Community Based Physician Experience – Approximately once every 4 weeks, students spend a 3-hour block of time with a local volunteer “community-based preceptor.” Students are assigned a community physician , day and time.  Students are to perform parts of a medical interview on patients selected by the community-based preceptor.  For guidance, an outline for the pediatric and adult medical interview is provided in this syllabus.  Students are assigned readings from the textbook “The Medical Interview” to develop their interviewing skills.  The Weekly Schedule of Activities lists the focus of the interviews.

Students are expected to arrive on time, dressed appropriately with a white coat and identification badge.  The primary goal is to practice interviewing skills.  Students may be asked to perform or be present during an examination of a patient, and this is permitted.  However, students are not to perform any procedures (i.e. remove sutures), as instruction for such activity will occur later in your education.   The community-based preceptor and office staff will be completing a student evaluation as part of the student’s grade for the course.

Small Group Sessions - The interpersonal arena is where physicians practice their craft and much of their learning occurs during their careers – first as medical students and residents on the wards and later with colleagues in practice.  An essential skill for physicians is effective communication skills and the ability to work constructively with colleagues and team members.  The small-group sessions provide students an opportunity to practice their skills and to receive feedback from preceptors and colleagues

Recognition of the importance of this communication skill is an important determinant of your success on the wards with attending physicians or with patients and their families.  Students and the preceptors in the Fundamentals of Patient Care are encouraged to view the small-group sessions as a place where you can practice and receive feedback about the complex set of interpersonal skills necessary for your success as a physician.

• Activities
• • Discuss the key issues identified from the readings.
  • Introduction to common patient problems in the practice of primary care.
  • Practice building a medical history from a standardized patient with a common complaint.
• Process
• • Three to four students are to interview the “patient” during each session.
  • Students are to interview the standardized patients separately.
  • Immediate instructive feedback from patient, students, and instructor.
  • Review of the issues associated with interviewing a patient with this complaint when all interviewers have finished.
• Evaluation
• • 3 written patient histories (community-based preceptor’s office)
  • 3 oral presentations
  • Interviewing skills
  • Professionalism and Global Rating

Students are expected to prepare for their small groups by reading the assigned material.  The majority of the examination questions are derived from the assigned readings.  All Students should wear professional attire, white coats, and ID badges while representing MUSC as a student physician.

Presentations in Small Group

            For the 3 written patient histories, students learn how to take a complete medical history, but must realize that a focused history is the usual method of interviewing.  You are to write the parts of the medical history you are assigned.  For example, if the interview consisted of eliciting the chief complaint, history of present illness and family history, these would be the components of the written presentation.  If you were not successful in gathering part of the history during your interview, note this in your write-up.  For patient confidentiality purposes, use the patient’s initials only and not the patient’s name on the written patient history. 

            For the 3 oral presentations, students are to present the information obtained during the patient interview of the community visit.  This information will likely parallel the information in the written patient history.  Reading the written patient history is NOT permitted; notes are permissible. Always include patient demographic information (i.e., name, age, sex, occupation) in the oral presentation.  A brief review of the illness should be discussed (but not handed in) including key components of the illness, epidemiology, key components of review of systems, key signs and symptoms, which lead you and your preceptor to choose the diagnosis.

Introduction to the Case Based Learning Exercises (CBLES)
Case Based Learning Exercises is an educational activity to help integrate material.  Students are to read and review information to help them through the POPS.  The POPS cases are written to address behavioral science concepts relevant to many areas of medical practice.  Each case centers on a human life-cycle stage: infant/child, adolescent, adult, and older adult.  Case Based Learning Exercises addresses the objectives related to behavioral science in medical practice skills; medical informatics skills; life-long, self-directed learning skills; and patient care and professional development skills.

The purposes are:

• To apply your behavior science knowledge to the solution of clinical problems.
• To apply informatics’ skills to learn how to better use sources (i.e., textbooks and peers).
• To collaborate with your fellow students.
• To evaluate your colleagues’ opinions, thought processes, and diagnoses.
• To increase communications skills.
• To get to know your classmates better.

This activity consists of three phases.

• Pre-class preparation and Pretest
• • Review the learning objectives
  • Background reading on the topics to be covered
  • Take the pretest prior to class
  • Prepare to explain 2 or 3 answers assigned after the Pre Test.
• Class
• • Join three other students and review the pretest answers in an “open-book” or “open-computer” discussion.
  • Discuss and solve patient-oriented problems. Information exchange and group interaction are keys to the success of this phase. This process will allow you to teach your fellow students and, at the same time, learn from them.
• Post-test and Debriefing
• • Take a post-test, individually to enable you to assess your progress.
  • Review your answers with your group.

The faculty role during the CBLES sessions is quite distinct from the role of the traditional lecture-based teacher.  The facilitator’s purpose is to serve more as a process guide or facilitator of the POPS session rather than as a content expert prepared to give answers.   The ideal facilitator ensures that students define their learning issues and participate extensively during sessions.  The facilitator’s purpose is not to answer students’ questions about case material, but to facilitate students’ abilities to research the answers to these questions on their own.

Basic Science Integration
Basic Science Integration is done in the sessions.  In small group, one method is to have you prepare a summary of the illness that your particular community patient may be suffering and start to learn some brief issues about the illness including epidemiology, Review of Systems, treatment, etc. during the presentations. Regardless, for any or the discussions, preparation prior to class discussion is necessary, as the discussions will be student initiated.  The Basic Science Integration segment addresses objectives related to integration of clinical and basic science.

Medical Informatics
The Medical Informatics segment is a series of learning activities intended to develop and evaluate your skill in retrieving, processing and sharing information electronically. Doctors are expected to develop the skills to communicate effectively, locate accurate, reliable and up to date information, manage biomedical information, use information technology, and enhance lifelong learning including using e-mail to send and receive messages, developing effective written and audiovisual presentations, comply with copyright law and Teach Act, retrieving information from a variety of sources (books, journals, electronic databases and the Internet); reading, evaluating and summarizing key points of published articles; and incorporating information and citations into course assignments.

The reference links part of WebCT for this course contains a selected list of electronic information resources that the medical community uses to locate current, accurate, reliable and up to date information.  There are brief descriptions of these resources.  There is also an outline of how to most efficiently and effectively search Ovid MEDLINE and PsycINFO.  Hands on classes covering electronic resources, searching Ovid, evaluating websites and Copyright and the teach Act will occur throughout the semester. Individualized instruction can be scheduled with Bob Poyer (792-2892, poyerrk@musc.edu). Screencasts or podcasts may be developed.  These classes will be offered as follows:

The following activities are required:

• Learn how to use electronic resources such as MEDLINE, PsycINFO, MICROMEDEX, MD Consult, UpToDate, AccessMedicine and other electronic resources, use Boolean logic to develop effective search strategies and learn to differentiate authoritative sources from untrustworthy sources of biomedical information.
• Be able to evaluate Internet Websites.
• Understand the Copyright Law and the Teach Act.

Course assignments in the Medical Informatics segment will relate to understanding and using a variety of biomedical resources including MEDLINE, developing effective and efficient search strategies, understanding Boolean logic, and weighing conflicting evidence.

Large Group Sessions

Block 1 Culture and Communication
Block 2 Prenate to Preteen
Block 3 Adolescent to Adult

Doctoring Exam Review & Medical Jeopardy

Medical Jeopardy will be held in small groups before Exam 2 and Exam 3.