The ability to obtain an accurate medical history and carefully perform a physical examination is fundamental to providing comprehensive care to patients.  The student must learn to be thorough and efficient in obtaining a history and performing a physical exam with a wide variety of patients, including healthy patients, patients with acute and chronic medical problems, and patients with life threatening diseases.

The optimal selection of diagnostic tests, choice of treatment, and use of subspecialists, as well as the physician’s relationship and rapport with patients, all depend on well developed history-taking and physical-diagnosis skills. These skills, which are fundamental to effective patient care, should be the primary focus of the student’s work during the hospital visits.

Small group teaching in the lab helps the student develop their analytic abilities in problem solving.

Please refer to the goals and objectives of semester 4. The following is supplemental to the material itemized in semester 4.

Communication including History Taking

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

• Communicate in a facilitative, effective and educative manner with patients and their families.
  
• Communicate clearly and succinctly with colleagues and other members of the healthcare team.
  
• Use language appropriate for each patient
  
• Elicit and record an appropriately complete, cogent and organized medical history
  
• Use subsequent questions to assign each diagnosis with a likelihood of correctness
  
• Determine what is relevant in the history with emphasis on the areas pertaining to the patient’s major problems and past health.
  
• Elicit the symptoms of disease process in the following disciplines:
  
  • Neurology
  • Psychiatry
    
  • Endocrine
    
  • Cardiology
    
  • Pulmonary
    
  • Gynecology
    
  • Head and Neck
    
  • Hematology
    
  • Rheumatology
    
  • Gastroenterology
    
  • Pediatrics

Physical Diagnosis

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

• Demonstrate proper hygienic practices whenever examining a patient
  
• Position the patient and themselves properly for each part of the physical exam
  
• Perform a physical examination of a patient in a respectful manner with dignity and paying attention to the patient’s privacy.
  
• Conduct and record an appropriately accurate, logical and sequential physical examination with emphasis on the areas pertaining to the patient’s major problems and past health.
  
• Alter the sequence of the examination according to the special needs of the patient.
  
• Explain to the patient about the likelihood of pain or discomfort during the examination
  
• Examine several systems for signs of a particular disease process
  
• Use the results of a physical exam to increase or decrease a diagnosis in the list of differential diagnoses based upon the history
  
• Demonstrate competency in eliciting abnormal findings (signs) in the following disciplines:
  
  • Neurology
    
  • Psychiatry
    
  • Endocrine
    
  • Cardiology
    
  • Pulmonary
    
  • Gynecology
    
  • Head and Neck
    
  • Hematology
    
  • Rheumatology
    
  • Gastroenterology
    
  • Pediatrics
    
• Distinguish the importance of abnormal findings in the assessment of the patient with illness in the following disciplines:
  
  • Neurology
    
  • Psychiatry
    
  • Endocrine
    
  • Cardiology
    
  • Pulmonary
    
  • Gynecology
    
  • Head and Neck
    
  • Hematology
    
  • Rheumatology
    
  • Gastroenterology
    
  • Pediatrics.

Lab Tests and Procedures

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

• Assess the patient’s problems and identify routine diagnostic procedures to be done based upon the history and physical examination findings
  
• Evaluate the usefulness of a test.
  
• Use the results of a laboratory test to increase or decrease the likelihood of a particular diagnosis.
  
• Interpret a 12 lead EKG (ECG) and rhythm strip for:
  
  • Rate and rhythm
    
  • Calculation Of Intervals
    
  • Recognition Of Abdominal Axis
    
  • Recognition Of St-T Wave Changes
    
  • Interpret routine x-ray studies including PA and lateral of chest and extremity films.

Putting It Together

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

• Accurately gather and interpret essential data from patient history, physical examination and diagnostic studies to diagnose and mange patients.
  
• Determine what is relevant in the history and physical
  
• Record all normal and abnormal findings
  
• Recognize the relationship between symptoms, physical findings and the pathophysiology involved. Apply the general concepts of the pathophysiology for the assessment and management of patients.
  
• Integrate data and make assessments
  
• Formulate accurate and complete problem list in chronological order and in order of priority
  
• Formulate a reasoned differential diagnosis for each problem.
  
• Assess the patients’ problems, identify those procedures/tests indicated and discuss appropriate differential diagnoses.
  
• Formulate an appropriate plan for confirming the diagnosis
  
• Assign probability of likelihood to the differential diagnosis based upon the history, physical examination and diagnostic test and procedures
  
• Demonstrate awareness of and respect for patients’ autonomy, patient’s informed choices, including the right to refuse treatment and including quality of life issues.

Case Presentation

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

• Compose the structure of the oral presentation to highlight relevant data
  
• Conduct the presentation fluently and with confidence
  
• Formulate the presentation to take into consideration different clinical scenarios

Continued Learning

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

Demonstrate an expanded fund of knowledge by active participation in group discussions

Demonstrate independent learning in response to questions raised in the clinical and group setting by using textbook, journals, articles and computer based tools.

Companion Reading

• Making a Diagnosis (Clinical Problem Solving)
• Format for small group discussion – term 5/6
• Case write-up
• Hospital evaluation
• Lab evaluation
• Checklist (evaluation)
  • Student of tutors
  • Tutors of student
  • Student of visiting professor
• Basic general competencies
• How to write  MCQ(s)
• Grading
• Lectures entitled – clinical skills