ICM 1 GOALS AND OBJECTIVES

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ICM1 Orientation
2004-2005 Stanford Massie M.D. Course Director
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• No greater opportunity, responsibility, or
  obligation is given to an individual than that of
  serving as a physician. In treating the
  suffering he needs technical skill, scientific
  knowledge, and human understanding. He who uses
  these with courage, with humility, and with
  wisdom will provide a unique service for his
  fellowman, and will build an enduring edifice of
  character within himself. The physician should
  ask of his destiny no more than this he should
  be content with no less.
• Tinsley Harrison M.D.
• Principles of Internal Medicine

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Medicine as a career

• A noble endeavor
• Responsibility
• Trust
• Service
• Rewards and Obligations
• Altruism
• Balance of personal and professional life
• Self improvement

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Medicine as a career

• Becoming a physician is a process
• Dont tread lightly
• Recognize your teachers and thank them
• Teach others
• Self-improvement
• Be a student of medicine and people
• Cultivate curiosity and relationships

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ICM and your career

• ICM marks a major step down the path
• ICM is different
• Life long skills
• Foundation of your future practice
• Practice, practice, practice
• Be proactive
• We want you to succeed!

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The hardest conviction to get into the mind of a
beginner is that the education upon which he is
engaged is not a college course, not a medical
course, but a life course, for which the work of
a few years under teachers is but a preparation
Sir William Osler
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Road Map

• Course Objectives
• Small Group Meetings/Learning activities
• Examinations and Grades
• Other course activities
• Suggestions for Students
• Introduction of course administration
• Comments from fourth year students

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ICM Course Objectives

• Contact with patients at the very beginning of
  medical school
• Clinical correlation with what you will study in
  basic science courses
• Familiarity with the techniques of physical
  examination, medical interviewing and history
  taking

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ICM Course Objectives

• Acquisition of communication skills necessary to
  establish effective therapeutic relationships
  with patients
• Ease with oral and written case presentation
• Promotion of professional behavior
• Development of skills necessary for lifelong
  self-directed learning
• Preparation for the clinical clerkships

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Why now? The changing face of medicine

• Shorter lengths of stay
• Faster pace
• Less time for teaching
• Less direct observation of students clinical
  skills

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Mixed messages

• Pre Med culture promotes a focus on grades to
  the exclusion of everything else
• Some get the message that its ok to
• Miss classes
• Show up late
• Not prepare adequately
• As long as you make good grades
• Clinical Medicine is the opposite a physician
  must be on time, be prepared, be engaged and
  dedicated, and internally motivated to do his/her
  best (professional excellence)

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What should you be striving for?

• Graduating students (and physicians) should
• possess the following attributes
• Altruism
• Knowledge
• Skill
• Sense of duty

AAMC Medical School Objectives Project. 1998.
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ICM1 Overview

• 17 Small Group Meetings
• Block I Medical Interviewing
• Small group discussions
• Patient contact and case presentations
• Guided History exercise
• Difficult interviewing issues
• Block II Physical Examination (PE)
• Overview of the Physical Exam
• Demo/practice of each component of PE
• Student teaching

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SGMs Who?

• Groups consist of 4-6 students
• Preceptors come from IM, Peds, Carraway, Baptist,
  TKC and St. Vincents
• Preceptors typically do one group solo, some may
  pair up to split a group

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SGMs Where?

• Your assignment of preceptor, day of the week and
  location are available on the web page
• Your group will be assigned a specific location
  in the hospital from which to draw patients

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SGMs When?

• Monday through Thursday (after 3pm)
• Some flexibility is necessary to accommodate
  preceptors busy (and unpredictable) schedules
• Significant effort has gone into avoiding
  conflicts in other courses (tests etc.) and
  respecting the many demands on your time

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Small Group Meeting (SGM) Policies

• Attendance required
• SGMs rescheduled only for extraordinary
  circumstances
• Students expected to be on time and prepared
• Diagnostic equipment purchased by 1/7/05
• Professional dress expected for SGMs
• White coat, embroidered with name
• Neckties for male students

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Small Group Meetings

• Syllabus lists learning objectives for each SGM
• Mid year evaluation opportunity to get
  preceptors view of your progress
• At year end, preceptor will evaluate each student
  on their performance in the small group this
  will be comprise 30 of the final grade

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ICM Grading

• Components
• Preceptor evaluation (30)
• OSCEs (30)
• Written examinations (30)
• Professionalism Score (10)
• Commendation letters awarded to top 10
• SOM pass-fail quartile system

