ed. Section III – Intrapartum
Care
Chapters 12-19
Chapter 19 is on c-section and is optional but recommended.
Chapter 17 is on malpresentation – also optional EXCEPT FOR SECTION ON
DYSTOCIA that is required.
4. Current Obstetric and Gynecologic Diagnosis and Treatment DeCherney, Alan H. (Author)
Nathan, Lauren (Author)
Section 3 Chapter 25
Section 3 Chapter 28
5. UptoDate
1. ―Clinical features and diagnostic evaluation of nausea and vomiting of pregnancy
(hyperemesis gravidarum and morning sickness)‖
2. ―Treatment of nausea and vomiting of pregnancy (hyperemesis gravidarum and
morning sickness)‖
3. ― Recommendations for exercise during pregnancy and the postpartum period‖
4. ―Risks and benefits of fish consumption and fish oil supplements during pregnancy‖
5. ―Diagnosis and clinical manifestations of early pregnancy‖
6. ―Calculator: Estimated date of delivery (EDD) pregnancy calculator‖
7.‖Calculator: Gestational age from estimated date of delivery (EDD)‖
Week 6
Gabbe: Obstetrics: Normal and Problem Pregnancies, 5th ed.
Chapter 33- Hypertension
Chapter 37 Diabetes Mellitus Complicating Pregnancy
Section V – Complicated Pregnancy
Chapter 26 – Preterm Birth
Chapter 27 – Premature Rupture of the Membranes
Section IV – Postpartum Care
Chapter 21 – Postpartum Care
section on Post Partum involution optional
Chapter 22 – Breast-Feeding
Summary of reading assignments
Chapters with * indicate only certain sections of the chapter are required – see above for details.
Katz Chapters
7, 14, 16, 19, 22*, 28*, 36, 37, 38, 42 (10 chapters)
Clinical Rotation Manual For Faculty and Students
Touro University-California
116
Gabbe Chapters
6, 7*, 9*, 11*, 12, -16, 17 (section on Dystocia only) 22, 21, 26, 27 *, 33, 37 * (16 chapters)
Current Diagnosis and Treatment – 25, 28, 41 (3 chapters)
UptoDate (8 articles)
Entire Pocket Contraception Book
UptoDate Articles
1. ―Clinical features and diagnostic evaluation of nausea and vomiting of pregnancy
(hyperemesis gravidarum and morning sickness)‖
2. ―Treatment of nausea and vomiting of pregnancy (hyperemesis gravidarum and morning
sickness)‖
3. ― Recommendations for exercise during pregnancy and the postpartum period‖
4. ―Risks and benefits of fish consumption and fish oil supplements during pregnancy‖
5. ―Diagnosis and clinical manifestations of early pregnancy‖
6. ―Calculator: Estimated date of delivery (EDD) pregnancy calculator‖
7.‖Calculator: Gestational age from estimated date of delivery (EDD)‖
8. ―The normal menstrual cycle‖
Med U cases – see objectives for cases for each week’s objectives.
Med u Family Medicine cases
1, 12, 14, 17, 24, 30, 32
SIMPLE case 14
ASCCP guidelines – see BB for link
OMM Power Point Presentations – see BB for link
Time Management Guide
6-Week Rotation
Review ASCCP Guidelines week 1
Review all headings of Pocket Guide to Contraception. Read all information chapters – i.e.
menstrual cycle, dealing with abuse, STI’s etc.
Reference the rest of the chapters when given the opportunity to counsel a patient on any
particular type of contraception
2 case per week starting week
1 OMM presentation per week – depending on if you have completed the first three in previous
rotations ( only four presentations required).
Read one Text book chapter daily on week days only
This leaves weekends to study for the exam or review other materials.
Pocket Guide to Contraception should be used as often as possible during all rotations. (FP, IM,
OB, and Pediatrics)
Clinical Rotation Manual For Faculty and Students
Touro University-California
117
Psychiatry Core Clerkship Syllabus
Psychiatry Core Rotation CLIN 705 four weeks or 6.00 units
2012-2013 Academic Year
Materials for TUCOM Class of 2014
Course Director
Jennifer Weiss, DO
Assistant Professor
Department of Clinical Education
Phone: available upon request.
Please email me to arrange phone appointment if needed.
Office hours: upon request, available for instant messaging
Email: [email protected]
Course Philosophy
The most important concept in your training is that you are an Osteopathic Physician. The
primary tenet of this concept is that you are treating whole people – no matter what specialty you
are in. This rotation is a core requirement in part because there is an extremely high prevalence
of psychiatric disorders that must be recognized by the primary care physician or they will go
untreated. Also, these disorders can contribute to the severity and worsening of many other
disease states and are a co-morbidity of pain and disease. Your ability to recognize, assess, and
treat psychiatric conditions and psychosocial issues is critical to your success as a physician in
any area of practice.
The most important clinical skill in psychiatry is history taking. As a third year medical student
your focus should be thoroughness. When given the opportunity to observe seasoned clinicians,
notice how they tailor their interview to the patient’s responses, both verbal and non-verbal. This
style of interview, based on experience, pattern recognition and tested intuition allows for
targeted and productive question choices and time efficiency.
As you review online materials, reading assignments and learning objectives keep in mind that
your primary goal is to be able to manage psychiatric issues in a primary care setting. As you
observe specialists and challenging patients, use the experience to understand what role you will
have in caring for these patients as their primary care doctor – including when to refer, how to
recognize disorders, and how to help your patient and their family understand the care they may
get from a specialist.
Clinical Rotation Manual For Faculty and Students
Touro University-California
118
Course Description
Core clinical sites for the psychiatry rotation offer a range of experiences. The overall goal of the
didactic portion of the rotation is to create a forum in which a consistent set of objectives can be
learned. Students will rotate in assigned clinical settings in order to complete the required third
year psychiatry clerkship. Psychiatry preceptors will specify site requirements for the clerkship
and will see that students are provided with an appropriate level of clinical and didactic
experience. To ensure consistency among psychiatry clerkship experiences, this standardized
curriculum is provided. In order to successfully complete the required third year Psychiatry
rotation, all students must fulfill requirements specified by their preceptor AND complete the
required elements of the standardized curriculum as outlined below.
Summary of AOA Competencies
1. Osteopathic Philosophy/Osteopathic Manipulative Medicine
2. Medical Knowledge
3. Patient Care
4. Professionalism
5. Interpersonal and Communication Skills
6. Practice-based Learning and Improvement
7. Systems Based Practice
Each AOA competency that can be improved by achieving learning outcomes is referenced after
the learning outcome. University Learning Outcomes and Program Learning Outcomes are
aligned with the Course Learning outcomes and AOA competencies in the Excel document,
―co2014 Psychiatry Course Outcome Alignment,‖ on the BB co2014 Psychiatry Organization.
Course Learning Outcomes*
1.
2.
3.
4.
5.
6.
By the end of the clerkship, the student will demonstrate the ability to obtain a complete
psychiatric history, recognize relevant physical findings, and perform a complete mental
status examination. They will demonstrate the ability to conduct the interview in a manner
that facilitates information gathering and formation of a therapeutic alliance. (AOA; 2,3,4,5)
By the end of the clerkship, the student will be able to identify psychopathology, formulate
differential diagnoses, and develop assessment and treatment plans for psychiatric patients.
(AOA; 2,3)
By the end of the clerkship, the student will use laboratory testing, imaging tests,
psychological tests, and consultation to assist in the diagnosis of persons with
neuropsychiatric symptoms. (AOA; 2,3)
By the end of the clerkship, the student will assess and begin emergency management and
referral of a person with neuropsychiatric symptoms. (AOA; 2,3)
By the end of the clerkship, the student will recognize the psychiatric manifestations of brain
disease of known etiology or pathophysiology, and will state the evaluation and initial
management of these neuropsychiatric disorders. (AOA; 2,3)
Clinical Rotation Manual For Faculty and Students
Touro University-California
119
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
By the end of the clerkship, the student will identify, clinically evaluate, and treat the
neuropsychiatric consequences of substance abuse and dependence. (AOA; 2)
By the end of the clerkship, the student will recognize, evaluate, and discuss management
options for persons with psychosis associated with schizophrenic, affective, general medical,
and other psychotic disorders. (AOA; 2,3)
By the end of the clerkship, the student will recognize, evaluate, and state the treatments for
patients with mood disorders and anxiety disorders. (AOA; 2,3)
By the end of the clerkship, the student will diagnose and discuss the principles of
management of patients with somatoform disorders. (AOA; 2,3)
By the end of the clerkship, the student will define dissociation, state its psychological
defensive role, and discuss the clinical syndromes with which it is associated. (AOA; 2,3)
By the end of the clerkship, the student will summarize the distinguishing clinical features,
evaluation, and treatment of patients with eating disorders. (AOA; 2,3)
By the end of the clerkship, the student will recognize maladaptive traits and interpersonal
patterns that typify personality disorders, and discuss strategies for caring for patients with
personality disorders. (AOA; 2,3)
By the end of the clerkship, the student will summarize the unique factors essential to the
evaluation of children and adolescents, and will diagnose the common child psychiatric
disorders. (AOA; 2,3)
By the end of the clerkship, the student will discuss the structure of the mental health system
and legal issues important in the care of psychiatric patients. (AOA; 7)
By the end of the clerkship, the student will summarize the indications, basic mechanisms of
action, common side effects, and drug interactions of each class of psychotropic medications
and demonstrate the ability to select and use these agents to treat mental disorders. (AOA;
2,3)
By the end of the clerkship, the student will understand the principles and techniques of the
psychosocial therapies sufficient to explain to a patient and make a referral when indicated.
