Phase 2 – MD Curriculum

• Demonstrate an inclusive and humanistic approach to patient care
• Demonstrate the relevant foundational knowledge for the diagnosis and/or differential diagnosis
• Appropriately interpret objective data such as vital signs and commonly used diagnostic studies (including CBC, urinalysis, CSF analysis, serum chemistries), accounting for the age of the patient, presence or absence of disease, and testing modality employed
• Describe the appropriate use of the following common medications (accounting for age/weight and other patient factors), including when it is NOT appropriate to treat with these medications: analgesics, antipyretics, antibiotics, bronchodilators, corticosteroids, IV fluids
• Adapt your approach (medical interview and complete or focused physical examination) as is appropriate to your interaction with the patient and/or their caregivers, the patient’s age/level of development, as well as the presenting concern and clinical setting
• Generate an appropriate differential diagnosis and plan for the presenting problem and patient’s age
• Consider the invasiveness, benefits, limitations, costs, and evidence-based best practices when generating plans for patients in different clinical scenarios
• Develop familiarity with common procedures performed in obstetrics and gynecology inpatient and outpatient settings
• Responsibly manage information within the electronic health record (EHR) to effectively obtain and document patient care and utilize clinical decision support
• Actively participate as an interprofessional team member to promote patient care by fostering a positive learning environment and providing focused, actionable feedback
• Identify members of the health care team and describe how they contribute to the care of patients (nurse, pharmacist, respiratory therapist, PT, OT, speech therapy, child life, etc.)
• Develop an understanding for the ethical and medicolegal implications of working with patients of various ages and their proxies, including issues of capacity, competency, decision-making, guardianship, and confidentiality
• Develop an understanding for the physician’s role in mandated reporting and safety (including how it varies for patients of different ages) in cases of neglect and abuse (physical, sexual, verbal/psychological)
• Discuss ways to advocate for patients on an individual, community, regional, state or national level. Consider barriers and health inequity pertinent to diverse populations.
• Present the history, exam/objective data, assessment and plan for patients of all ages as is appropriate to the clinical scenario (patient problems and setting-clinic vs inpatient, admission vs follow-up, team vs family-centered rounds)
• Document the history, physical examination, assessment and plan in a format appropriate to the clinical situation (clinic vs inpatient; admission vs progress; procedure notes), demonstrating best practices within the electronic health record
• Share medical information with patients and/or their caregivers in terms that are readily understandable while avoiding medical jargon
• Counsel patients and/or their caregivers on plans that are appropriate to the patient’s age/development and their reason for presentation (plans may include appropriate anticipatory guidance, health maintenance, screening & prevention, treatment, supportive care)
• Promote effective communication to minimize disparities and optimize health care outcomes by employing the guiding principles and practical strategies of health literate care
• Demonstrates an understanding of the role of social and structural determinants of pediatric and OB/GYN disease prevention, health promotion, and health equity

• Prenatal care: Assist in providing office-based prenatal care
• First trimester bleeding: Observe the evaluation of a patient with first trimester bleeding
• Normal spontaneous vaginal delivery: Assist a normal labor and spontaneous vaginal delivery
• Cesarean delivery: Assist with a cesarean delivery
• Post-partum depression screening: Perform a screen for post-partum depression
• Neonatal jaundice: Assist the evaluation of a newborn with jaundice
• Well child care-infant: Assist an infant well-child exam (age newborn to 12 months)
• Well child care-preschool: Assist a young well-child exam (age 15 to 60 months)
• Well child care-adolescent: Assist an adolescent well-child exam
• Child with chronic medical problem: Assist the evaluation of a child with a chronic medical problem (e.g., asthma, diabetes, epilepsy, cystic fibrosis, genetic syndrome)
• Pediatric cough/wheeze: Assist the evaluation of a child with cough or wheeze
• Pediatric ear pain/otitis media: Assist the evaluation of a child with ear pain or otitis media
• Pediatric fever: Assist the evaluation of a child with fever
• Pediatric gastrointestinal complaint: Assist the evaluation of a child with an active GI problem (e.g., vomiting, diarrhea, abdominal pain)
• Pediatric atypical growth or development: Observe the evaluation of a child with abnormal growth or development
• Pediatric rash: Observe the evaluation of a child with rash
• Menstrual abnormalities: Assist the evaluation of a patient with menstrual abnormalities
• Sexually transmitted infection: Assist the evaluation of a patient with a sexually transmitted disease
• Bimanual pelvic exam: Perform a bimanual pelvic exam
• Speculum exam: Perform a speculum exam
• Pap smear: Perform a pap smear
• Cervical dysplasia: Assist the evaluation of a patient with cervical dysplasia
• Cervical cultures: Perform cervical cultures
• Menopause: Assist the evaluation of patient with menopause
• Hysterectomy: Assist with a hysterectomy
• Laparoscopic abdominal/pelvic surgery: Assist with a laparoscopic abdominal/pelvic surgical case
• Breaking bad news: Observe breaking bad news to a patient

