Department of Internal Medicine
Student Learning Objectives Using the RIME Evaluation Form Categories
Following is a list of expectations of students for the ambulatory clerkship. Preceptors will help students improve their skills in these areas, and at the end of the two-week period, students will be assessed in their ability to demonstrate these skills and attributes.
Reporter Characteristics:A. Interviewing. Student is able to: 1. Demonstrate effective verbal skills
2. Obtain a patient's history in a logical, organized, and thorough manner.
3. Demonstrate appropriate listening skills
4. Obtain a patient's history in a logical, organized, and thorough manner. B. Physical Exam. Student is able to: 1. Demonstrate step-by-step performance of basic procedures with technical proficiency as appropriate
2. Demonstrate proper hygienic practices whenever examining a patient. (e.g. hand washing)
3. Position the patient and self properly for each part of the physical examination.
4. Observe precautions and contraindications for the procedures used.
5. Adapt the scope and focus of the history and physical exam appropriately to the medical situation and the time available.
6. Perform a physical examination for a patient in a logical, organized, respectful, and thorough manner, giving attention to the patient's general appearance, vital signs, and pertinent body regions
7. Repeat important parts of the physical exam during follow-up visits
8. Update historical information during follow-up visits.
C. Generate a Problem List. Student is able to: 1. Describe the pathophysiologic mechanisms that explain key findings in the history and physical exam.
2. Use the differential diagnosis to help guide the priority of diagnostic test ordering and sequence
3. Elicit the patient's chief complaint as well as a complete list of the patient's concerns. D. Presentations. Student is able to: 1. Orally present a new patient case in a logical manner.
2. Orally present a follow-up patient's case. E. Respect for Patient Values. Student is able to: 1. Identify patient's emotional needs.
2. Respect patient's informed choices, including the right to refuse treatment.
3. Always make efforts to maximize patient comfort during a procedure.
4. Determine the extent to which a patient wants to be involved in making decisions about his/her care. F. Professionalism. Student is able to: 1. Respect patient confidentiality
2. Ensure that patient's medical needs are addressed
3. Recognize potential conflicts of interest
4. Deal with uncertainty
5. Behave ethically G. Honesty and Reliability. Student is able to:
1. Personally review X-ray films, blood smears, etc.
2. Write prescriptions accurately.
3. Accurately and objectively record and present data
4. Handle clinic duties in responsible manner
5. Be prompt for clinic responsibilities
Interpreter Characteristics:H. Generate several explanations for acute clinical problems. Student is able to: 1. Use probability-based thinking to identify the most likely diagnoses.
2. Formulate a differential diagnosis based on the findings from the history and physical examination. I. Interpret basic test data. Student is able to: 1. Describe the various components of a complete blood count, blood smear, electrolyte panel, general chemistry panel, electrocardiogram, urinalysis, pulmonary function tests, and body fluid cell counts and chemistries.
2. Describe the performance characteristics of tests (sensitivity, specificity, likelihood ratios)
3. Understand test sensitivity, test specificity, pre-test probability, and predictive value.
4. Explain results of tests in terms of the related pathophysiology.
5. Estimate the implications of test results before ordering tests and after test results are available.
6. Describe the range of normal variation in the results of a complete blood count, blood smear, electrolyte panel, general chemistry panel, electrocardiogram, chest x-ray, urinalysis, pulmonary function tests, and body fluid cell counts and chemistries.
7. Explain how errors in test interpretation can affect clinical outcomes and costs.
8. Interpret a blood smear, gram stain, electrocardiogram, chest X-ray, and urinalysis.
9. Record the results of laboratory tests in an organized manner, using flow sheets when appropriate. J. Prioritize problems. Student is able to:
1. Assess priority of diagnostic tests
2. Differentiate patient problems
Manager Characteristics:K. Develop diagnostic plan. Student is able to: 1. Use information resources for determining medical and surgical treatment options for patients with common and uncommon medical problems
2. Identify key factors to consider in choosing among treatment options, including risk, cost, evidence about efficacy, consistency with pathophysiologic reasoning. including pretest probabilities
3. Describe alternatives to a given procedure. L. Develop therapeutic plan. Student is able to: 1. Formulate an initial therapeutic plan based on pathophysiologic reasoning and scientific evidence of effectiveness.
2. Access and utilize, when appropriate, information resources to help develop an appropriate and timely therapeutic plan.
3. Describe the factors to consider in selecting a medication from within a class of medication including drug interactions, potential adverse effects and compliance problems.
4. Incorporate the elements of patient autonomy, treatment efficacy, quality of life, and societal demands into decision-making.
5. Begin to estimate the probability that a therapeutic plan will produce the desired outcome.
6. Describe the factors to consider in monitoring a patient's response to treatment M. Understand the concept of benefit/risk decision-making. Student is able to: 1. Participate in selecting the diagnostic studies with the greatest likelihood of providing useful results at a reasonable cost while limiting the chances of false positive/false negative results.
2. Describe how critical pathways or practice guidelines can be used to guide diagnostic test ordering.
3. Describe how to use critical pathways and clinical practice guidelines to help guide therapeutic decision-making. N. Evidence-based approach 1. Use pretest probabilities and scientific evidence about performance characteristics of tests (sensitivity, specificity, likelihood ratios) to determine post-test probabilities.
2. Describe the various ways that evidence about clinical effectiveness is presented to clinicians and the potential biases of using absolute or relative risk or number of patients needed to treat. O. Informed Consent
Communicate risks and benefits to patients.
Educator Characteristics:P. Demonstrate self-directed learning. Student is able to: 1. Give and receive constructive feedback
2. Acknowledge gaps in knowledge to both colleagues and patients and request help.
3. Ask colleagues (students, residents, nurses, faculty) for help when needed.
4. Recognize when he or she needs additional information to care for the patient.
5. Assess the limits of medical knowledge in relation to patient problems
6. Make use of available instruments to assess own knowledge Q. Demonstrate teaching skills. Student is able to: 1. Educate patients and caregivers about how to take their medications and what to expect when they take their medications, including beneficial outcomes and potential adverse effects.
2. Educate members of the team regarding evolving diagnostic or therapeutic modalities utilizing evidence-based medicine. R. Demonstrate leadership skills. Student is able to: 1. Identify appropriate questions to ask
2. Show initiative in addressing patient care issues.
3. Provide a model for patients, peers, colleagues