(AOA; 2,3,4,5)
By the end of the clerkship, the student will work effectively with other health professionals.
((AOA; 3,4,5)
By the end of the clerkship, the student will demonstrate maturation in clinical and personal
development. (AOA; 4,5)
* Adapted from objectives by ADMSEP (http://www.admsep.org/appendix.html )
Objectives and Reading Assignments
The Psychiatry Objectives utilized are from ADMSEP (http://www.admsep.org/appendix.html )
which is a guideline also referenced by the developers of the COMAT examination. The
objectives are available on the BB site.
Texts
Diagnostic and Statistical Manual of Mental Disorders 4th Edition (Text Revision)
(DSM-IV-TR) APA 2004
Synopsis of Psychiatry Kaplan & Saddock 10th Edition 2007 **** this text is not available
online***
Clinical Rotation Manual For Faculty and Students
Touro University-California
120
Up-To-Date Inc Version 18.3 2011
An Osteopathic Approach to Diagnosis and Treatment DiGiovanna 3rd Edition 2004
Foundations for Osteopathic Medicine AOA 3rd Edition 2010
Learning Resources
The primary resource is your clinical experience during your rotation. The most valuable
teaching tools are your patients, adjunctive staff at your site, and supervising physicians.
However, as clinical training can vary based on site, all of the topics listed in the objectives
should be reviewed independently. It is highly recommended that you read about your patients’
conditions that day in order to solidify the knowledge. Recommended reading assignments for
each learning objective are provided and you should expect to spend two to four hours per day
reading. Due to the nature of the psychiatry rotation you often have more time for reading and
case based learning than on other rotations. The didactic assignments are therefore somewhat
more extensive relative to the number of weeks of rotation. Lectures and other learning tools
will be made available on the Blackboard site.
Materials and Texts
1. Med-U cases are required unless noted otherwise.
2. Synopsis of Psychiatry Kaplan & Saddock 10th Edition 2007
3. Up-to-date Inc Version 18.3 2011 - If you choose Up-to-date be sure that you read multiple
articles on each subject to ensure that you have thoroughly covered the topic.
4. Diagnostic and Statistical Manual of Mental Disorders 4th Edition (Text Revision) – there is
both a full and handbook version of this CRITICAL text available online. If you have not
familiarized yourself with it already, it is important to do so by the start of the rotation.
IF YOU HAVE NOT BEGUN YOUR ROTATION BEFORE NOTING THE NEED TO PURCHASE
THE TEXTBOOK YOU MAY USE THE FOLLOWING ONLINE RESOURCE BY SELECTING
APPROPRIATE CHAPTERS.
5. The American Psychiatric Publishing Textbook of Psychopharmacology, 4th Edition
(Schatzberg & Nemeroff, 2009). – this resource is available through the Touro Website. It has
supplementary PowerPoint summaries of each chapter and self-test question that are multiplechoice style.
6.Blackboard Materials in Class of 2014 Psychiatry Core Rotation Site
Additional Reading Assignments and Med-U
There are a multitude of resources at your disposal in your preparation for you’ your exit
examination. It is recommended that you review the CONTENT INFORMATION AND
BLUEPRINT
for
the
examination
found
on
the
NBOME
website
(http://www.nbome.org/comatmain.asp?m=coll) and study any topics on which you feel you
need additional review.
Communication to students for the Psychiatry course will be provided on Blackboard
(http://blackboard.touro.edu). Additionally email may be sent to your tu.edu account, which
Clinical Rotation Manual For Faculty and Students
Touro University-California
121
should be checked frequently. See this site for a more information regarding the course including
suggested and required resources.
Mid-clerkship Evaluation
At the mid-way point of the clerkship, students are expected to meet with their preceptors to
discuss their progress so far. Students should elicit feedback on possible areas of improvement
for the second half of the rotation. It is often necessary for you to request this meeting, as
preceptors may not initiate it.
Clinical Performance Evaluations (CPE)
At the end of the clerkship experience, attendings and other instructors who have supervised the
student during the clerkship complete CPE forms. CPE forms are included in the clinical
rotations manual accessible online and copies should be provided by the student to the
preceptors that he/she worked with during the clerkship. Completion of the clerkship is
dependent upon submission of a completed CPE. Obtaining a passing grade on the CPE is
required in order to pass the clerkship.
COMAT Clinical Exam in Psychiatry
The purpose of the COMAT Pediatrics subject examination is to assess the scope of knowledge
and cognitive skills for clinical problem solving of osteopathic medical school students at the end
of the Psychiatry rotation and/or to provide a summative assessment of their Pediatrics scope of
knowledge and cognitive skills for clinical problem-solving. It is presented in a style and format
comparable to the COMLEX licensure series. All students are expected to take the web-based
exam at the end of the clerkship. The exam consists of a 10-minute tutorial followed by two
hours allotted for the 100-item examination. Time will not be extended beyond the close of the
examination. The COMAT performance accounts for 20% of the final clerkship grade and must
be passed in order to pass the rotation.
Preparing for the Examination
You should review the documents on the NBOME website prior to beginning your rotation as
they suggest the percent of weight of each topic and can guide your time management. The
required texts are those recommended by the NBOME and the curriculum provided is based on
the curriculum recommended by the NBOME with some modifications. Doing your assigned
reading and cases as well as practicing with board review questions should help you prepare for
this examination.
The blueprint and content outlines provided by the NBOME available at
http://www.nbome.org/comat3.asp?m=coll
Clinical Rotation Manual For Faculty and Students
Touro University-California
122
Grading and Remediation
A cumulative score of 70% or higher is required to pass the rotation. A cumulative score lower
than 70% will result in failure and will require action as directed by the TUCOM Student
Promotions Committee, and as explained in the Clinical Rotations-Manual in Section II. In order
to pass the rotation each component may be completed, even if not completing it results in a
score of 70% or greater. If any individual component is completed late points will be deducted as
follows: Post rotation examination – no greater than 70% may be scored, the self-test, site
evaluations and Med-U cases which are completed late will be given 0%. Again, if they are not
completed you will not pass the rotation so even if they are late, they must be completed.
1. Preceptor Performance Assessment
70%
2. Student Site Evaluation
2.5 %
3. Med –U Cases
2.5%
3. Self Test
5%
4. Post Rotation Examination
20%
Course total
100.0%
All Assignments must be completed on the last Friday of your rotation. If you pass your overall
rotation with a grade of 70% or higher, but fail your preceptor performance assessment you will
need to remediate the rotation. Please see the Clinical Rotations Handbook for more details.
If you fail your examination you must retake it. The make up examination will be pass-fail and
your score - if passing - will be recorded as 70% and averaged in to your total for the 20% that the
post examination is worth. The score on the failed exam will not be recorded in your transcript
or averaged into your final grade.
In the event of a failed make – up examination the CED will review the situation and both
examinations and one of the following actions will be required of you: 1. remediate the rotation
or some portion of it, 2. Take a third written assessment 3. submit the matter to the student
promotions committee.
Course Map
Learning Outcome
Obtain psychiatric history,
recognize relevant physical
findings, and mental status
examination, facilitates
Learning
Opportunities
Rotation
Experiences
Med-U
Reading
Clinical Rotation Manual For Faculty and Students
Direct Assessments
Formative – self test,
med-U cases.
Summative – Shelf
Exam
Indirect
Assessments
OSCE,
COMAT,
COMLEX II,
COMLEX PE
Touro University-California
123
information gathering and
formation of a therapeutic
alliance.
Identify psychopathology,
formulate differential
diagnoses, and develop
assessment and treatment plans
for psychiatric patients.
Laboratory testing, imaging
tests, psychological tests, and
consultation to assist in the
diagnosis
Assess and begin emergency
management
Recognize the psychiatric
manifestations of brain disease
state the evaluation and initial
management
Identify, evaluate, and treat the
substance abuse and
dependence.
Recognition, evaluation, and
management of persons with
psychosis associated with
schizophrenic, affective,
general medical, and other
psychotic disorders.
Recognize, evaluate, and state
the treatments for patients with
mood disorders and anxiety
disorders.
Diagnose and discuss the
management of patients with
somatoform disorders.
Define dissociation, state its
psychological defensive role,
and discuss syndromes with
which it is associated.
Summarize the distinguishing
features, evaluation, and
treatment of patients with
eating disorders.
Recognize maladaptive traits
and patterns of personality
disorders, and discuss
strategies management
Summarize the unique factors
Rotation
Experiences
Med-U
Reading
Formative – self test,
med-U cases.
Summative – Shelf
Exam
OSCE,
COMAT,
COMLEX II,
COMLEX PE
Rotation
Experiences
Med-U
Reading
Rotation
Experiences
Med-U
Reading
Rotation
Experiences
Med-U
Reading
Rotation
Experiences
Med-U
Reading
Rotation
Experiences
Med-U
Reading
Formative – self test,
med-U cases.
Summative – Shelf
Exam
Formative – self test,
med-U cases.
Summative – Shelf
Exam
Formative – self test,
med-U cases.
