Medical Program

Communication Skills and Physical Diagnosis
CLSK 653

This course instructs students in communication skills that they will need as medical students and physicians in order to relate to senior physicians, colleagues, patients and their families, and other health care professionals. The course prepares students for their role in addressing the common problems found in delivering health care, for example, providing health care instruction and delivering “bad news.” Students will develop both oral and written communication skills and learn the components of the standard history and the art of presenting cases. The physical diagnosis portion builds on the clinical skills learned in the first year of the four-year MD program. The course uses both lectures and laboratory sessions to teach physical examination skills. The laboratory groups consist of small groups of students. The techniques of physical examination are taught by videotape demonstration, live demonstration, and supervised practice on fellow students.

 

Learning Objectives

 

Introduction:
Effective learning (teaching) requires use of a number of skills and modalities.These are:

Cognitive

  • Relate to understanding, awareness and insight
  • Includes knowledge or information recall, comprehension or concept understanding
  • It deals with the ability to apply knowledge, analyze a situation, synthesize information from a given situation and evaluate a given situation.

Affective

  • Deals with attitude, appreciation and relationships.
  • Encompasses bioethics and professionalism

Refer to the material and objectives covered in previous semesters dealing with Bioethics and Professionalism. The student is expected to follow these guidelines in semesters 4 & 5.  These are life long practices

Psychomotor (skills)

  • Deals with performing a physical skill
  • Requires practice
  • Must be measureable
  • Broken down into
    • Observing (perception) – mental attending of a physical event
    • Imitating – attempted copying of a physical behavior. Follows direction and sequences under close supervision. Requires  conscious effort
    • Practice –trying a physical activity over and over. Performance becomes habitual. Skill is acquired but is not expert
    • Adaptation – fine tuning, making adjustment in the physical activity in order to perfect it.

 

Communication (Including History Taking) Objectives

Cognitive
Broad Objectives

At the end of the course the student should be able to:

  • Demonstrate competency in communication skill
  • Conduct comprehensive and focused interviews
  • Identify pertinent historical information
  •  Associate current complaints with the presented history

Goals of Communication Skills

  • To provide the medical student an integrated system that embeds communication skills teaching in the context of the students personal and professional development
  • To enable the medical student to establish a therapeutic doctor – patient relationship and communicate verbally and non-verbally in a manner that facilitates good patient care.
  • To provide students with the skills and strategies to accomplish communication tasks of core competencies and
    • dealing with sensitive psychosocial issues such as sexuality
    • working with patients in challenging situations such as breaking “bad news” and
    • conflict management such as the angry patient
  •  To provide students with the ability to identify and interact effectively with other members of the health care team.

Detailed Objectives
Objectives in Communication Skills

At the end of the course the student will be able to:

  • Demonstrates tasks necessary for effective and efficient medical encounter:
    • open the discussion
    • gather information (including effective and efficient history taking)
    • understand the patient’s perspective
    • share information
    • reach agreement on problems and plans
    • provide closure
  • Demonstrate the modalities used in skilled interviewing
  • Demonstrate an understanding of the meaning and rationale of patient centered medicine.
  • Demonstrate sensitivity to the patient’s perspective\
  • Demonstrate sensitivity to cultural, personal and religious factors that might influence their reaction.
  • Demonstrate proficiency in using a number of different skills and strategies to accomplish the communication tasks at hand e.g. breaking “bad news”.
  • Demonstrate proficiency in using a number of different skills and strategies to communicate with patients in challenging situations such as patients in “trouble” or situations causing physician anxiety.
  • Delineate which communication skills and strategies are needed for a particular communication tasks e.g. using silence as a way to elicit the patient’s view of his or her health problems.
  • Demonstrate self awareness and the capacity for critical self-reflection
  • Deliver effective patient education: – patient illness, coping strategies, patients’ rights.
  • Demonstrate the ability to influence patients into behavioral changes when needed.
  • Demonstrate the importance of confidentiality when obtaining a health history
  • Discuss the importance of using open ended questions
  • Describe the use of the following in communication skills – non verbal communication, validation, reassurance, partnering, echoing, transitions, empathic responses, active listening, empowering the patient, summation
  • Differentiate between – verbal and non verbal communication, validation, mirroring, reassurance, partnering, echoing, transitions, empathic responses, active listening, empowering the patient, summation

