Clinical Diagnosis

Clinical Diagnosis Syllabus 2008

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Overview of Course

Course Description:
The Clinical Diagnosis Course (BMS 6811), taught in the spring of the second year of medical school, serves as a bridge to help facilitate the transition from the basic sciences to the clinical years. The course helps prepare second-year medical students for the clinical clerkships by emphasizing clinical problem-solving and focusing on the skills needed to diagnosis patients with common clinical presentations. Basic elements of diagnostic testing and interpretation are introduced.

Administrative Structure:

Overview of Course Structure:
The Clinical Diagnosis is a six-credit course which consists of 120 instructional hours and 12 hours of examinations. The course is divided into three units as follows: Unit 1: Neurology; Unit 2: Core Medicine Topics, and Unit 3: ECG Interpretation. Lectures are presented in rooms C1-15 or C1-17 and small group discussions take place in various locations.

An EKG exercise will take place in the Harrell Assessment Center. Students will team up in groups of two and sign up for a 30 minute session in which they will perform an ECG on a partner.

Education Philosophy:
Clinical diagnosis involves the application of medical knowledge to solve a clinical problem - usually a symptom for which a patient seeks medical attention. As physicians-in-training our goal is to help you learn how to apply factual medical knowledge - all the basic science knowledge and understanding of disease processes you have acquired over the past two years - to translate a patient's symptom into a working diagnosis and attend to a their health problem or concern. The course will thus present an opportunity to review material that you have covered in courses such as physiology and pathology, and build on this by illustrating the application of factual knowledge to common clinical presentations.

Learning Objectives

Competency Categories Addressed in This Course:
This course focuses on learning medical knowledge, which includes core discipline and problem-solving competencies as described below. In addition, students are expected to exhibit professionalism with respect to other students, faculty and patients and demonstrate appropriate truthfulness and honesty. A link to a copy of the summative evaluation is located on page 6. Students will be evaluated based on the competencies listed.

Learning Objectives

  1. Core Discipline competency. By the end of the Clinical Diagnosis Course each student will be able to:
    1. Specify the typical clinical presentation of common medical conditions.
    2. Cite an approach to the diagnosis of common medical problems and conditions.
    3. Utilize appropriate medical vocabulary in order to communicate clinical knowledge to other health professionals.
    4. Demonstrate mastery of the detailed learning objectives provided at the beginning of each section of the course.
    5. a.Indicate the multiple factors that inform clinical decision-making to include:
      1. Scientific data
      2. Psycho-social context
      3. Medico-legal
      4. Patient preference
  2. Problem Solving Competency: By the end of the Clinical Diagnosis Course each student will be able to:
    1. Demonstrate the ability to generate a differential diagnosis for common symptoms and medical conditions.
    2. Practice skills in laboratory test selection and interpretation in order to solve clinical problems.
    3. Relate the realities of problem-solving in the context of medical practice.
  3. Professional Behavior Competency: Throughout the Clinical Diagnosis course and related activities each student will:
    1. Demonstrate professional behavior toward peers, patients, staff and faculty.
    2. Exhibit appropriate work ethic by attending all learning activities, arriving on time, and actively participating in small group sessions.

Learning Activities and Instructional Methods:
To assist students in learning each of the above listed competencies, the course employs a variety of activities, including lectures, clinical presentations, small group sessions (including review of the ophthalmologic and neurological examinations), and clinical problem-solving cases. Reading assignments will be from the assigned texts or provided handouts.

Required Texts which (will be provided to students):
Grauer, K: A Practical Guide to ECG Interpretation.

Recommended Text:
Bickley, LS: Bates' Guide to Physical Examination and History Taking. Lippincott. 9th Edition, 2007.

Evaluation Methods Used to Assess Student Achievement of Course Objectives:
Learning activities for each core discipline are similar and can be summarized as follows: Students will be expected to understand, explain and apply concepts presented in lectures and assigned text materials. Evaluation methods used to assess these activities will be by written examination. There will five (5) subject exams, one EKG quiz, and one (1) cumulative (NBME "shelf") exam. Professional behavior will be assessed by students' interact with faculty and peers in the classroom, post-exam reviews, small group activities and exercises. Students are expected to be prompt to class and courteous to faculty and peers, and thus are expected to refrain from distracting activities such as talking in class during lecture, reading a newspaper or "surfing" on the internet.