Summative – Shelf
Exam
Formative – self test,
med-U cases
Summative – Shelf
Exam
Formative – self test,
med-U cases
Summative – Shelf
Exam
OSCE,
COMAT,
COMLEX II,
COMLEX PE
OSCE,
COMAT,
COMLEX II,
COMLEX PE
OSCE,
COMAT,
COMLEX II,
COMLEX PE
OSCE,
COMAT,
COMLEX II,
COMLEX PE
OSCE,
COMAT,
COMLEX II,
COMLEX PE
Rotation
Experiences
Med-U
Reading
Rotation
Experiences
Med-U
Reading
Rotation
Experiences
Med-U
Reading
Rotation
Experiences
Med-U
Reading
Rotation
Experiences
Med-U
Reading
Rotation
Formative – self test,
med-U cases
Summative – Shelf
Exam
Formative – self test,
med-U cases
Summative – Shelf
Exam
Formative – self test,
med-U cases
Summative – Shelf
Exam
Formative – self test,
med-U cases
Summative – Shelf
Exam
Formative – self test,
med-U cases
Summative – Shelf
Exam
Formative – self test,
OSCE,
COMAT,
COMLEX II,
COMLEX PE
OSCE,
COMAT,
COMLEX II,
COMLEX PE
OSCE,
COMAT,
COMLEX II,
COMLEX PE
OSCE,
COMAT,
COMLEX II,
COMLEX PE
OSCE,
COMAT,
COMLEX II,
COMLEX PE
OSCE,
Clinical Rotation Manual For Faculty and Students
Touro University-California
124
essential to the evaluation of
children and adolescents, and
will diagnose the common
child psychiatric disorders.
Discuss the structure of the
mental health system and legal
issues important in the care of
psychiatric patients.
Summarize the indications,
basic mechanisms of action,
common side effects, and drug
interactions of psychotropic
medications select and use
these agents
Understand the principles and
techniques of the psychosocial
therapies sufficient to explain
to a patient and make a referral
when indicated.
Work effectively with other
health professionals.
Experiences
Med-U
Reading
med-U cases
Summative – Shelf
Exam
COMAT,
COMLEX II,
COMLEX PE
Rotation
Experiences
Med-U
Reading
Rotation
Experiences
Med-U
Reading
Formative – self test,
med-U cases
Summative – Shelf
Exam
Formative – self test,
med-U cases
Summative – Shelf
Exam
OSCE,
COMAT,
COMLEX II,
COMLEX PE
OSCE,
COMAT,
COMLEX II,
COMLEX PE
Rotation
Experiences
Med-U
Reading
Formative – self test,
med-U cases
Summative – Shelf
Exam
OSCE,
COMAT,
COMLEX II,
COMLEX PE
Rotation
Experiences
Demonstrate maturation in
clinical and personal
development.
Rotation
Experiences
Reading
Formative – self test,
med-U cases
Summative – Shelf
Exam
Formative – self test,
med-U cases
Summative – Shelf
Exam
OSCE,
COMAT,
COMLEX II,
COMLEX PE
OSCE,
COMAT,
COMLEX II,
COMLEX PE
Clinical Rotation Manual For Faculty and Students
Touro University-California
125
The following document integrates the learning outcomes and assignments for each topic. There
is an extended document which also lists specific objectives for each learning outcome.
The assignments have been highlighted – yellow is uptodate or Kaplan and Saddock, blue is
DSMIV handbook and green is Med-U cases and OMM (all listed together at the end). Color
coding can be seen by downloading this document from the BB organization.
WEEK 1
Week 1 case: FM case 29
OMM Presentations – See BB links
I. INTERVIEWING SKILLS
Chapter 1
From: · DSM-IV-TR® Handbook of Differential Diagnosis
Differential Diagnosis
Chapter 1. Differential Diagnosis Step by Step
Chapter 2: section titled ―Trees Based on Presumed Etiology‖
Learning Outcome
By the end of the clerkship, the student will conduct an interview in a manner that facilitates
information gathering and formation of a therapeutic alliance.
II. PSYCHIATRIC HISTORY, PHYSICAL, AND THE MENTAL STATUS EXAMINATION
Chapter 7 and 8
Learning Outcome
By the end of the clerkship, the student will demonstrate the ability to obtain a complete
psychiatric history, recognize relevant physical findings, and perform a complete mental status
examination.
III. DIAGNOSIS, CLASSIFICATION, AND TREATMENT PLANNING
Chapter 9
Learning Outcome
By the end of the clerkship, the student will be able to identify psychopathology, formulate
accurate differential and worldng diagnoses, and develop appropriate assessment and treatment
plans for psychiatric patients.
IV. DIAGNOSTIC TESTING
Chapter 5
Learning Outcome
By the end of the clerkship, the student will use laboratory testing, imaging tests, psychological
tests, and consultation to assist in the diagnosis of persons with neuropsychiatric symptoms.
Clinical Rotation Manual For Faculty and Students
Touro University-California
126
V. COMMUNITY AND FORENSIC PSYCHIATRY
Chapters 58 and 59
Learning Outcome
By the end of the clerkship, the student will discuss the structure of the mental health system and
legal issues important in the care of psychiatric patients.
VI. PSYCHOPHARMACOLOGY
Chapter 36
Learning Outcome
By the end of the clerkship, the student will summarize the indications, basic mechanisms of
action, common side effects, and drug interactions of each class of psychotropic medications and
demonstrate the ability to select and use these agents to treat mental disorders.
VII. PSYCHOTHERAPIES
Chapter 35
Learning Outcome
By the end of the clerkship, the student will understand the principles and techniques of the
psychosocial therapies sufficient to explain to a patient and make a referral when indicated.
VIII. ATTITUDES, PERSPECTIVES, AND PERSONAL DEVELOPMENT
Learning Outcome
By the end of the clerkship, the student will demonstrate maturation in clinical and personal
development.
IX. COLLABORATION
Learning Outcome
By the end of the clerkship, the student will work effectively with other health professionals.
WEEK 2
Week 2 cases
1.
2.
3.
Simple Case 5
FM CASE 3
FM Case 9
X. PSYCHIATRIC EMERGENCIES
Chapter 34
From: · DSM-IV-TR® Handbook of Differential Diagnosis
Clinical Rotation Manual For Faculty and Students
Touro University-California
127
Decision Trees:
Decision Tree for Suicidal Ideation or Attempt
Mental Disorders Due to a General Medical Condition
Learning Outcome
By the end of the clerkship, the student will assess and begin emergency management and
referral of a person with neuropsychiatric symptoms.
XI. DELIRIUM, DEMENTIA, AND AMNESTIC AND OTHER COGNITIVE DISORDERS –
Chapter 10
Learning Outcome
By the end of the clerkship, the student will recognize the psychiatric manifestations of brain
disease of known etiology or pathophysiology, and will state the evaluation and initial
management of these neuropsychiatric disorders.
XII. SUBSTANCE-RELATED DISORDERS
Chapter 12
Learning Outcome
By the end of the clerkship, the student will identify, clinically evaluate, and treat the
neuropsychiatric consequences of substance abuse and dependence.
XIII. SCHIZOPHRENIA AND OTHER PSYCHOTIC DISORDERS
Chapter 13 and 14
And From DSM-IV-TR® Handbook of Differential Diagnosis
Decision Tree on: Delusions, disorganized or unusual speech, Avoidance Behavior, Aggressive
Behavior, Catatonia
Ddx by Tables for:
Schizophrenia and other Psychotic Disorders
Somataform Disorders
Personality Disorders
Learning Outcome
By the end of the clerkship, the student will demonstrate proficiency in the recognition,
evaluation, and management of persons with psychosis associated with schizophrenic, affective,
general medical, and other psychotic disorders.
Clinical Rotation Manual For Faculty and Students
Touro University-California
128
XIV. MOOD DISORDERS
Chapter 15
and
UptoDate Articles
1. Postpartum Blues and Depression
2. Seasonal Affective Disorder
3. Grief and Bereavement
Learning Outcome
By the end of the clerkship, the student will recognize, evaluate, and state the treatments for
patients with mood disorders.
XV. ANXIETY DISORDERS
Chapter 16
and from DSM-IV-TR® Handbook of Differential Diagnosis
Decision Tree for: Anxiety, Panic Attacks, Pain, Insomnia, Impulsivity, Depressed mood,
Elevated or Irritable mood
Ddx by Tables for:
Mood Disorders, Anxiety disorders, Adjustment Disorders
Learning Outcome
By the end of the clerkship, the student will recognize, evaluate, and state the treatments for
patients with anxiety disorders.
WEEK 3
XVI. SOMATOFORM AND FACTITIOUS DISORDERS
Chapters 17 and 19
Learning Outcome
By the end of the clerkship, the student will diagnose and discuss the principles of management
of patients with somatoform disorders.
XVII. DISSOCIATIVE AND AMNESTIC DISORDERS
Chapter 20
Learning Outcome
By the end of the clerkship, the student will define dissociation, state its psychological defensive
role, and discuss the clinical syndromes with which it is associated.
XVIII. EATING DISORDERS
Chapter 23
Learning Outcome
Clinical Rotation Manual For Faculty and Students
Touro University-California
129
By the end of the clerkship, the student will summarize the distinguishing clinical features,
evaluation, and treatment of patients with eating disorders.
XIX. SEXUAL DYSFUNCTIONS AND PARAPHILIAS
Chapter 21
Learning Outcome
By the end of the clerkship, the student will summarize the process of evaluation and treatment
of persons with sexual dysfunctions or paraphilias.
XX. PERSONALITY DISORDERS
Chapter 27
Learning Outcome
By the end of the clerkship, the student will recognize maladaptive traits and interpersonal
patterns that typify personality disorders, and discuss strategies for caring for patients with
personality disorders.
