What Clinical Skills Does My Student Have?

What Clinical Skills Does My Student Have?

Below is a schedule of topics covered in the Introduction to Clinical Medicine Course. Along with your student's goals for the course, this schedule should be used to help you decide how to focus your teaching time with your student.

Improving History Taking Skills: The One-Minute Preceptor Method

By the end of the first year, all students have learned how to elicit and write up a complete adult medical history. There are several effective ways to help students improve their history taking skills. One method that can be useful is the One Minute Preceptor.

  1. Get a Commitment get the student to commit to an aspect of the case. Encourages student to stretch beyond their comfort level and develop reasoning skills. “Based on the patient’s chief complaint, what parts of the history should you focus on?”
  2. Probe for Supporting Evidence ask a question that seeks to understand the rational for the learner’s answer to part 1. This enables you to determine the strength of the evidence upon which the commitment was made. “Why do you feel it is important to obtain a past medical history in this patient who complains of memory problems?”
  3. Reinforce what was done well comments should include specific behaviors that demonstrated knowledge, skills or attitudes of value. “Your history was well organized. You had a chief complaint followed by a detailed history of present illness. You included appropriate additional medical history and medications.”
  4. Give guidance about errors and omissions Avoid terms such as “bad” or “poor” and use phrases such as “not best” and “it is preferred” which carry less of a negative value judgment. Comments should be as specific as possible. “You mentioned a cough in your history but did not tell me how long the cough has been present or if the patient smokes. This information is particularly useful when considering the possible causes for the patient’s cough and can impact your diagnostic and treatment decisions for this patient.”

This method can also be used to help first and second year students refine their clinical reasoning pathways.

Improving Communication Skills

Preceptors can help student learn effective communication techniques by role modeling the use of open-ended questions, using a non-judgmental attitude and by displaying empathy when interacting with patients. Preceptors can also observe students’ interactions with patients to see if these elements are present and give constructive feedback on including these techniques in their patient interactions. Articles and books on models of doctor-patient communication such as the Patient Centered Care model and the Motivational Interviewing model can be found in the Additional Precepting Resources Section of this manual. First year students are introduced to Motivational Interviewing during their Spring Quarter.

Improving Physical Exam Skills

All UW medical students should be able to demonstrate an organized adult screening exam at the end of their first year. First year students are interested in opportunities that allow them to practice their new examination skills. While students are not expected to identify or interpret abnormal findings until the end of their second year, teaching them to recognize and describe normal and abnormal physical exam findings is useful in their educational process. Students often appreciate your thoughts on what techniques you have found most helpful in performing specific parts of the physical exam.

Talking Through Procedures

Students learn by observing and assisting at procedures, and when appropriate, by guided performance of the procedure. Don’t be reluctant to ask your student to talk through a procedure in detail before he/she is to assist you or perform it on a patient. The dry run also provides you a chance to embellish the basic steps with tips you’ve learned from experience.

Building on a Student’s Interests

Your student may indicate an interest in an aspect of family medicine that is part of your clinic but is outside of your own interest or expertise (e.g. casting, group visits, colposcopy, sigmoidoscopies). Students greatly appreciate preceptors who find colleagues in their office who are interested in having a student observe them or assist them with these procedures and visits.


First Year ICM I Topics

 
History Skills Physical Exam Skills

Fall Quarter

  • Social History
  • Patient's Illness Narrative
  • The Illness Narrative becomes HPI
  • Learn to Write Up an Organized Medical History

 

 

Winter Quarter

  • Difficult Interviews
  • Interviewing Adoloescents
  • Human Sexuality
  • Complete Medical Database Demonstration
  • Problem Oriented Medical Record
  • Interviewing for HIV and STD Risk
  • Pediatric Interview and History

 

 

Spring Quarter

  • Occupational History
  • Complementary / Alternative Medicine
  • Motivational Interviewing
  • Patients' view of the Dr. / Patient Relationship
  • Introduction to the Oral Case Presentation
  • Introduction to Clinical Reasoning

 

Spring Quarter

  • Vital Signs, Basic Head and Eye Exam
  • Basic ENT, Neck and Thyroid Exam
  • Basic Chest and Breast Exam
  • Basic Cardiac and Abdominal Exam
  • Basic CNS, Extremities, Male Genitalia
  • Rectal Exam

 

Second Year ICM II Topics

 
History Skills Physical Exam Skills

Fall Quarter

  • Social History
  • Complementary and Alternative Medicine
  • Geriatrics
  • Disabled Patients
  • Developing a Branching Differential Diagnosis

 

Fall Quarter

  • Female Genital and Rectal Exam
  • Thyroid and Lymph Nodes
  • Advanced Cardiovascular Exam
  • Advanced Pulmonary Exam

Winter Quarter

  • Substance Abuse
  • Uncertainty and Mistakes in Medicine
  • Care of Patients with Life Threatening and Terminal Illness
  • Continue to Develop Branching Differential Diagnosis

 

Winter Quarter

  • Advanced GI Exam
  • Advanced Musculoskeletal Exam

Spring Quarter

  • Human Sexuality
  • Professionalism and Human Sexuality
  • Ward Culture
  • Universal Precautions

 

Spring Quarter

  • Advanced Psychiatric Exam
  • Opthamology Exam