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Clinical Skills, Professional Development and the Practice of Medicine Curriculum

Clinical skills and professional development are major curricular focuses that span all four years, providing early patient exposure and the means to develop outstanding clinical thinking, technical skills, and a sense of professionalism. In the pre-clinical Fundamentals of Medicine phase and the Fundamentals of Clinical Practice phase, substantial curricular time is devoted to Clinical Skills and Reasoning (CSR) and Professional Development (PD) activities. In the Fundamentals of Medicine phase, CSR and PD are integrated into the existing blocks. Beginning Fall 2018 with the class of 2022, the CSR and PD content will be combined into one course entitled ‘Practice of Medicine’, which will be offered across the Fundamental of Medicine curriculum. Students meet at least weekly in CSR small groups as they work with clinical faculty to apply interview and examinations skills to diagnosis and treatment. In addition, each month, students meet in PD small groups to focus on the personal and professional aspects of becoming a physician. These activities provide focused opportunities to learn through cooperation and collaboration, which helps students develop their abilities to work with groups of colleagues and co-workers in a professional environment.

Clinical Skills and Reasoning Curriculum

Clinical Skills and Reasoning (CSR) provides the fundamental knowledge and skills needed for clinical clerkships and future practice as a physician. CSR activities allow students to practice these skills in a small group setting, in a simulated environment, and in a practicing physician's office; beginning in the first semester of medical school. CSR activities involve active learning in small groups with a focus on problem-solving, interviewing, and physical exam skills. Central to all components of CSR is the concept of professionalism and the integration of biomedical and psychosocial concepts of patient care.

CSR activities in the Fundamentals of Medicine include six major components:

The Clinical Apprenticeship Program (CAP) emphasizes early clinical learning by matching first-year students with clinical preceptors. Soon after the Foundations course, each student is assigned to a physician to complete a clinical apprenticeship in the physician’s office. During this time, students have an opportunity to observe the practice of medicine and begin to integrate what they are learning in the other segments of the curriculum.

Clinical integration sessions (CIS) are case‐based, small-group workshops that serve to integrate history and physical exam skills with clinical reasoning to learn how to diagnose and care for patients. Cases are coordinated with information learned in the organ system-based blocks and with the remaining curricular themes. Students will use clinical reasoning and clinical problem-solving skills, as they examine common diseases and disorders. CIS sessions are led by clinical faculty who students work regularly with during the entire curriculum.

In the Interview sessions, CSR small groups and faculty will work on introductory and then advanced history‐taking and communication skills. Some of these sessions will be co‐led by CSR instructors and professional development mentors who have expertise in interviewing and counselling patients.

Physical Diagnosis Sessions occur in our Clinical Learning and Simulation Skills (CLASS) Center and are led by standardized patient instructors as well as fourth-year medical student peer instructors. After students achieve proficiency in a core physical exam during the Foundations course, students will learn to use physical examination during each block as a clinical reasoning strategy to make appropriate diagnoses. Physical diagnosis sessions occur about once a month in the early evenings.

The Formative Observed Simulated Clinical Experience (FOSCE) sessions, which are led by CSR instructors, serve as an opportunity to work in simulated environment, allowing students to integrate practice of history‐taking, physical exam, and clinical reasoning skills in a series of standardized patient cases. Students will use information obtained from standardized patients’ history and physical exams to create differential diagnoses and order appropriate diagnostic testing, ultimately leading to the correct diagnosis.

With advances in information technology, informatics has become an important clinical skill. Library faculty work with small groups of students to teach skills in finding high‐quality medical information and assist them in critically evaluating sources.

Clinical Skills in the Fundamentals of Clinical Practice Phase

At the beginning of the Fundamentals of Clinical Practice, students will enroll in a month long course that focuses on enhancing clinical skills—including procedures—to prepare students for ward rotations. Throughout the Fundamentals of Clinical Practice phase, students will also participate in a Longitudinal Primary Care Clinic (LPCC) that complements the Primary Care Clerkship. Students will work one half-day every other week in a primary care setting (general internal medicine, general pediatrics, family medicine or geriatrics) regardless of their current rotation.

Clinical Skills in the Transitions to Advanced Clinical Practice: The Capstone Course

The Transition to Advanced Clinical Practice phase includes an intensive, one-month capstone experience involving the refinement of many technical skills and reinforcement of essential clinical competencies. Students are grouped by future specialty for much of this course, receiving direct mentorship from faculty physicians in their specialty. The course makes extensive use of the CLASS center with a focus on simulation training. The primary objective of the course is to prepare students to perform at a high level as they transition to their residency.

Clinical Learning and Simulation Skills Center (CLASS Center)

SMHS's educational facilities are at the forefront of academic medicine and give SMHS students a decided edge over their counterparts in programs at other institutions. The CLASS Center provides one of the most innovative educational environments in the nation. Students supplement their classroom learning with comprehensive clinical exposure, feedback, and evaluation that prepare them to become both technically adept and compassionate caregivers.

The 17,000 square-foot CLASS Center, located on the fourth floor of Ross Hall, opened its doors on March 1, 2014. The facility features some of the most innovative simulation, standardized patient, and learning/convening spaces available. The CLASS Center has 12 outpatient and two inpatient examination rooms for standardized patient encounters, as well as a labor and delivery suite; two mock operating theaters; two high-fidelity rooms; cutting-edge medical simulators, including full-body computerized manikins and surgical trainers; and laboratory space for procedural skills training.

Students can learn the basics of a procedure such as IV placement or resuscitation of a critically ill patient using simple anatomic models. More advanced trainees can transition to high-fidelity simulators, where students practice diagnostic skills, integrate previously learned procedures into patient care, and improve teamwork and communication skills.

A sophisticated data system allows for curricular content to be pushed from a control room to any of the 32 screens mounted throughout the CLASS Center. X-ray images, footage of real patients, and technique demonstration are just a few types of content that can be displayed to students working in the center.

Like the practice of medicine itself, simulation has both a human side and a technological side. The human side is embodied by standardized patients (SPs), who play the part of patients suffering from any number of medical maladies. Through face-to-face interaction with SPs, students can perfect their skills at history-taking, physical exams, and communication.

Professional Development Curriculum

The professional identity of an effective, compassionate physician is formed along two paths: scientific growth and inner growth. Acquisition of scientific, clinical and technical skills is essential to address patients’ medical problems and physical suffering, while growth of the inner person is essential to attend to patients’ emotional suffering and the impact of disease on what gives meaning to their lives. The Professional Development (PD) curriculum aims to support students as they grow in both of these areas and develop their unique professional identities.

On the first day of medical school, students will gather in small groups of eight students and meet their professional development mentors. PD small groups will have two mentors, a physician PD mentor and an interviewing PD mentor, who will be a psychiatrist (MD), psychologist, social worker, clergy or other faculty member with expertise in counseling. PD small-group sessions will explore students’ professional growth and development through both the Fundamentals of Medicine and Fundamentals of Clinical Practice phases, with monthly meetings during the first phase. PD mentors will use coaching and feedback to support students as they develop into physicians. Two important elements of the PD curriculum during the Fundamentals of Medicine phase are reflective writings and Professional Progress Assessments (PPAs). Students will often share reflective writings as part of PD small group sessions and receive feedback and guidance from their PD mentors. The PPAs are a self-directed learning tool designed for students to set their own learning goals and evaluate progress. They are reviewed one-on-one with PD mentors at the end of each semester.