WEEK 4
Week 4 cases
1.
2.
Clipp case 4
Clipp case 28
XXI. CHILD AND ADOLESCENT PSYCHIATRY
Chapter 32, 37,38, 39, 43,44, 48,49, 50 and
From Up-to-date
4.
5.
6.
7.
Diagnosis of autism spectrum disorders
Overview of the treatment and prognosis of attention deficit hyperactivity disorder in
children and adolescents
Asperger disorder: Management and prognosis in children and adolescents
Autism spectrum disorders in children and adolescents: Overview of management
Learning Outcome
By the end of the clerkship, the student will summarize the unique factors essential to the
evaluation of children and adolescents, and will diagnose the common child psychiatric
disorders.
Clinical Rotation Manual For Faculty and Students
Touro University-California
130
Optional Reading
If you find the required text book easy to read and assimilate, consider also reviewing Chapters
2,3,4, and 6 and 24-26, and 40-42 and 46, 47, 48, 49, 51-57 in preparation for your COMAT
examination
Summary of Required Cases from Med-U
Week 1 case
3.
FM case 29
Week 2 cases
4.
5.
6.
Simple Case 5
FM CASE 3
FM Case 9
Week 4 cases
7.
8.
Clipp case 4
Clipp case 28
Summary of Chapters from required text: 1, 5, 7, 8, 9 ,10 ,12, 13 ,14, 15 , 16, 17, 19, 20, 21, 23, 27, 32, 34,
35, 36 ,37, 38, 39, 43, 44, 49, 50, 58, 59 ( 30 chapters)
Time Management
Week one Monday review and familiarize yourself with the DSM IV. Review the syllabus and skim the
text book.
Read two up-to-date articles each week
Review three sections from the DSM IV assignments per week ( total of 10)
Then read two chapters m-thurs = 8 per week = 29 chapters
Do 1.5 cases per week – (one-two Friday)
OMM – number of presentations will depend on if this is your first core rotation. If it is not you will only
have one presentation to view. If it is you will have four.
Do Self Test on the First Monday and on the last Friday.
Clinical Rotation Manual For Faculty and Students
Touro University-California
131
Core Clerkship Syllabus Family Medicine
Core Rotations 702A and 702B Family Medicine I and II
Six units per block = four weeks each total of 8 weeks
2011-2012 Academic Year
Materials for TUCOM Class of 2014
Course Director
Jennifer Weiss, DO
Assistant Professor
Department of Clinical Education
Phone: available upon request.
Please email me to arrange phone appointment if needed.
Office hours: upon request, available for instant messaging
Email: [email protected]
Course Philosophy
The most important concept in your training is that you are an Osteopathic Physician. The
primary tenet of this concept is that you are treating whole people within their environment. In
the context of family medicine you will be faced with balance between time, available resources,
financial constraints and the kind of care you feel is in the best interest of the patient. You will
also find yourself facing the issue of evidence-based medicine vs. cultural or experience based
medicine. Both have strengths and weakness and your challenge is to gracefully evaluate what
you observe, and file away your experiences so that you can practice medicine in the way you
decide is most ethical and appropriate, while also meeting accepted standards of care. No matter
what your patients present with, remember that patients need education about health promotion
and disease prevention, and OMM/OPP may provide a patient with relief they might not get
from any other health care provider.
Course Description
Core clinical sites for the Family Medicine rotation offer a range of experiences. The overall goal
of the didactic online portion of the rotation is to create a forum in which a consistent set of
objectives can be learned. Students will rotate in assigned clinical settings in order to complete
the required third year clerkship. Family Medicine attendings will specify site requirements for
the clerkship and will see that students are provided with an appropriate level of clinical and
didactic experience. To ensure consistency among Family Medicine clerkship experiences, this
Clinical Rotation Manual For Faculty and Students
Touro University-California
132
standardized curriculum is provided. In order to successfully complete the required third year
rotation, all students must fulfill requirements specified by their preceptor AND complete the
required elements of the standardized curriculum as outlined in the Clinical Education
Handbook.
Summary of AOA Competencies
1. Osteopathic Philosophy/Osteopathic Manipulative Medicine
2. Medical Knowledge
3. Patient Care
4. Professionalism
5. Interpersonal and Communication Skills
6. Practice-based Learning and Improvement
7. Systems Based Practice
Each AOA competency that can be improved by achieving learning outcomes is referenced after
the learning outcome. Program and University learning outcomes, as well as the AOA
competencies are aligned with the course learning outcomes in the excel spreadsheet which can
be found in the co2014 Family Medicine Organization on BB. Please contact Dr. Weiss if you
have any further questions or would like a copy of this document.
Course Learning Outcomes*
At the end of the family medicine clerkship, each student should be able to:
1. Discuss the principles of family medicine care. (AOA: 3)
2. Gather information, formulate differential diagnoses, and propose plans for the initial
evaluation and management of patients with common presentations. (AOA: 1,2)
3. Manage follow-up visits with patients having one or more common chronic diseases.
(AOA; 1,2,3,4,5,6,7)
4. Develop evidence-based health promotion/disease prevention plans for patients of any
age or gender. (AOA; 1,2,3,4,5,6,7)
5. Demonstrate competency appropriate to a third year medical student, in elicitation of
history, communication, physical examination, and critical thinking skills. (1,2,3,4)
6. Discuss the critical role of family physicians within any health care system. (AOA 3,4,6,7)
7. Demonstrate active listening skills and empathy for patients. (AOA; 3,4)
8. Demonstrate setting a collaborative agenda with the patient for an office visit. (AOA; 3,4)
9. Demonstrate the ability to elicit and attend to patients’ specific concerns. (1,2,3,4,5)
10. Explain history, physical examination, and test results in a manner that the patient can
understand. (AOA; 1,2,3,4,5)
11. Effectively incorporate psychological issues into patient discussions and care planning.
(AOA; 1,3,4,5)
12. Use effective listening skills and empathy to improve patient adherence to medications
and lifestyle changes. (AOA; 3,4,5)
13. Reflect on personal frustrations, and transform this response into a deeper understanding
Clinical Rotation Manual For Faculty and Students
Touro University-California
133
of the patient’s and one’s own situation, when patients do not adhere to offered
recommendations or plans. (AOA: 4,5)
14. Formulate clinical questions important to patient management and conduct an
appropriate literature search to answer clinical questions. (AOA; 1,2,6)
15. Assess and remediate one’s own learning needs. (AOA; 1,4,5,6)
16. Describe how to keep current with preventive services recommendations. (AOA: 5,6)
17. Discuss the roles of multiple members of a health care team (e.g., pharmacy, nursing,
social work, and allied health). (AOA: 1, 2, 3,4,5,6)
18. Participate as an effective member of a clinical care team. (AOA: 5)
*Adapted From the society of Teachers of Family Medicine ―Family Medicine Clerkship
Curriculum‖
http://www.stfm.org/documents/fmcurriculum(v3).pdf
Objectives and Reading Assignments
The Family Medicine core clerkship objectives are divided into clinical knowledge and clinical
skills objectives. The clinical knowledge and clinical skill objectives and recommended
assignments are available on the blackboard organization: Class of 2014 Family Medicine Core
Rotation
Learning Resources
The primary resource is your clinical experience during your rotation. The most valuable
teaching tools are your patients, adjunctive staff at your site, and supervising physicians.
However, as clinical training can vary based on site, all of the topics listed in the objectives
should be reviewed independently. It is highly recommended that you read about your patients’
conditions that day in order to solidify the knowledge. Recommended reading assignments for
each learning objective are provided and you should expect to spend two to four hours per day
reading. Lectures and other learning tools will be made available on the Blackboard site.
Materials and Texts
Your reading requirements are from the following resources accessible through the library:
2. Up-to-Date
3. Harrison’s Principles of Internal Medicine, 17th ed.
DL Kasper, E Braunwald, S Hauser, D Longo, JL Jameson and AS Fauci
McGraw-Hill Professional
(Online version is available free through the Touro Library webpage.)
4. Current Medical Diagnosis & Treatment - 48th Ed. (2009) (available online through the Touro
Library).
5. Blackboard Materials in Class of 2014 Family Medicine Core Rotation Site
6. Med-U Lecture and Case Presentations*
7. OMM Links on Blackboard
Clinical Rotation Manual For Faculty and Students
Touro University-California
134
Additional Reading Assignments and Med-U
There are a multitude of resources at your disposal in your preparation for your exit examination.
It is recommended that you review the blueprint and objectives for the examination found on the
NBOME website (http://www.nbome.org/comatmain.asp?m=coll) and study any topics on
which you feel you need additional review.
Communication
Communication to students for the course will be provided on Blackboard
(http://blackboard.touro.edu). Additionally email may be sent to your tu.edu account, which
should be checked frequently. See this site for a more information regarding the course including
suggested and required resources.
Mid-clerkship Evaluation
At the mid-way point of the clerkship, students are expected to meet with their preceptors to
discuss their progress so far. Students should elicit feedback on possible areas of improvement
for the second half of the rotation. It is often necessary for you to request this meeting, as
preceptors may not initiate it.
Clinical Performance Evaluations (CPE)
At the end of the clerkship experience, attendings and other instructors who have supervised the
student during the clerkship complete CPE forms. CPE forms are included in the clinical
rotations manual accessible online and copies should be provided by the student to the
preceptors that he/she worked with during the clerkship. Completion of the clerkship is
dependent upon submission of a completed CPE. Obtaining a passing grade on the CPE is
required in order to pass the clerkship.