Objectives of History Taking

At the end of the course the student will be able to:

  • Describe the techniques of history taking
  • Describe the structure and purpose of a health history
  • Describe how to obtain a comprehensive health history.
  • Perform a proper introduction
  • Elicit identifying data
  • Determine the patient’s major problems and obtain a history of present illness including location of problem, quantity and quality of symptoms, chronology of symptoms, setting, aggravating and alleviating factors and associated symptoms.
  • Elicit a pertinent review of systems
  • Elicit a past history – medical, surgical obstetrical (if applicable), childhood diseases and immunization, hospitalizations, accidents, injuries
  • Elicit a history of allergies, transfusion reactions and reactions to medication.
  • Elicit a history of personal habits including nutritional history and the use of alcohol, tobacco and drugs
  • Elicit a sexual history
  • Elicit a list of current medication also including over the counter drugs
  • Elicit the occupational history pertaining to present or past health problems.
  • Elicit the socio-economic history relating to present or past health problems
  • Elicit the family history pertaining to exposure to illness, familiar predisposition to disease or genetic transmission. Family history related to cause of death and age of death.
  • Elicit an interval history pertaining to progression, regression or stability of chronic illness.
  • Elicit a cursory but pertinent history from the patients family or friends in an emergency situation.
  • Record all pertinent positive and negative historical data on the medical record in a clear, concise and relevant manner.
  • Perform closure of the interview

Affective Skills

At the end of the course the student will be able to:

  • Demonstrate the importance of empathy when obtaining a health history
  • Demonstrate the importance of confidentiality when obtaining a health history
  • Establish rapport with patients and their family
  • Demonstrate compassionate treatment of patients and respect for their privacy and dignity
  • Act in an ethically responsible manner displaying integrity, honesty and appropriate boundaries with patients, patients’ family and representatives and fellow health care professionals.
  • Demonstrate sensitivity to issues related to culture, race, age, gender, religion, customs, sexual orientation and disability in the environment of medical care.

At the end of this course the student should be able to demonstrate ability to:

  • Be punctual for all appointments with patients and/or their family
  • Recognize limits to one’s own knowledge and embark upon a course to improve one’s knowledge
  • Accept responsibility
  • Conduct activities always in the best interest of the patient
  • Show respect, honesty and cooperation in interactions with fellow students, teachers,   faculty and other members of the health care team.

Psychomotor

Patient assessment – techniques of physical examination

Broad Objectives (Goals)

At the end of the course the student should be able to:

  • Perform a complete or problem-oriented physical examination on a patient of either sex and any age or condition
  • Gain the patient’s confidence and provide reassurance about the examination.
  • Utilize correctly the various instruments of the physical examination identifying pertinent physical examination information
  • Evaluate the importance of a general survey
  • Recognize the physical findings that are normal for the patient’s age and sex.
  • Define and describe the techniques of inspection, palpation, percussion and auscultation.
  • Demonstrate the different techniques utilized in the examination of the different systems of the body.