Department of Pediatrics — Residents as Teachers
Obstetrics and Gynecology — Residents as Teachers

• Describe the anatomic, pathophysiologic and epidemiologic aspects of common conditions addressed in the outpatient setting, linking basic science concepts with clinical knowledge
• Recognize limitations and benefits in the scientific process and how to identify, evaluate and apply new knowledge
• Distinguish the varying causes of common conditions addressed in the outpatient setting, including both modifiable and non-modifiable factors
• Develop a clinical strategy to evaluate and treat common medical conditions which are addressed in the outpatient setting
• Communicate effectively with patients and families to identify goals and barriers related to health and arrive at individualized treatment plans
• Demonstrate effective use of health information technology
• Make evidence-based recommendations for screening and prevention of common conditions encountered in outpatient settings
• Using self-reflection, peer feedback, and mentor feedback; continue to develop the skills and attitudes necessary for clinical practice
• Identify and use skills necessary to improve quality of medical care and patient safety
• Recognize best practices for collaborating with communities to provide care for patients and populations
• Identify the physician’s role in patient care in a resource limited setting and how to weigh the disease burden effects of various chronic conditions at the levels of individual patients, families, communities, and society
• Demonstrate ethical principles in obtaining informed consent
• Participate in the design, implementation, or assessment of a community health intervention
• Use effective communication skills with patients and families
• Identify and use skills that promote interprofessional and team-based care
• Participate in the care of non-English speaking patients and discuss the regulatory requirements that direct services and how language differences may lead to health disparities
• Identify skills necessary to communicate patient information with health care teams

• HEENT exam: Perform an HEENT examination of a patient
• Shoulder exam: Perform a musculoskeletal shoulder examination of a patient
• Plan of care: Communicate the plan of care with a patient
• Chronic mental illness: Assist in the evaluation, management and disposition of a patient with chronic mental illness (severe mood disorder, schizophrenia or schizoaffective disorder) by interacting with a member of the patient’s outpatient mental health system
• Imbalance assessment: Evaluate a patient with a balance complaint and develop a differential diagnosis
• Patient evaluation: Evaluate at least two patients (may be done in conjunction with one of the experiences listed above)
• Writing a prescription: Write a medication prescription accurately and safely in a clinical setting
• SBIRTs and motivational interviews: Perform at least one SBIRT and one Motivational Interview with a patient in clinic
• Dermatologic exam: Obtain a focused history and exam and formulate a prioritized differential diagnosis for a patient presenting with a dermatologic concern
• Diabetic foot exam: Obtain a focused history and perform a foot exam for a patient with insulin dependent diabetes mellitus
• Pulmonary disorders: Obtain a focused history and exam and formulate a prioritized differential diagnosis for a patient presenting with a pulmonary concern
• MSK/rheumatological history: Obtain a focused MSK/rheumatological history in a clinical setting
• Substance use: Incorporate screening for substance use disorders as a routine part of clinical practice using evidence-based screening tools
• Patient preferences: Incorporate patient preferences when discussing prevention guidelines
• Religion and spirituality: Address aspects of a patient’s religion or spirituality that impact his or her health and health care in a clinical setting
• Metabolic disorder counseling: Counsel patients on behavioral strategies and recommend appropriate treatment to minimize morbidity due to different types of metabolic disorders
• Mental health counseling: Counsel patients on behavioral strategies and recommend appropriate treatment to minimize morbidity due to different types of mental health disorders
• Interpreter use: Assess a patient for the need of an interpreter
• HealthLink: Use HealthLink (or other clinical decision support) during patient care and demonstrate the integration of information technology into the process of clinical care, especially clinical decision-making
• Patient instructions: Demonstrate the ability to generate thorough and understandable patient instructions in the after-visit summary
• X-rays: Demonstrate a systematic approach for interpreting skeletal X-rays
• Diagnostic tests: Order common diagnostic tests for core clinical conditions in clinical settings