COMAT Clinical Exam in Family Medicine
The purpose of the COMAT Family Medicine subject examination is to assess the scope of
knowledge and cognitive skills for clinical problem-solving of osteopathic medical school
students at the end of the Family Medicine rotation and/or to provide a summative assessment
of their scope of knowledge and cognitive skills for clinical problem-solving. It is presented in a
style and format comparable to the COMLEX licensure series. All students are expected to take
the web-based exam at the end of the clerkship. The exam consists of a 10-minute tutorial
followed by two hours allotted for the 100-item examination. Time will not be extended beyond
the close of the examination. The COMAT performance accounts for 20% of the final clerkship
grade and must be passed in order to pass the rotation.
Preparing for the Examination:
The blueprint provided by the NBOME is as follows:
Clinical Rotation Manual For Faculty and Students
Touro University-California
135
The following objectives are from the COMAT bulletin for the Family Medicine Shelf Exam
For COMAT-Family Medicine, the examinee will be required to demonstrate the ability to
diagnose and manage selected patient presentations and clinical situations involving, but not
limited to:
1) Asymptomatic/General/Fever/Hypothermia: genetic screening, vaccination
recommendations, ethical and legal issues in clinical practice, population health
and systems-based practice issues, health maintenance examinations for all ages,
evidence-based cancer and other disease screening and prevention, anticipatory
guidance, geriatric functional assessment and end-of-life issues
2) Digestive/Metabolic: diabetes, gastroesophageal reflux disease, gastrointestinal
Clinical Rotation Manual For Faculty and Students
Touro University-California
136
tract cancer, hyperlipidemia, obesity, osteoporosis, thyroid disorders, liver
disease and inflammatory bowel disease
3)Cognitive/Consciousness/Fatigue/Sensory/SubstanceAbuse: neuropathies,
dementia, common psychiatric disorders, abuse, addiction, chronic
pain, insomnia, headache and transient ischemic attack/stroke
4) Musculoskeletal: sprains/strains/fractures, osteopathic manipulative treatment
techniques, somatic dysfunction, viscerosomatic relationships, arthritis and
rheumatic diseases
5) Genitourinary/Pregnancy/Neonatal: incontinence, erectile dysfunction, pelvic
pain, menstrual abnormalities, urinary tract infections, hematuria,
preconception care, antepartum/ intrapartum/ postpartum care, third trimester
bleeding, abnormal labor, spontaneous abortion, ectopic pregnancy, pelvic
inflammatory disease, and conditions of newborn and infant care
6) Bleeding/Respiratory/Circulation/HEENT: hematuria, common forms of
anemia, common eye and ear complaints, respiratory infections, common cardiac
conditions, asthma and chronic obstructive pulmonary disease
7) Discharge/Masses/Skin/Trauma: acne, other common skin lesions, lymphoma,
tumors, vaginal discharge and sexually transmitted infections
It is recommended that you supplement the assigned reading with reading from the required
materials on these topics. You may also wish to use a board review book to determine which
topics you need to spend more time reviewing. Some of the topics listed above are required
learning for other rotations such as pediatrics, Internal Medicine and OB/Gyn. For the purposes
of making your assignments manageable topics have been divided amongst rotations however
you are responsible for covering all of the material for each Shelf Exam. Therefore in reviewing
for the topics listed above that are not listed in your Core Family Medicine Objectives and
Reading Assignments, you may choose to access the topics and assignments listed in the other
core courses – for example vaccination recommendations from the Pediatric Core course or
thyroid disorders in the Internal Medicine Core course.
Course Units
The Core Family Medicine Clerkship Rotation consists of 8 weeks, which is equivalent to 12 units.
It is divided into two four-week rotation blocks that may be consecutive or divided in time.
Grading and Remediation
A cumulative score of 70% or higher is required to pass the rotation. A cumulative score lower
than 70% will result in failure and will require action as directed by the TUCOM Student
Promotions Committee, and as explained in the Clinical Rotations-handbook. In order to pass
the rotation each component may be completed, even if not completing it results in a score of 70%
or greater. If any individual component is completed late points will be deducted as follows:
Post rotation examination – no greater than 70% may be scored, the self-test, site evaluations and
Med-U cases which are completed late will be given 0%. Again, if they are not completed, you
will not pass the rotation so even if they are late, they must be completed.
1. Preceptor Performance Assessment
Clinical Rotation Manual For Faculty and Students
70%
Touro University-California
137
Two will be averaged*
2. Two Student Site Evaluations
3. Med –U Case
4. Self Test
5. Post Rotation Examination
Course total
2.5 %
2.5%
5%
20%
100.0%
All assignments and your evaluation must be complete by the last Friday of your rotation.
If you pass your overall rotation with a grade of 70% or higher, but fail your preceptor
performance assessment you will need to remediate the rotation. Please see the Clinical
Rotations Handbook for more details.
If you fail your examination you must retake it. The make up examination will be pass-fail and
your score - if passing - will be recorded as 70% and averaged in to your total for the 20% that the
post examination is worth. The score on the failed exam will not be recorded in your transcript
or averaged into your final grade.
In the event of a failed make – up examination the CED will review the situation and both
examinations and one of the following actions will be required of you: 1. remediate the rotation
or some portion of it, 2. Take a third written assessment 3. submit the matter to the student
promotions committee.
Course Outcome
1. Discuss the principles of family
medicine care.
2. Gather information, formulate
differential diagnoses, and
propose plans for the initial
evaluation and management of
patients with common
presentations.
3. Manage follow-up visits with
patients having one or more
common chronic diseases
4. Develop evidence-based health
promotion/disease prevention
plans for patients of any age or
Course Map
Learning
Direct
Opportunities
Assessments
Clinical rotation
COMAT, CPE,
experiences,
Reading
assignments, FM
cases
Clinical rotation
COMAT, CPE,
experiences,
Self-Test
Reading
assignments, SelfTest
FM cases
Clinical rotation
experiences,
Reading
assignments, FM
cases, Self-Test
Clinical rotation
experiences,
Reading
assignments, Self-
Clinical Rotation Manual For Faculty and Students
Indirect
Assessments
COMLEX II,
COMLEX PE
MATCH
COMLEX II,
COMLEX PE
OCSE
MATCH
COMAT, CPE,
Self-Test
COMLEX II,
COMLEX PE
OCSE
MATCH
COMAT, CPE,
Self-Test
COMLEX II,
COMLEX PE
OCSE
MATCH
Touro University-California
138
gender.
5. Demonstrate competency in
elicitation of history,
communication, physical
examination, and critical
thinking skills.
Test, FM cases
Clinical rotation
experiences,
Reading
assignments, SelfTest
FM cases
6.
Discuss the critical role of family
physicians within any health
care system.
7. Demonstrate active listening skills
and empathy for patients.
8. Demonstrate setting a
collaborative agenda with the
patient for an office visit.
9. Demonstrate the ability to elicit
and attend to patients’ specific
concerns.
10. Explain history, physical
examination, and test results in a
manner that the patient can
understand.
11. Effectively incorporate
psychological issues into patient
discussions and care planning.
12. Use effective listening skills and
empathy to improve patient
adherence to medications and
lifestyle changes.
13. Reflect on personal frustrations,
and transform this response into
a deeper understanding of the
patient’s and one’s own
situation, when patients do not
adhere to offered
recommendations or plans
COMAT, CPE,
Self-Test
COMLEX II,
COMLEX PE
OCSE
MATCH
Clinical rotation
experiences,
Reading
assignments
Clinical rotation
experiences,
Readings
COMAT, CPE,
Clinical rotation
experiences,
Reading
assignments, SelfTest
FM case
Clinical rotation
experiences,
Readings
COMAT, CPE,
Self-Test
COMLEX II,
COMLEX PE
OCSE
MATCH
COMLEX II,
COMLEX PE
OCSE
MATCH
COMLEX II,
COMLEX PE
OCSE
MATCH
COMAT, CPE,
Self-Test
COMLEX II,
COMLEX PE
MATCH
Clinical rotation
experiences,
Reading
assignments
CPE, Self-Test
COMLEX PE
MATCH
Clinical rotation
experiences,
Reading
assignments, SelfTest
Clinical rotation
experiences,
Reading
assignments, SelfTest
Clinical rotation
experiences,
Readings, cases
COMAT, CPE,
Self-Test
COMLEX PE
OCSE
MATCH
COMAT, CPE,
COMLEX PE
OCSE
MATCH
Clinical Rotation Manual For Faculty and Students
COMAT, CPE,
Self-Test
CPE,
MATCH
Touro University-California
139
14. Formulate clinical questions
important to patient
management and conduct an
appropriate literature search to
answer clinical questions.
15. Assess and remediate one’s own
learning needs.
16. Describe how to keep current
with preventive services
recommendations.
17. Discuss the roles of multiple
members of a health care team
(e.g., pharmacy, nursing, social
work, and allied health).
18. Participate as an effective
member of a clinical care team.