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Preceptor Evaluation/Performance in Small Group
Meetings

• Interest
• Enthusiasm
• Preparedness
• Participation in discussions
• Facility with oral and written presentation
• Physical examination techniques
• Communication skills
• Professional behavior

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Written Examinations

• Both written and clinical examinations cover
• Textbook reading assignments in Bates Cole/Bird
• Content of lectures on the physical exam
• Material presented in Small Group Meetings /
  teaching sessions with faculty
• Biweekly quizzes (3 in block I, 4 in block II)
• Taken in the computer lab anytime during the
  assigned period (48 hrs.)
• Quizzes are cumulative in nature
• Use of old test questions or sharing information
  about the quizzes is NOT permitted

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OSCEs Objective Structured Clinical
Examinations

• Simulated Patients used to present clinical
  scenarios
• Students assessed on abilities to interview and
  examine patients and assess common clinical
  problems
• Feedback will be given by the patient
• Adherence to UASOM Honor Code is essential

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Professionalism Score

• All students start with 100 points.
• Any unprofessional behavior may lead to
  deductions from the total
• at discretion of course director
• will be based on input from preceptors, staff,
  fellow students or SPs
• Final decision will be reviewed by the faculty
  members of the course Steering Committee
• This score will comprise 10 of final grade
• We fully expect all students to finish with 100
  points!

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ICM - Other Learning Activities

• Lectures
• given prior to PE demo sessions
• intended to introduce the concepts of exam
• Unscheduled time / off weeks
• ICM time is generally 3-5 pm each day of the week
  (with occasional exceptions)
• This time should be used for practicing skills
  learned

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Community Elder Experience

• Expose students to community dwelling elders,
  thus encouraging a broad perspective on care of
  the elderly
• Introduce some of the principles and challenges
  involved in care of the elderly
• Provide an opportunity to develop a longitudinal
  relationship with a patient

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Community Elder Experience

• 2 ICM1 students will be paired with a community
  dwelling elder volunteer
• Four meetings during the course of the year,
  arranged by students and volunteer at mutually
  agreeable time/location (preferably volunteers
  home)
• Activities will parallel SGM content
• Preceptors will only be peripherally involved

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Other course activities

• History taking practice sessions (HTP)
• Physical exam practice sessions (PEP)
• Designed to
• Augment experiences in the SGMs
• Allow opportunity for practice and feedback

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ICM Learning Resources

• Web page
• Bates Guide to Physical Examination History
  Taking (8th edition)
• Cole/BirdThe Medical Interview A Three Function
  Approach (2nd edition)
• Patients simulated and real
• LRC Media CD-ROM, Bates videotapes
• Preceptors

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ICM - Communication

• Communication/notification
• Announcements on UASOM website
• E-mail
• Individual phone calls
• Course evaluation
• Course evaluation must be turned in by student
  before grade will be released
• ICM Steering Committee
• Course Representatives

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ICM - Suggestions for Students

• Be prepared
• read pertinent assignments, think ahead about
  discussions
• review learning objectives for session
• ask questions!
• Establish relationship with preceptors
• Encourage preceptors to round on wards
• Practice techniques you learn
• Use all resources available to you

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ICM - Suggestions for Students

• You get out of ICM what you put into it.

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Contacts/Questions

• If you have questions or need help, contact
• Course Director Stanford Massie, M.D.
  (934-4473, smassie_at_uab.edu)
• Assistant Course Director Analia Castiglioni
  M.D., MPH (934-4473, acastigl_at_uab.edu)
• Program Director Pat Norton Ed.D (975-6315,
  pnorton_at_uab.edu)
• Program Associate Ann Lee (934-4473,
  annlee_at_uab.edu)
• Office hours for Dr. Massie will be Fridays from
  1-330 pm check with ICM office to confirm

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This, as I see it, is the vocation to
which you have been called. Understand what it
is, and what it requires from you with gleaming
clarity. Discipline yourself to accept and meet
the burdensome demands that it will continuously
make upon you. From now on, you are engaged in
the service of the sick. With the knowledge you
are acquiring as a scientist, with your clinical
art developed through experience, with the warmth
of your own spirit and the strength of your own
character, with the laying on of your hands, and
in response to your words, you can make the sick
better, and fill the dying with peace. These are
great powers. Always deserve them.
Adapted from Tumulty, P. NEJM.
1970283(1)20-24. Opening lecture to 3rd year
students in their ICM course. Johns Hopkins
University.