MedEdPORTAL (Nov 2008)
Cardinal Manifestations and Presentation of Disease—Making the Rounds on Standardized Patients With Alterations in Cardiac, Respiratory, Gastrointestinal, and Genitourinary Function
Abstract
Abstract Introduction To address the need to develop an organized approach to the undifferentiated patient, a new teaching series was created for second-year students in the patient-centered medicine course. The four modules, each with four individual cases, mirror the concept in Harrison's Principled of Internal Medicine, Part 2: Cardinal Manifestations and Presentation of Disease. The session was designed so that student would learn the approach to presentations of diseases in the cardiac, respiratory, gastrointestinal, and urinary and urogenital systems. Methods The structure of the course involves 16 small groups, each with eight students and a clinician facilitator. A student team leader for each group distributes one of four presentations to each pair of students. Student pairs prepare for an assigned symptom by reading, developing hypotheses, and considering lines of questioning and the physical exam findings key to developing the differential diagnosis. They are instructed to provide a one-page summary for the rest of the students. Each small group and the facilitator then make 30-minute visits to four different standardized patients trained by the clinical coordinator. For each encounter the pair takes a focused history pertinent to the presenting complaint. They recap the history and ask for the exam findings which is be key in their reasoning. The facilitator gives the physical exam findings. The pair then closes the encounter with the standardized patient. They present the case to the group, summarize and give the differential diagnosis. The facilitator will provide feedback. The group then rotates to another room and another pair begins on a new symptom. Results Second-year students are eager to practice physical diagnosis skills and value the ability to elicit an adequate history as less important than the exam skills. Discussion In the attempt to provide students with scenarios from which they could accumulate illness scripts for clinical reasoning, we may have overloaded them with too many cases per sessions. In the future we may limit the presentations on any given session to provide more time for physical examination. We also plan to augment the presentations with auscultatory findings. As we want the students to learn in teams, we suggested they provide guides to fellow group members on their own assigned symptom; the compliance with this suggestion has been variable. In the future, we will make these assignments mandatory and the faculty leaders will review them.
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