Clinical rotation
experiences,
Reading
assignments, SelfTest
FM cases
Clinical rotation
experiences,
Reading, Self-Test,
cases
Clinical rotation
experiences,
Reading
assignments
Clinical rotation
experiences,
Reading
assignments, Cases
CPE
COMLEX II,
MATCH
COMAT, CPE,
Self-Test
COMLEX II,
COMLEX PE
OCSE
MATCH
COMLEX II,
COMLEX PE
MATCH
COMAT, CPE,
Self-Test
COMLEX II,
COMLEX PE
OCSE
MATCH
Clinical rotation
experiences,
Reading, FM case
CPE,
Match
MATCH
Clinical Rotation Manual For Faculty and Students
COMAT, CPE,
Self-Test
Touro University-California
140
Family Medicine Rotation Reading Assignments
Course Director – Online Didactics
Dr. Jennifer Weiss
Assistant Professor
Department of Clinical Education
Phone: available upon request.
Please email me to arrange phone appointment if needed.
Office hours: upon request, available for instant messaging
Email: [email protected]
Textbooks and Supplemental Materials
The following texts may be accessed online through the Touro Library website.
Harrison’s Principles of Internal Medicine, 17th ed.
DL Kasper, E Braunwald, S Hauser, D Longo, JL Jameson and AS Fauci
McGraw-Hill Professional
(Online version is available free through the Touro Library webpage.)
Current Medical Diagnosis & Treatment - 48th Ed. (2009) (available online through the Touro
Library).
All other materials are accessible online through the corresponding Blackboard site.
For OMM materials see links on BB for required assignments
Learning Objectives
Following the Learning Objectives you will find the Reading Assignments and Cases, which
correspond to the Objectives.
Week 1 and 2
For these topics, your objective is to develop an approach to preventative care, which
includes an understanding of the most current evidence regarding primary secondary and
tertiary prevention in medicine. Your approach should be one that allows you to feel confident
that patients under your care will receive adequate counseling and screening. This means
beginning to conceptualize a systematic approach to wellness care. Additionally you should
begin to develop the means to speak with colleagues and attendings about the most current
evidence in primary care. These topics correspond to competencies 1.4, 1.6, 2.2, 3.6, 4.1, 4.2, 4.3,
5.3, 5.5, and 5.7 from the NBOME document. (See Clinical Education Resources BB organization)
Topics
1. Well Adult Care
Clinical Rotation Manual For Faculty and Students
Touro University-California
141
2. Addiction and Abuse
Tobacco, alcohol, domestic violence, prescription and non-prescription drug abuse
3. Cancer screening
4. Obesity
Approach to topics Weeks 3-8
The objectives for weeks 3-8 correspond to competencies 1 and 2 (all elements), and from
competencies 3-5 the following sections; 3.6, 3.7, 4.1, 5.1.3, 5.1.5, 5.1.6, 5.2, 5.3.3, 5.3.4,
5.5.1,5.5.2,5.5.6,5.6, 5.7
Your knowledge and understanding should be evident in your patient interactions, SOAP notes,
written history and physicals, didactic interactions with your preceptors and your performance
on the Self-Test and examinations and at the call back OSCE
Be able to demonstrate your knowledge of the following components of each listed disease entity:
Presentation
o History
o Physical to include
 Examination
 Lab and imaging findings
Diagnosis to include
o Basic pathophysiology of diagnosis and complications of the disease process
o Clinical reasoning process in determining the diagnosis
o Basic Epidemiology including risk factors for each diagnosis
Differential Diagnosis to include:
o Important things to rule out
o Most common alternative diagnoses
Management to include:
o Tests or studies needed to confirm or rule out diagnoses
o Medications - interactions/side effects dosing compliance issues, etc
o Non-pharmacologic medical treatment options including, osteopathic approach,
nutrition, behavior modification and so on.
o Consultations and interdisciplinary team management.
o Management of psychosocial issues, and rehabilitation.
o Patient education and follow up
As always, your information gathering, clinical reasoning and assessment and plan should include
osteopathic signs, symptoms, principles, management options and techniques.
Use this approach to navigate the following objectives:
Week 3 and 4
Topics
Metabolic, Endocrine and Cardiovascular Topics:
CAD, Risk Assessment & Management
Diabetes
Hyperlipidemia/Dysmetabolic Syndrome
Clinical Rotation Manual For Faculty and Students
Touro University-California
142
Hypertension
Week 5 and 6
Topics
Symptom Based Primary Care:
Cough
Insomnia, fatigue and other sleep disturbances
Neuropathic pain
Syncope
Other Chronic Disease:
Atopic disease: Asthma, Eczema and Allergies
Osteoarthritis
Osteoporosis
Week 7 and 8
Topics
Primary Care Neurology Topics
Alzheimer’s
Bells Palsy
Headache
Multiple Sclerosis
Parkinson’s
Gastro-Intestinal/Genitourinary Primary Care Topics
BPH
Incontinence
Prostatitis and Prostate CA
Pyelonephritis
UTI, bacteruria
Primary Care Musculoskeletal and Sports Medicine including Low Back Pain
Reading Assignments and Required Med- U Cases
The objectives are now listed in an abreviated form with the assignments and cases required for
each topic.
Week 1 and 2
Cases: FM Case 2, Simple case 13
Topics
1. Well Adult Care
2. Addiction and Abuse
Tobacco, alcohol, domestic violence, prescription and non-prescription drug abuse
Clinical Rotation Manual For Faculty and Students
Touro University-California
143
3. Cancer screening
4. Obesity
I. Harrison’s Internal Medicine
a. Chapter 4 Screening and Prevention of Disease
b. Chapter 78 Prevention and Early Detection of Cancer
II. UptoDate articles
a. Screening for and diagnosis of alcohol problems
b. Psychosocial treatment of alcohol abuse and dependence
c. Pharmacologic treatment of alcohol abuse and dependence
III. Monogram from NHLBI on Obesity
a. http://0-www.nhlbi.nih.gov.library.touro.edu/guidelines/obesity/prctgd_c.pdf
IV. Current Medical Diagnosis & Treatment - 48th Ed. (2009)
a. Chapter 1 Disease Prevention & Health Promotion - Michael Pignone, MD, MPH, & Rene
Salazar, MD
Weeks 3 and 4
FM Cases 5, 8, Simple case 2, 6, and 16
Simple case 8 optional
Topics
Metabolic, Endocrine and Cardiovascular Topics:
CAD, Risk Assessment & Management
Diabetes
Hyperlipidemia/Dysmetabolic Syndrome
Hypertension
I. Harrison’s Internal Medicine
a. Chapter 235 The Pathogenesis, Prevention, and Treatment of Atherosclerosis
b. Chapter 241 Hypertensive Vascular Disease
c. Chapter 339 Hypoglycemia
II. National Heart Lung and Blood institute
See specific links in the folder on the BB site in the didactic materials section
http://www.nhlbi.nih.gov/health/indexpro.htm
Week 5 and 6
Fm case 13, Simple Case 15
Topics
Symptom Based Primary Care:
Cough
Insomnia, fatigue and other sleep disturbances
Clinical Rotation Manual For Faculty and Students
Touro University-California
144
Neuropathic pain
Syncope
Other Chronic Disease:
Atopic disease: Asthma, Eczema and Allergies
Osteoarthritis
Osteoporosis
I. Harrison’s Internal Medicine
Appropriate Sections from the following chapters
a. Chapter 12 Pain: Pathophysiology and Management
b. Chapter 21 Syncope
c. Chapter 28 Sleep Disorders
d. Chapter 34 Cough and Hemoptysis
e. Chapter 53 Eczema, Psoriasis, Cutaneous Infections, Acne, and Other Common Skin
Disorders
f. Chapter 248 Asthma
f. Chapter 326 Osteoarthritis
g. Chapter 348 Osteoporosis
II. Up-to-date
a. ―Evaluation of Sub-acute and Chronic Cough in Adults‖
b. ―An overview of asthma management‖
Week 7 and 8
Simple case 18, 34
FM case 4
FM Case 10
FM case 18
Topics
Primary Care Neurology Topics
Alzheimer’s
Bells Palsy
Headache
Multiple Sclerosis
Parkinson’s
Gastro-Intestinal/Genitourinary Primary Care Topics
BPH
Incontinence
Prostatitis and Prostate CA
Pyelonephritis
UTI, bacteruria
Primary Care Musculoskeletal and Sports Medicine including Low Back Pain
I. Harrison’s Internal Medicine
Appropriate Sections from
Clinical Rotation Manual For Faculty and Students
Touro University-California
145
a. Chapter 15 Headache
b. Chapter 365 Dementia
c. Chapter 366 Parkinson's Disease and Other Extrapyramidal Movement Disorders
d. Chapter 371 Trigeminal Neuralgia, Bell's Palsy, and Other Cranial Nerve Disorders
e. Chapter 91 Benign and Malignant Diseases of the Prostate
f. Chapter 282 Urinary Tract Infections, Pyelonephritis, and Prostatitis
II. Up-to-date
a. ―Clinical Presentation and diagnosis of Urinary Incontinence‖
b. ―Treatment of Urinary Incontinence‖
III. Current Diagnosis and Treatment
Chapter e5Sports Medicine & Outpatient Orthopedics
Assignment Summary
Med U
14 cases – see above for specific cases
Current Diagnosis
Chapter 1, e5, 20
Harrison’s Internal Medicine
Chapters 4, 12, 15*, 21, 28, 34, 53, 78, 91*, 235, 241, 248, 282* 326, 339, 348, 365*, 366*, 371* (19
chapters)
Up To Date
1. Alcohol abuse and dependence: Epidemiology, clinical manifestations, and
diagnosis
2. Screening for alcohol misuse
3. Psychosocial treatment of alcohol abuse and dependence
4. Pharmacologic treatment of alcohol abuse and dependence
c. Evaluation of Sub-acute and Chronic Cough in Adults
d. An overview of asthma management
e. Clinical Presentation and diagnosis of Urinary Incontinence
f. Treatment of Urinary Incontinence
g. Overview of Medical Care in adults with diabetes
Other
Monogram from NHLBI on Obesity
National Heart Lung and Blood institute (JNC 7 guidelines)
ATP III guidelines
OMM Materials
Clinical Rotation Manual For Faculty and Students
Touro University-California
146
Time Management Strategy
8 weeks
Do 1-2 cases per week ( there are 8 weeks and 14 cases so most weeks do 2)
Reading UptoDate- one article per week except the last week read 2
Chapters from required Texts - read one every day except Friday for the first five weeks (you’ll
be done before the fifth week is over!)