Chronic and Preventative Care — Residents as Teachers

• Provide care to acutely ill adult patients by using clinical and physical exam findings and test results to develop and prioritize a differential diagnosis and treatment plan
• Explain the anatomy, physiology, biochemistry and pathophysiology as it relates to imaging and patient conditions
• Participate in appropriate communication with a radiologist to discuss a patient’s results
• Use interpersonal communication skills to provide effective medical care
• Demonstrate effective communication using oral, written and electronic formats to establish and maintain collaborative relationships with patients, families and communities
• Demonstrates effective communication using oral, written and electronic formats to establish and maintain collaborative relationships with members of the interprofessional team
• Use evidence-based practices in patient care
• Consider how bias and stigma affect health outcomes for diverse populations
• Identify appropriate use of scarce health care resources
• Self-assess to establish goals for future practice
• Identify policy interventions that impact health outcomes
• Use an electronic health record

Core clinical conditions: Students will participate in the care of patients with core clinical conditions:

• Myocardial infarction
• Atrial fibrillation
• Sepsis
• Pneumonia
• Heart failure
• Respiratory distress
• Suspected venous thromboembolic disorder
• GI bleed
• Liver disease
• Glucose disturbance
• Stroke/TIA
• Altered mental status
• Blood pressure disturbance
• Syncope
• Suicidal ideation
• Behavioral disturbance
• Acute Kidney Injury
• Electrolyte Imbalance
• Medication reaction

Acute Care Block Overview for Residents

• Relate anatomy to the pathophysiology of core clinical conditions and apply knowledge of anatomic relationships, therapeutics and prevention to the care of patients
• Explore the role of social determinants on the health outcomes of patients
• Demonstrate a comprehensive approach to the care of adult and pediatric patients
• Discuss important findings, management, treatment and prevention options with patients and families
• Demonstrate effective use of health information technology
• Participate in providing care to adult and pediatric patients who require common procedures as part of their medical care
• Access, analyze and evaluate scientific and medical literature to address learning needs and apply current evidence to patient care
• Identify and use skills necessary to improve quality of medical care and patient safety
• Identify appropriate ways to provide patient care in a resource limited setting
• Demonstrate legal and ethical principles with patients
• Communicate effectively with assigned patients and their families
• Identify and use skills that promote interprofessional and team-based care
• Identify the role of personal biases and morals in influencing patient care
• Model accurate, clear and concise oral and written presentations

• Abdominal pain: Participate in the care of a patient with abdominal pain
• Colorectal or anal disease: Participate in the care of a patient with colorectal or anal disease
• Hepatobiliary disease: Participate in the care of a patient with hepatobiliary disease
• Consent: Observe at least one instance of informed consent, paying particular attention to communication skills, potential for bias, and physician/patient power imbalance during the interaction
• Gown and glove: Gown and glove in sterile environment
• Suture skills: Suture and tie knots
• Trauma: Participate in the care of a trauma patient
• Multi-D conference: Observe or participate in multidisciplinary conference (e.g., tumor board, multi-D cancer management conferences, vascular anomaly working group, multi-D discharge planning)
• IV catheter: Place an intravenous catheter (must be performed no less than three times)
• Airway management: Manage a patient airway, including mask ventilation and either laryngeal mask airway (LMA) or endotracheal tube placement (must be performed no less than three times)
• Multiple exams: All students are expected to participate in the care of at least four patients with one or more conditions:
  • Ear pain
  • Throat pain
  • Neck mass
  • Joint disease
  • Back or neck pain
  • Spinal disease
  • Peripheral arterial disease
  • Venous disease
  • Cardiac disease
  • Lung disease
  • Skin and/or soft tissue disease
  • Breast disease
  • Benign genitourinary disease or injury
  • Malignant genitourinary disease or injury
  • Eye disease
  • Intracranial mass

Surgical and Procedural Care Overview for Residents