Specific Objectives

At the end of the course the student will be able to:

  • Describe the examination of the following body regions
    • Skin, hair, nails
    • Head scalp, skull
    • Ear, nose, sinuses
    • Eyes
    • Head and neck including thyroid, mouth and pharynx
    • Thorax anterior and posterior
    • Cardiovascular system
    • Peripheral vascular system
    • Abdomen including contents
    • Female and male genitalia and reproductive system
    • Neurology – central and peripheral and including mental status
    • Musculoskeletal
  • Describe special examination techniques related to the assessment of the
    • Ear, nose, sinuses – Whisper test, Webber test, Rinne test and sinus transillumination
    • Eyes – visual acuity, visual field
    • Thorax anterior and posterior – Vocal Resonance, Egophony, Whispering Pectoriloquy, Diaphragmatic Excursion
    • Cardiovascular system – special body position for Aortic Regurgitation, Mitral Stenosis
    • Peripheral vascular system – Allen’s test, Buerger’s test, manual compression test, Trendelenberg test, Pratt test and Homan sign
    • Abdomen including contents – fluid wave (thrill), shifting dullness,  Boa’s sign, Rovsing’s sign, Psoas sign, Obturator sign, CVA tenderness
    • Neurology – central and peripheral – mental status exam, Romberg test, Pronator Drift, Babinski Response, Ankle Clonus, Brudzinski’s sign, Kernig’s sign
    • Musculoskeletal – Bulge sign, Balloon sign, Ballotment test, Thomas test, straight leg raising test, Tinel’s sign, Phalen’s test, knee ligaments integrity, test for sacroilitis
  • Describe how to obtain vital signs (blood pressure, pulse, respiration, temperature) jugular venous pressure and pulsation.
  • Demonstrate the measurement of blood pressure, pulse (rate and other characteristics), respiration (rate, rhythm and Depth)
  • Demonstrate the examination of the following regions:
    • Skin, hair, nails
    • Head scalp, skull
    • Ear, nose, sinuses
    • Eyes
    • Head and neck including thyroid, mouth and pharynx
    • Thorax anterior and posterior
    • Cardiovascular system
    • Peripheral vascular system
    • Abdomen including contents
    • Female and male genitals and reproductive system
    • Nervous system – central and peripheral including cranial nerve
    • Musculoskeletal
  • Examine several systems for signs of a particular disease process
  • Demonstrate the measurement of the jugular venous pressure and pulsation
  • Differentiate the percussion notes and their characteristics
  • Distinguish between normal and abnormal auscultatory findings of the chest, heart and abdomen
  • Describe the parts of, and the relevance of these components, in the:
    • Ophthalmoscope
    • Stethoscope
    • Otoscope
    • lood pressure apparatus.
  • Explain the rationale for the use of, and demonstrate the use of the:
    • Ophthalmoscope
    • Otoscope
    • Blood pressure cuff including, infant, pediatric, adult and leg cuff
    • Stethoscope bell, diaphragm, adult and pediatrics
    • Tuning fork
    • Percussion hammer
    • Pin and cotton swab (neurological exam)
    • Pen light
    • Tongue depressor,
    • Tourniquet
    • ape measure
  • Demonstrate the special examination techniques related to the assessment of:
    • Ear, nose, sinuses – Whisper test, Webber test, Rinne test and sinus transillumination
    • Eyes – visual acuity, visual field
    • Thorax anterior and posterior – vocal resonance, Egophony, whispering Pectoriloquy, Diaphragmatic Excursion
    • Cardiovascular system – special body position for Aortic Regurgitation, Mitral Stenosis
    • Peripheral vascular system – Allen’s test, Buerger’s test, manual compression test, Trendelenberg test, Pratt test and Homan sign
    • Abdomen including contents – Fluid Wave (thrill), shifting dullness,  Boa’s sign, Rovsing’s sign, Psoas sign, Obturator sign, CVA tenderness
    • Neurology – central and peripheral – mental status exam, Romberg test, Pronator Drift, Babinski Response, Ankle Clonus, Brudzinski’s sign, Kernig’s sign
    • Musculoskeletal – Bulge sign, Balloon sign, Ballotment test, Thomas test, straight leg raising test, Tinel’s sign, Phalen’s test, knee ligaments integrity, test for sacroilitis.

In addition to the above, each lecture will have its own objectives.