Monograms – these are critical information and detailed: Week 1 - skim through each of them
and download pocket versions
Also do the OMM materials in Week 1 ( the amount of time this will take depends on if it is your
first rotation or not).
Week 2 – read JNC in detail
Week Three –Read ATP II in detail
Week Four - read Obesity monogram in detail
Weeks 6, 7, 8
Review for post rotation examination or cover chapters you haven’t read yet because you were so
busy studying the monograms and working on the cases.
Weekends
Practice board review test questions
Clinical Rotation Manual For Faculty and Students
Touro University-California
147
Core Clerkship Syllabus Pediatrics
Course Director
Jennifer Weiss, DO
Assistant Professor
Department of Clinical Education
Phone: available upon request.
Please email me to arrange phone appointment if needed.
Office hours: upon request, available for instant messaging
Email: [email protected]
Clerkship Directors
Tami Hendriksz, DO, FAAP, FACOP
Philip Malouf, MD, FAAP
Assistant Professor
Assistant Professor
Primary Care Department
Primary Care Department
Phone: 707-638-5910
Phone: 707-638-5963
Email: [email protected]
Email: [email protected]
COURSE PHILOSOPHY
The most important concept in your training is that you are an Osteopathic Physician. The primary tenet of this
concept is that you are treating whole people within their environment. In pediatrics one of the primary challenges
is working within the context of the family. It is important not only to be able to examine, diagnose and treat
children, but to understand the family dynamics and to be an advocate both for the child and for their parents. This
means that a critical aspect of your job is to help educate and inform parents about options for treatment, normal
development and parenting skills. When you observe seasoned attending physicians, pay close attention to how
they speak to the children as well as to the parents; note how their decisions are guided by the needs and means of
the family.
As an osteopathic physician, one of the greatest tools you have is the ability to seek health. When working with
children you will have the unique opportunity to observe the vital health and intrinsic healing of youth. In
addition, the healing capacity of children is often so strong, that changes are apparent from moment to moment.
Clinical Rotation Manual For Faculty and Students
Touro University-California
148
Take advantage of this chance to see health, and from it you can reason and imagine the possibilities for health in all
of your patients.
CLERKSHIP LEARNING OUTCOMES
The learning outcomes of the Pediatric Core Clerkship are based on the seven core competencies of the AOA. The
clerkship learning outcomes are listed with the corresponding core competencies noted in parentheses. Upon
completion of this course, the third year osteopathic medical student will be able to:
Identify normal and abnormal growth and development (physical, physiologic and psychosocial) from birth
through adolescence. (Medical Knowledge)
Diagnose and initiate management of common acute and chronic pediatric illnesses, recognizing age-specific
epidemiologic differences in the care of infants, children, and adolescents. (Medical Knowledge, Osteopathic
Philosophy and Osteopathic Manipulative Medicine, Patient Care)
Explain the influence of family, community and society on the child in health and disease. (Medical Knowledge,
Patient Care, Osteopathic Philosophy and Osteopathic Manipulative Medicine)
Show development of communication skills that will facilitate clinical interaction with children, adolescents and
their families and ensure that complete and accurate data are obtained. (Interpersonal and Communication Skills,
Systems-Based Practice)
Perform and document a complete and age-appropriate history and physical examination of infants, children
and adolescents. (Medical Knowledge, Osteopathic Philosophy and Osteopathic Manipulative Medicine, Systems-Based
Practice)
Use clinical findings and interpretation of laboratory and radiologic testing to generate an appropriate
diagnostic and management plan. (Medical Knowledge, Patient Care, Osteopathic Philosophy and Osteopathic
Manipulative Medicine)
Give verbal patient presentations and write encounter notes demonstrating how pertinent findings inform their
diagnostic reasoning. (Interpersonal and Communication Skills, Practice-Based Learning and Improvement, Medical
Knowledge, Osteopathic Philosophy and Osteopathic Manipulative Medicine)
Develop strategies for health promotion and disease prevention and apply them to pediatric patients. (Patient
Care, Osteopathic Philosophy and Osteopathic Manipulative Medicine)
Behave professionally towards colleagues, staff, and patients and display attitudes appropriate for clinical
practice in the care of children. (Professionalism)
Access the primary medical literature and apply principles of evidence-based medicine to the care of children.
(Practice-Based Learning and Improvement)
COURSE DESCRIPTION
The pediatrics core clerkship offers a range of clinical experiences, didactic sessions, reading, and exercises covering
core topics in pediatrics. Students will rotate in assigned clinical settings in order to complete the required third
year clerkship. Preceptors will specify site requirements for the clerkship and will see that students are provided
with an appropriate level of clinical experience. The standardized curriculum is provided to ensure consistency
among pediatric clerkship experiences. In order to successfully complete the required third year rotation, all
Clinical Rotation Manual For Faculty and Students
Touro University-California
149
students must fulfill requirements specified by their preceptor AND complete the required elements of the
standardized curriculum as outlined in this syllabus (Section VII).
OBJECTIVES
The pediatric core clerkship objectives are divided into clinical knowledge and clinical skills subsets.
The clinical knowledge objectives and recommended reading assignments are organized based on subject
competencies for the end-of-clerkship COMAT examination. These competencies are subdivided into common
pediatric complaints and diagnoses as outlined in the Council on Medical Student Education in Pediatrics
(COMSEP) suggested curriculum for medical student clerkships in pediatrics.
For each diagnosis on the list of clinical knowledge objectives the student should be comfortable demonstrating
knowledge of the following components of each listed disease entity:
History and Physical Exam (30-50%)
o History
o Physical examination findings
Diagnostic Technologies (5-15%)
o Laboratory study and imaging findings
Scientific Understanding of Mechanisms (3-7%)
o Basic pathophysiology of diagnosis and complications of the disease process
o Clinical reasoning process in determining the diagnosis
o Basic epidemiology including risk factors for each diagnosis
o Differential diagnosis to include:
 Important diagnoses to rule out
 Most common alternative diagnoses
Management (10-20%)
o Tests or studies needed to confirm or rule out diagnoses
o Medications - interactions/side effects, dosing, compliance issues
o Non-pharmacologic medical treatment options including osteopathic approach, nutrition, behavior
modification
o Consultations and interdisciplinary team management
o Management of psychosocial issues and rehabilitation
o Patient education and follow up
Health Promotion/Disease Prevention (10-30%)
o Patient Education and Screening
o Development and growth assessment
Health Care Delivery (5-15%)
o Effective verbal and non-verbal communications skills with children and their parents
o Confidentiality, privacy, and modesty
o Age-appropriate history and physical examination techniques
The clinical skills objectives are based on physician task competencies for the end-of-clerkship COMAT
examination. They are subdivided into competency specific skill areas as defined by the COMSEP suggested
curriculum skills list.
LEARNING RESOURCES
Clinical Rotation Manual For Faculty and Students
Touro University-California
150
The primary resource is your clinical experience during your rotation. The most valuable teaching tools are your
patients, adjunctive staff at your site, and supervising physicians. However, as clinical training can vary based on
site, all of the topics listed in the objectives should be reviewed independently. It is highly recommended that you
read about your patients’ conditions that day in order to solidify the knowledge. Recommended reading
assignments for each learning objective are provided and you should expect to spend two to four hours per day
reading. Lectures and other learning tools will be made available on the Blackboard site. You will also be expected
to participate in live internet didactic sessions hosted by the Pediatric Clerkship Directors.
Please watch the Pediatric Physical Examination Video prior to the first day of your rotation. The video can be
found at the following web address:
http://www.columbia.edu/itc/hs/medical/clerkships/peds/Student_Information/Reference_Materials/PE_Vide
o.html
The following resources are recommended for use on the Pediatric Clerkship. Nelson Textbook of Pediatrics is
considered the core text and the student is expected to be familiar with material in that text. The supplemental
resources are suggested as either unabridged compendia of information on pediatric disease (C), concise reviews of
key topics (R), validated education/self-assessment tools (T), or essential pediatric resources that all osteopathic
physicians should be familiar with (E). Recommended reading assignments can be found on the Clerkship
Curriculum Map.








Nelson Textbook of Pediatrics, 18th Ed. Saunders, 2007. ISBN 1416040048. (C)
http://www.mdconsult.com/books/about.do?about=true&eid=4-u1.0-B978-1-4160-2450-7..X5001-4-TOP&isbn=978-1-4160-2450-7&uniqId=238192007-2
UpToDate (R)
http://www.uptodate.com/index
The Harriet Lane Handbook, 18th Ed. Mosby, 2008. ISBN 9780323053037. (E)
http://www.mdconsult.com/books/about.do?eid=4-u1.0-B978-0-323-05303-7..X5001-6--TOP&isbn=978-0-32305303-7&about=true&uniqId=238192007-2
Red Book: 2009 Report of the Committee on Infectious Diseases, 28 th Ed. American Academy of Pediatrics, 2009.
