Integrating the Curriculum with Clinical Medicine

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Integrating the Curriculum with Clinical Medicine

• Richard Usatine, MD

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Early introduction of Clinical Medicine

• Teaching basic clinical skills in physical exam
  courses
• Preceptorships - early clinical experiences in
  the community

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Early introduction of Clinical Medicine

• PBL or clinical case-based teaching in small
  groups
• Clinical correlations in Basic Science Coursed

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Doctoring at FSU

• Clinical case-based teaching in small groups
• Teaching basic clinical skills in our Clinical
  Learning Center
• Preceptorship
• Medical Informatics

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Doctoring Goals

• Communication Skills
• Physical Exam Skills
• Clinical decision-making
• EBM
• Ethics
• Humanism
• Clinical application of sciences

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Horizontal Integration

• Coordinated with
• Pathology
• Microbiology
• Pharmacology
• Health issues in medicine
• Psychosocial aspects of medicine

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Vertical Integration

• Doctoring 1 Focus on basic interviewing,
  developmental psychology
• Doctoring 2 Cases based on common diseases
• Doctoring 3 Cases based on the 20 health
  priority areas of the IOM
• Each year builds directly on the preceding year

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Doctoring

• Simulate a clinical practice
• Every student sees the same basic core cases
• Patients return over time to simulate continuity
  and to see time course of various conditions
  breast cancer, prostate disease, asthma,
  depression

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Doctoring 2 topics

• Cellulitis
• Pharyngitis
• Smoking Cessation
• Breast Cancer 1
• Breast Cancer 2
• Hypertension
• Rape Case
• Obesity, Nutrition, Exercise

• Bioterrorism and Anxiety
• Parkinsons (Caregivers)
• Cardiac Simulator
• Healers Art
• Formative OSCEs
• Hip fractures
• Prostate/BPH
• Healers Art Grief and Loss

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Doctoring 2 cont.

• Alcoholic Physician
• Breast Cancer (metastatic)
• Prostate Cancer
• Diabetes (foot and eye exam)
• Gastroenteritis (interpreters)
• Asthma and adolescent depression
• Asthma, suicide

• Breast Cancer end of life
• Back Pain
• Dementia
• Abortion
• Tension HA vs Migraine
• Dermatology cases
• Malpractice
• Domestic Violence

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Doctoring 3 - IOM

• Asthma
• Health care Coordination
• Children with special health care requirements
• Diabetes
• End of life care for patients with advanced organ
  system failure
• Evidence based cancer tests
• Elder care
• Hypertension
• Immunization
• Coronary Heart Disease

• Major Depression
• Medication Errors
• Infections acquired in Hospitals
• Obesity
• Pain management
• Pregnancy and Childbirth
• Self management and health literacy (focus on
  arthritis case)
• Mental Illness
• Stroke
• Addiction and Substance Abuse

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Prostate Module

• By the completion of the module, students will be
  able to
• List the differential diagnosis of urinary
  symptoms
• Describe aspects of benign prostatic hyperplasia
  including
• Evidence-based medicine (EBM) approach to
  treatment using lifestyle changes, medicine,
  phytotherapy, surgery
• Critically appraise evidence on the risks and
  benefits of preventive services such as PSA

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Prostate Module Objectives

• Discuss the value of the USPSTF and the Cochrane
  database for systematic reviews (EBM)
• Describe the use and limitations of screening
  tests (using PSA as an example)
• Describe the importance of informed consent
  surrounding issues of screening
• Describe lead-time and length-time bias and their
  importance in evaluating the result of cancer
  screening studies

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Prostate Size
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PSA

• DVD on screening with PSA - includes interviews
  of 2 doctors considering having PSA screening
• Informed consent
• Students learn about uncertainty in medicine

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Surgery

• TURP (transurethral resection of the prostate)
• TUIP (transurethral incision of the prostate)
• TUMT Transurethral microwave thermotherapy
• TUVP Transurethral vaporization of the prostate
• TUNA Transurethral needle ablation
• Open Prostatectomy

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Prostate Case Part 2

• Patient returns with elevated PSA
• Show students rectal ultrasound and biopsies
• Get pathology results with Gleason Scores
• Help patient decide on course of action

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Dermatology Cases

• On the web at
• http//fm.mednet.ucla.edu/derm/search.cfm

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Breast Cancer Case

• Patient presents with painful lump
• Family History suggestive of genetic breast
  cancer
• Normal mammogram
• Suspicious ultrasound
• Send for core needle biopsy

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Breast Cancer Case Part 2

• Core needle biopsy result shows invasive
  intraductal carcinoma
• Counseling of patient to talk about where to go
  from here
• Treatment options
• Consider BRCA testing

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Questions?