CLSK 655 Introduction to Clinical Medicine

The Introduction to Clinical Medicine course consists of approximately 189 scheduled class hours where it serves as the bridge to help facilitate the student’s transition from the basic science to the clinical years. The course provides an introduction and opportunity to learn and practice the fundamental clinical and reasoning skills that are required to enter the third year clerkship.

The goal of the primary learning activity is to develop those analytic and problem-solving abilities that are needed to formulate a differential diagnosis, using information obtained from an appropriately done history taking and physical diagnosis that they learn in Term 4.

The teaching method (and learning) is defined as symptom-based differential diagnosis. Students must be able to determine and ask relevant questions in order to further elucidate all the symptoms. On completion of the history, the student should be able to make a tentative differential diagnosis, and determine the systems that require physical examination. Based upon this analysis of the system(s) to be examined, a focused (or if needed a complete) physical examination is carried out.

Students will focus primarily on obtaining and presenting the historical and physical examination findings to clinical preceptors during hospital and clinic visits. They will organize, prioritize, and accurately report these findings in the written and oral case presentation formats.

The clinical data gathered during the history and physical examination must be correctly interpreted. Students will also learn to interpret their findings from the history and physical examination, formulate a problem list and generate a differential diagnosis. Basic elements of the selection and interpretation of laboratory tests, as well as patient management concepts are also introduced.

Students will further develop their clinical problem-solving skills and critical thinking by actively participating in classroom small group sessions. During these sessions, a case is discussed each week that focuses on a different organ system. Each small group of students is given the presenting complaint(s) of a patient, in vignette format, by the tutor. Students are expected to determine what appropriate questions need to be asked and answered in order to progress toward a tentative differential diagnosis. Additional information from the history is then given by the tutor. Based on the complete history, students are expected to determine the appropriate organ system(s) on which the physical examination should be primarily focused. This process of critical thinking starts from the presentation of the vignette. Students then indicate the possible physical findings that may be expected. The actual physical findings are then given to the students by the tutor. A differential diagnosis is then prepared along with possible investigations and their likely findings. This leads to a final diagnosis with brief reference to management principles.

Student Assessment

  • Home Study—Clinical vignette of presenting complaints. Students make a list of differential diagnoses with supporting and non-supporting evidence.
  • Small Group—Detailed discussion of above vignette to arrive at a tentative diagnosis with brief discussion of investigation and management.
  • Hospital Rotation—One hospital visit per week.
  • Case Write-up—Based upon cases seen at hospital visits.
  • Written Examinations—Unified, Midterm, Final
  • 1 OSCE—Seven stations each with history and physical examinations.