ISBN 9781581103069. (E)
http://aapredbook.aappublications.org/
An Osteopathic Approach to Children, 2nd Ed. Elsevier, 2009. ISBN 9780443067389 (E)
http://0-www.sciencedirect.com.library.touro.edu/science/book/9780443067389
Computer-assisted Learning in Pediatrics Program (CLIPP) Cases (T)
http://app1.med-u.org/player/app/homepage.html
Powerpoint presentations (R) created by Touro University and adjunct faculty and made available for medical
student review
The American Academy of Pediatrics Journal titled Pediatrics (E)
http://ejournals.ebsco.com/Journal2.asp?JournalID=102792
BLACKBOARD SITE
Communication to students for the Pediatrics Core Clerkship will be provided on Blackboard
(http://blackboard.touro.edu). See this site for more information regarding the course, including the required
web-based didactic schedule and access to suggested resources.
Clinical Rotation Manual For Faculty and Students
Touro University-California
151
REQUIRED TASKS
A. CLIPP Cases
CLIPP cases are web-based simulated patient encounter scenarios based on the clinical knowledge and clinical skills
objectives of the course. Each student must complete a minimum of 10 CLIPP cases during the course of the 6-week
clerkship (1-2 cases per week). The five cases listed below must be completed. Additionally, five more cases of the
student’s choosing are to be completed.
The Clinical Curriculum Map includes suggested CLIPP cases
recommended for individual learning objectives. The students’ time spent on each required CLIPP case may be
monitored to ensure satisfactory completion of the exercise.
Required CLIPP cases:
Case 2: Infant well child (2, 6, and 9 months)—Asia
Case 3: 3-year-old well child check—Benjamin
Case 4: 8-year-old well child check—Jimmy
Case 5: 16-year-old girl’s health maintenance visit—Betsy
Case 6: 16-year-old boy’s pre-sport physical—Mike
B. Patient Logs
Students will document all required clinical experiences (encounters and procedures) on their Clinical Knowledge
Log & Clinical Skills Log (see Appendices A & B). For each clinical experience, the student should indicate the date
of the experience and have the preceptor initial the logs to verify the clinical interaction. This can be done at the end
of each workday during the rotation, on a weekly basis, at the end of the rotation, or in whichever time frame the
preceptor deems is appropriate and achievable. Alternative clinical experiences are included on the logs as well as
in the Clinical Skills and Clinical Knowledge Curriculum Maps (refer to Appendices C & D), and should be
completed by the student for any clinical experiences not encountered by the end of the clerkship. Verification of
completion of these alternative experiences should also be done via the preceptor’s initials on the log. In order to
receive a grade for the clerkship, the student is required to complete all items in all categories. These logs will be
faxed, mailed or handed into the TUCOM-CA Clinical Education Department at the end of the student’s Pediatric
Clerkship.
C. Case Conferences
There will be five interactive case conferences. Students rotating within 50 miles of the Touro University campus
will be expected to physically attend, while all others will participate via web-based interaction. Students will be
selected at random to present a case seen on their clinical rotation. An interactive discussion will follow the case
presentation. All students are expected to come prepared with a case to present. Attendance and participation is
mandatory. Students may be granted an excused absence if permission is obtained from the clerkship directors
prior to the conference. Students who have an excused absence to miss the session will be expected to complete a
make-up assignment. Those students who miss any of the didactic sessions without an excused absence will not
receive a grade for the Pediatric Core Clerkship until they have attended an additional didactic session (one that
most likely takes place after they have competed the full 6 weeks of their Pediatric Core Clerkship).
D. Self Test
The self-test is a multiple choice test which may be taken as many times as the you like. It must be completed by the
last Friday of your rotation. It will cover the material in the Clipp cases and in the OMM powerpoints available via
links Pediatric rotation BB organization. It is worth 2% of your grade. Challenges to any questions should be
Clinical Rotation Manual For Faculty and Students
Touro University-California
152
submitted to Dr. Weiss as per the guidelines in the overview section of part III of this manual. You may find it
useful to take this test at the beginning and end of your rotation.
E. Clinical Performance Evaluations (CPE)
At the end of the clerkship experience, CPE
supervised the student during the clerkship.
he/she worked with during the clerkship.
completed CPE to the TUCOM-CA Clinical
required in order to pass the clerkship.
F.
forms are completed by attendings and other instructors who have
CPE forms should be provided by the student to the preceptors that
Completion of the clerkship is dependent upon submission of a
Education Department. Obtaining a passing grade on the CPE is
COMAT Clinical Exam in Pediatrics
The purpose of the COMAT Pediatrics subject examination is to assess the scope of knowledge and cognitive skills
for clinical problem-solving of osteopathic medical school students at the end of the Pediatrics rotation and/or to
provide a summative assessment of their Pediatrics scope of knowledge and cognitive skills for clinical problemsolving. It is presented in a style and format comparable to the COMLEX licensure series. All students are expected
to take the web-based exam at the end of the clerkship. The exam consists of a 10 minute tutorial followed by two
hours allotted for the 100 item examination. Time will not be extended beyond the closure of the examination. The
COMAT performance accounts for 20% of the final clerkship grade. The student is required to score 70% or higher
on the COMAT examination in order to obtain a passing grade for the clerkship. If a student fails once, they may be
required to re-take the exam. If the student fails a second time, remediation will be discussed with and determined
by the Pediatric Clerkship Directors on a case-by-case basis.
RECOMMENDED TASKS
A. Structured Clinical Observation (SCO)
A Structured Clinical Observation (SCO) is a formal method for a student to be observed and then receive feedback
on a complete history and physical examination. For the pediatric clerkship, it is suggested that each student
complete two SCOs per six-week rotation. It is highly recommended that the first SCO be completed by the midclerkship evaluation. The preceptor should observe the student and then provide the student with oral and written
feedback using the forms provided in this syllabus. The SCO experience and feedback is dependent on individual
preceptors’ schedules and availability.
B. Journal Article Write-Up
It is crucial to be able to critically assess the primary medical literature in order to provide high quality, evidencebased care. During the 6-week pediatric clerkship the student will be expected to evaluate the validity and results
of at least two recent journal articles (published no greater than 2 years from the date of the clerkship in a reputable
medical journal) and produce a write-up of their findings. A suggested outline is provided in Appendix E. The
student will document the date of completion of 2 Journal Article Write-Ups, along with the citation of the article on
their Clinical Skills Log. The completion of these assignments will be verified by the initials of the preceptor on the
log. Review and discussion of the Journal Article Write-Up is ultimately dependent on individual preceptors’
schedules and availability.
C. Student Case Presentations
Students should be expected to give a minimum of two pediatric-focused case-style presentations during their 6week pediatric clerkship. These presentations are most valuable when related to a patient that was seen by the
student on the rotation. The typical case presentation will begin with the discussion of a patient, involve a
discourse of appropriate differential diagnoses, along with specific diagnostic and treatment plans for illnesses
presented, and then end with a recap of what happened to the patient involved in the initial case. Specific
requirements for the timing, content and format of these presentations will be determined by the individual
Clinical Rotation Manual For Faculty and Students
Touro University-California
153
preceptor (suggested topics are included in Appendix F) and is ultimately dependent on individual preceptors’
schedules and availability. There will be a checkbox on the Clinical Performance Evaluation for the preceptor to
indicate that the student adequately completed a Case Presentation.
D. Mid-clerkship Evaluation
At the mid-way point of the clerkship, students are encouraged to meet with their preceptors to discuss their
progress over the first half of the rotation. Students should elicit feedback on possible areas of improvement for the
second half of the rotation. Clinical Knowledge & Skills Logs should be reviewed at the halfway point and focus
should be placed on completing any required clinical experiences (and discussing necessary alternative clinical
activities).
GRADING AND REMEDIATION
At the end of the course, the student will submit a complete packet including the items indicated with a * below to
the TUCOM-CA Clinical Education Department. The student should make copies for themselves in the event that
the originals are lost in the mail. A cumulative score of 70% or higher is required to pass the rotation. A cumulative
score lower than 70% will result in failure and will require action as directed by the TUCOM Student Promotions
Committee.
Clinical performance evaluations*
70%
COMAT subject examination
20%
2%
Completion of required activities:
Clinical Knowledge & Clinical Skills Logs*
2%
Completion of required CLIPP cases and Self Test
Participation in weekly web-based didactics
Student site evaluation
4%
2%
Clerkship Total
100%
DISTINGUSHED STUDENT AWARD
The Division of Pediatrics offers the Pediatric Distinguished Student Award. This award is designed to honor a
senior medical student who intends to enter a pediatric residency and has demonstrated superior performance in
his or her activities as a medical student. Pediatrics evolved as a specialty because children have unique
physiologic, biochemical and psychosocial needs which reflect dynamics of change during growth and
development. The recipient of the Pediatric Distinguished Student Award should demonstrate a sound grasp of
these concepts as well as skill in applying them to the care of children. Awardees should have completed their
pediatric core clerkship and demonstrated exceptional ability and potential for future contributions to the specialty
of pediatrics.
Clinical Rotation Manual For Faculty and Students
Touro University-California
154
Clinical Rotation Manual For Faculty and Students
Touro University-California
155
Appendixes
Clinical Rotation Manual For Faculty and Students
Touro University-California
156