Student Performance Criteria

Measures of student performance:

Competencies & Evaluation Modalities Date of Exam Percentage of Final Grade
Core Discipline & Problem Solving    
Neurology Unit Exam Wednesday, Jan 23 10%
Core Medicine Topics Exam I: Wednesday, Feb 27 20%
Core Medicine Topics Exam II: Friday, March 28 25%
Core Medicine Topics Exam III: Friday, Apr 25 20%
EKG Quiz Friday, May 9 10%
National Board Subject Exam Friday, May 9 15%
Clinical Skills Exam 2 (CSE 2) April 22 – May 2 P/F
Professionalism   S/U
TOTAL EXAMINATION PERCENTAGE   100%

Content of Examinations:
The Neurology Unit and Core Medicine Topics examinations aim to evaluate mastery of core-discipline and problem solving competencies. Questions will be derived from the lectures, handouts and assigned readings. The focus of the Core Medicine Topics examinations are emphasized in the detailed learning objectives provided at the beginning of each section of the course. The format of examination questions will vary and include multiple choice, extended-matching, and fill in the blank questions. Practice tests will be provided and students are advised to familiarize themselves with the question styles prior to the actual examination.

The Clinical Skills Exam 2 (CSE 2) will serve as part of the final examination for the Clinical Diagnosis course (as well as the Essentials of Patient Care Course) and will serve as a capstone examination of the first two years of instruction in clinical skills. The CSE 2 will examine content areas covered in both EPC and CD, and will take place in the Harrell Professional Development and Assessment Center (HAC). Students will be required to pass the CSE 2 exam before proceeding to their clinical clerkships.

Methods of Examination:
Examination methods will include computer-based exams (which will be administered in the computer testing room CG-28) and HAC Standardized Patient encounters. Exam conduct is that established by the COM for the testing center and the Code of Conduct.

Absences:
Students are expected to take the exams on the day scheduled unless approval is obtained from the course director prior to the exam date and students have contacted the College of Medicine Office of Medical Education. Accommodations will only be made for emergency situations.

Description of Feedback to Students.

Formative Feedback:
Students will receive formative feedback in the form of scores on examinations throughout the course. The course and/or unit directors will score the examinations promptly. After the posting of grades, a date and time will be specified for students to review their own examination and answers in the testing center (CG-28). Any concern regarding an examination question must be presented in a professional manner to faculty during the review. Combative or excessively argumentative behavior will be considered as unprofessional behavior. After the exam review period is completed, the grades for that particular examination are final.

In addition, any student that scores 72% or below on any examination will be scheduled to meet with the course director to review content areas for improvement. The course director will also be available, by appointment, to meet with any student who wishes to discuss any issue related to the course.

Summative Feedback:
Summative feedback will consist of a Competency Evaluation (see attached form) and the final grade. The final grade will be determined based on the examination results evaluating the core discipline and problem solving competencies. Faculty will notify the course directors of any interactions that would negatively impact students’ competency evaluation. A summative evaluation of students’ level of proficiency in these selected competency categories will be forwarded from the teaching faculty to the Student Affairs Office. No numerical grading for your proficiency in the competence category of Professionalism will be provided (see below). As appropriate, the teaching faculty will provide summative assessment of each student in those areas if a deficiency exists.

The final course grade will be determined by the course director and will be assessed and based on the following standards:

Grading Scale Letter Grade
90- 100 A
87 - 89.9 B+
81 - 86.9 B
77 - 80.9 C+
72 - 76.9 C
68 - 71.9 D
Below 68 F

Unsatisfactory assessment in the core discipline and problem-solving competencies may lead to remediation if so determined by the course director. Unsatisfactory performance in the competency of professionalism may have a negative impact on the student’s final grade. Unprofessional behavior will be documented and the Academic Status Committee will be notified.

Students must pass the CSE 2 examination in order to successfully complete the CD course. Students who fail the CSE 2 exam must undergo remediation and retake the CSE 2 examination (and achieve a passing score) before they can proceed with their clinical education.

Administrative Policies

University of Florida Office of Medical Informatics Location: http://medinfo.ufl.edu/year2/clinical_diagnosis/syllabus.shtml
Updated: Feb 25, 2008, © 2006 University of Florida